[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2698 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 2698

 To provide for a system of health insurance certificates to increase 
        the number of Americans with health insurance coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 10, 2003

Mr. Bilirakis (for himself, Mr. Towns, Mr. Fletcher, and Mr. Walden of 
   Oregon) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To provide for a system of health insurance certificates to increase 
        the number of Americans with health insurance coverage.

    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 ``Health Insurance Certificate Act of 
2003''.

SEC. 2. ESTABLISHMENT OF PROGRAM.

    (a) In General.--The Secretary of Health and Human Services (in 
this Act referred to as the ``Secretary'') shall establish a program 
for the issuance to eligible individuals of health insurance 
certificates which may be applied towards the cost of purchasing 
qualified health insurance coverage for such individuals and family 
members. The issuance of such certificates for any fiscal year is 
limited to the amount appropriated under subsection (f) for such fiscal 
year.
    (b) Eligibility.--
            (1) In general.--For purposes of this Act, the terms 
        ``eligible individual'' and ``qualified family member'' mean, 
        with respect to a month, an adult or family member, 
        respectively, who--
                    (A) is a citizen or national of the United States 
                or an alien permanently residing lawfully in the United 
                States as of the first day of the month;
                    (B) is under 65 years of age as of the last day of 
                the month; and
                    (C) is not eligible to be covered under public 
                coverage described in paragraph (3) as of the first day 
                of the month.
            (2) No certificate for covered family members.--
                    (A) In general.--No certificate shall be issued 
                under this section to a member of the family of a 
                principal eligible individual if the family member is 
                covered under the qualified health insurance coverage 
                covering the principal eligible individual.
                    (B) Member of family.--For purposes of this Act, 
                the term ``member of family'' has the meaning given 
                such term under section 8901(5) of title 5, United 
                States Code.
                    (C) Spouse.--For purposes of this Act, the term 
                ``married'' and ``spouse'' shall have the meaning given 
                such term for purposes of chapter 89 of title 5, United 
                States Code.
                    (D) No duplication.--In no case may the certificate 
                value of more than one certificate take into account 
                any member of a family and, with respect to an eligible 
                individual, no more than 2 member of the individual's 
                family (other than the spouse of the individual) shall 
                be taken into account.
            (3) Exclusion for those eligible for coverage under public 
        program.--Subject to paragraph (4), an individual is not an 
        eligible individual as of the first day of a month if such 
        individual is eligible to be covered as of such day under any 
        medical care program described in--
                    (A) title XVIII, XIX, or XXI of the Social Security 
                Act;
                    (B) chapter 55 of title 10, United States Code;
                    (C) chapter 17 of title 38, United States Code;
                    (D) chapter 89 of title 5, United States Code; or
                    (E) the Indian Health Care Improvement Act.
            (4) Treatment of cobra continuation coverage.--In the case 
        of continuation coverage under a group health plan which is 
        required to be provided by Federal law for an individual during 
        the period specified in section 602(2) of the Employee 
        Retirement Income Security Act of 1974, section 4980B(f)(2)(B) 
        of the Internal Revenue Code of 1986, or section 2202(2) of the 
        Public Health Service Act, or coverage under chapter 89 of 
        title 5, United States Code which is required to be provided 
        under section 8905a of title 5, United States Code, paragraph 
        (3) shall not apply with respect to such continuation coverage 
and the coverage shall be treated as qualified health insurance 
coverage.
    (c) Health Insurance Certificates.--
            (1) In general.--The Secretary shall design health 
        insurance certificates to be in a form so that, when presented 
        to the issuer of a qualified health insurance coverage, the 
        issuer may secure directly from the Secretary the value 
        specified in the certificate towards the cost of purchasing 
        such coverage. Once paid, the Secretary may not seek 
        reimbursement from the issuer if there is a finding that any 
        relevant information provided by an individual was incorrect. A 
        certificate is issued with respect to the costs of obtaining 
        health insurance coverage in a year for a specified eligible 
        individual (and family members) and may not be used for such 
        coverage in any other period.
            (2) Limitation.--In no case shall the value of the 
        certificate, as applied with respect to health insurance 
        coverage, be applied towards an amount that exceeds--
                    (A) 70 percent of the premium for coverage for the 
                period involved, or
                    (B) in the case of a certificate described in 
                subsection (d)(2), 70 percent of the employee's premium 
                for coverage under the group health plan involved.
            (3) Form of certificate.--A health insurance certificate 
        for a year shall be valued and paid as follows:
                    (A) Value.--The value of the certificate for a year 
                shall be determined based upon a methodology for 
                determining income specified by the Secretary that is 
                similar to that applied for purposes of determining 
                eligibility on the basis of income under needs-based 
                Federal programs and that may be based on the standards 
                used under section 1612 for purposes of the 
                supplemental security income program. Such methodology 
                under this section may allow for use of both a Federal 
                methodology and alternate State methodologies where the 
                Secretary deems appropriate for ease of administration 
                and coordination of programs. The Secretary may provide 
                for self-certification of information by individuals 
                where the Secretary deems appropriate for 
                administration of the program.
                    (B) Availability of group health plan coverage.--If 
                an individual is (for the individual or for the 
                individual's family members) eligible for coverage 
                under a group health plan and the premium charged the 
                individual for such coverage does not exceed 50 percent 
                of the cost of coverage, such an individual is eligible 
                only for a certificate under section (d)(2) and not 
                under subsection (d)(1).
                    (C) Minimum threshold for issuance of 
                certificate.--No health insurance certificate shall be 
                issued under this section where the annualized value of 
                the certificate is less than $200.
    (d) Value of Certificate.--
            (1) In general.--The annualized value of a health insurance 
        certificate for an eligible individual shall be determined as 
        follows (and applied on a monthly basis based on \1/12\ of such 
        annualized value):
                    (A) Unmarried individual with no dependent family 
                members.--Subject to subparagraph (C)(i), in the case 
                of an eligible individual who is not married, who has 
                no dependent family members, who has qualified health 
                insurance coverage, and whose income--
                            (i) is $13,000 or less, the annualized 
                        value of the certificate is $1,000; or
                            (ii) exceeds $13,000, the annualized value 
                        of the certificate be equal to $1,000 minus 15 
                        percent of such amount for every $1000 of the 
                        amount by which such income exceeds $12,001.
                    (B) Individual with dependent family members.--
                Subject to subparagraph (C)(ii), in the case of an 
                eligible individual who has dependent family members 
                and who has qualified health insurance coverage that 
                covers the individual, such family members, or both, if 
                the family's income--
                            (i) is $25,000 or less, the annualized 
                        value of the certificate is the sum of--
                                    (I) $1,000, for the individual;
                                    (II) $750, if such a family member 
                                is the individual's spouse; and
                                    (III) $500 for each other family 
                                member, but not to exceed a total of 
                                $1,000 under this subclause; or
                            (ii) exceeds $25,000, the annualized value 
                        of the certificate shall be the amount 
                        determined under clause (i) minus 10 percent of 
                        such amount for each $1,000 by which such 
                        income exceeds $24,001.
                Each of two eligible individuals who are married to 
                each other may receive the appropriate amount 
                designated for an individual, as opposed to the amount 
                designated for a spouse, where they choose separate 
                insurance coverage.
                    (C) Application of assets test.--
                            (i) Self only coverage.--In the case of an 
                        individual described in clause (i) or (ii) of 
                        subparagraph (A) whose resources (as determined 
                        under a methodology that is similar to the 
                        methodology under section 1613 for purposes of 
                        the supplemental security income program) 
                        exceed $12,500, the annualized value of the 
                        certificate shall be 0.
                            (ii) Self and family coverage.--In the case 
                        of an individual described in clause (i) or 
                        (ii) of subparagraph (B) whose family resources 
                        (as determined under a methodology that is 
                        similar to the methodology under section 1613 
                        for purposes of the supplemental security 
                        income program) exceed $20,000, the annualized 
                        value of the certificate shall be 0.
                    (D) Rounding.--Any amount determined under 
                subparagraph (A) or (B) which is not a multiple of $12 
                shall be rounded to the next lowest $12.
            (2) Certificates for use in group health plans.--In the 
        case of an eligible individual who is covered under a group 
        health plan--
                    (A) subparagraph (C) of subsection (b)(1) shall not 
                apply;
                    (B) the exclusion with respect to such coverage 
                under subsection (e)(2)(C) shall not apply;
                    (C) the value of the certificate shall be 40 
                percent of the value determined otherwise determined 
                under paragraph (1) (before the application of 
                subparagraph (D) thereof); and
                    (D) certificates under this paragraph may be used 
                for qualified health insurance under any group health 
                plan available to any family member by virtue of that 
                member's employment status.
    (e) Qualified Health Insurance Coverage.--For purposes of this 
section--
            (1) In general.--The term ``qualified health insurance 
        coverage'' means health benefits coverage (including individual 
        health insurance coverage or coverage through a State high risk 
        pool) that is creditable coverage (as defined in section 
        2701(c)(1) of the Public Health Service Act), which does not 
        consist entirely of excepted benefits (as defined in section 
        2791(c) of such Act).
            (2) Exception.--The term `qualified health insurance 
        coverage' does not include--
                    (A) a flexible spending or similar arrangement;
                    (B) any insurance if substantially all of its 
                coverage is of excepted benefits described in section 
                9832(c) of the Internal Revenue Code of 1986;
                    (C) except as provided in subsection (d)(2), 
                insurance provided through any group health plan 
                related to employment, other than COBRA continuation 
                coverage; or
                    (D) any medical program described in section 
                2(b)(3).
    (f) Authorization of Appropriations.--To carry out this section and 
section 2745 of the Public Health Service Act (as amended by section 
3), there are authorized to be appropriated such sums as may be 
necessary not to exceed--
            (1) $28,457,000,000 for the period of fiscal years 2004 
        through 2008; and
            (2) $49,965,000,000 for the period of fiscal years 2004 
        through 2013.

SEC. 3. EXTENSION OF FUNDING FOR OPERATION OF STATE HIGH RISK HEALTH 
              INSURANCE POOLS.

    Section 2745 of the Public Health Service Act, as inserted by 
section 201 of the Trade Act of 2002 (Public Law 107-210), is amended--
            (1) in subsection (b)(1), by striking ``established a 
        qualified health risk pool that'' and all that follows through 
        the end of subparagraph (C) and inserting ``established a 
        qualified health risk pool that provides for premium rates and 
        covered benefits for such coverage consistent with standards 
        included in the NAIC Model Health Plan for Uninsurable 
        Individuals'';
            (2) in subsection (b)(2), by striking ``number of uninsured 
        individuals'' and inserting ``enrollees in qualified high risk 
        pools''; and
            (3) in subsection (c)(2), by striking ``$40,000,000 for 
        each of fiscal years 2003 and 2004'' and inserting 
        ``$40,000,000 for fiscal year 2003 and, subject to availability 
        of funds under section 2(f) of the Health Insurance Certificate 
        Act of 2003, $75,000,000 for each of fiscal years 2004 through 
        2009''.
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