San Diego

State insurance regulators should act quickly if they want to add real value to the health care discussion under way at the federal level, according to consumer advocates.

Regulators should define what “adequate coverage” is with respect to health care, Kevin Lucia, an NAIC-funded consumer representative from Georgetown University, said here at a consumer liaison forum at the spring meeting of the National Association of Insurance Commissioners, Kansas City, Mo.

Lucia said many states have focused on coverage affordability, leading to the rise of bare-bone policies, policies with inadequate networks, and coverage in state high-risk pools that have limited benefits.

Although these people are insured, Lucia said, their coverage does not work for them. He urged the NAIC to join with consumer advocates to determine what the definition of “adequate coverage” should be.

Joel Ario, the Pennsylvania commissioner, said that the NAIC has focused on access more than adequacy, and that assessing adequacy would be a new focus for commissioners. But he said that focus would be in line with consumer complaints he has heard.

Sally McCarty, insurance and advocacy specialist at Hemophilia of Indiana, a chapter of the National Hemophilia Foundation, New York, called on the NAIC to back laws that enact caps of $10 million or more on lifetime limits in health coverage, or eliminate the limits altogether.

Lifetime limits are provisions in health policies that limit the total dollar amount of benefits that can be paid over an enrollee’s lifetime.

For some insureds, these limits could be $1 million to $2 million.

The consequences of these limits are that 20,000 to 25,000 people who have insurance are no longer covered for medical expenses, according to an NHF-commissioned study conducted by PricewaterhouseCoopers L.L.P., New York.

About 300,000 people will lose coverage over the next 10 years, McCarty said.

If lifetime limits are set at $10 million or more, Medicaid savings over the next 10 years could reach $11 billion, McCarty said.

CORRECTION: An earlier version of this story described the number of insureds who have exhausted their benefits or could exhaust their benefits in the future incorrectly.