The latest iteration of Kennedy’s bill, the Affordable Health Choices Act, provides more guidance on the kinds of subsidies small employers can expect to receive in exchange for providing health insurance to employees, but generally resembles a draft that was leaked last week.

The legislation requires individuals to purchase insurance on par with the types of benefits enjoyed by federal employees. Employers are hoping that should they be required to provide coverage they will have the freedom to design benefits in a way that creates incentives for employees to seek higher-quality, lower-cost care.

Republicans and Democrats on the Senate Health, Education, Labor and Pensions Committee chaired by Kennedy will meet Wednesday and Thursday to hammer out key issues. A public hearing is planned for Thursday.

The Senate Finance Committee will also introduce a separate health care bill in the coming days. That bill could include a tax on employee benefits, though lobbyists believe that if such a tax is included, it would be limited to richer benefits or higher-income earners.

Kennedy’s bill reiterated guarantees that all Americans could find affordable health coverage regardless of a person’s income or health status.

Employers and individuals would have the option to purchase coverage through a national insurance exchange, known as the American Health Benefit Gateways, where coverage would be similar to the types of benefits available to federal employees.

Ultimately, a medical advisory council composed of health experts would be created to determine what would qualify as a health plan in the exchange. The conclusions of the council would be final unless overruled by a joint resolution from Congress, a design similar to a commission that determined military base closures in 2005.

Employers and individuals could also purchase health coverage outside the Gateways. This coverage would not have to conform to the federal government’s minimum standards.

Small employers would have the cost of providing insurance subsidized based on the number of employees and the average salary of its employees.

Among the most controversial issues is whether employers would be required to provide health coverage. Under a section titled “Shared Responsibility of Employers,” Kennedy’s staff has written “policy under discussion”—meaning the details have not yet been worked out.

Employer groups have lobbied against imposing an employer mandate, a public plan option, the taxation of health benefits and any changes to Employee Retirement Income Security Act of 1974, which allows employers to design and manage a single health plan for employees in different areas.

But lobbyists say it is likely that a public plan and an employer mandate will stay in the bill. Ensuing negotiations are focusing on exactly how the mandate would be applied and the level of coverage employers would be required to provide and how much flexibility they would have in managing the design of their plans.

Employers, especially large employers that already provide health insurance, would like to get more for their health care spending by covering procedures and medicines that are known to be the most effective in treating certain ailments.

—Jeremy Smerd

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