More than 70 million people who work at large companies would not get health insurance protections sought by President Obama under a closely watched Senate health care bill, a Democratic lawmaker involved in the debate says.
The proposed rules, which Obama said will "make the insurance you have work better for you," would prohibit insurers from denying coverage because of pre-existing conditions or imposing limits on how much will be paid out to sick patients.
However, under legislation in the Senate Finance Committee, the new rules would not apply to people who work for large companies that self-insure, meaning the employer pays health care claims out of its revenue rather than relying on a private insurer, says Sen. Jay Rockefeller, D-W.Va.
"They can be cut off; there are no caps," says Rockefeller, the second-highest-ranking Democrat on the committee. "I'm determined to fix it."
Rockefeller has proposed expanding the insurance regulations to cover everyone in an amendment he hopes will be considered this week.
A spokeswoman for Sen. Max Baucus, D-Mont., who drafted the bill, said the protections are targeted to employees of small businesses and people who buy insurance on their own because they have the most trouble obtaining good coverage.
"Health care reform is about building on what works in our system and fixing what doesn't," Baucus spokeswoman Erin Shields said in a statement. "The biggest problems exist today for people who don't have employer-sponsored insurance."
As many as 73 million people, or 55% of those who get insurance through private-sector jobs, are covered in self-insured plans, according to the non-partisan Employee Benefit Research Institute. Workers are often not aware their plans are self-insured because employers hire insurance companies to process claims.
Business groups have resisted the new regulations for large companies. In an e-mail to local chapters, U.S. Chamber of Commerce lobbyist R. Bruce Josten called the Rockefeller amendment "dangerous," arguing that it would "significantly and adversely impact larger employers."
In most states, large employers are defined as those that have more than 50 employees.
The Finance Committee continues work this week on the health care bill, which would cost $900 billion in the first 10 years and require everyone to buy a health care policy.
Other versions of the bill in Congress offer more of the protections for workers who receive health insurance through large employers, said Ron Pollack, executive director of non-partisan Families USA, which supports changing the health care system. Still, Pollack credited Baucus for focusing on small-business employers and individuals buying insurance outside of work because, he said, those are "the insurance markets that have the done the least to protect people."
Among the protections under consideration in the Senate Finance bill:
• Capping how much insurers will pay over a year or lifetime would end for small business and individual policies, but insurers would be barred only from imposing "unreasonable" caps for larger companies.
• Employees hired at small businesses could not be denied coverage for a pre-existing condition. For larger companies, current law would apply, which allows companies to deny claims for pre-existing conditions up to a year if the new employee allowed previous coverage to lapse.
• Insurers could no longer consider gender, health status and other risk factors when setting premiums for individual and small-business policies. Those factors could still be considered for larger employers.
Clifford Roberti, a lobbyist for the Self-Insurance Institute of America, said most large employers have "the most generous benefits out there."
"The self-insured plans are the area of insurance that's working," he said.