mr. speaker , i oppose the underlying bill for many reasons . 
fundamentally , it violates the concept of federalism that is embodied in our constitution , respect for our states , and the ability of our states to be able to regulate public safety issues and health issues for the people of our states . 
this legislation would preempt the ability of my state and your state to protect the rights of our own citizens through regulation . 
that is wrong . 
that is the wrong usurpation of power by the federal government . 
this underlying legislation would adversely affect the people of maryland , and let me tell you why . 
our legislature has passed small market reform . 
people who work for companies that are between two and 50 employees have the opportunity to purchase insurance , affordable health insurance in maryland as a result of our small market reform . 
the passage of this legislation will mean the end of the small market reform and the opportunity to purchase insurance by small employers in my state . 
that is wrong . 
we are going to be moving in the wrong direction with making affordable health insurance available for the people of this nation . 
mr. speaker , i want you to understand the insurance commissioner of maryland is a republican . 
the governor of maryland , who opposes this bill , is a republican . 
this should not be a partisan issue . 
this should be a matter about the appropriate use of the federal authority and it is being used wrong here . 
i congratulate the gentleman from wisconsin ( mr. kind ) xz4002180 for his substitute which is sensitive to the rights of our states . 
i hope members will support the substitute and reject the underlying bill . 
mr. speaker , as a member who is dedicated to protecting the rights of americans who have health insurance and to ensuring that opportunities to secure affordable health insurance can be expanded , i rise in opposition to h.r. 525 . 
since coming to congress , i have heard frequently from individuals who work in small business . 
they have spoken to me about the difficulties that result from a lack of health insurance coverage , skyrocketing premiums , and reductions in benefits . 
i remain committed to developing solutions that will alleviate the hardships faced by many maryland families and small businesses . 
however , the association health plan ( ahp ) legislation we are considering on the house floor today is not a viable solution . 
h.r. 525 would exempt ahps from state laws and state regulatory oversight . 
through this special exemption , ahps would be able to severely undermine the goal of greater health care access and affordability for maryland residents . 
although some supporters of this legislation claim it will benefit small employers , the reality is that h.r. 525 will only hurt the small business community . 
h.r. 525 would leave the maryland insurance commissioner powerless to protect our citizens . 
under this misguided bill , unregulated out-of-state ahps could operate in maryland without being required to comply with health care safeguards enacted by our state legislature , such as : appropriate access to emergency care . 
the right to independent appeal of denied claims , fair insurance premiums for small groups , consumer marketing protections , prevention of health plan failures due to insolvency . 
under this legislation , my constituents would not only lose their ability to demand an independent review of denied claims , but they would lose guaranteed access to important benefits such as emergency medical treatment and mammography screenings . 
workers who purchase association health plan coverage -- believing that they are getting comprehensive insurance -- may very well find that they would still have to shoulder the costs of these essential services . 
not only would this bill be harmful to potential subscribers , it would destroy the small group market reforms already in place in maryland . 
twelve years ago , my home state of maryland took a major step toward helping small businesses afford health insurance for their workers . 
our reforms guarantee the availability of reasonably priced , comprehensive health insurance for all small employers . 
specifically , maryland requires all health insurers to sell a comprehensive standard benefit package designed by an independent commission to all employers with between 2 and 50 employees . 
the plan must have benefits that are actuarially equivalent to those required to be offered by federally qualified hmos , and the average cost can not exceed 12 percent of maryland 's average annual wage . 
insurers have the option of offering additional benefits , but they must due to these reforms , more maryland small businesses offer health care coverage to their employees than in any surrounding states or in the nation as a whole . 
maryland 's system is one in which healthy subscribers subsidize those who are less healthy . 
these reforms work because insurers are not allowed to `` cherry pick '' the businesses that have the healthiest workers . 
association health plans have been outlawed in our state . 
the association health plan legislation before us would undermine our system by using the lure of lower premiums to attract firms whose workers have fewer health problems , firms whose employees might be willing to forgo some of the consumer protections offered under maryland law . 
businesses with older , sicker employees would remain in the state system , driving up premiums . 
h.r. 525 would , in effect , lead to the collapse of maryland 's system . 
this bill would be devastating on a national level , as well . 
the non-partisan congressional budget office found that premiums would increase for 20 million employees and their dependents who are covered through small firms , and that 100 , 000 of the sickest workers would lose coverage altogether if this ahp legislation were enacted . 
passage of this legislation would be a disservice to every worker , every family , and every small business in maryland . 
h.r. 525 fails to provide meaningful help for the uninsured , denies access to affordable health care for older , less healthy groups , and undermines the crucial consumer protections that our general assembly has enacted . 
for these reasons , i urge my colleagues to vote against this bill . 
mr. speaker , the following is a letter from our insurance commissioner who is opposed to h.r. 525 : maryland insurance administration , baltimore , md , april 19 , 2005 . 
dear congressman cardin : as commissioner of the maryland insurance administration i am writing to express my strong opposition to federal legislation that would create association health plans , ahps . 
i understand such legislation , h.r. 525 , has been passed , again , by the house education and the workforce committee and may soon come to the floor of the house for a vote . 
h.r. 525 would allow ahps to form and operate in maryland outside the authority of my office and beyond the reach of proven state consumer safeguards and solvency laws . 
if enacted into law , this could do irreparable harm to our small group market and strip our citizens of critical protections . 
altough i share the sponsor 's concern for the growing number of small business employees who can not afford adequate coverage , the fact is this legislation would do little , if anything to address this problem . 
h.r. 525 ignores the root cause of the current crisis -- skyrocketing healthcare spending . 
unless spending is brought under control no attempts to increase competition or enhance options for small business will truly make insurance affordable and , thus , promote coverage . 
even more troubling is the harm the legislation would do to consumers , h.r. 525 would : ( 1 ) permit risk selection thereby creating opportunities for `` cherry-picking '' among healthier groups ; ( 2 ) allow inadequate capital standards and solvency requirements , both of which are inferior to existing state standards ; ( 3 ) eliminate proven state consumer protection laws , including those designed to allow consumer appeals of adverse plan decisions and those aimed at preventing and fighting fraud ; and i remain committed to improving access to affordable insurance for small business owners and workers in maryland . 
together , we can find solutions that will be effective and not lead to greater problems in the future . 
h.r. 515 is clearly not the answer and i urge you to oppose it . 
sincerely , al redmer , jr. , 