[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1558 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1558

  To amend title I of the Employee Retirement Income Security Act of 
 1974, title XXVII of the Public Health Service Act, and the Internal 
 Revenue Code of 1986 to prohibit preexisting condition exclusions in 
   group health plans and health insurance coverage in the group and 
                          individual markets.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 17, 2009

  Mr. Courtney (for himself, Mr. Schiff, Mrs. Capps, Ms. DeLauro, Ms. 
  Clarke, Mr. Langevin, Ms. Schakowsky, Ms. Schwartz, Mr. Massa, Ms. 
  Baldwin, Ms. Ros-Lehtinen, Ms. Pingree of Maine, and Mrs. Davis of 
 California) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
Ways and Means and Education and Labor, 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 amend title I of the Employee Retirement Income Security Act of 
 1974, title XXVII of the Public Health Service Act, and the Internal 
 Revenue Code of 1986 to prohibit preexisting condition exclusions in 
   group health plans and health insurance coverage in the group and 
                          individual markets.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preexisting Condition Patient 
Protection Act of 2009''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) According to the United States Census Bureau, 45.7 
        million people were uninsured in 2007.
            (2) According to a recent study by the Commonwealth Fund, 
        the number of underinsured adults aged 19 to 64 has jumped 60 
        percent over the last 4 years, from 16,000,000 in 2003 to 
        25,000,000 in 2007.
            (3) According to the Centers for Disease Control and 
        Prevention (CDC), approximately 45 percent of Americans have at 
        least one chronic condition.
            (4) Forty-four States currently allow insurance companies 
        to deny coverage for, limit coverage for, or charge increased 
        premiums for a preexisting condition.
            (5) Over 26 million people were enrolled in private 
        individual market health plans in 2007. Under the Health 
        Insurance Portability and Accountability Act of 1996 (HIPAA), 
        these individuals have no protections against pre-existing 
        condition exclusions or waiting periods.
            (6) When a child or adult has a 63-day gap in insurance 
        coverage, pre-existing condition exclusions, such as limiting 
        coverage or instituting a waiting period, can be placed on them 
        when they become insured under a new health insurance policy.
            (7) Eliminating pre-existing condition exclusions for all 
        is a vital safeguard to ensuring that all Americans have access 
        to health care when in need.
            (8) According to a Kaiser Family Foundation/Harvard School 
        of Public Health public opinion poll, 58 percent of Americans 
        strongly favor the Federal Government requiring health 
        insurance companies to cover anyone who applies for health 
        coverage, even if they have a prior illness.

SEC. 3. AMENDMENTS RELATING TO PREEXISTING CONDITION EXCLUSIONS UNDER 
              GROUP HEALTH PLANS.

    (a) Amendments to the Employee Retirement Income Security Act of 
1974.--
            (1) Elimination of preexisting condition exclusions.--
        Section 701 of the Employee Retirement Income Security Act of 
        1974 (29 U.S.C. 1181) is amended--
                    (A) by amending the heading to read as follows: 
                ``elimination of preexisting condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, with respect to a 
participant or beneficiary--
            ``(1) may not impose any preexisting condition exclusion; 
        and
            ``(2) in the case of a group health plan that offers 
        medical care through health insurance coverage offered by a 
        health maintenance organization, may not provide for an 
        affiliation period with respect to coverage through the 
        organization.'';
                    (C) in subsection (b), by striking paragraph (3) 
                and inserting the following:
            ``(3) Affiliation period.--The term `affiliation period' 
        means a period which, under the terms of the health insurance 
        coverage offered by the health maintenance organization, must 
        expire before the health insurance coverage becomes 
        effective.'';
                    (D) by striking subsections (c), (d), (e), and (g); 
                and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Clerical amendment.--The item in the table of contents 
        of such Act relating to section 701 is amended to read as 
        follows:

``Sec. 701. Elimination of preexisting condition exclusions.''.
    (b) Amendments to the Public Health Service Act.--
            (1) In general.--Section 2701 of the Public Health Service 
        Act (42 U.S.C. 300gg) is amended--
                    (A) by amending the heading to read as follows: 
                ``elimination of preexisting condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, with respect to a 
participant or beneficiary--
            ``(1) may not impose any preexisting condition exclusion; 
        and
            ``(2) in the case of a group health plan that offers 
        medical care through health insurance coverage offered by a 
        health maintenance organization, may not provide for an 
        affiliation period with respect to coverage through the 
        organization.'';
                    (C) in subsection (b), by striking paragraph (3) 
                and inserting the following:
            ``(3) Affiliation period.--The term `affiliation period' 
        means a period which, under the terms of the health insurance 
        coverage offered by the health maintenance organization, must 
        expire before the health insurance coverage becomes 
        effective.'';
                    (D) by striking subsections (c), (d), (e), and (g); 
                and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Technical amendments relating to employer size.--
        Section 2711 of such Act (42 U.S.C. 300gg-11) is amended--
                    (A) in subsection (a)--
                            (i) in the heading, by striking ``Small'';
                            (ii) in paragraph (1)--
                                    (I) in the matter before 
                                subparagraph (A), by striking ``(c) 
                                through (f)'' and inserting ``(b) 
                                through (d)'' and by striking 
                                ``small''; and
                                    (II) in subparagraph (A), by 
                                striking ``small employer (as defined 
                                in section 2791(e)(4))'' and inserting 
                                ``employer''; and
                            (iii) in paragraph (2)--
                                    (I) by striking ``small'' each 
                                place it appears; and
                                    (II) by striking ``coverage to a'' 
                                and inserting ``coverage to an'';
                    (B) by striking subsection (b);
                    (C) in subsections (c), (d), and (e), by striking 
                ``small'' each place it appears; and
                    (D) by striking subsection (f).
    (c) Amendments to the Internal Revenue Code of 1986.--
            (1) Elimination of preexisting condition exclusions.--
        Section 9801 of the Internal Revenue Code of 1986 is amended--
                    (A) by amending the heading to read as follows: 
                ``elimination of preexisting condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan with respect to a 
participant or beneficiary may not impose any preexisting condition 
exclusion.'';
                    (C) by striking paragraph (3) of subsection (b);
                    (D) by striking subsections (c), (d), and (e); and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Clerical amendment.--The item in the table of sections 
        of chapter 100 of such Code relating to section 9801 is amended 
        to read as follows:

``Sec. 9801. Elimination of preexisting condition exclusions.''.
    (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 
        later 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) the date that is after the end of the 12th 
                calendar month following 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. 4. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS IN HEALTH 
              INSURANCE COVERAGE IN THE INDIVIDUAL MARKET.

    (a) In General.--Section 2741 of the Public Health Service Act (42 
U.S.C. 300gg-41) is amended--
            (1) in subsection (a)(1), by striking ``with respect to an 
        eligible individual'' and all that follows and inserting the 
        following: ``with respect to--
                    ``(A) an eligible individual (as defined in 
                subsection (b)) desiring to enroll in individual health 
                insurance coverage decline to offer such coverage to, 
                or deny enrollment of, such individual; and
                    ``(B) any individual desiring to enroll in such 
                coverage impose any preexisting condition exclusion (as 
                defined in section 2701(b)(1)(A)) with respect to such 
                coverage.''; and
            (2) in subsection (a)(2), by striking ``paragraph (1)'' and 
        inserting ``paragraph (1)(A)''.
    (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 on or after 
the end of the 12th month following the date of the enactment of this 
Act.

SEC. 5. TRANSPARENCY IN CLAIMS DATA.

    (a) In General.--Not later than 2 years after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the impact of this Act on health 
benefits coverage.
    (b) Examination of Claims Experience and Other Data.--In preparing 
the report under subsection (a), the Secretary may request from group 
health plans and health insurance issuers--
            (1) data on claims experience under the plan or health 
        insurance coverage issued by such issuers, such as the number, 
        nature, and dollar amount of claims made by enrollees during 
        the period involved;
            (2) data relating to enrollees in the plan or under such 
        coverage, such as number of new enrollees, number of 
        individuals reenrolling (or discontinuing enrollment) after the 
        first year of coverage, and changes in the demographic 
        composition of enrollees; and
            (3) such other information as the Secretary deems 
        appropriate.
The provisions of section 2722(b) of the Public Health Service Act 
shall apply to a failure of a group health plan or health insurance 
issuer to provide data or information requested by the Secretary under 
this subsection in the same manner as such provisions apply to the 
enforcement of a provision of part A of title XXVIII of such Act, 
except that any reference to an individual in paragraph (1)(C)(i) of 
such section shall be deemed for this purpose a reference to a covered 
life under the plan or health insurance coverage involved.

SEC. 6. GAO REPORT.

    Not later than 1 year after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit to Congress a 
report on the impact of this Act (and other Federal laws regarding the 
regulation of health insurance and health benefits coverage) on the 
reduction in the number of uninsured and underinsured individuals in 
the group market and the individual market and on the affordability of 
coverage in such markets.
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