Health insurance could be debate issue

WASHINGTON -- Now gaining momentum in Congress, a plan to vastly expand small businesses' ability to pool together to buy cheaper health insurance has prompted a skirmish in Missouri's U.S. Senate race.

At issue is legislation to place the pooled plans under federal law, which by necessity would pre-empt state laws where such plans are currently available.

Small business groups and their allies in Congress have tried for years to federalize so-called Association Health Plans to give small companies the buying power and lower premiums of Fortune 500 companies. While the House approved AHPs last year in its patients' rights bill and President Bush has endorsed the idea, AHPs have faced rougher waters in the Senate, although Sen. Kit Bond, R-Mo., recently signed onto the effort by sponsoring AHP legislation.

"We have 40 million uninsured in this country, and 24 million of them are either employees of small business or their family members," Bond said Wednesday. "It's children, it's moms, it's people who are in working families who can't get health insurance because a small business doesn't have the ability to spread the administrative cost."

Interests on both sides of the patients' rights debate -- those seeking more extensive rights to sue as well as big insurance companies -- are battling the AHP measure.

On Wednesday, the Blue Cross and Blue Shield Association unveiled a study it commissioned that warns of fraud and abuse problems that could result in millions of dollars in unpaid claims.

Talent for AHPs

Republican Jim Talent championed AHPs while serving in Congress, where he chaired the House Small Business Committee. His legislation drew fire last week from Democratic Sen. Jean Carnahan's campaign, which said, "Jim Talent opposed efforts to protect patients from HMO abuses."

The criticism was part of a written rebuttal issued Friday to pro-Talent television commercials airing throughout Missouri.

Carnahan's campaign detailed her work on health care issues, then thumped Talent for his AHP bill and for his vote against a 1999 patients' rights bill that he said exposed small employers to too much liability.

"Talent sponsored legislation that would allow HMOs and insurance companies to sidestep Missouri's patient protection laws," her campaign statement said. "Special interest groups hired Jim Talent as a paid lobbyist to push this legislation. Missourians need a senator who will stand up to big insurance companies and HMOs to ensure adequate patient protections."

But Carnahan seemed to soften her criticism in comments Monday by her Senate spokesman, Tony Wyche, to the St. Louis Post-Dispatch. The spokesman said Carnahan didn't want Missouri's strong patient protections weakened by federal law, but he said she was studying Bond's bill.

That's true, she told a reporter on Tuesday.

"I want to look it over to see if it can be done," she said, adding that she likes the idea of letting small businesses pool together so long as it doesn't supersede state law. Carnahan indicated she had not seen her campaign's criticism; she was traveling last Friday to New York for a Democratic issues conference.

Later Tuesday, her spokesman said staff had subsequently reviewed Bond's bill and that Carnahan would not support it.

"The threshold is, does it weaken Missouri's current, very strong patient protections," and by putting this all under the federal Employee Retirement Income Security Act, it would, Wyche said.

The same concern kept Bond from supporting the AHP measure for several years, but he argues now the concern is overshadowed by small businesses' health insurance needs. The pooled plans would be governed by federal law and, like large multistate employers, be shielded from most patient lawsuits brought in state courts, which are known for consumer-friendly rulings and generous jury awards.

Asked for comment, Talent's campaign seized the opportunity to call for a debate with Carnahan, which he has done repeatedly over the past month. Carnahan has said she would like to debate in the fall, after party primaries and when voters are paying more attention.

Talent was traveling and could not be reached Wednesday, but his campaign manager, Lloyd Smith, said the issue "illustrates the need for debates and candidate forums."