[Congressional Record Volume 149, Number 68 (Thursday, May 8, 2003)]
[Senate]
[Pages S5951-S5973]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. CANTWELL (for herself, Mr. Crapo, Mrs. Murry, Ms. 
        Murkowski, Mr. Leahy, Mrs. Clinton, and Mr. Schumer):
  S. 1024. A bill to authorize the Attorney General to carry out a 
program, known as the Northern Border Prosecution Initiative, to 
provide funds to northern States to reimburse county and municipal 
governments for costs associated with certain criminal activities, and 
for other purposes; to the Committee on the Judiciary.
  Ms. CANTWELL. Mr. President, today my colleagues and I introduce the 
Northern Border Prosecution Reimbursement Initiative. This bill 
outlines an important initiative that would give our northern border 
States and counties financial assistance in prosecuting criminal and 
immigration-related cases that arise because of proximity to the 
border. I thank my fellow northern border Senators and cosponsors, 
Senators Crapo, Murry, Murkowski, Leahy, Clinton and Schumer for 
joining with me to introduce and work to pass this important 
legislation.
  This initiative is modeled on a successful program already in place 
for southern border States. The Southern Border Prosecution Initiative 
allows States and counties to apply for reimbursement of costs incurred 
in any federally initiated or declined-referred criminal case. The 
program is targeted at immigration-related cases, but is not limited 
only to cases involving immigration charges. Cases arising out of 
immigration issues but ranging from a misdemeanor property charge to a 
felony drug conviction are eligible for reimbursement under the 
southern border program. The program proposed in the legislation 
introduced today would be operated in the same way.
  Federal agencies--such as the Border Patrol and INS--have ongoing 
efforts to police the Nation's borders, resulting in hundreds of 
arrests each year. For many reasons, some of those cases are not 
pursued by Federal law enforcement authorities and instead are handed 
off to State or county officials for further prosecution. Instead of 
asking States to absorb those costs--likely at the expense of other 
important local law enforcement initiatives--the Northern Border 
Prosecution Reimbursement Initiative allows States and counties to 
receive compensation for pursuing these immigration-related cases.
  The Northern Border Prosecution Reimbursement Initiative would be 
administered by the Department of Justice's Bureau of Justice 
Assistance. States and counties would be able to apply for 
reimbursement during an annual application period, with no limit on the 
number of cases submitted. Under the act, funds distribution is not 
based on the size or population of a northern border State, but upon 
the number of eligible cases submitted by each jurisdiction. It is 
possible for reimbursement to equal 100 percent of costs, though money 
is distributed on a pro rata basis if applications exceed available 
revenues. Each of the 14 States along the northern border would be 
eligible for the reimbursement program: Alaska, Idaho, Maine, Michigan, 
Minnesota, Montana, New Hampshire, New York, North Dakota, Ohio, 
Pennsylvania, Vermont, Washington and Wisconsin.
  Last year, $40 million was provided to southern border States 
Arizona, California, New Mexico and Texas, offsetting the costs of 
prosecuting immigration-related cases. For 2002, $50 million was 
allocated to the program. My legislation simply authorizes $28 million 
for Fiscal Year 2004 be made available to northern border states for 
the same purpose.

  In the years leading up to Sept. 11, 2001, activity along the 
northern border had shifted primarily from a focus on immigration 
issues to those related to

[[Page S5952]]

trade and commerce. However, homeland security has grown into a 
paramount concern in the wake of the 2001 terror attacks, and our 
States and local governments are increasingly bearing an unfair 
financial burden in protecting and patrolling our national borders. 
There are hundreds of crossings along the 4,000 mile long northern 
border between the United States and Canada, and though improvements 
have been made to tighten security, the northern border has yet to 
receive the resources it needs to adequately enforce our Nation's 
immigration laws and border restrictions.
  The need for greater enforcement efforts along the northern border 
became glaringly evident in 1998 when Ahmed Ressam, a terrorist trained 
at one of Osama bin Laden's training camps in Afghanistan, was arrested 
shortly after crossing the Canadian border into Washington State. 
Explosives and other bomb-making materials were found in the trunk of 
Ressam's car. This frightening incident made clear the vulnerabilities 
we face along the porous northern border, vulnerabilities that became 
even more concerning after the Sept. 11, 2001, terror attacks.
  In the last two years, the Senate has taken steps to improve northern 
border security. I have worked with Senators from the 14 States that 
comprise the northern border--including my colleagues who join me as 
cosponsors on this legislation today--and we have successfully devoted 
more resources to northern border security efforts. The 2001 Department 
of Defense Appropriation's bill included $55.8 million for 500 
additional Immigration and Naturalization Service inspectors along the 
northern border--a 105 percent increase in staffing levels. That 
legislation also provided $23.9 million to transfer 100 border patrol 
agents and hire 100 new agents. Working to protect our northern border 
has been a bipartisan effort, enjoying cooperation from senators across 
the aisle and across the country. Now it is time to take another step 
toward greater border and national security and approve the Northern 
Border Prosecution Reimbursement Initiative.
  The costs of homeland security are increasingly being borne by States 
and local governments, an issue that this legislation tackles head-on. 
Without giving States and counties the necessary resources to pay for 
cases initiated by Federal authorities, other important local law 
enforcement initiatives will undoubtedly be shortchanged. States and 
the Federal Government must work together if our borders are to be 
truly safe. The Northern Border Prosecution Reimbursement Initiative is 
a mechanism by which all of the resources of the criminal justice 
system--local, State, and Federal--can work in harmony.
  Mr. SHELBY. Mr. President, I rise today to introduce the Older 
Americans Tax Fairness Act of 2003. My bill would completely eliminate 
the unjust taxation of Social Security benefits once and for all. The 
underlying premise of my legislation is simple: Social Security 
benefits were never intended to be taxed. At its inception and 
continuing on for the next fifty years, Social Security benefits were 
exempt from taxation. Budgetary shortfalls in 1984 and 1993, however, 
led to the taxation of these benefits.
  Because of the rising cost of living, many of our seniors are forced 
to work past age 65. To these Americans, every penny counts in 
determining whether they are able to pay for food, heating, and 
healthcare. However, by taxing Social Security benefits, we make it 
increasingly impossible for millions of older Americans to make ends 
meet. In effect, then, taxation of Social Security benefits forces many 
Americans to endure stressful situations in what should be the golden 
years of their lives.
  Taxation of Social Security benefits is also wrong because it changes 
the rules in the middle of the game. When seniors contributed to Social 
Security through the payment of payroll taxes, they did so with the 
understanding that they would one day receive those benefits tax-free. 
Unfortunately, because of runaway spending, many in the government have 
viewed Social Security taxation as a way to make up the shortfall 
between Federal spending and revenue. Such a decision was wrong then 
and it is even more wrong now as seniors face rising living costs.
  In addition to being fundamentally unfair, I believe that taxing 
Social Security benefits once seniors pass certain income thresholds 
discourages them from working. I firmly believe that senior citizens 
add a wealth of knowledge and experience to the workplace. As such, we 
must make sure that our American workforce is not deprived of these 
valuable assets. Our laws should encourage older Americans with a 
desire to work to continue contributing to our society. Unfortunately, 
our laws do just the opposite.
  Every year my office receives hundreds of letters and calls from 
older Americans throughout the country and Alabama describing the 
hardship that Social Security taxation has placed on their lives. The 
solution to this situation is simple--repeal the unfair taxation of 
these benefits. I therefore urge my colleagues to listen to their 
constituents and join me in support of my bill.
                                 ______
                                 
      By Mr. ENSIGN:
  S. 1029. A bill to enhance peace between the Israelis and 
Palestinians; to the Committee on Foreign Relations.
  Mr. ENSIGN. Mr. President, I ask unanimous consent that the text of 
this bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1029

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

     SEC. 1. SHORT TITLE.

       This title may be cited as the ``Israeli-Palestinian Peace 
     Enhancement Act of 2003''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The security of the State of Israel is a major and 
     enduring national security interest of the United States.
       (2) A lasting peace in the Middle East region can only take 
     root in an atmosphere free of violence and terrorism.
       (3) The Palestinian people have been ill-served by leaders 
     who, by resorting to violence and terrorism to pursue their 
     political objectives, have brought economic and personal 
     hardship to their people and brought a halt to efforts 
     seeking a negotiated settlement of the conflict.
       (4) The United States has an interest in a Middle East in 
     which two states, Israel and Palestine, will live side by 
     side in peace and security.
       (5) In his speech of June 24, 2002, and in other 
     statements, President George W. Bush outlined a comprehensive 
     vision of the possibilities of peace in the Middle East 
     region following a change in Palestinian leadership.
       (6) The Palestinian state must be a reformed, peaceful, and 
     democratic state that abandons forever the use of terror.
       (7) On April 29, 2003, the Palestinian Legislative Council 
     confirmed in office, by a vote of 51 yeas, 18 nays, and 3 
     abstentions, the Palestinian Authority's first prime 
     minister, Mahmoud Abbas (Abu Mazen), and his cabinet.
       (8) In his remarks prior to the vote of the Palestinian 
     Legislative Council, Mr. Abbas declared: ``The government 
     will concentrate on the question of security . . . The 
     unauthorized possession of weapons, with its direct threat to 
     the security of the population, is a major concern that will 
     be relentlessly addressed . . . There will be no other 
     decision-making authority except for the Palestinian 
     Authority.''.
       (9) In those remarks, Mr. Abbas further stated: ``We 
     denounce terrorism by any party and in all its forms both 
     because of our religious and moral traditions and because we 
     are convinced that such methods do not lend support to a just 
     cause like ours but rather destroy it.''.
       (10) Israel has repeatedly indicated its willingness to 
     make painful concessions to achieve peace once there is a 
     partner for peace on the Palestinian side.

     SEC. 3. PURPOSES.

       The purposes of this title are--
       (1) to express the sense of Congress with respect to United 
     States recognition of a Palestinian state; and
       (2) to demonstrate United States willingness to provide 
     substantial economic and humanitarian assistance, and to 
     support large-scale multilateral assistance, after the 
     Palestinians have achieved the reforms outlined by President 
     Bush and have achieved peace with the State of Israel.

     SEC. 4. SENSE OF CONGRESS.

       It is the sense of Congress that--
       (1) peace between Israel and the Palestinians cannot be 
     negotiated until the Palestinian system of government has 
     been transformed along the lines outlined in President Bush's 
     June 24, 2002, speech;
       (2) substantial United States and international economic 
     assistance will be needed after the Palestinians have 
     achieved the reforms described in section 620K(c)(2) of the 
     Foreign Assistance Act of 1961 (as added by section 1506 of 
     this Act) and have made a lasting and secure peace with 
     Israel;
       (3) the Palestinian people merit commendation on the 
     confirmation of the Palestinian Authority's first prime 
     minister, Mahmoud Abbas (Abu Mazen), and his cabinet;

[[Page S5953]]

       (4) the new Palestinian administration urgently should take 
     the necessary security-related steps to allow for 
     implementation of a performance-based road map to resolve the 
     Israeli-Palestinian conflict;
       (5) the United States Administration should work vigorously 
     toward the goal of two states living side-by-side in peace 
     within secure and internationally-recognized boundaries free 
     from threats or acts of force; and
       (6) the United States has a vital national security 
     interest in a permanent, comprehensive, and just resolution 
     of the Arab-Israeli conflict, and particularly the 
     Palestinian-Israeli conflict, based on the terms of United 
     Nations Security Council Resolutions 242 and 338.

     SEC. 5. RECOGNITION OF A PALESTINIAN STATE.

        It is the sense of Congress that a Palestinian state 
     should not be recognized by the United States until the 
     President determines that--
       (1) a new leadership of a Palestinian governing entity, not 
     compromised by terrorism, has been elected and taken office; 
     and
       (2) the newly-elected Palestinian governing entity--
       (A) has demonstrated a firm and tangible commitment to 
     peaceful coexistence with the State of Israel and to ending 
     anti-Israel incitement, including the cessation of all 
     officially sanctioned or funded anti-Israel incitement;
       (B) has taken appropriate measures to counter terrorism and 
     terrorist financing in the West Bank and Gaza, including the 
     dismantling of terrorist infrastructures and the confiscation 
     of unlawful weaponry;
       (C) has established a new Palestinian security entity that 
     is fully cooperating with the appropriate Israeli security 
     organizations;
       (D) has achieved exclusive authority and responsibility for 
     governing the national affairs of a Palestinian state, has 
     taken effective steps to ensure democracy, the rule of law, 
     and an independent judiciary, and has adopted other reforms 
     ensuring transparent and accountable governance; and
       (E) has taken effective steps to ensure that its education 
     system promotes the acceptance of Israel's existence and of 
     peace with Israel and actively discourages anti-Israel 
     incitement.

     SEC. 6. LIMITATION ON ASSISTANCE TO A PALESTINIAN STATE.

       Chapter 1 of part III of the Foreign Assistance Act of 1961 
     (22 U.S.C. 2351 et seq.) is amended--
       (1) by redesignating the second section 620G (as added by 
     section 149 of Public Law 104-164 (110 Stat. 1436)) as 
     section 620J; and
       (2) by adding at the end the following new section:

     ``SEC. 620K. LIMITATION ON ASSISTANCE TO A PALESTINIAN STATE.

       ``(a) Limitation.--
       ``(1) In general.--Notwithstanding any other provision of 
     law, assistance may be provided under this Act or any other 
     provision of law to the government of a Palestinian state 
     only during a period for which a certification described in 
     subsection (c) is in effect. The limitation contained in the 
     preceding sentence shall not apply (A) to humanitarian or 
     development assistance that is provided through 
     nongovernmental organizations for the benefit of the 
     Palestinian people in the West Bank and Gaza, or (B) to 
     assistance that is intended to reform the Palestinian 
     Authority and affiliated institutions, or a newly elected 
     Palestinian governing entity, in order to help meet the 
     requirements contained in subparagraphs (A) through (H) of 
     subsection (c)(2) or to address the matters described in 
     subparagraphs (A) through (E) of section 1505(2) of the 
     Israeli-Palestinian Peace Enhancement Act of 2003.
       ``(2) Waiver.--The President may waive the limitation of 
     the first sentence of paragraph (1) if the President 
     determines and certifies to the Committee on International 
     Relations of the House of Representatives and the Committee 
     on Foreign Relations of the Senate that it is vital to the 
     national interest of the United States to do so.
       ``(b) Congressional Notification.--
       ``(1) In general.--Assistance made available under this Act 
     or any other provision of law to a Palestinian state may not 
     be provided until 15 days after the date on which the 
     President has provided notice thereof to the Committee on 
     International Relations and the Committee on Appropriations 
     of the House of Representatives and to the Committee on 
     Foreign Relations and the Committee on Appropriations of the 
     Senate in accordance with the procedures applicable to 
     reprogramming notifications under section 634A(a) of this 
     Act.
       ``(2) Sunset.--Paragraph (1) shall cease to be effective 
     beginning ten years after the date on which notice is first 
     provided under such paragraph.
       ``(c) Certification.--A certification described in this 
     subsection is a certification transmitted by the President to 
     Congress that--
       ``(1) a binding international peace agreement exists 
     between Israel and the Palestinians that--
       ``(A) was freely signed by both parties;
       ``(B) guarantees both parties' commitment to a border 
     between two states that constitutes a secure and 
     internationally recognized boundary for both states, with no 
     remaining territorial claims;
       ``(C) provides a permanent resolution for both Palestinian 
     refugees and Jewish refugees from Arab countries; and
       ``(D) includes a renunciation of all remaining Palestinian 
     claims against Israel through provisions that commit both 
     sides to the ``end of the conflict''; and
       ``(2) the new Palestinian government--
       ``(A) has been democratically elected through free and fair 
     elections, has exclusive authority and responsibility for 
     governing the national affairs of the Palestinian state, and 
     has achieved the reforms outlined by President Bush in his 
     June 24, 2002, speech;
       ``(B) has completely renounced the use of violence against 
     the State of Israel and its citizens, is vigorously 
     attempting to prevent any acts of terrorism against Israel 
     and its citizens, and punishes the perpetrators of such acts 
     in a manner commensurate with their actions;
       ``(C) has dismantled, and terminated the funding of, any 
     group within its territory that conducts terrorism against 
     Israel;
       ``(D) is engaging in ongoing and extensive security 
     cooperation with the State of Israel;
       ``(E) refrains from any officially sanctioned or funded 
     statement or act designed to incite Palestinians or others 
     against the State of Israel and its citizens;
       ``(F) has an elected leadership not compromised by terror;
       ``(G) is demilitarized; and
       ``(H) has no alliances or agreements that pose a threat to 
     the security of the State of Israel.
       ``(d) Recertifications.--Not later than 90 days after the 
     date on which the President transmits to Congress an initial 
     certification under subsection (c), and every 6 months 
     thereafter for the 10-year period beginning on the date of 
     transmittal of such certification--
       ``(1) the President shall transmit to Congress a 
     recertification that the requirements contained in subsection 
     (c) are continuing to be met; or
       ``(2) if the President is unable to make such a 
     recertification, the President shall transmit to Congress a 
     report that contains the reasons therefor.
       ``(e) Rule of Construction.--A certification under 
     subsection (c) shall be deemed to be in effect beginning on 
     the day after the last day of the 10-year period described in 
     subsection (d) unless the President subsequently determines 
     that the requirements contained in subsection (c) are no 
     longer being met and the President transmits to Congress a 
     report that contains the reasons therefor.''.

     SEC. 7. AUTHORIZATION OF ASSISTANCE TO A PALESTINIAN STATE.

       Chapter 1 of part III of the Foreign Assistance Act of 1961 
     (22 U.S.C. 2351 et seq.), as amended by section 1506, is 
     further amended by adding at the end the following new 
     section:

     ``SEC. 620L. AUTHORIZATION OF ASSISTANCE TO A PALESTINIAN 
                   STATE.

       ``(a) Assistance.--The President is authorized to provide 
     assistance to a Palestinian state in accordance with the 
     requirements of this section.
       ``(b) Activities To Be Supported.--Assistance provided 
     under subsection (a) shall be used to support activities 
     within a Palestinian state to substantially improve the 
     economy and living conditions of the Palestinians by, among 
     other things, providing for economic development in the West 
     Bank and Gaza, continuing to promote democracy and the rule 
     of law, developing water resources, assisting in security 
     cooperation between Israelis and Palestinians, and helping 
     with the compensation and rehabilitation of Palestinian 
     refugees.
       ``(c) Authorization of Appropriations.--Of the amounts made 
     available to carry out chapter 4 of part II of this Act for a 
     fiscal year, there are authorized to be appropriated to the 
     President to carry out subsections (a) and (b) such sums as 
     may be necessary for each such fiscal year.
       ``(d) Coordination of International Assistance.--
       ``(1)  In general.--Beginning on the date on which the 
     President transmits to Congress an initial certification 
     under section 620K(c), the Secretary of State shall seek to 
     convene one or more donors conferences to gain commitments 
     from other countries, multilateral institutions, and 
     nongovernmental organizations to provide economic assistance 
     to Palestinians to ensure that such commitments to provide 
     assistance are honored in a timely manner, to ensure that 
     there is coordination of assistance among the United States 
     and such other countries, multilateral institutions, and 
     nongovernmental organizations, to ensure that the assistance 
     provided to Palestinians is used for the purposes for which 
     is was provided, and to ensure that other countries, 
     multilateral institutions, and nongovernmental organizations 
     do not provide assistance to Palestinians through entities 
     that are designated as terrorist organizations under United 
     States law.
       ``(2)  Report.--Not later than 180 days after the date of 
     the enactment of this section, and on an annual basis 
     thereafter, the Secretary of State shall prepare and submit 
     to the Committee on International Relations and the Committee 
     on Appropriations of the House of Representatives and the 
     Committee on Foreign Relations and the Committee on 
     Appropriations of the Senate a report that describes the 
     activities undertaken to meet the requirements of paragraph 
     (1), including a description of amounts committed, and the 
     amounts provided, to a Palestinian state or Palestinians 
     during the reporting period by each country and 
     organization.''.
                                 ______
                                 
      By Mr. BINGAMAN:
  S. 1030. A bill to expand the number of individuals and families with 
health

[[Page S5954]]

insurance coverage, and for other purposes; to the Committee on 
Finance.
  Mr. BINGAMAN. Mr. President, yesterday, I introduced the first part 
of a series of proposals to protect and strengthen our nation's health 
care safety net. That bill, the ``Strengthening Our States'' or SOS Act 
of 2003,'' seeks to protect and improve the Medicaid program--a 
critical component of our country's health system. To repeat the words 
of Diane Rowland and Jim Tallon of the Kaiser Commission on Medicaid 
and the Uninsured, ``Medicaid is the glue that helps hold our health 
system together and takes on the highest-risk, sickest, and most 
expensive populations from private insurance and Medicare.
  Like a waterfront community that seeks to set up barricades against a 
rising river, defending the Medicaid program from attacks, such as the 
idea of a block grant, is a top priority.
  However, once that is assured, we must also take the next step and 
confront the fact that an estimated 41.2 million people, or almost 15 
percent of the population, was without health insurance during the 
entire year of 2001, which was an increase of 1.4 million people over 
2000.
  Moreover, the numbers in 2002 and this year have undoubtedly 
worsened. A report by the National Coalition on Health Care says, ``The 
confluence of powerful economic forces, fueled by the terrorist attacks 
on September 11, have unleashed a `perfect storm' that could increase 
dramatically the number of uninsured in the U.S.--with as many as 6 
million people in total losing their coverage in 2001 and 2002.''
  The number in New Mexico are staggering. New Mexico leads or ranks 
second only to Texas in the percentage of its citizens who are 
uninsured. In fact, New Mexico is the only state in the country with 
less than half of its population having private health insurance 
coverage.
  A rather shocking statistic, which also continues to worsen, is that 
one out of every three Hispanic citizens are uninsured. In fact, less 
than 43 percent of the Hispanic population now has employer-based 
coverage nationwide, which is in sharp comparison to the 68 percent of 
non-Hispanic whites who have employer-based coverage.
  To address this growing crisis, I have worked closely with the 
American College of Physicians since last fall on the legislative 
proposal, which I call the ``Health Coverage, Affordability, 
Responsibility, and Equity Act'' or the ``HealthCARE Act of 2003.'' The 
proposal seeks to: First, build upon programs that currently work, 
including Medicaid, employer coverage, and the private market; second, 
provide choices for uninsured individuals, states, and small businesses 
while rejecting either employer or individual mandates; third, use 
methods that have bipartisan support by borrowing the best ideas from 
Democratic and Republican proposals; and, fourth, simplify rather than 
complicate coverage.

  This is in sharp contrast, in a number of ways, to past efforts to 
create untried schemes or to impose mandates upon either businesses or 
the individual. It also seeks to bridge the divide between Democrats 
and Republicans. This has certainly not been easy to put together and 
nor will it be easy to pass. On the other hand, we have tried to start 
with the tools and principles more likely to get beyond the partisan 
divide.
  As Julie Rovner of the National Journal recently wrote, ``If 
reforming the nation's healthcare system was easy, the old saw goes, it 
would have been done long ago. But for the moment, those who care about 
the issue seem to be succeeding only in butting each other's heads. 
Republicans keep pushing market-oriented reforms while Democrats want 
to expand existing public programs. And each party continues to reject 
the other's ideas. . . .''
  The ``Health CARE Act'' seeks to break that partisan gridlock. First, 
it adopts and builds upon the notion of many Republicans to offer tax 
credits for the uninsured. As such, the bill would enact a new health 
insurance tax credit that is both refundable and advanceable to 
uninsured Americans with incomes up to 200 percent of the poverty level 
to purchase health coverage through a variety of options, including 
employer-coverage, State purchasing pools, or even the individual 
market--something pushed by a number of Republicans for many years but 
rejected by many Democrats.
  Second, the legislation expands coverage through a State option with 
Federal financial support through the Medicaid program to anyone up to 
100 percent of the poverty level. Medicaid has been a tried and tested 
program for low-income Americans over the years and is a far better and 
more viable option to people with incomes below the poverty level than 
a tax credit would be. Furthermore, few beneath the poverty level have 
the option of employer-coverage. Therefore, public programs, such as 
Medicaid, for low-income Americans makes far more sense than a tax 
credit.
  Furthermore, through the strengthened and improved state purchasing 
pools provided for in the legislation, individuals and small businesses 
would be afforded better options to get coverage with a choice of plans 
that is typically not available to them with, what we believe will be, 
lower costs due to the ability to purchase coverage as a group.
  Consequently, this approach attempts to build upon the ideas of both 
political parties, as it has both public program and tax credit aspects 
to it. Our hope is that people will see the things both parties like in 
it rather than focusing on what they do not like. In fact, we have also 
added the creation of an on-going expert health commission to make 
recommendations for further reforms and mid-course corrections in the 
future.
  This bill is introduced in the spirit of compromise. To those on the 
right, I recognize your concern about the expansion of Medicaid as not 
being as market-oriented as you might prefer, but would point out that 
tax credits are virtually unworkable and employer-sponsored coverage 
often unavailable for people below the poverty level and that Medicaid 
is largely contracted out to private health plans--the same that many 
of you are enrolled in.
  To those on the left, I recognize your concerns about tax credits and 
the potential for adverse selection with people buying coverage through 
the individual market, but I say to you that these are tax credits for 
low-income people and that we have taken steps in the legislation to 
mitigate problems that the added options in the bill create with 
respect to adverse selection. I would add that any expansion of 
coverage to people without health insurance is a good thing.
  The most important message that I hope this bill carries is that we 
must stop having the perfect be the enemy of the good. This proposal is 
certainly not perfect but we hope it makes a very good start.
  I would like to thank the American College of Physicians, or ACP, for 
their outstanding leadership and help in putting this legislation 
together. ACP has been a long-standing advocate for expanding health 
coverage and has authored landmark reports on the important role that 
health insurance has in reducing people's morbidity and mortality. In 
fact, to cite the conclusion of one of those studies, ``Lack of 
insurance contributes to the endangerment of the health of each 
uninsured American as well as the collective health of the nation.''
  I would also like to thank the many people at the Economic and Social 
Research Institute, or ERSI, on their forethought, advice, and counsel 
as we refined the proposal over the past number of months. Their non-
partisan approach and expertise have been invaluable to making the bill 
a workable and well-reasoned reality.
  It should also be noted that the ideas put forth in the bill are 
based upon much of the expert work commissioned by ESRI, funded by the 
Robert Wood Johnson Foundation, and the Task Force on the Future of 
Health Insurance, funded by the Commonwealth Fund. As a result, the 
work of a number of other experts is reflected in the legislation and 
we thank you as well.
  Among the endorsing organizations for this legislation are all of the 
leading primary care physician groups in our country. In addition to 
the American College of Physicians, the bill has been endorsed by the 
American Academy of Family Physicians, the American Academy of 
Pediatrics, and the American Geriatrics Society.
  As a practicing physician in New Mexico, Dr. Robert Strickland sums 
it up well. As he wrote in an editorial

[[Page S5955]]

published in the Albuquerque Journal about this legislation yesterday, 
``As a New Mexico internist for 31 years, I have seen many uninsured 
people go without care until it is too late for me to do much to help 
them. The HealthCARE Act offers the potential of breaking the political 
gridlock that has allowed this crisis in health care to go on for far 
too long.''
  I hope we can break the gridlock and urge my colleagues to heed the 
call of our nation's primary care doctors to support this legislation.
  I would ask unanimous consent that letters of endorsement from the 
American College of Physicians, the American Academy of Family 
Physicians, the American Academy of Pediatrics, the American Geriatrics 
Society, and Families USA, and the text of the legislation printed in 
the Record.
  There being no ojection, the material was ordered to be printed in 
the Record, as follows:


                               American College of Physicians,

                                      Washington, DC, May 8, 2003.
     Hon. Jeff Bingaman,
     U.S. Senate, 703 Senate Hart Office Building, Washington, DC.
       Dear Senator Bingaman: on behalf of the American College of 
     Physicians (ACP), I am pleased to express our strong support 
     for the Health Coverage, Affordability, Responsibility and 
     Equity Act of 2003 (HealthCARE Act of 2003). ACP is the 
     largest medical specialty society in the United States, 
     representing 115,000 doctors of internal medicine and medical 
     students.
       We very much appreciate the opportunity you have given us 
     to translate many of the ideas in ACP's proposal to provide 
     health insurance coverage to all Americans by the end of the 
     decade into the HealthCARE Act of 2003. Specifically:
       States will be given new options to extend health insurance 
     coverage to low-income working Americans, without imposing 
     unfunded mandates on financially strapped state treasuries.
       Advance, refundable tax credits will be made available to 
     uninsured working Americans with incomes up to 200 percent of 
     the federal poverty level.
       The tax credit will provide a premium subsidy equal to what 
     the Federal Government now provides to its own employees.
       Tax credit recipients will have the options of buying 
     coverage through state purchase group arrangements modeled 
     after the Federal Employees Health Benefits Program, giving 
     them the same types and variety of health plan options now 
     available only to federal employees, or from qualified non-
     group insurers.
       Small employers will have new options for obtaining 
     coverage, including having access to the variety and types of 
     health plans offered to federal employees.
       An expert advisory commission will recommend essential 
     benefits that participating health plans will be encouraged 
     to offer, as well as ways to expand coverage to those with 
     incomes above 200 percent of the federal poverty level.
       ACP is confident that this framework can succeed where 
     other health reform proposals have failed. By offering 
     incentives and choices to states, employers, and consumers, 
     instead of ``one-size-fits-all'' government mandates, the 
     HealthCARE Act has the potential of unifying, instead of 
     dividing, key stakeholders.
       The American College of Physicians commends you for your 
     leadership in introducing the HealthCARE Act of 2003, and we 
     look forward to working with you and lawmakers from both 
     political parties in getting the bill enacted into law.
           Sincerely,
                                        Munsey S. Wheby, MD, FACP,
     President.
                                  ____

                                                      May 5, 2003.
     The Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bingaman: On behalf of the 94,300 members of 
     the American Academy of Family Physicians, I commend you for 
     your outstanding leadership in the effort to assure access to 
     health care for the uninsured in this nation. The AAFP has 
     reviewed your draft legislation that would change Medicaid, 
     SCHIP and the federal income tax code to make health coverage 
     more affordable to uninsured Americans. I am pleased to 
     inform you that the AAFP supports your bill and offers you 
     our assistance in seeking its passage.
       Your legislative proposal is a wide-ranging measure that 
     would take us noticeably closer to affordable health care 
     coverage for all. For example, your bill would:
       assist states in creating purchasing pools to provide low-
     cost insurance for uninsured individuals with incomes up to 
     200 percent of the federal poverty level;
       allow small businesses to have access to these state-
     operated purchasing pools so that they can offer affordable 
     health insurance to their employees;
       provide states with the new option to offer ``need-based'' 
     eligibility for Medicaid beneficiaries;
       remove the federal cap on non-waivered SCHIP coverage; and
       offer federal income tax credits and premium subsidies for 
     those currently uninsured whose income is at or below 200 
     percent of the federal poverty level and who are ineligible 
     for Medicaid for SCHIP coverage or other insurance options.
       These and other provisions of your proposal demonstrate 
     your longstanding commitment to the health of everyone in 
     this country and we are pleased and honored to support you in 
     this effort.
           Sincerely,
                                     Warren A. Jones, M.D., FAAFP,
     Board Chair.
                                  ____



                               American Academy of Pediatrics,

                                      Washington, DC, May 7, 2003.
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bingaman: On behalf of the 57,000 pediatrician 
     members of the American Academy of Pediatrics (AAP), I write 
     today in support of the Health Coverage, Affordability, 
     Responsibility and Equity Act of 2003.
       The problem of the uninsured and underinsured is real and 
     growing. This legislation is an effective way to provide 
     greater access to comprehensive health care for more 
     Americans. This legislation would allow poor and near poor 
     families a variety of options for affordable and 
     comprehensive health coverage.
       The Academy especially appreciates the effort to 
     strengthen, not undermine current public programs. Currently, 
     more than 9 million children are uninsured in this country 
     and million more are uninsured for part of the year, churning 
     on and off of health coverage. Seventy percent of the 
     uninsured children are eligible for public programs but 
     unenrolled. This legislation would encourage greater 
     enrollment of these uninsured children by providing financial 
     incentives to the states to enroll and retain these children, 
     and by allowing families to unify their health coverage.
       Thank you for your leadership and commitment to our 
     nation's families and their access to quality health care. We 
     look forward to our continued work together.
           Sincerely,
                                         E. Stephen Edwards, M.D.,
     President.
                                  ____

                                      American Geriatrics Society,
                                     New York, NY, April 22, 2003.
     Hon. Jeff Bingaman
     U.S. Senate,
     Washington, DC.
       Dear Senator Bingaman: The American Geriatrics Society 
     (AGS), an organization of over 6,000 geriatricians and other 
     health professionals who are specially trained in the 
     management of care for frail, chronically ill older patients, 
     is pleased to endorse the Health CARE Act of 2003. We commend 
     you for your sponsorship of this important bill, which seeks 
     to improve health coverage for millions of uninsured 
     Americans.
       By simplifying and expanding coverage choices for uninsured 
     individuals and small businesses, your legislation represents 
     a balanced approach to confronting one of our nation's most 
     pressing problems. The consequences of having little or no 
     health insurance are well documented. People without coverage 
     are less likely to have a regular source of care, don't 
     receive recommended health screening services nor do they 
     have appropriate care management for chronic conditions. As a 
     result, uninsured patients often are sicker and are more 
     likely to die sooner than people who have health insurance. 
     Adults in late middle age are especially susceptible to 
     deteriorating health if they never had or lose their health 
     insurance coverage.
       The Health CARE Act of 2003 would improve the health of 
     million of Americans expanding their access to health 
     insurance coverage. AGS applauds your willingness to tackle 
     this complex issue and looks forward to working with you to 
     enact this bill.
           Sincerely,
                                                Jerry Johnson, MD,
     President.
                                  ____

                                                   April 28, 2003.
     Hon. Jeff Bingaman,
     U.S. Senate, 703 Hart Senate Office Building, Washington, DC 
         20510.
       Dear Senator Bingaman: Congratulations on your introduction 
     of the HealthCARE Act of 2003. Your bill is an important 
     initiative that seeks to combine good health policy with the 
     politically achievable.
       While Families USA, the national consumer health 
     organization, has historically supported expansions of public 
     programs like Medicaid and SCHIP, we recognize that different 
     approaches are necessary if we are to see the enactment of 
     major reductions in the number of uninsured. Your bill 
     adroitly combines (1) a federally financed expansion of 
     Medicaid and SCHIP to cover all those under 100 percent of 
     the federal poverty level with (2) a premium subsidy/tax 
     credit program to help those under 200 percent of poverty buy 
     into various health insurance plans. Further, it lays the 
     groundwork for an expansion of insurance to the rest of 
     society by the end of the decade.
       It is imperative that Congress act as soon as possible to 
     help the nearly one our of three non-elderly Americans who 
     are uninsured sometime during any two-year period. Federal 
     help with Medicaid is particularly urgent to counter the 
     massive cutbacks in coverage by the various states during the 
     current economic downturn. As our recent report (``Going 
     Without Health Insurance, Nearly One in Three Non-Elderly 
     Americans'') shows, the problem of the uninsured,

[[Page S5956]]

     and the adverse consequences of being uninsured, are much 
     worse than previously reported. In your State of New Mexico, 
     for example, 602,000 people--38.6 percent of the population 
     under age 65--were uninsured sometime in 2002-2002. Of that 
     number, 410,000 were uninsured for more than six months.
       Your bill would make a major reduction in these 
     unacceptable numbers. It would greatly improve the quality of 
     health and security in America, and we look forward to 
     working with you towards its enactment.
           Sincerely,
                                                Ronald F. Pollack,
                                               Executive Director.

                                S. 1030

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Health 
     Coverage, Affordability, Responsibility, and Equity Act of 
     2003''or the ``HealthCARE Act of 2003''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.

                TITLE I--INCREASING HEALTH CARE COVERAGE

                     Subtitle A--Medicaid and SCHIP

Sec. 101. State option to offer medicaid coverage based on need.
Sec. 102. State option to provide coverage of children under SCHIP in 
              excess of the State's allotment.

  Subtitle B--Refundable Tax Credit for Health Insurance Costs of Low-
                    Income Individuals and Families

Sec. 111. Credit for health insurance costs of certain low-income 
              individuals.
Sec. 112. Advance payment of credit for health insurance costs of 
              eligible low-income individuals.

               TITLE II--IMPROVING ACCESS TO HEALTH PLANS

Sec. 201. Definitions.
Sec. 202. Establishment of health insurance purchasing pools.
Sec. 203. Purchasing pools.
Sec. 204. Purchasing pool operators.
Sec. 205. Contracts with participating insurers.
Sec. 206. Options for health benefits coverage.
Sec. 207. Enrollment process for eligible individuals.
Sec. 208. Plan premiums.
Sec. 209. Enrollee premium share.
Sec. 210. Payments to purchasing pool operators and payments to 
              participating insurers.
Sec. 211. State-based reinsurance programs.
Sec. 212. Coverage under individual health insurance.
Sec. 213. Use of premium subsidies to unify family coverage with 
              members enrolled in medicaid and SCHIP.
Sec. 214. Coverage through employer-sponsored health insurance.
Sec. 215. Participation by small employers.
Sec. 216. Report.
Sec. 217. Authorization of appropriations.

 TITLE III--NATIONAL ADVISORY COMMISSION ON EXPANDED ACCESS TO HEALTH 
                                  CARE

Sec. 301. National Advisory Commission on Expanded Access to Health 
              Care.
Sec. 302. Congressional action.

                        TITLE IV--STATE WAIVERS

Sec. 401. State waivers.

                TITLE I--INCREASING HEALTH CARE COVERAGE

                     Subtitle A--Medicaid and SCHIP

     SEC. 101. STATE OPTION TO OFFER MEDICAID COVERAGE BASED ON 
                   NEED.

       (a) State Option.--Section 1902(a)(10)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1396a) is amended--
       (1) by striking ``or'' at the end of subclause (XVII);
       (2) by adding ``or'' at the end of subclause (XVIII); and
       (3) by adding at the end the following:

       ``(XIX) who are not otherwise eligible for medical 
     assistance under this title and whose income does not exceed 
     such income level as the State may establish, expressed as a 
     percentage (not to exceed 100) of the income official poverty 
     line (as defined by the Office of Management and Budget, and 
     revised annually in accordance with section 673(2) of the 
     Omnibus Budget Reconciliation Act of 1981) applicable to a 
     family of the size involved;''.

       (b) Increased FMAP.--Section 1905 of the Social Security 
     Act (42 U.S.C. 1396d) is amended--
       (1) in the first sentence of subsection (b)--
       (A) by striking ``and (4)'' and inserting ``(4)''; and
       (B) by inserting before the period the following: ``, and 
     (5) in the case of a State that meets the conditions 
     described in paragraph (1) of subsection (x), the Federal 
     medical assistance percentage shall be equal to the need-
     based enhanced FMAP described in paragraph (2) of subsection 
     (x)''; and
       (2) by adding at the end the following:
       ``(x)(1) For purposes of clause (5) of the first sentence 
     of subsection (b), the conditions described in this 
     subsection are the following:
       ``(A) The State provides medical assistance to individuals 
     described in subsection (a)(10)(A)(ii)(XIX).
       ``(B) The State uses streamlined enrollment and outreach 
     measures to all individuals described in subparagraph (A) 
     including--
       ``(i) the same application and retention procedures (such 
     as 1-page enrollment forms and enrollment by mail) used by 
     the majority of State programs under title XXI during the 
     preceding year; and
       ``(ii) outreach efforts proportional in scope and 
     reasonably expected effectiveness to those employed by the 
     State during a comparable stage of implementation of the 
     State's program under title XXI.
       ``(C) The State applies eligibility standards and 
     methodologies under this title with respect to individuals 
     residing in the State who have not attained age 65 that are 
     not more restrictive (as determined under section 
     1902(a)(10)(C)(i)(III)) than the standards and methodologies 
     that applied under this title with respect to such 
     individuals as of July 1, 2003.
       ``(2)(A) For purposes of clause (5) of the first sentence 
     of subsection (b), the need-based enhanced FMAP for a State 
     for a fiscal year, is equal to the Federal medical assistance 
     percentage (as defined in the first sentence of subsection 
     (b)) for the State increased, subject to subparagraph (B), by 
     such percentage increase as would compensate all States for 
     the additional expenditures that would be incurred by all 
     States if the States were to provide medical assistance to 
     all individuals whose income does not exceed 100 percent of 
     the income official poverty line (as defined by the Office of 
     Management and Budget, and revised annually in accordance 
     with section 673(2) of the Omnibus Budget Reconciliation Act 
     of 1981) applicable to a family of the size involved and who 
     are eligible for such assistance only on the basis of section 
     1902(a)(10)(A)(ii)(XIX).
       ``(B) In the case of a State that provides medical 
     assistance to individuals described in section 
     1902(a)(10)(A)(ii)(XIX) but limits such assistance to 
     individuals with income at or below a percentage of the 
     income official poverty line (as defined by the Office of 
     Management and Budget, and revised annually in accordance 
     with section 673(2) of the Omnibus Budget Reconciliation Act 
     of 1981) applicable to a family of the size involved that is 
     less than 100, the Secretary shall reduce the need-based 
     enhanced FMAP otherwise determined for the State under 
     subparagraph (A) by a proportion based on the national income 
     distribution of all individuals in all States who are 
     (regardless of whether such individuals are enrolled under 
     this title) eligible for medical assistance only on the basis 
     of section 1902(a)(10)(A)(ii)(XIX).''.
       (c) Conforming Amendments.--Section 1905(a) of the Social 
     Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
     preceding paragraph (1)--
       (1) by striking ``or'' at the end of clause (xii);
       (2) by adding ``or'' at the end of clause (xiii); and
       (3) by inserting after clause (xiii) the following:
       ``(xiv) individuals who are eligible for medical assistance 
     on the basis of section 1902(a)(10)(A)(ii)(XIX);''.
       (d) Effective Date.--The amendments made by this section 
     take effect on October 1, 2004, and apply to medical 
     assistance provided on or after that date, without regard to 
     whether final regulations to carry out such amendments have 
     been promulgated by such date.

     SEC. 102. STATE OPTION TO PROVIDE COVERAGE OF CHILDREN UNDER 
                   SCHIP IN EXCESS OF THE STATE'S ALLOTMENT.

       (a) In General.--Title XXI of the Social Security Act (42 
     U.S.C. 1397aa et seq.) is amended by adding at the end the 
     following:

     ``SEC. 2111. STATE OPTION TO PROVIDE COVERAGE OF CHILDREN IN 
                   EXCESS OF THE STATE'S ALLOTMENT.

       ``(a) State Option.--In the case of a State that meets the 
     condition described in subsection (b), the following shall 
     apply:
       ``(1) Notwithstanding section 2105 and without regard to 
     the State's allotment under section 2104, the Secretary shall 
     pay the State an amount for each quarter equal to the 
     enhanced FMAP of expenditures incurred in the quarter that 
     are described in section 2105(a)(1).
       ``(2) The Secretary shall reduce the State's allotment 
     under section 2104, for the first fiscal year for which the 
     State amendment described in subsection (b) applies, and for 
     each fiscal year thereafter, by an amount equal to the amount 
     that the Secretary determines the State would have expended 
     to provide child health assistance to targeted low-income 
     children during that fiscal year if that State had not 
     elected the State option to provide such assistance in 
     accordance with this section.
       ``(3) Subsections (f) and (g) of section 2104 shall not 
     apply to the State's reduced allotment (after the application 
     of paragraph (2)).
       ``(b) Condition Described.--For purposes of subsection (a), 
     the condition described in this subsection is that the State 
     has made an irrevocable election, through a plan amendment, 
     to provide child health assistance to all targeted low-income 
     children residing in the State (without regard to date of 
     application for assistance) and to cover health services 
     listed in the State plan whenever medically necessary.''.
       (b) Effective Date.--The amendment made by this section 
     takes effect on October 1, 2004, and apply to child health 
     assistance provided on or after that date, without regard to 
     whether final regulations to carry

[[Page S5957]]

     out such amendment have been promulgated by such date.

  Subtitle B--Refundable Tax Credit for Health Insurance Costs of Low-
                    Income Individuals and Families

     SEC. 111. CREDIT FOR HEALTH INSURANCE COSTS OF CERTAIN LOW-
                   INCOME INDIVIDUALS.

       (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 36 as 
     section 37 and inserting after section 35 the following new 
     section:

     ``SEC. 36. HEALTH INSURANCE COSTS OF ELIGIBLE LOW-INCOME 
                   INDIVIDUALS.

       ``(a) In General.--In the case of an individual, there 
     shall be allowed as a credit against the tax imposed by this 
     subtitle for the taxable year an amount equal to the 
     applicable percentage of the amount paid by the taxpayer (or 
     on behalf of the taxpayer) for coverage of the taxpayer or 
     qualifying family members under qualified health insurance 
     for eligible coverage months beginning in such taxable year.
       ``(b) Applicable Percentage.--For purposes of this 
     section--
       ``(1) In general.--Subject to paragraph (2), the term 
     `applicable percentage' means the standard Government 
     contribution (determined for full-time Federal employees 
     enrolling in coverage for which such contribution is not 
     limited by section 8906(b)(1) of title 5, United States Code) 
     for an employee enrolled in a health benefits plan under 
     chapter 89 of title 5, United States Code, for the calendar 
     year in which the taxable year begins, expressed as a 
     percentage of the total premium for such plan.
       ``(2) Increased percentage for certain taxpayers.--
       ``(A) In general.--In the case of a taxpayer whose adjusted 
     gross income for the preceding taxable year does not exceed 
     150 percent of the poverty level, the applicable percentage 
     determined under paragraph (1) shall be increased by such 
     percentage points as the Secretary determines will fully 
     compensate such an individual for the individual's limited 
     purchasing power in comparison to individuals whose adjusted 
     gross income equals the average adjusted gross income for all 
     Federal employees, to the extent that the amount of the 
     resulting increase in the credit amount for all such eligible 
     low-income individuals for the taxable year is not reasonably 
     expected to exceed the 5 percentage point dollar amount for 
     that year, as determined under subparagraph (B).
       ``(B) Determination of 5 percentage point dollar amount.--
     For purposes of subparagraph (A), the 5 percentage point 
     dollar amount for any taxable year is the product of--
       ``(i) the total number of individuals receiving credits 
     under this section for such year, and
       ``(ii) the amount equal to 5 percent of the average health 
     insurance premium amount to which such credits are applied.
       ``(C) Rule of construction.--Nothing in this paragraph 
     shall be construed to prevent the Secretary from establishing 
     more than 1 level of supplemental assistance that provides 
     greater assistance to individuals with lower income, 
     determined as a percentage of poverty.
       ``(3) Application of fehbp coverage categories to 
     determination of credit.--The percentages described in 
     paragraphs (1) and (2) shall be applied to a taxpayer 
     consistent with the coverage categories (such as self or 
     family coverage) applied with respect to a health benefits 
     plan under chapter 89 of title 5, United States Code.
       ``(c) Maximum Premium Amount.--The amount paid for 
     qualified health insurance taken into account under 
     subsection (a) for any taxable year shall not exceed an 
     amount equal to the capped premium established for the 
     applicable State under section 204(c)(10) of the Health 
     Coverage, Affordability, Responsibility, and Equity Act of 
     2003 for the calendar year in which the such taxable year 
     begins.
       ``(d) Eligible Coverage Month.--For purposes of this 
     section--
       ``(1) In general.--The term `eligible coverage month' means 
     any month if during such month the taxpayer or a qualifying 
     family member--
       ``(A) is an eligible low-income individual,
       ``(B) is covered by qualified health insurance, the premium 
     for which is paid by the taxpayer (or on behalf of the 
     taxpayer),
       ``(C) does not have other specified coverage, and
       ``(D) is not imprisoned under Federal, State, or local 
     authority.
       ``(2) Joint returns.--In the case of a joint return, the 
     requirement of paragraph (1)(A) shall be treated as met with 
     respect to any month if at least 1 spouse satisfies such 
     requirement.
       ``(e) Eligible Low-Income Individual.--For purposes of this 
     section--
       ``(1) In general.--The term `eligible low-income 
     individual' means an individual--
       ``(A) who has not attained age 65,
       ``(B) whose adjusted gross income does not exceed 200 
     percent of the poverty level,
       ``(C) who is ineligible for the medicaid program or the 
     State children's health insurance program under title XIX or 
     XXI of the Social Security Act (other than under section 1928 
     of such Act),
       ``(D) who has limited access to health insurance coverage 
     through the employer of the individual or a member of the 
     individual's family (either because the employer does not 
     offer such coverage to the individual or because the employee 
     contribution for such coverage would exceed an amount equal 
     to 5 percent of the household income of such individual, as 
     determined in accordance with paragraph (2)),
       ``(E) who applies for a credit under this section not later 
     than 60 days after receiving notice of potential eligibility 
     for such credit, under procedures established by the 
     Secretary, and
       ``(F) who resides in a State where the eligibility 
     standards and methodologies applied under the medicaid and 
     State children's health insurance programs with respect to 
     individuals residing in the State who have not attained age 
     65 are not more restrictive (as determined under section 
     1902(a)(10)(C)(i)(III) of the Social Security Act) than the 
     standards and methodologies that applied under such programs 
     with respect to such individuals as of July 1, 2003.
       ``(2) Determination of eligibility.--
       ``(A) SCHIP agency.--
       ``(i) In general.--The determination of whether an 
     individual is an eligible low-income individual for purposes 
     of this section shall be made by the State agency with 
     responsibility for determining the eligibility of individuals 
     for assistance under the State children's health insurance 
     program under title XXI of the Social Security Act.
       ``(ii) Application of screen and enroll requirements.--

       ``(I) In general.--The State agency referred to in clause 
     (i) shall ensure that individuals applying for a certificate 
     of eligibility are screened for potential eligibility under 
     the medicaid and State children's health insurance programs 
     and that individuals found through screening to be eligible 
     for assistance under such a program are enrolled for 
     assistance under the appropriate program. To the maximum 
     extent possible pursuant to State options under title XIX of 
     the Social Security Act, and notwithstanding any otherwise 
     applicable provision of, or State plan provision under, such 
     title, screening and enrollment activities described in the 
     previous sentence shall use the procedures employed by the 
     State children's health insurance program operated under 
     title XXI of the Social Security Act, if such procedures 
     differ from those ordinarily employed by the State program 
     operated under title XIX of such Act.
       ``(II) No delay of issuance of certificate.--The 
     application of the screen and enroll requirements of clause 
     (i) shall not delay the issuance of a certificate of 
     eligibility to an individual for purposes of this section. 
     The State agency referred to in clause (i) shall adopt 
     procedures to ensure than an individual issued a certificate 
     of eligibility under this paragraph who is subsequently 
     determined to be eligible for the State medicaid program 
     under title XIX of the Social Security Act or the State 
     children's health insurance program under XXI of such Act 
     shall be enrolled in the appropriate program without an 
     interruption in the individual's health insurance coverage.

       ``(B) Standards.--
       ``(i) In general.--An individual is an eligible low-income 
     individual for purposes of this section if--

       ``(I) on the basis of the individual's tax return for the 
     preceding taxable year, the individual meets the requirements 
     of paragraph (1)(B), and the individual otherwise satisfies 
     the requirements of paragraph (1), or
       ``(II) the individual is determined to satisfy the 
     requirements of paragraph (1) after the application of the 
     same eligibility methodologies as would apply for purposes of 
     determining the eligibility of an individual for assistance 
     under the State children's health insurance program under 
     title XXI of the Social Security Act.

       ``(ii) Application of schip income determination 
     methodologies.--For purposes of clause (i)(II), 
     determinations of income levels shall be made using the 
     methodologies described in that clause, to the extent such 
     methodologies for ascertaining household income differ from 
     any otherwise applicable method for determining adjusted 
     gross income or the definition of adjusted gross income.
       ``(C) Certificate of eligibility.--
       ``(i) In general.--An individual who is determined to be an 
     eligible low-income individual shall be issued a certificate 
     of eligibility by the State agency referred to in 
     subparagraph (A).
       ``(ii) Certificate amount.--Such certificate shall indicate 
     the applicable percentage of the amount paid for coverage 
     under qualified health insurance that the individual is 
     eligible for under this section (including any supplemental 
     assistance which the individual may be eligible for under 
     subsection (b)(2), unless the individual elects to not 
     receive such supplemental assistance).
       ``(iii) 12-month period of issue.--The certificate of 
     eligibility shall apply for a 12-month period from the date 
     of issue, notwithstanding any changes in household 
     circumstances following the individual's application for a 
     credit under this section or supplemental assistance.
       ``(D) Supplemental assistance.--The State agency described 
     in subparagraph (A) shall determine an individual's 
     eligibility for supplemental assistance under subsection 
     (b)(2) based on the methodologies referred to in subparagraph 
     (B)(ii).
       ``(f) Qualifying Family Member.--For purposes of this 
     section--
       ``(1) In general.--The term `qualifying family member' 
     means--
       ``(A) the taxpayer's spouse, and

[[Page S5958]]

       ``(B) any dependent of the taxpayer with respect to whom 
     the taxpayer is entitled to a deduction under section 151(c).

     Such term does not include any individual who is not an 
     eligible low-income individual under subsection (e)(1).
       ``(2) Special dependency test in case of divorced parents, 
     etc.--If paragraph (2) or (4) of section 152(e) applies to 
     any child with respect to any calendar year, in the case of 
     any taxable year beginning in such calendar year, such child 
     shall be treated as described in paragraph (1)(B) with 
     respect to the custodial parent (within the meaning of 
     section 152(e)(1)) and not with respect to the noncustodial 
     parent.
       ``(g) Qualified Health Insurance.--For purposes of this 
     section--
       ``(1) In general.--The term `qualified health insurance' 
     means any of the following:
       ``(A) Coverage under an insurance plan participating in a 
     purchasing pool established pursuant to section 203 of the 
     Health Coverage, Affordability, Responsibility, and Equity 
     Act of 2003.
       ``(B) Coverage under individual health insurance pursuant 
     to section 212 of such Act.
       ``(C) Coverage, pursuant to section 213 of such Act, under 
     the medicaid program or the State children's health insurance 
     program if 1 or more family members qualifies for coverage 
     under such program.
       ``(D) Coverage, pursuant to section 214 of such Act, under 
     an employer-sponsored insurance plan, including--
       ``(i) coverage under a COBRA continuation provision (as 
     defined in section 9832(d)(1)),
       ``(ii) State-based continuation coverage provided under a 
     State law that requires such coverage,
       ``(iii) coverage voluntarily offered by a former employer 
     of the individual or family member; or
       ``(iv) coverage under a group health plan that is available 
     through the employment of the individual or a family member.
       ``(2) Exception.--The term `qualified health insurance' 
     shall not include--
       ``(A) a flexible spending or similar arrangement, and
       ``(B) any insurance if substantially all of its coverage is 
     of excepted benefits described in section 9832(c).
       ``(3) Definitions.--For purposes of this subsection--
       ``(A) Employer-sponsored insurance.--
       ``(i) In general.--The term `employer-sponsored insurance' 
     means any insurance which covers medical care under any 
     health plan maintained by any employer (or former employer) 
     of the taxpayer or the taxpayer's spouse.
       ``(ii) Treatment of cafeteria plans.--For purposes of 
     clause (i), the cost of coverage shall be treated as paid or 
     incurred by an employer to the extent the coverage is in lieu 
     of a right to receive cash or other qualified benefits under 
     a cafeteria plan (as defined in section 125(d)).
       ``(B) Individual health insurance.--The term `individual 
     health insurance' means any insurance which constitutes 
     medical care offered to individuals other than in connection 
     with a group health plan and does not include Federal- or 
     State-based health insurance coverage.
       ``(h) Other Specified Coverage.--For purposes of this 
     section, an individual has other specified coverage for any 
     month if, as of the first day of such month--
       ``(1) Coverage under medicare.--Such individual is entitled 
     to benefits under part A of title XVIII of the Social 
     Security Act or is enrolled under part B of such title.
       ``(2) Certain other coverage.--Such individual--
       ``(A) is enrolled in a health benefits plan under chapter 
     89 of title 5, United States Code, or
       ``(B) is entitled to receive benefits under chapter 55 of 
     title 10, United States Code.
       ``(i) Federal Poverty Level; Poverty Level; Poverty.--For 
     purposes of this section, the terms `Federal poverty level' , 
     `poverty level', and `poverty' mean the income official 
     poverty line (as defined by the Office of Management and 
     Budget, and revised annually in accordance with section 
     673(2) of the Omnibus Budget Reconciliation Act of 1981) 
     applicable to a family of the size involved.
       ``(j) Special Rules.--
       ``(1) Coordination with advance payments of credit.--With 
     respect to any taxable year, the amount which would (but for 
     this subsection) be allowed as a credit to the taxpayer under 
     subsection (a) shall be reduced (but not below zero) by the 
     aggregate amount paid on behalf of such taxpayer under 
     section 7528 for months beginning in such taxable year.
       ``(2) Coordination with other deductions.--Amounts taken 
     into account under subsection (a) shall not be taken into 
     account in determining any deduction allowed under section 
     162(l) or 213.
       ``(3) MSA distributions.--Amounts distributed from an 
     Archer MSA (as defined in section 220(d)) shall not be taken 
     into account under subsection (a).
       ``(4) 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.
       ``(5) Both spouses eligible low-income individuals.--The 
     spouse of the taxpayer shall not be treated as a qualifying 
     family member for purposes of subsection (a), if--
       ``(A) the taxpayer is married at the close of the taxable 
     year,
       ``(B) the taxpayer and the taxpayer's spouse are both 
     eligible low-income individuals during the taxable year, and
       ``(C) the taxpayer files a separate return for the taxable 
     year.
       ``(6) Marital status; certain married individuals living 
     apart.--Rules similar to the rules of paragraphs (3) and (4) 
     of section 21(e) shall apply for purposes of this section.
       ``(7) Insurance which covers other individuals.--For 
     purposes of this section, rules similar to the rules of 
     section 213(d)(6) shall apply with respect to any contract 
     for qualified health insurance under which amounts are 
     payable for coverage of an individual other than the taxpayer 
     and qualifying family members.
       ``(8) Treatment of payments.--For purposes of this section:
       ``(A) Payments by secretary.--Any payment made by the 
     Secretary on behalf of any individual under section 7528 
     (relating to advance payment of credit for health insurance 
     costs of eligible low-income individuals) shall be treated as 
     having been made by the taxpayer (or on behalf of the 
     taxpayer) on the first day of the month for which such 
     payment was made.
       ``(B) Payments by taxpayer.--Any payment made by the 
     taxpayer (or on behalf of the taxpayer) for eligible coverage 
     months shall be treated as having been so made on the first 
     day of the month for which such payment was made.
       ``(9) Regulations.--
       ``(A) In general.--The Secretary, in consultation with the 
     Secretary of Health and Human Services, shall administer the 
     credit allowed under this section and shall prescribe such 
     regulations and other guidance as may be necessary or 
     appropriate to carry out this section, section 6050U, and 
     section 7528.
       ``(B) Eligibility determinations.--Such regulations shall 
     include such standards as the Secretary of Health and Human 
     Services may specify with respect to the requirements for 
     eligibility determinations under subsection (e)(2).
       ``(C) Measures to combat fraud and abuse.--Such regulations 
     shall include appropriate procedures to deter, detect, and 
     penalize fraudulent efforts to obtain a credit under this 
     section by individuals, providers of qualified health 
     insurance, and others.''.
       (b) 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 36 of such Code''.
       (2) The table of sections for subpart C of part IV of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     striking the last item and inserting the following new items:

``Sec. 36. Health insurance costs of eligible low-income individuals.
``Sec. 37. Overpayments of tax.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2005.
       (d) Reimbursement for Administrative Costs Incurred in 
     Determining Eligibility for Credit.--
       (1) In General.--The Secretary of Health and Human Services 
     shall reimburse States for the reasonable administrative 
     costs incurred in making eligibility determinations in 
     accordance with section 36(e) of the Internal Revenue Code of 
     1986 (as added by subsection (a)). Such reimbursement shall 
     not apply to State costs required under the medicaid or State 
     children's health insurance programs.
       (2) Application.--A State desiring reimbursement under this 
     subsection shall submit an application to the Secretary of 
     Health and Human Services in such manner, at such time, and 
     containing such information as the Secretary may require.
       (3) Appropriation.--Out of any money in the Treasury of the 
     United States not otherwise appropriated, there are 
     appropriated such sums as may be necessary to carry out this 
     subsection.

     SEC. 112. ADVANCE PAYMENT OF CREDIT FOR HEALTH INSURANCE 
                   COSTS OF ELIGIBLE LOW-INCOME INDIVIDUALS.

       (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. 7528. ADVANCE PAYMENT OF CREDIT FOR HEALTH INSURANCE 
                   COSTS OF ELIGIBLE LOW-INCOME INDIVIDUALS.

       ``(a) General Rule.--Not later than August 1, 2005, the 
     Secretary shall establish a program for making payments on 
     behalf of certified individuals to providers of qualified 
     health insurance (as defined in section 36(g)) for such 
     individuals.
       ``(b) Limitation on Advance Payments During any Taxable 
     Year.--The Secretary may make payments under subsection (a) 
     only to the extent that the total amount of such payments 
     made on behalf of any individual during the taxable year is 
     not reasonably expected to exceed the applicable percentage 
     (as defined in section 36(b)) of the amount paid by the 
     taxpayer (or on behalf of the taxpayer) for coverage of the 
     taxpayer and qualifying family members under qualified health 
     insurance for eligible coverage months beginning in the 
     taxable year.
       ``(c) Certified Individual.--For purposes of this section, 
     the term `certified individual' means any individual for whom 
     a health coverage eligibility certificate is in effect.

[[Page S5959]]

       ``(d) Health Coverage Eligibility Certificate.--For 
     purposes of this section, the term `health coverage 
     eligibility certificate' means any written statement that an 
     individual is an eligible low-income individual (as defined 
     in section 36(e)) if such statement provides such information 
     as the Secretary may require for purposes of this section and 
     is issued by the State agency responsible for administering 
     the State children's health insurance program under title XXI 
     of the Social Security Act.''.
       (b) Disclosure of Return Information for Purposes of 
     Carrying Out a Program for Advance Payment of Credit for 
     Health Insurance Costs of Eligible Low-Income Individuals.--
       (1) In general.--Subsection (l) of section 6103 of the 
     Internal Revenue Code of 1986 (relating to disclosure of 
     returns and return information for purposes other than tax 
     administration) is amended by adding at the end the following 
     new paragraph:
       ``(19) Disclosure of return information for purposes of 
     carrying out a program for advance payment of credit for 
     health insurance costs of eligible low-income individuals.--
     The Secretary may disclose to providers of health insurance 
     for any certified individual (as defined in section 7528(c)) 
     return information with respect to such certified individual 
     only to the extent necessary to carry out the program 
     established by section 7528 (relating to advance payment of 
     credit for health insurance costs of eligible low-income 
     individuals).''.
       (2) Procedures and recordkeeping related to disclosures.--
     Subsection (p) of such section is amended--
       (A) in paragraph (3)(A) by striking ``or (18)'' and 
     inserting ``(18), or (19)'', and
       (B) in paragraph (4), as amended by section 202(b)(2)(B) of 
     the Trade Act of 2002 (Public Law 107-210; 116 Stat. 961), by 
     striking ``or (17)'' after ``any other person described in 
     subsection (l)(16)'' each place it appears and inserting 
     ``(18), or (19)''.
       (3) Unauthorized inspection of returns or return 
     information.--Section 7213A(a)(1)(B) of such Code is amended 
     by striking ``section 6103(n)'' and inserting ``subsection 
     (l)(18) or (19) or (n) of section 6103''.
       (c) Information Reporting.--
       (1) In general.--Subpart B of part III of subchapter A of 
     chapter 61 of the Internal Revenue Code of 1986 (relating to 
     information concerning transactions with other persons) is 
     amended by inserting after section 6050T the following new 
     section:

     ``SEC. 6050U. RETURNS RELATING TO CREDIT FOR HEALTH INSURANCE 
                   COSTS OF ELIGIBLE LOW-INCOME INDIVIDUALS.

       ``(a) Requirement of Reporting.--Every person who is 
     entitled to receive payments for any month of any calendar 
     year under section 7528 (relating to advance payment of 
     credit for health insurance costs of eligible low-income 
     individuals) with respect to any certified individual (as 
     defined in section 7528(c)) shall, at such time as the 
     Secretary may prescribe, make the return described in 
     subsection (b) with respect to each such individual.
       ``(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 each individual 
     referred to in subsection (a),
       ``(B) the number of months for which amounts were entitled 
     to be received with respect to such individual under section 
     7528 (relating to advance payment of credit for health 
     insurance costs of eligible low-income individuals),
       ``(C) the amount entitled to be received for each such 
     month, and
       ``(D) such other information as the Secretary may 
     prescribe.
       ``(c) 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 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, and
       ``(2) the information required to be shown on the return 
     with respect to such individual.

     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.''.
       (2) Assessable penalties.--
       (A) Subparagraph (B) of section 6724(d)(1) of such Code 
     (relating to definitions) is amended by redesignating clauses 
     (xii) through (xviii) as clauses (xiii) through (xix), 
     respectively, and by inserting after clause (xi) the 
     following new clause:
       ``(xii) section 6050U (relating to returns relating to 
     credit for health insurance costs of eligible low-income 
     individuals),''.
       (B) Paragraph (2) of section 6724(d) of such Code is 
     amended by striking ``or'' at the end of subparagraph (AA), 
     by striking the period at the end of subparagraph (BB) and 
     inserting ``, or'', and by adding after subparagraph (BB) the 
     following new subparagraph:
       ``(CC) section 6050U (relating to returns relating to 
     credit for health insurance costs of eligible low-income 
     individuals).''.
       (d) Clerical Amendments.--
       (1) Advance payment.--The table of sections for chapter 77 
     of the Internal Revenue Code of 1986 is amended by adding at 
     the end the following new item:

``Sec. 7528. Advance payment of credit for health insurance costs of 
              eligible low-income individuals.''.

       (2) Information reporting.--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 6050T the following new item:

``Sec. 6050U. Returns relating to credit for health insurance costs of 
              eligible low-income individuals.''.

       (e) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2006.

               TITLE II--IMPROVING ACCESS TO HEALTH PLANS

     SEC. 201. DEFINITIONS.

       In this title:
       (1) Eligible individual.--The term ``eligible individual'' 
     means an individual with respect to whom a tax credit is 
     allowed under section 36 of the Internal Revenue Code of 1986 
     (as added by section 111).
       (2) Participating insurer.--The term ``participating 
     insurer'' means an entity with a contract under section 
     205(a).
       (3) Private group health insurance plan.--The term 
     ``private group health insurance plan'' means a plan offered 
     by a participating insurer that provides health benefits 
     coverage to eligible individuals and that meets the 
     requirements of this title.
       (4) Purchasing pool operator.--The term ``purchasing pool 
     operator'' means the entity designated by the State under 
     section 204.
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (6) Small employer.--The term ``small employer'' means an 
     employer with not less than 2 and not more than 100 
     employees.

     SEC. 202. ESTABLISHMENT OF HEALTH INSURANCE PURCHASING POOLS.

       There is established a program under which the Secretary 
     shall ensure that each eligible individual has the 
     opportunity to enroll, through a purchasing pool operator, in 
     a private group health insurance plan offered by a 
     participating insurer under this title.

     SEC. 203. PURCHASING POOLS.

       (a) Establishment of Purchasing Pools.--Each State 
     participating in the program under this title shall establish 
     a purchasing pool that is available to each eligible 
     individual who resides in the State.
       (b) Types of Purchasing Pools.--
       (1) In general.--A purchasing pool established under 
     subsection (a) shall be 1 of the following:
       (A) A statewide purchasing pool operated by the State.
       (B) A statewide purchasing pool operated on behalf of the 
     State by the Director of the Office of Personnel Management, 
     or the designee of such Director.
       (2) OPM operated pool.--In the case of a statewide 
     purchasing pool described in paragraph (1)(B), the Director 
     of the Office of Personnel Management or the Director's 
     designee, may limit participating insurers in such pool to 
     those described in section 205(e), except that the Director 
     or such designee shall ensure that additional private group 
     health insurance plans participate in such a pool to the 
     extent necessary to meet the requirements of section 
     204(c)(9).
       (c) State Election Process.--
       (1) In general.--Each State participating in the program 
     under this title shall notify the Secretary, not later than 
     January 4, 2005, of the type of purchasing pool that applies 
     to residents of the State.
       (2) Default choice.--If a State participating in the 
     program under this title fails to notify the Secretary of the 
     type of purchasing pool elected by the State by the date 
     described in paragraph (1), the State shall be deemed to have 
     elected the type of purchasing pool described in subsection 
     (b)(1)(B).
       (3) Change of election.--The Secretary shall establish 
     procedures under which a State participating in the program 
     under this title may change the election of the type of 
     purchasing pool applicable to residents of the State.

     SEC. 204. PURCHASING POOL OPERATORS.

       (a) Designation.--Each State shall designate a purchasing 
     pool operator that shall be responsible for operating the 
     purchasing pool established under section 203(a). A 
     purchasing pool operator may be (or, to have 1 or more of its 
     functions performed, may contract with) a private entity that 
     has entered into a contract with the State if such entity 
     meets requirements established by the Secretary for purposes 
     of the program under this title.
       (b) Operation Similar to FEHBP.--Each purchasing pool 
     operator shall operate the purchasing pool established under 
     section 203(a) in a manner that is similar to the manner in 
     which the Director of the Office of Personnel Management 
     operates the Federal employees' health benefits program under 
     chapter 89 of title 5, United States Code, including (but not 
     limited to) the performance of the specific functions 
     described in subsection (c).
       (c) Specific Functions Described.--The specific functions 
     described in this subsection include the following:
       (1) Each purchasing pool operator shall offer one-stop 
     shopping for eligible individuals to enroll for health 
     benefits coverage

[[Page S5960]]

     under private, group health insurance plans offered by 
     participating insurers.
       (2) Each purchasing pool operator shall limit participating 
     insurers to those that meet the conditions for participation 
     described in this title.
       (3) Each purchasing pool operator shall negotiate (or, in 
     the case of a purchasing pool described in section 
     203(b)(1)(B), shall negotiate or otherwise determine) bids 
     and terms of coverage with insurers.
       (4) Each purchasing pool operator shall provide eligible 
     individuals with comparative information on private group 
     health insurance plans offered by participating insurers.
       (5) Each purchasing pool operator shall assist eligible 
     individuals in enrolling with a private group health 
     insurance plan offered by a participating insurer.
       (6) Each purchasing pool operator shall collect private 
     group health insurance plan premium payments for 
     participating insurers and process such premium payments.
       (7) Each purchasing pool operator shall reconcile from year 
     to year aggregate premium payments and claims costs of 
     private group health insurance plans consistent with 
     practices under the Federal employees' health benefits 
     program under chapter 89 of title 5, United States Code.
       (8) Each purchasing pool operator shall offer customer 
     service to eligible individuals enrolled for health benefits 
     coverage under a private group health insurance plan offered 
     by a participating insurer.
       (9) Each purchasing pool operator shall ensure that each 
     eligible individual has the option of enrolling in either of 
     at least 2 benchmark or benchmark-equivalent plans with--
       (A) a premium at or below a cap established by the pool 
     operator for purposes of this title; and
       (B) coverage of essential services included in the report 
     required under section 301(e)(2), with cost-sharing 
     consistent with such report.
       (10) Each purchasing pool operator shall establish a 
     premium cap for purposes of determining the credit limitation 
     under section 36(c) of the Internal Revenue Code of 1986, as 
     added by section 111(a). The cap required under this 
     paragraph may not be less than the premium charged to Federal 
     employees by the most highly-enrolled health plan under the 
     Federal employees' health benefits program under chapter 89 
     of title 5, United States Code. If the most highly-enrolled 
     plan in that program differs for Federal enrollees in the 
     State and all Federal enrollees nationally in such plan, the 
     minimum permitted premium cap shall be the lower of such 
     premiums.

     SEC. 205. CONTRACTS WITH PARTICIPATING INSURERS.

       (a) In General.--Each purchasing pool operator shall 
     negotiate and enter into contracts for the provision of 
     health benefits coverage under the program under this title 
     with entities that meet the conditions of participation 
     described in subsection (b) and other applicable requirements 
     of this Act.
       (b) Consumer Information.--In carrying out its duty under 
     section 204(c)(4) to inform eligible individuals about 
     private group health plans, the purchasing pool operator 
     shall provide information that meets the requirements of 
     section 212(b)(2).
       (c) State Licensure.--
       (1) In general.--Subject to paragraph (2), a health plan 
     shall not be a participating insurer unless the plan has a 
     State license to provide State residents with the private 
     group coverage health insurance plans that it offers through 
     the pool.
       (2) Exception.--A pool operator may enter into a contract 
     under subsection (a) to cover pool participants through a 
     health plan without a State license described in paragraph 
     (1) if such plan is offered to Federal employees nationwide 
     and, with respect to such employees, is exempt from State 
     health insurance regulation. Nothing in this paragraph shall 
     be construed to permit coverage of pool participants through 
     such a plan except with groups, contracts, and premium rates 
     that are entirely distinct from those used for individuals 
     covered under the Federal employee's health benefits program 
     under chapter 89 of title 5, United States Code.
       (d) Additional Stop-Loss Coverage and Reinsurance.--
     Purchasing pool operators are authorized to encourage 
     participation in the program under this title, improve 
     covered benefits, reduce out-of-pocket cost-sharing, limit 
     premiums, or achieve other objectives of this Act by--
       (1) funding stop-loss coverage above levels otherwise 
     offered in the purchasing pool; or
       (2) providing or subsidizing reinsurance in addition to 
     that provided under section 211.
       (e) Participation of FEHBP Plans.--
       (1) In general.--Each entity with a contract under section 
     8902 of title 5, United States Code, shall be a participating 
     insurer unless such entity notifies the Secretary in writing 
     of its intention not to participate in the program under this 
     title prior to such time as is designated by the Secretary so 
     as to allow such decisions to be taken into account with 
     respect to eligible individuals' choice of a private group 
     health insurance plan under such program. Such participation 
     in the program under this title shall include at least the 
     covered benefits and provider networks available through such 
     an entity and shall not involve greater out-of-pocket cost-
     sharing than the plan offered by such entity pursuant to its 
     contract under section 8902 of title 5, United States Code.
       (2) No effect on fehbp coverage.--The Director of Office of 
     Personnel Management shall take such steps as are necessary 
     to ensure that each individual enrolled for health benefits 
     coverage under the program under chapter 89 of title 5, 
     United States Code, is not adversely affected by eligible 
     individuals or others enrolled for coverage under the program 
     under this title. Such steps shall include (but need not be 
     limited to) the establishment of separate risk pools, 
     separate contracts with participating insurers, and 
     separately negotiated premiums.

     SEC. 206. OPTIONS FOR HEALTH BENEFITS COVERAGE.

       (a) Scope of Health Benefits Coverage.--The health benefits 
     coverage provided to an eligible individual under a private 
     group health insurance plan offered by a participating 
     insurer shall consist of any of the following:
       (1) Benchmark coverage.--Health benefits coverage that is 
     equivalent to the benefits coverage in a benchmark benefit 
     package described in subsection (b).
       (2) Benchmark-equivalent coverage.--Health benefits 
     coverage that meets the following requirements:
       (A) Inclusion of essential services.--The coverage includes 
     each of the essential services identified by the National 
     Advisory Commission on Expanded Access to Health Care and 
     adopted by Congress under title III.
       (B) Aggregate actuarial value equivalent to benchmark 
     package.--The coverage has an aggregate actuarial value that 
     is equal to or greater than the actuarial value of one of the 
     benchmark benefit packages.
       (3) Alternative coverage.--Any other health benefits 
     coverage that the Secretary determines, upon application by a 
     State, offers health benefits coverage equivalent to or 
     greater than a plan described in and offered under section 
     8903(1) of title 5, United States Code.
       (b) Benchmark Benefit Packages.--The benchmark benefit 
     packages are as follows:
       (1) FEHBP-equivalent health benefits coverage.--The plan 
     described in and offered under chapter 89 of title 5, United 
     States Code with the highest number of enrollees under such 
     section for the year preceding the year in which the private 
     group health insurance plan is proposed to be offered.
       (2) Public program-equivalent health benefits coverage.--
     Coverage provided under the State plan approved under the 
     medicaid program under title XIX of the Social Security Act 
     or the State children's health insurance program under title 
     XXI of such Act (42 U.S.C. 1396 et seq., 1397aa et seq.) 
     (without regard to coverage provided under a waiver of the 
     requirements of either such program).
       (3) Coverage offered through hmo.--The health insurance 
     coverage plan that--
       (A) is offered by a health maintenance organization (as 
     defined in section 2791(b)(3) of the Public Health Service 
     Act (42 U.S.C. 33gg-91(b)(3))), and
       (B) has the largest insured commercial, nonmedicaid 
     enrollment of covered lives of such coverage plans offered by 
     such a health maintenance organization in the State.
       (4) State employee coverage.--The health insurance plan 
     that is offered to State employees and has the largest 
     enrollment of covered lives of any such plan.
       (5) Application of benchmark standards.--A private group 
     health plan offers benchmark benefits if, with respect to a 
     benchmark plan described in paragraph (1), (2), (3), or (4), 
     the private group health plan covers all items and services 
     offered by the benchmark plan, with out-of-pocket cost-
     sharing for such items and services that is not greater than 
     under the benchmark plan. Nothing in this title shall be 
     construed to forbid a private group health plan from offering 
     additional items and services not covered by such a benchmark 
     plan or reducing out-of-pocket cost-sharing below levels 
     applicable under such plan.

     SEC. 207. ENROLLMENT PROCESS FOR ELIGIBLE INDIVIDUALS.

       (a) In General.--The Secretary shall establish a process 
     through which an eligible individual--
       (1) may make an annual election to enroll in any private 
     group health insurance plan offered by a participating 
     insurer that has been awarded a contract under section 205(a) 
     and serves the geographic area in which the individual 
     resides, provided that such insurer's geographic area of 
     service and guaranteed issuance under this section is 
     conterminous with, or includes all of, a geographic area 
     served pursuant to an entity's contact under section 8902 of 
     title 5, United States Code; and
       (2) may make an annual election to change the election 
     under this clause.
       (b) Rules.--In establishing the process under subsection 
     (a), the Secretary shall use rules similar to the rules for 
     enrollment, disenrollment, and termination of enrollment 
     under the Federal employees health benefits program under 
     chapter 89 of title 5, United States Code, including the 
     application of the guaranteed issuance provision described in 
     subsection (c).
       (c) Guaranteed Issuance.--An eligible individual who is 
     eligible to enroll for health benefits coverage under a 
     private group health insurance plan that has been awarded a 
     contract under section 205(a) at a time during which 
     elections are accepted under this title with respect to the 
     plan shall not be denied enrollment based on any health 
     status-related factor (described in section 2702(a)(1) of the 
     Public Health Service Act (42 U.S.C. 300gg-1(a)(1))) or any 
     other factor.

[[Page S5961]]

     SEC. 208. PLAN PREMIUMS.

       (a) In General.--Each purchasing pool operator shall 
     negotiate (or, in the case of a purchasing pool operated 
     pursuant to section 203(b)(1)(B), shall otherwise determine) 
     a premium for each private group health insurance plan 
     offered by a participating insurer.
       (b) Permitted Profit Margins.--
       (1) In general.--Each premium negotiated under subsection 
     (a) may not permit a profit margin that exceeds the 
     applicable percentage (as defined in paragraph (2)).
       (2) Applicable percentage defined.--In this subsection, the 
     term ``applicable percentage'' means--
       (A) for the first 3 years that a purchasing pool is 
     operated, 2 percent;
       (B) for any subsequent year, the percentage determined by 
     the purchasing pool operator, which may not be--
       (i) less than the profit margin permitted under the Federal 
     employees health benefits program under chapter 89 of title 
     5, United States Code; or
       (ii) more than a multiple, established by the Secretary for 
     purposes of this subsection, of profit margins permitted 
     under such program.

     SEC. 209. ENROLLEE PREMIUM SHARE.

       (a) In General.--A participating insurer offering a private 
     group health insurance plan that has been awarded a contract 
     under section 205(a) in which the eligible individual is 
     enrolled may not deny, limit, or condition the coverage 
     (including out-of-pocket cost-sharing) or provision of health 
     benefits coverage or vary or increase the enrollee premium 
     share under the plan based on any health status-related 
     factor described in section 2702(a)(1) of the Public Health 
     Service Act (42 U.S.C. 300gg-1(a)(1)) or any other factor.
       (b) Risk-Adjusted Plan Payments and Premiums Charged to 
     Enrollees.--
       (1) In general.--For each private group health insurance 
     plan operated by a participating insurer, the pool operator 
     shall adjust premium payments to compensate for the 
     difference in health risk factors between plan enrollees and 
     State residents as a whole (including residents who are not 
     eligible individuals). Such adjustments shall employ risk-
     adjustment mechanisms promulgated by the Secretary.
       (2) Additional adjustments.--The pool operator shall also 
     provide additional adjustments to premium payments that 
     compensate participating insurers for the cost of keeping 
     out-of-pocket cost-sharing amounts consistent with section 
     204(c)(9)(B).
       (3) Enrollee premium costs.--The adjustments described in 
     this subsection shall not affect enrollee premium shares, 
     which shall be based on the premium that would be charged for 
     enrollees with health risk factors for State residents as a 
     whole (as described in paragraph (1)), without taking into 
     account cost-sharing adjustments under section 204(c)(9)(B).
       (c) Amount of Premium.--The amount of the enrollee premium 
     share shall be equal to premium amounts (if any) above the 
     applicable cap set pursuant to section 204(c)(10), plus 100 
     percent of the remainder minus the applicable percentage (as 
     defined in section 36(b) of the Internal Revenue Code of 
     1986, as added by section 111).

     SEC. 210. PAYMENTS TO PURCHASING POOL OPERATORS AND PAYMENTS 
                   TO PARTICIPATING INSURERS.

       The Secretary shall establish procedures for making 
     payments to each purchasing pool operator as follows:
       (1) Risk-adjustment payment.--The Secretary shall pay each 
     purchasing pool operator for the net costs of risk-adjusted 
     payments to plans under section 209(b), to the extent the sum 
     of upward adjustments exceeds the sum of downward adjustments 
     for the pool operator.
       (2) Stop-loss and reinsurance payments.--
       (A) In general.--The Secretary shall pay each purchasing 
     pool operator for the applicable percentage (as defined in 
     subparagraph (B)) of--
       (i) the costs of any stop-loss coverage funded by the 
     purchasing pool operator under section 205(d)(1); and
       (ii) any reinsurance provided in accordance with section 
     205(d)(2).
       (B) Applicable percentage defined.--In this paragraph, the 
     term ``applicable percentage'' means--
       (i) for the first 3 years that a purchasing pool is 
     operated, 100 percent;
       (ii) for the next 2 years that such purchasing pool is 
     operated, 50 percent; and
       (iii) for any subsequent year, 0 percent.
       (3) Payments necessary to keep cost-sharing within 
     applicable limits.--The Secretary shall make payments to 
     purchasing pool operators to reimburse purchasing pool 
     operators for the amount paid by such operators to 
     participating insurers necessary to keep out-of-pocket cost-
     sharing for individuals with limited ability to pay within 
     applicable limits.
       (4) Payment for administrative costs.--The Secretary shall 
     make payments to each purchasing pool operator for necessary 
     pool administrative expenses.
       (5) Payments to opm.--In the case of a purchasing pool 
     described in section 203(b)(1)(B), payments under this 
     section shall be made to the Director of the Office of 
     Personnel Management.

     SEC. 211. STATE-BASED REINSURANCE PROGRAMS.

       (a) Establishment.--The Secretary shall establish standards 
     for State-based reinsurance programs for eligible individuals 
     to guard against adverse selection and to improve the 
     functioning of the individual health insurance market.
       (b) Grants for Statewide Reinsurance Programs.--
       (1) In general.--The Secretary may award grants to States 
     for the reasonable costs incurred in providing reinsurance 
     under this section, consistent with standards developed by 
     the Secretary, for coverage offered in the individual health 
     insurance market and through State-based purchasing pools 
     described in section 203.
       (2) Limitation.--Such grants may not pay for reinsurance 
     extending beyond individuals in the top 3 percent of the 
     national health care spending distribution, as determined by 
     the Secretary.
       (3) Application.--A State desiring a grant under this 
     section shall submit an application to the Secretary in such 
     manner, at such time, and containing such information as the 
     Secretary may require.
       (4) Authorization of appropriations.--There are authorized 
     to be appropriated to the Secretary such sums as may be 
     necessary for making grants under this section.

     SEC. 212. COVERAGE UNDER INDIVIDUAL HEALTH INSURANCE.

       (a) In General.--Eligible individuals may use credits 
     allowed under the Internal Revenue Code of 1986 (including 
     supplemental assistance provided under such Code) for the 
     purchase of health insurance coverage to enroll in State-
     licensed individual health insurance meeting the conditions 
     of participation described in subsection (b).
       (b) Conditions of Participation.--The Secretary shall 
     promulgate regulations that establish the terms and 
     conditions under which an entity may participate in the 
     program under this section and that include the following:
       (1) Plan marketing.--Conditions of participation for plans 
     in the individual market (as developed by the Secretary) 
     that--
       (A) ensure that consumers receive the consumer information 
     described in paragraph (2) before selecting a plan; and
       (B) detect, deter, and penalize marketing fraud by entities 
     offering or purporting to offer individual insurance.
       (2) Consumer information.--Requirements for each entity 
     offering individual insurance to provide eligible individuals 
     with information in a uniform and easily comprehensible 
     manner that allows for informed comparisons by eligible 
     individuals and that includes information regarding the 
     health benefits coverage, costs, provider networks, quality, 
     the amount and proportion of health insurance premium 
     payments that go directly to patient care, and the plan's 
     coverage rules (including amount, duration, and scope limits) 
     and out-of-pocket cost-sharing (both inside and outside plan 
     networks) for each essential service recommended by the 
     National Advisory Commission on Expanded Access to Health 
     Care and adopted by Congress under title III (which shall be 
     prominently identified as an essential service, including by 
     reference to the Commission recommendation denoting the 
     service as essential). To the maximum extent feasible, such 
     requirements shall specify that the content and presentation 
     of the information shall be provided in the same manner as 
     similar information is presented to enrollees in the Federal 
     employees health benefits program under chapter 89 of title 
     5, United States Code.
       (3) Other conditions, including the elimination of barriers 
     to affordable coverage.--
       (A) In general.--Requirements for each entity offering 
     individual insurance to abide by conditions of participation 
     that the Secretary believes are reasonable and appropriate 
     measures to address barriers to affordable health insurance 
     coverage.
       (B) Specific conditions.--The requirements developed by the 
     Secretary under subparagraph (A) shall include (but need not 
     be limited to)--
       (i) guaranteed renewability, without premium increases 
     based on changed individual risk; and
       (ii) limits on risk rating.
       (4) Rule of construction.--Nothing in this section shall be 
     construed to authorize the Secretary to impose any 
     requirements on individual insurance, except with respect to 
     eligible individuals purchasing individual insurance using 
     advance payment of a tax credit provided under section 36 of 
     the Internal Revenue Code of 1986.

     SEC. 213. USE OF PREMIUM SUBSIDIES TO UNIFY FAMILY COVERAGE 
                   WITH MEMBERS ENROLLED IN MEDICAID AND SCHIP.

       Notwithstanding any other provision of law, the Secretary 
     shall establish procedures under which, in the case of a 
     family with 1 or more members enrolled in with a managed care 
     entity under the State medicaid program under title XIX of 
     the Social Security Act or the State children's health 
     insurance program under title XXI of such Act (42 U.S.C. 1396 
     et seq., 1397aa et seq.) and 1 or more members who are an 
     eligible individual under this title, the family shall have 
     the option to enroll all family members with the managed care 
     entity under either or both such State programs. The 
     procedures established by the Secretary shall provide that 
     premiums charged to eligible individuals for enrollment with 
     such an entity shall be based on the capitated payments 
     established for adults or children, excluding adults and 
     children who are known to be pregnant, blind, disabled, or 
     (in the case of adults) elderly, under the applicable State 
     program

[[Page S5962]]

     (except that, in the case of an eligible individual known to 
     be pregnant, premiums shall reflect capitated payments 
     established under such State program for individuals known to 
     be pregnant) plus reasonable administrative costs.

     SEC. 214. COVERAGE THROUGH EMPLOYER-SPONSORED HEALTH 
                   INSURANCE.

       (a) In General.--Eligible individuals may use credits 
     allowed under the Internal Revenue Code of 1986 and 
     supplemental assistance to enroll in coverage offered by 
     eligible employers.
       (b) Eligible Employers.--For purposes of this section, the 
     term ``eligible employers'' includes the following:
       (1) The current employer of the eligible individual or a 
     member of such individuals family.
       (2) A former employer required to offer coverage of the 
     eligible individual under a COBRA continuation provision (as 
     defined in section 9832(d)(1) of the Internal Revenue Code) 
     or a State law requiring continuation coverage; and
       (3) A former employer voluntarily offering coverage of the 
     eligible individual.
       (c) Application of Disregard of Preexisting Conditions 
     Exclusions.--Notwithstanding any other provision of law, in 
     the case of an individual who experiences a qualifying event 
     (as defined in section 603 of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1163) and who, not later than 
     6 months after such event, is determined to be an eligible 
     individual under this title, the same rules with respect to 
     preexisting conditions as apply to a nonelecting TAA-eligible 
     individual under section 605(b) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1165(b)) shall apply 
     with respect to such individual, regardless of which type of 
     qualified coverage the individual purchases.
       (d) Extension of COBRA Election Period.--Notwithstanding 
     any other provision of law, in the case of an individual who 
     experiences a qualifying event (as defined in section 603 of 
     the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1163) and who, not later than 6 months after such 
     event, is determined to be an eligible individual under this 
     title, the same rules with respect to the temporary extension 
     of a COBRA election period as apply to a nonelecting TAA-
     eligible individual under section 605(b) of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1165(b)) 
     shall apply with respect to such individual.
       (e) Current Employer Coverage.--If an eligible individual 
     uses the credits allowed under the Internal Revenue Code of 
     1986 and supplemental assistance to purchase coverage from an 
     employer described in subsection (b), such credits and 
     assistance shall apply as a percentage, not of the total 
     premium amount for the eligible individual, but of the 
     employee's or former employee's share of premium payments.

     SEC. 215. PARTICIPATION BY SMALL EMPLOYERS.

       (a) In General.--Notwithstanding any other provision of 
     this title, the Secretary shall establish procedures under 
     which, during annual open enrollment periods, a small 
     employer shall have the option of purchasing group coverage 
     for employees and dependents of employees, including 
     individuals who are not otherwise eligible individuals under 
     this title, through a purchasing pool established under 
     section 203(a).
       (b) Conditions of Participation.--
       (1) In general.--Except as otherwise provided in this 
     subsection, the same requirements that apply with respect to 
     participating insurers covering eligible low-income 
     individuals under section 203 shall apply with respect to 
     coverage offered by such insurers through a small employer.
       (2) Risk adjustment.--
       (A) Increased payments.--If employees of a small employer 
     who are not otherwise eligible individuals under this title 
     enroll in a private group health insurance plan under this 
     title and have a collective risk level that exceeds the 
     statewide average (as determined pursuant to risk adjustment 
     mechanisms developed by the Secretary consistent with section 
     209(b)(1)), the Secretary (through a pool operator) shall 
     provide participating insurers with such small employer 
     enrollment bonus payments as are necessary to compensate the 
     insurers for such increased risk. The premium charged to 
     enrollees under this section shall be the same premium that 
     is the basis of premium charges to enrollees who are eligible 
     low-income individuals.
       (B) Reduced payments.--A pool operator shall reduce 
     payments to any plan with a risk level that falls below the 
     statewide average (as so determined).
       (3) Administrative guidelines.--The Secretary shall develop 
     guidelines for pool operators to use in serving small 
     employers, which shall be modeled after existing, successful, 
     longstanding small business purchasing cooperatives, and 
     shall include administratively simple methods for small 
     employers and licensed insurance brokers to participate in 
     the program established under this title.
       (c) Information Campaign.--
       (1) In general.--The pool operator for a State shall 
     establish and conduct, directly or through 1 or more public 
     or private entities (which may include licensed insurance 
     brokers), a health insurance information program to inform 
     small employers about health coverage for employees.
       (2) Requirements.--The program established under paragraph 
     (1) shall educate small employers with respect to matters 
     that include (but are not limited to) the following:
       (A) The benefits of providing health insurance to 
     employees, including tax benefits to both the employer and 
     employees, increased productivity, and decreased employee 
     turnover.
       (B) The rights of small employers under Federal and State 
     health insurance reform laws.
       (C) Options for purchasing coverage, including (but not 
     limited to) through the State's purchasing pool operated 
     pursuant to section 203.
       (d) Grants To Help State-Based Pools Promote Small Business 
     Coverage.--
       (1) In general.--The Secretary may award grants to a pool 
     operator for the following:
       (A) The net costs of risk-adjusted payments under paragraph 
     (b)(2), to the extent the sum of upward adjustments exceeds 
     the sum of downward adjustments for the pool operator.
       (B) The reasonable cost of the information campaign under 
     subsection (c).
       (C) The pool operator's reasonable administrative costs to 
     implement this section.
       (2) Limitation.--This section shall not apply to a State's 
     pool unless sufficient grant funds have been received under 
     this subsection to implement this section on a fiscally sound 
     basis and such receipt is certified by the pool operator.
       (3) Application.--A pool operator desiring a grant under 
     this section shall submit an application to the Secretary in 
     such manner, at such time, and containing such information as 
     the Secretary may require.
       (4) Authorization of appropriations.--There are authorized 
     to be appropriated to the Secretary such sums as may be 
     necessary for making grants under this section.

     SEC. 216. REPORT.

       Not later than 1 year after the date of enactment of this 
     Act, the Secretary shall submit to Congress a report 
     containing recommendations for such legislative and 
     administrative changes as the Secretary determines are 
     appropriate to permit affinity groups related for reasons 
     other than a common employer to participate in purchasing 
     pools established under section 203.

     SEC. 217. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated, 
     such sums as may be necessary to carry out this title for 
     fiscal year 2006 and each fiscal year thereafter.
       (b) Rule of Construction.--Amounts appropriated in 
     accordance with subsection (a) shall be in addition to other 
     amounts appropriated directly under this title and nothing in 
     subsection (a) shall be construed to relieve the Secretary of 
     mandatory payment obligations required under this title.

 TITLE III--NATIONAL ADVISORY COMMISSION ON EXPANDED ACCESS TO HEALTH 
                                  CARE

     SEC. 301. NATIONAL ADVISORY COMMISSION ON EXPANDED ACCESS TO 
                   HEALTH CARE.

       (a) Establishment.--Not later than October 1, 2003, the 
     Secretary of Health and Human Services (referred to in this 
     section as the ``Secretary''), shall establish an entity to 
     be known as the National Advisory Commission on Expanded 
     Access to Health Care (referred to in this section as the 
     ``Commission'').
       (b) Appointment of Members.--
       (1) In general.--Not later than 45 days after the date of 
     enactment of this Act, the House and Senate Majority and 
     Minority Leaders shall each appoint 4 members of the 
     Commission and the Secretary shall appoint 1 member.
       (2) Criteria.--Members of the Commission shall include 
     representatives of the following:
       (A) Consumers of health insurance.
       (B) Health care professionals.
       (C) State officials.
       (D) Economists.
       (E) Health care providers.
       (F) Experts on health insurance.
       (G) Experts on expanding health care to individuals who are 
     uninsured.
       (3) Chairperson.--At the first meeting of the Commission, 
     the Commission shall select a Chairperson from among its 
     members.
       (c) Meetings.--
       (1) In general.--After the initial meeting of the 
     Commission which shall be called by the Secretary, the 
     Commission shall meet at the call of the Chairperson.
       (2)  Quorum.--A majority of the members of the Commission 
     shall constitute a quorum, but a lesser number of members may 
     hold hearings.
       (3) Supermajority voting requirement.--To approve a report 
     required under paragraph (2) or (3) of subsection (e), at 
     least 60 percent of the membership of the Commission must 
     vote in favor of such a report.
       (d) Duties.--The Commission shall--
       (1) assess the effectiveness of programs designed to expand 
     health care coverage or make health care coverage affordable 
     to the otherwise uninsured individuals through identifying 
     the accomplishments and needed improvements of each program;
       (2) make recommendations about benefits and cost-sharing to 
     be included in health care coverage for various groups, 
     taking into account--
       (A) the special health care needs of children and 
     individuals with disabilities;
       (B) the different ability of various populations to pay 
     out-of-pocket costs for services;

[[Page S5963]]

       (C) incentives for efficiency and cost-control; and
       (D) preventative care, disease management services, and 
     other factors;
       (3) recommend mechanisms to discourage individuals and 
     employers from voluntarily opting out of health insurance 
     coverage;
       (4) recommend mechanisms to expand health care coverage to 
     uninsured individuals with incomes above 200 percent of the 
     official income poverty line (as defined by the Office of 
     Management and Budget, and revised annually in accordance 
     with section 673(2) of the Omnibus Budget Reconciliation Act 
     of 1981) applicable to a family of the size involved;
       (5) recommend automatic enrollment and retention procedures 
     and other measures to increase health care coverage among 
     those eligible for assistance;
       (6) review the roles, responsibilities, and relationship 
     between Federal and State agencies with respect to health 
     care coverage and recommend improvements; and
       (7) analyze the size, effectiveness, and efficiency of 
     current tax and other subsidies for health care coverage and 
     recommend improvements.
       (e) Reports.--
       (1) Annual report.--The Commission shall submit annual 
     reports to the President and Congress addressing the matters 
     identified in subsection (d).
       (2) Biennial report.--
       (A) In general.--The Commission shall submit biennial 
     reports to the President and Congress, which shall contain--
       (i) recommendations concerning essential benefits and 
     maximum out-of-pocket cost-sharing (for the general 
     population and for individuals with limited ability to pay, 
     which shall not exceed the out-of-pocket cost-sharing 
     permitted under section 2103(e) of the Social Security Act 
     (42 U.S.C. 1397cc(e))) for the coverage options described in 
     title II; and
       (ii) proposed legislative language to implement such 
     recommendations.
       (B) Congressional action.--The legislative language 
     proposed under subparagraph (A)(ii) shall proceed to 
     immediate consideration on the floor of the House of 
     Representatives and the Senate and shall be approved or 
     rejected, without amendment, using procedures employed for 
     recommendations of military base closing commissions.
       (3) Commission report.--No later than January 15, 2007, the 
     Commission shall submit a report to the President and 
     Congress, which shall include--
       (A) recommendations on policies to provide health care 
     coverage to uninsured individuals with incomes above 200 
     percent of the official income poverty line (as defined by 
     the Office of Management and Budget, and revised annually in 
     accordance with section 673(2) of the Omnibus Budget 
     Reconciliation Act of 1981) applicable to a family of the 
     size involved;
       (B) recommendations on changes to policies enacted under 
     this Act; and
       (C) proposed legislative language to implement such 
     recommendations.
       (f) Administration.--
       (1) Powers.--
       (A) Hearings.--The Commission may hold such hearings, sit 
     and act at such times and places, take such testimony, and 
     receive such evidence as the Commission considers advisable 
     to carry out this section.
       (B) Information from federal agencies.--The Commission may 
     secure directly from any Federal department or agency such 
     information as the Commission considers necessary to carry 
     out this section. Upon request of the Chairperson of the 
     Commission, the head of such department or agency shall 
     furnish such information to the Commission.
       (C) Postal services.--The Commission may use the United 
     States mails in the same manner and under the same conditions 
     as other departments and agencies of the Federal Government.
       (D)  Gifts.--The Commission may accept, use, and dispose of 
     gifts or donations of services or property.
       (2) Compensation.--While serving on the business of the 
     Commission (including travel time), a member of the 
     Commission shall be entitled to compensation at the per diem 
     equivalent of the rate provided for level IV of the Executive 
     Schedule under section 5315 of title 5, United States Code, 
     and while so serving away from home and the member's regular 
     place of business, a member may be allowed travel expenses, 
     as authorized by the chairperson of the Commission. All 
     members of the Commission who are officers or employees of 
     the United States shall serve without compensation in 
     addition to that received for their services as officers or 
     employees of the United States.
       (3) Staff.--
       (A) In general.--The Chairperson of the Commission may, 
     without regard to the civil service laws and regulations, 
     appoint and terminate an executive director and such other 
     additional personnel as may be necessary to enable the 
     Commission to perform its duties. The employment of an 
     executive director shall be subject to confirmation by the 
     Commission.
       (B) Staff compensation.--The Chairperson of the Commission 
     may fix the compensation of the executive director and other 
     personnel without regard to chapter 51 and subchapter III of 
     chapter 53 of title 5, United States Code, relating to 
     classification of positions and General Schedule pay rates, 
     except that the rate of pay for the executive director and 
     other personnel may not exceed the rate payable for level V 
     of the Executive Schedule under section 5316 of such title.
       (C) Detail of government employees.--Any Federal Government 
     employee may be detailed to the Commission without 
     reimbursement, and such detail shall be without interruption 
     or loss of civil service status or privilege.
       (D) Procurement of temporary and intermittent services.--
     The Chairperson of the Commission may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code, at rates for individuals which do not 
     exceed the daily equivalent of the annual rate of basic pay 
     prescribed for level V of the Executive Schedule under 
     section 5316 of such title.
       (g) Termination.--Except with respect to activities in 
     connection with the ongoing biennial report required under 
     subsection (e)(2), the Commission shall terminate 90 days 
     after the date on which the Commission submits the report 
     required under subsection (e)(3).
       (h) Authorization of Appropriations.--There are authorized 
     to be appropriated, such sums as may be necessary to carry 
     out this section for fiscal year 2004 and each fiscal year 
     thereafter.

     SEC. 302. CONGRESSIONAL ACTION.

       (a) Bill Introduction.--
       (1) In general.--Any legislative language included in the 
     report required under section 301(e)(3) may be introduced as 
     a bill by request in the following manner:
       (A) House of representatives.--In the House of 
     Representatives, by the Majority Leader and the Minority 
     Leader not later than 10 days after receipt of the 
     legislative language.
       (B) Senate.--In the Senate, by the Majority Leader and the 
     Minority Leader not later than 10 days after receipt of the 
     legislative language.
       (2) Alternative by administration.--The President may 
     submit legislative language based on the recommendations of 
     the Commission and such legislative language may be 
     introduced in the manner described in paragraph (1).
       (b) Committee Consideration.--
       (1) In general.--Any legislative language submitted 
     pursuant to paragraph (1) or (2) of subsection (a) (in this 
     section referred to as ``implementing legislation'') shall be 
     referred to the appropriate committees of the House of 
     Representatives and the Senate.
       (2) Reporting.--
       (A) Committee action.--If, not later than 150 days after 
     the date on which the implementing legislation is referred to 
     a committee under paragraph (1), the committee has reported 
     the implementing legislation or has reported an original bill 
     whose subject is related to reforming the health care system, 
     or to providing access to affordable health care coverage for 
     Americans, the regular rules of the applicable House of 
     Congress shall apply to such legislation.
       (B) Discharge from committees.--
       (i) Senate.--

       (I) In general.--If the implementing legislation or an 
     original bill described in subparagraph (A) has not been 
     reported by a committee of the Senate within 180 days after 
     the date on which such legislation was referred to committee 
     under paragraph (1), it shall be in order for any Senator to 
     move to discharge the committee from further consideration of 
     such implementing legislation.
       (II) Sequential referrals.--Should a sequential referral of 
     the implementing legislation be made, the additional 
     committee has 30 days for consideration of implementing 
     legislation before the discharge motion described in 
     subclause (I) would be in order.
       (III) Procedure.--The motion described in subclause (I) 
     shall not be in order after the implementing legislation has 
     been placed on the calendar. While the motion described in 
     subclause (I) is pending, no other motions related to the 
     motion described in subclause (I) shall be in order. Debate 
     on a motion to discharge shall be limited to not more than 10 
     hours, equally divided and controlled by the Majority Leader 
     and the Minority Leader, or their designees. An amendment to 
     the motion shall not be in order, nor shall it be in order to 
     move to reconsider the vote by which the motion is agreed or 
     disagreed to.
       (IV) Exception.--If implementing language is submitted on a 
     date later than May 1 of the second session of a Congress, 
     the committee shall have 90 days to consider the implementing 
     legislation before a motion to discharge under this clause 
     would be in order.

       (ii) House of representatives.--If the implementing 
     legislation or an original bill described in subparagraph (A) 
     has not been reported out of a committee of the House of 
     Representatives within 180 days after the date on which such 
     legislation was referred to committee under paragraph (1), 
     then on any day on which the call of the calendar for motions 
     to discharge committees is in order, any member of the House 
     of Representatives may move that the committee be discharged 
     from consideration of the implementing legislation, and this 
     motion shall be considered under the same terms and 
     conditions, and if adopted the House of Representatives shall 
     follow the procedure described in subsection (c)(1).
       (c) Floor Consideration.--
       (1) Motion to proceed.--If a motion to discharge made 
     pursuant to subsection (b)(2)(B)(i) or (b)(2)(B)(ii) is 
     adopted, then, not earlier than 5 legislative days after the 
     date on which the motion to discharge is

[[Page S5964]]

     adopted, a motion may be made to proceed to the bill.
       (2) Failure of motion.--If the motion to discharge made 
     pursuant to subsection (b)(2)(B)(i) or (b)(2)(B)(ii) fails, 
     such motion may be made not more than 2 additional times, but 
     in no case more frequently than within 30 days of the 
     previous motion. Debate on each of such motions shall be 
     limited to 5 hours, equally divided.
       (3) Applicable rules.--Once the Senate is debating the 
     implementing legislation the regular rules of the Senate 
     shall apply.

                        TITLE IV--STATE WAIVERS

     SEC. 401. STATE WAIVERS.

       (a) In General.--Notwithstanding any other provision of 
     law, a State may apply to the Secretary of Health and Human 
     Services for waivers of such provisions of law as may be 
     necessary for the State to implement policies that make 
     comprehensive, affordable health coverage available for all 
     State residents, including access to essential benefits with 
     limits on cost-sharing, as provided in the most recent report 
     under section 301(e)(2).
       (b) Requirements.--In order to ensure that waivers under 
     this section benefit rather than harm health care consumers, 
     a State shall not be eligible for a waiver under this section 
     unless--
       (1) the State reasonably expects to achieve a level of 
     enrollment in coverage described in subsection (a) that is at 
     least equal to the level of coverage (taking into account the 
     number of insured individuals, covered benefits, and premium 
     and out-of-pocket costs to the consumer for such coverage) 
     that the State would have achieved if the State had fully 
     implemented the coverage options available under titles I and 
     II of this Act;
       (2) no individual who would have qualified for assistance 
     under the State medicaid program under title XIX of the 
     Social Security Act or the State children's health insurance 
     program under title XXI of such Act, as of either the date of 
     the waiver request or the date of enactment of this Act, will 
     be denied eligibility for such program, have a reduction in 
     benefits under such program, have reduced access to 
     geographically and linguistically appropriate care or 
     essential community providers, or be subject to increased 
     premiums or cost-sharing under the waiver program under this 
     section; and
       (3) the State agrees to comply with such standards or 
     guidelines as the Secretary of Health and Human Services may 
     require to ensure that the requirements of paragraphs (1) and 
     (2) are satisfied.
       (c) Federal Payments.--
       (1) In general.--The Secretary of Health and Human Services 
     shall pay a State with a waiver approved under this section 
     an amount each quarter equal to the sum of--
       (A) the Federal payments the State and residents of the 
     State (including, but not limited to, through the credit 
     allowed under section 36 of the Internal Revenue Code of 1986 
     for health insurance costs) would have received if the State 
     had exercised the coverage options under titles I and II of 
     this Act with respect to residents of the State who have not 
     attained age 65; and
       (B) the amount of any grants authorized by this Act that 
     the State would have received if the State had applied for 
     such grants.
       (2) Additional payment for medicare beneficiaries under age 
     65.--
       (A) In general.--In the case of a State that elects to 
     enroll an individual described in subparagraph (B) in 
     coverage described in subsection (a), the amount described in 
     paragraph (1) with respect to a quarter shall be increased by 
     the amount described in subparagraph (C).
       (B) Individual described.--An individual is described in 
     this subparagraph if the individual--
       (i) has not attained age 65;
       (ii) is eligible for coverage under title XVIII of the 
     Social Security Act; and
       (iii) voluntarily elects to enroll in coverage described in 
     subsection (a).
       (C) Amount described.--The amount described in this 
     subparagraph is the amount equal to the amount that the 
     Federal Government would have incurred with respect to a 
     quarter for providing coverage to an individual described in 
     subparagraph (B) under title XVIII of the Social Security Act 
     (42 U.S.C. 1395 et seq.).
       (d) Implementation Date.--No State may submit a request for 
     a waiver under this section before October 1, 2007.
                                 ______
                                 
      By Mr. SARBANES (for himself, Mr. Alexander, Mr. Akaka, Mr. 
        Baucus, Mr. Corzine, Mr. Dodd, Mr. Graham of Florida, Mr. 
        Kennedy, Mr. Lautenberg, Mr. Levin, Mr. Reid, Mr. Schumer, Ms. 
        Stabenow, and Mr. Wyden):
  S. 1032. A bill to provide for alternative transportation in certain 
federally owned or managed areas that are open to the general public; 
to the Committee on Energy and Natural Resources.
  Mr. SARBANES. Mr. President, I rise today to introduce legislation 
similar to measures I have introduced in previous Congresses that will 
help protect our Nation's natural resources and improve the visitor 
experience in our national parks and other public lands. The Transit in 
Parks Act, or ``TRIP,'' establishes a new Federal transit grant 
initiative to support the development of alternative transportation 
services for our national parks, wildlife refuges, Federal recreational 
areas, and other public lands. I am pleased to be joined by Senators 
Akaka, Alexander, Baucus, Corzine, Dodd, Graham, Kennedy, Lautenberg, 
Levin, Reid, Schumer, Stabenow, and Wyden, who are cosponsors of this 
legislation.
  I want to underscore again today some of the principal arguments I 
have made in past years as to why this legislation is urgently needed. 
Memorial Day weekend, the opening of the summer travel season, is just 
weeks away. Millions of visitors will soon head to our national parks 
to enjoy the incredible natural heritage with which our Nation was 
endowed. But too many of them will spend hours looking for parking, or 
staring at the bumper of the car in front of them.
  Clearly, the world has changed significantly since the national parks 
first opened in the second half of the nineteenth century, when 
visitors arrived by stagecoach along dirt roads. At that time, travel 
through parklands, such as Yosemite or Yellowstone, was long, 
difficult, and costly. Not many people could afford or endure such a 
trip. The introduction of the automobile gave every American greater 
mobility and freedom, which included the freedom to travel and see some 
of our Nation's great natural wonders. Early in this century, landscape 
architects from the National Park Service and highway engineers from 
the U.S. Bureau of Public Roads collaborated to produce many feats of 
road engineering that opened the national park lands to millions of 
Americans.
  Yet greater mobility and easier access now threaten the very 
environments that the National Park Service is mandated to protect. The 
ongoing tension between preservation and access has always been a 
challenge for our national park system. Today, record numbers of 
visitors and cars have resulted in increasing damage to our parks. The 
Grand Canyon alone has almost five million visitors a year. As many as 
6,000 vehicles arrive in a single summer day. They compete for 2,400 
parking spaces. Between 32,000 and 35,000 tour buses go to the park 
each year. During the peak summer season, the entrance route becomes a 
giant parking lot.
  In 1975, the total number of visitors to America's national parks was 
190 million. By 2002, that number had risen to 277 million annual 
visitors--almost equal to one visit by every man, woman, and child in 
this country. This dramatic increase in visitation has created an 
overwhelming demand on these areas, resulting in severe traffic 
congestion, visitor restrictions, and in some instances vacationers 
being shut out of the parks altogether. The environmental damage at the 
Grand Canyon is visible at many other parks: Yosemite, which has more 
than four million visitors a year; Yellowstone, which has more than 
three million visitors a year and experiences such severe traffic 
congestion that access has to be restricted; Zion; Acadia; Bryce; and 
many others. We need to solve these problems now or risk permanent harm 
to our nation's natural, cultural, and historical heritage.
  Visitor access to the parks is vital not only to the parks 
themselves, but to the economic health of their gateway communities. 
For example, visitors to Yosemite infuse $3 billion a year into the 
local economy of the surrounding area. At Yellowstone, tourists spend 
$725 million annually in adjacent communities. Wildlife-related tourism 
generates an estimated $60 billion a year nationwide. If the parks are 
forced to close their gates to visitors due to congestion, the economic 
vitality of the surrounding region would be jeopardized.
  The challenge for park management has always been twofold: to 
conserve and protect the nation's natural, historical, and cultural 
resources, while at the same time ensuring visitor access and enjoyment 
of these sensitive environments. Until now, the principal 
transportation systems that the Federal Government has developed to 
provide access into our national parks are roads, primarily for private 
automobile access. The TRIP legislation recognizes that we need to do 
more than simply

[[Page S5965]]

build roads; we must invest in alternative transportation solutions 
before our national parks are damaged beyond repair.
  In developing solutions to the parks' transportation needs, this 
legislation builds upon the 1997 Memorandum of Understanding between 
Secretary of Transportation Rodney Slater and Secretary of the Interior 
Bruce Babbitt, in which the two Departments agreed to work together to 
address transportation and resource management needs in and around 
national parks. The findings in the MOU are especially revealing: 
Congestion in and approaching many National Parks is causing lengthy 
traffic delays and backups that substantially detract from the visitor 
experience. Visitors find that many of the National Parks contain 
significant noise and air pollution, and traffic congestion similar to 
that found on the city streets they left behind.
  In many National Park units, the capacity of parking facilities at 
interpretive or scenic areas is well below demand. As a result, 
visitors park along roadsides, damaging park resources and subjecting 
people to hazardous safety conditions as they walk near busy roads to 
access visitor use areas.
  On occasion, National Park units must close their gates during high 
visitation periods and turn away the public because the existing 
infrastructure and transportation systems are at, or beyond, the 
capacity for which they were designed.
  In addition, the TRIP legislation is designed to implement the 
recommendations from a comprehensive study of alternative 
transportation needs in public lands that I was able to include in the 
Transportation Equity Act for the 21st Century, TEA-21, as section 
3039. The Federal Lands Alternative Transportation Systems Study 
confirmed what those of us who have visited our national parks already 
know: there is a significant and well-documented need for alternative 
transportation solutions in the national parks to prevent lasting 
damage to these incomparable natural treasures.
  The study examined over two hundred sites, and identified needs for 
alternative transportation services at two-thirds of those sites. The 
study found that implementation of such services can help achieve a 
number of desirable outcomes: ``Relieve traffic congestion and parking 
shortages; enhance visitor mobility and accessibility; preserve 
sensitive natural, cultural, and historic resources; provide improved 
interpretation, education and visitor information services; reduce 
pollution; and improve economic development opportunities for gateway 
communities.''
  In fact, the study concluded that ``the provision of transit in 
federally-managed lands can have national economic implications as well 
as significant economic benefits for local areas surrounding the 
sites.'' The study determined that funding transit needs would support 
thousands of jobs around the country, while also providing a direct 
benefit to the economy of gateway communities by ``expand[ing] the 
number of visits to the site and expand[ing] the amount of visitor 
spending in the surrounding communities.''
  The study identified ``lack of a dedicated funding source for 
developing, implementing, and operating and maintaining transit 
systems'' as a key barrier to implementation of alternative 
transportation in and around federally-managed lands. The Transit in 
Parks Act will go far toward helping parks and their gateway 
communities overcome this barrier. This new Federal transit grant 
program will provide funding to the Federal land management agencies 
that manage the 388 various sites within the National Park System, the 
National Wildlife Refuges, Federal recreational areas, and other public 
lands, including National Forest System lands, and to their State and 
local partners.
  The bill's objectives are to develop new and expanded transit 
services throughout the national parks and other public lands to 
conserve and protect fragile natural, cultural, and historical 
resources and wildlife habitats, to prevent or mitigate adverse impact 
on those resources and habitats, and to reduce pollution and 
congestion, while at the same time facilitating appropriate visitor 
access and improving the visitor experience. The program will provide 
capital funds for transit projects, including rail or clean fuel bus 
projects, joint development activities, pedestrian and bike paths, or 
park waterway access, within or adjacent to national parks and other 
public lands. The Secretary of Transportation may make funds available 
for operations as well. The bill authorizes $90 million for this new 
program for each of the fiscal years 2004 through 2009, consistent with 
the level of need identified in the study. It is anticipated that other 
resources--both public and private--will be available to augment these 
amounts.
  The bill formalizes the cooperative arrangement in the 1997 MOU 
between the Secretary of Transportation and the Secretary of the 
Interior to exchange technical assistance and to develop procedures 
relating to the planning, selection and funding of transit projects in 
national park lands. The bill further provides funds for planning, 
research, and technical assistance that can supplement other financial 
resources available to the Federal land management agencies. The 
projects eligible for funding would be developed through the 
transportation planning process and prioritized for funding by the 
Secretary of the Interior in consultation and cooperation with the 
Secretary of Transportation. It is anticipated that the Secretary of 
the Interior would select projects that are diverse in location and 
size. While major national parks such as the Grand Canyon or 
Yellowstone are clearly appropriate candidates for significant transit 
projects under this section, there are numerous small urban and rural 
Federal park lands that can benefit enormously from small projects, 
such as bike paths or improved connections with an urban or regional 
public transit system. No single project will receive more than 12 
percent of the total amount available in any given year. This ensures a 
diversity of projects selected for assistance.
  In addition, I firmly believe that this program will create new 
opportunities for the Federal land management agencies to partner with 
local transit agencies in gateway communities adjacent to the parks, 
both through the TEA-21 planning process and in developing integrated 
transportation systems. This will spur new economic development within 
these communities, as they develop transportation centers for park 
visitors to connect to transit links into the national parks and other 
public lands.
  The ongoing tension between preservation and access has always been a 
challenge for the National Park Service. Today, that challenge has new 
dimensions, with overcrowding, pollution, congestion, and resource 
degradation increasing at many of our national parks. This 
legislation--the Transit in Parks Act--will give our Federal land 
management agencies important new tools to improve both preservation 
and access. Just as we have found in metropolitan areas, transit is 
essential to moving large numbers of people in our national parks--
quickly, efficiently, at low cost, and without adverse impact. At the 
same time, transit can enhance the economic development potential of 
our gateway communities.
  As we begin a new millennium, I cannot think of a more worthy 
endeavor to help our environment and preserve our national parks, 
wildlife refuges, and Federal recreational areas than by encouraging 
alternative transportation in these areas. My bill is strongly 
supported by the National Parks Conservation Association, Environmental 
Defense, the American Public Transportation Association, Community 
Transportation Association, Amalgamated Transit Union, Surface 
Transportation Policy Project, Natural Resources Defense Council, 
Friends of the Earth, Rails-to-Trails Conservancy, America Bikes and 
others, and I ask unanimous consent that the bill, a section-by-section 
analysis, and letters of support be printed in the Record, along with 
the USA Today article, ``Save Parks: Park Cars.''
  I believe that we have a clear choice before us: we can turn paradise 
into a parking lot--or we can invest in alternatives. I urge my 
colleagues to support the Transit in Parks Act to ensure that our 
Nation's natural treasures will be preserved for many generations to 
come.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Mr. Lugar, Mrs. Lincoln, Mr.

[[Page S5966]]

        Corzine, Ms. Landrieu, Mr. Breaux, Mr. Kerry, Ms. Cantwell, 
        Mrs. Murray, Mrs. Clinton, and Mr. Miller):
  S. 1033. A bill to amend titles XIX and XXI of the Social Security 
Act to expand or add coverage of pregnant women under the medicaid and 
State children's health insurance program, and for other purposes; to 
the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce bipartisan 
legislation with Senators Lugar, Lincoln, Corzine, Landrieu, Breaux, 
Kerry, Murray, Cantwell, Clinton, and Miller. This legislation, 
entitled the ``Start Healthy, Stay Healthy Act of 2003,'' would 
significantly reduce the number of uninsured pregnant women and 
newborns by expanding coverage to pregnant women through Medicaid and 
the Children's Health Insurance Program, or CHIP, and to newborns 
through the first full year of life.
  Sunday is Mothers' Day. Every year, we honor our Nation's mothers and 
we should take the time to assess how we can do better by them, 
including their health and well-being.
  According to a recent report by Save the Children entitled ``The 
State of the World's Mothers,'' the United States fares no better than 
11th in the world. Why is this? According to the report, ``The United 
States earned its 11th place rank this year based on several factors: 
One of the key indicators used to calculate the well-being for mothers 
is lifetime risk of maternal mortality . . . Canada, Australia, and all 
the Western and Northern European countries in the study performed 
better than the United States in this indicator.''
  The study adds, ``Similarly, the United States did not do as well as 
the top 10 countries with regard to infant mortality rates.''
  In fact, the United States ranks 21st in maternal mortality and 28th 
in infant mortality, the worst among developed nations. We should and 
must do better by our Nation's mothers and infants.
  Throughout our Nation's history, there has been long-standing policy 
linking programs for pregnant women and infants, including Medicaid, 
WIC, and the Maternal and Child Health Block Grant. CHIP, 
unfortunately, fails to provide coverage to pregnant women beyond the 
age of 18. As a result, it is more likely that newborns eligible for 
CHIP are not covered from the moment of birth, and therefore, often 
miss having comprehensive prenatal care and those first critical months 
of life until their CHIP application is processed.
  By expanding coverage to pregnant women through CHIP, the ``Start 
Healthy, Stay Healthy Act'' recognizes the importance of prenatal care 
to the health and development of a child. As Dr. Alan Waxman of the 
University of New Mexico School of Medicine has written, ``Prenatal 
care is an important factor in the prevention of birth defects and the 
prevention of prematurity, the most common causes of infant death and 
disability. Babies born to women with no prenatal care or late prenatal 
care are nearly twice as likely to [be] low birthweight or very low 
birthweight as infants born to women who received early prenatal 
care.''
  Unfortunately, according to the Centers for Disease Control and 
Prevention, New Mexico ranked worst in the Nation in the percentage of 
mothers receiving late or no prenatal care last year. The result is 
often quite costly--both in terms of the health of the mother and 
newborn but also in terms of the long-term expenses since the result 
can be chronic, lifelong health problems.
  In fact, according to the Agency for Healthcare Research and Quality, 
``four of the top 10 most expensive conditions in the hospital are 
related to care of infants with complications (respiratory distress, 
prematurity, heart defects, and lack of oxygen).'' As a result, in 
addition to reduced infant mortality and morbidity, the provision to 
expand coverage to pregnant women can be cost effective.
  The ``Start Healthy, Stay Healthy Act'' also eliminates the 
unintended federal policy through CHIP that covers pregnant women only 
through the age of 18 and cuts off that coverage once the women turn 19 
years of age. Certainly, everybody can agree that the government should 
not be telling women that they are more likely to receive prenatal care 
coverage only if they become pregnant as a teenager.
  This bipartisan legislation has previously received or has added 
endorsements from the following organizations: the March of Dimes, The 
American Academy of Pediatrics, the American College of Obstetricians 
and Gynecologists, the What to Expect Foundation, the American Academy 
of Family Physicians, the American Academy of Pediatric Dentistry, the 
American Academy of Child and Adolescent Psychiatry, the National 
Association of Community Health Centers, the American Hospital 
Association, the National Association of Children's Hospitals, the 
Federation of American Health Systems, the National Association of 
Public Hospitals and Health Systems, Premier, Catholic Health 
Association, Catholic Charities USA, Family Voices, the Association of 
Maternal and Child Health Programs, the National Health Law Program, 
the National Association of Social Workers, Every Child By Two, the 
United Cerebral Palsy Associations, the Society for Maternal-Fetal 
Medicine, and Families USA.
  This legislation is a reintroduction of a bill that was introduced in 
2001. Throughout that year, the Administration made numerous statements 
in support of the passage of this type of legislation, but 
unfortunately, reversed course in October 2002 after publishing a 
regulation allowing states to redefine a ``child'' as an ``unborn 
child'' and to provide prenatal care through CHIP in that manner. In a 
letter to Senator Nickles dated October 8, 2002, Secretary Thompson 
argued, ``I believe the regulation is a more effective and 
comprehensive solution to this issue.''
  While a number of senators strongly disagreed with Secretary 
Thompson's assertion and sent him letters to that effect on October 10, 
2002, and on October 23, 2002, we felt it was important to get the 
testimony of our Nation's medical experts on the health and well-being 
of both pregnant women and newborns. We called for a hearing in the 
Senate Health, Education, Labor and Pensions Committee on October 24, 
2002. Witnesses included representatives from the March of Dimes, the 
American College of Obstetricians and Gynecologists, the American 
Academy of Pediatrics, and the What to Expect Foundation. They were 
asked to compare the regulation to the legislation and I will let their 
testimony speak for itself.
  Dr. Nancy Green testified on behalf of the March of Dimes Birth 
Defects Foundation. She said:

       We support giving states the flexibility they need to cover 
     income-eligible pregnant women age 19 and older, and to 
     automatically enroll infants born to SCHIP-eligible mothers. 
     By establishing a uniform eligibility threshold for coverage 
     for pregnant women and infants, states will be able to 
     improve maternal health, eliminate waiting periods for 
     infants and streamline administration of publicly supported 
     health programs. Currently, according to the Department of 
     Health and Human Services' Centers for Medicare and Medicaid 
     Services and the National Governors' Association, 36 states 
     and the District of Columbia have income eligibility 
     thresholds that are more restrictive for women than for their 
     newborns. Encouraging states to eliminate this disparity by 
     allowing them to establish a uniform eligibility threshold 
     for pregnant women and their infants should be a national 
     policy priority.

  Dr. Green adds:

       Specifically, we are deeply concerned that final regulation 
     fails to provide to the mother the standard scope of 
     maternity care services recommended by the American College 
     of Obstetricians and Gynecologists (ACOG) and the American 
     Academy of Pediatrics (AAP). Of particular concern, the 
     regulation explicitly states that postpartum care is not 
     covered and, therefore, federal reimbursement will not be 
     available for these services. In addition, because of the 
     contentious collateral issues raised by this regulation 
     groups like the March of Dimes will find it even more 
     difficult to work in the states to generate support for 
     legislation to extend coverage to uninsured pregnant women.

  Dr. Laura Riley testified on behalf of ACOG. In her testimony, she 
stated:

       ACOG is very concerned that mothers will not have access to 
     postpartum services under the regulation. The rule clearly 
     states that ``. . . care after delivery, such as postpartum 
     services could not be covered as part of the Title XXI State 
     Plan . . . because they are not services for an eligible 
     child.''

  On the importance of postpartum care, Dr. Riley adds:


[[Page S5967]]


       When new mothers develop postpartum complications, quick 
     access to their physicians is absolutely critical. Postpartum 
     care is especially important for women who have preexisting 
     medical conditions, and for those whose medical conditions 
     were induced by their pregnancies, such as gestational 
     diabetes or hypertension, and for whom it is necessary to 
     ensure that their conditions are stabilized and treated.

  As a result, Dr. Riley concludes:

       Limiting coverage to the fetus instead of the mother omits 
     a critical component of postpartum care that physicians 
     regard as essential for the health of the mother and the 
     child. Covering the fetus as opposed to the mother also 
     raises questions of whether certain services will be 
     available during pregnancy and labor if the condition is one 
     that more directly affects the woman. The best way to address 
     this coverage issue is to pass S. 724, supported by Senators 
     Bond, Bingaman and Lincoln and many others, and which 
     provides a full range of medical services during and after 
     pregnancy directly to the pregnant woman.

  Dr. Richard Bucciarelli testified on behalf of the American Academy 
of Pediatrics. He said:

       Recently, the Administration published a final rule 
     expanding SCHIP cover unborn children. The Academy is 
     concerned that, as written, this regulation falls dangerously 
     short of the clinical standards of care outlined in our 
     guidelines, which describe the importance of covering all 
     stages of a birth--pregnancy, delivery, and postpartum care.

  It is important to note that the regulation subtracts the time that 
an ``unborn child'' is covered from the period of continuously 
eligibility after birth. Consequently, children would be denied 
insurance coverage at very critical points during the first full year 
of life. As such, Dr. Bucciarelli expressed support for the legislation 
over the regulation because it, in his words:

       . . . takes an important step to decrease the number of 
     uninsured children by providing 12 months of continuous 
     eligibility for those children born. . . . This legislation 
     ensures that children born to women enrolled in Medicaid or 
     SCHIP are immediately enrolled in the program for which they 
     are eligible. Additionally, this provision prevents newborns 
     eligible for SCHIP from being subject to enrollment waiting 
     periods, ensuring that infants receive appropriate health 
     care in their first year of life.

  And finally, Lisa Bernstein testified as Executive Director of The 
What to Expect Foundation, which takes its name from the bestselling 
What to Expect pregnancy and parenting series that has helped over 20 
million families from pregnancy through their child's toddler years. 
Ms. Bernstein also supported the legislation as a far superior option 
over the regulation and make this simple but eloquent point:

       . . . only a healthy parent can provide a healthy future 
     for a healthy child.

  The testimony of these experts speak for themselves and I urge my 
colleagues to pass this legislation as soon as possible.
  I ask unanimous consent that the text of the bill and a series of 
letters be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1033

       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 ``Start Healthy, Stay Healthy 
     Act of 2003''.

     SEC. 2. STATE OPTION TO EXPAND OR ADD COVERAGE OF CERTAIN 
                   PREGNANT WOMEN UNDER MEDICAID AND SCHIP.

       (a) Medicaid.--
       (1) Authority to expand coverage.--Section 1902(l)(2)(A)(i) 
     of the Social Security Act (42 U.S.C. 1396a(l)(2)(A)(i)) is 
     amended by inserting ``(or such higher percent as the State 
     may elect for purposes of expenditures for medical assistance 
     for pregnant women described in section 1905(u)(4)(A))'' 
     after ``185 percent''.
       (2) Enhanced matching funds available if certain conditions 
     met.--Section 1905 of the Social Security Act (42 U.S.C. 
     1396d) is amended--
       (A) in the fourth sentence of subsection (b), by striking 
     ``or subsection (u)(3)'' and inserting ``, (u)(3), or 
     (u)(4)''; and
       (B) in subsection (u)--
       (i) by redesignating paragraph (4) as paragraph (5); and
       (ii) by inserting after paragraph (3) the following:
       ``(4) For purposes of the fourth sentence of subsection (b) 
     and section 2105(a), the expenditures described in this 
     paragraph are the following:
       ``(A) Certain pregnant women.--If the conditions described 
     in subparagraph (B) are met, expenditures for medical 
     assistance for pregnant women described in subsection (n) or 
     under section 1902(l)(1)(A) in a family the income of which 
     exceeds the effective income level (expressed as a percent of 
     the poverty line and considering applicable income 
     disregards) that has been specified under subsection 
     (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, as of 
     January 1, 2003, but does not exceed the income eligibility 
     level established under title XXI for a targeted low-income 
     child.
       ``(B) Conditions.--The conditions described in this 
     subparagraph are the following:
       ``(i) The State plans under this title and title XXI do not 
     provide coverage for pregnant women described in subparagraph 
     (A) with higher family income without covering such pregnant 
     women with a lower family income.
       ``(ii) The State does not apply an effective income level 
     for pregnant women that is lower than the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) that has been 
     specified under the State plan under subsection 
     (a)(10)(A)(i)(III) or (l)(2)(A) of section 1902, as of 
     January 1, 2003, to be eligible for medical assistance as a 
     pregnant woman.
       ``(C) Definition of poverty line.--In this subsection, the 
     term `poverty line' has the meaning given such term in 
     section 2110(c)(5).''.
       (3) Payment from title xxi allotment for medicaid expansion 
     costs; elimination of counting medicaid child presumptive 
     eligibility costs against title xxi allotment.--Section 
     2105(a)(1) of the Social Security Act (42 U.S.C. 
     1397ee(a)(1)) is amended--
       (A) in the matter preceding subparagraph (A), by striking 
     ``(or, in the case of expenditures described in subparagraph 
     (B), the Federal medical assistance percentage (as defined in 
     the first sentence of section 1905(b)))''; and
       (B) by striking subparagraph (B) and inserting the 
     following:
       ``(B) for the provision of medical assistance that is 
     attributable to expenditures described in section 
     1905(u)(4)(A);''.
       (4) Additional amendments to medicaid.--
       (A) Eligibility of a newborn.--Section 1902(e)(4) of the 
     Social Security Act (42 U.S.C. 1396a(e)(4)) is amended in the 
     first sentence by striking ``so long as the child is a member 
     of the woman's household and the woman remains (or would 
     remain if pregnant) eligible for such assistance''.
       (B) Application of qualified entities to presumptive 
     eligibility for pregnant women under medicaid.--Section 
     1920(b) of the Social Security Act (42 U.S.C. 1396r-1(b)) is 
     amended by adding at the end after and below paragraph (2) 
     the following flush sentence:

     ``The term `qualified provider' includes a qualified entity 
     as defined in section 1920A(b)(3).''.
       (b) SCHIP.--
       (1) Coverage.--Title XXI of the Social Security Act (42 
     U.S.C. 1397aa et seq.) is amended by adding at the end the 
     following:

     ``SEC. 2111. OPTIONAL COVERAGE OF TARGETED LOW-INCOME 
                   PREGNANT WOMEN.

       ``(a) Optional Coverage.--Notwithstanding any other 
     provision of this title, a State may provide for coverage, 
     through an amendment to its State child health plan under 
     section 2102, of pregnancy-related assistance for targeted 
     low-income pregnant women in accordance with this section, 
     but only if the State meets the conditions described in 
     section 1905(u)(4)(B).
       ``(b) Definitions.--For purposes of this title:
       ``(1) Pregnancy-related assistance.--The term `pregnancy-
     related assistance' has the meaning given the term child 
     health assistance in section 2110(a) as if any reference to 
     targeted low-income children were a reference to targeted 
     low-income pregnant women, except that the assistance shall 
     be limited to services related to pregnancy (which include 
     prenatal, delivery, and postpartum services and services 
     described in section 1905(a)(4)(C)) and to other conditions 
     that may complicate pregnancy.
       ``(2) Targeted low-income pregnant woman.--The term 
     `targeted low-income pregnant woman' means a woman--
       ``(A) during pregnancy and through the end of the month in 
     which the 60-day period (beginning on the last day of her 
     pregnancy) ends;
       ``(B) whose family income exceeds the effective income 
     level (expressed as a percent of the poverty line and 
     considering applicable income disregards) that has been 
     specified under subsection (a)(10)(A)(i)(III) or (l)(2)(A) of 
     section 1902, as of January 1, 2003, to be eligible for 
     medical assistance as a pregnant woman under title XIX but 
     does not exceed the income eligibility level established 
     under the State child health plan under this title for a 
     targeted low-income child; and
       ``(C) who satisfies the requirements of paragraphs (1)(A), 
     (1)(C), (2), and (3) of section 2110(b).
       ``(c) References to Terms and Special Rules.--In the case 
     of, and with respect to, a State providing for coverage of 
     pregnancy-related assistance to targeted low-income pregnant 
     women under subsection (a), the following special rules 
     apply:
       ``(1) Any reference in this title (other than in subsection 
     (b)) to a targeted low-income child is deemed to include a 
     reference to a targeted low-income pregnant woman.
       ``(2) Any such reference to child health assistance with 
     respect to such women is deemed a reference to pregnancy-
     related assistance.

[[Page S5968]]

       ``(3) Any such reference to a child is deemed a reference 
     to a woman during pregnancy and the period described in 
     subsection (b)(2)(A).
       ``(4) In applying section 2102(b)(3)(B), any reference to 
     children found through screening to be eligible for medical 
     assistance under the State medicaid plan under title XIX is 
     deemed a reference to pregnant women.
       ``(5) There shall be no exclusion of benefits for services 
     described in subsection (b)(1) based on any preexisting 
     condition and no waiting period (including any waiting period 
     imposed to carry out section 2102(b)(3)(C)) shall apply.
       ``(6) Subsection (a) of section 2103 (relating to required 
     scope of health insurance coverage) shall not apply insofar 
     as a State limits coverage to services described in 
     subsection (b)(1) and the reference to such section in 
     section 2105(a)(1)(C) is deemed not to require, in such case, 
     compliance with the requirements of section 2103(a).
       ``(7) In applying section 2103(e)(3)(B) in the case of a 
     pregnant woman provided coverage under this section, the 
     limitation on total annual aggregate cost-sharing shall be 
     applied to the entire family of such pregnant woman.
       ``(d) Automatic Enrollment for Children Born to Women 
     Receiving Pregnancy-Related Assistance.--If a child is born 
     to a targeted low-income pregnant woman who was receiving 
     pregnancy-related assistance under this section on the date 
     of the child's birth, the child shall be deemed to have 
     applied for child health assistance under the State child 
     health plan and to have been found eligible for such 
     assistance under such plan or to have applied for medical 
     assistance under title XIX and to have been found eligible 
     for such assistance under such title, as appropriate, on the 
     date of such birth and to remain eligible for such assistance 
     until the child attains 1 year of age. During the period in 
     which a child is deemed under the preceding sentence to be 
     eligible for child health or medical assistance, the child 
     health or medical assistance eligibility identification 
     number of the mother shall also serve as the identification 
     number of the child, and all claims shall be submitted and 
     paid under such number (unless the State issues a separate 
     identification number for the child before such period 
     expires).''.
       (2) Additional allotments for providing coverage of 
     pregnant women.--
       (A) In general.--Section 2104 of the Social Security Act 
     (42 U.S.C. 1397dd) is amended by inserting after subsection 
     (c) the following:
       ``(d) Additional Allotments for Providing Coverage of 
     Pregnant Women.--
       ``(1) Appropriation; total allotment.--For the purpose of 
     providing additional allotments to States under this title, 
     there is appropriated, out of any money in the Treasury not 
     otherwise appropriated, for each of fiscal years 2004 through 
     2007, $200,000,000.
       ``(2) State and territorial allotments.--In addition to the 
     allotments provided under subsections (b) and (c), subject to 
     paragraphs (3) and (4), of the amount available for the 
     additional allotments under paragraph (1) for a fiscal year, 
     the Secretary shall allot to each State with a State child 
     health plan approved under this title--
       ``(A) in the case of such a State other than a commonwealth 
     or territory described in subparagraph (B), the same 
     proportion as the proportion of the State's allotment under 
     subsection (b) (determined without regard to subsection (f)) 
     to the total amount of the allotments under subsection (b) 
     for such States eligible for an allotment under this 
     paragraph for such fiscal year; and
       ``(B) in the case of a commonwealth or territory described 
     in subsection (c)(3), the same proportion as the proportion 
     of the commonwealth's or territory's allotment under 
     subsection (c) (determined without regard to subsection (f)) 
     to the total amount of the allotments under subsection (c) 
     for commonwealths and territories eligible for an allotment 
     under this paragraph for such fiscal year.
       ``(3) Use of additional allotment.--Additional allotments 
     provided under this subsection are not available for amounts 
     expended before October 1, 2003. Such amounts are available 
     for amounts expended on or after such date for child health 
     assistance for targeted low-income children, as well as for 
     pregnancy-related assistance for targeted low-income pregnant 
     women.
       ``(4) No payments unless election to expand coverage of 
     pregnant women.--No payments may be made to a State under 
     this title from an allotment provided under this subsection 
     unless the State provides pregnancy-related assistance for 
     targeted low-income pregnant women under this title, or 
     provides medical assistance for pregnant women under title 
     XIX, whose family income exceeds the effective income level 
     applicable under subsection (a)(10)(A)(i)(III) or (l)(2)(A) 
     of section 1902 to a family of the size involved as of 
     January 1, 2003.''.
       (B) Conforming amendments.--Section 2104 of the Social 
     Security Act (42 U.S.C. 1397dd) is amended--
       (i) in subsection (a), in the matter preceding paragraph 
     (1), by inserting ``subject to subsection (d),'' after 
     ``under this section,'';
       (ii) in subsection (b)(1), by inserting ``and subsection 
     (d)'' after ``Subject to paragraph (4)''; and
       (iii) in subsection (c)(1), by inserting ``subject to 
     subsection (d),'' after ``for a fiscal year,''.
       (3) Presumptive eligibility under title xxi.--
       (A) Application to pregnant women.--Section 2107(e)(1)(D) 
     of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
     amended to read as follows:
       ``(D) Sections 1920 and 1920A (relating to presumptive 
     eligibility).''.
       (B) Exception from limitation on administrative expenses.--
     Section 2105(c)(2) of the Social Security Act (42 U.S.C. 
     1397ee(c)(2)) is amended by adding at the end the following 
     new subparagraph:
       ``(C) Exception for presumptive eligibility expenditures.--
     The limitation under subparagraph (A) on expenditures shall 
     not apply to expenditures attributable to the application of 
     section 1920 or 1920A (pursuant to section 2107(e)(1)(D)), 
     regardless of whether the child or pregnant woman is 
     determined to be ineligible for the program under this title 
     or title XIX.''.
       (4) Additional amendments to title xxi.--
       (A) No cost-sharing for pregnancy-related services.--
     Section 2103(e)(2) of the Social Security Act (42 U.S.C. 
     1397cc(e)(2)) is amended--
       (i) in the heading, by inserting ``or pregnancy-related 
     services'' after ``preventive services''; and
       (ii) by inserting before the period at the end the 
     following: ``or for pregnancy-related services''.
       (B) No waiting period.--Section 2102(b)(1)(B) of the Social 
     Security Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
       (i) by striking ``, and'' at the end of clause (i) and 
     inserting a semicolon;
       (ii) by striking the period at the end of clause (ii) and 
     inserting ``; and''; and
       (iii) by adding at the end the following:
       ``(iii) may not apply a waiting period (including a waiting 
     period to carry out paragraph (3)(C)) in the case of a 
     targeted low-income pregnant woman.''.
       (c) Effective Date.--The amendments made by this section 
     apply to items and services furnished on or after October 1, 
     2003, without regard to whether regulations implementing such 
     amendments have been promulgated.

     SEC. 3. COORDINATION WITH THE MATERNAL AND CHILD HEALTH 
                   PROGRAM.

       (a) In General.--Section 2102(b)(3) of the Social Security 
     Act (42 U.S.C. 1397bb(b)(3)) is amended--
       (1) in subparagraph (D), by striking ``and'' at the end;
       (2) in subparagraph (E), by striking the period and 
     inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(F) that operations and activities under this title are 
     developed and implemented in consultation and coordination 
     with the program operated by the State under title V in areas 
     including outreach and enrollment, benefits and services, 
     service delivery standards, public health and social service 
     agency relationships, and quality assurance and data 
     reporting.''.
       (b) Conforming Medicaid Amendment.--Section 1902(a)(11) of 
     such Act (42 U.S.C. 1396a(a)(11)) is amended--
       (1) by striking ``and'' before ``(C)''; and
       (2) by inserting before the semicolon at the end the 
     following: ``, and (D) provide that operations and activities 
     under this title are developed and implemented in 
     consultation and coordination with the program operated by 
     the State under title V in areas including outreach and 
     enrollment, benefits and services, service delivery 
     standards, public health and social service agency 
     relationships, and quality assurance and data reporting''.
       (c) Effective Date.--The amendments made by this section 
     take effect on January 1, 2004.

     SEC. 4. INCREASE IN SCHIP INCOME ELIGIBILITY.

       (a) Definition of Low-Income Child.--Section 2110(c)(4) of 
     the Social Security Act (42 U.S.C. 42 U.S.C. 1397jj(c)(4)) is 
     amended by striking ``200'' and inserting ``250''.
       (b) Effective Date.--The amendment made by subsection (a) 
     applies to child health assistance provided, and allotments 
     determined under section 2104 of the Social Security Act (42 
     U.S.C. 1397dd), for fiscal years beginning with fiscal year 
     2004.

     SEC. 5. REVIEW OF STATE AGENCY BLINDNESS AND DISABILITY 
                   DETERMINATIONS.

       Section 1633 of the Social Security Act (42 U.S.C. 1383b) 
     is amended by adding at the end the following:
       ``(e)(1) The Commissioner of Social Security shall review 
     determinations, made by State agencies pursuant to subsection 
     (a) in connection with applications for benefits under this 
     title on the basis of blindness or disability, that 
     individuals who have attained 18 years of age are blind or 
     disabled as of a specified onset date. The Commissioner of 
     Social Security shall review such a determination before any 
     action is taken to implement the determination.
       ``(2)(A) In carrying out paragraph (1), the Commissioner of 
     Social Security shall review--
       ``(i) at least 25 percent of all determinations referred to 
     in paragraph (1) that are made in fiscal year 2004; and
       ``(ii) at least 50 percent of all such determinations that 
     are made in fiscal year 2005 or thereafter.
       ``(B) In carrying out subparagraph (A), the Commissioner of 
     Social Security shall, to the extent feasible, select for 
     review the determinations which the Commissioner of Social 
     Security identifies as being the most likely to be 
     incorrect.''.


[[Page S5969]]




                                       The Secretary of Health

                                           and Human Services,

                                   Washington, DC, April 12, 2002.
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bingaman: Thank you for sharing your views on 
     our new proposal to expand health care coverage for low-
     income pregnant women under the State Children's Health 
     Insurance Program (SCHIP). I believe it is not only 
     appropriate, but indeed, medically necessary that our 
     approach to child health care include the prenatal stage.
       Prenatal care for women and their babies is a crucial part 
     of medical care. These services can be a vital, life-long 
     determinant of health, and we should do everything we can to 
     make this care available for all pregnant women. It is one of 
     the most important investments we can make for the long-term 
     good health of our nation.
       Our regulation would enable states to make use of funding 
     already available under SCHIP to provide prenatal care for 
     more low-income pregnant women and their babies. The proposed 
     regulation, published in the Federal Register March 5, would 
     clarify the definition of ``child'' under the SCHIP program. 
     At present, SCHIP allows states to provide health care 
     coverage to targeted low-income children under age 19. States 
     may further limit their coverage to age groups within that 
     range. The new regulation would clarify that states may 
     include coverage for children from conception to age 19, 
     enabling SCHIP coverage to include prenatal and delivery care 
     to ensure the birth of healthy infants.
       Although Medicaid currently provides coverage for prenatal 
     care for some women with low incomes, implementing this new 
     regulation will allow states to offer such coverage to 
     additional women. States would not be required to go through 
     the section 1115 waiver process to expand coverage for 
     prenatal care.
       By explicitly recognizing in our SCHIP regulations the 
     health needs of children before birth, we can help states 
     provide vital prenatal health care. I believe our approach is 
     entirely appropriate to serve these health purposes. It has 
     been an option for states in their Medicaid programs in the 
     past and it should be made an option for states in their 
     SCHIP program now. As I testified recently at a hearing held 
     by the Health Subcommittee of the House Energy and Commerce 
     Committee, I also support legislation to expand SCHIP to 
     cover pregnant women. However, because legislation has not 
     moved and because of the importance of prenatal care, I felt 
     it was important to take this action.
       I know we share the same commitment to achieving the goal 
     of expanding health insurance coverage in order to reduce the 
     number of uninsured.
       A similar letter is being sent to the cosigners of your 
     letter. Please feel free to call me if you have any questions 
     or concerns.
           Sincerely,
     Tommy G. Thompson.
                                  ____

                                           The Secretary of Health


                                           and Human Services,

                                  Washington, DC, October 8, 2002.
     Hon. Don Nickles,
     Assistant Republican Leader,
     Washington, DC.
       Dear Senator Nickles: Thank you for contacting me about the 
     Department of Health and Human Services' final regulation to 
     expand pre-natal and pregnancy related services to unborn 
     children under the State Children's Health Insurance Program 
     (SCHIP).
       The final rule allows states the option to extend such 
     services under SCHIP to low-income pregnant women and their 
     unborn children immediately. The rule also enables states to 
     cover a broader population of low-income women and children 
     because it extends coverage to unborn children regardless of 
     their mothers' immigrant status.
       In your letter, you ask if ``this regulation has obviated 
     the need for additional legislation, and has addressed this 
     issue in a more timely and effective manner.'' As I have 
     stated many times this year, my overarching goal has been to 
     extend prenatal and pregnancy related services to low-income 
     women and their children as quickly as possible so that those 
     mothers are cared for during their pregnancy and their 
     children are born healthy and strong. The law provided me the 
     flexibility to do that and I believe the rule that was 
     published this week achieves this universally desired goal. 
     The proposed legislation, which has been pending in Congress 
     for some time, would amend the SCHIP law so as to duplicate 
     what we have already established as administration policy. I 
     believe the regulation is a more effective and comprehensive 
     solution to this issue. Therefore, there is no need for the 
     Senate to pursue this legislation now.
       Thank you for inquiring on this important policy matter.
           Sincerely,
     Tommy G. Thompson.
                                  ____



                                                  U.S. Senate,

                                 Washington, DC, October 10, 2002.
     Hon. Tommy Thompson,
     Secretary, Department of Health and Human Services, 
         Washington, DC.
       Dear Secretary Thompson: Over the course of the past year, 
     you have issued press releases, written letters, and 
     responded to direct questions in both Senate and House 
     hearings in support of passing legislation to provide health 
     care coverage to pregnant women through the State Children's 
     Health Insurance Program (SCHIP). You have repeatedly stated 
     that you were proceeding with the regulation to expand SCHIP 
     to ``unborn children'' only because legislation to expand 
     coverage to pregnant women had not passed.
       Your own regulation explicitly makes that very point and 
     acknowledges that ``gaps remain'' and that a number of 
     important health services for pregnant women, including 
     postpartum care, are not provided for in the regulation. And 
     yet, we now read in a letter from you to Senator Nickles 
     dated October 8, 2002, that the ``gaps'' have somehow 
     disappeared. As you write, ``The proposed legislation, which 
     has been pending in Congress for some time, would amend the 
     SCHIP law so as to duplicate what we have already established 
     as administration policy. I believe the regulation is a more 
     effective and comprehensive solution to this issue. 
     Therefore, there is no need for the Senate to pursue this 
     legislation now.''
       Yet, your own regulation contradicts that statement and 
     notes that ``there are still gaps'' and repeatedly points out 
     those coverage gaps for pregnant women and children. With 
     respect to care for women, under the regulation, it is 
     explicitly stated that ``there must be a connection between 
     the benefits provided and the health of the unborn child.'' A 
     whole range of health services to pregnant women during 
     pregnancy and delivery could be potentially denied as a 
     result. In the case of epidurals, for example, the best the 
     regulation can say is that you ``expect'' coverage.
       For postpartum care, the regulation explicitly states that 
     any care during that period, including but not limited to 
     hemorrhage, infection, episiotomy repair, C-section repair, 
     family planning counseling, treatment of complications after 
     delivery (including life-saving surgery), and postpartum 
     depression, would be denied. As the regulation reads, 
     ``Commenters are correct that care after delivery, such as 
     postpartum services could not be covered as part of [SCHIP], 
     (unless the mother is under age 19 and eligible for SCHIP in 
     her own right), because they are not services for an eligible 
     child.''
       According to the Centers for Disease Control and Prevention 
     (CDC), the United States ranks 21st in the world in maternal 
     mortality. The major causes of which were hemorrhage, ectopic 
     pregnancy, pregnancy-induced hypertension, embolism, 
     infection, and other complications of pregnancy and 
     childbirth. Again, health coverage for many of these 
     conditions is denied under the regulation but not in S. 724. 
     How then do you argue the regulation is ``more effective and 
     comprehensive'' and that the legislation is ``duplicat[ive]'' 
     of the regulation with respect to care for pregnant women?
       With respect to coverage of children, under the regulation, 
     the 12-month continuous eligibility for children is not from 
     the time of birth but the clock begins running during the 
     time of coverage prior to birth. S. 724 provides 
     comprehensive pediatric care to children throughout the first 
     and most fragile year of life. In contrast, for prenatal care 
     delivered to an ``unborn child'' under this regulation, that 
     time is subtracted from the 12-month period after birth. 
     Therefore, under the regulation, if nine months of prenatal 
     care are provided, the child could lose coverage at the end 
     of the 3rd month after birth. Potentially lost would be a 
     number of important well-baby visits, immunizations, and 
     access to their pediatric caregiver. Once again, how then do 
     you argue the regulation is ``more effective and 
     comprehensive'' and that the legislation is 
     ``duplicat[ative]'' to the regulation for children?
       Furthermore, according to the rule, the Administration 
     estimates that only 13 states will elect to adopt this 
     definition to include ``unborn children'' in their SCHIP 
     state plans. The other 37 states will either not expand SCHIP 
     to provide prenatal care to additional populations or be 
     forced to seek a federal waiver to also cover pregnant women, 
     as Colorado did just two weeks ago. However, the regulation 
     was right on the mark in stating that it is ``an inferior 
     option'' to require states to have to get waivers to provide 
     the full range of care to pregnant women and 12-month 
     continuous eligibility for children after birth.
       As the regulation reads, ``. . . the Secretary's ability to 
     intervene through one mechanism (a waiver) should not be the 
     sole option for States and may in fact be an inferior option. 
     Waivers are discretionary on the part of the Secretary and 
     time limited while State plan amendments are permanent, and 
     are subject to budget neutrality.'' For a third time, how can 
     you now argue, less than a week after issuing the regulation, 
     that it is ``more effective and comprehensive'' than the 
     legislation?
       The States agree, as you know. The National Governors' 
     Association has clear policy expressing support for the 
     passage of such legislation. As their policy position (HR-15. 
     ``The State Children's Health Insurance Program (S-CHIP) 
     Policy'') reads:
       ``The Governors have a long tradition of expanding coverage 
     options for pregnant women through the Medicaid program. 
     However, pregnant women in working families are not eligible 
     for SCHIP coverage. The Governors call on Congress to create 
     a state option that would allow states to provide health 
     coverage to income-eligible pregnant women under SCHIP. This 
     small shift in federal policy would allow states to provide 
     critical prenatal care and would increase the likelihood that 
     children born to SCHIP mothers would have a healthy start.''

[[Page S5970]]

       Finally, unlike S. 724, the regulation provides absolutely 
     no additional resources (despite estimating the cost to be 
     $330 million over the next five years) for covering ``unborn 
     children'' and certain pregnancy-related services. Current 
     projections by the Office of Management and Budget indicate 
     that SCHIP funds will ultimately be inadequate to cover all 
     the children currently enrolled, even though millions of 
     additional children are eligible but not currently covered. 
     In sharp contrast, just as S. 724 does, we must provide 
     adequate resources to serve both low-income children and low-
     income pregnant women.
       Mr. Secretary, just as you said in your press release on 
     January 31, 2002, we also praise Senators Bond, Breaux, and 
     Collins for ``bipartisan leadership in supporting S. 724, a 
     bill that would allow states to provide prenatal coverage for 
     low-income women through the SCHIP program. We support this 
     legislative effort in this Congress.'' We agreed with you on 
     January 31, 2002, and hope that you will once again support 
     the passage of S. 724, the ``Mothers and Newborns Health 
     Insurance Act.''
       We eagerly await your response to this very important 
     matter with respect to the health and well-being of our 
     nation's children and mothers.
           Sincerely,
         Jeff Bingaman, Jon Corzine, Edward M. Kennedy, Maria 
           Cantwell, Hillary Rodham Clinton, Dianne Feinstein, 
           Blanche L. Lincoln, Mary Landrieu, Patty Murray, James 
           M. Jeffords, John B. Breaux, Jack Reed, Patrick J. 
           Leahy, Barbara A. Mikulski, Charles E. Schumer.
                                  ____

                                           The Secretary of Health


                                           and Human Services,

                                 Washington, DC, October 15, 2002.
     Hon. Jeff Bingaman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bingaman: Thank you for your letter of last 
     week and your continued interest in finding effective ways to 
     increase prenatal coverage.
       I have frequently stated in the past that my chief 
     objective in proposing the rule to extend coverage to unborn 
     children was to ensure that pregnant women and children who 
     are currently ineligible for health care under either 
     Medicaid or S-CHIP are given the support they need for a 
     healthy pregnancy and a safe delivery. This is clearly a goal 
     we share. When asked my position on pending legislation 
     earlier this year, I expressed general support because my 
     overriding interest and concern has always been to provide 
     prenatal care to more women and children. If legislation 
     could provide that coverage more expeditiously, then it 
     seemed to me it would be advantageous to women and children 
     to see that go forward.
       However, despite years of committed effort by you and other 
     members, Congress has yet to move legislation through the 
     process. Legislation was introduced in the 106th Congress but 
     was never reported out of Committee in either the House or 
     Senate. In this current Congress, the Senate Finance 
     Committee reported S. 724 in early August of this year, but 
     no floor time was scheduled for its consideration. 
     Consequently, after seven months without any legislative 
     action, I issued a final regulation.
       Last year, when I saw that I had the authority under 
     current law to provide prenatal and delivery care to low-
     income pregnant mothers and their unborn children, I was 
     excited because I realized the Department could accomplish 
     what we all wish to achieve: helping those children get a 
     healthy start in life. A great deal of thought went into the 
     regulation and, with the exception of postpartum care after 
     hospitalization, we were able to give the states the same 
     flexibility the would have under the proposed legislation to 
     provide prenatal and delivery care to unborn children and 
     their mothers.
       Under current law, however, we have the authority to grant 
     waivers that include coverage for women if they become 
     pregnant, including postpartum care. Since January 2001, I 
     have granted approval to a number of states to allow for 
     expanded health insurance coverage through comprehensive 1115 
     waivers, which also include postpartum care. In fact, this 
     summer I approved a waiver for New Mexico which included 
     prenatal care, labor and delivery, and postpartum care. This 
     regulation simply adds to the options available to the states 
     in expanding health insurance coverage.
       In addition to making it possible for states to use federal 
     funds to provide the prenatal and pregnancy-related coverage 
     options available under S. 724, the regulation provides 
     additional opportunities and assistance for states to reach 
     low-income women. For example, under the regulation, we were 
     able to reach an even broader population of vulnerable women 
     and children because we could offer prenatal care to the 
     children of immigrants who are otherwise ineligible for any 
     coverage. The establishment of eligibility regardless of 
     immigrant status is possible under the regulation but not 
     under S. 724, making the regulation more comprehensive. I am 
     sure you appreciate the importance of the new opportunity to 
     provide prenatal care and pregnancy-related services to 
     immigrant mothers, given the substantial immigrant population 
     in New Mexico.
       Additionally, the regulation provides more opportunities 
     for states to access enhanced-match funds than S. 724. Under 
     the bill, states with current eligibility levels for pregnant 
     women below 185 percent of poverty would not be eligible for 
     the enhanced match until they raised their eligibility at 
     their regular match rate. States have already had the option 
     to raise eligibility for pregnant women at their regular 
     match rate, but many have not done so. Thus, we expect that 
     many states will not expand prenatal coverage under S. 724. 
     However, access to enhanced-match funds under the regulation 
     will provide them a more affordable opportunity to do so.
       With regard to specific criticisms of the rule, you have 
     raised concerns about the reference in the S-CHIP regulation 
     to ``gaps.'' It is important to put the use of the term 
     ``gaps'' in the proper context. This reference is to the 
     eleigbility gap between Medicaid and S-CHIP, which the 
     regulation and S. 724 both seek to close. The response in the 
     regulation does not refer to benefits, so the reference in 
     your recent letter that ``gaps remain'' is taken out of 
     context and, in fact, an incorrect referencing of the 
     regulation.
       Under both the regulation and the legislation, the states 
     ultimately determine the benefit package. That feature of 
     your legislation does not differ from the rule. And, we have 
     clearly indicated federal funds will be available for 
     services including prenatal care and labor and delivery. Your 
     letter makes assumptions regarding medical services during 
     pregnancy and delivery that HHS does not. The letter confuses 
     medical decisions that are made by physicians with payment of 
     claims under a public assistance program. The regulation is 
     used to establish eligibility for benefits and does not 
     itself extend into medical decision-making between a woman 
     and her physician. HHS responded to a number of questions 
     regarding services and clearly indicated federal financial 
     participation would be available. There is no need to further 
     question whether a claim for a service already provided will 
     receive federal matching funds.
       The issue of 12 months continuous eligibility is an option 
     for the states. Under the regulation, states that want to 
     extend eligibility can easily do so.
       I hope this explanation of the regulation and where it 
     extends beyond the reach of S. 724 will give you confidence 
     in our policy and it's ability to meet the ultimate goal that 
     you and I have worked over the years to meet. You are due a 
     large measure of credit for your efforts on behalf of low-
     income women and their children. The regulation is a victory 
     for those women and children and will give otherwise 
     uncovered needy mothers and their babies a healthy start in 
     life.
           Sincerely,
     Tommy G. Thomspon.
                                  ____



                                                  U.S. Senate,

                                 Washington, DC, October 23, 2002.
     Hon. Tommy Thompson,
     Secretary, Department of Health and Human Services, 
         Washington, DC.
       Dear Senator Thompson: Thank you for your letter yesterday 
     with regard to improving health coverage for pregnant women 
     and children. We appreciate your stated desire to ``give 
     otherwise uncovered needy mothers and their babies a healthy 
     start in life'' by adding ``to the options available to the 
     states in expanding health insurance options.'' We believe we 
     can take the best aspects of the legislation and the 
     regulation to truly improve the health and well-being of our 
     nation's children and mothers.
       In light of the fact that our nation ranks 26th in infant 
     mortality and 21st in maternal mortality in the world, which 
     is the worst among developed nations, we would be remiss to 
     not take the simple but critical step of increasing access to 
     prenatal, delivery, and postpartum care through the State 
     Children's Health Insurance Program (SCHIP) to help prevent 
     birth defects and prematurity, the most common causes of 
     infant death and disability, and maternal death and 
     disability.
       As your letter acknowledges, postpartum care is not covered 
     under the regulation. This gap in coverage includes a range 
     of critical care for women, including potentially life-saving 
     postpartum care for hemorrhage, pregnancy-induced 
     hypertension, infection, ectopic pregnancy, embolism, 
     episiotomy repair, Caesarean section repair, family planning 
     counseling, postpartum depression, and other complications of 
     pregnancy and childbirth. In fact, according to the National 
     Committee for Quality Assurance (NCQA), ``Hemorrhage, 
     pregnancy-induced hypertension, infection, and ectopic 
     pregnancy continue to account for more than half of all 
     maternal deaths (59 percent).''
       According to the Centers for Disease Control and Prevention 
     (CDC), there were 3,193 pregnancy-related deaths in this 
     country between 1991 and 1997 for an overall pregnancy-
     related mortality ratio (PRMR) of 11.5 per 100,000 live 
     births. Racial disparities are rather dramatic with respect 
     to maternal mortality. African-American women had mortality 
     rates over four times higher than that of non-Hispanic whites 
     over the period. American Indian/Alaska Natives, Asian/
     Pacific Islanders, and Hispanic women had mortality rates 67 
     percent, 55 percent, and 41 percent, respectively, higher 
     than non-Hispanic whites.
       Those disparities are even more pronounced in some states. 
     For example, in Wisconsin, the maternal mortality rate for 
     African-American women was 4.2 times that of white women 
     between 1987 and 1996. Certainly, this is something that we 
     can all agree should be addressed.

[[Page S5971]]

       To allow states the option to provide comprehensive 
     coverage to pregnant women, including postpartum care, 
     through SCHIP would help achieve that important goal. S. 724, 
     the ``Mothers and Newborns Health Insurance Act,'' gives 
     states that important coverage option while the regulation 
     does not.
       While your letter correctly notes that states may receive 
     comprehensive 1115 waivers to provide coverage to pregnant 
     women, your regulation is correct in noting that is an 
     inferior option. As the regulation reads, ``. . . the 
     Secretary's ability to intervene through one mechanism (a 
     waiver) should not be the sole option for States and may in 
     fact be an inferior option. Waivers are discretionary on the 
     part of the Secretary and time limited while State plan 
     amendments are permanent, and are subject to budget 
     neutrality.'' We should remove those barriers and give states 
     the option to provide pregnant women coverage without having 
     to seek waivers.
       We would add that the waiver option is allowed for the 
     purposes of giving the Secretary demonstration authority. We 
     certainly can all acknowledge that coverage of pregnant women 
     has reduced both infant mortality and maternal mortality and 
     need not be demonstrated any further. The waiver process 
     seems inappropriate for this purpose. Instead, we should 
     remove those barriers for states to provide comprehensive 
     coverage to pregnant women. As the National Governors' 
     Association has stated in its policy (HR-15. ``The State 
     Children's Health Insurance Program (S-CHIP) Policy''): The 
     Governors call on Congress to create a state option that 
     would allow states to provide health coverage to income-
     eligible women under SCHIP. This small shift in federal 
     policy would allow states to provide critical prenatal care 
     and would increase the likelihood that children born to SCHIP 
     mothers would have a healthy start.
       Just as the governors have requested, we can still make 
     that ``small shift'' in policy through the passage of S. 724.
       As for the coverage of infants, your letter did not address 
     the issues raised in a previous letter to you from 15 
     senators, including many of us, dated October 10, 2002. Your 
     letter restates the fact that states have the option to 
     provide children 12 months of continuous eligibility in 
     Medicaid and SCHIP. However, under the regulation, the 12-
     month continuous eligibility for children is not from the 
     time of birth. Rather, the clock begins running during the 
     time of coverage prior to birth. Thus, it is likely that most 
     newborns would have far less than 12 months of coverage after 
     birth if a State chooses to use the option to provide care to 
     ``unborn children.'' If covered for the full nine months of 
     pregnancy, the child could lose eligibility for SCHIP after 
     the third month of life and consequently lose important 
     coverage for well-baby visits, immunizations, and access to 
     their pediatric caregiver. That would be an outright 
     reduction of coverage for some children after birth.
       We would note that the legislation continues to have the 
     strong support of a number of groups, including some who 
     support the regulation but acknowledge its shortcomings and 
     continue to support passing legislation. Those groups include 
     the American Association of University Affiliated Programs, 
     the American Academy of Pediatrics, the American College of 
     Nurse Midwives, the American College of Obstetrics and 
     Gynecologists, the American Hospital Association, the 
     American Medical Association, the American Public Health 
     Association, the Association of Women's Health, Obstetric and 
     Neonatal Nurses, the Association of Maternal and Child Health 
     Programs, the Catholic Health Association, Catholic Charities 
     USA, the Council of Women's and Infants' Specialty Hospitals, 
     the Easter Seals, FamilyVoices, the March of Dimes, the 
     National Association of Children's Hospitals, the National 
     Association of Public Hospitals and Health Systems, the 
     National Women's Health Network, the National Association of 
     County and City Health Officials, the Society for Maternal-
     Fetal Medicine, the Spina Bifida Association of America, the 
     Alan Guttmacher Institute, and the United Cerebral Palsy 
     Associations.
       There are certainly areas where the regulation is more 
     comprehensive than the legislation, such as providing 
     coverage to the ``unborn children'' of immigrant mothers and 
     by providing states easier access to enhanced matching funds. 
     We believe we could certainly amend S. 724 to address these 
     shortcomings rather easily. It would be easy to drop the 
     requirement in the bill for a state to expand eligibility to 
     185 percent of poverty before receiving the enhanced matching 
     rate. However, this begs the question about the need for 
     providing additional resources in SCHIP to cover these 
     options. Current projections by the Office of Management and 
     Budget indicate that SCHIP funds will ultimately be 
     inadequate to cover all the children currently enrolled, even 
     though millions of additional children are eligible but not 
     currently covered. S. 724 provides such funding, which the 
     regulation does not and cannot.
       In short, we believe that we can rather quickly achieve the 
     best of both the legislation and the regulation. S. 724 
     expands state options to cover critically important 
     postpartum services for women, ensures children are eligible 
     for coverage throughout the first and most critical year of 
     life, and provides much needed resources to provide such 
     care. In contrast, the regulation provides states with more 
     opportunities to access enhanced matching funds and provides 
     certain prenatal care services to immigrant mothers that S. 
     724 does not provide.
       We would like to arrange a meeting with you or your staff 
     to jointly modify S. 724 to address, as best as we can, the 
     concerns we have discussed above and that you have raised 
     with the legislation to accomplish the objective we all share 
     of improving the health and well-being of out nation's 
     children and mothers.
           Sincerely,
         Jeff Bingaman. Blanche L. Lincoln. Jon Corzine. Maria 
           Cantwell. Patty Murray. Mary Landrieu. James M. 
           Jeffords. Edward M. Kennedy. Hillary Rodham Clinton. 
           Charles E. Schumer. John F. Kerry. John R. Edwards. 
           Daniel K. Akaka. Jack Reed. Robert G. Torricelli.

  Mr. LUGAR. Mr. President, I rise today with my colleague Senator 
Bingaman to re-introduce the Start Healthy, Stay Healthy Act of 2003.
  The United States ranks 26th in infant mortality and 21st in maternal 
mortality in the world, the worst among developed nations. Study after 
study shows that providing prenatal care to pregnant women reduces 
maternal and infant mortality and the incidence of low birth weight 
babies. According to the American Medical Association, ``Babies born to 
women who do not receive prenatal care are four times more likely to 
die before their first birthday.''
  The Start Healthy, Stay Healthy Act of 2003 would significantly 
reduce the number of uninsured pregnant women and newborns by providing 
States with the option to further extend coverage to pregnant women 
through Medicaid and CHIP, to reduce infant and maternal mortality and 
low birth weight babies, and to cover newborns through the first full 
year of life.
  Current federal law allows pregnant women to receive coverage through 
CHIP through age 18--creating a perverse Federal incentive of covering 
only teenage pregnant women and cutting off that coverage once they 
turn 19 years of age. This legislation would eliminate this problem by 
allowing States to cover pregnant women through CHIP, regardless of 
age. This also eliminates the unfortunate separation between pregnant 
women and infants that has been created through CHIP, and is contrary 
to longstanding federal policy through programs such as Medicaid, Women 
with Infants and Children, WIC, Maternal and Child Health, MCH, etc.
  An estimated 4.3 million, or 32 percent, of mothers below 200 percent 
of poverty are uninsured. According to the March of Dimes, ``Over 95 
percent of all uninsured pregnant women could be covered through a 
combination of aggressive Medicaid outreach, maximizing coverage for 
young women through [CHIP], and expanding CHIP to cover income-eligible 
pregnant women regardless of age.''
  Increasing the availability of affordable health care is certainly an 
issue of great importance to our Nation--particularly those who are 
uninsured. While our bill will not solve the problem of the uninsured, 
we believe that helping more pregnant women and babies receive care is 
a significant step in the right direction.
  I ask our colleagues to support the Start Healthy, Stay Healthy Act 
of 2003, and help us take this important step in improving health care 
for the mothers of tomorrow.
                                 ______
                                 
      By Mrs. FEINSTEIN (for herself, Mr. Schumer, Mr. Chafee, Mr. 
        Jeffords, Mr. Kennedy, Mr. Durbin, Mr. Lautenberg, Mrs. Boxer, 
        and Mr. Reed):
  S. 1034. A bill to repeal the sunset date on the assault weapons ban, 
to ban the importation of large capacity ammunition feeding devices, 
and for other purposes; to the Committee on the Judiciary.
  Mrs. FEINSTEIN. Mr. President, I rise today to introduce legislation 
with Senators Chuck Schumer, Lincoln Chafee, Barbara Boxer, Dick 
Durbin, Jack Reed, Frank Lautenberg, Jim Jeffords, and Edward Kennedy 
that would permanently reauthorize the assault weapons ban and close 
the clip-importation loophole.
  Military-style assault weapons simply have no place on America's 
streets. But if Congress fails to act, the current ban will expire next 
year. This would be a terrible mistake.
  This is why Congress must reauthorize the ban and close the high-
capacity

[[Page S5972]]

clip importation loophole so that we can help keep America's streets 
safe from the violence produced by assault weapons.
  Almost 10 years ago on July 1, 1993 Gian Luigi Ferri walked into 101 
California Street in San Francisco carrying two high-capacity TEC-9 
assault pistols.
  Within minutes, he had murdered eight people, and six others were 
wounded. This tragedy shook San Francisco and the entire nation.
  We saw with absolute clarity the destruction that could be inflicted 
with these military-style assault weapons.
  Navegar's advertising for the TEC-9 touted the gun as being for 
`paramilitary' use and `resistant to fingerprints,' with a `military 
non-glare finish,' a `military blowback system,' and `combat-type' 
sights.
  Guns like these are the weapons of choice to commit crimes. They are 
the weapons of choice for drive-by shooters, criminals going into a 
major criminal event, and malcontents who are seeking to do the maximum 
damage possible in the shortest amount of time.
  That's what makes them so dangerous because they have light triggers, 
you can spray fire them, you can hold them with two hands, and you 
don't really need to aim.
  They are not weapons of choice for hunting or defensive purposes.
  In the aftermath of 101 California and countless other shootings, I 
decided to do something that no one had succeeded in doing before: to 
ban the manufacture and importation of military style assault weapons.
  I authored the bill in the Senate, and Senator Schumer authored it in 
the House of Representatives.
  I remember all the late night calls I got and all the friends who 
took me aside and said to me: ``Don't do it. The gunners are too 
powerful. You'll never ever win.''
  Well, we did win. We passed the first-ever ban on assault weapons, 
and since September 13, 1994, it has been illegal to manufacture and 
import military-style assault weapons.
  The hope of the bill has been to drive down the supply of these 
weapons and make them more expensive to obtain.
  And in the years following the enactment of the ban, crimes using 
assault weapons were reduced dramatically.
  In 1993, assault weapons accounted for 8.2 percent of all guns used 
in crimes; By the end of 1995, that proportion had fallen to 4.3 
percent--a dramatic drop; and by November 1996, the last date for which 
statistics are available, the proportion had fallen to 3.2 percent.
  These are dramatic results, which show that the Assault Weapons ban 
has worked. We have had trouble getting updated statistics from this 
Justice Department, but it is clear that after we banned these guns, 
criminals used them less frequently in crime.
  Unfortunately, to get the bill passed in 1994, we had to agree to a 
ten-year sunset in the bill--and this is why we are here today. If we 
do not re-authorize the 1994 assault weapons ban this Congress, it will 
expire on September 13, 2004.
  That means that at the end of next year, manufacturers could once 
again begin making AK-47s, TEC-9s, and other banned guns that have but 
one purpose--to kill other human beings.
  We are here today because we believe that this would be a terrible 
mistake--with deadly consequences for thousands of Americans each year.
  So today we will introduce legislation to do two simple things. 
First, the legislation would reauthorize the 1994 assault weapons ban 
by striking the sunset date from the original law. This would ban the 
manufacture of 19 types of common military style assault weapons--for 
all time.
  It would ban an additional group of these assault weapons that have 
been banned by characteristic for 8 years.
  It would protect some 670 hunting and other recreational rifles for 
use by law-abiding citizens.
  And it would preserve the right of police officers and other law 
enforcement officials to use and obtain newly manufactured semi-
automatic assault weapons--helping to prevent instances when law 
enforcement agents are outgunned by perpetrators.
  We certainly would like a stronger bill that would tighten the ban--
based on our 10 years of experience of what the gun companies have done 
to get around the bill.
  But unfortunately there is not the support for that right now. If the 
support becomes evident, then we may amend the bill at a later date.
  Second, the legislation would close a loophole in the 1994 law, which 
prohibits the domestic manufacture of high-capacity ammunition 
magazines, but allows foreign companies to continue sending them to 
this country by the millions.
  A measure that would have closed this loophole passed the House and 
Senate in 1999 by wide margins, but got bottled up in a larger 
conference due to an unrelated provision.
  The result: the Bureau of Alcohol, Tobacco and Firearms has approved 
the importation of almost 50 million high capacity ammunition magazines 
from some 50 countries since 1994.
  It is these large clips, drums, and strips that allow lone gunmen, or 
small groups of teenagers, to inflict so much damage in such a small 
amount of time.
  We must close this loophole now.
  The good news: President Bush has indicated that he supports each of 
these provisions. During the 2000 Presidential Campaign, President Bush 
indicated that he supported both reauthorization of the assault weapons 
ban and closing the clip importation loophole.
  And just a few weeks ago, President Bush's spokesman Scott McClellan 
reiterated his support for reauthorizing the ban when he said: ``The 
President supports the current law, and he supports reauthorization of 
the current law.''
  It is therefore our hope that the President will work with us to see 
this bill passed. We welcome the President's support and look forward 
to working with him to gain swift passage of this legislation.
  One of the best examples of the damage that assault weapons can 
inflict is the massacre in Littleton, Colorado.
  On April 24, 1999, Eric Harris and Dylan Klebold used a TEC DC-9 
semi-automatic pistol to attack the students and teachers of Columbine 
High School.
  They used this weapon to take the lives of 13 innocents, 12 students 
and 1 teacher, and injured dozens more mothers, fathers, sons and 
daughters.
  I do not believe that the 2nd Amendment protects military assault 
weapons. The Constitution is not an umbrella for mayhem. The Bill of 
Rights is not a guarantor of violence.
  Congress has passed this legislation once--it is time to pass the 
assault weapons ban again.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1034

       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 ``Assault Weapons Ban 
     Reauthorization Act of 2003''.

     SEC. 2. REPEAL OF SUNSET DATE.

       Section 110105 of the Public Safety and Recreational 
     Firearms Use Protection Act (18 U.S.C. 921 note) is amended 
     to read as follows:

     ``SEC. 110105. EFFECTIVE DATE.

       ``This subtitle and the amendments made by this subtitle 
     shall take effect on September 13, 1994.''.

     SEC. 3. BAN ON IMPORTING LARGE CAPACITY AMMUNITION FEEDING 
                   DEVICES.

       (a) In General.--Section 922(w) of title 18, United States 
     Code, is amended--
       (1) in paragraph (1), by striking ``(1) Except as provided 
     in paragraph (2)'' and inserting ``(1)(A) Except as provided 
     in subparagraph (B)'';
       (2) in paragraph (2), by striking ``(2) Paragraph (1)'' and 
     inserting ``(B) Subparagraph (A)'';
       (3) by inserting before paragraph (3) the following:
       ``(2) It shall be unlawful for any person to import a large 
     capacity ammunition feeding device.''; and
       (4) in paragraph (4)--
       (A) by striking ``(1)'' each place it appears and inserting 
     ``(1)(A)''; and
       (B) by striking ``(2)'' and inserting ``(1)(B)''.
       (b) Conforming Amendment.--Section 921(a)(31) of title 18, 
     United States Code, is amended by striking ``manufactured 
     after the date of enactment of the Violent Crime Control and 
     Law Enforcement Act of 1994''.

[[Page S5973]]



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