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US Residents With Major Health Problems

Armen Hareyan's picture

A"small but growing" number of U.S. residents with "costlychronic illnesses" are reaching the "lifetime benefits cap of $1million or more that is a standard part of many insurance policies," the Washington Post reports. People who reach thelimits can face health care bills of "hundreds of thousands of dollars ormore, prompting their families to seek help from the government, or to scrambleto change jobs or even divorce for no other reason that to qualify for newhealth insurance," according to the Post.

The Post reports that the "predicament of those who burstthrough lifetime insurance caps is largely ignored in the debate aboutoverhauling the U.S.health care system," which mainly focuses on expanding access to care forthe uninsured. Some advocates for the chronically ill are planning lobbyingefforts aimed at persuading lawmakers to require health insurers to increasethe lifetime benefits limit to as high as $10 million. According to advocates,the amount of many caps has not increased in decades or has not kept pace withthe rate of health care inflation, and the high cost of new treatments andtherapies makes it more likely that some people will reach their benefitslimit.

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Glenn Mones -- vice president for public policy at the National Hemophilia Foundation, which is launching a lobbyingeffort to push increased caps -- said, "The majority of people who haveprivate insurance don't have super-low caps, but there are enough of them forit to be a problem. ... Where you really have a problem is the people who havethe $1 million and $2 million caps, especially if they develop complications.It's something that we have to pay a lot of attention to." According to a surveyby the Kaiser Family Foundation and the Health Research & Education Trust, 55% of employees with employer-sponsoredcoverage had a lifetime limit in 2007, including 23% with a cap of less than $2million, compared with about 50% who faced caps in 2004.

Mohit Ghose, a spokesperson for America's HealthInsurance Plans,said increasing the caps will not address the larger problem of ensuring thatpeople get the most value from every health care dollar spent. He said,"Are we in a position to pay a quarter-million dollars for a course oftreatment as a nation, or is there a way that the public and private sectorscan work together to shore up the mechanisms that are used to pay for thosehigh-cost treatments?" adding, "What we are saying is that there'sgot to be a better way of helping those with the highest health care costs. Andconsequently, we need to be addressing those costs very directly -- not justthe fact that people are incurring those costs, but why are those costs sohigh?" (Lee, Washington Post, 1/27).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.