[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4519 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 4519
To amend the Public Health Service Act to extend funding for the
operation of State high risk health insurance pools.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 13, 2005
Mr. Shadegg introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to extend funding for the
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 OPERATION OF STATE HIGH RISK HEALTH
INSURANCE POOLS.
Section 2745 of the Public Health Service Act (42 U.S.C. 300gg-45)
is amended to read as follows:
``SEC. 2745. RELIEF FOR HIGH RISK POOLS.
``(a) Seed Grants to States.--The Secretary shall provide from the
funds appropriated under subsection (d)(1)(A) a grant of up to
$1,000,000 to each State that has not created a qualified high risk
pool as of the date of enactment of the State High Risk Pool Funding
Extension Act of 2005 for the State's costs of creation and initial
operation of such a pool.
``(b) Grants for Operational Losses.--
``(1) In general.--In the case of a State that has
established a qualified high risk pool that--
``(A) restricts premiums charged under the pool to
no more than 200 percent of the premium for applicable
standard risk rates;
``(B) offers a choice of two or more coverage
options through the pool; and
``(C) has in effect a mechanism reasonably designed
to ensure continued funding of losses incurred by the
State in connection with operation of the pool after
the end of the last fiscal year for which a grant is
provided under this paragraph;
the Secretary shall provide, from the funds appropriated under
paragraphs (1)(B)(i) and (2)(A) of subsection (d) and allotted
to the State under paragraph (2), a grant for the losses
incurred by the State in connection with the operation of the
pool.
``(2) Allotment.--Subject to paragraph (4), the amounts
appropriated under paragraphs (1)(B)(i) and (2)(A) of
subsection (d) for a fiscal year shall be allotted and made
available to the States (or the entities that operate the high
risk pool under applicable State law) that qualify for a grant
under paragraph (1) as follows:
``(A) An amount equal to 40 percent of such
appropriated amount for the fiscal year shall be
allotted in equal amounts to each qualifying State that
is one of the 50 States or the District of Columbia and
that applies for a grant under this subsection.
``(B) An amount equal to 30 percent of such
appropriated amount for the fiscal year shall be
allotted among qualifying States that apply for such a
grant so that the amount allotted to such a State bears
the same ratio to such appropriated amount as the
number of uninsured individuals in the State bears to
the total number of uninsured individuals (as
determined by the Secretary) in all qualifying States
that so apply.
``(C) An amount equal to 30 percent of such
appropriated amount for the fiscal year shall be
allotted among qualifying States that apply for such a
grant so that the amount allotted to a State bears the
same ratio to such appropriated 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 (as determined by the
Secretary) in all qualifying States that so apply.
``(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 the State to carry out this
subsection to reduce premiums for enrollees.
``(4) Limitation for territories.--In no case shall the
aggregate amount allotted and made available under paragraph
(2) for a fiscal year to States that are not the 50 States or
the District of Columbia exceed $1,000,000.
``(c) Bonus Grants for Supplemental Consumer Benefits.--
``(1) In general.--In the case of a State that is one of
the 50 States or the District of Columbia, that has established
a qualified high risk pool, and that is receiving a grant under
subsection (b)(1), the Secretary shall provide, from the funds
appropriated under paragraphs (1)(B)(ii) and (2)(B) of
subsection (d) and allotted to the State under paragraph (3), 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.--A State shall use amounts received under a
grant under this subsection 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.
``(D) Less stringent rules, or additional waiver
authority, with respect to coverage of pre-existing
conditions.
``(E) Increased benefits.
``(F) The establishment of disease management
programs.
``(3) Allotment; limitation.--The Secretary shall allot
funds appropriated under paragraphs (1)(B)(ii) and (2)(B) of
subsection (d) among States qualifying for a grant under
paragraph (1) in a manner specified by the Secretary, but in no
case shall the amount so allotted to a State for a fiscal year
exceed 10 percent of the funds so appropriated for the fiscal
year.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to prohibit a State that, on the date of the
enactment of the State High Risk Pool Funding Extension Act of
2005, is in the process of implementing a program to provide
benefits of the type described in paragraph (2), from being
eligible for a grant under this subsection.
``(d) Funding.--
``(1) Appropriation for fiscal year 2006.--There are
authorized to be appropriated for fiscal year 2006--
``(A) $15,000,000 to carry out subsection (a); and
``(B) $75,000,000, of which, subject to paragraph
(4)--
``(i) two-thirds of the amount appropriated
shall be made available for allotments under
subsection (b)(2); and
``(ii) one-third of the amount appropriated
shall be made available for allotments under
subsection (c)(3).
``(2) Authorization of appropriations for fiscal years 2007
through 2010.--There are authorized to be appropriated
$75,000,000 for each of fiscal years 2007 through 2010, of
which, subject to paragraph (4)--
``(A) two-thirds of the amount appropriated for a
fiscal year shall be made available for allotments
under subsection (b)(2); and
``(B) one-third of the amount appropriated for a
fiscal year shall be made available for allotments
under under subsection (c)(3).
``(3) Availability.--Funds appropriated for purposes of
carrying out this section for a fiscal year shall remain
available for obligation through the end of the following
fiscal year.
``(4) Reallotment.--If, on June 30 of each fiscal year for
which funds are appropriated under paragraph (1)(B) or (2), the
Secretary determines that all the amounts so appropriated are
not allotted or otherwise made available to States, such
remaining amounts shall be allotted and made available under
subsection (b) among States receiving grants under subsection
(b) for the fiscal year based upon the allotment formula
specified in such subsection.
``(5) No entitlement.--Nothing in this section shall be
construed as providing a State with an entitlement to a grant
under this section.
``(e) 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.
``(f) 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
States and the use of grant funds by States.
``(g) Definitions.--In this section:
``(1) Qualified high risk pool.--
``(A) In general.--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--
``(A) 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) that is established using reasonable
actuarial techniques; and
``(C) that 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 and includes Puerto Rico, the
Virgin Islands, Guam, American Samoa, and the Northern Mariana
Islands.''.
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