BasiCare Health Access and Cost Control Act

TABLE OF CONTENTS:

Title I: Immediate Reforms

Subtitle A: Small Employer Health Insurance Market

Reform

Subtitle B: Community Health Services Expansion

Subtitle C: Expansion of Tax Incentives for Self-

Employed Individuals

Subtitle D: Expanding the Supply of Health Professionals

in Rural Areas

Subtitle E: Malpractice Reform

Subtitle F: Joint Ventures

Title II: Long-Term Reforms

Subtitle A: Establishment of Commission and Advisory

Board

Subtitle B: Reform and Standardization of Private

Insurance

Subtitle C: Low-Income Assistance

Subtitle D: Congressional Consideration of Commission

Recommendation

Subtitle E: Enforcement Provisions

Subtitle F: Financial Provisions

Subtitle G: Definitions

BasiCare Health Access and Cost Control Act - Title I: Immediate Reforms - Subtitle A: Small Employer Health Insurance Market Reform - (Sec. 101) Regulates small employer (fewer than 51 employees) accident and health insurance regarding: (1) price; (2) sales practices; (3) issuance; (4) core benefits (requiring the same benefits as title XVIII (Medicare) of the Social Security Act); (5) deductibles, out-of-pocket expenses, and copayments; and (6) children's preventive benefits. Preempts State and local laws. Regulates eligibility, exclusion of preexisting conditions, renewability, waiting periods, and rating requirements. Allows application of State standards instead of these requirements, provided core benefits and sales practices requirements are met.

(Sec. 106) Amends the Internal Revenue Code (IRC) to prohibit deductions for the tax imposed by this Act on insurers offering plans that do not qualify as BasiCare plans.

Subtitle B: Community Health Services Expansion - (Sec. 111) Amends the Public Health Service Act (PHSA) to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations regarding infant mortality and referrals for the health management of infants and pregnant women. Earmarks for the allotments specified percentages of appropriations under certain provisions added by this Act.

(Sec. 112) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations.

Subtitle C: Expansion of Tax Incentives for Self-Employed Individuals - (Sec. 121) Amends the IRC to increase the portion of health insurance costs self-employed individuals may deduct. Removes provisions ending the deduction on a specified date.

Subtitle D: Expanding the Supply of Health Professionals in Rural Areas - (Sec. 131) Amends the PHSA to authorize appropriations to carry out provisions relating to the National Health Service Corps scholarship and loan repayment program. Earmarks certain portions to carry out provisions of this Act relating to FQHCs.

(Sec. 132) Amends the IRC to allow a credit for service by a physician, physician assistant, or nurse practitioner who: (1) provides primary health services to individuals in a rural health professional shortage area; and (2) is not receiving a National Health Service Corps scholarship or loan repayment and not fulfilling service obligations under such programs.

Excludes National Health Service Corps loan repayments from gross income.

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 a rural community to perform professional services in the community. Authorizes use of the deduction in computing adjusted gross income.

Subtitle E: Malpractice Reform - (Sec. 142) Declares that these provisions apply to any health care liability action brought in any Federal or State court.

(Sec. 143) Limits the dollar amount of: (1) recovery by an individual and the individual's family members in a health care liability action, regardless of the number of providers or the number of actions; and (2) single payments which may be required. Requires collateral source offset. Limits punitive damages. Regulates attorney's fees and joint and several liability. Sets forth time limits on initiation of actions. Preempts State laws in certain circumstances.

(Sec. 148) Mandates grants to States for the development and implementation of alternative dispute resolution systems (ADRs).

(Sec. 149) Requires the Commission to advise the Secretary on ADR eligibility, approval, and review requirements, providing for the establishment of a panel of advisors.

(Sec. 150) Authorizes appropriations for the ADR grants.

(Sec.151) Mandates grants for demonstration private sector no-fault compensation programs, using the same panel of advisors. Authorizes appropriations.

Subtitle F: Joint Ventures - (Sec. 161) Amends provisions of the National Cooperative Research Act of 1984 allowing, notwithstanding antitrust laws, certain cooperative research agreements to add references to joint health care provider ventures, defined as a group of activities by two or more hospitals for the provision or delivery of health care services.

Title II: Long-Term Reforms - Subtitle A: Establishment of Commission and Advisory Board - (Sec. 201) Establishes the Commission on National Health Care Access and Reform and the National Advisory Board. Authorizes appropriations.

Subtitle B: Reform and Standardization of Private Insurance - (Sec. 212) Requires the Commission to submit to the Congress a legislative proposal with specified elements, including: (1) a uniform national health benefits package (BasiCare); (2) a national health care insurance reform plan applicable to all carriers of health insurance in the United States; (3) self-insured plan requirements; and (4) a program to assist low-income individuals in the transfer from coverage under title XIX (Medicaid) of the Social Security Act to BasiCare coverage and financial assistance in obtaining BasiCare coverage.

(Sec. 213) Sets forth the Commission's continuing duties, including: (1) submission of a legislative proposal annually for the next two years if the Congress does not approve the Commission's recommendation; (2) annual review and revision, subject to congressional recision, of benefits and premiums; (3) oversight of provider participation and billing; (4) oversight of the supplemental health insurance market; and (5) submission of plans for the long-term disposition of Medicaid benefits not covered or subsumed by BasiCare and assimilation of Medicare (title XVIII of the Social Security Act), the veterans health care program, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the Indian health service program, and the Federal employees' health benefits program into the BasiCare system.

(Sec. 214) Includes in BasiCare coverage basic hospitalization, basic outpatient services, protection against catastrophic out-of-pocket costs, coverage against extraordinary long-term care costs, and coverage for preventive care.

(Sec. 215) Requires each carrier to offer BasiCare. Preempts inconsistent State and local laws. Prohibits duplication of BasiCare benefits. Prohibits discrimination based on health status, including preexisting conditions. Requires guaranteed issue, a minimum plan period, guaranteed renewability, and community-wide ratings. Applies these standards to reinsurance policies. Mandates guidelines for a risk adjustment structure. Regulates premiums.

(Sec. 217) Prohibits employment-related BasiCare plans from imposing waiting periods. Requires: (1) such plans to apply equally to employees of all income levels; and (2) total contributions for an employer for low-income employees to equal or exceed the total for other employees.

(Sec. 219) Regulates self-insured plans.

(Sec. 220) Requires providers, as a BasiCare participation condition, to accept any BasiCare payment as full payment.

(Sec. 221) Mandates development of recommended managed care plan standards regarding benefits, coverage, and delivery systems. Establishes the Managed Care Advisory Committee. Preempts certain laws regarding managed care plans.

Subtitle C: Low-Income Assistance - (Sec. 231) Requires the Commission to provide for the termination of Medicaid program coverage duplicating BasiCare. Terminates, after five years, any remaining Medicaid benefits. Mandates financial assistance, through a voucher system, to low-income individuals for BasiCare premiums, deductibles, and other cost-sharing.

Subtitle D: Congressional Consideration of Commission Recommendation - (Sec. 241) Declares that these provisions are enacted as an exercise of the rulemaking power of the House of Representatives and the Senate with recognition of the right of either House to change the rules as any other rule of that House. Provides for the introduction and consideration of a joint resolution approving of the Commission's legislative proposal under subtitle B of this title.

Subtitle E: Enforcement Provisions - (Sec. 251) Amends the Internal Revenue Code to remove provisions relating to a tax on any employer or employee organization that contributes to a group health plan or large group health plan that does not comply with certain Medicare provisions.

Imposes a tax on: (1) insurers offering plans that do not qualify as BasiCare plans; (2) the failure of any service provider under a BasiCare plan to comply with specified provisions of this Act; and (3) the failure of any person to comply with provisions of this Act relating to employer responsibilities and self-insured plan requirements.

(Sec. 252) Disallows personal exemptions unless the individual's BasiCare policy number is included in the individual's tax return.

Subtitle F: Financial Provisions - (Sec. 261) Creates the BasiCare Trust Fund and transfers to the Fund: (1) a specified percentage of wages and self-employment income; (2) all of the taxes imposed by this Act; (3) additional revenues resulting from this Act; (4) the State's Medicaid share; and (5) all unobligated amounts in the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Appropriates to the Fund: (1) the Federal Medicaid share; and (2) amounts equal to appropriations for the veterans health care program, CHAMPUS, the Indian health service program, and the Federal employees' health benefits program. Authorizes appropriations for additional sums as required to make expenditures under specified provisions of this Act.

Amends title II (Old-Age, Survivors, and Disability Insurance) of the Social Security Act to exclude amounts under certain provisions of this Act from appropriation to the Federal Old-Age and Survivors Insurance Trust Fund.

(Sec. 262) Amends the Internal Revenue Code to: (1) exclude from gross income employer-provided coverage under a BasiCare plan (currently, under an accident or health plan); (2) prohibit deductions for employer expenses for a group health plan unless the plan qualifies as a BasiCare plan; (3) include amounts paid for a BasiCare plan (currently, for insurance) in the definition of "medical care" for provisions relating to medical and dental expenses; and (4) allow a deduction, without regard to adjusted gross income, for BasiCare premiums.

Subtitle G: Definitions - (Sec. 272) Defines various terms as used in this Act.