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H.R. 109 (111th): America’s Affordable Health Care Act of 2009

The text of the bill below is as of Jan 6, 2009 (Introduced).


I

111th CONGRESS

1st Session

H. R. 109

IN THE HOUSE OF REPRESENTATIVES

January 6, 2009

introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To provide for the offering of Health Benefit Plans to individuals, to increase funding for State high risk health insurance pools, and to promote best practice protocols for State high risk pools.

1.

Short title; findings and purposes; table of contents

(a)

Short title

This Act may be cited as the America’s Affordable Health Care Act of 2009.

(b)

Findings and purposes

(1)

Findings

Congress finds the following:

(A)

The regulation of the practice of insurance is a State prerogative.

(B)

It is in the interests of health care consumers that Congress allows for policies that increase the affordability of health insurance products.

(C)

The Federal Government provides States and the medical community with public financing to support the medical needs of the uninsured.

(D)

There is a correlation between the amount of insurance benefits and the cost of insurance products.

(E)

State mandate laws have created barriers to affordable health coverage.

(F)

A number of States allow for the creation of insurance products that recognize the increased costs associated with mandate laws.

(G)

Consumers throughout the United States are finding it increasingly hard to secure affordable health care coverage which contributes to the national uninsured rate.

(2)

Federal insurance product

Congress further finds that it is in the interests of taxpayers, health care purchasers, and the health care provider community, to allow for a class of federally certified insurance products that can be purchased in the individual market without being subject to State benefit mandate laws.

(3)

Purposes

The purposes of this Act are—

(A)

to promote increased affordability and access to health care coverage for citizens of the United States;

(B)

to allow consumers the ability to make choices by weighing insurance benefits with the cost of insurance;

(C)

to provide incentives to health plans and health insurance issuers to offer increasingly affordable insurance policies to all those in the individual market;

(D)

to provide low-income and uninsured workers with incentives to purchase insurance policies;

(E)

to provide incentives to companies and States to offer health care solutions for high risk beneficiaries;

(F)

to provide for new coverage opportunities to solve the problems of affordability and uninsurance; and

(G)

to promote the availability of health insurance coverage through high risk pools for individuals whose health conditions create barriers to such coverage.

(c)

Table of contents

The table of contents of this Act is as follows:

Sec. 1. Short title; findings and purposes; table of contents.

Title I—Health Benefit Plans

Sec. 101. Certification of Health Benefit Plans.

Sec. 102. Conditions for certification.

Sec. 103. Review of implementation.

Sec. 104. Definitions.

Title II—Expansion of State High Risk Health Insurance Pools

Sec. 201. Increasing and expanding funding for State high risk health insurance pools.

Sec. 202. Qualified high risk pools best practices guidelines and grant program.

I

Health Benefit Plans

101.

Certification of Health Benefit Plans

(a)

In general

A health insurance issuer may apply to the Secretary for up to 3 health insurance coverage policies offered in the individual market in any State to be certified as Health Benefit Plans under this title with respect to eligible individuals and the policies so certified may be offered and sold to such individuals without regard to any State or local law respecting mandates for benefits.

(b)

Construction

Except as specifically provided under subsection (a) with respect to health insurance benefits, nothing in this title shall be construed as—

(1)

modifying the application of State or local requirements relating to matters not described in subsection (a), such as underwriting, enrollment, and premiums;

(2)

superseding any provision of State or local law or regulation relating to the business of insurance, including the regulation of insurers and insurance products, underwriting, enrollment, and premiums;

(3)

preventing a State or local jurisdiction from applying fraud and abuse provisions otherwise applicable with respect to the sale and marketing of health insurance coverage to the sale and marketing of Health Benefit Plans under this title; or

(4)

exempting a Health Benefits Plan, and the health insurance issuer offering such a plan, from applicable requirements of State law and compliance with applicable provisions of title XXVII of the Public Health Service Act.

102.

Conditions for certification

(a)

In general

The Secretary shall not certify under this title a Health Benefit Plan offered by a health insurance issuer unless—

(1)

the Plan includes benefits for items and services within each of the categories of basic services described in subsection (b); and

(2)

the issuer—

(A)

is licensed under State law to offer health insurance coverage in the State involved; and

(B)

submits to the Secretary such information and assurances as the Secretary may require to assure compliance of the issuer, and Health Benefit Plans offered by the issuer, with the applicable requirements of this title.

(b)

Categories of basic services

(1)

In general

The categories of basic services described in this subsection are as follows:

(A)

Inpatient hospital services.

(B)

Physicians' surgical and medical services.

(2)

Treatment of other categories

Nothing in this section shall be construed as preventing a Health Benefit Plan from providing coverage of benefits that are not within a category of basic services described in paragraph (1).

(c)

Reciprocal arrangements

Health insurance issuers offering Health Benefit Plans may create reciprocal arrangements with other issuers of such plans in order to improve the portability of such plans among eligible individuals.

103.

Review of implementation

(a)

Review

The Secretary shall review the implementation of this title and the impact of such implementation on the availability and purchase of health insurance coverage.

(b)

Report

Not later than 3 years after the date of the enactment of this Act, the Secretary shall submit to Congress a report on this title and its impact on making health insurance coverage more affordable.

104.

Definitions

In this title:

(1)

The term eligible individual means an individual who is a citizen or national of the United States or an alien lawfully residing permanently in the United States.

(2)

The terms health insurance coverage, health insurance issuer, and individual market have the meanings given such terms in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91).

(3)

The term Secretary means the Secretary of Health and Human Services.

II

Expansion of State High Risk Health Insurance Pools

201.

Increasing and expanding funding for State high risk health insurance pools

(a)

In general

Section 2745(d) of the Public Health Service Act (42 U.S.C. 300gg–45(d)) is amended—

(1)

in paragraph (2)—

(A)

in the heading, by striking through 2010 and inserting through 2009; and

(B)

in the matter preceding subparagraph (A), by striking through 2010 and inserting through 2009;

(2)

by redesignating paragraphs (3), (4), and (5) as paragraphs (4), (5), and (6), respectively; and

(3)

by inserting after paragraph (2) the following new paragraph:

(3)

Authorization of appropriations for fiscal years 2010 through 2014

There are authorized to be appropriated for each of fiscal years 2010 through 2014—

(A)

$10,000,000 to carry out subsection (a); and

(B)

$100,000,000, of which, subject to paragraph (5)—

(i)

two-thirds of the amount appropriated shall be made available for allotments under subsection (b)(2); and

(ii)

one-third of the amount appropriated shall be made available for allotments under subsection (c)(3).

.

(b)

Conforming amendments

Section 2745 of the Public Health Service Act (42 U.S.C. 300gg–45) is amended—

(1)

in subsection (a), by striking subsection (d)(1)(A) and inserting paragraphs (1)(A) and (3)(A) of subsection (d);

(2)

in each of paragraphs (1) and (2) of subsection (b), by striking (1)(B)(i) and (2)(A) and inserting (1)(B)(i), (2)(A), and (3)(B)(i);

(3)

in each of paragraphs (1) and (3) of subsection (c), by striking (1)(B)(ii) and (2)(B) and inserting (1)(B)(ii), (2)(B), and (3)(B)(ii); and

(4)

in subsection (d)—

(A)

in each of paragraphs (1)(B) and (2), by striking paragraph (4) and inserting paragraph (5); and

(B)

in paragraph (5), as redesignated by subsection (a)(2), by striking paragraph (1)(B) or (2) and inserting paragraph (1)(B), (2), or (3)(B).

202.

Qualified high risk pools best practices guidelines and grant program

Section 2745 of the Public Health Service Act (42 U.S.C. 300gg–45) is amended—

(1)

in subsection (b)(1), by striking In the case and inserting Subject to subsection (f)(1), in the case;

(2)

by redesignating subsection (f) and (g) as subsections (g) and (h), respectively; and

(3)

by inserting after subsection (e) the following new subsection:

(f)

Qualified high risk pools best practices guidelines and grant program

(1)

Best practices report requirement

To be eligible to receive a grant under subsection (b) for a fiscal year beginning more than 60 days after the date of the enactment of the America’s Affordable Health Care Act of 2009, a State that has established a qualified high risk pool shall submit to the Secretary, not later than 120 days after the beginning of such fiscal year, evidence-based information on the operation of such pool, as specified by the Secretary for purposes of creating the best practices guidelines described in paragraph (2).

(2)

Best practice guidelines

Not later than 120 days after the date of the enactment of the America’s Affordable Health Care Act of 2009, the Secretary shall, after providing for notice and comment, recommend and post on the public Internet site of the Department of Health and Human Services a list of best practices with respect to the operation of qualified high risk pools. The Secretary shall provide for notice to the States and insurers who manage such qualified high risk pools of the proposed development of such practices and shall develop such best practices with input obtained from such States and insurers. Such best practices should be categorized and applied according to the number of individuals enrolled in the qualified high risk pool involved.

(3)

Bonus grants for State qualified high risk pools that follow best practices

(A)

In general

In the case of a State that is one of the 50 States or the District of Columbia, that has established a qualified high risk pool, and that is receiving a grant under subsection (b)(1), for each fiscal year for which the State demonstrates according to a process specified by the Secretary that such qualified high risk pool was operated in accordance with the best practices posted under paragraph (2), the Secretary shall provide a bonus grant from the funds appropriated under subparagraph (C) and allotted to the State under subparagraph (B).

(B)

Allotment; limitation

The Secretary shall allot funds appropriated under subparagraph (C) among States qualifying for a bonus grant under subparagraph (A) in a manner specified by the Secretary, but in no case shall the amount so allotted to a State for a fiscal year exceed 10 percent of the funds so appropriated for the fiscal year.

(C)

Authorization of appropriations for bonuses

There are authorized to be appropriated for each of fiscal years 2010 through 2013 $26,000,000 for allotments under subparagraph (B).

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