HCR Senate Version: Caps on Coverage

[amborin]

"...........

........there are Senate provisions that many House Democrats simply can’t swallow, according to the House speaker, Nancy Pelosi — provisions that might fuel voter outrage of the sort so vividly on on display in Massachusetts.

Here’s just one little-discussed but instructive example: caps on insurance coverage.

Many health plans limit the total amount that the insurer will pay for medical care annually or over the policy holder’s lifetime. It’s an insurance industry practice that angers many consumers, and it’s one of many things a health care overhaul must address. But the House and Senate bills take wildly divergent approaches.

Advocates for patients with rare and chronic diseases are concerned that the Senate health bill would allow existing health plans to avoid new rules prohibiting lifetime and annual limits on the dollar value of coverage. Sick people who need expensive, long-term treatment will run the risk, just as they currently do under many policies, of running out of insurance.

“I think it’s a loophole that people have overlooked,” said Diane Dorman, vice president for public policy for the National Organization for Rare Disorders.

snip

The House bill would eliminate lifetime caps in all individual and group insurance plans starting in 2010 and eliminate annual caps in 2013.

The Senate bill, on the other hand, would eliminate lifetime limits for new health plans six months after the law’s enactment. Annual limits would be prohibited for new plans starting in 2014 and allowed only on a restricted basis before then. But current plans would get a pass: health plans that people already belong to at the time of enactment would be permanently exempt from the requirement to eliminate lifetime and annual caps.

snip

In 2007, about a third of people in employer-sponsored plans had lifetime coverage limits of $2 million or more, while another 22 percent had caps of between $1 million and $2 million, according to the Kaiser Family Foundation’s annual employer health benefits survey. Forty-five percent of people had coverage without any lifetime caps."

snip

http://prescriptions.blogs.nytimes.com/2010/01/26/when-the-insurer-says-no-more/

[DJ13]

1. There is really no way to not have caps when the insurance is for profit

Thats why we need to scrap a system based on for profit insurance and move completely over to a single payer system based on an income tax surcharge, not on individual mandates.

You cant legislate corporations to potentially spend more than they make in profits, it just wont work.