Matthew Thrasher · October 2014
82 GEO. WASH. L. REV. 1674 (2014)
The Patient Protection and Affordable Care Act, commonly known as “Obamacare,” includes a provision that prohibits insurers from setting annual or lifetime limits to the “dollar value” of coverage for essential health benefits. This element of the law was meant to protect patients with chronic or catastrophic conditions from facing bankruptcy despite having—seemingly—robust health insurance. Notwithstanding this provision, the agencies responsible for implementing the law have informally stated that insurers may convert the statutorily prohibited dollar caps into frequency or duration limitations on benefits. These new forms of benefit limits have the potential to be worse for those with chronic conditions than the simpler dollar caps, and will distort the market in perverse ways. Additionally, these new limits are contrary to the statutory language and purpose. This Essay challenges the agencies’ guidance on this issue as an improper interpretation of the statute, and furthermore, bad policy. Part I explains the law’s provision on annual and lifetime limits and then describes the current implementation of these provi- sions. Part II describes the negative real-world effects this implementation is having on those beneficiaries whom the law was meant to help. Part III looks at the statutory interpretation of the provision and analyzes the amount of deference a court would give to the agency interpretation of this issue. Part IV calls on the responsible agencies to issue a bright-line rule in accordance with the statute that would prohibit all annual or lifetime limits to essential health benefits, or else to conduct a more thorough and transparent process to address the topic. Until this occurs, insurers will perversely be free to apply more restrictive annual limits to the sickest beneficiaries because of an interpretation of a statute that was meant to end such limits outright.
