State High Risk Pool Funding Extension Act of 2005 - (Sec. 2) Amends the Public Health Service Act to reauthorize funds for grants to each state that has not created a qualified high risk pool for the state's cost to create and initially operate such a pool.
Increases the maximum allowable premium charged under a qualified high risk pool to 200% of the premium for applicable standard risk rates. Defines "standard risk rate" as a rate that: (1) is determined under the state high risk pool by considering the premiums charged by other health insurers in the same market; (2) is established using reasonable actuarial techniques; and (3) reflects anticipated claims experience and expenses.
Permits grants awarded by the Secretary of Health and Human Services to states with existing qualified high risk pools to cover operating losses to be made to entities that operate such a pool under applicable state law. Changes the allocation of such grants to give 40% to eligible states equally, 30% based on the number of uninsured individuals in a state relative to all states, and 30% based on the number of enrollees in a state's qualified high risk pool relative to all states. (Currently, all funds are allotted based solely on the number of uninsured individuals in the state.)
Requires a state which charges premiums that exceed 150% of the premium for applicable standard risk to use at least 50% of the grant amount to reduce premiums for enrollees.
Limits the maximum grant amount allotted to territories.
Requires the Secretary to award grants to states with qualified high risk pools for the provision of supplemental consumer benefits, which must include one or more of the following: (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. Limits to 10% of appropriated funds the amount that any state may be allotted.
Authorizes appropriations for FY2006-FY2010 and appropriates funds for FY 2006.
Sets forth reporting requirements.
Revises the definition of "qualified high risk pool" to allow a state to elect to meet the requirement to provide all eligible individuals with health insurance coverage by utilizing an acceptable alternative mechanism that includes a high risk pool as a component.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3204 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 3204
To amend title XXVII of the Public Health Service Act to extend Federal
funding for the establishment and operation of State high risk health
insurance pools.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 12, 2005
Mr. Shadegg (for himself and Mr. Towns) introduced the following bill;
which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to extend Federal
funding for the establishment and 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 ESTABLISHMENT AND OPERATION OF STATE
HIGH RISK HEALTH INSURANCE POOLS.
(a) Additional Seed Grant Funding.--Subsection (c)(1) of section
2745 of the Public Health Service Act (42 U.S.C. 300gg-45) is amended
by inserting ``and $15,000,000 for fiscal year 2005'' after ``fiscal
year 2003''.
(b) Funding for Operation of State High Risk Pools in Fiscal Years
2005 Through 2009.--Subsection (c)(2) of such section is amended by
inserting ``and $50,000,000 for each of fiscal years 2005 through
2009'' after ``2004''.
(c) Change in Requirements for Qualified High Risk Pools.--
(1) Change in requirement for operational grants.--
Subsection (b) of such section is amended--
(A) in paragraph (1)(A), by inserting ``(or 200
percent in the case of a State that meets the
requirements of paragraph (3))'' after ``150 percent'';
(B) in paragraph (1)(C), by striking ``after the
end of fiscal year 2004'' and inserting ``after the end
of the last fiscal year for which a grant is provided
under this paragraph''; and
(C) by adding at the end the following new
paragraph:
``(3) Special rule for pools charging higher premiums.--In
the case of a qualified high risk pool of a State which charges
premiums that exceed 150 percent of the premium for applicable
standard risks, the State shall use at least 50 percent of the
amount of the grant provided to carry out this subsection to
reduce premiums for enrollees.''.
(2) Change in definition of qualified high risk pool.--
Subsection (d) of such section is amended to read as follows:
``(d) Definitions.--In this section:
``(1) Qualified high risk pool.--The term `qualified high
risk pool' has the meaning given such term in section
2744(c)(2), except that a State may elect to meet the
requirement of subparagraph (A) of such section (insofar as it
requires the provision of coverage to all eligible individuals)
through providing for the enrollment of eligible individuals
through an acceptable alternative mechanism (as defined for
purposes of section 2744) that includes a high risk pool as a
component.
``(2) Standard risk rate.--The term `standard risk rate'
means a rate that--
``(A) is 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;
``(B) is established using reasonable actuarial
techniques; and
``(C) reflects anticipated claims experience and
expenses for the coverage involved.
``(3) State.--The term `State' means any of the 50 States
and the District of Columbia.''.
(3) Effective date.--The amendments made by this subsection
shall apply to grants for fiscal years beginning with fiscal
year 2005.
(d) Change in Allotment Formula for Operational Grants.--Subsection
(b)(2) of such section is amended--
(1) by inserting ``(before fiscal year 2005)'' after ``for
a fiscal year''; and
(2) by adding at the end the following:
``The amount appropriated under subsection (c)(2) for a fiscal year
beginning with fiscal year 2005 (less the portion of such amount made
available to carryout subsection (f)) shall be made available to the
States (including entities that operate the high risk pool under
applicable State law in a State) that qualify for a grant under
subsection (b) as follows:
``(A) An amount equal to \1/3\ of such amount shall
be allocated in equal amounts among such qualifying
States.
``(B) An amount equal to \1/3\ of such amount shall
be allocated among such 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 such States (as determined by the
Secretary).
``(C) An amount equal to \1/3\ of such amount shall
be allocated among such 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 such States (as determined by the
Secretary).''.
(e) Administrative Provisions; Annual Report.--Such section is
amended by adding at the end the following new subsection:
``(e) Administrative Provisions; Annual Report.--
``(1) Applications.--To be eligible for a grant under this
section, a State shall submit to the Secretary an application
at such time, in such manner, and containing such information
as the Secretary may require.
``(2) No entitlement.--Nothing in this section shall be
construed as providing a State with an entitlement to a grant
under this section.
``(3) Annual report.--The Secretary shall submit to
Congress an annual report on grants provided under this
section. Each such report shall include information on the
distribution of such grants among the States and the use of
grant funds by States.''.
(f) Bonus Grants for Supplemental Consumer Benefits.--Such section
is further amended--
(1) in subsection (c)(2), as amended by subsection (b), by
inserting before the period at the end the following: ``, and
up to 10 percent of the amount appropriated for fiscal year
2005 shall be available to carry out subsection (f)''; and
(2) by adding at the end the following new subsection:
``(f) Bonus Grants for Supplemental Consumer Benefits.--
``(1) In general.--In the case of each State that has
established a qualified high risk pool, the Secretary shall
provide, from the funds made available under subsection (c)(2)
to carry out this subsection, a grant to be used to provide
supplemental consumer benefits to enrollees or potential
enrollees (or defined subsets of such enrollees or potential
enrollees) in qualified high risk pools.
``(2) Benefits.--Funds provided to a State under paragraph
(1) may be used only to provide one or more of the following
benefits:
``(A) Low-income premium subsidies.
``(B) A reduction in premium trends, actual
premiums, or other cost-sharing requirements.
``(C) An expansion or broadening of the pool of
individuals eligible for coverage, such as through
eliminating waiting lists, increasing enrollment caps,
or providing flexibility in enrollment rules.
``(3) Limitation.--In no case shall the amount of a grant
under this subsection to a State, from the amount made
available under subsection (c)(2) for a fiscal year to carry
out this subsection, exceed 10 percent of the amount so made
available.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to prohibit a State that, on the date of
enactment of this subsection, is in the process of implementing
programs to provide benefits of the type described in paragraph
(2), from being eligible for a grant under this subsection.
``(5) Funding.--
``(A) Availability.--Funds appropriated under this
subsection for a fiscal year shall remain available for
obligation through the end of the following fiscal
year.
``(B) Reallotment.--If, on June 30 of a fiscal year
for which funds are made available under this
subsection, the Secretary determines that the full
amounts will not be made available for grants under
this subsection, such remaining amounts shall be made
available and allotted among qualifying States under
subsection (b) for the fiscal year in accordance with
the formula under subsection (b)(2).''.
<all>
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
Subcommittee Consideration and Mark-up Session Held.
Forwarded by Subcommittee to Full Committee by Voice Vote.
Committee Consideration and Mark-up Session Held.
Ordered to be Reported (Amended) by Voice Vote.
Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 109-192.
Placed on the Union Calendar, Calendar No. 116.
Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 109-192.
Mr. Deal (GA) moved to suspend the rules and pass the bill, as amended.
Considered under suspension of the rules. (consideration: CR H6668-6671)
DEBATE - The House proceeded with forty minutes of debate on H.R. 3204.
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Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H6668-6669)
On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H6668-6669)
Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate. Read twice. Placed on Senate Legislative Calendar under General Orders. Calendar No. 181.
Measure laid before Senate by unanimous consent. (consideration: CR S11597-11598)
Passed/agreed to in Senate: Passed Senate with an amendment by Unanimous Consent.
Passed Senate with an amendment by Unanimous Consent.
Message on Senate action sent to the House.