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The Obamacare provision that saved thousands from bankruptcy

Timmy Morrison was delivered by emergency C-section, weighing in at 3 pounds, 9 ounces. Doctors put him under anesthesia within a week and into surgery within a month. Some of the contents of his stomach sometimes made their way to his lungs. Workers in the intensive care unit frequently needed to resuscitate him.

He arrived seven weeks premature — but, in a way, just at the right time.

Six months before Timmy was born, President Barack Obama signed a sweeping health care law that would come to bear his name. Six days before Timmy’s birth, the Obama administration began to phase in a provision that banned insurance companies from limiting how much they would pay for any individual’s medical bills over his or her lifetime. At the time the Affordable Care Act passed, 91 million Americans had employer-sponsored plans that imposed those so-called lifetime limits.

That group included Timmy’s parents, whose plan previously included a $1 million lifetime limit. This Obamacare provision took effect September 23, 2010. Timmy was born September 29. On December 17, he surpassed $1 million worth of bills in the neonatal intensive care unit. He didn’t leave the NICU until he was 6 months old.

If Timmy had been born a week earlier, his medical benefits could have run out while he was still in the NICU. But that didn’t happen. His insurer covered everything. The NICU bills his parents save total just over $2 million (they come out to $2,070,146.94, to be exact).

“He would have lost his insurance at a million dollars,” his mom, Michelle Morrison, estimates, “which would have been about [halfway through] the NICU stay.”

Timmy still has significant and expensive medical needs. His rare genetic disease, called Opitz G/BBB Syndrome, causes abnormalities along the body’s midline. He is now 6 years old and has been under anesthesia 45 times. It happens so much, he and his mom have a routine: They sing the alphabet until he falls asleep.

Timmy breathes through a tracheostomy tube. A nurse accompanies him to school. But he’s still, in most ways, just a normal kindergartner. He climbs off his school bus wearing a backpack covered in cartoon dogs. He rides around his suburban Maryland neighborhood on a bright orange scooter with his little sister, Ivy, until they’re out of breath. He is obsessed with his collection of toy cars, which he zooms around the coffee table after school. He cannot decide whether he likes robots or pirates best.

Timmy’s parents switched insurance plans (and jobs) when Timmy was 8 months old and out of the NICU. On that new plan, he has run up $985,147.19 in medical bills. He will likely hit $1 million in the next few months.

Right now that doesn’t really matter. But if Republicans roll back this provision of the law — as some replacement plans do and some lobbyists are urging — it could drop a threat of bankruptcy onto Timmy’s family.

Timmy could find himself above the cap the moment the new law passed. Or he might have his old costs grandfathered in and the counting start anew. It would all “depend on the language of the statute that Congress passes,” says Nicholas Bagley, a health law expert at the University of Michigan. “I don’t think there’s any guarantee for the family of the 6-year-old boy. There’s just a lot of uncertainty.”

The Affordable Care Act is brimming with provisions like these: small parts of the law that are hugely consequential for the people who rely on them. These provisions complicate the matter of repeal and replace, because they all have constituencies that will show up for a lobbying battle in Washington — and their stories could tug at the heartstrings of voters who otherwise support the repeal effort.

The lifetime limits ban is a few paragraphs of a 1,300-page law. It isn’t crucial to making the coverage expansion work in the way that, for example, the individual mandate or insurance subsidies are. But the ban is absolutely crucial to making the Morrisons’ lives work.

“We don’t really know what to do right now,” Michelle Morrison says. “Should we start pressuring his doctors to do a surgery now so he can get it in time? That doesn’t feel right. Insurance is supposed to cover things that you can’t anticipate — and for us, this is one of them.”

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