[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 2149 Introduced in Senate (IS)]







104th CONGRESS
  2d Session
                                S. 2149

To establish a program to provide health insurance for workers changing 
                                 jobs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 27, 1996

Mr. Kennedy (for himself and Mr. Kerry) introduced the following bill; 
 which was read twice and referred to the Committee on Labor and Human 
                               Resources

_______________________________________________________________________

                                 A BILL


 
To establish a program to provide health insurance for workers changing 
                                 jobs.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Transitional Health Insurance for 
Workers Changing Jobs Act of 1996''.

SEC. 2. HEALTH INSURANCE FOR WORKERS CHANGING JOBS.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end thereof the following new title:

       ``TITLE XXVIII--HEALTH INSURANCE FOR WORKERS CHANGING JOBS

``SEC. 2801. ESTABLISHMENT OF PROGRAM; APPROPRIATIONS.

    ``(a) Establishment of Program.--
            ``(1) In general.--The Secretary of Labor and the Secretary 
        of Health and Human Services shall establish a joint program to 
        award grants to States to enable such States to provide 
        temporary health insurance premium assistance for eligible 
        individuals and their families in accordance with this title.
            ``(2) Federal operation.--In the case of a State that, for 
        a fiscal year--
                    ``(A) declines to participate in the program under 
                this title; or
                    ``(B) does not have in effect a State plan approved 
                by the Secretaries under section 2802,
        the Secretaries shall operate (either directly or by contract) 
        a health insurance program under this title in such State for 
        such fiscal year, using the funds allotted to the State 
        pursuant to section 2805(b).
    ``(b) Appropriations.--
            ``(1) In general.--There are authorized to be appropriated, 
        and there are appropriated, for fiscal year 1998 to carry out 
        this title, $2,000,000,000.
            ``(2) Subsequent fiscal years.--There are authorized to be 
        appropriated, and there are appropriated, to carry out this 
        title for fiscal year 1999 and for each subsequent fiscal year, 
        $2,000,000,000, adjusted to reflect--
                    ``(A) the projected increase (if any) in the 
                average number of unemployment compensation recipients 
                for such fiscal year as compared to the prior fiscal 
                year; and
                    ``(B) the average annual increase in health 
                insurance premiums for the fiscal year preceding the 
                fiscal year involved (as determined by the Secretary of 
                Health and Human Services).
            ``(3) Excess appropriations.--
                    ``(A) Amount available.--Amounts appropriated for a 
                fiscal year under paragraph (2) that remain available 
                at the end of such fiscal year shall remain available 
                for expenditure under this title in any subsequent 
                fiscal year.
                    ``(B) Unused allotments.--The amount of any 
                allotment made to a State under section 2805 that the 
                State determines will not be used by the State in the 
                fiscal year for which the allotment was made shall be 
                made available and used in accordance with subparagraph 
                (A).
            ``(4) Projected increase (if any) in the average number of 
        unemployment compensation recipients.--As used in this 
        subsection, the term `projected increase (if any) in the 
        average number of unemployment compensation recipients' means, 
        with respect to a fiscal year, a percentage increase (if any) 
        equal to--
                            ``(i)(I) the average number of individuals 
                        receiving unemployment compensation in the 12-
                        month period ending on June 30 of the fiscal 
                        year preceding the fiscal year for which such 
                        determination is being made; less
                            ``(II) the average number of individuals 
                        receiving unemployment compensation in the 12-
                        month period ending June 30, 1996, as 
                        determined by the Secretary of Labor; divided 
                        by
                            ``(ii) the average number of individuals 
                        receiving unemployment compensation in the 12-
                        month period ending June 30, 1996, as 
determined by the Secretary of Labor.
    ``(c) Availability of Funds.--Funds appropriated under this section 
shall remain available until expended.

``SEC. 2802. STATE PLAN.

    ``(a) In General.--To be eligible to receive a grant under this 
title, a State shall prepare and submit to the Secretaries a State plan 
that contains the following:
            ``(1) Plan summary.--A description of the program the State 
        will conduct under the plan.
            ``(2) Use of funds.--An assurance that funds received by 
        the State under this title for a fiscal year will be used 
        only--
                    ``(A) to provide premium assistance payments; and
                    ``(B) to pay administrative costs that do not 
                exceed 5 percent of the amount of the allotment of the 
                State for the fiscal year (or such greater percentage, 
                not to exceed 10 percent, as the Secretaries may 
                approve).
            ``(3) Commitment to provide required coverage.--An 
        assurance that the State will use amounts received under the 
        grant to provide temporary health insurance premium assistance, 
        in accordance with section 2803, to all eligible individuals 
        and their eligible family members (as determined under section 
        2804).
            ``(4) Methodology for determination of eligibility.--A 
        description of the mechanism to be used, in accordance with any 
        standards the Secretaries may set, to determine income 
        eligibility of individuals for premium assistance under the 
        State program.
            ``(5) Coverage formula.--A statement of the monthly amount 
        (or the formula to be used to determine the monthly amount) of 
        payments to be made under the plan to or on behalf of eligible 
        individuals and eligible family members.
            ``(6) Coverage reduction method.--A statement of the method 
        to be used, in accordance with section 2803(c), to adjust the 
        duration or amount of payments under the State plan in the 
        event that the allotment of the State for the fiscal year 
        involved is insufficient to cover program costs specified in 
        paragraph (2) for such fiscal year.
            ``(7) Notices to eligible individuals.--An assurance, and a 
        statement of the methods to be used--
                    ``(A) that the State will ensure that all 
                individuals determined to be eligible for unemployment 
                compensation are informed, at the time such 
                determination is made, of their potential eligibility 
                for temporary health insurance premium assistance under 
                the State program under this title;
                    ``(B) that the State will make broadly and readily 
                available, information concerning and applications for 
                participation in the State program; and
                    ``(C) that the State will--
                            ``(i) inform eligible individuals receiving 
                        premium assistance under the State program at 
                        the time eligibility is determined, of the plan 
                        of the State for reducing or terminating such 
                        premium assistance in accordance with section 
                        2803(c); and
                            ``(ii) provide notice to the individuals 
                        required under section 2803(c)(2) in the event 
                        of such a reduction or termination of such 
                        assistance.
            ``(8) Records and reports.--An assurance that the State 
        will maintain such records, collect such data, and furnish the 
        Secretaries with reports, at such times and in such format as 
        the Secretaries may require, that contain--
                    ``(A) such information as may be necessary to 
                enable the Secretaries to operate and administer the 
                program under this title and to monitor State 
                administration of the program under this title;
                    ``(B) such information as may be necessary to 
                enable the Secretaries to evaluate the program under 
                this title; and
                    ``(C) such additional information as the 
                Secretaries may require.
    ``(b) Approval of State Plan.--
            ``(1) In general.--The Secretaries shall approve a State 
        plan that meets the requirements of this section.
            ``(2) 90-day approval deadline.--A State plan shall be 
        deemed to be approved unless the Secretary notifies the State 
        in writing not later than 90 days after the receipt of the 
        State plan under subsection (a) that the plan is disapproved 
        (and the reasons therefor) or that specifies that additional 
        information is needed prior to approval.

``SEC. 2803. COVERAGE REQUIREMENTS AND LIMITATIONS.

    ``(a) Coverage Standard.--Except provided in subsection (c), a 
State, under a State program operated under this title, shall provide 
assistance to eligible individuals and their eligible family members in 
the State to enable such individuals and family members to obtain 
health benefit coverage through the payment of all or part of the cost 
of--
            ``(1) premiums relating to COBRA continuation coverage 
        obtained from the prior employer of the eligible individual; or
            ``(2) in the case of an eligible individual who is not 
        eligible for COBRA continuation coverage as described in 
        paragraph (1), premiums relating to--
                    ``(A) health benefit coverage that is actuarily 
                equivalent to (or, at the option of the eligible 
                individual, less than) the coverage provided under the 
                Federal Employees Health Benefit Program Blue Cross/
                Blue Shield standard option plan; or
                    ``(B) any alternative coverage subject to the 
                approval of the Secretaries.
    ``(b) Individual Premium Assistance.--
            ``(1) In general.--Under a State program under this title, 
        a State may provide a monthly premium assistance payment to, or 
        on behalf of, eligible individuals and their eligible family 
        members in the State.
            ``(2) Amount.--Subject to paragraph (3) and subsection (c), 
        the amount of a monthly premium assistance payment under this 
        title with respect to an eligible individual shall be equal to 
        the following percentage of the monthly premium to be paid by 
        the individual for health benefit coverage for such individual 
        in accordance with subsection (a):
                    ``(A) 100 percent of such premium, if the combined 
                family income of such individual does not exceed \1/12\ 
                of the annual Federal poverty income guidelines for the 
                month involved.
                    ``(B) If such combined family income for the month 
                involved is greater than 100 percent but less than 240 
                percent of \1/12\ of the annual Federal poverty income 
                guidelines, the percentage determined under this 
                subparagraph shall be equal to--
                            ``(i) 140 less the number of percentage 
                        points by which the combined family income of 
                        the individual for the month involved exceeds 
                        \1/12\ of the annual Federal poverty income 
                        guidelines; divided by
                            ``(ii) 140.
            ``(3) Adjustment based on actuarial value.--If an eligible 
        individual elects to use assistance provided under a State 
        program for the cost of premiums relating to health benefit 
        coverage (not provided through COBRA continuation coverage) 
        that has an actuarial value that is greater than that described 
        in subsection (a)(2)(A), the percentage of the monthly premium 
        assistance payment under this subsection shall be reduced to 
        reflect the percentage by which the actuarial value of the 
        coverage exceeds the actuarial value described in such 
        subsection (a)(2)(A).
            ``(4) Duration.--Premium assistance shall not be provided 
        with respect to an eligible individual under a State program 
        under this title for more than 6 months during each period of 
        unemployment.
    ``(c) Options When State Allotment Insufficient.--If a State 
demonstrates to the satisfaction of the Secretaries that the State 
reasonably expects to be required to expend more than the amount of the 
State allotment for the fiscal year involved under section 2805 to meet 
the program costs of the State (as specified in section 2802(a)(2)) 
under the State plan in effect for such fiscal year, the State, to the 
extent necessary to ensure that State resources under the program are 
commensurate with State obligations, may--
            ``(1) request an additional allotment from the Secretaries; 
        or
            ``(2) after providing 30 days advance notice to covered 
        eligible individuals (and, in the case of the option under 
        subparagraph (B), to the Secretaries)--
                    ``(A) reduce the duration or extent of premium 
                assistance under the program for the fiscal year; or
                    ``(B) cease payments under the program for the 
                balance of such fiscal year.

``SEC. 2804. INDIVIDUAL ELIGIBILITY.

    ``(a) Eligibility Criteria.--
            ``(1) eligible individual.--An individual shall be an 
        ``eligible individual'' for purposes of a State plan under this 
        title if, on the date on which an application is submitted by 
        the individual for assistance under this title--
                    ``(A) the individual--
                            ``(i) resides in the State;
                            ``(ii) received unemployment compensation 
                        for at least one week in the month previous to 
the month for which the determination of eligibility is being made;
                            ``(iii) received health benefits coverage 
                        (as defined by the Secretary of Health and 
                        Human Services) through employment for at least 
                        the last six months during which such 
                        individual was employed; and
                            ``(iv) is ineligible for assistance under 
                        title XIX of the Social Security Act (other 
                        than payments for COBRA continuation coverage 
                        under section 1902(a)(10)(F) of such Act) or 
                        title XVIII of such Act;
                    ``(B) the combined family income of the individual 
                is less than 240 percent of \1/12\ of the annual 
                Federal poverty income guidelines for the month in 
                which the application is made; and
                    ``(C) the employed spouse of the individual, if any 
                is not eligible for employer-provided family health 
                insurance coverage or such employer contributes less 
                than 50 percent of the premium for such family 
                coverage.
            ``(2) Eligible family member.--As used in this title, the 
        term ``eligible family member'' means the spouse or dependent 
        child of an eligible individual who is ineligible for 
        assistance under title XIX of the Social Security Act Medicaid 
        (other than payments for COBRA continuation coverage under 
        section 1902(a)(10)(F) of such Act) or title XVIII of such Act.
    ``(b) Eligibility Determinations.--A State shall, in accordance 
with this section and any implementing regulations the Secretaries may 
prescribe, conduct, either directly or by contract, monthly 
determinations as to the eligibility of individuals for assistance 
under the State plan under this title.

``SEC. 2805. ALLOTMENTS TO STATES.

    ``(a) In General.--Of the amounts appropriated for each fiscal year 
the Secretaries shall allot 25 percent for each quarter among all 
States (including States for which the Secretaries operates a State 
program under section 2801(a)(2)). With respect to a State with an 
application approved under section 2803(c)(1), such allotment shall be 
made on the basis of the unemployment percentage formula described in 
subsection (b) as applied to the measuring period described in 
subsection (c) for such quarter, together with such additional funds as 
may be approved for allotment by the Secretaries based on the 
application of a State under section 2803(c)(1). With respect to a 
State for which the Secretaries will operate the State program under 
section 2801(a)(2), the Secretaries shall determine the allotment 
necessary for such State.
    ``(b) Unemployment Percentage Formula.--
            ``(1) In general.--For purposes of each quarterly allotment 
        under subsection (a), the share of a State shall be equal to an 
        amount bearing the same ratio to the amount to be allotted for 
        such quarter as the number of unemployed individuals in the 
        State who collected unemployment compensation benefits during 
        such quarter bears to the number of such individuals in all 
        States (as determined on the basis of data provided by the 
        Bureau of Labor Statistics on the average unemployment 
        compensation claims in the States for the measuring period 
        concerned). Such ratio shall be adjusted for each State to 
        reflect the average per capita premium payment amount in each 
        State.
            ``(2) Additional allotment.--The Secretaries shall use 
        amounts available for the fiscal year involved under section 
        2801(b)(3) and remaining after allotments under paragraph (1) 
        to make additional allotments to States submitting applications 
        under section 2803(c)(1).
    ``(c) Measuring Periods.--For purposes of the allotment under 
subsection (a), the measuring periods are the 12 months ending in--
            ``(1) with respect to the first quarter, June of the 
        preceding fiscal year;
            ``(2) with respect to the second quarter, September of the 
        preceding fiscal year;
            ``(3) with respect to the third quarter, December of such 
        fiscal year; and
            ``(4) with respect to the fourth quarter, March of such 
        fiscal year.

``SEC. 2806. PAYMENTS TO STATES.

    ``(a) In General.--The Secretaries shall make quarterly payments to 
each State with a plan approved under section 2802 in an amount equal 
to the allotment for the State under section 2805 for such quarter.
    ``(b) Payment Adjustments.--Payments to a State under subsection 
(a) shall be reduced as necessary to recoup payments for the current or 
any prior fiscal year not expended by the State in accordance with this 
title.

``SEC. 2807. REGULATIONS.

    ``The Secretaries (in consultation, as appropriate, with the 
Secretary of Labor and the Secretary of the Treasury) is authorized to 
promulgate such regulations as may be necessary to carry out the 
program under this title. The Secretaries may promulgate any interim 
final rules as the Secretaries determine are appropriate to carry out 
this title.

``SEC. 2808. AUDITS.

    ``The Secretaries and the Comptroller General of the United States 
or any of their duly authorized representatives shall have access for 
the purpose of audit and examination to any books, documents, papers, 
and records that are pertinent to a grant received under this title.

``SEC. 2809. DEFINITIONS.

    ``In this title:
            ``(1) Blue cross/blue shield standard option plan.--The 
        term `Blue Cross/Blue Shield standard option plan' means, with 
        respect to a program under this title in a State, such plan as 
        is available through the Federal Employees Health Benefit 
        Program.
            ``(2) Cobra continuation coverage.--The term `COBRA 
        continuation coverage' means temporarily extended coverage of 
        employment-related health benefits for an individual after 
        termination of employment, in accordance with part 6 of 
        subtitle B of title I of the Employee Retirement Income 
        Security Act of 1974 (29 U.S.C. 1161 et seq.), title XXII of 
        the Public Health Service Act (42 U.S.C. 300bb-1 et seq.), or 
        section 4980B of the Internal Revenue Code of 1986.
            ``(3) Federal poverty income guidelines.--The term `Federal 
        poverty income guidelines' means the poverty guidelines updated 
        annually in the Federal Register by the Department of Health 
        and Human Services under the authority of section 673(2) of the 
        Omnibus Reconciliation Act of 1981 (42 U.S.C. 9902(2)).
            ``(4) Premium assistance.--The term `premium assistance' 
        means the amount paid to or on behalf of an eligible individual 
        and eligible family members, if any, under the program under 
        this title for the purchase of health insurance coverage.
            ``(5) Secretaries.--The term `Secretaries' means the 
        Secretary of Health and Human Services and the Secretary of 
        Labor.
            ``(6) State.--The term `State' means each of the several 
        States, the District of Columbia, and the Commonwealth of 
        Puerto Rico.
            ``(7) Unemployment compensation.--The term `unemployment 
        compensation' has the meaning given that term in section 85(b) 
        of the Internal Revenue Code of 1986.''.

SEC. 3. SENSE OF THE COMMITTEE REGARDING FINANCING.

    It is the sense of the Committee on Labor and Human Resources of 
the Senate that the joint program established under title XXVIII of the 
Public Health Service Act (as added by section 2) should be financed in 
a budget neutral manner by offsetting revenues derived from eliminating 
undeserved corporate tax breaks, especially tax breaks that encourage 
American corporations to move jobs overseas and that reward book-
keeping transactions that artificially place corporate income overseas 
for tax purposes.
                                 <all>