S 1955 "The Lose Your Benefits Bill"

Oppose the "Lose Your Benefits Bill," otherwise known as the Health Insurance Marketplace Modernization and Affordability Act (S. 1955)(HIMMAA), which would result in nullifying state laws that protect insurance benefits.

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Oppose the Bill that Jeopardizes Diabetes Insurance Coverage for Millions of Americans

You might have heard about the bill, S. 1955 or "Health Insurance Marketplace Modernization and Affordability Act", which could leave millions of Americans with diabetes without insurance coverage for their diabetes education, equipment, and supplies.

The American Diabetes Association is asking for your help to lobby Senators and secure their opposition to S. 1955 in its current state.

Full Story

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S. 1955 Pork Barrel Legislation for the Benefit of National Associations

The reality about Health Insurance Marketplace Modernization and Affordability Act (S. 1955) is that national associations, such as see list below, support it because they all want a piece of the health care premium flow. At the end of the day these organizations are not acting in the best interest of their consituents, but in the their own interests. It is all about money, isn't it always in Washington?

The local associations and local health plans oppose it because they'll be left out of the initiative. Sounds like a big land grab to me and another attempt to undermine the Federalist System.

ABL - America's Beer, Wine and Spirits Retailers
Adhesive and Sealant Council
Air Conditioning Contractors of America
Alliance of Automotive Service Providers
American Alliance of Service Providers
American Apparel & Footwear Association
American Association for Medical Transcription
American Association of Advertising Agencies
American Association of Engineering Societies
American Association of Small Property Owners
American Bakers Association
American Composites Manufacturers Association
American Concrete Pumping Association
American Council of Engineering Companies
American Disk Jockey Association
American Electronics Association
American Fence Association
American Foundry Society
American Home Furnishings Alliance
American Hotel and Lodging Association
American Institute of Certified Public Accountants
American Institute of Chemical Engineers
American International Automobile Dealers Association
American Land Title Association
American Lighting Association
American Nursery and Landscape Association
American Rental Association
American Road and Transportation Builders Association
American Small Businesses Association
American Society of Association Executives
American Society of Civil Engineers
American Society of Mechanical Engineers, Board on Member Interests & Development
American Staffing Association
American Veterinary Medical Association
American Wholesale Marketers Association
AOMAlliance
Associated Builders and Contractors
Associated General Contractors of America
Associated Prevailing Wage Contractors
Association for Manufacturing Technology
Association of California Water Agencies
Association of Ship Brokers and Agents (USA), Inc.
Automotive Aftermarket Association Southeast
Automotive Parts & Services Association
Automotive Service Association
Automotive Undercar Trade Organization
Automotive Wholesalers Association of New England
Bowling Proprietors' Association of America
Broydrick & Associates
California Society of CPAs
California/Nevada Automotive Wholesalers Association
Central Service Association
Centre for New Black Leadership
Chesapeake Automotive Business Association
Christian Schools International
Cleveland Automobile Dealers Association
Club Managers Association of America
Coca-Cola Bottlers' Association
Communicating for Agriculture
Construction Management Association of America
Consumer Specialty Products Association
Deep South Equipment Dealers Association
Electronics Representatives Association Insurance Trust
Farm Equipment Manufacturers Association
Financial Executives International
Financial Planning Association
First Health Group Corporation
Food Marketing Institute
Gas Appliance Manufacturers Association
GrassRoots Impact
Hearth, Patio and Barbecue Association
Hispanic Business Roundtable
Independent Electrical Contractors
Independent Office Products & Furniture Dealers Association
International Association of Professional Event Photographers
International Foodservice Distributors Association
International Foodservice Distributors Association
Iowa Automobile Dealers Association
Latino Coalition
Maine’s Software and Information Technology Industry Association
Mason Contractors Association of America
Material Handling Equipment Distributors Association
Midwest Automotive Industry Association
Midwest Equipment Dealers Association
Motor & Equipment Manufacturers Association
NAMM, the International Music Products Association
National Association for the Self-Employed
National Association of Chemical Distributors
National Association of Community Health Centers
National Association of Computer Consultant Businesses
National Association of Convenience Stores
National Association of Home Builders
National Association of Manufacturers
National Association of Mortgage Brokers
National Association of Mutual Insurance Companies
National Association of Plumbing-Heating-Cooling Contractors
National Association of Realtors
National Association of Theatre Owners
National Association of Water Companies
National Association of Wholesaler-Distributors
National Association of Women Business Owners
National Automobile Dealers Association
National Automobile Dealers Association
National Black Chamber of Commerce
National Burglar & Fire Alarm Association
National Club Association
National Concrete Masonry Association
National Court Reporters Association
National Federation of Independent Business
National Franchisee Association
National Funeral Directors Association
National Lumber and Building Material Dealers Association
National Newspaper Association
National Office Products Alliance
National Portable Storage Association
National Ready Mixed Concrete Association
National Rental Association
National Restaurant Association
National Retail Federation
National Roofing Contractors Association
National Spa and Pool Institute
National Sporting Goods Association
National Systems Contractors Association
National Tile Contractors Association
National Tooling & Machining Association
National Utility Contractors Association
Nebraska New Car and Truck Dealers Association
New York State Automotive Aftermarket Association
North American Die Casting Association
North American Equipment Dealers Association
North American Retail Dealers Association
North Dakota Automobile and Implement Dealers Association
Northeastern Retail Lumber Association
Office Furniture Dealers Alliance
Ohio Valley Automotive Aftermarket Association
Outdoor Industry Association
Owner-Operator Independent Drivers Association
Pennsylvania Builders Association
Piano Technicians Guild
Precision Machined Products Association
Precision Metalforming Association
Printing Industries of America
Printing Industries of Maryland
Professional Detailing Technicians Association
Professional Golfers' Association of America
Professional Photographers of America
Retailers Bakery Association
Self Insurance Institute of America
Service Station Dealers of America And Allied Trades
Small Business & Entrepreneurship Council
Snack Food Association
Society of American Florists
Society of Professional Benefit Administrators
Society of the Plastics Industry
Southeastern Farm Equipment Dealers Association
SouthWestern Association
Specialty Equipment Market Association
Student Photographic Society
Textile Rental Services Association of America
The American Institute of Architects
The National Precast Concrete Association
Tire Industry Association
U.S. Chamber of Commerce
U.S. Hispanic Chamber of Commerce
U.S. Pan Asian American Chamber of Commerce
United States Federation of Small Businesses
Virginia Bankers Association
Washington Area New Automobile Dealers Association
Western Growers Association
Wisconsin Automobile & Truck Dealers Association
Women Impacting Public Policy
World Wide Insurance Services

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Enzi Health Insurance Legislation Jeopardizes State Diabetes Protections and Harms People with Diabetes

The American Diabetes Association is committed to expanding insurance coverage for people with diabetes, and to ensuring that such coverage meets their health care needs. A critically important component of this effort has been passage of state laws that require insurers of state-regulated health plans to provide adequate coverage for diabetes supplies, medication, equipment and education. Today, 46 states and the District of Columbia require such coverage, but these provisions would be undermined by the Health Insurance Marketplace Modernization and Affordability Act (S.1955), legislation currently under consideration in the Senate.

State Diabetes Laws Should Be Protected

• 20.8 million Americans have diabetes and that number is growing at 8 percent each year.
• Diabetes is a serious disease that can lead to serious complications – in fact; it is a leading cause of blindness, lower limb amputation, heart disease and kidney failure. With proper management, including constant blood sugar monitoring, the risk of these complications can be significantly reduced. It is therefore essential that people with diabetes have access to the appropriate tools to do their testing on the schedule recommended by their doctor. Many people with diabetes need to test 8 to 10 times per day.
• A vast majority of state legislatures have recognized the importance of guaranteeing coverage for diabetes supplies and education and have passed laws that provide this coverage to residents in state-regulated health plans. Currently, only Alabama, Idaho, North Dakota, and Ohio lack these coverage protections.
• The laws enacted in 46 states and the District of Columbia cover roughly 5.7 million Americans, which is approximately the entire population of Tennessee.
• The cost of diabetes benefit protections on health insurance premiums has been studied by numerous states and has proven to have an insignificant effect on the cost of monthly health insurance premiums. Louisiana, for example, found that their state diabetes requirement accounted for a mere .006% of monthly premiums.1 In Utah, after conducting a comprehensive analysis of that state’s diabetes mandate,2 legislators chose to strengthen their state law, doing away with a sunset clause that would abolish the diabetes requirement if they found the cost too burdensome.

Under S. 1955, millions with diabetes could lose existing health coverage protections

• S. 1955 would affect not only small business health plans, but the entire state-regulated health insurance market, including individual health insurance policies and small group health plans.
• Under the proposed legislation, all people with diabetes covered under state-regulated health insurance plans would be in jeopardy of losing their diabetes coverage protections. Insurers will be able to offer a low-cost health plan to employers or individuals that exclude one or more state health care requirements, such as coverage for diabetes supplies, education, and training. In addition, when a low-cost plan is offered, insurers must also provide employers and individuals the option to purchase a second health plan that is based on one of the state employee health plans from one of the five (5) most populous states; these employee health plans do not require or guarantee diabetes coverage.
• This proposal takes away the right of states to govern health plans and to determine important health care coverage that their residents should be able to receive.
  

For people with diabetes, it is not always true that having some insurance is better than no insurance

• Last year, the American Diabetes Association released a report that sheds some light on what we can expect coverage to look like if S.1955 were enacted. According to the Association’s report, Falling Through the Cracks: How Health Insurance Can Fail People with Diabetes, having access to adequate health insurance coverage is as important as finding affordable coverage for people with diabetes.
• Many people will be transferred from their state-protected diabetes coverage to policies that may not cover their vital diabetes needs. As a result, patients will not only have to pay all of their out-of-pocket costs for their life-sustaining diabetes supplies and medications, but they will also have to pay insurance premiums for the privilege. Essentially, they will have to pay to be uninsured for diabetes care.
• As the ADA report shows, many patients in this type of situation are forced to reduce the number of times they check their glucose levels so as to ration their test strips, often times leading to hospitalization for high-cost complications. This never ending cycle also forces many people with diabetes and other chronic disease into bankruptcy. In fact, the New York University Law Review found that medical bills are the single leading factor contributing to personal bankruptcy in the U.S.3
• Studies have also shown that coverage for the care and treatment of diabetes not only reduces the costs of diabetes, but also improves the lives of those affected by the disease. For example, research has shown that appropriately managing diabetes can save employers an estimated 16.1 annual [disability] days for diabetes4 and that mean total health care costs can be reduced by as much as $950 a year for adult patients with diabetes who are able to sustain a reduction in their hemoglobin A1c. These significant cost savings can be seen within only one to two years of improvement5.
  

Making a Difference: What Congress can do

The Association is deeply concerned about the impact of S. 1955 on people with diabetes, as well as on larger societal costs. As a result of this legislation, persons with diabetes will be unable to successfully manage their disease, and will inevitably develop debilitating and destructive complications. The societal effect will be a drastic rise in the cost of diabetes to this country, which was $132 billion in 2002.

America’s health insurance crisis will not be solved through a reduction in the quality of health coverage for millions of Americans. The American Diabetes Association (ADA) believes that all people with diabetes should have health insurance coverage comprised of three necessary components: availability, affordability, and adequacy.

The American Diabetes Association calls on Members of Congress to:

• Oppose S. 1955, the “Health Insurance Marketplace Modernization and Affordability Act”
• Support legislation that protects and expands access, affordability, and adequacy of health coverage.

1 Louisiana Department of Insurance. A Study of the Costs Associated with Healthcare Benefits Mandated in Louisiana. February 28, 2003. 2 Utah Insurance Department, 2003 Diabetes Mandate Report, October 28, 2003.
3 Jacoby, M. B., Sullivan, T. A. and Warren, E., “Rethinking the Debates over Health Care Financing:
Evidence from the Bankruptcy Courts,” New York University Law Review, Volume 76, Number 2, May
2001: 375 – 415
4 Health Economics. 5(3): 249-265. May-June 1996
5 Journal of American Medical Association, 285:182-189, 2001

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S. 1955: Claims Don't Meet Reality - Studies Cited by S. 1955 Proponents

STUDIES CITED BY S. 1955 PROPONENTS

Claim: S. 1955 will decrease the number of uninsured Americans by 8 percent, according to a new study.

Reality: The recent Mercer study of S. 1955 does not mention the number of older, sicker and more vulnerable individuals who will be priced out of coverage due to the preemption of state laws that limit price discrimination. Nor does the study mention the millions of American who may become underinsured as a result of S. 1955’s sweeping elimination of current state requirements that health insurance cover basic services (such as diabetes care, mental health care, home healthcare, hospital care following a mastectomy, rehabilitation care following accidents, prescription drugs, chemotherapy and others).

The study notes the bill’s intent to allow insurance companies an unlimited ability to charge higher premiums to small businesses based on their employees’ “age, gender, geographic area, family composition, group size and participation in wellness programs.” Any gains in coverage among those who are young, healthy and male will be at the expense of those who need health coverage the most. Furthermore, newly covered individuals will remain at risk if they purchase inadequate coverage. Research shows medical bills are the leading cause of personal bankruptcy in the U.S. and many of these filers have health insurance.

Even if we accepted the Mercer study’s estimate of the number of people who would gain coverage, it represents only 2.2 percent of the 45 million uninsured, while all Americans with state-regulated coverage would find their insurance less secure and more expensive when they need it most. The 8 percent figure cited by the bill’s proponents is based on only a subset of the uninsured.

Claim: Premiums will drop by 12 percent under S. 1955, a savings of about $1000 per employee, according to a new study.

Reality: The actual study never claims that the bill saves $1000 per employee. The study presents its findings in the aggregate, which is highly deceptive and masks the real and negative impact the bill will have on those who need health care the most. The report itself admits that the “magnitude of decreases will vary significantly by state. The premium decreases will be modest in states that already have adopted rating regulations equal to or broader [less protective] than those contained in the proposed legislation.” For states that have put in place stronger protections for those who are older, or facing chronic and complex health conditions, women of childbearing age, or very small businesses, premiums will go up. The primary savings from the bill accrue to small businesses that employ young and healthy workers and are located in states that historically have chosen to protect the most vulnerable but who won’t be able to enforce those protections under this bill. While some in those states will see lower premiums, those who need health coverage the most will see their rates rise.

Claim: State mandated benefits add between 5 and 22 percent to the cost of health care, according to the GAO.

Reality: The 1996 GAO report, cited by S. 1955 supporters, looked at the impact of state benefit requirements on total claims, not on the impact the requirements have on premiums. In fact, the elimination of state benefit protections would lead to one-time savings of only 5 percent, according to the new Mercer study touted by the bill’s sponsors. The bulk of those limited savings come from eliminating the more costly benefits, such as maternity and mental health benefits, which are fundamental to adequate insurance coverage. The relatively small potential savings gained from wiping out important consumer protections hardly make a dent in the double digit premium increases that have occurred year after year over the past half decade.

A 2003 GAO report includes comments from the NAIC that reflect more accurately the impact of wiping away state insurance laws:

“NAIC agreed with our finding that the costs associated with benefit and provider mandates over what businesses would normally incur are estimated to be relatively small. NAIC also commented that mandates provide important protections for consumers and help prevent insurers from limiting their risk by denying coverage for certain benefits or limiting access to certain providers. NAIC further noted that such mandates have been carefully considered and adopted by state legislators. . . . Finally, NAIC highlighted the states’ long-standing role in providing consumer protections for health insurance, such as small group market reforms for premium rates and eligibility practices. . . .”

Source: National Partnership for Women and Families

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S. 1955: Claims Don't Meet Reality - Enforcement and Lawsuits Against States

ENFORCEMENT AND LAWSUITS AGAINST STATES

Claim: State regulatory oversight is preserved.

Reality: Enforcement is ultimately left to insurers and federal courts. S. 1955 creates three scenarios under which states regulation might take place, all of which compromise existing state authority. First, states might adopt new federal health insurance standards created by the bill. However, interpretation of the bill’s standards is given exclusively to federal courts. State enforcement could be severely hampered if insurers challenge the state in federal court. Second, states can choose not to adopt new federal standards. S. 1955 allows insurance companies to sue so-called non-adopting states in federal court if these states try to enforce their existing laws. Third, states can choose not to adopt or enforce federal health insurance standards. However, S. 1955 gives no authority to the federal government to enforce new federal standards under Titles II and III. Nor does S. 1955 specify any federal sanctions (criminal or civil money penalties) for insurers that violate federal standards. Finally, while S. 1955 gives insurers the right to sue state regulators, it does not authorize injured consumers to go to federal court to seek enforcement of federal standards.

Claim: The ability of insurance companies to sue states in federal court is necessary to ensure enforcement of the bill.

Reality: Lawsuits against states are not necessary for enforcement. There are other enforcement models that could be adopted. For example, the Health Insurance Portability and Accountability Act (HIPAA) set a common federal floor of protection, but did not expose states to lawsuits as a method of enforcement. Instead, HIPAA required HHS to enforce the law (including imposition of civil money fines on violators), should states fail to act.

Source: National Partnership for Women and Families

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Blog Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation, Diabetes Blogger, Diabetes Blog, dBlog, dBlogger, Diabetes Blog Community

S. 1955: Claims Don't Meet Reality - Comparison to Original AHP Bill

COMPARISON TO ORIGINAL AHP BILL

Claim: Unlike the original association health plan (AHP) proposal, this bill does not lead to adverse selection (a problem also known as “cherry picking,” when young and healthy people are in one insurance pool, while older, sicker, and vulnerable people are in a separate pool that becomes unaffordable and over time disappears).

Reality: S. 1955 leads to adverse selection, but in different ways. Cherry picking can occur through discriminatory pricing of premiums, benefit design, and marketing practices. S. 1955 would allow insurers to engage in all three practices in ways that states currently prohibit or limit.

Title I of the bill would segment insurance markets by allowing associations to create separate risk pools and cherry pick using all three methods and, in doing so, cover only healthy people. As a result, premiums in the rest of the state-based small group market will be substantially higher as healthy people are pulled out of that market by AHPs.

Title II of the bill allows all insurers in the small group market to charge very different premiums to all small groups based on the health care needs of their workers and dependents and a host of other factors. In addition to the broad variation they can charge based on health status, the bill allows unlimited premium surcharges based on age, gender, geography, group size, and other factors.

Title II also subjects group and individual health insurance to cherry picking through benefit design. The bill allows insurers to discourage coverage among sick individuals by offering policies that will only be attractive to those without immediate health care needs. While S. 1955 requires insurers to offer a choice of two policies, there is no requirement that one must be comprehensive. Even if comprehensive policies are offered, sicker individuals will gravitate toward the higher level of coverage, raising the average cost of that coverage beyond what is affordable. Over time, insurers cannot sustain policies offering greater coverage if only sick people buy them. The end result of S. 1955 is to shift costs to older and sicker people, resulting in many eventually losing coverage altogether.

Claim: S. 1955 gives associations the power to negotiate on behalf of and provide lower prices to small businesses.

Reality: Under the bill, associations evaluate each small business owner individually and charge different rates based on the make up of each business’ employees. This is the same as the original AHP legislation. Associations could charge businesses with high medical needs significantly more than businesses with healthy employees. On top of this, associations can apply additional, unlimited premium surcharges to businesses based on age, gender, group size (with very small firms penalized the most), and other factors. Insurers can even “redline” premiums based on geographic neighborhoods. Proponents suggest that all small businesses will be charged the same low rate, but this obscures the fact that purchasing through an association does not make these businesses part of a big group. They are all judged and charged on their own.

Source: National Partnership for Women and Families

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S. 1955: Claims Don't Meet Reality - Affordability and Choice

AFFORDABILITY AND CHOICE

Claim: S. 1955 gives business owners more affordable coverage options.

Reality: While small businesses want more affordable coverage, their employees deserve coverage that’s worth something. No one would buy a car that’s inexpensive because it’s missing its engine, transmission, breaks, wheels, seats, and doors. A health insurance policy that leaves people uninsured for certain diseases, basic preventive care, or events like pregnancy, is not real coverage.

Claim: S. 1955 will make health care more affordable.

Reality: S. 1955 does nothing to address the problem of health care costs and their growth, which are the real challenges facing employers today. Instead, the bill allows insurers to charge higher premiums and impose higher cost-sharing on workers while leaving them uninsured for basic health needs and increasing the costs for those who need health care most to a prohibitive level. Instead of spending time on bills that shift costs to the most vulnerable Americans, we should be working toward solutions that actually contain health care costs and make health care more affordable.

Claim: S. 1955 provides more choices to businesses and does not take away any options that they currently have (including policies or benefits currently required under state law). S. 1955 provides businesses with three options: (1) a new low-cost option, (2) coverage that meets existing state laws, and (3) an “enhanced” option that matches the benefits and services of a plan offered to state employees in one of the five most populous states.

Reality: The bill guarantees only two bad choices, because no rational insurer will offer a plan that meets the states’ benefits and service requirements (option 2) when offered the “choice” to offer policies completely free of these requirements. Thus, the remaining choices are: option 1, a low-cost, stripped-down policy designed by the insurer; and option 3, the so-called “enhanced” option that has no limits on cost-sharing, allowing for extremely high deductibles and coinsurance. While both options (1) and (3) may cost less up front, they leave people uninsured for major medical needs.

Claim: Business owners won’t buy bad coverage for their employees. After all, they’re buying the same coverage for their own families.

Reality: Small business owners and their workers can only buy what they can afford, and we know that they need help with the cost of meaningful health coverage. Unfortunately, S. 1955 does not give real help to small businesses. Instead, it promotes coverage that leaves business owners, their workers, and their families uninsured for certain diseases, basic preventive care, and events like pregnancy. This is hardly a solution for small businesses seeking affordable health care.

Source: National Partnership for Women and Families

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Blog Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation, Diabetes Blogger, Diabetes Blog, dBlog, dBlogger, Diabetes Blog Community

S. 1955: Claims Don’t Meet Reality - Preemption

PREEMPTION

Claim: S. 1955 does not preempt state insurance laws.

Reality: The bill explicitly preempts state laws. It prevents states from enforcing laws they have passed to guarantee access to basic benefits, as well as to prevent insurers from charging unaffordable premiums to businesses that employ older or sicker workers, or women of childbearing age. The preemption of state law is explicitly written into the bill (pp. 47-48, pp. 56-57).

In addition, Title I (establishing federally certified “Small Business Health Plans” or AHPs), preempts state regulation of associations that are certified by the Department of Labor. It also preempts state laws that regulate the coverage offered through associations certified by the Department of Labor.

Claim: Title III of S. 1955 only preempts simple administrative functions and will not affect the states’ ability to regulate insurance.

Reality: Title III of S. 1955 preempts the most basic tools of state insurance regulation including: requirements that insurers file policy forms specifying covered benefits; requirements that insurers file rates and an explanation of how rates are calculated; requirements that insurers actually pay claims for covered benefits accurately and on time; requirements that insurers conduct fair appeals when claims are denied; and requirements that insurers submit to periodic or targeted audits, called market conduct examinations, to ensure they are in compliance with laws and regulations.

New federal standards in all these areas would be established by an appointed board (that includes the insurance industry, but no consumer representation). The federal government would have no capacity to enforce these new standards. Instead, states would be allowed to enforce federal rules, but S. 1955 authorizes insurance companies to sue states in federal court if they do not like state enforcement.

Claim: There is no need to specifically protect existing state laws that cover classes of people, such as newborn children. S. 1955 does not touch those laws.

Reality: S. 1955 contains broad, general language that preempts state insurance laws and includes no provision explicitly retaining laws that require insurers to cover newborns, adopted children, disabled dependents, or other vulnerable populations. Whether or not the bill’s broad preemption also invalidates these protections remains an open question and will be litigated in federal court. If supporters of S. 1955 believe that these state laws are not preempted by the bill, they should agree to clarifying amendments.

Source: National Partnership for Women and Families

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FTCR: California Attorney General Opposes Federal Junk Health Plan Bill to Eliminate State Health Insurance Consumer Protections

SANTA MONICA, Calif., March 28 /U.S. Newswire/ -- California Attorney General Bill Lockyer strongly opposed federal legislation that will eliminate state health insurance consumer protection rules in a letter released yesterday, warning the bill "will result in many being priced out of the health insurance market."

"The mere fact that insurers would prefer a nationwide marketplace on their terms is not a legitimate reason to change our constitutionally-created federal system which leaves to the states the police power to regulate those activities that affect the daily lives of their citizens," wrote Attorney General Lockyer.

Full Press Release

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Contact the Diabetes Caucus to Oppose S. 1955

Caucus Curiousity
March 28, 2006
Source: dLife

Last week we posted about proposed federal legislation that may jeopardize diabetic supply coverage for millions of Americans - the "Health Insurance Marketplace Modernization and Affordability Act." Naturally dLife was interested in what the Congressional Diabetes Caucus had to say about the legislation, so we contacted the office of Caucus co-chair Rep. Diana DeGette to ask what action they were taking on the issue. We were more than a bit surprised to see this response issued by her representative:

"The Congressional Diabetes Caucus is a bipartisan group of Congress with over 275 members, committed to improving the lives of the nearly 21 million Americans with diabetes. The Caucus is also dedicated to supporting important research funding into diabetes and diabetes-related complications. As a standing policy, the House Diabetes Caucus does not take positions on general legislation such as S. 1955, the "Health Insurance Marketplace Modernization and Affordability Act."

Now according to their website, one of the primary goals of the Caucus is to "[e]nsure diabetes is adequately addressed in all relevant legislation and regulations." And what could be more relevant to "improving the lives of the nearly 21 million Americans with diabetes" than ensuring that they have basic health care coverage for their medical supplies? What makes this even more contradictory is the fact that the Caucus has previously, and successfully, fought for Medicare and HCFA coverage of diabetes supplies and insulin pumps, respectively.

dLife urges you to contact your Caucus representative and ask them to take a stand on this critical piece of legislation.

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Blog Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation, Diabetes Blogger, Diabetes Blog, dBlog, dBlogger, Diabetes Blog Community

Vote S. 1955 Bill Down

Tuesday, March 28, 2006

Dear Editor,

Last Wednesday I attended the campaign "kick-off" for hometown Sen. Ben Nelson. And ... I agree and support the Honorable Senator on many items and am generally pleased with what Sen. Nelson has done for not only his hometown but also Nebraska.

(But) in his speech last Wednesday he mentioned how he supported making insurance more affordable for small business owners. In fact, Sen. Nelson is co-sponsor of Senate bill 1955, also known as "The Health Insurance Marketplace Modernization and Affordability Act."

This bill was voted out of committee recently and could be taken up by the full Senate as early as this week. Senator Nelson was quoted in a press release concerning this matter as saying "The continuing problem of skyrocketing health care costs is a grave threat to our working families. This action by the HELP Committee today is the first step in addressing this problem."

While I agree with Sen. Nelson about the rising healthcare costs I disagree with his stand on this bill.

In its current language it would allow insurance companies to exclude certain cancer screening coverages now guaranteed by current insurance regulations.

I believe if these early detection screenings are excluded when you could discover cancer at its earliest and most treatable stages it would actually cause an increase in costs for everyone in the future. If this bill passes the Senate in its current language it could be a step in the wrong direction.

I recognize the increasing cost of insurance and healthcare in this country, yet I know how important prevention and early detection programs are and how these programs can actually save insurance companies money.

So with that I would like to close by asking anyone who has been impacted by cancer to contact Sen. Nelson and Sen. Hagel asking them to vote against S.1955, until any and all coverages guaranteed by current regulations would not be lost.

Let's fight to become "One Nebraska Voice" working to eliminate suffering and death due to cancer by 2015.

Sincerely,
Shane Smith
McCook

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Blog Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation, Diabetes Blogger, Diabetes Blog, dBlog, dBlogger, Diabetes Blog Community

FTCR: Will Brownback Betray Kansas State Patients' Rights Laws and Allow Insurers Federal Right To Sell Junk Health Policies?

To: State Desk

Contact: Jerry Flanagan, 310-392-0522 ext. 319, or David Fink, 310-392-0522 ext. 320, both of the Foundation for Taxpayer and Consumer Rights

TOPEKA, Kan., March 28 /U.S. Newswire/ -- Kansas Sen. Sam Brownback (R) will cast a critical patient protection vote in the U.S. Senate as early as this week determining whether an over- reaching bill to dismantle state oversight of health insurance and hard-won HMO patients' rights will move forward. The Foundation for Taxpayer and Consumer Rights (FTCR) urged Kansas patients to contact Brownback and call on him to oppose the bill at http://www.consumerwatchdog.org/.

Sen. Brownback has taken $62,000 in campaign contributions from the insurance industry since 2001, according to the Center for Responsive Politics.

The legislation, S. 1955 (Enzi, R-Wyo.), would gut state Patient Bill of Rights laws established in 41 states and remove local state oversight to replace them with weaker or non-existent "harmonized" federal standards. State rules at risk include Kansas laws requiring health insurance plans to provide cervical, prostate and breast cancer screenings and guaranteeing an independent review if an insurer denies coverage.

For an analysis of the Kansas patient protection laws likely to be overridden by S. 1955 go to: http://64.82.65.67/health/hmolaws.htm..

"Senator Brownback must choose between the rights of HMO patients to benefits and services required by the Kansas legislature and an insurance industry that has given him tens of thousands of dollars in campaign contributions," said Jerry Flanagan of the non-partisan Foundation for Taxpayer and Consumer Rights.

FTCR sent a letter to Sen. Brownback condemning the attack on patients' rights.

"This attack on states' rights puts millions of patients, many of whom are business owners and self-employed, at risk in a move that amounts to national deregulation of health care," wrote FTCR. "Instead of making health care affordable, these plans are likely to curb early diagnosis of disease by eliminating preventive treatments and exams. Delaying care makes treatment more costly to the policyholder and ultimately to taxpayers ... S. 1955 would tempt small business owners and other employers, even those already providing legitimate insurance, to cut health care costs by pushing employees into junk health plans."

Read FTCR's letter at: http://www.consumerwatchdog.org/resources/BrownbackS1955Letter.pdf
Dana Christensen, a widow who was insured with a junk association health plan and owed more than $450,000 when her husband died of bone cancer, spoke out against the bill that would "allow insurance companies to sell junk policies that don't protect patients when they are sick."

Though similar legislation has been proposed in past sessions and passed by the House of Representatives, the bill was approved by the U.S. Senate health committee for the first time this month.

The Christensens' story can be found in an online resource published by FTCR outlining the skeletal benefits of the junk health plans: http://www.ConsumerWatchdog.org.

---

The Foundation for Taxpayer and Consumer Rights is a nonpartisan consumer advocacy organization. For more information, visit them on the Web at http://www.ConsumerWatchdog.org.

http://www.usnewswire.com/

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Blog Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation, Diabetes Blogger, Diabetes Blog, dBlog, dBlogger, Diabetes Blog Community

Diabetes Community Unite Against S.1955

S. 1955 will jeopardize lifesaving coverage protections for millions with diabetes by allowing health insurers to circumvent existing laws in 46 states that guarantee coverage for diabetes medications, supplies and training.

We need your help!

The Diabetes Community is enormous, passionate and wields a great deal of influence. We need your help in defeating S. 1955 and hope you will contact your Senator to stop this destructive bill.

We have made it very easy for you to join the fight! Just click the button below and it will take you to a form on the American Diabetes Association site, that makes if very easy for you to contact your Senator and stop this harmful legislation.

There are two steps in the process.

• Step 1 - asks for your contact info, including your zip code, which is required to contact your Senator. The contact settings on their sites are set up so that only residents of their state can actually contact them, they accomplish this via the zip code.
  
  You have the option of opting in or out of future communications with the ADA.
  
  (See Screen Shot Below)
  
  
• Step 2 - pulls up the Senators from your state, based upon your zip code, and asks you if you would like to email, fax or email and fax your Senators.
  
  (See Screen Shot Below)

If you have any problem with the button, the link below will get you to the site:

Preserve Diabetes Coverage Laws!

Step 1 Screen Shot (Your Contact Information)

Step 2 Screen Shot (Select your Communication Preferences with your Senator)

Thank You

Your cooperation is greatly appreciated. We can only defeat this legislation if we work together.

Thank you so much!

Technorati Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation, Diabetes Blogger, Diabetes Blog, dBlog, dBlogger, Diabetes Blog Community

Call for Action from the Diabetes Bloggers

S. 1955 will jeopardize lifesaving coverage protections for millions with diabetes by allowing health insurers to circumvent existing laws in 46 states that guarantee coverage for diabetes medications, supplies and training.

We need your help!

The Diabetes Blogger Community is enormous, passionate and wields a great deal of influence. We need your help in defeating S. 1955 and hope you will post a button or a link on your site to help encourage member of the Diabetes Community to contact their Senators to help defeat this harmful legislation.

The button looks as follows:

The URL for the button is:

http://photos1.blogger.com/blogger/1253/2573/200/action.jpg

The URL is:

https://secure2.convio.net/adap/site/Advocacy?pagename=
homepage&page=UserAction&id=
792&AddInterest=2401

Thank You

Your cooperation is greatly appreciated. We can only defeat this legislation if we band together.

Thank you so much!

Technorati Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation, Diabetes Blogger, Diabetes Blog, dBlog, dBlogger, Diabetes Blog Community

Michigan Diabetes Advocates Urge Senators to Protect Vital Diabetes Coverage

Michigan Diabetes Advocates Urge Senators Levin and Stabenow to Oppose Enzi Health Insurance Legislation; Bill Fails to Protect Vital Diabetes Coverage
S.1955 will jeopardize lifesaving coverage protections for millions with diabetes by allowing health insurers to circumvent existing laws in 46 states that guarantee coverage for diabetes medications, supplies and training

Sylvan Lake, MI (Date, 2006) – American Diabetes Association (ADA) advocates from Michigan today strongly urged U.S. Senators Levin and Stabenow to oppose proposed federal legislation that would enable health insurers to bypass existing state health insurance regulations. In doing so, the “Health Insurance Marketplace Modernization and Affordability Act” (S. 1955) would result in the loss of critical health coverage guarantees for millions of people with diabetes. Forty-six states and the District of Columbia, including MI require insurers to provide coverage for diabetes supplies, medication, equipment and education, but S. 1955 would undermine those basic protections. Last week, the U.S. the Senate Health, Education, Labor and Pensions (HELP) Committee approved S.1955 on a party-line vote, and it could be voted on in the full Senate as early as next week.

“At a time when diabetes has become an epidemic in this country, we simply cannot afford to eliminate the diabetes health coverage guarantees that 46 states have wisely taken the initiative to provide,” said Jonathan B. Smith, ADA Research Foundation Board Member. “It has been our experience that without these protections, state-regulated insurers often do not provide adequate diabetes coverage. When that happens, it is not just people with diabetes who suffer, but our already over-burdened health care system. We strongly urge Senators Levin and Stabenow to oppose S.1955 so long as the bill in its current form fails to protect and honor vital state diabetes coverage.”

The American Diabetes Association is committed to ensuring that the 20.8 million children and adults in the U.S. – including 587,000 in Michigan - with diabetes have access to the health coverage they need to manage disease and stroke, kidney disease, blindness and amputations.

A critically important component of this effort has been the consumer protections in 46 states requiring insurers to provide adequate coverage for diabetes supplies, equipment and education. Those protections have literally been a lifeline for millions of people with diabetes. In attempting to provide much-needed relief to small business owners, S.1955 would make changes that would impact all state-regulated plans, and would result in millions of Americans with diabetes losing their guarantee of diabetes coverage.

The cost of diabetes requirements on health insurance premiums has been studied by numerous states and has proven to have an insignificant effect on the overall cost of monthly health insurance premiums. Louisiana, for example, found that their diabetes requirement accounted for a mere .006% of monthly premiums. After conducting a comprehensive analysis of Utah’s diabetes mandate, state legislators chose to strengthen their state law, doing away with a sunset clause that would abolish the diabetes requirement if they found the cost too burdensome.

“At a time when diabetes has become an epidemic in this country, we should be doing more – not less – when it comes to diabetes health coverage,” Jonathan B. Smith added. “States have taken the initiative to provide vital diabetes coverage for people in their state. Unfortunately, this legislation would strike a blow to those efforts. We all want to make health care more affordable. But by taking away the tools people with diabetes need to manage the disease and prevent its serious complications, we will be doing more harm than good.

Nearly 21 million Americans have diabetes, up from 18.2 million since last estimates in 2003. If present trends continue, one in three Americans, and one in two minorities, born in 2000 will develop diabetes in their lifetime. The cost of diabetes in the United States in 2002 was at least $132 billion; one in ten healthcare dollars is spent on diabetes and its complications.

The American Diabetes Association is the nation’s leading voluntary health organization supporting diabetes research, information and advocacy. The Association’s advocacy efforts include helping to combat discrimination against people with diabetes; advocating for the increase of federal diabetes research and programs; and improved access to, and quality of, healthcare for people with diabetes. The Association’s mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Founded in 1940, the Association provides service to hundreds of communities across the country. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit http://www.diabetes.org/. Information from both these sources is available in English and Spanish.

Blog Tags: ADA, American Diabetes Association, Diabetes, Diabetic, Diabetes Advocate, Diabetes Advocacy, e-Advocacy, S. 1955, Health Insurance Marketplace Modernization and Affordability Act, HIMMAA, Senator Enzi, Enzi, Enzi Health Insurance Legislation

State Diabetes Health Benefits & Protections Threatened by S. 1955 (Enzi)

More than 170 million Americans now receive health care coverage or benefits through some type of “managed care” setting. Many of these services are directly provided by an HMO (health maintenance organization), although many others are served through other managed arrangements, termed Preferred Provider Organizations (PPO) or Point of Service (PSO) plans.

Nearly all states now have passed “patient protection” or consumer-oriented laws and/or regulations. The U.S. Congress has not enacted comparable managed care consumer legislation, although different plans have passed the Senate and/or House in 1999-2000 and 2001-02.

S.1955 – the “Health Insurance Marketplace Modernization Act” – would undermine those laws by removing existing health coverage protections.

Under this legislation, insurers will be able to circumvent state regulations and offer a low-cost health plan to employers that could exclude diabetes coverage. This proposal takes away the right of states to govern health plans and to determine important health care coverage that their residents should be able to receive.

Don’t forget that your voice and vote counts and you can help influence the future of diabetes issues in America.

Recent State Laws & Updates
(Source: http://www.ncsl.org/programs/health/diabetes.htm)

Alaska
Sec. 21.42.390. Coverage for treatment of diabetes.H.298 - signed and effective April 29, 2000

Arizona
A.R.S. ?20-826(P), ?20-934 - 1998 law - Any contract covering diabetes must include coverage for equipment and supplies that are medically necessary.

California
SB 64 - signed 9/27/99 - expands a 1981 law to include equipment, supplies and drugs.SB 2094 of 2000 - signed 9/30/2000 - updates coverage to include outpatient daily self-management training, education and medical nutrition therapy services

Colorado
?10-16-104 (13) - 1998 law - coverage “shall include equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy if prescribed by a health care provider.”

Connecticut
? 38a-492(d) - 1997, 1999 laws - Provides medically necessary equipment, laboratory and diagnostic tests.

Delaware
S. 190 of 2000 - enacted 6/30/2000 - requires coverage for diabetes equipment and supplies if prescribed by a physician.

Florida
? 627.6408 - 1995 law - Covers medically appropriate and necessary equipment, supplies and training for the treatment of diabetes.

Georgia
? 33-24-59.2 - 1998 law - Must offer coverage for medically necessary equipment, supplies, pharmacological agents and out-patient self-therapy prescribed by a physician
H 1492 - 2002 law - Changes law from an offer to a mandate for coverage, effective July 1, 2002.

Hawaii
H2392 - signed 6/19/2000. Requi