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House of Representatives
Session of 2019 - 2020 Regular Session


Posted: January 2, 2019 01:35 PM
From: Representative Dan Frankel and Rep. Anthony M. DeLuca
To: All House members
Subject: Prohibiting arbitrary annual/lifetime health insurance coverage limits
Health insurance plans should pay for the care you need, when you need it. Prior to regulation under the Affordable Care Act, however, many plans had pre-set limits on the amount of money they would pay out on medical care, both annually and over a lifetime.
A serious accident or a cancer diagnosis could result in spending through the limits rapidly, leaving patients with serious conditions no recourse. Patients with severe, chronic and rare diseases, like hemophilia, could find their lifetime spending limit of 1 million dollars consumed within just a few years.
For these patients in desperate need of medical attention, annual and lifetime limits created crises. That's why the Affordable Care Act prohibited the practice.
The recent court case from Texas ruling the ACA unconstitutional combined with concerted efforts to diminish the strength of protections under the law by the current administration could once again leave Pennsylvanians facing lifetime and annual caps on health care. When they are most in need of medical treatment due to serious medical conditions, their insurer could refuse to pay for it.
Insurance companies regulated by the Affordable Care Act cannot impose annual or lifetime limits, but prior to the passage of the ACA, many insurance companies used them. Under our legislative proposal, Pennsylvania would adopt the prohibition on annual and lifetime limits into state law.
According to the 2009 Kaiser Family Foundations Employer Health Benefit Survey, almost sixty percent of workers with employer based coverage had some lifetime limit, and almost 90 percent of people purchasing in the individual marketplace did.
More than 4.5 million Pennsylvanians are estimated to have benefited from the prohibition on lifetime limits, including more than one million children.
Please join us in strengthening health insurance plans in Pennsylvania, ensuring that millions of Pennsylvanians do not again find themselves without access to care when they need it most.

Introduced as HB470