When the House passed health reform in March, Joe Hansen, president of the United Food and Commercial Workers International Union, responded with fulsome praise.
"This is an achievement that will rank among the highest in our national experience," he said. Among other things, he said, the law would put "an end to the worst of insurance company abuses," including "lifetime limits on the dollar value of benefits."
Less than six months later, UFCW sent a note to its members complaining that "the gradual elimination of annual limits on benefits under the Act has a significant impact on many of our benefit plans." And it promised help to local unions get waivers from that provision. Since then, more than two dozen UFCW locals applied for and received waivers from the federal government, exempting more than 100,000 of its members from this part of the new law.
The United Federation of Teachers also praised the reform for blocking insurance companies "from establishing lifetime limits on coverage." By October, it had secured a waiver for 351,000 members on its health plan.
In total, more than 700 companies, unions and a handful of states -- accounting for a total of more than 2 million workers -- have received waivers from this part of the health reform law, according to the Department of Health and Human Services.
What's going on here?
Turns out that a lot of companies offer inexpensive health plans to their workers -- often called mini-meds -- that provide limited benefits, high deductibles and annual dollar caps, with some caps as low as thousands of dollars. It's not much in the way of coverage, but it's better than nothing.
The problem is that the reform law required health plans to raise these annual dollar caps to at least $750,000 this year, apparently not realizing that this would have the effect of forcing hundreds of companies to drop benefits for millions of workers.
The White House admits that this reform could "cause mini-med premiums to rise by more than 200 percent, forcing employers to drop coverage."
But it tried to downplay the issue, saying there's been lots of "confusion" about it. The waivers, it says in a blog post, are just for one year, and only exempt these companies from this one specific part of the new law. And in any case, the whole issue will be moot, the administration says, once the insurance exchanges start up in 2014.
Of course, the cap gets raised again to $1.25 million this September, and then $2 million in September 2012, before it's removed altogether in 2014. So if anything, more companies are likely to push for waivers over the next two years.
A House Energy and Commerce subcommittee plans to hold hearings on this today -- trying to figure out just how many waiver applications were submitted, how many were denied and what criteria the administration used to grant them.
The White House should provide those answers.
But the whole issue raises a more troubling question about the health care reform law that needs to be addressed.
This lifetime limit reform was supposed to be one of the easy fixes to health care. That's why it went in force almost immediately. But without the waivers, this change would have pushed more than 2 million people off insurance rolls this year.
So the question is, if health reformers bungled this simple fix so badly, what other unpleasant surprises await as the far more complicated elements of health reform start to kick in?