Hill Notes: Congress and Health Week: A Spark or a Sputter?

Published September 1, 2005

During the final week of July, the U.S. House of Representatives allotted precious floor time to health care reform, and the Senate laid out a health care agenda before Congress recessed for a five-week “summer district work period.”

Senate Offers Broad Reforms

The Senate Republican leadership introduced the text of a broad health care reform bill, encompassing everything from Health Savings Accounts (HSAs), state high-risk pools, and health care tax credits to medical liability reform and the creation of electronic medical records.

It is an ambitious list. The Patient Safety and Quality Improvement Act (S. 544) has already made it over the goal line, passing Congress and being signed into law by the president in July. This law addresses the malpractice debate with a preventive strike, creating a voluntary system for reporting medical errors with some protection from lawsuits. Data from the reports will be analyzed, allowing policymakers and providers to see patterns and practices that can be altered to reduce medical error.

The Healthy America Act of 2005 (S. 4) was introduced July 27, a week before Congress recessed. The bill was read twice and referred to the Finance Committee. It is designed to “reduce health care costs, expand access to affordable health care coverage, improve health care and strengthen the health care safety net.”

House Discusses GOP Items

The House discussed and passed several items from the Republican health care agenda, including revisits to medical liability reform and Association Health Plans (AHPs) and reauthorization of a program that supports the creation and operation of state high-risk pools to help individuals who do not have employer-provided coverage and are sick with chronic health conditions that make their premiums unaffordable or unavailable.

Passed by voice vote, both Republicans and Democrats supported legislation to create state high-risk pools. Those pools are a critical piece of the safety net that should be in place for market-based solutions to work most effectively.

Currently 32 states have such pools, but others are looking to create them. The bill will give states seed money to move forward. Once created, high-risk pools become self-sustaining, many through assessments on insurance companies operating in the state, some through general revenues, and others through assessments on hospitals.

Rather than require private insurance firms to offer policies to those whose “house is already on fire” when they come forward for insurance, high-risk pools accomplish the goals of giving affordable coverage to people who desperately need it (usually at 150 percent of the average premiums) while keeping carriers in the market and offering affordable policies to those seeking coverage before a health crisis.

In the Senate, high-risk pool legislation is one of the named priorities on the Senate Republican agenda and it passed the authorizing committee unanimously. The measure is currently stalled due to a formula fight between large and small states.

House Approves AHPs Again

For the fifth time since 1997, the House passed legislation by Rep. Sam Johnson (R-TX) to allow small businesses to provide health insurance to their workers through AHPs. Supporters of the “Small Business Health Fairness Act of 2005” believe the legislation will give business greater bargaining power and lower premium prices because it exempts the policies from state mandates.

“Today, 45 million Americans cannot afford a Cadillac health insurance policy with all the mandated benefits,” explained Rep. Albert Wynn (D-MD) during the July 26 House debate on AHPs. “However, they might be able to afford a more modest vehicle that would get them to their doctor’s office for a diagnosis . . . and recommendations to improve their quality of life.”

The bill passed 263-165, with the support of all House Republicans and 36 Democrats, including 12 of the 35 Democrats who are part of the moderate House “Blue Dog Coalition.”

The AHP bill will not receive consideration in the Senate in its current form, because the Republicans who support it do not have the votes necessary to overcome a Democratic filibuster. Senate Health Education, Labor, and Pensions Committee Chairman Michael Enzi (R-WY) told reporters on July 26 he would have an alternative to introduce after the August recess.

Enzi is seeking the counsel of major stakeholders involved in implementing the proposal.

Access Issues Remain

Every election and each May, during “Cover the Uninsured Week,” politicians of all parties give speeches citing the need to cover the 45 million Americans considered uninsured by the U.S. Census Bureau.

For the past two Congresses, Republicans have controlled the White House and both Houses of Congress. President George W. Bush has supported health care tax credits to make health insurance more affordable for working Americans who currently can’t afford coverage. House and Senate Republican leadership have put health care tax credits on their list of reforms that need to take place.

If all those who hold the reins of power want to help the uninsured by improving access to private coverage with health care tax credits, why doesn’t it happen?

“We have the vision for what American health care should look like,” Senate Majority Leader Bill Frist (R-TN) said on the Senate floor on July 26. “Now we only need the courage to make it happen.”

Pay Now or Pay Later

Funding is widely cited as another barrier. According to “scoring” procedures for congressional legislation, providing health care tax credits to those who need coverage will cost $75 billion over 10 years. The House declined to include health care tax credits in the bills they considered during Health Week because these provisions cost money. Similar protestations are heard from Senate staff.

But if the leadership is truly committed to making the health care system more accessible through market-based solutions rather than government mandates or control, they must act aggressively with solutions. Paying something now could stem a growing force of economic and human desperation that is demanding relief.

Laura Clay Trueman ([email protected]) is executive director of the Coalition for Affordable Health Coverage, a diverse group of businesses, associations, health care providers, insurance carriers and brokers, consumer groups, and pharmaceutical and medical device companies who lobby to enact market-based reforms to reduce the number of uninsured in America. She is also senior director of Jefferson Government Relations, LLC.