Short title

This Act may be cited as the

Preexisting Condition Patient Protection Act of 2009

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.

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

;

(C)in subsection (b), by striking paragraph (3) and inserting the following:

(3)

Affiliation period

;

(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.

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.

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.

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.