[Congressional Record Volume 151, Number 104 (Wednesday, July 27, 2005)]
[House]
[Pages H6668-H6671]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           STATE HIGH RISK POOL FUNDING EXTENSION ACT OF 2005

  Mr. DEAL of Georgia. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 3204) to amend title XXVII of the Public Health 
Service Act to extend Federal funding for the establishment and 
operation of State high risk health insurance pools, as amended.
  The Clerk read as follows:

                               H.R. 3204

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``State High Risk Pool Funding 
     Extension Act of 2005''.

     SEC. 2. EXTENSION OF FUNDING FOR ESTABLISHMENT AND OPERATION 
                   OF STATE HIGH RISK HEALTH INSURANCE POOLS.

       (a) Authorization of Appropriations.--Subsection (c) of 
     section 2745 of the Public Health Service Act (42 U.S.C. 
     300gg-45) is amended to read as follows:
       ``(c) Authorization of Appropriations.--
       ``(1) Seed grants.--For the purpose of carrying out 
     subsection (a), there is authorized to be appropriated 
     $15,000,000 for fiscal year 2005.
       ``(2) Operation of pools.--For the purpose of carrying out 
     subsection (b), there is authorized to be appropriated 
     $50,000,000 for each of the fiscal years 2005 through 2009.
       ``(3) Availability; rule of construction.--Funds 
     appropriated under this subsection for a fiscal year shall 
     remain available for obligation through the end of the 
     following fiscal year. Nothing in this section shall be 
     construed as providing a State with an entitlement to a grant 
     under this section.''.
       (b) Change in Requirements for Qualified High Risk Pools.--
       (1) Change in requirement for operational grants.--
     Subsection (b) of such section is amended--
       (A) in paragraph (1)(A), by inserting ``(or 200 percent in 
     the case of a State that meets the requirements of paragraph 
     (3))'' after ``150 percent'';
       (B) in paragraph (1)(C), by striking ``after the end of 
     fiscal year 2004'' and inserting ``after the end of the last 
     fiscal year for which a grant is provided under this 
     paragraph''; and
       (C) by adding at the end the following new paragraph:
       ``(3) Special rule for pools charging higher premiums.--In 
     the case of a qualified high risk pool of a State which 
     charges premiums that exceed 150 percent of the premium for 
     applicable standard risks, the State shall use at least 50 
     percent of the amount of the grant provided to carry out this 
     subsection to reduce premiums for enrollees. ''.
       (2) Change in definition of qualified high risk pool.--
     Subsection (d) of such section is amended to read as follows:
       ``(d) Definitions.--In this section:
       ``(1) Qualified high risk pool.--The term `qualified high 
     risk pool' has the meaning given such term in section 
     2744(c)(2), except that a State may elect to meet the 
     requirement of subparagraph (A) of such section (insofar as 
     it requires the provision of coverage to all eligible 
     individuals) through providing for the enrollment of eligible 
     individuals through an acceptable alternative mechanism (as 
     defined for purposes of section 2744) that includes a high 
     risk pool as a component.
       ``(2) Standard risk rate.--The term `standard risk rate' 
     means a rate that--
       ``(A) is determined under the State high risk pool by 
     considering the premium rates charged by other health 
     insurers offering health insurance coverage to individuals in 
     the insurance market served;
       ``(B) is established using reasonable actuarial techniques; 
     and
       ``(C) reflects anticipated claims experience and expenses 
     for the coverage involved.
       ``(3) State.--The term `State' means any of the 50 States 
     and the District of Columbia.''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to grants for fiscal years beginning with fiscal 
     year 2005.
       (c) Change in Allotment Formula for Operational Grants.--
     Subsection (b)(2) of such section is amended--
       (1) by inserting ``(before fiscal year 2005)'' after ``for 
     a fiscal year''; and
       (2) by adding at the end the following: ``The amount 
     appropriated under subsection (c)(2) for a fiscal year 
     beginning with fiscal year 2005 (less the portion of such 
     amount amount made available to carry out subsection (f)) 
     shall be made available to the States (including entities 
     that operate the high risk pool under applicable State law in 
     a State) that qualify for a grant under subsection (b) as 
     follows
       ``(A) An amount equal to \1/3\ of such amount shall be 
     allocated in equal amounts among such qualifying States.
       ``(B) An amount equal to \1/3\ of such amount shall be 
     allocated among such States so that the amount provided to a 
     State bears the same ratio to such available amount as the 
     number of uninsured individuals in the State bears to the 
     total number of uninsured individuals in all such States (as 
     determined by the Secretary).
       ``(C) An amount equal to \1/3\ of such amount shall be 
     allocated among such States so that the amount provided to a 
     State bears the same ratio to such available amount as the 
     number of individuals enrolled in health care coverage 
     through the qualified high risk pool of the State bears to 
     the total number of individuals so enrolled through qualified 
     high risk pools in all such States (as determined by the 
     Secretary).''.
       (d) Administrative Provisions; Annual Report.--Such section 
     is amended by adding at the end the following new subsection:
       ``(e) Administrative Provisions; Annual Report.--
       ``(1) Applications.--To be eligible for a grant under this 
     section, a State shall submit to the Secretary an application 
     at such time, in such manner, and containing such information 
     as the Secretary may require.
       ``(2) No entitlement.--Nothing in this section shall be 
     construed as providing a State with an entitlement to a grant 
     under this section.
       ``(3) Annual report.--The Secretary shall submit to 
     Congress an annual report on grants provided under this 
     section. Each such report shall include information on the 
     distribution of such grants among the States and the use of 
     grant funds by States.''.
       (e) Bonus Grants for Supplemental Consumer Benefits.--Such 
     section is further amended--
       (1) in subsection (c)(2), as added by subsection (a), by 
     adding at the end the following: ``Of the amount appropriated 
     under the preceding sentence for fiscal year 2005, up to 50 
     percent shall be available for the purpose of carrying out 
     subsection (f).''; and
       (2) by adding at the end the following new subsection:
       ``(f) Bonus Grants for Supplemental Consumer Benefits.--
       ``(1) In general.--In the case of each State that has 
     established a qualified high risk pool, the Secretary shall 
     provide, from the funds made available under subsection 
     (c)(2) to carry out this subsection, a grant to be used to 
     provide supplemental consumer benefits to enrollees or 
     potential enrollees (or defined subsets of such enrollees or 
     potential enrollees) in qualified high risk pools.
       ``(2) Benefits.--Funds provided to a State under paragraph 
     (1) may be used only to provide one or more of the following 
     benefits:
       ``(A) Low-income premium subsidies.
       ``(B) A reduction in premium trends, actual premiums, or 
     other cost-sharing requirements.
       ``(C) An expansion or broadening of the pool of individuals 
     eligible for coverage, such as through eliminating waiting 
     lists, increasing enrollment caps, or providing flexibility 
     in enrollment rules.
       ``(3) Limitation.--In no case shall the amount of a grant 
     under this subsection to a State, from the amount made 
     available under subsection (c)(2) for a fiscal year to carry 
     out this subsection, exceed 10 percent of the amount so made 
     available.
       ``(4) Rule of construction.--Nothing in this subsection 
     shall be construed to prohibit a State that, on the date of 
     enactment of this subsection, is in the process of 
     implementing programs to provide benefits of the type 
     described in paragraph (2), from being eligible for a grant 
     under this subsection.
       ``(5) Funding.--

[[Page H6669]]

       ``(A) Availability.--Funds appropriated under this 
     subsection for a fiscal year shall remain available for 
     obligation through the end of the following fiscal year.
       ``(B) Reallotment.--If, on June 30 of a fiscal year for 
     which funds are made available under this subsection, the 
     Secretary determines that the full amounts will not be made 
     available for grants under this subsection, such remaining 
     amounts shall be made available and allotted among qualifying 
     States under subsection (b) for the fiscal year in accordance 
     with the formula under subsection (b)(2).''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Georgia (Mr. Deal) and the gentleman from Ohio (Mr. Brown) each will 
control 20 minutes.
  The Chair recognizes the gentleman from Georgia (Mr. Deal).


                             General Leave

  Mr. DEAL of Georgia. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on this legislation.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mr. DEAL of Georgia. Mr. Speaker, I yield such time as he may consume 
to the gentleman from Texas (Mr. Barton), the chairman of the Committee 
of Energy and Commerce.
  Mr. BARTON of Texas. Mr. Speaker, I apologize to the Speaker. There 
is some confusion. I have tried several times today to file the energy 
conference report. Because of technical glitches, every time we get 
right to the lip of the cliff, we have to do one little more thing. So 
I apologize for any confusion.
  Mr. Speaker, I am here today multi-hatted. In addition to working on 
energy, my committee has also been working on health care. The bills 
that are under suspension, the five bills in the House and the Senate, 
are all moving to make health care better and more affordable and also 
more understandable for the American people.
  My excellent subcommittee chairman, the gentleman from Georgia (Mr. 
Deal), has worked very hard on this on a bipartisan fashion. The 
ranking member, the gentleman from Michigan (Mr. Dingell) of the full 
committee level, and the gentleman from Ohio (Mr. Brown), the ranking 
member of the subcommittee, have worked to make the bills that we are 
going to consider today very, very good bills as well as very 
bipartisan bills.
  So, Mr. Speaker, I am simply saying that the first bill that we are 
going to consider is very worthy of consideration, and I hope the House 
will pass it expeditiously and then move to the next four.
  Mr. DEAL of Georgia. Mr. Speaker, I yield myself such time as I might 
consume.
  Mr. Speaker, I am pleased that we are on the verge of passing H.R. 
3204, the State High Risk Pool Funding Extension Act. Simply put, this 
bill will help more people get health insurance. People with 
preexisting conditions or high health care expenses face major 
difficulties when they seek to purchase health insurance.
  This is especially true for workers in small businesses or those who 
are self-employed. So they often go without health insurance and turn 
to government programs like Medicaid when they become sick or disabled.
  This bill authorizes Federal grant money to help fund the initial 
start-up and operation of State high-risk pools. Risk pools allow 
eligible individuals to purchase health insurance, pay premiums, and 
receive health coverage through private insurers. This grant money will 
allow States with those pools to cover more individuals and reduce the 
premiums they must pay.
  It will also allow States like my home State of Georgia that do not 
have a qualified high-risk pool to simply start one. This bill will 
help to reduce the number of uninsured and provide affordable health 
insurance for more Americans.
  Mr. Speaker, I want to thank the bill's sponsors, the gentleman from 
Arizona (Mr. Shadegg), who I will recognize in a few moments, and his 
Democratic counterpart, the gentleman from New York (Mr. Towns), and 
their staffs for their hard work on this bill.
  I would also like to thank the staff of the Energy and Commerce 
Committee, including Bill O'Brien of the majority staff, and Amy Hall 
on the ranking member, the gentleman from Michigan's (Mr. Dingell), 
staff for their efforts to come up with a bipartisan proposal that will 
help States to ensure that individuals who do not otherwise have health 
insurance are able to purchase it.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself 4 minutes.
  I am pleased to join the gentleman from Georgia (Mr. Deal) in 
supporting H.R. 3204, which reauthorizes funding for State high-risk 
insurance pools. I commend my colleagues, the gentleman from Arizona 
(Mr. Shadegg) and the gentleman from New York (Mr. Towns), for their 
work on this legislation.
  In many States, high-risk insurance pools are the only option for 
individuals who have been denied access to coverage in the commercial 
insurance system. The legislation before us is intended not only to 
strengthen existing high-risk pools, but to help States without such 
pools, my home State of Ohio is one of them, to help States without 
such pools to establish them.
  But as we reauthorize this legislation, it is important to place 
high-risk insurance pools in context. These pools are a symptom of a 
troubled insurance system, not a cure for it.
  The fact is, health insurance itself is supposed to serve as a high-
risk pool. It used to be that health insurance was offered to everyone 
at the same premium, because any one of us could be the unlucky one to 
need the health care we cannot afford.
  By spreading risk broadly, good health insurance can be affordable 
for everyone regardless of their health needs, regardless of their 
health status. But commercial insurers did what businesses do, they 
figured out how to maximize profits. You can hardly blame them for 
that.
  You can, however, blame policymakers in this body and other places. 
You can blame policymakers for letting the insurance industry get away 
with that. The best way to earn profits in the health insurance 
industry, of course, is to avoid insuring people who may actually use 
the coverage.
  And health insurers use every trick in the book to do that, to avoid 
those people. To the extent they can get away with it, commercial 
insurers underwrite and price people who need coverage right out of the 
insurance market. Private health insurance used to be a community; now 
it is almost a country club. So we are left with stopgap mechanisms 
like high-risk insurance pools.
  They are far from ideal, but our most vulnerable citizens certainly 
would be worse off without them. We should make sure high-risk 
insurance pools are available. We should also keep working until we 
render them unnecessary.
  I appreciate the author's willingness, the gentleman from Arizona 
(Mr. Shadegg), and the gentleman from Texas (Chairman Barton) to accept 
an amendment I offered during committee consideration to ensure that 
States use at least 50 percent of the bill's funding to expand access 
to the pool or to improve the high-risk coverage.
  As it stands, States can and have used Federal risk-pool funding to 
replace dollars collected for the pool from private insurers, leaving 
the risk pools themselves no better off. That is a subversion of the 
bill's purposes and a questionable use of Federal funding. My amendment 
that the committee accepted reminds the States that Federal high-risk 
pool funding is intended to expand the quality and reach of high-risk 
pools, not to let commercial insurers off the hook for making those 
pools unnecessary.
  Mr. Speaker, I urge my colleagues to support this legislation on 
behalf of individuals disenfranchised from private health insurance 
because they are not in perfect health. That hardly makes sense.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I want to thank my counterpart as the ranking member of 
the health subcommittee for what I perceive to be his unqualified 
endorsement of this legislation.
  Mr. Speaker, I yield 3 minutes to the gentleman from Arizona (Mr. 
Shadegg), the author of the legislation.

[[Page H6670]]

  Mr. SHADEGG. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  Mr. Speaker, this piece of legislation addresses a concern which 
touches literally every single American life. A number of areas ago, in 
2002, this Congress looked at the issue of health care in America and 
recognized that, sadly, there are those in this country who as a result 
of some form of health condition cannot acquire affordable health 
insurance.

                              {time}  1200

  That is a reflection of the medical conditions they suffer, whatever 
it might be, and it drives the cost of the health insurance they need 
to acquire beyond their means.
  We have decided as a Nation that no one in this country should go 
without a basic level of health care; and recognizing these high-risk 
individuals, the Congress in 2002 passed legislation to encourage each 
of States across the country to establish a high-risk pool; that is, to 
create a pool of money sponsored by the State where individuals with 
serious illnesses, individuals in this high-risk category, could go and 
could acquire insurance at a more affordable rate, indeed, at a rate 
they could afford as opposed to going uninsured. I think this is a 
charitable thing to do, I think it is a compassionate thing to do, and 
I think it is important.
  This legislation today extends that principle. I am extremely 
encouraged that 33 States across this country have taken advantage of 
the prior legislation enacted in 2002 and have established these high-
risk pools to help individuals in their State who are in the high-risk 
category and cannot find available to them insurance at an affordable 
rate.
  In carrying those principles forward, this legislation first and 
foremost encourages additional States to create high-risk pools. To 
accomplish that goal it provides $15 million in seed grants available 
to any State which does not currently have a high-risk pool. Each State 
is eligible for up to $1 million to found and begin its high-risk pool. 
So I hope that that money is taken advantage of by as many States as 
possible that do not currently have high-risk pools so that they can 
create a high-risk pool so those in our society who have the kinds of 
illnesses that make it impossible for them to acquire affordable health 
insurance will have that opportunity available to them in their State.
  The legislation also assists those States who have already 
established high-risk pools. It provides $50 million a year each year 
from fiscal year 2005 through fiscal year 2009 to offset operational 
losses for high-risk pools. These high-risk pools are funded by 
everyone in the State that has insurance. That is, a tax is levied on 
every single person that has insurance, and that tax is contributed to 
the high-risk pool. By having additional money from the Federal 
Government to help offset operating losses, we are lowering the cost of 
health insurance for every single insured American.
  This is vitally important legislation. I want to thank the chairman 
of the subcommittee, the ranking chairman of the subcommittee, the 
chairman of the full committee and the ranking member of the full 
committee for their assistance in bringing this important legislation 
to the floor.
  Mr. BROWN of Ohio. Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield 3 minutes to the gentleman 
from Georgia (Mr. Norwood).
  Mr. NORWOOD. Mr. Speaker, I thank my friend from Georgia (Mr. Deal), 
my chairman, for yielding me time.
  Mr. Speaker, I rise in strong support of H.R. 3204, which would 
extend seed grant money as well as provide $50 million for the next 4 
years for the creation and operation of high-risk pools.
  Mr. Speaker, this is a nonpartisan issue. As we all well know, the 
increasing cost of health care has affected millions of Americans. The 
number of uninsured Americans is obviously too high. It underscores the 
needs for a change in the way we think about delivering health 
insurance. Congress must act in a way that will increase the 
affordability and the accessibility of health care for our citizens. We 
must also be mindful of those who are hard to insure or are simply 
uninsurable due to their preexisting conditions or chronic illness.
  In that light, high-risk pools have quietly become an important part 
of our Nation's public/private patchwork of health care coverage for 
individuals with costly health conditions. These folks are oftentimes 
employed and paying their taxes, but cannot get coverage under a normal 
insurance plan in the individual market. Pools are already covering 
thousands of people who through no fault of their own do not have 
access to group health insurance and simply cannot afford coverage in 
the individual market.
  Thirty-one States thankfully are already operating high-risk pools. 
The coverage they offer is good coverage. Oftentimes it is as good as 
what is offered in the private insurance market in that State. However, 
enrollees are charged more for that coverage. This makes sense because 
pool members are by definition those who are considered to be 
uninsurable. However, we limit how much can be charged, generally 
between 125 and 150 percent of the base individual market rate.
  One of the important provisions of H.R. 3204 is that it requires 
States that charge premiums that exceed 150 percent to use at least 250 
percent of their Federal grant to reduce their premiums.
  Mr. Speaker, this legislation takes us a step closer to making sure 
that everyone can purchase the health insurance protection they need. I 
understand the worries associated with serious health conditions, and 
my constituents know the danger that catastrophic health care costs can 
pose to working families, especially in rural families and the self-
employed.
  High-risk pools reduce costs on the government in the long term by 
providing those with serious conditions a private safety net of 
coverage. I hope that all States, and that includes my home State of 
Georgia, will soon have high-risk pools. I urge everyone to support 
this legislation.
  Mr. DEAL of Georgia. Mr. Speaker, I want to thank my colleague from 
Georgia (Mr. Norwood) for taking time out on his birthday to be with 
us, and I congratulate him on his birthday.
  Mr. Speaker, I yield such time as she may consume to the gentlewoman 
from the Virgin Islands (Mrs. Christensen) for the purposes of engaging 
in a colloquy.
  Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman from Georgia 
(Mr. Deal) for yielding me time and for entering into a colloquy.
  Mr. Speaker, residents of the U.S. territories face many obstacles to 
obtaining affordable health insurance. The cost of providing health 
care in the territories is relatively high, and corresponding insurance 
rates are high due to a number of factors, including the high level of 
chronic disease in small populations over which to spread risk.
  The State's high-risk pool model is an innovative manner of 
addressing the need for health insurance for high-risk populations. 
H.R. 3204 authorizes Federal seed funding and additional grants in the 
50 States and the District of Columbia for the purpose of initiating 
and operating high-risk pools, but unfortunately fails to include the 
U.S. territories.
  H.R. 3204 is a good approach to decreasing the number of uninsured. 
In fact, it makes coverage accessible to people who, often through no 
fault of their own, suffer from these chronic diseases. It can be very 
helpful to my constituents and the constituents of my fellow delegates, 
especially given the limitations the cap on Medicaid imposes on health 
care delivery in the territories.
  I am sure that the exclusion of the territories was an oversight, and 
I respectfully request your assistance and the assistance from the 
gentleman from Ohio (Mr. Brown) in working to add the territories as 
eligible recipients of this funding as this bill moves through the rest 
of the legislative process and in any conference with the Senate on 
this reauthorization.
  Mr. DEAL of Georgia. Mr. Speaker, will the gentlewoman yield?
  Mrs. CHRISTENSEN. I yield to the gentleman from Georgia.
  Mr. DEAL of Georgia. Mr. Speaker, I thank the gentlewoman. I want to 
assure her that we will work with her and the other Representatives 
from the territories in conference to try to make

[[Page H6671]]

sure that they are included in this reauthorization of the State high-
risk pool. I thank her for her comments. I think they were well taken. 
And I have already spoken to the author of the legislation, and he 
assures me that he is in agreement with the proposition that the 
gentlewoman has brought to our attention.
  Mrs. CHRISTENSEN. I thank the gentleman for agreeing to take this up 
in conference.
  Mr. DINGELL. Mr. Speaker, this bill extends Federal grant funding for 
State high risk pools first authorized under the Trade Adjustment 
Assistance Act of 2005. High risk pools provide coverage for those who 
are otherwise medically uninsurable, for example, individuals with 
preexisting conditions or catastrophic illnesses such as cancer or 
multiple sclerosis. Today, 32 States operate high risk pools but these 
pools are far from an ideal solution. Many pools exclude coverage for 
certain benefits such as prescription drugs or maternity care. Other 
pools have waiting lists or closed enrollment. Still others exclude 
pre-existing conditions from coverage.
  Because of these limitations, Congress established parameters around 
eligibility for Federal grant funding of high risk pools. The intent 
was to ensure that Federal funding was used to improve access and 
coverage under these pools. Unfortunately, in the first round of 
grants, half of the States that received funding used the money solely 
to lower insurance company assessments that fund high risk pools rather 
than to actually improve the pools for individual beneficiaries.
  I am particularly pleased that H.R. 3204 includes bonus grants for 
supplemental consumer benefits. This legislation would require States 
to use up to 50 percent of their grant funds to improve the risk pools 
for consumers by lowering premiums, reducing waiting lists, or 
improving benefits.
  Many of the bills relating to health insurance coverage and access in 
this Congress--such as Association Health Plans--are partisan and have 
little chance of passage. But I am pleased to support this legislation 
which is the product of a bipartisan effort to improve access to 
coverage under high risk pools.
  Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield back the balance of my 
time.
  The SPEAKER pro tempore (Mr. Culberson). The question is on the 
motion offered by the gentleman from Georgia (Mr. Deal) that the House 
suspend the rules and pass the bill, H.R. 3204, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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