[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.
____________________