[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 109 Introduced in House (IH)]







111th CONGRESS
  1st Session
                                H. R. 109

To provide for the offering of Health Benefit Plans to individuals, to 
  increase funding for State high risk health insurance pools, and to 
       promote best practice protocols for State high risk pools.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 6, 2009

 Mr. Fortenberry introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To provide for the offering of Health Benefit Plans to individuals, to 
  increase funding for State high risk health insurance pools, and to 
       promote best practice protocols for State high risk pools.

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

SECTION 1. SHORT TITLE; FINDINGS AND PURPOSES; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``America's 
Affordable Health Care Act of 2009''.
    (b) Findings and Purposes.--
            (1) Findings.--Congress finds the following:
                    (A) The regulation of the practice of insurance is 
                a State prerogative.
                    (B) It is in the interests of health care consumers 
                that Congress allows for policies that increase the 
                affordability of health insurance products.
                    (C) The Federal Government provides States and the 
                medical community with public financing to support the 
                medical needs of the uninsured.
                    (D) There is a correlation between the amount of 
                insurance benefits and the cost of insurance products.
                    (E) State mandate laws have created barriers to 
                affordable health coverage.
                    (F) A number of States allow for the creation of 
                insurance products that recognize the increased costs 
                associated with mandate laws.
                    (G) Consumers throughout the United States are 
                finding it increasingly hard to secure affordable 
                health care coverage which contributes to the national 
                uninsured rate.
            (2) Federal insurance product.--Congress further finds that 
        it is in the interests of taxpayers, health care purchasers, 
        and the health care provider community, to allow for a class of 
        federally certified insurance products that can be purchased in 
        the individual market without being subject to State benefit 
        mandate laws.
            (3) Purposes.--The purposes of this Act are--
                    (A) to promote increased affordability and access 
                to health care coverage for citizens of the United 
                States;
                    (B) to allow consumers the ability to make choices 
                by weighing insurance benefits with the cost of 
                insurance;
                    (C) to provide incentives to health plans and 
                health insurance issuers to offer increasingly 
                affordable insurance policies to all those in the 
                individual market;
                    (D) to provide low-income and uninsured workers 
                with incentives to purchase insurance policies;
                    (E) to provide incentives to companies and States 
                to offer health care solutions for high risk 
                beneficiaries;
                    (F) to provide for new coverage opportunities to 
                solve the problems of affordability and uninsurance; 
                and
                    (G) to promote the availability of health insurance 
                coverage through high risk pools for individuals whose 
                health conditions create barriers to such coverage.
    (c) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; findings and purposes; table of contents.
                     TITLE I--HEALTH BENEFIT PLANS

Sec. 101. Certification of Health Benefit Plans.
Sec. 102. Conditions for certification.
Sec. 103. Review of implementation.
Sec. 104. Definitions.
     TITLE II--EXPANSION OF STATE HIGH RISK HEALTH INSURANCE POOLS

Sec. 201. Increasing and expanding funding for State high risk health 
                            insurance pools.
Sec. 202. Qualified high risk pools best practices guidelines and grant 
                            program.

                     TITLE I--HEALTH BENEFIT PLANS

SEC. 101. CERTIFICATION OF HEALTH BENEFIT PLANS.

    (a) In General.--A health insurance issuer may apply to the 
Secretary for up to 3 health insurance coverage policies offered in the 
individual market in any State to be certified as Health Benefit Plans 
under this title with respect to eligible individuals and the policies 
so certified may be offered and sold to such individuals without regard 
to any State or local law respecting mandates for benefits.
    (b) Construction.--Except as specifically provided under subsection 
(a) with respect to health insurance benefits, nothing in this title 
shall be construed as--
            (1) modifying the application of State or local 
        requirements relating to matters not described in subsection 
        (a), such as underwriting, enrollment, and premiums;
            (2) superseding any provision of State or local law or 
        regulation relating to the business of insurance, including the 
        regulation of insurers and insurance products, underwriting, 
        enrollment, and premiums;
            (3) preventing a State or local jurisdiction from applying 
        fraud and abuse provisions otherwise applicable with respect to 
        the sale and marketing of health insurance coverage to the sale 
        and marketing of Health Benefit Plans under this title; or
            (4) exempting a Health Benefits Plan, and the health 
        insurance issuer offering such a plan, from applicable 
        requirements of State law and compliance with applicable 
        provisions of title XXVII of the Public Health Service Act.

SEC. 102. CONDITIONS FOR CERTIFICATION.

    (a) In General.--The Secretary shall not certify under this title a 
Health Benefit Plan offered by a health insurance issuer unless--
            (1) the Plan includes benefits for items and services 
        within each of the categories of basic services described in 
        subsection (b); and
            (2) the issuer--
                    (A) is licensed under State law to offer health 
                insurance coverage in the State involved; and
                    (B) submits to the Secretary such information and 
                assurances as the Secretary may require to assure 
                compliance of the issuer, and Health Benefit Plans 
                offered by the issuer, with the applicable requirements 
                of this title.
    (b) Categories of Basic Services.--
            (1) In general.--The categories of basic services described 
        in this subsection are as follows:
                    (A) Inpatient hospital services.
                    (B) Physicians' surgical and medical services.
            (2) Treatment of other categories.--Nothing in this section 
        shall be construed as preventing a Health Benefit Plan from 
        providing coverage of benefits that are not within a category 
        of basic services described in paragraph (1).
    (c) Reciprocal Arrangements.--Health insurance issuers offering 
Health Benefit Plans may create reciprocal arrangements with other 
issuers of such plans in order to improve the portability of such plans 
among eligible individuals.

SEC. 103. REVIEW OF IMPLEMENTATION.

    (a) Review.--The Secretary shall review the implementation of this 
title and the impact of such implementation on the availability and 
purchase of health insurance coverage.
    (b) Report.--Not later than 3 years after the date of the enactment 
of this Act, the Secretary shall submit to Congress a report on this 
title and its impact on making health insurance coverage more 
affordable.

SEC. 104. DEFINITIONS.

    In this title:
            (1) The term ``eligible individual'' means an individual 
        who is a citizen or national of the United States or an alien 
        lawfully residing permanently in the United States.
            (2) The terms ``health insurance coverage'', ``health 
        insurance issuer'', and ``individual market'' have the meanings 
        given such terms in section 2791 of the Public Health Service 
        Act (42 U.S.C. 300gg-91).
            (3) The term ``Secretary'' means the Secretary of Health 
        and Human Services.

     TITLE II--EXPANSION OF STATE HIGH RISK HEALTH INSURANCE POOLS

SEC. 201. INCREASING AND EXPANDING FUNDING FOR STATE HIGH RISK HEALTH 
              INSURANCE POOLS.

    (a) In General.--Section 2745(d) of the Public Health Service Act 
(42 U.S.C. 300gg-45(d)) is amended--
            (1) in paragraph (2)--
                    (A) in the heading, by striking ``through 2010'' 
                and inserting ``through 2009''; and
                    (B) in the matter preceding subparagraph (A), by 
                striking ``through 2010'' and inserting ``through 
                2009'';
            (2) by redesignating paragraphs (3), (4), and (5) as 
        paragraphs (4), (5), and (6), respectively; and
            (3) by inserting after paragraph (2) the following new 
        paragraph:
            ``(3) Authorization of appropriations for fiscal years 2010 
        through 2014.--There are authorized to be appropriated for each 
        of fiscal years 2010 through 2014--
                    ``(A) $10,000,000 to carry out subsection (a); and
                    ``(B) $100,000,000, of which, subject to paragraph 
                (5)--
                            ``(i) two-thirds of the amount appropriated 
                        shall be made available for allotments under 
                        subsection (b)(2); and
                            ``(ii) one-third of the amount appropriated 
                        shall be made available for allotments under 
                        subsection (c)(3).''.
    (b) Conforming Amendments.--Section 2745 of the Public Health 
Service Act (42 U.S.C. 300gg-45) is amended--
            (1) in subsection (a), by striking ``subsection (d)(1)(A)'' 
        and inserting ``paragraphs (1)(A) and (3)(A) of subsection 
        (d)'';
            (2) in each of paragraphs (1) and (2) of subsection (b), by 
        striking ``(1)(B)(i) and (2)(A)'' and inserting ``(1)(B)(i), 
        (2)(A), and (3)(B)(i)'';
            (3) in each of paragraphs (1) and (3) of subsection (c), by 
        striking ``(1)(B)(ii) and (2)(B)'' and inserting ``(1)(B)(ii), 
        (2)(B), and (3)(B)(ii)''; and
            (4) in subsection (d)--
                    (A) in each of paragraphs (1)(B) and (2), by 
                striking ``paragraph (4)'' and inserting ``paragraph 
                (5)''; and
                    (B) in paragraph (5), as redesignated by subsection 
                (a)(2), by striking ``paragraph (1)(B) or (2)'' and 
                inserting ``paragraph (1)(B), (2), or (3)(B)''.

SEC. 202. QUALIFIED HIGH RISK POOLS BEST PRACTICES GUIDELINES AND GRANT 
              PROGRAM.

    Section 2745 of the Public Health Service Act (42 U.S.C. 300gg-45) 
is amended--
            (1) in subsection (b)(1), by striking ``In the case'' and 
        inserting ``Subject to subsection (f)(1), in the case'';
            (2) by redesignating subsection (f) and (g) as subsections 
        (g) and (h), respectively; and
            (3) by inserting after subsection (e) the following new 
        subsection:
    ``(f) Qualified High Risk Pools Best Practices Guidelines and Grant 
Program.--
            ``(1) Best practices report requirement.--To be eligible to 
        receive a grant under subsection (b) for a fiscal year 
        beginning more than 60 days after the date of the enactment of 
        the America's Affordable Health Care Act of 2009, a State that 
        has established a qualified high risk pool shall submit to the 
        Secretary, not later than 120 days after the beginning of such 
        fiscal year, evidence-based information on the operation of 
        such pool, as specified by the Secretary for purposes of 
        creating the best practices guidelines described in paragraph 
        (2).
            ``(2) Best practice guidelines.--Not later than 120 days 
        after the date of the enactment of the America's Affordable 
        Health Care Act of 2009, the Secretary shall, after providing 
        for notice and comment, recommend and post on the public 
        Internet site of the Department of Health and Human Services a 
        list of best practices with respect to the operation of 
        qualified high risk pools. The Secretary shall provide for 
        notice to the States and insurers who manage such qualified 
        high risk pools of the proposed development of such practices 
        and shall develop such best practices with input obtained from 
        such States and insurers. Such best practices should be 
        categorized and applied according to the number of individuals 
        enrolled in the qualified high risk pool involved.
            ``(3) Bonus grants for state qualified high risk pools that 
        follow best practices.--
                    ``(A) In general.--In the case of a State that is 
                one of the 50 States or the District of Columbia, that 
                has established a qualified high risk pool, and that is 
                receiving a grant under subsection (b)(1), for each 
                fiscal year for which the State demonstrates according 
                to a process specified by the Secretary that such 
                qualified high risk pool was operated in accordance 
                with the best practices posted under paragraph (2), the 
                Secretary shall provide a bonus grant from the funds 
                appropriated under subparagraph (C) and allotted to the 
                State under subparagraph (B).
                    ``(B) Allotment; limitation.--The Secretary shall 
                allot funds appropriated under subparagraph (C) among 
                States qualifying for a bonus grant under subparagraph 
                (A) in a manner specified by the Secretary, but in no 
                case shall the amount so allotted to a State for a 
                fiscal year exceed 10 percent of the funds so 
                appropriated for the fiscal year.
                    ``(C) Authorization of appropriations for 
                bonuses.--There are authorized to be appropriated for 
                each of fiscal years 2010 through 2013 $26,000,000 for 
                allotments under subparagraph (B).''.
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