Medical savings accounts and federally mandated benefits loom as the most contentious issues that will face House and Senate negotiators when they meet to hash out the differences in their health insurance reform bills.
The basic structure of the House and Senate versions of health insurance reform are similar (See chart). However, contentious issues remain. House and Senate negotiators may start meeting later this week, sources said.
The House bill contains a provision-defeated in the Senate-that would spur the use of medical savings accounts. MSAs allow individuals to set up an account to pay for unreimbursed medical expenses, and any money not used for current healthcare expenses may be kept by the employee. Supporters believe such accounts would make consumers more aware of the cost of their medical decisions.
The Clinton administration sent strong signals before the Senate vote that it would veto the bill if it included a medical savings account provision similar to the House version.
But other Democratic proposals have included less ambitious medical savings account plans, and both the administration and House Republican leaders have indicated in the past that a limited pilot project might be acceptable.
"The House sees the importance of sending a bill to the president that he can sign," said Pamela Bailey, president of the Healthcare Leadership Council, which represents hospitals, insurers and business. "They don't want to jeopardize the bill and will probably be willing to compromise (on medical savings accounts)."
Another problematic provision added via an amendment to the Senate bill would require insurers to allow the same level of coverage, such as number of days covered, for mental health services as for other covered services. It also would prohibit charging higher copayments or deductibles than for other benefits.
The measure, which was sponsored by Sens. Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.), is not included in the House-passed bill.
The mental health provision has come under fire from employer and insurance groups that claim it will drive up the cost of insurance. The ERISA (Employee Retirement Income Security Act) Industry Committee, which represents large employers, withdrew its support for the Senate plan last week because of the mental health amendment.
The Domenici-Wellstone amendment presents a problem for a number of lawmakers, most of them Republicans, who don't want to be seen as opposing mental health but who also don't support federally mandated benefits.
One GOP House aide said that while House leaders did not support the measure, "we're not going to be the ones to strip it out."
A number of other controversial provisions, such as medical malpractice reforms, seem to have little chance of surviving the negotiations between the House and Senate.
A Senate amendment that would have added the malpractice reforms was slated to be offered but was pulled when it became clear that it could not pass.
Federation of American Health Systems President Thomas Scully predicted that "(congressional Republicans) want to pass this badly enough that anything as controversial as (medical malpractice reform) will fall out."*n