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Congresswoman McCollum Fights to Protect Americans from Insurance Caps

March 15, 2010
Statements For the Record

No one should be forced to lose their health insurance when they need it the most or be faced with bankruptcy trying to pay for health care. Unfortunately, we have a system today where insurance companies, not patients, are making those decisions.

Insurance companies have been using lifetime and annual limits since the 1970s to limit the total dollars in benefits that they will pay out over a year or the lifetime of a patient.

This affects everyone- every child, every American family, every person in this room today.

Once a cap is reached, someone who has been buying health insurance coverage for years can be left with no health insurance and forced to find ways to pay for medical costs out of pocket. These caps cost American taxpayers as people are forced onto Medicaid or seek uncompensated care from hospitals. Some patients who reach their limits are forced to forego treatment they need to stay alive.

We hear a lot from the other side about how the current system gives people choices.

When an insurance company pulls the plug on a patient who reaches their limit they are faced with a choice: to pay out of pocket and be forced into bankruptcy or poverty, or to forego the treatment they need and die.

I want to share with you a couple of stories about what facing a cap means.

She defied expectations -- Australia Montoya, 42 years old. After being diagnosed with advanced colon cancer 20 months ago, she underwent surgery, 25 rounds of chemotherapy and a second major operation. Now back at her normal weight, she says she feels good.

Except for one thing: She has no more medical coverage for her cancer. She exhausted her plan's $150,000- per-illness limit months ago.

Her husband, Jose Montoya, spelled out the consequences when he appealed in writing to her health plan: Failure to provide continued cancer treatment for my wife's condition will result in DEATH.

The appeal was denied.

Melissa Connolly, a social worker at Gillette Children's specialty Healthcare writes. ‘I have been attempting to assist a family with a son with Cerebral Palsy Diplegia who has reached their lifetime max on their private insurance. As a result, he required orthopedic surgery on both of his legs to improve his function, but could only afford to do one. They are trying to get MA coverage for kids with disabilities, but he was denied because he is not disabled "enough". We are appealing and hopeful.'

This is unjust and wrong, and should not be taking place in America.

We know that two out of three personal bankruptcies are the result of medical debt, even though more than 75% of those bankrupted had private health insurance.

We know what maintaining the status quo will mean for American families and what the cost of inaction will be: lost productivity, pushing families into poverty, and making families sicker.

On February 13, 2010 Senator Olympia Snow stated: Overly restrictive lifetime caps on benefits can cause everyday Americans to go bankrupt and ultimately shift their health care costs to public programs such as Medicaid.

We can give stability and peace of mind for the more than 133 million Americans that have at least one chronic condition that insurance companies won't be able to limit their coverage when they are sick.

We can save taxpayer dollars by increasing the lifetime cap, which is predicted to result in a net savings for federal and state governments as people can maintain their current health insurance, approximately $7 billion over 7 years due to decreased enrollment in Medicaid.

We can put patients first, and no longer let insurance companies to continue to profit as families are forced to go without care or go bankrupt trying to get the care they need to stay alive.

The choice today is clear. We can give patients a real choice.

American families need help and they need reform and I urge my colleagues to support this motion to protect American families.