No caps

[okarol]

No caps
by Kitsap River

Fri Jul 03, 2009 at 03:44:14 AM PDT

I'm sitting here with tears streaming down my face, reading the HELP committee's bill. I don't usually cry at legislation, no matter how bad or good, but this has really hit me where I live.

    ‘‘SEC. 2710. NO LIFETIME OR ANNUAL LIMITS.

Read that again.

    ‘‘SEC. 2710. NO LIFETIME OR ANNUAL LIMITS.

That's what's bringing tears to my eyes.

    * Kitsap River's diary :: ::
*

Whether private insurer, group plan or, one would assume, the public option, they've done away with lifetime maximum caps.

To understand what this means, look at your current insurance policy, if you have one, or the brief description that your company provides you in lieu of a full policy document, if you're insured. There's probably a lifetime maximum provision on it. Ours is $2 million.

$2 million seems like a lot of money until you start adding up the cost of keeping me in health care. There's my dialysis, at $298/day. There's my nephrologist, at about $315/month. There's my GP, at another $150-$180 every time I see him. My vascular surgeon. My opthamologist, every 6 months, for medical reasons (I'm a diabetic at risk for diabetic retinopathy - I don't have any now, but I did a year or so ago, and though it is gone, I am still at risk). My podiatrist (also because of being diabetic). The large amounts of money that we shell out in prescription co-pays that may well represent a large amount that our insurance company has to shell out as well. 3 surgeries last year and six within the last 10 years. Goddess knows, with all this, I'm not a cheap date.

It adds up. It adds up fast. Throw in the cost of an eventual transplant, and it'll add up very quickly indeed.

And yet, here this is, in black and white:

    ‘‘SEC. 2710. NO LIFETIME OR ANNUAL LIMITS.
    20 ‘‘A group health plan and a health insurance issuer
    21 offering group or individual health insurance coverage
    22 may not establish lifetime or annual limits on benefits for
    23 any participant or beneficiary.’’.

And I looked at that for the first time a short few minutes ago, and started to cry.

No caps means no running out of benefits.
No caps means no worrying about how we're going to pay for my health care.
No caps means no concern that a transplant will cause me to max out my health insurance, causing me to lose my transplant and go back on dialysis.
No caps means that I am not too expensive to keep alive.
No caps means that my lifespan is not dependent on a company's bottom line.

No caps means I can live.

It means others with catastrophic illnesses can live despite the cost of their care. They won't run out of benefits.

No caps means the tiny preemie baby who spends 3 months in the NICU will be covered. Even after he gets out.

You know, there's really a lot NOT to like in this proposal, like mandating a maximum out-of-pocket in keeping with HSA junk insurance policies. I have no idea what the premiums for the top-tier plans would be, but given what I use in health care in a year, they're what we would need. The sky could well be the limit in terms of premiums, however.

I haven't read through the entire bill yet, at over 600 pages. I'll get there. But one thing I do know about this bill...

If it passes, or if the no-caps stipulation is included in the final legislation, I'm home free. I won't have to go on hospice and die because we can't afford to keep me alive due to my maxing out our cap.

The Senate may well have saved my life.



http://www.dailykos.com/storyonly/2009/7/3/749458/-No-caps