I 111th CONGRESS 1st Session H. R. 4020 IN THE HOUSE OF REPRESENTATIVES November 4, 2009 Mr. Burgess (for himself, Mr. Deal of Georgia, Mr. Pitts, Mr. Buyer, and Mr. Blunt) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To enable States to establish reinsurance programs or high risk pools to ensure that high risk individuals are able to access health insurance.

1.

Short title

This Act may be cited as the Guaranteed Access to Health Insurance Act of 2009.

2.

Ensuring affordability for all through special pooling of the cost of high risk individuals

(a)

State requirement

(1)

In general

Not later than 2 years after the date of the enactment of this Act, each State is encouraged to ensure that an adequate financial backstop exists to mitigate the cost of high risk individuals in the State, through establishing either— (A)a qualified State reinsurance program described in subsection (b); or (B)a qualifying State high risk pool described in subsection (c)(1). (2)

Preference

Beginning 3 years after the date of the enactment of this Act, in the case of a competitive grant for which the only eligible entities are States, the Secretary, in awarding such grant to a State, shall give preference to any State with a program that meets the requirements of paragraph (1)(A). (b)

Qualified State reinsurance program

(1)

In general

For purposes of this section, the term qualified State reinsurance program means a program operated by a State or a State authorized program that provides reinsurance for health insurance coverage offered in the individual, small group market, or in both markets. (2)

Form of program

A qualified State reinsurance program may provide reinsurance— (A)on a prospective or retrospective basis; (B)that protects health insurance issuers against the annual aggregate spending of their enrollees; and (C)that provides purchase protection against individual catastrophic costs. (c)

Qualifying State high risk pool

(1)

In general

A qualifying State high risk pool described in this subsection means a section 2745 qualified high risk pool that meets the following requirements: (A)The high risk pool does not have a lifetime coverage cap. (B)The high risk pool incorporates applicable Federal or State programs (such as coverage under title XIX of the Social Security Act) for eligible low-income individuals. (C)The high risk pool provides a variety of types of coverage, including at least one high deductible health plan that is combined with a health savings account. (D)The high risk pool eliminates any waiting list and pre-existing condition exclusionary periods so that all eligible residents who are seeking coverage through the pool can receive coverage through the pool. (E)The high risk pool allows for coverage of individuals who, but for the 24-month disability waiting period under section 226(b) of the Social Security Act, would be eligible for Medicare during the period of such waiting period. (F)The high risk pool must not charge participants more than 150 percent of the average premium in the individual market for health insurance coverage in that State. (G)The high risk pool conducts education and outreach initiatives so that residents and insurance brokers understand that the pool is available to eligible residents. (2)

Use of funds for the transition

A State may use any funding sources available to it as of the date of the enactment of this Act to transition from operating a section 2745 high risk pool, to operating a qualified State reinsurance program described in paragraph (1). (3)

Funding source

The high risk pool described in this subsection is also encouraged to have stable funding source that is not solely dependent on an appropriation from the State legislature. (d)

Relation to section 2745

Section 2745 of the Public Health Service Act is amended— (1)in subsection (a)(2)— (A)in subparagraph (A), strike 40 and insert 30; and (B)add at the end the following new subparagraph: (D)An amount equal to 10 percent of such appropriated amount for the fiscal year shall be allotted among qualifying States that apply for such a grant so that the amount allotted to a State bears the same ratio to such appropriated amount as the amount of funds contributed to the operation of the qualified high risk pool of the State by funding sources other than grants under this subsection. ; and (2)in subsection (g)(1)— (A)in subparagraph (A), by striking The term and inserting Subject to subparagraph (B), the term; and (B)by adding at the end the following new subparagraph: (B)

Updated definition

Beginning on the last day of the 2-year period beginning in the date of the enactment of the Guaranteed Access to Health Insurance Act of 2009, the term qualified high risk pool means— (i)a pool that meets the requirements of subparagraph (A) of this paragraph and the requirements of section 2(c)(1) of such Act; or (ii)a qualified State reinsurance program as such term is defined in section 2(b) of such Act. . (e)

Waivers

(1)

In general

In order to accommodate new and innovative programs, the Secretary may waive such requirements of this section for qualified State reinsurance programs and for qualifying State high risk pools as the Secretary deems appropriate. (2)

Coverage of high risk individuals

The Secretary may waive the requirement under subsection (a)(1) in the case of a State that demonstrates, to the satisfaction of the Secretary, that the State has provided an adequate financial backstop to mitigate the cost of high risk individuals in the State in a manner that is better than, as determined by the Secretary, the requirements under such subsection. (f)

Seed grants to States

The Secretary shall provide, from the funds appropriated, a grant of up to $5,000,000 to each State that has not created a qualified high risk pool as of the date of enactment of this Act. Such grants shall be made in the same manner, for the same purpose, but are in addition to, grants to States made under Section 2745(a) of the Public Health Service Act. (g)

Verification of citizenship or alien qualification

(1)

In general

Only citizens and nationals of the United States shall be eligible to participate in a qualifying State high risk pool or qualifying State reinsurance program receiving funding under this section. (2)

Grant conditions

As a condition of receiving grants under this section, the Secretary shall require any State that applies to receive grant funding under this section to certify to the satisfaction of the Secretary that such State requires all applicants for coverage in a qualifying State high risk to pool or a qualifying State reinsurance program to provide satisfactory documentation of such citizenship or nationality and identity in a manner consistent with section 1903(x) of the Social Security Act. The Secretary shall keep sufficient records such that a determination of citizenship or nationality has to be made once for any individual. (h)

Definitions

In this section: (1)The terms health insurance coverage and health insurance issuer have the meanings given such terms in section 2791 of the Public Health Service Act. (2)The term section 2745 qualified high risk pool has the meaning given the term qualified high risk pool under section 2745(g)(1) of the Public Health Service Act as such section is in effect on the date of the enactment of this Act. (3)The term Secretary means Secretary of Health and Human Services. (4)The term State has the meaning given such term for purposes of title XIX of the Social Security Act. (i)

Authorization of appropriations

For the purposes of carrying out section 2745 of the Public Health Service Act and this section, in addition to any other amounts authorized to be appropriated, there is authorized to be appropriated, $20,000,000,000 beginning with 2010. Any funds that are authorized under this subsection that are used for purposes of carrying out section 2745 of the Public Health Service Act shall be allocated to the allotments under such section in the proportions required under subsection (d)(2) of such section.