The administration has failed to meet 44 statutory deadlines required under Obamacare, according to a new report by the Congressional Research Service (CRS).
The report, released on Monday, documents every provision with a specific deadline within the health care law and the administration’s actions taken as of April 15, 2014. The Department of Health and Human Services (HHS) has missed more than half of the 83 deadlines mandated since March 2011.
The missed deadlines range from several days to years. The administration was only four days late in issuing a final regulation for HIPAA electronic transactions, while it was two years and seven months past the deadline for a report on domestic violence victims on Indian reservations.
The secretary was one year and one month late in developing a plan to increase HHS’s Indian Health Service (IHS) by 500 positions. Due by June 21, 2010, HHS did not begin implementing a plan for a "skilled and culturally competent behavioral health workforce" for the agency until August 2011.
Several reports that were late related to Native American health. A report by Attorney General Eric Holder on "prescription drug abuse in Indian communities," was submitted one month past its Sep. 23, 2011 deadline.
Reports on "findings related to Indian Men’s Health" and HIV prevention "specific to Indians" were both issued two years and one month late, and an HHS report on the "feasibility of considering the Navajo Nation as a state for Medicaid purposes" was submitted over a year past its deadline.
The report details many lesser known provisions within Obamacare, including a required three year "Independence at Home demonstration" to test if "home-based care" can reduce hospital visits. HHS started the project four months past its deadline on Jan. 1, 2012.
HHS did meet deadlines. For instance, the agency was two weeks early in submitting a required report to Congress on "the benefits of screening for postpartum depression" in March 2012.
The report found six cases where it appears the administration has taken no action at all. The CRS could find "no public information" relating to a March 2012 mandate for health plans to "report on their efforts to improve health outcomes."
"That indication does not necessarily mean that an agency or other federal entity has taken no action towards meeting a deadline," the CRS noted. "It may be that there has been internal activity, but that CRS was unable to locate any public information about the activity."
In addition, no public information was available on a study of "procedures necessary to protect certain employer and employee rights" under Obamacare.
Six deadlines, which were not included in the total 44, were missed due to Congress defunding certain provisions of the law. For example, funding for an "alternative dental care providers demonstration project" has been prohibited each year in appropriation acts since 2011.
The CRS said that due to the law’s "complexity" it had to exclude numerous other provisions of Obamacare, which only have "effective dates" and not hard deadlines.
"To make those determinations, CRS relied on a close reading of the statutory text, acceptable principles of statutory interpretation, and subject matter expertise regarding typical implementing agency practice in the issue areas covered by the ACA," the report said.
In a section addressing the "Legal Effect of Deadlines," the report explained that private civil litigation is likely the only way to make the administration enforce deadlines in Obamacare.
The CRS said Congress could pass legislative "hammers" that would require the executive branch to follow deadlines or face legal consequences, such as "the loss of agency funding if the final regulations were not promulgated by the statutory deadline."
"As previously noted, none of the provisions in the ACA establishing deadlines on agency implementation appear to contain any type of legislative ‘hammer,’" the CRS said.
"Thus, it would appear that enforcement of any of these deadlines is to be left either to political enforcement, such as through congressional oversight and/or other forms of legislative pressure, or to the types of civil litigation discussed above."