Health Care bill

Health Equity and Access Improvement Act of 1991 - Title I: Tax Incentives for Health Care Access - Amends the Internal Revenue Code to provide a tax credit of up to $600 for an individual ($1,200 for a family) for qualified health expenses. Provides that in the case of a taxpayer whose adjusted gross income exceeds $10,000 ($20,000 for a family) the credit shall be reduced by an amount equal to ten percent of the excess.

Permits a tax deduction, for both itemizers and nonitemizers, for the cost of health insurance premiums for which no other compensation is received.

Provides an employer health insurance credit for small businesses equal to 25 percent of the qualified health care costs of the employer in the first year the employer offers health coverage to employees and which is then reduced five percentage points annually.

Raises from 25 percent to 100 percent the deduction allowed to self-employed individuals for health insurance premiums and makes the deduction permanent.

Provides a credit for a qualified primary health services provider who practices in a rural health professional shortage area. Sets forth a formula for determining such credit.

Excludes from gross income any payment made on behalf of a taxpayer by the National Health Service Corps Loan Repayment Program. Permits a physician in a rural health professional shortage area to expense up to $25,000 worth of rural health care property. Provides that interest on student loan payments by medical professionals practicing in rural areas shall not be treated as personal interest and will therefore qualify as a tax deduction.

Title II: Health Care Reform Provisions - Directs the Secretary of Health and Human Services (the Secretary) to request the National Association of Insurance Commissioners (NAIC) to develop a model health care insurance benefits plan that shall contain standards that entities offering health care insurance policies should meet with respect to the benefits and coverage provided under such policies and report on such standards to the Secretary. Requires the Secretary to develop such a plan if the NAIC fails to develop such a plan or if the NAIC plan does not meet specified requirements. Sets forth such requirements.

Requires the Secretary, taking into account recommendations of the Managed Care Advisory Committee, to develop recommended standards that insurers offering managed care plans should meet with respect to the benefits, coverage, and delivery systems provided under such plans. Establishes the Managed Care Advisory Committee. Provides that, in the case of a managed care plan meeting recommended standards, specified provision of State law will be preempted and will not be enforced against the managed care plan with respect to an insurer offering such plan.

Permits a qualified small employer purchasing group, upon application to and approval by the Secretary, to enter into contracts with carriers to provide health insurance coverage to eligible employees.

Establishes standards which health care insurers must meet in a contract with a small business. Requires such insurers, among other things, to: (1) provide coverage and benefits consistent with the model health care insurance benefits plan; (2) meet specified registration and disclosure requirements; (3) not exclude from coverage any eligible employee; (4) not extend beyond six months any limitation on any preexisting condition and, with respect to such limitation, apply it only to preexisting conditions which manifested themselves or for which medical care was sought during the three months preceding coverage; (5) guarantee renewability of the contract at the employer's election, unless the contract is terminated for cause; and (6) establish premiums that meet specified standards.

Title III: Medical Liability Reform - Sets forth provisions concerning settlement offers in medical malpractice cases.

Establishes an Alternative Dispute Resolution Board of Advisers to make recommendations to the Secretary concerning the establishment of a model voluntary alternative dispute resolution program for medical malpractice cases.

Sets caps on the payment of future losses, non-economic damages, and attorneys' fees. Prohibits joint liability in a civil action for non-economic damages. Establishes a statute of limitations for a medical malpractice civil action.

Requires each State to: (1) allocate its medical licensing fees to the State agency responsible for licensing and disciplinary actions; (2) require that at least 25 percent of a disciplinary board's membership shall be from the general public; (3) have in effect a Statewide risk management program; and (4) establish a health care disciplinary trust fund consisting of all punitive damage awards resulting from medical malpractice and medical product civil actions.

Protects a health care producer of a drug or device from punitive damages if the drug or device was subject to approval or premarket approval under the Federal Food, Drug, and Cosmetic Act.

Amends the Public Health Service Act to direct the Secretary to make a grant to an entity representing recipients of assistance at migrant and community health centers to develop a business plan and establish a nationwide risk retention group as provided for in the Liability Risk Retention Act of 1986. Authorizes appropriations.

Title IV: Public Health Provisions - Amends the Social Security Act to add a new title, Title XXI: BASICARE. Authorizes appropriations under title XXI for the purpose of providing basic health care benefits to low-income uninsured individuals who are not eligible for Medicaid (title XIX of the Social Security Act) coverage. Requires a State, in order to receive funding under title XXI, to submit and have approved by the Secretary a BasiCare assistance plan. Sets forth plan requirements. Requires, for BasiCare eligibility, that: (1) family income be below 200 percent of the poverty line; (2) an individual not be eligible for Medicaid; and (3) an individual not be otherwise covered under a health plan by the individual's employer. Permits the imposition of deductibles, copayments, and premiums if income is between 100 to 200 percent of the poverty line.

Establishes the Federal Medical Waiver Demonstration Board to review applications submitted by States to conduct health care-related demonstration projects. Requires the Board to develop at least three different model health care delivery plans. Permits the Board, upon approval of a State's demonstration project, to waive the following provisions of Federal law: (1) the Public Health Service Act; (2) title XVIII (Medicare) of the Social Security Act; (3) titles XIX (Medicaid) and XXI (BASICARE) of the Social Security Act; (4) all health care programs administered by the Secretary of Veterans Affairs; and (5) the Employee Retirement Income Security Act of 1974.

Title V: Medically Underserved Areas - Authorizes appropriations for the National Health Service Corps Scholarship Program and the National Health Service Corps Loan Repayment Program.

Directs the Secretary to establish and administer a program to provide allotments to States to enable such States to provide grants for the creation or enhancement of community based primary health care entities that provide services to pregnant women and children up to age three. Requires grant recipients to substantially target populations of pregnant women and children who: (1) lack health care coverage or ability to pay for health care services; or (2) reside in medically underserved or health professional shortage areas.

Directs the Secretary to award grants to federally qualified health centers (FQHCs) and other entities submitting applications for the purpose of providing access to services for medically underserved populations or in high impact areas not currently served by a FQHC. Limits the expenditure of funds awarded an FQHC to the provision of those services provided under the Medicaid program and any unreimbursed costs of providing services under the community based primary health care grant program. Authorizes appropriations.

Authorizes the Secretary to award competitive grants to eligible entities to enable such entities to develop and implement a plan for mental health outreach programs in rural areas. Authorizes appropriations.

Directs the Secretary, in awarding grants under the Public Health Service Act relating to the research, teaching, and training activities of health personnel educational entities, to give priority to those entities that have a high permanent rate for placing graduates in settings serving residents of medically underserved communities and that otherwise demonstrate a commitment to serving such communities.

Directs the Secretary to award grants to health professions institutions to expand training programs that are targeted at those individuals desiring to practice in or serve the needs of medically underserved communities. Authorizes appropriations.

Directs the Secretary to award grants to eligible regional consortia to enhance and expand coordination among various health professions programs, particularly in medically underserved rural areas. Authorizes appropriations.

Authorizes the Secretary to award grants, under the area health education center provisions of the Act, to rural communities to enable such communities to provide stipends to physicians, nurses, or other health professional trainees to encourage such individuals to continue to provide health care services in such rural communities. Authorizes appropriations.

Authorizes the Secretary to award competitive grants to eligible entities to enable such entities to facilitate the development of networks among rural and urban health care providers to preserve and share health care resources and enhance the quality and availability of health care in rural areas. Authorizes appropriations.

Authorizes the Secretary to award competitive grants to eligible entities to enable such entities to develop and administer cooperatives in rural areas that will establish an effective case management and reimbursement system designed to support the economic viability of essential public or private health services, facilities, health care systems, and health care resources in such rural areas. Authorizes appropriations.

Amends the: (1) Omnibus Budget Reconciliation Act of 1987 to authorize appropriations for the Rural Health Care Transition Grant Program; and (2) Medicare program to authorize appropriations for the Essential Access Community Hospital Program.

Title VI: Incentives to Encourage Preventive Services - Provides a tax credit for qualified preventive services of up to $250. Includes on a list of preventive services: (1) cancer screening tests; (2) childhood immunizations; (3) mammograms; (4) pap tests for uterine cancer; and (5) other specified examinations and tests.

Authorizes appropriations, under the Public Health Service Act, for grants for preventive health service programs for the provision, without charge, of immunizations.