Senate Invokes Cloture on AHP Bill
The Senate invoked cloture with a 96-2 vote on a motion to proceed to formal consideration of the association health plan bill (S 1955) offered by Senate Health, Education, Labor and Pensions Committee Chair Michael Enzi (R-Wyo.), CQ Today reports. However, the bill "faces stiff head winds" as it has "drawn opposition from patient advocacy groups, state attorneys general, medical provider organization and others, and it has split the insurance industry," according to CQ Today (CQ Today, 5/9).
In addition, Democrats have threatened to filibuster the measure unless they are allowed to offer several health-related amendments (Schuler, CQ Today, 5/9). The bill 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.
The bill would preempt state laws that limit how much insurers can vary premiums from one small business to another (California Healthline, 5/9).
According to a Congressional Budget Office analysis, the bill would benefit most small businesses but not all. CBO said about 25% of employees would face higher premiums and 700,000 uninsured people would gain private coverage.
However, about 100,000 who are now covered would lose their insurance, CBO said (Alonso-Zaldivar, Los Angeles Times, 5/10).
Enzi said the bill "will provide for small businesses to be able to join across state lines to negotiate against the insurance companies with enough power to make a difference," adding, "This is something that the small businesses have been asking for almost 15 years" (Freking, AP/San Francisco Chronicle, 5/9).
Enzi hopes to win more votes by modifying provisions on how insurance companies set premiums by reducing the variance allowed between the highest and lowest rates charged for different patients. However, any amendments Enzi might offer are not guaranteed to gain enough Democratic support to help the bill earn the 60 votes it needs to overcome a second cloture vote and advance to an up-or-down vote, according to CQ Today (CQ Today, 5/9).
A motion to cut off debate on the bill could come Wednesday, although Republican and Democratic leaders said they are continuing to try to reach an agreement. If a compromise is not reached, a cloture vote would come Thursday or Friday and probably fail, CQ Today reports (Schuler, CQ Today, 5/9).
Sen. Richard Durbin (D-Ill.) said two Democrats were likely to vote with Republicans on a cloture motion, including Sen. Ben Nelson (D-Neb.) -- the only Democrat to co-sponsor the bill -- and possibly Sen. Robert Byrd (D-W.Va.), because he has sponsored similar legislation in the past.
Durbin said that Republicans are targeting "two or three others," adding that a second cloture vote "will be close" (Heil, CongressDaily, 5/10).
Senate Minority Leader Harry Reid (D-Nev.) predicted the bill would not get the 60 votes needed to bring about a final vote (Schuler, CQ Today, 5/9).
Democrats are considering adding unrelated measures that would extend the enrollment deadline for the Medicare prescription drug benefit past May 15; permit the purchase of lower-cost prescription drugs from Canada; and expand federal funding for embryonic stem cell research (Young, The Hill, 5/10).
Reid said, "The [Democratic] caucus is united in its opposition to the Enzi bill. Unless we have the opportunity for amendments, I would hope the Democratic caucus would not let this flawed legislation to go forward" (Schuler, CQ Today, 5/9).
However, Reid spokesperson Jim Manley said Senate Majority Leader Bill Frist (R-Tenn.) has indicated to Democratic leadership that he might "fill the tree" to prevent any amendments.
By using the procedural maneuver known as filling the tree, Frist would use his special floor privileges as majority leader to continually raise amendments to prevent Democrats from adding their own (The Hill, 5/10).
Sen. Olympia Snowe (R-Maine) plans to offer an amendment that would require coverage mandates that at least 26 states have in place and would limit the ability to preempt state laws to insurers in the small and large group markets, leaving individual markets unchanged. She said, "We have a solution at hand if we're all willing to forge the consensus to make it happen" (CQ Today, 5/9).
Snowe added, "I believe my amendment can serve as a foundation for building the bipartisan support necessary for the Senate to pass a bill that will allow small businesses to afford insurance for their employees" (Heil/Wodele, CongressDaily, 5/9). However, Snowe's amendment risks losing conservative members who think state mandates are one of the biggest obstacles to lower premiums, CQ Today reports.
Senate Budget Committee Chair Judd Gregg (R-N.H.) said, "If you make the Enzi bill more and more expensive ... you're undermining the basic thrust of the bill" (Schuler, CQ Today, 5/9).
Reid called the amendment a "fig leaf" that will not assuage Democrats (Heil, CongressDaily, 5/10).
Durbin and Sen. Blanche Lincoln (D-Ark.) are going to try to offer a substitute bill (S 2510) that also would allow small businesses to partner to purchase health insurance. It would be based on the Federal Employees Health Benefit Program and would be run by the Office of Personnel Management.
Lincoln said, "If [FEHBP] is good enough for federal employees, and it's good enough for members of Congress, there's no reason we shouldn't use this model for small businesses and self-employed people" (AP/San Francisco Chronicle, 5/9).
Durbin said the bill would preserve state coverage requirements and provide tax credits to help employers get coverage for low-wage workers. He estimated the bill would cover more than three times as many people as Enzi's bill (Los Angeles Times, 5/10).
The Bush administration issued a statement expressing support for the Enzi bill, saying, "The administration applauds efforts to find ways to lower costs by reducing unnecessary administrative complexity and expense, as well as to allow the opportunity for a health insurance market available across state lines, and will continue to work with Congress in this area" (CQ Today, 5/9).
Sen. Jim Talent (R-Mo.) noted that insurance policies for large employers already are exempt from state coverage requirements, adding that it is time to do the same for small employers (AP/San Francisco Chronicle, 5/9).
Tom Stevens, president of the National Association of Realtors, said, "It's good for America when you can create something that many people can take advantage of and it is something as meaningful and necessary as health insurance" (Wheeler, Tallahassee Democrat, 5/10).
Sen. Edward Kennedy (D-Mass.), ranking Democrat on the HELP Committee, praised Enzi for trying to help small businesses that cannot afford to buy health coverage for their workers. However, he said, "The course laid out in this proposal is the wrong one for health care. This bill will raise premiums when Americans are older or fall ill. It will mean the end of guaranteed coverage for cancer, for diabetes, for mental health coverage and other illnesses. It offers no real help for the self-employed" (CQ Today, 5/9).
Sen. Chris Dodd (D-Conn.) said he feared the insurance industry would offer plans that do not include childhood immunizations and other important services. He said insurance companies would also be allowed to increase premiums beyond what individual states now allow (AP/San Francisco Chronicle, 5/9).
Nathan Bush, New Mexico government relations director for the American Cancer Society, said, "This spells trouble for us. When you look at this bill and look at what benefits are going to be stripped from plans, we are very concerned that prevention and early detection benefits related to cancer screenings would be first ones to go" (Tallahassee Democrat, 5/10).
Several broadcast programs reported on the Senate debate on the bill:
- APM's "Marketplace": The segment includes comments from Amanda Austen, spokesperson for the National Federation of Independent Business; Beth Fuchs, an analyst with Health Policy Alternatives; and David Sloane, managing director of government relations and advocacy for AARP (Palmer, "Marketplace," APM, 5/9). A transcript and audio of the segment in RealPlayer are available online.
- KPCC's "Patt Morrison": The segment includes comments from Jerry Flanagan, health care policy director at the Foundation for Taxpayer & Consumer Rights, and Julie Rovner, health policy correspondent for NPR (Morrison, "Patt Morrison," KPCC, 5/9). The complete segment is available online in RealPlayer.
- NPR's "All Things Considered": The segment includes comments from President Bush; Senate Health, Education, Labor and Pensions Committee Chair Michael Enzi (R-Wyo.); Sens. Blanche Lincoln (D-Ark.) and Debbie Stabenow (D-Mich.); and Florida state Sen. Debbie Wasserman Schultz (D) (Rovner, "All Things Considered," NPR, 3/9). The complete segment is available online in RealPlayer.