H. R. 6806
IN THE HOUSE OF REPRESENTATIVES
August 1, 2008
Mr. Goode introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Oversight and Government Reform and House Administration, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
To establish a Citizens Congressional Health Benefits Program, based on the Federal employees health benefits program, to provide health insurance coverage for the President, Vice President, and Members of Congress, and citizens not eligible for coverage under the Federal employees health benefits program.
Short title; table of contents
This Act may be cited as the
Count for Something Act.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Establishment of Citizens Congressional Health Benefits Program (CCHBP).
Sec. 3. Eligibility; enrollment.
Sec. 4. Qualified health plans; benefits; premiums.
Sec. 5. Government contribution.
Sec. 6. Administration.
Sec. 7. Definitions.
Establishment of Citizens Congressional Health Benefits Program (CCHBP)
There is established
under this title a program (to be known as the
Health Benefits Program) to provide comprehensive health insurance
coverage to Federal elected officials and to all other citizens who are not
covered under the Federal Employees Health Benefits Program (FEHBP). The
coverage shall be provided in a manner similar to the manner in which coverage
has been provided to Members of Congress and Federal Government employees and
retirees and their dependents under the Federal Employees Health Benefits
Benefits shall first be made available under this title for items and services furnished on or after January 1, 2010.
Non-preemption of existing collective bargaining agreements
Nothing in this Act shall be construed as preempting any collective bargaining agreement that is in effect as of the date of the enactment of this Act, during the period in which such agreement is in effect (without regard to any extension of such agreement effected as such date of enactment).
Each CCHBP-eligible individual (as defined in paragraph (2)) is eligible to enroll in accordance with this title in a qualified health plan offered under this title.
CCHBP-eligible individual defined
For purposes of this title, the term CCHBP-eligible individual means elected Federal officials (including the President, Vice President, and Members of Congress) and any other individual residing in the United States who—
is a citizen or national of the United States; and
is not enrolled under the Federal employees health benefits program under chapter 89 of title 5, United States Code.
Conforming elimination of FEHBP eligibility for Federal elected officials
Effective for benefits for items and services furnished on or after January 1, 2010, section 8901 of title 5, United States Code, is amended—
by striking subparagraphs (B) and (D); and
in the matter following subparagraph (J)—
or at the end of clause (iii);
striking the period at the end of clause (iv) and inserting
by adding at the end the following new clause:
the President, the Vice President, or a Member of Congress as defined in section 2106 of this title.
The Director shall establish a process for CCHBP-eligible individuals to enroll in qualified health plans. Such process shall be based on the enrollment process used under FEHBP and shall provide for the dissemination of information to CCHBP-eligible individuals on qualified health plans being offered.
Changes in enrollment
The Director shall establish enrollment procedures that include an annual open season and permit changes in enrollment with qualified health plans at other times (such as by reason of changes in marital or dependent status or eligibility). Such procedures shall be based on the enrollment procedures established under FEHBP.
CCHBP-eligible individuals may be enrolled in a qualified health plan under this title only during enrollment periods specified by the Director.
Treatment of family members
Enrollment under this title includes both individual and family enrollment, in a manner similar to that provided under FEHBP. To the extent consistent with eligibility under subsection (a), the Director shall provide rules similar to the rules under FEHBP for the enrollment of family members who are CCHBP-eligible individuals in the same plan.
Changes in plan enrollment
The Director shall provide for and permit changes in the qualified health plan in which an individual or family is enrolled under this section in a manner similar to the manner in which such changes are provided or permitted under FEHBP. The Director shall provide for termination of such enrollment for an individual at the time the individual is no longer an CCHBP-eligible individual.
The Director shall provide for the broad dissemination of information on qualified health plans offered under this title. Such information shall be provided in a comparative manner, similar to that used under FEHBP, and shall include information, collected through surveys of enrollees, on measures of enrollee satisfaction with the different plans.
Qualified health plans; benefits; premiums
Offering of plans
The Director shall enter into contracts with entities for the offering of qualified health plans in accordance with this title. Such contracts shall be entered into in a manner similar to the process by which the Director is authorized to enter into contracts with health benefits plans under FEHBP.
Requirements for entities offering plans
No such contract shall be entered into with an entity for the offering of a qualified health plan in a region unless the entity—
is licensed as a health maintenance organization in that State or is licensed to sell group health insurance coverage in that State; and
meets such requirements, similar to requirements under FEHBP, as the Director may establish relating to solvency, organization, structure, governance, access, quality, and minimum loss-ratios.
FEHBP scope of benefits
Qualified health plans shall provide for the same scope and type of comprehensive benefits that have been provided under FEHBP, including the types of benefits described in section 8904 of title 5, United States Code and including benefits previously required by regulation or direction (such as preventive benefits, including childhood immunization and cancer screening, and mental health parity) under FEHBP.
No exclusion for pre-existing conditions
Qualified health plans shall not impose pre-existing condition exclusions or otherwise discriminate against any enrollee based on the health status of such enrollee (including genetic information relating to such enrollee).
Other consumer protections
Qualified health plans also shall meet consumer and patient protection requirements that the Director establishes, based on similar requirements previously imposed under FEHBP, including protections of patients’ rights previously effected pursuant to Executive Memorandum.
Collective bargaining agreements
Nothing in this Act shall be construed as preventing a collectively bargained agreement from providing coverage that is additional to, or supplementary of, benefits provided under this Act.
The premiums established for a qualified health plan under this title for individual or family coverage shall be community-rated and shall not vary based on gender, health status (including genetic information), or other factors.
The Director shall establish a process for the timely and accurate collection of premiums owed by enrollees, taking into account any Government contribution under section 5(a). Such process shall include methods for payment through payroll withholding, as well as payment through automatic debiting of accounts with financial institutions, and shall be coordinated with the application of section 59B of the Internal Revenue Code of 1986.
Marketing practices and costs
The Director shall monitor marketing practices with respect to qualified health plans in order to assure—
the accuracy of the information disseminated regarding such plans; and
that costs of marketing are reasonable and do not exceed a percentage of total costs that is specified by the Director and that takes into account costs of market entry for new qualified health plans.
Amount established biannually by Congress
The Director shall provide each year (beginning with 2010) for a contribution under this subsection towards the coverage provided under this title for CCHBP-eligible individuals. The amount of such contribution shall be determined biannually by Congress
The Director shall provide for payment of qualified health plans of the premiums for such plans, as adjusted under this subsection.
Risk adjusted payment
The payment to a qualified health plan under this subsection shall be adjusted in a budget-neutral manner specified by the Director to reflect the actuarial risk of the enrollees in the plan compared to an average actuarial risk.
Reduction for administrative expenses and contingency reserve
The Director may provide for a uniform percentage reduction in payment otherwise made to a qualified health plan under this subsection in order to provide for a contingency reserve and for Federal administrative costs in carrying out this title.
Application of FEHBP rules
Except as otherwise provided in this title, the program under this title shall be administered in the same manner as FEHBP.
In carrying out this title, the Director pursuant to paragraph (1) shall provide for the following:
Approval and disapproval of plans as qualified health plans.
Negotiation of plan benefits (including cost-sharing) and plan premiums.
The Director shall administer the program under this title.
Establishment of CCHBP regions
For purposes of carrying out this title, the Director shall divide the United States into, and establish, CCHBP regions.
The Director is authorized to issue such regulations as may be required to carry out this title.
Use of regional and field offices
The Director shall establish such regional and field offices as may be appropriate for the convenient and efficient administration of this title.
Coverage of administration costs
The Director shall provide for the collection of administrative costs of offering coverage under this title from entities offering qualified health plans in the same manner as FEHBP provides for coverage of its administrative costs.
CCHBP contingency reserve
The Director is authorized to establish and maintain a contingency reserve for purposes of carrying out this title and is authorized to impose under section 5(b)(3)(A) a premium surcharge of up to three percent in order to provide financing for such reserve.
A qualified health plan may establish contingency reserves, that are in addition to the reserve described in paragraph (1), in a manner similar to that permitted under FEHBP.
For purposes of this Act:
The term CCHBP-eligible individual means an individual described in section 3(a)(2).
The term CCHBP region means a region as specified by the Director under section 6(c)(2).
The term Director means the Director of the Office of Personnel Management.
The term FEHBP means the program under chapter 89 of title 5, United States Code.
The term qualified health plan means such a plan offered under this title.