HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, January 31, 2008

Lifetime Benefit Caps

TPM Cafe's Cindy Zeldin has a great discussion of today's Washington Post article on the issues and problems surrounding lifetime benefit caps on insurance spending.  She writes,

Today’s Washington Post explores lifetime benefit caps, provisions of most private health insurance policies that limit the total amount of expenditures an insurer will pay, with these limits typically falling in the one- to two-million dollar range. These lifetime caps and other insurance gaps like high out-of-pocket maximums and uncovered medical services are colliding with escalating health care costs to force questions about just what it means to have health insurance anyway. . . .

A few years back, the Institute of Medicine released a series of reports that painstakingly analyzed the importance of health insurance in accessing health care, highlighting the myriad problems that result from uninsurance, both to individuals and to society. We know that health insurance matters. Thanks to a growing body of research, at the heart of which is Professor Warren's findings on medical bankruptcies, we also know that, while insurance is crucial, it isn't always enough. Even the insured can face barriers to care and bills that exceed their ability to pay. The Washington Post article notes that the National Hemophilia Foundation is embarking on a lobbying effort to increase the amount of health insurance caps. If we move down the road of health reform in '09, we're going to wrestle with questions about how much individuals should be expected to pay and how much insurance should cover--questions we haven't exactly built a consensus around as a society but which threaten to fracture the public support that is building for health reform if left unaddressed.

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