Advocate: S. 1955 Is Not Just An AHP Bill

The third part of the S. 1955, the “affordable plans” section, would require the secretary of Health and Human Services to create “Benefit Choice Standards” for national health insurance benefit plans. Issuers of those plans, which could serve the individual, small-group or large-group markets, could ignore state benefits mandates as long as they also offered an “enhanced option,” according to the bill text.

The enhanced option plan would have to include the “covered benefits, services and categories of providers as are covered by a state employee coverage plan in one of the 5 most populous States as are in effect in the calendar year in which such enhanced option is offered,” according to the bill text.

The secretary of Health and Human Services would have to help insurers comply with the law by publishing annual descriptions of the state employee benefits plans in the 5 most populous states.

State insurance regulators would continue to have the authority to help consumers make insurers comply with the Benefit Choice Standards, according to the bill text.

Harmonization

The fourth section of S. 1955, the harmonization section, would require the secretary of Health and Human Services to work with a Health Insurance Consensus Standards Board to set national health insurance standards for form and rate filing; market conduct; prompt payment of claims; and internal claim review procedures.

The board would include 4 insurance commissioners; 2 governors; 2 state lawmakers; 4 representatives of health insurers; 2 representatives of health insurance brokers; 2 representatives of the American Academy of Actuaries; and a representative of the HHS secretary.

A separate advisory council that would advise the standards board would include 2 representatives of small business health plans; 1 representative of small employers; 1 representative of large employers; 2 representatives of health care providers; and 2 representatives of consumers.

States would have to allow the sale of health insurance policies meeting the new national standards.

Flanagan says the lack of consumer and employer representation on the standards board and the weak representation of consumers and employers on the standards advisory council are troubling.

In addition, even many groups that oppose some state benefits mandates might strongly favor mandates for benefits such as coverage for cancer testing and diabetes supplies, Flanagan says.

Insurance industry advocates of S. 1955 contend that the standards board system might adopt the most popular, most cost-effective mandates, such as those requiring coverage for certain types of screening tests and preventive care, while cutting mandates that provide only limited benefits and contribute to skyrocketing health coverage costs.

Advocates point to surveys showing that most U.S. residents are satisfied with the quality of their own health coverage and that they now are far more concerned about the cost of health coverage than about issues such as choice of physicians.

Requiring U.S. residents with beer budgets to buy champagne plans or no coverage at all is bad public policy, S. 1955 advocates argue.

Bill opponents, in turn, say few patients know enough about health care or health coverage to have any idea which plan features are frills and which features are basics until they become seriously ill.

Information about S. 1955 and links to information about the bill, including the original version of the bill, are on the Web at Document Link:

A copy of the new version of S. 1955 that was reported out of the Senate Health, Education, Labor and Pensions Committee in March is on the Web at Document Link

A summary of S. 1955 and other health finance reform bills written by analysts at the Robert Wood Johnson Foundation, Princeton, N.J., are on the Web at Document Link