Possible loopholes, insurance costs in Senate health bill

"A critical loophole in the current version of the Senate health-care bill would allow insurers to charge more for those who don't participate in wellness programs, essentially negating the measure's key goal of eliminating higher costs for those with pre-existing conditions, a group of health experts said Thursday," MarketWatch reports. "In a conference with reporters, representatives from a group known as Health Care for America Now, along with the American Heart Association and other health-care experts, said the law calls for the creation of pilot programs that would allow insurers to penalize those with certain conditions via higher premiums or deductibles." MarketWatch reports that insurers can already charge policyholders 20 percent more for not participating in wellness programs. The Senate bill would increase the difference to 50 percent (Britt, 1/7).

CongressDaily: "Liberal groups say the effect would violate one of health reform's core goals: offering affordable insurance to people who are already sick. 'It will undermine other efforts to bar insurance companies from discriminating against customers,' Andrew Kurz, a former insurance industry executive, said of the provision" (1/7). 

Meanwhile, Newsweek reports that while the Senate health bill offers incentives to small businesses to provide insurance for employees, medium-size businesses with 26 to 49 employees get little assistance. "They do not get the tax credits provided to smaller businesses, nor do they have fines assessed like larger companies. 'Beyond any kind of added bonus of trying to be competitive, there's not a lot spelled out in the bill,' says Molly Brogan, spokesperson for National Small Business Association. 'There are not a lot of incentives ... for businesses this size to go beyond what already exists.' For all the groups that health-care reform will reach out to, this is one that apparently gets left behind" (Kliff, 1/7).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.