The number of Americans living without health coverage rose in 2005 to 46.6 million, an increase of almost 16 percent over the previous year. In a 2005 survey, the National Association for the Self-Employed (NASE) found that a majority of micro-business owners (51.1%) say they do not currently offer, nor plan to offer, a health insurance plan through their business for themselves or their employees. The smallest companies are most impacted, with only 13.8% of companies that grossed less than $50,000 annually offering health insurance compared to 70% among those grossing more than $500,000 yearly. Thus, the NASE supports efforts to improve our health care system to make it easier for individuals to attain and understand health coverage.

Price Transparency in the Health Care Sector:
In order for individuals, families and business owners to make informed decisions regarding their health coverage, they need accurate information on both price and quality of service providers.

The Bush Administration has been encouraging health care providers to voluntarily begin offering information on price and quality to consumers. Some insurers have moved forward with efforts to give their customers price information. In addition, the White House is phasing in efforts to make companies that provide benefits/health coverage in the Federal Employees Health Benefits Program to disclose prices. However, voluntary efforts to disclose pricing and quality information have not been widespread. The Administration has indicated in remarks that if providers resist transparency, they will work to impose regulations requiring price and quality transparency.

The Republicans in both the Senate and House in the 109th Congress have focused their health policy efforts on expansion of Health Savings Accounts and expansion of health information technology. Price transparency has factored into the debate on the bills relating to health information technology.

In the Senate, S.1418 was passed and would designate $116 million in 2006 fiscal year, $141 million in 2007 and whatever monies may be necessary from 2008-2010 in the form of grants to facilitate adoption of interoperable health information technology. It also beefed up privacy rules as it relations to any health information stored or transmitted electronically. The Senate bill did not address the issue of price transparency.

H.R. 4157 was recently considered by the House. This bill would authorize $20 million a year for 2007 and 2008 to be offered as grants to health providers to adopt technology. It also required the development of voluntary guidelines for interoperability by Aug. 2009 and increased the number of medical procedure and billing codes used by insurers and health care providers in recordkeeping from 24,000 to more than 200,000. Providers have until October 2010 to implement this change.

Prior to the vote on H.R. 4157, House leadership announced that they were including new language in this bill regarding price transparency requirements. The hospital pricing transparency provision would have required the Secretary of Health and Human Services to develop a method for reporting price data for selected inpatient and outpatient hospital services. This provision would have required the hospitals to disclose to HHS the charges to and payments for seniors on Medicare, Medicaid beneficiaries, private insurance payments, and the uninsured. However, the hospitals strongly opposed this provision and put intense pressure on Members. Thus, the provision was stripped from the bill prior to a floor vote. H.R. 4157 passed in the House.

S. 1418 and H.R. 4157 was to go to conference but at the closing of the 109th Congress neither the House nor Senate named conferees to resolve the differences between the two bills. The NASE expects to see discussion surround health IT and price transparency in the next Congress.

Expansion and Funding for High Risk Pools:
The NASE supports the expansion and increased funding of state high risk pools to assist in providing coverage for those with pre-existing conditions and chronic illnesses that often have difficulty obtaining health coverage. Established over 25 years ago, high-risk pools operate in 33 states and covered more than 181,000 people as of June 2004. According to the Council for Affordable Health Insurance, in August 2002 the federal government approved funding of up to $1 million each for states that did not have a qualified high-risk pool as an incentive to establish them.

In the 109th Congress, the State High-Risk Pool Funding Extension Act (H.R. 4519) was signed into law and authorized $75 million annually to states with existing, qualified high-risk pools for fiscal years 2006 to 2010. Additionally, the law extends unused grant money for 2006 to be used to assist states in establishing new high risk pools. The legislation changes the formula which determines each state's high risk pool funding -- the new formula is based on three factors: (1) the percentage of uninsured individuals in the state, (2) the number of participants in each state's risk pool, and (3) requires that 40% of the funding be shared equally (benefiting small states).

The NASE is working with organizations such as Communicating for Agriculture & the Self-Employed (www.selfemployedcountry.org), Coalition for Affordable Health Coverage (www.cahc.net), and the Council for Affordable Health Insurance (www.cahi.org) in efforts with appropriators to ensure that high-risk pools to secure funding at the maximum level in the 110th Congress.

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