Requires each health insurer, health maintenance organization, and health service organization to participate in a health insurance safety net which shall assure the availability of health insurance to uninsurable individuals. Funds such safety nets through assessments against such insurers and organizations. Permits such insurers and organizations to add the costs of such assessments to the costs of its insurance or coverage.
Amends the Public Health Service Act to allow health benefits coverage through individual membership associations (IMAs). Sets forth IMA requirements, including that the IMA be an organization operated under the direction of an association and that IMA health benefits coverage only be provided through contracts with health insurance issuers. Requires IMAs to include a minimum of two health insurance coverage options.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 683 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 683
To amend the Internal Revenue Code of 1986 to allow individuals a
refundable credit against income tax for the purchase of private health
insurance, and to establish State health insurance safety-net programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 3, 2001
Mr. Santorum (for himself, Mr. Torricelli, and Mr. Smith of New
Hampshire) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend the Internal Revenue Code of 1986 to allow individuals a
refundable credit against income tax for the purchase of private health
insurance, and to establish State health insurance safety-net programs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Fair Care for the Uninsured Act of
2001''.
TITLE I--REFUNDABLE CREDIT FOR HEALTH INSURANCE COVERAGE
SEC. 101. REFUNDABLE CREDIT FOR HEALTH INSURANCE COVERAGE.
(a) In General.--Subpart C of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 (relating to refundable credits)
is amended by redesignating section 35 as section 36 and by inserting
after section 34 the following new section:
``SEC. 35. HEALTH INSURANCE COSTS.
``(a) In General.--In the case of an individual, there shall be
allowed as a credit against the tax imposed by this subtitle an amount
equal to the amount paid during the taxable year for qualified health
insurance for the taxpayer, his spouse, and dependents.
``(b) Limitations.--
``(1) In general.--The amount allowed as a credit under
subsection (a) to the taxpayer for the taxable year shall not
exceed the sum of the monthly limitations for coverage months
during such taxable year for each individual referred to in
subsection (a) for whom the taxpayer paid during the taxable
year any amount for coverage under qualified health insurance.
``(2) Monthly limitation.--
``(A) In general.--The monthly limitation for an
individual for each coverage month of such individual
during the taxable year is the amount equal to 1/12
of--
``(i) $1,000 if such individual is the
taxpayer,
``(ii) $1,000 if--
``(I) such individual is the spouse
of the taxpayer,
``(II) the taxpayer and such spouse
are married as of the first day of such
month, and
``(III) the taxpayer files a joint
return for the taxable year, and
``(iii) $500 if such individual is an
individual for whom a deduction under section
151(c) is allowable to the taxpayer for such
taxable year.
``(B) Limitation to 2 dependents.--Not more than 2
individuals may be taken into account by the taxpayer
under subparagraph (A)(iii).
``(C) Special rule for married individuals.--In the
case of an individual--
``(i) who is married (within the meaning of
section 7703) as of the close of the taxable
year but does not file a joint return for such
year, and
``(ii) who does not live apart from such
individual's spouse at all times during the
taxable year,
the limitation imposed by subparagraph (B) shall be
divided equally between the individual and the
individual's spouse unless they agree on a different
division.
``(3) Coverage month.--For purposes of this subsection--
``(A) In general.--The term `coverage month' means,
with respect to an individual, any month if--
``(i) as of the first day of such month
such individual is covered by qualified health
insurance, and
``(ii) the premium for coverage under such
insurance for such month is paid by the
taxpayer.
``(B) Employer-subsidized coverage.--
``(i) In general.--Such term shall not
include any month for which such individual is
eligible to participate in any subsidized
health plan (within the meaning of section
162(l)(2)) maintained by any employer of the
taxpayer or of the spouse of the taxpayer.
``(ii) Premiums to nonsubsidized plans.--If
an employer of the taxpayer or the spouse of
the taxpayer maintains a health plan which is
not a subsidized health plan (as so defined)
and which constitutes qualified health
insurance, employee contributions to the plan
shall be treated as amounts paid for qualified
health insurance.
``(C) Cafeteria plan and flexible spending account
beneficiaries.--Such term shall not include any month
during a taxable year if any amount is not includible
in the gross income of the taxpayer for such year under
section 106 with respect to--
``(i) a benefit chosen under a cafeteria
plan (as defined in section 125(d)), or
``(ii) a benefit provided under a flexible
spending or similar arrangement.
``(D) Medicare and medicaid.--Such term shall not
include any month with respect to an individual if, as
of the first day of such month, such individual--
``(i) is entitled to any benefits under
title XVIII of the Social Security Act, or
``(ii) is a participant in the program
under title XIX or XXI of such Act.
``(E) Certain other coverage.--Such term shall not
include any month during a taxable year with respect to
an individual if, at any time during such year, any
benefit is provided to such individual under--
``(i) chapter 89 of title 5, United States
Code,
``(ii) chapter 55 of title 10, United
States Code,
``(iii) chapter 17 of title 38, United
States Code, or
``(iv) any medical care program under the
Indian Health Care Improvement Act.
``(F) Prisoners.--Such term shall not include any
month with respect to an individual if, as of the first
day of such month, such individual is imprisoned under
Federal, State, or local authority.
``(G) Insufficient presence in united states.--Such
term shall not include any month during a taxable year
with respect to an individual if such individual is
present in the United States on fewer than 183 days
during such year (determined in accordance with section
7701(b)(7)).
``(4) Coordination with deduction for health insurance
costs of self-employed individuals.--In the case of a taxpayer
who is eligible to deduct any amount under section 162(l) for
the taxable year, this section shall apply only if the taxpayer
elects not to claim any amount as a deduction under such
section for such year.
``(c) Qualified Health Insurance.--For purposes of this section--
``(1) In general.--The term `qualified health insurance'
means insurance which constitutes medical care as defined in
section 213(d) without regard to--
``(A) paragraph (1)(C) thereof, and
``(B) so much of paragraph (1)(D) thereof as
relates to qualified long-term care insurance
contracts.
``(2) Exclusion of certain other contracts.--Such term
shall not include insurance if a substantial portion of its
benefits are excepted benefits (as defined in section 9832(c)).
``(d) Medical Savings Account Contributions.--
``(1) In general.--If a deduction would (but for paragraph
(2)) be allowed under section 220 to the taxpayer for a payment
for the taxable year to the medical savings account of an
individual, subsection (a) shall be applied by treating such
payment as a payment for qualified health insurance for such
individual.
``(2) Denial of double benefit.--No deduction shall be
allowed under section 220 for that portion of the payments
otherwise allowable as a deduction under section 220 for the
taxable year which is equal to the amount of credit allowed for
such taxable year by reason of this subsection.
``(e) Special Rules.--
``(1) Coordination with medical expense deduction.--The
amount which would (but for this paragraph) be taken into
account by the taxpayer under section 213 for the taxable year
shall be reduced by the credit (if any) allowed by this section
to the taxpayer for such year.
``(2) Denial of credit to dependents.--No credit shall be
allowed under this section to any individual with respect to
whom a deduction under section 151 is allowable to another
taxpayer for a taxable year beginning in the calendar year in
which such individual's taxable year begins.
``(3) Inflation adjustment.--In the case of any taxable
year beginning in a calendar year after 2002, each dollar
amount contained in subsection (b)(2)(A) shall be increased by
an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year in which
the taxable year begins, determined by substituting
`calendar year 2001' for `calendar year 1992' in
subparagraph (B) thereof.
Any increase determined under the preceding sentence shall be
rounded to the nearest multiple of $50 ($25 in the case of the
dollar amount in subsection (b)(2)(A)(iii)).''
(b) Maintenance of Effort Requirement.--Section 162 of such Code
(relating to trade or business expenses) is amended by redesignating
subsection (p) as subsection (q) and by inserting after subsection (o)
the following new subsection:
``(p) Group Health Plan Maintenance of Effort.--No deduction shall
be allowed under this chapter to an employer for any amount paid or
incurred in connection with a group health plan (as defined in
subsection (n)(3)) for any taxable year in which occurs the date of
introduction of the Fair Care for the Uninsured Act of 2001 unless such
plan remains in effect for at least 60 months after the date of the
enactment of such Act.''.
(c) Information Reporting.--
(1) In general.--Subpart B of part III of subchapter A of
chapter 61 of such Code (relating to information concerning
transactions with other persons) is amended by inserting after
section 6050S the following new section:
``SEC. 6050T. RETURNS RELATING TO PAYMENTS FOR QUALIFIED HEALTH
INSURANCE.
``(a) In General.--Any person who, in connection with a trade or
business conducted by such person, receives payments during any
calendar year from any individual for coverage of such individual or
any other individual under creditable health insurance, shall make the
return described in subsection (b) (at such time as the Secretary may
by regulations prescribe) with respect to each individual from whom
such payments were received.
``(b) Form and Manner of Returns.--A return is described in this
subsection if such return--
``(1) is in such form as the Secretary may prescribe, and
``(2) contains--
``(A) the name, address, and TIN of the individual
from whom payments described in subsection (a) were
received,
``(B) the name, address, and TIN of each individual
who was provided by such person with coverage under
creditable health insurance by reason of such payments
and the period of such coverage, and
``(C) such other information as the Secretary may
reasonably prescribe.
``(c) Creditable Health Insurance.--For purposes of this section,
the term `creditable health insurance' means qualified health insurance
(as defined in section 35(c)) other than--
``(1) insurance under a subsidized group health plan
maintained by an employer, or
``(2) to the extent provided in regulations prescribed by
the Secretary, any other insurance covering an individual if no
credit is allowable under section 35 with respect to such
coverage.
``(d) Statements To Be Furnished to Individuals With Respect to
Whom Information Is Required.--Every person required to make a return
under subsection (a) shall furnish to each individual whose name is
required under subsection (b)(2)(A) to be set forth in such return a
written statement showing--
``(1) the name and address of the person required to make
such return and the phone number of the information contact for
such person,
``(2) the aggregate amount of payments described in
subsection (a) received by the person required to make such
return from the individual to whom the statement is required to
be furnished, and
``(3) the information required under subsection (b)(2)(B)
with respect to such payments.
The written statement required under the preceding sentence shall be
furnished on or before January 31 of the year following the calendar
year for which the return under subsection (a) is required to be made.
``(e) Returns Which Would Be Required To Be Made by 2 or More
Persons.--Except to the extent provided in regulations prescribed by
the Secretary, in the case of any amount received by any person on
behalf of another person, only the person first receiving such amount
shall be required to make the return under subsection (a).''.
(2) Assessable penalties.--
(A) Subparagraph (B) of section 6724(d)(1) of such
Code (relating to definitions) is amended by
redesignating clauses (xi) through (xvii) as clauses
(xii) through (xviii), respectively, and by inserting
after clause (x) the following new clause:
``(xi) section 6050T (relating to returns
relating to payments for qualified health
insurance),''.
(B) Paragraph (2) of section 6724(d) of such Code
is amended by striking ``or'' at the end of the next to
last subparagraph, by striking the period at the end of
the last subparagraph and inserting ``, or'', and by
adding at the end the following new subparagraph:
``(BB) section 6050T(d) (relating to returns
relating to payments for qualified health
insurance).''.
(3) Clerical amendment.--The table of sections for subpart
B of part III of subchapter A of chapter 61 of such Code is
amended by inserting after the item relating to section 6050S
the following new item:
``Sec. 6050T. Returns relating to
payments for qualified health
insurance.''.
(d) Conforming Amendments.--
(1) Paragraph (2) of section 1324(b) of title 31, United
States Code, is amended by inserting before the period ``, or
from section 35 of such Code''.
(2) The table of sections for subpart C of part IV of
subchapter A of chapter 1 of such Code is amended by striking
the last item and inserting the following new items:
``Sec. 35. Health insurance costs.
``Sec. 36. Overpayments of tax.''.
(e) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2001.
SEC. 102. ADVANCE PAYMENT OF CREDIT FOR PURCHASERS OF QUALIFIED HEALTH
INSURANCE.
(a) In General.--Chapter 77 of the Internal Revenue Code of 1986
(relating to miscellaneous provisions) is amended by adding at the end
the following new section:
``SEC. 7527. ADVANCE PAYMENT OF HEALTH INSURANCE CREDIT FOR PURCHASERS
OF QUALIFIED HEALTH INSURANCE.
``(a) General Rule.--In the case of an eligible individual, the
Secretary shall make payments to the provider of such individual's
qualified health insurance equal to such individual's qualified health
insurance credit advance amount with respect to such provider.
``(b) Eligible Individual.--For purposes of this section, the term
`eligible individual' means any individual--
``(1) who purchases qualified health insurance (as defined
in section 35(c)), and
``(2) for whom a qualified health insurance credit
eligibility certificate is in effect.
``(c) Qualified Health Insurance Credit Eligibility Certificate.--
For purposes of this section, a qualified health insurance credit
eligibility certificate is a statement furnished by an individual to
the Secretary which--
``(1) certifies that the individual will be eligible to
receive the credit provided by section 35 for the taxable year,
``(2) estimates the amount of such credit for such taxable
year, and
``(3) provides such other information as the Secretary may
require for purposes of this section.
``(d) Qualified Health Insurance Credit Advance Amount.--For
purposes of this section, the term `qualified health insurance credit
advance amount' means, with respect to any provider of qualified health
insurance, the Secretary's estimate of the amount of credit allowable
under section 35 to the individual for the taxable year which is
attributable to the insurance provided to the individual by such
provider.
``(e) Regulations.--The Secretary shall prescribe such regulations
as may be necessary to carry out the purposes of this section.''.
(b) Clerical Amendment.--The table of sections for chapter 77 of
such Code is amended by adding at the end the following new item:
``Sec. 7527. Advance payment of health
insurance credit for purchasers
of qualified health
insurance.''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2002.
TITLE II--ASSURING HEALTH INSURANCE COVERAGE FOR UNINSURABLE
INDIVIDUALS
SEC. 201. ESTABLISHMENT OF HEALTH INSURANCE SAFETY NETS.
(a) In General.--
(1) Requirement.--For years beginning with 2002, each
health insurer, health maintenance organization, and health
service organization shall be a participant in a health
insurance safety net (in this title referred to as a ``safety
net'') established by the State in which it operates.
(2) Functions.--Any safety net shall assure, in accordance
with this title, the availability of qualified health insurance
coverage to uninsurable individuals.
(3) Funding.--Any safety net shall be funded by an
assessment against health insurers, health service
organizations, and health maintenance organizations on a pro
rata basis of premiums collected in the State in which the
safety net operates. The costs of the assessment may be added
by a health insurer, health service organization, or health
maintenance organization to the costs of its health insurance
or health coverage provided in the State.
(4) Guaranteed renewable.--Coverage under a safety net
shall be guaranteed renewable except for nonpayment of
premiums, material misrepresentation, fraud, medicare
eligibility under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.), loss of dependent status, or eligibility
for other health insurance coverage.
(5) Compliance with naic model act.--In the case of a State
that has not established, as of the date of the enactment of
this Act, a high risk pool or other comprehensive health
insurance program that assures the availability of qualified
health insurance coverage to all eligible individuals residing
in the State, a safety net shall be established in accordance
with the requirements of the ``Model Health Plan For
Uninsurable Individuals Act'' (or the successor model Act), as
adopted by the National Association of Insurance Commissioners
and as in effect on the date of the safety net's establishment.
(b) Deadline.--Safety nets required under subsection (a) shall be
established not later than January 1, 2002.
(c) Waiver.--This title shall not apply in the case of insurers and
organizations operating in a State if the State has established a
similar comprehensive health insurance program that assures the
availability of qualified health insurance coverage to all eligible
individuals residing in the State.
(d) Recommendation for Compliance Requirement.--Not later than
January 1, 2003, the Secretary of Health and Human Services shall
submit to Congress a recommendation on appropriate sanctions for States
that fail to meet the requirement of subsection (a).
SEC. 202. UNINSURABLE INDIVIDUALS ELIGIBLE FOR COVERAGE.
(a) Uninsurable and Eligible Individual Defined.--In this title:
(1) Uninsurable individual.--The term ``uninsurable
individual'' means, with respect to a State, an eligible
individual who presents proof of uninsurability by a private
insurer in accordance with subsection (b) or proof of a
condition previously recognized as uninsurable by the State.
(2) Eligible individual.--
(A) In general.--The term ``eligible individual''
means, with respect to a State, a citizen or national
of the United States (or an alien lawfully admitted for
permanent residence) who is a resident of the State for
at least 90 days and includes any dependent (as
defined for purposes of the Internal Revenue Code of 1986) of such a
citizen, national, or alien who also is such a resident.
(B) Exception.--An individual is not an ``eligible
individual'' if the individual--
(i) is covered by or eligible for benefits
under a State medicaid plan approved under
title XIX of the Social Security Act (42 U.S.C.
1396 et seq.),
(ii) has voluntarily terminated safety net
coverage within the past 6 months,
(iii) has received the maximum benefit
payable under the safety net,
(iv) is an inmate in a public institution,
or
(v) is eligible for other public or private
health care programs (including programs that
pay for directly, or reimburse, otherwise
eligible individuals with premiums charged for
safety net coverage).
(b) Proof of Uninsurability.--
(1) In general.--The proof of uninsurability for an
individual shall be in the form of--
(A) a notice of rejection or refusal to issue
substantially similar health insurance for health
reasons by one insurer; or
(B) a notice of refusal by an insurer to issue
substantially similar health insurance except at a rate
in excess of the rate applicable to the individual
under the safety net plan.
For purposes of this paragraph, the term ``health insurance''
does not include insurance consisting only of stoploss, excess
of loss, or reinsurance coverage.
(2) Exception for individuals with uninsurable
conditions.--The State shall promulgate a list of medical or
health conditions for which an individual shall be eligible for
safety net plan coverage without applying for health insurance
or establishing proof of uninsurability under paragraph (1).
Individuals who can demonstrate the existence or history of any
medical or health conditions on such list shall not be required
to provide the proof described in paragraph (1). The list shall
be effective on the first day of the operation of the safety
net plan and may be amended from time to time as may be
appropriate.
SEC. 203. QUALIFIED HEALTH INSURANCE COVERAGE UNDER SAFETY NET.
In this title, the term ``qualified health insurance coverage''
means, with respect to a State, health insurance coverage that provides
benefits typical of major medical insurance available in the individual
health insurance market in such State.
SEC. 204. FUNDING OF SAFETY NET.
(a) Limitations on Premiums.--
(1) In general.--The premium established under a safety net
may not exceed 125 percent of the applicable standard risk
rate, except as provided in paragraph (2).
(2) Surcharge for avoidable health risks.--A safety net may
impose a surcharge on premiums for individuals with avoidable
high risks, such as smoking.
(b) Additional Funding.--A safety net shall provide for additional
funding through an assessment on all health insurers, health service
organizations, and health maintenance organizations in the State
through a nonprofit association consisting of all such insurers and
organizations doing business in the State on an equitable and pro rata
basis consistent with section 201.
SEC. 205. ADMINISTRATION.
A safety net in a State shall be administered through a contract
with 1 or more insurers or third party administrators operating in the
State.
SEC. 206. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary to reimburse States for their costs in administering this
title.
TITLE III--INDIVIDUAL MEMBERSHIP ASSOCIATIONS
SEC. 301. EXPANSION OF ACCESS AND CHOICE THROUGH INDIVIDUAL MEMBERSHIP
ASSOCIATIONS (IMAS).
The Public Health Service Act is amended by adding at the end the
following new title:
``TITLE XXVIII--INDIVIDUAL MEMBERSHIP ASSOCIATIONS
``SEC. 2801. DEFINITION OF INDIVIDUAL MEMBERSHIP ASSOCIATION (IMA).
``(a) In General.--For purposes of this title, the terms
`individual membership association' and `IMA' mean a legal entity that
meets the following requirements:
``(1) Organization.--The IMA is an organization operated
under the direction of an association (as defined in section
2804(1)).
``(2) Offering health benefits coverage.--
``(A) Different groups.--The IMA, in conjunction
with those health insurance issuers that offer health
benefits coverage through the IMA, makes available
health benefits coverage in the manner described in
subsection (b) to all members of the IMA and the
dependents of such members in the manner described in
subsection (c)(2) at rates that are established by the
health insurance issuer on a policy or product specific
basis and that may vary only as permissible under State
law.
``(B) Nondiscrimination in coverage offered.--
``(i) In general.--Subject to clause (ii),
the IMA may not offer health benefits coverage
to a member of an IMA unless the same coverage
is offered to all such members of the IMA.
``(ii) Construction.--Nothing in this title
shall be construed as requiring or permitting a
health insurance issuer to provide coverage
outside the service area of the issuer, as
approved under State law, or preventing a
health insurance issuer from excluding or limiting the coverage on any
individual, subject to the requirement of section 2741.
``(C) No financial underwriting.--The IMA provides
health benefits coverage only through contracts with
health insurance issuers and does not assume insurance
risk with respect to such coverage.
``(3) Geographic areas.--Nothing in this title shall be
construed as preventing the establishment and operation of more
than one IMA in a geographic area or as limiting the number of
IMAs that may operate in any area.
``(4) Provision of administrative services to purchasers.--
``(A) In general.--The IMA may provide
administrative services for members. Such services may
include accounting, billing, and enrollment
information.
``(B) Construction.--Nothing in this subsection
shall be construed as preventing an IMA from serving as
an administrative service organization to any entity.
``(5) Filing information.--The IMA files with the Secretary
information that demonstrates the IMA's compliance with the
applicable requirements of this title.
``(b) Health Benefits Coverage Requirements.--
``(1) Compliance with consumer protection requirements.--
Any health benefits coverage offered through an IMA shall--
``(A) be underwritten by a health insurance issuer
that--
``(i) is licensed (or otherwise regulated)
under State law,
``(ii) meets all applicable State standards
relating to consumer protection, subject to
section 2802(2), and
``(iii) offers the coverage under a
contract with the IMA; and
``(B) subject to paragraph (2) and section 2902(2),
be approved or otherwise permitted to be offered under
State law.
``(2) Examples of types of coverage.--The benefits coverage
made available through an IMA may include, but is not limited
to, any of the following if it meets the other applicable
requirements of this title:
``(A) Coverage through a health maintenance
organization.
``(B) Coverage in connection with a preferred
provider organization.
``(C) Coverage in connection with a licensed
provider-sponsored organization.
``(D) Indemnity coverage through an insurance
company.
``(E) Coverage offered in connection with a
contribution into a medical savings account or flexible
spending account.
``(F) Coverage that includes a point-of-service
option.
``(G) Any combination of such types of coverage.
``(3) Health insurance coverage options.--An IMA shall
include a minimum of 2 health insurance coverage options. At
least 1 option shall meet all applicable State benefit
mandates.
``(4) Wellness bonuses for health promotion.--Nothing in
this title shall be construed as precluding a health insurance
issuer offering health benefits coverage through an IMA from
establishing premium discounts or rebates for members or from
modifying otherwise applicable copayments or deductibles in
return for adherence to programs of health promotion and
disease prevention so long as such programs are agreed to in
advance by the IMA and comply with all other provisions of this
title and do not discriminate among similarly situated members.
``(c) Members; Health Insurance Issuers.--
``(1) Members.--
``(A) In general.--Under rules established to carry
out this title, with respect to an individual who is a
member of an IMA, the individual may apply for health
benefits coverage (including coverage for dependents of
such individual) offered by a health insurance issuer
through the IMA.
``(B) Rules for enrollment.--Nothing in this
paragraph shall preclude an IMA from establishing rules
of enrollment and reenrollment of members. Such rules
shall be applied consistently to all members within the
IMA and shall not be based in any manner on health
status-related factors.
``(2) Health insurance issuers.--The contract between an
IMA and a health insurance issuer shall provide, with respect
to a member enrolled with health benefits coverage offered by
the issuer through the IMA, for the payment of the premiums
collected by the issuer.
``SEC. 2802. APPLICATION OF CERTAIN LAWS AND REQUIREMENTS.
``State laws insofar as they relate to any of the following are
superseded and shall not apply to health benefits coverage made
available through an IMA:
``(1) Benefit requirements for health benefits coverage
offered through an IMA, including (but not limited to)
requirements relating to coverage of specific providers,
specific services or conditions, or the amount, duration, or
scope of benefits, but not including requirements to the extent
required to implement title XXVII or other Federal law and to
the extent the requirement prohibits an exclusion of a specific
disease from such coverage.
``(2) Any other requirements (including limitations on
compensation arrangements) that, directly or indirectly,
preclude (or have the effect of precluding) the offering of
such coverage through an IMA, if the IMA meets the requirements
of this title.
Any State law or regulation relating to the composition or organization
of an IMA is preempted to the extent the law or regulation is
inconsistent with the provisions of this title.
``SEC. 2803. ADMINISTRATION.
``(a) In General.--The Secretary shall administer this title and is
authorized to issue such regulations as may be required to carry out
this title. Such regulations shall be subject to Congressional review
under the provisions of chapter 8 of title 5, United States Code. The
Secretary shall incorporate the process of `deemed file and use' with
respect to the information filed under section 2801(a)(5)(A) and shall
determine whether information filed by an IMA demonstrates compliance
with the applicable requirements of this title. The Secretary shall
exercise authority under this title in a manner that fosters and
promotes the development of IMAs in order to improve access to health
care coverage and services.
``(b) Periodic Reports.--The Secretary shall submit to Congress a
report every 30 months, during the 10-year period beginning on the
effective date of the rules promulgated by the Secretary to carry out
this title, on the effectiveness of this title in promoting coverage of
uninsured individuals. The Secretary may provide for the production of
such reports through one or more contracts with appropriate private
entities.
``SEC. 2804. DEFINITIONS.
``For purposes of this title:
``(1) Association.--The term `association' means, with
respect to health insurance coverage offered in a State, an
association which--
``(A) has been actively in existence for at least 5
years;
``(B) has been formed and maintained in good faith
for purposes other than obtaining insurance;
``(C) does not condition membership in the
association on any health status-related factor
relating to an individual (including an employee of an
employer or a dependent of an employee); and
``(D) does not make health insurance coverage
offered through the association available other than in
connection with a member of the association.
``(2) Dependent.--The term `dependent', as applied to
health insurance coverage offered by a health insurance issuer
licensed (or otherwise regulated) in a State, shall have the
meaning applied to such term with respect to such coverage
under the laws of the State relating to such coverage and such
an issuer. Such term may include the spouse and children of the
individual involved.
``(3) Health benefits coverage.--The term `health benefits
coverage' has the meaning given the term health insurance
coverage in section 2791(b)(1).
``(4) Health insurance issuer.--The term `health insurance
issuer' has the meaning given such term in section 2791(b)(2).
``(5) Health status-related factor.--The term `health
status-related factor' has the meaning given such term in
section 2791(d)(9).
``(6) IMA; individual membership association.--The terms
`IMA' and `individual membership association' are defined in
section 2801(a).
``(7) Member.--The term `member' means, with respect to an
IMA, an individual who is a member of the association to which
the IMA is offering coverage.''.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S3346-3347)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S3347-3350)
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