The House GOP bill includes two poison pill provisions: vastly expanded Medical Savings Accounts (MSAs) and Association Health Plans (AHPs). They describe these provisions as additions that will increase access to health insurance coverage. Unfortunately, the impact is likely to be the opposite.

• Medical Savings Accounts. The GOP bill attempts to breathe life into a failed demonstration of MSAs. The bill would make MSAs permanent, make them universally available, lower the deductible, raise the contribution level to the full amount of the deductible, allow both employers and employees to contribute to the MSA, and allow MSAs to be offered through cafeteria plans.

COULD CAUSE TRADITIONAL INSURANCE PREMIUMS TO DOUBLE: Changes such as those in the House GOP bill are predicted to have a negative impact on the health insurance marketplace. Analysts such as the American Academy of Actuaries, RAND, and the Urban Institute indicate that these sweeping changes to the existing MSA demonstration could destabilize the state-regulated health insurance marketplace through adverse selection -- culling the healthy into the MSA market and leaving the sick and disabled in the traditional insurance marketplace with the potential of doubling traditional insurance premiums for those individuals.

The American Academy of Actuaries has noted that, "The greatest saving [from MSAs] will be for the employees who have little or no health care expenditures. The greatest losses will be for the employees with substantial health expenditures. Those with high expenditures are primarily older employees and pregnant women."

The General Accounting Office (GAO) has noted that, "Insurers expect relatively better health status and lower service utilization by [MSA] enrollees and price their products accordingly. Insurers confirmed this conclusion in the survey."

CREATES A NEW TAX SHELTER: An MSA acts like an Individual Retirement Account (IRA) except, unlike IRAs, there are no income limits that prevent wealthy people from using them as tax shelters. By increasing the amount of contribution that people are eligible to make to their MSA, the Republican proposal increases the attractiveness of MSAs as an alternative IRA for the wealthy, thus creating another new tax shelter for those with upper incomes.

An Associated Press article cited Eclipse MediSave America Corp, an MSA servicing company, as having calculated that a family making $3,375 annual MSA contributions and earning 8 percent interest for a year could accumulate $1.4 million in the account over 45 years. Even if they withdrew $1,000 a year, they would still accumulate $991,000.

A GAO Report found that "The entry of Merrill Lynch and other investment firms in the MSA trustee arena and the maturing of the market have led to increased investment choices for MSA holders. This trend may be affected as well by some insurers perceptions that MSA enrollees are using their accounts primarily as tax-sheltered savings vehicles rather than as sources of tax-sheltered funds for paying medical expenses."

• Association Health Plans (AHPs). Nothing prevents small businesses from banding together now to purchase health insurance. The GOP bill, however, would allow AHPs to escape state regulation and jeopardize current risk pools. That’s just one reason that AHP legislation is opposed by the National Governor’s Association, the National Council of State Legislatures, the National Association of Insurance Commissioners, and countless consumer and patient groups.

GANSKE-DINGELL-NORWOOD-BERRY ACCESS PROVISIONS INCREASE ACCESS WITHOUT GUTTING PATIENT PROTECTIONS OR INCREASING PREMIUMS

The main purpose of the Ganske-Dingell-Norwood-Berry bill is to ensure that the 191 million Americans in private health insurance plans get what they pay for and are guaranteed basic rights when enrolled in those plans. However, the Ganske-Dingell-Norwood-Berry bill does include a few responsible access provisions that don’t cause adverse selection, don’t allow HMO’s and other plans to get out from under patient protections, and don’t drive up premiums for the disabled and chronically ill. They are a responsible alternative to the "access" provisions in the House GOP bill.

• The bill provides a very limited expansion of MSA’s but does not make sweeping changes to the operations of MSA’s that would drastically increase their use as a tax shelter or cause adverse selection, hurting the disabled and chronically ill.

• The bill provides a targeted health insurance tax credit to encourage small businesses to offer new health insurance coverage for the first time and speeds up the 100 percent deductibility of health insurance costs for the self-employed.

• The bill also establishes a grant program for states to pursue innovative ways to increase access to health insurance, including establishing group purchasing arrangements, and it clarifies that qualified group purchasing arrangements can accept start-up money from foundations to help operate the purchasing pool.