by Brigette Courtot, Policy Analyst
National Women’s Law Center
This post is part of a weekly series on Women and Health Reform.
Does your health coverage have a lifetime maximum? Is it adequate? (If you’re already stumped, a lifetime benefit maximum or cap is the maximum amount of money an insurer will pay for healthcare services over the course of the insured person’s lifetime.) Granted, most insured Americans probably haven’t thought too much about this issue. But in 2007, 55 percent of people with job-based coverage had a lifetime limit on health benefits, an increase from 2004. Nearly a quarter of all workers had a lifetime benefit limit of $2 million or less. If $2 million seems like a lot of money, consider these eye-opening estimates of lifetime costs for certain illnesses and injuries:
- Coronary Artery Disease (the leading killer of women in the U.S.): over $1 million
- Multiple Sclerosis (which affects twice as many women as men): $2.2 million
- Single Kidney Transplant: $500,000
- Spinal Cord Injury: between $624,000 and $2.8 million
- HIV Care: $618,000
- Autism: over $300,000
Chances are you know someone who has suffered from one of these conditions. Maybe you know a family whose members have battled two or more of them. Throw in several years’ worth of more common medical costs — broken bones, rounds of antibiotics, asthma treatments, hearing aids — and it becomes easy to see how a $2 million limit wouldn’t cut it for families that experience major medical problems. Moreover, if health care costs continue to grow by leaps and bounds while lifetime benefit limits remain at levels set in the 1970s, even those with more minor medical costs could find themselves bumping up against lifetime limits.
When a benefit cap is exhausted, an employee faces the difficult decision of switching jobs to get a new coverage plan, stopping work altogether to become eligible for a public health insurance program, or going without coverage. Last week, Congresswoman Anna Eshoo (CA) introduced a bill--the Health Insurance Coverage Protection Act, or H.R. 6528 -- that would make this unfortunate scenario a lot less likely. The bill would raise lifetime health insurance benefit caps for those in group health plans. It would require that a lifetime benefit maximum be at least $5 million for the first two years in the plan and at least $10 million in the next two years (the amount would increase with inflation for each year thereafter).
Like some other legislative efforts on our radar, H.R. 6528 is hardly the comprehensive solution that we need to fix the nation’s health care system. For one thing, this federal bill does not address insurance policies sold in the “Wild, Wild, West” (our favorite moniker for the majorly-flawed individual insurance market) at all. While this is unsurprising given that the states are responsible for nearly all regulation (or lack thereof) of this market, as it turns out, the lifetime limit situation is much worse there. Because the law would make a tremendous difference in the lives of some women and their families, I would urge anyone to support it (you can voice that support through the Hemophilia Federation of America’s campaign). Still, this bill is no substitute for truly progressive reform that will provide all women with a guarantee of high-quality, comprehensive, and affordable health care. If anything, the fact that many of us with insurance don’t currently have adequate financial protection against serious injury or illness is another vivid example of why we need comprehensive health reform. We’ll continue to keep our eye on the prize.