Lifetime Insurance Caps Bills Introduced in Congress
NORD recently sent the following Legislative Alert to its member organizations:
Health Insurance Coverage Protection Act
HR 6528 Sponsored by Rep. Anna Eshoo (D-14th CA)
S 2706 Sponsored by Sen. Byron Dorgan (D-ND)
Rep. Anna Eshoo and Senator Byron Dorgan have introduced legislation to address
the aggregate spending limits placed on insurance policies after which the
policy no longer provides coverage. This issue is of particular interest to
those with rare diseases who require often high cost orphan drug therapies and
chronic care.
Background
According to a 2007 Kaiser Family Foundation survey of employer-sponsored health
plans (2007 Annual Survey of Employer Health Benefits):
- Over half of the employer-sponsored health plans and seventy percent of
private individual insurance plans set aggregate lifetime caps on covered
benefits.
- In some cases smaller firms' health plans lifetime caps are set at a higher
level than large firms.
- 76% of employer-sponsored HMO plans and 33% of PPO plans have no lifetime
caps.
- Employer-sponsored plans with caps are most typically set at $2-$3 million.
The Health Insurance Coverage Protection Act will phase in an increase in
minimum lifetime caps in private insurance plans to $10 million with an annual
inflationary index thereafter. This legislation will allow people with high cost
chronic conditions who have private insurance to maintain their coverage and not
have to seek public assistance such as Medicaid or state high-risk pools. For
many with rare diseases, a lifetime cap of $1 million is sometimes inadequate.
Specifically, HR 6528 and S 2706:
- Sets the minimum level of a lifetime cap placed on a group health plan at $5
million for the first two years and $10 million in years three and four.
- Provides for an annual inflationary adjustment to a group insurance plan's
lifetime cap based on the consumer price index in subsequent years.
- Exempts health plans offered to businesses with few than 20 employees, but
would require that health plans meeting the parameters of the bill be offered to
a small business at the employer's request.
- Calls for an Institute of Medicine (IOM) study to determine the number of
individuals who reach their lifetime caps.
How you can help
Contact your Representative and Senators asking them to cosponsor HR 6528 or S
2706:
- Visit www.congress.org and enter your zip code in the small box at the top
right and click "GO". The next page directs you to your elected officials.
- Call the U.S. Capitol switchboard at (202) 224-3121 and ask for your
representative's or senators offices. When connected, ask to speak with the
legislative assistant (LA) who handles the issue.
- After identifying yourself, including where you are from in the
district/state, tell the LA that you support H.R. 6528/S 2706. State the reasons
why you support the bill.
- Ask for their position and request that your Representative/Senator cosponsor
the legislation. You may request a written response to your call.
For more information, please contact Diane Edquist Dorman, Vice President for
Public Policy at ddorman@rarediseases.org.
Read about events on Capitol Hill, funding for rare-disease research, and other topics of interest from NORD's office in Washington, DC.