Legislation in Congress could help a number of groups representing small business line up affordable health insurance, backers say.

Critics say allowing the creation of "association" health plans will still leave many business owners or employees without coverage or facing even higher premiums.

Rep. Denny Rehberg recently joined National Federation of Independent Business representatives on a statewide tour, pitching the idea of allowing groups like the NFIB or National Association of Realtors to provide health coverage to members.

Of the roughly 45 million Americans without health insurance, more than 60 percent own or work for a small business, Rehberg told a gathering in Great Falls recently.

"Obviously, we've got a market that's not being fulfilled right now," Rehberg said.

For instance, there are about 1.2 million members of the National Association of Realtors nationwide, said Ronda Tompers, president of the Great Falls Association of Realtors.

"About a third of those people don't have any health insurance at all so it's an important issue for us," Tompers said.

Rehberg is backing a measure called the Small Business Health and Fairness Act, which would allow bona fide trade associations to buy health insurance nationally, provide the same rates and coverage to all their members and be exempt from state coverage mandates.

There are versions of the bill pending in the U.S. House and Senate. Currently, it is illegal for such insurance pools to be formed across state lines.

Backers of the plan say it will do much to give small business owners and their employees access to health insurance similar to that enjoyed by big companies and members of labor unions.

But opponents, including Montana Auditor John Morrison and others, oppose such legislation. Health plans formed by such a measure would be exempt from regulation by state insurance commissioners, a role held by Morrison in Montana.

Without state regulation, such plans could siphon off the healthiest groups and force up premiums for other small businesses, Morrison says. They also could be more prone to fraud.

Without state regulators, there could also be a lack of someone to keep association plans from becoming insolvent and leaving policy holders stranded without coverage.

Morrison recently testified against association plans before a Senate committee. Joining state insurance regulators in opposition are the National Governor's Association, the National Association of Attorneys General and the National Conference of State Legislatures.

Rehberg and others say "cherry picking" the healthiest customers is already forbidden under federal law.

Backers say one of the biggest opponents of association plans are Blue Cross Blue Shield plans, which could stand to lose a sizable number of customers if the legislation is approved.

Stacy Jenkins, an NFIB representative, said association plans could give small business owners more choices in health care and the opportunity to pay rates as much as 50 percent below current levels.

"Many small business health insurance for their employers but they simply can't afford it," Jenkins said.

While the U.S. House has backed such legislation several times, the Senate has been a roadblock, Rehberg said.

Having a Republican, Sen. Mike Enzi of Wyoming, as chairman of the Senate Committee on Small Business and Entrepreneurship could boost its chances of passage, according to Rehberg.

"This is getting more and more attention, and we need to get it through the Senate," he said.

A Blue Cross Blue Shield board member, former Montana Rep. Rick Hill, told Rehberg that such legislation would help some but leave plenty of small business owners who are not members of big trade groups behind. Those folks could face even higher premiums than they do now.

"That's the problem," Hill said.