[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 906 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 906
To provide for the certification of programs to provide uninsured
employees of small businesses access to health coverage, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 11, 2003
Ms. Stabenow introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide for the certification of programs to provide uninsured
employees of small businesses access to health coverage, and for other
purposes.
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 ``Health Care Access for Small
Businesses Act of 2003''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) For most of the past 16 years, the number of Americans
without health insurance has been on the rise, reaching more
than 41,000,000 in 2002.
(2) People without health insurance are less likely to get
preventive care and often delay or forgo needed care. They are
therefore more likely than those with health insurance to be
hospitalized for conditions that could have been avoided.
(3) Not only are the health and financial circumstances of
uninsured Americans adversely affected by the lack of health
insurance, their care is ultimately being paid for in the least
efficient manner: after they get sick.
(4) People who were uninsured during any part of 2001
received $99,000,000,000 in care, of which $34,500,000,000 was
not paid for either out of pocket or by a private or public
insurance source. Federal, State, and local governments covered
85 percent of such uncompensated care, amounting to
$30,000,000,000.
(5) Private health insurance enrollees also help pay for
uncompensated care through higher premiums.
(6) Covering more Americans will not only contribute to
better overall health, it will lower the amount of health care
costs assumed by taxpayers, businesses, and consumers.
(7) Helping small businesses gain access to affordable
health care benefits is essential to insuring more Americans.
(8) Eighty-two percent of uninsured people are part of
working families.
(9) More than \1/2\ of small businesses with less than 50
employees do not offer their employees health insurance.
(10) Innovative community-based solutions have developed
and should serve as a model for insuring more Americans.
SEC. 3. THREE-SHARE PROGRAMS.
The Social Security Act (42 U.S.C. 301 et seq.) is amended by
adding at the end the following:
``TITLE XXII--PROVIDING FOR THE UNINSURED
``SEC. 2201. THREE-SHARE PROGRAMS.
``(a) Certification.--
``(1) In general.--The Secretary, acting through the
Administrator, shall promulgate regulations for the
certification of three-share programs for purposes of section
36 of the Internal Revenue Code.
``(2) Three-share program requirements.--
``(A) In general.--The Administrator shall require,
for purposes of a certification under regulations under
paragraph (1) that each three-share program shall--
``(i) be either a non-profit or local
governmental entity;
``(ii) define a region in which such
program will provide services;
``(iii) have the capacity to carry out
administrative functions of managing health
plans, including monthly billings,
verification/enrollment of eligible employers
and employees, maintenance of membership
rosters, development of member materials (such
as handbooks and identification cards),
customer service, and claims processing; and
``(iv) have community involvement, as
determined by the Administrator.
``(B) Payment.--To obtain the certification
described in paragraph (1), a three-share program shall
pay the costs of services provided under subparagraph
(A)(ii) by charging a monthly premium for each covered
individual to be divided as follows:
``(i) Not more than thirty percent of such
fee shall be paid by a qualified employee
desiring coverage under the three-share
program.
``(ii) At least seventy percent of such fee
shall be paid by the qualified employer of such
a qualified employee.
``(3) Coverage.--
``(A) In general.--To obtain the certification
described in paragraph (1) a 3-share program shall
provide at least the following benefits:
``(i) Physicians services.
``(ii) In-patient hospital services.
``(iii) Out-patient services.
``(iv) Emergency room visits.
``(v) Emergency ambulance services.
``(vi) Diagnostic lab fees and x-rays.
``(vii) Prescription drug benefits.
``(B) Limitation.--Nothing in subparagraph (A)
shall be construed to require that a three-share
program provide coverage for services performed outside
the region described in paragraph (2)(A)(i).
``(C) Preexisting conditions.--A program described
in subparagraph (A) shall not be eligible for
certification under paragraph (1) if any individual can
be excluded from coverage under such program because of
a preexisting health condition.
``(b) Startup Grants for Three-Share Programs.--
``(1) Establishment.--The Administrator may award startup
grants to eligible entities to establish three-share programs
for certification under subsection (a).
``(2) Three-share program plan.--Each entity desiring a
grant under this subsection shall develop a plan for the
establishment and operation of a three-share program that meets
the requirements of paragraphs (2) and (3) of subsection (a).
``(3) Application.--Each entity desiring a grant under this
subsection shall submit an application to the Administrator at
such time, in such manner and containing such information as
the Administrator may require, including--
``(A) the three-share program plan described in
paragraph (2); and
``(B) an assurance that the eligible entity will--
``(i) determine a benefit package;
``(ii) recruit businesses and employees for
the three-share program;
``(iii) build and manage a network of
health providers or contract with an existing
network or licensed insurance provider; and
``(iv) manage all administrative needs.
``(4) Number of grants.--An eligible entity may receive
only 1 grant under this subsection for each three-share program
and may not receive a grant for such program under both this
subsection and subsection (c).
``(c) Grants for Existing Three-Share Programs To Meet
Certification Requirements.--
``(1) In general.--The Administrator may award grants to
three-share programs that are operating on the date of
enactment of this section, to assist such programs in meeting
the certification requirements of subsection (a).
``(2) Number of grants.--An eligible entity may receive
only 1 grant under this subsection for a three-share program
and may not receive a grant for such program under both this
subsection and subsection (b).
``(3) Application.--Each eligible entity desiring a grant
under this subsection shall submit an application to the
Administrator at such time, in such manner, and containing such
information as the Administrator may require.
``(d) Risk Pool Grants.--
``(1) In general.--The Administrator may award grants to
eligible entities administering certified three-share programs
to enhance the risk pools of such programs.
``(2) Number of grants.--An eligible entity administering a
three-share program described in paragraph (1) may receive only
1 grant under this subsection for such three-share program.
``(3) Application.--Each eligible entity desiring a grant
under this subsection shall submit an application to the
Administrator at such time, in such manner, and containing such
information as the Administrator may require.
``(e) Application of State Laws.--Nothing in this Act shall be
construed to preempt State law.
``(f) Distressed Business Formula.--
``(1) In general.--Not later than 60 days after the date of
enactment of this section, the Administrator of the Health
Resources and Services Administration shall develop a formula
to determine which businesses qualify as distressed businesses
for purposes of this Act.
``(2) Effect on insurance market.--Granting eligibility to
a distressed business using the formula under paragraph (1)
shall not interfere with the insurance market. Any business
found to have reduced benefits to qualify as a distressed
business under the formula under paragraph (1) shall not be
eligible for any three-share program certified pursuant to this
section.
``(g) Definitions.--In this section:
``(1) Administrator.--The term `Administrator' means the
Administrator of the Health Resources and Services
Administration.
``(2) Covered individual.--The term `covered individual'
means--
``(A) a qualified employee; or
``(B) a child under the age of 23 or a spouse of
such qualified employee who--
``(i) lacks access to health care coverage
through their employment or employer;
``(ii) lacks access to health coverage
through a family member;
``(iii) is not eligible for coverage under
the medicare program under title XVIII or the
medicaid program under title XIX; and
``(iv) does not qualify for benefits under
the State Children's Health Insurance Program
under title XXI.
``(3) Distressed business.--The term `distressed business'
means a business that--
``(A) in light of economic hardship and rising
health care premiums may be forced to discontinue or
scale back its health care coverage; and
``(B) qualifies as a distressed business according
to the formula under subsection (f).
``(4) Eligible entity.--The term `eligible entity' means an
entity that meets the requirements of subsection (a)(2)(A).
``(5) Full time.--The term `full time', for purposes of
employment, means regularly working at least 35 hours per week.
``(6) Qualified employee.--The term `qualified employee'
means any individual employed by a qualified employer who meets
certain criteria including--
``(A) working full time;
``(B) lacking access to health coverage through a
family member or common law partner;
``(C) not being eligible for coverage under the
medicare program under title XVIII or the medicaid
program under title XIX; and
``(D) agreeing that the share of fees described in
subsection (a)(2)(B)(i) shall be paid in the form of
payroll deductions from the wages of such individual.
``(7) Qualified employer.--The term `qualified employer'
means an employer as defined in section 3(d) of the Fair Labor
Standards Act of 1938 (29 U.S.C. 203(d)) who--
``(A) is a small business concern as defined in
section 3(a) of the Small Business Act (15 U.S.C. 632);
``(B) is located in the region described in
subsection (a)(2)(A)(i); and
``(C) has not contributed to the health care
benefits of its employees for at least 12 months
consecutively or currently provides insurance but is
classified as a distressed business.
``(h) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $50,000,000 for fiscal year 2004
and such sums as may be necessary for each subsequent fiscal year.''.
SEC. 4. REFUNDABLE CREDIT FOR PORTION OF EMPLOYER COSTS OF THREE-SHARE
PROGRAM.
(a) In General.--Subpart C of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 (relating to refundable credits)
is amended by redesignating section 36 as section 37 and inserting
after section 35 the following new section:
``SEC. 36. EMPLOYER COSTS OF THREE-SHARE PROGRAM.
``(a) In General.--In the case of an eligible employer, there shall
be allowed as a credit against the tax imposed by this subtitle an
amount equal to 40 percent of the costs of a three-share program
resulting from the participation of the taxpayer in such program during
the taxable year.
``(b) Eligible Employer.--For purposes of this section, the term
`eligible employer' means any employer which pays or incurs at least 70
percent of the costs of a three-share program resulting from the
participation of the taxpayer in such program during the taxable year.
``(c) Three-Share Program.--For purposes of this section, the term
`three-share program' means an employee health care coverage program
approved for participation by an eligible employer pursuant to title
XXII of the Social Security Act.
``(d) Denial of Double Benefit.--No deduction or credit under any
other provision of this chapter shall be allowed with respect to costs
of a three-share program taken into account under subsection (a).
``(e) Advanced Refundability.--The Secretary shall provide for the
advanced refundability of the credit allowed under this section to be
made in quarterly payments to taxpayers providing such information as
the Secretary requires in order to make a proper determination of such
payments.
``(f) Regulations.--The Secretary may prescribe such regulations
and other guidance as may be necessary or appropriate to carry out this
section.''.
(b) Conforming Amendments.--
(1) Paragraph (2) of section 1324(b) of title 31, United
States Code, is amended by inserting before the period ``, or
from section 36 of such Code''.
(2) The table of sections for subpart C of part IV of
chapter 1 of the Internal Revenue Code of 1986 is amended by
striking the last item and inserting the following new items:
``Sec. 36. Employer costs of three-share
program.
``Sec. 37. Overpayments of tax.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
<all>