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3. Must Have: No spending caps on insurance plans
"Before the ACA, insurance plans could have lifetime and annual dollar limits on benefits," says Dania Palankar, assistant research professor at Georgetown University's Center on Health Insurance Reforms. "When families with sick children or serious conditions exceeded their limits, they'd have to seek charity care, negotiate with hospitals, not pay their bills, or go without care." Massive medical debt destroyed people's credit and forced them into bankruptcy.
Spending caps hit women particularly hard. Treating long-term illnesses that predominantly affect women, like multiple sclerosis, can run upwards of $100,000 a year in the most severe cases, eventually outpacing lifetime spending caps.
Even if lawmakers don't go back to explicitly permitting spending caps, insurers may be allowed to limit their costs nonetheless: Federal legislators could change the preexisting condition rules so that states may let insurers effectively price people with serious health conditions out of the individual market. Those with a chronic illness would then apply for admission to new state-run high-risk pools, which are currently banned by the ACA. "In the past, these pools had waiting lists and high premiums," says Miller. "Their return would drive up premiums for many people who would be least able to afford them because they have serious chronic illnesses."
Published 06/13/2017
