[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 288 Reported in Senate (RS)]






                                                         Calendar No. 2
109th CONGRESS
  1st Session
                                 S. 288

   To extend Federal funding for operation of State high risk health 
                            insurance pools.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES



   Mr. Gregg (for himself, Mr. Baucus, Mr. DeWine, Mr. Bingaman, Mr. 
   Roberts, Mr. Lieberman, Mr. Cochran, and Mr. Enzi) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

                           February 10, 2005

                Reported by Mr. Enzi, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
   To extend Federal funding for 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``State High Risk Pool 
Funding Extension Act of 2005''.</DELETED>

<DELETED>SEC. 2. EXTENSION OF FUNDING FOR OPERATION OF STATE HIGH RISK 
              HEALTH INSURANCE POOLS.</DELETED>

<DELETED>    (a) Extension of Seed Grants.--Section 2745 of the Public 
Health Service Act (42 U.S.C. 300gg-45) is amended--</DELETED>
        <DELETED>    (1) in subsection (a), in the subsection heading 
        by inserting ``Extension of'' before ``Seed''; and</DELETED>
        <DELETED>    (2) in subsection (c)(1), by striking 
        ``$20,000,000'' and all that follows through ``2003'' and 
        inserting ``$15,000,000 for the period of fiscal years 2005 and 
        2006''.</DELETED>
<DELETED>    (b) Funds for Operations.--Section 2745 of the Public 
Health Service Act (42 U.S.C. 300gg-45) is amended--</DELETED>
        <DELETED>    (1) in subsection (b)--</DELETED>
                <DELETED>    (A) in the subsection heading by striking 
                ``Matching''; and</DELETED>
                <DELETED>    (B) by striking paragraph (2) and 
                inserting the following:</DELETED>
        <DELETED>    ``(2) Allotment.--The amounts appropriated under 
        subsection (c)(2) for a fiscal year shall be made available to 
        the States (or the entities that operate the high risk pool 
        under applicable State law) as follows:</DELETED>
                <DELETED>    ``(A) An amount equal to 50 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated in equal amounts among each eligible State 
                that applies for assistance under this 
                subsection.</DELETED>
                <DELETED>    ``(B) An amount equal to 25 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated among the 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 States (as determined by the 
                Secretary).</DELETED>
                <DELETED>    ``(C) An amount equal to 25 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated among the 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 
                States (as determined by the Secretary).''; 
                and</DELETED>
        <DELETED>    (2) in subsection (c)(2), by striking 
        ``$40,000,000'' and all that follows through the period and 
        inserting ``$75,000,000 for each of fiscal years 2005 through 
        2009 to make allotments under subsection (b)(2).''.</DELETED>
<DELETED>    (c) Definitions.--Section 2745 of the Public Health 
Service Act (42 U.S.C. 300gg-45) is amended--</DELETED>
        <DELETED>    (1) in subsection (d), by inserting after 
        ``2744(c)(2)'' the following: ``, except that with respect to 
        subparagraph (A) of such section a State may elect to provide 
        for the enrollment of eligible individuals through an 
        acceptable alternative mechanism,''; and</DELETED>
        <DELETED>    (2) by adding at the end the following:</DELETED>
<DELETED>    ``(e) Standard Risk Rate.--In subsection (b)(1)(A), the 
term `standard risk rate' means a rate--</DELETED>
        <DELETED>    ``(1) 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;</DELETED>
        <DELETED>    ``(2) that is established using reasonable 
        actuarial techniques; and</DELETED>
        <DELETED>    ``(3) that reflects anticipated claims experience 
        and expenses for the coverage involved.''.</DELETED>

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. PROMOTION OF QUALIFIED HIGH RISK POOLS.

    ``(a) Extension of 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 this section 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 150 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 after the end of fiscal year 2004 in connection 
                with operation of the pool;
        the Secretary shall provide, from the funds appropriated under 
        subsection (d)(1)(B)(i) 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.--The amounts appropriated under subsection 
        (d)(1)(B)(i) for a fiscal year shall be made available to the 
        States (or the entities that operate the high risk pool under 
        applicable State law) as follows:
                    ``(A) An amount equal to 50 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated in equal amounts among each eligible State 
                that applies for assistance under this subsection.
                    ``(B) An amount equal to 25 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated among the 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 States (as determined by the 
                Secretary).
                    ``(C) An amount equal to 25 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated among the 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 
                States (as determined by the Secretary).
    ``(c) Bonus Grants for Supplemental Consumer Benefits.--
            ``(1) In general.--In the case of a State that has 
        established a qualified high risk pool, the Secretary shall 
        provide, from the funds appropriated under subsection 
        (d)(1)(B)(ii) 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, including 
                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) Limitation.--In allotting amounts under this 
        subsection, the Secretary shall ensure that no State receives 
        an amount that exceeds 10 percent of the amount appropriated 
        for the fiscal year involved under subsection (d)(1)(B)(ii).
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed to prohibit States that, on the date of 
        enactment of the State High Risk Pool Funding Extension Act of 
        2005, are 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.
    ``(d) Funding.--
            ``(1) In general.--Out of any money in the Treasury of the 
        United States not otherwise appropriated, there are authorized 
        and appropriated--
                    ``(A) $15,000,000 for the period of fiscal years 
                2005 and 2006 to carry out subsection (a); and
                    ``(B) $75,000,000 for each of fiscal years 2005 
                through 2009, of which--
                            ``(i) two-thirds of the amount appropriated 
                        for a fiscal year shall be made available for 
                        allotments under subsection (b)(2); and
                            ``(ii) one-third of the amount appropriated 
                        for a fiscal year shall be made available for 
                        allotments under subsection (c)(2).
            ``(2) Availability.--Funds appropriated under this 
        subsection for a fiscal year shall remain available for 
        obligation through the end of the following fiscal year.
            ``(3) Reallotment.--If, on June 30 of each fiscal year, the 
        Secretary determines that all amounts appropriated under 
        paragraph (1)(B)(ii) for the fiscal year are not allotted, such 
        remaining amounts shall be allotted among States receiving 
        grants under subsection (b) for the fiscal year in amounts 
        determined appropriate by the Secretary.
            ``(4) 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) 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 with respect to subparagraph 
                (A) of such section a State may elect to provide for 
                the enrollment of eligible individuals through--
                            ``(i) a combination of a qualified high 
                        risk pool and an acceptable alternative 
                        mechanism; or
                            ``(ii) other health insurance coverage 
                        described in subparagraph (B).
                    ``(B) Health insurance coverage.--Health insurance 
                coverage described in this subparagraph is individual 
                health insurance coverage--
                            ``(i) that meets the requirements of 
                        section 2741;
                            ``(ii) that is subject to limits on the 
                        rates charged to individuals;
                            ``(iii) that is available to all 
                        individuals eligible for health insurance 
                        coverage under this title who are not able to 
                        participate in a qualified high risk pool; and
                            ``(iv) the defined rate limit of which does 
                        not exceed the limit allowed for a qualified 
                        risk pool that is otherwise eligible to receive 
                        assistance under a grant under this section.
                    ``(C) Other coverage.--In addition to coverage 
                described in subparagraph (B), a State may provide for 
                the offering of health insurance coverage that provides 
                first dollar coverage, limits on cost-sharing, and 
                comprehensive medical, hospital and surgical coverage, 
                if the limits on rates for such coverage do not exceed 
                125 percent of the limit described in subparagraph 
                (B)(iv).
            ``(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.''.
                                                         Calendar No. 2

109th CONGRESS

  1st Session

                                 S. 288

_______________________________________________________________________

                                 A BILL

   To extend Federal funding for operation of State high risk health 
                            insurance pools.

_______________________________________________________________________

                           February 10, 2005

                       Reported with an amendment