On June 11, the House Education and the Workforce Committee approved, 26-21, a bill (H.R. 660) designed to make health care more affordable for small businesses. The House is expected to consider the bill next week.
Sponsored by Rep. Ernie Fletcher (R-KY), the Small Business Health Fairness Act of 2003 would allow small businesses to come together to form associations for the purpose of purchasing health insurance at more affordable group rates. The bill would establish rules governing these associations, including certification, sponsorship, participation, coverage, contribution rates, benefit options, and termination. Regulation of association health plans (AHP) would be overseen by the Department of Labor, rather than the states.
In his opening statement, Chair John Boehner (R-OH) quoted a speech given by President Bush last year at the Women’s Entrepreneurship Summit saying that, “Small businesses will be able to pool together and spread their risk across a large employee base. It makes no sense in America to isolate small businesses as little health care islands unto themselves. We must have association health plans.”
During consideration of the bill, Rep. Ron Kind (D-WI) offered a Democratic substitute amendment that would have offered discounts on insurance premiums to small businesses instead of forming association plans. The amendment was defeated, 20-25.
Speaking in support of the substitute, Rep. Lynn Woolsey (D-CA) pointed out that, “instead of solving the real problem of affordability for both employees and employers, H.R. 660 denies working families who participate in association health plans important state regulated protections that guarantee critical medical exams and equipment.”
Democrats offered a series of amendments aimed at preserving state laws regulating health coverage and treatments for specific illnesses. The amendments, which were defeated en bloc, 22-27, included:
- an amendment by Rep. Susan Davis (D-CA) that would have required AHPs to provide direct access to obstetrical and gynecological services if such direct access is required by state law;
- an amendment by Rep. Dale Kildee (D-MI) and Rep. Ruben Hinojosa (D-TX) that would have required AHPs to cover diabetes treatment if such treatment is required by state law;
- an amendment by Rep. Dennis Kucinich (D-OH) that would have ensured that the level of benefits under AHPs is not decreased and that the cost of premiums is kept down;
- an amendment by Rep. Robert Andrews (D-NJ) that would have prohibited discrimination in contribution rates based on the employer’s workforce composition in terms of race, color, religion, gender, national origin, or age;
- an amendment by Rep. Kind that would have required AHPs to follow state law in treating and screening for autism;
- an amendment by Rep. Rush Holt (D-NJ) that would have required AHPs to provide equitable mental health and substance abuse treatment if parity is required by state law;
- an amendment by Rep. Denise Majette (D-GA) that would have required AHPs to offer the same premiums to all participants and follow state laws on how to set premiums;
- an amendment by Rep. Carolyn McCarthy (D-NY) that would have required AHPs to abide by state mandates for prostate cancer screening and care;
- an amendment by Rep. George Miller (D-CA) that would have required AHPs to offer a plan equivalent to existing participant plans; and
- an amendment by Rep. Andrews that would have specified that multiple employer welfare arrangements may not operate as AHPs.
The Committee also defeated the following amendments:
- an amendment by Rep. Betty McCollum (D-MN) that would have required AHPs to cover pregnancy, childbirth, and children’s health services if such services are required by state law. It was defeated, 14-24;
- an amendment by Rep. McCarthy and Rep. Woolsey that would have required AHPs to cover breast cancer screening tests if the tests are required by state law. It was defeated, 17-20;
- an amendment by Rep. John Tierney (D-MA) and Rep. Chris Van Hollen (D-MD) that would have required AHPs to comply with the states’ patients’ bill of rights. It was defeated, 23-24;
- an amendment by Rep. Holt that would have prohibited AHP providers from denying contraceptive coverage if such coverage is required by state law. It was defeated, 22-26;
- an amendment by Rep. Charlie Norwood (R-GA) that would have prevented AHPs from providing varying rates based on the health status or claims experience of companies. It was defeated, 23-26; and
- an amendment by Rep. Andrews that would have established liability for AHPs. It was defeated, 22-27.
Before final approval, the committee adopted, by voice vote, a substitute amendment by Rep. Sam Johnson (R-TX) that would make technical changes to correct out of date citations in ERISA; grant the Secretary of Labor the ability to require additional indemnity insurance; require missed payments to be reported to the Secretary; ensure that actuaries are part of the American Academy of Actuaries; and mandate that state solvency requirements apply to AHPs.
