Health Equity and Access Reform Today Act of 1991

Health Equity and Access Reform Today Act of 1991 - Title I: Increase in Access to Health Care and Affordable Health Insurance - Subtitle A: Provision of Insurance Through Small Employers - Part I: Small Employer Health Insurance Reforms - Provides for development by the National Association of Insurance Commissioners of model standards regarding requirements under this Act relating to: (1) offering by small employer carriers of MedAccess plans; (2) benefits under such plans; (3) guaranteed issue; (4) initial writing; and (5) premium increases. Directs the Secretary of Health and Human Services to adopt those standards or specify alternative standards. Provides for enforcement of the standards through each State. Allows a State to have more stringent standards.

Directs the Secretary to enforce the standards in any State which fails to comply with enforcement or reporting requirements (Federal standard State). Amends the Internal Revenue Code tax on a small employer carrier for any failure in a Federal standard State to comply with the standards. Sets the tax at a specified percentage of the amounts received by the carrier for providing any health benefit plan to any small employer in the Federal standard State.

Preempts any provision of State law with regard to a small employer health benefit plan that meets requirements of this Act relating to initial writing and premium increases.

Requires each small employer carrier to offer a MedAccess Plan, defined as a plan which: (1) is designed to provide only basic hospital, medical, surgical, and preventive benefits so as to make it affordable to small employers as specified in standards under this Act; (2) is guaranteed issue; and (3) meets requirements of this Act relating to initial writing and premium increases. Defines the term, for a health maintenance organization (HMO), as a plan of the type described above, but with benefits consistent with applicable Federal or State requirements for HMOs.

Requires each MedAccess plan to accept every small employer in the State that applies for coverage and every full-time employee, with associated family coverage. Provides special rules allowing HMOs to: (1) limit enrollment of employers and employees to the HMO's service area; and (2) deny coverage on the basis of inadequate capacity, provided the denial is applied uniformly without regard to health status, claims experience, or duration of coverage.

Sets forth requirements for the initial writing of policies, including prohibiting limiting or excluding coverage for pre-existing conditions under certain circumstances. Limits: (1) variation of index rates between distinct groups of employers (blocks of business) as shown on the records of the carrier; (2) variation of premium rates within a block of business; and (3) transfer of employers among blocks of business. Sets forth rules for establishing blocks of business.

Requires: (1) a carrier to fully disclose rating practices; (2) actuarial certification that a carrier is in compliance with these provisions and the rating methods are sound; and (3) registration of carriers with and reporting by carriers to the State insurance commissioner. Allows a carrier to condition issuance or renewal on enrollment of a minimum number or percentage of an employer's employees. Requires such conditions to be imposed uniformly on employers of the same size.

Prohibits cancellation or denial of renewal other than for specified reasons, including for: (1) nonpayment of premiums; (2) noncompliance with plan provisions; (3) failure to maintain the required number or percentage of enrollees; or (4) misuse of a provider network provision. Limits premium increases. Prohibits for five years market reentry after a carrier terminates the offering of plans in an area.

Provides for development by the National Association of Insurance Commissioners of models for reinsurance mechanisms for individuals and small employers who are enrolled under a small employer plan and for whom a carrier is at risk of incurring high costs under the plan.

Requires each State to establish and fund one or more reinsurance mechanisms. Allows a State, in order to assure the financial solvency of the mechanism, to impose charges on any entity, including a self-insured entity, providing employee-related health benefits.

Directs the Secretary to establish a mechanism for a State which fails to do so (Federal reinsurance State). Requires the mechanism in a Federal reinsurance State to charge the carrier a premium equal to 500 percent of the premium charged to a reinsured individual or 150 percent of the premium charged a reinsured group.

Amends the Internal Revenue Code to impose a tax on the providing of any health benefit plan which covers any employee in a Federal reinsurance State. Ties the amount of the tax to the percentage estimated as generating sufficient revenues to carry out the reinsurance. Requires the tax to be paid by the plan provider (the carrier, the HMO, or the administrator of a self-insured plan).

Allows each State commissioner of insurance to require each employer health benefit plan, including a self-insured plan, to be registered with that commissioner. Allows the Secretary to impose such a requirement with regard to a Federal reinsurance State.

Part II: Requiring Employers to Offer Health Insurance to Employees - Requires each small employer to make available to each full-time employee the option to enroll the employee, and the employee's spouse and dependent children, in a MedAccess plan. Declares that the employer need not make any contribution towards the cost. Considers an employer in compliance if the employer sought coverage but the plan was not made available because an insufficient number or percentage of employees enrolled.

Requires each large employer to make available to each full-time employee the option to enroll the employee, and the employee's spouse and dependent children, in a health benefits plan providing for at least the benefits required of a MedAccess plan. Declares that the employer need not make any contribution towards the cost. Defines a large employer as having 26 or more full-time employees.

Amends the Internal Revenue Code to impose a tax on an employer for failure to offer a health insurance plan. Sets the amount of the tax at a specified amount per employee per year, to a specified maximum.

Part III: Definitions - Sets forth definitions of terms as used in this subtitle, including defining a small employer to include certain employers with between three and 26 employees.

Subtitle B: Incentives for Managed Care Plans - Amends the Internal Revenue Code to impose a tax on an employer for providing any health plan unless the plan is a cost-controlled plan or a safe harbor plan. Sets the amount of the tax at a specified percentage of the amount paid or incurred by the employer in providing the plan which is not a cost-controlled or safe harbor plan.

Defines "cost-controlled health benefit plan" to mean either a managed care plan or a responsible co-payment plan. Defines "safe harbor plan" as a plan under which the average monthly employer contribution does not exceed specified levels for individual and group coverage.

Increases the percentage of medical care insurance costs which a self-employed individual is allowed to deduct from income taxes. Removes provisions terminating all health care insurance deductions for self-employed individuals as of a specified date. Allows such deductions only for controlled-cost or safe harbor plans.

Preempts and prohibits the enforcement of any State law that restricts: (1) carriers from negotiating reimbursement rates with providers or contracting selectively with one or a limited number of providers; (2) financial incentives a health plan may require a beneficiary to pay for using a non-plan provider on a non-emergency basis; and (3) certain aspects of utilization review. Requires the Comptroller General to conduct a study of the benefits and cost effectiveness of the use of managed care in the delivery of health services and report to the Congress. Declares the provisions superseding State law inapplicable after five years.

Subtitle C: Study and Report - Directs the Secretary of Health and Human Services to study and report to the Congress on the impact of the changes made by this title on: (1) increasing access to health care; (2) the number of employees of small employers who do not have health insurance; (3) the cost of small employer health benefit plans; and (4) the effectiveness of MedAccess plans.

Title II: Encouraging Expansion of Services to the Poor and Working Poor - Declares that the remedy provided by specified provisions of Federal law relating to claims against the United States for personal injury resulting from medical care provided by an entity receiving a grant or contract under provisions relating to migrant and community health centers, or provided by an individual employed by or under contract to such a center, shall be exclusive of any other civil action or proceeding. Directs the Attorney General to defend any civil action or proceeding brought in any court against a protected person for such injury. Directs the Secretary of Health and Human Services to certify that an entity receiving a grant or contract under such provisions has: (1) implemented policies and procedures to assure against malpractice; and (2) no history of claims against it or, if such claims exist, has fully cooperated with the Attorney General in defending against the claims and taken corrective steps.

Directs the Secretary to provide for a program of grants to migrant and community health centers receiving grants or contracts under provisions of the Public Health Service Act relating to such centers to promote the provision of primary health care services for underserved individuals. Authorizes appropriations.

Title III: Preserving and Improving Quality of Care - Directs the Secretary to develop standards for: (1) a common set of hospital clinical patient data; and (2) the confidential transfer of data in electronic form. Directs the Secretary to report to the Congress on restructuring the Medicare peer review quality assurance program given the availability of hospital data in electronic form.

Amends title XVIII (Medicare) of the Social Security Act to require hospitals, in order to be eligible for Medicare payments, to: (1) maintain clinical data in electronic form on all inpatients; and (2) transmit electronically to the Secretary or a utilization and quality control peer view organization a common set of clinical inpatient hospital data relating to any individual receiving services for which certain Medicare payments may be made.

Directs the Secretary to provide grants to demonstrate and conduct research on the application of comprehensive information systems in monitoring and improving patient care. Makes up to a specified amount available each year from the Federal Hospital Insurance Trust Fund for the grants.