Senate Blocks Association Health Plan Bill

The Senate on Thursday blocked legislation (S 1955) that would allow small businesses to join together and create association health plans, falling five votes short of the 60 votes needed to invoke cloture and limit debate, the Wall Street Journal reports. The measure was defeated in a 55-43 vote, mostly along party lines (Lueck, Wall Street Journal, 5/12).

The bill, sponsored by Senate Health, Education, Labor and Pensions Committee Chair Mike Enzi (R-Wyo.), would allow small businesses and trade associations to form association health plans across state lines. Under the bill, insurers would be permitted to sell plans to businesses and individuals that do not meet current state benefits requirements.

However, they then also would have to offer a plan with benefits provided under a state employees' plan in one of the five most heavily populated states -- California, Florida, Illinois, New York and Texas. In addition, the bill would preempt state laws that limit how much insurers can vary premiums from one small business to another (California Healthline, 5/11).

Sen. Ben Nelson (D-Neb.), a bill co-sponsor, and Sen. Mary Landrieu (D-La.) broke party lines and voted to consider the bill. Sen. Lincoln Chafee (R-R.I.) voted against the measure (Schuler, CQ Today, 5/11).

According to the Philadelphia Inquirer, "failure to limit debate usually dooms legislation" (Philadelphia Inquirer, 5/12).

However, Enzi said he would work with Democrats to seek a compromise that would allow the bill to be brought up again later this year.

According to the Los Angeles Times, [S]upporters and opponents agreed that this week represented the best chance in years of passing the legislation" (Alonso-Zaldivar, Los Angeles Times, 5/12).

Supporters of the measure, which included the Bush administration, said it would help more small companies offer coverage by freeing them from having to comply with expensive and varying state requirements (Wall Street Journal, 5/12).

"I'm pleased with the vote we got. I'm disappointed we didn't get to 60, ... but this is the first time the Senate has gotten it to a cloture vote," Enzi said (CQ Today, 5/11). "Obviously, we have some more work to do," Enzi added (Wall Street Journal, 5/12). He said, "[The] campaign of misinformation directed at the American public is deeply troubling. However, I am confident that when Americans understand the truth about this bill, they will support it in overwhelming numbers" (CongressDaily, 5/11).

Opponents said the measure would have allowed insurers and small businesses to bypass state-mandated protections and, in some cases, increase costs for firms with sicker workers (Wall Street Journal, 5/12). Democrats said the measure would have harmed about as many people as it would have helped, according to the AP/Houston Chronicle (Freking, AP/Houston Chronicle, 5/11).

Sen. Edward Kennedy (D-Mass.) said, "I think tonight we avoided taking a step backward" (CQ Today, 5/11).

Sen. Christopher Dodd (D-Conn.) said he opposed the measure because the Senate should let each individual state "decide how it can best serve its people when it comes to health care coverage" (Philadelphia Inquirer, 5/12).

Sen. Dianne Feinstein (D-Calif.) said, "California has one of the most comprehensive sets of required insurance benefits in the country. The reality is that any attempt to 'harmonize' state benefit mandates will likely result in harm to Californians" (Los Angeles Times, 5/12).

Sen. Patrick Leahy (D-Vt.) said the measure would have preempted requirements in his state that insurers cover, including treatments for alcoholism, contraceptives, diabetes supplies and home health care. He said, "It kind of makes you wonder what's going to be left to be covered" (AP/Houston Chronicle, 5/11).

Todd Stottlemyer -- president of the National Federation of Independent Business, which supported the measure -- said that it was "incredibly disheartening" that a minority of senators "used Senate rules to block a final vote on legislation favored by a clear majority" (Wall Street Journal, 5/12).

According to CQ Today, the debate on the Enzi bill "succeed[ed] in helping" Sen. Olympia Snowe (R-Maine) "win a compromise that could be the basis for a bill addressing small business insurance" that might get passed in the Senate.

Under Snowe's legislation (S 406), which she finalized as an amendment to the Enzi bill in the days before the vote, coverage mandates in at least 26 states would be left intact (CQ Today, 5/11).

According to the Los Angeles Times, "The dead-end turn for the small business bill is another example of the health care impasse that persists in Washington as costs and the number of uninsured keep rising." The Times reports that election-year "mistrust" between Republicans and Democrats shut down most compromise efforts.

Robert Blendon, a public opinion expert at the Harvard School of Public Health, said, "In health care, you need people who are absolutely committed to making some major changes and to reaching across the political aisle." He added, "The partisan nature of Washington politics has just gotten so extreme that you have a sense people don't want to move on a problem unless it's done completely on the terms of their own party" (Los Angeles Times, 5/12).

The failure to pass the Enzi bill means that the week Republican leaders dubbed "Health Week" ended without any bills passing, Reuters reports (Kenen, Reuters, 5/11).

The Senate on Monday voted to block two bills that would have capped noneconomic damages in medical malpractice lawsuits (California Healthline, 5/9).

The votes on the three measures "gave Republicans an opportunity to accuse Democrats of obstructionism, while Democrats lobbed accusations at the GOP for inaction on other health issues," according to CQ Today (CQ Today, 5/11). Democrats were unable to bring votes on federally funded stem cell research, an extension of the May 15 deadline for the Medicare prescription drug plan enrollment and an alternative small business health bill.

Sen. John Ensign (R-Nev.) said Democrats blocked the majority agenda to earn political points, adding that he thought the week was a success because Republicans were able to show the public they heard their concerns.

Sen. Blanche Lincoln (D-Ark.) said Republicans drew "lines in the sand" and did not work on bipartisan compromises. She said, "We have missed an opportunity" (Reuters, 5/11).

Senate Minority Leader Harry Reid (D-Nev.) said, "We haven't had a health care minute" this week (Phillips, New York Times, 5/12).

Sen. Joseph Lieberman (D-Conn.) said before the vote, "We're going to spend the whole week banging our heads -- and in the end, nothing is passing. That is a failure that ultimately will signify nothing good for millions of Americans who need health insurance. I yearn for a day when we can sit down and reason together" (Los Angeles Times, 5/12).