[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7129 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 7129

   To provide for innovation in health care through a demonstration 
   program to expand coverage under the State Child Health Insurance 
 Program through an employer buy-in, through access to health benefits 
through regional State arrangements, and through State initiatives that 
          expand coverage and access, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 26, 2008

 Mr. Andrews introduced the following bill; which was referred to the 
Committee on Education and Labor, and in addition to the Committees on 
  Ways and Means, Rules, and Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
   To provide for innovation in health care through a demonstration 
   program to expand coverage under the State Child Health Insurance 
 Program through an employer buy-in, through access to health benefits 
through regional State arrangements, and through State initiatives that 
          expand coverage and access, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Several Approaches 
to Reduce the Uninsured Act of 2008''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
TITLE I--PROMOTION UNDER ERISA OF STATE-BASED EXPANSION OF HEALTH CARE 
                                COVERAGE

Sec. 101. Exemption from ERISA preemption for State comprehensive 
                            health care programs.
Sec. 102. State coverage buy-in arrangements and small employer 
                            coverage buy-in arrangements.
Sec. 103. Exemption from preemption to permit pay or play under State 
                            law.
Sec. 104. Exemption from preemption to permit mandates for data 
                            collection under State law relating to 
                            group health plans.
        TITLE II--HEALTH PARTNERSHIP THROUGH CREATIVE FEDERALISM

Sec. 201. Short title.
Sec. 202. State health reform projects.
Sec. 203. Effective date.
          TITLE III--DEMONSTRATION PROJECT FOR EMPLOYER BUY-IN

Sec. 301. Demonstration project for employer buy-in.
TITLE IV--ACCESS TO HEALTH BENEFITS THROUGH REGIONAL STATE ARRANGEMENTS

Sec. 401. Promoting access through regional State arrangements under a 
                            demonstration project.
Sec. 402. Transparency and accountability for health benefit plans.
    TITLE V--AMENDMENTS RELATING TO PREEXISTING CONDITION EXCLUSION

Sec. 501. Short title.
Sec. 502. Amendments relating to preexisting condition exclusions under 
                            group health plans.
Sec. 503. Amendments relating to preexisting condition exclusions in 
                            health insurance coverage in the individual 
                            market.

TITLE I--PROMOTION UNDER ERISA OF STATE-BASED EXPANSION OF HEALTH CARE 
                                COVERAGE

SEC. 101. EXEMPTION FROM ERISA PREEMPTION FOR STATE COMPREHENSIVE 
              HEALTH CARE PROGRAMS.

    (a) Exemption From Preemption.--Section 514(b) of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)) is amended--
            (1) by redesignating paragraph (9) as paragraph (10); and
            (2) by inserting after paragraph (8) the following new 
        paragraph:
    ``(9)(A) Except as provided in subparagraph (B), subsection (a) 
shall not apply to any program established by or under the laws of any 
State which is listed pursuant to section 721 as a State comprehensive 
health care program (as defined in section 722(a)).
    ``(B) Nothing in subparagraph (A) shall be construed to exempt from 
subsection (a) any State tax law relating to employee benefit plans.
    ``(C) Notwithstanding subparagraph (A), parts 1 and 4 of this 
subtitle, and the preceding sections of this part to the extent they 
govern matters which are governed by the provisions of such parts 1 and 
4, shall supersede any program described in subparagraph (A), but the 
Secretary may enter into cooperative arrangements under this paragraph 
and section 506 with officials of the State involved to assist them in 
effectuating the policies of the provisions of such program which are 
superseded by such parts 1 and 4 and the preceding sections of this 
part.''.
    (b) State Comprehensive Health Care Programs.--
            (1) In general.--Part 7 of subtitle B of title I of such 
        Act (29 U.S.C. 1181 et seq.) is amended--
                    (A) by redesignating subpart C ad subpart D; and
                    (B) by inserting after subpart B the following new 
                subpart:

         ``Subpart C--State Comprehensive Health Care Programs

``SEC. 721. DESIGNATION OF STATE COMPREHENSIVE HEALTH CARE PROGRAMS 
              EXEMPT FROM FEDERAL PREEMPTION.

    ``The Secretary shall, for purposes of the application section 
514(b)(9), establish and maintain a comprehensive list of which 
programs (if any) established by or under the laws of each State 
constitute, as determined by the Secretary, State comprehensive health 
care programs. The Secretary shall undertake an ongoing review of such 
list so as to ensure such list remains comprehensive and exclusive of 
any programs which may have ceased to be State comprehensive health 
care programs. Such list shall be periodically published in the Federal 
Register and maintained so as to be readily accessible to the general 
public.

``SEC. 722. REQUIREMENTS.

    ``(a) In General.--For purposes of this subpart and section 
514(b)(9), the term `State comprehensive health care program' means a 
program established by or under the laws of any State under which--
            ``(1) residents of such State are required to obtain and 
        maintain health insurance coverage meeting the Federal 
        threshold of adequate medical care,
            ``(2) each employer employing individuals in such State--
                    ``(A) that is not a small employer within the 
                meaning of subsection (c) for a calendar year,
                    ``(B) that does not otherwise provide group health 
                plan coverage for its employees which provides benefits 
                meeting the criteria for the Federal threshold of 
                adequate medical care (as described in subsection (d)) 
                for such calendar year, and
                    ``(C) in whose case the Secretary has not waived 
                the requirements of this subsection for such calendar 
                year pursuant to subsection (e) on the basis of 
                substantial business hardship,
        is required to establish and maintain a group health plan for 
        such employees for such calendar year providing benefits which 
        meet the Federal threshold of adequate medical care.
    ``(b) Single Program Per State.--A program may be considered a 
State comprehensive health care program in connection with any State 
only if it is the only such program in effect by or under the laws of 
such State.
    ``(c) Federal Threshold of Adequate Medical Care.--For purposes of 
this section, the term `Federal threshold of adequate medical care' 
means the package of benefits constituting medical care which the 
Comprehensive Health Care Commission currently maintains as the Federal 
threshold of adequate medical care as prescribed pursuant to section 
723(f)(1).
    ``(d) Small Employers.--
            ``(1) In general.--For purposes of subsection (a)(2), the 
        term `small employer' means, with respect to a calendar year, 
        an employer who employed an average of at least 2 but not more 
        than 100 employees on business days during the preceding 
        calendar year and who employs at least 2 employees on the first 
        day of the current calendar year. For purposes of the preceding 
        sentence, all persons treated as a single employer under 
        subsection (b), (c), (m), or (o) of section 414 of the Internal 
        Revenue Code of 1986 shall be treated as 1 employer.
            ``(2) Employers not in existence in preceding year.--In the 
        case of an employer which was not in existence throughout the 
        preceding calendar year, the determination of whether such 
        employer is a small employer shall be based on the average 
        number of employees that it is reasonably expected such 
        employer will employ on business days in the current calendar 
        year.
            ``(3) Predecessors.--Any reference in this subsection to an 
        employer shall include a reference to any predecessor of such 
        employer.
    ``(e) Exception Allowed for Employers Otherwise Providing Group 
Health Plan Coverage.--For purposes of subsection (a)(2), an employer 
shall be treated, for any current calendar year, as otherwise providing 
coverage of an employee under a group health plan for its employees 
which meets the criteria for the Federal threshold of adequate medical 
care if, with respect to such calendar year, such employee--
            ``(1) was eligible under such a group health plan 
        maintained by the employer for the preceding calendar year, or
            ``(2) may be reasonably expected to be eligible during the 
        current calendar year under a group health plan referred to in 
        paragraph (1).
    ``(f) Waiver in Cases of Substantial Business Hardship.--
            ``(1) In general.--If an employer is unable to satisfy the 
        requirements of subsection (a) for any calendar year without 
        substantial business hardship and application of such 
        requirements for such calendar year would be adverse to the 
        interests of plan participants in the aggregate, the Secretary 
        may waive the requirements of subsection (a) for such calendar 
        year. The Secretary shall not waive such requirements with 
        respect to a plan for more than 3 of any 15 consecutive 
        calendar years.
            ``(2) Determination of substantial business hardship.--For 
        purposes of this section, the factors taken into account in 
        determining substantial business hardship shall include (but 
        shall not be limited to) whether or not--
                    ``(A) the employer is operating at an economic 
                loss,
                    ``(B) there is substantial unemployment or under-
                employment in the trade or business and in the industry 
                concerned,
                    ``(C) the sales and profits of the industry 
                concerned are depressed or declining, and
                    ``(D) it is reasonable to expect that the plan will 
                be established or maintained only if the waiver is 
                granted.

``SEC. 723. COMPREHENSIVE HEALTH CARE COMMISSION.

    ``(a) Establishment.--The Secretary, in consultation with the 
Secretary of Health and Human Services, shall establish a commission to 
be known as the Comprehensive Health Care Commission (referred to in 
this section as the `Commission').
    ``(b) Membership.--
            ``(1) Number and appointment.--The Commission shall be 
        composed of 15 members appointed by the Secretary, in 
        consultation with the Secretary of Health and Human Services.
            ``(2) Qualifications.--
                    ``(A) In general.--The membership of the Commission 
                shall include--
                            ``(i) consumers of health services that 
                        represent those individuals who have not had 
                        insurance within 2 years of appointment, that 
                        have had chronic illnesses, including mental 
                        illness, are disabled, and those who receive 
                        insurance coverage through medicare and 
                        medicaid; and
                            ``(ii) individuals with expertise in 
                        financing and paying for benefits and access to 
                        care, business and labor perspectives, and 
                        providers of health care. The membership shall 
                        reflect a broad geographic representation and a 
                        balance between urban and rural 
                        representatives.
                    ``(B) Prohibited appointments.--Members of the 
                Commission shall not include Members of Congress or 
                other elected government officials (Federal, State, or 
                local). Individuals appointed to the Commission shall 
                not be paid employees or representatives of 
                associations or advocacy organizations involved in the 
                health care system.
    ``(c) Periods of Appointment.--Members of the Commission shall 
serve for terms of 6 years, except that, of the members first 
appointed--
            ``(1) 5 shall serve for a term of 2 years,
            ``(2) 5 shall serve for a term of 4 years, and
            ``(3) 5 shall serve for a term of 6 years,
as designated by the Secretary at the time of appointment. Any 
vacancies shall not affect the power and duties of the Commission but 
shall be filled in the same manner as the original appointment.
    ``(d) Designation of the Chairperson.--The Secretary shall 
designate the chairperson of the Commission.
    ``(e) Subcommittees.--The Commission may establish subcommittees if 
doing so increases the efficiency of the Commission in completing its 
tasks.
    ``(f) Duties.--
            ``(1) In general.--The Commission shall prescribe, and from 
        time to time revise as the Commission deems appropriate, a 
        package of benefits constituting medical care which it 
        determines to be, for purposes of this part, the Federal 
        threshold of adequate medical care.
            ``(2) Hearings.--The Commission may hold hearings which are 
        determined by the Commission to be necessary by the Commission 
        in carrying out its duties.
            ``(3) Community meetings.--
                    ``(A) In general.--Not later than 1 year after the 
                date on which all the members of the Commission have 
                been appointed under subsection (b)(1) and 
                appropriations are first made available to carry out 
                this section, the Commission shall annually provide for 
                health care community meetings throughout the United 
                States (in this paragraph referred to as `community 
                meetings'). Such community meetings may be 
                geographically or regionally based.
                    ``(B) Frequency of meetings.--The Commission shall 
                ensure that community meetings are held with such 
                frequency as to ensure that the Commission receives 
                information that reflects, on an ongoing basis--
                            ``(i) the geographic differences throughout 
                        the United States;
                            ``(ii) diverse populations; and
                            ``(iii) a balance among urban and rural 
                        populations.
                    ``(C) Meeting requirements.--
                            ``(i) Facilitator.--A State health officer 
                        may be the facilitator at the community 
                        meetings.
                            ``(ii) Attendance.--At least 1 member of 
                        the Commission shall attend and serve as chair 
                        of each community meeting. Other members may 
                        participate through interactive technology.
                            ``(iii) Topics.--The community meetings 
                        shall, at a minimum, address the following 
                        questions:
                                    ``(I) What health care benefits and 
                                services should be provided?
                                    ``(II) How does the American public 
                                want health care delivered?
                                    ``(III) How should health care 
                                coverage be financed?
                                    ``(IV) What trade-offs are the 
                                American public willing to make in 
                                either benefits or financing to ensure 
                                access to affordable, high quality 
                                health care coverage and services?
                            ``(iv) Interactive technology.--The 
                        Commission may encourage public participation 
                        in community meetings through interactive 
                        technology and other means as determined 
                        appropriate by the Commission.
    ``(g) Administration.--
            ``(1) Executive director.--There shall be an Executive 
        Director of the Commission who shall be appointed by the 
        chairperson of the Commission in consultation with the members 
        of the Commission.
            ``(2) Compensation.--While serving on the business of the 
        Commission (including travel time), a member of the Commission 
        shall be entitled to compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive Schedule under 
        section 5315 of title 5, United States Code, and while so 
        serving away from home and the member's regular place of 
        business, a member may be allowed travel expenses, as 
        authorized by the chairperson of the Commission. For purposes 
        of pay and employment benefits, rights, and privileges, all 
        personnel of the Commission shall be treated as if they were 
        employees of the Senate.
            ``(3) Information from federal agencies.--The Commission 
        may secure directly from any Federal department or agency such 
        information as the Commission considers necessary to carry out 
        this section. Upon request of the Commission, the head of such 
        department or agency shall furnish such information.
            ``(4) Postal services.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as other departments and agencies of the Federal Government.
    ``(h) Detail.--Not more than 10 Federal Government employees 
employed by the Department of Labor and 10 Federal Government employees 
employed by the Department of Health and Human Services may be detailed 
to the Commission under this section without further reimbursement. Any 
detail of an employee shall be without interruption or loss of civil 
service status or privilege.
    ``(i) Temporary and Intermittent Services.--The chairperson of the 
Commission may procure temporary and intermittent services under 
section 3109(b) of title 5, United States Code, at rates for 
individuals which do not exceed the daily equivalent of the annual rate 
of basic pay prescribed for level V of the Executive Schedule under 
section 5316 of such title.
    ``(j) Annual Report.--Not later than 1 year after the date of 
enactment of this Act, and annually thereafter, the Commission shall 
report to Congress and make public a detailed description of the 
expenditures of the Commission used to carry out its duties under this 
section.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $3,000,000 for each fiscal year 
beginning on or after October 1, 2008.''.
            (2) Conforming amendments.--The table of contents in 
        section 1 of such Act is amended by inserting after the item 
        relating to section 713 the following new items:

         ``subpart c--state comprehensive health care programs

``Sec. 721. Designation of State comprehensive health care programs 
                            exempt from Federal preemption.
``Sec. 722. Requirements.
``Sec. 723. Comprehensive Health Care Commission.''.

SEC. 102. STATE COVERAGE BUY-IN ARRANGEMENTS AND SMALL EMPLOYER 
              COVERAGE BUY-IN ARRANGEMENTS.

    (a) Authorization for Inclusion of Individuals as Participants in 
Group Health Plans Under State Coverage Buy-In Arrangements.--Section 
404 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
1104) is amended by adding at the end the following new subsection:
    ``(e)(1) Any requirement of the preceding provisions of this 
section or any other provision of this title shall not be treated as 
violated by reason of the entry of the plan administrator into a State 
coverage buy-in arrangement or the treatment as a participant under the 
plan, pursuant to such an arrangement, of an individual who is not an 
employee, former employee, or member or former member of an employee 
organization described in section 3(7)(A) in connection with the plan.
    ``(2) For purposes of paragraph (1), the term `State coverage buy-
in arrangement' means an arrangement entered into between the plan 
administrator of a group health plan and a State pursuant to which--
            ``(A) individuals who are residents of such State, are 
        identified under the arrangement, and are not otherwise 
        participants (within the meaning of section 3(7)(A)) in the 
        plan are treated as participants in the plan,
            ``(B) premiums are payable to the plan, by such 
        individuals, by the State on behalf of such individuals, or by 
        both, in total amounts equivalent to the total cost of coverage 
        of the individuals and their beneficiaries under the plan, and
            ``(C) the Secretary determines, under a procedure providing 
        for determinations prior to the entry into the arrangement, and 
        annually thereafter during the term of the arrangement, that 
        the arrangement is--
                    ``(i) administratively feasible,
                    ``(ii) in the interests of the plan and of its 
                participants and beneficiaries, and
                    ``(iii) protective of the rights of participants 
                and beneficiaries of the plan.
    ``(3) A fiduciary of a group health plan shall have the same 
fiduciary duties with respect to participants and their beneficiaries 
who are covered under a group health plan solely by reason of a State 
coverage buy-in arrangement as are applicable with respect to 
individuals who are otherwise participants or beneficiaries under the 
plan.''.
    (b) Authorization for Inclusion of Employees of Small Employers as 
Participants in Group Health Plans of Large Employers Under Small 
Employer Coverage Buy-In Arrangements.--Section 404 of such Act (as 
amended by subsection (a)) is amended further by adding at the end the 
following new subsection:
    ``(f)(1) Any requirement of the preceding provisions of this 
section or any other provision of this title shall not be treated as 
violated by reason of the entry of a small employer into a small 
employer coverage buy-in arrangement with the plan administrator of a 
large employer group health plan or the treatment as a participant 
under the plan, pursuant to such an arrangement, of an individual who 
is an employee of the small employer and who is not an employee or 
former employee of the plan sponsor of the plan or a member or former 
member of an employee organization referred to in section 3(7)(A) in 
connection with the plan.
    ``(2) For purposes of paragraph (1), the term `small employer 
coverage buy-in arrangement' means an arrangement entered into between 
a small employer referred to in paragraph (1) and a plan administrator 
of a large employer group health plan referred to in paragraph (1) 
pursuant to which--
            ``(A) individuals who are employees of the small employer, 
        are identified under such arrangement, and are not otherwise 
        participants (within the meaning of section 3(7)(A)) in the 
        plan are treated as participants in the plan,
            ``(B) premiums are payable to the plan, by such 
        individuals, by the small employer, or by both, in total 
        amounts equivalent to the total cost of coverage of such 
        individuals and their beneficiaries under the plan, and
            ``(C) the Secretary determines, under a procedure providing 
        for determinations prior to the entry into the arrangement, and 
        annually thereafter during the term of the arrangement, that 
        the arrangement is--
                    ``(i) administratively feasible,
                    ``(ii) in the interests of the plan and of its 
                participants and beneficiaries, and
                    ``(iii) protective of the rights of participants 
                and beneficiaries of the plan.
    ``(3) A fiduciary of a group health plan shall have the same 
fiduciary duties with respect to participants and their beneficiaries 
who are covered under a group health plan solely by reason of a small 
employer coverage buy-in arrangement as are applicable with respect to 
individuals who are otherwise participants or beneficiaries under the 
plan.
    ``(4) For purposes of this subsection--
            ``(A)(i) The term `small employer' means, in connection 
        with the calendar year in which the arrangement referred to in 
        paragraph (1) is entered into, an employer who, on business 
        days during the period commencing with the preceding calendar 
        year and ending on the date on which the arrangement referred 
        to in paragraph (1) is entered into, employed an average of at 
        least 2 but not more than 50 employees.
            ``(ii) For purposes of this subparagraph--
                    ``(I) rules similar to the rules under subsections 
                (b), (c), (m), and (o) of section 414 of the Internal 
                Revenue Code of 1986 shall apply for purposes of 
                treating persons as a single employer;
                    ``(II) in the case of an employer which was not in 
                existence throughout the period described in 
                subparagraph (A), the determination of whether the 
                employer is a small employer shall be based on the 
                average number of employees that it is reasonably 
                expected the employer will employ on business days in 
                the calendar year during which the arrangement referred 
                to in paragraph (1) is entered into; and
                    ``(III) any reference in this subparagraph to an 
                employer shall include a reference to any predecessor 
                of the employer.
            ``(B) The term `large employer group health plan' means a 
        group health plan with respect to which the plan sponsor is not 
        a small employer in connection with the calendar year in which 
        the arrangement referred to in paragraph (1) is entered 
        into.''.
    (c) Conforming Amendments.--
            (1) Inclusion in definition of participant.--Section 3(7) 
        of such Act (29 U.S.C. 1002(7)) is amended--
                    (A) by inserting ``(A)'' after ``(7)''; and
                    (B) by adding at the end the following new 
                subparagraph:
    ``(B) In connection with a group health plan (as defined in section 
733(a)), the term `participant' includes any individual not described 
in subparagraph (A) who is treated as a participant in connection with 
a State coverage buy-in arrangement entered into pursuant to section 
404(e) or a small employer coverage buy-in arrangement entered into 
pursuant to section 404(f).''.
            (2) Exclusion from definition of multiple employer welfare 
        arrangement.--Section 3(40)(A) of such Act (29 U.S.C. 
        1002(40((A)) is amended--
                    (A) in clause (ii), by striking ``or'';
                    (B) in clause (iii), by striking ``association.'' 
                and inserting ``association, or''; and
                    (C) by adding at the end the following new clause:
                    ``(iv) pursuant to subsection (e) or (f) of section 
                404.''.
    (d) Credit for Premiums Paid Under State Coverage Buy-In 
Arrangements.--
            (1) In general.--Subpart D of part IV of subchapter A of 
        chapter 1 of the Internal Revenue Code of 1986 (relating to 
        business related credits) is amended by adding at the end the 
        following new section:

``SEC. 45Q. PREMIUMS PAID UNDER QUALIFIED COVERAGE BUY-IN ARRANGEMENTS.

    ``(a) General Rule.--For purposes of section 38, the qualified 
coverage buy-in arrangement credit determined under this section for 
any taxable year is the aggregate amount paid in the taxable year as 
premiums for qualified participants under a qualified coverage buy-in 
arrangement.
    ``(b) Definitions.--For purposes of this section--
            ``(1) Qualified coverage buy-in arrangement.--The term 
        `qualified coverage buy-in arrangement' means--
                    ``(A) a State coverage buy-in arrangement, and
                    ``(B) a small employer coverage buy-in arrangement.
            ``(2) State coverage buy-in arrangement; small employer 
        coverage buy-in arrangement.--The terms `State coverage buy-in 
        arrangement' and `small employer coverage buy-in arrangement' 
        have the respective meanings given such terms by subsections 
        (e)(2) and (f)(2) of section 404 of the Employee Retirement 
        Income Security Act of 1974.
            ``(3) Qualified participant.--The term `qualified 
        participant' means a participant (as defined in section 3(7)(B) 
        of the Employee Retirement Income Security Act of 1974).
            ``(4) Premium.--The term `premium' means the applicable 
        premium (as defined in section 4980B(f)(4)).''.
            (2) Credit allowed as part of general business credit.--
        Section 38(b) of such Code (defining current year business 
        credit) is amended by striking ``plus'' at the end of paragraph 
        (32), by striking the period at the end of paragraph (33) and 
        inserting ``, plus'', and by adding at the end the following 
        new paragraph:
            ``(34) State coverage buy-in arrangement credit determined 
        under section 45Q(a).''.
            (3) Clerical amendment.--The table of sections for subpart 
        D of part IV of subchapter A of chapter 1 of such Code is 
        amended by adding at the end the following new item:

``Sec. 45Q. Premiums paid under State coverage buy-in arrangements.''.
    (e) Effective Dates.--The amendments made by subsections (a), (b), 
and (c) shall apply with respect to arrangements entered into after 
December 31, 2008. The amendments made by subsection (d) shall apply to 
costs paid or incurred in taxable years beginning after December 31, 
2008.

SEC. 103. EXEMPTION FROM PREEMPTION TO PERMIT PAY OR PLAY UNDER STATE 
              LAW.

    Section 514(b) of the Employee Retirement Income Security Act of 
1974 (as amended by section 201) is amended further--
            (1) by redesignating paragraph (10) as paragraph (11); and
            (2) by inserting after paragraph (9) the following new 
        paragraph:
    ``(10) Subsection (a) shall not apply to any provision of State law 
to the extent it provides an assessment against an employer, or a 
credit against an otherwise applicable assessment against an employer, 
based on whether, or the extent to which, such employer makes 
contributions to a group health plan established or maintained by such 
employer, if such provision does not condition the applicability of the 
assessment or credit on the satisfaction of any requirement applicable 
to such plan.''.

SEC. 104. EXEMPTION FROM PREEMPTION TO PERMIT MANDATES FOR DATA 
              COLLECTION UNDER STATE LAW RELATING TO GROUP HEALTH 
              PLANS.

    Section 514(b) of the Employee Retirement Income Security Act of 
1974 (as amended by the preceding provisions of this title) is amended 
further--
            (1) by redesignating paragraph (11) as paragraph (12); and
            (2) by inserting after paragraph (10) the following new 
        paragraph:
    ``(10)(A) Subsection (a) shall not apply to any provision of State 
law to the extent such provision--
            ``(i) provides for the collection from the plan sponsor or 
        plan administrator of a group health plan, by the agency or 
        instrumentality of the State responsible for the administration 
        or enforcement of any State law regulating insurance or medical 
        care (as defined in section 733(a)(2)), of information relating 
        to the cost and availability of such medical care through group 
        health insurance coverage or access of individuals to such 
        coverage, or
            ``(ii) provides for the enforcement of any State law 
        described in clause (i).
    ``(B) For purposes of subparagraph (A), any provision of State law 
providing for the extent of the information described in subparagraph 
(A)(i) to be collected or the timing allowed for compliance with 
requests for such information shall be treated as a provision of State 
law referred to in subparagraph (A)(i).''.

        TITLE II--HEALTH PARTNERSHIP THROUGH CREATIVE FEDERALISM

SEC. 201. SHORT TITLE.

    This title may be cited as the ``Health Partnership Through 
Creative Federalism Act''.

SEC. 202. STATE HEALTH REFORM PROJECTS.

    (a) Purposes; Establishment of State Health Care Expansion and 
Improvement Program.--
            (1) Purposes.--The purposes of the programs approved under 
        this section shall include--
                    (A) achieving the goals of increased health 
                coverage and access; and
                    (B) testing alternative reforms, such as building 
                on the public or private health systems, or creating 
                new systems, to achieve the objectives of this title.
            (2) Intent of congress.--It is the intent of Congress 
        that--
                    (A) the programs approved under this title each 
                comprise significant coverage expansions;
                    (B) taken as a whole, such programs should be 
                diverse and balanced in their approaches to covering 
                the uninsured; and
                    (C) each such program should be rigorously and 
                objectively evaluated, so that the State programs 
                developed pursuant to this title may guide the 
                development of future State and national policy.
    (b) Applications by States and Local Governments.--
            (1) Entities that may apply.--
                    (A) In general.--A State may apply for a State 
                health care expansion and improvement program for the 
                entire State (or for regions of the State) under 
                paragraph (2).
                    (B) Regional and sub-state groups.--A regional 
                entity consisting of more than one State or one or more 
                local governments within a State may apply for a multi-
                State or a sub-State, respectively, health care 
                expansion and improvement program for the region or 
                area involved.
                    (C) State defined.--In this title, the term 
                ``State'' means the 50 States, the District of 
                Columbia, and the Commonwealth of Puerto Rico. Such 
                term shall include a regional entity described in 
                subparagraph (B).
            (2) Submission of application.--In accordance with this 
        section, each State or regional entity desiring to implement a 
        State health care expansion and improvement program may submit 
        an application to the State Health Coverage Innovation 
        Commission under subsection (c) for approval.
            (3) Local government applications.--Where a State fails to 
        submit an application under this section, a unit of local 
        government of such State, or a consortium of such units of 
        local governments, may submit an application directly to the 
        Commission for programs or projects under this subsection. Such 
        an application shall be subject to the requirements of this 
        section.
    (c) State Health Coverage Innovation Commission.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall establish a State Health Coverage Innovation Commission 
        (referred to in this section as the ``Commission'').
            (2) Membership.--The Commission shall be composed of the 
        following members:
                    (A) The Secretary.
                    (B) Four State governors to be appointed by the 
                National Governors Association on a bipartisan basis.
                    (C) Two members of a State legislature to be 
                appointed, on a joint and bipartisan basis, by the 
                National Conference of State Legislators and the 
                American Legislative Exchange Council.
                    (D) Two county officials to be appointed by the 
                National Association of Counties on a bipartisan basis.
                    (E) Two mayors to be appointed, on a joint and 
                bipartisan basis, by the National League of Cities and 
                by the United States Conference of Mayors.
                    (F) Two individuals to be appointed by the Speaker 
                of the House of Representatives.
                    (G) Two individuals to be appointed by the minority 
                leader of the House of Representatives.
                    (H) Two individuals to be appointed by the majority 
                leader of the Senate.
                    (I) Two individuals to be appointed by the minority 
                leader of the Senate.
            (3) Duties.--The Commission--
                    (A) shall request States to submit proposals, which 
                may include a variety of reform options such as tax 
                credit approaches, expansions of public programs such 
                as Medicaid and the State Children's Health Insurance 
                Program, the creation of purchasing pooling 
                arrangements similar to the Federal Employees Health 
                Benefits Program, individual market purchasing options, 
                single risk pool or single payer systems, health 
                savings accounts, a combination of the options 
                described in this subparagraph, or other alternatives 
                determined appropriate by the Commission, including 
                options suggested by States or the public, and nothing 
                in this subparagraph shall be construed to prevent the 
                Commission from approving a reform proposal not 
                included in this subparagraph;
                    (B) shall conduct a thorough review of the grant 
                application from a State and carry on a dialogue with 
                all State applicants concerning possible modifications 
                and adjustments;
                    (C) shall submit the recommendations and 
                legislative proposal described in subsection (d)(4)(C);
                    (D) shall be responsible for receiving information 
                to determine the status and progress achieved under the 
                program or projects granted under this section;
                    (E) shall report to the public concerning progress 
                made by States with respect to the performance measures 
                and goals established under this title, the periodic 
                progress of the State relative to its State performance 
                measures and goals, and the State program application 
                procedures, by region and State jurisdiction;
                    (F) shall promote information exchange between 
                States and the Federal Government;
                    (G) shall be responsible for making recommendations 
                to the Secretary and the Congress, using equivalency or 
                minimum standards, for minimizing the negative effect 
                of State program on national employer groups, provider 
                organizations, and insurers because of differing State 
                requirements under the programs; and
                    (H) may require States to submit additional 
                information or reports concerning the status and 
                progress achieved under health care expansion and 
                improvement programs granted under this section, as 
                needed.
            (4) Period of appointment; representation requirements; 
        vacancies.--Members shall be appointed for a term of 5 years. 
        In appointing such members under paragraph (2), the designated 
        appointing individuals shall ensure the representation of urban 
        and rural areas and an appropriate geographic distribution of 
        such members. Any vacancy in the Commission shall not affect 
        its powers, but shall be filled in the same manner as the 
        original appointment.
            (5) Chairperson, meetings.--
                    (A) Chairperson.--The Commission shall select a 
                Chairperson from among its members.
                    (B) Quorum.--Two-thirds of the members of the 
                Commission shall constitute a quorum, but a lesser 
                number of members may hold hearings.
                    (C) Meetings.--Not later than 30 days after the 
                date on which all members of the Commission have been 
                appointed, the Commission shall hold its first meeting. 
                The Commission shall meet at the call of the 
                Chairperson.
            (6) Powers of the commission.--
                    (A) Negotiations with states.--The Commission may 
                conduct detailed discussions and negotiations with 
                States submitting applications under this section, 
                either individually or in groups, to facilitate a final 
                set of recommendations for purposes of subsection 
                (d)(4)(C).
                    (B) Hearings.--The Commission may hold such 
                hearings, sit and act at such times and places, take 
                such testimony, and receive such evidence as the 
                Commission considers advisable to carry out the 
                purposes of this subsection.
                    (C) Meetings.--In addition to other meetings the 
                Commission may hold, the Commission shall hold an 
                annual meeting with the participating States under this 
                section for the purpose of having States report 
                progress toward the purposes in subsection (a) and for 
                an exchange of information.
                    (D) Information.--The Commission may secure 
                directly from any Federal department or agency such 
                information as the Commission considers necessary to 
                carry out the provisions of this subsection. Upon 
                request of the Chairperson of the Commission, the head 
                of such department or agency shall furnish such 
                information to the Commission if the head of the 
                department or agency involved determines it 
                appropriate.
                    (E) Postal services.--The Commission may use the 
                United States mails in the same manner and under the 
                same conditions as other departments and agencies of 
                the Federal Government.
            (7) Personnel matters.--
                    (A) Compensation.--Each member of the Commission 
                who is not an officer or employee of the Federal 
                Government or of a State or local government shall be 
                compensated at a rate equal to the daily equivalent of 
                the annual rate of basic pay prescribed for level IV of 
                the Executive Schedule under section 5315 of title 5, 
                United States Code, for each day (including travel 
                time) during which such member is engaged in the 
                performance of the duties of the Commission. All 
                members of the Commission who are officers or employees 
                of the United States shall serve without compensation 
                in addition to that received for their services as 
                officers or employees of the United States.
                    (B) Travel expenses.--The members of the Commission 
                shall be allowed travel expenses, including per diem in 
                lieu of subsistence, at rates authorized for employees 
                of agencies under subchapter I of chapter 57 of title 
                5, United States Code, while away from their homes or 
                regular places of business in the performance of 
                services for the Commission.
                    (C) Staff.--The Chairperson of the Commission may, 
                without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel as may be 
                necessary to enable the Commission to perform its 
                duties. The employment of an executive director shall 
                be subject to confirmation by the Commission.
                    (D) Detail of government employees.--Any Federal 
                Government employee may be detailed to the Commission 
                without reimbursement, and such detail shall be without 
                interruption or loss of civil service status or 
                privilege.
                    (E) Temporary and intermittent services.--The 
                Chairperson of the Commission may procure temporary and 
                intermittent services under section 3109(b) of title 5, 
                United States Code, at rates for individuals which do 
                not exceed the daily equivalent of the annual rate of 
                basic pay prescribed for level V of the Executive 
                Schedule under section 5316 of such title.
            (8) Funding.--For the purpose of carrying out this 
        subsection, there are authorized to be appropriated $3,000,000 
        for fiscal year 2009 and each fiscal year thereafter.
    (d) Requirements for Programs.--
            (1) State plan.--A State that seeks to operate a program 
        under this section shall prepare and submit to the Commission, 
        as part of the application under subsection (b)(2), a State 
        plan that shall have as its goal increased health care 
        coverage, and in service of that goal such additional goals as 
        improvements in health care quality, efficiency, cost-
        effectiveness, and the appropriate use of information 
        technology. To achieve such goal, the State plan shall comply 
        with the following:
                    (A) Coverage.--
                            (i) In general.--With respect to coverage, 
                        the State plan shall--
                                    (I) provide and describe the manner 
                                in which the State will ensure that an 
                                increased number of individuals 
                                residing within the State will have 
                                expanded access to health care coverage 
                                with a specific 5-year target for 
                                reduction in the number or proportion 
                                of uninsured individuals through either 
                                private or public program expansion, or 
                                both, in accordance with or in addition 
                                to the options established by the 
                                Commission;
                                    (II) describe the number and 
                                percentage of current uninsured 
                                individuals who will achieve coverage 
                                under a State health program;
                                    (III) describe the coverage that 
                                will be provided to beneficiaries under 
                                a State health program;
                                    (IV) identify Federal, State, or 
                                local and private programs that 
                                currently provide health care services 
                                in the State and describe how such 
                                programs could be coordinated with a 
                                State health program, to the extent 
                                practicable; and
                                    (V) provide for improvements in the 
                                availability of appropriate health care 
                                coverage that will increase access to 
                                care in urban, suburban, rural, and 
                                frontier areas of the State with 
                                medically underserved populations or 
                                where there may be an inadequate supply 
                                of health care providers.
                            (ii) Coverage options.--The coverage under 
                        the State plan may be--
                                    (I) health insurance coverage that 
                                meets the aggregate actuarial value 
                                requirement of section 2103(a)(2)(B) of 
                                the Social Security Act (42 U.S.C. 
                                1397cc(a)(2)(B));
                                    (II) a combination of health 
                                insurance coverage and a consumer-
                                directed health care spending account, 
                                if the actuarial value of such coverage 
                                plus the amount of annual deposits into 
                                such account from sources other than 
                                the beneficiary is not less than the 
                                actuarial value amount described in 
                                subclause (I); or
                                    (III) health care access not less 
                                on average than that provided through 
                                coverage described in subclause (I).
                            (iii) Construction.--Nothing in this clause 
                        shall be construed to limit in any way the 
                        authority of the Secretary of Health and Human 
                        Services to issue waivers under section 1115 of 
                        the Social Security Act.
                    (B) Quality.--With respect to quality, the State 
                plan may describe efforts to improve health care 
                quality in the State, including an explanation of how 
                such efforts would change (if at all) under the State 
                plan.
                    (C) Costs.--With respect to costs, the State plan 
                shall--
                            (i) describe such steps as the State may 
                        undertake to improve the efficiency of health 
                        care;
                            (ii) describe the public and private sector 
                        financing to be provided for the State health 
                        program;
                            (iii) estimate the amount of Federal, 
                        State, and local expenditures, as well as, the 
                        costs to business and individuals under the 
                        State health program; and
                            (iv) describe how the State plan will 
                        ensure the financial solvency of the State 
                        health program.
                    (D) Health information technology.--With respect to 
                health information technology, the State plan may 
                describe efforts to improve the appropriate use of 
                health information technology, including an explanation 
                of how such efforts would change (if at all) under the 
                State plan.
                    (E) Exceptions to federal policies.--
                            (i) In general.--Subject to clause (ii), 
                        the State plan shall describe the exceptions to 
                        otherwise applicable Federal statutes, 
                        regulations, and policies that would apply 
                        within the geographic area and time period 
                        governed by the plan.
                            (ii) Recognition of erisa requirements.--
                        Except to the extent authorized under 
                        subsection (j)(4), the State plan may not 
                        include exceptions to the provisions of the 
                        Employee Retirement Income Security Act of 1974 
                        but may take into account the amendments made 
                        by title I of this Act.
            (2) Technical assistance.--The Secretary shall, if 
        requested, provide technical assistance to States to assist 
        such States in developing applications and plans under this 
        section, including technical assistance by private sector 
        entities if determined appropriate by the Commission.
            (3) Initial review.--With respect to a State application 
        under subsection (b)(2), the Secretary and the Commission shall 
        complete an initial review of such State application not later 
        than 60 days after the receipt of such application, analyze the 
        scope of the proposal, and determine whether additional 
        information is needed from the State. The Commission shall 
        advise the State within such period of the need to submit 
        additional information.
            (4) Final determination.--
                    (A) In general.--In a timely manner consistent with 
                subparagraph (C), the Commission shall determine 
                whether to submit a State proposal to Congress for 
                approval.
                    (B) Voting.--
                            (i) In general.--The determination to 
                        submit a State proposal to Congress under 
                        subparagraph (A) shall be approved by \2/3\ of 
                        the members of the Commission who are present 
                        and eligible to vote and a majority of the 
                        entire Commission.
                            (ii) Eligibility.--A member of the 
                        Commission shall not participate in a 
                        determination under subparagraph (A) if--
                                    (I) in the case of a member who is 
                                a Governor, such determination relates 
                                to the State of which the member is the 
                                Governor; or
                                    (II) in the case of member not 
                                described in subclause (I), such 
                                determination relates to the geographic 
                                area of a State of which such member 
                                serves as a State or local official or 
                                as a Member of Congress.
                    (C) Submission.--Not later than 90 days before 
                October 1 of each fiscal year, the Commission may 
                submit to Congress a list, in the form of a legislative 
                proposal, of the State applications that the Commission 
                recommends for approval under this section.
            (5) Program or project period.--A State program or project 
        may be approved for a period of 5 years and may be extended for 
        a subsequent period of time upon approval by the Commission, 
        based upon achievement of targets.
    (e) Expedited Congressional Consideration.--
            (1) Introduction and expedited consideration in the house 
        of representatives.--
                    (A) Introduction in house of representatives.--The 
                legislative proposal submitted pursuant to subsection 
                (d)(4)(C) shall be in the form of a joint resolution 
                (in this subsection referred to as the ``resolution''). 
                Such resolution shall be introduced in the House of 
                Representatives by the Speaker immediately upon receipt 
                of the language and shall be referred non-sequentially 
                to the appropriate committee (or committees) of House 
                of Representatives. If the resolution is not introduced 
                in accordance with the preceding sentence, the 
                resolution may be introduced by any member of the House 
                of Representatives.
                    (B) Committee consideration.--Not later than 15 
                calendar days after the introduction of the resolution 
                described in subparagraph (A), each committee of the 
                House of Representatives to which the resolution was 
                referred shall report the resolution. The report may 
                include, at the committee's discretion, a 
                recommendation for action by the House. If a committee 
                has not reported such resolution (or an identical 
                resolution) at the end of 15 calendar days after its 
                introduction or at the end of the first day after there 
                has been reported to the House a resolution, whichever 
                is earlier, such committee shall be deemed to be 
                discharged from further consideration of such 
                resolution and such resolution shall be placed on the 
                appropriate calendar of the House of Representatives.
                    (C) Expedited procedure in house.--Not later than 5 
                legislative days after the date on which all committees 
                have been discharged from consideration of a 
                resolution, the Speaker of the House of 
                Representatives, or the Speaker's designee, shall move 
                to proceed to the consideration of the resolution. It 
                shall also be in order for any member of the House of 
                Representatives to move to proceed to the consideration 
                of the resolution at any time after the conclusion of 
                such 5-day period. All points of order against the 
                resolution (and against consideration of the 
                resolution) are waived. A motion to proceed to the 
                consideration of the resolution is highly privileged in 
                the House of Representatives and is not debatable. The 
                motion is not subject to amendment, to a motion to 
                postpone consideration of the resolution, or to a 
                motion to proceed to the consideration of other 
                business. A motion to reconsider the vote by which the 
                motion to proceed is agreed to or not agreed to shall 
                not be in order. If the motion to proceed is agreed to, 
                the House of Representatives shall immediately proceed 
                to consideration of the resolution without intervening 
                motion, order, or other business, and the resolution 
                shall remain the unfinished business of the House of 
                Representatives until disposed of. A motion to recommit 
                the resolution shall not be in order. Upon its passage 
                in the House, the clerk of the House shall provide for 
                its immediate transmittal to the Senate.
            (2) Expedited consideration in the senate.--
                    (A) Referral to committee.--If the resolution is 
                agreed to by the House of Representatives, upon its 
                receipt in the Senate the majority leader of the 
                Senate, or the leader's designee, the resolution shall 
                be referred to the appropriate committee of Senate.
                    (B) Committee consideration.--Not later than 15 
                calendar days after the referral of the resolution 
                under subparagraph (A), the committee of the Senate to 
                which the resolution was referred shall report the 
                resolution. The report may include, at the committee's 
                discretion, a recommendation for action by the Senate. 
                If a committee has not reported such resolution (or an 
                identical resolution) at the end of 15 calendar days 
                after its referral or at the end of the first day after 
                there has been reported to the Senate a resolution, 
                whichever is earlier, such committee shall be deemed to 
                be discharged from further consideration of such 
                resolution and such resolution shall be placed on the 
                appropriate calendar of the Senate.
                    (C) Expedited floor consideration.--Not later than 
                5 legislative days after the date on which all 
                committees have been discharged from consideration of a 
                resolution, the majority leader of the Senate, or the 
                majority leader's designee, shall move to proceed to 
                the consideration of the resolution. It shall also be 
                in order for any member of the Senate to move to 
                proceed to the consideration of the resolution at any 
                time after the conclusion of such 5-day period. All 
                points of order against the resolution (and against 
                consideration of the resolution) are waived. A motion 
                to proceed to the consideration of the resolution in 
                the Senate is privileged and is not debatable. The 
                motion is not subject to amendment, to a motion to 
                postpone consideration of the resolution, or to a 
                motion to proceed to the consideration of other 
                business. A motion to reconsider the vote by which the 
                motion to proceed is agreed to or not agreed to shall 
                not be in order. If the motion to proceed is agreed to, 
                the Senate shall immediately proceed to consideration 
                of the resolution without intervening motion, order, or 
                other business, and the resolution shall remain the 
                unfinished business of the Senate until disposed of.
            (3) Rules of the senate and house of representatives.--This 
        subsection is enacted by Congress--
                    (A) as an exercise of the rulemaking power of the 
                Senate and House of Representatives, respectively, and 
                is deemed to be part of the rules of each House, 
                respectively, but applicable only with respect to the 
                procedure to be followed in that House in the case of a 
                resolution under this subsection, and it supersedes 
                other rules only to the extent that it is inconsistent 
                with such rules; and
                    (B) with full recognition of the constitutional 
                right of either House to change the rules (so far as 
                they relate to the procedure of that House) at any 
                time, in the same manner, and to the same extent as in 
                the case of any other rule of that House.
            (4) Federal budget neutrality.--Except insofar as it allots 
        appropriations made pursuant to subsection (k), the legislative 
        proposal submitted pursuant to subsection (d)(4)(C) may not 
        increase the cumulative, net Federal budget deficit during the 
        multi-year operation of all the State applications contained 
        therein, taking into account such applications' impact on 
        Federal mandatory and discretionary spending, Federal revenue, 
        and Federal tax expenditures.
    (f) Funding.--
            (1) In general.--The Secretary shall provide a grant to a 
        State that has an application approved under subsection (e) to 
        enable such State to carry out an innovative State health 
        program in the State, to the extent that such a grant is 
        included in the recommendation of the Commission.
            (2) Amount of grant.--The amount of a grant provided to a 
        State under paragraph (1) shall be determined based upon the 
        recommendations of the Commission, subject to the amount 
        appropriated under subsection (k).
            (3) Performance-based funding allocation.--In awarding 
        grants under paragraph (1), the Commission shall direct the 
        Secretary to--
                    (A) fund a balanced diversity of approaches as 
                provided for by the Commission in subsection (c)(1)(B); 
                and
                    (B) link allocations to the State to the meeting of 
                the goals and performance measures relating to health 
                care coverage and health care costs established under 
                this title through the State project application 
                process.
            (4) Report.--One year before the end of the 5-year period 
        beginning on the date on which the first State begins to 
        implement a plan approved under subsection (e), the Commission 
        shall prepare and submit to the appropriate committees of 
        Congress, a report on the progress made by States in meeting 
        the goals of expanded coverage and cost containment through 
        performance measures established during the 5-year period of 
        the State plan. Such report may contain the recommendation of 
        the Commission concerning any future action that Congress 
        should take concerning health care reform, including whether or 
        not to extend the program established under this subsection.
    (g) Monitoring and Evaluation.--
            (1) Annual reports and participation by states.--Each State 
        that has received a program approval shall--
                    (A) submit to the Commission an annual report based 
                on the period representing the respective State's 
                fiscal year, detailing compliance with the requirements 
                established by the Commission and the Secretary in the 
                approval and in this section; and
                    (B) participate in the annual meeting under 
                subsection (c)(4)(C).
            (2) Evaluations by commission.--The Commission shall 
        prepare and submit to Congress annual reports that shall 
        contain--
                    (A) a description of the effects of the reforms 
                undertaken in States receiving approvals under this 
                section;
                    (B) a description of the recommendations of the 
                Commission and actions taken based on these 
                recommendations;
                    (C) an independent evaluation of the effectiveness 
                of such reforms in--
                            (i) expanding health care coverage for 
                        State residents; and
                            (ii) reducing or containing health care 
                        costs in the States,
                as well as other relevant or significant findings;
                    (D) recommendations regarding the advisability of 
                increasing Federal financial assistance for State 
                ongoing or future health program initiatives, including 
                the amount and source of such assistance; and
                    (E) as required by the Commission or the Secretary 
                under this section, a periodic, independent evaluation 
                of the program.
    (h) Noncompliance.--
            (1) Corrective action plans.--If a State is not in 
        compliance with a requirement of this section, the Commission, 
        on recommendation of the Secretary, shall develop a corrective 
        action plan for such State.
            (2) Termination.--The Commission, on recommendation of the 
        Secretary, may revoke any program granted under this section. 
        Such decisions shall be subject to a petition for 
        reconsideration and appeal pursuant to regulations established 
        by the Secretary.
    (i) Relationship to Federal Programs.--
            (1) In general.--Nothing in this title, or in section 1115 
        of the Social Security Act (42 U.S.C. 1315) shall be construed 
        as authorizing the Secretary, the Commission, a State, or any 
        other person or entity to alter or affect in any way--
                    (A) the provisions of title XIX of such Act (42 
                U.S.C. 1396 et seq.) or the regulations implementing 
                such title or,
                    (B) except as authorized in subsection (j)(4), the 
                provisions of the Employee Retirement Income Security 
                Act of 1974 (as amended by this Act) or the regulations 
                implementing such Act.
            (2) Maintenance of effort.--No payment may be made under 
        subsection (f)(1) if the State adopts criteria for benefits or 
        criteria for standards and methodologies for purposes of 
        determining an individual's eligibility for medical assistance 
        under the State plan under title XIX that are more restrictive 
        than those required under Federal law and applied as of the 
        date of enactment of this Act.
    (j) Miscellaneous Provisions.--
            (1) Application of certain requirements.--
                    (A) Restriction on application of preexisting 
                condition exclusions.--
                            (i) In general.--Subject to subparagraph 
                        (B), a State shall not permit the imposition of 
                        any preexisting condition exclusion for covered 
                        benefits under a program or project under this 
                        section.
                            (ii) Group health plans and group health 
                        insurance coverage.--If the State program or 
                        project provides for benefits through payment 
                        for, or a contract with, a group health plan or 
                        group health insurance coverage, the program or 
                        project may permit the imposition of a 
                        preexisting condition exclusion but only 
                        insofar and to the extent that such exclusion 
                        is permitted under the applicable provisions of 
                        part 7 of subtitle B of title I of the Employee 
                        Retirement Income Security Act of 1974 and 
                        title XXVII of the Public Health Service Act.
                    (B) Compliance with other requirements.--Coverage 
                offered under the program or project shall comply with 
                the requirements of subpart 2 of part A of title XXVII 
                of the Public Health Service Act insofar as such 
                requirements apply with respect to a health insurance 
                issuer that offers group health insurance coverage.
            (2) Prevention of duplicative payments.--
                    (A) Other health plans.--No payment shall be made 
                to a State under subsection (f)(1) for expenditures for 
                health assistance provided for an individual to the 
                extent that a private insurer (as defined by the 
                Secretary by regulation and including a group health 
                plan (as defined in section 607(1) of the Employee 
                Retirement Income Security Act of 1974), a service 
                benefit plan, and a health maintenance organization) 
                would have been obligated to provide such assistance 
                but for a provision of its insurance contract which has 
                the effect of limiting or excluding such obligation 
                because the individual is eligible for or is provided 
                health assistance under the plan.
                    (B) Other federal governmental programs.--Except as 
                provided in any other provision of law, no payment 
                shall be made to a State under subsection (f)(1) for 
                expenditures for health assistance provided for an 
                individual to the extent that payment has been made or 
                can reasonably be expected to be made promptly (as 
                determined in accordance with regulations) under any 
                other federally operated or financed health care 
                insurance program. For purposes of this paragraph, 
                rules similar to the rules for overpayments under 
                section 1903(d)(2) of the Social Security Act shall 
                apply.
            (3) Application of certain general provisions.--The 
        following provisions of the Social Security Act shall apply to 
        States under subsection (f)(1) in the same manner as they apply 
        to a State under such title XIX:
                    (A) Title xix provisions.--
                            (i) Section 1902(a)(4)(C) (relating to 
                        conflict of interest standards).
                            (ii) Paragraphs (2), (16), and (17) of 
                        section 1903(i) (relating to limitations on 
                        payment).
                            (iii) Section 1903(w) (relating to 
                        limitations on provider taxes and donations).
                            (iv) Section 1920A (relating to presumptive 
                        eligibility for children).
                    (B) Title xi provisions.--
                            (i) Section 1116 (relating to 
                        administrative and judicial review), but only 
                        insofar as consistent with this title.
                            (ii) Section 1124 (relating to disclosure 
                        of ownership and related information).
                            (iii) Section 1126 (relating to disclosure 
                        of information about certain convicted 
                        individuals).
                            (iv) Section 1128A (relating to civil 
                        monetary penalties).
                            (v) Section 1128B(d) (relating to criminal 
                        penalties for certain additional charges).
                            (vi) Section 1132 (relating to periods 
                        within which claims must be filed).
            (4) Relation to hipaa.--Health benefits coverage provided 
        under a State program or project under this section shall be 
        treated as creditable coverage for purposes of part 7 of 
        subtitle B of title I of the Employee Retirement Income 
        Security Act of 1974, title XXVII of the Public Health Service 
        Act, and subtitle K of the Internal Revenue Code of 1986.
    (k) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section (other than subsection (c)), 
such sums as may be necessary for each of fiscal years 2009 through 
2013. Amounts appropriated for a fiscal year under this subsection and 
not expended may be used in subsequent fiscal years to carry out this 
section.

SEC. 203. EFFECTIVE DATE.

    The provisions of this title shall take effect as of the date of 
the enactment of this Act.

          TITLE III--DEMONSTRATION PROJECT FOR EMPLOYER BUY-IN

SEC. 301. DEMONSTRATION PROJECT FOR EMPLOYER BUY-IN.

    Title XXI of the Social Security Act is amended by adding at the 
end the following new section:

``SEC. 2111. DEMONSTRATION PROJECT FOR EMPLOYER BUY-IN.

    ``(a) Authority.--
            ``(1) In general.--The Secretary shall establish a 
        demonstration project under which up to 10 States (each 
        referred to in this section as a `participating State') that 
        meet the conditions of paragraph (2) may provide, under its 
        State child health plan (notwithstanding section 2102(b)(3)(C)) 
        for a period of 5 years, for child health assistance in 
        relation to family coverage described in subsection (d) for 
        children who would be targeted low-income children but for 
        coverage as beneficiaries under a group health plan as the 
        children of participants by virtue of a qualifying employer's 
        contribution under subsection (b)(2).
            ``(2) Conditions.--The conditions described in this 
        paragraph for a State are as follows:
                    ``(A) No waiting lists.--The State does not impose 
                any waiting list, enrollment cap, or similar limitation 
                on enrollment of targeted low-income children under the 
                State child health plan.
                    ``(B) Eligibility of all children under 200 percent 
                of poverty line.--The State is applying an income 
                eligibility level under section 2110(b)(1)(B)(ii)(I) 
                that is at least 200 percent of the poverty line.
            ``(3) Qualifying employer defined.--In this section, the 
        term `qualifying employer' means an employer that has a 
        majority of its workforce composed of full-time workers with 
        family incomes reasonably estimated by the employer (based on 
        wage information available to the employer) at or below 200 
        percent of the poverty line. In applying the previous sentence, 
        two part-time workers shall be treated as a single full-time 
        worker.
    ``(b) Funding.--A demonstration project under this section in a 
participating State shall be funded, with respect to assistance 
provided to children described in subsection (a)(1), consistent with 
the following:
            ``(1) Limited family contribution.--The family involved 
        shall be responsible for providing payment towards the premium 
        for such assistance of such amount as the State may specify, 
        except that the limitations on cost-sharing (including 
        premiums) under paragraphs (2) and (3) of section 2103(e) shall 
        apply to all cost-sharing of such family under this section.
            ``(2) Minimum employer contribution.--The qualifying 
        employer involved shall be responsible for providing payment to 
        the State child health plan in the State of at least 50 percent 
        of the portion of the cost (as determined by the State) of the 
        family coverage in which the employer is enrolling the family 
        that exceeds the amount of the family contribution under 
        paragraph (1) applied towards such coverage.
            ``(3) Limitation on federal financial participation.--In no 
        case shall the Federal financial participation under section 
        2105 with respect to a demonstration project under this section 
        be made for any portion of the costs of family coverage 
        described in subsection (d) (including the costs of 
        administration of such coverage) that are not attributable to 
        children described in subsection (a)(1).
    ``(c) Uniform Eligibility Rules.--In providing assistance under a 
demonstration project under this section--
            ``(1) a State shall establish uniform rules of eligibility 
        for families to participate; and
            ``(2) a State shall not permit a qualifying employer to 
        select, within those families that meet such eligibility rules, 
        which families may participate.
    ``(d) Terms and Conditions.--The family coverage offered to 
families of qualifying employers under a demonstration project under 
this section in a State shall be the same as the coverage and benefits 
provided under the State child health plan in the State for targeted 
low-income children with the highest family income level permitted.''.

TITLE IV--ACCESS TO HEALTH BENEFITS THROUGH REGIONAL STATE ARRANGEMENTS

SEC. 401. PROMOTING ACCESS THROUGH REGIONAL STATE ARRANGEMENTS UNDER A 
              DEMONSTRATION PROJECT.

    (a) In General.--
            (1) Regional state arrangements.--Under this title the 
        Secretary of Health and Human Services, in collaboration with 
        the Secretary of Labor, shall facilitate the establishment of 
        regional State arrangements (each in this title referred to as 
        a ``regional State arrangement'') under which two or more 
        States ban together in order to increase their purchasing 
        pooling power and offer affordable health insurance to citizens 
        of those States consistent with paragraph (2). Such 
        arrangements shall include the following components:
                    (A) The appointment of a Benefits Administrator 
                under subsection (b)
                    (B) The offering of standard health benefit plans 
                under subsection (c).
                    (C) The charging of premiums using a modified 
                community-rated premiums under subsection (d).
                    (D) A requirement for individual health insurance 
                coverage under subsection (e).
                    (E) Subsidies for financially disadvantages persons 
                under subsection (f).
                    (F) Employer rule in funding health benefit plans 
                under subsection (g).
            (2) Application on a demonstration basis.--This title shall 
        be implemented on a demonstration basis so that--
                    (A) the regional State arrangements cover no more 
                than 20 States; and
                    (B) implementation occurs only over a 10-year 
                period.
            (3) Collaborative federal implementation.--
                    (A) In general.--In carrying out this title--
                            (i) the Secretary of Labor shall be 
                        primarily responsible for implementation with 
                        respect to employees and dependents; and
                            (ii) the Secretary of Health and Human 
                        Services shall be primarily responsible for 
                        implementation for all other individuals.
                    (B) Reference to secretary.--Except as otherwise 
                provided, in this title, the term ``Secretary'' means 
                the Secretary of Health and Human Services working in 
                collaboration with the Secretary of Labor.
            (4) Report.--The Secretary shall jointly submit to Congress 
        a biannual report on the implementation of this title and shall 
        include in such report recommendations regarding the expansion 
        and extension of the program under this title.
    (b) Benefit Administrator.--
            (1) In general.--Each regional State arrangement shall be 
        administered by a Benefit Administrator who shall be 
        responsible for the administration of this title under the 
        arrangement.
            (2) Disclosure of performance of benefit administrators.--
        The Secretary shall make available to the public information on 
        the relative administrative performance of each Benefit 
        Administrator.
    (c) Standard Health Benefit Plans.--
            (1) Offering of standard health benefit plans.--Under each 
        regional State arrangement State, the Benefit Administrator 
        shall, through a bidding process determined and administered by 
        the Secretary, offer, directly or indirectly, three to five 
        standard health benefit plans to all individuals, regardless of 
        employment, who reside in a State covered by the arrangement.
            (2) Standard health benefit plans.--In this title, the term 
        ``standard health benefit plan'' means a health benefits plan 
        that meets standards relating to benefits recognized by the 
        Secretary. The Secretary shall request the National Association 
        of Insurance Commissioners or another appropriate entity to 
        develop such standards for such plans in a manner consistent 
        with the model for standards development used under section 
        1881 of the Social Security Act (42 U.S.C. 1395rr) for medicare 
        supplemental policies. Such standards shall be designed to 
        permit the offering of low-cost benefit options.
    (d) Application of Modified Community-Rated Premiums.--
            (1) In general.--The premiums for the standard health 
        benefit plans offered under a regional State arrangement within 
        a defined service area (as identified under paragraph (2)) 
        shall be established consistent with the following:
                    (A) All such plans in the area shall uniformly bear 
                the cost of disease and injury.
                    (B) Except as otherwise provided in this paragraph, 
                the premiums shall be uniform within such area for 
                family coverage and for individual coverage for each 
                plan in such area.
                    (C) In the case of a plan purchased by an 
                individual and not in connection with a group health 
                plan, the regional State arrangement may permit the 
                variation of premiums based upon the age band in which 
                an individual or family falls in a manner that 
                reasonable reflects the health cost differences of 
                individuals among such age bands.
                    (D) There shall be a mechanism whereby there would 
                be standardized risk adjustments to premiums of each 
                plan in the area based on the actual claims under the 
                respective plans during the previous plan year.
                    (E) Adjustments related to self-imposed lifestyle 
                risks, such as smoking, alcohol consumption, and 
                avoidance of personal risk, may be made.
                    (F) Premiums may be varied among standard health 
                benefit plans based on efficiencies generated by better 
                administrator practices, including efficiencies derived 
                from superior disease management, utilization 
                management, case management, lifestyle management, 
                ``pay-for-performance'' systems, and other innovative 
                initiatives designed to lower costs, increase quality, 
                and improve accountability.
            (2) Identification of defined service areas.--For purposes 
        of paragraph (1), the Secretary shall divide the area covered 
        by each regional State arrangement into separate defined 
        service areas based on major medical markets.
    (e) Individual Coverage Mandate.--
            (1) In general.--Subject to paragraph (3), each regional 
        State arrangement shall provide that each uninsured individual 
        (as defined in paragraph (4)) shall--
                    (A) automatically be enrolled in a standard health 
                benefit plan under this title; and
                    (B) be liable, through payroll deduction or 
                otherwise, for the payment of premiums for such 
                enrollment, taking into account the amount of any 
                financial subsidy offered under subsection (f).
            (2) Certification.--Each Benefit Administrator for a 
        regional State arrangement shall develop a satisfactory method 
        for certifying compliance with the provisions of individuals 
        residing in the area covered by the arrangement with the 
        requirement of paragraph (1).
            (3) Exceptions.--The Secretary may establish exceptions to 
        the requirement of paragraph (1) in appropriate cases, such as 
        in the case of individuals who are financially unable to afford 
        to pay the premiums required to enroll in a standard health 
        benefit plan.
            (4) Uninsured individual defined.--In this subsection, the 
        term ``uninsured individual'' means, with respect to a regional 
        State arrangement, an individual who--
                    (A) resides in a State included in a regional State 
                arrangement;
                    (B) is not enrolled for benefits under--
                            (i) the Medicare or Medicaid program or 
                        another government-sponsored health program (as 
                        identified by the Secretary of Health and Human 
                        Services); or
                            (ii) a group health plan (as defined in 
                        section 607(1) of the Employee Retirement 
                        Income Security Act of 1974); and
                    (C) does not have coverage that is otherwise found 
                to be qualifying by the Secretary.
    (f) Subsidies for Financially Disadvantaged Persons.--The Secretary 
shall establish a system of subsidies to assist in the payment of 
premiums and cost-sharing for individuals who are required under 
subsection (e) (but for paragraph (3)) to be covered under a standard 
health benefit plan but who are financially unable to afford to pay 
such premiums..
    (g) Employer Role in Funding Health Benefit Plans.--
            (1) In general.--Nothing in this title shall prevent an 
        employer from providing health benefits coverage to employees 
        and their dependents through existing arrangements or through a 
        standard health benefit plan offered through a regional State 
        arrangement under this title.
            (2) Required registration with benefits administrator.--
        Each employer with employees residing in an area covered by a 
        regional State arrangement shall register with the Benefits 
        Administrator for such arrangement.

SEC. 402. TRANSPARENCY AND ACCOUNTABILITY FOR HEALTH BENEFIT PLANS.

    (a) Plan Comparisons.--The Secretary shall establish a method for 
making available, in comparative form, to health consumers, providers, 
employers, and health plans, how health benefit plans offered under 
this title compare to each other within a regional State arrangement.
    (b) Provider Transparency and Accountability.--
            (1) Quality standards.--Not later than 1 year after the 
        date of the enactment of this Act, the Secretary shall develop 
        definitions and standards for quality care in collaboration 
        with providers, public and private-sector representatives, 
        payers, and consumers.
            (2) Coverage.--The quality standards developed under 
        paragraph (1) shall cover both process and outcome measures and 
        shall be applied to health care entities, including individual 
        physicians, groups of physicians, hospitals, integrated 
        systems, and, to the extent specified by the Secretary, an 
        entire enterprise. Such standards shall be based on evidence-
        based medicine and shall be continuously updated and expanded.
            (3) Measurement.--Once such standards are developed, 
        performance of health care entities shall be measured against 
        these standards.
    (c) Health Plan Transparency and Accountability.--
            (1) Accountability.--The Secretary shall develop standards 
        to hold administrators of health benefit plans accountable for 
        their claims administrative practices, including overhead 
        costs, delayed claims payments, errors, lost claims, and 
        aggressive denial of claims.
            (2) Development of standards.--The Secretary shall develop 
        such standards through a collaborative process between the 
        public-sector and private-sector stakeholders to measure and 
        make available to the public information on the performance of 
        health benefit plan administrators during the period measured. 
        Such information for each health benefit plan administrator 
        shall include, for each health plan administered for each 
        measurement period, the following:
                    (A) Expense loadings added to the basic premium 
                amount to cover expenses of the plan, including 
                commissions, premium taxes, marketing support costs, 
                and other similar expenses.
                    (B) The total number and cost of denied claims.
                    (C) The total cost of denied claims that is 
                transferred to providers.
                    (D) The average out-of-pocket expense incurred by 
                participants.
                    (E) Consumer assessments regarding plan 
                administration.
                    (F) The relative efficiency and quality of claims 
                administration and other administrative processes.
    (d) Oversight.--The Secretary shall have oversight responsibility 
to ensure that health benefit plans are administered properly.

    TITLE V--AMENDMENTS RELATING TO PREEXISTING CONDITION EXCLUSION

SEC. 501. SHORT TITLE.

    This Act may be cited as the ``Preexisting Condition Exclusion 
Patient Protection Act of 2008''.

SEC. 502. AMENDMENTS RELATING TO PREEXISTING CONDITION EXCLUSIONS UNDER 
              GROUP HEALTH PLANS.

    (a) Amendments to the Employee Retirement Income Security Act of 
1974.--
            (1) Reduction in look-back period.--Section 701(a)(1) of 
        the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
        1181(a)(1)) is amended by striking ``6-month period'' and 
        inserting ``30-day period''.
            (2) Reduction in permitted preexisting condition limitation 
        period.--Section 701(a)(2) of such Act (29 U.S.C. 1181(a)(2)) 
        is amended by striking ``12 months'' and inserting ``3 
        months'', and by striking ``18 months'' and inserting ``9 
        months''.
    (b) Amendments to the Public Health Service Act.--
            (1) Reduction in look-back period.--Section 2701(a)(1) of 
        the Public Health Service Act (42 U.S.C. 300gg(a)(1)) is 
        amended by striking ``6-month period'' and inserting ``30-day 
        period''.
            (2) Reduction in permitted preexisting condition limitation 
        period.--Section 2701(a)(2) of such Act (42 U.S.C. 300gg(a)(2)) 
        is amended by striking ``12 months'' and inserting ``3 
        months'', and by striking ``18 months'' and inserting ``9 
        months''.
    (c) Amendments to the Internal Revenue Code of 1986.--
            (1) Reduction in look-back period.--Paragraph (1) of 
        section 9801(a) of the Internal Revenue Code of 1986 (relating 
        to limitation on preexisting condition exclusion period and 
        crediting for periods of previous coverage) is amended by 
        striking ``6-month period'' and inserting ``30-day period''.
            (2) Reduction in permitted preexisting condition limitation 
        period.--Paragraph (2) of section 9801(a) of such Code is 
        amended by striking ``12 months'' and inserting ``3 months'', 
        and by striking ``18 months'' and inserting ``9 months''.
    (d) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply with respect to 
        group health plans for plan years beginning after the end of 
        the 12th calendar month following the date of the enactment of 
        this Act.
            (2) Special rule for collective bargaining agreements.--In 
        the case of a group health plan maintained pursuant to one or 
        more collective bargaining agreements between employee 
        representatives and one or more employers ratified before the 
        date of the enactment of this Act, the amendments made by this 
        section shall not apply to plan years beginning before the 
        earlier of--
                    (A) the date on which the last of the collective 
                bargaining agreements relating to the plan terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of the enactment of this Act), 
                or
                    (B) 3 years after the date of the enactment of this 
                Act.
        For purposes of subparagraph (A), any plan amendment made 
        pursuant to a collective bargaining agreement relating to the 
        plan which amends the plan solely to conform to any requirement 
        added by the amendments made by this section shall not be 
        treated as a termination of such collective bargaining 
        agreement.

SEC. 503. AMENDMENTS RELATING TO PREEXISTING CONDITION EXCLUSIONS IN 
              HEALTH INSURANCE COVERAGE IN THE INDIVIDUAL MARKET.

    (a) Applicability of Group Health Insurance Limitations on 
Imposition of Preexisting Condition Exclusions.--
            (1) In general.--Section 2741 of the Public Health Service 
        Act (42 U.S.C. 300gg-41) is amended--
                    (A) by redesignating the second subsection (e) 
                (relating to market requirements) and subsection (f) as 
                subsections (f) and (g), respectively; and
                    (B) by adding at the end the following new 
                subsection:
    ``(h) Application of Group Health Insurance Limitations on 
Imposition of Preexisting Condition Exclusions.--
            ``(1) In general.--Subject to paragraph (2), a health 
        insurance issuer that provides individual health insurance 
        coverage may not impose a preexisting condition exclusion (as 
        defined in subsection (b)(1)(A) of section 2701) with respect 
        to such coverage except to the extent that such exclusion could 
        be imposed consistent with such section if such coverage were 
        group health insurance coverage.
            ``(2) Limitation.--In the case of an individual who--
                    ``(A) is enrolled in individual health insurance 
                coverage;
                    ``(B) during the period of such enrollment has a 
                condition for which no medical advice, diagnosis, care, 
                or treatment had been recommended or received as of the 
                enrollment date; and
                    ``(C) seeks to enroll under other individual health 
                insurance coverage which provides benefits different 
                from those provided under the coverage referred to in 
                subparagraph (A) with respect to such condition,
        the issuer of the individual health insurance coverage 
        described in subparagraph (C) may impose a preexisting 
        condition exclusion with respect to such condition and any 
        benefits in addition to those provided under the coverage 
        referred to in subparagraph (A), but such exclusion may not 
        extend for a period of more than 3 months.''.
            (2) Elimination of cobra requirement.--Subsection (b) of 
        such section is amended--
                    (A) by adding ``and'' at the end of paragraph (2);
                    (B) by striking the semicolon at the end of 
                paragraph (3) and inserting a period; and
                    (C) by striking paragraphs (4) and (5).
            (3) Conforming amendment.--Section 2744(a)(1) of such Act 
        (42 U.S.C. 300gg-44(a)(1)) is amended by inserting ``(other 
        than subsection (h))'' after ``section 2741''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated in the individual market after the end 
of the 12th calendar month following the date of the enactment of this 
Act.
                                 <all>