[Congressional Record Volume 151, Number 103 (Tuesday, July 26, 2005)]
[House]
[Pages H6477-H6509]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SMALL BUSINESS HEALTH FAIRNESS ACT OF 2005
Mr. BOEHNER. Mr. Speaker, pursuant to H. Res. 379, I call up the bill
(H.R. 525) 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.
The Clerk read the title of the bill.
[[Page H6478]]
The SPEAKER pro tempore (Mr. Gillmor). Pursuant to House Resolution
379, the bill is considered read for amendment.
The text of H.R. 525 is as follows:
H.R. 525
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 2005''.
(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 2005,
``(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 2005.
``(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 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--
[[Page H6479]]
``(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
2005, 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 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--
[[Page H6480]]
``(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 2005,
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.
``(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
[[Page H6481]]
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.
``(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
[[Page H6482]]
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 2005.
``(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 2005, 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 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
[[Page H6483]]
``(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 2005 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,
2010, 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 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,''.
[[Page H6484]]
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 in the nature of a substitute
printed in House Report 109-183, 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. 525.
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. The number of
uninsured Americans today stands at 45 million Americans; 27 million
are fully employed. And 63 percent of these working uninsured are
either self-employed or work for a small business with fewer than 100
employees. It is tragic that so many employers cannot afford to
purchase high-quality health insurance benefits for their workers.
The problem is not going away, and we have a responsibility to
confront it. With health care costs continuing to rise sharply across
the country, more and more employers and their employees are sharing
the burden of increased insurance premiums. Employer-based health
insurance premiums jumped by 11 percent last year following a 15
percent increase in 2003.
Clearly, we need to focus on providing affordable health care to the
uninsured as well as ensure employers
[[Page H6485]]
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 responds to this problem and
can help reduce the high cost of health insurance for small businesses
and uninsured working families. By creating association health plans
which would be strictly regulated by the Department of Labor, small
businesses could pool their resources and increase their bargaining
power with benefit providers which will allow them to negotiate better
rates and purchase quality health care at a lower cost.
President Bush addressed this point directly last year during his
speech at the United States Chamber of Commerce where he said, ``AHPs
would provide small businesses the same opportunity that big businesses
get, and that is the economies of scale, the economies of purchase, the
abilities to share risk in larger pools which drives down the costs of
health care for small businesses.''
The President is right, and we should help level the playing field so
small businesses can offer quality coverage to their workers.
Americans overwhelmingly agree with President Bush that association
health plans are the right plan to help the uninsured. A poll conducted
last year showed that 93 percent of Americans support association
health plans as a way of providing access to affordable care for
American workers who lack coverage. Over the last year, we have seen
how large corporations are now starting to band together to provide
health care to their part-time workers. Do small businesses and their
workers not deserve the same opportunity?
Importantly, the bill gives AHPs the 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
exemptions today. Clearly, these mandates are useless to families who
have no health coverage in the first place. If you do not have health
care coverage, State mandates requiring health plans to offer specific
benefits do you and your family no good at all. This measure includes
strong safeguards to protect American workers.
Despite the bipartisan nature of this bill, I would like to correct
some of the misinformation that I have heard. The 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 a 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 where the employer is located. The bill
also includes strict requirements under which only bona fide
professional and trade associations 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 for at least 3 years.
We in Congress have a responsibility to deal with a problem of small
businesses who cannot afford to provide health insurance because of
skyrocketing health care costs. The U.S. economy is getting stronger by
the day, and more and more employers are hiring workers each month.
Earlier this month the unemployment rate dropped to its lowest level
since September of 2001 and the Labor Department reported that 3.7
million new jobs have been created since March of 2003. That is 25
consecutive months of sustained job creation.
We want to make sure that these workers have the opportunity to
receive quality health insurance through their employer, and this bill
can help make that happen.
Mr. Speaker, I reserve the balance of my time.
Mr. ANDREWS. Mr. Speaker, I rise in opposition to the bill and I
yield myself 4 minutes.
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. Mr. Speaker, today there is a point of agreements and a
strong point of disagreement. There is a point of agreement that health
care costs are rising too fast for too many people. There is a point of
agreement that the consequences of that price increase is a tremendous
burden on small business and a high likelihood that more people will be
uninsured.
I do not think there is a Member of this body that does not favor
finding an intelligent and effective way to reduce health care costs
for small business so they can continue to insure the people they do
insure and expand and insure more people in the future.
Where we disagree is over whether this underlying bill is the right
way to do it, and we emphatically believe that it is not.
There are four reasons to oppose this bill. The first is that there
is a better idea. There is a better way to solve this problem, and the
gentleman from Wisconsin (Mr. Kind) will address that issue when our
substitute is brought to the floor in a little while.
The second reason is that this bill will not result in a reduction of
the number of uninsured. To the contrary, it will result in an increase
in the number of uninsured people, and here is how. It is estimated by
the experts in this field that 8 million people will be shifted from
conventional health care policies and plans to association health
plans. These 8 million people will, in fact, probably have a lower
premium than they do right now for a little while. But when those 8
million people are shifted out of conventional health care plans and
they will tend to be younger and healthier people, the people remaining
in the conventional health care plans will have to bear more of the
costs, and premiums will go up by an estimate of 23 percent. When the
premiums go up on the rest of those in the pool, fewer of them will be
insured.
The experts estimate that while 8 million people will be shifted from
regular plans to AHPs, 9 million people approximately will lose their
coverage altogether, and the results will be a net loss in the number
of insured of 1 million people.
So supporting this bill will increase the number of uninsured, not
decrease it; and it will increase premiums by 23 percent.
The second reason to oppose this bill is that it fails to provide the
protection to patients, providers and consumers that good insurance
regulation provides. There are simply no effective regulations that
will keep an insurance company from going bankrupt and being unable to
meet its obligations to its policy holders and pay its claims. We have
seen this happen before in multiemployer welfare associations. We will
be submitting at the appropriate time a list for the Record of MEWAs
that have failed.
This is the reason that the National Governors Association, that
attorneys general, that commissioners of insurance both Republican and
Democrat oppose this bill because the regulation that would protect
patients and providers and consumers is not there.
The third reason that we should oppose this bill, the final reason,
is that the coverage that people have fought for over the years, so
that women have a minimum stay in the hospital after they have a C
section, so that women have the right to an annual mammogram, so that
people with diabetes have the right to insulin or diabetic care, so
that people struggling with mental health problems or with substance
abuse have the right to have those services covered, those protections
which have been supported by Republicans and Democrats in State
legislatures around this country are effectively repealed by the
underlying bill, a judgment being made in Washington that contravenes
the good judgment of Republicans and Democrats around the country.
This bill should be opposed. There is a better way that the gentleman
from Wisconsin (Mr. Kind) will be putting forward with my assistance.
This is a bill that will increase the number of uninsured and increase
health insurance premiums for small businesses.
{time} 1545
This is a bill that will leave patients and providers and consumers
unprotected if and when insurance companies go bankrupt. Finally, this
is a bill
[[Page H6486]]
that effectively repeals protections for breast cancer screening, colon
cancer screening, diabetes care, substance abuse care, and mental
health care. It is a bill that should be defeated.
Mr. Speaker, I reserve the balance of my time.
Mr. BOEHNER. Mr. Speaker, I yield 4 minutes to the gentleman from
Texas (Mr. Sam Johnson), chairman of the Subcommittee on Employer-
Employee Relations.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I thank the gentleman from
Ohio for yielding me this time.
As you know, Mr. Speaker, the cost of providing health care for
employees has become the number one issue for small businesses around
this country. It is especially important to me, because in my home
State of Texas, one in four workers are uninsured. Small businesses
have it especially tough because there is an inherent problem in a
small number of people. You need to be able to pool risk to make
insurance work. To make matters worse, there is a lack of competition
in the small group health insurance market, allowing a few insurers to
charge whatever they want. That is why we need association health
plans.
These AHPs would allow small businesses to pool together to purchase
health insurance. So instead of one individual company shopping for
health care insurance, they would bring an entire trade association,
for example, the U.S. Chamber of Commerce, to the table with much
better bargaining power.
However, pooling risk and buying in bulk is not enough. If your
association had members all across the United States, you would have to
abide by 50 different sets of mandated benefits in order to offer your
insurance. Not only is that a headache, but it is more costly. Some of
the mandates that have been enacted by State legislatures include
infertility treatment and alternative health solutions such as
acupuncture. These mandates drive up the cost of premiums.
To resolve this, AHPs would allow small businesses to buy insurance
under the same terms that large corporations and unions enjoy today.
ERISA, a law that governs employer benefits, lets these sort of self-
insured plans use one set of Federal rules, not 50 State rules. Talk
about a quick way to lower administrative costs.
And lower administrative costs, Mr. Speaker, means lower premiums, up
to 30 percent lower by some estimates, and that means affordable health
care for employers and their employees alike. So who would not want
AHPs to pass?
Some critics say AHPs will be an opportunity for fly-by-night groups
that front as insurance companies and then leave employers with unpaid
claims. The AHP bill in both the House and the Senate has tough
safeguards to protect small businesses and their employees. A bona fide
trade organization must have been in existence for 3 years before
enactment of the law in order to offer an AHP. And there are Federal
solvency standards set up for these health plans, including
requirements for a reserve fund and stop-loss coverage. This is beyond
and above what ERISA requires.
Moreover, the Department of Labor would be charged with the oversight
of these plans, and the bill gives them the power to pursue criminal
penalties against those who commit fraud. The Department of Labor has
testified in hearings that they are up to the task and support the
legislation.
Who else? Groups that have worked so hard to get coverage for their
particular treatment mandated by State legislatures do not want AHPs to
be exempt from the 50 different State laws. Let me say it plainly: That
is the point of the legislation. One uniform set of benefits lowers
administrative costs. If it is good enough for large corporations and
unions, it ought to be good enough for small businesses.
Mr. Speaker, AHPs are a big step in the right direction for our hard-
working families who need health insurance now.
Mr. ANDREWS. Mr. Speaker, I am pleased to yield 3 minutes to the
gentleman from Wisconsin (Mr. Kind), who has come up with a very
constructive and progressive alternative.
Mr. KIND. Mr. Speaker, I want to commend my friend and colleague, the
gentleman from New Jersey (Mr. Andrews), for the leadership he has
shown on this issue.
Here we are again, Mr. Speaker. Year after year after year it seems
we continue to rise in this Chamber to debate the same issue. One of
the reasons we have to do this year after year is because bad policy is
tough to sell, and especially tough to sell in the Senate right now,
which has refused to take this up and move it forward because it has
been bad policy.
The chairman of the full committee, the gentleman from Ohio (Mr.
Boehner), had a chart showing us a 93 percent approval of AHPs. That is
not surprising, Mr. Speaker. There is such a craving throughout America
for any type of legislative proposal that would bring price relief to
the rising cost of health care, that I am afraid people will chase any
proposal and even jump off a cliff without looking where they are going
to land.
That is why, Mr. Speaker, especially under these conditions, it is
more incumbent upon us here in this Chamber to be extra careful in
regard to the policy proposals that we are proposing so we do not
violate the Hippocratic oath, and that is: first do no harm to the
current health care system. There is plenty of places where this
legislation that is being offered today would do substantial harm.
We have had studies outside and inside this body that have come back
explaining the true deficiencies of this legislation, but none probably
summarize it better than the National Small Business Association that
recently sent us a letter expressing their concerns. Now, this is an
organization of some of the largest Chambers of Commerce and some of
the biggest local and national organizations throughout the country,
all of which see this AHP proposal for what it really is: an empty
promise.
Mr. Speaker, I quote from this letter from the National Small
Business Association in which they state, ``The biggest loser from the
passage of AHPs would be small businesses. AHPs are not an answer to
rising health care costs and would significantly worsen the state of
health care for all businesses. More and more small businesses are
realizing that despite the bumper sticker pitch in its favor, AHPs are,
simply put, bad public policy.''
They go on to cite the Mercer study, saying that ``premiums for those
outside the AHP market would increase an additional 23 percent, and an
additional 1 million people would become uninsured as this policy plays
out.'' They go on to state that ``the minimal price savings realized by
some businesses through AHPs would come from attracting healthier
participants and depleting benefits that are currently required by
States. AHPs could create plans that manipulate benefits and are
extremely unattractive to sicker, less healthy participants.
``Furthermore, the CBO found most of the enrollment in AHPs would
come from businesses switching coverage. Only 1 in 14 would be newly
insured. AHPs do nothing to solve the problem in rising health care
costs to small businesses and their employees.'' And they conclude by
saying, ``They simply shift the cost from the overall market to a more
concentrated group of people. This is hardly a long-term solution.''
There is a better proposal, one that we will talk about in more
detail when our substitute is offered. There is a way for us, I
believe, to come together in a bipartisan fashion to address one of the
most pressing issues of the day, and that is affordability and access
to quality health care.
Businesses large and small, family farmers, individual employees are
all suffering alike, and that is why it is important for us to come
together and do something meaningful to relieve the health care
pressures in this economy.
Mr. BOEHNER. Mr. Speaker, I yield 3 minutes to the gentleman from
Georgia (Mr. Norwood), the chairman of the Subcommittee on Workforce
Protections.
Mr. NORWOOD. Mr. Speaker, I thank the chairman very much for yielding
me this time.
Mr. Speaker, it is my understanding that H.R. 525 is supposed to
decrease the cost of health insurance for small businesses that cannot
afford it today. Well, I support that. That is a good goal. All of us
support that. Yet, unfortunately, I believe that in this bill that
[[Page H6487]]
has been undermined a little bit, and my logic is fairly simple.
As I read it, in section 805 of the bill, it allows an AHP to preempt
State-level patient protection laws that prevent cherry-picking against
small businesses with sick employees. Now, that troubles me a great
deal. Look at the bill. Line 8 through 14 gives us the right, and line
21 through 22 takes it away. Sure, everybody can buy an AHP. It is just
if you have anybody sick, you are in serious trouble, because the
premium is going to be so high you cannot afford it.
After all, H.R. 525 is supposed to allow small businesses to come
together to form large pools and purchase affordable health care
through an association. That is a good idea. This makes sense, since
large employers use this concept under ERISA to provide employees good
rates, regardless of preexisting conditions. But in my opinion we,
somewhere along the way, allowed this very good idea to be corrupted by
a very bad provision, a sort of fly in the buttermilk of health care
reform, in the form of section 805.
Mr. Speaker, 49 out of 50 States have instituted at least some
patient protections that prevent insurers from using health status to
discriminate against patients. Yet in plain English it appears to me
that section 805 allows an AHP to preempt those rating laws. This
simply makes no sense.
This is the bottom line: A small business owner in remission from
cancer likely cannot get health insurance for himself, his family, or
his employees if he lives in a State that allows for rating based on
health status. Will that small business owner be able to afford high-
quality health insurance from an AHP if H.R. 525 becomes law? Based on
the language as I understand it, as I believe it to be true, he will
not be able to get that insurance. Now, I believe that if H.R. 525
becomes law, it may even be much harder for that employer to get
insurance. Why is that? Because all other employers with healthy
employees will be in the AHPs.
I do not believe that is the intention of this bill. I hope I am
wrong. I am going to vote for this bill. I am going to vote for it to
move it forward, and I dearly hope I am wrong, and I hope that my
chairman is right. But if time proves my position correct, I want these
comments on the record so we will know exactly where to go to fix this
when the milk turns sour.
Mr. BOEHNER. Mr. Speaker, I yield myself 30 seconds.
Mr. Speaker, the gentleman from Georgia and I have had a disagreement
over this particular provision for several years. It is very clear in
the bill, as I read it, not the way the gentleman from Georgia (Mr.
Norwood) reads it, and this is where the source of the disagreement
comes in terms of how plans can choose groups of employees.
Under current ERISA law, you are allowed to have different rates for
different groups of employees as long as there is a reason other than
the health status of that group to have a separate group. Maybe you
have a plant located in one part of the State, another plant in another
part of the State. You could have two different rates at those two
different plants, just like you can under most State laws and what you
can under ERISA.
So I look forward to continuing to work with my friend from Georgia
to resolve our misunderstanding of this issue.
Mr. ANDREWS. Mr. Speaker, I am pleased to yield 3 minutes to the
gentlewoman from California (Ms. Woolsey), a person who is a strong
voice for the rights of patients and families.
Ms. WOOLSEY. Mr. Speaker, there currently are 45 million Americans
who do not have health insurance and are looking for real solutions for
their lack of health care coverage. Unfortunately, H.R. 525, the so-
called Small Business Health Fairness Act, is not their answer. In
fact, this bill allows insurance companies to preempt State law, making
possible a race to the bottom by associated health plans as companies,
because of this bill, can offer the cheapest insurance with the least
coverage.
The idea that we would allow insurance companies to trump State law
is really outrageous. Laws to protect those with diabetes, those with
cancer, and a host of other ailments are at risk under this plan. That
is why I offered an amendment in the Committee on Rules, along with the
gentlewoman from New York (Mrs. McCarthy), that would protect
mammograms and cervical cancer screenings from being preempted by
association health plans. Unfortunately, the Republican majority does
not see the value in protecting women from breast and/or cervical
cancer, because they would not allow our amendment to come to the floor
to be debated before we voted on this bill.
{time} 1600
Mr. Speaker, in my district, the Sixth Congressional District of
California, the women of Marin County are plagued by an unusually high
rate of breast cancer, and particularly young woman have the high
incidence of breast cancers. But, fortunately, in California we require
insurance companies to cover mammograms. So while the women of Marin
County still have to worry about their community's high rate of breast
cancer, at least they know their insurance companies cannot deny them
access to the best available screening tools.
I cannot accept the idea of even one woman in this Nation foregoing
an annual mammogram or a pap smear only to be diagnosed later with
advanced breast or cervical cancer because an association health plan
does not provide coverage. This is a risk we cannot afford, and I urge
my colleagues to vote ``no'' on H.R. 525.
Mr. BOEHNER. Mr. Speaker, I yield 2 minutes to the gentleman from
Louisiana (Mr. Boustany), a physician.
Mr. BOUSTANY. Mr. Speaker, 45 million Americans lack health insurance
today, and the number is rapidly growing. Twenty-six percent of all
adults in Louisiana lack health insurance, and 22.6 percent of all
working adults in Louisiana lack insurance.
It has been said over here that we need the insurance mandates to
protect the patient. Insurance mandates are meaningless without
insurance. We need a free market health care system that allows doctors
to make decisions and not insurance companies. Fifty-two percent of
Louisiana's small businesses offer health insurance, and the number is
constantly declining. We must act to ensure that Americans can afford
the health insurance that they need, and we can do so by passing H.R.
525, the Small Business Health Fairness Act.
This bill will create association health plans that will allow small
businesses to band together through bona fide trade associations to
become larger purchasers of health insurance, thus giving small
businesses the same benefits that Fortune 500 companies now enjoy.
The Congressional Budget Office has estimated that small businesses
obtaining insurance through AHPs would average premium reductions of 13
percent and some as high as 25 percent reductions. Overhead costs alone
would decrease by as much as 30 percent under these plans. What is
wrong with this? This is offering affordable coverage to workers.
There is additional research that also shows that up to 8.5 million
Americans who are currently uninsured would become insured under AHPs.
And this bill offers very many protections, consumers protections and
protections with regard to solvency, as outlined.
If we are going to lower costs and increase accessibility to health
care, we need to create choices and enhance competition. This bill is
an important first step, and I urge its passage.
Mr. ANDREWS. Mr. Speaker, I yield 3 minutes to the gentleman from New
Jersey (Mr. Holt), a Member who does not want to see a 23-percent
increase in premiums for his constituents.
(Mr. HOLT asked and was given permission to revise and extend his
remarks.)
Mr. HOLT. Mr. Speaker, today Member after Member has been talking
about the 45 million Americans who lack health insurance. At the origin
of our problem, we are the only major country where your health care
coverage depends on who you work for. But that is not to be debated
today.
We are talking about the small businesses in New Jersey and elsewhere
around the country that face the high cost of health insurance. We all
hear about it from our small businesses and their employees.
Unfortunately, what has been brought to the floor here is a bill that
creates more problems than it solves.
The concept of companies working together to control costs has worked
in
[[Page H6488]]
some States, and it is certainly something I support. However, I cannot
support allowing association health plans to achieve cost savings by
offering inferior coverage. Allowing AHPs to circumvent existing State
laws, for example, with regard to mental health coverage or
contraceptive equity or mammograms or prostate screening or countless
other necessary benefits is not an acceptable means to cut premiums.
Supporters of this legislation claim that millions of small
businesses and their employees will be eligible for this new insurance
option. However, the Congressional Budget Office estimates that only
600,000 of those eligible are currently uninsured, a small fraction of
this huge population.
And H.R. 525 would allow AHPs to offer artificially lower costs by
offering cheaper premiums to lower-risk populations, a policy that will
lead to older and sicker people paying higher premiums. The CBO found
that more than 20 million workers and their dependents would see their
premiums increase due to AHPs cherry-picking.
States require that qualified health plans cover certain basic items.
States say that anything that is worthy of the name health plan must
cover certain things. Well, under this bill I could create a health
plan that covers nothing but ingrown toenail surgery. It would be the
cheapest plan out there, but it would not help employees very much.
I urge my colleagues to vote against H.R. 525 and to support the
Andrews-Kind substitute. Their legislation would address the real needs
of small employers. It would establish a small employer health benefits
plan that would grant small business employees the same benefits as
Federal employees receive. It provides prorated premium assistance for
companies of varying sizes and employees of varying income. It would be
much preferable to H.R. 525.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield 2 minutes to the
gentleman from Georgia (Mr. Price), a member of the committee.
Mr. PRICE of Georgia. Mr. Speaker, I thank the gentleman for yielding
me this time and for his work on this issue and so many other important
issues.
When I go home, and especially as a physician in Congress, when I go
home and talk to small businesses, they say whatever you do, whatever
you do, do something about my health care costs. Make it so I can help
my employees get insurance.
Mr. Speaker, 45 million uninsured we have heard, 60 percent or more
of those are employed currently, and why do they not have health
insurance. Either they are self-employed or they work for small
businesses so they have to purchase health insurance in the individual
market.
So what is the solution? Pool together. Six people can buy insurance
for cheaper than one person; 60 cheaper than 6; 600 cheaper than 60;
and 6 million cheaper than 600, and it can be quality insurance, and
H.R. 525 is a step in the right direction.
We have heard that the number of uninsured will go up, the cost for
the premium will go up 23 percent. I will take that wager. This is the
same crowd that said welfare reform would not work. I will take that
bet.
Once again, the rhetoric we have heard is disgraceful. We have heard
that Republicans do not care about women with breast cancer. Come on.
What kind of nonsense is this. Who do you think will be making the
decisions about the kinds of provisions that will be in that insurance
policy? It is patients. It is patients in the associations, and they
are much closer I would argue to the individuals making decisions about
what is going to be included under those plans than human resources
officers in large companies.
H.R. 525 is a step in the right direction. I encourage my colleagues
on both sides of the aisle to support it.
Mr. ANDREWS. Mr. Speaker, I yield 3 minutes to the gentlewoman from
New York (Ms. Velazquez), a person with whom I share an important goal,
but have a disagreement on means.
(Ms. VELAZQUEZ asked and was given permission to revise and extend
her remarks.)
Ms. VELAZQUEZ. Mr. Speaker, in every State and every district when we
meet with small business owners, their number one concern is rising
health care costs. Even as we sit here, the cost of health care
continues to rise.
Today's legislation will help address this problem. Association
health plans will provide an employer-based solution to help the sector
of the economy that is being hit the hardest: small businesses. Critics
of the bill will come forward today and tell you how association health
plans are going to lead to a devastating impact on small businesses and
the insurance market. Well, from where I stand, it is hard to imagine
that it could get any worse.
We have 45 million Americans without health insurance and over half
are small businesses and their employees. This includes up to 7 million
children that have family members working for small firms. And for the
last 5 years, small businesses have seen insurance costs increase by
over 60 percent. These are statistics that are so often stated in this
town that we forget what the real impact is. When an employer has to
spend an additional $3,000 a year for coverage per employee year after
year, it is easy to understand why some are dropping coverage all
together.
We have a modest solution before us today that no one can claim will
address all of the problems, but it can provide some help in a market
that needs it. I think it is important to talk about what association
health plans are and what they are not. These plans will be under the
same set of rules that apply to corporate and union plans. In fact, the
requirements for association health plans are even more strict. It will
require that an association health plan have sufficient reserves to pay
all claims. It includes protections against cherry-picking to prevent
adverse selection. It provides a structure to ensure that the DOL can
monitor these plans.
Critics will cite an outdated CBO study that does not even examine
the legislation before us today. Will association health plans cure all
of the problems when it comes to health insurance in the small group
market? Absolutely not. But will it bring some elements of
affordability and competition in these markets? I think so.
By some estimates, this bill is estimated to provide as many as 8
million Americans with insurance, no small sum. One of the best
indicators as to whether AHPs will increase competition is the strong
opposition from insurance companies. They are worried that they will
lose their stranglehold on the small-group market. These insurance
companies with highly paid lobbyists from Blue Cross/Blue Shield, for
example, that hold monopolies on State markets are worried that they
will have to start negotiating premiums rather than dictating them.
I rise in strong support of this legislation. I ask my colleagues to
do the same. Just as important, I call on the Senate to act on this
legislation and the administration to put its full backing behind this
bill. This Nation's entrepreneurs deserve it.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I reserve the balance of my
time.
Mr. ANDREWS. Mr. Speaker, I yield 3 minutes to the gentleman from
Massachusetts (Mr. Tierney), a Member who understands that this bill
will increase the number of uninsured by at least 1 million people.
Mr. TIERNEY. Mr. Speaker, this so-called Small Business Health
Fairness Act is a bill that is attractive to a few, seems to be
sufficient for none, and is going to be harmful for many.
The Congressional Budget Office did an estimate of the proposed bill.
It estimated that only 600,000 of the 45 million uninsured will be
provided new insurance coverage by these AHPs. In fact, the respected
2003 Mercer Consultant Study that was done for the National Small
Business Association found that the number of uninsured will increase
by 1 million, as increased nonassociated market costs force small
employers to drop coverage.
The fact of the matter is there is not going to be the dramatic
savings proposed here. That is not going to materialize. The
Congressional Budget Office found that these premiums for AHPs would
only be marginally less than traditional premiums for health care
plans.
In fact, the 2003 Mercer Study found that premiums would increase by
23 percent for those outside the AHP market. It also found that there
would be an increase in the number of uninsured workers in small firms,
an increase of 1
[[Page H6489]]
million people as a result of this plan being implemented.
Again, the fact of the matter is that Americans would also lose their
right to vital medical coverage, like OB-GYN and pediatrician services,
cervical, colon, mammography and prostate cancer screening, maternity
benefits, well-care child services, and diabetes treatment.
Mr. Speaker, this bill is going to disallow a lot of State
protections. In fact, that is how you get cheaper insurance. If you
want to lower the price, you just do not give people the coverage that
they need and deserve. Almost all of the States that we talk about have
protections for people with coverage. Almost every Member of this House
voted for the Federal Patient Bill of Rights that would have recognized
these State protections that are in place for insurance programs; yet
this bill would take those out carte blanche.
{time} 1615
As a person in small business for over 22 years, and having
represented a lot of small businesses, I can tell you from personal
experience that small business employers do not want inferior coverage
for their employees. We cannot allow it to happen again here. In fact,
Mr. Speaker, I can tell you that AHPs really already exist. They are
called the multiple employer welfare arrangements, the MEWAs. The
public record is filled with stories of failed MEWAs that left
employers and employees alike with unpaid medical bills. From 1988 to
1991, dozens of MEWAs failed, leaving 400,000 individuals with over
$123 million of unpaid medical claims.
Small business owners and their families and their employees deserve
protections. They deserve to go to the emergency room. Women in small
businesses deserve to go to gynecologists without referral from another
doctor. Why should we treat small business owners and employees as
second-class citizens and give them second-class health care? Instead
of extending the patient protections to all Americans, this AHP bill
would actually roll them back and roll back the limited protections
that they get today.
Plainly speaking, Mr. Speaker, this bill eliminates all those
protections. For this reason and for the other reasons I have
mentioned, and the fact that over 1,000 different organizations oppose
this bill, the National Governors Association, the Republican Governors
Association, 41 State attorneys general, the National Small Business
Administration, the National Association of Insurance Commissioners, as
well as a dozen other labor, business and consumer groups think that
this is not a good bill, I urge my colleagues to reject this bill and
vote for the substitute.
Announcement By the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. Gillmor). The Chair would request that
Members, as a courtesy to their colleagues, respect those time limits.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield 4 minutes to the
gentleman from Maryland (Mr. Wynn).
Mr. WYNN. I thank the gentleman for yielding me this time.
Mr. Speaker, I rise in strong support of H.R. 525, the Small Business
Health Fairness Act, designed to allow small businesses to create large
insurance pools in order to give them market power which will allow
them to purchase quality health insurance at affordable prices through
association health plans.
In truth, our biggest bipartisan failure in this Congress has been
our inability to help 45 million, now pushing 50 million, Americans who
do not have health insurance. Sixty percent of these people work in
small businesses or are self-employed. Unfortunately, small business
employers either cannot afford to offer health insurance or offer it at
premium costs that employees cannot afford. Small businesses and their
employees need our help. AHPs are not a panacea, but they are a step in
the right direction.
AHPs, association health plans, will be subject to Federal consumer
protections, unlike what you may have heard, such as continuation of
coverage; Federal claims procedures for benefit denials and appeals;
guaranteed portability and renewability of health coverage for those
with preexisting conditions; as well as the Mental Health Parity Act,
the Women's Health and Cancer Rights Act, and the Newborns' and
Mothers' Health Protection Act.
We have also heard that AHPs will allow for cherry-picking, that only
the healthiest will be signed up. That is not true due to the
antidiscrimination language in the bill. Really and centrally,
opponents claim that AHPs are bad because they do not provide mandated
State benefits. This misanalysis reflects some of the backward thinking
in our health care system, that people would put mandated benefits
ahead of prevention. That does not make sense.
Consider a State's mandated coverage for diabetes supplies. But what
good is mandated benefits for diabetes supplies if you cannot afford to
go to the doctor, and therefore do not know you have diabetes? Under
AHPs you have an affordable, basic policy which covers doctors' visits.
Therefore, you can get checkups and learn about your risk of diabetes
or other health problems. The doctor can give you advice, prescribe
life-style changes, and help you overcome, control, or avoid health
problems. In fact, the American Diabetes Association cited a recently
completed study on diabetes prevention that conclusively showed that
people with prediabetes can prevent the development of Type 2, or full-
blown, diabetes by making changes in their diet and increasing their
level of physical activity.
Our approach provides affordable access to this kind of preventive
care, allowing people to lead healthier lives and not go to the
emergency room, which is driving up costs for all of us.
Some of our elitist opponents will call these policies worthless
because they do not offer 30 or more State mandates. For a single
mother who is a waitress who is able to take her son to the doctor,
that is not a worthless policy. That is called progress. If the plans
are so inadequate, don't worry, the people won't buy them.
Most professional men and women have health insurance. Members of
Congress have a great health insurance plan. Members of labor unions
have health insurance. Why do they not want the mechanics and the
barbers and the waitresses and the realtors to have health insurance?
The attitude of our opponents seems to be, ``I drive a Cadillac. If you
can't afford to drive a Cadillac, you don't get to drive at all.'' That
does not make sense.
Today 45 million Americans cannot afford a Cadillac health insurance
policy with all the mandated benefits. However, they might be able to
afford a more modest vehicle that would get them to their doctor's
office where they could at least get a diagnosis, advice and
recommendations in order to improve their quality of life.
A broad and diverse coalition of more than 180 groups support this
bill, including the U.S. Chamber of Commerce, the National Federation
of Independent Business, the American Farm Bureau, the Associated
Builders and Contractors, the Latino Coalition, and the National Black
Chamber of Commerce. People want health insurance. Opponents of AHPs
say, ``If you can't do everything for everyone, do nothing.'' We say
this bill will help some people get health insurance, and we think that
is a good thing.
Please, support AHPs. Let us quit talking about health insurance and
actually deliver it to the American people who work in small businesses
and who are self-employed, because they really need it.
Mr. ANDREWS. Mr. Speaker, among those who know the difference between
a Cadillac and a lemon are the insurance commissioners of our States
who oppose this bill.
Mr. Speaker, I yield 2 minutes to the gentleman from North Dakota
(Mr. Pomeroy), one of their former members.
Mr. POMEROY. I thank the gentleman for yielding time.
Mr. Speaker, let us understand something fundamental here. People do
not just want the appearance of health insurance. They want a program
that they can trust and that will pay when they incur the claim, and
that is the critical problem with the bill being put before us. There
are no meaningful consumer safeguards. This can manifest itself in
three critical ways. First, as to content. We all know about insurance
loopholes, the fine print that says, oh, we will pay your claim unless
you file a claim, in which case we
[[Page H6490]]
won't pay the claim. This kind of malarkey has been with us ever since
insurance first came in the marketplace. Insurance commissioners make
certain that the policy does what it purports to do, no fine print
taking away the meaningful coverage. This bill takes away that
insurance commissioner protection provided to the consumers.
The second protection, rating. Do you know that in our States, there
was a company that tried to sell a policy that actually raised the
premium whenever you went to see a doctor? You thought you had good
health care coverage, you went to see a doctor, your premium went up
until it quickly became unaffordable. That is no insurance coverage.
There is not the kind of protection on this kind of terrible rating
scheme in this plan. As an insurance commissioner, I have seen rating
schemes. Do not think for a second there are not people that will try
this under this legislation. Consumers need protection there.
Thirdly, solvency. If there is one part of this bill that I think
just screams out, ``This is stupid,'' it is the part on solvency. There
is a $2 million cap on the solvency required for an AHP, no matter how
many lives you have. Millions and millions of lives, $2 million maximum
coverage. Do you know that the claims incurred by two premature babies
could totally bust this plan? Again, people want coverage that is there
when they need it, not coverage that gives them the appearance of
having something only to have it go bust because it did not have enough
capitalization. This business of capping solvency stands in stark
contrast to any actuarial approach and shows that this is absolute
danger for our consumers. Reject this bill.
Mr. BOEHNER. Mr. Speaker, I am pleased to yield 2 minutes to the
gentleman from Louisiana (Mr. Boustany).
Mr. BOUSTANY. I thank the gentleman for yielding me this time.
Mr. Speaker, first of all, I have respect for our insurance
commissioners, but I want to say that three out of the last four in
Louisiana went to jail. So that is no automatic protection. I think
other States have had similar problems.
The preemption language in the bill only grants two limited
exceptions from State laws that regulate insurance. Fully insured AHPs
are exempted from State laws that would, one, preclude them from
establishing an AHP; or, two, prevent them from designing their own
benefit package. These two exemptions are narrowly tailored to allow
AHPs to set a uniform benefit package that can be offered across State
lines and to ensure that State regulators will not pass laws that
prohibit the establishment of AHPs. State laws that regulate insurance
and do not impact benefit design will apply, including prompt pay,
external review, and solvency requirements. Assistant Secretary Ann
Combs testified to this at a March 2003 Subcommittee on Employer-
Employee Relations hearing. At that hearing she noted that, quote,
``fully insured AHPs would purchase insurance products with solvency
standards and consumer protections regulated by the States.''
Further specifying which State laws are not preempted is unnecessary.
All State laws will apply except those that prevent a uniform benefit
design or prevent an AHP from existing. Consumer protection laws that
States see fit to pass will apply to fully insured AHPs. No further
change in the legislation is necessary. Benefit mandates, as we have
discussed, will be preempted as is the case for unions and large
employers.
Mr. ANDREWS. Mr. Speaker, I yield 3 minutes to the gentleman from
Maryland (Mr. Van Hollen), a Member who understands that this bill will
raise premiums by 23 percent and cost 1 million people their coverage.
Mr. VAN HOLLEN. Mr. Speaker, I thank the gentleman from New Jersey
for his leadership on this.
This is a bad bill, Mr. Speaker, for many reasons. I want to focus on
one of them, which is that this bill will strip away the consumer
protections and the patient protections that exist under State law for
our constituents today. I understand that we have 50 States, and in
those 50 States many of them have different mandates for what has to be
covered and what does not have to be covered, and there is some sense
when you are talking about organizations operating across State lines
that you would streamline that effort.
That is exactly what the gentleman from Massachusetts (Mr. Tierney)
and I tried to do when we took an amendment the other day to the Rules
Committee. We said, let us look at six patients' rights that have been
agreed to on a bipartisan basis by this Congress in previous
legislation and which are overwhelmingly agreed to in our States, and
let us say with respect to those six rights, you can't take that right
away from one of our constituents, one of our patients, one of our
consumers if you are an associated health plan.
What happened to that amendment? We did not even get to hear it or
vote on it in this House. What are we afraid of? What were those six
provisions that we wanted to make sure all our constituents, all our
consumers, were protected by? The right to an independent external
review of coverage decisions. Forty-three States have this rule
already. It says if you disagree with your insurance company as to
whether or not you are covered, let us not ask the insurance company
who is right and who is wrong, let us have an independent individual
who can make that decision. Does that make sense? Most of our
constituents think they will have that right. If you pass this
legislation and if you are in an AHP, you are not going to get it.
Second, direct access to obstetric, gynecological, or pediatric
services. You do not have to wait in line before you take your child to
see the pediatrician.
Third, imposition of prudent layperson decision-making standards. If
you show up at the hospital, and you have a good faith reason for
thinking you are sick, and it turns out you did not have a heart
attack, but you went thinking you had one and you had good reason to
think so, your insurance company cannot deny you coverage for that
visit. You do not have to be the doctor. That is why we have doctors.
Use of drug formularies, access to hospital emergency room treatment,
42 States have this requirement; and making sure that we do not
restrict the ability of our doctors to give us their opinions, to make
sure that those States where they say you cannot have a gag rule, where
your physician can tell you, the patient, what he or she thinks is in
your best medical interest, they cannot be punished by the insurance
company for telling you the truth.
These are common-sense provisions, six common-sense provisions. That
is what our amendment would have done. It would have made this piece of
legislation stronger and protected our constituents. What happened? We
did not even allow a vote on that.
I would just like to quote from 42 State attorneys general,
Republicans and Democrats, who say, ``Consumers rightfully expect their
States to protect them from fraud and abuse. Elimination of the State
role and replacement with weak Federal oversight is a bad deal for
small businesses and for consumers.'' Those are State attorneys
general, Republican and Democrat, who, like us, are trying to look out
for the consumer interest.
Do not pass this bill. If you do, you are going to have a lot of
explaining to do to your constituents when they are denied by their
insurance companies coverage that they thought they rightfully had.
Mr. BOEHNER. Mr. Speaker, I reserve the balance of my time.
Mr. ANDREWS. Mr. Speaker, I am pleased to yield 3 minutes to the
gentleman from California (Mr. George Miller), the ranking member of
the full committee and a fighter for working families throughout his
career here.
(Mr. GEORGE MILLER of California asked and was given permission to
revise and extend his remarks.)
{time} 1630
Mr. GEORGE MILLER of California. Mr. Speaker, I thank the gentleman
for yielding me this time.
I must say the Republicans are on a roll here. Last week they voted
in the Committee on Education and the Workforce to raise the cost of
education to those students seeking a higher education by raising the
cost of the loans that they will seek to finance that education. In
this legislation what we see them doing is taking away vital
[[Page H6491]]
health benefits that millions of Americans currently have but will lose
if this legislation is passed. And later this week they are going to
bring an energy to the bill to the floor of the Congress that The Wall
Street Journal says will raise the price of gasoline.
What is it that the middle class did to them to make them so angry at
them? They raise the cost of their education, they take away their
health care benefits, and now they are going to increase the price of
gasoline. Do the Members know what the price of gasoline is in
California? It is $2.67, $2.77, $2.87 a gallon. Do the Members know how
hard people have struggled in these States to have minimum health care
benefits so that they can have a mammogram, so they can have diabetes
testing, and now they are going to take that away. And now they raise
the cost of college education. It just does not make any sense.
The theory is that Congress should be trying to extend meaningful
health care coverage to families and to making sure that they have
benefits that, in fact, are there when they need them. But that is not
what this legislation does. This legislation overrides all of the hard
work that was done in 40 or 45 States to make sure that people would
have access to well baby care, to make sure that they would have access
to maternity benefits, to make sure that they would have access to
mammograms, crucial services that families need. This legislation says
not necessarily so, they do not get that, on the theory that we have
heard argued here that some plan is better than no plan.
But a plan without benefits is not worth much at all. And why would
one keep paying premiums even if they are low premiums if they do not
get the coverage that their family needs?
The point is for the people running that plan, that can turn out to
be very profitable. That is why they do not want the insurance
commissioners involved, because at some point the insurance
commissioners would do what they have done in the past. They would blow
the whistle on people running plans where they take premiums from
middle-class workers, but they do not give the benefit that they want.
The record is replete with that, replete with that in State after State
after State. But that is stripped out of this legislation.
This legislation should be rejected because it just is not the
benefits that people need. What we ought to be doing is extending that
kind of universal access to plans that provide people the benefits.
The Congressional Budget Office in its most recent report, April of
this year, analyzed the legislation two other times and concluded that
8\1/2\ million workers would end up in AHPs under this bill, and over
90 percent of them would come from existing health care plans where in
all likelihood their benefits are better. The CBO looked at it once, it
looked at it twice, it looked at it three times, and it said that is
their conclusion.
This means that millions of Americans, working Americans today with
health insurance, under this plan would get stripped of the health care
coverage that they now have and that they need, that they need. They
are talking about trying to cover a couple hundred thousand people.
That is their argument, but they are going to strip the health care
benefits away from almost 8 million people that have this kind of
coverage. It is unacceptable.
We ought to reject this. Later this week we ought to reject the
energy bill, and maybe we can do something to keep people in decent
health care plans, lower their energy costs, and, when the higher ed
bill comes, reject that, and we can save them some money on a college
education.
Mr. BOEHNER. Mr. Speaker, I yield 3 minutes to the gentleman from
Texas (Mr. Sam Johnson), the chairman of the Employer-Employee
Relations Subcommittee.
Mr. SAM JOHNSON of Texas. Mr. Speaker, we have heard it over and over
again today on the floor. Too many working Americans have a job, but
are uninsured because their employers cannot afford to purchase quality
health insurance benefits for their workers.
This bill addresses the two most important issues in the health care
reform debate: cost and access. H.R. 525 would, one, increase small
businesses' bargaining power with health care providers; two, give them
much-needed freedom from costly State-mandated benefit packages; and,
three, lower their overhead costs by as much as 30 percent.
Our small businesses are denied the ability to purchase health
coverage with the benefits large multistate companies and unions have
enjoyed for decades. This bill fixes that problem.
By pooling their resources, increasing their bargaining power, AHPs
will help small businesses reduce their health insurance costs. As the
Members have heard me say before, if it is good enough for Wall Street,
it is good enough for Main Street. Small businesses in most States are
stuck with disproportionately higher costs because they have to choose
from fewer than five providers. So AHPs offer them a new option to
choose from. Most importantly, AHPs will expand access to quality
health care for the people for whom it is currently out of reach:
uninsured working families.
This bill has had unwavering support in the House for nearly a decade
now. The other body is taking a serious look at the legislation this
year, and it is a priority in the President's health care agenda. I
look forward to working with our colleagues from the other body to make
this bill law this year.
The problem is getting worse every day. Small businesses need our
help now. Let us vote ``yes'' on H.R. 525.
Mr. ANDREWS. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, the argument for this bill rests upon a false choice
that I believe would have catastrophic consequences for many Americans.
We are told by proponents of the bill that if we are willing to yield
the guarantees that they presently enjoy under the law that guarantee
them a mammogram, guarantee them care for diabetic illness, guarantee
them other rights that they fought and won for, if we make that trade-
off, we will get more people health insurance. If that were true, this
would be a difficult choice, but it is not true.
The net impact of this bill will be to increase the number of
uninsured people by nearly 1 million people because the increases in
premiums for small business that will occur in businesses that stay in
conventional plans will chase more people out of these plans. The
experts estimate that these increases will be in excess of 20 percent.
So this is a false choice. This bill does not say that if we yield
these benefits that people cherish, more people will be insured. The
opposite is true. If we were to make the mistake of yielding these
cherished benefits, more people would lose their coverage than would
gain it.
This is a choice not worth making, and it is why the National
Governors Association opposes the bill, Republicans and Democrats. And
it is why the Attorneys General oppose the bill, Republicans and
Democrats. And it is why commissioners of insurance, Republicans and
Democrats, oppose the bill.
I urge our colleagues on both sides of the aisle to protect the
benefits that our constituents earned and deserve and to prevent the
increase in the number of uninsured and the increase in health
insurance benefit premiums and vote ``no'' on this bill.
Mr. Speaker, I yield back the balance of my time.
Mr. BOEHNER. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, small employers today have a difficult problem. They are
trying to keep their business alive. They are trying to make enough
money to hire and grow their business and at the same time trying to
provide affordable health insurance. About 60 percent of the 45 million
people who have no health insurance work for small businesses of some
sort. But what happens to those small employers in most of these State
risk pools? They are in the small group coverage area, and guess what
happens? There may be a provider or two that will offer them insurance.
They are stuck in a small pool, and they pay the highest rates of any
group that is out there, unless, unless, one happens to be self-
employed.
Let us say that they were a realtor, and as a realtor they are self-
employed, they are not an employee of a company, and they try to buy
health insurance for themselves out in the open market again in these
small State risk pools. Here it comes, $1,500 a month,
[[Page H6492]]
$2,000 a month. And, my goodness, if they are sick, they will not get
it at all.
So what we have been proposing now for some 10 years, and the House
has passed this on a bipartisan basis at least five times, is to allow
businesses and self-employed individuals who belong to bona fide
organizations to group together for the purposes of health insurance.
Why should a realtor who belongs to the National Association of
Realtors not have an opportunity, whether their State association or
the national association wants to put together a package of plans and
allow them to choose one of those plans that might fit the kind of
coverage that they want, why would we not want to do this?
We have heard all this shtick about all these plans are lousy, they
are low-cost coverage. No. These plans would look exactly like the
plans that big companies and unions offer today. Everybody in America
wants to work for a big company or a union. Why? Because they have got
great health benefits. And why do they have great health benefits?
Because that is what their employees and that is that their members
want. People do not want to go out and buy low-cost coverage that does
not cover anything. That does not accomplish anything.
So when we look at the opportunity for small businesses to go out and
to be able to purchase health insurance for their employees, just like
a big company or just like a union under the same set of rules, the
same set of rules for small companies that big companies have today, we
should not let the perfect become the enemy of the good. This will not
solve the problem of all 45 million of the uninsured, but it will help
millions of Americans who work for small businesses have a better
opportunity at getting good health coverage at competitive prices.
We have heard an awful lot of talk about it does not have this
mandate, that mandate, that mandate. And why do big companies who do
not have to have any mandated coverages under ERISA, why do they
provide those? Why do they have breast cancer screening? Why? Because
it makes sense to screen for this to detect it early and to deal with
it. Why do they have these benefits that are not mandated? Why? Because
they make sense to find out early in the illness.
These small companies are going to have the same types of high-
quality plans that big companies have today without State mandates,
because what happens is every State has a mandate. Some of them have as
many as 30 mandated benefits that drive up the cost of health insurance
and drive the number of uninsured up as well. But companies that offer
a lot of these benefits, they do so with, as an example, a breast
cancer benefit that covers the whole country, one size, not 50
different States done in 50 different ways that they have to find out
exactly how it is going to be covered in each of those 50 States.
I have no doubt that the policies that will be offered by these
association health plans will, in fact, be high-quality policies at
very competitive prices.
As I said before, this bill has passed the House on a number of
occasions with broad bipartisan support, and I expect that will occur
again today. So I would ask my colleagues to stand up and vote. We hope
that the other body will eventually take this bill up and move it and
to help reduce the number of uninsured Americans that we have.
Mrs. CHRISTENSEN. Mr. Speaker, I rise in strong opposition to the
Small Business Fairness Act, which is not fair any place, but in its
name, and in strong support for the Kind-Andrews substitute.
As a 5-term member of the Small Business Committee, I know and am
very concerned that 60 percent of the uninsured are employees of small
businesses.
We all want to make sure they are covered, but H.R. 525 will not do
that, it is an empty promise.
Worse, it would more likely increase the number of uninsured instead
of reduce them. Even for those who might be covered. This bill is
designed to provide great coverage if you don't need it, but please
don't get sick--what it provides then is a false sense of security.
The stories of individuals with similar low cost plans in States with
little regulations are tragic, and must not be replicated as H.R. 525
would do.
AHPs specifically remove State consumer protection laws and appeal
rights. It is fool hardy to think that the market will provide any
protection, and our experience with the Department of Labor and
hearings with the Secretary have added no reassurance.
People of color, who make up a sizeable portion of small business
employees and who tend to be sicker because this government will not
build fairness and equality into our healthcare system, will get the
shortest end of the stick again. Because of the higher costs of taking
care of them, minorities will be left out, and left behind.
There is nothing fair about this bill, I urge my colleagues vote
``no'' on 525 and vote for a bill that provides insurance relief to
small businesses, keeps the cost low, and protects the consumer. I urge
my colleagues to vote ``yes'' on the Kind/Andrews substitute. The only
fair bill before us at this time.
Mr. REYES. Mr. Speaker, I rise in opposition to H.R. 525, the Small
Business Health Fairness Act, but in strong support of meaningful
measures to help small businesses offer affordable, quality health care
coverage to their employees.
For many businesses in my congressional district and across the
country, the rising cost of health insurance is a growing crisis.
Currently, many small businesses devote significant resources to offer
health insurance to their employees--money they could have otherwise
invested in their businesses. Others have had to reduce or drop
coverage entirely.
While I agree that we must find a solution to this problem, H.R. 525
is not the answer, for several reasons. First, supporters of H.R. 525
claim the legislation would reduce the number of uninsured. However, a
recent Urban Institute survey states that the number would actually
increase, because some small employers in the State-regulated market
would be forced to drop coverage when premiums increase as a result of
the creation of Association Health Plans, AHPs.
Second, AHPs would be exempt from State rules that limit how much and
how often premiums can be increased, making it likely that premiums
would go up rather than down. In fact, the Congressional Budget Office
estimates that AHP legislation would result in higher premiums for 80
percent of small employers, and as many as 100,000 sick people would
lose coverage because they would not be able to afford the increases.
Finally, AHPs would mean that consumers would lose important health
benefits, such as treatment and care for diabetes, child immunizations,
cancer screenings, and preventive care. Consumers would lose State-
based patient protections such as direct access to specialty care,
emergency care, and the right to an independent, external review of
denied medical claims.
Instead of this flawed bill, I support the substitute offered by
Representatives Kind and Andrews. This legislation would expand the
health care options available for small businesses by building on the
efforts of many State governments that are providing health care plans
specifically for small businesses. Under the substitute, Federal and
State health insurance pools would be created for small businesses to
band together to purchase coverage. Participating businesses would be
able to defray the costs of their participation through a 4-year tax
credit provided under the legislation. By grouping small companies in
healthcare pools, this bill would give small firms some of the same
advantages large corporations have in trying to keep costs down.
Mr. Speaker, I urge my colleagues to oppose the Small Business Health
Fairness Act, and instead support real relief for small businesses
trying to meet the health care needs of their employees by voting for
the Kind-Andrews substitute.
Mr. LARSON of Connecticut. Mr. Speaker, I rise today in opposition to
H.R. 525, the Small Business Health Fairness Act of 2005. Today we face
a problem. An estimated 45 million people are without health insurance.
The number of uninsured has risen in almost every year since 1989 and
is expected to continue its rise in the near term. Most people in the
U.S. who have health insurance obtain it through their employer or a
family member's employer as a workplace benefit. Due to the rising cost
of health coverage, small employers are far less likely than larger
employers to provide health insurance to their workers and almost half
of the uninsured work for, or are family members of employees who work
for, small employers. The Small Business Health Fairness Act would not
address this problem.
As a former small business owner, I understand the need for employers
to offer benefits like health insurance to attract the best employees.
I also understand the desire to offer benefits to employees to reward
them for their efforts in making their business a success. Small
businesses are a vital part of our economy, and it is critical that we
provide them with affordable heath coverage that not only covers their
employees, but helps reduce the ranks of the uninsured in our Nation.
Unfortunately, the association health plans created by H.R. 525 would
actually reduce
[[Page H6493]]
health care benefits and coverage. In fact, the Congressional Budget
Office estimates that only 600,000 of the 45 million uninsured would
receive coverage as a result of this bill. The CBO also found that
almost 75 percent of workers would actually see their premiums rise.
These numbers are evidence that this legislation will not address the
problem.
The bill raises numerous other concerns as well. It would create an
uneven playing field where Federal law would provide one set of
favorable rules for employers who join association health plans and a
different, less favorable set of rules for those who do not.
Association health plans would be exempt from most State benefit
requirements, including those that ensure access to emergency services,
mental health services and cancer screening. They would be free to
choose healthier individuals who are cheaper to insure and leave behind
those most in need of health care coverage. Finally, association health
plans under this bill would be allowed to license themselves in a State
with looser consumer protection provisions than the State they offer
coverage in, leaving consumers open to fraud and abuse. These loopholes
will not address the problem.
However, today we will offer a real solution to this problem. The
substitute amendment offered by the gentleman from Wisconsin, Mr. Kind,
and the gentleman from New Jersey, Mr. Andrews, would address the needs
of small businesses by providing them with the same access to health
benefits as Federal employees through a Small Employer Health Benefits
Plan. This plan would provide coverage to all small businesses and
their employees, ensuring that every worker gets the coverage they need
regardless of age, sex, race or any other factor. Additionally, it
would commit Federal funds to aid small businesses in offering health
insurance to employees. Finally, it would work within existing State
laws and not preempt state regulations regarding health care coverage.
This substitute will help small businesses more, cover more of the
uninsured, and protect the rights of States.
Unfortunately, without the Kind/Andrews amendment, I cannot support
the Small Business Health Fairness Act. This is the fourth time the
House has voted on association health plans and the fourth time it has
been the wrong answer for small businesses and the uninsured. This is
just another example of the Majority bringing the same legislation to
the floor year after year knowing that it will go nowhere because it is
the wrong answer for Americans. I urge my colleagues to join me in
supporting the Kind/Andrews amendment, which would provide real
solutions to help our Nation's small businesses and cover the 45
million uninsured Americans.
Mr. MANZULLO. Mr. Speaker, as the chairman of the Small Business
Committee, our Nation's small business men and women tell me over and
over that finding accessible and affordable quality health care is
their number one priority for themselves and their employees.
I have heard from thousands of small employers in America who have
been pleading for options to help them manage their surging health care
costs.
Small business owners tell me regularly how they struggle to provide
their workers health insurance, but each year they face double digit
increases.
``Mom and Pop'' businesses tell me how they want to provide
healthcare for their employees, but every single year it gets more
difficult.
Many are giving up. Our Nation's entrepreneurs, whose ingenuity and
hard work ethic have driven the American economy, have run out of
options to battle this crisis. They need our help.
And today, we bring forward a great option--Association Health
Plans--to help them control these outrageous costs and continue
offering vital health insurance to their employees and their families.
In March of this year, I held a hearing on AHPs. The Coca Cola
Bottlers Association testified they have long offered AHPs.
However, in 1990, they had to stop offering AHPs to members with
under 100 employees because of the disparity of law from State to
State. Those small employers have incurred increased premiums of
between 20-25 percent per year.
For those bottlers employing over 100 workers and who still were able
to maintain an AHP, they only had an average increase of 9 percent a
year.
The proof is irrefutable. AHPs work. I urge all of my colleagues to
support H.R. 525. Give hope to America's entrepreneurs. Vote for H.R.
525.
Mr. ENGEL. Mr. Speaker, the so-called Small Business Health Fairness
Act is anything but fair. Congress should not be in the business of
promoting the reduction of healthcare benefits and coverage and that is
exactly what this bill does.
Proponents of H.R. 525 argue that health insurance will be cheaper
under this bill, but the devil is in the details. Healthy people would
enjoy low premiums under association health plans because the plans are
exempt from State consumer protections and minimum quality
requirements, and therefore meaningful coverage. Without consumer
safeguards, association health plans would be largely unregulated and
unlikely to cover such benefits as mammography screening, cervical
cancer screening, well-child visits, mental health services and
diabetic supplies. While this might appeal to healthy people, it will
be devastating to those who actually need medical care. Those who are
sicker would remain in non-association health plans and would have to
pay higher premiums to compensate for those individuals who are
siphoned off into the association health plans.
It is also troublesome that this legislation exempts association
health plans from State solvency standards. Many States have strict
solvency laws that protect workers from insurance fraud and abuse. Any
meaningful insurance company should have to adhere to adequate
standards of protection.
We should reject this anti-consumer proposal in favor of the Kind/
Andrews substitute. This measure would create a Small Employer Health
Benefits Plan, SEHB, similar to the Federal Employee Health Benefit
Plan and would offer coverage to all small businesses with fewer than
100 workers. Significantly, this legislation works with existing State
laws and does not preempt State mandates regarding health care
coverage. This substitute very clearly commits Federal funds to aid
small businesses in offering insurance to employees.
True health insurance coverage offers meaningful benefits with
appropriate solvency safeguards. Our constituents deserve no less. I
urge my colleagues to reject H.R. 525 and pass the Kind/Andrews
substitute today.
Mr. MORAN of Virginia. Mr. Speaker, I rise in support of the Small
Business Health Fairness Act, H.R. 525, which will allow small
businesses and associations to band together to purchase health
insurance coverage for their workers and their families.
The Small Business Health Fairness Act can directly benefit the over
2,300 small businesses and associations in my congressional district
and their employees.
H.R. 525 would allow AHPs and small businesses to be certified under
one Federal law, instead of 50 different State regulations.
Like large employers and labor unions that offer health insurance to
their employees and members, AHPs would be regulated by the U.S.
Department of Labor.
Many opponents of the Small Business Health Fairness Act claim that
AHPs will ``cherry pick'' and therefore only benefit healthy people.
This is not true.
All AHPs must comply with the Health Insurance Portability and
Accountability Act, which prohibits group plans from excluding high-
risk individuals that have required repeated health insurance claims.
H.R. 525 also guarantees that only bona fide professional and trade
associations can sponsor an AHP. This measure ensures that AHPs will
undergo a strict, new certification process before they will be allowed
to offer health benefits to employers. This new certification process
includes stronger solvency standards, including stop-loss and
indemnification insurance.
Studies have shown that AHPs would save the typical small business
owner between 15 percent and 30 percent on health insurance.
Currently, there are 45 million Americans who are uninsured. Even
more troubling is the fact that 60 percent of uninsured Americans work
for small businesses that lack the resources to provide health care
benefits to their workers.
In fact, 65 percent of small-business owners indicate high cost as
the main reason why they do not offer health insurance.
Small employers are facing 50 percent premium hikes, even as many
insurers are leaving the small group market because it is not
profitable enough.
The time to offer small businesses and associations the ability to
band together to offer health insurance to their employees is now.
The Small Business Health Fairness Act represents a first step in
helping to lower the number of uninsured Americans, many of whom work
for small businesses.
H.R. 525 would introduce more competition into the market, reduce
unnecessary regulation and administrative costs and make health
coverage more affordable for small employers and their employees.
I urge support of H.R. 525.
Mr. BLUMENAUER. Mr. Speaker, it is unfortunate that while we are in
the midst of a healthcare crisis for the uninsured, for small
businesses, and for practitioners, Congress is recycling the same
flawed legislation. The proposal would allow association health plans
to bypass the State solvency framework requirements, leaving the
consumers at a significant risk.
The reason that over 1,350 business, labor, and community
organizations oppose H.R.
[[Page H6494]]
525--including organizations such as the National Governors
Association, 41 Attorneys General, the National Association of
Insurance Commissioners, Blue Cross/Blue Shield, National Small
Business United and 69 local Chambers of Commerce--is because it not
only misses the point, it will make things worse.
The bill would undermine our efforts to provide essential services to
everyone by providing incentives to insure only the healthiest and
wealthiest, leaving the vast majority of over \1/2\ million uninsured
Oregonians and 45 million uninsured Americans behind. Even worse, the
adverse selection process will mean that the insurance pool will be
narrower and sicker, resulting in more expensive insurance for most
families. Furthermore, the Congressional Budget Office estimates that 8
million individuals who currently have health coverage will be switched
to a lower benefit plan. Consumers may be denied the proper screening,
procedures and treatment they deserve.
These are critical issues for taxpayers and businesses alike. I will
continue to work with the healthcare and business community to produce
the type of process, discussion and legislation Americans critically
deserve.
Mr. STARK. Mr. Speaker, I rise today in strong opposition to H.R.
525, the regurgitated association health plan, AHP, bill. This is the
fourth vote on this exact same legislation in as many years. So, if my
statement sounds familiar, that's because it has all been said before.
While they've titled the bill the Small Business Health Fairness Act,
its impact would be the opposite. This bill would have the perverse
effect of increasing the cost of health insurance for many people and
increase the number of people without health insurance altogether.
This bill would allow new entities, called association health plans,
AHPs, to bypass State regulation and offer bare-bones health insurance
policies. Small businesses that don't choose to offer these inadequate
policies would see their premiums increase by 23 percent on average.
This premium hike would occur because AHPs, which would offer only
bare-bones coverage, would attract the healthiest individuals, leaving
traditional health insurance plans with the sickest and most expensive
patients. This shift would penalize businesses with sicker employees,
and make health insurance for those who need it the most even more
unaffordable.
Further, this legislation would swell the ranks of the uninsured by
over 1 million more individuals. As traditional health insurance
becomes increasingly expensive, more and more businesses would have no
choice but to drop health insurance for their employees, leaving these
individuals with little or no opportunity to purchase health coverage.
Contrary to what proponents of this bill claim, AHPs would not truly
help small businesses purchase health insurance for their employees.
Although proponents claim that AHPs would give small employers
bargaining power to purchase affordable health insurance, most States
already have laws in place that allow for group purchasing
arrangements. This bill would only harm existing laws while usurping
the traditional role of States to regulate insurance.
In fact, this bill would override key State laws and regulations that
protect millions of Americans. For example, many States regulate
insurance premiums to prevent insurers from discriminating against the
ill. But under this bill those laws wouldn't apply. AHPs would be
allowed to offer extremely low, ``teaser'' rates, and then rapidly
increase the premium if the enrollee becomes sick. Furthermore, nearly
all States have enacted external review laws that guaranteed patients
an independent doctor review if a health plan denies them coverage for
a particular service. Patients who join AHPs would lose this vitally
important consumer protection.
This bill also exempts AHPs from State laws that require health
insurance to cover particular benefits. These laws have helped to
ensure that millions of Americans get access to the healthcare that
they need--such as mammography screenings, maternity care, well-child
care, and prompt payment rules. In my State of California, employees
who join AHPs could well lose access to these services as well as
certain emergency services, direct access to OB/GYNs, mental health
parity, and other important benefits. Moreover, this law would allow
health plans to ``gag'' doctors, the currently illegal practice of
health insurers preventing doctors from discussing treatment options
that the plan does not cover, even if some of those options are in the
patient's best medical interest.
The problems go on. AHPs are likely to create new fraud and abuse
problems in health care as well. These plans are very similar to
multiple employer welfare plans, MEWAs, that Congress created in the
1970s. MEWAs were also exempt from State insurance regulation. The
Department of Labor found that many of these plans were frauds and left
their enrollees holding the bag for more than $123 million in unpaid
health expenses. Congress had to come back and clean up the law to end
this blatant abuse. We should learn from that mistake, not repeat it.
This bill is bad for patients, bad for small business, and bad for
States. It is opposed by more than 1,300 organizations, including the
National Governors Association, the National Association of Insurance
Commissioners, the American Academy of Actuaries, local Chambers of
Commerce, small business associations, physician organizations, labor
unions, and healthcare coalitions.
The Senate has no intention of taking up this legislation. It's bad
policy, and our colleagues on the other side of the Capitol know it.
Taking yet another vote on AHPs is an enormous waste of time and
taxpayer resources, and has nothing to do with providing affordable
healthcare options to our citizens. Health care reform shouldn't raise
premiums, increase the number of uninsured, lead to massive fraud, and
remove key State patient protections. I urge my colleagues to reject
this legislation once and for all.
Mr. SHUSTER. Mr. Speaker, I rise today in support of the Small
Business Health Fairness Act, H.R. 525. This legislation is a
prescription to provide quality, affordable health care to the
Americans who need it most: 45 million people from working families
across the country.
By lowering costs and strengthening bargaining power, Association
Health Plans, AHPs, would allow small businesses to band together
through associations and purchase quality health care for workers and
their families at a lower cost. Small businesses currently have little
buying power and few affordable options--five or fewer insurers control
at least three-quarters of the small group market in most States,
according to a GAO report in 2002. By banding together through bona-
fide trade associations, AHPs would level the playing field and give
participating small employers the exact same advantages Fortune 500
companies and unions currently enjoy.
It is important to note that this legislation does not make AHPs a
mandatory program for employers. AHPs are about choice and healthy,
competitive options for those seeking quality coverage. Each business
would have the option of remaining with their current insurance
provider, if they have one, or joining up with a legitimate, certified,
and regulated association that is able to pool risk and offer small
businesses a seat at the table when it comes to really being serious
about providing health care for American workers.
Contrary to opponent's claims, H.R. 525 provides safeguards against
fraud and abuse with a strict, new certification process that must be
adhered to before any association can offer health benefits to
employers. Included are strong solvency protections that go beyond what
is required of single employer and labor union plans under current law.
The bill requires self-insured AHPs to maintain reserves that are
sufficient for unearned contribution, benefit liabilities, expected
administrative costs, and any other obligations. With the reserve
levels required to be recommended by a certified actuary who is a
member of the American Academy of Actuaries, AHPs are designed to
protect the employer from fraudulent abuse and those who would seek to
take advantage of the system.
Under this bill, regulated by the Department of Labor and current
ERISA and HIPPA laws, AHPs would be prohibited from excluding high-risk
individuals from their plans and AHPs would also be barred from
charging higher rates for sicker individuals or groups within the plan.
The lack of current competition in the health care market contributes
to double-digit rate increases for many small businesses and a
resulting rise in the number of small business employees who are
uninsured. Too many small business owners and employers are forced to
choose between offering health care benefits to their employees and
hiring, expanding, or even maintaining their business. With the
adoption of AHPs, the door of opportunity is opened to millions who do
not currently have access to the kind of quality, affordable health
care America's working families deserve.
Mr. Speaker, I would strongly encourage my colleagues in joining me
and voting in favor of H.R. 525.
Mr. AKIN. Mr. Speaker, I rise today in support of H.R. 525, the Small
Business Health Fairness Act of 2005.
In 2003, there were an estimated 45 million Americans without health
insurance. Small businesses employ over 60 percent of those currently
uninsured.
Without question, cost is often the biggest barrier to affordable
health insurance for small businesses. Too often, I hear from small
businesses owners back in my district in Missouri that the
affordability of health insurance is their number one concern. This
problem has been deepened in recent years as the overall cost of health
care has risen. While large employer-sponsored health plans have seen
an average 12-percent increase in health insurance premiums, small
businesses have been
[[Page H6495]]
faced with annual premium increases of up to 50 percent, forcing many
firms to drop coverage altogether.
By allowing small firms to join an association health plan as H.R.
525 would do, small employers would enjoy greater bargaining power
because they would become part of a larger bargaining force, enabling
them to offer their employees the same advantages and benefits that are
currently available to larger companies.
I doubt that many of my colleagues here would deny the fact that
small businesses are leaders in innovation. They pay the majority of
our Nation's taxes and employ the majority of our Nation's workforce.
Yet we have burdened them with excessive regulations to the point that
they cannot afford to provide health insurance to their employees. We
must not deny quality, affordable health care to these hard-working
Americans who want to safeguard their own health and provide their
families access to such protections.
I urge my colleagues to support the Small Business Health Fairness
Act.
Mr. WELDON of Florida. Mr. Speaker, an issue I often hear about from
my constituents is concern about the high cost of health insurance and
the need for affordable insurance coverage. We all know health
insurance premiums continue to increase substantially each year. As
such, many small businesses are unable to afford health insurance for
their employees. Furthermore, for those who can afford insurance for
their employees, rising costs make U.S. products more expensive,
harming U.S. competitiveness and costing American jobs.
Small businesses are the backbone of our economy, but the financial
viability of many small businesses is being hurt by the escalating
costs of health insurance. This hurts job creation and economic growth.
The U.S. Small Business Administration's Office of Advocacy found that
administrative expenses for small health plans make up about 35 percent
of total costs. This is not good for small business owners, their
employees, or the American economy. Congress must address this problem,
which is why I support H.R. 525, the Small Business Health Fairness
Act.
By passing H.R. 525 Congress will be leveling the playing field
between small businesses, the self-employed, and large corporations.
This allows organizations of individuals and businesses to enter into
Association Health Plans, AHPs. Under AHPs, small business can pool
their resources and purchase group health care similar to the way large
corporations do today. They can get better bargaining power in terms of
costs and benefits for their employees. It gives workers, who do not
have health insurance today, the opportunity to obtain health insurance
coverage.
Whether it is a small business a trade association, a farm bureau, or
a local community organization that is seeking to purchase more
affordable health insurance, this legislation will help them. They can
join together with other groups and purchase health insurance at much
more affordable rates and have better negotiating power with insurance
providers.
It is generally reported that there are over 40 million people in
America without health insurance at any given time. According to the
Congressional Budget Office, a more accurate estimate of the number of
people who were uninsured for all of an entire year is 21 million to 31
million. Regardless, almost 60 percent of those individuals are
employed by a small business. As health care costs increase, fewer
employers and working families will be able to afford coverage, and
more Americans will be without health insurance. Those who work for
small businesses should have the same type of access to health
insurance that their counterparts in large corporations already enjoy.
I urge Congress to pass H.R. 525. Congress must pass this bipartisan
legislation to give much needed relief to American small businesses,
farmers, and hard working families.
Mr. SHAYS. Mr. Speaker, I rise in support of H.R. 525, the Small
Business Health Fairness Act. This legislation would allow small
businesses to pool their resources into what are known as Association
Health Plans, AHPs, to purchase health insurance.
Pooled alliances, including AHPs, help control health care costs by
permitting individuals to use their collective bargaining power to win
cost concessions from insurance companies.
These alliances also achieve economies of scale for administrative
functions--substantially cutting overhead costs, which currently amount
to between 30 and 40 cents of every premium dollar paid by small
businesses to insurers.
Purchasing alliances have been a popular response in many States to
the problems many self-employed and small business owners have had
securing affordable health insurance for themselves or their employees.
While I sensitive to the concerns many disease advocacy groups have
about this legislation, the fact is this legislation provides the same
exemption from State benefit mandates for small businesses already
enjoyed by large employers.
The cost savings from avoiding benefit mandates has been estimated to
be between 4 and 13 percent. This could make a huge difference for
small businesses looking to offer their employees health insurance.
Because small businesses are extremely cost-sensitive, studies indicate
that even a 5 percent reduction in costs will result in a 10 to 15-
percent increase in small businesses offering health insurance.
The legislation also protects against these plans ``cherry-picking''
the healthiest employees by restricting the ability of self-insured
health plans to be qualified as an AHP. Unless a self-insured plan is
in existence before the date of enactment, it would be required to
offer membership to a broad cross-section of trades or to employers
representing at least one higher-risk occupation.
Additionally, AHPs must comply with the Health Insurance Portability
and Accountability Act, which prohibits group health plans from
excluding high-risk individuals with high claims experience.
The bottom line is this legislation will help small businesses, which
are the engine in our economy, provide health insurance to their
employees. I urge the passage of this bill.
Mr. HONDA. Mr. Speaker, I rise today in strong opposition to the
Small Business Health Fairness Act, H.R. 525. This bill would not only
fail to expand health coverage for the uninsured, but would actually
reduce health care benefits and coverage for 8 million individuals who
would be switched to lower benefit AHP health plans. Only 1 percent--
600,000 people--of the 45 million uninsured Americans would be provided
new coverage by AHPs.
Instead of providing broader access to comprehensive health insurance
for the millions of uninsured Americans, H.R. 525 will undermine access
to quality, affordable health insurance and may actually increase the
ranks of the uninsured. Under current law, the majority of health
insurance plans are regulated at the State level. States have enacted a
number of protections to ensure the fairness of health insurance
coverage for patients. Most States now require insurers to allow direct
access to emergency services, independent external appeal of health
care claims denials, and access to an adequate range of health
professionals. AHPs would be exempt from these requirements, leaving
those with AHP coverage with inadequate protection.
Insurers naturally have incentives to select the healthiest
individuals or groups that are seeking coverage. State regulations
counter this incentive by mandating that certain benefits be covered,
and by limiting and defining how policies are to be priced. By
exempting AHPs from these State regulations, AHPs would offer less-
generous policies that would be attractive to healthier individuals and
groups. By permitting AHPs to offer coverage to specific types of
employers, the bill allows them to hand pick populations that are
better risks and therefore less costly to insure. Under H.R. 525, AHPs
would offer different premiums to each member employer, charging lower
rates for lower risk persons and charging much higher rates for higher
risk persons.
The only restriction on premiums is that differences could not be
based on health status. This provision is essentially meaningless
because it permits AHPs to accomplish the same goal by varying premiums
based on age, sex, race, national origin, or any other factor in the
employers' workforce, including claims experience. As a Nation, we have
recognized and are committed to eliminating health disparities based on
race, ethnicity, and national origin. Why then would we create laws
that perpetuate and encourage further health disparities?
Small businesses comprise nearly one-third of the private sector
workforce, and are much less likely than large firms to provide health
coverage for their employees. Although this is a serious concern, AHPs
are not the answer. The Kind/Andrews substitute offers provisions that
would address the real health insurance needs of small employers. It
would provide small employers the same access to health benefits as
Federal employees by establishing a Small Employer Health Benefits
Plan, SEHB, similar to the Federal Employees Health Benefits Plan. It
offers coverage to all small employers and their employees to apply for
coverage under SEHB. Those working less than full-time would be
eligible for pro rata coverage. It would also minimize adverse
selection, use State-licenses insurers without preempting State laws,
provide a minimum benefit package similar to Federal employees, and
provide premium assistance to make employee and employer premiums
affordable.
I urge my colleagues to support the Kind/Andrews substitute and
oppose the Republican leadership's flawed approach to AHPs.
Ms. SCHAKOWSKY. Mr. Speaker, I rise today in support of the Kind/
Andrews substitute and in strong opposition to H.R. 525, the Small
Business Health Fairness Act of 2005. We have the opportunity to give
small business owners and employees meaningful
[[Page H6496]]
access to affordable and comprehensive coverage by adopting the Kind/
Andrews substitute. Or, by passing H.R. 525, we can give access to
cheap, flimsy insurance policies that will not provide meaningful
protection and leave those who need better coverage far worse off.
All of us are concerned about the high cost of health insurance,
particularly for small businesses. We all agree that we need to allow
small businesses to band together to achieve economies of scale in
purchasing coverage. The Kind/Andrews substitute would give small
businesses the ability to pool together through a Small Employer Health
Benefits Plan. It would provide premium assistance to make coverage
affordable for small business employers and employees. The Kind/Andrews
substitute will guarantee that insurance policies are not worthless
paper but provide meaningful access to benefits.
What the Kind/Andrews substitute will not do is preempt State
consumer protection laws--laws that have been enacted by State
legislatures on a bipartisan basis in response to real-life problems in
the insurance market. The Kind/Andrews approach would benefit employers
and consumers. The so-called Small Business Health Fairness Act of 2005
would not. In fact, this ill-conceived bill would make the current
situation worse--adding to the ranks of the uninsured, reducing
benefits, and leaving small business workers with insurance policies
that do not provide the care that they and their families need.
There are three fundamental problems with this bill--all of which
stem from the decision to preempt State laws and leave no other
protections in their place. First, the bill will not significantly
reduce the number of uninsured and may actually make this crisis worse.
It would preempt State insurance regulation--allowing association
health plans to cherry pick healthy small businesses. Small businesses
with older workers, persons with disabilities or chronic conditions,
and women of child-bearing age would face higher premiums. The
nonpartisan Congressional Budget Office estimates that only 620,000
uninsured workers would buy these new, barebones policies but that 75
percent of currently insured small business employees--20 million--
would see their premiums increase. National Small Business United--a
group whose reason for being is to promote the interests of small
businesses--opposes the bill because it would increase health
``insurance premiums for small employers by up to 23 percent and cause
some to drop coverage altogether. A Mercer Consultants study in 2003
found that it would actually increase the number of uninsured by 1
million. The CBO says that up to 100,000 of the most medically needy
workers--those with chronic, ongoing conditions or disabilities--would
be among those losing coverage.
Second, the bill would take away protections from consumers
victimized by fraud and abuse. All 50 States and the District of
Columbia have passed tough laws to stop abuses in the small group
health insurance market. Again, these laws would be preempted. The U.S.
Department of Labor is not going to have the will or the resources to
respond when consumers are injured by benefit denials, AHPs go belly-
up, or fraud is committed. AHP policy holders and health consumers
would be left in a regulatory blackhole--with no place to turn if they
are defrauded, cheated, or denied benefits. That's why the National
Association of Insurance Commissioners and 41 attorneys general oppose
this bill.
Third, the bill would preempt basic benefit requirements and patient
protections, allowing AHPs to drop coverage for preventive services,
screening, mental health and other critical services. CBO estimates
that 8 million workers with health coverage today would lose benefits
under H.R. 525.
In Illinois, we have enacted benefits that include mammograms, pap
tests, minimum mastectomy stays, colorectal screening, diabetes
education and supplies, pre- and postnatal care, mental health parity
that goes beyond inadequate federal requirements, and access to cancer
drugs. We have a prudent layperson rule to ensure access to emergency
services, direct access to OB-GYNs, and a ban on HMOs ``gagging''
doctors in their communications with patients. We have prompt payment
rules for providers and fair marketing requirements. We require that
insurance companies cover newborns. Those protections would be
preempted under H.R. 525.
Many of us who previously served in State legislatures fought for
those benefits because private insurance policies refused to cover
items like mammograms, maternity care, diabetes education, prosthetics,
or chemotherapy. We had constituents whose insurance companies refused
to cover their babies, arguing that conditions developed in the
mother's womb were ``preexisting.'' Dropping those critical benefits
will not make health care more affordable; it will simply shift costs
to employees and their families. And, despite having so-called
insurance, if workers cannot afford to pay those costs on their own,
they might as well be uninsured. That is why groups from Consumers
Union to the American Diabetes Association, from the National Mental
Health Association to the NAACP oppose this bill.
I also want to point out that women have a tremendous stake in this
debate. Nearly all women-owned firms are small firms, most with fewer
than five employees. Women are half of all workers at very small firms.
And women are the beneficiaries of many of the State benefits enacted
because private insurers refused to cover critical services--
mammography, pap smears, reconstructive surgery following mastectomies,
contraceptive services, breast and cervical cancer screening, direct
access to OB-GYNs and nurse-midwives, and osteoporosis screening. A
bill that raises premiums to women-owned small businesses and cuts
women's health services is no solution.
Finally, I want to respond to the arguments of the proponents of H.R.
525 that something is better than nothing. As I have mentioned, for at
least 8 million people, the something that would be provided under this
bill would be a policy with lower benefits than they have today, for at
least 20 million it would be a policy with higher premiums than they
pay today. That is hardly a good deal. But there is a more important
issue at stake here. H.R. 525 says that we owe small business owners
and employees nothing better than barebones coverage, an insurance
policy that may be affordable but that doesn't provide access to needed
medical services and is stripped of consumer protections. I believe
that we can do better and that is why I support the Kind/Andrews
substitute.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise today in support of
H.R. 525. This bill, introduced by the Employer-Employee Relations
Subcommittee Chairman Sam Johnson, Committee Chairman John Boehner,
Small Business Committee Ranking Member Nydia Velazquez and Albert
Wynn, would allow small businesses to join together through association
health plans, AHPs, to purchase health insurance for their workers at a
lower cost. The measure would increase small businesses' bargaining
power with health care providers, give them freedom from costly State-
mandated benefit packages, and lower their overhead costs by as much as
30 percent. This is a benefit that many large corporations like GM and
Ford already enjoy because of their larger economies of scale.
Furthermore, this bill expressly prohibits discrimination by
requiring that all employers who are association members are eligible
for participation, all geographically available coverage options are
made available upon request to eligible employers, and eligible
individuals cannot be excluded from enrolling because of health status.
Premium contribution rates for any particular small employer cannot be
based on the health status or claims experience of plan participants or
beneficiaries or on the type of business or industry in which the
employer is engaged.
The measure makes clear that AHPs must comply with the Health
Insurance Portability and Accountability Act, HIPAA, which prohibits
group health plans from excluding high-risk individuals with high
claims experience. Thus, it will not be possible for AHPs to ``cherry
pick'' because sick or high risk-groups or individuals cannot be denied
coverage. The bill prohibits AHPs from charging higher rates for sicker
individuals or groups within the plan, except to the extent already
allowed under the relevant State rating law.
While I support all of these positive aspects of the bill, I do have
concerns with other areas. Due to this fact, I also stand today to
support the Kind/Andrews substitute. This substitute would strengthen
the larger goal of the legislation which is to lower health care cost
for workers. The substitute does this by providing small employers the
same access to health benefits as Federal employees. Under the
substitute, the Department of Labor will establish a Small Employer
Health Benefits Plan, SEHB, similar to the Federal Employees Health
Benefits Plan, FEHB. The States also may establish State small employer
health pools.
In addition, the substitute offers coverage to all small employers
and their employees. In essence, all employers with fewer than 100
employees during the previous calendar year shall be eligible to apply
for coverage under SEHB. Employers must offer coverage to all employees
who have completed 3 months of service. Employees working less than
full-time are eligible for pro rata coverage.
Furthermore, the substitute also minimizes adverse selection. This is
done by requiring the Secretary to establish an initial open enrollment
period and thereafter an annual enrollment period.
One of the most important things achieved by the substitute is the
fact that is uses State-licensed insurers without preempting State
laws. It also provides a minimum benefit package similar to Federal
employees, i.e., all participating insurers must offer benefits similar
to the benefits offered under the four largest FEHB health plans.
[[Page H6497]]
As I close, I would hope that the differences I have mentioned are
reconciled as this bill moves to conference.
Mr. GENE GREEN of Texas. Mr. Speaker, I rise in opposition to H.R.
525, the Small Business Health Fairness Act.
The sponsors of this legislation have a laudable intent: To make
health insurance more affordable for small businesses by allowing them
to band together to increase their purchasing power and negotiate lower
health insurance rates.
With costs in the private health insurance growing 12.8 percent each
year, no one would disagree that our small businesses are struggling to
provide coverage for their employees.
But this legislation is not the answer to the rising cost of health
insurance in this country.
Mr. Speaker, the regulation of health insurance has long rested with
the States.
For decades, State legislatures in each of our States have enacted
State coverage mandates and consumer protections to ensure that
residents of those States purchase a quality health insurance policy.
While some policies cost more than others, thanks to State
regulations, consumers can be assured that all policies offer a minimum
level of coverage.
In my home State of Texas, health plans must provide access to
emergency services, immunizations for children, direct access to OB/
GYNs, and coverage of diabetes supplies and education--just to name a
few guaranteed benefits.
The State has also enacted important consumer protection laws that
afford consumers external review and limit how much insurers can charge
sicker groups of people.
Under H.R. 525, however, the State would have no authority to ensure
that Federal association health plans provide these benefits and
consumer protections.
By taking away these vital patient protections, the policies
purchased under AHPs would be worth little more than the paper they are
printed on.
The amendment offered by our colleagues Mr. Kind and Mr. Andrews
would correct many of the flaws in this legislation.
Specifically, the alternative would allow small businesses to
purchase insurance through a Small Employees Health Benefit Plan--
similar to the Federal employees health plan.
The Kind/Andrews amendment would ensure that the quality of health
plans is protected; that low income employees have assistance in
purchasing policies; and that the smallest of small businesses get the
additional assistance they need.
As a former small business employee charged with choosing my
company's health plan, I am all too aware of the need for the
assistance outlined in the Kind/Andrews amendment.
The employees choosing these health plans for small businesses most
often are not human resources or insurance professionals.
The coverage and benefit mandates enacted by State legislatures
ensure that small businesses won't fall victim to sham policies and
that their employees can depend on quality health insurance when an
illness strikes.
Because H.R. 525 eviscerates these assurances by preempting the laws
enacted by State legislatures, I urge my colleagues to oppose the
underlying bill and support the Kind/Andrews alternative.
Mr. BACA. Mr. Speaker, I rise in opposition of H.R. 525 and the
association health plans it creates.
There are 44 million Americans who are uninsured in this country and
this bill will not even affect 1 percent of them. Not 1 percent.
CBO found that only 360,000 uninsured Americans would join AHPs.
This bill in fact hurts those who enroll in the plans and will even
cause healthcare costs to go up for many other Americans.
There has to be a better way to help 44 million uninsured Americans.
AHPs will not be accountable to State health regulations. This will
leave consumers who enroll in these plans without protection or a right
to appeal if their cancer or diabetes treatment or medicines are
denied.
We cannot let AHPs become bargain basement plans that enroll only the
healthiest Americans. What will happen to our sick, elderly and those
with severe health conditions?
Twenty million Americans will face higher healthcare costs. Twenty
million.
Health insurers will give breaks to the AHPs and charge other
consumers more. Studies show that these higher healthcare costs could
cause up to 10,000 Americans to become insured.
There is a better way to help small businesses and the uninsured.
H.R. 525 will not help small businesses or their employees. This is a
shortsighted plan that does nothing to cover the 44 million uninsured
Americans who cannot afford to get sick.
Mr. BOEHNER. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Rehberg). All time for debate on the
bill has expired.
Amendment in the Nature of a Substitute Offered by Mr. Kind
Mr. KIND. Mr. Speaker, I offer an amendment in the nature of a
substitute.
The SPEAKER pro tempore. The Clerk will designate the amendment in
the nature of a substitute.
The text of the amendment in the nature of a substitute is as
follows:
Amendment in the nature of a substitute offered by Mr.
Kind:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Small
Business Affordable Health Insurance Act of 2005''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Establishment of Small Employer Health Benefits Program
(SEHBP).
``Part 8--Small Employer Health Benefits Program (SEHBP)
``Sec. 801. Establishment of program.
``Sec. 802. Premium assistance for small employers and their employees.
``Sec. 803. Qualified State health pooling arrangements.
``Sec. 804. Establishment of national health pooling arrangement.
``Sec. 805. Coordination and consultation.
``Sec. 806. Public education.
``Sec. 807. Funding for premium assistance and pooling arrangements.
Sec. 3. Institute of Medicine study and report.
SEC. 2. ESTABLISHMENT OF SMALL EMPLOYER HEALTH BENEFITS
PROGRAM (SEHBP).
(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--SMALL EMPLOYER HEALTH BENEFITS PROGRAM (SEHBP)
``SEC. 801. ESTABLISHMENT OF PROGRAM.
``(a) In General.--The Secretary shall establish, in
accordance with this part, a program (to be known as the
`Small Employer Health Benefits Program' or `SEHBP')
providing--
``(1) access to qualified health pooling arrangements
(consisting of both qualified State health pooling
arrangements and a national health pooling arrangement) under
which self-only and family coverage is offered to small
employers and their employees, and
``(2) premium assistance to small employers and their
employees to assist with the payment of premiums incurred for
coverage offered under such arrangements.
``(b) Limitations.--
``(1) Employer must bear 50 percent of cost.--Premium
assistance shall not be provided under this part with respect
to premiums incurred for any period for coverage under a
qualified health pooling arrangement unless at least 50
percent of the premiums are paid by the employer.
``(2) 10-year period of coverage.--Premium assistance shall
be provided under this part only with respect to coverage for
the 10-year period beginning on the date the employer first
begins participating in a qualified health pooling
arrangement.
``(3) Employers offering other health benefits.--In the
case of an employer who paid or incurred any expenses for
health benefits for the employees of such employer during the
first calendar year ending on or after the date of the
enactment of this section, premium assistance shall be
provided under this part only if the employer begins
participating in a qualified health pooling arrangement
during the 2-year period beginning on the later of--
``(A) the date of the enactment of this section, or
``(B) the first date that a qualified health pooling
arrangement exists which allows such employer to participate.
``(4) Participation requirements.--Premium assistance shall
not be provided under this part with respect to premiums
incurred for any period unless at all times during such
period coverage for health benefits under a qualified health
pooling arrangement is available to all employees of the
employer under similar terms, except that, under regulations
of the Secretary--
``(A) coverage under the arrangement may exclude employees
with less than 90 days of service with the employer, and
``(B) in the case of an employee serving in a position in
which service is customarily less than 1,000 hours per year,
the reference in paragraph (1) to `50 percent' shall be
deemed a percentage reduced to a percentage that bears the
same ratio to 50 percent as the number of hours of service
per year customarily in such position bears to 1,000.
``(5) Amounts paid under salary reduction arrangements.--No
amount paid or incurred pursuant to a salary reduction
arrangement shall be taken into account under subsection (a).
``(c) Definitions and Special Rules.--For purposes of this
part--
``(1) Small employer.--
``(A) In general.--The term `small employer' means an
employer who normally employed not more than 100 employees on
a
[[Page H6498]]
typical business day during the preceding calendar year
(determined under rules similar to the rules applicable under
section 601(b)).
``(B) Employers not in existence in preceding year.--In the
case of an employer which was not in existence throughout the
preceding calendar year, the determination of whether such
employer is a small employer shall be based on the number of
employees that it is reasonably expected such employer will
normally employ on business days in the current calendar
year.
``(C) Predecessors.--The Secretary may prescribe
regulations which provide for references in this paragraph to
an employer to be treated as including references to
predecessors of such employer.
``(D) Permanent status as small employer.--In the case of
an employer who meets the requirements of this paragraph with
respect to the calendar year in which such employer first
begins participating in a qualified health pooling
arrangement, such employer shall not fail to be treated as a
small employer for any subsequent calendar year.
``(2) Family coverage.--The term `family coverage' means
coverage for health benefits of the employee and qualified
family members of the employee (as defined in section 35(d)
of the Internal Revenue Code of 1986, but without regard to
the last sentence of paragraph (1) thereof).
``(3) Qualified health pooling arrangement.--The term
`qualified health pooling arrangement' means a qualified
State health pooling arrangement described in section 802 or
the national health pooling arrangement described in section
803.
``(4) Entities under common control.--
``(A) Controlled group of corporations.--All employees of
all corporations which are members of the same controlled
group of corporations shall be treated as employed by a
single employer. In any such case, the total premium
assistance (if any) provided to each member of the controlled
group and the total premium assistance (if any) provided to
its employees shall be its proportionate share of the wages
paid to all employees of members of the controlled group. For
purposes of this subparagraph, the term `controlled group of
corporations' has the meaning given to such term by
subsection (a) of section 1563 of the Internal Revenue Code
of 1986, except that--
``(i) `more than 50 percent' shall be substituted for `at
least 80 percent' each place it appears in subsection (a)(1)
of such section 1563, and
``(ii) the determination shall be made without regard to
subsections (a)(4) and (e)(3)(C) of such section 1563.
``(B) Employees of partnerships, proprietorships, etc.,
which are under common control.--Under regulations prescribed
by the Secretary--
``(i) all employees of trades or business (whether or not
incorporated) which are under common control shall be treated
as employed by a single employer, and
``(ii) the total premium assistance (if any) provided to
each trade or business and the total premium assistance (if
any) provided to its employees shall be its proportionate
share of the wages paid to all employees of such trades or
business under common control.
The regulations prescribed under this subparagraph shall be
based on principles similar to the principles which apply in
the case of subparagraph (A).
``SEC. 802. PREMIUM ASSISTANCE FOR SMALL EMPLOYERS AND THEIR
EMPLOYEES.
``(a) Employer Premium Assistance.--
``(1) In general.--Pursuant to section 801(a)(2), the
Secretary shall provide to small employers who are eligible
under paragraph (3) and who elect to provide for coverage of
their employees under a qualified health pooling arrangement
premium assistance for premiums paid by the employer for such
coverage with respect to employees whose individual income
(as determined by the Secretary) is at or below 200 percent
of the poverty line (as defined in section 673(2) of the
Community Services Block Grant Act (42 U.S.C. 9902(2)),
including any revision required by such section) for an
individual.
``(2) Premium assistance scaled according to size of
employer.--The premium assistance provided under paragraph
(1) shall be designed so that the premium assistance equals,
for any calendar year--
``(A) 50 percent of the portion of the premium payable by
the employer for the coverage, in the case of small employers
who employ an average of fewer than 11 employees on business
days during the preceding calendar year;
``(B) 35 percent of the portion of the premium payable by
the employer for the coverage, in the case of small employers
who employ an average of more than 10 employees but fewer
than 26 employees on business days during the preceding
calendar year; and
``(C) 25 percent of the portion of the premium payable by
the employer for the coverage, in the case of small employers
who employ an average of more than 25 employees but fewer
than 51 employees on business days during the preceding
calendar year.
``(3) eligible employers.--A small employer is eligible
under this paragraph if such employer--
``(A) normally employed fewer than 25 employees on a
typical business day during the preceding calendar year
(determined under rules similar to the rules applicable under
section 601(b)), and
``(B) paid such employees during such year at an average
annual rate of income (consisting of wages and salary) per
employee which was at or below the median income (as
determined by the Secretary for the most recent calendar year
for which data are available as of the end of the preceding
calendar year) for an individual residing in the State in
which the employer maintains its principal place of business.
``(b) Employee Premium Assistance.--
``(1) In general.--Pursuant to section 801(a)(2), the
Secretary shall provide to employees of small employers
premium assistance for premiums for coverage under qualified
health pooling arrangements paid by such employees in the
case of employees whose family income (as determined by the
Secretary) is at or below 200 percent of the poverty line (as
defined in section 673(2) of the Community Services Block
Grant Act (42 U.S.C. 9902(2)), including any revision
required by such section) for a family of the size involved.
``(2) Amount of premium assistance.--Such premium
assistance shall be in an amount equal to the excess of the
portion of the total premium for coverage otherwise payable
by the employee under this part for any period, over 5
percent of the family income (as determined under paragraph
(1)(A)) of the employee for such period.
``(3) Coordination of premium assistance.--Notwithstanding
paragraph (1), under regulations of the Secretary, the total
premium assistance to which any employee may be provided
under this subsection for any period shall be reduced (to not
less than zero) by the total amount of subsidies for which
such employee is eligible for such period under any Federal
or State health insurance subsidy program (including a
program under title V, XIX, or XXI of the Social Security
Act). For purposes of this paragraph, an employee is
`eligible' for a subsidy under a program if such employee is
entitled to such subsidy or would, upon filing application
therefore, be entitled to such subsidy.
``(4) Authority to expand eligibility.--The Secretary may,
to the extent of available funding, provide for expansion of
the premium assistance program under this subsection to
employees whose family income (as defined by the Secretary)
is at or below 300 percent of the poverty line (as determined
under paragraph (1)).
``(c) Procedures.--The Secretary shall establish by
regulation applications, methods, and procedures for carrying
out this section, including measures to ascertain or confirm
levels of income.
``SEC. 803. QUALIFIED STATE HEALTH POOLING ARRANGEMENTS.
``(a) Defined.--For purposes of this part, the term
`qualified State health pooling arrangement' means an
arrangement established by a State which meets the following
requirements:
``(1) Coverage provided by health insurance issuer.--The
health benefits coverage is provided by a health insurance
issuer (as defined in section 733(b)(2)).
``(2) Health benefits coverage.--The arrangement provides
health benefits coverage that the Secretary determines is
substantially similar to the health benefits coverage in any
of the four largest health benefits plans (determined by
enrollment) offered under chapter 89 of title 5, United
States Code.
``(3) Group health plan requirements.--The health benefits
coverage provided under the arrangement meets the
requirements applicable to a group health plan under this
title and State law.
``(4) Guaranteed issue and renewable.--The arrangement does
not deny coverage (including renewal of coverage) with
respect to employees of any eligible small employer or
qualifying family members of such employees on the basis of
health status of such employees or family members or any
other condition or requirement that the Secretary determines
constitutes health underwriting.
``(5) No preexisting condition exclusion.--The arrangement
does not permit a preexisting condition exclusion as defined
under section 701(b)(1).
``(6) No underwriting; community-rated premiums.--(A)
Subject to subparagraph (B), the arrangement does not permit
underwriting, through a preexisting condition limitation,
differential benefits, or different premium levels, or
otherwise, with respect to such coverage for employees or
their qualifying family members.
``(B) The premiums charged for such coverage are community-
rated for individuals without regard to health status.
``(7) No riders.--The arrangement does not permit riders to
the health benefits coverage.
``(8) Accessibility to eligible small employers.--The
arrangement makes such coverage available to an eligible
small employer without regard to whether premium assistance
is available under section 802 with respect to such employer
or its employees.
``(9) Minimum of two plans offered under the arrangement.--
The arrangement makes available at least two alternative
forms of health benefits coverage.
``(b) Limitation on Enrollment Periods.--A qualified State
health pooling arrangement may provide limits on the periods
of times during which employees may elect coverage offered
under the arrangement, but the arrangement shall not be
treated as meeting the requirements of this section unless
the arrangement provides for at least
[[Page H6499]]
annual open enrollment periods and enrollment at the time of
initial eligibility to enroll and upon appropriate changes in
family circumstances.
``(c) Qualifying Family Member.--For purposes of this part,
the term `qualifying family member' has the meaning given
such term in section 35(d) of the Internal Revenue Code of
1986, applied without regard to the last sentence of
paragraph (1) thereof.
``(d) State Defined.--For purposes of this part, the term
`State' includes the District of Columbia, Puerto Rico, the
Virgin Islands of the United States, Guam, American Samoa,
and the Northern Mariana Islands.
``(e) Construction.--Nothing in this section shall be
construed as requiring a State to establish or maintain a
qualified State health pooling arrangement.
``(f) Creditable Coverage for Purposes of HIPAA.--Health
benefits coverage provided under a qualified State health
pooling arrangement under this section (and coverage provided
under a National Pooling Arrangement under section 803) shall
be treated as creditable coverage for purposes of part 7.
``(g) Annual Reports.--
``(1) In general.--Each State that offers a qualified State
health pooling arrangement under this section in a year shall
submit, in a form and manner specified by the Secretary, a
report on the operation of the arrangement in that year.
``(2) Contents of report.--Reports required under paragraph
(1) shall include the following:
``(A) A description of the health benefits coverage offered
under the arrangement.
``(B) The number of employers that participated in the
arrangement.
``(C) The number of employees and qualifying family members
of employees who received health benefits coverage under the
arrangement.
``(D) The premiums charged for the health benefits coverage
under the arrangement.
``(3) Certification.--Each State that offers a qualified
State health pooling arrangement under this section in a year
shall submit, in a form and manner specified by the
Secretary, a certification that the arrangement meets the
requirements of this part.
``(h) Negotiations to Lower Health Care Costs.--The
Secretary and States offering qualified State health pooling
arrangements may collectively negotiate for lower prices for
medical services, supplies, equipment, and pharmaceuticals
for the purpose of lowering the health care costs to
employers and employees served by such arrangements.
``(i) Coordination With State Regulation.--Nothing in this
section shall be construed as preempting provisions of State
law that provide protections in excess of the protections
required under this section. The Secretary shall coordinate
with the insurance commissioners for the various States in
establishing a process for handling and resolving any
complaints relating to health benefits coverage offered under
this part, to the extent necessary to augment processes
otherwise available under State law.
``SEC. 804. ESTABLISHMENT OF NATIONAL HEALTH POOLING
ARRANGEMENT.
``(a) In General.--The Secretary shall provide for the
offering and oversight of a national health pooling
arrangement to eligible small employers.
``(b) National Health Pooling Arrangement Defined.-- For
purposes of this section, the term `national health pooling
arrangement' means an arrangement under which health benefits
coverage is offered under terms and conditions that meet the
requirements of section 803(a).
``(c) Use of FEHBP Model.--The Secretary shall provide for
the national health pooling arrangement using the model of
the Federal employees health benefits program under chapter
89 of title 5, United States Code, to the extent practicable
and consistent with the provisions of this part. In carrying
out such model, the Secretary shall, to the maximum extent
practicable, negotiate the most affordable and substantial
coverage possible for small employers.
``(d) Limitation on Enrollment Periods.--The Secretary may
provide limits on the periods of times during which employees
may elect coverage offered under the national health pooling
arrangement, but the Secretary shall provide for at least
annual open enrollment periods and enrollment at the time of
initial eligibility to enroll and upon appropriate changes in
family circumstances.
``(e) Authorizing Use of States in Making Arrangements for
Coverage.--In lieu of the coverage otherwise arranged by the
Secretary under this section, the Secretary may enter an
arrangement with a State under which a State arranges for the
provision of qualifying health insurance coverage to eligible
small employers in such manner as the Secretary would
otherwise arrange for such coverage.
``SEC. 805. COORDINATION AND CONSULTATION.
``(a) Coordination of State and National Programs.--The
Secretary shall provide by regulation for coordination of the
offering under this part of health benefits coverage to
employees of small employers under State health pooling
arrangements and the offering under this part of such
coverage to such employees under the national health pooling
arrangement.
``(b) Consultation.--In carrying out the provisions of this
part, the Secretary shall consult with the Secretary of
Health and Human Services and the Director of the Office of
Personnel Management.
``SEC. 806. PUBLIC EDUCATION.
``The Secretary shall maintain an ongoing program of public
education under which the Secretary shall--
``(1) publicize the national health pooling arrangement
established under section 804, and
``(2) assist, and participate with, the States in
publicizing the qualified State health pooling arrangements
established under section 803.
``SEC. 807. FUNDING FOR PREMIUM ASSISTANCE AND POOLING
ARRANGEMENTS.
``(a) Premium Assistance.--There are authorized to be
appropriated to the Secretary such sums as may be necessary
to provide for premium assistance under section 802.
``(b) Grants to States Establishing and Operating Qualified
State Health Pooling Arrangements.--The Secretary may provide
for grants to States to establish and operate qualified State
health pooling arrangements described in section 803. There
are authorized to be appropriated to the Secretary such sums
as may be necessary to provide such grants.
``(c) Funding for National Health Pooling Arrangement and
Other Duties of the Secretary.--There are authorized to be
appropriated to the Secretary such sums as may be necessary
to provide for the offering and operation of the national
health pooling arrangement under section 804 and to carry out
the other duties of the Secretary under this part.''.
(b) 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--Small Employer Health Benefits Program (SEHBP)
``Sec. 801. Establishment of program.
``Sec. 802. Premium assistance for small employers and their employees.
``Sec. 803. Qualified State health pooling arrangements.
``Sec. 804. Establishment of national health pooling arrangement.
``Sec. 805. Coordination and consultation.
``Sec. 806. Public education.
``Sec. 807. Funding for premium assistance and pooling arrangements.''.
SEC. 3. INSTITUTE OF MEDICINE STUDY AND REPORT.
(a) Study.--The Secretary shall enter into an arrangement
under which the Institute of Medicine of the National Academy
of Sciences shall conduct a study on the operation of
qualified State health pooling arrangements under section 803
of the Employee Retirement Income Security Act of 1974 and
the national health pooling arrangement under section 804 of
such Act.
(b) Matters Studied.--The study conducted under subsection
(a) shall include the following:
(1) An assessment of the success of the arrangements.
(2) A determination of the affordability of health benefits
coverage under the arrangements for employers and employees.
(3) A determination of the access of small employers to
health benefits coverage.
(4) A determination of the extent to which part 8 of
subtitle B of title I of the Employee Retirement Income
Security Act of 1974 provides premium assistance for eligible
small employers (and premium assistance for employees of such
employers) that provided (or would have provided) health
benefits coverage in the absence of such premium assistance.
(5) Recommendations with respect to--
(A) extension of the period for which the premium
assistance under part 8 of subtitle B of title I of the
Employee Retirement Income Security Act of 1974 is available
to employers and employees or an appropriate phase-out of
such premium assistance over time;
(B) expansion of categories of persons eligible for such
premium assistance;
(C) expansion of persons eligible for health benefits
coverage under the arrangements; and
(D) such other matters as the Institute determines
appropriate.
(c) Report.--Not later than January 1, 2010, the
Comptroller General shall submit to the Congress a report on
the study conducted under subsection (a).
Amend the title so as to read: ``A bill to amend title I of
the Employee Retirement Income Security Act of 1974 to
encourage small employers to offer affordable health coverage
to their employees through qualified health pooling
arrangements, to encourage the establishment and operation of
these arrangements, and for other purposes.''.
The SPEAKER pro tempore. Pursuant to House Resolution 379, the
gentleman from Wisconsin (Mr. Kind) and a Member opposed each will
control 30 minutes.
The Chair recognizes the gentleman from Wisconsin (Mr. Kind).
Mr. KIND. Mr. Speaker, I yield myself 5 minutes.
Mr. Speaker, this morning we fortunately witnessed the successful
take-off of the latest space shuttle mission into space, and I, and I
know all my colleagues, our thoughts and prayers go with that crew and
their families. We wish them a successful mission and a safe return
here to Earth at the conclusion of that mission.
[[Page H6500]]
But, Mr. Speaker, ``Houston, we have got a problem'' right here on
Earth today, and that problem we all can agree to is the rising cost of
health care, the impact that it is having on businesses large and
small, family farmers, individual employees. It is a crisis that has
been building through a number of years, and there is nothing more
heart-wrenching or gut-wrenching than to speak to young parents who
have a young child in desperate need of emergency medical attention,
having to take that child to the hospital knowing that they do not have
adequate health care coverage to provide for their sick child.
{time} 1645
Today, one of the major factors for individual and personal
bankruptcies is health care-related costs. There is also nothing more
disheartening than speaking to the multitude of small business owners
throughout this country who would love nothing better than to be able
to extend affordable health care coverage to their employees; but they
cannot because it is too expensive.
I think we can all agree to the fact that this is something that we
have to have focused attention to alleviate the high costs of health
care and the growing ranks of the uninsured, which is roughly 45
million to 48 million today. When we think about who comprises these 45
million to 48 million uninsured, the vast majority of them are working
Americans, working in small businesses who cannot afford to provide
coverage. Again, it is something we all recognize, because we hear
about it daily when we are back home traveling in our congressional
districts. So, yes, action is needed; but there is a right way and a
wrong way in taking action.
A wrong way would be doing more harm than good in passing legislation
and, for the previous hour, we have had a discussion in regard to the
deficiencies and the shortfalls of the underlying associated health
plans bill. That is why over 1,400 organizations around the country
have come out in opposition to it.
But today, the gentleman from New Jersey (Mr. Andrews) and I are
offering the right way, an alternative way, another approach to dealing
with the health care crisis that our small businesses are facing, one
that we believe would extend health care coverage to millions of
Americans, while keeping a lid on the rising premium costs.
What it does, in essence, Mr. Speaker, is it builds upon the
successful framework that the Federal Employees Health Benefits Program
has offered to countless Federal employees throughout the country. It
is a purchasing pool concept that they can enter into, with the
competition of the marketplace and different insurance plans competing
for that business that has proven to be extremely cost effective in not
only extending coverage to millions of Federal employees, but also by
guaranteeing the State protections and consumer protections that have
been passed by State legislatures throughout the country.
Mr. Speaker, it is one of the more amazing aspects of this debate
that the party that claims to be for States' rights and tries to take
political advantage of saying, listen, States, we stand for you and
what you decide to do on a policy level, is so quick to jettison
States' rights when it becomes politically inconvenient for their
political allies, and that is exactly what is going on here today with
the proposed associated health plans, which will preempt and trump the
public policy decisions that have been made throughout this country by
State legislatures.
Now, our plan also would offer a minimum guarantee of coverage, one
that the Federal Employee Health Plan currently does. It does not
preempt the consumer protections and the State laws that have been
passed. And the reason those State laws have been passed throughout the
years is because the free marketplace and the insurance companies
competing for the business were not offering this type of coverage, and
that is why the State legislatures, in working with the Governors, had
to pass legislation requiring certain minimal safeguards of health care
coverage. So if a State legislature has felt in the past that it is
necessary to require prenatal care, for instance, or to prohibit drive-
through deliveries, or to require screening for diabetes, autism,
cancer, they have chosen to do so; and it has made sense for those
States that have.
But, instead, this one-size-fits-all approach comes in and tries to
preempt what the States have been doing for many, many years.
But what is also different with our substitute is it actually offers
premium support payments to make it more affordable to small businesses
to offer health care coverage to their employees, something that the
underlying AHP plan is silent on. Again, an analysis of our bill would
show that it would actually increase the coverage of the uninsured,
help premium prices come down by building on this purchasing-pool
concept, but also maintaining important and safe consumer protections.
There is a reason why the National Governors Association and the States
attorneys general have opposed the underlying bill. It is for all of
these reasons, and we would respectfully submit the right approach is
the substitute that we are offering today.
Mr. Speaker, I reserve the balance of my time.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I rise in opposition to the
amendment in the nature of a substitute.
The SPEAKER pro tempore (Mr. Rehberg). The gentleman from Texas (Mr.
Sam Johnson) is recognized for 30 minutes.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, as the number of uninsured Americans continues to
increase and health insurance costs continue to rise by double digits
annually, it is clear that something must be done. I commend our
friends across the aisle for coming up with a plan they think works.
While I have great respect for the gentleman from New Jersey (Ranking
Member Andrews) and the gentleman from Wisconsin (Mr. Kind), I have to
disagree with them. Their substitute will have the unintended
consequence of raising, not lowering, costs for small businesses trying
to offer health insurance. It will impose new mandates on employers and
saddle the American public with yet another government program to fund.
The proponents of the plan claim that the new ``small employer health
benefits plan'' is modeled after ours here in the Federal Government.
Unfortunately, unlike the Federal Employee Health Benefit Plan, health
insurance provided under the Democrat substitute would be subject to
more than 1,500 State mandates that make up 15 percent of the rising
costs of health insurance. That increased cost would likely be funded
by higher taxes, adding another burden to small businesses. And on top
of that, the substitute would force small businesses to deal with a
host of new mandates.
Their substitute mandates employers provide health coverage to every
employee who has been employed for more than 3 months. It mandates that
employers pay 50 percent of the health care premiums for employees. It
mandates that they cover the dependents of their workers. More mandates
are supposed to lower costs? The Democrat substitute just does not make
sense.
In contrast, AHPs utilize the strengths of the employer-based system,
the private market, competition, economy of scale enjoyed by large
union and employer plans, and ERISA's preemption of State mandates, to
lower costs. Mr. Speaker, AHPs are supported by our Nation's small
businesses. The NFIB, the National Retail Federation; the National
Association of Wholesalers and Distributors; the National Restaurant
Association; Associated Builders and Contractors; National Association
of Homebuilders; the United States Chamber of Commerce, and others are
strongly supportive of this legislation.
I hope my colleagues will join me in offering assistance to our
Nation's small businesses and their workers by supporting AHPs and
opposing the Democrat substitute.
Mr. Speaker I reserve the balance of my time.
Mr. KIND. Mr. Speaker, at this time I yield 4 minutes to the
gentlewoman from Colorado (Ms. DeGette), a person who certainly
appreciates the role of States and consumer protection in this health
care debate.
Ms. DeGETTE. Mr. Speaker, I rise today to urge a ``no'' vote on H.R.
525 and a ``yes'' vote on the Kind-Andrews substitute.
[[Page H6501]]
This debate is, frankly, misdirected. The question is not who
recognizes that there is a health care crisis in this country and who
does not. This is not a contest to see who among us truly understands
that small businesses are finding themselves in an increasingly
difficult predicament when it comes to providing health care insurance
for their employees.
We all care about this issue, and we all have constituents who need
help affording health care insurance. Small businesses, which do face
unique challenges across the board compared to large corporations, are
the backbone of our economy; and we should be doing more to help them.
And providing better and more health care coverage is one of the
biggest problems they face today.
So I ask our friends on the other side of the aisle, why do we have
before us a bill that does nothing to really address the problem for
small businesses and very well may end up hurting the people who we say
we are trying to help? There is a reason why the National Governors
Association and 41 attorneys general are against this bill. There is a
reason why numerous advocacy associations, consumer groups, and others
oppose this misguided legislation.
This bill has been hailed as the answer to covering many of the 45
million Americans who are currently uninsured; but in truth, a very
small percentage of the population would be helped in any way. This is
because association health plans would help a relatively small number
of the youngest and healthiest among us who will gain access to cheap
minimalist plans. But that would come at the expense of the vast
majority of workers whose premiums would actually increase. It would
also make it nearly impossible for those with previous health
challenges or chronic diseases to obtain any coverage at all.
Let me give an example. I am the cochair of the bipartisan Diabetes
Caucus in Congress. Forty-six States have mandated that insurance plans
must cover diabetic supplies? Why? One little vial of strips, test
strips costs $50, and insurance companies simply were not giving that
benefit in the past. That is why 46 of the 50 States said, you have to
pay for this. Now, if diabetics test their blood, long-term
complications like heart disease, kidney failure, end-stage renal
disease, all of those are eliminated; but they have to have insurance
coverage for these supplies. This legislation wipes out that
requirement. It says, you do not have to pay for that; you do not have
to follow that State law. That is not only wrong for those
beneficiaries who are diabetic; it is shortsighted in the long run for
the cost of our health care system.
We need to address the real access and affordability issues that
affect employees of small businesses, and the only way we can do that
is by passing the Kind-Andrews substitute. This substitute will give
small employers the ability to provide the same access to health
benefits as Federal employees. It will also allow States to establish
small employer health pools. It would also minimize adverse selection
and use state-licensed insurers without preempting State laws. Sounds
like a good substitute to me.
If we pass the substitute, we can make a true impact on the status of
millions of uninsured workers across this country; and for that reason,
I urge a ``no'' vote on H.R. 525 and a ``yes'' vote on the substitute.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield such time as he may
consume to the gentleman from Ohio (Mr. Boehner), the chairman of the
committee.
Mr. BOEHNER. Mr. Speaker, I thank my colleague for yielding me this
time to speak on the substitute that has been offered.
Now, if we think that having States regulate insurance in a small
group market is a problem with state-mandated benefits, this is the
mother of all complicated programs to offer health insurance, because
what are we going to do? We are going to have the Federal Government do
it. Now, none of us really believes that the Federal Government ought
to be in the business of running big-risk pools and offering plans to
small businesses.
Secondly, the bill is estimated, and it has changed from last year;
last year there was a $50 billion authorization, but it is still going
to cost an awful lot of money to do this bill.
One of the most damaging parts, though, is that each employer who
would take part in this plan that is being offered would still be
subjected to the State mandates on health insurance in their particular
State. There are 1,500 State-mandated health benefits around the
country. It also requires that the employer must pay at least 50
percent of the premium. In most cases, I would imagine the employer
would pay far more than that of the premium; but maybe it is a small
company, maybe it is five or six employees, and maybe together they
decide, we want to qualify for this, but we will each pick up our own
share of the cost. Why would we want to prohibit them from including
themselves in this by this type of a requirement?
It also says that every employer must offer this to every employee
who has worked at the company for 3 months. That seems like a very
short period of time, especially in some industries where you have an
awful lot of turnover where they would typically require that you wait
6 months before you would qualify. All this would do would be to drive
up the cost.
But one of the most amazing parts of this substitute, we would
subsidize this from the Federal Government and, for employers with 25
or fewer employees, we would give them a subsidy to help entice them
into this program. And, if you qualified, you qualify for a 10-year
period. Now, some small company with less than 25 employees may
qualify, may get the subsidy and may, over a course of several years,
become highly successful. But under this particular substitute, they
would still qualify for the subsidy.
{time} 1700
I do not think any of us believe that the Federal Government ought to
be operating a health insurance company. There are a lot of mechanisms
in the private market for this association health plan program to work.
And, again, why do we want to make the perfect the enemy of the good?
The underlying bill that we have will, in fact, work. It will allow
millions of Americans to get better-quality coverage at much more
competitive prices than what they get today.
So let us allow the underlying bill to go forward. Let us defeat the
substitute.
Mr. KIND. Mr. Speaker, I yield myself 1 minute to respond quickly,
just to clarify a couple of facts.
Mr. Speaker, I have all of the respect and admiration for the chair
of our committee, but a closer reading of the substitute bill would
not, in fact, require a Federal-run program; rather the Department of
Labor would contract out the State-licensed health insurance plans in
order to administer these programs.
But we do feel that there is a requirement or a necessity to offer
greater incentives and inducements for small businesses to offer this
coverage. That is why we are offering a premium support program with
it.
Mr. Speaker, I yield 5 minutes to the coauthor and codrafter of this
substitute amendment, the gentleman from New Jersey (Mr. Andrews).
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. Mr. Speaker, I thank my friend, the gentleman from
Wisconsin (Mr. Kind), for yielding me the time.
I think the best way to understand the difference between the plan
that the gentleman from Wisconsin (Mr. Kind) and I are putting forward
and the majority plan is to look at it from the point of view of one of
the small business people that we keep hearing referred to over and
over again here today.
My friend, the gentleman from Wisconsin (Mr. Obey), often refers to
speeches on the floor as posing for holy pictures, and I think that is
what is going on here today, where everyone is embracing the small
businessman or small businesswoman and saying how much we love them and
care about them, and I am sure everyone does. But I think what matters
is the impact of these various proposals, what the proposals would have
on the small business person.
In my State the cost of insuring a family is about $14,000 a year. So
let us
[[Page H6502]]
take a small business person that has 10 employees and is looking at a
situation where he or she would have to spend $140,000 to insure each
of those employees and their families if the employer was going to bear
the whole cost. That is a huge amount of money, but is probably well
beyond the ability of that employer to pay for.
Under the majority's bill, if we give the majority every benefit of
the doubt, if we assume that the majority's bill will work exactly as
they say that it will, the most optimistic forecast is the majority's
bill will save 13 percent in premiums for that employer. And let us
round it up a little bit and give them the benefit of the doubt further
and say it will save $2,000 per employee off that $14,000.
So what would happen? We would save $20,000, and the employer would
be looking at spending $120,000 to insure the families instead of
$140,000. That is not going to do it. That is still far more than the
person running a machine shop or a small retail store or landscaping
business or a delicatessen is ever going to be able to afford. This
just is not going to happen. It is not going to happen.
Our proposal is very different. It says that in a case of a small
business like the one I am hypothesizing here, where you have about 10
employees, and where those employees make less than 200 percent of the
poverty level, which in my State for a family of four would be about
$40,000, so just about anybody making less than $20 an hour or so would
be eligible for this kind of subsidy, that is most people. That is most
people. Under our plan that employer, if the employer chose to do this,
my friend a minute ago said that the employers were mandated to do
this, that is not so. No one is required to insure their employees
under this plan, but if the employer chooses to insure his or her
employees, what would happen is they would get a credit of $7,000 per
employee toward the cost of this health insurance, a 50 percent credit.
So the price of the coverage would drop from $140,000 down to $70,000.
That is still an awful lot of money. It is an awful lot of money for a
person running a small business, but it puts the person in reach of
maybe covering that family, particularly if they ask the family to
share with copays and deductibles and their own contribution.
Now, my friend, the gentleman from Ohio (Mr. Boehner), the chairman
of the full committee, said, my goodness, the Government will be
subsidizing small employers if we do this. It is big government. Well,
government already subsidizes health care for large employers, because
they permit the large employers to deduct every premium dollar. And
that employer is paying at the 36 or 37 percent corporate tax rate,
which most of them do. That constitutes a 36 or 37 percent subsidy. So
General Motors is getting a nearly 40 percent subsidy, but the person
running the delicatessen or the machine shop is not. This evens the
playing field.
Now, how do we pay for this? Now, the chairman knows that under the
rules of the House that it would not be appropriate or germane for us
to identify the source of paying for this, because it would take it
outside of the committee's jurisdiction.
There are different views as to how we could pay for this. I speak
only for myself when I say this, but I would note for the record that
the cost of tax breaks to companies that outsource their jobs outside
of the United States is $100 billion over the next 10 years. So if that
machine shop, if its competitor takes all of the jobs and moves them to
Malaysia or Mexico, gets a tax break for doing that, which I think is a
foolish policy, if we were to repeal that tax break for companies that
are outsourcing their jobs out of this country, that would go a long
way toward paying for the plan that we are talking about.
That to me is a pretty good trade-off. Companies that are sending
their jobs overseas would lose a tax break; companies here in America
would gain health insurance.
Vote yes on the Kind-Andrews substitute.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield 3 minutes to the
gentleman from Louisiana (Mr. Boustany).
Mr. BOUSTANY. Mr. Speaker, you know what we are trying to do here is
to make health care more affordable, available and accessible to all
Americans. It seems to me that if we are going to achieve this goal, we
have to adhere to some principles, and I can think of three right off
the bat that are very important. One is to provide information to the
consumer; second, choices to the consumer; and, thirdly, thirdly,
control to the consumer.
Now, this amendment that is being proposed seems to me that it is
going to limit choice rather than create choice. And I find it odd that
there is no mention of what its cost is going to be to the Federal
Government in putting forth these subsidies. I think we need to know
that information. I think it is very important information.
And it also seems to me that this program is going to add to the cost
of health care, and not lower the cost. What we need to do is foster
competition in health care, and right now 45 percent of all of the
health care dollars are within governmental systems, Medicare and
Medicaid and so forth. The other 55 percent is in the insurance market,
and there is no competition. There is no competition in this arena. And
so if we stick to these three principles I mentioned earlier, we can
create competition.
It seems to me that if we are going to give subsidies, why not give
subsidies to individuals to buy health savings accounts which provide
those choices which will allow for an information flow to the patient,
to the consumer?
And so I urge colleagues on both sides of the aisle to not support
this amendment and to vote for H.R. 525, which offers a good starting
point to creating competition in the health care market.
Mr. KIND. Mr. Speaker, I just recommend to the previous speaker that
he should talk to any Federal employee with regard to the choices that
they are offered under the Federal Employee Health Plan.
Mr. Speaker, I yield 2 minutes to the gentlewoman from Ohio (Mrs.
Jones), a person who would rather take millions of people off the ranks
of the uninsured rather than add a million people into the uninsured.
Mrs. JONES of Ohio. Mr. Speaker, first of all, I want to thank my
colleagues, the gentleman from Wisconsin (Mr. Kind) and the gentleman
from New Jersey (Mr. Andrews), for offering this substitute.
I live in the city of Cleveland. We have a great organization
representing many of our smaller enterprises called COSE, and COSE has
come together in an attempt to provide health care coverage to small
businesses.
I wanted to vote for a piece of legislation that will allow small
business to have insurance policies for their people, but I did not
want to vote for a plan that did not provide the same kind of coverage
that everybody else has, meaning that it did not have to be responsible
for State insurance regulations as did other policies.
So by presenting this amendment, the gentleman from Wisconsin (Mr.
Kind) and the gentleman from New Jersey (Mr. Andrews) have offered me
an opportunity to say to the small businesses in my community, I
support you, and I want to make sure you can provide health care
coverage to your employees.
What is also of particular concern to me is that offering something
that does not provide the same safeguards is like offering nothing. All
we have to do is go back and look at the MEWAs, the Multiple Employer
Welfare Arrangement, I guess that is what they call them, the Multiple
Employer Welfare Arrangements, which have been used by employers as
vehicles to provide benefits. The public record is filled with
instances where they have failed, left employees and employers alike
with unpaid medical bills.
Mr. Speaker, the other thing that we have to look at is, and the
prior speaker said something about subsidies, and you give them to
people, and they do not get anything in return. We gave subsidies to
the drug companies in the Medicare prescription drug bill, and they got
money that they did not even have to use towards a prescription
benefit. So do not talk to me about subsidizing anything.
Let us make sure that the people of America and the small businesses
have an opportunity to have health care. If we do preventive health
care, we would not have so many people coming into
[[Page H6503]]
hospitals with acute problems because they have not had any prevention.
It is so wonderful that we have a substitute that offers coverage to
small employers. Vote for the substitute and vote against H.R. 525, the
Small Business Fairness Act.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I reserve the balance of my
time.
Mr. KIND. Mr. Speaker, I yield 4 minutes to the gentleman from
Tennessee (Mr. Cooper).
Mr. COOPER. Mr. Speaker, I think the Rules Committee has made a
terrible mistake here, and not the usual Rules Committee sort of
mistake, because they have actually allowed to come to the floor a
substitute that is so clearly superior to the AHP bill it is amazing.
Now, let my friends on the other side understand, I am not against
AHPs. I am an original cosponsor of the gentleman from Texas (Mr.
Johnson's) legislation. AHPs would be an improvement over current
market conditions, which are appalling. But this plan put forward by
the gentleman from Wisconsin (Mr. Kind) and the gentleman from New
Jersey (Mr. Andrews) is better than AHPs, and let me describe some of
the ways.
First, the gentleman from Louisiana (Mr. Boustany) mentioned choice
earlier. Under the AHP approach, the average small business might be
able to offer their employees one or two insurance plans, and that
employee of the small business would have no idea whether their doctor
was going to be a apart of one of those plans. But under the Federal
employee approach, such as the one that we enjoy in this House of
Representatives, they could have 10 or 20 or more plans to choose from,
and the likelihood that their physician, their caregiver, would be part
of one or more of those plans increases substantially.
So when you are talking about unleashing the free market to work for
the individual, the Federal Employee Health Benefits-type plan, and
this would not infringe on Federal employees' benefits, but it would
set up a parallel organization that small businesses could benefit
from, the opportunities for the small businesses of America are
magnificent under this approach.
Another key aspect of this is the substitute approach is more likely
to work. AHPs are largely a thought experiment. They have never really
worked anywhere. But the Federal Employee Health Benefit System has
worked well for decades, 30 or 40 years of a magnificent track record
of experience. It has got bipartisan support. Men and women of goodwill
on both sides of the aisle know that this sort of approach works; it
lowers the sales load, it increases the risk pool to the maximum size
which you need for lower group rates.
It really is the fairest and best way to approach this nagging small
business problem that we have had. It is also going to be more
affordable, because while it lowers the sales load and increases the
size of the risk pool, it is fairer to all industries.
There are probably going to be a lot of insurance companies that want
to offer insurance to software companies, because those employees tend
to be young and healthy. How many are going to be eager to insure older
Rust Belt industries?
The tax credit approach that my friend has mentioned has had to be
adjusted for purposes of this substitute, but we need to acknowledge,
as my friend from New Jersey (Mr. Andrews) mentioned, health care is
already seriously subsidized in this country. All we are trying to do
is make that subsidy fairer.
I think also the substitute approach would make the system higher
quality. First of all, under AHPs, there would be minimal solvency
requirements. By completely overturning all State regulation, as AHPs
would do, that is a truly radical approach, and while my friends on the
other side may be radicals in this regard, I think they are going
further than they realize. These insurance plans need to be thoroughly
solvent. You need to have adequate capital requirements so that you
know the insurance is going to be there when you need it.
{time} 1715
I think you would have better benefits under this plan, too, because
you would have more proven traditional insurance policies that I think
more folks who work for small businesses are accustomed to.
Let me admit, Mr. Speaker, in closing, our approach is less famous.
Why? Because we do not have every PAC and trade association in
Washington, D.C. favoring this because they stand to personally benefit
from promoting AHPs to their members. They are desperate for non-dues
revenue for those associations.
For any tourist who comes to Washington, if you do not think these
PACs and trade associations are rich enough, come visit again. You will
see skyscrapers full of these folks all over town, and they would love
to make money as insurance salesmen to all the small businesses in
America. That is not doing justice for our folks back home.
As I say, AHPs are an improvement, but they are not as good as the
Kind-Andrews approach. Please vote for Kind-Andrews.
Mr. KIND. Mr. Speaker, how much time remains?
The SPEAKER pro tempore (Mr. Rehberg). The gentleman from Wisconsin
(Mr. Kind) has 9\1/2\ minutes remaining. The gentleman from Texas (Mr.
Sam Johnson) has 22 minutes remaining.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I reserve the balance of my
time.
Mr. KIND. Mr. Speaker, I yield 4 minutes to the gentleman from Rhode
Island (Mr. Kennedy), someone who understands the importance of
maintaining consumer protections as we have in our substitute bill.
Mr. KENNEDY of Rhode Island. Mr. Speaker, I thank the gentleman for
yielding me time.
As we all know, we are in a health care crisis and many propose many
solutions. But let us just find out the simple facts. Facts are,
insurance ratings are really dependent on the notion that some people
are higher risk than others. Those are the people that insurance
companies love to insure. They love to insure them because if they have
low risk, every dollar that they pay in terms of premium is another
dollar down on their bottom line of profit. However, if you are
unfortunate enough to be born with a congenital defect in your organs,
if you are unfortunate to be run over by a car, if you are struck by
some ailment that is out of any control that you have whatsoever, under
the insurance system you are known as a risk. Simply growing old titles
you as a risk.
Do you think an insurance company wants to cover you? Of course they
do not.
This is a zero sum game. If some get insurance, others get zero. But
the fact of the matter is we all pay. The notion that some people are
going to get away from paying, meaning some small businesses are going
to get away from paying, is just hogwash.
The fact of the matter is, we all know that when we pay our premiums,
we are paying for someone who is uninsured. We are paying for someone
who is underinsured. The way out of this problem is not to escape
giving people health insurance, which this legislation does. Of course
it is going to be cheaper if you do not pay for care. That should not
be a surprise to any of us. That is pretty obvious. If you want to get
lower insurance costs, let us just cut out treatment for cancer. That
will reduce insurance costs. Let us just cut out treatment for mental
health.
That is just what this act does. It says ``no State mandates'' which
means all the provisions, for example, for pregnant women to be able to
have at least 72 hours after giving birth, all those provisions that
States have put in for consumer protection, are no longer there under
this legislation because this obviates all those State requirements
that the people want in their insurance coverage. By joining the
insurance pool of Federal employees, we bring everyone under a
community rating, which means that we all pay our share, irrespective
of whether someone is healthy and young versus old and sick.
All of us should be paying our fair share unless you want to escape
paying for the notion that there but for the grace of God go you. The
fact of the matter is there but for the grace of God go you, someone
else, and I. All of us
[[Page H6504]]
have an obligation to those who have needs that need that health
insurance.
Why? Because it could be any one of us that is the person that is in
great need. And I do not think any one of us would be denied health
care coverage simply because as a human being we have greater health
care needs. And that is why I believe people ought to support the Kind
substitute. We ought to support people's access to the same coverage
all of us as Federal Members of Congress receive.
Thank you to my good friends, Mr. Kind and Mr. Andrews, for yielding
me this time to speak in support of this substitute, the Small Employer
Health Benefits Program, which will provide a real solution for many of
the forty-five million Americans without health insurance.
Mr. Speaker, our health care system is broken.
To live in a country as great and as wealthy as ours, and to have
millions of hard working, employed Americans who cannot afford quality
health insurance is inexcusable.
My friends from across the aisle would like the American people to
believe that Association Health Plans are the only available option to
relieve the burden of increased health care costs on small business
owners.
However, the fact remains that Association Health Plans not only
ignore the unique needs of small businesses, but will actually
undermine our insurance system by allowing healthy individuals to opt
out.
We shouldn't be making policy only for the fortunate. We should be
making policy for everybody.
The proposed substitute, the Small Employers Health Benefits Program,
would provide the same access to health benefits as the Federal
Employees Health Benefits Program, FEHBP.
If we are not ready to provide an overall solution to the Nation's
health care crisis, then why don't we at least extend small businesses
the courtesy of providing a plan that meets the same requirements that
Members of Congress and their families currently enjoy.
My colleagues on the other side of the aisle are right about one
thing, small business owners are facing a crisis. Now let's provide
them with a solution.
Mr. KIND. Mr. Speaker, I yield 2 minutes to the gentleman from
Maryland (Mr. Cardin), a person who has built up considerable health
care expertise from his position on the Committee on Ways and Means.
(Mr. CARDIN asked and was given permission to revise and extend his
remarks.)
Mr. CARDIN. Mr. Speaker, I oppose the underlying bill for many
reasons. Fundamentally, it violates the concept of federalism that is
embodied in our Constitution, respect for our States, and the ability
of our States to be able to regulate public safety issues and health
issues for the people of our States.
This legislation would preempt the ability of my State and your State
to protect the rights of our own citizens through regulation. That is
wrong. That is the wrong usurpation of power by the Federal Government.
This underlying legislation would adversely affect the people of
Maryland, and let me tell you why. Our legislature has passed small
market reform. People who work for companies that are between two and
50 employees have the opportunity to purchase insurance, affordable
health insurance in Maryland as a result of our small market reform.
The passage of this legislation will mean the end of the small market
reform and the opportunity to purchase insurance by small employers in
my State. That is wrong.
We are going to be moving in the wrong direction with making
affordable health insurance available for the people of this Nation.
Mr. Speaker, I want you to understand the Insurance Commissioner of
Maryland is a Republican. The Governor of Maryland, who opposes this
bill, is a Republican. This should not be a partisan issue. This should
be a matter about the appropriate use of the Federal authority and it
is being used wrong here.
I congratulate the gentleman from Wisconsin (Mr. Kind) for his
substitute which is sensitive to the rights of our States. I hope
Members will support the substitute and reject the underlying bill.
Mr. Speaker, as a member who is dedicated to protecting the rights of
Americans who have health insurance and to ensuring that opportunities
to secure affordable health insurance can be expanded, I rise in
opposition to H.R. 525. Since coming to Congress, I have heard
frequently from individuals who work in small business. They have
spoken to me about the difficulties that result from a lack of health
insurance coverage, skyrocketing premiums, and reductions in benefits.
I remain committed to developing solutions that will alleviate the
hardships faced by many Maryland families and small businesses.
However, the Association Health Plan (AHP) legislation we are
considering on the House floor today is not a viable solution. H.R. 525
would exempt AHPs from State laws and State regulatory oversight.
Through this special exemption, AHPs would be able to severely
undermine the goal of greater health care access and affordability for
Maryland residents. Although some supporters of this legislation claim
it will benefit small employers, the reality is that H.R. 525 will only
hurt the small business community.
H.R. 525 would leave the Maryland insurance commissioner powerless to
protect our citizens. Under this misguided bill, unregulated out-of-
state AHPs could operate in Maryland without being required to comply
with health care safeguards enacted by our state legislature, such as:
Appropriate access to emergency care. The right to independent appeal
of denied claims, Fair insurance premiums for small groups, Consumer
marketing protections, Prevention of health plan failures due to
insolvency.
Under this legislation, my constituents would not only lose their
ability to demand an independent review of denied claims, but they
would lose guaranteed access to important benefits such as emergency
medical treatment and mammography screenings. Workers who purchase
association health plan coverage--believing that they are getting
comprehensive insurance--may very well find that they would still have
to shoulder the costs of these essential services.
Not only would this bill be harmful to potential subscribers, it
would destroy the small group market reforms already in place in
Maryland. Twelve years ago, my home state of Maryland took a major step
toward helping small businesses afford health insurance for their
workers. Our reforms guarantee the availability of reasonably priced,
comprehensive health insurance for all small employers. Specifically,
Maryland requires all health insurers to sell a comprehensive standard
benefit package designed by an independent commission to all employers
with between 2 and 50 employees. The plan must have benefits that are
actuarially equivalent to those required to be offered by federally
qualified HMOs, and the average cost cannot exceed 12 percent of
Maryland's average annual wage. Insurers have the option of offering
additional benefits, but they must be priced separately. Insurers must
use adjusted community rating to price their plans, and they cannot
impose pre-existing condition limitations. The Maryland plan not only
guarantees the availability of reasonably priced insurance, it also
makes it easier for small employers to make ``apples to apples''
comparisons of health costs throughout the state.
Due to these reforms, more Maryland small businesses offer health
care coverage to their employees than in any surrounding states or in
the nation as a whole. Maryland's system is one in which healthy
subscribers subsidize those who are less healthy. These reforms work
because insurers are not allowed to ``cherry pick'' the businesses that
have the healthiest workers. Association health plans have been
outlawed in our state. The association health plan legislation before
us would undermine our system by using the lure of lower premiums to
attract firms whose workers have fewer health problems, firms whose
employees might be willing to forgo some of the consumer protections
offered under Maryland law. Businesses with older, sicker employees
would remain in the state system, driving up premiums. H.R. 525 would,
in effect, lead to the collapse of Maryland's system. I want to
emphasize that this is not a partisan issue--AHS's are opposed by my
own governor, our former colleague Robert Ehrlich, and by the National
Governors' Association, and the National Association of Insurance
Commissioners. I will submit for the Record an April 19 letter from
Alfred Redmer, Maryland's Insurance Commissioner, expressing his
opposition to H.R. 525.
This bill would be devastating on a national level, as well. The non-
partisan Congressional Budget Office found that premiums would increase
for 20 million employees and their dependents who are covered through
small firms, and that 100,000 of the sickest workers would lose
coverage altogether if this AHP legislation were enacted.
Passage of this legislation would be a disservice to every worker,
every family, and every small business in Maryland. H.R. 525 fails to
provide meaningful help for the uninsured, denies access to affordable
health care for older, less healthy groups, and undermines the crucial
consumer protections that our General Assembly has enacted. For these
reasons, I urge my colleagues to vote against this bill.
[[Page H6505]]
Mr. Speaker, the following is a letter from our insurance
commissioner who is opposed to H.R. 525:
Maryland Insurance Administration,
Baltimore, MD, April 19, 2005.
Hon. Benjamin L. Cardin,
House of Representatives,
Washington, DC.
Dear Congressman Cardin: As Commissioner of the Maryland
Insurance Administration I am writing to express my strong
opposition to federal legislation that would create
Association Health Plans, AHPs. I understand such
legislation, H.R. 525, has been passed, again, by the House
Education and the Workforce Committee and may soon come to
the floor of the House for a vote. H.R. 525 would allow AHPs
to form and operate in Maryland outside the authority of my
office and beyond the reach of proven State consumer
safeguards and solvency laws. If enacted into law, this could
do irreparable harm to our small group market and strip our
citizens of critical protections.
Altough I share the sponsor's concern for the growing
number of small business employees who cannot afford adequate
coverage, the fact is this legislation would do little, if
anything to address this problem. H.R. 525 ignores the root
cause of the current crisis--skyrocketing healthcare
spending. Unless spending is brought under control no
attempts to increase competition or enhance options for small
business will truly make insurance affordable and, thus,
promote coverage.
Even more troubling is the harm the legislation would do to
consumers, H.R. 525 would: (1) permit risk selection thereby
creating opportunities for ``cherry-picking'' among healthier
groups; (2) allow inadequate capital standards and solvency
requirements, both of which are inferior to existing State
standards; (3) eliminate proven State consumer protection
laws, including those designed to allow consumer appeals of
adverse plan decisions and those aimed at preventing and
fighting fraud; and (4) allow AHPs to ignore State benefit
requirements. To add insult to injury, while longstanding
State oversight and consumer protections would be eliminated,
H.R. 525 provides no additional resources to the Department
of Labor to regulate AHPs or help consumers.
I remain committed to improving access to affordable
insurance for small business owners and workers in Maryland.
Together, we can find solutions that will be effective and
not lead to greater problems in the future. H.R. 515 is
clearly not the answer and I urge you to oppose it.
Sincerely,
Al Redmer, Jr.,
Insurance Commissioner.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield 30 seconds to the
gentleman from Louisiana (Mr. Boustany).
Mr. BOUSTANY. Mr. Speaker, I would like to engage the gentleman from
Wisconsin (Mr. Kind) in a colloquy.
My question is, I think we need to know this information, what is the
cost of your amendment to the Federal Government?
Mr. KIND. Mr. Speaker, will the gentleman yield?
Mr. BOUSTANY. I yield to the gentleman from Wisconsin.
Mr. KIND. We are waiting to get a cost estimate back, but based on
two previous debates on this issue, it was comparable to the amount of
money set aside for the health savings account that has been a part of
this bill in the past, but is not this year.
Mr. BOUSTANY. I think we need to have that information. I am all for
choices and the gentleman's plan is intriguing, it is interesting; but
I think it may be premature.
Mr. SAM JOHNSON of Texas. Mr. Speaker, do I have the right to close?
The SPEAKER pro tempore. Yes.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I reserve the balance of my
time.
Mr. KIND. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I think there is wide agreement, bipartisan agreement
that we have got a serious issue on our hands, a huge challenge that is
facing our Nation, that is, rising health care costs and the impact it
is having on economic growth, the opportunities for businesses large
and small to grow and hire additional workers. I think it is one of the
main reasons why we have experienced such anemic job growth in this
country in recent years, because of the hesitancy of so many
businesses, especially small businesses to hire additional workers
because of the associated rising health care costs. It is something
that we must address in order to deal with an expanding economy at a
rate that we would all like to see, but also to get a grip on the
stagnant wages right now that are holding so many of our workers back.
I think there is a direct cause and effect whereas the typical
worker's wages have been frozen in effect in recent years because of
the additional costs coming out of their pockets to afford health care.
That is why, again, we have had an important debate today, but it is
one we should be working on in a bipartisan fashion to address the
underlying causes.
Volumes have been written about the underlying associated health plan
that is before us today. And, unfortunately, the verdict is in and that
verdict is this is just bad public policy. That is why so many of the
Governors and so many of the attorneys general, and the commissioners
of insurance, the Association of State Legislatures in a bipartisan
fashion have roundly criticized and condemned the underlying associated
health plan, because they feel as we do on this side that it will do
more harm than good.
I understand and appreciate the motivation on the other side to try
to move forward on this issue. But we are stuck. The wheels are stuck
in the mud, and it is just spinning because it is not getting any
traction. And that is because the Senate in their analysis of the
underlying bill has found that it, too, is bad public policy. And I am
afraid we are going to have this debate today, it is going to expire
and it is going to get stuck with no progress being made.
Perhaps there may be some deficiencies in what we are offering in our
substitute, just as we believe there are deficiencies in theirs. But
now is the time for us to come together to try to find some common
ground so we can make progress and deal with this issue that is
affecting more and more Americans every year.
One of the issues that really has not received that much attention,
and I would just like to close on and highlight it, is again the fact
of the Federal preemption and taking away from States the ability to
conduct proper oversight and accountability with these insurance plans.
Both the GAO in a study and a recent Georgetown University study that
came out this summer indicated that the underlying AHP bill, as it is
written with the weak provisions that would go to the Department of
Labor, would lead to an explosion of fraud and abuse with these types
of plans throughout the country. And there is a history of fraud and
abuse.
Currently, there are over 144 plans that are set up fraudulently that
are not paying the claims that are affecting well over 200,000 workers.
But for the effective oversight and the policing that is taking place
at the State level, even these would probably go unnoticed. It would
impact more and more Americans. It is another reason why the underlying
bill does not make sense, why the Federal preemption over State
jurisdiction, which has been the history of health care regulation in
this country, is another bad idea.
Our substitute addresses that by not preempting State law by allowing
the State jurisdiction and oversight to continue. It does build upon
the concept of a purchasing pool modeled after the Federal employee
health plan which, as was stated earlier, has worked marvelously over
the years. No one is recommending dismantling that.
I would encourage a ``yes'' on the substitute and a ``no'' on the
underlying bill.
Mr. Speaker, I yield back the balance of my time.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I yield myself the balance of
my time.
Mr. Speaker, we do not know the cost. It is going to be out of
reason, I believe. And while AHP legislation will be implemented
quickly, this Democrat substitute might take years to get up and
running.
In addition, the funds are subject to appropriations. And if an
appropriation did not go through or did not provide enough funds, small
employers and their workers would be left hanging.
Let me make myself clear. I believe our Nation's employer-sponsored
health care system is a success story. Employers provide coverage for
the vast majority of our Nation's population; 131 million Americans
obtain their coverage from private employers.
The Committee on Education and the Workforce and the Department of
Labor through our oversight of ERISA have jurisdiction over employer-
sponsored health care. So I support using
[[Page H6506]]
the employer-based system to address the problems of the uninsured.
{time} 1730
However, the way to do that is to build on the success of the current
system by utilizing the strengths that enable large employers and
unions to offer Cadillac health plans. AHPs are the way to do that.
Vote down this amendment. Vote for AHPs.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Rehberg). Pursuant to House Resolution
379, the previous question is ordered on the bill and on the amendment
in the nature of a substitute offered by the gentleman from Wisconsin
(Mr. Kind).
The question is on the amendment in the nature of a substitute
offered by the gentleman from Wisconsin (Mr. Kind).
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. KIND. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 197,
nays 230, not voting 6, as follows:
[Roll No. 424]
YEAS--197
Abercrombie
Ackerman
Allen
Andrews
Baca
Baird
Baldwin
Barrow
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Butterfield
Capps
Capuano
Cardin
Cardoza
Carnahan
Carson
Case
Chandler
Clay
Cleaver
Clyburn
Conyers
Cooper
Costa
Costello
Crowley
Cuellar
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Doyle
Edwards
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Ford
Frank (MA)
Gonzalez
Gordon
Green, Al
Green, Gene
Grijalva
Gutierrez
Harman
Hastings (FL)
Herseth
Higgins
Hinchey
Hinojosa
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick (MI)
Kind
Kucinich
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren, Zoe
Lowey
Lynch
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy
McCollum (MN)
McDermott
McGovern
McKinney
McNulty
Meehan
Meek (FL)
Meeks (NY)
Melancon
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Schakowsky
Schiff
Schwartz (PA)
Schwarz (MI)
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Snyder
Solis
Spratt
Stark
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Udall (CO)
Udall (NM)
Van Hollen
Visclosky
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
NAYS--230
Aderholt
Akin
Alexander
Bachus
Baker
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Bean
Beauprez
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Boren
Boustany
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Castle
Chabot
Chocola
Coble
Cole (OK)
Conaway
Cox
Crenshaw
Cubin
Culberson
Cunningham
Davis (KY)
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Drake
Dreier
Duncan
Ehlers
Emerson
English (PA)
Everett
Ferguson
Fitzpatrick (PA)
Flake
Foley
Forbes
Fortenberry
Fossella
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gilchrest
Gillmor
Gingrey
Gohmert
Goode
Goodlatte
Granger
Graves
Green (WI)
Gutknecht
Hall
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Hulshof
Hunter
Hyde
Inglis (SC)
Issa
Istook
Jenkins
Jindal
Johnson (CT)
Johnson (IL)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
Kuhl (NY)
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
McCaul (TX)
McCotter
McCrery
McHenry
McHugh
McIntyre
McKeon
McMorris
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Otter
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Poe
Pombo
Porter
Price (GA)
Pryce (OH)
Putnam
Radanovich
Ramstad
Regula
Rehberg
Reichert
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (NJ)
Smith (TX)
Sodrel
Souder
Stearns
Sullivan
Sweeney
Tancredo
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Turner
Upton
Velazquez
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Wynn
Young (AK)
Young (FL)
NOT VOTING--6
Cramer
Feeney
Gibbons
Owens
Oxley
Westmoreland
{time} 1753
Messrs. WYNN, WELLER, and SHERWOOD changed their vote from ``yea'' to
``nay.''
Mr. RUSH changed his vote from ``nay'' to ``yea.''
So the amendment in a nature of a substitute was rejected.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore (Mr. Hayes). The question is on the
engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
Motion to Recommit Offered by Mr. George Miller of California
Mr. GEORGE MILLER of California. Mr. Speaker, I offer a motion to
recommit.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. GEORGE MILLER of California. I am, Mr. Speaker.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. George Miller of California moves to recommit the bill
H.R. 525 to the Committee on Education and the Workforce with
instructions to report the same back to the House forthwith
with the following amendments:
Page 17, line 16, insert ``subsection (c) and'' before
``section 514(d)''.
Page 18, insert after line 6 the following:
``(c) Maintenance of State Laws Providing for Certain Forms
of Coverage .--Nothing in this part or section 514 shall be
construed to preclude the application of State law (as
defined in section 514(c)(1)) to an association health plan,
or any health insurance issuer offering health insurance
coverage in connection with the plan--
``(1) to the extent that such law requires coverage for the
expenses of--
``(A) pregnancy and childbirth, or
``(B) children's health services (including the application
of any such State law to the extent such law requires certain
numbers of child health supervision visits or requires
exemption of reasonable and customary charges for child
health supervision services from a deductible, copayment, or
other coinsurance or dollar limitation requirement),
``(2) to the extent that such law requires--
``(A) a minimum hospital stay for mastectomy,
``(B) coverage for reconstructive surgery following
mastectomies (in excess of coverage required under section
713), and
``(C) coverage for the expenses of screening and tests
recommended by a physician for breast cancer,
``(3) to the extent that such law requires--
``(A) coverage for medical treatments relating to cervical
cancer, and
``(B) coverage for the expenses of screening and tests
recommended by a physician for cervical cancer,
``(4) to the extent that such law requires--
``(A) the offering of, or coverage for, medical treatments
related to mental illness or substance abuse and other
services related to the treatment of mental illness or
substance abuse,
``(B) coverage for prescription medications associated with
the management of mental illness or substance abuse, or
``(C) education and self-management training services
relating to mental illness or substance abuse,
[[Page H6507]]
``(5) to the extent that such law requires--
``(A) coverage for medical treatments related to diabetes,
``(B) coverage for diabetes-specific supplies, including
blood glucose monitors, insulin pumps, insulin syringes, and
single-use medical supplies associated with the management of
diabetes,
``(C) coverage for prescription medications when prescribed
by a physician associated with the management of diabetes,
including insulin, or
``(D) diabetes education and self-management training
services, or
``(6) to the extent that such law imposes annual, lifetime,
or day and visit benefit minimums or limits copayments,
deductibles, or out-of-pocket or other coinsurance
requirements in connection with coverage, or items and
services, described in the preceding paragraphs of this
subsection.
Mr. GEORGE MILLER of California (during the reading). Mr. Speaker, I
ask unanimous consent that the motion to recommit be considered as read
and printed in the Record.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
The SPEAKER pro tempore. The gentleman from California (Mr. George
Miller) is recognized for 5 minutes in support of his motion to
recommit.
Mr. GEORGE MILLER of California. Mr. Speaker, I submit a motion to
recommit along with my colleagues on the Committee on Education and the
Workforce, the gentlewoman from New York (Mrs. McCarthy), the
gentlewoman from California (Ms. Woolsey), and the gentlewoman from
Minnesota (Ms. McCollum).
This motion shows exactly what the issue is about. It is about the
minimum standard of health care protection for all Americans, including
those who work for small businesses.
Mr. Speaker, all employees, including the employees of small
employers, may need access to pregnancy, to well-child care, to cancer
treatment, mental health treatment, or even diabetes treatment. We
should not encourage insurers to offer bare-bones treatment that does
not protect anyone.
Everyone gets sick at some point in their lives, and everyone will
need access to a meaningful package of benefits. That is why I am
offering this motion to recommit.
Mr. Speaker, I yield to the gentlewoman from New York (Mrs.
McCarthy).
Mrs. McCARTHY. Mr. Speaker, as we worked on this on the Committee on
Education and the Workforce, we tried to put our thoughts into it.
People have to understand, if the main bill is passed, health care for
our small employers is not going to help the majority of those
employees seeking coverage.
The recommittal goes back to what the States have already done,
mainly because in the beginning the insurance companies would not give
health care to women that needed to have a mammogram or to have a pap
smear to make sure they do not have cervical cancer.
This House spends money constantly on cancer research, and here we
are using a tool that we can prevent cancer and make sure that women
are treated earlier. With this bill, the mainline bill is taking that
away. I ask my colleagues, do not be fooled, stand up for your State.
Stand up for the health care of your constituents. That is what our job
is.
Mr. GEORGE MILLER of California. Mr. Speaker, I yield to the
gentlewoman from Minnesota (Ms. McCollum).
Ms. McCOLLUM of Minnesota. Mr. Speaker, I rise to support the motion
to recommit because AHPs are awful health plans. AHPs roll back State
benefit standards that protect women and children. They are awful for
women; they are awful for children.
Our motion protects Americans who have access to mental health
benefits. It protects families' access to maternity care and well-baby
checks.
{time} 1800
Maternity coverage is critical for women. It should not be optional.
Fortunately, many States require health plans to cover maternity care
and well-baby checks for their children. The bottom line is healthy
moms equal healthy children. Healthy children, valuing children's
lives, should be a goal we all share.
Children deserve a healthy start in life with regular visits to the
doctor and necessary immunizations. Preventive care makes economic
sense. It can prevent avoidable illness and reduce future health care
costs.
I encourage all Members to reject awful health plans and to support
the motion to recommit.
Mr. GEORGE MILLER of California. Mr. Speaker, I yield to the
gentlewoman from California (Ms. Woolsey).
Ms. WOOLSEY. Mr. Speaker, the preemption of State law that is allowed
under H.R. 525 makes no sense. For example, 49 States guarantee that
health insurance plans include mammograms, and for good reason. We know
that if a woman has health insurance, the likelihood she will receive a
mammogram is promising. We know that early detection increases a
woman's chance of surviving breast cancer. No one knows this better
than my constituents in Marin County, California, who suffer from the
highest rates of breast cancer in the country. They deserve more
protections from this deadly disease, not a rollback in coverage of the
most basic screening tool we have, mammograms. They are looking to
Congress to help more women get the services they need to catch this
disease before it becomes fatal. Instead, today we are telling them
that insurance companies are allowed to trump State law and decide what
is best for their health.
I am sure that all of the men and women here today want their wives,
sisters, mothers, and daughters to have annual screenings as
recommended by physicians. It is common sense. I urge each of my
colleagues, support the women in your lives. Support the motion to
recommit.
Mr. GEORGE MILLER of California. Mr. Speaker, I would hope that
people would support this motion to recommit. This is fundamental and
basic. It is about whether or not people will have coverage that works
for them when they or a member of their family becomes sick.
CBO has looked at this legislation three times, and three times they
have determined that almost 8 million people who today have health care
coverage that is good coverage, they will be stripped of that coverage
and put into these AHPs. In fact, they expect that 90 percent of the
new enrollees will be people who come out of better plans who will lose
that coverage that people have fought hard for in almost every State in
this Union, to have those kinds of health care protections that our
three colleagues just spoke about in support of this motion to
recommit.
I would urge the House to support the motion to recommit and reject
this legislation that is harmful to the health care coverage of
millions of Americans and their families.
Mr. BOEHNER. Mr. Speaker, I rise in opposition to the gentleman's
motion.
The SPEAKER pro tempore (Mr. Hayes). The gentleman is recognized for
5 minutes.
Mr. BOEHNER. Mr. Speaker, the most coveted health insurance available
to Americans is offered by big companies and unions. All we are trying
to do in the underlying bill is to give small employers the same
opportunity to provide high-quality health insurance to their employees
at competitive prices.
The motion to recommit would require every AHP to cover every mandate
known to man, driving up the cost of those policies and making sure
that no new employees would ever be covered by an AHP. There are 45
million Americans with no health insurance. While this will not cover
all 45 million Americans, it will help some Americans who have no
access to health insurance today have access to high-quality,
competitively priced health insurance. You can have all the mandates in
the world; but if you do not have health insurance, you get no coverage
at all. No doctors' visits. No nothing. It is a bad motion. Support the
underlying bill.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. Without objection, the previous question is
ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. GEORGE MILLER of California. Mr. Speaker, on that I demand the
yeas and nays.
[[Page H6508]]
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule
XX, this 15-minute vote on the motion to recommit will be followed by
5-minute votes on passage of H.R. 525, if ordered, and suspending the
rules on H.R. 2894.
The vote was taken by electronic device, and there were--yeas 198,
nays 230, not voting 5, as follows:
[Roll No. 425]
YEAS--198
Abercrombie
Ackerman
Allen
Andrews
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boren
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Butterfield
Capps
Capuano
Cardin
Cardoza
Carnahan
Carson
Case
Chandler
Clay
Cleaver
Clyburn
Conyers
Cooper
Costa
Costello
Crowley
Cuellar
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Doyle
Edwards
Emanuel
Engel
Eshoo
Etheridge
Farr
Fattah
Filner
Ford
Frank (MA)
Gonzalez
Gordon
Green, Al
Green, Gene
Grijalva
Gutierrez
Harman
Hastings (FL)
Herseth
Higgins
Hinchey
Hinojosa
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick (MI)
Kind
Kucinich
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren, Zoe
Lowey
Lynch
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy
McCollum (MN)
McDermott
McGovern
McIntyre
McKinney
McNulty
Meehan
Meek (FL)
Meeks (NY)
Melancon
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Reyes
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Schakowsky
Schiff
Schwartz (PA)
Scott (GA)
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Snyder
Solis
Spratt
Stark
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Udall (CO)
Udall (NM)
Van Hollen
Visclosky
Wasserman Schultz
Waters
Watson
Watt
Weiner
Wexler
Woolsey
Wu
NAYS--230
Aderholt
Akin
Alexander
Bachus
Baker
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Boustany
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Castle
Chabot
Chocola
Coble
Cole (OK)
Conaway
Cox
Crenshaw
Cubin
Culberson
Cunningham
Davis (KY)
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Drake
Dreier
Duncan
Ehlers
Emerson
English (PA)
Evans
Everett
Ferguson
Fitzpatrick (PA)
Flake
Foley
Forbes
Fortenberry
Fossella
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gilchrest
Gillmor
Gingrey
Gohmert
Goode
Goodlatte
Granger
Graves
Green (WI)
Gutknecht
Hall
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Hulshof
Hunter
Hyde
Inglis (SC)
Issa
Istook
Jenkins
Jindal
Johnson (CT)
Johnson (IL)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
Kuhl (NY)
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
McCaul (TX)
McCotter
McCrery
McHenry
McHugh
McKeon
McMorris
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Otter
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Poe
Pombo
Porter
Price (GA)
Pryce (OH)
Putnam
Radanovich
Ramstad
Regula
Rehberg
Reichert
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schwarz (MI)
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Smith (NJ)
Smith (TX)
Sodrel
Souder
Stearns
Sullivan
Sweeney
Tancredo
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Turner
Upton
Velazquez
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Westmoreland
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Wynn
Young (AK)
Young (FL)
NOT VOTING--5
Cramer
Feeney
Gibbons
Oxley
Waxman
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. Hayes) (during the vote). Members are
advised there are 2 minutes remaining in this vote.
{time} 1821
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. ANDREWS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--yeas 263,
nays 165, not voting 5, as follows:
[Roll No. 426]
YEAS--263
Aderholt
Akin
Alexander
Bachus
Baird
Baker
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Bean
Beauprez
Biggert
Bilirakis
Bishop (GA)
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Boren
Boustany
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Case
Castle
Chabot
Chocola
Coble
Cole (OK)
Conaway
Cooper
Costello
Cox
Crenshaw
Cubin
Cuellar
Culberson
Cunningham
Davis (AL)
Davis (KY)
Davis (TN)
Davis, Jo Ann
Davis, Tom
Deal (GA)
DeLay
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Drake
Dreier
Duncan
Edwards
Ehlers
Emerson
English (PA)
Everett
Ferguson
Fitzpatrick (PA)
Flake
Foley
Forbes
Ford
Fortenberry
Fossella
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gilchrest
Gillmor
Gingrey
Gohmert
Gonzalez
Goode
Goodlatte
Gordon
Granger
Graves
Green (WI)
Gutknecht
Hall
Harman
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Herseth
Hobson
Hoekstra
Hostettler
Hulshof
Hunter
Hyde
Inglis (SC)
Israel
Issa
Istook
Jackson-Lee (TX)
Jenkins
Jindal
Johnson (CT)
Johnson (IL)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
Kuhl (NY)
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
Matheson
McCaul (TX)
McCotter
McCrery
McHenry
McHugh
McIntyre
McKeon
McMorris
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Mollohan
Moran (KS)
Moran (VA)
Murphy
Musgrave
Myrick
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Ortiz
Osborne
Otter
Paul
Pearce
Pence
Peterson (MN)
Peterson (PA)
Petri
Pickering
Pitts
Platts
Poe
Pombo
Porter
Price (GA)
Pryce (OH)
Putnam
Radanovich
Rahall
Ramstad
Regula
Rehberg
Reichert
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Rothman
Royce
Ryan (WI)
Ryun (KS)
Salazar
Sanchez, Loretta
Saxton
Schwarz (MI)
Sensenbrenner
Sessions
Shadegg
Shaw
Shays
Sherwood
Shimkus
Shuster
Simmons
Simpson
Skelton
Smith (NJ)
Smith (TX)
Snyder
Sodrel
Souder
Stearns
Sullivan
Sweeney
Tancredo
Taylor (MS)
Taylor (NC)
Terry
Thomas
Thompson (MS)
Thornberry
Tiahrt
Tiberi
Turner
Upton
Velazquez
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Westmoreland
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Wynn
Young (AK)
Young (FL)
NAYS--165
Abercrombie
Ackerman
Allen
Andrews
Baca
Baldwin
Barrow
Becerra
Berkley
Berman
Berry
Bishop (NY)
Blumenauer
Boswell
Boucher
[[Page H6509]]
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Butterfield
Capps
Capuano
Cardin
Cardoza
Carnahan
Carson
Chandler
Clay
Cleaver
Clyburn
Conyers
Costa
Crowley
Cummings
Davis (CA)
Davis (FL)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Doyle
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Filner
Frank (MA)
Green, Al
Green, Gene
Grijalva
Gutierrez
Hastings (FL)
Higgins
Hinchey
Hinojosa
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Jackson (IL)
Jefferson
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick (MI)
Kind
Kucinich
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lofgren, Zoe
Lowey
Lynch
Maloney
Markey
Matsui
McCarthy
McCollum (MN)
McDermott
McGovern
McKinney
McNulty
Meehan
Meek (FL)
Meeks (NY)
Melancon
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Moore (KS)
Moore (WI)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Pomeroy
Price (NC)
Rangel
Reyes
Ross
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanders
Schakowsky
Schiff
Schwartz (PA)
Scott (GA)
Scott (VA)
Serrano
Sherman
Slaughter
Smith (WA)
Solis
Spratt
Stark
Strickland
Stupak
Tanner
Tauscher
Thompson (CA)
Tierney
Towns
Udall (CO)
Udall (NM)
Van Hollen
Visclosky
Wasserman Schultz
Waters
Watson
Watt
Weiner
Wexler
Woolsey
Wu
NOT VOTING--5
Cramer
Feeney
Gibbons
Oxley
Waxman
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members are advised there
are 2 minutes remaining in this vote.
{time} 1834
Ms. MILLENDER-McDONALD changed her vote from ``yea'' to ``nay.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________