[Congressional Record Volume 147, Number 90 (Tuesday, June 26, 2001)]
[Senate]
[Pages S6930-S6934]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 813. Mr. BROWNBACK submitted an amendment intended to be proposed 
by him to the bill S. 1052, to amend the Public Health Service Act and 
the Employee Retirement Income Security Act of 1974 to protect 
consumers in managed care plans and other health coverage; which was 
ordered to lie on the table; as follows:

       At the end of the bill, add the following

               TITLE __--HUMAN GERMLINE GENE MODIFICATION

     SEC.   01. SHORT TITLE.

       This title may be cited as the ``Human Germline Gene 
     Modification Prohibition Act of 2001''.

     SEC.   02. FINDINGS.

       Congress makes the following findings:
       (1) Human Germline gene modification is not needed to save 
     lives, or alleviate suffering, of existing people. Its target 
     population is ``prospective people'' who have not been 
     conceived.
       (2) The cultural impact of treating humans as biologically 
     perfectible artifacts would be entirely negative. People who 
     fall short of some technically achievable ideal would be seen 
     as ``damaged goods'', while the standards for what is 
     genetically desirable will be those of the society's 
     economically and politically dominant groups. This will only 
     increase prejudices and discrimination in a society where too 
     many such prejudices already exist.
       (3) There is no way to be accountable to those in future 
     generations who are harmed or stigmatized by wrongful or 
     unsuccessful human germline modifications of themselves or 
     their ancestors.
       (4) The negative effects of human germline manipulation 
     would not be fully known for generations, if ever, meaning 
     that countless people will have been exposed to harm probably 
     often fatal as the result of only a few instances of germline 
     manipulations.
       (5) All people have the right to have been conceived, 
     gestated, and born without genetic manipulation.

     SEC.   03. PROHIBITION ON HUMAN GERMLINE GENE MODIFICATION.

       (a) In General.--Title 18, United States Code, is amended 
     by inserting after chapter 15, the following:

                ``CHAPTER 16--GERMLINE GENE MODIFICATION

``Sec.
``301. Definitions
``302. Prohibition on germline gene modification.

     ``Sec. 301. Definitions

       ``In this chapter:
       (1) Human germline gene modification.--The term `human 
     germline gene modification' means the introduction of DNA 
     into any human cell (including human eggs, sperm, fertilized 
     eggs, (ie. embryos, or any early cells that will 
     differentiate into gametes or can be manipulated to do so) 
     that can result in a change which can be passed on to future 
     individuals, including DNA from any source, and in any form, 
     such as nuclei, chromosomes, nuclear, mitochondrial, and 
     synthetic DNA. The term does not include any modification of 
     cells that are not a part

[[Page S6931]]

     of or are not used to construct human embryos.
       ``(2) Human haploid cell.--The term `haploid cell' means a 
     cell that contains only a single copy of each of the human 
     chromosomes, such as eggs, sperm, and their precursors; the 
     haploid number in a human cell is 23.
       ``(3) Somatic cell.--The term `somatic cell' means a 
     diploid cell (having two sets of the chromosomes of almost 
     all body cells) obtained or derived from a living or deceased 
     human body at any stage of development; its diploid number is 
     46. Somatic cells are diploid cells that are not precursors 
     of either eggs or sperm. A genetic modification of somatic 
     cells is therefore not germline genetic modification.

     ``Sec. 302. Prohibition on germline gene modification

       ``(a) In General.--It shall be unlawful for any person or 
     entity, public or private, in or affecting interstate 
     commerce--
       ``(1) to perform or attempt to perform human germline gene 
     modification;
       ``(2) to participate in an attempt to perform human 
     germline gene modification; or
       ``(3) to ship or receive the product of human germline gene 
     modification for any purpose.
       ``(b) Importation.--It shall be unlawful for any person or 
     entity, public or private, to import the product of human 
     germline gene modification for any purpose.
       ``(c) Penalties--
       ``(1) In general.--Any person or entity that is convicted 
     of violating any provision of this section shall be fined 
     under this section or imprisoned not more than 10 years, or 
     both.
       ``(2) Civil penalty.--Any person or entity that is 
     convicted of violating any provision of this section shall be 
     subject to, in the case of a violation that involves the 
     derivation of a pecuniary gain, a civil penalty of not less 
     than $1,000,000 and not more than an amount equal to the 
     amount of the gross gain multiplied by 2, if that amount is 
     greater than $1,000,000.
       (b) Clerical Amendment.--The table of chapters for part I 
     of title 18, United States Code, is amended by inserting 
     after the item relating to chapter 15 the following:

301''.rmline Gene Modification.......................................
                                  ____


  SA 814. Mr. SANTORUM submitted an amendment intended to be proposed 
by him to the bill S. 1052, to amend the Public Health Service Act and 
the Employee Retirement Income Security Act of 1974 to protect 
consumers in managed care plans and other health coverage; which was 
ordered to lie on the table; as follows:

       On page 179, after line 14, add the following:

     SEC. __. DEFINITION OF BORN-ALIVE INFANT.

       (a) In General.--Chapter 1 of title 1, United States Code, 
     is amended by adding at the end the following:

     ``Sec. 8. `Person', `human being', `child', and `individual' 
       as including born-alive infant

       ``(a) In determining the meaning of any Act of Congress, or 
     of any ruling, regulation, or interpretation of the various 
     administrative bureaus and agencies of the United States, the 
     words `person', `human being', `child', and `individual', 
     shall include every infant member of the species homo sapiens 
     who is born alive at any stage of development.
       ``(b) As used in this section, the term `born alive', with 
     respect to a member of the species homo sapiens, means the 
     complete expulsion or extraction from his or her mother of 
     that member, at any stage of development, who after such 
     expulsion or extraction breathes or has a beating heart, 
     pulsation of the umbilical cord, or definite movement of 
     voluntary muscles, regardless of whether the umbilical cord 
     has been cut, and regardless of whether the expulsion or 
     extraction occurs as a result of natural or induced labor, 
     caesarean section, or induced abortion.
       ``(c) Nothing in this section shall be construed to affirm, 
     deny, expand, or contract any legal status or legal right 
     applicable to any member of the species homo sapiens at any 
     point prior to being born alive as defined in this 
     section.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 1 of title 1, United States Code, is 
     amended by adding at the end the following new item:

``8. `Person', `human being', `child', and `individual' as including 
              born-alive infant.''.
                                  ____

  SA 815. Mr. SANTORUM submitted an amendment intended to be proposed 
by him to the bill S. 1052, to amend the Public Health Service Act and 
the Employee Retirement Income Security Act of 1974 to protect 
consumers in managed care plans and other health coverage; which was 
ordered to lie on the table; as follows:

       At the end, add the following:

                 TITLE __--FAIR CARE FOR THE UNINSURED

      Subtitle A--Refundable Credit for Health Insurance Coverage

     SEC. __01. REFUNDABLE CREDIT FOR HEALTH INSURANCE COVERAGE.

       (a) In General.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 (relating to 
     refundable credits) is amended by redesignating section 35 as 
     section 36 and by inserting after section 34 the following 
     new section:

     ``SEC. 35. HEALTH INSURANCE COSTS.

       ``(a) In General.--In the case of an individual, there 
     shall be allowed as a credit against the tax imposed by this 
     subtitle an amount equal to the amount paid during the 
     taxable year for qualified health insurance for the taxpayer, 
     his spouse, and dependents.
       ``(b) Limitations.--
       ``(1) In general.--The amount allowed as a credit under 
     subsection (a) to the taxpayer for the taxable year shall not 
     exceed the sum of the monthly limitations for coverage months 
     during such taxable year for each individual referred to in 
     subsection (a) for whom the taxpayer paid during the taxable 
     year any amount for coverage under qualified health 
     insurance.
       ``(2) Monthly limitation.--
       ``(A) In general.--The monthly limitation for an individual 
     for each coverage month of such individual during the taxable 
     year is the amount equal to 1/12 of--
       ``(i) $1,000 if such individual is the taxpayer,
       ``(ii) $1,000 if--

       ``(I) such individual is the spouse of the taxpayer,
       ``(II) the taxpayer and such spouse are married as of the 
     first day of such month, and
       ``(III) the taxpayer files a joint return for the taxable 
     year, and

       ``(iii) $500 if such individual is an individual for whom a 
     deduction under section 151(c) is allowable to the taxpayer 
     for such taxable year.
       ``(B) Limitation to 2 dependents.--Not more than 2 
     individuals may be taken into account by the taxpayer under 
     subparagraph (A)(iii).
       ``(C) Special rule for married individuals.--In the case of 
     an individual--
       ``(i) who is married (within the meaning of section 7703) 
     as of the close of the taxable year but does not file a joint 
     return for such year, and
       ``(ii) who does not live apart from such individual's 
     spouse at all times during the taxable year,

     the limitation imposed by subparagraph (B) shall be divided 
     equally between the individual and the individual's spouse 
     unless they agree on a different division.
       ``(3) Coverage month.--For purposes of this subsection--
       ``(A) In general.--The term `coverage month' means, with 
     respect to an individual, any month if--
       ``(i) as of the first day of such month such individual is 
     covered by qualified health insurance, and
       ``(ii) the premium for coverage under such insurance for 
     such month is paid by the taxpayer.
       ``(B) Employer-subsidized coverage.--
       ``(i) In general.--Such term shall not include any month 
     for which such individual is eligible to participate in any 
     subsidized health plan (within the meaning of section 
     162(l)(2)) maintained by any employer of the taxpayer or of 
     the spouse of the taxpayer.
       ``(ii) Premiums to nonsubsidized plans.--If an employer of 
     the taxpayer or the spouse of the taxpayer maintains a health 
     plan which is not a subsidized health plan (as so defined) 
     and which constitutes qualified health insurance, employee 
     contributions to the plan shall be treated as amounts paid 
     for qualified health insurance.
       ``(C) Cafeteria plan and flexible spending account 
     beneficiaries.--Such term shall not include any month during 
     a taxable year if any amount is not includible in the gross 
     income of the taxpayer for such year under section 106 with 
     respect to--
       ``(i) a benefit chosen under a cafeteria plan (as defined 
     in section 125(d)), or
       ``(ii) a benefit provided under a flexible spending or 
     similar arrangement.
       ``(D) Medicare and medicaid.--Such term shall not include 
     any month with respect to an individual if, as of the first 
     day of such month, such individual--
       ``(i) is entitled to any benefits under title XVIII of the 
     Social Security Act, or
       ``(ii) is a participant in the program under title XIX or 
     XXI of such Act.
       ``(E) Certain other coverage.--Such term shall not include 
     any month during a taxable year with respect to an individual 
     if, at any time during such year, any benefit is provided to 
     such individual under--
       ``(i) chapter 89 of title 5, United States Code,
       ``(ii) chapter 55 of title 10, United States Code,
       ``(iii) chapter 17 of title 38, United States Code, or
       ``(iv) any medical care program under the Indian Health 
     Care Improvement Act.
       ``(F) Prisoners.--Such term shall not include any month 
     with respect to an individual if, as of the first day of such 
     month, such individual is imprisoned under Federal, State, or 
     local authority.
       ``(G) Insufficient presence in united states.--Such term 
     shall not include any month during a taxable year with 
     respect to an individual if such individual is present in the 
     United States on fewer than 183 days during such year 
     (determined in accordance with section 7701(b)(7)).
       ``(4) Coordination with deduction for health insurance 
     costs of self-employed individuals.--In the case of a 
     taxpayer who is eligible to deduct any amount under section 
     162(l) for the taxable year, this section

[[Page S6932]]

     shall apply only if the taxpayer elects not to claim any 
     amount as a deduction under such section for such year.
       ``(c) Qualified Health Insurance.--For purposes of this 
     section--
       ``(1) In general.--The term `qualified health insurance' 
     means insurance which constitutes medical care as defined in 
     section 213(d) without regard to--
       ``(A) paragraph (1)(C) thereof, and
       ``(B) so much of paragraph (1)(D) thereof as relates to 
     qualified long-term care insurance contracts.
       ``(2) Exclusion of certain other contracts.--Such term 
     shall not include insurance if a substantial portion of its 
     benefits are excepted benefits (as defined in section 
     9832(c)).
       ``(d) Archer MSA Contributions.--
       ``(1) In general.--If a deduction would (but for paragraph 
     (2)) be allowed under section 220 to the taxpayer for a 
     payment for the taxable year to the Archer MSA of an 
     individual, subsection (a) shall be applied by treating such 
     payment as a payment for qualified health insurance for such 
     individual.
       ``(2) Denial of double benefit.--No deduction shall be 
     allowed under section 220 for that portion of the payments 
     otherwise allowable as a deduction under section 220 for the 
     taxable year which is equal to the amount of credit allowed 
     for such taxable year by reason of this subsection.
       ``(e) Special Rules.--
       ``(1) Coordination with medical expense deduction.--The 
     amount which would (but for this paragraph) be taken into 
     account by the taxpayer under section 213 for the taxable 
     year shall be reduced by the credit (if any) allowed by this 
     section to the taxpayer for such year.
       ``(2) Denial of credit to dependents.--No credit shall be 
     allowed under this section to any individual with respect to 
     whom a deduction under section 151 is allowable to another 
     taxpayer for a taxable year beginning in the calendar year in 
     which such individual's taxable year begins.
       ``(3) Inflation adjustment.--In the case of any taxable 
     year beginning in a calendar year after 2002, each dollar 
     amount contained in subsection (b)(2)(A) shall be increased 
     by an amount equal to--
       ``(A) such dollar amount, multiplied by
       ``(B) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2001' 
     for `calendar year 1992' in subparagraph (B) thereof.

     Any increase determined under the preceding sentence shall be 
     rounded to the nearest multiple of $50 ($25 in the case of 
     the dollar amount in subsection (b)(2)(A)(iii)).''
       (b) Information Reporting.--
       (1) In general.--Subpart B of part III of subchapter A of 
     chapter 61 of such Code (relating to information concerning 
     transactions with other persons) is amended by inserting 
     after section 6050S the following new section:

     ``SEC. 6050T. RETURNS RELATING TO PAYMENTS FOR QUALIFIED 
                   HEALTH INSURANCE.

       ``(a) In General.--Any person who, in connection with a 
     trade or business conducted by such person, receives payments 
     during any calendar year from any individual for coverage of 
     such individual or any other individual under creditable 
     health insurance, shall make the return described in 
     subsection (b) (at such time as the Secretary may by 
     regulations prescribe) with respect to each individual from 
     whom such payments were received.
       ``(b) Form and Manner of Returns.--A return is described in 
     this subsection if such return--
       ``(1) is in such form as the Secretary may prescribe, and
       ``(2) contains--
       ``(A) the name, address, and TIN of the individual from 
     whom payments described in subsection (a) were received,
       ``(B) the name, address, and TIN of each individual who was 
     provided by such person with coverage under creditable health 
     insurance by reason of such payments and the period of such 
     coverage, and
       ``(C) such other information as the Secretary may 
     reasonably prescribe.
       ``(c) Creditable Health Insurance.--For purposes of this 
     section, the term `creditable health insurance' means 
     qualified health insurance (as defined in section 35(c)) 
     other than--
       ``(1) insurance under a subsidized group health plan 
     maintained by an employer, or
       ``(2) to the extent provided in regulations prescribed by 
     the Secretary, any other insurance covering an individual if 
     no credit is allowable under section 35 with respect to such 
     coverage.
       ``(d) Statements To Be Furnished to Individuals With 
     Respect to Whom Information Is Required.--Every person 
     required to make a return under subsection (a) shall furnish 
     to each individual whose name is required under subsection 
     (b)(2)(A) to be set forth in such return a written statement 
     showing--
       ``(1) the name and address of the person required to make 
     such return and the phone number of the information contact 
     for such person,
       ``(2) the aggregate amount of payments described in 
     subsection (a) received by the person required to make such 
     return from the individual to whom the statement is required 
     to be furnished, and
       ``(3) the information required under subsection (b)(2)(B) 
     with respect to such payments.

     The written statement required under the preceding sentence 
     shall be furnished on or before January 31 of the year 
     following the calendar year for which the return under 
     subsection (a) is required to be made.
       ``(e) Returns Which Would Be Required To Be Made by 2 or 
     More Persons.--Except to the extent provided in regulations 
     prescribed by the Secretary, in the case of any amount 
     received by any person on behalf of another person, only the 
     person first receiving such amount shall be required to make 
     the return under subsection (a).''.
       (2) Assessable penalties.--
       (A) Subparagraph (B) of section 6724(d)(1) of such Code 
     (relating to definitions) is amended by redesignating clauses 
     (xi) through (xvii) as clauses (xii) through (xviii), 
     respectively, and by inserting after clause (x) the following 
     new clause:
       ``(xi) section 6050T (relating to returns relating to 
     payments for qualified health insurance),''.
       (B) Paragraph (2) of section 6724(d) of such Code is 
     amended by striking ``or'' at the end of the next to last 
     subparagraph, by striking the period at the end of the last 
     subparagraph and inserting ``, or'', and by adding at the end 
     the following new subparagraph:
       ``(BB) section 6050T(d) (relating to returns relating to 
     payments for qualified health insurance).''.
       (3) Clerical amendment.--The table of sections for subpart 
     B of part III of subchapter A of chapter 61 of such Code is 
     amended by inserting after the item relating to section 6050S 
     the following new item:

``Sec. 6050T. Returns relating to payments for qualified health 
              insurance.''.

       (c) Conforming Amendments.--
       (1) Paragraph (2) of section 1324(b) of title 31, United 
     States Code, is amended by inserting before the period ``, or 
     from section 35 of such Code''.
       (2) The table of sections for subpart C of part IV of 
     subchapter A of chapter 1 of such Code is amended by striking 
     the last item and inserting the following new items:

``Sec. 35. Health insurance costs.
``Sec. 36. Overpayments of taxes.''.

       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2001.

     SEC. __02. ADVANCE PAYMENT OF CREDIT FOR PURCHASERS OF 
                   QUALIFIED HEALTH INSURANCE.

       (a) In General.--Chapter 77 of the Internal Revenue Code of 
     1986 (relating to miscellaneous provisions) is amended by 
     adding at the end the following new section:

     ``SEC. 7527. ADVANCE PAYMENT OF HEALTH INSURANCE CREDIT FOR 
                   PURCHASERS OF QUALIFIED HEALTH INSURANCE.

       ``(a) General Rule.--In the case of an eligible individual, 
     the Secretary shall make payments to the provider of such 
     individual's qualified health insurance equal to such 
     individual's qualified health insurance credit advance amount 
     with respect to such provider.
       ``(b) Eligible Individual.--For purposes of this section, 
     the term `eligible individual' means any individual--
       ``(1) who purchases qualified health insurance (as defined 
     in section 35(c)), and
       ``(2) for whom a qualified health insurance credit 
     eligibility certificate is in effect.
       ``(c) Qualified Health Insurance Credit Eligibility 
     Certificate.--For purposes of this section, a qualified 
     health insurance credit eligibility certificate is a 
     statement furnished by an individual to the Secretary which--
       ``(1) certifies that the individual will be eligible to 
     receive the credit provided by section 35 for the taxable 
     year,
       ``(2) estimates the amount of such credit for such taxable 
     year, and
       ``(3) provides such other information as the Secretary may 
     require for purposes of this section.
       ``(d) Qualified Health Insurance Credit Advance Amount.--
     For purposes of this section, the term `qualified health 
     insurance credit advance amount' means, with respect to any 
     provider of qualified health insurance, the Secretary's 
     estimate of the amount of credit allowable under section 35 
     to the individual for the taxable year which is attributable 
     to the insurance provided to the individual by such provider.
       ``(e) Regulations.--The Secretary shall prescribe such 
     regulations as may be necessary to carry out the purposes of 
     this section.''.
       (b) Clerical Amendment.--The table of sections for chapter 
     77 of such Code is amended by adding at the end the following 
     new item:

``Sec. 7527. Advance payment of health insurance credit for purchasers 
              of qualified health insurance.''.

       (c) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2002.

    Subtitle B--Assuring Health Insurance Coverage for Uninsurable 
                              Individuals

     SEC. __11. ESTABLISHMENT OF HEALTH INSURANCE SAFETY NETS.

       (a) In General.--
       (1) Requirement.--For years beginning with 2002, each 
     health insurer, health maintenance organization, and health 
     service organization shall be a participant in a health

[[Page S6933]]

     insurance safety net (in this subtitle referred to as a 
     ``safety net'') established by the State in which it 
     operates.
       (2) Functions.--Any safety net shall assure, in accordance 
     with this subtitle, the availability of qualified health 
     insurance coverage to uninsurable individuals.
       (3) Funding.--Any safety net shall be funded by an 
     assessment against health insurers, health service 
     organizations, and health maintenance organizations on a pro 
     rata basis of premiums collected in the State in which the 
     safety net operates. The costs of the assessment may be added 
     by a health insurer, health service organization, or health 
     maintenance organization to the costs of its health insurance 
     or health coverage provided in the State.
       (4) Guaranteed renewable.--Coverage under a safety net 
     shall be guaranteed renewable except for nonpayment of 
     premiums, material misrepresentation, fraud, medicare 
     eligibility under title XVIII of the Social Security Act (42 
     U.S.C. 1395 et seq.), loss of dependent status, or 
     eligibility for other health insurance coverage.
       (5) Compliance with naic model act.--In the case of a State 
     that has not established, as of the date of the enactment of 
     this Act, a high risk pool or other comprehensive health 
     insurance program that assures the availability of qualified 
     health insurance coverage to all eligible individuals 
     residing in the State, a safety net shall be established in 
     accordance with the requirements of the ``Model Health Plan 
     For Uninsurable Individuals Act'' (or the successor model 
     Act), as adopted by the National Association of Insurance 
     Commissioners and as in effect on the date of the safety 
     net's establishment.
       (b) Deadline.--Safety nets required under subsection (a) 
     shall be established not later than January 1, 2002.
       (c) Waiver.--This subtitle shall not apply in the case of 
     insurers and organizations operating in a State if the State 
     has established a similar comprehensive health insurance 
     program that assures the availability of qualified health 
     insurance coverage to all eligible individuals residing in 
     the State.
       (d) Recommendation for Compliance Requirement.--Not later 
     than January 1, 2003, the Secretary of Health and Human 
     Services shall submit to Congress a recommendation on 
     appropriate sanctions for States that fail to meet the 
     requirement of subsection (a).

     SEC. __12. UNINSURABLE INDIVIDUALS ELIGIBLE FOR COVERAGE.

       (a) Uninsurable and Eligible Individual Defined.--In this 
     subtitle:
       (1) Uninsurable individual.--The term ``uninsurable 
     individual'' means, with respect to a State, an eligible 
     individual who presents proof of uninsurability by a private 
     insurer in accordance with subsection (b) or proof of a 
     condition previously recognized as uninsurable by the State.
       (2) Eligible individual.--
       (A) In general.--The term ``eligible individual'' means, 
     with respect to a State, a citizen or national of the United 
     States (or an alien lawfully admitted for permanent 
     residence) who is a resident of the State for at least 90 
     days and includes any dependent (as defined for purposes of 
     the Internal Revenue Code of 1986) of such a citizen, 
     national, or alien who also is such a resident.
       (B) Exception.--An individual is not an ``eligible 
     individual'' if the individual--
       (i) is covered by or eligible for benefits under a State 
     medicaid plan approved under title XIX of the Social Security 
     Act (42 U.S.C. 1396 et seq.),
       (ii) has voluntarily terminated safety net coverage within 
     the past 6 months,
       (iii) has received the maximum benefit payable under the 
     safety net,
       (iv) is an inmate in a public institution, or
       (v) is eligible for other public or private health care 
     programs (including programs that pay for directly, or 
     reimburse, otherwise eligible individuals with premiums 
     charged for safety net coverage).
       (b) Proof of Uninsurability.--
       (1) In general.--The proof of uninsurability for an 
     individual shall be in the form of--
       (A) a notice of rejection or refusal to issue substantially 
     similar health insurance for health reasons by one insurer; 
     or
       (B) a notice of refusal by an insurer to issue 
     substantially similar health insurance except at a rate in 
     excess of the rate applicable to the individual under the 
     safety net plan.

     For purposes of this paragraph, the term ``health insurance'' 
     does not include insurance consisting only of stoploss, 
     excess of loss, or reinsurance coverage.
       (2) Exception for individuals with uninsurable 
     conditions.--The State shall promulgate a list of medical or 
     health conditions for which an individual shall be eligible 
     for safety net plan coverage without applying for health 
     insurance or establishing proof of uninsurability under 
     paragraph (1). Individuals who can demonstrate the existence 
     or history of any medical or health conditions on such list 
     shall not be required to provide the proof described in 
     paragraph (1). The list shall be effective on the first day 
     of the operation of the safety net plan and may be amended 
     from time to time as may be appropriate.

     SEC. __13. QUALIFIED HEALTH INSURANCE COVERAGE UNDER SAFETY 
                   NET.

       In this subtitle, the term ``qualified health insurance 
     coverage'' means, with respect to a State, health insurance 
     coverage that provides benefits typical of major medical 
     insurance available in the individual health insurance market 
     in such State.

     SEC. __14. FUNDING OF SAFETY NET.

       (a) Limitations on Premiums.--
       (1) In general.--The premium established under a safety net 
     may not exceed 125 percent of the applicable standard risk 
     rate, except as provided in paragraph (2).
       (2) Surcharge for avoidable health risks.--A safety net may 
     impose a surcharge on premiums for individuals with avoidable 
     high risks, such as smoking.
       (b) Additional Funding.--A safety net shall provide for 
     additional funding through an assessment on all health 
     insurers, health service organizations, and health 
     maintenance organizations in the State through a nonprofit 
     association consisting of all such insurers and organizations 
     doing business in the State on an equitable and pro rata 
     basis consistent with section __11.

     SEC. __15. ADMINISTRATION.

       A safety net in a State shall be administered through a 
     contract with 1 or more insurers or third party 
     administrators operating in the State.

     SEC. __16. AUTHORIZATION OF APPROPRIATIONS.

       There are authorized to be appropriated such sums as may be 
     necessary to reimburse States for their costs in 
     administering this subtitle.
                                  ____

  SA 816. Mr. BOND proposed an amendment to the bill S. 1052, to amend 
the Public Health Service Act and the Employee Retirement Income 
Security Act of 1974 to protect consumers in managed care plans and 
other health coverage; as follows:

       On page 179, after line 14, add the following:

     SEC. __. ANNUAL REVIEW.

       (a) In General.--Not later than 24 months after the general 
     effective date referred to in section 401(a)(1), and annually 
     thereafter for each of the succeeding 4 calendar years (or 
     until a repeal is effective under subsection (b)), the 
     Secretary of Health and Human Services shall request that the 
     Institute of Medicine of the National Academy of Sciences 
     prepare and submit to the appropriate committees of Congress 
     a report concerning the impact of this Act, and the 
     amendments made by this Act, on the number of individuals in 
     the United States with health insurance coverage.
       (b) Limitation With Respect to Certain Plans.--If the 
     Secretary, in any report submitted under subsection (a), 
     determines that more than 1,000,000 individuals in the United 
     States have lost their health insurance coverage as a result 
     of the enactment of this Act, as compared to the number of 
     individuals with health insurance coverage in the 12-month 
     period preceding the date of enactment of this Act, section 
     302 of this Act shall be repealed effective on the date that 
     is 12 month after the date on which the report is submitted, 
     and the submission of any further reports under subsection 
     (a) shall not be required.
       (c) Funding.--From funds appropriated to the Department of 
     Health and Human Services for fiscal years 2003 and 2004, the 
     Secretary of Health and Human Services shall provide for such 
     funding as the Secretary determines necessary for the conduct 
     of the study of the National Academy of Sciences under this 
     section.
                                  ____

  SA 817. Mr. ALLARD (for himself, Mr. Bond, Mr. Santorum, and Mr. 
Nickles) proposed an amendment to the bill S. 1052, to amend the Public 
Health Service Act and the Employee Retirement Income Security Act of 
1974 to protect consumers in managed care plans and other health 
coverage; as follows:

       On page 148, between lines 23 and 24, insert the following:
       ``(D) Exclusion of small employers.--
       ``(i) In general.--Notwithstanding any other provision of 
     this paragraph, in addition to excluding certain physicians, 
     other health care professionals, and certain hospitals from 
     liability under paragraph (1), paragraph (1)(A) does not 
     create any liability on the part of a small employer (or on 
     the part of an employee of such an employer acting within the 
     scope of employment).
       ``(ii) Definition.--In clause (i), the term `small 
     employer' means an employer--

       ``(I) that, during the calendar year preceding the calendar 
     year for which a determination under this subparagraph is 
     being made, employed an average of at least 2 but not more 
     than 50 employees on business days; and
       ``(II) maintaining the plan involved that is acting, 
     serving, or functioning as a fiduciary, trustee or plan 
     administrator, including--

       ``(aa) a small employer described in section 3(16)(B)(i) 
     with respect to a plan maintained by a single employer; and
       ``(bb) one or more small employers or employee 
     organizations described in section 3(16)(B)(iii) in the case 
     of a multi-employer plan.
       ``(iii) Application of certain rules in determination of 
     employer size.--For purposes of this subparagraph:

       ``(I) Application of aggregation rule for employers.--All 
     persons treated as a single employer under subsection (b), 
     (c), (m), or (o) of section 414 of the Internal Revenue Code 
     of 1986 shall be treated as 1 employer.
       ``(II) Employers not in existence in preceding year.--In 
     the case of an employer which was not in existence throughout 
     the

[[Page S6934]]

     preceding calendar year, the determination of whether such 
     employer is a small employer shall be based on the average 
     number of employees that it is reasonably expected such 
     employer will employ on business days in the current calendar 
     year.
       ``(III) Predecessors.--Any reference in this paragraph to 
     an employer shall include a reference to any predecessor of 
     such employer.

       On page 165, between lines 14 and 15, insert the following:
       ``(D) Exclusion of small employers.--
       ``(i) In general.--Notwithstanding any other provision of 
     this paragraph, in addition to excluding certain physicians, 
     other health care professionals, and certain hospitals from 
     liability under paragraph (1), paragraph (1)(A) does not 
     create any liability on the part of a small employer (or on 
     the part of an employee of such an employer acting within the 
     scope of employment).
       ``(ii) Definition.--In clause (i), the term `small 
     employer' means an employer--

       ``(I) that, during the calendar year preceding the calendar 
     year for which a determination under this subparagraph is 
     being made, employed an average of at least 2 but not more 
     than 50 employees on business days; and
       ``(II) maintaining the plan involved that is acting, 
     serving, or functioning as a fiduciary, trustee or plan 
     administrator, including--

       ``(aa) a small employer described in section 3(16)(B)(i) 
     with respect to a plan maintained by a single employer; and
       ``(bb) one or more small employers or employee 
     organizations described in section 3(16)(B)(iii) in the case 
     of a multi-employer plan.
       ``(iii) Application of certain rules in determination of 
     employer size.--For purposes of this subparagraph:

       ``(I) Application of aggregation rule for employers.--All 
     persons treated as a single employer under subsection (b), 
     (c), (m), or (o) of section 414 of the Internal Revenue Code 
     of 1986 shall be treated as 1 employer.
       ``(II) Employers not in existence in preceding year.--In 
     the case of an employer which was not in existence throughout 
     the preceding calendar year, the determination of whether 
     such employer is a small employer shall be based on the 
     average number of employees that it is reasonably expected 
     such employer will employ on business days in the current 
     calendar year.
       ``(III) Predecessors.--Any reference in this paragraph to 
     an employer shall include a reference to any predecessor of 
     such employer.
                                  ____


  SA 818. Mr. KYL (for himself, Mr. Nelson of Nebraska, and Mr. 
Nickles) proposed an amendment to the bill S. 1052, to amend the Public 
Health Service Act and the Employee Retirement Income Security Act of 
1974 to protect consumers in managed care plans and other health 
coverage; as follows:

       Beginning on page 35, strike line 20 and all that follows 
     through line 8 on page 36, and insert the following:
       (C) No coverage for excluded benefits.--Nothing in this 
     subsection shall be construed to permit an independent 
     medical reviewer to require that a group health plan, or 
     health insurance issuer offering health insurance coverage in 
     connection with a group health plan, provide coverage for 
     items or services that are specifically excluded or expressly 
     limited under the plan or coverage and that are disclosed 
     under subparagraphs (C) and (D) of section 121(b)(1) and that 
     are not covered regardless of any determination relating to 
     medical necessity and appropriateness, experimental or 
     investigational nature of the treatment, or an evaluation of 
     the medical facts in the case involved.
       On page 37, line 16, strike ``and''.
       On page 37, line 25, strike the period and insert ``; 
     and''.
       On page 37, after line 25, add the following:
       ``(iii) notwithstanding clause (ii), adhere to the 
     definition used by the plan or issuer of `medically necessary 
     and appropriate', or `experimental or investigational' if 
     such definition is the same as either--

       ``(I) in the case of a plan or coverage that is offered in 
     a State that requires the plan or coverage to use a 
     definition of such term for purposes of health insurance 
     coverage offered to participants, beneficiaries and enrollees 
     in such State, the definition of such term that is required 
     by that State;
       ``(II) a definition that determines whether the provision 
     of services, drugs, supplies, or equipment--

       ``(aa) is appropriate to prevent, diagnose, or treat the 
     condition, illness, or injury;
       ``(bb) is consistent with standards of good medical 
     practice in the United States;
       ``(cc) is not primarily for the personal comfort or 
     convenience of the patient, the family, or the provider;
       ``(dd) is not part of or associated with scholastic 
     education or the vocational training of the patient; and
       ``(ee) in the case of inpatient care, cannot be provided 
     safely on an outpatient basis;

     except that this subclause shall not apply beginning on the 
     date that is 1 year after the date on which a definition is 
     promulgated based on a report that is published under 
     subsection (i)(6)(B); or
       ``(III) the definition of such term that is developed 
     through a negotiated rulemaking process pursuant to 
     subsection (i).

       On page 66, between lines 10 and 11, insert the following:
       ``(i) Establishment of Negotiated Rulemaking Safe Harbor.--
       ``(1) In general.--The Secretary shall establish, on an 
     expedited basis and using a negotiated rulemaking process 
     under subchapter III of chapter 5 of title 5, United States 
     Code, standards described in subsection (d)(3)(E)(iii)(IV) 
     (relating to the definition of `medically necessary and 
     appropriate' or `experimental or investigational') that group 
     health plans and health insurance issuers offering health 
     insurance coverage in connection with group health plans may 
     use when making a determination with respect to a claim for 
     benefits.
       ``(2) Publication of notice.--In carrying out the 
     rulemaking process under paragraph (1), the Secretary shall, 
     not later than November 30, 2002, publish a notice of the 
     establishment of a negotiated rulemaking committee, as 
     provided for under section 564(a) of title 5, United States 
     Code, to develop the standards described in paragraph (1). 
     Such notice shall include a solicitation for public comment 
     on the committee and description of--
       ``(A) the scope of the committee;
       ``(B) the interests that may be impacted by the standards;
       ``(C) the proposed membership of the committee;
       ``(D) the proposed meeting schedule of the committee; and
       ``(E) the procedure under which an individual may apply for 
     membership on the committee.
       ``(3) Target date for publication of rule.--As part of the 
     notice described in paragraph (2), and for purposes of this 
     subsection, the term `target date for publication' (as 
     referred to in section 564(a)(5) of title 5, United States 
     Code, means May 15, 2003.
       ``(4) Abbreviated period for submission of comments.--
     Notwithstanding section 564(c) of title 5, United States 
     Code, the Secretary shall provide for a period, beginning on 
     the date on which the notice is published under paragraph (2) 
     and ending on December 14, 2002, for the submission of public 
     comments on the committee under this subsection.
       ``(5) Appointment of negotiated rulemaking committee and 
     facilitator.--The Secretary shall carry out the following:
       ``(A) Appointment of committee.--Not later than January 10, 
     2003, appoint the members of the negotiated rulemaking 
     committee under this subsection.
       ``(B) Facilitator.--Not later than January 21, 2002, 
     provide for the nomination of a facilitator under section 
     566(c) of title 5, United States Code, to carry out the 
     activities described in subsection (d) of such section.
       ``(C) Membership.--Ensure that the membership of the 
     negotiated rulemaking committee includes at least one 
     individual representing--
       ``(i) health care consumers;
       ``(ii) small employers;
       ``(iii) large employers;
       ``(iv) physicians;
       ``(v) hospitals;
       ``(vi) other health care providers;
       ``(vii) health insurance issuers;
       ``(viii) State insurance regulators;
       ``(ix) health maintenance organizations;
       ``(x) third-party administrators;
       ``(xi) the medicare program under title XVIII of the Social 
     Security Act;
       ``(xii) the medicaid program under title XIX of the Social 
     Security Act;
       ``(xiii) the Federal Employees Health Benefits Program 
     under chapter 89 of title 5, United States Code;
       ``(xiv) the Department of Defense;
       ``(xv) the Department of Veterans' Affairs; and
       ``(xvi) the Agency for Healthcare Research and Quality.
       ``(6) Final committee report.--
       ``(A) In general.--Not later than 1 year after the general 
     effective date referred to in section 401, the committee 
     shall submit to the Secretary a report containing a proposed 
     rule.
       ``(B) Publication of rule.--If the Secretary receives a 
     report under subparagraph (A), the Secretary shall provide 
     for the publication in the Federal Register, by not later 
     than the date that is 30 days after the date on which such 
     report is received, of the proposed rule.
       ``(7) Failure to report.--If the committee fails to submit 
     a report as provided for in paragraph (6)(A), the Secretary 
     may promulgate a rule to establish the standards described in 
     subsection (d)(3)(E)(iii)(IV) (relating to the definition of 
     `medically necessary and appropriate' or `experimental or 
     investigational') that group health plans and health 
     insurance issuers offering health insurance coverage in 
     connection with group health plans may use when making a 
     determination with respect to a claim for benefits.

                          ____________________