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ACA’s Ban on Lifetime Caps Protects 105 Million Americans

Posted by John McDonough  March 5, 2012 10:20 PM

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Here is an excerpt from a letter to the editor published in the Bismarck Tribune in North Dakota on December 28, 2009 from Brenda Neubauer:

"My son has hemophilia, a bleeding disorder that requires lifelong treatment with high-cost clotting medications that allow the blood to clot and prevent painful and life-threatening bleeds. ... By 12, my son reached his lifetime cap. We obtained a second policy as a substantial expense. He has used $1 million of this $2 million cap, and will cap out in 3 years or less. His clotting medication costs $30,000 per month. Dosage and cost increase with growth. If lifetime caps are not increased or eliminated, my son will not receive quality and life-sustaining care.

"Blue Cross is unwilling to increase the $2 million caps established in the 1970s, though health care costs have risen and individuals with chronic conditions such as hemophilia, cancer, cystic fibrosis, spinal cord and brain injuries face these unreasonable limits. When Congress returns to deliver a final health care bill, it is essential that lifetime caps be eliminated in all plans."

I wrote about Brenda and her efforts in my book on the ACA, Inside National Health Reform. She was part of a national campaign to eliminate lifetime and annual benefit caps, and her advocacy was key in getting then-Senator Byron Dorgan (D-ND) to make this issue one of his make-or-break issues for inclusion in the Senate version of health reform legislation.

Brenda and her side won. Elimination of lifetime benefit caps became effective in September 2010, and annual limits are being phased out between now and 2014. And today, the U.S. Department of Health & Human Services released a new report on the real numbers of who will be helped because of this small part of national health reform.

Prior to reform, an estimated 59% of those with employer-provided health insurance had a lifetime limit on their policies, and 89% of those with individual health insurance had a lifetime limit. The number of individuals who had a policy with a lifetime limit and who do not now have a limit -- 105 million Americans.

105 million.

More than 2.5 million in Massachusetts.

Not all or most or even many of these 105 million would ever rack up enough medical costs to come close to the prior caps. Yet any single one of these 105 million could have with an unlucky roll of the genetic dice. But enough of them would have hit the lifetime limit to create immeasurable pain and distress in the lives of those families. Funny thing is -- most people who will benefit from the elimination of these caps will never know what they might have faced; and even fewer will know they didn't face this because of the ACA.

Thanks ACA, and thanks Brenda.

And, Mitt Romney and Scott Brown, when you say you will repeal the ACA, will you also repeal the elimination of lifetime and annual benefit caps? C'mon, please tell us.

Pretty please with sugar on it?

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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