A Shout-out to the Associated Press

For exposing a big loophole in the health reform bill

Back in August, Campaign Desk pointed out that President Obama’s much-ballyhooed consumer protections required the media’s critical eye as legislation moved along. Obama promised eight consumer protections, some of which consumers already had. For example, he promised that he would make sure insurance companies couldn’t drop people who had serious illnesses. HIPAA rules already bar insurers from doing that, but companies have still found a way around that prohibition.

We also told reporters what might happen to the protections once the lobbyists took to the back rooms and slipped mitigating language into the bills. An AP story by Ricardo Alonso-Zaldivar tells of lobbyists doing just that. One of Obama’s consumer protections called for “no annual or lifetime caps on coverage;” we advised reporters to “look for lobbyists trying to limit lifetime and annual coverage. The lower the limits, the less protection people will have for truly expensive medical treatments.”

Well, guess what? The Senate bill, Zaldivar reports, calls for annual limits on the dollar value of medical care as long as those limits are not “unreasonable.” What is, or is not, unreasonable will be determined by administration officials. The bill does not define the allowable limits for coverage. Officials of the American Cancer Society’s Cancer Action Network were caught unawares, but they shouldn’t have been. “We don’t know who put it in, or why it was put in,” said Network policy expert Stephen Finan, who explained that annual limits make the “no lifetime caps on coverage” meaningless protection. No kidding! He added:

The primary purpose of insurance is to protect people against catastrophic loss. If you put a limit on benefits, by definition it’s going to affect people who are dealing with catastrophic loss.

Zaldivar reported that Democratic officials on the Senate Health, Education, Labor, and Pensions Committee would not say publicly how the language about annual limits snuck into the bill. Staffers, like journalists, don’t like revealing their sources. Blogger David Dayen, who posts at firedoglake.com, had better luck and got Harry Reid’s chief spokesman, Jim Manley, to offer at least a blah-blah explanation. Said Manley:

One of the goals of our bill is to reduce costs to American families who are being crushed by skyrocketing health care costs. We are concerned that banning all annual limits, regardless of whether services are voluntary, could lead to higher premiums.

Sounds to me like the bill reflects the handiwork of the insurance industry on this point. It would be interesting to know what the White House has to say. After all, it was the president who took to the airwaves last summer to promote his consumer protections. What does the president think now? Does he side with insurers or with consumers? It would be good for Zaldivar, Dayen, or any other journalist to enlighten us on this matter.

Memo to reporters: Review our August post and watch for language that waters down other consumer protections.

Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.