Psychiatr News May 19, 2006
Volume 41, Number 10, page 20
© 2006 American Psychiatric Association
Opinion Divided on Plans To Improve Insurance Access
Rich Daly
Proposed insurance plans for some businesses could provide improved
access to coverage for small employers or endanger coverage for those with
chronic physical and mental health conditions.
Measures to allow small businesses to obtain less-expensive insurance
through a united approach to insurers are the focus of an intense lobbying
campaign as businesses push the measures in the face of opposition from
organizations representing those with disabilities and chronic illnesses.
Called different names under different proposals, "association health
plans" or "small business health plans" would allow smaller
employers to band together to obtain insurance discounts now available only to
large companies.
The proposals are seen as a key step in reining in ever-accelerating health
care costs for workers and employers by mostly Republican legislators and the
Bush administration.
In comments to insurance company executives and others in the health care
industry at the April meeting of the World Health Care Congress, President
Bush and senior administration officials repeatedly described the plans as key
elements in their effort to rein in rising insurance costs. Bush said the
association health plans will provide small companies with the same insurance
savings as large companies, which should help hold down costs overall.
The full Senate is expected to take up the leading bill to create such
programs in mid-May. The bill (S 1955), sponsored by the powerful chair of the
Senate Health, Education, Labor, and Pensions (HELP) Committee, Sen. Mike Enzi
(R-Wyo.), would allow small businesses to organize to offer health insurance
to their workers and bypasses most state coverage mandates.
The legislation is strongly supported by the National Federation of
Independent Businesses, which presented members of Congress with 450,000
signed petitions in support of legislation in April.
The bill's opposition, which includes 39 state attorneys general and
several organizations focused on chronic diseases, said it will undermine the
insurance market and drive up costs for the sickest beneficiaries. In a letter
to the Senate, the attorneys general said the bill would strip states of many
of their rights to regulate health insurers, including limits on what insurers
charge for small-group plans sold to businesses with two to 50 workers.
"This legislation is a step backward in the effort to get federal
mental health parity."
The bill also would remove states' authority to require insurers to provide
specific services, such as screening tests for cancer, diabetes supplies, or
substance abuse treatment.
The National Mental Health Association warned that the bill could lead many
insurers to limit or even drop mental health coverage. Such limitations could
leave untreated those with psychiatric disorders and result in decreased job
productivity, increased absenteeism, unemployment, costly emergency room care,
hospitalization, homelessness, and even suicide.
APA agrees with the bill's underlying goal of decreasing the number of
uninsured but opposes the the bill's intent to override state mandates.
APA unsuccessfully sought to amend the bill while it was before the HELP
committee to require full parity for mental health care in health plans
covered by the legislation (Psychiatric News, April 7).
"This legislation is a step backward in the effort to get federal
mental health parity," said Nicholas Meyers, director of APA's
Department of Government Relations.
The criticisms of the legislation generally fall under concerns that it
will either weaken many state guidelines that govern health care insurance
providers or eliminate the ability of states to take enforcement actions.
The bill would also remove limits on how much of a surcharge insurers can
impose on small groups when one of their members is seriously ill. It would
preempt state accountability rules for all types of health insurance in areas
such as prompt claims payment, appeals rights, audit authority, and insurers'
filing requirements.
Another criticism of the measure is that it would allow insurers to choose
to follow state laws or the new, less strict federal rules. It would limit
state enforcement of federal rules to federal court and give insurers the
right to sue a state if they disagree with the way it is enforcing the
rules.
"Regulation adds to the cost of health insurance, but it is needed to
make sure the insurers do what they say they will," said Karen Pollitz,
an opponent of the bill and policy director for the Georgetown University
Health Policy Institute.
The changes would allow insurers to more easily circumvent the law and find
out how sick the people applying for their policies are, she said. "The
unintended consequences of this legislation will be splitting the risk pool,
and a lot of sick people are not going to get coverage," Pollitz
said.
The bill's supporters, including Joseph Rossmann, vice president of
Associated Builders and Contractors Inc., said that within the new system, it
is in the associations' interests to make sure their members are offered
comprehensive plan options that include chronic illness coverage.
The bill's opponents said opposition by most Senate Democrats and weak
support from moderate Republicans may limit the bill's future, but the need
for lawmakers to boast of a health care accomplishment in an election year may
spur its advance.
Sen. Olympia Snowe (R-Maine) is the author of an alternative bill (S 406)
that is opposed by the insurance industry and has been stalled in the Senate
for years. Snowe has yet to sign on to Enzi's bill, which lacks a key
provision in her bill that would allow small-business health plans to
self-insure and thus be exempt from state regulation. The Enzi bill would
allow small-business health plans to bypass state coverage mandates only if
they also sell at least one policy that matches a benefit plan offered to
state employees in one of the five most populous states.
Opponents of the Enzi bill describe this provision as a weak protection for
the public, since there are several options within those state plans that are
offer only minimal coverage.
"We foresee the number of uninsured and underinsured going up if this
becomes law," Pollitz said.
The House passed legislation (HR 525) last July that mirrors Snowe's bill.
If the Enzi bill is approved, members of the two houses would have to resolve
differences and come up with final language.
Although most Democratic senators oppose both bills and are expected to
offer amendments to draw away Republican support when it is considered by the
full Senate, Pollitz said grass-roots pressure is pushing many to support the
bill. Other issues that may arise as amendments, according to congressional
staffers, are those that address a cap on medical malpractice awards,
expanding health savings accounts, and extending the May 15 Medicare Part D
enrollment deadline.
Information on both sides of the issue is posted at
<www.protectyourhealthcare.org/>
and
<http://capwiz.com/nfib/issues/alert/?alertid=8167701>;
S 1955 is posted at
<http://thomas.loc.gov/cgi-bin/bdquery/z?d109:s.01955:/>;
HR 525 is posted at
<http://thomas.loc.gov/cgi-bin/query/z?c109:H.R.525:/>.
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