Access to Health Care for All Americans Act of 1991

Access to Health Care for All Americans Act of 1991 - Title I: Access and Affordability of Health Insurance for Small Employers - Amends the Internal Revenue Code to allow a deduction of 100 percent (currently, 25 percent) of the health insurance costs of self-employed individuals and to remove provisions terminating on a specified date the deductibility of such costs.

Imposes a tax on insurers who fail to meet certain requirements regarding accident and health contracts for eligible small employers. Includes in those requirements issuance of contracts providing benefits identical to Medplan core benefits and contracts providing benefits identical to Medplan standard benefits. Sets forth pricing and marketing requirements. Requires that the contracts be guaranteed issue.

Requires core and standard benefits to include: (1) inpatient and outpatient hospital services; (2) inpatient and outpatient surgical services; (3) inpatient and outpatient physicians' services; (4) diagnostic and screening services; (5) prenatal care; (6) ambulance services; and (7) durable medical equipment. Requires, in addition, that standard benefits include: (1) inpatient or outpatient treatment for a mental disorder; and (2) inpatient and outpatient treatment of a chemical dependency disorder.

Limits deductibles, out-of-pocket expenses, and copayments. Requires guaranteed eligibility. Regulates preexisting condition limitations. Requires guaranteed renewability. Sets forth rating, disclosure, and recordkeeping requirements.

Allows the Secretary of Health and Human Services to enter into an agreement with any State to apply State standards instead of the requirements of this Act if the Secretary determines that the State standards will carry out the purposes of this Act. Prohibits any such agreement from waiving the requirement of offering contracts with benefits identical to Medplan core benefits and contracts with benefits identical to Medplan standard benefits.

Defines "eligible small employer" to mean those with between one and 50 employees.

Preempts any provision of State law: (1) requiring any employer member of a qualified small employer purchasing group to offer any services, category of care, or services of any class or type of provider; (2) requiring any provider of insurance to pay a tax on premiums received from members of such a group; or (3) restricting certain aspects of managed care.

Title II: Health Care Cost Control - Subtitle A: Encouraging Managed Care Plans - Mandates development of recommended standards regarding the benefits, coverage, and delivery systems provided under managed care plans, as well as the standards by which managed care entities operate.

Establishes the Managed Care Advisory Committee.

Preempts, with regard to managed care plans, provisions of State law relating to: (1) reimbursement rates or selective contracting; (2) differential financial incentives; (3) utilization review methods; or (4) benefits.

Subtitle B: Medical Malpractice Reform - Chapter 1: Definitions and Findings - Sets forth definitions and findings with regard to this subtitle.

Chapter 2: Expedited Medical Malpractice Settlements - Allows any claimant to bring a civil action for damages against a person for harm caused during the provision of medical care under State law, except as superseded by this chapter.

Provides, in certain circumstances, for recovery of attorney's fees by the prevailing party if the opposing party failed to accept an offer of settlement.

Chapter 3: Alternative Dispute Resolution Procedures - Establishes the Alternative Dispute Resolution Board of Advisors to advise the Secretary of Health and Human Services on the establishment of a model voluntary alternative dispute resolution (ADR) program.

Mandates a program to encourage States to develop and implement voluntary ADR procedures that meet the requirements of this subtitle. Requires a State which does not adopt its own procedures to adopt the model system.

Allows a claimant or defendant to offer to proceed with an ADR procedure. Requires assessment of attorney's fees and costs against a recipient of such an offer who refuses to proceed if the refusal was unreasonable or not in good faith. Creates a rebuttable presumption that the refusal was unreasonable and not in good faith.

Chapter 4: Uniform Standards for Medical Malpractice Cases - Applies this chapter to any medical malpractice action in any Federal or State court and any medical malpractice claim resolved through an ADR system.

Limits: (1) lump sum payments for future losses; (2) noneconomic damages; and (3) attorney's fees. Makes the liability of each defendant for noneconomic damages several and not joint. Sets forth time limits.

Requires proof of malpractice by clear and convincing evidence in cases related to delivery of a baby when the health care professional did not previously provide prenatal care to the claimant (sometimes referred to as "drop in deliveries").

Chapter 5: Uniform Disciplinary Reforms - Requires States to comply with this chapter.

Requires each State to: (1) allocate all fees for licensing or certification of each type of health care practitioner to the State agencies responsible for the conduct of licensing and disciplinary actions regarding that type of practitioner; and (2) allow the general public to be represented on State practitioner disciplinary boards. Prohibits monetary liability on the part of any individual serving on a State disciplinary board.

Requires each State to: (1) have in effect a statewide risk management program; and (2) establish a health care disciplinary trust fund. Requires all punitive damages from all medical malpractice and medical products civil actions to be transferred to the fund. Mandates use of fund amounts to provide additional resources to the boards and to provide additional resources for State consumer protection activities.

Chapter 6: Medical Products - Limits whether punitive damages, otherwise permitted by applicable law, may be awarded against a health care producer (defined as a designer, manufacturer, producer, or seller of a drug or device) in certain circumstances and, if so, specifies that specified evidence may be considered in determining the amount of the damages. Makes approval of a drug or device by the Food and Drug Administration an absolute defense to a claim of strict liability.

Chapter 7: Community Health Centers - Amends the Public Health Service Act to mandate a grant to an entity that represents recipients of grants under provisions relating to migrant and community health centers for the establishment of a nationwide risk retention group as provided for in the Liability Risk Retention Act of 1986. Requires that all such centers become members in the group and purchase the professional liability insurance offered by the group. Authorizes appropriations to carry out provisions relating to the group. Requires amounts saved by centers as a result of the group to be used for additional services by the centers and to defend against medical malpractice claims arising from center services.

Authorizes appropriations to carry out specified provisions relating to the centers.

Chapter 8: Miscellaneous Provisions - Provides for severability and for compliance deadlines.

Title III: Rural Health Improvement Initiatives - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services and the Prospective Payment Assessment Commission to each submit to the Congress a report recommending a methodology for the elimination of the system of determining separate average standardized amounts for hospitals in large urban, other urban, or rural areas.

Amends the Public Health Service Act to modify priorities for awarding National Health Service Corps scholarship and loan repayment contracts.

Amends the Internal Revenue Code to exclude from gross income repayment under the National Health Service Corps Loan Repayment Program.

Amends the Public Health Service Act to authorize appropriations to carry out specified provisions relating to area health education centers.

Authorizes competitive grants for 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. Allows the networks to be statewide or regional. Authorizes appropriations.

Amends the Internal Revenue Code to allow a tax credit for certain health professionals providing services in rural health professional shortage areas during periods when they are not receiving scholarships or loan repayments under National Health Service Corps programs.

Allows, with regard to elections to expense depreciable business assets, a higher aggregate cost to be taken into account for rural health care property in a rural health professional shortage area.

Allows a deduction for a limited amount of the interest paid on medical education loans by an individual performing services under an agreement with an applicable rural community to perform professional services in the community. Authorizes use of the deduction in computing adjusted gross income.

Amends the Public Health Service Act to authorize competitive grants for the development and implementation of a plan for mental health outreach programs in rural areas. Authorizes appropriations.

Title IV: Improved Access to Long-Term Care - Subtitle A: Long-Term Care Insurance Promotion - Directs the Secretary of Health and Human Services to establish a procedure for the certification of health insurance policies for the elderly as meeting minimum standards and requirements, including: (1) meeting or exceeding the National Association of Insurance Commissioners Model Act Standards; (2) guaranteed renewability; (3) limited exclusion of preexisting conditions; (4) a specified period during which purchasers may rescind their purchase; and (5) simplified language. Mandates a study and report to the Congress on health insurance policies for the elderly.

Amends the Internal Revenue Code to allow a credit for a percentage of qualified long-term care premiums paid.

Mandates: (1) an agreement between the Secretary of the Treasury and each State for the advance payment to certain individuals of the tax credit in the form of certificates usable for the purchase of long-term care insurance; and (2) a program to inform the public of the availability of the credit and filing procedures.

Excludes distributions from qualified retirement plans, when used by certain individuals to pay for long-term care insurance contracts, from provisions imposing an additional tax on early distributions from such plans.

Prohibits recognizing a gain or loss from the exchange by certain individuals of a life insurance, endowment, or annuity contract for a long-term care insurance contract.

Subtitle B: Other Provisions Relating to Long-Term Care - Amends the Internal Revenue Code to exclude from gross income any distribution from an individual retirement plan used to pay premiums for any qualified long-term health insurance policy.

Requires any amount paid under a life insurance contract on the life of an insured who is terminally ill, has a dread disease, or has been permanently confined to a nursing home to be treated as an amount paid by reason of the death of the insured.

Requires, for provisions relating to definitions and special rules involving life insurance companies, references to life insurance to be treated as including a reference to a terminal illness or dread disease rider, defined as a provision of a life insurance contract which provides for payments to or for the benefit of an insured upon the insured becoming a terminally ill individual or incurring a dread disease.

Amends provisions defining "life insurance contract" to include a terminal illness or dread disease rider or any qualified long-term care rider in the definition of "qualified additional benefits."