While most of the major health reforms start in 2014, the Affordable Care Act (ACA) imposes several new requirements in 2011 on health plans and self-insured employers.

To prevent either a large increase in premiums or a significant decrease in access to health coverage, the Centers for Medicare and Medicaid Services (CMS) has granted nearly 1,400 waivers of the ACA requirement to phase out annual dollar limits on health benefits.  The waivers affect health coverage for about 3.1 million Americans.

The CMS Center for Consumer Information and Insurance Oversight (CHIIO), which is responsible for implementing much of the Affordable Care Act at the federal level, reviews waiver requests on a case by case basis.

According to CHIIO’s published criteria, they consider a series of factors, particularly whether or not a premium increase is large or if a significant number of enrollees would lose access to their current plan because the coverage would not be offered in the absence of a federal waiver.

Critics of the Affordable Care Act (“ObamaCare”) point to the need for the waivers as evidence of how ACA will increase health care costs and jeopardize employer-sponsored health insurance.  They also say that the Obama Administration is exceeding its authority to grant waivers.

So far, one-year waivers of the rule on annual dollar limits have been granted to:

Self-Insured Employers (528)
Health Reimbursement Arrangements (457)
Multi-Employer Plans (315)
Non-Taft Hartley Union Plans (27)
Health Insurance Issuers (39)
State-Mandated Policies (4)
Association Plans (2)