[Congressional Record (Bound Edition), Volume 151 (2005), Part 17]
[Senate]
[Pages 23242-23244]
[From the U.S. Government Publishing Office, www.gpo.gov]




           STATE HIGH RISK POOL FUNDING EXTENSION ACT OF 2005

  Mr. McCONNELL. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 181, H. R. 3204.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A 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.

  There being no objection, the Senate proceeded to consider the bill.
  Mr. ENZI. Mr. President, I am pleased today to bring to the floor an 
amendment to H.R. 3204, The State High Risk Pool Funding Extension Act 
of 2005. The Senate companion, S. 288, sponsored by Senators Gregg and 
Baucus, was approved unanimously in February by the Health, Education, 
Labor, and Pensions Committee. A similar bill also unanimously passed 
the full Senate in the last Congress.
  The amendment to H. R. 3204 that I bring before us today reflects 
much careful and bipartisan work, not only within the Senate, but with 
the House as well. After we pass this amendment and send it to the 
House, I expect our colleagues in that Chamber will approve it quickly, 
thus paving the way for a swift trip to the President's desk and into 
law.
  This legislation extends and makes improvements in the Federal Health 
Insurance High Risk Pool Grant Program originally enacted in 2002 as 
part of the Trade Adjustment Assistance Reform Act, TAA. This grant 
program provides critical assistance States both for the start-up of 
new risk pools and for the continued operation of existing ones.
  State high risk pools are State-created nonprofit entities that 
provide access to health insurance for persons who are not covered 
under an employer plan or a government program, and whose medical 
profile makes it very difficult or impossible for them to find coverage 
in the individual insurance market.
  These individuals are often the sickest and most vulnerable among us, 
and who, without access to high risk pools would otherwise fall through 
the cracks and be forced to bankrupt themselves onto the Medicaid 
rolls.
  Nearly 200,000 people have purchased health insurance policies 
through high risk pools nationwide. In my home State of Wyoming more 
than 650 people have comprehensive health insurance thanks to the 
Wyoming Health Insurance Pool.
  This insurance covers doctor visits, prescription drugs, home health 
visits, rehabilitation services, mental health, physical therapy, and 
maternity care. It is meaningful insurance coverage for people who 
would otherwise be uninsurable.
  Under these programs, individuals pay capped premiums for their 
coverage, but such premiums generally cover only 50 to 60 percent of 
the total cost of their care. The rest of the expense must be made up 
by other revenues, typically through an annual assessment of insurance 
companies.
  The current Federal Risk Pool Grant Program authorized up to $40 
million annually to help existing State high risk pools ease the steep 
losses requiring subsidies that they incur in these programs each year. 
Last year alone, total combined losses in State risk pools was more 
than $539 billion, an increase of 12 percent over the previous year.
  The legislation before us today would increase authorization for 
grants to existing risk pool programs from $40 million to $75 million 
per year through 2009. It would also extend through 2006 authorization 
for $15 million annually

[[Page 23243]]

for seed grants to States without risk pools that wish to establish 
them. Under this program, States would be eligible for grants of up to 
$1 million for the creation and initial operation of a risk pool.
  It is critical that Congress act swiftly on this important bill. 
Authorization for the current grant program expired at the end of 
fiscal year 2004, and all remaining funds will be exhausted upon the 
expiration of fiscal year 2005. Moreover, many State legislatures are 
assessing whether or not to move ahead with risk pool programs. Passage 
of this legislation would send to the States a strong signal of 
continued and renewed Federal commitment to such programs.
  In addition to extending and increasing authorization for Federal 
grant assistance, our legislation also makes a certain targeted 
improvements in how the Federal risk pool grants operate. For example, 
the bill would allow States a greater degree of flexibility in how they 
apply Federal grant dollars to their risk pool programs, and in the 
requirements for qualifying for grants. In part, this greater 
flexibility is an acknowledgement that State programs do vary and that 
a number of States are experimenting with new and innovative approaches 
in how they set up and administer their risk pool programs--approaches 
that in some cases may not fit easily into the Federal grant parameters 
as they are currently drafted.
  The legislation also makes some adjustments in the way grant funds 
are allocated, such that each State will now receive a sufficient 
incentive to establish or improve its high risk pool. At the same time, 
the revised allocation system recognizes that some states have greater 
numbers of uninsured than others, and provides extra assistance to 
States that operate the largest risk pools.
  The bill also includes a new bonus pool that can be tapped by States 
to offer lower premiums or improved benefits in connection with their 
high-risk pool, rather than requiring that all funds go to help defray 
operational losses. Up to one third of State's annual grant award could 
be used for this purpose.
  The legislation before us today is the same as that which drew 
unanimous and bipartisan support in our committee, both in this 
Congress and the last. It would extend and improve a program that has 
helped thousands of medically vulnerable Americans maintain lifesaving 
health coverage and avoid potentially devastating financial ruin. It is 
an important part of this Congress's comprehensive efforts to make 
health care and health insurance more affordable and accessible for 
everyone.
  I commend Senators Gregg and Baucus for their effective leadership on 
this important legislation, and to our committee's ranking member, 
Senator Kennedy, for his hard work and commitment. I urge all of my 
colleagues to join me in giving this much needed legislation our full 
support.
  Finally, credit should go as well to a number of current and past 
Senate staff, some of whom have worked for several years to bring this 
bill to fruition. We greatly appreciate the work of many, including 
David Bowen, David Fisher, Kim Monk, Stephen Northrup, Andrew Patzman, 
Stacey Sachs, Conwell Smith, and Vince Ventimiglia.
  I urge the Senate to give this much needed legislation the strong 
support it deserves.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the Enzi 
amendment at the desk be agreed to, the bill, as amended, be read a 
third time and passed, the motions to reconsider be laid upon the 
table, and that any statements relating to the bill be printed in the 
Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 2142) was agreed to, as follows:

       Strike all after the enacting clause and insert the 
     following:

     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.
       ``(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.

[[Page 23244]]

       ``(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 and there are 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 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 bill (H. R. 3204), as amended, was read the third time and 
passed.

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