The ObamaCare Escape Hatch

By Joseph Smith

The rush to obtain waivers from ObamaCare will not be receding any time soon.

A recent New York Times column, highlighted at the Washington Examiner, describes the push by nursing homes to "seek a reprieve" from the health care law.

Nursing homes employ low-wage workers with minimal or no health care coverage, and Medicaid and Medicare "do not pay them enough to offer their employees medical coverage," the Times relates.

Nursing homes are now knocking on the waiver-office door:

Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize nursing home, that penalty could easily exceed $200,000 a year. Nursing home executives are urging Congress and the Obama administration to spare them from the penalties.

Nursing homes are begging to be added to the 1,372 exemptions, covering 3.1 million employees, already granted by the supreme authorities at the HHS.

According to a trade web site, long-term care facilities alone have over 3.1 million employees, and the industry is seeking more than just a short-term annual limits waiver.

An industry-sponsored study concludes that the nursing home industry loses $17 per Medicaid patient day, and that the combined Medicaid/Medicare payment shortfall was $2.5 billion in 2010.

Proposed remedies to help nursing homes meet the mandate include hardship waivers, delayed implementation, and tax deductions.

Which begs the question, if nursing homes get such benefits, how about everyone else.

The likely outcome for small nursing homes and home care providers is they "either fire employees and restrict services, be bought out by nursing home conglomerates, or both. The result will be fewer jobs ... and fewer care options available to those who desperately need them," the Examiner concludes.

The Examiner illustrates the leaden hand of government:

What is best for patients becomes an afterthought when bureaucratic formulas determine what care is provided and how.

An article in The Hill last month also notes that

HHS must still bridge the gap until 2014, when the mini-med plans will supposedly be phased out ... HHS said it is now examining waivers options for 2012 and 2013.

According to a guidance letter posted on the Center for Medicare and Medicaid Services web site, the waiver process was included in so-called "interim final regulations" written by HHS:

...the interim final regulations contemplated a waiver process for plan or policy years beginning prior to January 1, 2014 for cases in which compliance with the restricted annual limit provisions of the interim final regulations "would result in a significant decrease in access to benefits" or "would significantly increase premiums."

The CMS web site, in a section labeled "Improving Transparency," states that "Annual limits waivers are temporary. In 2014 annual dollar limits will be prohibited and mini-med plans will no longer be necessary."

A group backed by Karl Rove is suing to obtain more transparency on waiver requests, according to The Hill, and Michelle Malkin, writing on CNS News, observes that

the stench of waivers-for-favors won't be dispelled until and unless the Obama administration releases a full list not only of those who won exemptions, but also of those who applied and were denied.

More "interim final" regulations allowing new kinds of waivers would hardly be surprising, as the 65,000 employees of HHS emulate the Dutch boy with his finger in the dike, holding back the toxic tide of ObamaCare.

And, as the Examiner concludes, it's still only 2011.