Congress looks to make health insurance more affordable, but some fear legislation might cost consumer protections.

Star Tribune (Minneapolis, MN)

Washington, D.C. – Over the years, Minnesota legislators have passed many laws telling health insurers exactly what they must pay for: blood tests to screen for prostate cancer, mammograms and supplies to treat diabetes, to name a few.

They passed a law saying it’s illegal for insurers to discriminate against unmarried women in providing maternity benefits. And they set minimum standards for health plans that cover mental health services.

The U.S. Senate will vote soon on a landmark bill that would effectively strip Minnesota and other states of their ability to impose such mandates. Backers say it would help more consumers afford basic health insurance, but opponents say it would gut consumer protections.

Sen. Michael Enzi, R-Wyo., the bill’s chief sponsor, calls it the “first major step in 15 years toward more affordable health insurance options for small business and working families.”

Minnesota Attorney General Mike Hatch, leading a charge to defeat it, called the bill “special interest legislation at its worst.”

He said it would override at least 25 Minnesota coverage mandates.

The bill, passed 11 to 9 by the Senate Health, Education, Labor and Pensions Committee last month, could come to a full Senate vote in early May.

Similar legislation already has passed in the House.

Proponents say the bill would allow business and trade associations to band their members together and offer group health coverage for less, adding more people to insurance rolls. Preempting state coverage plans is an important way to reduce costs, they contend, arguing that mandates make it harder and more costly for small-business owners to provide any insurance.

“If you can’t afford any insurance, then no mandates are covered,” said Ryan Taylor, a Health Committee spokesman.

Sen. Norm Coleman, R-Minn., said the bill “may not be a perfect solution, but it is a good place to start the discussion.” He said the bill would save employers $1,000 a year for each of their employees.

“I am deeply concerned about the 44 million people who do not have insurance in the United States,” Coleman said. “Small businesses are the largest employer in the United States and many of them are unable to afford to offer the benefit of health insurance.”

Sen. Mark Dayton, D-Minn., opposes the bill, his spokeswoman said. He’s backing a Democratic alternative that would aid businesses while keeping state mandates intact.

State Sen. David Tomassoni, DFL-Chisholm, who sponsored the 1996 law requiring insurers to pay for blood tests to screen for prostate cancer, defended the right of states to pass mandates. He said the prostate-screening law “made all the sense in the world” because the tests can detect medical problems earlier, saving costs in the long run.

“If you leave it to insurers, they might not cover anything,” Tomassoni said.

The bill is drawing opposition from consumer groups.

The Foundation for Taxpayer and Consumer Rights said the move by Congress, “under the guise of making health care affordable,” would encourage health insurers to sell coverage that provides no benefit guarantees. The American Diabetes Association said the nation “simply cannot afford to eliminate the diabetes health coverage guarantees that 46 states and the District of Columbia have wisely taken the initiative to provide.”

In a letter to Enzi, the Blue Cross Blue Shield Association said it strongly backs the idea of applying the same rules throughout the insurance market, but added that it’s still reviewing the bill and its “implications of such sweeping change.” The National Association of Health Underwriters said “greater uniformity in a number of areas” could cut costs and improve access to health insurance.

Companies that self-insure are generally exempt from most state mandates.

Enzi, the chairman of the health committee, said the legislation would lower costs for small businesses by 12 percent and reduce the number of uninsured by 8 percent, or about 1 million people.

Massachusetts Sen. Edward Kennedy, the top Democrat on the Health Committee, said consumers would lose important protections mandated by states, including well-baby care, immunizations, cancer screening and access to specialists.

Hatch said the bill would take away the state’s power to review premium increases, giving insurance companies “an almost unlimited ability to set high premiums.” And health plans could sue in federal court if they believed a state was violating preemption provisions, Hatch said, calling that language “unconscionable.”

Hatch, a DFL candidate for governor, said the bill would nationalize the trend of “Swiss-cheese” health plans, which often do not even cover maternity benefits. In a letter to Enzi, he said it would result in “a race to the bottom,” leaving consumers with fewer protections at a higher cost and states powerless to do anything.

Sen. Ben Nelson, D-Neb., a cosponsor of Enzi’s bill, said Congress must respond to annual double-digit increases in health-care premiums.

“If we don’t do something to help small businesses cope with the costs of health care, soon we will have an entire workforce without health insurance coverage,” Nelson said.
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Rob Hotakainen is a correspondent in the Star Tribune Washington Bureau:
202-383-0009.

COVERAGE MANDATES:

Among the coverage most Minnesota insurance plans must include:

• Routine screening for cancer, including mammograms and pap smears.
• Prostate cancer screening for men 50 and older.

For a complete list, see: http://www.startribune.com/a1191