WASHINGTON - Insurance regulators have been struggling to decipher which health insurance plans are subject to the new health care law that allows consumers the option of retaining their existing plans and are thus exempt from the new provisions, The Washington Post reports.
At issue: To what extent can an existing health care plan change and still retain the same grandfathered exemption status as mandated by the new law.
For instance, whether increasing a copayment amount is a fundamental change is not clear, and how regulators sort through the issue could affect many Americans. Indeed, some believe the grandfathering provision could become a "giant loophole."
"It's two sides of the same coin," said Paul Ginsburg, president of the Center for Studying Health System Change. "It was meant to assure people who see nothing wrong with their insurance, but...of course it's creating a loophole."
The unanswered questions underscore that the dramatic health care overhaul is far from resolved, as officials now must translate the law into detailed regulations.
Large corporations are pushing for flexibility in making routine changes in their plans from year-to-year without subjecting themselves to the lawï¿½ï¿½s full requirements. "I think employers want maximum flexibility in order to do the kinds of things they have to do to manage costs," said Helen Darling, president of the National Business Group on Health.
Consumer advocates maintain that grandfathering "could prevent many consumers from fully benefiting from increased consumer protections and standards," according to several consumer representatives in a recent report to the National Association of Insurance Commissioners. They argued that any change to a grandfathered plan should force a relinquishment of the grandfathered status, unless the change benefits all consumers in the plan.
The government is under pressure to draft rules soon, as employers are readying their next open-enrollment season and their 2011 coverage. The administration has been "trying to find the appropriate balance" between interest groups, according to an administration official.