Congressional Activity
Report
109th Congress
September 2006
Overview
Over the last several years, we have published a Voters’ Guide during
a general election year to aid our membership when going to the polls. Our
reports have focused on bills that affect, for better or worse, our legislative
priorities and principles. While the 109th Congress has introduced, examined,
and in some cases, debated legislative issues important to CAHI, there has
been very little activity in recorded votes or completed legislation. As a
result, and in lieu of a 2006 Voters’ Guide, we are providing this web-based
report that discusses some of the key pieces of legislation, which ones we
supported or opposed, and where they stalled (as most of them did) in the
legislative process.
HOUSE VOTES
H.R. 525, the Small Business Health Fairness Act
During Health Week 2005, the U.S. House of Representatives considered
a number of health related bills, including Association Health Plan (AHP)
legislation. The House AHP bill introduced by Rep. Sam Johnson (R-TX) would
preempt state laws under the Employee Retirement Income Security Act (ERISA).
Under this bill, AHPs would be defined under ERISA as group health plans whose
sponsors are trade, industry, professional chambers of commerce, or similar
business associations.
While Democratic support has slowly increased over the years,
support largely breaks on party lines. The Democrats were allowed a vote on
a substitute proposal. The substitute amendment offered by Rep. Ron Kind (D-WI)
would have required the Department of Labor to establish a Small Employer
Health Benefits Plan (SEHBP) similar to the Federal Employees Health Benefits
Plan (FEHBP).
July 26, 2005
The Kind (D-WI) amendment in the nature of a substitute, failed by a vote
of 197Y
to 230N.
The House passed H.R. 525 by a vote of 263
to 165.
H.R. 5, the Help Efficient, Accessible, Low-Cost,
Timely Health Care Act
This legislation would have limited noneconomic damages to $250,000 in medical
malpractice lawsuits; made each party in malpractice lawsuits liable only
for the amount of damages directly proportional to such party’s percentage
of responsibility; allowed courts to restrict the payment of attorney contingency
fees; and limited the liability of manufacturers, distributors, suppliers,
and providers of medical products that comply with Food and Drug Administration
standards. As with the AHP legislation, the bill easily passed the House largely
along party lines to meet an uncertain, though unlikely successful, fate in
the Senate.
July 28, 2005
The House passed H.R. 5 by a vote of 230Y
to 194N.
SENATE VOTES
S. 22, the Medical Care Access Protection Act
S. 22 is the Senate companion to the House medical malpractice legislation,
H.R. 5. Medical malpractice legislation is always controversial in the Senate,
requiring a cloture vote to proceed to consideration. Three-fifths majority
vote (60) would be needed to invoke cloture. As in the past, the Senate failed
to invoke cloture (cut-off debate) in order to vote on the measure.
May 8, 2006
The Senate failed to invoke cloture on S.22 by a vote of 48Y
to 42N.
S. 23, the Healthy Mothers and Healthy Babies Access
to Care Act
This bill is medical malpractice legislation focused on obstetrical and gynecological
services. Despite the narrow scope, all medical malpractice legislation in
the Senate is controversial. Three-fifths majority vote would be needed to
invoke cloture and proceed to consideration of the bill.
May 8, 2006
The Senate failed to invoke cloture on S.23 by a vote of 49Y
to 44N.
S. 1955, the Health Insurance Marketplace Modernization
and Affordability Act
S.1955 sponsored by Sen. Mike Enzi (R-WY), Chairman of the Senate Health Education
Labor and Pensions (HELP) Committee, was the Senate small business health
plan (AHP) bill. The House AHP bill would have allowed AHPs preemption of
state law and regulation under ERISA. The Senate regulatory harmonization
provisions would have relied on an unelected “Standards Board”
to established federal health regulatory standards that, if met, would have
allowed insurers and AHPs preemption from certain state regulations and laws.
The intent of the legislation was to provide small business
with more affordable health coverage options while allowing a “level
playing field” for insurers that wanted to offer the same options in
the small group marketplace. While the intent of the legislation was laudable,
the effect would have been a substantial move toward the federal regulation
of health insurance [CAHI's
Letter].
Sen. Enzi made a number of changes to the legislation in
the hope of attracting sufficient Democratic support to invoke cloture. Despite
his efforts, only two Democrats voted for cloture, Sens. Ben Nelson (D-NE)
and Mary Landrieu (D-LA).
May 11, 2006
The Senate failed to invoke cloture on S.1955 by a vote of 55Y
to 43N.
ADDITIONAL LEGISLATIVE ACTIVITY
The State High Risk Pool Funding Extension Act (P.L.
109-172)
After overcoming two Senate holds (parliamentary procedure that blocks legislation
from floor consideration), the State High Risk Pool Funding Extension Act
was signed by President Bush on February 10, 2006. The legislation extended
seed grant funding of $15 million for fiscal year (FY) 2006 and authorized
$75 million per year for operational grant funding for FY 2006 – 2010.
The Act increased the amount of funding authorized for operational grant funding,
created optional bonus grants, and changed the allocation formula. Eligibility
for operational grants was expanded to include eligibility for territories
and high risk pools that provide for the enrollment of eligible individuals
through an acceptable alternative mechanism that includes a high risk pool
as a component. Additionally qualified pools that charge more than 150% but
less than 200% of a standard premium are eligible for funding, provided 50%
of the grant money is used to reduce enrollee premiums. $90 million for FY2006
funding was provided in the Deficit Reduction Act.
The legislation was approved unanimously in both chambers;
hence there are no recorded votes on final passage. CAHI was proud and pleased
that a long sought after legislative goal was achieved and became law.
While funding was provided for FY2006, getting money appropriated
for FY2007 has proved challenging at best. We started at a disadvantage, since
money for the State High Risk Pool Grants program was zeroed out in President
Bush’s FY2007 Budget proposal. We have spearheaded support efforts through
a high risk pool sign-on letter [Senate
letter, House
letter], support letters from House Energy & Commerce Committee leaders
[House
Energy & Commerce Committee letter] and Senate members [Durbin-Hutchison
letter].
Senate Republicans where supportive of legislation enhancing
and extending the grants programs for state high risk pools. However, they
have been reticent to support funding for them. State high risk pools are
a critical safety net for sick individuals and are crucial to maintaining
a healthy individual insurance market. We hope to get some funding included
in any must-pass legislation this year.
H.R. 2355, the Health Care Choice Act
The Health Care Choice Act was introduced by Rep. John Shadegg (R-AZ) on May
12, 2005. The Senate companion, S.1015, was introduced by Sen. Jim DeMint
(R-SC). The legislation would allow individuals to purchase health insurance
coverage over state lines. It would require that the state law where the policy
is filed (primary state) would apply both in that state as well as any other
state (secondary state). Other consumer protections include requirements regarding
disclosure, fraud and abuse, prohibition against “bait and switch”
tactics, financial stability of the insurance company, and ensuring an independent
review mechanism for all who purchase coverage under the terms of this legislation.
There have been a number of hearings on this legislation
in the House (CAHI testified at two) and a few in the Senate. The House Energy
& Commerce Committee favorably reported the legislation on July 20, 2005.
It has been on the House Calendar since February 16, 2006. CAHI helped spearhead
an organizational sign on letter, signed by 53 organizations [Health
Care Choice Act support letter], addressed to House leaders and copied
to the entire U.S. House of Representatives. This effort was undertaken to
show support for the legislation and encourage the House leadership to schedule
the bill for a floor vote. Unfortunately, at this writing we are still waiting
for a floor vote, which may be scheduled in a lame duck session.
Health Savings Account Legislation
There have been numerous bills introduced in both the House and Senate related
to Health Savings Accounts (HSAs). CAHI has sent letters supporting the following
bills:
There have been congressional hearings (mostly in the House)
on these legislative initiatives. None of the bills have moved to committee
consideration and approval at this time. It is questionable whether committee
and floor action will take place in the waning days of the 109th Congress.
There have been congressional hearings on this issue, and the
House attempted to add hospital transparency provisions in the recently passed
health information technology legislation. The Bush administration has undertaken
efforts to make this information available for public plans, such as Medicare.
Again, while there has been much effort on the congressional and administrative
front, no legislation has been approved by committees or put to a congressional
vote. This underscores the strong hospital lobby that is strenuously resisting
efforts to make pricing information available to consumers.
Members of Congress acknowledge the pending entitlement meltdown
and the need to reform our entitlement systems. There was movement in this area
with the Medicaid reform and expansion of Long-Term Care Partnership Act. However,
the costs imposed by creating tax incentives to purchase long-term care insurance
seem to be an almost intractable hurdle to full congressional consideration.
