[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6280 Introduced in House (IH)]
110th CONGRESS
2d Session
H. R. 6280
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 17, 2008
Mr. Fortenberry 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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 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 2008''.
(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.
TITLE I--HEALTH BENEFIT PLANS
SEC. 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.
SEC. 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.
SEC. 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.
SEC. 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.
TITLE II--EXPANSION OF STATE HIGH RISK HEALTH INSURANCE POOLS
SEC. 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 ``and 2008''; and
(B) in the matter preceding subparagraph (A), by
striking ``through 2010'' and inserting ``and 2008'';
(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 2009
through 2013.--There are authorized to be appropriated for each
of fiscal years 2009 through 2013--
``(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)''.
SEC. 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 2008, 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 2008, 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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