[Congressional Record Volume 153, Number 163 (Thursday, October 25, 2007)]
[Senate]
[Pages S13450-S13451]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER:
  S. 2236. A bill to title I of the Employee Retirement Income Security 
Act of 1974, title XXVII of the Public Health Service Act, and the 
Internal Revenue Code of 1986 to provide additional limitations on 
preexisting condition exclusions in group health plans and health 
insurance coverage in the group and individual markets; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Pre-
existing Condition Exclusion Patient Protection Act of 2007. This is a 
critical bill for the tens of millions of individuals who suffer from 
chronic, disabling, and life-threatening conditions, as it will ensure 
that they have access to affordable, comprehensive, and meaningful 
health insurance coverage despite ``pre-existing conditions.''
  The Centers for Disease Control & Prevention estimates that fully 
one-third of all Americans will have a chronic, disabling, and life-
threatening condition at some time during their lifetimes. In West 
Virginia, that translates to approximately 600,000 of our neighbors who 
will face these serious health problems. Far too often these are the 
very people who find their health insurance coverage interrupted, 
cancelled, or denied because of pre-existing condition limitations in 
their health insurance policies.
  That is why, over 10 years ago, Congress passed the Health Insurance 
Portability and Accountability Act of 1996, HIPAA, P.L. 104-191, with 
the objective of protecting Americans from interruptions in health 
insurance coverage resulting from job changes or other life 
transitions. HIPAA provides this protection by restricting when private 
insurers can use pre-existing conditions to limit health care coverage. 
HIPAA has been successful, and many individuals have come to rely on 
its protections. However, after more than a decade, certain gaps in 
HIPAA's protection have become apparent that hamper individuals' access 
to care for which they could be covered, but for their pre-existing 
conditions.
  First, individuals who have been without health insurance coverage 
for 63 days or more, risk becoming permanently uninsurable. This is 
particularly true of individuals with pre-existing conditions, because 
a 63-day gap in coverage eliminates any prior creditable coverage. If 
an employee cannot demonstrate that he or she had prior creditable and 
continuous coverage, an employer can exclude coverage for pre-existing 
conditions for up to 12 months.
  Second, employers can restrict coverage for pre-existing conditions 
to otherwise qualified employees based on a 6-month ``look-back'' 
period. This means that an employer may use medical recommendations, 
diagnoses, and treatments within the most recent 6 months to exclude 
coverage as a ``pre-existing condition.'' This ``look-back'' period is 
sufficiently long that it likely impacts all Americans with at least 
one chronic illness, a category that includes a staggering one out of 
every three Americans, according to the Centers for Disease Control.
  Third, the protections offered to individuals moving into a group 
health plan, or moving into the individual insurance market from a 
group plan, are not available to individuals attempting to shop around 
for policies within the individual market. As a result, individuals who 
purchase policies in the non-group market and never have a gap in 
coverage still have no protection against the pre-existing condition 
exclusions that insurers may choose to impose.
  The Pre-existing Condition Exclusion Patient Protection Act of 2007 
takes significant steps to improve these weaknesses in the law, thereby 
protecting patients who are currently at risk of being denied health 
insurance coverage. To close the first gap in the law, the bill reduces 
the timeframe during which an employer can exclude coverage for pre-
existing conditions from 12 months to three months. This would ensure 
that more Americans have access to health insurance coverage; 
furthermore, it is consistent with the requirements for ``state-
qualified plans'' under the Trade Adjustment Assistance Reform Act of 
2002.
  To close the second HIPAA gap, this legislation shrinks the permitted 
``look-back'' period from 6 months to 30 days, which would result in a 
decrease in the number of Americans who are unfairly denied health 
coverage due to pre-existing conditions. Finally, the bill closes the 
third gap by applying the same pre-existing condition protections 
afforded to individuals in the group health insurance market under 
HIPAA to individuals moving to, and within, the individual health 
insurance market.
  Passing this legislation would increase access to private health 
insurance for the almost 94 million Americans who suffer from at least 
one chronic illness. It also would ensure

[[Page S13451]]

that the 158 million individuals who are insured through employer-based 
private plans and the more than 14 million individuals who are covered 
by non-group, private plans would have far better protection when 
changing jobs or their health care plans.
  I am confident that with these actions, we can achieve a significant 
improvement in the access of Americans to health insurance coverage. 
For this reason, I urge my colleagues to advance progress toward this 
important goal by supporting the Pre-existing Condition Exclusion 
Patient Protection Act of 2007.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2236

       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 ``Preexisting Condition 
     Exclusion Patient Protection Act of 2007''.

     SEC. 2. AMENDMENTS RELATING TO PREEXISTING CONDITION 
                   EXCLUSIONS UNDER GROUP HEALTH PLANS.

       (a) Amendments to the Employee Retirement Income Security 
     Act of 1974.--
       (1) Reduction in look-back period.--Section 701(a)(1) of 
     the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1181(a)(1)) is amended by striking ``6-month period'' 
     and inserting ``30-day period''.
       (2) Reduction in permitted preexisting condition limitation 
     period.--Section 701(a)(2) of such Act (29 U.S.C. 1181(a)(2)) 
     is amended by striking ``12 months'' and inserting ``3 
     months'', and by striking ``18 months'' and inserting ``9 
     months''.
       (b) Amendments to the Public Health Service Act.--
       (1) Reduction in look-back period.--Section 2701(a)(1) of 
     the Public Health Service Act (42 U.S.C. 300gg(a)(1)) is 
     amended by striking ``6-month period'' and inserting ``30-day 
     period''.
       (2) Reduction in permitted preexisting condition limitation 
     period.--Section 2701(a)(2) of such Act (42 U.S.C. 
     300gg(a)(2)) is amended by striking ``12 months'' and 
     inserting ``3 months'', and by striking ``18 months'' and 
     inserting ``9 months''.
       (c) Amendments to the Internal Revenue Code of 1986.--
       (1) Reduction in look-back period.--Paragraph (1) of 
     section 9801(a) of the Internal Revenue Code of 1986 
     (relating to limitation on preexisting condition exclusion 
     period and crediting for periods of previous coverage) is 
     amended by striking ``6-month period'' and inserting ``30-day 
     period''.
       (2) Reduction in permitted preexisting condition limitation 
     period.--Paragraph (2) of section 9801(a) of such Code is 
     amended by striking ``12 months'' and inserting ``3 months'', 
     and by striking ``18 months'' and inserting ``9 months''.
       (d) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by this section shall apply with respect to 
     group health plans for plan years beginning after the end of 
     the 12th calendar month following the date of the enactment 
     of this Act.
       (2) Special rule for collective bargaining agreements.--In 
     the case of a group health plan maintained pursuant to one or 
     more collective bargaining agreements between employee 
     representatives and one or more employers ratified before the 
     date of the enactment of this Act, the amendments made by 
     this section shall not apply to plan years beginning before 
     the earlier of--
       (A) the date on which the last of the collective bargaining 
     agreements relating to the plan terminates (determined 
     without regard to any extension thereof agreed to after the 
     date of the enactment of this Act), or
       (B) 3 years after the date of the enactment of this Act.

     For purposes of subparagraph (A), any plan amendment made 
     pursuant to a collective bargaining agreement relating to the 
     plan which amends the plan solely to conform to any 
     requirement added by the amendments made by this section 
     shall not be treated as a termination of such collective 
     bargaining agreement.

     SEC. 3. AMENDMENTS RELATING TO PREEXISTING CONDITION 
                   EXCLUSIONS IN HEALTH INSURANCE COVERAGE IN THE 
                   INDIVIDUAL MARKET.

       (a) Applicability of Group Health Insurance Limitations on 
     Imposition of Preexisting Condition Exclusions.--
       (1) In general.--Section 2741 of the Public Health Service 
     Act (42 U.S.C. 300gg-41) is amended--
       (A) by redesignating the second subsection (e) (relating to 
     market requirements) and subsection (f) as subsections (f) 
     and (g), respectively; and
       (B) by adding at the end the following new subsection:
       ``(h) Application of Group Health Insurance Limitations on 
     Imposition of Preexisting Condition Exclusions.--
       ``(1) In general.--Subject to paragraph (2), a health 
     insurance issuer that provides individual health insurance 
     coverage may not impose a preexisting condition exclusion (as 
     defined in subsection (b)(1)(A) of section 2701) with respect 
     to such coverage except to the extent that such exclusion 
     could be imposed consistent with such section if such 
     coverage were group health insurance coverage.
       ``(2) Limitation.--In the case of an individual who--
       ``(A) is enrolled in individual health insurance coverage;
       ``(B) during the period of such enrollment has a condition 
     for which no medical advice, diagnosis, care, or treatment 
     had been recommended or received as of the enrollment date; 
     and
       ``(C) seeks to enroll under other individual health 
     insurance coverage which provides benefits different from 
     those provided under the coverage referred to in subparagraph 
     (A) with respect to such condition,

     the issuer of the individual health insurance coverage 
     described in subparagraph (C) may impose a preexisting 
     condition exclusion with respect to such condition and any 
     benefits in addition to those provided under the coverage 
     referred to in subparagraph (A), but such exclusion may not 
     extend for a period of more than 3 months.''.
       (2) Elimination of cobra requirement.--Subsection (b) of 
     such section is amended--
       (A) by adding ``and'' at the end of paragraph (2);
       (B) by striking the semicolon at the end of paragraph (3) 
     and inserting a period; and
       (C) by striking paragraphs (4) and (5).
       (3) Conforming amendment.--Section 2744(a)(1) of such Act 
     (42 U.S.C. 300gg-44(a)(1)) is amended by inserting ``(other 
     than subsection (h))'' after ``section 2741''.
       (b) Effective Date.--The amendments made by this section 
     shall apply with respect to health insurance coverage 
     offered, sold, issued, renewed, in effect, or operated in the 
     individual market after the end of the 12th calendar month 
     following the date of the enactment of this Act.
                                 ______