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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.

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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said they'd bring back annual limits and 15 percent said they'd bring back lifetime limits if the ACA rules were repealed.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 3 hours ago - World

In photos: Pope Francis spreads message of peace on first trip to Iraq

Pope Francis waving as he arrives near the ruins of the Syriac Catholic Church of the Immaculate Conception (al-Tahira-l-Kubra), in the old city of Iraq's northern Mosul on March 7. Photo: Vincenzo Pinto/AFP via Getty Images

Pope Francis was on Sunday visiting areas of northern Iraq once held by Islamic State militants.

Why it matters: This is the first-ever papal trip to Iraq. The purpose of Francis' four-day visit is largely intended to reassure the country's Christian minority, who were violently persecuted by ISIS, which controlled the region from 2014-2017.

Cuomo faces fresh misconduct allegations from former aides

New York Gov. Andrew Cuomo during a February press conference in New York City. Photo: Seth Wenig/Pool/AFP via Getty Images

The office of New York Gov. Andrew Cuomo (D) was on Saturday facing fresh accusations of misconduct against his staff, including further allegations of inappropriate behavior against two more women. His office denies the claims.

Driving the news: The Washington Post reported Cuomo allegedly embraced an aide when he led the U.S. Department of Housing and Urban Development and that two male staffers who worked for him in the governor's office accused him of routinely berating them "with explicit language."

In photos: Protesters rally for George Floyd ahead of Derek Chauvin's trial

Chaz Neal, a Redwing community activist, outside the Minnesota Governor's residence during a protest in support of George Floyd in St.Paul, Minnesota, on March 6. Photo: Kerem Yucel/AFP via Getty Images

Dozens of protesters were rallying outside the Minnesota governor's mansion in St Paul Saturday, urging justice for George Floyd ahead of former Minneapolis police officer Derek Chauvin's trial over the 46-year-old's death.

The big picture: Chauvin faces charges for second-degree murder and manslaughter over Floyd's death last May, which ignited massive nationwide and global protests against racism and for police reform. His trial is due to start this Monday, with jury selection procedures.

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