[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6283 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 6283

 To enable States to establish reinsurance programs or high risk pools 
    to ensure that high risk individuals are able to access health 
                               insurance.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 2, 2012

 Mr. Burgess (for himself, Mr. Sessions, Mr. Barton of Texas, and Mr. 
 Daniel E. Lungren of California) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
 to the Committees on Ways and Means and Education and the Workforce, 
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 enable States to establish reinsurance programs or high risk pools 
    to ensure that high risk individuals are able to access health 
                               insurance.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Guaranteed Access to Health 
Insurance Act of 2012''.

SEC. 2. REPEAL OF CERTAIN HEALTH INSURANCE REQUIREMENTS.

    Title I and subtitle A of title X of the Patient Protection and 
Affordable Care Act and section 2301 of the Health Care and Education 
Reconciliation Act of 2010 are repealed, and the provisions of law 
amended or repealed by such title, subtitle, and section, respectively, 
are restored or revived as if such Acts had not been enacted.

SEC. 3. ENSURING AFFORDABILITY OF HEALTH COVERAGE THROUGH HIGH RISK 
              POOLS, REINSURANCE PROGRAMS, AND OTHER INNOVATIVE 
              METHODS.

    (a) Treatment of Qualified State Reinsurance Program as an 
Alternative Mechanism.--Section 2744 of the Public Health Service Act 
(42 U.S.C. 300gg-44) is amended--
            (1) in subsection (a)(1)(D)--
                    (A) by striking ``or'' at the end of clause (ii);
                    (B) by striking the period at the end of clause 
                (iii) and inserting a comma; and
                    (C) by adding at the end the following:
                            ``(iv) a qualified reinsurance program 
                        described in subsection (c)(4), or
                            ``(v) an innovative method described in 
                        subsection (c)(5).''; and
            (2) in subsection (c), by adding at the end the following:
            ``(4) Qualified reinsurance program.--For purposes of 
        subsection (a)(1)(D)(iv), a `qualified reinsurance program' 
        described in this paragraph is a program that--
                    ``(A) is operated by a State (directly, or through 
                a contract with an entity that provides reinsurance for 
                health insurance coverage offered in the individual 
                market, the small group market, or in both such 
                markets); and
                    ``(B) is designed to make reinsurance payments to, 
                or otherwise limit the risk of, health insurance 
                issuers that provide health insurance coverage to 
                eligible individuals in the individual market in the 
                State.
            ``(5) Innovative method.--For purposes of subsection 
        (a)(1)(D)(v), the term `innovative method' has the meaning 
        given such term in section 2745(g).''.
    (b) Seed Grants to States.--Section 2745(a) of the Public Health 
Service Act (42 U.S.C. 300gg-45(a)) is amended to read as follows:
    ``(a) Seed Grants to States.--
            ``(1) In general.--The Secretary shall provide from the 
        funds appropriated under subsection (d)(1)(A) a grant of up to 
        $5,000,000 to a State described in paragraph (2) for the 
        State's costs for the creation and initial operation of a 
        qualified high risk pool, a qualified reinsurance program, or 
        an innovative method.
            ``(2) State described.--A State described in this paragraph 
        is a State that, as of the date of enactment of the Guaranteed 
        Access to Health Insurance Act of 2012, has not created any of 
        the following:
                    ``(A) A qualified high risk pool.
                    ``(B) A qualified reinsurance program.
                    ``(C) An innovative method.
            ``(3) Limitations on seed grants.--
                    ``(A) One grant per state.--After the date of 
                enactment of the Guaranteed Access to Health Insurance 
                Act of 2012, a State may receive only one grant under 
                paragraph (1).
                    ``(B) One year to spend.--The funds made available 
                to a State under a grant under paragraph (1) shall not 
                be available for obligation after the end of the 12-
                month period beginning on the date that the State 
                receives such grant.
                    ``(C) Unexpended funds available for allotment.--
                Any funds made available under a grant under this 
                subsection that are not expended in the period under 
                subparagraph (B) shall be made available for purpose of 
                allotment under subsection (b).''.
    (c) Grants for Operational Losses.--
            (1) In general.--Paragraph (1) of section 2745(b) of the 
        Public Health Service Act (42 U.S.C. 300gg-45(b)(1)) is amended 
        to read as follows:
            ``(1) In general.--
                    ``(A) Grants for pools, reinsurance programs, and 
                innovative methods.--In the case of a State that has 
                established a qualified high risk pool described in 
                subparagraph (B), a qualified reinsurance program, or 
                an innovative method the Secretary shall provide, from 
                funds allotted to the State under paragraph (2), a 
                grant for the losses incurred by the State in 
                connection with the operation of the qualified high 
                risk pool, qualified reinsurance program, or innovative 
                method.
                    ``(B) Qualified high risk pool described.--A 
                qualified high risk pool described in this subparagraph 
                is a qualified high risk pool (as such term is defined 
                in subsection (g)(1)) that has in effect a mechanism 
                reasonably designed to ensure continued funding of 
                losses incurred by the State in connection with 
                operation of the pool after the end of the last fiscal 
                year for which a grant is provided under this 
                paragraph.''.
            (2) Allotment.--Paragraph (2) of section 2745(b) the Public 
        Health Service Act (42 U.S.C. 300gg-45(b)(2)) is amended--
                    (A) in the matter preceding subparagraph (A)--
                            (i) by striking ``appropriated under 
                        paragraphs (1)(B)(i) and (2)(A) of subsection 
                        (d) for a fiscal year'' and inserting 
                        ``allocated for a fiscal year under subsection 
                        (d)(2)(A)''; and
                            (ii) by inserting ``, reinsurance program, 
                        or innovative method'' after ``operate the high 
                        risk pool'';
                    (B) in subparagraph (A)--
                            (i) by striking ``40'' and inserting 
                        ``30''; and
                            (ii) by striking ``appropriated'' and 
                        inserting ``allocated'';
                    (C) in subparagraph (B), by striking each instance 
                of ``appropriated'' and inserting ``allocated'';
                    (D) in subparagraph (C)--
                            (i) by striking each instance of 
                        ``appropriated'' and inserting ``allocated''; 
                        and
                            (ii) by striking ``as the number of 
                        individuals'' and all that follows through the 
                        end of the subparagraph and inserting the 
                        following: ``as--
                            ``(i) the sum of--
                                    ``(I) the number of individuals 
                                enrolled in health care coverage 
                                through the qualified high risk pool of 
                                the State; and
                                    ``(II) the number of individuals 
                                whose health care coverage is covered 
                                by the qualified reinsurance program or 
                                innovative method of the State; bears 
                                to
                            ``(ii) the total number of individuals in 
                        all qualifying States that so apply that are so 
                        enrolled or so covered (as determined by the 
                        Secretary).''; and
                    (E) by adding at the end the following new 
                subparagraph:
                    ``(D) An amount equal to 10 percent of such 
                allocated 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 allocated amount as--
                            ``(i) the amount of funds contributed to 
                        the operation of any qualified high risk pool, 
                        qualified reinsurance program, or innovative 
                        method of the State by funding sources other 
                        than grants under this subsection; bears to
                            ``(ii) the total of the amount described in 
                        clause (i) for all States.''.
            (3) Consistent premium rules.--Section 2745(b) the Public 
        Health Service Act (42 U.S.C. 300gg-45(b)) is amended--
                    (A) by striking paragraph (3); and
                    (B) by redesignating paragraph (4) as paragraph 
                (3).
    (d) Preference Policy; No Bonus Grants.--Section 2745 of the Public 
Health Service Act (42 U.S.C. 300gg-45) is amended by striking 
subsection (c) and inserting the following:
    ``(c) Preference Policy.--Beginning 3 years after the date of the 
enactment of the Guaranteed Access to Health Insurance Act of 2012, for 
the purpose of providing access to health insurance for high risk 
individuals in a State, the Secretary, in awarding any competitive 
grant for Federal funding for which the only eligible entities are 
States, shall give preference to any State that has received a grant 
under this section in the year during which such grant is awarded.''.
    (e) Funding.--Section 2745(d) of the Public Health Service Act (42 
U.S.C. 300gg-45(d)) is amended--
            (1) by striking paragraphs (1), (2), (3), and (4) and 
        inserting the following:
            ``(1) Appropriations for fiscal year 2013 and subsequent 
        years.--Out of any funds in the Treasury not otherwise 
        appropriated, on October 1, 2012, there is appropriated to the 
        Secretary, $25,000,000,000, to remain available until expended, 
        to carry out this section, of which--
                    ``(A) $35,000,000 is to carry out subsection (a); 
                and
                    ``(B) $22,965,000,000 subject to paragraph (2), 
                shall be made available for allotments under subsection 
                (b)(2).
            ``(2) Allotments.--
                    ``(A) Annual amount.--
                            ``(i) In general.--For each fiscal year, 
                        the Secretary shall determine, from the amount 
                        available under paragraph (1)(B), the amount to 
                        allocate to such fiscal year for purposes of 
                        allotments under subsection (b)(2) for such 
                        fiscal year.
                            ``(ii) Criteria.--In determining the amount 
                        for a fiscal year under clause (i), the 
                        Secretary shall ensure that an adequate, but 
                        not excessive, amount of funding is made 
                        available to support qualified high risk pools, 
                        qualified reinsurance programs, and innovative 
                        methods in the States.
                    ``(B) Reallotment.--If, on June 30 of each fiscal 
                year for which the Secretary made funds available for 
                allotment under subparagraph (A), the Secretary 
                determines that all the amounts made available for 
                allotment for such fiscal year are not allotted or 
                otherwise made available to States, such remaining 
                amounts shall be allotted and made available under 
                subsection (b) among States receiving grants under 
                subsection (b) for the fiscal year based upon the 
                allotment formula specified in such subsection.''; and
            (2) by redesignating paragraph (5) as paragraph (3).
    (f) Definitions.--
            (1) Qualified high risk pool.--Section 2745(g)(1) of the 
        Public Health Service Act (42 U.S.C. 300gg-45(g)(1)) is 
        amended--
                    (A) in subparagraph (A)--
                            (i) by striking ``has the meaning given 
                        such term in section 2744(c)(2)'' and inserting 
                        ``means a `qualified high risk pool' (as such 
                        term is described in section 2744(c)(2)) that 
                        meets the requirements of subparagraph (B)'';
                            (ii) by striking ``subparagraph (A) of such 
                        section'' and inserting ``subparagraph (A) of 
                        section 2744(c)(2)''; and
                            (iii) by adding at the end the following:
                    ``(B) Requirements for consumer protections.--The 
                requirements under this subparagraph for consumer 
                protections for a qualified high risk pool are the 
                following:
                            ``(i) Choice of coverage.--The high risk 
                        pool provides all eligible individuals with a 
                        choice of health insurance coverage that 
                        includes at least one policy form that is a 
                        high deductible health plan that is combined 
                        with a health savings account.
                            ``(ii) Lifetime limits.--The high risk pool 
                        provides to all eligible individuals health 
                        insurance coverage that does not impose any 
                        lifetime limit on the dollar value of benefits 
                        for any participant or beneficiary of such 
                        coverage.
                            ``(iii) Guaranteed availability.--The high 
                        risk pool shall provide health insurance 
                        coverage to all eligible individuals who--
                                    ``(I) seek such coverage; and
                                    ``(II) pay any applicable premiums.
                            ``(iv) No wait list.--The high risk pool 
                        may not--
                                    ``(I) apply any waiting period for 
                                health insurance coverage offered 
                                through the pool;
                                    ``(II) maintain any waiting list 
                                for access to such coverage; or
                                    ``(III) otherwise require an 
                                eligible individual to wait for access 
                                to such coverage.
                            ``(v) Premiums.--The high risk pool may not 
                        charge any participant or beneficiary of 
                        coverage under such pool a premium for such 
                        coverage that is greater than 150 percent of 
                        the average premium in the individual market 
                        for health insurance coverage in that State.
                            ``(vi) Outreach and education.--The high 
                        risk pool conducts education and outreach to 
                        residents of the State and insurance brokers in 
                        the State to ensure that such residents and 
                        brokers understand that the high risk pool is 
                        available to eligible individuals.''.
            (2) Eligible individual.--
                    (A) In general.--Section 2745(g) of the Public 
                Health Service Act (42 U.S.C. 300gg-45(g)), as amended 
                by paragraph (1), is further amended by striking 
                paragraph (2) and inserting the following:
            ``(2) Eligible individual.--The term `eligible individual' 
        means an individual who--
                    ``(A) is an eligible individual (as such term is 
                defined in section 2741(b)); or
                    ``(B) would be eligible for Medicare under title 
                XVIII of the Social Security Act, except that such 
                individual is subject to a 24-month disability waiting 
                period under section 226(b) of the Social Security Act, 
                during such period.''.
                    (B) Conforming amendment.--Section 2741(b) of the 
                Public Health Service Act (42 U.S.C. 300gg-41(b)) is 
                amended by inserting ``(except, for purposes of section 
                2745)'' after ``In this part''.
            (3) Qualified reinsurance program and innovative method.--
        Section 2745(g) of the Public Health Service Act (42 U.S.C. 
        300gg-45(g)), as amended by paragraph (2), is further amended 
        by adding at the end the following:
            ``(4) Qualified reinsurance program.--The term `qualified 
        reinsurance program' means a `qualified reinsurance program', 
        as such term is defined in section 2744(c)(4), that does not 
        require any waiting period for health insurance coverage 
        offered to eligible individuals in connection with such 
        qualified reinsurance program.
            ``(5) Innovative method.--The term `innovative method' 
        means a method implemented by a State, to provide access to 
        health insurance coverage for eligible individuals in the 
        State, that the Secretary determines will--
                    ``(A) mitigate the cost of providing health 
                insurance coverage to eligible individuals in the State 
                in a manner that is better than, as determined by the 
                Secretary, the provision of such coverage through a 
                qualified high risk pool; and
                    ``(B) that ensures that such individuals receive 
                consumer protections that are similar to the consumer 
                protections required under paragraph (1)(B) for a 
                qualified high risk pool.''.
    (g) Protection Against Dumping.--Section 2745 of the Public Health 
Service Act (42 U.S.C. 300gg-45) is amended by adding at the end the 
following:
    ``(h) Protection Against Dumping Risk by Insurers.--
            ``(1) In general.--Subject to the criteria established by 
        the Secretary under paragraph (1) of section 2746(d), a State 
        operating a qualified high risk pool, qualified reinsurance 
        program, or innovative method under this section may enforce 
        sanctions against health insurance issuers in the State that 
        are similar to the sanctions described in paragraph (2) of such 
        section.
            ``(2) Rule of construction.--The rule of construction under 
        paragraph (3) of section 2746(d) shall apply to this subsection 
        in the same manner that such paragraph (3) applies to section 
        2746(d).''.
    (h) Effective Date.--The amendments made by this section shall take 
effect on October 1, 2012.

SEC. 4. FEDERAL FALLBACK HIGH RISK POOL.

    (a) In General.--Subpart 1 of part B of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-41 et seq.) is amended by adding at 
the end the following:

``SEC. 2746. FEDERAL FALLBACK HIGH RISK POOL.

    ``(a) Establishment and Application of Federal Fallback High Risk 
Pool.--
            ``(1) For states with no history of providing support for 
        eligible individuals.--If, by October 1, 2015, a State has not 
        established a qualified high risk pool, qualified reinsurance 
        program, or innovative method at any point in the 5-year period 
        before such date, the Secretary shall establish a Federal 
        fallback high risk pool program to provide health insurance 
        coverage for eligible individuals in such State.
            ``(2) For states that discontinue state high risk pools.--
        Beginning October 1, 2015, if a State that operated a qualified 
        high risk pool, a qualified reinsurance program, or innovative 
        method under section 2745 before such date fails to operate a 
        qualified high risk pool, qualified reinsurance program, or 
        innovative method for any period of 2 consecutive years after 
        such date, the Secretary shall, at the end of such 2-year 
        period, establish a Federal fallback high risk pool to provide 
        health insurance coverage for eligible individuals in such 
        State.
    ``(b) Administration.--
            ``(1) In general.--The Secretary may carry out the program 
        under this section directly or through contracts to eligible 
        entities.
            ``(2) Eligible entities.--To be eligible for a contract 
        under paragraph (1), an entity shall--
                    ``(A) be a nonprofit private entity;
                    ``(B) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require; and
                    ``(C) agree to utilize contract funding to 
                establish and administer a Federal fallback high risk 
                pool for eligible individuals.
    ``(c) Use of Funds.--Amounts made available under this section 
shall be used to establish and operate a Federal fallback high risk 
pool that is a qualified high risk pool, as such term is defined in 
section 2744(c)(2), that meets the requirements of section 
2745(g)(1)(B) of such Act, with respect to each State in which such 
Federal fallback high risk pool applies.
    ``(d) Protection Against Dumping Risk by Insurers.--
            ``(1) In general.--The Secretary shall establish criteria 
        for determining whether health insurance issuers and 
        employment-based health plans have discouraged an individual 
        from remaining enrolled in prior coverage based on that 
        individual's health status.
            ``(2) Sanctions.--An health insurance issuer or employment-
        based health plan shall be responsible for reimbursing the 
        Federal fallback high risk pool under this section for the 
        medical expenses incurred by the Federal fallback high risk 
        pool for an individual who, based on criteria established by 
        the Secretary, the Secretary finds was encouraged by the health 
        insurance issuer to disenroll from health benefits coverage 
        prior to enrolling in coverage through the Federal fallback 
        high risk. The criteria shall include at least the following 
        circumstances:
                    ``(A) In the case of prior coverage obtained 
                through an employer, the provision by the employer, 
                group health plan, or the health insurance issuer of 
                money or other financial consideration for disenrolling 
                from the coverage.
                    ``(B) In the case of prior coverage obtained 
                directly from a health insurance issuer or under an 
                employment-based health plan--
                            ``(i) the provision by the health insurance 
                        issuer or plan of money or other financial 
                        consideration for disenrolling from the 
                        coverage; or
                            ``(ii) in the case of an individual whose 
                        premium for the prior coverage exceeded the 
                        premium required by the program (adjusted based 
                        on the age factors applied to the prior 
                        coverage)--
                                    ``(I) the prior coverage is a 
                                policy that is no longer being actively 
                                marketed (as defined by the Secretary) 
                                by the health insurance issuer; or
                                    ``(II) the prior coverage is a 
                                policy for which duration of coverage 
                                form issue or health status are factors 
                                that can be considered in determining 
                                premiums at renewal.
            ``(3) Construction.--Nothing in this subsection shall be 
        construed as constituting exclusive remedies for violations of 
        criteria established under paragraph (1) or as preventing 
        States from applying or enforcing such paragraph or other 
        provisions under law with respect to health insurance issuers.
    ``(e) Oversight.--The Secretary shall establish--
            ``(1) an appeals process to enable individuals to appeal a 
        determination under this section; and
            ``(2) procedures to protect against waste, fraud, and 
        abuse.
    ``(f) Funding; Termination of Authority.--
            ``(1) In general.--There are authorized to be appropriated 
        to the Secretary $2,500,000,000 for the 3-fiscal-year period 
        beginning on October 1, 2015, to pay claims against (and the 
        administrative costs of) the Federal fallback high risk pool 
        under this section that are in excess of the amount of premiums 
        collected from eligible individuals enrolled in the Federal 
        fallback high risk pool.
            ``(2) Insufficient funds.--If the Secretary estimates for 
        any fiscal year that the aggregate amounts available for the 
        payment of the expenses of the Federal fallback high risk pool 
        will be less than the actual amount of such expenses, the 
        Secretary shall make such adjustments as are necessary to 
        eliminate such deficit.
            ``(3) Relationship to state high risk pools.--
                    ``(A) Termination of federal coverage.--Subject to 
                subparagraph (B), if a State establishes a qualified 
                high risk pool, qualified reinsurance program, or 
                innovative method under section 2745, coverage of an 
                eligible individual in such State under a Federal 
                fallback high risk pool shall terminate on the date 
                that--
                            ``(i) is the last day of the plan year that 
                        applies to such individual under such Federal 
                        fallback high risk pool; and
                            ``(ii) that occurs after the date on which 
                        the State establishes such a qualified high 
                        risk pool, qualified reinsurance program, or 
                        innovative method.
                    ``(B) Transition to state high risk pools.--The 
                Secretary shall develop procedures to provide for the 
                transition of eligible individuals in a State enrolled 
                in health insurance coverage offered through a Federal 
                fallback high risk pool established under this section 
                into a qualified high risk pool in such State. Such 
                procedures shall ensure that there is no lapse in 
                coverage with respect to the individual and may extend 
                coverage after the applicable termination date under 
                subparagraph (A) of the Federal fallback risk pool 
                involved, if the Secretary determines necessary to 
                avoid such a lapse.
                    ``(C) No new enrollment.--The Federal fallback high 
                risk pool in a State shall not enroll any individual in 
                the State for coverage under such a Federal fallback 
                high risk pool at any time that the State is operating 
                such a qualified high risk pool, qualified reinsurance 
                program, or innovative method under section 2745.
            ``(4) Limitations.--The Secretary has the authority to stop 
        taking applications for participation in the Federal fallback 
        high risk pool under this section to comply with paragraph (2).
            ``(5) Relation to state laws.--The standards established 
        under this section shall supersede any State law or regulation 
        (other than State licensing laws or State laws relating to plan 
        solvency) with respect to any Federal fallback high risk pool 
        which is established in accordance with this section.
    ``(g) Definitions.--For purposes of this section--
            ``(1) Terms from section 2745.--Except as otherwise 
        provided in this section, the terms `eligible individual', 
        `innovative method', `qualified high risk pool', and `qualified 
        reinsurance program' have the meanings given such terms in 
        section 2745(g).
            ``(2) Employment-based health plan.--The term `employment-
        based health plan' shall have the meaning given such term by 
        the Secretary, consistent with the meaning given such term 
        under section 1101 of Public Law 111-148.''.
    (b) Conforming Amendment.--Section 2741(b) of the Public Health 
Service Act (42 U.S.C. 300gg-41(b)), as amended by section 3(f)(2)(B), 
is further amended, in the matter before paragraph (1), by inserting 
``and section 2746'' after ``for purposes of section 2745''.
                                 <all>