On Thursday, May 11, 2006, the Senate blocked legislation by a 55-43 vote that would have allowed health insurance plans to bypass all state insurance mandates, including prosthetic parity laws. The bill, S. 1955, the Health Insurance Market Modernization and Affordability Act, would allow small business to pool insurance risk across state lines also known as Association Health Plans (AHPs) and, skirt current state insurance laws and regulations.
State laws currently in place to establish parity between prosthetics and other rehabilitation care would be rendered useless, as would all state insurance laws, since the new plans would be federally regulated. Reducing health care costs for small businesses through AHPs has been one of the Bush Administration priorities, as mentioned in his most recent State of the Union Speech. This legislation was the centerpiece of the United States Senate Health Week in which Senate leaders brought multiple health-related bills to the floor, including two other bills on medical malpractice reform.
Under the Enzi bill, insurers would be permitted to sell plans to businesses and trade associations across state lines in a new class of group health insurance under federal regulations. Purportedly, the bill would allow lower-cost insurance options for small businesses and associations of individual citizens, such as national membership organizations, so that they could get group insurance rates. Critics of the bill stated that the bill would raise premiums for some purchasers since plans would begin charging more for groups with sicker enrollees, a violation of many state insurance laws. Additionally, because the legislation would allow health insurers to offer plans exempt from state mandates to any entity, not just AHPs, many fear that access to comprehensive care would be compromised for the general population.
For orthotic and prosthetic coverage, the situation is similar. All health insurers could create basic option and enhanced option health plans. Basic option plans would only need to meet a minimum set of federal standards. Such a basic option would leave insurers with the option to exclude coverage of orthotic and prosthetic services. Health insurers offering the basic option would also have to offer an enhanced option based on the set of benefits from one of the five most populous states: California, Florida, Illinois, New York and Texas. Because not all five of the most populous states require coverage of orthotic or prosthetic services, an insurer could choose to forego coverage of orthotic and prosthetic care in the enhanced option as well.
Furthermore, the Senate bill could increase the number of underinsured individuals. Beneficiaries may have greater access to insurance overall, but would not be protected by state benefit mandates for medically necessary services, such as orthotic and prosthetic care. With respect to other insurers, insurance sponsors would be free to create plans that offer a low premium in exchange for minimal benefits.
NAAOP took an active role within the disability community and in the Orthotic and Prosthetic Alliance by sending two major letters to Congress expressing their opposition to the legislation. The first letter from the Alliance, a group representing the major O&P associations: AAOP, ABC, AOPA, and NAAOP, outlined specific concerns with the legislation and how it would impact all enrollees overall, as well as those with orthotics and prosthetics. With the support of NAAOP, the Consortium for Citizens with Disabilities also sent a letter outlining many of the same concerns, but from a disability organization perspective.
The political future of the legislation is not promising. Health care observers dubbed this week as the best chance yet for Association Health Plan legislation to pass. But even a potential compromise bill that would have preserved some state coverage mandates failed on account of opposition from the small business community. Though there is support in the House of Representatives for a similar bill, it would likely be stymied by the same forces that derailed the Senate bill. The likelihood of the legislation being enacted this year is slim, but the debate is not over as Democratic and Republican leaders continue to seek a compromise. NAAOP will continue to monitor and report as necessary.
THE NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF ORTHOTICS AND PROSTHETICS
Your Voice for Professional O&P Patient Care
Founded in 1987, the National Association for the Advancement of Orthotics and Prosthetics, NAAOP, exists because of the need for a strong presence in O&P healthcare legislation and regulation. Through this presence, we advocate for the millions of people with amputations, limb differences, and orthopedic impairments, as well as the providers who serve their O&P needs. NAAOP is a strong voice that represents all constituents in the comprehensive O&P patient care process. We represent the individual clinicians, fitters, technicians, clinician owners, and select manufacturers (those dedicated to advanced O&P technologies and outcomes) for the benefit of the patients they collectively serve.