Congressional negotiators last week neared agreement on compromise health insurance reform legislation with the hope of submitting it for votes by the full Senate and House this week.
After a week marked by fits and starts, temper flare-ups and behind-the-scenes dealmaking, House and Senate Republicans appeared to be close to consensus on the most contentious measures included in the versions of the insurance reform bills passed by each house-notably, provisions giving favorable tax treatment to medical savings accounts and requiring equal coverage for mental health benefits.
MSAs are private accounts that could be used to pay for routine medical expenses. People could combine them with high-deductible insurance policies for complete health coverage. MSA advocates say their expanded use would increase consumer choices and hold down medical costs.
Democrats who oppose expansion of MSAs said they were prepared to accept a limited demonstration project to test the controversial program. Republicans also indicated that they were willing to accept a pared-back version of MSAs, however, at week's end, there was still no consensus on how to accomplish that.
According to several sources, GOP House leaders were considering putting several restrictions on the MSA project, including limiting the lifespan of the program to five years, requiring enrollees to stay in an MSA for three years and capping the amount that could be accumulated in an individual account.
One of the Senate sponsors of the health insurance reform bill, Sen. Nancy Kassebaum (R-Kan.), said she favored limiting the program only to workers in small firms and those holding individual insurance policies.
Democrats said they also hoped to limit the MSA project to certain areas of the country, but a spokesman for House Ways and Means Chairman Bill Archer (R-Texas) said Archer would not accept any geographic restrictions. Archer did suggest, however, that he could accept other restrictions on the program.
Progress also was made on the other most controversial provisions in the plan. Business groups have said they will oppose the health insurance bill if it included a Senate provision that would require insurers to offer the same level of coverage for mental healthcare as for other types of coverage. Business leaders say such a requirement would make insurance prohibitively expensive. Kassebaum suggested that a compromise could be in the offing that would eliminate the federal requirement for mental health parity in favor of a commission that would seek ways to reach parity between mental health insurance and other types of coverage.
Kassebaum also said negotiators had agreed to kill the medical malpractice reform measure that had been passed by the House but not by the Senate (See related story, p. 28).
Another remaining obstacle is fraud- and-abuse provisions included in both plans. Providers object to new criminal and civil penalties for healthcare fraud that the provider groups say do not differentiate between fraud and unintentional mistakes such as errors in diagnosis-related coding.
Under the compromise plan being considered by House and Senate Republicans, federal officials would be forced to prove that providers acted "willfully and knowingly" to prosecute under the new fraud statutes. Provider groups say the more stringent "willfully and knowingly" statute is necessary to ensure that honest mistakes are not subject to prosecution.
Providers also hope to retain a provision in the House health insurance reform plan that would require federal officials to offer "advisory opinions" on a timely basis. Advisory opinions are issued on a case-by-case basis and can give providers guidance before a transaction is completed.
Justice Department officials have opposed the measures, which they say will put an undue strain on federal resources. However, provider groups say they are looking for guidance in an area of the law that is ambiguous at best.