Battle Over AHPs Gets Intense

He also said it is "really hard to tell at this point" if the bill has the votes to pass the Senate.

Enzi said he is still working to craft a compromise "with all stakeholders that would bridge the differences" critics have with his bill.

Enzi also admitted that one major concern of Democrats on the edge is that if they support the moderate Senate bill, that in a conference to mesh the bill with one calling for greater pre-emption of state regulators and other tougher provisions, language from the stronger–and unacceptable–House bill would prevail. "That is the way I read it," he said, conceding there are a "lot of differences between the House and Senate bills."

Countering Enzi, Nelson and the NFIB, AARP, the American Cancer Society and the American Diabetes Association scheduled a press conference for April 27 to announce they are working together to defeat the bill.

The groups said the Senate bill "could make health care coverage more expensive for sicker or older workers and could eliminate important health screenings for cancer, diabetes and other life-threatening or chronic illnesses."

The three groups also said they were preparing joint national advertising that will help educate voters about the "negative effects" of the bill, which they said, "among other things, could make it harder for workers age 50 and older to get a job that provides health insurance."

In addition, health advocates worry about the long-term effects this bill will have on people's health, as it pre-empts many state-mandated health benefits such as mammography, cancer screenings, emergency care, mental health services, and diabetic supplies and education, the three groups said.

The bill would allow small businesses to work through their national trade associations (such as the National Association of Realtors and the National Federation of Independent Businesses) across state lines to form larger "pools" of people, the three health groups said. The businesses could then purchase health insurance for their workers free of important state regulation.

"By doing so, Congress would partly undercut the states' traditional role of regulating the business of insurance, such as setting requirements for what benefits should be covered and how insurance should be priced," the groups said. "The bill would let insurance companies sell health policies that do not meet state requirements, such as fairness in pricing for those who are older and those who are sicker."

AARP CEO Bill Novelli said, "While it is a laudable goal to make health insurance more accessible and affordable for small businesses, the Health Insurance Marketplace Modernization and Affordability Act does so by giving these businesses an incentive to avoid hiring or retaining sicker or older workers."

American Cancer Society CEO John R. Seffrin said, "Most states also require insurers to provide important health screenings and supplies. If this bill passes, state regulation would be pre-empted and many would lose important health benefits."

American Diabetes Association CEO Lynn Nicholas said, "Forty-six states currently require state-regulated insurers to cover diabetes supplies, medication and treatment. S. 1955, however, would allow small business health plans to bypass these vital coverage regulations. This would be devastating to millions of Americans with diabetes to whom this assurance of coverage has been a lifeline, not a luxury."

The bill will be coming to the Senate floor against the background of a new report that says the percentage of working-age Americans with moderate to middle incomes who lacked health insurance for at least part of the year rose to 41% in 2005, a dramatic increase from 28% in 2001.

Moreover, more than half of the uninsured adults said they were having problems paying their medical bills, with 20% of working adults paying off medical debt–often $2,000 or more, according to the report by the Commonwealth Fund, a New York-based private health care policy foundation.

The study of 4,350 adults also found that people without insurance were more likely to forgo recommended health screenings such as mammograms than those with coverage, and were less likely to have a regular doctor than their insured counterparts.

The report paints a bleak health care picture for the uninsured.

"It represents an explosion of the insurance crisis into those with moderate incomes," said Sara Collins, a senior program officer at the Commonwealth Fund.

Collins said the study also illustrates how more employers are dropping coverage or are offering plans that are just too expensive for many people.