[House Report 109-183]
[From the U.S. Government Publishing Office]



109th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    109-183

======================================================================



 
PROVIDING FOR CONSIDERATION OF H.R. 525, SMALL BUSINESS HEALTH FAIRNESS 
                              ACT OF 2005

                                _______
                                

   July 25, 2005.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

    Mr. Bishop of Utah, from the Committee on Rules, submitted the 
                               following

                              R E P O R T

                       [To accompany H. Res. 379]

    The Committee on Rules, having had under consideration 
House Resolution 379, by a nonrecord vote, report the same to 
the House with the recommendation that the resolution be 
adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for the consideration of H.R. 525, 
the Small Business Health Fairness Act of 2005, under a 
structured rule. The rule provides one hour of debate in the 
House equally divided and controlled by the chairman and 
ranking minority member of the Committee on Education and the 
Workforce. The rule waives all points of order against 
consideration of the bill.
    The rule makes in order the amendment in the nature of a 
substitute printed in this report, if offered by Representative 
Kind of Wisconsin or his designee, which shall be considered as 
read, and shall be separately debatable for one hour equally 
divided and controlled by the proponent and an opponent. The 
rule waives all points of order against the amendment printed 
in this report.
    Finally, the rule provides one motion to recommit with or 
without instructions.

                         EXPLANATION OF WAIVERS

    The Committee is not aware of any points of order against 
consideration of the bill. The waiver of all points of order 
against consideration of the bill is prophylactic in nature.

                            COMMITTEE VOTES

    Pursuant to clause 3(b) of House rule XIII the results of 
each record vote on an amendment or motion to report, together 
with the names of those voting for and against, are printed 
below:

Rules Committee Record Vote No. 106

    Date: July 25, 2005.
    Measure: H.R. 525--Small Business Health Fairness Act of 
2005.
    Motion by: Mrs. Matsui.
    Summary of motion: To make in order and provide the 
appropriate waivers to the amendment offered by Representatives 
McCarthy and Woolsey which prohibits employers from joining 
AHPs if it would mean a reduction in coverage for breast and 
cervical cancer services.
    Results: Defeated 4 to 7.
    Vote by Members: Diaz-Balart--Nay; Hastings (WA)--Nay; 
Sessions--Nay; Putnam--Nay; Capito--Nay; Gingrey--Nay; 
Slaughter--Yea; McGovern--Yea; Hastings (FL)--Yea; Matsui--Yea; 
Dreier--Nay.

           SUMMARY OF AMENDMENT MADE IN ORDER UNDER THE RULE

    Kind/Andrews:
    Amendment in the Nature of a Substitute. Requires the 
Department of Labor to establish a Small Employer Health 
Benefits Plan (SEHB) similar to the Federal Employees Health 
Benefits Plan (FEHB). Requires the Secretary to widely 
disseminate information about SEHB through the media, internet, 
public service announcements, and other employer and employee 
directed communications. All employers with fewer than 100 
employees during the previous calendar year shall be eligible 
to apply for coverage under SEHB. Employers must offer coverage 
to all employees who have completed 3 months of service. 
Employees working fewer than 30 hours a week are eligible for 
pro rata coverage. Requires the Secretary to establish an 
initial open enrollment period and thereafter an annual 
enrollment period. Requires the Department of Labor to annually 
contract with state licensed health insurers to offer health 
insurance coverage in a state. Participating insurers shall 
remain subject to state laws applicable to the states in which 
they cover residents. Requires all participating insurers to 
offer benefits equivalent to or greater than the options 
offered under the four largest FEHB health plans. Provides that 
employers are eligible for premium assistance for employees 
earning below 200% of the poverty level: employers with fewer 
than 11 employees are eligible for assistance of 50% of 
premiums; employers with 11-25 employees are eligible for 
assistance of 35% of premiums; employers with 26-50 employees 
are eligible for assistance of 25% of premiums. Provides that 
employees earning less than 200% of poverty are eligible for 
assistance for premiums above 5% of family income. (One hour)

TEXT OF AMENDMENT IN THE NATURE OF A SUBSTITUTE MADE IN ORDER UNDER THE 
                                  RULE

    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Small 
Business Affordable Health Insurance Act of 2005''.
  (b) Table of Contents.--The table of contents of this Act is 
as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Establishment of Small Employer Health Benefits Program (SEHBP).

        ``Part 8--Small Employer Health Benefits Program (SEHBP)

    ``Sec. 801. Establishment of program.
    ``Sec. 802. Premium assistance for small employers and their 
              employees.
    ``Sec. 803. Qualified State health pooling arrangements.
    ``Sec. 804. Establishment of national health pooling arrangement.
    ``Sec. 805. Coordination and consultation.
    ``Sec. 806. Public education.
    ``Sec. 807. Funding for premium assistance and pooling arrangements.
Sec. 3. Institute of Medicine study and report.

SEC. 2. ESTABLISHMENT OF SMALL EMPLOYER HEALTH BENEFITS PROGRAM 
                    (SEHBP).

  (a) In General.--Subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 is amended by adding 
after part 7 the following new part:

        ``PART 8--SMALL EMPLOYER HEALTH BENEFITS PROGRAM (SEHBP)

``SEC. 801. ESTABLISHMENT OF PROGRAM.

  ``(a) In General.--The Secretary shall establish, in 
accordance with this part, a program (to be known as the `Small 
Employer Health Benefits Program' or `SEHBP') providing--
          ``(1) access to qualified health pooling arrangements 
        (consisting of both qualified State health pooling 
        arrangements and a national health pooling arrangement) 
        under which self-only and family coverage is offered to 
        small employers and their employees, and
          ``(2) premium assistance to small employers and their 
        employees to assist with the payment of premiums 
        incurred for coverage offered under such arrangements.
  ``(b) Limitations.--
          ``(1) Employer must bear 50 percent of cost.--Premium 
        assistance shall not be provided under this part with 
        respect to premiums incurred for any period for 
        coverage under a qualified health pooling arrangement 
        unless at least 50 percent of the premiums are paid by 
        the employer.
          ``(2) 10-year period of coverage.--Premium assistance 
        shall be provided under this part only with respect to 
        coverage for the 10-year period beginning on the date 
        the employer first begins participating in a qualified 
        health pooling arrangement.
          ``(3) Employers offering other health benefits.--In 
        the case of an employer who paid or incurred any 
        expenses for health benefits for the employees of such 
        employer during the first calendar year ending on or 
        after the date of the enactment of this section, 
        premium assistance shall be provided under this part 
        only if the employer begins participating in a 
        qualified health pooling arrangement during the 2-year 
        period beginning on the later of--
                  ``(A) the date of the enactment of this 
                section, or
                  ``(B) the first date that a qualified health 
                pooling arrangement exists which allows such 
                employer to participate.
          ``(4) Participation requirements.--Premium assistance 
        shall not be provided under this part with respect to 
        premiums incurred for any period unless at all times 
        during such period coverage for health benefits under a 
        qualified health pooling arrangement is available to 
        all employees of the employer under similar terms, 
        except that, under regulations of the Secretary--
                  ``(A) coverage under the arrangement may 
                exclude employees with less than 90 days of 
                service with the employer, and
                  ``(B) in the case of an employee serving in a 
                position in which service is customarily less 
                than 1,000 hours per year, the reference in 
                paragraph (1) to `50 percent' shall be deemed a 
                percentage reduced to a percentage that bears 
                the same ratio to 50 percent as the number of 
                hours of service per year customarily in such 
                position bears to 1,000.
          ``(5) Amounts paid under salary reduction 
        arrangements.--No amount paid or incurred pursuant to a 
        salary reduction arrangement shall be taken into 
        account under subsection (a).
  ``(c) Definitions and Special Rules.--For purposes of this 
part--
          ``(1) Small employer.--
                  ``(A) In general.--The term `small employer' 
                means an employer who normally employed not 
                more than 100 employees on a typical business 
                day during the preceding calendar year 
                (determined under rules similar to the rules 
                applicable under section 601(b)).
                  ``(B) Employers not in existence in preceding 
                year.--In the case of an employer which was not 
                in existence throughout the preceding calendar 
                year, the determination of whether such 
                employer is a small employer shall be based on 
                the number of employees that it is reasonably 
                expected such employer will normally employ on 
                business days in the current calendar year.
                  ``(C) Predecessors.--The Secretary may 
                prescribe regulations which provide for 
                references in this paragraph to an employer to 
                be treated as including references to 
                predecessors of such employer.
                  ``(D) Permanent status as small employer.--In 
                the case of an employer who meets the 
                requirements of this paragraph with respect to 
                the calendar year in which such employer first 
                begins participating in a qualified health 
                pooling arrangement, such employer shall not 
                fail to be treated as a small employer for any 
                subsequent calendar year.
          ``(2) Family coverage.--The term `family coverage' 
        means coverage for health benefits of the employee and 
        qualified family members of the employee (as defined in 
        section 35(d) of the Internal Revenue Code of 1986, but 
        without regard to the last sentence of paragraph (1) 
        thereof).
          ``(3) Qualified health pooling arrangement.--The term 
        `qualified health pooling arrangement' means a 
        qualified State health pooling arrangement described in 
        section 802 or the national health pooling arrangement 
        described in section 803.
          ``(4) Entities under common control.--
                  ``(A) Controlled group of corporations.--All 
                employees of all corporations which are members 
                of the same controlled group of corporations 
                shall be treated as employed by a single 
                employer. In any such case, the total premium 
                assistance (if any) provided to each member of 
                the controlled group and the total premium 
                assistance (if any) provided to its employees 
                shall be its proportionate share of the wages 
                paid to all employees of members of the 
                controlled group. For purposes of this 
                subparagraph, the term `controlled group of 
                corporations' has the meaning given to such 
                term by subsection (a) of section 1563 of the 
                Internal Revenue Code of 1986, except that--
                          ``(i) `more than 50 percent' shall be 
                        substituted for `at least 80 percent' 
                        each place it appears in subsection 
                        (a)(1) of such section 1563, and
                          ``(ii) the determination shall be 
                        made without regard to subsections 
                        (a)(4) and (e)(3)(C) of such section 
                        1563.
                  ``(B) Employees of partnerships, 
                proprietorships, etc., which are under common 
                control.--Under regulations prescribed by the 
                Secretary--
                          ``(i) all employees of trades or 
                        business (whether or not incorporated) 
                        which are under common control shall be 
                        treated as employed by a single 
                        employer, and
                          ``(ii) the total premium assistance 
                        (if any) provided to each trade or 
                        business and the total premium 
                        assistance (if any) provided to its 
                        employees shall be its proportionate 
                        share of the wages paid to all 
                        employees of such trades or business 
                        under common control.
                The regulations prescribed under this 
                subparagraph shall be based on principles 
                similar to the principles which apply in the 
                case of subparagraph (A).

``SEC. 802. PREMIUM ASSISTANCE FOR SMALL EMPLOYERS AND THEIR EMPLOYEES.

  ``(a) Employer Premium Assistance.--
          ``(1) In general.--Pursuant to section 801(a)(2), the 
        Secretary shall provide to small employers who are 
        eligible under paragraph (3) and who elect to provide 
        for coverage of their employees under a qualified 
        health pooling arrangement premium assistance for 
        premiums paid by the employer for such coverage with 
        respect to employees whose individual income (as 
        determined by the Secretary) is at or below 200 percent 
        of the poverty line (as defined in section 673(2) of 
        the Community Services Block Grant Act (42 U.S.C. 
        9902(2)), including any revision required by such 
        section) for an individual.
          ``(2) Premium assistance scaled according to size of 
        employer.--The premium assistance provided under 
        paragraph (1) shall be designed so that the premium 
        assistance equals, for any calendar year--
                  ``(A) 50 percent of the portion of the 
                premium payable by the employer for the 
                coverage, in the case of small employers who 
                employ an average of fewer than 11 employees on 
                business days during the preceding calendar 
                year;
                  ``(B) 35 percent of the portion of the 
                premium payable by the employer for the 
                coverage, in the case of small employers who 
                employ an average of more than 10 employees but 
                fewer than 26 employees on business days during 
                the preceding calendar year; and
                  ``(C) 25 percent of the portion of the 
                premium payable by the employer for the 
                coverage, in the case of small employers who 
                employ an average of more than 25 employees but 
                fewer than 51 employees on business days during 
                the preceding calendar year.
          ``(3)  eligible employers.--A small employer is 
        eligible under this paragraph if such employer--
                  ``(A) normally employed fewer than 25 
                employees on a typical business day during the 
                preceding calendar year (determined under rules 
                similar to the rules applicable under section 
                601(b)), and
                  ``(B) paid such employees during such year at 
                an average annual rate of income (consisting of 
                wages and salary) per employee which was at or 
                below the median income (as determined by the 
                Secretary for the most recent calendar year for 
                which data are available as of the end of the 
                preceding calendar year) for an individual 
                residing in the State in which the employer 
                maintains its principal place of business.
  ``(b) Employee Premium Assistance.--
          ``(1) In general.--Pursuant to section 801(a)(2), the 
        Secretary shall provide to employees of small employers 
        premium assistance for premiums for coverage under 
        qualified health pooling arrangements paid by such 
        employees in the case of employees whose family income 
        (as determined by the Secretary) is at or below 200 
        percent of the poverty line (as defined in section 
        673(2) of the Community Services Block Grant Act (42 
        U.S.C. 9902(2)), including any revision required by 
        such section) for a family of the size involved.
          ``(2) Amount of premium assistance.--Such premium 
        assistance shall be in an amount equal to the excess of 
        the portion of the total premium for coverage otherwise 
        payable by the employee under this part for any period, 
        over 5 percent of the family income (as determined 
        under paragraph (1)(A)) of the employee for such 
        period.
          ``(3) Coordination of premium assistance.--
        Notwithstanding paragraph (1), under regulations of the 
        Secretary, the total premium assistance to which any 
        employee may be provided under this subsection for any 
        period shall be reduced (to not less than zero) by the 
        total amount of subsidies for which such employee is 
        eligible for such period under any Federal or State 
        health insurance subsidy program (including a program 
        under title V, XIX, or XXI of the Social Security Act). 
        For purposes of this paragraph, an employee is 
        `eligible' for a subsidy under a program if such 
        employee is entitled to such subsidy or would, upon 
        filing application therefore, be entitled to such 
        subsidy.
          ``(4) Authority to expand eligibility.--The Secretary 
        may, to the extent of available funding, provide for 
        expansion of the premium assistance program under this 
        subsection to employees whose family income (as defined 
        by the Secretary) is at or below 300 percent of the 
        poverty line (as determined under paragraph (1)).
  ``(c) Procedures.--The Secretary shall establish by 
regulation applications, methods, and procedures for carrying 
out this section, including measures to ascertain or confirm 
levels of income.

``SEC. 803. QUALIFIED STATE HEALTH POOLING ARRANGEMENTS.

  ``(a) Defined.--For purposes of this part, the term 
`qualified State health pooling arrangement' means an 
arrangement established by a State which meets the following 
requirements:
          ``(1) Coverage provided by health insurance issuer.--
        The health benefits coverage is provided by a health 
        insurance issuer (as defined in section 733(b)(2)).
          ``(2) Health benefits coverage.--The arrangement 
        provides health benefits coverage that the Secretary 
        determines is substantially similar to the health 
        benefits coverage in any of the four largest health 
        benefits plans (determined by enrollment) offered under 
        chapter 89 of title 5, United States Code.
          ``(3) Group health plan requirements.--The health 
        benefits coverage provided under the arrangement meets 
        the requirements applicable to a group health plan 
        under this title and State law.
          ``(4) Guaranteed issue and renewable.--The 
        arrangement does not deny coverage (including renewal 
        of coverage) with respect to employees of any eligible 
        small employer or qualifying family members of such 
        employees on the basis of health status of such 
        employees or family members or any other condition or 
        requirement that the Secretary determines constitutes 
        health underwriting.
          ``(5) No preexisting condition exclusion.--The 
        arrangement does not permit a preexisting condition 
        exclusion as defined under section 701(b)(1).
          ``(6) No underwriting; community-rated premiums.--(A) 
        Subject to subparagraph (B), the arrangement does not 
        permit underwriting, through a preexisting condition 
        limitation, differential benefits, or different premium 
        levels, or otherwise, with respect to such coverage for 
        employees or their qualifying family members.
          ``(B) The premiums charged for such coverage are 
        community-rated for individuals without regard to 
        health status.
          ``(7) No riders.--The arrangement does not permit 
        riders to the health benefits coverage.
          ``(8) Accessibility to eligible small employers.--The 
        arrangement makes such coverage available to an 
        eligible small employer without regard to whether 
        premium assistance is available under section 802 with 
        respect to such employer or its employees.
          ``(9) Minimum of two plans offered under the 
        arrangement.--The arrangement makes available at least 
        two alternative forms of health benefits coverage.
  ``(b) Limitation on Enrollment Periods.--A qualified State 
health pooling arrangement may provide limits on the periods of 
times during which employees may elect coverage offered under 
the arrangement, but the arrangement shall not be treated as 
meeting the requirements of this section unless the arrangement 
provides for at least annual open enrollment periods and 
enrollment at the time of initial eligibility to enroll and 
upon appropriate changes in family circumstances.
  ``(c) Qualifying Family Member.--For purposes of this part, 
the term `qualifying family member' has the meaning given such 
term in section 35(d) of the Internal Revenue Code of 1986, 
applied without regard to the last sentence of paragraph (1) 
thereof.
  ``(d) State Defined.--For purposes of this part, the term 
`State' includes the District of Columbia, Puerto Rico, the 
Virgin Islands of the United States, Guam, American Samoa, and 
the Northern Mariana Islands.
  ``(e) Construction.--Nothing in this section shall be 
construed as requiring a State to establish or maintain a 
qualified State health pooling arrangement.
  ``(f) Creditable Coverage for Purposes of HIPAA.--Health 
benefits coverage provided under a qualified State health 
pooling arrangement under this section (and coverage provided 
under a National Pooling Arrangement under section 803) shall 
be treated as creditable coverage for purposes of part 7.
  ``(g) Annual Reports.--
          ``(1) In general.--Each State that offers a qualified 
        State health pooling arrangement under this section in 
        a year shall submit, in a form and manner specified by 
        the Secretary, a report on the operation of the 
        arrangement in that year.
          ``(2) Contents of report.--Reports required under 
        paragraph (1) shall include the following:
                  ``(A) A description of the health benefits 
                coverage offered under the arrangement.
                  ``(B) The number of employers that 
                participated in the arrangement.
                  ``(C) The number of employees and qualifying 
                family members of employees who received health 
                benefits coverage under the arrangement.
                  ``(D) The premiums charged for the health 
                benefits coverage under the arrangement.
          ``(3) Certification.--Each State that offers a 
        qualified State health pooling arrangement under this 
        section in a year shall submit, in a form and manner 
        specified by the Secretary, a certification that the 
        arrangement meets the requirements of this part.
  ``(h) Negotiations to Lower Health Care Costs.--The Secretary 
and States offering qualified State health pooling arrangements 
may collectively negotiate for lower prices for medical 
services, supplies, equipment, and pharmaceuticals for the 
purpose of lowering the health care costs to employers and 
employees served by such arrangements.
  ``(i) Coordination With State Regulation.--Nothing in this 
section shall be construed as preempting provisions of State 
law that provide protections in excess of the protections 
required under this section. The Secretary shall coordinate 
with the insurance commissioners for the various States in 
establishing a process for handling and resolving any 
complaints relating to health benefits coverage offered under 
this part, to the extent necessary to augment processes 
otherwise available under State law.

``SEC. 804. ESTABLISHMENT OF NATIONAL HEALTH POOLING ARRANGEMENT.

  ``(a) In General.--The Secretary shall provide for the 
offering and oversight of a national health pooling arrangement 
to eligible small employers.
  ``(b) National Health Pooling Arrangement Defined.-- For 
purposes of this section, the term `national health pooling 
arrangement' means an arrangement under which health benefits 
coverage is offered under terms and conditions that meet the 
requirements of section 803(a).
  ``(c) Use of FEHBP Model.--The Secretary shall provide for 
the national health pooling arrangement using the model of the 
Federal employees health benefits program under chapter 89 of 
title 5, United States Code, to the extent practicable and 
consistent with the provisions of this part. In carrying out 
such model, the Secretary shall, to the maximum extent 
practicable, negotiate the most affordable and substantial 
coverage possible for small employers.
  ``(d) Limitation on Enrollment Periods.--The Secretary may 
provide limits on the periods of times during which employees 
may elect coverage offered under the national health pooling 
arrangement, but the Secretary shall provide for at least 
annual open enrollment periods and enrollment at the time of 
initial eligibility to enroll and upon appropriate changes in 
family circumstances.
  ``(e) Authorizing Use of States in Making Arrangements for 
Coverage.--In lieu of the coverage otherwise arranged by the 
Secretary under this section, the Secretary may enter an 
arrangement with a State under which a State arranges for the 
provision of qualifying health insurance coverage to eligible 
small employers in such manner as the Secretary would otherwise 
arrange for such coverage.

``SEC. 805. COORDINATION AND CONSULTATION.

  ``(a) Coordination of State and National Programs.--The 
Secretary shall provide by regulation for coordination of the 
offering under this part of health benefits coverage to 
employees of small employers under State health pooling 
arrangements and the offering under this part of such coverage 
to such employees under the national health pooling 
arrangement.
  ``(b) Consultation.--In carrying out the provisions of this 
part, the Secretary shall consult with the Secretary of Health 
and Human Services and the Director of the Office of Personnel 
Management.

``SEC. 806. PUBLIC EDUCATION.

  ``The Secretary shall maintain an ongoing program of public 
education under which the Secretary shall--
          ``(1) publicize the national health pooling 
        arrangement established under section 804, and
          ``(2) assist, and participate with, the States in 
        publicizing the qualified State health pooling 
        arrangements established under section 803.

``SEC. 807. FUNDING FOR PREMIUM ASSISTANCE AND POOLING ARRANGEMENTS.

  ``(a) Premium Assistance.--There are authorized to be 
appropriated to the Secretary such sums as may be necessary to 
provide for premium assistance under section 802.
  ``(b) Grants to States Establishing and Operating Qualified 
State Health Pooling Arrangements.--The Secretary may provide 
for grants to States to establish and operate qualified State 
health pooling arrangements described in section 803. There are 
authorized to be appropriated to the Secretary such sums as may 
be necessary to provide such grants.
  ``(c) Funding for National Health Pooling Arrangement and 
Other Duties of the Secretary.--There are authorized to be 
appropriated to the Secretary such sums as may be necessary to 
provide for the offering and operation of the national health 
pooling arrangement under section 804 and to carry out the 
other duties of the Secretary under this part.''.
  (b) Clerical Amendment.--The table of contents in section 1 
of the Employee Retirement Income Security Act of 1974 is 
amended by inserting after the item relating to section 734 the 
following new items:

        ``Part 8--Small Employer Health Benefits Program (SEHBP)

``Sec. 801. Establishment of program.
``Sec. 802. Premium assistance for small employers and their employees.
``Sec. 803. Qualified State health pooling arrangements.
``Sec. 804. Establishment of national health pooling arrangement.
``Sec. 805. Coordination and consultation.
``Sec. 806. Public education.
``Sec. 807. Funding for premium assistance and pooling arrangements.''.

SEC. 3. INSTITUTE OF MEDICINE STUDY AND REPORT.

  (a) Study.--The Secretary shall enter into an arrangement 
under which the Institute of Medicine of the National Academy 
of Sciences shall conduct a study on the operation of qualified 
State health pooling arrangements under section 803 of the 
Employee Retirement Income Security Act of 1974 and the 
national health pooling arrangement under section 804 of such 
Act.
  (b) Matters Studied.--The study conducted under subsection 
(a) shall include the following:
          (1) An assessment of the success of the arrangements.
          (2) A determination of the affordability of health 
        benefits coverage under the arrangements for employers 
        and employees.
          (3) A determination of the access of small employers 
        to health benefits coverage.
          (4) A determination of the extent to which part 8 of 
        subtitle B of title I of the Employee Retirement Income 
        Security Act of 1974 provides premium assistance for 
        eligible small employers (and premium assistance for 
        employees of such employers) that provided (or would 
        have provided) health benefits coverage in the absence 
        of such premium assistance.
          (5) Recommendations with respect to--
                  (A) extension of the period for which the 
                premium assistance under part 8 of subtitle B 
                of title I of the Employee Retirement Income 
                Security Act of 1974 is available to employers 
                and employees or an appropriate phase-out of 
                such premium assistance over time;
                  (B) expansion of categories of persons 
                eligible for such premium assistance;
                  (C) expansion of persons eligible for health 
                benefits coverage under the arrangements; and
                  (D) such other matters as the Institute 
                determines appropriate.
  (c) Report.--Not later than January 1, 2010, the Comptroller 
General shall submit to the Congress a report on the study 
conducted under subsection (a).
  Amend the title so as to read: ``A bill to amend title I of 
the Employee Retirement Income Security Act of 1974 to 
encourage small employers to offer affordable health coverage 
to their employees through qualified health pooling 
arrangements, to encourage the establishment and operation of 
these arrangements, and for other purposes.''.

                                  
