[Congressional Record Volume 150, Number 67 (Thursday, May 13, 2004)]
[House]
[Pages H2951-H2966]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page H2951]]
               SMALL BUSINESS HEALTH FAIRNESS ACT OF 2004

  Mr. BOEHNER. Mr. Speaker, pursuant to House Resolution 638, I call up 
the bill (H.R. 4281) to amend title I of the Employee Retirement Income 
Security Act of 1974 to improve access and choice for entrepreneurs 
with small businesses with respect to medical care for their employees, 
and ask for its immediate consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to H. Res. 638, the bill is 
considered read for amendment.
  The text of H.R. 4281 is as follows:

                               H.R. 4281

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

     SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Small 
     Business Health Fairness Act of 2004''.
       (b) Table of Contents.--The table of contents is as 
     follows:

Sec. 1. Short title and table of contents.
Sec. 2. Rules governing association health plans.
Sec. 3. Clarification of treatment of single employer arrangements.
Sec. 4. Enforcement provisions relating to association health plans.
Sec. 5. Cooperation between Federal and State authorities.
Sec. 6. Effective date and transitional and other rules.

     SEC. 2. RULES GOVERNING ASSOCIATION HEALTH PLANS.

       (a) In General.--Subtitle B of title I of the Employee 
     Retirement Income Security Act of 1974 is amended by adding 
     after part 7 the following new part:

           ``PART 8--RULES GOVERNING ASSOCIATION HEALTH PLANS

     ``SEC. 801. ASSOCIATION HEALTH PLANS.

       ``(a) In General.--For purposes of this part, the term 
     `association health plan' means a group health plan whose 
     sponsor is (or is deemed under this part to be) described in 
     subsection (b).
       ``(b) Sponsorship.--The sponsor of a group health plan is 
     described in this subsection if such sponsor--
       ``(1) is organized and maintained in good faith, with a 
     constitution and bylaws specifically stating its purpose and 
     providing for periodic meetings on at least an annual basis, 
     as a bona fide trade association, a bona fide industry 
     association (including a rural electric cooperative 
     association or a rural telephone cooperative association), a 
     bona fide professional association, or a bona fide chamber of 
     commerce (or similar bona fide business association, 
     including a corporation or similar organization that operates 
     on a cooperative basis (within the meaning of section 1381 of 
     the Internal Revenue Code of 1986)), for substantial purposes 
     other than that of obtaining or providing medical care;
       ``(2) is established as a permanent entity which receives 
     the active support of its members and requires for membership 
     payment on a periodic basis of dues or payments necessary to 
     maintain eligibility for membership in the sponsor; and
       ``(3) does not condition membership, such dues or payments, 
     or coverage under the plan on the basis of health status-
     related factors with respect to the employees of its members 
     (or affiliated members), or the dependents of such employees, 
     and does not condition such dues or payments on the basis of 
     group health plan participation.

     Any sponsor consisting of an association of entities which 
     meet the requirements of paragraphs (1), (2), and (3) shall 
     be deemed to be a sponsor described in this subsection.

     ``SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS.

       ``(a) In General.--The applicable authority shall prescribe 
     by regulation a procedure under which, subject to subsection 
     (b), the applicable authority shall certify association 
     health plans which apply for certification as meeting the 
     requirements of this part.
       ``(b) Standards.--Under the procedure prescribed pursuant 
     to subsection (a), in the case of an association health plan 
     that provides at least one benefit option which does not 
     consist of health insurance coverage, the applicable 
     authority shall certify such plan as meeting the requirements 
     of this part only if the applicable authority is satisfied 
     that the applicable requirements of this part are met (or, 
     upon the date on which the plan is to commence operations, 
     will be met) with respect to the plan.
       ``(c) Requirements Applicable to Certified Plans.--An 
     association health plan with respect to which certification 
     under this part is in effect shall meet the applicable 
     requirements of this part, effective on the date of 
     certification (or, if later, on the date on which the plan is 
     to commence operations).
       ``(d) Requirements for Continued Certification.--The 
     applicable authority may provide by regulation for continued 
     certification of association health plans under this part.
       ``(e) Class Certification for Fully Insured Plans.--The 
     applicable authority shall establish a class certification 
     procedure for association health plans under which all 
     benefits consist of health insurance coverage. Under such 
     procedure, the applicable authority shall provide for the 
     granting of certification under this part to the plans in 
     each class of such association health plans upon appropriate 
     filing under such procedure in connection with plans in such 
     class and payment of the prescribed fee under section 807(a).
       ``(f) Certification of Self-Insured Association Health 
     Plans.--An association health plan which offers one or more 
     benefit options which do not consist of health insurance 
     coverage may be certified under this part only if such plan 
     consists of any of the following:
       ``(1) a plan which offered such coverage on the date of the 
     enactment of the Small Business Health Fairness Act of 2004,
       ``(2) a plan under which the sponsor does not restrict 
     membership to one or more trades and businesses or industries 
     and whose eligible participating employers represent a broad 
     cross-section of trades and businesses or industries, or
       ``(3) a plan whose eligible participating employers 
     represent one or more trades or businesses, or one or more 
     industries, consisting of any of the following: agriculture; 
     equipment and automobile dealerships; barbering and 
     cosmetology; certified public accounting practices; child 
     care; construction; dance, theatrical and orchestra 
     productions; disinfecting and pest control; financial 
     services; fishing; foodservice establishments; hospitals; 
     labor organizations; logging; manufacturing (metals); mining; 
     medical and dental practices; medical laboratories; 
     professional consulting services; sanitary services; 
     transportation (local and freight); warehousing; wholesaling/
     distributing; or any other trade or business or industry 
     which has been indicated as having average or above-average 
     risk or health claims experience by reason of State rate 
     filings, denials of coverage, proposed premium rate levels, 
     or other means demonstrated by such plan in accordance with 
     regulations.

     ``SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND BOARDS OF 
                   TRUSTEES.

       ``(a) Sponsor.--The requirements of this subsection are met 
     with respect to an association health plan if the sponsor has 
     met (or is deemed under this part to have met) the 
     requirements of section 801(b) for a continuous period of not 
     less than 3 years ending with the date of the application for 
     certification under this part.
       ``(b) Board of Trustees.--The requirements of this 
     subsection are met with respect to an association health plan 
     if the following requirements are met:
       ``(1) Fiscal control.--The plan is operated, pursuant to a 
     trust agreement, by a board of trustees which has complete 
     fiscal control over the plan and which is responsible for all 
     operations of the plan.
       ``(2) Rules of operation and financial controls.--The board 
     of trustees has in effect rules of operation and financial 
     controls, based on a 3-year plan of operation, adequate to 
     carry out the terms of the plan and to meet all requirements 
     of this title applicable to the plan.
       ``(3) Rules governing relationship to participating 
     employers and to contractors.--
       ``(A) Board membership.--
       ``(i) In general.--Except as provided in clauses (ii) and 
     (iii), the members of the board of trustees are individuals 
     selected from individuals who are the owners, officers, 
     directors, or employees of the participating employers or who 
     are partners in the participating employers and actively 
     participate in the business.
       ``(ii) Limitation.--

       ``(I) General rule.--Except as provided in subclauses (II) 
     and (III), no such member is an owner, officer, director, or 
     employee of, or partner in, a contract administrator or other 
     service provider to the plan.
       ``(II) Limited exception for providers of services solely 
     on behalf of the sponsor.--Officers or employees of a sponsor 
     which is a service provider (other than a contract 
     administrator) to the plan may be members of the board if 
     they constitute not more than 25 percent of the membership of 
     the board and they do not provide services to the plan other 
     than on behalf of the sponsor.
       ``(III) Treatment of providers of medical care.--In the 
     case of a sponsor which is an association whose membership 
     consists primarily of providers of medical care, subclause 
     (I) shall not apply in the case of any service provider 
     described in subclause (I) who is a provider of medical care 
     under the plan.

       ``(iii) Certain plans excluded.--Clause (i) shall not apply 
     to an association health plan which is in existence on the 
     date of the enactment of the Small Business Health Fairness 
     Act of 2004.
       ``(B) Sole authority.--The board has sole authority under 
     the plan to approve applications for participation in the 
     plan and to contract with a service provider to administer 
     the day-to-day affairs of the plan.
       ``(c) Treatment of Franchise Networks.--In the case of a 
     group health plan which is established and maintained by a 
     franchiser for a franchise network consisting of its 
     franchisees--
       ``(1) the requirements of subsection (a) and section 801(a) 
     shall be deemed met if such requirements would otherwise be 
     met if the franchiser were deemed to be the sponsor referred 
     to in section 801(b), such network were deemed to be an 
     association described in section 801(b), and each franchisee 
     were deemed

[[Page H2952]]

     to be a member (of the association and the sponsor) referred 
     to in section 801(b); and
       ``(2) the requirements of section 804(a)(1) shall be deemed 
     met.

     The Secretary may by regulation define for purposes of this 
     subsection the terms `franchiser', `franchise network', and 
     `franchisee'.

     ``SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.

       ``(a) Covered Employers and Individuals.--The requirements 
     of this subsection are met with respect to an association 
     health plan if, under the terms of the plan--
       ``(1) each participating employer must be--
       ``(A) a member of the sponsor,
       ``(B) the sponsor, or
       ``(C) an affiliated member of the sponsor with respect to 
     which the requirements of subsection (b) are met,

     except that, in the case of a sponsor which is a professional 
     association or other individual-based association, if at 
     least one of the officers, directors, or employees of an 
     employer, or at least one of the individuals who are partners 
     in an employer and who actively participates in the business, 
     is a member or such an affiliated member of the sponsor, 
     participating employers may also include such employer; and
       ``(2) all individuals commencing coverage under the plan 
     after certification under this part must be--
       ``(A) active or retired owners (including self-employed 
     individuals), officers, directors, or employees of, or 
     partners in, participating employers; or
       ``(B) the beneficiaries of individuals described in 
     subparagraph (A).
       ``(b) Coverage of Previously Uninsured Employees.--In the 
     case of an association health plan in existence on the date 
     of the enactment of the Small Business Health Fairness Act of 
     2004, an affiliated member of the sponsor of the plan may be 
     offered coverage under the plan as a participating employer 
     only if--
       ``(1) the affiliated member was an affiliated member on the 
     date of certification under this part; or
       ``(2) during the 12-month period preceding the date of the 
     offering of such coverage, the affiliated member has not 
     maintained or contributed to a group health plan with respect 
     to any of its employees who would otherwise be eligible to 
     participate in such association health plan.
       ``(c) Individual Market Unaffected.--The requirements of 
     this subsection are met with respect to an association health 
     plan if, under the terms of the plan, no participating 
     employer may provide health insurance coverage in the 
     individual market for any employee not covered under the plan 
     which is similar to the coverage contemporaneously provided 
     to employees of the employer under the plan, if such 
     exclusion of the employee from coverage under the plan is 
     based on a health status-related factor with respect to the 
     employee and such employee would, but for such exclusion on 
     such basis, be eligible for coverage under the plan.
       ``(d) Prohibition of Discrimination Against Employers and 
     Employees Eligible to Participate.--The requirements of this 
     subsection are met with respect to an association health plan 
     if--
       ``(1) under the terms of the plan, all employers meeting 
     the preceding requirements of this section are eligible to 
     qualify as participating employers for all geographically 
     available coverage options, unless, in the case of any such 
     employer, participation or contribution requirements of the 
     type referred to in section 2711 of the Public Health Service 
     Act are not met;
       ``(2) upon request, any employer eligible to participate is 
     furnished information regarding all coverage options 
     available under the plan; and
       ``(3) the applicable requirements of sections 701, 702, and 
     703 are met with respect to the plan.

     ``SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN DOCUMENTS, 
                   CONTRIBUTION RATES, AND BENEFIT OPTIONS.

       ``(a) In General.--The requirements of this section are met 
     with respect to an association health plan if the following 
     requirements are met:
       ``(1) Contents of governing instruments.--The instruments 
     governing the plan include a written instrument, meeting the 
     requirements of an instrument required under section 
     402(a)(1), which--
       ``(A) provides that the board of trustees serves as the 
     named fiduciary required for plans under section 402(a)(1) 
     and serves in the capacity of a plan administrator (referred 
     to in section 3(16)(A));
       ``(B) provides that the sponsor of the plan is to serve as 
     plan sponsor (referred to in section 3(16)(B)); and
       ``(C) incorporates the requirements of section 806.
       ``(2) Contribution rates must be nondiscriminatory.--
       ``(A) The contribution rates for any participating small 
     employer do not vary on the basis of any health status-
     related factor in relation to employees of such employer or 
     their beneficiaries and do not vary on the basis of the type 
     of business or industry in which such employer is engaged.
       ``(B) Nothing in this title or any other provision of law 
     shall be construed to preclude an association health plan, or 
     a health insurance issuer offering health insurance coverage 
     in connection with an association health plan, from--
       ``(i) setting contribution rates based on the claims 
     experience of the plan; or
       ``(ii) varying contribution rates for small employers in a 
     State to the extent that such rates could vary using the same 
     methodology employed in such State for regulating premium 
     rates in the small group market with respect to health 
     insurance coverage offered in connection with bona fide 
     associations (within the meaning of section 2791(d)(3) of the 
     Public Health Service Act),

     subject to the requirements of section 702(b) relating to 
     contribution rates.
       ``(3) Floor for number of covered individuals with respect 
     to certain plans.--If any benefit option under the plan does 
     not consist of health insurance coverage, the plan has as of 
     the beginning of the plan year not fewer than 1,000 
     participants and beneficiaries.
       ``(4) Marketing requirements.--
       ``(A) In general.--If a benefit option which consists of 
     health insurance coverage is offered under the plan, State-
     licensed insurance agents shall be used to distribute to 
     small employers coverage which does not consist of health 
     insurance coverage in a manner comparable to the manner in 
     which such agents are used to distribute health insurance 
     coverage.
       ``(B) State-licensed insurance agents.--For purposes of 
     subparagraph (A), the term `State-licensed insurance agents' 
     means one or more agents who are licensed in a State and are 
     subject to the laws of such State relating to licensure, 
     qualification, testing, examination, and continuing education 
     of persons authorized to offer, sell, or solicit health 
     insurance coverage in such State.
       ``(5) Regulatory requirements.--Such other requirements as 
     the applicable authority determines are necessary to carry 
     out the purposes of this part, which shall be prescribed by 
     the applicable authority by regulation.
       ``(b) Ability of Association Health Plans to Design Benefit 
     Options.--Subject to section 514(d), nothing in this part or 
     any provision of State law (as defined in section 514(c)(1)) 
     shall be construed to preclude an association health plan, or 
     a health insurance issuer offering health insurance coverage 
     in connection with an association health plan, from 
     exercising its sole discretion in selecting the specific 
     items and services consisting of medical care to be included 
     as benefits under such plan or coverage, except (subject to 
     section 514) in the case of (1) any law to the extent that it 
     is not preempted under section 731(a)(1) with respect to 
     matters governed by section 711, 712, or 713, or (2) any law 
     of the State with which filing and approval of a policy type 
     offered by the plan was initially obtained to the extent that 
     such law prohibits an exclusion of a specific disease from 
     such coverage.

     ``SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS FOR 
                   SOLVENCY FOR PLANS PROVIDING HEALTH BENEFITS IN 
                   ADDITION TO HEALTH INSURANCE COVERAGE.

       ``(a) In General.--The requirements of this section are met 
     with respect to an association health plan if--
       ``(1) the benefits under the plan consist solely of health 
     insurance coverage; or
       ``(2) if the plan provides any additional benefit options 
     which do not consist of health insurance coverage, the plan--
       ``(A) establishes and maintains reserves with respect to 
     such additional benefit options, in amounts recommended by 
     the qualified actuary, consisting of--
       ``(i) a reserve sufficient for unearned contributions;
       ``(ii) a reserve sufficient for benefit liabilities which 
     have been incurred, which have not been satisfied, and for 
     which risk of loss has not yet been transferred, and for 
     expected administrative costs with respect to such benefit 
     liabilities;
       ``(iii) a reserve sufficient for any other obligations of 
     the plan; and
       ``(iv) a reserve sufficient for a margin of error and other 
     fluctuations, taking into account the specific circumstances 
     of the plan; and
       ``(B) establishes and maintains aggregate and specific 
     excess /stop loss insurance and solvency indemnification, 
     with respect to such additional benefit options for which 
     risk of loss has not yet been transferred, as follows:
       ``(i) The plan shall secure aggregate excess /stop loss 
     insurance for the plan with an attachment point which is not 
     greater than 125 percent of expected gross annual claims. The 
     applicable authority may by regulation provide for upward 
     adjustments in the amount of such percentage in specified 
     circumstances in which the plan specifically provides for and 
     maintains reserves in excess of the amounts required under 
     subparagraph (A).
       ``(ii) The plan shall secure specific excess /stop loss 
     insurance for the plan with an attachment point which is at 
     least equal to an amount recommended by the plan's qualified 
     actuary. The applicable authority may by regulation provide 
     for adjustments in the amount of such insurance in specified 
     circumstances in which the plan specifically provides for and 
     maintains reserves in excess of the amounts required under 
     subparagraph (A).
       ``(iii) The plan shall secure indemnification insurance for 
     any claims which the plan is unable to satisfy by reason of a 
     plan termination.

     Any person issuing to a plan insurance described in clause 
     (i), (ii), or (iii) of subparagraph (B) shall notify the 
     Secretary of any

[[Page H2953]]

     failure of premium payment meriting cancellation of the 
     policy prior to undertaking such a cancellation. Any 
     regulations prescribed by the applicable authority pursuant 
     to clause (i) or (ii) of subparagraph (B) may allow for such 
     adjustments in the required levels of excess /stop loss 
     insurance as the qualified actuary may recommend, taking into 
     account the specific circumstances of the plan.
       ``(b) Minimum Surplus in Addition to Claims Reserves.--In 
     the case of any association health plan described in 
     subsection (a)(2), the requirements of this subsection are 
     met if the plan establishes and maintains surplus in an 
     amount at least equal to--
       ``(1) $500,000, or
       ``(2) such greater amount (but not greater than $2,000,000) 
     as may be set forth in regulations prescribed by the 
     applicable authority, considering the level of aggregate and 
     specific excess /stop loss insurance provided with respect to 
     such plan and other factors related to solvency risk, such as 
     the plan's projected levels of participation or claims, the 
     nature of the plan's liabilities, and the types of assets 
     available to assure that such liabilities are met.
       ``(c) Additional Requirements.--In the case of any 
     association health plan described in subsection (a)(2), the 
     applicable authority may provide such additional requirements 
     relating to reserves, excess /stop loss insurance, and 
     indemnification insurance as the applicable authority 
     considers appropriate. Such requirements may be provided by 
     regulation with respect to any such plan or any class of such 
     plans.
       ``(d) Adjustments for Excess /Stop Loss Insurance.--The 
     applicable authority may provide for adjustments to the 
     levels of reserves otherwise required under subsections (a) 
     and (b) with respect to any plan or class of plans to take 
     into account excess /stop loss insurance provided with 
     respect to such plan or plans.
       ``(e) Alternative Means of Compliance.--The applicable 
     authority may permit an association health plan described in 
     subsection (a)(2) to substitute, for all or part of the 
     requirements of this section (except subsection 
     (a)(2)(B)(iii)), such security, guarantee, hold-harmless 
     arrangement, or other financial arrangement as the applicable 
     authority determines to be adequate to enable the plan to 
     fully meet all its financial obligations on a timely basis 
     and is otherwise no less protective of the interests of 
     participants and beneficiaries than the requirements for 
     which it is substituted. The applicable authority may take 
     into account, for purposes of this subsection, evidence 
     provided by the plan or sponsor which demonstrates an 
     assumption of liability with respect to the plan. Such 
     evidence may be in the form of a contract of indemnification, 
     lien, bonding, insurance, letter of credit, recourse under 
     applicable terms of the plan in the form of assessments of 
     participating employers, security, or other financial 
     arrangement.
       ``(f) Measures to Ensure Continued Payment of Benefits by 
     Certain Plans in Distress.--
       ``(1) Payments by certain plans to association health plan 
     fund.--
       ``(A) In general.--In the case of an association health 
     plan described in subsection (a)(2), the requirements of this 
     subsection are met if the plan makes payments into the 
     Association Health Plan Fund under this subparagraph when 
     they are due. Such payments shall consist of annual payments 
     in the amount of $5,000, and, in addition to such annual 
     payments, such supplemental payments as the Secretary may 
     determine to be necessary under paragraph (2). Payments under 
     this paragraph are payable to the Fund at the time determined 
     by the Secretary. Initial payments are due in advance of 
     certification under this part. Payments shall continue to 
     accrue until a plan's assets are distributed pursuant to a 
     termination procedure.
       ``(B) Penalties for failure to make payments.--If any 
     payment is not made by a plan when it is due, a late payment 
     charge of not more than 100 percent of the payment which was 
     not timely paid shall be payable by the plan to the Fund.
       ``(C) Continued duty of the secretary.--The Secretary shall 
     not cease to carry out the provisions of paragraph (2) on 
     account of the failure of a plan to pay any payment when due.
       ``(2) Payments by secretary to continue excess /stop loss 
     insurance coverage and indemnification insurance coverage for 
     certain plans.--In any case in which the applicable authority 
     determines that there is, or that there is reason to believe 
     that there will be: (A) a failure to take necessary 
     corrective actions under section 809(a) with respect to an 
     association health plan described in subsection (a)(2); or 
     (B) a termination of such a plan under section 809(b) or 
     810(b)(8) (and, if the applicable authority is not the 
     Secretary, certifies such determination to the Secretary), 
     the Secretary shall determine the amounts necessary to make 
     payments to an insurer (designated by the Secretary) to 
     maintain in force excess /stop loss insurance coverage or 
     indemnification insurance coverage for such plan, if the 
     Secretary determines that there is a reasonable expectation 
     that, without such payments, claims would not be satisfied by 
     reason of termination of such coverage. The Secretary shall, 
     to the extent provided in advance in appropriation Acts, pay 
     such amounts so determined to the insurer designated by the 
     Secretary.
       ``(3) Association health plan fund.--
       ``(A) In general.--There is established on the books of the 
     Treasury a fund to be known as the `Association Health Plan 
     Fund'. The Fund shall be available for making payments 
     pursuant to paragraph (2). The Fund shall be credited with 
     payments received pursuant to paragraph (1)(A), penalties 
     received pursuant to paragraph (1)(B); and earnings on 
     investments of amounts of the Fund under subparagraph (B).
       ``(B) Investment.--Whenever the Secretary determines that 
     the moneys of the fund are in excess of current needs, the 
     Secretary may request the investment of such amounts as the 
     Secretary determines advisable by the Secretary of the 
     Treasury in obligations issued or guaranteed by the United 
     States.
       ``(g) Excess /Stop Loss Insurance.--For purposes of this 
     section--
       ``(1) Aggregate excess /stop loss insurance.--The term 
     `aggregate excess /stop loss insurance' means, in connection 
     with an association health plan, a contract--
       ``(A) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation) provides for payment to the plan with respect to 
     aggregate claims under the plan in excess of an amount or 
     amounts specified in such contract;
       ``(B) which is guaranteed renewable; and
       ``(C) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(2) Specific excess /stop loss insurance.--The term 
     `specific excess /stop loss insurance' means, in connection 
     with an association health plan, a contract--
       ``(A) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation) provides for payment to the plan with respect to 
     claims under the plan in connection with a covered individual 
     in excess of an amount or amounts specified in such contract 
     in connection with such covered individual;
       ``(B) which is guaranteed renewable; and
       ``(C) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(h) Indemnification Insurance.--For purposes of this 
     section, the term `indemnification insurance' means, in 
     connection with an association health plan, a contract--
       ``(1) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation) provides for payment to the plan with respect to 
     claims under the plan which the plan is unable to satisfy by 
     reason of a termination pursuant to section 809(b) (relating 
     to mandatory termination);
       ``(2) which is guaranteed renewable and noncancellable for 
     any reason (except as the applicable authority may prescribe 
     by regulation); and
       ``(3) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(i) Reserves.--For purposes of this section, the term 
     `reserves' means, in connection with an association health 
     plan, plan assets which meet the fiduciary standards under 
     part 4 and such additional requirements regarding liquidity 
     as the applicable authority may prescribe by regulation.
       ``(j) Solvency Standards Working Group.--
       ``(1) In general.--Within 90 days after the date of the 
     enactment of the Small Business Health Fairness Act of 2004, 
     the applicable authority shall establish a Solvency Standards 
     Working Group. In prescribing the initial regulations under 
     this section, the applicable authority shall take into 
     account the recommendations of such Working Group.
       ``(2) Membership.--The Working Group shall consist of not 
     more than 15 members appointed by the applicable authority. 
     The applicable authority shall include among persons invited 
     to membership on the Working Group at least one of each of 
     the following:
       ``(A) a representative of the National Association of 
     Insurance Commissioners;
       ``(B) a representative of the American Academy of 
     Actuaries;
       ``(C) a representative of the State governments, or their 
     interests;
       ``(D) a representative of existing self-insured 
     arrangements, or their interests;
       ``(E) a representative of associations of the type referred 
     to in section 801(b)(1), or their interests; and
       ``(F) a representative of multiemployer plans that are 
     group health plans, or their interests.

     ``SEC. 807. REQUIREMENTS FOR APPLICATION AND RELATED 
                   REQUIREMENTS.

       ``(a) Filing Fee.--Under the procedure prescribed pursuant 
     to section 802(a), an association health plan shall pay to 
     the applicable authority at the time of filing an application 
     for certification under this part a filing fee in the amount 
     of $5,000, which shall be available in the case of the 
     Secretary, to the extent provided in appropriation Acts, for 
     the sole purpose of administering the certification 
     procedures applicable with respect to association health 
     plans.
       ``(b) Information to Be Included in Application for 
     Certification.--An application for certification under this 
     part meets the requirements of this section only if it 
     includes, in a manner and form which shall be prescribed by 
     the applicable authority by regulation, at least the 
     following information:
       ``(1) Identifying information.--The names and addresses 
     of--
       ``(A) the sponsor; and
       ``(B) the members of the board of trustees of the plan.

[[Page H2954]]

       ``(2) States in which plan intends to do business.--The 
     States in which participants and beneficiaries under the plan 
     are to be located and the number of them expected to be 
     located in each such State.
       ``(3) Bonding requirements.--Evidence provided by the board 
     of trustees that the bonding requirements of section 412 will 
     be met as of the date of the application or (if later) 
     commencement of operations.
       ``(4) Plan documents.--A copy of the documents governing 
     the plan (including any bylaws and trust agreements), the 
     summary plan description, and other material describing the 
     benefits that will be provided to participants and 
     beneficiaries under the plan.
       ``(5) Agreements with service providers.--A copy of any 
     agreements between the plan and contract administrators and 
     other service providers.
       ``(6) Funding report.--In the case of association health 
     plans providing benefits options in addition to health 
     insurance coverage, a report setting forth information with 
     respect to such additional benefit options determined as of a 
     date within the 120-day period ending with the date of the 
     application, including the following:
       ``(A) Reserves.--A statement, certified by the board of 
     trustees of the plan, and a statement of actuarial opinion, 
     signed by a qualified actuary, that all applicable 
     requirements of section 806 are or will be met in accordance 
     with regulations which the applicable authority shall 
     prescribe.
       ``(B) Adequacy of contribution rates.--A statement of 
     actuarial opinion, signed by a qualified actuary, which sets 
     forth a description of the extent to which contribution rates 
     are adequate to provide for the payment of all obligations 
     and the maintenance of required reserves under the plan for 
     the 12-month period beginning with such date within such 120-
     day period, taking into account the expected coverage and 
     experience of the plan. If the contribution rates are not 
     fully adequate, the statement of actuarial opinion shall 
     indicate the extent to which the rates are inadequate and the 
     changes needed to ensure adequacy.
       ``(C) Current and projected value of assets and 
     liabilities.--A statement of actuarial opinion signed by a 
     qualified actuary, which sets forth the current value of the 
     assets and liabilities accumulated under the plan and a 
     projection of the assets, liabilities, income, and expenses 
     of the plan for the 12-month period referred to in 
     subparagraph (B). The income statement shall identify 
     separately the plan's administrative expenses and claims.
       ``(D) Costs of coverage to be charged and other expenses.--
     A statement of the costs of coverage to be charged, including 
     an itemization of amounts for administration, reserves, and 
     other expenses associated with the operation of the plan.
       ``(E) Other information.--Any other information as may be 
     determined by the applicable authority, by regulation, as 
     necessary to carry out the purposes of this part.
       ``(c) Filing Notice of Certification With States.--A 
     certification granted under this part to an association 
     health plan shall not be effective unless written notice of 
     such certification is filed with the applicable State 
     authority of each State in which at least 25 percent of the 
     participants and beneficiaries under the plan are located. 
     For purposes of this subsection, an individual shall be 
     considered to be located in the State in which a known 
     address of such individual is located or in which such 
     individual is employed.
       ``(d) Notice of Material Changes.--In the case of any 
     association health plan certified under this part, 
     descriptions of material changes in any information which was 
     required to be submitted with the application for the 
     certification under this part shall be filed in such form and 
     manner as shall be prescribed by the applicable authority by 
     regulation. The applicable authority may require by 
     regulation prior notice of material changes with respect to 
     specified matters which might serve as the basis for 
     suspension or revocation of the certification.
       ``(e) Reporting Requirements for Certain Association Health 
     Plans.--An association health plan certified under this part 
     which provides benefit options in addition to health 
     insurance coverage for such plan year shall meet the 
     requirements of section 103 by filing an annual report under 
     such section which shall include information described in 
     subsection (b)(6) with respect to the plan year and, 
     notwithstanding section 104(a)(1)(A), shall be filed with the 
     applicable authority not later than 90 days after the close 
     of the plan year (or on such later date as may be prescribed 
     by the applicable authority). The applicable authority may 
     require by regulation such interim reports as it considers 
     appropriate.
       ``(f) Engagement of Qualified Actuary.--The board of 
     trustees of each association health plan which provides 
     benefits options in addition to health insurance coverage and 
     which is applying for certification under this part or is 
     certified under this part shall engage, on behalf of all 
     participants and beneficiaries, a qualified actuary who shall 
     be responsible for the preparation of the materials 
     comprising information necessary to be submitted by a 
     qualified actuary under this part. The qualified actuary 
     shall utilize such assumptions and techniques as are 
     necessary to enable such actuary to form an opinion as to 
     whether the contents of the matters reported under this 
     part--
       ``(1) are in the aggregate reasonably related to the 
     experience of the plan and to reasonable expectations; and
       ``(2) represent such actuary's best estimate of anticipated 
     experience under the plan.

     The opinion by the qualified actuary shall be made with 
     respect to, and shall be made a part of, the annual report.

     ``SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TERMINATION.

       ``Except as provided in section 809(b), an association 
     health plan which is or has been certified under this part 
     may terminate (upon or at any time after cessation of 
     accruals in benefit liabilities) only if the board of 
     trustees, not less than 60 days before the proposed 
     termination date--
       ``(1) provides to the participants and beneficiaries a 
     written notice of intent to terminate stating that such 
     termination is intended and the proposed termination date;
       ``(2) develops a plan for winding up the affairs of the 
     plan in connection with such termination in a manner which 
     will result in timely payment of all benefits for which the 
     plan is obligated; and
       ``(3) submits such plan in writing to the applicable 
     authority.

     Actions required under this section shall be taken in such 
     form and manner as may be prescribed by the applicable 
     authority by regulation.

     ``SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMINATION.

       ``(a) Actions to Avoid Depletion of Reserves.--An 
     association health plan which is certified under this part 
     and which provides benefits other than health insurance 
     coverage shall continue to meet the requirements of section 
     806, irrespective of whether such certification continues in 
     effect. The board of trustees of such plan shall determine 
     quarterly whether the requirements of section 806 are met. In 
     any case in which the board determines that there is reason 
     to believe that there is or will be a failure to meet such 
     requirements, or the applicable authority makes such a 
     determination and so notifies the board, the board shall 
     immediately notify the qualified actuary engaged by the plan, 
     and such actuary shall, not later than the end of the next 
     following month, make such recommendations to the board for 
     corrective action as the actuary determines necessary to 
     ensure compliance with section 806. Not later than 30 days 
     after receiving from the actuary recommendations for 
     corrective actions, the board shall notify the applicable 
     authority (in such form and manner as the applicable 
     authority may prescribe by regulation) of such 
     recommendations of the actuary for corrective action, 
     together with a description of the actions (if any) that the 
     board has taken or plans to take in response to such 
     recommendations. The board shall thereafter report to the 
     applicable authority, in such form and frequency as the 
     applicable authority may specify to the board, regarding 
     corrective action taken by the board until the requirements 
     of section 806 are met.
       ``(b) Mandatory Termination.--In any case in which--
       ``(1) the applicable authority has been notified under 
     subsection (a) (or by an issuer of excess /stop loss 
     insurance or indemnity insurance pursuant to section 806(a)) 
     of a failure of an association health plan which is or has 
     been certified under this part and is described in section 
     806(a)(2) to meet the requirements of section 806 and has not 
     been notified by the board of trustees of the plan that 
     corrective action has restored compliance with such 
     requirements; and
       ``(2) the applicable authority determines that there is a 
     reasonable expectation that the plan will continue to fail to 
     meet the requirements of section 806,

     the board of trustees of the plan shall, at the direction of 
     the applicable authority, terminate the plan and, in the 
     course of the termination, take such actions as the 
     applicable authority may require, including satisfying any 
     claims referred to in section 806(a)(2)(B)(iii) and 
     recovering for the plan any liability under subsection 
     (a)(2)(B)(iii) or (e) of section 806, as necessary to ensure 
     that the affairs of the plan will be, to the maximum extent 
     possible, wound up in a manner which will result in timely 
     provision of all benefits for which the plan is obligated.

     ``SEC. 810. TRUSTEESHIP BY THE SECRETARY OF INSOLVENT 
                   ASSOCIATION HEALTH PLANS PROVIDING HEALTH 
                   BENEFITS IN ADDITION TO HEALTH INSURANCE 
                   COVERAGE.

       ``(a) Appointment of Secretary as Trustee for Insolvent 
     Plans.--Whenever the Secretary determines that an association 
     health plan which is or has been certified under this part 
     and which is described in section 806(a)(2) will be unable to 
     provide benefits when due or is otherwise in a financially 
     hazardous condition, as shall be defined by the Secretary by 
     regulation, the Secretary shall, upon notice to the plan, 
     apply to the appropriate United States district court for 
     appointment of the Secretary as trustee to administer the 
     plan for the duration of the insolvency. The plan may appear 
     as a party and other interested persons may intervene in the 
     proceedings at the discretion of the court. The court shall 
     appoint such Secretary trustee if the court determines that 
     the trusteeship is necessary to protect the interests of the 
     participants and beneficiaries or providers of medical care 
     or to avoid any unreasonable deterioration of the financial 
     condition of the plan. The trusteeship of such Secretary 
     shall continue until the conditions described in the first 
     sentence of this subsection are remedied or the plan is 
     terminated.

[[Page H2955]]

       ``(b) Powers as Trustee.--The Secretary, upon appointment 
     as trustee under subsection (a), shall have the power--
       ``(1) to do any act authorized by the plan, this title, or 
     other applicable provisions of law to be done by the plan 
     administrator or any trustee of the plan;
       ``(2) to require the transfer of all (or any part) of the 
     assets and records of the plan to the Secretary as trustee;
       ``(3) to invest any assets of the plan which the Secretary 
     holds in accordance with the provisions of the plan, 
     regulations prescribed by the Secretary, and applicable 
     provisions of law;
       ``(4) to require the sponsor, the plan administrator, any 
     participating employer, and any employee organization 
     representing plan participants to furnish any information 
     with respect to the plan which the Secretary as trustee may 
     reasonably need in order to administer the plan;
       ``(5) to collect for the plan any amounts due the plan and 
     to recover reasonable expenses of the trusteeship;
       ``(6) to commence, prosecute, or defend on behalf of the 
     plan any suit or proceeding involving the plan;
       ``(7) to issue, publish, or file such notices, statements, 
     and reports as may be required by the Secretary by regulation 
     or required by any order of the court;
       ``(8) to terminate the plan (or provide for its termination 
     in accordance with section 809(b)) and liquidate the plan 
     assets, to restore the plan to the responsibility of the 
     sponsor, or to continue the trusteeship;
       ``(9) to provide for the enrollment of plan participants 
     and beneficiaries under appropriate coverage options; and
       ``(10) to do such other acts as may be necessary to comply 
     with this title or any order of the court and to protect the 
     interests of plan participants and beneficiaries and 
     providers of medical care.
       ``(c) Notice of Appointment.--As soon as practicable after 
     the Secretary's appointment as trustee, the Secretary shall 
     give notice of such appointment to--
       ``(1) the sponsor and plan administrator;
       ``(2) each participant;
       ``(3) each participating employer; and
       ``(4) if applicable, each employee organization which, for 
     purposes of collective bargaining, represents plan 
     participants.
       ``(d) Additional Duties.--Except to the extent inconsistent 
     with the provisions of this title, or as may be otherwise 
     ordered by the court, the Secretary, upon appointment as 
     trustee under this section, shall be subject to the same 
     duties as those of a trustee under section 704 of title 11, 
     United States Code, and shall have the duties of a fiduciary 
     for purposes of this title.
       ``(e) Other Proceedings.--An application by the Secretary 
     under this subsection may be filed notwithstanding the 
     pendency in the same or any other court of any bankruptcy, 
     mortgage foreclosure, or equity receivership proceeding, or 
     any proceeding to reorganize, conserve, or liquidate such 
     plan or its property, or any proceeding to enforce a lien 
     against property of the plan.
       ``(f) Jurisdiction of Court.--
       ``(1) In general.--Upon the filing of an application for 
     the appointment as trustee or the issuance of a decree under 
     this section, the court to which the application is made 
     shall have exclusive jurisdiction of the plan involved and 
     its property wherever located with the powers, to the extent 
     consistent with the purposes of this section, of a court of 
     the United States having jurisdiction over cases under 
     chapter 11 of title 11, United States Code. Pending an 
     adjudication under this section such court shall stay, and 
     upon appointment by it of the Secretary as trustee, such 
     court shall continue the stay of, any pending mortgage 
     foreclosure, equity receivership, or other proceeding to 
     reorganize, conserve, or liquidate the plan, the sponsor, or 
     property of such plan or sponsor, and any other suit against 
     any receiver, conservator, or trustee of the plan, the 
     sponsor, or property of the plan or sponsor. Pending such 
     adjudication and upon the appointment by it of the Secretary 
     as trustee, the court may stay any proceeding to enforce a 
     lien against property of the plan or the sponsor or any other 
     suit against the plan or the sponsor.
       ``(2) Venue.--An action under this section may be brought 
     in the judicial district where the sponsor or the plan 
     administrator resides or does business or where any asset of 
     the plan is situated. A district court in which such action 
     is brought may issue process with respect to such action in 
     any other judicial district.
       ``(g) Personnel.--In accordance with regulations which 
     shall be prescribed by the Secretary, the Secretary shall 
     appoint, retain, and compensate accountants, actuaries, and 
     other professional service personnel as may be necessary in 
     connection with the Secretary's service as trustee under this 
     section.

     ``SEC. 811. STATE ASSESSMENT AUTHORITY.

       ``(a) In General.--Notwithstanding section 514, a State may 
     impose by law a contribution tax on an association health 
     plan described in section 806(a)(2), if the plan commenced 
     operations in such State after the date of the enactment of 
     the Small Business Health Fairness Act of 2004.
       ``(b) Contribution Tax.--For purposes of this section, the 
     term `contribution tax' imposed by a State on an association 
     health plan means any tax imposed by such State if--
       ``(1) such tax is computed by applying a rate to the amount 
     of premiums or contributions, with respect to individuals 
     covered under the plan who are residents of such State, which 
     are received by the plan from participating employers located 
     in such State or from such individuals;
       ``(2) the rate of such tax does not exceed the rate of any 
     tax imposed by such State on premiums or contributions 
     received by insurers or health maintenance organizations for 
     health insurance coverage offered in such State in connection 
     with a group health plan;
       ``(3) such tax is otherwise nondiscriminatory; and
       ``(4) the amount of any such tax assessed on the plan is 
     reduced by the amount of any tax or assessment otherwise 
     imposed by the State on premiums, contributions, or both 
     received by insurers or health maintenance organizations for 
     health insurance coverage, aggregate excess /stop loss 
     insurance (as defined in section 806(g)(1)), specific excess 
     /stop loss insurance (as defined in section 806(g)(2)), other 
     insurance related to the provision of medical care under the 
     plan, or any combination thereof provided by such insurers or 
     health maintenance organizations in such State in connection 
     with such plan.

     ``SEC. 812. DEFINITIONS AND RULES OF CONSTRUCTION.

       ``(a) Definitions.--For purposes of this part--
       ``(1) Group health plan.--The term `group health plan' has 
     the meaning provided in section 733(a)(1) (after applying 
     subsection (b) of this section).
       ``(2) Medical care.--The term `medical care' has the 
     meaning provided in section 733(a)(2).
       ``(3) Health insurance coverage.--The term `health 
     insurance coverage' has the meaning provided in section 
     733(b)(1).
       ``(4) Health insurance issuer.--The term `health insurance 
     issuer' has the meaning provided in section 733(b)(2).
       ``(5) Applicable authority.--The term `applicable 
     authority' means the Secretary, except that, in connection 
     with any exercise of the Secretary's authority regarding 
     which the Secretary is required under section 506(d) to 
     consult with a State, such term means the Secretary, in 
     consultation with such State.
       ``(6) Health status-related factor.--The term `health 
     status-related factor' has the meaning provided in section 
     733(d)(2).
       ``(7) Individual market.--
       ``(A) In general.--The term `individual market' means the 
     market for health insurance coverage offered to individuals 
     other than in connection with a group health plan.
       ``(B) Treatment of very small groups.--
       ``(i) In general.--Subject to clause (ii), such term 
     includes coverage offered in connection with a group health 
     plan that has fewer than 2 participants as current employees 
     or participants described in section 732(d)(3) on the first 
     day of the plan year.
       ``(ii) State exception.--Clause (i) shall not apply in the 
     case of health insurance coverage offered in a State if such 
     State regulates the coverage described in such clause in the 
     same manner and to the same extent as coverage in the small 
     group market (as defined in section 2791(e)(5) of the Public 
     Health Service Act) is regulated by such State.
       ``(8) Participating employer.--The term `participating 
     employer' means, in connection with an association health 
     plan, any employer, if any individual who is an employee of 
     such employer, a partner in such employer, or a self-employed 
     individual who is such employer (or any dependent, as defined 
     under the terms of the plan, of such individual) is or was 
     covered under such plan in connection with the status of such 
     individual as such an employee, partner, or self-employed 
     individual in relation to the plan.
       ``(9) Applicable state authority.--The term `applicable 
     State authority' means, with respect to a health insurance 
     issuer in a State, the State insurance commissioner or 
     official or officials designated by the State to enforce the 
     requirements of title XXVII of the Public Health Service Act 
     for the State involved with respect to such issuer.
       ``(10) Qualified actuary.--The term `qualified actuary' 
     means an individual who is a member of the American Academy 
     of Actuaries.
       ``(11) Affiliated member.--The term `affiliated member' 
     means, in connection with a sponsor--
       ``(A) a person who is otherwise eligible to be a member of 
     the sponsor but who elects an affiliated status with the 
     sponsor,
       ``(B) in the case of a sponsor with members which consist 
     of associations, a person who is a member of any such 
     association and elects an affiliated status with the sponsor, 
     or
       ``(C) in the case of an association health plan in 
     existence on the date of the enactment of the Small Business 
     Health Fairness Act of 2004, a person eligible to be a member 
     of the sponsor or one of its member associations.
       ``(12) Large employer.--The term `large employer' means, in 
     connection with a group health plan with respect to a plan 
     year, an employer who employed an average of at least 51 
     employees on business days during the preceding calendar year 
     and who employs at least 2 employees on the first day of the 
     plan year.
       ``(13) Small employer.--The term `small employer' means, in 
     connection with a group health plan with respect to a plan 
     year, an employer who is not a large employer.
       ``(b) Rules of Construction.--
       ``(1) Employers and employees.--For purposes of determining 
     whether a plan, fund, or

[[Page H2956]]

     program is an employee welfare benefit plan which is an 
     association health plan, and for purposes of applying this 
     title in connection with such plan, fund, or program so 
     determined to be such an employee welfare benefit plan--
       ``(A) in the case of a partnership, the term `employer' (as 
     defined in section 3(5)) includes the partnership in relation 
     to the partners, and the term `employee' (as defined in 
     section 3(6)) includes any partner in relation to the 
     partnership; and
       ``(B) in the case of a self-employed individual, the term 
     `employer' (as defined in section 3(5)) and the term 
     `employee' (as defined in section 3(6)) shall include such 
     individual.
       ``(2) Plans, funds, and programs treated as employee 
     welfare benefit plans.--In the case of any plan, fund, or 
     program which was established or is maintained for the 
     purpose of providing medical care (through the purchase of 
     insurance or otherwise) for employees (or their dependents) 
     covered thereunder and which demonstrates to the Secretary 
     that all requirements for certification under this part would 
     be met with respect to such plan, fund, or program if such 
     plan, fund, or program were a group health plan, such plan, 
     fund, or program shall be treated for purposes of this title 
     as an employee welfare benefit plan on and after the date of 
     such demonstration.''.
       (b) Conforming Amendments to Preemption Rules.--
       (1) Section 514(b)(6) of such Act (29 U.S.C. 1144(b)(6)) is 
     amended by adding at the end the following new subparagraph:
       ``(E) The preceding subparagraphs of this paragraph do not 
     apply with respect to any State law in the case of an 
     association health plan which is certified under part 8.''.
       (2) Section 514 of such Act (29 U.S.C. 1144) is amended--
       (A) in subsection (b)(4), by striking ``Subsection (a)'' 
     and inserting ``Subsections (a) and (d)'';
       (B) in subsection (b)(5), by striking ``subsection (a)'' in 
     subparagraph (A) and inserting ``subsection (a) of this 
     section and subsections (a)(2)(B) and (b) of section 805'', 
     and by striking ``subsection (a)'' in subparagraph (B) and 
     inserting ``subsection (a) of this section or subsection 
     (a)(2)(B) or (b) of section 805'';
       (C) by redesignating subsection (d) as subsection (e); and
       (D) by inserting after subsection (c) the following new 
     subsection:
       ``(d)(1) Except as provided in subsection (b)(4), the 
     provisions of this title shall supersede any and all State 
     laws insofar as they may now or hereafter preclude, or have 
     the effect of precluding, a health insurance issuer from 
     offering health insurance coverage in connection with an 
     association health plan which is certified under part 8.
       ``(2) Except as provided in paragraphs (4) and (5) of 
     subsection (b) of this section--
       ``(A) In any case in which health insurance coverage of any 
     policy type is offered under an association health plan 
     certified under part 8 to a participating employer operating 
     in such State, the provisions of this title shall supersede 
     any and all laws of such State insofar as they may preclude a 
     health insurance issuer from offering health insurance 
     coverage of the same policy type to other employers operating 
     in the State which are eligible for coverage under such 
     association health plan, whether or not such other employers 
     are participating employers in such plan.
       ``(B) In any case in which health insurance coverage of any 
     policy type is offered in a State under an association health 
     plan certified under part 8 and the filing, with the 
     applicable State authority (as defined in section 812(a)(9)), 
     of the policy form in connection with such policy type is 
     approved by such State authority, the provisions of this 
     title shall supersede any and all laws of any other State in 
     which health insurance coverage of such type is offered, 
     insofar as they may preclude, upon the filing in the same 
     form and manner of such policy form with the applicable State 
     authority in such other State, the approval of the filing in 
     such other State.
       ``(3) Nothing in subsection (b)(6)(E) or the preceding 
     provisions of this subsection shall be construed, with 
     respect to health insurance issuers or health insurance 
     coverage, to supersede or impair the law of any State--
       ``(A) providing solvency standards or similar standards 
     regarding the adequacy of insurer capital, surplus, reserves, 
     or contributions, or
       ``(B) relating to prompt payment of claims.
       ``(4) For additional provisions relating to association 
     health plans, see subsections (a)(2)(B) and (b) of section 
     805.
       ``(5) For purposes of this subsection, the term 
     `association health plan' has the meaning provided in section 
     801(a), and the terms `health insurance coverage', 
     `participating employer', and `health insurance issuer' have 
     the meanings provided such terms in section 812, 
     respectively.''.
       (3) Section 514(b)(6)(A) of such Act (29 U.S.C. 
     1144(b)(6)(A)) is amended--
       (A) in clause (i)(II), by striking ``and'' at the end;
       (B) in clause (ii), by inserting ``and which does not 
     provide medical care (within the meaning of section 
     733(a)(2)),'' after ``arrangement,'', and by striking 
     ``title.'' and inserting ``title, and''; and
       (C) by adding at the end the following new clause:
       ``(iii) subject to subparagraph (E), in the case of any 
     other employee welfare benefit plan which is a multiple 
     employer welfare arrangement and which provides medical care 
     (within the meaning of section 733(a)(2)), any law of any 
     State which regulates insurance may apply.''.
       (4) Section 514(e) of such Act (as redesignated by 
     paragraph (2)(C)) is amended--
       (A) by striking ``Nothing'' and inserting ``(1) Except as 
     provided in paragraph (2), nothing''; and
       (B) by adding at the end the following new paragraph:
       ``(2) Nothing in any other provision of law enacted on or 
     after the date of the enactment of the Small Business Health 
     Fairness Act of 2004 shall be construed to alter, amend, 
     modify, invalidate, impair, or supersede any provision of 
     this title, except by specific cross-reference to the 
     affected section.''.
       (c) Plan Sponsor.--Section 3(16)(B) of such Act (29 U.S.C. 
     102(16)(B)) is amended by adding at the end the following new 
     sentence: ``Such term also includes a person serving as the 
     sponsor of an association health plan under part 8.''.
       (d) Disclosure of Solvency Protections Related to Self-
     Insured and Fully Insured Options Under Association Health 
     Plans.--Section 102(b) of such Act (29 U.S.C. 102(b)) is 
     amended by adding at the end the following: ``An association 
     health plan shall include in its summary plan description, in 
     connection with each benefit option, a description of the 
     form of solvency or guarantee fund protection secured 
     pursuant to this Act or applicable State law, if any.''.
       (e) Savings Clause.--Section 731(c) of such Act is amended 
     by inserting ``or part 8'' after ``this part''.
       (f) Report to the Congress Regarding Certification of Self-
     Insured Association Health Plans.--Not later than January 1, 
     2009, the Secretary of Labor shall report to the Committee on 
     Education and the Workforce of the House of Representatives 
     and the Committee on Health, Education, Labor, and Pensions 
     of the Senate the effect association health plans have had, 
     if any, on reducing the number of uninsured individuals.
       (g) Clerical Amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 is 
     amended by inserting after the item relating to section 734 
     the following new items:

           ``Part 8--Rules governing association health plans

``801. Association health plans.
``802. Certification of association health plans.
``803. Requirements relating to sponsors and boards of trustees.
``804. Participation and coverage requirements.
``805. Other requirements relating to plan documents, contribution 
              rates, and benefit options.
``806. Maintenance of reserves and provisions for solvency for plans 
              providing health benefits in addition to health insurance 
              coverage.
``807. Requirements for application and related requirements.
``808. Notice requirements for voluntary termination.
``809. Corrective actions and mandatory termination.
``810. Trusteeship by the Secretary of insolvent association health 
              plans providing health benefits in addition to health 
              insurance coverage.
``811. State assessment authority.
``812. Definitions and rules of construction.''.

     SEC. 3. CLARIFICATION OF TREATMENT OF SINGLE EMPLOYER 
                   ARRANGEMENTS.

       Section 3(40)(B) of the Employee Retirement Income Security 
     Act of 1974 (29 U.S.C. 1002(40)(B)) is amended--
       (1) in clause (i), by inserting after ``control group,'' 
     the following: ``except that, in any case in which the 
     benefit referred to in subparagraph (A) consists of medical 
     care (as defined in section 812(a)(2)), two or more trades or 
     businesses, whether or not incorporated, shall be deemed a 
     single employer for any plan year of such plan, or any fiscal 
     year of such other arrangement, if such trades or businesses 
     are within the same control group during such year or at any 
     time during the preceding 1-year period,'';
       (2) in clause (iii), by striking ``(iii) the 
     determination'' and inserting the following:
       ``(iii)(I) in any case in which the benefit referred to in 
     subparagraph (A) consists of medical care (as defined in 
     section 812(a)(2)), the determination of whether a trade or 
     business is under `common control' with another trade or 
     business shall be determined under regulations of the 
     Secretary applying principles consistent and coextensive with 
     the principles applied in determining whether employees of 
     two or more trades or businesses are treated as employed by a 
     single employer under section 4001(b), except that, for 
     purposes of this paragraph, an interest of greater than 25 
     percent may not be required as the minimum interest necessary 
     for common control, or
       ``(II) in any other case, the determination'';
       (3) by redesignating clauses (iv) and (v) as clauses (v) 
     and (vi), respectively; and
       (4) by inserting after clause (iii) the following new 
     clause:
       ``(iv) in any case in which the benefit referred to in 
     subparagraph (A) consists of medical care (as defined in 
     section 812(a)(2)), in determining, after the application of 
     clause (i), whether benefits are provided to employees of two 
     or more employers, the arrangement shall be treated as having 
     only

[[Page H2957]]

     one participating employer if, after the application of 
     clause (i), the number of individuals who are employees and 
     former employees of any one participating employer and who 
     are covered under the arrangement is greater than 75 percent 
     of the aggregate number of all individuals who are employees 
     or former employees of participating employers and who are 
     covered under the arrangement,''.

     SEC. 4. ENFORCEMENT PROVISIONS RELATING TO ASSOCIATION HEALTH 
                   PLANS.

       (a) Criminal Penalties for Certain Willful 
     Misrepresentations.--Section 501 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1131) is amended--
       (1) by inserting ``(a)'' after ``Sec. 501.''; and
       (2) by adding at the end the following new subsection:
       ``(b) Any person who willfully falsely represents, to any 
     employee, any employee's beneficiary, any employer, the 
     Secretary, or any State, a plan or other arrangement 
     established or maintained for the purpose of offering or 
     providing any benefit described in section 3(1) to employees 
     or their beneficiaries as--
       ``(1) being an association health plan which has been 
     certified under part 8;
       ``(2) having been established or maintained under or 
     pursuant to one or more collective bargaining agreements 
     which are reached pursuant to collective bargaining described 
     in section 8(d) of the National Labor Relations Act (29 
     U.S.C. 158(d)) or paragraph Fourth of section 2 of the 
     Railway Labor Act (45 U.S.C. 152, paragraph Fourth) or which 
     are reached pursuant to labor-management negotiations under 
     similar provisions of State public employee relations laws; 
     or
       ``(3) being a plan or arrangement described in section 
     3(40)(A)(i),

     shall, upon conviction, be imprisoned not more than 5 years, 
     be fined under title 18, United States Code, or both.''.
       (b) Cease Activities Orders.--Section 502 of such Act (29 
     U.S.C. 1132) is amended by adding at the end the following 
     new subsection:
       ``(n) Association Health Plan Cease and Desist Orders.--
       ``(1) In general.--Subject to paragraph (2), upon 
     application by the Secretary showing the operation, 
     promotion, or marketing of an association health plan (or 
     similar arrangement providing benefits consisting of medical 
     care (as defined in section 733(a)(2))) that--
       ``(A) is not certified under part 8, is subject under 
     section 514(b)(6) to the insurance laws of any State in which 
     the plan or arrangement offers or provides benefits, and is 
     not licensed, registered, or otherwise approved under the 
     insurance laws of such State; or
       ``(B) is an association health plan certified under part 8 
     and is not operating in accordance with the requirements 
     under part 8 for such certification,

     a district court of the United States shall enter an order 
     requiring that the plan or arrangement cease activities.
       ``(2) Exception.--Paragraph (1) shall not apply in the case 
     of an association health plan or other arrangement if the 
     plan or arrangement shows that--
       ``(A) all benefits under it referred to in paragraph (1) 
     consist of health insurance coverage; and
       ``(B) with respect to each State in which the plan or 
     arrangement offers or provides benefits, the plan or 
     arrangement is operating in accordance with applicable State 
     laws that are not superseded under section 514.
       ``(3) Additional equitable relief.--The court may grant 
     such additional equitable relief, including any relief 
     available under this title, as it deems necessary to protect 
     the interests of the public and of persons having claims for 
     benefits against the plan.''.
       (c) Responsibility for Claims Procedure.--Section 503 of 
     such Act (29 U.S.C. 1133) is amended by inserting ``(a) In 
     General.--'' before ``In accordance'', and by adding at the 
     end the following new subsection:
       ``(b) Association Health Plans.--The terms of each 
     association health plan which is or has been certified under 
     part 8 shall require the board of trustees or the named 
     fiduciary (as applicable) to ensure that the requirements of 
     this section are met in connection with claims filed under 
     the plan.''.

     SEC. 5. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES.

       Section 506 of the Employee Retirement Income Security Act 
     of 1974 (29 U.S.C. 1136) is amended by adding at the end the 
     following new subsection:
       ``(d) Consultation With States With Respect to Association 
     Health Plans.--
       ``(1) Agreements with states.--The Secretary shall consult 
     with the State recognized under paragraph (2) with respect to 
     an association health plan regarding the exercise of--
       ``(A) the Secretary's authority under sections 502 and 504 
     to enforce the requirements for certification under part 8; 
     and
       ``(B) the Secretary's authority to certify association 
     health plans under part 8 in accordance with regulations of 
     the Secretary applicable to certification under part 8.
       ``(2) Recognition of primary domicile state.--In carrying 
     out paragraph (1), the Secretary shall ensure that only one 
     State will be recognized, with respect to any particular 
     association health plan, as the State with which consultation 
     is required. In carrying out this paragraph--
       ``(A) in the case of a plan which provides health insurance 
     coverage (as defined in section 812(a)(3)), such State shall 
     be the State with which filing and approval of a policy type 
     offered by the plan was initially obtained, and
       ``(B) in any other case, the Secretary shall take into 
     account the places of residence of the participants and 
     beneficiaries under the plan and the State in which the trust 
     is maintained.''.

     SEC. 6. EFFECTIVE DATE AND TRANSITIONAL AND OTHER RULES.

       (a) Effective Date.--The amendments made by this Act shall 
     take effect one year after the date of the enactment of this 
     Act. The Secretary of Labor shall first issue all regulations 
     necessary to carry out the amendments made by this Act within 
     one year after the date of the enactment of this Act.
       (b) Treatment of Certain Existing Health Benefits 
     Programs.--
       (1) In general.--In any case in which, as of the date of 
     the enactment of this Act, an arrangement is maintained in a 
     State for the purpose of providing benefits consisting of 
     medical care for the employees and beneficiaries of its 
     participating employers, at least 200 participating employers 
     make contributions to such arrangement, such arrangement has 
     been in existence for at least 10 years, and such arrangement 
     is licensed under the laws of one or more States to provide 
     such benefits to its participating employers, upon the filing 
     with the applicable authority (as defined in section 
     812(a)(5) of the Employee Retirement Income Security Act of 
     1974 (as amended by this subtitle)) by the arrangement of an 
     application for certification of the arrangement under part 8 
     of subtitle B of title I of such Act--
       (A) such arrangement shall be deemed to be a group health 
     plan for purposes of title I of such Act;
       (B) the requirements of sections 801(a) and 803(a) of the 
     Employee Retirement Income Security Act of 1974 shall be 
     deemed met with respect to such arrangement;
       (C) the requirements of section 803(b) of such Act shall be 
     deemed met, if the arrangement is operated by a board of 
     directors which--
       (i) is elected by the participating employers, with each 
     employer having one vote; and
       (ii) has complete fiscal control over the arrangement and 
     which is responsible for all operations of the arrangement;
       (D) the requirements of section 804(a) of such Act shall be 
     deemed met with respect to such arrangement; and
       (E) the arrangement may be certified by any applicable 
     authority with respect to its operations in any State only if 
     it operates in such State on the date of certification.

     The provisions of this subsection shall cease to apply with 
     respect to any such arrangement at such time after the date 
     of the enactment of this Act as the applicable requirements 
     of this subsection are not met with respect to such 
     arrangement.
       (2) Definitions.--For purposes of this subsection, the 
     terms ``group health plan'', ``medical care'', and 
     ``participating employer'' shall have the meanings provided 
     in section 812 of the Employee Retirement Income Security Act 
     of 1974, except that the reference in paragraph (7) of such 
     section to an ``association health plan'' shall be deemed a 
     reference to an arrangement referred to in this subsection.

  The SPEAKER pro tempore. After 1 hour of debate on the bill, it shall 
be in order to consider the amendment printed in part B of House Report 
108-484, if offered by the gentleman from Wisconsin (Mr. Kind), or his 
designee, which shall be considered read, and shall be debatable for 1 
hour, equally divided and controlled by the proponent and an opponent.
  The gentleman from Ohio (Mr. Boehner) and the gentleman from New 
Jersey (Mr. Andrews) each will control 30 minutes of debate on the 
bill.
  The Chair recognizes the gentleman from Ohio (Mr. Boehner).


                             General Leave

  Mr. BOEHNER. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks on H.R. 4281.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Ohio?
  There was no objection.
  Mr. BOEHNER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the most pressing crisis we face in health care today is 
the number of Americans who lack basic health insurance benefits. It is 
a problem that can be illustrated by just a few numbers, so let us look 
at the facts.
  The number of uninsured Americans today stands at 43.6 million. This 
problem is not going to go away, and I think we have a responsibility 
to confront it.
  With health care costs continuing to rise sharply across the country, 
more and more employers and workers are sharing the burden of increased 
health care premiums. Employer-based health

[[Page H2958]]

insurance premiums jumped by 15 percent on average in 2003, the largest 
increase in a decade; and, for many small employers, those increases 
were far larger.
  The second number is 60, which represents the percentage of these 
uninsured working Americans who either work for a small business or are 
dependent upon someone who does. Many of these Americans work for small 
employers who cannot afford to purchase quality health insurance 
benefits for their workers.
  Notably, the Census Bureau statistics show that employer-sponsored 
health coverage has declined because small businesses with less than 25 
workers have been forced to drop coverage because of the rising cost of 
health insurance.

                              {time}  1345

  The next number is $130 billion. Yes, that is right, $130 billion 
which represents the annual cost to the citizens of our country of the 
poor health and premature deaths of individuals without health 
insurance, according to a study released last year by the Institute of 
Medicine.
  The implications of these numbers I think are tragic. Clearly, we 
need to focus on providing affordable health care to the uninsured, as 
well as to ensure employers who provide health benefits to their 
employees are not forced to drop their coverage because of rising 
premiums and high administrative costs.
  The Small Business Health Fairness Act which we bring to the floor 
today responds to this problem and can help reduce the high cost of 
health insurance for small businesses and uninsured workers. By 
creating association health plans, which would strictly be regulated by 
the Labor Department, small businesses could pool their resources and 
increase their bargaining power with benefit providers, which would 
allow them to negotiate better rates and purchase quality health care 
for their employees at a lower cost.
  President Bush addressed this point directly last year during a 
speech at the Women's Entrepreneurship Summit, and he said, ``Small 
businesses will be able to pool together and spread their risk across a 
large employee base. It makes no sense in America to isolate small 
businesses as little health care islands unto themselves. We must have 
association health plans.''
  Well, the President is right, and we should help level this playing 
field so that small businesses can offer high-quality coverage to their 
employees.
  Americans overwhelmingly agree with President Bush that AHPs are the 
right approach to helping the uninsured. A recent poll conducted in 
March reveals that 93 percent of Americans support association health 
plans as a way of providing access to affordable care for American 
workers who lack coverage. Media reports from the last few days reveal 
how large corporations are now starting to band together to provide 
health care insurance to their part-time workers. Do not small 
businesses and their workers deserve this same opportunity?
  Importantly, the bill gives AHPs freedom from costly State mandates 
because small businesses deserve to be treated in the same fashion as 
large corporations and unions who receive the same type of an 
exemption. Clearly, these mandates are useless to families who have no 
health coverage in the first place. And if you do not have health 
coverage, State mandates requiring health mandates and specific 
benefits do you and your family no good at all. This measure includes, 
I believe, strong safeguards to protect workers.
  Despite the bipartisan nature of this bill, some misinformation has 
been spread and I would like to correct it. This measure protects 
against cherry-picking because we make clear that AHPs must comply with 
the 1996 Health Insurance Portability and Accountability Act which 
prohibits group health plans from excluding or charging a higher rate 
to high-risk individuals with high claims experience. Under our bill, 
sick or high-risk groups or individuals cannot be denied coverage. In 
addition, AHPs cannot charge higher rates for employers with sicker 
individuals within the plan except to the extent already allowed by 
State law, based on where the employer is located.
  The bill also contains strict requirements under which only bona fide 
professional and trade organizations can sponsor an association health 
plan and, therefore, does not allow ``sham association plans'' set up 
by health insurance companies. These organizations must be established 
for purposes other than providing health insurance and they have to be 
in business for at least 3 years.
  Now, some may ask why we need to pass this bill again, especially 
after it passed with significant bipartisan support last year. We are 
here today because we want to remind the American people and uninsured 
working families that we are here working on their behalf. We have a 
bipartisan solution to help address the problem of the uninsured, and 
passing this bill again demonstrates our commitment to helping 
Americans without health insurance. The next step is for the other body 
across the Capitol to begin to deal with this bill in a serious way. On 
Tuesday of this week, the Senate Task Force on the Uninsured included 
association health plans amongst its proposals to address the needs of 
uninsured working Americans, so we remain hopeful.
  We in Congress, I think, have a responsibility to deal with the 
problems of small businesses who cannot afford to provide health 
insurance because of skyrocketing health care costs and being stuck in 
small State insurance pools.
  The United States economy is improving, and more and more employers 
are hiring workers each month. Last Friday, the Labor Department 
reported that 1.1 million new jobs have been created over the last 8 
months, including 625,000 new net jobs over the last 2 months alone. We 
want to make sure that those new workers have opportunity to receive 
quality health insurance through their employer, and we believe that 
this bill can help make that happen.
  Mr. Speaker, I reserve the balance of my time.
  Mr. ANDREWS. Mr. Speaker, it is my pleasure to yield such time as he 
may consume to the gentleman from California (Mr. George Miller), the 
Democratic leader of our committee.
  Mr. GEORGE MILLER of California. Mr. Speaker, I thank the gentleman 
for yielding me this time and I thank him for all of his leadership on 
this legislation.
  I was wondering why we were here today, but I guess we are here today 
to demonstrate that we are working on behalf of the American people. It 
is an interesting definition of work, that we are going to repeat 
something that we have already done earlier in the year that has 
already been completed, but we are going to go through it again, so you 
think we are working for you. I thought they called that featherbedding 
or something in the old days, when you looked like you were working but 
you were not working.
  But anyway, what is interesting here is that once again we see the 
Republicans offering another piece of legislation that just continues 
an assault on middle-income Americans. They did it with overtime pay: 
cut it, will not let us consider it; comp time, ended; unemployment 
insurance assistance, terminated; job training, slashed; negotiations 
for cheaper prescription drugs, prohibited. When is it the middle class 
is going to get to win one with this Republican leadership in the 
Congress?
  Now we come to this health care plan which is to basically give an 
offer to people of health care that is unregulated, that is opposed by 
all of the State Attorneys General and the National Governors 
Association and so many others who have experience with these plans in 
trying to make sure that people are not cheated out of the money that 
they pay and the benefits that are offered.
  But they are not going to allow us to have the amendments that would 
substantially change this bill, because they do not want to vote on 
those amendments. They do not want to vote on amendments that would 
improve this legislation. That is unfortunate, because as they do 
continue their assault on the middle class, at least those of us 206 
Members on the Democratic side ought to be able to reflect the voices 
of the people that we represent. We ought to be able to offer the 
amendments to provide for their protection and for their expanded 
health care, but that is not the way they run the House nowadays. 
Nowadays you either have to take their idea or no idea.

[[Page H2959]]

And that is just unacceptable when we are considering a problem as 
complicated and with the absolute sense of urgency that the Nation has 
about health care.
  So this is very unfortunate, that we would take these 4 hours that we 
will probably consume on this legislation and simply go through a 
charade that was already acted out in the House of Representatives last 
year in this Congress. The Senate can consider it anytime they want. 
But we are going to go through this charade rather than allowing 
amendments that could be offered to substantially improve this 
legislation, amendments much like the effort we made yesterday on 
overtime, to offer a chance to vote on overtime, we would prevail on a 
bipartisan basis, but the Republicans are so concerned that they would 
rather choke off the debate and not allow those amendments to take 
place.
  Mr. BOEHNER. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentleman from Texas (Mr. Sam Johnson), the chairman of the 
Subcommittee on Employer-Employee Relations.
  Mr. SAM JOHNSON of Texas. Mr. Speaker, as the House moves forward 
with its competitiveness agenda to make America's businesses more 
attractive and efficient, it is imperative that we help the backbone of 
our economy: small business.
  Health care costs are rising at a rate of 15 percent annually, and 
double that for many small businesses. What is astounding is that 
according to the Congressional Budget Office, for each percentage point 
rise in health insurance costs, the number of uninsured increases by 
300,000. That is a terrible ratio.
  Since this trend shows no sign of slowing, it means we need to act 
now. By allowing small businesses to band together in trade 
associations, this bill will give small businesses access to more 
affordable health care, give them freedom from costly State-mandated 
benefit requirements, and lower their administrative costs by as much 
as 30 percent.
  Some critics of the bill say there will be a loss in consumer 
protection because AHPs exempt small business from burdensome State 
mandates such as covering in vitro fertilization. Obviously, these 
mandates just cost the States more money. Large employers and unions 
have been exempt from State mandates since 1974, and they continue to 
offer fantastic coverage to working families. We ought to act now to 
help small businesses enjoy that same privilege or they will not be 
able to offer any health coverage to employees and their family 
members.
  In my home State of Texas, a shocking 27 percent of all employed or 
self-employed adults are uninsured, according to a recent study. The 
facts are clear and the facts demand action.
  An overwhelming majority of small businesses agree that AHPs are the 
right solution. This bill has the support of NFIB, the Associated 
Builders and Contractors, the U.S. Chamber of Commerce, and many 
others. I would like to be sure and thank my good friend, the gentleman 
from Ohio (Mr. Boehner), and other cosponsors of this legislation: the 
gentleman from Georgia (Mr. Burns), the gentlewoman from New York (Ms. 
Velazquez), and the gentleman from California (Mr. Dooley). They have 
shown their commitment to small business employees and their families 
by supporting this legislation, and I commend them for it.
  This bill gets to the heart of health care reform. Let us just do it.
  Mr. ANDREWS. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. Mr. Speaker, I rise in strong opposition to this bill. 
My friend, the chairman, went through a series of numbers about this 
bill a few minutes ago, and I would respectfully suggest that he got 
some numbers wrong.
  I think the most important numbers about this bill are 1 million, 
zero, and 50. There will be an addition of 1 million people to the roll 
of the uninsured should this bill become law, and here is why. The 
chairman argues that the provisions of this bill would limit the 
ability of association health plans to choose only the youngest and the 
most healthy would be affected. I think the evidence is strongly to the 
contrary. I think there are loopholes in this law that are wide enough 
to drive an ambulance through that would allow association health plans 
to refuse to insure, or raise the premiums to insure people who are 
older or more infirm.
  Mercer & Associates, a respected, nonpartisan study group on health 
care is the source of this number. They believe that when we add up the 
number of people who will gain health insurance as a result of AHPs and 
we subtract from that that number of people who will lose health 
insurance because of rising premiums in plans that are more 
traditional, that we will add 1 million people to the ranks of the 
uninsured.
  The second number is zero. That is the number of consumer protections 
that the law will guarantee if this bill became law. Legislators across 
this country, Republican and Democrat, have fought for the right of 
women to have guaranteed mammograms and OB-GYN care, the right of 
people dealing with the difficulties of substance abuse or mental 
health problems to have guaranteed coverage, the right of couples who 
wish to have children to have infertility coverage, the rights for 
diabetic care, for mental health care. These are rights that people 
have fought for and won in State legislatures across the country. Every 
single one of those protections is repealed should this bill become 
law. There will be zero consumer protections guaranteed to our 
constituents should this happen.

                              {time}  1400

  The final number that we should take into consideration is 50 because 
that is the number of State Attorneys General who oppose this bill. 
That is the number of insurance commissioners, Republican and Democrat, 
who oppose this bill. The National Governors Association, Republicans, 
Democrats and Independents across the country oppose this bill.
  Mr. Speaker, it is customary on the floor of the House for us to have 
our partisan differences, that happens; but do not listen to the 
partisan differences here. Listen to the experts of both parties who 
spent their careers out in the several States regulating health care. 
Republican Governors and Democratic Governors, Republican Attorneys 
General and Democratic Attorneys General, Republican insurance 
commissioners and Democratic insurance commissioners oppose this bill 
because it opens the door for the possibility of fraud and loss in 
these plans.
  There is a better way; and later this afternoon my friend, the 
gentleman from Wisconsin (Mr. Kind), and I will be offering a plan 
which truly will reduce premiums for small businesses, which truly will 
expand health care opportunities for the uninsured and will do so 
without risking or jeopardizing the important protections that people 
presently enjoy under the law.
  I would urge my colleagues to oppose this bill, to support our 
substitute.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BOEHNER. Mr. Speaker, I am pleased to yield 3 minutes to the 
gentleman from Hickory, North Carolina (Mr. Ballenger), a senior member 
of our committee.
  Mr. BALLENGER. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, I am a small business owner, and I know the burden that 
rising health care costs are having on small companies across America. 
My health insurance costs in my company have skyrocketed over the past 
few years, and I know that other small U.S. firms are experiencing the 
same burden. In my particular case, over the last 10 years my sales 
have doubled, but my health care costs have gone up by 450 percent.
  When I first started my business, we could cover the full cost of an 
employee's medical insurance; but even with growing sales, we have not 
been able to keep pace with the ever-increasing cost of medical 
premiums, and I hear this same story over and over again from other 
small business owners in my district.
  Like me, most employers care deeply about their employees and want to 
give them access to quality health care. Unfortunately, soaring costs 
have forced many small businesses to shift their health insurance costs 
to the employees, to drop health care coverage or to close up shop 
altogether.

[[Page H2960]]

  Considering that more than half of the uninsured are small business 
employees and their dependents, this is nothing short of a tragedy. We 
must act to help small businesses which are at the mercy of the 
insurance companies. They simply do not have the bargaining power or 
resources needed to get the best deal.
  That is why I am a strong supporter of the Small Business Health 
Fairness Act. This bill allows small businesses to pool their resources 
into association health plans, giving them purchasing clout and power 
to do what they do not have today. AHPs will allow small businesses to 
negotiate better rates and purchase better plans at a lower cost. It is 
good for small employers. It is good for employees.
  Now, we know the problem of the uninsured will not got away with this 
bill, but it will help small employers and millions of their employees 
and their dependents to gain access to quality care; and it may help 
prevent some companies from dropping their health care plans 
altogether.
  I strongly urge my colleagues to support this employer- and employee-
friendly bill, and I thank the gentleman for yielding me the time.
  Mr. ANDREWS. Mr. Speaker, I yield 2\1/2\ minutes to the gentleman 
from Maryland (Mr. Van Hollen), one of our Members who has extensive 
experience as a State legislator in achievement in this area.
  Mr. VAN HOLLEN. Mr. Speaker, I thank my colleague for yielding me the 
time, and I want to thank him for all his work on this issue.
  As the chairman of the committee said at the beginning of his 
remarks, we have 43.6 million Americans who have no health insurance 
today. Now, the Congressional Budget Office tells us that the 
associated health plan approach might cover 550,000 of them, less than 
1 percent of the insured. If that were the end of the story, we might 
say, okay, does not do much, but it is better than nothing.
  The problem is it is not better than nothing because it violates the 
first principle in medicine, which is first do no harm, because the 
Congressional Budget Office also tells us that 7.9 million Americans 
who currently are covered will get worse coverage or pay more as a 
result of the actions taken in this bill.
  Mercer Consultants has said that 1 million Americans will lose their 
coverage. Do the math. Clearly, it is a lousy bargain. Much more harm, 
very, very little benefit, and that is because associated health plans, 
by design, eliminate many of the protections that are currently 
provided through State legislatures around the country for our 
consumers: basic commonsense rules of the road, like the right to 
external review if a person's insurance claim is denied; direct access 
for women to OB/GYNs; access to emergency room treatment; a prohibition 
against gag orders on doctors. In fact, these basic patient protections 
are so fundamental, they have been adopted in a bipartisan manner by 
this House before. When this House passed a Patients' Bill of Rights, 
it was going to apply those rights to ERISA plans and the other plans. 
Why not do the same thing today?
  Well, my colleague, the gentleman from Massachusetts (Mr. Tierney), 
and I just the other day went to the Committee on Rules and said let us 
have an amendment here on the floor of the House that guarantees those 
patients the same protections this House, in a bipartisan manner, 
guaranteed them a number of years ago. We were not even allowed a vote 
on that very simple amendment. Why is the other side afraid of a vote 
on providing patients the very same rights that this House has already 
provided those patients?
  Let me just say that if my colleagues ask State legislators and 
Governors from around this country whether they are for or against 
this, we have heard the National Governors Association is against this. 
In fact, my Governor, the Governor of the State of Maryland, a 
Republican Governor, one of our former colleagues, Governor Ehrlich, 
has written to the Maryland congressional delegation and said please do 
not pass this bill because it will interfere with a primary piece of 
legislation that was passed in the State of Maryland to provide for 
small group insurance benefits, and small employers throughout the 
State of Maryland are taking advantage of it. This would undercut it.
  There is a better alternative. We are going to be debating that 
later. We are not saying we do not have any proposal out here. We have 
a much better proposal.
  I urge my colleagues to reject this idea and later adopt the 
substitute.
  Mr. BOEHNER. Mr. Speaker, I am pleased to yield 1 minute to my 
colleague, the gentleman from Ohio (Mr. Gillmor).
  (Mr. GILLMOR asked and was given permission to revise and extend his 
remarks.)
  Mr. GILLMOR. Mr. Speaker, I thank the chairman for yielding me the 
time.
  Mr. Speaker, I rise in support of H.R. 4281. This bill will open the 
door to nearly 41 million Americans that are currently without health 
care coverage. Providing small businesses with an opportunity to offer 
their employees affordable health care access is essential in promoting 
not only the physical health of the American workforce but also the 
overall economic health of the United States.
  The American economy has always been driven by the entrepreneurial 
nature of its citizens, and blocking access to affordable health care 
will only suffocate growth within the small business sector of our 
economy. Recently, I had the honor of addressing a group of small 
business owners from my northwest Ohio district at an NFIB regional 
luncheon, and the most common concern I heard from them was their 
inability to secure affordable health care for themselves and their 
employees.
  This piece of legislation provides a real solution to one of the 
major problems plaguing our business and health care industries, and I 
urge its support.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (Mr. Simpson). Would Members please remove 
their electronic devices from the floor or turn them off.
  Mr. ANDREWS. Mr. Speaker, it is my pleasure to yield such time as he 
may consume to the gentleman from Michigan (Mr. Dingell), the senior 
Member and the dean of the House of Representatives, my very dear 
friend.
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Mr. Speaker, I rise in opposition to the legislation and 
to applaud the efforts of my good friend and colleague from New Jersey 
and his opposition to it.
  This legislation is bad. It is going to encourage cherry-picking and 
cream-skimming. It is going to create a bunch of plans that are going 
to be exempt from State regulation. It is going to actually reduce the 
quality of care available, the quality of health insurance available, 
and also the amount of insurance available and the people who will be 
covered.
  More than 1,000 organizations oppose AHPs: the National Governors, 
Republicans and Democrats alike; the National Association of Insurance 
Commissioners who say that it is going to encourage cherry-picking and 
cream-skimming; the National Association of Attorneys General, 
Republicans and Democrats alike; the American Academy of Pediatrics; 
the Consumers Union; and Families USA, plus many others.
  What it is going to do is to actually undermine the current employer-
sponsored market. As I mentioned, it will encourage cherry-picking of 
healthier and younger populations because they will be permitted to 
cover specific types of employers and thus establish a special new, 
separate market and will be a market where it will not cover many 
people, who will find that the difficulties in procuring insurance will 
be more difficult because of this.
  The Congressional Budget Office tells us that AHPs will cut benefits 
for 8 million Americans who now have coverage. That alone is argument 
enough to defeat this legislation. Additionally, CBO determined that 
AHPs will only increase enrollment in employer-sponsored coverage by 
330,000 people.
  A Mercer study commissioned by the National Small Business 
Association found that AHPs would cause the uninsured to grow by better 
than 1 million. That, again, should be warning enough.
  At a time when 43 million of our people are uninsured, AHPs will 
simply move us backwards. I urge us to defeat this legislation. It is 
bad. It is not in the interest of the country. Everybody who is 
responsible for dealing with insurance has said this is bad 
legislation. Reject it.

[[Page H2961]]

  Mr. BOEHNER. Mr. Speaker, I yield myself such time as I may consume.
  With all due respect to my good friend from Michigan, I think what we 
see here at the central issue of this debate is a basic distrust of the 
private sector. Now, two-thirds of the American people get their health 
insurance through their employer. We have an employer-based system in 
America, and it has worked very well; and some of the best coverage and 
the most high-quality health plans are offered by employers to their 
employees.
  Today, both employers, and increasingly employees, are paying for the 
cost of those plans. What we are attempting to do here is to give small 
businesses who do not have big purchasing power in the marketplace the 
ability to join together and to offer the same kinds of plans that 
large companies and unions offer to their employees and members, give 
those small employers and their employees the same opportunity.
  Plain and simple.
  Mr. Speaker, I am pleased to yield 2 minutes to the gentlewoman from 
Tennessee (Mrs. Blackburn), a member of the committee.
  Mrs. BLACKBURN. Mr. Speaker, I thank the chairman for his excellent 
work on this issue for our Nation's small businesses.
  We know that those small businesses fuel this economic growth in our 
country, and we appreciate their efforts; and we know that our small 
business employees are being burdened paying on average 17 percent more 
for their health benefits than their counterparts at large companies.
  I recently held a small business health care roundtable in my 
district and talked with these small business employers about their 
desire to make better health benefits available to their employees and 
still stay competitive. This legislation is an opportunity that 
Congress has to help bring about that affordable health care to 
millions of employees.
  AHPs would save the typical small business owner between 15 and 30 
percent on health insurance and help make that coverage available. As 
our chairman said, too often regulations and mandates add to the cost 
burden.
  Current law exempts large employers and unions from State mandates so 
that they are able to offer quality benefits across State lines. The 
Small Business Health Fairness Act will give that same opportunity to 
our small businesses in this country.
  This is a benefit that will help them to be competitive in the world 
market. It is bipartisan legislation. It passed overwhelmingly last 
year, and I urge all of my colleagues to support this commonsense 
legislation for our Nation's small businesses.
  Mr. ANDREWS. Mr. Speaker, I yield myself 15 seconds.
  My friend said that the opposition is evidence of distrust of the 
private sector. It is odd, because 66 local chambers of commerce have 
mounted an objection to the bill and the Republican Governors 
Association. I guess they share our distrust for the private sector.
  Mr. Speaker, I am submitting a list of over 1,050 organizations that 
oppose this bill for the Record.

Organizations and Public Officials Opposed to Federal AHP Legislation, 
                             April 23, 2004

       Over 1,050 Organizations Have Expressed Opposition:


                            state officials

     National Groups
     National Governors Association
     Republican Governors Association
     Democratic Governors Association
     Attorneys General Representing 41 States
     National Association of Insurance Commissioners
     National Association of State Mental Health Program Directors
     National Conference of Insurance Legislators
     National Conference of State Legislatures


                          chambers of commerce

     Albuquerque (NM) Chamber
     Arapahoe Chamber of Commerce (Nebraska)
     Ashland Chamber of Commerce (Nebraska)
     Black Chamber of Commerce of Greater Kansas City
     Blanding Chamber of Commerce (Utah)
     Bloomfield Chamber of Commerce (Nebraska)
     Boise Metro Chamber of Commerce (Idaho)
     Boston Chamber
     Broken Bow Chamber of Commerce (Nebraska)
     Buffalo-Niagara Partnership (New York)
     Carey Area Chamber of Commerce (Ohio)
     Cherry Creek Chamber (Colorado)
     Colorado Black Chamber of Commerce
     Colorado Hispanic Chamber of Commerce
     Council of Smaller Enterprises/Greater Cleveland Growth 
           Association (COSE)
     Denver Metro
     Detroit
     Draper Chamber of Commerce (Utah)
     Duchesne Chamber of Commerce (Utah)
     Evans Chamber of Commerce (Colorado)
     Florence, Colorado
     Grand Raids Area Chamber of Commerce
     Greater Akron Chamber (Ohio)
     Greater Cincinnati Chamber
     Greater Columbus Chamber (Ohio)
     Greater Des Moines Partnership (Iowa)
     Greater Indianapolis Chamber (Indiana)
     Greater Louisville, Inc. (Louisville, Kentucky Chamber of 
           Commerce)
     Greater Manchester, New Hampshire
     Greater North Dakota Association
     Greater Seattle Chamber
     Heber Valley Economic Development (Utah)
     Herington Chamber of Commerce (Kansas)
     Hiawatha Chamber of Commerce (Kansas)
     Holton Area Chamber of Commerce (Kansas)
     Lake City Chamber of Commerce (Colorado)
     Lansing Regional Chamber (Michigan)
     Lehi Chamber of Commerce (Utah)
     Merrimack Valley Chamber of Commerce
     Metro Jackson, Mississippi
     Michigan Chamber of Commerce
     Midvale Chamber of Commerce (Utah)
     New Hampshire Business and Industry Association
     North Central Massachusetts Chamber of Commerce
     North Park Chamber (Colorado)
     Northern Kentucky Chamber of Commerce
     Northern Ohio Chamber of Commerce
     Oklahoma City
     Oklahoma State
     Oregon Association of Industries (Oregon State Chamber of 
           Commerce)
     Palisade Chamber (Colorado)
     Paola Chamber of Commerce (Kansas)
     Ravenna Area Chamber of Commerce (Ohio)
     Salem Economic Development (Utah)
     Saratoga County Chamber of Commerce (New York)
     Spanish Fork Area Chamber of Commerce (Utah)
     Springfield Chamber of Commerce (Colorado)
     Springville Area Chamber of Commerce (Utah)
     Tacoma-Pierce County Chamber of Commerce
     Toledo Area Chamber of Commerce
     Tulsa, Oklahoma
     Washington State (Association of Washington Business)
     West Jordan Chamber (Utah)
     Woodson County Chamber of Commerce (Kansas)
     Worland Chamber of Commerce (Wyoming)
     Youngstown-Warren Chamber (Ohio)


                             farm bureaus:

     Alabama Farmers Association (ALFA)
     Mississippi Farm Bureau
     Tennessee Farm Bureau Federation--Tennessee Rural Health
     Virginia Farm Bureau


                      small business associations

     Alaska Coalition of Small Business
     Arizona Small Business Association
     4D Industries (Oregon)
     Indiana Association of Community and Economic Development
     Indiana Manufacturers' Association
     Fargo-Moorhead Homebuilders' Association
     Ohio/Kentucky Concrete Pavement Association
     National Small Business Association (Represents over 150,000 
           small businesses nationwide)
     New England Council
     New Hampshire Business Council
     New Hampshire High Tech Council
     Oregon Business Alliance
     Professional Musicians Of Arizona
     Rhode Island Small Business Association
     SMC Business Councils (Pennsylvania)
     Santaquin Economic Development Agency (Utah)
     Small Business Association of Michigan
     Utah Small Business Development Center--Utah Valley State 
           College


                              labor unions

     AFL-CIO--American Federation of Labor and Congress of 
           Industrial Organizations
       With additional letters from: Alabama AFL-CIO, Alaska AFL-
     CIO, Arkansas AFL-CIO, Arizona AFL-CIO, California AFL-CIO, 
     Indiana AFL-CIO, Kansas AFL-CIO, Louisiana AFL-CIO, Maine 
     AFL-CIO, Minnesota AFL-CIO, Missouri AFL-CIO, Montana State 
     AFL-CIO, Nebraska AFL-CIO, Nevada State AFL-CIO, New Mexico 
     Federation of Labor, North Carolina State AFL-CIO, Northern 
     Nevada Central Labor Council, Nevada State AFL-CIO, District 
     2, Ohio AFL-CIO, Oregon AFL-CIO, Rhode Island AFL-CIO, 
     Southern Nevada Central Labor Council, Nevada State AFL-CIO, 
     District 3, Tennessee Labor Council, Utah State AFL-CIO, 
     Virginia AFL-CIO, Washington State Labor Council

     Alabama Education Retirees Association
     Alabama Retired State Employees Association
     Alabama Teacher's Union (AEA)
     American Federation of State, County and Municipal Employees 
           (AFSCME)
       With additional letters from: Alabama, Colorado, Indiana, 
     Kansas Council 72 (Local 1715--Chapter 3371), Louisiana 
     AFSCME Council 17, Nebraska, New Mexico, Ohio AFSCME United, 
     AFSCME Local 4, AFSCME Council 8, Ohio Local 11 OCSEA, AFSCME 
     Local 11, Rhode Island Council 94, Utah Local 1004, Virginia 
     Local 27


[[Page H2962]]


     American Federation of Teachers (AFT)

       With additional letters from: Albuquerque, New Mexico 
     Federation of Teachers, Arkansas Federation of Teachers, 
     Colorado Federation of Teachers, Kansas Southwest and 
     Mountain States Region for the AFT, Louisiana Federation of 
     Teachers, Oregon Federation of Teachers, Rapides (Louisiana), 
     Utah American Federation of Teachers

     Atlanta Labor Council
     Boilermaker's Lodge 101 (Colorado)
     Cement Masons Local 577 (Colorado)
     Central Georgia Federation of Trades and Labor Council
     Colorado Federation of Public Employees
     International Brotherhood of Electrical Workers (IBEW)

       With additional letters from: Cleveland, Ohio Local 1377, 
     Dayton, Ohio Local 82, Kansas Local 304, Milan, Ohio Local 
     1194, Oak Harbor, Ohio Local 1432, Ohio Local 2331, Oregon

     International Union, United Auto Workers (UAW)

       With additional letters from: Indiana UAW--Region 3 
     (Indiana and Kentucky), Kansas Local 31

     International Union of Bricklayers and Allied Craftworkers
     Kansas Association of Public Employees
     Kansas Postal Workers Union
     Labor Federation of Central Kansas
     Laborers' International Union--Local 149--Aurora, Illinois
     Maine Teacher's Union/Maine Educational Association
     Middle Georgia Central Labor Council
     Missouri Steelworkers Union
     Montana Progressive Labor Caucus
     National Education Association--Rhode Island
     Nebraska State Education Association
     Ocean State Action (AFT--Rhode Island)
     Ohio AFSCME Retiree Chapter 1184
     Ohio Association of Public School Employees
     Oregon Federation of Nurses
     Paper Allied-Industrial, Chemical and Energy Workers 
           International Union (PACE)
     Providence (Rhode Island) Central Federation of Labor
     Service Employees International Union (SEIU)

       With additional letters from: Alabama, Arkansas, Colorado, 
     Georgia, Local 1985, Kansas, Missouri, Local 2000, New 
     Hampshire, Local 1984, Ohio, District 1199, Oregon, Local 
     503, Rhode Island, Washington

     Shipbuilders and Boilermakers International Union--Virginia 
           Chapter
     Teamsters Union--Maine
     Teamsters' 190--Montana
     Teamsters Local 407--Ohio
     United Food and Commercial Workers Union--Nebraska (Local 22)
     United Food and Commercial Workers Union--Washington
     United Teachers of Wichita, Kansas
     United Transportation Union--Louisiana


                        consumer/advocacy groups

     National Groups
     Alliance for Children and Families
     American Agricultural Movement, Inc.
     American Association of Pastoral Counselors
     American Association of People with Disabilities
     American Association of University Women--Oregon Chapter
     American Cancer Society
     American Congress of Community Supports and Employment 
           Services
     American Corn Growers Association
     American Diabetes Association

       With additional letters from: Alabama Chapter, Arkansas 
     Chapter, Central Ohio Chapter, Cleveland Ohio Chapter, 
     Colorado Chapter, Indiana Chapter, Kansas Chapter, Louisiana 
     Chapter, Maine Chapter, Minnesota Chapter, Montana Chapter, 
     Nebraska Chapter, Nevada Chapter, New Hampshire Chapter, New 
     Mexico Chapter, North Carolina Chapter, Northeast Ohio 
     Chapter, Oregon Chapter, Utah Chapter, Seattle, Washington 
     Chapter, Southwest Ohio & Northern Kentucky Chapter, 
     Washington Chapter

     American Family Foundation
     American Homeowners Grassroots Alliance
     Americans for a Balanced Budget
     Anxiety Disorders Association of America
     Association for the Advancement of Psychology
     Bazelon Center for Mental Health Law
     Center on Disability and Health
     Child Welfare League of America
     Children & Adults with Attention-Deficit/Hyperactivity 
           Disorder

       With additional letters from: Ohio Chapter

     Children's Defense Fund--With additional letters from: Ohio 
           Chapter

     Coalition Against Insurance Fraud
     Consumer Federation of America
     Consumers Union
     Depression and Bipolar Support Alliance

       With additional letters from: Depression and Bi-Polar 
     Support Alliance of Ohio, Depression and Bi-Polar Support 
     Alliance of Columbus, Ohio, Depression and Bi-Polar Support 
     Alliance of Dayton, Ohio, Depression and Bi-Polar Support 
     Alliance of Medina, Ohio

     Families USA
     Federation of Families for Children's Mental Health
     Federation of Southern Cooperatives
     Friends Committee on National Legislation
     International Certification and Reciprocity Consortium
     League of United Latin American Citizens (LULAC)--With 
           additional letters from: Arkansas Chapter
     Maternal and Child Health Coalition for Healthy Families
     National Alliance for the Mentally Ill

       With additional letters from: Arkansas Chapter, Colorado 
     Chapter, Georgia Chapter, Kansas Chapter, Louisiana Chapter, 
     Maine Chapter, Montana Chapter, Nebraska Chapter, New 
     Hampshire Chapter, New Mexico Chapter, North Carolina 
     Chapter.
       Ohio Chapter: Allen, Auglaize & Hardin Counties, Adams 
     County, Butler County, Clark County, Clermont County, 
     Cleveland Metro, Fairfield County, Franklin County, 
     Licking County, Logan & Champaign County, Richland County, 
     Ross/Pickaway Counties, Seneca, Sandusky and Wyandot 
     Counties, Stark County, Warren County.
       Oregon Chapter, Rhode Island Chapter, St. Louis Chapter, 
     Utah Chapter, Washington Chapter

     National Association for Children's Behavioral Health
     National Association for Rural Mental Health
     National Association for the Advancement of Colored People 
           (NAACP) North Carolina Chapter
     National Association of Anorexia Nervosa and Associated 
           Disorders
     National Association of Farmer Elected Committees
     National Association of Protection and Advocacy Systems
     National Coalition for the Homeless
     National Council of La Raza
     National Farmers Organization
     National Foundation for Depressive Illness
     National Mental Health Association

       With additional letters from: California Chapter, Colorado 
     Chapter, Franklin County (Ohio), Georgia Chapter, Greater St. 
     Louis Chapter (Missouri), Illinois Chapter, Indiana Chapter, 
     Knox County (Ohio), Licking County (Ohio), Louisiana Chapter, 
     Lucas County (Ohio), Miami County (Ohio), Minnesota Chapter, 
     Montana Chapter, New Mexico Chapter, Nebraska Chapter, North 
     Carolina, Oregon Chapter (Mental Health Association of 
     Oregon--MHAO), Ottawa County (Ohio), Stillwater-Sweetgrass 
     Counties (Montana), Summit County (Ohio), Union County 
     (Ohio), Utah Chapter, Wyoming Chapter

     National Partnership for Women & Families
     National Patient Advocate Foundation
     Planned Parenthood Federation of America
     Research Institute for Independent Living
     Soybean Producers of America
     Suicide Prevention Action Network
     Tourette Syndrome Association
     United Cerebral Palsy Association
     USAction
     Women Involved in Farm Economics
     Local Groups
     9 to 5 National Working Women's Association (Colorado)
     AIDS Alliance Service (North Carolina)
     AIDS Prevention ACTION Network (California)
     AIDS Project Rhode Island
     AIDS Response Seacoast--New Hampshire
     AIDS Survival Project (Georgia)
     ARC of Alabama
     ARC of Colorado
     ARC of Indiana
     ARC of Norfolk, Nebraska
     ARC of Ohio
     ARC of Oregon
     ARC of Utah
     Access Utah Network
     Adoption Options (Colorado)
     Advocacy Coalition of Seniors and People with Disabilities 
           (Oregon)
     Alabama Council on Substance Abuse
     Alabama Watch
     Alaskans for Tax Reform
     Alliance Against Family Violence (Kansas)
     Allies With Families (Utah)
     American Agricultural Movement of Arkansas, Inc.
     American Association of University Women--Oregon Chapter
     American Lung Association--Alaska Chapter
     American Lung Association--Colorado Chapter
     Arkansas Interfaith Conference
     Arizona Association of Community Mental Health Centers
     Assistive Technology Through Action in Indiana (ATTAIN)
     Association of Community Organizations for Reform Now 
           (California)
     Bethpage Omaha (Nebraska)
     Best Buddies International--Indiana Chapter
     Big Brother and Big Sister--Illinois
     Bosom Buddies of Georgia, Inc.
     Brain Injury Association of Colorado
     Brain Injury Association of Utah
     Buckeye Art Therapy Association of Ohio
     California Coalition for Mental Health
     California Pan-Ethnic Health Network
     Campaign for Better Health Care (Illinois)
     Campaign for Health Security (Oregon)
     Cancer World (Oregon)
     Catholic Charities of Colorado
     Catholic Charities of Colorado Springs
     Catholic Charities of Omaha, Nebraska
     Catholic Charities Pueblo (Colorado)
     Catholic Community Services of Utah
     Catholic Conference of Kentucky
     Center for Policy Analysis (California)
     Central Ohio Diabetes Association
     Centro Legal (Minnesota Minority Support Group)
     Child Connect (Nebraska)
     Children's Defense Fund--Ohio Chapter
     Children's Diabetes Foundation--Denver Chapter

[[Page H2963]]

     Children's First of Oregon
     Citizen Action of Arizona
     Citizen Action of Illinois
     Citizen Action of New York
     Citizen Action Network of Iowa
     Coalition for Accountable Government (Utah)
     Coalition for Independence (Kansas)
     Coalition of New Hampshire Taxpayers
     Colorado Classified School Employees Association
     Colorado Forum on Community
     Colorado Developmental Disabilities Planning Council
     Colorado Programs for Children with Disabilities
     Colorado Progress Coalition
     Colorado Women's Agenda
     Columbus Ohio Chapter of N.O.W.
     Community Action Directors of Oregon
     Community Connection (Utah)
     Community Connections (Nebraska)
     Community Harvest Food Bank of Northeast Indiana
     Community Humanitarian Resource Center (Nebraska)
     Community Pharmacists of Indiana
     Community Support Services (Oregon)
     Concerned Christian Americans--Illinois
     Congress of California Seniors
     Connecticut Citizen Action Group
     Damien Center--Indiana
     Day At A Time Club (Colorado)
     Denver, Adams and Arapahoe County (CO) CARES
     Diocese of Salt Lake City (Utah)
     Durango Ltd. (Illinois)
     Eagle Forum (Illinois)
     East Liverpool (Ohio) Breast Cancer Support Group
     Ecumenical Ministries of Oregon
     El Comite--Colorado
     Electric League (Missouri)
     EMPOWER Colorado
     Families First (Georgia)
     Family Planning Association of Maine
     Family Planning Association of Northeast Ohio
     Family Ties Adoption Center of Colorado
     Federation of Families for Children's Mental Health--Colorado
     Future Coalition (Ohio)
     Gathering Place (Nebraska)
     Georgia Abortion and Reproductive Rights Action League 
           (GARAL)
     Georgia Rural--Urban Summit
     Georgia Watch
     Georgians for Healthcare
     Good Faith Fund (Arkansas)
     Granite State Independent Living Foundation (New Hampshire)
     Gray Panthers California
     Gray Panthers of Oregon
     Gray Panthers of Rhode Island
     Health Action New Mexico
     Health Care for All (Massachusetts)
     Health Law Advocates (Massachusetts)
     Healthy Kids Learn Better (Oregon)
     Healthy Mothers/Healthy Babies (Montana)
     Helena Indian Alliance--Montana
     Hispanic Community Center (Nebraska)
     Hispanic Contractors Association (Colorado)
     Human Services Coalition of Oregon
     Illinois Caucus for Adolescent Health
     Indiana Association of Area Agencies on Aging
     Indiana Central Association of Diabetes Educators (ICADE)
     Indiana Coalition on Housing and Homeless Issues
     Indiana Pharmacy Alliance
     Individual and Family Counseling--Illinois
     Insure the Uninsured Project (California)
     Interfaith Service Bureau (California)
     Iowa Christian Coalition
     Jewish Community Relations Council--Indiana
     Kansas Alcohol & Drug Services Providers Association
     Kansas Association of Middle School Administrators
     Kansas United School Administrators
     Kentuckians for Health Care Reform
     Kentucky Minority Farmers Association
     Latin American Research and Service Agency (Colorado)
     Louisiana Maternal and Children's Health Coalition
     Maine Consumers for Affordable Healthcare
     Maine Women's Lobby
     Maine Women's Policy Center
     Mental Health Consumer Advocates of Rhode Island
     MESA (Moving to End Sexual Assault) Administrative Office 
           (Colorado)
     Minnesota AIDS Project 10
     Minnesota Lawsuit Abuse Watch (M-LAW)
     Minnesota State Council on Disability
     Montana Children's Initiative
     Montana Coalition for Competitive Choices
     Montana Council for Families
     Montana March of Dimes
     Montana NARAL
     Montana Peoples Action
     Montana Senior Citizens Association
     Montana's Child Project
     Multiple Sclerosis Society of Indiana
     Mutual Ground--Illinois
     National Barter and Commodity Association (Formerly the 
           Colorado Citizens for an Alternative Tax System)
     National Kidney Foundation of Georgia
     Navajo County Arizona Special Public Health District
     Nebraska Arthritis Foundation
     Nebraska Tax Research Council
     Nebraskans for Equal Taxation
     Neighborhood Activists Inter-Linked Empowerment Movement 
           (NAILEM)--Arizona
     Nevada Alliance for Retired Americans
     Nevada Cancer Institute
     Nevada Diabetes Assocaition for Children and Adults
     Nevadans for Affordable Health Care
     New Mexico Voices for Children (formerly--New Mexico 
           Advocates for Children and Families)
     New Mexico Teen Pregnancy Coalition
     New Hampshire Commission on the Status of Women
     New Hampshire Developmental Disabilities Commission
     New Hampshire for Health Care
     Noble/ARC of Central Indiana
     Noble/ARC of Greater Indianapolis
     North Carolina Committee to Defend Healthcare
     Ohio AIDS Coalition
     Ohio Advocates for Mental Health
     Ohio Association of Mental Retardation
     Ohio Citizen Advocates for Chemical Dependency, Prevention 
           and Treatment
     Ohioans for Diabetes Control
     Oregon Alliance of Retired Americans
     Oregon Association of Retired Persons (AARP Chapter)
     Oregon Council of Senior Citizens
     Oregon Disabilities Commission
     Oregon Health Action Campaign
     Oregon Heart and Lung Association
     Oregon Law Center
     Oregon Special Concerns Ministry
     Oregonians for Health Security
     Paola Foster Grandparent Program (Kansas)
     People First of Nebraska
     People Living Through Cancer--New Mexico
     Planned Parenthood of Alaska
     Planned Parenthood of Georgia
     Planned Parenthood of Greater Indiana
     Planned Parenthood of Mid/East Tennessee
     Planned Parenthood of Northern New England
     Precita Park Democratic Club (California)
     Protectmontanakids.org
     Pulaski County Democratic Women (Arkansas)
     Pulaski County Young Democrats (Arkansas)
     Quality Care for Children (Georgia)
     Redemptorist Social Services Center (Missouri)
     Religious Action Center of Reform Judaism
     Rhode Island Kids Count
     Rhode Island Poverty Institute
     Rhode Island Public Health Association
     Safe Kids--Safe Communities--Montana
     Self-Determination Resources (Oregon)
     Small Business Lobby (Virginia)
     Special Concerns Ministry (Oregon)
     Sudden Arrhythmia Death Syndrome (Utah)
     Support Oregon Services Alliance
     Tennessee Association of Alcohol and Drug Abuse Services
     United Cerebral Palsy Association--Colorado
     United Cerebral Palsy Association--Nebraska
     United Cerebral Palsy Association--Utah
     United Seniors of Oregon
     Universal Health Care Action Network of Ohio
     University Village Association (Illinois)
     Utah Association of Counties
     Utah Center for Persons With Disabilities
     Utah Coalition Against Sexual Assault
     Utah Hispanic Advisory Council
     Utah State University
     Victim Assistance Team of Grand County Colorado
     Virginia Coalition of Police and Deputy Sheriffs
     Washington Citizen Action
     Wisconsin Citizen Action
     Wisdom of Wellness Foundation (Georgia)
     WISE Foundation (Tennessee)
     Women's Association of Northshore Democrats--Louisiana
     Women's Policy Group (Georgia)
     Women's Rights Organization (Oregon)
     Working for Equality and Economic Liberation (WEEL)--Montana


                            Physician Groups

                            National Groups

     American Academy of Child and Adolescent Psychiatry
     American Academy of Neurology
     American Academy of Pediatrics

       With additional letters from: Alabama Chapter, Illinois 
     Chapter, Indiana Chapter, Iowa Chapter, Louisiana Chapter, 
     Minnesota Chapter, Montana Chapter, Nebraska Chapter, New 
     Hampshire Chapter, New Mexico Chapter, Ohio Chapter, 
     Oregon Chapter, Rhode Island Chapter, Tennessee Chapter, 
     Utah Chapter

     American Association for Geriatric Psychiatry
     American College of Foot & Ankle Surgeons
     American Psychiatric Association

       With additional letters from: Colorado Chapter, Kansas 
     Chapter, Louisiana Chapter, New Hampshire Chapter, New Mexico 
     Chapter, Ohio Chapter, Tennessee Chapter, Utah Chapter

     National Alliance of Medical Researchers and Teaching 
           Physicians
     National Hispanic Medical Association
     Pediatrix Medical Group
     The Society for Maternal Fetal Medicine
     Local Groups
     Alabama Academy of Family Physicians
     Alabama Medical Association
     American Academy of Physicians--Nebraska Chapter
     American College of Cardiology--Alabama Chapter
     American College of Emergency Physicians--Alabama Chapter
     American College of Surgeons--Rhode Island Chapter

[[Page H2964]]

     Arkansas Medical Society
     Bellevue Pediatric Center (Nebraska)
     Bennett Breast Cancer Center (Maine)
     Colorado Medical Society
     Family Medicine Specialists of St. George (Utah)
     Internal Medicine and Pediatric Medicine (Utah)
     Missouri State Medical Association
     Nebraska Academy of Family Physicians
     Nebraska Academy of Physicians
     Nebraska Medical Association
     New Hampshire Health Care Association
     New Mexico Medical Society
     Rhode Island Medical Association
     Rhode Island Neurological Society
     Rose Breast Center (Colorado)
     Utah Optometric Physicians
     Utah Valley Pediatrics
     Virginia Medical Society
     Washington Healthcare Forum


                            Provider Groups

     National Groups
     American Association for Marriage and Family Therapy
     American Association for Psychosocial Rehabilitation
     American Association on Mental Retardation
     American Chiropractic Association

       With additional letters from: Alabama Chapter, Arkansas 
     Chapter, Indiana Chapter, Kansas Chapter, Kentucky Chapter, 
     Louisiana Chapter, Maine Chapter, Minnesota Chapter, Montana 
     Chapter, New Hampshire Chapter, New Mexico Chapter, North 
     Carolina Chapter, Oregon Chapter, Rhode Island Chapter, 
     Tennessee Chapter, Washington Chapter

     American College of Nurse-Midwives
     American Counseling Association
     American Group Psychotherapy Association
     American Mental Health Counselors Association
     American Nurses Association

       With additional letters from: Alabama Chapter, Arkansas 
     Chapter, California Chapter, Colorado Chapter, Illinois 
     Chapter, Kansas Chapter, Maine Chapter, Minnesota Chapter, 
     Montana Chapter, Nebraska Chapter, Nevada Chapter, New 
     Hampshire Chapter, New Mexico Chapter, Ohio Chapter, Oregon 
     Chapter, Rhode Island Chapter, Tennessee Chapter, Utah 
     Chapter, Virginia Chapter, Wyoming Chapter

     American Optometric Association

       With additional letters from: Alabama Chapter, Arizona 
     Chapter, Arkansas Chapter, Indiana Chapter, Iowa Chapter, 
     Kentucky Chapter, Louisiana Chapter, Montana Chapter, 
     Nebraska Chapter, Nevada Chapter, New Hampshire Chapter, 
     New Mexico Chapter, Tennessee Chapter, Utah Chapter, 
     Virginia Chapter, Wyoming Chapter

     American Podiatric Medical Association
     American Psychiatric Nurses Association
     American Psychological Association

       With additional letters from: Arkansas Chapter, Colorado 
     Chapter, Illinois Chapter, Indiana Chapter, Iowa Chapter, 
     Kansas Chapter, Kentucky Chapter, Louisiana Chapter, 
     Minnesota Chapter, Montana Chapter, Nebraska Chapter, Nevada 
     Chapter, North Carolina Chapter, Ohio Chapter, Oregon 
     Chapter, Rhode Island Chapter, Tennessee Chapter, Utah 
     Chapter, Wyoming Chapter

     American Psychotherapy Association
     American Society of Clinical Psychopharmacology, Inc.
     Association for Ambulatory Behavioral Healthcare
     Association of Women's Health, Obstetrics and Neonatal Nurses
     Clinical Social Work Federation
     Employee Assistance Professionals Association
     Federation of Behavioral, Psychological and Cognitive 
           Sciences
     National Association of County Behavioral Health Directors
     National Association of School Psychologists
     National Association of Social Workers

       With additional letters from: Alabama Chapter, Arkansas 
     Chapter, Iowa Chapter, Kansas Chapter, Louisiana Chapter, 
     Maine Chapter, Nebraska Chapter, New Hampshire Chapter, New 
     Mexico Chapter, North Carolina Chapter, Ohio Chapter, Rhode 
     Island Chapter, Utah Chapter

     National Council for Community Behavioral Healthcare
     Local Groups
     AAC Association (Nebraska)
     Access Utah Network
     Act Now Counseling (Utah)
     Action Counseling (Colorado)
     Acupuncture Association of Colorado
     Acupuncture Association of Utah
     Acupuncture Association of Washington
     Addiction and Behavioral Health Center (Nebraska)
     Advance Women's Health Care (Utah)
     Advantage Eye Care (Utah)
     AIM Institute (Nebraska)
     Affiliates in Psychology (Nebraska)
     Alabama Association of Home Health Agencies
     Alabama Association of State & Provincial Psychology Boards
     Alabama Council for Community Mental Health Boards
     Alabama Family Practitioners Rural Health
     Alaska Ophthalmological Society
     Alegent Health Psychiatric (Nebraska)
     Alternative Health Center (Utah)
     Alternative Pathways (Colorado)
     Alzheimer's Association of Oregon and Greater Idaho
     Alzheimer's Association of Utah
     American Society of Addictive Medicine--Kansas Chapter
     American Society of Addictive Medicine--Utah Chapter
     Andrus Vision Center (Utah)
     Arden Courts (Illinois)
     Arkansas Association for Marriage and Family Therapy
     Arkansas Chiropractic Legislative Council
     Arkansas Independent Living Council
     Arkansas Mental Health Counselors Association
     Aspen Therapy (Utah)
     Association of Community Service Agencies (California)
     Association of Oregon Community Mental Health Programs
     Association of School Based Health Centers (Oregon)
     Asthma and Allergy Clinic (Utah)
     Autism Coalition of Indiana
     Autism Society of Arkansas
     Autism Society of Nebraska
     Autism Society of Ohio
     Avenues to New Horizons (Nebraska)
     Avera St. Anthony's Hospital (Nebraska)
     A.W.A.R.E. Inc. (Mental Health Provider--Montana)
     Bear River Medical Arts (Utah)
     Bear River Mental Health Services (Utah)
     Beaver Valley Hospital (Utah)
     Behavioral Health Specialists (Nebraska)
     Bergan Mercy Child Development Center (Nebraska)
     Berner Eye Clinic (Utah)
     Black River Mental Health Services (Utah)
     Blue Valley Mental Health Center (Nebraska)
     Boulder County Partners (Colorado)
     Boulder Valley Women's Health Center (Colorado)
     Broadway Counseling Services (Colorado)
     Bungalow Care Center (Utah)
     California Council of Community Mental Health Agencies
     California Society for Clinical Social Work
     Care Oregon
     Cedar Springs Behavioral Health (Colorado)
     Centennial Mental Health Center (Colorado)
     Center for Counseling and Consultation (Kansas)
     Center for Human Development (Kansas)
     Center for Independent Living (Kansas)
     Center for Psychological Services (Nebraska)
     Central District Health Center (Nebraska)
     Central Iowa Psychological Services
     Central Kansas Psychological
     Children and Adults with Attention Deficit/Hyperactivity 
           Disorder (Ohio)
     Chiropractic and Spinal Rehabilitation (Colorado)
     City of Geneva Mental Health Board (Illinois)
     Clarian Health (Methodist Hospital, Indiana University 
           Hospital, Riley's Children's Hospital) (Indiana)
     Collidge Mental Health Center (Nebraska)
     Colorado Association of Surgical Technicians
     Colorado Dental Association
     Colorado Health and Hospital Association
     Colorado Osteopathic Society
     Colorado Podiatric Medical Society
     Community Adolescent Counseling (Colorado)
     Community Access Services (Oregon)
     Community Counseling Center of Fox Valley (Illinois)
     Community Nursing Services (Utah)
     Community Pharmacists of Indiana
     Community Providers Association of Oregon
     Conway Regional Health Systems (Arkansas)
     Council of Volunteers and Organizations for Hoosiers with 
           Disabilities (Indiana)
     Council on Substance Abuse (Alabama)
     Counseling Associates (Utah)
     Counseling Center for the Rockies (Colorado)
     Coventry Group (Kansas)
     Crawford County Health Department (Kansas)
     Danville Services Corporation (Utah)
     Delta Resource Independent Living Center (Arkansas)
     Denver Naturopathic Clinic--Colorado
     DPF Counseling Services (Kansas)
     Dignity Health & Home Care (Utah)
     Direct Benefits (Minnesota)
     Elgin Mental Health Facility (Illinois)
     Family Counseling Service of Aurora, Illinois
     Family Life Center (Kansas)
     Family Medicine Specialists of St. George (Utah)
     Fetzer OB-GYN (Illinois)
     First Call For Help (Nebraska)
     First Plan in Two Harbors (Minnesota)
     Fore Chiropractic Clinic (Kansas)
     Four Corners Community Behavioral Health (Utah)
     Four County Mental Health Center (Kansas)
     Franklin County Memorial Hospital (Nebraska)
     Full Circle Alternative Center (Colorado)
     Gabriel Chiropractic Office (Colorado)
     Geneva Mental Health (Illinois)
     Gordon Memorial Hospital (Nebraska)
     Greenwood Health Center (Utah)
     Gynecology, Obstetrics & Infertility (Colorado)
     Healthy Mothers--Healthy Babies (Montana)
     Heartland Counseling and Consulting (Nebraska)
     Higgins Center for Natural Health (Colorado)
     Highland Family Eye Care (Utah)
     Highland Ridge Hospital (Utah)
     Holladay Family and Child Guidance Clinic (Utah)
     Home Health Services and Staffing Association of New Jersey
     Hutchinson Psychological & Family Services (Kansas)

[[Page H2965]]

     Idaho Hospital Association
     Independent Living Resource Center (New Mexico)
     Indiana Association of Rehabilitation Facilities
     Indiana Pharmacy Alliance
     Institute for Alcohol Awareness (Fort Collins, Colorado)
     Institute for Alcohol Awareness (Greeley, Colorado)
     Intermountain Health Care (Utah)
     Intermountain Health Care Diabetes Education (Utah)
     Iowa Breast Cancer Education-Action (IBCE)
     Iowa Dental Association
     Iowa Podiatric Medical Society
     Jane Phillips Nowata Health Center (Oklahoma)
     Johnson County Hospital (Nebraska)
     Josephine County Mental Health (Oregon)
     Kane County Hospital (Utah)
     KANZA--Mental Health and Guidance Center (Kansas)
     Kelly Roybal-Sanchez Pediatric Clinic (Colorado)
     Kentucky Dental Association
     Kentucky Mental Health Coalition
     Lane Independent Living Alliance (Oregon)
     Larimer Center for Mental Health (Colorado)
     Legislative Coalition of Virginia Nurses
     Leo Pocha Clinic (Montana)
     Leukemia Lymphoma Society of Oregon
     LifeWise Health Plan of Oregon
     Lincoln/Lancaster County Human Services Federation (Nebraska)
     Longmont Psychiatric Associates (Colorado)
     Louisiana Academy of Medical Psychologists
     Louisiana Association of Ambulatory Healthcare
     Louisiana Association for the Advancement of Psychology
     Louisiana Healthcare Commission
     Louisiana Mental Health Consortium
     LTC Resolutions (Indiana)
     Maine Association of Mental Health Services
     Maine Association of Substance Abuse Programs
     Maine Nurse Practitioners Association
     Medical Weight Management (California)
     Melham Medical Center (Nebraska)
     Mental Health and Guidance Center (Kansas)
     Mental Health Associates (Kansas)
     Mental Health Care Associates (Nebraska)
     Mental Health Corporation (Colorado)
     Mental Health Liaison Group
     Mesability (Colorado)
     Metro Chiropractic (Nebraska)
     Midwest Parkinson's Awareness of Northeast Ohio
     Minnesota Association of Community Mental Health Programs
     Minnesota Council of Health Plans
     Missouri Ambulance Association
     Montana Academy of Ophthalmology
     Montana Academy of Otolaryngology
     Montana Association of Ambulatory Surgery Centers
     Montana Association of Independent Disability Services
     Montana Council of Community Mental Health Centers
     Montana Podiatric Medical Association
     Nebraska Chiropractic Physicians Association
     Nebraska Dental Association
     Nebraska Health Care Association
     Nebraska Methodist Hospital
     Neighborhood Health Plan of Rhode Island
     Nemaha County Breast Cancer Support Group (Nebraska)
     Nevada Dental Hygienists Association
     New Hampshire Mental Health Coalition
     New Hampshire Mental Health Counselors Association
     New Hampshire Pastoral Psychotherapists Association
     New Mexico Podiatric Medical Association
     New West Health Services (Montana)
     Niobrara Valley Hospital (Nebraska)
     Norfolk Psychological Service (Nebraska)
     Northstar Mental Health Services (Nebraska)
     Northwest Alzheimer's Association (Nebraska)
     Norton Health Care (Kentucky)
     Nurse Practitioners of Oregon
     Ogallala Counseling Center (Nebraska)
     Ohio Ambulatory Behavioral Healthcare Association
     Ohio Association of Women's Health, Obstetrics and Neonatal 
           Nurses
     Ohio Clinical Social Work Society
     Ohio Counseling Association
     Ohio Council of Behavioral Healthcare Providers
     Ohio Dietetic Association
     Old Mill Counseling (Nebraska)
     Omni Behavioral Health (Nebraska)
     One Source (Nevada)
     Oregon Advocates for the Mentally Ill
     Oregon Association of Physicians' Assistants
     Oregon Centers for Mental Health and Addiction
     Oregon Dental Association
     Oregon Health Sciences University
     Oregon Optometric Physicians Association
     Oregon State Denturists' Association
     Oriental Medical Association of New Mexico
     Palmer Chiropractic College (Iowa)
     Park City Family Health and Urgent Care Center (Utah)
     Parkview Medical Center Department of Pathology (Colorado)
     Pediatric Pathways (Colorado)
     Phelps Memorial Health Center (Nebraska)
     Phoenix Rising Center (Utah)
     Polk County Mental Health (Oregon)
     Professional Christian Counseling Services (Nebraska)
     Providence Medical Center (Nebraska)
     Pueblo Women's Center--Obstetrics and Gynecology (Colorado)
     Rainbow Center (Nebraska)
     Region VI Behavioral Healthcare (Nebraska)
     Rhode Island Association of Health Centers
     Rhode Island Autism Project
     Rhode Island Council of Community Mental Health Organizations
     Rhode Island Dental Society
     Richard H. Young Hospital (Nebraska)
     River Park Psychology Services (Kansas)
     Riverton Eye Care (Utah)
     Rock County Hospital (Nebraska)
     Rural Counties Program, Spanish Peaks Mental Health Center 
           (Colorado)
     Rural Health Management (Utah)
     Rural Hospital Coalition (Louisiana)
     Saint Francis Memorial Hospital (Nebraska)
     Sanpete Valley Hospital (Utah)
     Saunders County (Nebraska) Health Services
     Serenity Place (Nebraska)
     Shopko Eyecare Center
     Southwest Kansas Independent Living Resources Center
     Southwest Utah Community Health Center
     Spa Area Independent Living Services (Arkansas)
     St. Mary's Health Network--Oregon
     Stoney Ridge Day Treatment Center (Nebraska)
     Sundance Women's Healthcare (Utah)
     Sweetgrass-Stillwater Mental Health Association (Montana)
     Swope Parkway Health Center (Missouri)
     Tennessee Academy of Ophthalmology
     The Home Team of Kansas
     The Psychology Clinic (Louisiana)
     Three Rivers Independent Living (Kansas)
     Topeka Independent Living Resource Center (Kansas)
     Town Center Chiropractic (Montana)
     Tri-County Hospital (Nebraska)
     Tri-County Mental Health Services--Maine
     Tulane University Health Sciences Center (Louisiana)
     United Healthcare--Alabama
     Utah Society of Pathologists
     Valley Community Clinic (California)
     Valley Counseling Services (Ohio)
     Valley County Hospital (Nebraska)
     Valley View Medical Center (Utah)
     Van WYK Family Chiropractic Center (Colorado)
     Virginia Academy of School Psychologists
     Virginia Association of Community Services Boards
     Virginia Association of Free Clinics
     Virginia Association of Hospices
     Vision Health Center (Utah)
     Wasatch Canyon Mental Health (Utah)
     Washington Massage Therapy Association
     West Holt Memorial Hospital (Nebraska)
     Wills Chiropractic Clinic (Nebraska)
     Willowbrook Mental Health Center (Nebraska)
     Wiseman Chiropractic Wellness Center (Nebraska)
     Workman Chiropractic Clinic (Nebraska)
     Wyoming Counseling Association


                  health insurance trade associations

     Alabama Associated Life Insurance Companies
     America's Health Insurance Plans (AHIP)

       With additional letters from: Alabama Association of Health 
     Plans, California Association of Health Plans, Georgia 
     Association of Health Plans, Indiana Association of Health 
     Plans, Kansas Association of Health Plans, Kentucky 
     Association of Health Plans, Nebraska Association of Health 
     Plans, Nevada Association of Health Plans, New Jersey 
     Association of Health Plans, North Carolina Association of 
     Health Plans, Ohio Association of Health Plans, Virginia 
     Association of Health Plans, Association of Washington 
     Healthcare Plans, American Managed Behavioral Healthcare 
     Association, American Republic Insurance Company (Iowa)

     Association of Health Insurance Advisors/National Association 
           of Insurance and Financial Advisors

       With additional letters from: Indiana Chapter, Maine 
     Chapter, Nebraska Chapter, Ohio Chapter, Utah Chapter

     Blue Cross and Blue Shield Association
     Delta Dental Plans Association

       With additional letters from: Delta Dental Plan of 
     Arkansas, Delta Dental Plan of Indiana, Delta Dental Plan of 
     Iowa, Delta Dental Plan of Kentucky, Delta Dental Plan of 
     Minnesota, Delta Dental Plan of New Mexico, Delta Dental Plan 
     of North Carolina, Delta Dental Plan of Virginia

     Christiana Care Health Plans
     Cimarron Healthcare (New Mexico)

[[Page H2966]]

     Federation of Iowa Insurers
     Health Net (Oregon)
     Louisiana Pest Control Insurance Company (LIPCA)
     Lovelace Health Systems (New Mexico)
     Magellan Health Services
     National Association of Health Underwriters

       With additional letters from: Alabama Chapter, Arkansas 
     Chapter, Central Arkansas Chapter, Georgia Chapter, Indiana 
     Chapter, Maine Chapter, Minnesota Chapter, Nevada Chapter, 
     New Hampshire, New Mexico Chapter, North Carolina Chapter, 
     Ohio Chapter, Oregon Chapter, Rhode Island Chapter, Virginia 
     Chapter

     Nebraska Association of Professional Insurance Agents
     Nevada Hometown Health
     NevadaCare
     PacifiCare of Nevada
     Principal Financial Group--with additional letters from: Iowa 
           Office
     Sierra Health Services (Nevada)
     Tufts Health Plan

  Mr. Speaker, I yield such time as he might consume to the gentleman 
from New Jersey (Mr. Holt).
  (Mr. HOLT asked and was given permission to revise and extend his 
remarks.)