Consumer Watchdog, a non-partisan consumer advocacy group, announced Tuesday that it has called on the Obama administration to make health reform waivers "the exception, not the rule."
The letter comes as the Department of Health and Human Services granted an additional 111 waivers this month, bringing the number of organizations with waivers up to 1,004.
HHS said the waivers granted to date involve protecting 2.1 million enrollees, representing only about 1 percent of all Americans who have private health insurance.
Consumer Watchdog's letter comes as the GOP turns up heat on the waiver issue among an arsenal of attacks on the Affordable Care Act.
Consumer Watchdog says Anthem is using the waiver as an attempt to evade medical spending rules in New Hampshire.
Under ACA, in 2011, most health plans can impose an annual limit of no less than $750,000. However, some workers are only offered "mini-med" health plans, with limits below those allowed by ACA. According to HHS, the waiver provision is designed to temporarily protect those workers.
In 2014, the Affordable Care Act "will end" mini-med plans, according to HHS. In the meantime, the law requires insurers to phase out the use of annual dollar limits on benefits. Waivers only last for one year and are only available to plans that certify a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage. "No other provision of the ACA is affected by these waivers: they only apply to the annual limit policy," HHS said.
According to HHS, states may apply for a waiver on the restricted annual limit if the insurance company offering the state plan made its contract with the state prior to Sept. 23, 2010. Four waivers have gone to state governments, HHS said.
"It is not your job to preserve the status quo for companies as they operate in the market today," Consumer Watchdog wrote to HHS. "The standard for granting a state waiver should be whether consumers will be able to access insurance when the rules are implemented, not whether they will cause a shift in the market as more efficient insurers increase their business and more wasteful insurers clean up their act."
Consumer Watchdog said that, as part of New Hampshire's waiver application, Anthem should have been required to prove it had tried to shrink its administrative costs.
A March 15 House Oversight and Government Reform subcommittee hearing examined the need for waivers under ACA. Subcommittee Chairman Trey Gowdy (R-S.C.) said, it "has become abundantly clear" over the past year that companies are having trouble complying with the new law.
A witness at the hearing, Edmund F. Haislmaier, senior research fellow at the Heritage Foundation's Center for Health Policy Studies, said the waiver program creates the opportunity – and the temptation – for Administration officials to apply the law corruptly or to engage in political favoritism.
This month the Crossroads Global Policy Strategies, a political group with GOP ties, filed a lawsuit against the administration to force it to reveal its reasons for granting waivers to the law.
On March 22, Mitt Romney, a potential 2012 Republican presidential candidate, wrote in the National Review, "If I were president, on Day One I would issue an executive order paving the way for Obamacare waivers to all 50 states."
David Axelrod, former White House senior advisor, has said the Obama administration got some of its health reform ideas from Romney's own stint as Governor of Massachusetts.
[See related stories: Mini-Meds: The Saga Continues; Romney on healthcare: end 'free rides']
Follow Diana Manos on Twitter @DManosHFN.