Mar. 10, 2006 – Senate legislation aimed at reducing health insurance expenses for small businesses carries with it what government watchdogs say is a poison pill for patientsâ€™ rights provisions passed by various states in recent years.
Sponsored by Senator Michael Enzi (R-Wyoming), the Health Insurance Marketplace Modernization and Affordability Act, permits small businesses and trade associations to pool resources with which to purchase employee health coverage. The bill would create a uniform national standard for group insurance purchasing. The Secretary of Health and Human Services would oversee the standards and coordinate state cooperation.
In a statement last Friday, Enzi said the measure is necessary to "streamline the current hodgepodge of varying state regulation." Citing a commissioned market study released earlier this week, the Senator said the bill will lower costs to small businesses and decrease the number of uninsured workers.
But consumer rights groups and some patient advocates say that the legislation may actually have a negative effect on peopleâ€™s ability to access quality health care. In a statement released Wednesday, the progressive Foundation for Taxpayer and Consumer Rights (FTCR) called the Enzi bill "lowest-common-denominator legislation" that would undermine state regulations requiring insurance providers to give patients access to a variety of services that have been denied in the past due to cost concerns.
According to FTCR President Jamie Court, in creating a single standard, the measure "threatens the gains of the HMO patients' rights movement, which established standards such as requiring HMOs to provide patients access to second opinions, give women direct access to OBGYNs without having to go through HMO gatekeepers, and ensure patients have access to medically necessary care."
FTCR contends that Enziâ€™s bill would undermine "Patientsâ€™ Bill of Rights" laws enacted by 41 states. The laws carry varying provisions but generally include patient access to review boards, limits on out-of-pocket payments, state oversight of complaints against insurers, and medical-record protections, FTCR said.
Attempts to move legislation on the issue at the federal level have foundered so far, though Senator Edward Kennedy (D-Massachusetts) introduced a bill to do so last year. His bill is currently in the Senate Finance Committee.
In addition, FTCR noted that the legislation would give association health plans near-equal status to more tradition insurance, despite the fact that most such plans carry no out-of-pocket caps and oftentimes cover only a small percentage of medical costs. Patient and consumer advocates refer to the plans as "junk health plans" because of the false promises.
On Tuesday, the American Diabetes Association warned that the Enzi bill could roll back "critical health coverage guarantees for millions of people with diabetes." The association noted that the legislation would usurp decisions made by 46 states and the District of Columbia to mandate that insurers cover diabetes treatments.
In a statement Tuesday, Enzi said Senators had filed dozens of amendments to his proposed legislation. Information on the amendments has not been made public.
The Senate Committee on Health, Education, Labor and Pensions held hearings on the Enzi bill Wednesday. According to the committeeâ€™s website, a second mark-up session is scheduled for next Wednesday. Enzi introduced the bill in November.