Senate Health Bill Has Loophole Allowing Coverage Limits

Ezra has a post today, talking about the important rule that healthcare reform is going to establish. "As the exchanges open up -- if they open up, more to the point -- all of this will work better and more smoothly. This is how the Netherlands' health-care system looks, and few would accuse their insurers of being evil."


The problem with this argument, the problem many of us of had all along, is that the United States is not the Netherlands. We don't have a private industry that is particularly committed to following the rules, nor do we have a government that is particularly adept at enforcing them. But it's even worse than that--we have a Congress that's already subverting the rules before they've even started.

WASHINGTON — 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."

Maybe they were hoping nobody was going to read what was actually under the section title until the bill was actually passed and signed by Obama. Who, btw, as Jane points out expressly promised that lifetime limits on coverage would be banned in his healthcare speech on September 10. That's a promise that the Senate can't break.

Let's just get this clear--annual limits are just as pernicious as lifetime limits, perhaps even more so. Here's Stephen Finan, a policy expert with the cancer society's advocacy affiliate:

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