Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Health Insurance > Health Insurance

On the Third Hand: Infinity

Your article was successfully shared with the contacts you provided.

Sun Life Financial has started to publish data that could shed light on one of the interesting questions about the Patient Protection and Affordable Care Act (PPACA): How much the PPACA ban on annual and lifetime medical insurance benefits would cost.

Thanks in part to emotional congressional hearings featuring witnesses who suffered from catastrophic conditions such as hemophilia, the idea of banning major medical benefits limits had bipartisan support.

When the Republicans introduced a PPACA alternative in November 2009, for example, their measure included a ban on annual and lifetime benefits limits. The ban on benefits limits is so strict that it’s one of the reasons the limited-benefit medical insurance market is gone. No insured or self-insured individual or group medical plan can cap lifetime benefits payments.

Health insurers, stop-loss carriers and others were vague about how much the ban on benefits limits might cost. Executives at the direct health insurance writers and the stop-loss carriers that protect the direct writers against giant claims seemed, understandably, to be reluctant to get anywhere near the topic of the value of a human life.

Sun Life doesn’t actually address that topic in a new report on catastrophic stop-loss claims paid since 2010. The company does report that it saw 22 stop-loss claims for more than $1 million over the period it covered in the report. Over that four-year period, it processed more than 100,000 claims and paid about $1.9 billion to self-insured employer plans.

The number of claims for more than $1 million increased to 22 in 2013, from two in 2010. Twelve of the jumbo claims were for premature babies and other babies facing serious complications. Five had to do with transplants, three with leukemia, and 21 for all other conditions.

Although Sun Life does not say how much cash it actually paid out in connection with the 22 jumbo claims, it seems possible that the total could amount to about 1 percent to 3 percent of the $1.9 billion in stop-loss reimbursement payments.

On the one hand: I’m not any more eager to try to put a value on the life of a premature baby than anyone else is. What ogre who was looking at a premature baby would want to skimp on efforts to try to save that baby? 

On the other hand, that question gets to the heart of why anything anyone does to reform or not reform health care finance is bound to be controversial.

Who would want to economize on efforts to save a premature baby — but our country economizes on efforts to help women have healthy pregnancies and keep their babies healthy all the time. U.S. health benefits for pregnant women tend to be relatively generous, even for the poorest women, but, because our hearts are bigger than our willingness to write checks, even women with good insurance may have to wait hours in an office for what may seem like perfunctory, unnecessary prenatal care. 

Because we economize on research on conditions such as preeclampsia, women who know they are at risk of giving birth to babies in need of catastrophic care may not know what concrete steps to take to decrease that risk.

On the third hand, people who are getting organ transplants, fighting leukemia, and doing their best to live normal lives with hemophilia have dramatic stories of their own. 

We have a national policy of allocating resources to the people who need dramatic catastrophic care, and efforts to prevent the need for dramatic catastrophic care, with policy dice. If Republicans try to talk seriously about tradeoffs, the Democrats will call them monsters. If Democrats try to talk about the tradeoffs, the Republicans will haul out the death panel campaigns.

Somehow, we have to find a way to free the health actuaries to tell us what they know about all of this, in detail, without rocks getting thrown through anyone’s windows.


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.