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How The "Lifetime Cap" Affects Premature Babies

by Emily Lee

Senate Republicans have finally revealed their proposed health care legislation and it's worse than many Americans imagined. The Better Care Reconciliation Act (BRCA) will reinstate something called the "lifetime cap," which has the potential send many people in desperate need of healthcare into financial ruin. Expectant parents in particular should be aware of how the lifetime cap affects premature babies, because their medical care might become quite expensive.

Under the Affordable Care Act (ACA), President Obama succeeded in banning insurance companies from instituting lifetime caps in their coverage. If this cap is brought back, insurance companies will be able to limit the amount of money a patient can use while enrolled in their coverage programs. After that allotted amount of money runs out, patients will be responsible for covering the rest of their medical expenses on their own.

The March of Dimes foundation released a report in 2009 stating that the average cost of medical care for a premature or low birth-weight baby is $49,000 in its first year of life, according to CNN. Before the ACA was enacted, most insurance companies capped spending on benefits at $1 or $2 million, according to After somebody enrolled in that company's coverage exceeded expenses of that amount, the health insurance benefits expire for life. Babies who are born premature start incurring medical expenses from the outset, which can be a serious problem if they face a medical crisis later in life.

Time reported in 2012 that "around the world, 15 million babies are born prematurely each year, and 1 million of them die." The United States doesn't have a great record, either, in terms of premature birth prevention. In fact, the U.S. ranked 131st for preterm prevention in a group report released in by the March of Dimes, the World Health Organization, the Partnership for Maternal, Newborn and Child Health and Save the Children. For every 100 babies born in the United States, 12 are delivered early enough to be considered preterm. This amounts to roughly half a million premature births in our country every year. These statistics are worrisome, but they also highlight how important it is to make sure premature babies have access to good medical coverage.

While the average cost of premature births in the first year of life is $49,000, medical expenses can quickly amount to much more than that, especially if you give birth to a set of multiples. Case in point: For Jen Sinconis and her husband Justin, who welcomed premature twins in 2006, they ended up with $2.2 million in medical expenses within 18 months of the babies' birth. The Sinconis' paid close to $450,000 out of pocket, according to Time. If a lifetime cap is reinstated under the BCRA, many more families will face this same type of financial crisis, and that's something no one should want.

If the BRCA is put into action, premature babies will suffer the consequences from the outset of their lives. American health coverage should aim to protect the most vulnerable among us, not bankrupt them.