Health Summit Pressures Reform Debate While the much anticipated health summit yielded no groundbreaking results, per se, it has reenergized a once faltering effort to overhaul the nation’s health care system. The Feb. 25 summit lasted nearly all day and, while there was some time spent identifying areas of broad agreement on cost-containment and insurance market reforms, the majority of the day was dominated with the trading of predictable talking points. The summit did highlight the greatest area of contention for both Republicans and Democrats – a philosophical divide on the role of the federal government in health care. Representative of their differences was Republican support of the deregulation of the health insurance industry, and Democrats support for a greater focus on centralization and regulation of the health insurance industry, as well as expanded federal support, via subsidies and other measures, for low-income individuals and families. In particular, Republicans promoted the ability of insurers to sell insurance across state lines as a panacea to problems with health insurance access and cost. However, similar proposals in the past that exempt certain health plans from various state laws that govern health insurance sold to small employers, such as federally certified Association Health Plans (AHPs), have already been researched and analyzed for their viability. NSBA has fought the battle over selling insurance across state lines in a deregulated market on behalf of small businesses years ago and found that the proposal would actually harm, not benefit, small businesses, their employees and their families. In fact, a 2003 report by Mercer found that such a proposal would have a “detrimental” impact on premiums for small businesses that would result in many small businesses dropping coverage altogether, an exact opposite result from what its proponents suggest. The 2003 report indicated that premiums for those outside the AHP market would increase an additional 23 percent and lead directly to one million uninsured on top of the then 45 million uninsured in the U.S. The report suggests that minimal price savings reaped through AHPs would come from depleting benefits that are currently mandated by the states. Furthermore, the Congressional Budget Office found that of the estimated 4.6 million people expected to participate in AHPs, only 330,000 people, or one in 14, would be newly insured. Selling insurance across state lines is clearly not the answer that small businesses need for their health insurance problems. NSBA has been a long-time advocate for a comprehensive approach to health care reform that would deliver appropriate and meaningful changes for small businesses. In fact, NSBA has repeatedly advocated for the principles set forth in Small Business Health Care Reform—A Long-Term Solution for All. This broad reform proposal developed by NSBA in 2003 seeks to achieve universal coverage, focus on individual responsibility and empowerment, the creation of the right market-based incentives, and a relentless focus on improving quality while driving out unnecessary, wasteful, and harmful care. The President is expected to deliver a revised health proposal March 3 that is likely to eliminate special deals including in the Senate-passed bill, as well as other measures, including sending investigators disguised as patients to uncover fraud and waste in Medicare and Medicaid; $50 million in grants to expand medical malpractice reform pilot programs in states; increasing payments to Medicaid providers; and, expanding the use of health savings accounts by offering high-deductible plans in the exchanges With the President’s renewed effort to pass health care reform has emerged the controversial use of budget reconciliation. President Obama concluded the summit alluding to his desire to find bipartisan agreement; however, he noted that if nothing is reach in the coming weeks then he will pursue an “up-or-down vote” (i.e. budget reconciliation). The likely scenario for its use would have the House of Representatives pass the Senate-passed proposal then use budget reconciliation to pass a companion bill that reflects President Obama’s proposed changes and perhaps others from House Democrats. While reconciliation is riddled with arcane rules that govern what can and can not be included, it does allow for the majority in the Senate to pass a bill by a simple majority vote. The procedure would allow Senators to bypass the traditional process that requires 60 votes to end debate and move on to final passage of legislation with 51 votes. Perhaps of greater concern to reform’s proponents is the ability of House leadership to garner 216 votes for passage of the Senate proposal. House leadership is negotiating with thin margins in regard to recent vacancies or changed motivations as a result of planned or early retirements, deaths, or newly undecided votes based on various reasons. NSBA has asserted that the process to achieve appropriate and meaningful reform should not be the issue, but rather the substance of the proposal being considered. If the legislation is good, then the process of its passage should not be an issue. Unfortunately, neither proposal addresses the concerns with health insurance cost that have plagued small businesses for the past decade. NSBA’s advocacy continues to focus on these areas of improvement to ensure that Congress passes responsible and meaningful reform for small businesses. Click here to view NSBA’s issue brief on AHPs. Click here for NSBA’s Health Reform Today Web site.
Click here to view the Alliance for Health Reforms toolkit on budget reconciliation |