1.
(a)This Act may be cited
as the Improving Health Care for All
Americans Act
.
(b)The table of contents for this Act is as follows:
Sec. 1. Short title, etc.
Sec. 2. Statement of constitutional authority.
Sec. 3. Findings.
Title I—Refundable and Advanceable Credit For Medical
Costs
Sec. 101. Refundable and advanceable credit for medical
costs.
Title II—Expansion of access and choice of health insurance
coverage through individual membership associations (IMAs)
Sec. 201. Expansion of access and choice of health insurance
coverage through individual membership associations (IMAs).
Title III—Federal matching funding for State insurance
expenditures
Sec. 301. Federal matching funding for StatFederal matching
funding for State insurance expenditurese insurance expenditures.
2.Statement of
constitutional authorityCongress enacts this Act pursuant to its
authority under article I of the Constitution to regulate commerce.
3.The Congress finds the following:
(1)Approximately 180
million Americans receive health care through employer-sponsored
coverage.
(2)Surveys indicate
that 8 in 10 Americans are satisfied with the current employer-sponsored health
care plan.
(3)Taxing
employer-sponsored health care benefits, creating a new government-run health
care plan, and expanding existing entitlement programs will result in the loss
of private health care coverage for an estimated 120 million Americans.
<enum>I</enum><header>Refundable and
Advanceable Credit For Medical Costs</header>
<section display-inline="no-display-inline" id="H371411D32EAA40BD8FDBB388524C937F" section-type="subsequent-section"><enum>101.</enum><header>Refundable and
advanceable credit for medical costs</header>
<subsection id="H9B902B235C264DD4BEA8C6D5F8803462"><enum>(a)</enum><header>In
General</header><text>Subpart C of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 (relating to refundable credits) is amended by
inserting after section 36A the following new section:</text>
<quoted-block id="H3CB27C1E72FF4324AD4E4670F25633A3">
<section id="H2C73063426F0450D8762540C1CC4EE0F"><enum>36B.</enum><header>Medical
costs</header>
<subsection id="H870CCB95285A424D8477F14E2EF1E8CF"><enum>(a)</enum><header>In
General</header><text>In the case of an eligible individual, there shall be
allowed as a credit against the tax imposed by this subtitle an amount equal to
the sum of—</text>
<paragraph id="H6BE93D5E13C94EC896FD62A0C366528D"><enum>(1)</enum><text>the amount paid by
the taxpayer during the taxable year for qualified health insurance for
coverage of the taxpayer, his spouse, and dependents, and</text>
</paragraph><paragraph id="HE0E588CF42844669AD16B656741388DA"><enum>(2)</enum><text>the amount paid by
the taxpayer during the taxable year for medical care for the taxpayer, his
spouse, and his dependents.</text>
</paragraph></subsection><subsection id="H0F5CA4BA488247D2A2A1ACF6B83C4509"><enum>(b)</enum><header>Limitation</header><text display-inline="yes-display-inline">The amount allowed as a credit under
subsection (a) for a taxable year shall not exceed $2,500 ($5,000 in the case
of a joint return).</text>
</subsection><subsection id="HF0FE5E113D4242528E5FA120CE635075"><enum>(c)</enum><header>Eligible
individual</header><text>For purposes of this section, the term <term>eligible
individual</term> means an individual who is—</text>
<paragraph id="H486308A9DC334351A30F9B7249DCA62E"><enum>(1)</enum><text>a citizen or
national of the United States, or</text>
</paragraph><paragraph id="HFCC0252CBB4C41ED9656272371254D2A"><enum>(2)</enum><text>lawfully present
in the United States.</text>
</paragraph></subsection><subsection id="H7B067AFA425A4BEFA7810B4225215972"><enum>(d)</enum><header>Medical
care</header><text>For purposes of this section, the term <term>medical
care</term> has the meaning given such term by section 213(d), determined
without regard to subparagraphs (C) and (D) of paragraph (1) thereof.</text>
</subsection><subsection id="H13692EA375BB4B56A57157ADBF653895"><enum>(e)</enum><header>Qualified health
insurance</header><text>For purposes of this section—</text>
<paragraph id="H033C6B955FA546F6AC1A3743BB8F9796"><enum>(1)</enum><header>In
General</header><text>The term <term>qualified health insurance</term> means
insurance which constitutes medical care.</text>
</paragraph><paragraph commented="no" id="HCB6D7B8C0EA34CF68AFD6B46A08A688C"><enum>(2)</enum><header>Employer
subsidized coverage</header><text display-inline="yes-display-inline">Such term
shall not include amounts paid for coverage of any individual for any month for
which such individual participates in any subsidized health plan maintained by
any employer of the taxpayer or of the spouse of the taxpayer. For purposes of
the preceding sentence, the rule of the last sentence of section 162(l)(2)(B)
shall apply and health care flexible spending accounts and health reimbursement
arrangements shall not be treated as a subsidized health plan maintained by any
employer.</text>
</paragraph><paragraph id="H5B9E8B51E40A4CA09EB9D1640310DE0D"><enum>(3)</enum><header>Governmental
coverage</header><text>Such term shall not include medical care provided
through a program described in—</text>
<subparagraph id="H362D51BA700342CAAAF2682A4F298A2A"><enum>(A)</enum><text>title XVIII or XIX
of the <act-name parsable-cite="SSA">Social Security Act</act-name>,</text>
</subparagraph><subparagraph id="H7E680DEAA2204FEBAE6EBBB6213C2377"><enum>(B)</enum><text>chapter 55 of
title 10, United States Code,</text>
</subparagraph><subparagraph id="HE5E3D251B0C34EE298AA0B9D763B06D9"><enum>(C)</enum><text>chapter 17 of
title 38, United States Code,</text>
</subparagraph><subparagraph id="H557D31A7234E4D119C5E048A9BCA519E"><enum>(D)</enum><text>chapter 89 of
title 5, United States Code, or</text>
</subparagraph><subparagraph id="H0B675BE91881457D9AA2817B13D7D400"><enum>(E)</enum><text>the
<act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name>,
and</text>
</subparagraph></paragraph><paragraph id="H2179D23C06294B638AAD54C724C57260"><enum>(4)</enum><header>Exclusion of
certain plans</header><text>Such term does not include insurance if
substantially all of its coverage is coverage described in section
223(c)(1)(B).</text>
</paragraph></subsection><subsection id="HC388BCC9DB544FD5ADF17CAF88AA547F"><enum>(f)</enum><header>Special
rules</header>
<paragraph id="H95415FD5645448459A270E6D738A8B3E"><enum>(1)</enum><header>Coordination
with medical deduction, etc</header><text>Any amount paid by a taxpayer for
insurance to which subsection (a) applies shall not be taken into account in
computing the amount allowable to the taxpayer as a credit under section 35 or
as a deduction under section 162(l) or 213(a).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H29AA3A5048A5426FA8F48E18A84A07FB"><enum>(2)</enum><header>Coordination
with advance payments of credit; recapture of excess advance
payments</header><text>With respect to any taxable year—</text>
<subparagraph commented="no" id="HB001352B664645D9B9899F79474D8B78"><enum>(A)</enum><text>the amount which
would (but for this subsection) be allowed as a credit to the taxpayer under
subsection (a) shall be reduced (but not below zero) by the aggregate amount
paid on behalf of such taxpayer under section 7529 for months beginning in such
taxable year, and</text>
</subparagraph><subparagraph commented="no" id="H9742B98FD2E7428B8DE7420F266CA94B"><enum>(B)</enum><text>the tax imposed by
section 1 for such taxable year shall be increased by the excess (if any)
of—</text>
<clause commented="no" id="HE335E3B8247F433E82E792E9C6497FDB"><enum>(i)</enum><text display-inline="yes-display-inline">the aggregate amount paid on behalf of such
taxpayer under section 7529 for months beginning in such taxable year,
over</text>
</clause><clause commented="no" id="H9560AA8C5EC94FB281BCC419F71F74DA"><enum>(ii)</enum><text display-inline="yes-display-inline">the amount which would (but for this
subsection) be allowed as a credit to the taxpayer under subsection (a).</text>
</clause></subparagraph></paragraph><paragraph id="H966A9A0275104085BF7A65B5E91D3752"><enum>(3)</enum><header>Denial of credit
to dependents</header><text>No credit shall be allowed under this section to
any individual with respect to whom a deduction under section 151 is allowable
to another taxpayer for a taxable year beginning in the calendar year in which
such individual’s taxable year begins.</text>
</paragraph><paragraph commented="no" id="HCCF4E070A0CF4A9DBC9E5F1818ABE10C"><enum>(4)</enum><header>Married couples
must file joint return</header>
<subparagraph commented="no" id="H602A45EDABD34CFF902E3E2591C8D65B"><enum>(A)</enum><header>In
General</header><text>If the taxpayer is married at the close of the taxable
year, the credit shall be allowed under subsection (a) only if the taxpayer and
his spouse file a joint return for the taxable year.</text>
</subparagraph><subparagraph commented="no" id="H898F779CC519460694756ACA905B99D1"><enum>(B)</enum><header>Marital status;
certain married individuals living apart</header><text>Rules similar to the
rules of paragraphs (3) and (4) of section 21(e) shall apply for purposes of
this paragraph.</text>
</subparagraph></paragraph><paragraph commented="no" id="H147FD91797DA4DD1BDFD071E18E6EB0B"><enum>(5)</enum><header>Verification of
coverage, etc</header><text>No credit shall be allowed under this section to
any individual unless such individual’s coverage under qualified health
insurance, and the amount paid for such coverage, are verified in such manner
as the Secretary may prescribe.</text>
</paragraph><paragraph commented="no" id="HC9ED633E743C46328DBAF61F717D159C"><enum>(6)</enum><header>Cost-of-living
adjustment</header><text>In the case of any taxable year beginning in a
calendar year after 2010, each dollar amount contained in subsection (b) shall
be increased by an amount equal to—</text>
<subparagraph commented="no" id="HC71FDFE6C052454AA21A12CE7CE082A9"><enum>(A)</enum><text>such dollar
amount, multiplied by</text>
</subparagraph><subparagraph commented="no" id="HB9D9F61F5CB448C18627466F978E1FFF"><enum>(B)</enum><text>the cost-of-living
adjustment determined under section 1(f)(3) for the calendar year in which the
taxable year begins by substituting <quote>calendar year 2009</quote> for
<quote>calendar year 1992</quote> in subparagraph (B) thereof.</text>
</subparagraph><continuation-text commented="no" continuation-text-level="paragraph">Any increase determined under the
preceding sentence shall be rounded to the nearest multiple of
$10.</continuation-text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection display-inline="no-display-inline" id="HEDF155C9AB5146BA82E605DADF1ADE6A"><enum>(b)</enum><header>Advance
payment</header>
<paragraph id="HDCCD707CC4FA4F9799A80B7B1C927CD9"><enum>(1)</enum><header>In
general</header><text>Chapter 77 of the Internal Revenue Code of 1986 (relating
to miscellaneous provisions) is amended by adding at the end the
following:</text>
<quoted-block id="H53DFF5975DC74FF79A98215BE4518A57">
<section id="H9853C80D28B549929AB490956EC79096"><enum>7529.</enum><header>Advance
payment of credit for medical costs</header><text display-inline="no-display-inline">The Secretary shall establish a program
for—</text>
<paragraph id="H3A54E4AEBC7A40F5BCCBE199876CBC97"><enum>(1)</enum><text>making payments to
providers of qualified health insurance (as defined in section 36B(e)) on
behalf of taxpayers eligible for the credit under section 36B, and</text>
</paragraph><paragraph id="H810E12606310489FAAD0CEF7DBE1B06F"><enum>(2)</enum><text>making payments
relating to medical care for which a credit is allowable under such
section.</text>
</paragraph></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HC1A87A11C95B4734B66FE27705E2DBAF"><enum>(2)</enum><header>Information
reporting</header>
<subparagraph id="H7A5C3C587CCB4F1EA45D943514657D9F"><enum>(A)</enum><header>In
general</header><text>Subpart B of part III of subchapter A of chapter 61 of
such Code (relating to information concerning transactions with other persons)
is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="HA763F96B9B87403888210426361D69FD" style="OLC">
<section id="H37E9A6BA9A594B538CBE3C921E7528B3"><enum>6050X.</enum><header>Returns
relating to credit for medical costs</header>
<subsection id="HCA4FDA2EE1B847B8AFDD783D093F96FE"><enum>(a)</enum><header>Requirement of
reporting</header><text display-inline="yes-display-inline">Every person who
receives payments for any month of any calendar year under section 7529 with
respect to any individual shall, at such time as the Secretary may prescribe,
make the return described in subsection (b) with respect to each such
individual.</text>
</subsection><subsection id="H28FA37D591EA468792B814146BE58B15"><enum>(b)</enum><header>Form and manner
of returns</header><text>A return is described in this subsection if such
return—</text>
<paragraph id="H819FE7A36485439EBD487AF3194C2CCF"><enum>(1)</enum><text>is in such form as
the Secretary may prescribe, and</text>
</paragraph><paragraph id="H76EA33C5F1294A589C5B759D9EEF9766"><enum>(2)</enum><text>contains—</text>
<subparagraph id="HE2E09B18E1874F6892F88A23A3D8E326"><enum>(A)</enum><text>the name, address,
and TIN of each individual referred to in subsection (a), and</text>
</subparagraph><subparagraph id="H1D1DB7D8739442B3AD10A798EA52EBE2"><enum>(B)</enum><text>such other
information as the Secretary may prescribe.</text>
</subparagraph></paragraph></subsection><subsection id="HFC06F1C7DFBA424AB6D41CF96A9CCD6E"><enum>(c)</enum><header>Statements To be
furnished to individuals with respect to whom information is
required</header><text>Every person required to make a return under subsection
(a) shall furnish to each individual whose name is required to be set forth in
such return a written statement showing—</text>
<paragraph id="H02528473C3CD4AF2A08D2CB984A33A63"><enum>(1)</enum><text>the name and
address of the person required to make such return and the phone number of the
information contact for such person, and</text>
</paragraph><paragraph id="HFC4B95966268493E856702594463CD4E"><enum>(2)</enum><text>the information
required to be shown on the return with respect to such individual.</text>
</paragraph><continuation-text continuation-text-level="subsection">The
written statement required under the preceding sentence shall be furnished on
or before January 31 of the year following the calendar year for which the
return under subsection (a) is required to be
made.</continuation-text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H304AC7F18E8A40E1A1F35CE57CF096D1"><enum>(B)</enum><header>Assessable
penalties</header>
<clause id="H9418A193929844309D797ECA894CED40"><enum>(i)</enum><text>Subparagraph (B)
of section 6724(d)(1) of such Code (relating to definitions) is amended by
striking <quote>or</quote> at the end of clause (xxii), by striking
<quote>and</quote> at the end of clause (xxiii) and inserting
<quote>or</quote>, and by inserting after clause (xxiii) the following new
clause:</text>
<quoted-block display-inline="no-display-inline" id="HC7CFB1CF633545CBBD103981D9052EDE" style="OLC">
<clause id="H9BB0950FF9F240F1AD939F055E57E798"><enum>(xxiv)</enum><text display-inline="yes-display-inline">section 6050X (relating to returns relating
to credit for medical costs),
and</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</clause><clause id="HD72E755FD0E64FBEB63F27C3D98921D4"><enum>(ii)</enum><text>Paragraph (2) of
section 6724(d) of such Code is amended by striking the period at the end of
subparagraph (EE) and inserting a comma, by striking the period at the end of
subparagraph (FF) and inserting <quote>, or</quote>, and by adding after
subparagraph (FF) the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H502E3131015C4A068E5FB1AC6B9FF170" style="OLC">
<subparagraph id="H85075AA060B84A59A9588204A2C3AA2F"><enum>(GG)</enum><text display-inline="yes-display-inline">section 6050X (relating to returns relating
to credit for medical
costs).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph><paragraph id="HA74A0B3633BE4D988E20372030E50581"><enum>(3)</enum><header>Clerical
amendments</header>
<subparagraph id="H5E904A30F9C94FB7B5B4A24E1881C811"><enum>(A)</enum><text>The table of
sections for chapter 77 of such Code is amended by adding at the end the
following new item:</text>
<quoted-block display-inline="no-display-inline" id="HDAF1733FFCB64383964D383061D01CEF" style="OLC">
<toc container-level="quoted-block-container" idref="H53DFF5975DC74FF79A98215BE4518A57" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="H9853C80D28B549929AB490956EC79096" level="section">Sec. 7529. Advance payment of credit for medical
costs.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph><subparagraph id="H0003D0C800D14BEBB8B62609C8E3173D"><enum>(B)</enum><text>The table of
sections for subpart B of part III of subchapter A of chapter 61 of such Code
is amended by adding at the end the following new item:</text>
<quoted-block display-inline="no-display-inline" id="HE2CAB11260EB40908F8DECA57B85738B" style="OLC">
<toc container-level="quoted-block-container" idref="HA763F96B9B87403888210426361D69FD" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="H37E9A6BA9A594B538CBE3C921E7528B3" level="section">Sec. 6050X. Returns relating to credit for medical
costs.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection id="HAEB013E84F2E4ED98E71E538B85DB56D"><enum>(c)</enum><header>Conforming
amendments</header>
<paragraph id="HE0AFE58B94CE406A8445716C7946BD6A"><enum>(1)</enum><text>Paragraph (2) of
section 1324(b) of title 31, United States Code, is amended by inserting
<quote>36B,</quote> after <quote>35A,</quote>.</text>
</paragraph><paragraph id="H5566321E54BA40BF8B26175858A324C8"><enum>(2)</enum><text>The table of
sections for subpart C of part IV of subchapter A of chapter 1 of the Internal
Revenue Code of 1986 is amended by striking the item relating to section 36 and
inserting the following new items:</text>
<quoted-block display-inline="no-display-inline" id="HC319CA795D684DF98E9DC80D4718A35B" style="OLC">
<toc container-level="quoted-block-container" idref="H3CB27C1E72FF4324AD4E4670F25633A3" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
<toc-entry idref="H2C73063426F0450D8762540C1CC4EE0F" level="section">Sec. 36B. Medical
costs.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H2F2C68DB779F43C39335ECB1D65E8E53"><enum>(d)</enum><header>Effective
date</header><text>The amendments made by this section shall apply to taxable
years beginning after December 31, 2009.</text>
</subsection></section><enum>II</enum><header>Expansion of
access and choice of health insurance coverage through individual membership
associations (IMAs)</header>
<section id="H9984277190554E9292FAC111EED256EF"><enum>201.</enum><header>Expansion of
access and choice of health insurance coverage through individual membership
associations (IMAs)</header><text display-inline="no-display-inline">The
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> is amended
by adding at the end the following new title:</text>
<quoted-block act-name="Public Health Service Act" id="HACB1CFC49344443B8488892D6F135EAD">
<title id="HD7306271BA124FBE84DF0EDA5BA39057"><enum>XXXI</enum><header>Individual
Membership Associations</header>
<section id="H57A881F954A241C0B41A3C32DB2DF490"><enum>3101.</enum><header>Definition of
individual membership association (IMA)</header>
<subsection id="H65D6CC7D67554C0A9A91435E3159808A"><enum>(a)</enum><header>In
General</header><text>For purposes of this title, the terms <term>individual
membership association</term> and <term>IMA</term> mean a legal entity that
meets the following requirements:</text>
<paragraph id="H57E37BD926FE4D3D8957AF819079694F"><enum>(1)</enum><header>Organization</header><text>The
IMA is an organization operated under the direction of an association (as
defined in section 3104(1)).</text>
</paragraph><paragraph id="HDAE1D0C2BBE64329B88CBB3085A8B301"><enum>(2)</enum><header>Offering health
benefits coverage</header>
<subparagraph id="H3DB4EAE11D5448FD959DA5D44594A7C8"><enum>(A)</enum><header>Different
groups</header><text>The IMA, in conjunction with those health insurance
issuers that offer health benefits coverage through the IMA, makes available
health benefits coverage in the manner described in subsection (b) to all
members of the IMA and the dependents of such members in the manner described
in subsection (c)(2) at rates that are established by the health insurance
issuer on a policy or product specific basis and that may vary only as
permissible under State law.</text>
</subparagraph><subparagraph id="HE76297BB13294F71B921FFF7D0FA9FC9"><enum>(B)</enum><header>Nondiscrimination
in coverage offered</header>
<clause id="H47185B2771D84346B1FB725058601A93"><enum>(i)</enum><header>In
General</header><text>Subject to clause (ii), the IMA may not offer health
benefits coverage to a member of an IMA unless the same coverage is offered to
all such members of the IMA.</text>
</clause><clause id="H1C0A09ADBB934B32AB1A93E1368B1FC3"><enum>(ii)</enum><header>Construction</header><text>Nothing
in this title shall be construed as requiring or permitting a health insurance
issuer to provide coverage outside the service area of the issuer, as approved
under State law, or requiring a health insurance issuer from excluding or
limiting the coverage on any individual, subject to the requirement of section
2741.</text>
</clause></subparagraph><subparagraph id="H04E34F8374214DFE846592D8154F2776"><enum>(C)</enum><header>No financial
underwriting</header><text>The IMA provides health benefits coverage only
through contracts with health insurance issuers and does not assume insurance
risk with respect to such coverage.</text>
</subparagraph></paragraph><paragraph id="H2612A7CE2DE54C9E852A0EE74FC43A5E"><enum>(3)</enum><header>Geographic
areas</header><text>Nothing in this title shall be construed as preventing the
establishment and operation of more than one IMA in a geographic area or as
limiting the number of IMAs that may operate in any area.</text>
</paragraph><paragraph id="H5CA68AD78D95420198D24BF1C3413D23"><enum>(4)</enum><header>Provision of
administrative services to purchasers</header>
<subparagraph id="H1D710D0493AE48219E951053E40DF0CC"><enum>(A)</enum><header>In
General</header><text>The IMA may provide administrative services for members.
Such services may include accounting, billing, and enrollment
information.</text>
</subparagraph><subparagraph id="H82A3F8655E874EC297AF9019CF9A72AD"><enum>(B)</enum><header>Construction</header><text>Nothing
in this subsection shall be construed as preventing an IMA from serving as an
administrative service organization to any entity.</text>
</subparagraph></paragraph><paragraph id="HE8B9377833FC40DEB42E41AB640CE1C2"><enum>(5)</enum><header>Filing
information</header><text>The IMA files with the Secretary information that
demonstrates the IMA’s compliance with the applicable requirements of this
title.</text>
</paragraph></subsection><subsection id="H647D60C3761A4D3B93AC18DE1722F0C3"><enum>(b)</enum><header>Health benefits
coverage requirements</header>
<paragraph id="HCE934407F48B4C83B83F40E03581131D"><enum>(1)</enum><header>Compliance with
consumer protection requirements</header><text>Any health benefits coverage
offered through an IMA shall—</text>
<subparagraph id="H406B4ABFB69046B9B3DAB9C53F4E921E"><enum>(A)</enum><text>be underwritten by
a health insurance issuer that—</text>
<clause id="H4F991CCFF9CE4CE0A057FBB52ADF4252"><enum>(i)</enum><text>is
licensed (or otherwise regulated) under State law,</text>
</clause><clause id="H4A7AD496898349D1B445A02392E136BA"><enum>(ii)</enum><text>meets all
applicable State standards relating to consumer protection, subject to section
3002(b), and</text>
</clause></subparagraph><subparagraph id="H1A21AFBD9F2246138C518DA2BEFA41E9"><enum>(B)</enum><text>subject to
paragraph (2), be approved or otherwise permitted to be offered under State
law.</text>
</subparagraph></paragraph><paragraph id="H7FE1D9A9C117429A888D252AA64DFA00"><enum>(2)</enum><header>Examples of
types of coverage</header><text>The benefits coverage made available through an
IMA may include, but is not limited to, any of the following if it meets the
other applicable requirements of this title:</text>
<subparagraph id="H308A3EBDEA904353AA41CAA8D4B57656"><enum>(A)</enum><text>Coverage through a
health maintenance organization.</text>
</subparagraph><subparagraph id="H228E148593A440E1B048709EA8C69F1C"><enum>(B)</enum><text>Coverage in
connection with a preferred provider organization.</text>
</subparagraph><subparagraph id="H3E4F3519B2594A75B79232BF0A75F8FB"><enum>(C)</enum><text>Coverage in
connection with a licensed provider-sponsored organization.</text>
</subparagraph><subparagraph id="HB23B9CB662A4409B9BDDC7A3D146CA31"><enum>(D)</enum><text>Indemnity coverage
through an insurance company.</text>
</subparagraph><subparagraph id="H9646C0984500405F84A519A331E07B1A"><enum>(E)</enum><text>Coverage offered
in connection with a contribution into a medical savings account, health
savings account, or flexible spending account.</text>
</subparagraph><subparagraph id="HBA95AC5AFDD14E619518A18248EF5018"><enum>(F)</enum><text>Coverage that
includes a point-of-service option.</text>
</subparagraph><subparagraph id="HB5D02C00297F4A578A3DD672FBEEE35F"><enum>(G)</enum><text>Any combination of
such types of coverage.</text>
</subparagraph></paragraph><paragraph id="HD0C4D9011BEF4A3B8C056105A0CA0FA2"><enum>(3)</enum><header>Wellness bonuses
for health promotion</header><text>Nothing in this title shall be construed as
precluding a health insurance issuer offering health benefits coverage through
an IMA from establishing premium discounts or rebates for members or from
modifying otherwise applicable copayments or deductibles in return for
adherence to programs of health promotion and disease prevention so long as
such programs are agreed to in advance by the IMA and comply with all other
provisions of this title and do not discriminate among similarly situated
members.</text>
</paragraph></subsection><subsection id="H04BF07D860274D909D482C7D477A3BB3"><enum>(c)</enum><header>Members; health
insurance issuers</header>
<paragraph id="H27EB8BEFF5384022A058F60D66B29612"><enum>(1)</enum><header>Members</header>
<subparagraph id="H23F55CF4259D47F493B5B8FBF5CECBBB"><enum>(A)</enum><header>In
General</header><text>Under rules established to carry out this title, with
respect to an individual who is a member of an IMA, the individual may enroll
for health benefits coverage (including coverage for dependents of such
individual) offered by a health insurance issuer through the IMA.</text>
</subparagraph><subparagraph id="HF5D56D052B134385B0AE4F5F24DA6790"><enum>(B)</enum><header>Rules for
enrollment</header><text>Nothing in this paragraph shall preclude an IMA from
establishing rules of enrollment and reenrollment of members. Such rules shall
be applied consistently to all members within the IMA and shall not be based in
any manner on health status-related factors.</text>
</subparagraph></paragraph><paragraph id="HB2C60D837A1443EEB5936304D4932DED"><enum>(2)</enum><header>Health insurance
issuers</header><text>The contract between an IMA and a health insurance issuer
shall provide, with respect to a member enrolled with health benefits coverage
offered by the issuer through the IMA, for the payment of the premiums
collected by the issuer.</text>
</paragraph></subsection></section><section id="HD59A5C3133214F41B119D88743AD3148"><enum>3102.</enum><header>Application of
certain laws and requirements</header><text display-inline="no-display-inline">State laws insofar as they relate to any of
the following are superseded and shall not apply to health benefits coverage
made available through an IMA:</text>
<paragraph id="H92494540EDFD4CF1BF26ADAE9BCCAE13"><enum>(1)</enum><text>Benefit
requirements for health benefits coverage offered through an IMA, including
(but not limited to) requirements relating to coverage of specific providers,
specific services or conditions, or the amount, duration, or scope of benefits,
but not including requirements to the extent required to implement title XXVII
or other Federal law and to the extent the requirement prohibits an exclusion
of a specific disease from such coverage.</text>
</paragraph><paragraph id="HFFF61A29E32C4899A15A3CD30F28C6D7"><enum>(2)</enum><text>Any other
requirements (including limitations on compensation arrangements) that,
directly or indirectly, preclude (or have the effect of precluding) the
offering of such coverage through an IMA, if the IMA meets the requirements of
this title.</text>
</paragraph><continuation-text continuation-text-level="section">Any State
law or regulation relating to the composition or organization of an IMA is
preempted to the extent the law or regulation is inconsistent with the
provisions of this title.</continuation-text></section><section id="H1B516F433BD8462A8DC38910779B5616"><enum>3103.</enum><header>Administration</header>
<subsection id="H4BD1657A31284F63B2DF7E6D2F7BD2FA"><enum>(a)</enum><header>In
General</header><text>The Secretary shall administer this title and is
authorized to issue such regulations as may be required to carry out this
title. Such regulations shall be subject to Congressional review under the
provisions of chapter 8 of title 5, United States Code. The Secretary shall
incorporate the process of <quote>deemed file and use</quote> with respect to
the information filed under section 3001(a)(5)(A) and shall determine whether
information filed by an IMA demonstrates compliance with the applicable
requirements of this title. The Secretary shall exercise authority under this
title in a manner that fosters and promotes the development of IMAs in order to
improve access to health care coverage and services.</text>
</subsection><subsection id="H5AAF482804C04E1EA21E1B767A0AD52B"><enum>(b)</enum><header>Periodic
reports</header><text>The Secretary shall submit to Congress a report every 30
months, during the 10-year period beginning on the effective date of the rules
promulgated by the Secretary to carry out this title, on the effectiveness of
this title in promoting coverage of uninsured individuals. The Secretary may
provide for the production of such reports through one or more contracts with
appropriate private entities.</text>
</subsection></section><section id="H2EE2F9D60BA54CB48A18CD8C67499CB0"><enum>3104.</enum><header>Definitions</header><text display-inline="no-display-inline">For purposes of this title:</text>
<paragraph id="H3D96DB08EC724997AE14C2F1B3C59A96"><enum>(1)</enum><header>Association</header><text>The
term <term>association</term> means, with respect to health insurance coverage
offered in a State, an association which—</text>
<subparagraph id="H7A1263D534E146CEB809FB9861BC46B0"><enum>(A)</enum><text>has been actively
in existence for at least 5 years;</text>
</subparagraph><subparagraph id="HD8D32815F81A490E94A02D931099E047"><enum>(B)</enum><text>has been formed
and maintained in good faith for purposes other than obtaining
insurance;</text>
</subparagraph><subparagraph id="H4B0D572FE21C472FAEBA98328031A117"><enum>(C)</enum><text>does not condition
membership in the association on any health status-related factor relating to
an individual (including an employee of an employer or a dependent of an
employee); and</text>
</subparagraph><subparagraph id="H0C25FB868711426686A95F5F410BA8FD"><enum>(D)</enum><text>does not make
health insurance coverage offered through the association available other than
in connection with a member of the association.</text>
</subparagraph></paragraph><paragraph id="H43EDE85397DD49288C95B7999C39C882"><enum>(2)</enum><header>Dependent</header><text>The
term <term>dependent</term>, as applied to health insurance coverage offered by
a health insurance issuer licensed (or otherwise regulated) in a State, shall
have the meaning applied to such term with respect to such coverage under the
laws of the State relating to such coverage and such an issuer. Such term may
include the spouse and children of the individual involved.</text>
</paragraph><paragraph id="HD9F3F1D079F04C8690B7CD9D848D09E7"><enum>(3)</enum><header>Health benefits
coverage</header><text>The term <term>health benefits coverage</term> has the
meaning given the term health insurance coverage in section 2791(b)(1).</text>
</paragraph><paragraph id="H50F60979B9E046758C25CEDB54ACFCED"><enum>(4)</enum><header>Health insurance
issuer</header><text>The term <term>health insurance issuer</term> has the
meaning given such term in section 2791(b)(2).</text>
</paragraph><paragraph id="H5028E09FFC724622ABB8A503F26CDB32"><enum>(5)</enum><header>Health
status-related factor</header><text>The term <term>health status-related
factor</term> has the meaning given such term in section 2791(d)(9).</text>
</paragraph><paragraph id="HA57B3F13DFB44F729356D6BC1A70CBC7"><enum>(6)</enum><header>IMA; individual
membership association</header><text>The terms <term>IMA</term> and
<term>individual membership association</term> are defined in section
3101(a).</text>
</paragraph><paragraph id="H5D9084A0F3864C94AB1F5E6AF41F227B"><enum>(7)</enum><header>Member</header><text>The
term <term>member</term> means, with respect to an IMA, an individual who is a
member of the association to which the IMA is offering
coverage.</text>
</paragraph></section>.
<enum>III</enum><header>Federal matching
funding for State insurance expenditures</header>
<section id="H4CA3AD80E467496D9129FDC8D5B7DE04"><enum>301.</enum><header>Federal
matching funding for StatFederal matching funding for State insurance
expenditurese insurance expenditures</header>
<subsection id="HDD2BC94E00CB4E1492D03311A83D1BC2"><enum>(a)</enum><header>In
General</header><text>Subject to the succeeding provisions of this section,
each State shall receive from the Secretary of Health and Human Services an
amount equal to 50 percent of the funds expended by the State in providing for
the use, in connection with providing health benefits coverage, of a high-risk
pool, a reinsurance pool, or other risk-adjustment mechanism used for the
purpose of subsidizing the purchase of private health insurance.</text>
</subsection><subsection id="HF1D1BE504DBA4D139325AB8F14DB1634"><enum>(b)</enum><header>Funding
limitation</header><text>A State shall not receive under this section for a
fiscal year more than a total of 50 cents multiplied by the average number of
residents (as estimated by the Secretary) in the State in the fiscal
year.</text>
</subsection><subsection id="H25CC9BA6842D4571AA9D976D8EBFF67D"><enum>(c)</enum><header>Administration</header><text>The
Secretary of Health and Human Services shall provide for the administration of
this section and may establish such terms and conditions, including the
requirement of an application, as may be appropriate to carry out this
section.</text>
</subsection><subsection id="H34E4594532BE46FEB906BB4F703A1E81"><enum>(d)</enum><header>Construction</header><text>Nothing
in this section shall be construed as requiring a State to operate a
reinsurance pool (or other risk-adjustment mechanism) under this section or as
preventing a State from operating such a pool or mechanism through one or more
private entities.</text>
</subsection><subsection id="HE5C0732573F04BFEBC49E04D3B3BD8B4"><enum>(e)</enum><header>High-risk
pool</header><text>For purposes of this section, the term <term>high-risk
pool</term> means any qualified high risk pool (as defined in section
2744(c)(2) of the <act-name parsable-cite="PHSA">Public Health Service
Act</act-name>).</text>
</subsection><subsection id="H4F8D58892DE84DFAA2CE7D133118EA8D"><enum>(f)</enum><header>Reinsurance pool
or other risk-adjustment mechanism defined</header><text>For purposes of this
section, the term <term>reinsurance pool or other risk-adjustment
mechanism</term> means any State-based risk spreading mechanism to subsidize
the purchase of private health insurance for the high-risk population.</text>
</subsection><subsection id="H83E61FE6C927474BBD6AFD06D11CA98C"><enum>(g)</enum><header>High-risk
population</header><text>For purposes of this section, the term <term>high-risk
population</term> means—</text>
<paragraph id="H63E217B2C4F54EF480EA134CEFDB3C1A"><enum>(1)</enum><text>individuals who,
by reason of the existence or history of a medical condition, are able to
acquire health coverage only at rates which are at least 150 percent of the
standard risk rates for such coverage, and</text>
</paragraph><paragraph id="HE018BFBC040145D2A1BAD8B309AEDF77"><enum>(2)</enum><text>individuals who
are provided health coverage by a high-risk pool.</text>
</paragraph></subsection><subsection id="H26CDC5BE18864869BB0F4F00B7C4DD90"><enum>(h)</enum><header>State
defined</header><text>For purposes of this section, the term <term>State</term>
includes the District of Columbia, Puerto Rico, the Virgin Islands, Guam,
American Samoa, and the Northern Mariana Islands.</text>
</subsection></section>