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  • 2009-08-14 (xsd:date)
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  • Reform plan caps out-of-pocket expenses (en)
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  • The White House is fighting chain e-mails with chain e-mails. After spending days responding to inaccurate e-mails about the health care reform plan, the White House responded with its own e-mail from David Axelrod, senior adviser to President Barack Obama. The subject line was Something worth forwarding.Axelrod began his e-mail with a list of ways that reform provides security and stability to those with or without coverage.One of his claims is that refom ends exorbitant out-of-pocket expenses, deductibles or co-pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.We recognize that exorbitant is subjective, but we thought it would be helpful to research whether Axelrod is right that the plan limits charges that a typical person or family would find excessive.The main health care reform bill in Congress does set annual limits on out-of-pocket expenses. That means there's a cap on what people would have to pay in a year for medical costs. And insurance companies won't be allowed to require patients to pay for preventive treatments such as check-ups.In the House legislation, outlined in section 122, the annual cap on out-of-pocket expenses is $5,000 for an individual and $10,000 for a family. Those numbers are indexed for inflation.The policy would be phased in. Employer-provided policies would have a grace period of five years, as outlined in section 102, before they are required to comply with the caps. If you get a new individual policy through the health care exchange, it would have to comply right away.We asked Sara Collins of the Commonwealth Fund about the caps. The Commonwealth Fund is a nonpartisan private foundation that advocates for a better health care system. She said the caps are a good form of consumer protection.Axelrod is correct that the main health care reform bill requires insurance companies to abide by yearly caps on how much they can charge for out-of-pocket expenses. But ending exorbitant out-of-pocket expenses, deductibles or co-pays? 'Exorbitant' may be in the eye of the beholder. For a family, $10,000 in the course of a year can be a serious financial hit. (The median income for a family of four is $67,000.) Still, the new limits are better than nothing, and health care advocates praise them as an important safeguard for consumers. So we rate Axelrod's statement Mostly True. (en)
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