Health Access and Affordability Today Act of 1991

Health Access and Affordability Today Act of 1991 - Title I: Improvements in Access to Health Care - Subtitle A: Improvements in Medicaid Eligibility - Amends title XIX (Medicaid) of the Social Security Act to mandate Medicaid eligibility for eligible persons with incomes below 133 percent of a State-adjusted poverty level.

Allows each State Medicaid plan to elect to make eligible for medical assistance: (1) students in schools at which at least 70 percent of the students are eligible for assistance under specified programs; and (2) a younger sibling of the students being made eligible by these provisions. Mandates availability under these provisions of assistance for medical services required to terminate a pregnancy resulting from rape or incest. Adjusts payments to States.

Amends the Internal Revenue Code to eliminate references to the health insurance credit in provisions relating to: (1) the earned income credit; and (2) deductions for health insurance costs of self-employed individuals.

Subtitle B: Improvements in Access to Providers Under the Medicare and Medicaid Programs - Amends the Internal Revenue Code to impose a tax on any health care provider (payable by a hospital, nursing facility, or individual provider) who discriminates against or denies treatment to any individual covered under title XIX (Medicaid) or parts A (Hospital Insurance) or B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act. Sets forth circumstances in which a hospital or nursing facility shall be treated as discriminating. Applies certain deficiency procedures to these provisions.

Sets forth requirements regarding minimum Medicaid payment rates.

Subtitle C: Improving Access of All Workers to Employer Health Insurance - Amends the Internal Revenue Code to impose a tax on the providing of a group health plan unless: (1) all employees are eligible to participate in the plan (or another group plan of the employer meeting these requirements); and (2) the employer-provided benefit received by all employees is either the same dollar amount or the same percentage of the value of the coverage provided to each employee under the plan. Provides for part-time employees, small employers, and plans maintained pursuant to collective bargaining agreements.

Subtitle D: Improved Provision of Services through Community Health Centers - Amends the Immigration and Nationality Act to add physicians coming to the United States to provide full-time medical services in a medically underserved area to the list of nonimmigrant aliens excluded from the definition of "immigrant."

Declares that it is the sense of the Congress that: (1) health professions schools should require clinical experience in outpatient facilities that are principal sources of primary health services for medically underserved populations and offer courses that prepare students to practice at such facilities; (2) the Secretary of Health and Human Services should issue, and the Director of the Office of Management and Budget should cooperate in the issuance of, specified regulations regarding assignment of members of the National Health Service Corps; and (3) the Secretary should ensure the equitable allocation of assignments among urban and rural areas.

Amends the Public Health Service Act to mandate a grant for the establishment of a nationwide risk retention group to provide professional liability insurance and other approved types of profitable insurance to the migrant and community health centers. Requires all centers receiving funds under specified provisions and centers and clinics under certain other provisions to become members in the group. Makes all professional staff members of such centers eligible to obtain the insurance offered by the group. Authorizes appropriations for the grant and for capitalization of the group.

Subtitle E: Continuation of Access through College and University Health Plans - Prohibits any State or the District of Columbia from establishing or enforcing any law or regulation that prevents a college or university health plan from offering students enrolled in the plan continuation coverage after graduation.

Title II: Improvements in Affordability of Health Care- Preempts State laws and regulations dealing with: (1) health insurance under a health benefit plan; or (2) managed care.

Mandates adoption of a specified standard (known as the X12 Standard) for electronic data interchange of health care related transactions as a standard under: (1) titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act; (2) the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); and (3) veterans health programs and the Federal employees health benefit program under specified provisions of Federal law.

Amends the Internal Revenue Code to allow deduction of the full amount (currently, 25 percent of the amount) of health insurance costs of self-employed individuals. Removes provisions ending the deduction on a specified date.

Authorizes the Secretary of Health and Human Services to waive programmatic restrictions in title XVIII (Medicare) of the Social Security Act that hinder implementation of managed care plans under Medicare.

Mandates a study of fraud in the health care industry and its impact on health care costs.

Establishes the National Advisory Council on Access to Health Care.

Requires data collection on: (1) rates and patterns of use of health services, collected through data on hospital discharges, including medical records and hospital bills; and (2) State efforts in health care reform.

Authorizes the provision of funds to selected States to demonstrate innovative approaches of using existing data systems to evaluate State-based health care reform efforts. Authorizes appropriations.

Title III: Medicaid Financial Incentive for State Comprehensive Reform Package to Improve Access to Health Care and Reduce Costs of Health Care - Deems the Federal medical assistance percentage, if a State complies with this title, to be 100 percent of the expenditures attributable to: (1) individuals eligible for assistance only because of this title; or (2) the amount by which payments for medical assistance are increased by specified provisions relating to minimum Medicaid payment rates.

Requires a State to enact a small employer health insurance market reform program including: (1) guaranteed access by each small employer group to private health insurance coverage, with a reinsurance mechanism mandated; (2) coverage of whole groups, with neither the employer nor the insurer able to exclude a high risk individual; (3) renewability of coverage; (4) continuity of coverage when an employee changes jobs or when an employer changes carriers; (5) rate and rate change limits; and (6) disclosure of rating practices and annual rating certification.

Requires a State to enact laws requiring juveniles riding motorcycles to wear helmets, front seat passengers to wear a safety belt, and children under the age of four to be in a child restraint system.

Requires a State to establish an alternative dispute resolution system for health care negligence and provide for malpractice liability reforms at least as stringent as specified requirements regarding future damages, collateral payment, noneconomic losses, attorney's fees, and statutes of limitations.

Requires a State to establish one or more managed care plans for the provision of Medicaid services. Authorizes waiver of Medicaid programmatic restrictions that hinder implementation of managed care plans.

Requires that there be in operation in a State a qualified pooling association, defined as an organization which: (1) is a nonprofit corporation; (2) permits health insurers, hospital and medical service plan corporations, health maintenance organizations, and employers and other health financing entities to be members; (3) makes specified levels of health insurance available, without regard to health, to all State residents not eligible for benefits under part A (Hospital Insurance) of title XVIII (Medicare) of the Social Security Act; (4) charges a pool premium rate; and (5) assesses pool losses equitably among members. Specifies the levels of insurance covered.

Amends the Employee Retirement Income Security Act of 1974 (ERISA) to exclude such pools from provisions preempting State law.