[Congressional Record Volume 151, Number 163 (Saturday, December 17, 2005)]
[House]
[Pages H12072-H12075]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATE HIGH RISK POOL FUNDING EXTENSION ACT OF 2005
Mr. BURGESS. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 4519) to amend the Public Health Service Act to extend
funding for the operation of State high risk health insurance pools.
The Clerk read as follows:
H.R. 4519
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 OPERATION OF STATE HIGH RISK
HEALTH INSURANCE POOLS.
Section 2745 of the Public Health Service Act (42 U.S.C.
300gg-45) is amended to read as follows:
``SEC. 2745. RELIEF FOR HIGH RISK POOLS.
``(a) Seed Grants to States.--The Secretary shall provide
from the funds appropriated under subsection (d)(1)(A) a
grant of up to $1,000,000 to each State that has not created
a qualified high risk pool as of the date of enactment of the
State High Risk Pool Funding Extension Act of 2005 for the
State's costs of creation and initial operation of such a
pool.
``(b) Grants for Operational Losses.--
``(1) In general.--In the case of a State that has
established a qualified high risk pool that--
``(A) restricts premiums charged under the pool to no more
than 200 percent of the premium for applicable standard risk
rates;
``(B) offers a choice of two or more coverage options
through the pool; and
``(C) has in effect a mechanism reasonably designed to
ensure continued funding of losses incurred by the State in
connection with operation of the pool after the end of the
last fiscal year for which a grant is provided under this
paragraph;
the Secretary shall provide, from the funds appropriated
under paragraphs (1)(B)(i) and (2)(A) of subsection (d) and
allotted to the State under paragraph (2), a grant for the
losses incurred by the State in connection with the operation
of the pool.
``(2) Allotment.--Subject to paragraph (4), the amounts
appropriated under paragraphs (1)(B)(i) and (2)(A) of
subsection (d) for a fiscal year shall be allotted and made
available to the States (or the entities that operate the
high risk pool under applicable State law) that qualify for a
grant under paragraph (1) as follows:
``(A) An amount equal to 40 percent of such appropriated
amount for the fiscal year shall be allotted in equal amounts
to each qualifying State that is one of the 50 States or the
District of Columbia and that applies for a grant under this
subsection.
``(B) An amount equal to 30 percent of such appropriated
amount for the fiscal year shall be allotted among qualifying
States that apply for such a grant so that the amount
allotted to such a State bears the same ratio to such
appropriated amount as the number of uninsured individuals in
the State bears to the total number of uninsured individuals
(as determined by the Secretary) in all qualifying States
that so apply.
``(C) An amount equal to 30 percent of such appropriated
amount for the fiscal year shall be allotted among qualifying
States that apply for such a grant so that the amount
allotted to a State bears the same ratio to such appropriated
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 (as determined by the Secretary) in
all qualifying States that so apply.
``(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 the State to
carry out this subsection to reduce premiums for enrollees.
``(4) Limitation for territories.--In no case shall the
aggregate amount allotted and made available under paragraph
(2) for a fiscal year to States that are not the 50 States or
the District of Columbia exceed $1,000,000.
``(c) Bonus Grants for Supplemental Consumer Benefits.--
``(1) In general.--In the case of a State that is one of
the 50 States or the District of Columbia, that has
established a qualified high risk pool, and that is receiving
a grant under subsection (b)(1), the Secretary shall provide,
from the funds appropriated under paragraphs (1)(B)(ii) and
(2)(B) of subsection (d) and allotted to the State under
paragraph (3), 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.--A State shall use amounts received under a
grant under this subsection 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.
``(D) Less stringent rules, or additional waiver authority,
with respect to coverage of pre-existing conditions.
``(E) Increased benefits.
[[Page H12073]]
``(F) The establishment of disease management programs.
``(3) Allotment; limitation.--The Secretary shall allot
funds appropriated under paragraphs (1)(B)(ii) and (2)(B) of
subsection (d) among States qualifying for a grant under
paragraph (1) in a manner specified by the Secretary, but in
no case shall the amount so allotted to a State for a fiscal
year exceed 10 percent of the funds so appropriated for the
fiscal year.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to prohibit a State that, on the date of
the enactment of the State High Risk Pool Funding Extension
Act of 2005, is in the process of implementing a program to
provide benefits of the type described in paragraph (2), from
being eligible for a grant under this subsection.
``(d) Funding.--
``(1) Appropriation for fiscal year 2006.--There are
authorized to be appropriated for fiscal year 2006--
``(A) $15,000,000 to carry out subsection (a); and
``(B) $75,000,000, of which, subject to paragraph (4)--
``(i) two-thirds of the amount appropriated shall be made
available for allotments under subsection (b)(2); and
``(ii) one-third of the amount appropriated shall be made
available for allotments under subsection (c)(3).
``(2) Authorization of appropriations for fiscal years 2007
through 2010.--There are authorized to be appropriated
$75,000,000 for each of fiscal years 2007 through 2010, of
which, subject to paragraph (4)--
``(A) two-thirds of the amount appropriated for a fiscal
year shall be made available for allotments under subsection
(b)(2); and
``(B) one-third of the amount appropriated for a fiscal
year shall be made available for allotments under under
subsection (c)(3).
``(3) Availability.--Funds appropriated for purposes of
carrying out this section for a fiscal year shall remain
available for obligation through the end of the following
fiscal year.
``(4) Reallotment.--If, on June 30 of each fiscal year for
which funds are appropriated under paragraph (1)(B) or (2),
the Secretary determines that all the amounts so appropriated
are not allotted or otherwise made available to States, such
remaining amounts shall be allotted and made available under
subsection (b) among States receiving grants under subsection
(b) for the fiscal year based upon the allotment formula
specified in such subsection.
``(5) No entitlement.--Nothing in this section shall be
construed as providing a State with an entitlement to a grant
under this section.
``(e) 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.
``(f) 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 States and the use of grant
funds by States.
``(g) Definitions.--In this section:
``(1) Qualified high risk pool.--
``(A) In general.--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--
``(A) 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) that is established using reasonable actuarial
techniques; and
``(C) that 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 and includes Puerto Rico, the
Virgin Islands, Guam, American Samoa, and the Northern
Mariana Islands.''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Texas (Mr. Burgess) and the gentleman from Ohio (Mr. Brown) each will
control 20 minutes.
The Chair recognizes the gentleman from Texas.
General Leave
Mr. BURGESS. 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 the bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I am pleased that we are on the verge of passing H.R.
4519, 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
startup 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 these pools to cover more individuals and reduce the
premiums they must pay.
Mr. Speaker, my home State of Texas was left out of the Federal
funding when this program was created, and now States like my State of
Texas will have the ability to access these Federal funds. This bill
will help reduce the number of uninsured and provide affordable health
insurance for more Americans. That is an important part, affordable
health insurance, one of the things we talk about every day in this
body.
I want to thank the bill's sponsors, John Shadegg and Ed Towns, and I
want to thank their staffs for their hard work on this bill. I would
also note that the bill before us today is the result of bipartisan and
bicameral compromise, and I want to additionally thank the staff at the
Senate Health Education Labor and Pensions Committee for their efforts
on this legislation. Lastly, I would like to thank the staff of the
Energy and Commerce Committee, including Bill O'Brien on the majority
staff, Amy Hall and Bridgett Taylor on Ranking Member John Dingell's
staff for their efforts to develop this bipartisan proposal that will
help States to insure individuals who would otherwise not have been
able to get affordable health coverage.
Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself as much time as I
consume.
Mr. Speaker, I am pleased to support H.R. 3204, which authorizes
funding for State high risk insurance pools. I commend my colleagues
Mr. Shadegg and Mr. Towns for their hard work on this legislation.
In many States, high risk insurance pools are the only options for
individuals who have been denied access to coverage in the commercial
insurance system. This legislation before us is intended not only to
strengthen existing high risk pools but to help States without such
pools, my State of Ohio is one of them, 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 health care that we simply could not afford. By spreading the risk
broadly, good health insurance could be affordable for everyone
regardless of their health needs. But commercial insurers did what
businesses do: They figured out, of course, how to maximize profits.
You cannot blame them for that. You can, however, blame us, blame this
Congress, blame State legislators, blame policymakers for letting them
get away with it.
The best way to earn profits in the health insurance industry is
simple: It is to avoid insuring people who might actually use their
coverage. Health insurers use every trick in the book, as we know, that
they can come up with to avoid those people. To the extent that 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 a country club. So we are
left with stop-gap mechanisms like high risk insurance pools. They are
far from ideal, but our most vulnerable citizens would be worse off
without them. We should make sure high risk insurance pools are
available. But we should also keep
[[Page H12074]]
working until we render them unnecessary.
I appreciate the author's willingness to accept an amendment I
offered during committee to ensure that States use at least 50 percent
of the bill's funding to expand to the pool or to improve the high risk
coverage. As it stands today, States can and States have used Federal
risk pool funding to replace dollars collected for the pool from
private health insurers, leaving the risk pools themselves no better
off. That is a subversion of the bill's purpose. That is a questionable
use of Federal funding.
My amendment reminds the States the Federal high risk pool funding is
intended to expand the quality and the reach of high risk pools, not to
let commercial insurers again off the hook for making these pools
necessary. I urge my colleagues to support this legislation on behalf
of individuals disenfranchised from private health insurance.
Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I am pleased to yield such time as he may
consume to the gentleman from Arizona (Mr. Shadegg).
(Mr. SHADEGG asked and was given permission to revise and extend his
remarks.)
Mr. SHADEGG. Mr. Speaker, I want to begin by thanking the full
committee chairman, Mr. Barton, who is not with us today, who has been
hospitalized as a result of a medical problem and, I understand, doing
well; the ranking member, Mr. Dingell; the chairman of our
subcommittee, Mr. Deal; as well as the ranking member, Mr. Brown, for
moving this important legislation forward. It is in fact critically
important legislation for all Americans but particularly for those with
preexisting conditions and those with chronic illnesses.
H.R. 4519 extends Federal funding, which was first made available
under the Trade Act of 2002, for the establishment and the operation of
State high risk pools. The bill provides $15 million in seed grants to
any State or, as a result of a bipartisan amendment of the bill, to any
territory which has not yet created a State high risk pool for creation
of that high risk pool. That is very important, because a number of
States do not yet have them. This money is available as $1 million one-
time grants for the creation of such a high risk pool.
In addition, it provides $75 million in each of the fiscal years
between 2006 and 2010 for the operational expenses of these high risk
pools. Those moneys are allocated according to a formula referred to a
moment ago by the ranking member, Mr. Brown. That formula includes the
number of qualifying States, the number of uninsured individuals and
the number of individuals enrolled in the State's high risk program.
These moneys are extremely important, and I think it is important also
to note that territories are available both for the seed grants to
establish a high risk pool and for the operational grants.
{time} 1645
State high risk pools, as have been noted here, help provide health
insurance for those who have preexisting conditions or chronic
illnesses or who for any other reason cannot afford health insurance.
High risk pools allow individuals who are eligible to purchase health
insurance to pay a premium and receive coverage.
Because they are at-risk people with very high medical needs, these
premiums are capped in the high risk pool, and often the premiums do
not cover the cost of the health insurance that is provided. As a
result, the cost of operating the pool needs to be subsidized or offset
by the States. States operating these pools make up that shortfall, and
the operating funds that are provided here assist in doing that.
There are many things that we can do in this area of health
insurance; and I agree with my colleague, Mr. Brown, that high risk
pools are not in fact a solution; they are, in fact, rather a symptom
of a problem we have in health insurance today.
I think that there is much more that we can and should do to make
health insurance affordable and available to all Americans. I would
like to see us create here in this Congress a refundable tax credit for
all Americans so that they can go out and purchase health insurance
themselves. We have sadly today in America some 44 million-plus who
cannot afford health insurance and who are, therefore, uncovered.
If we were to create a tax credit allowing people to take a portion
of the income taxes they would otherwise send to the government to go
buy health insurance, and for those who are poor and do not pay income
taxes now, make that a refundable tax credit, that is, actually provide
them with a voucher or with cash to go buy health insurance, we could
cut the number of uninsured in America dramatically. And that would be
a huge step forward in this Nation, to reduce the number of uninsured
and make sure that everyone in this country has health insurance.
Unfortunately, that legislation is not before us at this point. It is
the kind of progress that I hope we can make. But this legislation is.
Before we move forward on the idea of a refundable tax credit, we must
make sure that we take care of those who are most in need in America.
High risk pools are a targeted tool for the uninsured. They are a
safety net.
In addition to providing access to insurance for those with
preexisting conditions and the chronically ill, they also alleviate the
need for cross-subsidization. All of us are aware that those of us
buying insurance today pay a higher premium because of the needs of
those who cannot afford insurance.
High risk pools alleviate that need. I join my colleagues in calling
for the passage of this legislation. I appreciate that it is a
bipartisan effort, and I want to thank my colleagues on the opposite
side of the aisle for their help. I urge passage of the legislation.
Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from
Georgia (Mr. Norwood).
Mr. NORWOOD. Mr. Speaker, I thank my friend from Texas for the time.
Mr. Speaker, I rise in strong support of H.R. 4519, which would
extend seed grant money for the creation and operation of high risk
pools. I thank my friend, Mr. Shadegg, for bringing this. This is
extremely important legislation. It has the potential, if it works
right, to help all of us pay lower premiums in the future for our
insurance policies.
This is a nonpartisan issue. High risk pools have quietly become very
important and are a very important part of our Nation's public-private
patchwork of health care coverage. The folks covered are often times
employed. They are paying taxes. But they cannot get coverage under a
normal insurance plan.
Pools are already covering thousands of people who through no fault
of their own do not have access to group health insurance and cannot
simply afford the coverage in the individual market. Thirty-one States
are already operating high risk pools that offer good coverage at
reasonable prices.
I hope with the passage of this bill my home State now will be able
to join that number. Mr. Speaker, this legislation takes us a step
closer to making sure that everyone can purchase the health insurance
protection they need. I know the worries associated with a serious
health condition, and my constituents know the danger that catastrophic
health care costs can pose to working families, especially rural
families and the self-employed. High risk pools reduce costs on the
government in the long term by providing a private safety net of
coverage.
I urge my colleagues to support this legislation, and I hope at some
point in time we will take up Mr. Shadegg's idea of tax credits for
health care. But in the meantime, we need to make sure we get these
high risk pools in place, and that will allow many Americans to buy
health care insurance because the premiums will be reduced.
Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
Mr. BURGESS. Mr. Speaker, just in closing, I would say that I do
appreciate Mr. Shadegg bringing this bill to the floor today. I
appreciate him bringing up the concept of the refundable tax credit. I,
too, think this is important legislation, that we in the Chamber today
have some of the best minds on the health subcommittee. I hope we can
work together to get that passed next year.
I hope we can look at other opportunities such as what Governor Jeb
Bush
[[Page H12075]]
is doing down in the State of Florida for purchasing insurance for
those working poor who cannot afford it. But this is a good bill; this
is good legislation. It will be very helpful back in my home State of
Texas.
Ms. BORDALLO. Mr. Speaker, I rise in support of H.R. 4519, the State
High Risk Pool Funding Extension Act of 2005. I do so mainly because
this bill would not only extend the authorization for Federal support
for State high risk health insurance pools until 2010, but also because
it provides, for the first time, authorization for the U.S. territories
to receive this Federal support. With this Federal support, the U.S.
territories will be able to establish and operate high risk health
insurance pools like those already successfully operating in several
States.
The costs of providing health care in the U.S. territories are very
high due to the number of uninsured individuals, the prevalence of
chronic diseases among residents, significant transportation expenses,
and small risk pools over which to spread the cost of health insurance.
Additionally, the vast majority of employers in the U.S. territories
are small businesses. Like most small businesses nationwide, Guam's
small businesses are limited in their financial ability to offer
affordable health coverage to their employees.
The State high risk pool model is an innovative method to address the
need for health insurance for high risk populations. To date, 31 States
have established high risk health insurance pools. However, section
201(b) of the Trade Act of 2002 (Public Law 107-210), which authorized
Federal funding for the creation and initial operation of high risk
pools in the States did not include the U.S. territories among those
eligible to receive this funding. The ineligibility of the U.S.
territories for this assistance remains a concern. Previous versions of
this bill being considered today to reauthorize this Federal program
did not include the U.S. territories among those to be qualified to
receive seed funding and additional grants to initiate and operate high
risk pools.
However, the bill before us today, the product of negotiations over
the last several months, does include the U.S. territories. H.R. 4519
will enable Guam and the other U.S. territories to form high risk
insurance pools. The establishment of such pools will save the Federal
Government Medicaid resources, because individuals with chronic
illnesses will have another alternative to utilize to pay for expensive
healthcare services. Assisting the U.S. territories in operating high
risk pools will help the local treasuries with insuring high risk
individuals. The establishment of high risk pools will reduce the risk
of the general pool of health insurance consumers in the U.S.
territories. This will allow for greater competition in the health
insurance market, reduced costs for consumers, and will result in more
economically manageable and affordable employee health plans for small
businesses.
I came to this floor on July 27 of this year to highlight the need to
include the U.S. territories in this Federal program, when this House
debated H.R. 3204, the precursor to the bill before us today. The
gentleman from Arizona, Mr. Shadegg, the author of this bill,
recognized this need. The gentleman from Georgia, Mr. Deal, and the
gentleman from Ohio, Mr. Brown, supported this request. I thank them
for their leadership and for their attention to and understanding of
the needs of the U.S. territories. Additionally, I want to thank the
gentleman from Texas, Mr. Barton, and the gentleman from Michigan, Mr.
Dingell, the chairman and the ranking Democratic member of the House
Committee on Energy and Commerce, respectively, and their staffs, for
their attention to this issue. I thank all of these gentlemen for their
cooperation and assistance on this important issue. Together, with my
colleagues from the Virgin Islands, Mrs. Christensen, American Samoa,
Mr. Faleomavaega, and Puerto Rico, Mr. Fortuno, we were able to improve
the legislation to take into account the needs of the U.S. territories.
I look forward to working with the U.S. Department of Health and Human
Services and the Government of Guam in establishing a high risk pool in
Guam with Federal seed money.
I urge my colleagues to support H.R. 4519.
Mr. DINGELL. Mr. Speaker, I am pleased the House is taking up H.R.
4519, a bill to reauthorize funds for State high risk health insurance
pools, a program that was first passed in the Trade Adjustment
Assistance Act. This bill also makes a number of improvements to the
program.
High risk pools are by no means a solution for all of the more than
45 million uninsured in this nation. As long as we, however, continue
to have a system of health care cobbled together as it is, high risk
pools will fill part of the void.
Unfortunately, these high risk pools have included very high premiums
and limited benefits. When Congress first provided funding for these
pools, the majority of the States used the funding to lower assessments
on insurance companies rather than improve benefits or reduce out-of-
pocket costs for families. H.R. 4519 includes an important provision
that would ensure some portion of this Federal funding goes to
improving the pools by reducing premium costs or improving benefits for
those who need health care.
And although we have taken a small step here to do good, the Congress
is considering a budget reconciliation package that includes harsh cuts
in the program that provides health insurance to more than 50 million
Americans--Medicaid. These cuts would strip benefits and increase out-
of-pocket costs for low-income families and individuals, including
children, pregnant women, and those living with disabilities.
If Congress were really determined to help the uninsured, we would
begin by rejecting the provisions in the reconciliation package that
cut coverage and increase costs for our most vulnerable citizens.
Mr. BURGESS. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Boozman). The question is on the motion
offered by the gentleman from Texas (Mr. Burgess) that the House
suspend the rules and pass the bill, H.R. 4519.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the bill was passed.
A motion to reconsider was laid on the table.
____________________