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Health Care Bill Weighs Access, Price: Health Groups Fear Disease Screening Will Be Lost in Small-Business Proposal

Posted on: Thursday, 11 May 2006, 03:12 CDT

By Robert Dodge, The Dallas Morning News

May 11--WASHINGTON -- It seems like a simple solution: Allow small businesses to band together across state lines and negotiate less expensive employee health insurance.

But a proposal in the Senate to allow small businesses to pool their bargaining power has turned into a nasty political brawl. Small businesses find themselves pitted against politically influential health groups, including the AARP and the American Cancer Society.

The health groups are concerned the proposal by Sen. Mike Enzi, R-Wyo., would usurp state laws and allow insurance companies to dump coverage of things like mammograms, colonoscopies and other life-saving screening tests.

But many small businesses argue they increasingly cannot afford health insurance for their employees.

With 46 million Americans lacking health insurance, they add, limited coverage would be better than none.

"We are in a real crisis on health care," said Peter Snider, who owns Alco Glass Inc. in Mesquite.

"There will be a lot of it dropped if we do not fix it."

The 59-year-old business owner said he pays $350 a month per employee in premiums.

That compares with $90 a month in 1990.

Mr. Snider said he has scaled back coverage for his 19 employees to keep the cost from rising to $600 a month.

"We pay all the premiums, but it is getting harder and harder," Mr. Snider said, adding that employees now have to absorb higher deductibles and co-payments for doctor visits and prescription drugs.

Average premium

Nationwide, the average family health plan premium rose to $10,880 this year, up from $6,438 five years ago, according to the Kaiser Family Foundation.

The employee portion of the premium rose to $2,713, up from $1,619 in 2000.

Kaiser reports that 60 percent of employers are offering insurance this year, down from 69 percent five years ago.

Mr. Snider estimates that he might be able to save $8,000 annually if he worked with other small businesses to negotiate a 10 percent premium savings.

He thinks that is possible based on the savings on workers' compensation insurance offered through a small-business trade group.

"It could be spent on a lot of things, like upgrading our equipment or giving a raise to the guys," Mr. Snider said.

Frist's initiative

The Senate is considering the bill as part of a health care week led by Capitol Hill's most-prominent physician: Senate Majority Leader Bill Frist, R-Tenn.

It's part of an election-year strategy to draw public attention to free-market solutions for health care issues.

But this week's debate also underscores the difficulties policy-makers face in bringing competing interests to agreement on the complicated issues of access and cost.

More than half of the 46 million people without health insurance are believed to work in small businesses, according to the National Federation of Independent Business.

But the Congressional Budget Office estimated that the Senate proposal would make it possible for only 600,000 new workers to get coverage.

The Senate is expected to vote on the plan this week, although its progress has been slowed by partisan bickering.

A similar bill by Rep. Sam Johnson, R-Plano, was approved by the House last July.

"It is a toss-up whether it will pass," said Mr. Johnson, referring to the debate in the Senate. "But it is important to get insurance for people who otherwise might not have it."

In the Senate, Republicans and Democrats are negotiating to close the differences over coverage between small businesses and the health groups.

A compromise could guarantee approval for a proposal that otherwise faces a close vote.

Amendment attempt

Sen. Olympia Snowe, R-Maine, has a pending amendment that would allow mandated benefits to remain in place if they were required by a majority of states -- at least 26.

But Senate Republican leaders may block her from offering the amendment.

"They're not allowing us to amend this bad piece of legislation," said Senate Minority Leader Harry Reid, D-Nev.

If Ms. Snowe's amendment is adopted, the Council for Affordable Health Insurance said a list of popular benefits would be guaranteed: alcoholism treatment, breast reconstruction, contraception, diabetic supplies, emergency services, mammography, maternity stay, mental health, off-label drug use and prostrate screening.

And without a compromise, health groups worry that the bill will sweep away the right of states to regulate insurance coverage.

With that power, they argue that years of hard-fought battles to guarantee benefits that save lives and money by catching diseases early will be eliminated.

Cancer Society

"We have worked for the last 20 years to make sure that a woman who needs a mammogram is covered," said Daniel Smith, a national vice president for the American Cancer Society.

"That is something people expect when they go to see the doctor," he said.

Even so, Mr. Smith said, Ms. Snowe's amendment does not go far enough to win the cancer society's endorsement.

He said it remains flawed.

They worry about the fate of people like Jennifer Cutrer, who discovered she had a small breast tumor four-and-a-half years ago during a routine mammogram.

Dr. Cutrer, 57, is a sociologist and director of legislative affairs at Parkland Hospital in Dallas.

She understands the importance of early screening both as a cancer survivor and as an executive in a major medical institution.

'Mixed blessing'

"It was kind of a mixed blessing. You are not glad they found cancer, but you are glad they found it early," Dr. Cutrer said, explaining that preventive tests are even more important for families with a history of cancer.

Her family lived near the chemical plants along the Louisiana coast, and she has three cousins who are cancer survivors.

Dr. Cutrer can only speculate about whether she would have delayed the mammogram if she did not have insurance.

But she knows many of Parkland's low-income patients find it tough to pay for such tests.

"When they are talking about putting food on the table, getting their kids to school, they do not have the money," she said.

"When you are talking about paying for a mammogram, that can be expensive for someone who cannot afford to take that additional money out of their budget."

Internet campaign

The cancer society has generated more than 150,000 e-mails and 8,000 phone calls to senators in the last two weeks through an advertising campaign.

One Internet ad features a red bra with a headline: "Tell the U.S. Senate not to leave women exposed."

"We are fighting very hard against the bill," Mr. Smith said.

Despite the opposition of health groups, small-business interests said they could live with the approach offered by Ms. Snowe.

They hope her amendment will win support from enough Democrats to give proponents the 60 senators they may need in a parliamentary vote to cut off debate and approve the bill.

"We are not willing to give the whole barn away, but hopefully we can get both sides to come together," said Amanda Austin, manager of legislative affairs for the National Federation of Independent Business.

Proponents argue that existing mandated benefits would not be dumped wholesale by employers who are under competitive pressure to offer good benefits.

But they would allow smaller companies to offer scaled-down benefit packages that would save money for both employers and workers.

"People don't even have coverage at all today. That's who we are trying to help," said Sen. Kay Bailey Hutchison, R-Texas.

Mr. Snider said he is one employer who does not want to cut benefits.

"My employees are very close to me," Mr. Snider said, explaining many are young and may not value health insurance until they unexpectedly get sick. "If that happens, I would feel bad if I could not take care of them."

E-mail rdodge@dallasnews.com

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Source: The Dallas Morning News

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