"SEC. 2711. NO LIFETIME OR ANNUAL LIMITS
(a) IN GENERAL. —A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish—
(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or
(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary."
The second clause is the killer. Some staffer under some Senator got this clause in most likely written by some insurance company and handed over by some lobbyist at some time!
In a WBZ (Boston) report they state:
"As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not "unreasonable." The bill does not define what level of limits would be allowable, delegating that task to administration officials.
Adding to the puzzle, the new language was quietly tucked away in a clause in the bill still captioned "No lifetime or annual limits."
The 2,074-page bill would carry out President Barack Obama's plan to revamp the health care system, expanding coverage to millions now uninsured and trying to slow budget-busting cost increases. A tentative deal among Senate Democrats to back away from creating a new government program to compete with private insurers appears to have overcome a major obstacle to the bill's passage.
Officials of the American Cancer Society Cancer Action Network said they were taken by surprise when the earlier ban on annual coverage limits was undercut, adding that they have not been able to get a satisfactory explanation.
"We don't know who put it in, or why it was put in," said Stephen Finan, a policy expert with the cancer society's advocacy affiliate."
The Cancer Action Network response is as follows:
“People with cancer are very encouraged that their concerns have been heard about a provision currently in the Senate health care reform bill that could subject patients to a sudden termination of coverage for critical care. After discussions with senior White House and Congressional staff this afternoon, we are confident that our concerns will be resolved and the bill strengthened.
“The Senate bill prohibits insurers from establishing ‘unreasonable’ annual limits on coverage and gives the Treasury Secretary the authority to define what that means. As cancer patients and survivors know, the definition of ‘unreasonable’ may differ dramatically depending on whether a person is healthy or in active treatment for cancer. The American Cancer Society Cancer Action Network (ACS CAN) has expressed concern that a vague ‘unreasonable’ standard would leave people with cancer at risk of having their care cut off when they need it most.
“We are working with the White House and Congress to strengthen the Senate bill by eliminating annual limits on benefits and preserving the bill’s existing ban on lifetime limits. This improvement will ensure that people with cancer and other life-threatening diseases receive quality coverage that provides access to the care they need, when they need it."
Posts
