Sen. Enzi To Introduce Compromise Legislation on Association Health Plans
Kaiser Daily Health Policy Report
March 3, 2006
Senate Health, Education, Labor and Pensions Committee Chair Michael Enzi (R-Wyo.) early next week plans to introduce a bill (S 1955) that would allow association health plans to form under certain conditions, and he has scheduled a March 8 markup for the proposal, CongressDaily reports (CongressDaily, 3/3). Like two other pending bills, Enzi’s proposal would allow small businesses and trade associations to join together to offer group health coverage on a statewide or nationwide basis. However, Enzi’s bill differs from pending House (HR 525) and Senate (S 406) legislation in that it would require AHPs to cover any benefits mandated by at least 45 states. To address further the concerns of opponents who say the plans would impair state-mandated consumer protections, Enzi’s bill would leave supervision of the plans with state officials rather than the Department of Labor. In addition, while the bill “would permit business and trade associations to pool their members independently, they would not be allowed to establish self-insured plans, but would rather have to provide benefits through a fully-funded plan,” CQ HealthBeat reports. Enzi said, “Working with a diverse group of senators and business groups representing small business, we’ve bridged the gap between small business proponents of traditional AHPs and state-based interests worried about the prospects of dramatic regulatory changes in health insurance markets.” Mary Nell Lehnhard, senior vice president of the Blue Cross Blue Shield Association, a group that has opposed other AHP proposals, said, “I feel all of our concerns have been listened to. The process has been amazing.”
http://www.kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=35779&dr_cat=3
S. 1955:
http://thomas.loc.gov/cgi-bin/bdquery/z?d109:s.01955:
And…
January 21, 2006
President’s Radio Address
The White House
Congress also needs to pass Association Health Plans, which allow small businesses across the country to join together and pool risk so they can buy insurance at the same discounts big companies get.
http://www.whitehouse.gov/news/releases/2006/01/
20060121.html
Comment: By Don McCanne, M.D.
Proposals for Association Health Plans (AHPs) have been criticized partly because they allow circumvention of state mandated benefits. The savings for small businesses would not come from group discounts, but rather from being able to purchase stripped down plans with very low premiums. Such plans would fall far short of the protection that their employees need. Also they would allow employers who currently provide coverage to drop their plans in favor of these cheap alternatives.
Sen. Enzi’s proposal pretends to address this issue by requiring that benefits mandated by at least 45 states be covered. If only 6 states fail to mandate any given benefit, then it would not be a requirement of the AHPs. Although I haven’t seen any survey, it is improbable that there is any state mandate that would end up being a required benefit for AHPs.
Insurers have not been supportive since they could be left out if the AHPs established their own self-insured pools. Small businesses are potentially a very large market for insurers. Sen. Enzi’s new version pleases the insurers since it would require that benefits be provided through fully-funded plans.
The BlueCross BlueShield Association management finds it amazing that their concerns were listened to. S 1995 will protect and enhance their market for their highly profitable, stripped down plans.
So the President and his colleagues in Congress are addressing the concerns of his friends in the insurance industry.
But, Mr. Bush… What about the patients?