As NHF has previously shared with the community, the elimination of lifetime caps has been included in each health reform proposal currently being considered by Congress. This is great news and shows genuine progress on lifetime caps in the past two years. However, each of the three bills under consideration implements the provision to eliminate caps differently. We are concerned about the delayed implementation included in some of the bills.
Below is the timeline for when and in which insurance markets the bill would eliminate caps. For two of the bills, the elimination of caps depends on whether the plan is purchased through an exchange, a new insurance marketplace that would facilitate access to coverage for individuals and employers.
America's Affordable Health Choices Act of 2009 (H.R. 3200, the House Tri-Committee bill)
- Plans in the exchange and new employer-sponsored plans: effective in 2013
- Existing, employer-based plans: effective in 2018
Affordable Health Choices Act (S. 1679, the Senate HELP Committee bill)
- All new plans: effective in next plan year after enactment of law, likely 2010
- All existing plans: exempted indefinitely
America's Healthy Future Act (the Senate Finance Committee mark as amended)
- All new individual and small group plans in the Exchange: effective in 2010
- All individual and small group plans (whether in or out of Exchange): effective in 2013
- Group health plans would be precluded from imposing "unreasonable" lifetime limits: effective in 2013 (Note: "unreasonable" is undefined.)
- All existing plans: exempted indefinitely
At the time of this writing, the way that the bills are currently drafted would result in many people potentially facing lifetime caps, even after health reform is enacted. Since the bills phase-in the people who are eligible to purchase insurance through the exchange, individuals with employer-sponsored insurance could face caps until 2018 or possibly indefinitely if their insurance coverage does not change.
NHF believes that this is unacceptable and has been advocating for the immediate implementation of lifetime caps in all markets. NHF and the Lifetime Caps Coalition have sent letters to the Chairmen and Ranking Members of the House Tri-Committee bill asking for more immediate implementation of the elimination of lifetime caps. Click here to read the letter. NHF is also working with our congressional champions in the House and the Senate to determine the most appropriate strategies to ensure that lifetime caps are eliminated as soon as possible.