II 111th CONGRESS 1st Session S. 643 IN THE SENATE OF THE UNITED STATES March 19, 2009 Mr. Lautenberg (for himself, Mr. Brown, and Ms. Klobuchar) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 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 pre-existing condition exclusions for children in group health plans and health insurance coverage in the group and individual markets.

1.

Short title

This Act may be cited as the Children’s Health Protection Act of 2009.

2.

Findings

Congress makes the following findings: (1)According to the Bureau of the Census, 8,100,000 children and young adults are uninsured at some point during the year. Young adults between the ages of 18 and 25 years old make up 21 percent of the total uninsured population. (2)According to a recent study, approximately 20 percent of school-aged children suffer from a chronic illness. (3)Thirteen States have passed legislation that increased the age of dependency for young adults for purposes of private insurance coverage to age 25. (4)When a child or young adult has a 63 day gap in insurance coverage, pre-existing condition exclusions, such as coverage limits or waiting periods, can be applied when the child or young adult becomes insured under a new health insurance policy. (5)Eliminating pre-existing condition exclusions for children is a vital safeguard to ensure all children have access to health care when in need. (6)High-risk pools were created to help individuals with pre-existing conditions purchase insurance with the assistance of government subsidies. However, State high-risk pools are often underfunded, unaffordable for patients, have long waiting lists and impose pre-existing condition waiting periods once enrolled. (7)Pre-existing condition limitation periods for children in the private market discourage families from moving off Medicaid or the Children's Health Insurance Program.

3.

Prohibition of pre-existing condition exclusions for children under group health plans

(a)

Amendments to the Employee Retirement Income Security Act of 1974

Section 701(d) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(d)) is amended— (1)by striking paragraph (1) and inserting the following: (1)

Exclusion not applicable to children

A group health plan, and a health insurance issuer offering group health insurance coverage, may not impose any pre-existing condition exclusion in the case of an individual who has not attained 25 years of age. ; (2)by striking paragraphs (2) and (4); and (3)by redesignating paragraph (3) as paragraph (2). (b)

Amendments to the Public Health Service Act

Section 2701(d) of the Public Health Service Act (42 U.S.C. 300gg(d)) is amended— (1)by striking paragraph (1) and inserting the following: (1)

Exclusion not applicable to children

A group health plan, and a health insurance issuer offering group health insurance coverage, may not impose any pre-existing condition exclusion in the case of an individual who has not attained 25 years of age. ; (2)by striking paragraphs (2) and (4); and (3)by redesignating paragraph (3) as paragraph (2). (c)

Amendments to the Internal Revenue Code of 1986

Subsection (d) of section 9801 of the Internal Revenue Code of 1986 (relating to exceptions) is amended— (1)by striking paragraph (1) and inserting the following: (1)

Exclusion not applicable to children

A group health plan may not impose any pre-existing condition exclusion in the case of an individual who has not attained 25 years of age. ; (2)by striking paragraphs (2) and (4); and (3)by redesignating paragraph (3) as paragraph (2). (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 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.

4.

Prohibition of pre-existing condition exclusions for children 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)by redesignating the second subsection (e) (relating to market requirements) and subsection (f) as subsections (f) and (g), respectively; and (2)by adding at the end the following new subsection: (h)

Prohibition of pre-existing condition exclusions for children

Each health insurance issuer that offers health insurance coverage in the individual market may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A)) in the case of an individual who has not attained 25 years of age. . (b)

Conforming amendment

Section 2744(a)(1) of such Act (42 U.S.C. 300gg–44(a)(1)) is amended by inserting (other than subsection (h)) after section 2741 . (c)

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 after the end of the 12th calendar month following the date of the enactment of this Act.