A pair of legislative proposals pending in Congress could help employers in their ongoing struggle to slow the growth of health benefit costs.
One measure, H.R. 1304, the “Self-Insurance Protection Act,” has cleared the House Committee on Education and the Workforce for consideration by the full house. The second bill, H.R. 1215, known as the “Protecting Access to Care Act,” is also waiting for action there.
H.R. 1304, proposed by Rep. Phil Roe (R-Tenn.), is intended to ensure that medical stop-loss carriers aren’t regulated as health insurance carriers.
Specifically, as summarized by the Committee on Education and the Workforce, H.R. 1304 would amend ERISA, the Public Health Services Act and the Internal Revenue Code “to clarify that federal regulators cannot redefine stop-loss insurance as “health insurance coverage” under federal law, ensuring that employers can continue to utilize this important financial risk-management tool when offering employees healthcare coverage through a self-funded plan.
In testimony on the measure, Self Insurance Institute of America chairman Jay Ritchie warned that if stop-loss is categorized as health insurance coverage, “it will drive up the cost and threaten the existence of self-insured plans.”
H.R. 1304, he said, would “preclude harmful regulatory action that would limit access to stop-loss coverage, ensuring that many groups seeking to self-insure are able to access the necessary tools to do so.”
In the wake of the defeat of the American Health Care Act, it is possible that opponents of the Affordable Care Act will pay more attention to measures like H.R. 1304, which is intended to limit the erosion of employers’ flexibility in designing health plans.
Meanwhile, H.R. 1215 would establish limits on medical malpractice claims in order to, its authors believe, curb the costly practice of defensive medicine. The legislation is “modeled after California’s decades-old and highly successful health care litigation reforms,” according to the House Judiciary Committee’s report on the measure. Similar legislation has been proposed in previous sessions of Congress without enactment
In a letter of support for the measure, American Medical Association CEO James Madara asserts that the legislation provides “the right balance of reforms by promoting speedier resolutions to disputes, maintaining access to courts, and maximizing patient recovery of damage awards.”
H.R. 1215 would:
· Provide for an unlimited amount of damages for “actual economic losses” but cap non-economic damages at $250,000,
· Impose a three-year deadline for starting a health care lawsuit—or one year after the patient discovered the alleged evidence of malpractice,
· Limit the proportion of awarded damages that can be split with plaintiffs’ attorneys, limiting the financial incentives for attorneys to take such cases on a contingency basis, and
· Shield healthcare providers from product liability claims associated with FDA-approved drugs and medical products.
However, Judiciary Committee ranking member minority Rep. John Coyners Jr. (D-Mich.) opposed the measure. In the Judiciary Committee’s report on the bill, Rep. Conyers claimed it would “undermine the ability of victims of medical malpractice and defective medical products to be fully compensated for their injuries.”
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