Medical Device Daily Washington Editor

WASHINGTON – A diverse group of organizations gathered late last week to voice their opposition to upcoming legislation they say would harm consumer and employee access to quality healthcare.

The legislation in question, called the “Small Business Health Fairness Act,” would create association health plans (AHPs), which are certified group health plans sponsored by a business or professional association.

Supporters of AHPs argue that these plans will allow small business owners to join similar employers in order to offer employees health insurance coverage at lower cost.

The bill (HR 525/ S 406) is currently being debated in both houses of Congress.

During a meeting at the National Press Club, representatives from the American Diabetes Association (ADA; Alexandria, Virginia), the American Cancer Society (Atlanta), the American Nurses Association (Silver Springs, Maryland), the Blue Cross and Blue Shield Association (Washington), and the National Partnership for Women and Families (Washington), argued that the legislation would be exempt from state regulation and oversight and would negatively affect millions.

“This is an issue that device manufacturers should be very interested in, especially with conditions related to diabetes,” Mary Nell Lehnhard, senior vice president in the office of policy and representation at the Blue Cross and Blue Shield Association, told Medical Device Daily.

According to the ADA, the legislation, if enacted, would severely limit healthcare coverage and access to supplies for people with diabetes.

“It’s neither fair nor accurate for AHP proponents to say that some coverage is better than no coverage,” said Jim Schlicht, ADA’s chief government affairs and advocacy officer. “For the 18.2 million Americans who have diabetes, being under-insured with respect to their diabetes education and supplies is as problematic as having no coverage at all.”

Schlicht said inadequate coverage would lead to poor disease management, which raises the risk of diabetes-related complications, including heart disease, blindness, kidney failure, and amputations.

Also at Thursday’s press conference, the Blue Cross and Blue Shield Association released a new report called “Association Health Plans: No State Regulation Means Loss of Protections for Consumers, Small Employers and Providers.”

The report provides a state-by-state overview of key health coverage protection laws, including diabetes coverage protections, for individuals and small groups enrolled in state-regulated health insurance plans that could be jeopardized if the legislation passes.

According to the report, state laws and regulations currently protect consumers from unlimited insurance premium increases, allow the right to external review in the case of denied claims, minimize the likelihood of fraud and abuse, and ensure access to important health services.

For example, 49 states limit how much and how often employer’s premiums can increase when an employee gets sick. A total of 44 states provide access to an independent, external review when an insurer denies a medical claim. All 50 states and the District of Columbia have regulations in place to ensure healthcare providers are paid promptly and dependably and to make sure that consumers are not left with unpaid medical bills.

According to the organizations presenting on Thursday, AHPs – assuming the legislation passes in its current form – would eliminate those guarantees.

“This current version of AHP legislation is nearsighted and misguided and ultimately would impede our efforts to keep these costs from spiraling out of control,” Schlicht said.

Lehnhard said the legislation would probably get to the House of Representatives for a floor vote sometime in June. “It’ll pass the house easily; it has passed before,” she said. “The challenge now is to make changes in the Senate.”

Lehnhard said that Mike Enzi (R-Wyoming), chairman of the Senate’s Health, Education, Labor and Pensions Committee, is holding hearings on the subject but also is looking at broader market reforms, which may “change the legislation for the better.”

“As small businesses continue to grapple with the rising cost of healthcare, they need meaningful solutions that will allow them to provide affordable and reliable coverage for their workers. AHPs are not the answer.”

Report offers ‘mass casualty’ guidelines

Guidelines outlining how to plan for delivering health and medical care in the event of a “mass casualty” event are presented in a new report from an expert panel convened by the Healthcare Research and Quality organization and the Office of Public Health Emergency Preparedness (both Washington).

The report, “Altered Standards of Care in Mass Casualty Events,” offers a framework for what is described as “optimal care during a potential bioterrorism or other public health emergency involving thousands, or even tens of thousands, of victims.” For example, planners at federal, state, regional, community, and health systems levels are encouraged to develop or revise triage guidelines for specific kinds of events, as well as guidelines for allocating scarce resources such as ventilators, burn beds or surgical suites.

The report includes the recommendations of a 39-member panel of experts in bioethics, emergency medicine, emergency management, health administration, health law and policy, and public health that was convened last August.

“Providing optimal care in a mass casualty event requires that we identify, plan, and prepare for the circumstances of available providers, facilities, equipment, and transportation of casualties,” said Carolyn Clancy, MD, director of AHRQ.

AHRQ says it has funded more than 50 emergency preparedness-related studies and other activities.

In related news, Mike Leavitt, secretary of Health and Human Services, on Friday said that the department “has made available” another $1.3 billion to the states, territories and four metropolitan areas to strengthen their capacity to respond to terrorism and other public health emergencies.

The funds, he said, will be used to upgrade infectious disease surveillance, “improve the ability of hospitals and the healthcare system to deal with large numbers of casualties, expand public health laboratory and communications capacities and improve connectivity between hospitals, and city, local and state health departments to enhance disease reporting.”

Leavitt said the funds “will help us build on the prog-ress we have made the past three years with our state and local partners, and will result in a stronger system to care for Americans in emergencies, whether it be a bioterror attack or an infectious disease outbreak like SARS or West Nile virus.”

CMS to provide new identifier

The Centers for Medicare & Medicaid Services (CMS; Baltimore) has reported the availability of a new identifier for use in the standard electronic healthcare transactions. The national provider identifier (NPI), CMS said, “will be the single provider identifier, replacing the different provider identifiers providers currently use for each health plan with which they do business.”

CMS said the NPI is one of the steps it is taking to improve electronic transactions for healthcare.

“National standards for electronic health care transactions encourage electronic commerce in the healthcare industry and simplify the processes involved to reduce the administrative burdens on healthcare providers,” it said.

A May 6 letter was distributed to aid in understanding the background of this requirement and what steps are necessary to apply for and receive the NPI.