Possible Unintended Consequences in New Health Care Regulation

The Affordable Care Act bans health insurers from denying people coverage if they have certain pre-existing medical conditions. A regulation partially implementing that policy appeared in today’s Federal Register. It is the first “economically significant” regulation ($100 million or more in annual economic impact) to appear since April 18. This interim final rule extends the Pre-Existing Condition Insurance Plan (PCIP) program through 2014.

How much does it cost? The analysis accompanying the rule is vague. It does say that the Health and Human Services Department “is authorized to disperse $5 billion to pay claims and the administrative costs of the PCIP program that are in excess of premiums collected from enrollees.” Essentially, if insurers and providers are required to take losses on some of their patients, Washington has agreed to subsidize some of the difference with taxpayer dollars.

Since this is government spending, I won’t include this $5 billion in my running tally of compliance costs for this year’s economically significant rules (currently ranging from $5.58 billion to $10.19 billion, as of the most recent Battered Business Bureau post).

The rule acknowledges administrative costs, but claims they will be minimal since they build on existing systems. It gives no numbers.

The cost analysis also states, “With respect to other parties, we lack data with which to quantify costs associated with this regulation.” Since the bread and butter of this regulation is a series of price controls and subsidies, it can be hard to quantify how patients and providers might change their behavior.

Some providers, because of the price controls and paperwork involved with the PCIP, might opt to simply refuse to treat patients in the PCIP program. The rule acknowledges this:

While we understand that the decision to no longer treat PCIP enrollees is possible, we believe and are hopeful that most facilities and providers will accept the new payment rates established in this interim final rule given the serious health conditions many federally-administered PCIP enrollees have and the prospect that such reduced payment is temporary until 2014 when no one can generally be denied health coverage because of a pre-existing condition.

People change their behavior when their incentives change. The PCIP program gives health care providers an incentive to refuse treatment to people who desperately need it. And that unintended consequence, as opposed to paperwork, may be the true cost of today’s regulation.

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