Senate reform loophole allows caps on payouts for some illnesses

While advocates have succeeded in getting language into Congressional reform bills that would eliminate medical underwriting for patients, other observers have noted that health plans would find other ways to limit their exposure.

One of those ways seems to have popped up in some tweaks to the Senate reform bill, which would let insurers cap benefits for some expensive illnesses. The original reforms passing the Senate health committee didn't allow for such limits.

The current version of the Senate Democrats' healthcare bill lets insurance companies place annual limits on the dollar value of medical care, as long as they are not "unreasonable." The term isn't defined, however, which obviously gives insurers a great deal of latitude. The bill still bans lifetime limits on the dollar value of coverage, but critics say that if annual limits are allowed, the lack of lifetime limits will be all but neutered.

Groups backing care for costly diseases like cancer--treatment for which can rise above $100,000 per year--told the Associated Press that they were blindsided. "We don't know who put [the provision] in, or why it was put in," said Stephen Finan, a policy expert with the American Cancer Society Cancer Action Network's advocacy affiliate.

Get more background on the changed health reform bill:
- read this Associated Press article

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