Progressives, health groups say health bill ‘loophole’ could allow rate hikes

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Advocacy groups raise concerns on health bill

WASHINGTON — Advocacy groups lobbied President Barack Obama and Congress on Thursday, trying to eliminate what they called a “loophole” in Senate health care legislation they said could allow insurers to raise rates on customers based on their weight or blood sugar levels.

The groups said that would contradict one of the main goals of the congressional health care overhaul, which is to eliminate insurance company practices such as charging more, or denying coverage, based on health status.

The push came amid intense behind-the-scenes negotiations on Capitol Hill and at the White House to reconcile sweeping health care legislation passed by the House and Senate into a final bill Obama could sign before his State of the Union address in early February.

House Democrats held a conference call during which a number of lawmakers vented frustration over provisions in the Senate bill they don’t want to be forced to accept, most prominently a tax on high-value insurance plans that House Democrats fear could hurt middle-class workers and union members.

Obama will meet with union leaders on the issue Monday, union officials said. Aiming to build consensus on Capitol Hill over that issue and others, Obama met Thursday with key Senate architects of the health care bill, Democrats Max Baucus of Montana and Chris Dodd of Connecticut. Also, Health and Human Services Secretary Kathleen Sebelius convened a conference call of Democratic governors, some of whom have raised concerns about issues including costs to their state of a proposed Medicaid expansion.

That’s been an irritant from some state officials because Sen. Ben Nelson, D-Neb., the Democrats’ crucial 60th vote for the Senate health bill, got a deal to permanently exempt Nebraska from paying any cost of a Medicaid expansion in the bill. Nelson said Thursday he was working to extend the same deal to other states.

The so-called loophole is separate issue. It’s a provision that allows employers to establish “workplace wellness” programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels.

Current law allows employers to vary costs for workers based on whether they can hit those targets by as much as 20 percent. The Senate bill would raise that to 30 percent, with the possibility of a further increase to 50 percent at the discretion of government officials.

Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more, even though some of them may not be physically able, through no fault of their own, to reach the goals.

“There could be an inclination to say, ‘Let’s raise everyone’s costs and just lower them for the 15 percent that can meet the standards,’” Sue Nelson, a vice president at the American Heart Association, said in an interview.

“There’s going to be a lot of people on that more expensive tier, I’m afraid. A lot of American adults.”

The Senate bill also sets up a test wellness program beginning in 2014 for individuals and small businesses who buy insurance directly from insurance companies. Most Americans under age 65 are covered through their employers.

Separate provisions in the legislation would allow insurers to charge more to people who smoke and to older people.

Insurance companies generally support wellness provisions.

“Promoting prevention and wellness is a critical component of health care reform,” Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said in a statement. He said the programs should have clear guidelines — something advocacy groups say is lacking in current law and the Senate bill — and noted they were often negotiated between employers and unions.

The wellness provision is not part of the House health care bill. Jim Manley, a spokesman for Senate Majority Leader Harry Reid, D-Nev., declined comment except to say the issue would be discussed with the House and the Obama administration during discussions for a final bill.