The chairman of the U.S. Senate Committee on Health, Education, Labor and Pensions has come out with a 5-point proposal for shaping association health plan legislation.[@@]

President Bush has promoted the idea of developing a system of national association health plans that would give small businesses the freedom to escape from state benefits mandates that larger, self-insured employers now enjoy.

Many health insurers and state regulators oppose the AHP proposal, arguing that it would weaken the ability of state regulators to protect local customers of local health carriers, and that it would expose the carriers remaining in the state-regulated market to unfair competition.

Sen. Michael Enzi, R-Wyo., an AHP supporter, said last week in a speech on the Senate floor that Congress has to make an effort to see if the AHP concept will work.

“I am hearing an ever-growing chorus of concern from my constituents about health insurance – and most especially from small businesses,” Enzi said, according to a written version of his remarks printed in the Congressional Record. “America’s families and small businesses don’t want us to wait for the perfect solution or the perfect moment. They need real help, and they need it now.”

Enzi said talks about AHP reforms and other health system reforms should:

1. Harness the power of independent pooling, even if that means putting pressure on insurers. But Enzi said AHPs should be subject to regulatory and consumer protection requirements similar to those that apply to ordinary health insurers.

2. The current hodgepodge of state health insurance regulation should be streamlined.

3. Individuals and businesses should be able to buy lower-cost plans free of state benefit mandates.

4. Primary responsibility for most insurance oversight should remain with the state insurance commissions. “Our state commissions are much closer to the real problems confronted by purchasers of insurance in their communities than would be a federal agency in Washington,” Enzi said.

5. The focus of immediate efforts should be on efforts that do not require significant federal outlays.