[Congressional Record Volume 150, Number 84 (Thursday, June 17, 2004)]
[Senate]
[Pages S7014-S7016]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. STABENOW (for herself, Mrs. Lincoln, and Mr. Levin):
  S. 2544. A bill to provide for the certification of programs to 
provide uninsured employees of small businesses access to health 
coverage, and for other purposes; to the Committee on Finance.
  Ms. STABENOW. Mr. President, today I rise to introduce the Health 
Care Access for Small Businesses Act of 2004. I am pleased to be joined 
in this endeavor by my colleagues, Senator Lincoln and Michigan's 
senior Senator Levin. My bill would help small businesses provide 
health coverage for their employees, an important first step in 
providing access to health care for all Americans.
  Last month, thousands of Americans participated in the annual Cover 
the Uninsured week, a discussion about the urgent need to cover the 
uninsured. The sheer breadth of the groups that participated in the 
unprecedented effort demonstrates the urgency of this issue. Labor 
unions were united with business groups, doctors with nurses, and 
charity health care providers with for-profit hospitals and insurance 
companies.
  And yesterday, the consumer group Families USA and the governors of 
Iowa, Kansas, and Maine released even more disturbing news. Using 
Census Bureau data, they found that approximately 81.8 million 
Americans--one out of three people under 65 years of age--were 
uninsured at some point of time for the past two years. Almost two-
thirds were uninsured for six months or more; and over half were 
uninsured for at least nine months.
  We need to stop having discussions and start finding solutions. Too 
many hard working Americans are going without health insurance. There 
is a great misconception that uninsured Americans are largely 
unemployed or on welfare. That is simply not the case. More than 80 
percent of uninsured Americans are part of working families, and almost 
half work for small businesses. If we can help small businesses cover 
their employees, we will have made great progress in covering the 
uninsured.
  The bill I am introducing today is aimed at making coverage more 
affordable for employees of small businesses through what is called a 
``three-share'' program. It would not impose any new funding mandates 
on state or local governments nor would it create new bureaucracy. It 
is an innovative community-based approach that could work throughout 
the country.
  And it's aimed at ensuring primary care services are more available. 
We know that the primary care model through federally qualified health 
centers has been a tremendous success. This would build on this success 
by empowering communities--health care providers, small businesses, 
churches, civic groups--to form their own health care programs.

  The three-share model is an innovative community-based idea that has 
been working across the U.S. from California to Arkansas to Maryland 
and, of course, Michigan. The name ``three-share'' stems from the 
program's payment structure. Premiums are shared between the employer 
who pays 30 percent, the employee who pays 30 percent, and the 
community which covers the remaining 40 percent of the cost.
  In a three share model, a non-profit or local government entity 
serves as the manager of the plan. They design a benefit package by 
negotiating directly with providers or contracting through an insurance 
company. Then, they recruit small businesses that have not offered 
insurance coverage to their employees for the past year. The average 
cost for coverage is about $1,800 per year, much lower than the 
national average for commercial insurance, which on average costs about 
$3,400 for a single person and $9,000 for a family, according to the 
2003 Kaiser survey of

[[Page S7015]]

employer benefits. Of the $1,800, the employer and employee would each 
pay approximately $540 and the community would pay about $720.
  And they have been successful. For example, in Muskegon, Michigan, 
the three-share program Access Health has been working with about 400 
small businesses to cover some 1,500 uninsured full and part-time 
employees. Wayne County has operated Health Choice for a decade. 
Although it is undergoing some changes, it has nearly 1,300 businesses 
enrolled and covers everyone from cab drivers, nail salon technicians, 
and nursing aides. Kent County, where Grand Rapids is located, began 
enrolling small businesses and employees in their program in 2002 and 
hope to grow to cover 2,500 individuals this year.
  Different three share plans have received funds for the community 
portion from various places. In Michigan, most of the money has come 
from Medicaid funds. A plan in California uses money from the tobacco 
settlement, while a plan in Arkansas raises funds through church events 
and other community initiatives.
  Unfortunately, despite the nuances that distinguish three share plans 
from one another, they all share a common challenge: they all lack a 
stable and sustainable funding source for the community share. This 
bill will help provide a steady stream of funding and analyze what 
three shares do right and how communities can develop their own three 
share model programs.
  Insuring more working families will also take the pressure off state 
Medicaid budgets. Adequate care for those presently uninsured will also 
help slash the billions that is spent on uncompensated care.
  Providing health care for these families fulfills a moral commitment. 
No one in America who gets up in the morning and goes to work should go 
to sleep at night fearful that an illness or injury in the family could 
wipe out everything they have worked hard for. This is a great nation, 
and together we can ensure that no American has to go without health 
care again.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2544

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Health Care Access for Small 
     Businesses Act of 2004''.

     SEC. 2. THREE-SHARE PROGRAMS.

       The Social Security Act (42 U.S.C. 301 et seq.) is amended 
     by adding at the end the following:

               ``TITLE XXII--PROVIDING FOR THE UNINSURED

     ``SEC. 2201. THREE-SHARE PROGRAMS.

       ``(a) Pilot Programs.--The Secretary, acting through the 
     Administrator, shall award grants under this section for the 
     startup and operation of 50 eligible three-share pilot 
     programs for a 5-year period.
       ``(b) Grants for Three-Share Programs.--
       ``(1) Establishment.--The Administrator may award grants to 
     eligible entities--
       ``(A) to establish three-share programs;
       ``(B) to provide for contributions to the premiums assessed 
     for coverage under a three-share program as provided for in 
     subsection (c)(2)(B)(iii); and
       ``(C) to establish risk pools.
       ``(2) Three-share program plan.--Each entity desiring a 
     grant under this subsection shall develop a plan for the 
     establishment and operation of a three-share program that 
     meets the requirements of paragraphs (2) and (3) of 
     subsection (c).
       ``(3) Application.--Each entity desiring a grant under this 
     subsection shall submit an application to the Administrator 
     at such time, in such manner and containing such information 
     as the Administrator may require, including--
       ``(A) the three-share program plan described in paragraph 
     (2); and
       ``(B) an assurance that the eligible entity will--
       ``(i) determine a benefit package;
       ``(ii) recruit businesses and employees for the three-share 
     program;
       ``(iii) build and manage a network of health providers or 
     contract with an existing network or licensed insurance 
     provider;
       ``(iv) manage all administrative needs; and
       ``(v) establish relationships among community, business, 
     and provider interests.
       ``(4) Priority.--In awarding grants under this section the 
     Secretary shall give priority to an applicant--
       ``(A) that is an existing three-share program;
       ``(B) that is an eligible three-share program that has 
     demonstrated community support; or
       ``(C) that is located in a State with insurance laws and 
     regulations that permit three-share program expansion.
       ``(c) Grant Eligibility.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator, shall promulgate regulations providing for the 
     eligibility of three-share programs for participation in the 
     pilot program under this section.
       ``(2) Three-share program requirements.--
       ``(A) In general.--To be determined to be an eligible 
     three-share program for purposes of participation in the 
     pilot program under this section a three-share program 
     shall--
       ``(i) be either a non-profit or local governmental entity;
       ``(ii) define the region in which such program will provide 
     services;
       ``(iii) have the capacity to carry out administrative 
     functions of managing health plans, including monthly 
     billings, verification/enrollment of eligible employers and 
     employees, maintenance of membership rosters, development of 
     member materials (such as handbooks and identification 
     cards), customer service, and claims processing; and
       ``(iv) have demonstrated community involvement.
       ``(B) Payment.--To be eligible under paragraph (1), a 
     three-share program shall pay the costs of services provided 
     under subparagraph (A)(ii) by charging a monthly premium for 
     each covered individual to be divided as follows:
       ``(i) Not more than 30 percent of such premium shall be 
     paid by a qualified employee desiring coverage under the 
     three-share program.
       ``(ii) Not more than 30 percent of such premium shall be 
     paid by the qualified employer of such a qualified employee.
       ``(iii) At least 40 percent of such premium shall be paid 
     from amounts provided under a grant under this section.
       ``(iv) Any remaining amount shall be paid by the three-
     share program from other public, private, or charitable 
     sources.
       ``(C) Program flexibility.--A three-share program may set 
     an income eligibility guideline for enrollment purposes.
       ``(3) Coverage.--
       ``(A) In general.--To be an eligible three-share program 
     under this section, the three-share program shall provide at 
     least the following benefits:
       ``(i) Physicians services.
       ``(ii) In-patient hospital services.
       ``(iii) Out-patient services.
       ``(iv) Emergency room visits.
       ``(v) Emergency ambulance services.
       ``(vi) Diagnostic lab fees and x-rays.
       ``(vii) Prescription drug benefits.
       ``(B) Limitation.--Nothing in subparagraph (A) shall be 
     construed to require that a three-share program provide 
     coverage for services performed outside the region described 
     in paragraph (2)(A)(i).
       ``(C) Preexisting conditions.--A program described in 
     subparagraph (A) shall not be an eligible three-share program 
     under paragraph (1) if any individual can be excluded from 
     coverage under such program because of a preexisting health 
     condition.
       ``(d) Grants for Existing Three-Share Programs To Meet 
     Certification Requirements.--
       ``(1) In general.--The Administrator may award grants to 
     three-share programs that are operating on the date of 
     enactment of this section.
       ``(2) Application.--Each eligible entity desiring a grant 
     under this subsection shall submit an application to the 
     Administrator at such time, in such manner, and containing 
     such information as the Administrator may require.
       ``(e) Application of State Laws.--Nothing in this section 
     shall be construed to preempt State law.
       ``(f) Distressed Business Formula.--
       ``(1) In general.--Not later than 60 days after the date of 
     enactment of this section, the Administrator of the Health 
     Resources and Services Administration shall develop a formula 
     to determine which businesses qualify as distressed 
     businesses for purposes of this section.
       ``(2) Effect on insurance market.--Granting eligibility to 
     a distressed business using the formula under paragraph (1) 
     shall not interfere with the insurance market. Any business 
     found to have reduced benefits to qualify as a distressed 
     business under the formula under paragraph (1) shall not be 
     eligible to be a three-share program for purposes of this 
     section.
       ``(g) Definitions.--In this section:
       ``(1) Administrator.--The term `Administrator' means the 
     Administrator of the Health Resources and Services 
     Administration.
       ``(2) Covered individual.--The term `covered individual' 
     means--
       ``(A) a qualified employee; or
       ``(B) a child under the age of 23 or a spouse of such 
     qualified employee who--
       ``(i) lacks access to health care coverage through their 
     employment or employer;
       ``(ii) lacks access to health coverage through a family 
     member;
       ``(iii) is not eligible for coverage under the medicare 
     program under title XVIII or the medicaid program under title 
     XIX; and
       ``(iv) does not qualify for benefits under the State 
     Children's Health Insurance Program under title XXI.
       ``(3) Distressed business.--The term `distressed business' 
     means a business that--

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       ``(A) in light of economic hardship and rising health care 
     premiums may be forced to discontinue or scale back its 
     health care coverage; and
       ``(B) qualifies as a distressed business according to the 
     formula under subsection (g).
       ``(4) Eligible entity.--The term `eligible entity' means an 
     entity that meets the requirements of subsection (a)(2)(A).
       ``(5) Qualified employee.--The term `qualified employee' 
     means any individual employed by a qualified employer who 
     meets certain criteria including--
       ``(A) lacking access to health coverage through a family 
     member or common law partner;
       ``(B) not being eligible for coverage under the medicare 
     program under title XVIII or the medicaid program under title 
     XIX; and
       ``(C) agreeing that the share of fees described in 
     subsection (a)(2)(B)(i) shall be paid in the form of payroll 
     deductions from the wages of such individual.
       ``(6) Qualified employer.--The term `qualified employer' 
     means an employer as defined in section 3(d) of the Fair 
     Labor Standards Act of 1938 (29 U.S.C. 203(d)) who--
       ``(A) is a small business concern as defined in section 
     3(a) of the Small Business Act (15 U.S.C. 632);
       ``(B) is located in the region described in subsection 
     (a)(2)(A)(i); and
       ``(C) has not contributed to the health care benefits of 
     its employees for at least 12 months consecutively or 
     currently provides insurance but is classified as a 
     distressed business.
       ``(g) Evaluation.--Not later than 90 days after the end of 
     the 5-year period during which grants are available under 
     this section, the General Accounting Office shall submit to 
     the Secretary and the appropriate committees of Congress a 
     report concerning--
       ``(1) the effectiveness of the programs established under 
     this section;
       ``(2) the number of individuals covered under such 
     programs;
       ``(3) any resulting best practices; and
       ``(4) the level of community involvement.
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $100,000,000 for each of fiscal years 2005 through 2010.''.
                                 ______