Thursday, March 23, 2006

A Dangerous Bill

This week, while listening to diabeticfeed, I discovered the status of a truly frightening piece of legislation:

The "Health Insurance Marketplace Modernization and Affordability Act" or "S. 1955."

It wasn't the first time I'd heard of this bill. Back in November, I'd read a disturbing article that outlined some of the devastating consequences of S. 1955-- a bill that supporters believe will help more Americans gain access to health insurance.

In reality, should this bill become law, it would jeopardize health insurance coverage for diabetes medicine, supplies, screening tests...

In other words, everything my son needs to stay alive and healthy.

Needless to say, I worried about this thing for weeks-- imagining what would happen if my son's pump, test strips, insulin were no longer covered by insurance.

If regular visits with the endocrinologist, annual eye exams, tests for thyroid, celiac, kidney dysfunction-- were all no longer covered.

But wait, under this new legislation surely there would be some kind of health insurance that would cover all of these things?

There had to be.

Yes, in fact there would be (in some cases) options--but options with high deductibles and no premium restrictions.

God knows what we'd be paying for insurance if this bill became law. What my son would be forced to pay-- if in fact, he could afford it-- down the road.

And what if he had nothing?

Yeah, this bill scared the hell out of me.

So what did I do about it?

I forced the damn thing right out of my mind, because there was just no way something that reprehensible could pass in this country.

Maybe S. 1955 could pass in 1955.

But not in 2006.

Well, last week, S. 1955 passed by an 11-9 vote in the Senate Health, Education, Labor and Pensions (HELP) Committee.

What this means is that S. 1955 (unlike so many bills that never make it out of committee) will be voted on by the full Senate.

And what happens if this piece of legislation makes it to the White House?

Do you think President Bush will veto it? A bill that will dramatically cut costs for health insurers? For business owners? Corporations?

Pointless questions, I know.

So, we've got to do something.

Today, I found an excellent post on this very issue that outlines ways in which we can all act. Please go and check it out.

And call or email your Senator.

Or go to the ADA website , or call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) to find out other ways in which you can make your voice heard.

If you're a blogger, post about this thing. Help make more people aware of what's at stake.

And for those of you reading who do not have diabetes, who don't have a child with the disease, please consider this:

It's not just my son's future we're talking about here. Not just the millions of Americans who struggle with diabetes each and every day.

S. 1955 would affect, not only diabetics, but everyone.

Please read the following letter as it gives a sense of how this bill will impact you and your family:

March 7, 2006

Dear Senator:

The undersigned organizations are writing in opposition to the Health Insurance Marketplace Modernization and Affordability Act of 2005, S. 1955. This controversial legislation would preempt state insurance laws, not just in the small group market (as is done by Association Health Plan legislation), but also in the individual and large group markets. S. 1955 would thwart years of state efforts to make sure that consumers have adequate health coverage.

S. 1955 would take away the states’ autonomy to regulate health insurance. The bill preempts state benefit, service and provider laws that states have enacted to ensure that consumers have adequate health coverage. Cancer screenings and treatment, diabetes supplies and education, mental health, preventive care, rehabilitation, well-child care and immunizations, maternity care, and other vital benefits and protections would be lost. S. 1955 also exempts Small Business Health Plans (SBHPs, also known as AHPs) from state benefit, service and provider access laws.

Insurance companies, instead of state-elected legislators, would now decide the benefits that consumers should have when they purchase health care. States would have no recourse to protect their own residents and they would lose their incentives to enact laws in the future and be laboratories for healthcare innovation.

An insurer would only need to meet one requirement in order to bypass a state’s protections: offer a second plan that resembles one offered to state employees in one of the five most populous states, a requirement that allows an insurer to choose a high deductible/HSA plan that can require a family to pay as much as $5000 out-of-pocket (after paying premiums), before coverage kicks in. Again, a state has no recourse if the plan does not meet the needs of its residents.

S. 1955 also would preempt stronger state laws that limit the ability of insurers to vary premiums based on health status, age, gender and geography. For many older, sicker Americans and those with complex health needs and disabilities, this would price them out of the health insurance market, undermining the stated purpose of the legislation. The bill imposes on all the states an outdated model law created by the National Association of Insurance Commissioners (NAIC), rather than using the NAIC’s current model standard that is more protective.

A bill that preempts over 1000 state laws should warrant review before it is moved quickly through the Health Education, Labor and Pensions (HELP) Committee and considered on the Senate floor. There is no evidence that this bill will lead to more affordable coverage or increase the number of Americans with adequate health insurance. As we have found through analysis of the federal AHP legislation, a proposal that purports to provide more affordable and expanded coverage sometimes can fail to do what it claims and even make existing access and cost problems worse.

While the sponsors of S. 1955 have made a sincere effort to address shortcomings of the AHP legislation, their solution makes things worse by endangering the quality of health care for the 68 million Americans in state-regulated group health plans and 16.5 million with individual coverage. We urge your opposition to this legislation.


American Academy of Child & Adolescent Psychiatry
American Academy of Pediatrics
American Academy of Physician Assistants
American Association of People with Disabilities
American Diabetes Association
American Federation of State, County and Municipal Employees
American Chiropractic Association
American Federation of Teachers
American Nurses Association
American Pediatric Society
American Podiatric Medical Association
American Psychological Association
Arc of the United States
Association of Medical School Pediatric Department Chairs
Bazelon Center for Mental Health Law
Brain Injury Association of America
Communications Workers of America
Department for Professional Employees, AFL-CIO
Families USA
Guttmacher Institute
International Association of Machinists & Aerospace Workers
International Brotherhood of Electrical Workers
International Longshore & Warehouse Union
International Union of Painters and Allied Trades
National Association of Social Workers
National Disability Rights Network
National Family Planning and Reproductive Health Association
National Mental Health Association
National Spinal Cord Injury Association
National Partnership for Women & Families
National Women's Law Center
Planned Parenthood Federation of America
Small Business Majority
Society for Pediatric Research
United Cerebral Palsy
United Steelworkers International Union (USW)

[Emph. added]


Megan said...

I saw this on the insulin-pumpers mailing list. It's very scary indeed. Luckily, thanks to the attention being brought to it by people like Sandra, it seems to be getting a lot of opposition. That is quite the list of organizations.

art-sweet said...


I will put this up on my blog as well - should infuriate the infertility crowd as well, I imagine.

and the letter writing commences tonight.

ScW said...

Actually, it isn't as quite like you think it is. In some ways, insurance is already like this. For large companies that are able to afford being "self-insured", their plans are generally not governed by state laws anyway. I looked at this when I worked for my previous company and was having trouble getting adequate coverage for my son's pump. ERISA is the problem there. Georgia's State Insurance Comissioner's office was ready to jump all over them until it turned out my company was "self-insured" and therefore governed by ERISA.

Here is my slightly more detailed description of the problem with ERISA. So for what it's worth, I doubt this law would have much impact on your insurance since most folks are already covered by insurance governed by ERISA so they are already able to "bypass" those state laws. The only thing the state laws are doing is hurting smaller businesses who can't self-insure.

If the playing field isn't level, though, I don't think the answer is to lighten it up on the issue. On the contrary, we ought to have a law that doesn't allow ERISA governed insurance the ability to so easily side-step what a majority of the states demand.

Sandra Miller said...


While I agree that insurance plans governed by ERISA alone are woefully inadequate (because they allow very large companies to avoid state laws governing insurance coverage-- offering no guarantee for coverage of anything related to diabetes), I cannot agree that "the only thing the state laws are doing is hurting smaller businesses who can't self-insure."

My husband works for a medium-sized company-- one that does not "self-insure." In other words, like many small to mid-size companies, they purchase an HMO through a large insurance carrier.

And because my son is not covered by a "self-insured" plan, state laws do govern what coverage he receives. As a result, 80% of the cost of his insulin pump was covered by our insurance.

I just can't believe the answer here is to level the playing field by making it possible for all insurers to side-step state regulations.

To make all families with diabetic children, for example, experience the same frustrations you have in trying to get an insulin pump for their child.

Rather than taking away protections, wouldn't it make more sense to require that those very large companies comply with state laws governing coverage?

ScW said...

Actually, Sandra, that's essentially what I was saying when I said "On the contrary, we ought to have a law that doesn't allow ERISA governed insurance the ability to so easily side-step what a majority of the states demand." I guess what I was saying was that we need to revise ERISA so that the self-insured companies can't side-step state laws. So really we're in agreement on that.

I think the only difference here is that I am not so sure that this federal law is going to make as big an impact as people think it will. It might be more for show (i.e. "look we're 'working' to make healthcare more affordable"). I'd have to study the law more to see if it really has that much authority to actually override the state laws or not. Regardless, I'll still work for the law not to be passed. I'm just not sure it's the crisis that the ADA is making it out to be.

julia said...

The ADA is making it a crisis in order to get people to act. How many would have called/emailed their senators if the ADA was saying "Well, you know, this could be a bad thing, we're really not sure, so if you want to take action, go ahead." No one would do jack.

I emailed both of my senators. I never get an answer from John Kerry, but Ted Kennedy always sends me something - a form reply, I know, but at least I know his office got the email.

I'll post about this today, too.

Penny said...

I also posted this on my blog last night and referred people to your blog and to Nicole's blog.

I have emailed both of my senators numerous times. I always get a nice letter in the mail a few weeks later from Senator Burr (be it a form letter). But, I never get a response from Senator Dole.

Nicole P said...

It's not only the ADA making a 'crisis' of it, it's over 35 well-respected health and wellness organizations from across the country. I'd venture a guess that these groups have had their legal departments study the law and that they see the damage it might do. Perhaps it's not this particular piece of legislation that makes for disastrous consequences for people with chronic illnesses and their families; but the precedent it sets - the loopholes it creates.

And Julia makes an excellent point. These organizations are trying to get people to DO something. And it seems to be working.

Kennedy actually voted opposed in committee; Kerry's office assured me the Senator would oppose this legislation. It looks like this is one that will split down party lines; hopefully, there will be some Republican Senators that split from the party and make a difference in the full-Senate vote.

As a side note, a friend of mine works at Senator Clinton's office and she's told me on more than one occasion that the number and position of constituents that call, write, or visit on an issue is something that legislators share - so, although I know that contacting your Republican Senators may be more important in this case, I still think it's just as important for those of us with Democratic legislators to make calls, write, etc.

Vivian said...

I posted about this a while back but not in the detail that you did and really no one cared. I guess I need to be more detailed about my posts. Thanks for doing this, it looks like you have gotten quite a response. If we lose coverage for Daniel or my husband we are sunk. You know what it costs for Daniel, my husbands meds are about $1300 dollars a month, just for his shots. We have to make sure this gets shot down! It will only open the door for so much more.

Anonymous said...

I hope lots of people with blogs of their own will spread the news. This is truly an awful bill, and it definitely scares me that so many Americans would have to go back to cutting corners to afford their diabetes treatment supplies. I hope everyone reading this contacts their Senator.

Megan said...

I e-mailed my senetors, but I was wondering where you found the code for the button you put on your blog? I would like to add it to my blog and website.

Anonymous said...

I have written to Sen Burr and Dole of North Carolina. I wrote both of them when the bill came out of the HELP committee with a 11-9 nay vote. Shortly after the bill came out of the HELP Committee, Senator Burr added his name to the co-sponsor list. Burr is strictly a pro small business Senator but we in North Carolina need to continue to urge him to vote NO on SENATE BILL 1955.
Senator Dole has yet to respond on any of the emails I have sent her. Again we , in North Carolina, need to continue to write our Senators..I have even written to our Governor who should be opposed to this bill as it is treading on States Rights.
I am a diabetic, mental health consumer, leg amputee and various other physical problems, Darn right this bill would harm all of America and anyone foolish enough to think that this bill will not harm anyone, think again and read this bill in it's entirety.

Danny Haszard said...

Appreciate your blog,mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it's Zyprexa product causing my diabetes.--Daniel Haszard