Enzi Prepares for Floor Debate on Health Care Bill

May 3, 2006

Sen. Michael Enzi (R-Wyo.), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, is putting the final touches on his health care bill in preparation for upcoming debate on the House floor. Initially scheduled for the first week in May, which is also Cover the Uninsured Week, the debate was pushed back by leadership due to the emergency supplemental bill.

The Health Insurance Marketplace Modernization and Affordability Act of 2005 (S. 1955) was introduced in November 2005 and has been billed as the compromise between Association Health Plan (AHP) proponents and opponents. While the role of associations in delivering health care has remained a consistent piece of the bill, both the rating and benefits pieces have remained in flux.

Following a two-day mark-up in early April, the most recent iteration of the bill would allow for only fully-insured AHPs (referred to in the bill as Small Business Health Plans (SBHPs), create federal rating rules that would preempt certain states' existing rules, allow any insurance company (not just the SBHP) to offer a health insurance package under the new rules, and allow benefit packages to be sold free of state mandates or "benefit-light" so long as another "benefit-rich" plan is also offered by that insurer. S. 1955 will also harmonize states' procedures relative to form and rate filing, market conduct review, prompt payment and internal review.

When Enzi and co-sponsor Sen. Ben Nelson (D-Neb.) bring the bill to the floor, it is expected they will offer a managers amendment in the form of a substitution. Expected changes in the substitution will include possibly changing the benefits structure to a 45-state threshold, which was the original language in the bill introduced last year. That would require insurers to sell a package with benefits equaling, at a minimum, the benefit-mandates required in 45 states. That 45-state threshold also could be dropped down to a 40-state threshold or possibly even lower, which would mean additional benefit mandates to be included in the federally-outlined minimum package.

Though NSBA opposes House-passed AHP legislation, the compromises made to S. 1955 are very promising. Increasing state oversight, excluding self-funded AHPs from the bill, and efforts to harmonize across state-lines could be an important first step in dealing with the many problems facing small businesses seeking affordable, quality health care choices.