CFO.com

The proposed legislation would help members band together to secure lower group rates for health care; opponents maintain that the measure would raise out-of-pocket costs and gut Patient Bill of Rights laws in 41 states.

The Senate Health, Education, Labor, and Pensions Committee voted 11-9 in favor of a bill that would allow business and trade associations to band their members together to offer group health coverage on a national or regional basis.

“Today’s vote is the first major step in 15 years toward more affordable health insurance options for small business and working families,” said Sen. Mike Enzi (R-Wyo.), the committee chairman, in a statement. Enzi introduced S. 1955, The Health Insurance Marketplace Modernization and Affordability Act, “in direct response to runaway costs that are driving far too many employers and families from comprehensive health insurance.”

The narrow margin by which the bill was approved in committee, however, reflects the significant opposition that it has stirred up.

According to a press release by the nonprofit Foundation for Taxpayer and Consumer Rights, the bill would raise costs for patients, who would need to pay out of pocket for medically necessary treatments that insurers would no longer be required to cover. The foundation also asserted that the current bill “is a dramatic departure from earlier versions” because it would allow health insurers and HMOs to ignore the Patient Bill of Rights laws already established by 41 states and replace them with weaker or non-existent “harmonized” federal standards.

State laws at risk, according to the foundation, include ones that require health-insurance plans to provide cervical cancer screening, that ban “drive-thru” child delivery, and that guarantee an independent review if an insurer denies coverage, as well as pending protections that would cap out-of-pocket costs. The foundation also specifically cited the potential loss of state benefits such as a California woman’s right to visit an OB-GYN, a New Jersey child’s access to Hepatitis B inoculation, and a Tennessee patient’s coverage for diabetes treatment.

“When 45 million Americans cannot afford health care at same time health insurance profits triple, we clearly need more regulation to bring prices down, not less,” said Jerry Flanagan of the foundation, in a statement. “Under the guise of making health care affordable, S.1955 encourages HMOs and insurers to sell coverage that provides no benefit guarantees. This bill does nothing to address out-of-control health care costs — like health insurance overhead and profits — which are now the fastest-growing component of health care spending.”

A press release from the senator, acknowledging this opposition, stated that “Enzi believes this bill has a better chance of survival because he’s worked with diverse interests to include important safeguards to prevent adverse selection that would split healthy and sick groups and send premiums skyrocketing for the sick groups.” Added the release, “The bill preserves the state role in protecting insurance consumers and ensures that small business owners will have the choice of both basic and enhanced packages of benefits.”

In a separate statement, Enzi maintained: “My bill would allow a small business benefit health association to offer a more affordable healthcare package that may not include some of the state’s benefit mandates, but it would be required to offer a comprehensive alternative package’.[It ensures] that at least one comprehensive policy must be offered to every small or family-owned business, while ensuring that basic, affordable policies are available as well.”