[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1159 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1159

 To amend the Public Health Service Act to assure the availability of 
 health insurance coverage for children in the individual market in a 
    manner similar to guaranteed availability of individual health 
insurance coverage for certain previously covered individuals under the 
      Health Insurance Portability and Accountability Act of 1996.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 20, 1997

 Ms. Furse (for herself, Ms. Stabenow, Mr. Allen, Ms. Christian-Green, 
 Ms. Woolsey, Mr. DeFazio, Ms. Rivers, and Mr. Markey) introduced the 
    following bill; which was referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to assure the availability of 
 health insurance coverage for children in the individual market in a 
    manner similar to guaranteed availability of individual health 
insurance coverage for certain previously covered individuals under the 
      Health Insurance Portability and Accountability Act of 1996.

    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 ``Children Health Insurance Access 
Amendments of 1997''.

SEC. 2. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

    (a) In General.--Title XXVII of the Public Health Service Act, as 
added by section 111(a) of the Health Insurance Portability and 
Accountability Act of 1996, is amended by inserting after section 2741 
the following new section:

``SEC. 2741A. GUARANTEED AVAILABILITY OF INDIVIDUAL HEALTH INSURANCE 
              COVERAGE TO UNINSURED CHILDREN.

    ``(a) Guaranteed Availability.--
            ``(1) In general.--Subject to the succeeding subsections of 
        this section, each health insurance issuer that offers health 
        insurance coverage (as defined in section 2791(b)(1)) in the 
        individual market in a State, in the case of an eligible child 
        (as defined in subsection (b)) desiring to enroll in individual 
        health insurance coverage--
                    ``(A) may not decline to offer such coverage to, or 
                deny enrollment of, such child;
                    ``(B) either (i) does not impose any preexisting 
                condition exclusion (as defined in section 
                2701(b)(1)(A)) with respect to such coverage, or (ii) 
                imposes such a preexisting condition exclusion only to 
                the extent such an exclusion may be imposed under 
                section 2701(a) in the case of an individual who is not 
                a late enrollee; and
                    ``(C) shall provide that the premium for the 
                coverage is determined in a manner so that the ratio of 
                the premium for such eligible children to the premium 
                for eligible individuals described in section 2741(b) 
                does not exceed the ratio of the actuarial value of 
                such coverage (calculated based on a standardized 
                population and a set of standardized utilization and 
                cost factors) for children to such actuarial value for 
                such coverage for such eligible individuals.
            ``(2) Substitution by state of acceptable alternative 
        mechanism.--The requirement of paragraph (1) shall not apply to 
        health insurance coverage offered in the individual market in a 
        State in which the State is implementing an acceptable 
        alternative mechanism under section 2744.
    ``(b) Eligible Child Defined.--In this part, the term `eligible 
child' means an individual born after September 30, 1983, who has not 
attained 16 years of age and--
            ``(1) who is a citizen or national of the United States, an 
        alien lawfully admitted for permanent residence, or an alien 
        otherwise permanently residing in the United States under color 
        of law;
            ``(2) who is not eligible for coverage under (A) a group 
        health plan, (B) part A or part B of title XVIII of the Social 
        Security Act, or (C) a State plan under title XIX of such Act 
        (or any successor program), and does not have other health 
        insurance coverage; and
            ``(3) with respect to whom the most recent coverage (if 
        any, within the 1-year period ending on the date coverage is 
        sought under this section) was not terminated based on a factor 
        described in paragraph (1) or (2) of section 2712(b) (relating 
        to nonpayment of premiums or fraud).
For purposes of paragraph (2)(A), the term `group health plan' does not 
include COBRA continuation coverage.
    ``(c) Incorporation of Certain Provisions.--
            ``(1) In general.--Subject to paragraph (2), the provisions 
        of subsections (c), (d), (e) and (f) (other than paragraph (1)) 
        of section 2741 and section 2744 shall apply in relation to 
        eligible children under subsection (a) in the same manner as 
        they apply in relation to eligible individuals under section 
        2741(a).
            ``(2) Special rules for acceptable alternative 
        mechanisms.--With respect to applying section 2744 under 
        paragraph (1)--
                    ``(A) the requirement in subsection (a)(1)(B) shall 
                be applied instead of the requirement of section 
                2744(a)(1)(B);
                    ``(B) the requirement in subsection (a)(1)(C) shall 
                be applied instead of the requirement of section 
                2744(a)(1)(D); and
                    ``(C) any deadline specified in such section shall 
                be 1 year after the deadline otherwise specified.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply 1 year after the effective date for section 2741 of the Public 
Health Service Act (as provided under section 111(b)(1) of the Health 
Insurance Portability and Accountability Act of 1996).
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