[Congressional Record Volume 155, Number 79 (Thursday, May 21, 2009)]
[Senate]
[Pages S5861-S5862]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REID (for Mr. Rockefeller):
  S. 1149. A bill to eliminate annual and lifetime aggregate limits 
imposed by health plans; to the Committee on Health, Education, Labor, 
and Pensions.
  Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Annual 
and Lifetime Health Care Limit Elimination Act of 2009, legislation 
that would prohibit insurance companies from imposing any annual or 
lifetime limit on any individual or group health insurance policy, thus 
providing continuity and affordability of health care coverage for 
those with serious chronic conditions.
  Each year, thousands of insured Americans face daunting medical 
expenses and challenges when they reach the annual or lifetime limit on 
their individual or employer-sponsored health insurance plan. Once a 
beneficiary's medical costs have exceeded the annual or lifetime limit 
of their plan, the insurance company no longer pays for the medical 
costs incurred by that individual.
  In April, I held a roundtable discussion on health care in Raleigh 
County. There, I met a woman who had myelodysplastic syndrome, which is 
a non-curable pre-leukemia type disease. Unfortunately, her husband's 
insurance policy had a lifetime limit of $300,000, which she had 
reached. Another young West Virginian, born with serious congenital 
heart defects, reached the $1 million limit on his mother's insurance 
policy within the first nine months of his life. The limits on their 
health insurance plans have left these families struggling to find a 
way to pay for the expensive and life-sustaining treatments their loved 
ones desperately need.
  Unfortunately, these two West Virginia families are not alone. In 
2007, it was estimated that 55 percent of all people who obtain health 
benefits from their employer have some type of lifetime limit on their 
plan, an increase of approximately 4 percent since 2004. More than 23 
percent of people have health insurance plans that impose limits of $2 
million or less. Also, some health insurance policies renew less 
frequently than annually and contain annual limits to reduce the 
medical expenses paid by insurance companies. It is estimated that 
approximately 20,000 to 25,000 people no longer have health care 
benefits through their employers because of lifetime limits on their 
employer-sponsored health care plans.
  When individuals with serious chronic conditions--such as transplant 
recipients, patients living with hemophilia, and newborns with life-
threatening illnesses--hit the annual or lifetime limits on their 
policies, they are often left with very few options to meet their 
health care needs. Individuals and families that can afford it can try 
to pay for their health care costs completely out-of-pocket. However, 
this is rarely financially feasible; therefore, many people are forced 
to leave good, stable jobs and seek different employment in an effort 
to obtain new employer-sponsored coverage. Unfortunately, new enrollees 
are often subject to a waiting period for coverage if there was any 
break in their previous health care coverage.
  Should an individual try to find health insurance in the individual 
market, coverage is likely to be prohibitively expensive. More often 
then not, these individuals are denied coverage altogether because of 
the insurer's pre-existing condition exclusion. Annual or lifetime 
limits can force people to turn to public programs such as Medicaid, or 
spend down their savings to meet the financial restrictions of the 
program. Others are forced to forgo treatment altogether, which can 
lead to serious complications and greater long-term health care costs.
  It is time to stop health insurance companies from imposing annual or 
lifetime limits on health insurance policies. The beneficiaries 
affected by these limits have paid their premiums, deductibles, and 
copays faithfully, only to lose access to life-saving treatment when 
they need care the most. This is unacceptable and I encourage my 
colleagues to join me in supporting the Annual and Lifetime Health Care 
Limit Elimination Act.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1149

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Annual and Lifetime Health 
     Care Limit Elimination Act of 2009''.

     SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY 
                   ACT OF 1974.

       (a) In General.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 715. ELIMINATION OF ANNUAL OR LIFETIME AGGREGATE 
                   LIMITS.

       ``(a) In General.--A group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, may not impose an 
     aggregate dollar annual or lifetime limit with respect to 
     benefits payable under the plan or coverage.
       ``(b) Definition.--In this section, the term `aggregate 
     dollar annual or lifetime limit' means, with respect to 
     benefits under a group health plan or health insurance 
     coverage, a dollar limitation on the total amount that may be 
     paid with respect to such benefits under the plan or health 
     insurance coverage with respect to an individual or other 
     coverage unit on an annual or lifetime basis.''.
       (b) Clerical Amendment.--The table of contents in section 1 
     of such Act, is amended by inserting after the item relating 
     to section 714 the following new item:

``Sec. 715. Elimination of annual or lifetime aggregate limits.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     the date that is 1 year after the date of enactment of this 
     Act.

     SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING 
                   TO THE GROUP MARKET.

       (a) In General.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is 
     amended by adding at the end the following:

     ``SEC. 2708. ELIMINATION OF ANNUAL OR LIFETIME AGGREGATE 
                   LIMITS.

       ``(a) In General.--A group health plan and a health 
     insurance issuer providing health insurance coverage in 
     connection with a group health plan, may not impose an 
     aggregate dollar annual or lifetime limit with respect to 
     benefits payable under the plan or coverage.
       ``(b) Definition.--In this section, the term `aggregate 
     dollar annual or lifetime limit' means, with respect to 
     benefits under a group health plan or health insurance 
     coverage, a dollar limitation on the total amount that may be 
     paid with respect to such benefits under the plan or health 
     insurance coverage with respect to an individual

[[Page S5862]]

     or other coverage unit on an annual or lifetime basis.''.
       (b) Individual Market.--Subpart 2 of part B of title XXVII 
     of the Public Health Service Act (42 U.S.C. 300gg-51 et seq.) 
     is amended by adding at the end the following:

     ``SEC. 2754. ELIMINATION OF ANNUAL OR LIFETIME AGGREGATE 
                   LIMITS.

       ``The provisions of section 2708 shall apply to health 
     insurance coverage offered by a health insurance issuer in 
     the individual market in the same manner as they apply to 
     health insurance coverage offered by a health insurance 
     issuer in connection with a group health plan in the small or 
     large group market.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     the date that is 1 year after the date of enactment of this 
     Act.
                                 ______