[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1038 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 1038

To direct the Secretary of Health and Human Services to provide Federal 
 minimum standards for health insurance for the elderly, and to amend 
title XVIII of the Social Security Act for the purpose of directing the 
   Secretary to study methods of further improving the regulation of 
 health insurance for the elderly and to evaluate methods by which the 
 Medicare Program could more fully meet the health insurance needs of 
                              the elderly.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 23, 1993

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

_______________________________________________________________________

                                 A BILL


 
To direct the Secretary of Health and Human Services to provide Federal 
 minimum standards for health insurance for the elderly, and to amend 
title XVIII of the Social Security Act for the purpose of directing the 
   Secretary to study methods of further improving the regulation of 
 health insurance for the elderly and to evaluate methods by which the 
 Medicare Program could more fully meet the health insurance needs of 
                              the elderly.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

                              short title

    Section 1. This Act may be cited as the ``Senior Citizens Health 
Insurance Standards Act of 1993''.

                          findings and purpose

    Sec. 2. The Congress finds that--
            (1) health care costs are a major expense and source of 
        concern for the elderly;
            (2) Medicare covers less than half of the health care costs 
        for the elderly;
            (3) because of their condition and needs, many elderly have 
        to purchase private health insurance;
            (4) the paucity of consumer information in the field of 
        health insurance for the elderly makes it almost impossible for 
        those seeking such insurance to make reasoned choices;
            (5) many of the policies sold to supplement Medicare 
        coverage provide inadequate coverage and low return to 
        consumers;
            (6) the many instances of abuse and deception in the 
        marketing of health insurance for the elderly, which have been 
        documented by recent congressional hearings, constitute a 
        national disgrace; and
            (7) these instances of abuse, deception, inadequate 
        coverage, and low return are now a national problem and the 
        Federal Government has a responsibility to assist in the 
        remedy.
    (b) It is, therefore, the purpose of this Act to direct the 
Secretary to require Federal minimum standards for the sale of health 
insurance for the elderly and to take other action designed to provide 
future benefits to the elderly who need assistance in meeting their 
health insurance needs.

                           minimum standards

    Sec. 3. (a) Each State shall, no later than two years after the 
date of enactment of this Act, submit a plan to the Secretary of Health 
and Human Services for the purpose of specifying the minimum standards 
applicable to health insurance for the elderly in such State. Such plan 
shall specify minimum standards which--
            (1) provide that at least 75 per centum of the premiums 
        collected from the sale of such health insurance be returned in 
        the form of benefits provided under such health insurance, as 
        specified by the Secretary in regulations;
            (2) limit the exclusions of preexisting conditions in 
        accordance with regulations prescribed by the Secretary;
            (3) provide that policies of such health insurance be 
        written in simplified language which can be understood by 
        purchasers, as specified in regulations prescribed by the 
        Secretary;
            (4) prohibit the sale of such health insurance if such 
        health insurance duplicates the coverage provided under the 
        Medicare Program, except that such a sale may be made if the 
        purchaser signs a written statement expressing his knowledge of 
        the duplicative coverage, as specified in regulations 
        prescribed by the Secretary; and
            (5) are in accordance with disclosure provisions, specified 
        in regulations, which the Secretary determines necessary to 
        protect purchasers of such insurance, including, but not 
        limited to, provisions which require a simplified written 
        statement, to all prospective purchasers, of--
                    (A) the percentage of premiums collected for such 
                health insurance which is returned in the form of 
                benefits;
                    (B) the name and address of the agent who sold the 
                policy and a toll free telephone number of the 
                insurance company;
                    (C) general information which briefly, simply, and 
                adequately explains the premiums, benefits, 
                renewability, coverage, deductibles, coinsurance 
                charges, and other matters; and
                    (D) general information which briefly, simply, and 
                adequately explains the specific matters covered by the 
                insurance which are not covered under the Medicare 
                Program.
    (b) The Secretary shall issue final regulations referred to in 
subsection (a) no later than one hundred and eighty days after the date 
of enactment of this Act.
    (c) The Secretary shall approve or disapprove any plan submitted 
pursuant to subsection (a) no later than ninety days after such 
submission.
    (d)(1) In the case of any State whose plan is disapproved under 
subsection (c), the Secretary shall return such plan to the State with 
a detailed explanation of the reasons for such disapproval. The State 
may submit a new plan within thirty days after receiving such 
explanation, and the Secretary shall approve or disapprove such plan no 
later than thirty days after such submission.
    (2) If the Secretary disapproves a new plan submitted in accordance 
with the second sentence of paragraph (1) of this subsection, such 
disapproval shall be subject to judicial review in the United States 
court of appeals for the circuit in which the State is located or in 
the United States Court of Appeals for the District of Columbia 
Circuit. Any such review shall be instituted only by the State involved 
and shall be commenced within sixty days after the date on which the 
disapproval was issued. The provisions of subsection (f) shall apply 
and shall not be stayed pending any such review.
    (e)(1) The Secretary shall conduct oversight activities in each 
State in which a plan is approved for the purpose of assuring that such 
plan is carried out in each such State. Each State shall submit an 
annual report to the Secretary containing a detailed account of the 
operation of the plan in the State during the previous year. Such 
report shall be in such form and contain such information as is 
specified by the Secretary in regulations.
    (2) No change may be made in a plan by any State unless approved by 
the Secretary before the effective date of such change.
    (3) In any case in which the Secretary finds that a State, which 
has an approved plan, is not carrying out such plan, the Secretary 
shall notify the State of such finding and provide the State with 
detailed information about the basis of such finding. The Secretary 
shall provide the State with an opportunity to correct any problems 
specified by the Secretary or to present evidence that such problems do 
not exist. After a reasonable time for allowing for corrections of the 
problems or for submission of evidence that such problems do not exist, 
the Secretary shall make a final determination that an approved plan is 
or is not being carried out in the State. If the Secretary determines 
that such a plan is not being carried out in the State, the provisions 
of subsection (f) shall apply with respect to the State. A final 
determination by the Secretary that a State plan is not being carried 
out in any State shall be subject to judicial review under the 
conditions described in subsection (d)(2).
    (f) In any case in which--
            (1) a State does not submit a plan under subsection (a);
            (2) the Secretary fails to approve a plan submitted by a 
        State after giving such State an opportunity to submit a new 
        plan under subsection (d); or
            (3) the Secretary makes a final determination under 
        paragraph (3) of subsection (e) that an approved plan is not 
        being carried out in such State;
the Secretary shall implement, as soon as practicable, a plan in such 
State which carries out the minimum standards described in subsection 
(a) with respect to the sale of health insurance for the elderly. The 
Secretary shall implement such plan in such State until the Secretary 
determines that such State will carry out the plan. The Secretary may 
prescribe any regulations that are necessary to implement and 
administer such plan in any State.
    (g) Any provision of State law which would prevent the 
establishment and implementation in that State of a plan implementing 
the minimum standards described in subsection (a) is preempted by the 
provisions of this Act.

                              definitions

    Sec. 4. For purposes of section 3--
            (1) the term ``health insurance for the elderly'' means 
        health insurance (as specified in regulations prescribed by the 
        Secretary) sold to persons who, at the time of such sale, are 
        (A) aged sixty-five or older, or (B) receiving benefits under 
        the Medicare Program;
            (2) the term ``Medicare Program'' means the health 
        insurance program for the aged and disabled established by 
        title XVIII of the Social Security Act;
            (3) the term ``Secretary'' means the Secretary of Health 
        and Human Services; and
            (4) the term ``State'' means each of the fifty States of 
        the United States and the District of Columbia.

                                studies

    Sec. 5. Section 1875 of the Social Security Act is amended by 
adding the following new subsections at the end thereof:
    ``(c) The Secretary shall conduct a study for the purpose of making 
recommendations to the Congress with respect to a uniform approach to 
the regulation of all private health insurance which is offered for 
sale to the aged and disabled. Such study shall include, but not be 
limited to, an examination of the following matters--
            ``(1) minimum loss ratios;
            ``(2) uniform exclusions of pre-existing conditions;
            ``(3) the various means of differentiating categories of 
        coverage for purchasers of such health insurance;
            ``(4) the effectiveness of labels, numerical ratings, or 
        disclosure information in assisting the aged and disabled to 
        compare policies;
            ``(5) whether the sale of dread disease and other indemnity 
        policies should be banned or limited;
            ``(6) whether agents' commissions for selling such health 
        insurance should be limited;
            ``(7) methods of eliminating misconduct by agents in 
        selling policies;
            ``(8) the need for and costs of individualized health 
        insurance counseling for the aged and disabled;
            ``(9) whether claims handling requirements should be 
        imposed;
            ``(10) whether the sale of overlapping and/or duplicative 
        coverage should be banned; and
            ``(11) whether policy standardization is necessary to 
        promote competition.
The Secretary shall, no later than two years after the date of 
enactment of this subsection, transmit a report to the Congress 
containing the findings and recommendations of such study and proposed 
legislation concerning a comprehensive approach to the regulation of 
such health insurance.
    ``(d) The Secretary shall conduct a study for the purpose of making 
recommendations to the Congress with respect to the feasibility of 
health insurance coverage under this title in addition to the coverage 
provided under parts A and B. Such study shall include, but not be 
limited to, an examination of the following matters--
            ``(1) the need for such additional coverage;
            ``(2) eligibility requirements;
            ``(3) alternative approaches to providing such additional 
        coverage;
            ``(4) cost estimates of the alternative approaches, taking 
        into consideration the different coinsurance and deductible 
        requirements, coverage provisions, and eligibility standards of 
        each approach; and
            ``(5) alternative methods of financing such additional 
        coverage.
The Secretary shall, no later than two years after the date of 
enactment of this subsection, transmit a report to the Congress 
containing the findings and recommendations of such study.''.

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