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The Senate health care bill is expected to allow states to relax the Affordable Care Act rules only on benefits, not on pricing as the House bill does. But that change could impact people far beyond those states, according to a new analysis by the liberal Center for American Progress — because it could lead to a return of annual and lifetime benefit limits, and not just in the states with the waivers.

The bottom line: As many as 27 million Americans could face annual limits on their coverage, and 20 million could be hit with lifetime limits, according to the analysis.

Expand chart
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Data: CAP analysis, 2015 American Community Survey, Centers for Medicare & Medicaid Services, 2017 Willis Towers Watson Survey; Table: Andrew Witherspoon / Axios

Why it could happen: The Affordable Care Act bans lifetime and annual limits, but only for the 10 categories of "essential health benefits" defined in the law. If a state decides that, say, prescription drugs or maternity care aren't essential benefits anymore, insurers can bring back annual and lifetime limits for them.

Why it could spread beyond those states: Large employers that operate in several states can choose which state they want to use as the basis for their benefits. So if an employer operates in 15 states, and one of them has a waiver from ACA benefit rules, it can set all of its benefits based on that state.

How the study was done: CAP based its estimates on a Willis Towers Watson survey of large employers, in which 20 percent said they'd bring back annual limits and 15 percent said they'd bring back lifetime limits if the ACA rules were repealed. It also used survey data suggesting how many people get their health insurance from large employers.

Go deeper

Updated 48 mins ago - World

Trudeau's Liberals set to form minority government after Canada election win

Canadian Prime Minister Justin Trudeau. Photo: Jeff Vinnick/Getty Images

Canadian Prime Minister Justin Trudeau's Liberal government was reelected for a third term in Monday's parliamentary elections, but preliminary results show it failed to win a majority.

Why it matters: Trudeau has governed Canada with a minority of legislative support in parliament for the past two years. Last month, he called for an election two years earlier than scheduled in the hope of forming a majority government.

DOJ urges Supreme Court not to overturn Roe v Wade

Attorney General Merrick Garland during a Sept. 9 news conference at the Department of Justice in Washington, D.C. Photo: Samuel Corum/Bloomberg via Getty Images

The Department of Justice sought permission Monday to present oral arguments when the Supreme Court hears a case challenging Mississippi's strict abortion law, as it called on justices to uphold Roe v. Wade.

Why it matters: The two briefs, filed by acting solicitor general Brian Fletcher, mark the latest attempt by President Biden's DOJ to "protect the legal right to an abortion," per the New York Times, which first reported on the court filings.

3 hours ago - World

Reports: CIA director's team member reported Havana Syndrome symptoms

Central Intelligence Agency (CIA) director Bill Burns during a House Intelligence Committee hearing in April on Capitol Hill. Photo: Al Drago-Pool/Getty Images

A member of CIA director Bill Burns' team who traveled with him to India this month was treated for "symptoms consistent with Havana syndrome," CNN first reported Monday.

Why it matters: Current and former officials told the New York Times the incident signals a "possible escalation" in the mysterious neurological symptoms affecting as many as 200 Americans who've worked in overseas posts since 2016.

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