Dianne Stewart at Capitol press conference ALAN POGUE that’s why other states that have tried such bare-bones policies haven’t reaped the benefits of more insured workers. “Even in an experimental program in seven states under which the states pay 50 percent of the cost of bare-bones health plans for small firms, employer participation is not very strong,” said Dallas Salisbury, president of the Washington-based Employee Benefit Research Institute, in testimony before the U.S. House of Representatives Ways and Means Committee earlier this year. Rep. Taylor said that despite his efforts to generate figures on how many more workers would be covered by insurance if his proposal were enacted, he had not been able to do so. Stewart reports that the Texas Employment Commission has said it is willing and able to perform such a survey of employer needs, but Taylor nevertheless forged ahead with his proposal. Stripped to the Bone If HB 532 won’t significantly reduce costs to small businesses, it will certainly endanger hundreds of thousands of Texans who depend on employer-supplied insurance policies to protect them when illness or injury strikes. Some of the benefits the bill would eliminate include treatment for drug and alcohol abuse, breast-cancer screening and treatment for AIDS/HIV infections. Oral contraceptives and special infant dietary formulas would no longer be required to be reimbursed. It repeals the requirement that policies be offered to employees’ spouses on an equal basis regardless of gender. More ominously,the bill would strike at the most vulnerable members of society by eliminating mandatory continuation of coverage during labor disputes, if a policyholder becomes mentally or physically disabled, and for dependents if a policyholder dies. As might be expected, this broadside attack on benefits provoked an angry response from a broad spectrum of public-interest groups. A coalition of 32 such organizations held a press conference at the Capitol on May 21 to exprss their opposition. Women’s groups decried the elimination of coverage for pregnancy-related conditions, maternity care, and mammography screening. Representatives from three different children’s rights groups, noting that 35 percent of Texas’ uninsured citizens are children, objected to the omission of required benefits for immunization, newborn care, and preventive services. Counselors and social workers, who see the tragic impact of inadequate prenatal and perinatal care every day, joined the chorus. Church groups, olderTexans organizations, and advocates for the poor expressed similar concerns. Disability groups protest the discriminatory impact such policies would have upon them, and Jacqueline Shannon of the Texas Alliance for the Mentally Ill pointed out that the proposal might force uninsured people with mental disabilities to resort to the already overburdened state mental health and mental retardation facilities a cost to the state that Taylor evidently didn’t consider when he said, “I think this is the best legislation I’ve ever carried because it deals with a serious problem and it doesn’t cost the state a dime.” The state would also pick up additional costs for newborn-infant and maternitS , care. Organized labor, of course, opposes making employees bear the full burden of the health crisis with no comparable sacrifices on the part of the other players: employers and insurance companies. Under the plan, employers could pick and choose arming their workers, excluding members of certain groups from full coverage. Or they could form a small subsidiary to obtain separate, bare-. bones insurance policies for high-risk or lowseniority workers. And if a company qualifies as a small business at the time it applies for insurance coverage, it retains the ability to offer the stripped-down policies even if it grows beyond 50 employees. Hidden Agenda If the bill won’t give many more Texans insurance coverage, and will deprive some of the state’s most vulnerable citizens of a way to pay for expensive medical treatment, then what possible motive could be behind it? One clue lies in the groups that testified in favor of the bill, during House committee hearings: automobile dealers and insurance companies. Taylor’s campaign contribution reports are littered with contributions from business and insurance interests; he received $500 this year from veteran lobbyist Gene Fondren’s Texas Automobile Dealers Asso ciation political action committee. He has not, in the past, demonstrated a commitment to improving access to health care. Insurance companies have an interest in cutting out mandatory coverage for lessprofitable lines of insurance. Their reluctance to cover such services is the principal reason the state required them to offer the benefits in the first place. Auto dealers are typically small businesses that would get a price break on insurance rates from the bill. Dianne Stewart believes the motives of such businesses aren’t to extend coverage to uninsured workers but to devastate coverage for workers who already have insurance by dropping comprehensive policies or letting them expire and then forcing workers to accept the cheaper, bare-bones policies Taylor’s bill would permit. “In other states that have tried this approach, such as Illinois, the real market is for people who already have insurance,” said Stewart. “The true target isn’t the uninsured, it’s the insured. The effect will be a huge increase in the number of underinsured Texans,” she said. “The best evidence the bill is aimed at the insured and not the uninsured is the fact that the business lobby doesn’t want a ‘maintenance-of-effort’ policy in the bill,” Stewart provision, which most other states who have allowed bare-bones policies require, would prohibit businesses that already offer insurance coverage to switch to the stripped-down version. If the goal is to give more Texans coverage rather than undermine the coverage most Texans already enjoy, such a require See Insurance page 24 THE TEXAS OBSERVER 9 v,yyq
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