The Democratic push for health care reform has always paid deference to the faith many of us have in the health insurance policies we are paying for. The administration has assured us: “If you’re happy with your health care coverage, you’ll be able to keep it.”

Many of those who enjoy both good health and good coverage realize that a change in either of these variables could affect the other. Keeping your insurance is not always possible when illness strikes, and a lack of insurance can be hazardous to your health.

A lifetime cap on benefits, explained in fine print in the policies where it applies, is one strategy used by insurers to control their costs. Last week, the Maine Legislature outlawed such caps, effective next January. The bill eliminating annual and lifetime caps provides valuable protection until the new federal law takes effect in 2014.

Unfortunately, it comes too late for Theresa D’Andrea of Limerick, whose husband, Rocky, died of cancer last month.

Testifying on behalf of the legislation, she explained how bills for his treatments at one point reached $1.6 million. At the time, she was still paying premiums on a health insurance policy, unaware that it was tapped out because of its lifetime cap of $250,000.

She was eventually able to negotiate the medical debts down to $60,000, but agreed to testify in favor of the bill in the hopes of protecting others in the same situation. “I don’t want anyone to waste their time like I did on things like money when your heart is emptying out,” she told reporter Tammy Wells in an interview last week.

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In his early 60s, Rocky D’Andrea was faced with a diagnosis of stage 4 melanoma. He endured rounds of chemotherapy and experimental treatments. Theresa provided support, and struggled with the bill collectors, health care providers and drug companies.

In the end, the health care system will largely absorb the cost of these treatments. Such write-offs are common practice, so liminating caps on health insurance benefits shouldn’t cost more ”“ just make the system more efficient and humane for those who are seriously ill.

But we aren’t there quite yet. Maine’s effort to bar lifetime caps is scheduled to take effect next January, but plenty of new policies will take effect between now and then. A recent mailing from Anthem told group customers that the company would impose a $3 million cap, effective this June.

Ending such caps will evidently take awhile, but it is an effort worth making.

— Questions? Comments? Contact Managing Editor Nick Cowenhoven at nickc@journaltribune.com.



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