So Much For Health Care Consumer Protection: Reid Guts Ban On Annual Limits

For all those apologist who say we should absolutely pass a health care bill, even without a public option, because it still “has so many great consumer protections,” I have a rude awakening for you. The AP is reporting that Harry Reid quietly gutted one of the most important consumer protections in the bill, the ban on annual limits:

The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.

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 Senate HELP committee bill had the following section.

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 lifetime or annual limits on the dollar value of benefits for any participant or beneficiary.
`(b) Preventing Fraud and Abuse- This section shall not apply until the date on which the Secretary certifies that enacting this section will not result in undue proliferation of fraud and abuse, especially with regard to durable medical equipment.

Reid took this section, left the name, but completely gutted the consumer protection:

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.
`(b) Per Beneficiary Limits- Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.

Even the Senate Finance Committee bill made banning annual limits a mandatory part of any “essential benefits package” (the minimum requirement for any plan sold on the new exchanges):

‘‘(4) does not impose any annual or lifetime limit on the coverage of such covered health care items and services.

For some reason, Harry Reid decided to remove this core consumer protection. This “unreasonable” qualifier he added is a loophole you can drive a school bus through. Is our goal only to help Americans who are “reasonably” sick and “reasonably” in need? The whole point of insurance reform is to help those most in need, and not let insurance companies take away their care. No one who is suffering from a serious medical condition should be driven into bankruptcy because he or she is in need of an “unreasonable” amount of help. Insurance companies will still be allowed to drop their sick customers and deny claims if the care their customers need is of an “unreasonable” amount.