[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4496 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4496

 To establish universal access programs to improve high risk pools and 
    reinsurance markets to ensure coverage for individuals with pre-
              existing conditions, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 28, 2014

 Mr. Gardner introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To establish universal access programs to improve high risk pools and 
    reinsurance markets to ensure coverage for individuals with pre-
              existing conditions, and for other purposes.

    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 ``Covering People With Pre-Existing 
Conditions Act of 2014''.

SEC. 2. ESTABLISHING UNIVERSAL ACCESS PROGRAMS TO IMPROVE HIGH RISK 
              POOLS AND REINSURANCE MARKETS FOR INDIVIDUALS WITH PRE-
              EXISTING CONDITIONS.

    (a) State Requirement.--
            (1) In general.--Not later than January 1, 2015, each State 
        shall--
                    (A) subject to paragraph (3), operate--
                            (i) a qualified State reinsurance program 
                        described in subsection (b); or
                            (ii) qualifying State high risk pool 
                        described in subsection (c)(1); and
                    (B) subject to paragraph (3), apply to the 
                operation of such a program from State funds an amount 
                equivalent to the portion of State funds derived from 
                State premium assessments (as defined by the Secretary) 
                that are not otherwise used on State health care 
                programs.
            (2) Relation to current qualified high risk pool program.--
                    (A) States not operating a qualified high risk 
                pool.--In the case of a State that is not operating a 
                current section 2745 qualified high risk pool as of the 
                date of the enactment of this Act--
                            (i) the State may only meet the requirement 
                        of paragraph (1) through the operation of a 
                        qualified State reinsurance program described 
                        in subsection (b); and
                            (ii) the State's operation of such a 
                        reinsurance program shall be treated, for 
                        purposes of section 2745 of the Public Health 
                        Service Act, as the operation of a qualified 
                        high risk pool described in such section.
                    (B) State operating a qualified high risk pool.--In 
                the case of a State that is operating a current section 
                2745 qualified high risk pool as of the date of the 
                enactment of this Act--
                            (i) as of January 1, 2015, such a pool 
                        shall not be treated as a qualified high risk 
                        pool under section 2745 of the Public Health 
                        Service Act unless the pool is a qualifying 
                        State high risk pool described in subsection 
                        (c)(1); and
                            (ii) the State may use premium assessment 
                        funds described in paragraph (1)(B) to 
                        transition from operation of such a pool to 
                        operation of a qualified State reinsurance 
                        program described in subsection (b).
            (3) Application of funds.--If the program or pool operated 
        under paragraph (1)(A) is in strong fiscal health, as 
        determined in accordance with standards established by the 
        National Association of Insurance Commissioners and as approved 
        by the State Insurance Commissioner involved, the requirement 
        of paragraph (1)(B) shall be deemed to be met.
    (b) Qualified State Reinsurance Program.--
            (1) In general.--For purposes of this section, a 
        ``qualified State reinsurance program'' means a program 
        operated by a State program that provides reinsurance for 
        health insurance coverage offered in the small group market in 
        accordance with the model for such a program established (as of 
        the date of the enactment of this Act).
            (2) Form of program.--A qualified State reinsurance program 
        may provide reinsurance--
                    (A) on a prospective or retrospective basis; and
                    (B) on a basis that protects health insurance 
                issuers against the annual aggregate spending of their 
                enrollees as well as purchase protection against 
                individual catastrophic costs.
            (3) Satisfaction of hipaa requirement.--A qualified State 
        reinsurance program shall be deemed, for purposes of section 
        2745 of the Public Health Service Act, to be a qualified high 
        risk pool under such section.
    (c) Qualifying State High Risk Pool.--
            (1) In general.--A qualifying State high risk pool 
        described in this subsection means a current section 2745 
        qualified high risk pool that meets the following requirements:
                    (A) The pool must provide at least two coverage 
                options, one of which must be a high deductible health 
                plan coupled with a health savings account.
                    (B) The pool must be funded with a stable funding 
                source.
                    (C) The pool must eliminate any waiting lists so 
                that all eligible residents who are seeking coverage 
                through the pool should be allowed to receive coverage 
                through the pool.
                    (D) The pool must allow 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.
                    (E) The pool must limit the pool premiums to no 
                more than 150 percent of the average premium for 
                applicable standard risk rates in that State.
                    (F) The pool must conduct education and outreach 
                initiatives so that residents and brokers understand 
                that the pool is available to eligible residents.
                    (G) The pool must provide coverage for preventive 
                services and disease management for chronic diseases.
            (2) Verification of citizenship or alien qualification.--
                    (A) In general.--Notwithstanding any other 
                provision of law, only citizens and nationals of the 
                United States shall be eligible to participate in a 
                qualifying State high risk pool that receives funds 
                under section 2745 of the Public Health Service Act or 
                this section.
                    (B) Condition of participation.--As a condition of 
                a State receiving such funds, the Secretary shall 
                require the State to certify, to the satisfaction of 
                the Secretary, that such State requires all applicants 
                for coverage in the qualifying State high risk pool to 
                provide satisfactory documentation of citizenship or 
                nationality in a manner consistent with section 1903(x) 
                of the Social Security Act.
                    (C) Records.--The Secretary shall keep sufficient 
                records such that a determination of citizenship or 
                nationality only has to be made once for any individual 
                under this paragraph.
            (3) Relation to section 2745.--As of January 1, 2015, a 
        pool shall not qualify as qualified high risk pool under 
        section 2745 of the Public Health Service Act unless the pool 
        is a qualifying State high risk pool described in paragraph 
        (1).
    (d) Waivers.--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.
    (e) Funding.--In addition to any other amounts appropriated, there 
is appropriated to carry out section 2745 of the Public Health Service 
Act (including through a program or pool described in subsection 
(a)(1))--
            (1) $15,000,000,000 for the period of fiscal years 2015 
        through 2024; and
            (2) an additional $10,000,000,000 for the period of fiscal 
        years 2020 through 2024.
    (f) Definitions.--In this section:
            (1) Health insurance coverage; health insurance issuer.--
        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) Current section 2745 qualified high risk pool.--The 
        term ``current section 2745 qualified high risk pool'' has the 
        meaning given the term ``qualified high risk pool'' under 
        section 2745(g) of the Public Health Service Act as in effect 
        as of the date of the enactment of this Act.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (4) Standard risk rate.--The term ``standard risk rate'' 
        means a rate that--
                    (A) is determined under the State high risk pool by 
                considering the premium rates charged by other health 
                insurance issuers offering health insurance coverage to 
                individuals in the insurance market served;
                    (B) is established using reasonable actuarial 
                techniques; and
                    (C) reflects anticipated claims experience and 
                expenses for the coverage involved.
            (5) State.--The term ``State'' means any of the 50 States 
        or the District of Columbia.
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