WASHINGTON — In recent decades, it has become common for states to require that insurance companies offer coverage for certain types of cancer screenings, such as mammograms, 49 states; colorectal examinations, 22 states; and cervical cancer screenings, 29 states.

"If you find cancer early and detect it early, you're not only going to save costs, you're going to save a life," said Daniel Smith of the American Cancer Society. "One of the barriers to going to get screened is if your insurance company won't cover it."

But how many state mandates are too many when insurers are also required to cover acupuncture, speech therapy, or the treatment and evaluation of Lyme disease? That's a question the Senate will consider when it takes up a bill that would let insurers bypass coverage requirements mandated by states.

Debate was to begin Tuesday.

Under legislation sponsored by Sen. Mike Enzi, R-Wyo., businesses could band together based on their membership in a professional trade association to offer their workers limited health insurance. Enzi predicted that most businesses will stick with policies they currently offer rather than switch to a less comprehensive benefit.

However, some businesses that don't offer health insurance will find they can now afford to do so through the small business health plans. As a result, about 1 million currently uninsured workers would get coverage, he said.

"They have no insurance right now, so this would be an improvement," Enzi said.

Opponents say the bill would result in health insurance policies that don't protect workers when they get ill.

The vote, expected to be close, is also likely to fall largely along party lines, with Republicans in support and Democrats in opposition. The legislation pits business groups such as the National Federation of Independent Businesses, which supports the bill, against consumer groups, such as AARP and the American Cancer Society, which oppose it.

Sen. Chris Dodd, D-Conn., said he believes insurance companies will offer plans with minimal or no benefits, hoping to attract young and healthy people. Older, sicker people are going to be left without a plan that meets their needs.

"In one fell swoop, this bill will undo the work of each state to protect their citizens," Dodd said.

Insurers say the state mandates are driving up the cost of policies, and the ranks of the uninsured. States have approved more than 1,800 coverage requirements, says the Council for Affordable Health Insurance.

"Although one mandate may only increase the cost of a policy by 1 percent, 40 such mandates will price many people out of the market," the council said in a recent report.

Democrats are expected to offer a competing bill Tuesday that also would allow small businesses to band together to purchase health insurance. The Office of Personnel Management would administer the benefit. The program would be set up like the Federal Employees Health Benefit Program, said the bill's sponsors, Sens. Dick Durbin, D-Ill., and Blanche Lincoln, D-Ark.

"If it's good enough for federal employees, and it's good enough for members of Congress, there's no reason we shouldn't use this model for small businesses and self-employed people," Lincoln said.

Senate Majority Leader Bill Frist, R-Tenn., has labeled this week as "health week" in the Senate. On Monday, Democrats blocked legislation that would cap the amount of damages juries can award in medical malpractice cases. The roll calls fell well short of the 60 votes Republicans needed to advance the bill.

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By KEVIN FREKING Associated Press Writer
© 2006 The Associated Press

On the Net:

Alliance for Health Reform-small business health plans: http://www.allhealth.org/event_042406.asp

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