Wednesday, May 3, 2006

Delay vote on health act

Whenever Congress puts a high-sounding name on a peace of legislation, it should send up a red flag for every American.

Such should be the case with the so-called Health Insurance Marketplace Modernization and Affordability Act.

The goal is noble — to allow small businesses and associations to merge their multi-state membership into a single group for the purposes of shopping for health insurance, with the ultimate aim of more affordable health insurance coverage for everyone, including the currently uninsured.

But lurking within the bill are provisions that opponents claim could easily lead to reduced benefits for everyone, the disappearance of state-mandated benefits for such conditions as diabetes and mental illness, higher costs for seniors and the chronically ill, and a loss of women's health care benefits including mammograms and maternity care.

The problem rests in the nature of existing coverage mandates, which are set for the most part state-by-state. A plan that crosses state lines, however, needs some sort of uniformity in mandated coverage.

Unfortunately, HIMMAA takes a minimalist approach to this question in the name of affordability.

While the act calls for negotiations with states to establish benefits, what it allows at a certain point is for insurers to ignore a state's mandate if the particular benefit isn't mandated in at least 45 states.

New Mexico has some very strong mandates. Insurers offering health coverage in the state must cover such conditions as cancer treatment, diabetes, mental illness, pregnancy and others that are not necessarily mandated in 44 other states.

Opponents also claim the act would allow insurers to "cherry-pick" companies that have a younger, healthier workforce, while forcing higher premiums on companies with older employees, thus actually making health insurance premiums more expensive while providing fewer benefits. This, organizations such as AARP contend, would make companies less likely to hire or retain older workers and would eliminate the long-established principle of "shared risk" in setting premiums.

Proponents of the measure say those very same provisions will give employers and associations more options, encouraging those who offer no insurance coverage to provide some coverage at a cost they can live with, while companies that wish to provide more benefits can do so.

Their argument is that some benefits are better than none — that people aren't going to get any benefits if they or their employers can't afford it.

The problem with that, opponents say, is that the vast majority of business that now offer insurance that covers the mandated benefits will beat a path to the lower cost — and minimal benefit — plans. Their argument is that reducing benefits just means people have to pay more out-of-pocket expenses, actually raising their health care costs, and the only savings will be for the insurers and the businesses.

More insidiously, this clearly appears to be a back-door attempt to insulate insurers and business from the two largest and fastest growing groups of health-care consumers — women and aging baby-boomers — two groups for whom this act will provide less affordable insurance and care, not more, according to many analyses.

Although this bill was first introduced in November, it flew under the radar until it came out of a U.S. Senate committee in mid-March.

But even at that, it is opposed by nearly every health advocacy organization from the American Cancer Society and American Diabetes Association to virtually every mental health advocacy group to every senior citizen advocate such as AARP, along with several states and the National Association of Insurance Commissioners.

The full Senate is scheduled to vote on this measure within the next couple of weeks.

There are far too many questions about the impact of this act on the states and on individuals, and far too much evidence that it will have "unintended" consequences (if indeed they are unintended), for the Senate to approve it now.

This bill needs much more public scrutiny than it has received. The Senate should delay a vote until it gets it.

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