[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3937 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3937

To establish a health benefits program, based on the Federal employees 
 health benefits program, to provide health insurance coverage for the 
 President, Vice President, and Members of Congress, and citizens not 
   eligible for coverage under the Federal employees health benefits 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 27, 2009

  Mr. Terry introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
  Oversight and Government Reform, Education and Labor, and Ways and 
 Means, 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 establish a health benefits program, based on the Federal employees 
 health benefits program, to provide health insurance coverage for the 
 President, Vice President, and Members of Congress, and citizens not 
   eligible for coverage under the Federal employees health benefits 
                                program.

    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 ``Simple Universal 
Healthcare Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Establishment of Citizens Congressional Health Benefits Program 
                            (CCHBP).
Sec. 3. Contracts with entities to offer qualified CCHBP health plans.
Sec. 4. Scope of benefits and coverage.
Sec. 5. Eligibility.
Sec. 6. Enrollment.
Sec. 7. Premiums.
Sec. 8. High-risk reinsurance fund.
Sec. 9. Definitions.
Sec. 10. Effective date and treatment of collective bargaining 
                            agreements.

SEC. 2. ESTABLISHMENT OF CITIZENS CONGRESSIONAL HEALTH BENEFITS PROGRAM 
              (CCHBP).

    (a) In General.--The Director of the Office of Personnel Management 
shall establish a program (to be known as the ``Citizen's Congressional 
Health Benefits Program'') to provide comprehensive health insurance 
coverage to--
            (1) Federal elected officials (including the President, 
        Vice President, and Members of Congress); and
            (2) residents of the United States who are not covered 
        under the Federal Employees Health Benefits Program (FEHBP).
    (b) Similar to FEHBP.--The coverage shall be provided in a manner 
similar to the manner in which coverage has been provided to Members of 
Congress and Federal Government employees and retirees and their 
dependents under the Federal Employees Health Benefits Program (FEHBP).

SEC. 3. CONTRACTS WITH ENTITIES TO OFFER QUALIFIED CCHBP HEALTH PLANS.

    (a) In General.--The Director shall enter into contracts with 
entities for the offering of qualified CCHBP health plans in accordance 
with this Act. Such contracts shall be entered into in a manner similar 
to the process by which the Director is authorized to enter into 
contracts with entities offering health benefits plans under FEHBP.
    (b) Requirements for Entities Offering Plans.--The Director may 
only enter into a contract under subsection (a) with an entity that 
is--
            (1) licensed--
                    (A) as a health maintenance organization in the 
                State in which the entity will offer the qualified 
                CCHBP health plan; or
                    (B) to sell group health insurance coverage in such 
                State;
            (2) meets such requirements, similar to requirements under 
        FEHBP, as the Director may establish, relating to solvency, 
        adequacy of plan benefits (subject to section 4), organization, 
        structure, governance, access, and quality; and
            (3) agrees to participate in the high-risk reinsurance fund 
        described in section 8.
    (c) FEHBP Plans.--Any health plan offered under FEHBP shall be 
treated as a qualified CCHBP health plan for purposes of this Act.
    (d) Preemption of State Law.--The requirements of section 4, with 
respect to the scope and type of benefits required to be provided by a 
CCHBP health plan, shall supersede any and all State laws.

SEC. 4. SCOPE OF BENEFITS AND COVERAGE.

    (a) Comprehensive Benefits.--
            (1) In general.--Subject to paragraph (2), qualified CCHBP 
        health plans shall provide for the same scope and type of 
        benefits that are provided under FEHBP, including--
                    (A) the types of benefits described in section 8904 
                of title 5, United States Code; and
                    (B) benefits required by regulation or guidance 
                under FEHBP.
            (2) Preventive benefits and mental health parity.--
        Qualified CCHBP health plans shall provide a minimum level of 
        preventive benefits determined by the Director, in consultation 
        with the U.S. Preventive Service Task Force, which shall 
        include vaccines for both children and adults, an annual 
        physical, cancer screening (including mammographies for women 
        of an appropriate age), and mental health parity.
    (b) No Exclusion for Pre-Existing Conditions.--Subject to section 
6(b)(2), qualified CCHBP health plans shall not impose pre-existing 
condition exclusions or otherwise discriminate against any individual 
based on the health status of such individual (including genetic 
information relating to such enrollee, or any disease or condition).
    (c) Annual and Lifetime Out-Of-Pocket Limit Information.--An entity 
offering a qualified CCHBP health plan must provide notice to any 
individual covered by such plan of any benefit or service that is not 
included in the calculation of the annual or lifetime out-of-pocket 
limit under such plan.

SEC. 5. ELIGIBILITY.

    (a) In General.--An individual is eligible to enroll in a qualified 
CCHBP health plan if--
            (1) the individual resides in the United States; and
            (2) the individual is--
                    (A) a citizen or national of the United States;
                    (B) an alien lawfully admitted to the United States 
                for permanent residence;
                    (C) an alien admitted into the United States under 
                section 207 of the Immigration and Nationality Act 
                (relating to refugees);
                    (D) an alien otherwise permanently residing in the 
                United States under color of law (as specified by the 
                Director); or
                    (E) an alien with the status of a nonimmigrant who 
                is within a class of long-term nonimmigrants under 
                section 101(a)(15) of the Immigration and Nationality 
                Act that the Director determines, in consultation with 
                the Secretary of Homeland Security, to be appropriate.
    (b) Exceptions.--The following individuals are not eligible to 
enroll in a qualified CCHBP health plan:
            (1) Individuals enrolled under public health insurance 
        programs.--An individual who is enrolled under the Federal 
        employees health benefits program under chapter 89 of title 5, 
        United States Code (except for a member of Congress, as defined 
        by section 2106 of title 5, United States Code; or the 
        President); the Medicare program under title XVIII of the 
        Social Security Act; the Medicaid program under title XIX of 
        such Act; the Children's Health Insurance Program under title 
        XXI of such Act; or Tricare under chapter 55 of title 10, 
        United States Code.
            (2) Incarcerated individuals.--An individual who is 
        incarcerated (as specified by the Director).
    (c) Treatment of Elected Officials.--A member of Congress (as 
defined under section 2106 of title 5, United States Code) or the 
President may enroll in either a qualified CCHBP health plan under this 
Act or an FEHBP plan under title 5, United States Code, but may not be 
enrolled in both types of plans at the same time.
    (d) Confirmation of Immigration Status.--The Director, in 
consultation with each entity offering a qualified CCHBP plan, shall 
promulgate regulations for the use of the automated system known as the 
Systematic Alien Verification for Entitlements, as provided for by 
section 404 of the Illegal Immigrations Reform and Immigrant 
Responsibility Act of 1996 (110 Stat. 3009-664) to verify the legal 
presence of the status of an individual, other than a United States 
citizen, who seeks to enroll in a qualified CCHBP plan.
    (e) Employer Option.--
            (1) In general.--An employer may choose to participate in 
        CCHBP and offer qualified CCHBP health plans to employees of 
        such employer as employer-sponsored health insurance.
            (2) Notice.--The employer shall inform the Director that 
        the employer is taking such option in a form and manner 
        determined by the Director.
            (3) Maintenance of effort required.--An employer who 
        provides notice under paragraph (2) must pay the percentage of 
        the cost of the premium, as determined under section 7, for 
        each employee that enrolls in a qualified CCHBP health plan, 
        that is the same as the percentage of the cost of the premium 
        of the health insurance plan that such employer offered to its 
        employees before the employer provided notice under paragraph 
        (2).
            (4) Tax treatment.--For purposes of the Internal Revenue 
        Code of 1986, a qualified CCHBP health plan offered by an 
        employer under this subsection shall not fail to be treated as 
        employer-provided coverage solely because such employer 
        provides such plan through the CCHBP.

SEC. 6. ENROLLMENT.

    (a) Enrollment Process.--The Director shall establish a process to 
enroll eligible individuals and their families in qualified CCHBP 
health plans. Such process shall be conducted in a manner that is 
similar to the manner enrollment is conducted under FEHBP. To the 
extent consistent with eligibility under section 3, the Director shall 
provide rules similar to the rules under FEHBP for the enrollment of 
family members who are CCHBP-eligible individuals in the same plan.
    (b) Enrollment Period.--
            (1) Enrollment upon initial eligibility.--
                    (A) In general.--An eligible individual may enroll 
                in a qualified CCHBP health plan--
                            (i) at any time during the 1-year period 
                        beginning on the date that the Citizen's 
                        Congressional Health Benefits Program begins to 
                        operate; or, if later,
                            (ii) at any time during the 3-month period 
                        beginning on the date that such individual 
                        becomes eligible to enroll in any qualified 
                        CCHBP health plan.
                    (B) Treatment of preexisting conditions.--An 
                individual who enrolls during the periods under 
                paragraph (1) shall not be subject to exclusions or 
                additional costs due to any preexisting conditions that 
                such individual developed before the date such 
                individual enrolled in a qualified CCHBP plan.
            (2) Annual enrollment.--
                    (A) In general.--An eligible individual who does 
                not enroll in a qualified CCHBP health plan under 
                paragraph (1) may enroll in such a plan during an 
                annual enrollment period of not more than 1 month, as 
                determined by the Director.
                    (B) Treatment of preexisting conditions.--Subject 
                to rules developed by the Director, the entity offering 
                the qualified CCHBP health plan may exclude such 
                individual from enrolling in such a plan under this 
                paragraph due to any preexisting condition which such 
                individual develops before the date of such annual 
                enrollment period. Upon excluding such individual, the 
                entity offering the qualified CCHBP health plan shall 
                provide such individual with notice of such exclusion 
                and information about enrolling in a high risk pool.
    (c) Changes in Enrollment.--The Director shall establish enrollment 
procedures that include an annual open season of at least 1 month and 
permit changes in enrollment with qualified health plans at other times 
(such as by reason of changes in marital or dependent status or 
eligibility). Such procedures shall be based on the enrollment 
procedures established under FEHBP. The Director shall provide for 
termination of such enrollment for an individual at the time the 
individual is no longer an eligible individual.
    (d) Enrollment of Employees.--Notwithstanding subsection (b)(2), 
the employees of an employer that provides notice to the Director under 
section 5(e)(2) may enroll in a qualified CCHBP health plan during 
either the 3-month period beginning on the date that such employer 
provides such notice or the 3-month period beginning on the date that 
such employee begins working for such employer, whichever is later. 
Such employee shall not be subject to any costs related to such 
employee's pre-existing conditions if so enrolled during such period.
    (e) Enrollment Guides.--The Director shall provide for the broad 
dissemination of information on qualified CCHBP health plans offered 
under this title. Such information shall be provided in a comparative 
manner, similar to that used under FEHBP, and shall include 
information, collected through surveys of enrollees, on measures of 
enrollee satisfaction with the different plans.

SEC. 7. PREMIUMS.

    The premiums established for a qualified CCHBP health plan under 
this Act for individual or family coverage--
            (1) based on the rating system used under FEHBP; and
            (2) shall not vary based on age, gender, health status 
        (including genetic information), or other factors.

SEC. 8. HIGH-RISK REINSURANCE FUND.

    The Director shall establish an arrangement among the entities 
offering qualified health plans under which such entities contribute in 
an equitable manner (as determined by the Director) into a fund that 
provides payment to plans for a percentage (specified by the Director 
and not to exceed 90 percent) of the costs that they incur for 
enrollees beyond a predetermined threshold specified by the Director. 
Such fund shall be funded exclusively by such entities.

SEC. 9. DEFINITIONS.

    For purposes of this Act:
            (1) The term ``CCHBP-eligible individual'' means an 
        individual described in section 5.
            (2) The term ``Director'' means the Director of the Office 
        of Personnel Management.
            (3) The term ``FEHBP'' means the program under chapter 89 
        of title 5, United States Code.
            (4) The term ``qualified CCHBP health plan'' means a fee-
        for-service plan, health maintenance organization plan, high 
        deductible health insurance plan, or other health insurance 
        plan that meets the requirements for a health insurance plan 
        under FEHBP and is offered through the CCHBP under this Act by 
        an entity that is qualified to offer such plans.

SEC. 10. EFFECTIVE DATE AND TREATMENT OF COLLECTIVE BARGAINING 
              AGREEMENTS.

    (a) Effective Date.--Benefits shall first be made available under 
this title for items and services furnished on or after the last day of 
the 9-month period beginning on the date of the enactment of this Act.
    (b) Non-Preemption of Existing Collective Bargaining Agreements.--
Nothing in this Act shall be construed as preempting any collective 
bargaining agreement that is in effect as of the date of the enactment 
of this Act, during the period in which such agreement is in effect 
(without regard to any extension of such agreement effected as of such 
date of enactment).
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