Universal Health Insurance Act of 1991

Universal Health Insurance Act of 1991 - Requires each State to: (1) submit to the Secretary of Health and Human Services, by July 1, 1993, a description of a State health insurance and cost control plan as described in this Act; and (2) have such plan in place and operating by January 1, 1994.

Directs the Secretary to make grants to States for developing such plans. Authorizes appropriations.

Requires the Secretary to make grants to eligible States based on a specified formula (50 percent for payments in amounts determined by the Advisory Commission on Intergovernmental Relations to assist States in the operation of such plans, 25 percent based on each State's relative percentage of payments made to all States under the Social Security Act (SSA) for quarters in 1991, and 25 percent as determined based on each State's relative percentage of individuals 75 years of age or older in all States).

Amends the SSA to provide that the amount of Medicaid payments to a State for quarters beginning January 1, 1994, shall be equal to the amount of such payments for the quarter ending December 31, 1993, increased by an amount considered appropriate by the Secretary to take into account increases in the costs of items and services provided under the State plan for medical assistance under Medicaid and the State's approved health insurance plan under this Act.

Directs the Secretary to evaluate the State health insurance plans developed and implemented and, by January 1, 1994, to approve those plans that efficiently and effectively provide quality health care to State residents in a cost-effective manner, to periodically review such plans, and to report to the Congress.

Requires the Secretary, for years after 1992, to provide a specified additional payment to at least two States that have implemented a single-payer system for all health care services provided to all individuals in the State.

Sets forth required provisions of the State plans. Provides that in the case of a State that elects to operate a plan under which employers either provide coverage or pay for others to provide coverage, such plan shall provide for: (1) a requirement that each employer of 50 or more persons enroll its employees and family members in a health benefit plan (HBP) that meets specified requirements or make a contribution to enable its employees to enroll in such a plan; and (2) the creation and implementation of mechanisms (including insurance pools) designed to reduce the costs of providing health insurance coverage for self-employed individuals, unemployed individuals, and individuals employed by businesses with fewer than 50 employees. Requires State plans to provide for: (1) the establishment of a HBP under which low-income individuals, individuals who are unable to obtain health insurance because of preexisting health conditions, and other individuals who are otherwise unable to obtain health insurance are provided health insurance coverage for a premium that is determined by taking into account the individuals' incomes, subject to specified requirements; (2) the creation of specified mechanisms designed to limit an individual's costs of coverage under health insurance plans offered, such as limitations on the amount of premiums, deductibles, copayment, and coinsurance for individuals; (3) a requirement that the State plan for medical assistance under Medicaid meet national minimum standards; (4) the creation of mechanisms designed to assure, monitor, and maintain the provision of high quality health care; (5) the creation of mechanisms designed to control the costs of providing such care; and (6) any requirements or provisions necessary to ensure that the State is in compliance with specified managed care standards.

Specifies services that each HBP shall include, such as: (1) inpatient and outpatient hospital care and physician services with exceptions; (2) diagnostic and screening tests; (3) prenatal and well-baby care provided to children one year of age or younger; (4) long-term care services; (5) prescription drugs; (6) early and periodic screening, diagnostic, and testing services; and (7) immunizations. States that such provisions shall not be construed as requiring a HBP to provide coverage for care and services not medically necessary or for experimental services and procedures.

Sets forth provisions with respect to: (1) the amount, scope, and duration of certain benefits; (2) mental health care; (3) a prohibition of preexisting condition provisions; (4) permitting proportional contribution by part-time employees; (5) allowing States to establish or participate in a joint or multistate insurance mechanism; and (6) permitting HBPs to impose deductibles, coinsurance, or other forms of cost-sharing, subject to such restrictions as the Secretary may impose.

Prohibits any State insurance, health care, or any other law or regulations from imposing specified limitations with respect to managed care, including: (1) prohibiting a managed care plan from freely selecting the health care providers as participating providers for any HBP in the State; or (2) limiting the ability of a managed care entity to negotiate, enter into contracts or establish alternative rates or forms for payment for participating providers for HBPs in the State or to require or provide incentives that promote the use of participating providers.

Specifies that if a carrier in the State (other than a health maintenance organization or reinsurance carrier) offers HBPs to employers that are not small employers in a community where a managed care plan exists, the carrier must make available to small employers in the community a HBP that is such a managed care plan.

Amends the SSA to change from discretionary to mandatory the authority of the Secretary to provide that payment for operating costs of inpatient hospital service under Medicare in accordance with alternate State plans shall be made, beginning on October 1, 1993.

Directs the Secretary to establish a demonstration program under which the Secretary makes grants to ten eligible States to cover the Federal share (50 percent) of the costs of implementing not more than one feature of the State's health insurance plan under this Act during a period determined by the Secretary. Sets forth provisions regarding: (1) eligibility for grants; and (2) preferences to States that will use the grant to finance features of the State health insurance plan designed to provide health care to specified categories of individuals.

Amends the SSA to require that, in order to receive Medicaid payments for any quarter beginning on or after January 1, 1994, a State must certify to the Secretary that it has adopted (and assumed responsibility for enforcing) an approved State health insurance plan under this Act, or has otherwise adopted (and assumed responsibility for enforcing) laws, rules, or regulations which ensure the provision of health insurance coverage to all residents of the State as effectively as such plan, with exceptions.

Specifies that: (1) a State is not required under its medical assistance plan to provide assistance for items and services for which payment is made under an approved State health insurance plan under this Act; and (2) nothing in this Act shall be construed as changing the eligibility of individuals for medical assistance under Medicaid or changing the amount, duration, or scope of medical assistance required (or permitted) to be provided under such Act, with exceptions.

Directs the Secretary to develop and submit to the Congress appropriate recommendations for uniform eligibility and coverage requirements with respect to the SSA, subject to specified minimum requirements for HBPs developed under this Act.

Amends the Employee Retirement Income Security Act of 1974 to require self-insurance plans to comply with State health insurance plan requirements.

Amends the Internal Revenue Code (relating to special rules for health insurance costs of self-employed individuals) to: (1) allow as a deduction 25 percent for 1992 or 1993, 50 percent for 1994 or 1995, and 100 percent for 1996 or thereafter (currently, 25 percent) of the amount paid during the taxable year for insurance which constitutes medical care for the taxpayer, his spouse, and dependents; and (2) make such deduction permanent.