By RICARDO ALONSO-ZALDIVAR, Associated Press Writer
WASHINGTON – A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.
The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.
As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not "unreasonable." The bill does not define what level of limits would be allowable, delegating that task to administration officials.UPDATE: 12/10, 4:40 PM
Adding to the puzzle, the new language was quietly tucked away in a clause in the bill still captioned "No lifetime or annual limits."
The 2,074-page bill would carry out President Barack Obama's plan to revamp the health care system, expanding coverage to millions now uninsured and trying to slow budget-busting cost increases. A tentative deal among Senate Democrats to back away from creating a new government program to compete with private insurers appears to have overcome a major obstacle to the bill's passage.
Officials of the American Cancer Society Cancer Action Network said they were taken by surprise when the earlier ban on annual coverage limits was undercut, adding that they have not been able to get a satisfactory explanation.
"We don't know who put it in, or why it was put in," said Stephen Finan, a policy expert with the cancer society's advocacy affiliate.
Democratic officials of the Senate Health, Education, Labor and Pensions Committee would not comment publicly but said the bill contains numerous provisions that will benefit patients with cancer and other life-threatening illnesses, not to mention improvements in preventive care.
Advocates for patients say they're concerned the language will stay in the bill all the way to Obama's desk.
"The primary purpose of insurance is to protect people against catastrophic loss," Finan said. "If you put a limit on benefits, by definition it's going to affect people who are dealing with catastrophic loss." The cost of cancer treatment can exceed $100,000 a year.
Under the health care bills in Congress, the major expansion of health insurance coverage won't take place until three to four years after enactment. Democrats have touted a series of consumer protections as immediate benefits Americans will secure through the legislation. Both the Senate and House bills, for example, ban lifetime limits on the dollar value of coverage.
But Finan said the change in the Senate bill essentially invalidates the legislation's ban on lifetime limits.
"If you can have annual limits, saying there's no lifetime limits becomes meaningless," he said. A patient battling aggressive disease in its later stages could conceivably exhaust insurance benefits in the course of a year.
It's unclear how widespread such coverage limits are in the current insurance marketplace. Large employers have moved away from coverage limits, but insurers have wide discretion in designing plans for small businesses and individual customers.
In the House bill, neither annual nor lifetime limits would be allowable under an essential benefits package intended to provide comprehensive coverage.
Senate Democrats are considering changing a proposed expansion of Medicare to address complaints from doctors and hospitals and defray costs for consumers, officials said Thursday, two days after party leaders hailed it as part of a breakthrough for health care.---------------------------
Under the plan, uninsured individuals ages 55 to 64 could purchase coverage under Medicare. The expansion is part of a compromise for dropping a full-blown national government-run insurance plan from the legislation that Democrats and the White House hope to push through the Senate by Christmas.
The American Hospital Association and American Medical Association have both criticized the proposed Medicare expansion since it was announced Tuesday night, saying the program pays health care providers less than private insurance companies, and warning against increasing the number of patients.
"We are trying to find a solution," Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, told reporters in the Capitol, saying that the groups had raised legitimate concerns. Complete Article
The Obama administration has clearly shown those to whom it promised change that there is so little or no change when it comes to the promised public option and other health care issues that keep cost high and care results abysmally poor.
Big Insurance and Big PhRMA still seem to have the cash cow flowing with gallons of grease to members of Congress to keep the folly alive.
It is interesting to note that on the Ed Schultz show a day or so ago a US postal worker called in to tell how his Blue Cross-Blue Shied policy cost his family of four $130 a month. I wonder what the monthly cost of Medicare (the trade-off) will be for the 55-64 age group. Certainly I can be sure that the level of coverage won't be as good as the fellow from the post office gets. This will be especially true as reimbursement for medicare is being cute and drug prices still remain free of price negotiation.
Members of Congress have a choice of 21 plans. I just wonder why they are so selfish and so self-absorbed with their insurance, yet do not see those who elected them as equal.
They just have decided to throw scraps at the people once again.
And if you are looking for health care advocacy see our service offerings and educational programs.
Dramatic defeat for Obama as U.S. Democrats 'drop public option' from healthcare reform
By Mail Foreign Service, 10th December 2009
Plans for an 'NHS-style' government-run health insurance scheme in the U.S. have been dropped by Democrat senators.
In an attempt to get President Barack Obama's controversial health care bill through the Senate, the 'public option' part of the legislation was jettisoned.
In its place would be a nonprofit private alternative overseen by a federal agency.
Politicians are looking at reforms that would extend medical coverage to tens of millions of Americans who are shut out in the current system.
Under yesterday's compromise, those aged 55 and over would be able to buy into Medicare, the government-funded provision available to the over 65s.
Senate majority leader Democrat Harry Reid announced that a 'broad agreement' had been reached. He did not give details of the deal, but Senate sources confirmed that it would mark the end of the public option.
But even if the revised bill gets through the Senate, negotiators have more work ahead.
Democrats in the House of Representatives would also have to abandon the public option. A version of the bill already approved in the House includes the government-run programme.
Opponents of Mr Obama's health reforms claim that getting the government involved will lead to a health system similar to the NHS.
US tops world in health care spending, results lag
By GREG KELLER, AP Business Writer, Tue Dec 8,
PARIS – The United States ranks near the bottom in life expectancy among wealthy nations despite spending more than double per person on health care than the industrialized world's average, an economic group said Tuesday.
Life expectancy at birth in the U.S. was 78.1 years in 2007, according to the Organization for Economic Cooperation and Development.
That's a year less than the OECD average of 79.1, and puts the U.S. just ahead of the Czech Republic, Poland and Mexico, where spending on health care is many times less per person, the Paris-based organization said in its latest survey of health trends among its 30 rich member countries.
Total U.S. spending on health care was $7,290 a person in 2007, nearly two-and-a-half times the OECD average of $2,984. The figures include spending by both individuals and governments.
Spending on health care in the U.S. grew more quickly between 1997 and 2007 than in France, Italy, Germany and Spain, averaging 3.4 percent annually over the period. The U.S. growth rate was still below the OECD average of 4.1 percent.
The U.S. far outspent the next biggest health care spenders, Norway and Switzerland, despite the fact that those countries' life expectancies are two to four years longer, according to the report.
The report notes that, in addition to the U.S., Denmark and Hungary also have lower life expectancies than would be predicted by their relative wealth and levels of health care spending.
On the other hand, the Japanese and the Spanish live longer on average than their national income and their health care spending would predict.
The U.S. also underperforms other rich countries in the health of its youngest.
U.S. infant mortality, at 6.7 deaths per 1,000 live births, was well above the OECD average of 3.9 in 2007. Only Mexico and Turkey had worse rates of infant mortality. In Luxembourg, the top performer, the infant mortality rate was only 1.8.
The report noted that research suggests many factors beyond the quality of a country's health system, such as income inequality and individual lifestyles and attitudes, influence infant mortality rates.
Per capita spending on pharmaceuticals rose by almost 50 percent over the last 10 years in OECD countries, reaching a total of $650 billion in 2007. The U.S. was the world's biggest spender on pharmaceuticals, spending $878 per person, with Canada next at $691 per person and the OECD average at $461.
The report was released as the U.S. Senate is considering a health care overhaul promised by President Barack Obama during his presidential campaign.