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Affordable Care Act Hits More Road Bumps


This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.


And I'm Audie Cornish.

Another day, another delay of a piece of the federal health care law known as Obamacare. The administration is having trouble setting up some of the new computer systems required by the Affordable Care Act. Last week, they announced a year-long delay in the implementation of some of the law's requirements for businesses. Today, it's smokers who are affected. Critics say this is more evidence that the administration is not ready to roll out the law, which takes effect in October.

NPR health policy correspondent Julie Rovner is here in the studio to explain. Hey there, Julie.


CORNISH: All right, so this rule for smokers, this was supposed to deal with smokers who would choose to get coverage through the new health insurance exchanges. And they would have faced some surcharges or penalties for that habit, right?

ROVNER: That's right. The law allows insurance companies in these new marketplaces, the exchanges, to charge higher premiums for people who smoke - up to one and a half times the premiums that nonsmokers will be paying. But some insurers had wanted to charge younger smokers a smaller surcharge, if you will, than older smokers. Maybe one and a quarter times instead of one and a half times, since they've been smoking less long and are likely to be healthier overall.

But it turns out the computer system being developed for the exchanges won't be able to process that, at least not for the first year. So it turns out the smoking surcharges will pretty much have to be the same percentage for all smokers, regardless of age, at least for 2014.

CORNISH: Wow. OK, all of that just because of what is - what, a computer glitch, it sounds like.

ROVNER: That's exactly right. The computer can't process it.

CORNISH: All right. Well, now that Congress is back, they are reacting to the major delay we've been talking about, which is this rule for businesses. The administration is postponing the requirement for employers to provide coverage or face a penalty. What have you been hearing from lawmakers?

ROVNER: Well, here was Senate Minority Leader Mitch McConnell, one of many who were complaining about these rules.

SENATOR MITCH MCCONNELL: Now, I agree it's a terrible law. I understand why people harmed by it would want it changed. In fact, I think we ought to repeal it altogether and opt instead for real reforms that would actually lower costs. But the fact is, for now at least, it is the law. And it's the president's constitutional duty to enforce the law.

CORNISH: So, constitutional duty to enforce the law. Does the president have the authority to delay these pieces of the law?

ROVNER: Well, that's clearly going to be the subject of a lot of debate. But it appears most likely, particularly in the case of the employer requirement, the administration probably does have the authority. And even if it doesn't, it's not clear who would be able to show enough harm to go to court to stop it.

CORNISH: So is there a real sense of what the impact would be, in terms of what this means for businesses or their workers?

ROVNER: Well, you know, it doesn't apply to that many people. It only applies to companies with 50 or more full-time workers. More than 96 percent of those firms already provide health insurance. But still, it has set off a huge cry of outrage, particularly from the law's opponents.

CORNISH: All right. Now for people who are keeping track, we're going to talk about a third part of the law that's being delayed. And this has to do with individuals who are buying their own insurance, right?

ROVNER: That's right. On these exchanges that we've talked about, this got announced last Friday, the day after the Fourth of July. No coincidence, I think the administration was trying to make this as invisible as possible. And what they said is that, once again, computer problems mean that when people sign up for insurance on the exchanges, if they're eligible for federal subsidies, they won't get their income checked automatically or verified automatically.

Which means, effectively, they'll be on the honor system to get that federal help. Again, just for this first year, until they can get all the right computers to be able to talk to each other.

CORNISH: The honor system. I'm sure there are people worried about fraud, right?

ROVNER: Absolutely. The administration says that that won't necessarily be a problem. It will go back and audit people's claims and compare what they put on their insurance applications to their tax returns. And if they end up owing money they'll have to pay it back, which will be the case when the computer matching system is in place also, by the way.

Remember, whenever you get money from the government - whether it's a student loan or a tax refund or whatever - you're legally promising you're telling the truth when you sign that form.

CORNISH: So we're talking about what seems like minor glitches, right - the smokers thing or some of these other rules. But at some point, does all this sort of combine to create a sense that the rollout of the law is kind of coming off the rails?

ROVNER: Well, I think that's exactly what the administration is most worried about. They want this law to have a sense of inevitability, particularly with the opponents still so very vocal and outspoken. And while all these glitches and delays won't really affect how many people will or won't get health insurance, they do create a perception, first, that things aren't going as well as the administration keeps saying. And second, that there may be other shoes yet to drop.

CORNISH: Julie, thanks so much for walking us through it.

ROVNER: Thank you.

CORNISH: That's NPR's Julie Rovner. Transcript provided by NPR, Copyright NPR.

Over two decades of journalism, Audie Cornish has become a recognized and trusted voice on the airwaves as co-host of NPR's flagship news program, All Things Considered.