Senate Advances Health Care Coverage Bill

By KEVIN FREKING

WASHINGTON – Republican-backed legislation to expand access to health care took a modest step forward in the Senate on Tuesday, but Democrats vowed a fight over provisions they said would reduce coverage for millions who already have insurance.

The bill "will provide for small businesses to be able to join across state lines to negotiate against the insurance companies with enough power to make a difference," said Sen. Mike Enzi, the chairman of Senate’s health committee and lead supporter of the measure. "This is something that the small businesses have been asking for for almost 15 years."

But Sen. Edward M. Kennedy, D-Mass., said the legislation marked "a retreat from our commitment to cancer. It’s a retreat for our commitment to diabetes. It’s a retreat from our commitment to mental health parity." He and other critics said it would allow small businesses to purchase insurance that overrode coverage requirements mandated by the states.

Democrats said they hadn’t ruled out a filibuster to block passage of the measure, which Republicans brought to the floor as part of a week-long concentration of health legislation.

Democrats blocked action on two other GOP-supported bills on Monday. Both sought to limit the amount of money that patients can receive from medical malpractive cases.

Republicans and business groups say the ranks of the uninsured would be reduced because the legislation would allow businesses to offer insurance at a lower cost. But Democrats and consumer groups who oppose the bill point out that in exchange for the lower costs, insurers would be freed from state requirements that they cover mammograms, childhood physicals and diabetes, as well as other health services.

Enzi said he was open to compromises, but the bill’s ultimate prospects were not clear. Democrats said the 96-2 procedural vote should not be viewed as a precursor to certain passage.

Sen. Jim Talent, R-Mo., said that insurance policies for large employers already are exempt from state coverage requirements. He said it’s time to do the same for small group coverage.

"The small business people are paying more to get the same benefits because they have higher administrative costs and higher overhead costs," Talent said.

But Sen. Chris Dodd, D-Conn., said he fears that the insurance industry would offer plans that exclude childhood immunizations and other important services. They would also be allowed to increase premiums beyond what individuals states now allow.

"What we’re doing here is shrinking the amount of benefits offered to people," Dodd said.

In recent decades, it has become common for states to require that insurance companies offer coverage for certain types of cancer screenings, such as mammograms, 49 states; colorectal examinations, 22 states; and cervical cancer screenings, 29 states.

"If you find cancer early and detect it early, you’re not only going to save costs, you’re going to save a life," said Daniel Smith of the American Cancer Society. "One of the barriers to going to get screened is if your insurance company won’t cover it."

But how many state mandates are too many when insurers are also required to cover acupuncture, speech therapy, or the treatment and evaluation of Lyme disease? That’s the question the Senate had before it in connection with the bill that would let insurers bypass coverage requirements mandated by states.

Insurers say the state mandates are driving up the cost of policies, and the ranks of the uninsured. States have approved more than 1,800 coverage requirements, says the Council for Affordable Health Insurance.

"Although one mandate may only increase the cost of a policy by 1 percent, 40 such mandates will price many people out of the market," the council said in a recent report.

Opponents say the bill would result in health insurance policies that don’t protect workers when they get ill.

Democrats are expected to offer a competing bill Tuesday that also would allow small businesses to band together to purchase health insurance. The Office of Personnel Management would administer the benefit. The program would be set up like the Federal Employees Health Benefit Program, said the bill’s sponsors, Sens. Dick Durbin, D-Ill., and Blanche Lincoln, D-Ark.

"If it’s good enough for federal employees, and it’s good enough for members of Congress, there’s no reason we shouldn’t use this model for small businesses and self-employed people," Lincoln said.

Senate Majority Leader Bill Frist, R-Tenn., has labeled this week as "health week" in the Senate. On Monday, Democrats blocked legislation that would cap the amount of damages juries can award in medical malpractice cases. The roll calls fell well short of the 60 votes Republicans needed to advance the bill.

—

On the Net:

Alliance for Health Reform-small business health plans: http://www.allhealth.org/event-042406.asp