[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3204 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 3204

To amend title XXVII of the Public Health Service Act to extend Federal 
 funding for the establishment and operation of State high risk health 
                            insurance pools.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 12, 2005

Mr. Shadegg (for himself and Mr. Towns) introduced the following bill; 
       which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XXVII of the Public Health Service Act to extend Federal 
 funding for the establishment and operation of State high risk health 
                            insurance pools.

    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 ``State High Risk Pool Funding 
Extension Act of 2005''.

SEC. 2. EXTENSION OF FUNDING FOR ESTABLISHMENT AND OPERATION OF STATE 
              HIGH RISK HEALTH INSURANCE POOLS.

    (a) Additional Seed Grant Funding.--Subsection (c)(1) of section 
2745 of the Public Health Service Act (42 U.S.C. 300gg-45) is amended 
by inserting ``and $15,000,000 for fiscal year 2005'' after ``fiscal 
year 2003''.
    (b) Funding for Operation of State High Risk Pools in Fiscal Years 
2005 Through 2009.--Subsection (c)(2) of such section is amended by 
inserting ``and $50,000,000 for each of fiscal years 2005 through 
2009'' after ``2004''.
    (c) Change in Requirements for Qualified High Risk Pools.--
            (1) Change in requirement for operational grants.--
        Subsection (b) of such section is amended--
                    (A) in paragraph (1)(A), by inserting ``(or 200 
                percent in the case of a State that meets the 
                requirements of paragraph (3))'' after ``150 percent'';
                    (B) in paragraph (1)(C), by striking ``after the 
                end of fiscal year 2004'' and inserting ``after the end 
                of the last fiscal year for which a grant is provided 
                under this paragraph''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(3) Special rule for pools charging higher premiums.--In 
        the case of a qualified high risk pool of a State which charges 
        premiums that exceed 150 percent of the premium for applicable 
        standard risks, the State shall use at least 50 percent of the 
        amount of the grant provided to carry out this subsection to 
        reduce premiums for enrollees.''.
            (2) Change in definition of qualified high risk pool.--
        Subsection (d) of such section is amended to read as follows:
    ``(d) Definitions.--In this section:
            ``(1) Qualified high risk pool.--The term `qualified high 
        risk pool' has the meaning given such term in section 
        2744(c)(2), except that a State may elect to meet the 
        requirement of subparagraph (A) of such section (insofar as it 
        requires the provision of coverage to all eligible individuals) 
        through providing for the enrollment of eligible individuals 
        through an acceptable alternative mechanism (as defined for 
        purposes of section 2744) that includes a high risk pool as a 
        component.
            ``(2) Standard risk rate.--The term `standard risk rate' 
        means a rate that--
                    ``(A) is determined under the State high risk pool 
                by considering the premium rates charged by other 
                health insurers offering health insurance coverage to 
                individuals in the insurance market served;
                    ``(B) is established using reasonable actuarial 
                techniques; and
                    ``(C) reflects anticipated claims experience and 
                expenses for the coverage involved.
            ``(3) State.--The term `State' means any of the 50 States 
        and the District of Columbia.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to grants for fiscal years beginning with fiscal 
        year 2005.
    (d) Change in Allotment Formula for Operational Grants.--Subsection 
(b)(2) of such section is amended--
            (1) by inserting ``(before fiscal year 2005)'' after ``for 
        a fiscal year''; and
            (2) by adding at the end the following:
 ``The amount appropriated under subsection (c)(2) for a fiscal year 
beginning with fiscal year 2005 (less the portion of such amount made 
available to carryout subsection (f)) shall be made available to the 
States (including entities that operate the high risk pool under 
applicable State law in a State) that qualify for a grant under 
subsection (b) as follows:
                    ``(A) An amount equal to \1/3\ of such amount shall 
                be allocated in equal amounts among such qualifying 
                States.
                    ``(B) An amount equal to \1/3\ of such amount shall 
                be allocated among such States so that the amount 
                provided to a State bears the same ratio to such 
                available amount as the number of uninsured individuals 
                in the State bears to the total number of uninsured 
                individuals in all such States (as determined by the 
                Secretary).
                    ``(C) An amount equal to \1/3\ of such amount shall 
                be allocated among such States so that the amount 
                provided to a State bears the same ratio to such 
                available amount as the number of individuals enrolled 
                in health care coverage through the qualified high risk 
                pool of the State bears to the total number of 
                individuals so enrolled through qualified high risk 
                pools in all such States (as determined by the 
                Secretary).''.
    (e) Administrative Provisions; Annual Report.--Such section is 
amended by adding at the end the following new subsection:
    ``(e) Administrative Provisions; Annual Report.--
            ``(1) Applications.--To be eligible for a grant under this 
        section, a State shall submit to the Secretary an application 
        at such time, in such manner, and containing such information 
        as the Secretary may require.
            ``(2) No entitlement.--Nothing in this section shall be 
        construed as providing a State with an entitlement to a grant 
        under this section.
            ``(3) Annual report.--The Secretary shall submit to 
        Congress an annual report on grants provided under this 
        section. Each such report shall include information on the 
        distribution of such grants among the States and the use of 
        grant funds by States.''.
    (f) Bonus Grants for Supplemental Consumer Benefits.--Such section 
is further amended--
            (1) in subsection (c)(2), as amended by subsection (b), by 
        inserting before the period at the end the following: ``, and 
        up to 10 percent of the amount appropriated for fiscal year 
        2005 shall be available to carry out subsection (f)''; and
            (2) by adding at the end the following new subsection:
    ``(f) Bonus Grants for Supplemental Consumer Benefits.--
            ``(1) In general.--In the case of each State that has 
        established a qualified high risk pool, the Secretary shall 
        provide, from the funds made available under subsection (c)(2) 
        to carry out this subsection, a grant to be used to provide 
        supplemental consumer benefits to enrollees or potential 
        enrollees (or defined subsets of such enrollees or potential 
        enrollees) in qualified high risk pools.
            ``(2) Benefits.--Funds provided to a State under paragraph 
        (1) may be used only to provide one or more of the following 
        benefits:
                    ``(A) Low-income premium subsidies.
                    ``(B) A reduction in premium trends, actual 
                premiums, or other cost-sharing requirements.
                    ``(C) An expansion or broadening of the pool of 
                individuals eligible for coverage, such as through 
                eliminating waiting lists, increasing enrollment caps, 
                or providing flexibility in enrollment rules.
            ``(3) Limitation.--In no case shall the amount of a grant 
        under this subsection to a State, from the amount made 
        available under subsection (c)(2) for a fiscal year to carry 
        out this subsection, exceed 10 percent of the amount so made 
        available.
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed to prohibit a State that, on the date of 
        enactment of this subsection, is in the process of implementing 
        programs to provide benefits of the type described in paragraph 
        (2), from being eligible for a grant under this subsection.
            ``(5) Funding.--
                    ``(A) Availability.--Funds appropriated under this 
                subsection for a fiscal year shall remain available for 
                obligation through the end of the following fiscal 
                year.
                    ``(B) Reallotment.--If, on June 30 of a fiscal year 
                for which funds are made available under this 
                subsection, the Secretary determines that the full 
                amounts will not be made available for grants under 
                this subsection, such remaining amounts shall be made 
                available and allotted among qualifying States under 
                subsection (b) for the fiscal year in accordance with 
                the formula under subsection (b)(2).''.
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