By Jeffrey Young - 04/12/06 12:00 AM EDT
A small-business health-insurance bill expected to hit the Senate floor next month already has spurred intense lobbying — and now has attracted the attention of the influential senior-citizens group AARP.
Last week, AARP came out squarely against the legislation, which would allow trade associations representing small companies to offer health benefits through small-business health plans, also known as association health plans (AHPs).
At the same time that AARP is working closely with the Bush administration to sign up seniors for the new Medicare prescription-drug benefit, the group’s lobbyists are working to stall one of the GOP’s best chances at passing a healthcare-reform bill during an election year.
Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Mike Enzi (R-Wyo.) moved the bill through his committee in March and got it on a fast track to the Senate floor largely by neutralizing the opposition of some key interest groups, most notably the health insurers that fought against previous association-health-plan bills.
The aggressive involvement of the deep-pocketed and powerful AARP could change the debate.
The Senate bill is the latest in a string of measures considered by Congress in recent years, but those were not a high priority for AARP, said David Certner, the group’s director of federal affairs.
“We haven’t weighed in in a very big way” in the past, he said.
AARP believes, however, that the latest version of the bill threatens the health coverage of older workers, he explained.
The House has passed legislation to create association health plans numerous times. The bills faltered in the Senate, however, largely because the plans would not have to comply with certain state laws.
Many states require health insurers to cover specific diseases or treatments and forbid them from refusing to cover older or sicker people or from charging them higher premiums. Health plans sold under the Enzi bill would not have to follow those rules.
Certain states have adopted laws designed to prevent older or sicker people from being priced out of the insurance market or from being charged unaffordable premiums.
Critics of the state mandates say that the rulses discourage insurers from selling plans in those states, making it harder for consumers to obtain health insurance, and that allowing health insurers to offer the same benefits in multiple states will expand the availability of insurance.
The Enzi bill goes further than the original AHP bill, Certner said. Enzi’s bill would allow health-insurance companies to offer plans that are exempt from the state laws to anyone, not just to small businesses buying coverage through associations. The bill also would require insurers to offer at least one more generous plan.
Nevertheless, Certner said that allowing insurers to charge higher premiums for older people would create an incentive for employers not to hire older workers, who tend to use more healthcare services. He suggested that the bill would sacrifice older workers in the service of helping younger small-business employees.
“There’s going to be winners and losers,” Certner said. “The impact tends to be on [the] older and sicker.”
Patients groups such as the American Diabetes Association and the American Cancer Society are fighting the bill for similar reasons.
The health-insurance industry long opposed AHPs in part because those new products would have been exempt from state laws that their other plans would have had to follow. But the insurers like the provisions in Enzi’s bill that would allow them to sell the same plan nationwide, irrespective of state laws.
Health insurers are divided on the Enzi bill, however, and their two largest trade associations have been notably quiet. America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association have stopped short of endorsing or rebuking the bill and have continued to negotiate with Enzi and other senators.
Likewise, the National Governors Association and the National Association of Insurance Commissioners stood against the previous bills but so far have remained publicly neutral on Enzi’s.