[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 288 Reported in Senate (RS)]
Calendar No. 2
109th CONGRESS
1st Session
S. 288
To extend Federal funding for operation of State high risk health
insurance pools.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
Mr. Gregg (for himself, Mr. Baucus, Mr. DeWine, Mr. Bingaman, Mr.
Roberts, Mr. Lieberman, Mr. Cochran, and Mr. Enzi) introduced the
following bill; which was read twice and referred to the Committee on
Health, Education, Labor, and Pensions
February 10, 2005
Reported by Mr. Enzi, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
A BILL
To extend Federal funding for operation of State high risk health
insurance pools.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``State High Risk Pool
Funding Extension Act of 2005''.</DELETED>
<DELETED>SEC. 2. EXTENSION OF FUNDING FOR OPERATION OF STATE HIGH RISK
HEALTH INSURANCE POOLS.</DELETED>
<DELETED> (a) Extension of Seed Grants.--Section 2745 of the Public
Health Service Act (42 U.S.C. 300gg-45) is amended--</DELETED>
<DELETED> (1) in subsection (a), in the subsection heading
by inserting ``Extension of'' before ``Seed''; and</DELETED>
<DELETED> (2) in subsection (c)(1), by striking
``$20,000,000'' and all that follows through ``2003'' and
inserting ``$15,000,000 for the period of fiscal years 2005 and
2006''.</DELETED>
<DELETED> (b) Funds for Operations.--Section 2745 of the Public
Health Service Act (42 U.S.C. 300gg-45) is amended--</DELETED>
<DELETED> (1) in subsection (b)--</DELETED>
<DELETED> (A) in the subsection heading by striking
``Matching''; and</DELETED>
<DELETED> (B) by striking paragraph (2) and
inserting the following:</DELETED>
<DELETED> ``(2) Allotment.--The amounts appropriated under
subsection (c)(2) for a fiscal year shall be made available to
the States (or the entities that operate the high risk pool
under applicable State law) as follows:</DELETED>
<DELETED> ``(A) An amount equal to 50 percent of the
appropriated amount for the fiscal year shall be
allocated in equal amounts among each eligible State
that applies for assistance under this
subsection.</DELETED>
<DELETED> ``(B) An amount equal to 25 percent of the
appropriated amount for the fiscal year shall be
allocated among the States so that the amount provided
to a State bears the same ratio to such available
amount as the number of uninsured individuals in the
State bears to the total number of uninsured
individuals in all States (as determined by the
Secretary).</DELETED>
<DELETED> ``(C) An amount equal to 25 percent of the
appropriated amount for the fiscal year shall be
allocated among the States so that the amount provided
to a State bears the same ratio to such available
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 in all
States (as determined by the Secretary).'';
and</DELETED>
<DELETED> (2) in subsection (c)(2), by striking
``$40,000,000'' and all that follows through the period and
inserting ``$75,000,000 for each of fiscal years 2005 through
2009 to make allotments under subsection (b)(2).''.</DELETED>
<DELETED> (c) Definitions.--Section 2745 of the Public Health
Service Act (42 U.S.C. 300gg-45) is amended--</DELETED>
<DELETED> (1) in subsection (d), by inserting after
``2744(c)(2)'' the following: ``, except that with respect to
subparagraph (A) of such section a State may elect to provide
for the enrollment of eligible individuals through an
acceptable alternative mechanism,''; and</DELETED>
<DELETED> (2) by adding at the end the following:</DELETED>
<DELETED> ``(e) Standard Risk Rate.--In subsection (b)(1)(A), the
term `standard risk rate' means a rate--</DELETED>
<DELETED> ``(1) 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;</DELETED>
<DELETED> ``(2) that is established using reasonable
actuarial techniques; and</DELETED>
<DELETED> ``(3) that reflects anticipated claims experience
and expenses for the coverage involved.''.</DELETED>
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. PROMOTION OF QUALIFIED HIGH RISK POOLS.
``(a) Extension of 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 this section 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 150 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 after the end of fiscal year 2004 in connection
with operation of the pool;
the Secretary shall provide, from the funds appropriated under
subsection (d)(1)(B)(i) 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.--The amounts appropriated under subsection
(d)(1)(B)(i) for a fiscal year shall be made available to the
States (or the entities that operate the high risk pool under
applicable State law) as follows:
``(A) An amount equal to 50 percent of the
appropriated amount for the fiscal year shall be
allocated in equal amounts among each eligible State
that applies for assistance under this subsection.
``(B) An amount equal to 25 percent of the
appropriated amount for the fiscal year shall be
allocated among the States so that the amount provided
to a State bears the same ratio to such available
amount as the number of uninsured individuals in the
State bears to the total number of uninsured
individuals in all States (as determined by the
Secretary).
``(C) An amount equal to 25 percent of the
appropriated amount for the fiscal year shall be
allocated among the States so that the amount provided
to a State bears the same ratio to such available
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 in all
States (as determined by the Secretary).
``(c) Bonus Grants for Supplemental Consumer Benefits.--
``(1) In general.--In the case of a State that has
established a qualified high risk pool, the Secretary shall
provide, from the funds appropriated under subsection
(d)(1)(B)(ii) 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, including
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) Limitation.--In allotting amounts under this
subsection, the Secretary shall ensure that no State receives
an amount that exceeds 10 percent of the amount appropriated
for the fiscal year involved under subsection (d)(1)(B)(ii).
``(4) Rule of construction.--Nothing in this subsection
shall be construed to prohibit States that, on the date of
enactment of the State High Risk Pool Funding Extension Act of
2005, are in the process of implementing programs to provide
benefits of the type described in paragraph (2), from being
eligible for a grant under this subsection.
``(d) Funding.--
``(1) In general.--Out of any money in the Treasury of the
United States not otherwise appropriated, there are authorized
and appropriated--
``(A) $15,000,000 for the period of fiscal years
2005 and 2006 to carry out subsection (a); and
``(B) $75,000,000 for each of fiscal years 2005
through 2009, of which--
``(i) two-thirds of the amount appropriated
for a fiscal year shall be made available for
allotments under subsection (b)(2); and
``(ii) one-third of the amount appropriated
for a fiscal year shall be made available for
allotments under subsection (c)(2).
``(2) Availability.--Funds appropriated under this
subsection for a fiscal year shall remain available for
obligation through the end of the following fiscal year.
``(3) Reallotment.--If, on June 30 of each fiscal year, the
Secretary determines that all amounts appropriated under
paragraph (1)(B)(ii) for the fiscal year are not allotted, such
remaining amounts shall be allotted among States receiving
grants under subsection (b) for the fiscal year in amounts
determined appropriate by the Secretary.
``(4) 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) 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 with respect to subparagraph
(A) of such section a State may elect to provide for
the enrollment of eligible individuals through--
``(i) a combination of a qualified high
risk pool and an acceptable alternative
mechanism; or
``(ii) other health insurance coverage
described in subparagraph (B).
``(B) Health insurance coverage.--Health insurance
coverage described in this subparagraph is individual
health insurance coverage--
``(i) that meets the requirements of
section 2741;
``(ii) that is subject to limits on the
rates charged to individuals;
``(iii) that is available to all
individuals eligible for health insurance
coverage under this title who are not able to
participate in a qualified high risk pool; and
``(iv) the defined rate limit of which does
not exceed the limit allowed for a qualified
risk pool that is otherwise eligible to receive
assistance under a grant under this section.
``(C) Other coverage.--In addition to coverage
described in subparagraph (B), a State may provide for
the offering of health insurance coverage that provides
first dollar coverage, limits on cost-sharing, and
comprehensive medical, hospital and surgical coverage,
if the limits on rates for such coverage do not exceed
125 percent of the limit described in subparagraph
(B)(iv).
``(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.''.
Calendar No. 2
109th CONGRESS
1st Session
S. 288
_______________________________________________________________________
A BILL
To extend Federal funding for operation of State high risk health
insurance pools.
_______________________________________________________________________
February 10, 2005
Reported with an amendment