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Lifetime Caps on Health Insurance Could Harm Millions

If the so-called House “replacement” bill becomes law, then everyone in the country who is covered by an employer-sponsored plan – 159 million Americans – could be harmed. As written, the bill would allow insurers to put lifetime limits on coverage.
By Pablo Ros ·

If you get health insurance through your employer, you may have thought that the right-wing attacks on Obamacare wouldn’t affect you much. After all, the marketplaces set up by the Affordable Care Act (ACA) are for people to buy their insurance directly. And 30 million people now have coverage thanks to the ACA.

But if the so-called House “replacement” bill becomes law, everyone in the country who is covered by an employer-sponsored plan – 159 million Americans – could be harmed. As written, the bill passed by House right wingers last week would allow lifetime limits on coverage.

Lifetime coverage limits were common before the ACA became law in 2010. Such caps helped insurance companies boost profits by capping expenses for policy holders. If your insurance plan was capped at, say, $1 million and you had a catastrophic illness, then your insurer would’ve covered up to $1 million in health care costs. Anything beyond that would’ve been your responsibility.

In 2009, about 55 percent of Americans with employer health coverage were subject to lifetime limits, or 91 million people, according to this PricewaterhouseCoopers study. About 20,000 to 25,000 people were no longer covered by their employer-sponsored plans because they had used up their lifetime limits, the study estimated.

No wonder the ACA provision that did away with lifetime caps is so popular.

To put a face on these numbers, let’s consider Timmy Morrison.

Timmy was born seven weeks premature, weighing just three pounds and nine ounces. As Vox reports, during his first few months of life, he struggled to survive. He required so many medical procedures that by the time he was three months old, his medical bills had surpassed $1 million.

Luckily for him and his parents, Timmy was born just around the time that Obamacare’s ban on lifetime caps began taking effect. This made a world of difference.

By the time Timmy left the neonatal intensive care unit at six months, his medical bills had surpassed $2 million. If not for Obamacare’s ban on lifetime caps, it would have been up to his parents to figure out how to cover the costs.

Thanks to the ACA, Timmy has continued to receive lifesaving care covered by insurance. And his case is not unusual.

Tens of thousands of Americans who suffer from chronic conditions require a lifetime of care. Many go beyond the $1 million or $2 million cap that was common in employer-sponsored plans. Thanks to the ACA, they’re able to receive the care they need without selling their homes or filing for bankruptcy.

The House bill, which is really a tax cut for the wealthy, puts the interests of insurance companies above those of patients like Timmy, who must receive ongoing medical care to survive.

The Senate has the power to block this terrible bill. Call 888-981-9704 to tell your senators to oppose changes to the ACA. 

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