State High Risk Pool Funding Extension Act of 2005

State High Risk Pool Funding Extension Act of 2005 - Reauthorizes funds to provide grants to States to create and operate qualified high risk health insurance pools.

Amends provisions requiring the Secretary to award grants to States with existing qualified high risk pools to cover losses incurred by a State in connection with the operation of such a pool to: (1) remove the limit that provided that such grants would cover up to 50 percent of such losses; and (2) allow such grants to be made to entities that operate such a pool under applicable State law; and (3) change the allocation of such grants to give one-half of the funds to eligible States equally and apportion the other half based on the number of uninsured individual in each State and the number of enrollees in a State's qualified high risk pool. (Currently all funds are allotted based solely on the number of uninsured individuals in a State.)

Requires the Secretary to award grants to States with established qualified high risk pools for the provision of supplemental consumer benefits, which must include one or more of the following benefits: (1) low-income premium subsidies; (2) a reduction in premium trends, actual premiums, or other cost-sharing requirements; (3) an expansion or broadening of the pool of individuals eligible for coverage; (4) less stringent rules or additional waiver authority with respect to coverage of preexisting conditions; (5) increased benefits; or (6) establishment of disease management programs.

Authorizes appropriations.

Defines "qualified high risk pools" to allow States to provide for enrollment through: (1) a combination of a qualified high risk pool and an acceptable alternative mechanism; (2) health insurance coverage that meets the requirements for a high risk pool, limits rates, is available to all eligible individuals, and does not exceed the rate limit allowed for high risk pools; or (3) health insurance coverage that provides first dollar coverage, limits on cost-sharing, and comprehensive medical, hospital, and surgical coverage if the rate limits do not exceed 125 percent of the rate limit otherwise allowable for qualified high risk pools.

[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 288 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                 S. 288

   To extend Federal funding for operation of State high risk health 
                            insurance pools.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            February 3, 2005

   Mr. Gregg (for himself, Mr. Baucus, Mr. DeWine, Mr. Bingaman, Mr. 
Roberts, Mr. Lieberman, and Mr. Cochran) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To extend Federal funding for operation of State high risk health 
                            insurance pools.

    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 ``State High Risk Pool Funding 
Extension Act of 2005''.

SEC. 2. EXTENSION OF FUNDING FOR OPERATION OF STATE HIGH RISK HEALTH 
              INSURANCE POOLS.

    (a) Extension of Seed Grants.--Section 2745 of the Public Health 
Service Act (42 U.S.C. 300gg-45) is amended--
            (1) in subsection (a), in the subsection heading by 
        inserting ``Extension of'' before ``Seed''; and
            (2) in subsection (c)(1), by striking ``$20,000,000'' and 
        all that follows through ``2003'' and inserting ``$15,000,000 
        for the period of fiscal years 2005 and 2006''.
    (b) Funds for Operations.--Section 2745 of the Public Health 
Service Act (42 U.S.C. 300gg-45) is amended--
            (1) in subsection (b)--
                    (A) in the subsection heading by striking 
                ``Matching''; and
                    (B) by striking paragraph (2) and inserting the 
                following:
            ``(2) Allotment.--The amounts appropriated under subsection 
        (c)(2) for a fiscal year shall be made available to the States 
        (or the entities that operate the high risk pool under 
        applicable State law) as follows:
                    ``(A) An amount equal to 50 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated in equal amounts among each eligible State 
                that applies for assistance under this subsection.
                    ``(B) An amount equal to 25 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated among the States so that the amount provided 
                to a State bears the same ratio to such available 
                amount as the number of uninsured individuals in the 
                State bears to the total number of uninsured 
                individuals in all States (as determined by the 
                Secretary).
                    ``(C) An amount equal to 25 percent of the 
                appropriated amount for the fiscal year shall be 
                allocated among the States so that the amount provided 
                to a State bears the same ratio to such available 
                amount as the number of individuals enrolled in health 
                care coverage through the qualified high risk pool of 
                the State bears to the total number of individuals so 
                enrolled through qualified high risk pools in all 
                States (as determined by the Secretary).''; and
            (2) in subsection (c)(2), by striking ``$40,000,000'' and 
        all that follows through the period and inserting ``$75,000,000 
        for each of fiscal years 2005 through 2009 to make allotments 
        under subsection (b)(2).''.
    (c) Definitions.--Section 2745 of the Public Health Service Act (42 
U.S.C. 300gg-45) is amended--
            (1) in subsection (d), by inserting after ``2744(c)(2)'' 
        the following: ``, except that with respect to subparagraph (A) 
        of such section a State may elect to provide for the enrollment 
        of eligible individuals through an acceptable alternative 
        mechanism,''; and
            (2) by adding at the end the following:
    ``(e) Standard Risk Rate.--In subsection (b)(1)(A), the term 
`standard risk rate' means a rate--
            ``(1) determined under the State high risk pool by 
        considering the premium rates charged by other health insurers 
        offering health insurance coverage to individuals in the 
        insurance market served;
            ``(2) that is established using reasonable actuarial 
        techniques; and
            ``(3) that reflects anticipated claims experience and 
        expenses for the coverage involved.''.
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