Thankfully, Representative Giffords, by all reports, is doing well. And while we know her recovery will probably be long and arduous, we know she will be getting some of the best rehabilitative care in the country at TIRR Memorial Hermann in Houston, TX. I wish her a speedy recovery and a successful return to the House of Representatives.
But I couldn’t help but wonder — what if it had been me or someone I know. Would my insurance company pay for this care? How much would they pay? Would I reach my coverage limit cap? Would my company agree to pay for “out of network” care?
And then I remembered — the Affordable Care Act eliminated lifetime caps on policies issued or renewed on or after September 23, 2010. Since most plans typically renew at the beginning of each year, that cap has been eliminated on existing polices. So Gabby and the rest of us won’t end up in bankruptcy because of a catastrophic injury or illness that exceeds our lifetime limits. But the annual limits ban of the Affordable Care Act for existing policies doesn’t end until 2014. And for new policies being written after September 23, 2010, there are waivers as outlined below.
Annual Limit Waivers
The Affordable Care Act bans annual dollar limits beginning in 2014. Until then, annual limits are limited under HHS regulations published in June 2010. For plan years starting between September 23, 2010 and September 22, 2011, plans may not limit annual coverage of essential benefits such as hospital, physician and pharmacy benefits to less than $750,000. The restricted annual limit will be $1.25 million for plan years starting on or after September 23, 2011, and $2 million for plan years starting between September 23, 2012 and January 1, 2014. For plans issued or renewed beginning January 1, 2014, all annual dollar limits on coverage of essential health benefits will be prohibited.
And, HHS has approved applications for a one year Waiver of Annual Limits Requirements for hundreds of insurers that will effect over 1.5 million people. Are you one of them?
So Gabby may be facing annual caps that she probably exceeded her first day in the hospital. And caps all of us are facing for the next three years until the law becomes effective. That is, unless the GOP is successful in repealing the Affordable Care Act or defunding its provisions to keep it from being enacted. Then we will be back to square one. During the election and even now the “solutions” the GOP are proposing are already in the bill. I posted an article about this earlier: Have These Candidate Read the Bill?
It’s all kabuki theater. While they waste time acting like spoiled brats unhappy with what the grownups have done, claiming they’ll enact the laws we need that are already part of the bill, people are still without jobs and more and more are still losing their homes.
Sure, there are parts of the bill that need fixed. No one is disputing that fact. But rather than fix the parts of the bill that need fixed, they simply want to dismantle the entire bill.
And while they scream “socialism” they had no problem whatsoever in refunding the Federal Flood Insurance program or in expanding the Crop Insurance program.
Sep 21, 2010: This bill passed in the Senate by Unanimous Consent. A record of each senator’s position was not kept.
Sep 23, 2010: This bill passed in the House of Representatives by voice vote. A record of each representative’s position was not kept.
H.R. 2559: Agricultural Risk Protection Act of 2000
I guess it comes down to this – owning property increases your value. So those who own property are, therefore, more valuable than those who don’t. So that appears to make corporations more valuable than people, since they own more property than most people. The GOP seems to still be working under the original Constitution where only land owners were allowed to vote – some of us seem to be less valuable than others. That would explain the SCOTUS ruling on Citizens United. Happy Anniversary!
Get well soon, Gabby. I hope you chose a good insurance plan from those in your “Exchange.”