Group health insurance through a job is the way most working Americans can afford coverage. But high costs strain small businesses, or preclude any employee benefits at all. It makes sense to create purchasing pools so workplaces can combine buying power for better rates on medical protection.

That's the theory in Congress to help 41 million Americans uninsured even though many work -- about 72,000 of them Delawareans. Good intentions don't bless complicated legislation, though, which the U.S. Senate is to pick up next week.

The Senate Health Insurance Marketplace Modernization and Affordability Act's weakness is it would let trade associations or chambers of commerce offer small business health plans that ignore state mandates for particular kinds of benefits -- such as cancer screenings or mental health treatment.

Eligible insurers offering bare-bones coverage could also sue state officials in federal courts if they don't comply with what would be superceding law.

And the bill would set up an insurance standards board to "harmonize" or erase state differences in filing, payment and rate-setting, instead favoring what most states do -- to facilitate policy sales across borders.

For all these reasons, Delaware Insurance Commissioner Matt Denn and Attorney General Carl Danberg are among 13 state commissioners and 41 attorneys general opposing this bill. So are a formidable number of health organizations across the country, including the American Academy of Pediatrics, American Cancer Society, American Diabetes Association, and American Psychiatric Association. Planned Parenthood of Delaware, which offers women's health care, and the Delaware Psychological Association are among them.

The U.S. House of Representatives passed a small business health insurance bill last year. This Senate version is from Michael Enzi, R-Wyo., and Ben Nelson, D-Neb. Already Republican Majority Leader Bill Frist is gathering amendments.

Nonetheless, Denn said Delaware's health coverage mandates "were thought out pretty carefully" by the General Assembly in response to public health problems here. Delaware requires insurers to pay for newborn screening, childhood immunizations, direct access to obstetrician-gynecologists, mammography, contraception, diabetes supplies, cancer tests, mental health care, clinical trials and emergency care.

Delaware also has more rigorous standards for insurance processing than many states, which Denn fears would be rolled back under a federal rule.

Sen. Thomas Carper similarly acknowledges the effort of his colleagues, but says that state-mandated coverage should be left intact, like the cancer tests that confront Delaware's high mortality rates.

Carper has put forward an alternative modeled on federal employees' health coverage, with co-sponsors Blanche Lincoln of Arkansas and Dick Durbin of Illinois. They'd have the federal Office of Personnel Management run a small-business group purchase plan for economies of scale.

Interestingly, the skeptics include James Wolfe, president of the Delaware State Chamber of Commerce, who adds there's a lot of mixed opinions among chambers nationally. The National Federation of Independent Business is strongly for it.

"I always support competition and I always support lowering costs," he said. But he doesn't see where savings will result when local treatment and hospitalization costs won't change.

This is cache, read story here