July 25, 2005
United States House of Representatives
Washington, DC 20515
RE:
The Small Business Health Fairness Act of 2005 (H.R. 525)
Dear Representative:
The undersigned organizations supporting women’s health and access to reproductive services
write to express our concerns regarding the Small Business Fairness Act of 2005 (H.R. 525).
H.R. 525, which the House is expected to vote on this week, would exempt association health
plans (AHPs) from critical state regulation and oversight. Instead of providing broader access to
comprehensive health insurance for the millions of uninsured American women and families,
H.R. 525 will undermine women’s access to quality, affordable health insurance and may actually
increase the ranks of the uninsured.
Women especially are at risk in the current health insurance crisis that our nation faces. Women
are the primary health care decision-makers for their families – as health insurance premiums
increase, women are often the ones making difficult choices about how to make ends meet.
Women are the primary users of health care services, and need access to a range of
comprehensive health care services during their entire lives. And women are disproportionately
likely to work for or own small businesses, many of which are now either struggling with the
burden of increased health insurance costs or unable to offer coverage because it is too expensive.
The Small Business Health Fairness Act would only increase the barriers that many women now
face in finding affordable, comprehensive and secure coverage. Significant problems with the
bill include:
•
Loss of Critical Benefits for Women: Current state laws now require health insurers
to cover a number of benefits that are critically important for women, including prenatal and maternity services, mammography, cervical cancer screenings, bone-density
screenings, contraceptive prescription drugs and devices, mental health services, wellchild care, direct access to obstetrical and gynecological service providers, and
participation in clinical trials. Under this bill, AHPs could avoid these requirements.
Denying women access to these services would not only drive up the cost of coverage
for most women but could have a dramatic impact on public health for women who
cannot afford to pay out-of-pocket for these essential preventive services.
•
Loss of Consumer Protections: States have enacted a number of patient protections
to ensure the fairness of health insurance coverage. Most states now require insurers
to allow direct access to emergency services, independent external appeal of health
care claims denials, and access to an adequate range of health professionals. AHPs
would be exempt from these requirements, leaving those with AHP coverage with
inadequate protection against potential abuses. Because AHPs would also be exempt
from most direct state oversight, women would be left with no meaningful avenues
for assistance if they have a problem with their health plan.
•
No Help for the Uninsured: Contrary to proponents’ claims, H.R. 525 does little to
respond to the growing number of uninsured. According to the nonpartisan
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Congressional Budget Office (CBO), only 600,000 of the nearly 44 million uninsured
Americans would become insured by the new AHPs the bill creates. CBO estimated
that the only way AHPs could offer coverage at a lower price would be by avoiding
state benefit requirements and offering coverage to more healthy individuals. For this
reason, CBO estimates that AHPs could actually cause the number of uninsured to
grow, with 10,000 of the least healthy individuals losing coverage. A Mercer study
estimates that AHPs could cause the number of uninsured to rise by as much as
1,000,000.
•
Increased Cost of Coverage: The vast majority of small businesses and others who
are not covered by AHPs could see their health insurance costs rise under H.R. 525.
CBO estimates that 4 out of 5 small businesses and their workers now covered would
see their premiums increase. Mercer estimates that premiums could rise dramatically,
in some cases by as much as 23%. At a time when employer-sponsored coverage is
already experiencing double-digit increases, these additional costs could price health
insurance out of reach for many women and their families.
•
Risk of Fraud and Unpaid Claims: A recent GAO report documented that
association health plans now operating under closer scrutiny by state and federal
agencies have provided fertile ground for scam operators to defraud millions of health
care consumers. GAO found that at least 144 unauthorized or fraudulent health
benefits operators were operating in every state from 2000 to 2002, leaving $252
million in unpaid medical claims and affecting 200,000 individuals. H.R. 525 would
roll back current oversight by the states and replace it with minimal and inadequate
federal oversight, leaving consumers at risk for fraud and unpaid medical claims.
Women have much to lose from this AHP bill. We urge you to oppose AHPs and instead
consider real solutions to help uninsured Americans that do not undermine women’s access to
affordable, comprehensive coverage.
Sincerely,
National Partnership for Women & Families
Alan Guttmacher Institute
American College of Nurse-Midwives
American College of Obstetricians and Gynecologists
Americans for Democratic Action
American Humanist Association Feminist Caucus
American Nurses Association
Black Women’s Health Imperative
Center for Reproductive Rights
Center for Women Policy Studies
Institute for Reproductive Health Access
Legal Momentum
NARAL Pro-Choice New York
National Abortion Federation
National Asian Pacific American Women's Forum
National Council of Jewish Women
National Council of Women’s Organizations
National Family Planning and Reproductive Health Association
National Latina Institute for Reproductive Health
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National Organization for Women
National Women’s Health Network
National Women’s Law Center
Planned Parenthood Federation of America
Physicians for Reproductive Choice and Health
Population Connection
Reproductive Health Technologies Project
Unitarian Universalist Association of Congregations
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