On April Fools’ Day, HR 4302 officially became Public Law 113-93.  It was the latest in a long line of so-called “Doc fix” bills, delaying scheduled Medicare reductions of payments to physicians.   Few onlookers noticed this, inserted between provisions on ICD-10 Code set delay and a GAO child health care report mandate:


(a) IN GENERAL.—Section 1302(c) of the Patient Protection and Affordable Care Act (Public Law 111–148; 42 U.S.C. 18022(c)) is amended—

(1) by striking paragraph (2); and

(2) in paragraph (4)(A), by striking ‘‘paragraphs (1)(B)(i) and (2)(B)(i)’’ and inserting ‘‘paragraph (1)(B)(i)’’.

(b) CONFORMING AMENDMENT.—Section 2707(b) of the Public Health Service Act (42 U.S.C. 300gg–6(b)) is amended by striking ‘‘paragraphs (1) and (2)’’ and inserting ‘‘paragraph (1)’’.

(c) EFFECTIVE DATE.—The amendments made by this Act shall be effective as if included in the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148).

Shorn of legalese, it says that the ACA’s annual cap on small group health plan deductibles  – $2,000 individual, $4,000 family in 2014 – is repealed, retroactive to the date of the ACA’s passage, as if it had never been in the Act.  Was it just six months ago that our government shut down over failed attempts to repeal various ACA bits and pieces?  Yes.  So why this, why now?  Any why no uproar?

In ACA §  1302(c), Congress capped non-grandfathered, small group health plan deductibles, but not individual or large group plan deductibles.  That’s why so many of the plans being sold through www.healthcare.gov feature deductibles near the out of pocket maximum limit.  It was either a Congressional drafting error or a poison pill that only Congress could fix.  Part XII of the enforcement agencies’ Frequently Asked Question publications and the proposed rules on the subject (45 CFR § 156.130) effectively said, “It is what it is.”

But imposing similar limits on individual and large group plans probably would have been rejected even by ACA supporters, because www.healthcare.gov sticker shock would be much worse without high deductibles.  And the premium inflation consequences for small group plans contributed to the ACA’s unpopularity in an election year.  So, ACA opponents got a scalp.  ACA defenders hope it was not theirs.