Reflections on Repeal Redux

Hearing last week’s news about the 37th House vote to repeal the Affordable Care Act (ACA) caused me to reflect on how that news may have been received by the millions of people who are benefiting from the Act’s early market reforms.  These reforms include new consumer protections such as dependent coverage up to age 26 and the coverage of preventive services without cost-sharing, among others. Amidst all the discussion surrounding the repeal vote, it seems that very little has been said about the people who would be impacted and the damage that would ensue should the ACA actually be repealed.

While serving as an Indiana insurance regulator for nearly 10 years, seven as insurance commissioner, I saw on a daily basis how our broken system of paying for healthcare disrupted people’s lives.  As a result, I have an intense appreciation for the value of the ACA reforms.  But the reform that came most prominently to mind last week was the prohibition against lifetime benefit limits, a measure that addresses a problem I became acutely aware of while doing advocacy work for the National Hemophilia Foundation (NHF).

During the time I worked with the NHF, the organization was seeking federal legislation to prohibit lifetime limits on health insurance policies.  As with many chronic diseases, million dollar lifetime limits prevented families dealing with hemophilia from ever feeling secure about their coverage.  Expensive treatments meant that the lifetime limits could potentially be met in as few as five or six years, so families lived in a constant state of worry, wondering where their next insurance coverage was coming from.

Among the many people in the hemophilia community who were forced to live under this cloud of concern was a man with hemophilia whom my colleague JoAnn Volk wrote about here a few months ago.  Mr. Addie had reached lifetime limits on two consecutive policies and shared with JoAnn the problems he had experienced finding coverage when he when was facing his third lifetime limit.  Another example is a woman I met who was a nurse and the mother of a college-aged son with hemophilia.  She related to me how, as her son was growing up, she was able to convince the large hospital system she worked for to change insurers each time her family was up against the group policy’s limits.  She wondered how many more times she would be able to do that.

These brave and resourceful people were forced to play a cruel game of “Russian Roulette” with their healthcare coverage, switching from plan to plan to assure that they could continue to pay for necessary, life-sustaining treatments for themselves or their loved ones.  And, those dealing with a chronic disease were not the only ones plagued with worries about lifetime limits.  Serious accidents, newborns with extensive medical problems, cancer, and any number of other medical conditions caused people to max out their policies before the ACA became law.

In 2009, the NHF commissioned a PriceWaterhouseCoopers study of lifetime limits on health insurance policies. The study report noted that an estimated 20,000 to 25,000 people were no longer covered by employer sponsored plans at that time because they had reached their lifetime limits on coverage.  The report observed that, with an assumed  6 percent annual growth rate, healthcare costs would be 80 percent higher in 2019, causing the number of people losing coverage because of lifetime limits to grow exponentially if the limits remained in effect.

As we know, the limits did not remain in effect.  They were prohibited by the ACA in 2010 and, for more than two years, individuals formerly plagued by lifetime limits have been relieved of their coverage concerns and are able to focus on their healthcare.  For their sake, and that of millions of others benefitting from all of the ACA’s early reforms, I hope the 37th vote to repeal was the last one.  If it wasn’t, the impact of repeal on those whose lives have been much improved by the ACA should certainly be taken into consideration before any future vote.

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