what would this mean to you?

Before our family was touched by catastrophic illness all this healthcare jazz bored me. To tears. I had little concern for who was advocating for whom. Who might be managing insurance budgets. And cuts. Or for the unfortunate souls who found themselves at the short end of the coverage stick. I was too busy gearing up to save the world. One Tanzanian child at a time.


Two years ago my thinking radically changed. Which is most likely why my working hubby would forward me the article below. (nothin' like a little hot n' steamy poli-talk) And equally why I would read it.


Health care loophole would allow coverage limits

(the author Mr. ALONSO-ZALDIVAR knows how to catch this girl's eye)

A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.

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 2,074-page bill would carry out President Barack Obama's plan to revamp the health care system...

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...

Advocates for patients say they're concerned the language will stay in the bill all the way to Obama's desk.

"The primary purpose of insurance is to protect people against catastrophic loss," Finan said. "If you put a limit on benefits, by definition it's going to affect people who are dealing with catastrophic loss." The cost of cancer treatment can exceed $100,000 a year.

...Both the Senate and House bills, for example, ban lifetime limits on the dollar value of coverage.

But Finan said the change in the Senate bill essentially invalidates the legislation's ban on lifetime limits.

"If you can have annual limits, saying there's no lifetime limits becomes meaningless," he said. A patient battling aggressive disease in its later stages could conceivably exhaust insurance benefits in the course of a year.


Not to get all Squeaky Wheel on this crisp approaching Christmas night. But does that sound scarey? Or is it just me?


lisa said...

Yeah, definitely sounds scary...especially as the benefit statements from our insurance company keep rolling in for Julia's surgery/complication management. I haven't added up the total cost of what our insurance paid yet but I know it's definitely reaching the $100k+ mark.

The Blatchford Family said...

Very scary. We have also racked up quite the medical costs in the past year. I hope that this language gets changed or at least written more clearly. Yikes!

Love your blog, btw. I don't know if I have commented before, but I found your blog through the Field's Triplets blog.

baby trevor's mommy said...

I know...and what about the poor little one who needs multiple rounds of ACTH and qualifies for brain surgery in the same year? Oh I'm so sorry...but baby will have to wait another six months and uncountable seizures for the new year's budget. Grrrrr...

And thank you for the blog-liment! ;)


MJStump said...

okay that is pretty scary to me.

yeah, one around of ACTH would probably be enough for reaching the limits, so anything on top of that would be ummm...not good.

what wonderful thoughts to close the year with.

Adesta said...

Even for me, who doesn't have a SN child, that is scary. I'm positive my family doesn't spend any where near as much as $100K a year seeing doctors, but just knowing that there could be a limit makes me worry about the "what if's".

I certainly hope they get this taken care of before it's signed by Obama.....*shudders*

Bacon Wife said...

Like Adesta, I do not have a SN child but it scares the poop out of me that a government would and could control how much health care i can get or tell the insurance companies how much health care i can get. I could really say how i think about the whole thing but i will refrain! :o)


JSmith5780 said...

Makes me want to vomit.

Famileies sit around and stress over whether they sick family member will get the treatment they need, while the insurance execs are sitting around getting fat on our dime.

Wendi said...

This type of blatant deception is why some folks are so against the healthcare "reform" bills. As necessary as true reform is, I've yet to see either party put forth a bill that will bring it about. :(

Sinead said...

I am FOR healthcare reform because it is worse the way it is. Call your senators and tell them you don't like that clause and why. Get it changed. I billed $320K this year without even trying ACTH so I get how quickly the costs rack up. I genuinely believe that reform will put care in the hands of the lost today and that is essential. There is a lot of misinformation floating around out there and one thing is clear to me is that the government is not deciding how much health care I get - they are trying to ensure that everyone has access to the care I get. Moreover, the system as it stands is horribly rationed and every day people who thought they had insurance find that it does not cover what they need. At least once a month we encounter a parent who cannot get insurance to cover ACTH. We go nuts and blame the manufacturer and thats fair enough but we need to get angry at the system that lets that happen. Its not just the insurance. Its the cost of healthcare and the goal of profit making insurance companies to limit how much they pay out and what they cover. Why does a drug that cost $95 in Canada cost $1500 here? (Vigabatrin) Who regulates the prices? Who protects the consumer? We are being ripped off royally today and as it stands the special interests are trying to get the health care bill watered down so that they can profit more. Its scary. We need to fight for our children because if this legislation does not go through, NO insurance company will ever insure Emma when she reaches adulthood and that is not a good status quo for me.

If you need further convincing that the industry as it stands is a mess - go look at the names in the highly profitable Fortune 100 list. Yes - the health insurance companies that say no, no, no to our friends are prominent on that list.

Call your senator. Tell them what you want. Don't give up fighting for what you want healthcare to deliver.

Shelby said...

Unfortunately, I'm not surprised at this either. I've been afraid of these "loopholes" since day one. I'm thankful this one has been uncovered. I am also thankful I read Sinead's post because I will say that I look at things a little differently now. The system is so broken and if it stays as is, it will get only worse. My husband's primary care doctor sent him something last week that he and his partner were becoming affiliated with a larger physician network, were dropping their patients to include only 600 per physician, and to remain a patient there is an annual cost of $1,500 which includes your annual exam and a mini CD with your personal records, 24-hour appointment guarantees with no wait. UGHHHH, what if every physician we all go to and our children go to have this requirement, specialists included? There is no one to stop them now if they all want to jump on the bandwagon? Your right Sinead, we have to stay on it, make our voices heard, and don't give up! Thanks Danielle for posting this, I haven't heard of this loophole until now!!!!

Colby said...

Sickening...That's all
I have the energy to say....

Thanks, Danielle, for keeping us informed...

You are a champ!