How the Affordable Care Act Can Benefit Traumatic Brain Injury Victims

Posted on August 10, 2012 at 9:17am by

On June 28, the U.S. Supreme Court upheld the hotly contested individual mandate provision of the Affordable Care Act (ACA), President Barack Obama’s signature healthcare reform law. In a 5-4 majority opinion, the court ruled that the “financial penalty for not obtaining health insurance may reasonably be characterized as a tax” and that “the Constitution permits such a tax.” With this ruling, the ACA’s individual mandate provision and other components will remain in effect, though the law may still encounter other challenges. Fortunately, one facet of the ACA that can benefit traumatic brain injury (TBI) victims in particular is the end of health insurance lifetime limits.

Before the new law, many insurance companies were imposing limits on the total benefits they would pay over a person’s lifetime. When people hit their policy’s benefits ceiling, they had to pay for healthcare costs out of pocket. For patients in need of ongoing treatment and care, such as TBI victims and people with chronic illnesses, mounting out-of-pocket costs could be financially crippling.

The Washington Post reported in 2008 that a growing number of families were exceeding their health insurance lifetime limits, forcing many people “to seek help from the government . . . to change jobs or even divorce for no other reason than to qualify for new health insurance.” CNN reported in 2009 that one study found 62 percent of bankruptcy filings in 2007 were due to medical bills. Considering the lifetime cost of care for one person with a severe traumatic brain injury can be as much as $4 million, the elimination of lifetime limits has been great news for TBI victims. They no longer have to worry about hitting limits as low as $1 million.

The Affordable Care Act prohibits lifetime limits on essential services for all health insurance policies issued or renewed after Sept. 23, 2010. The act also phases out most annual benefit limits by 2014. According to data from the U.S. Department of Health and Human Services, the elimination of lifetime limits has benefited approximately 105 million people whose health plans previously imposed such limits, including:

  • 3.274 million people in New Jersey
  • 70 million people covered under large employer plans
  • 25 million people covered under small employer plans
  • 10 million people covered by individual plans
  • 39.5 million women
  • 28 million children
  • 11.8 million Latinos
  • 10.4 million African Americans

Even with lifetime limits gone, TBI victims can still incur medical bills in the form of co-pays, co-insurance, prescriptions and other costs. On top of that, they may be unable to return to work for months, years or even at all. If you have suffered a traumatic brain injury in an explosion, car accident, elevator or escalator accident, construction accident, or slip or trip and fall accident, contact an experienced Atlantic City injury attorney today. You may be entitled to compensation for your medical bills, lost wages, and pain and suffering — let an Atlantic City injury lawyer help you fight to get it.



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