Ensuring Quality Health Care for All Americans Act of 2012 - Repeals the Patient Protection and Affordable Care Act and restores provisions of law amended by such Act or provisions.
Repeals the health care provisions of the Health Care and Education Reconciliation Act of 2010 and restores provisions of law amended by such Act's health care provisions.
Revises Public Health Service Act provisions concerning health insurance coverage to require each health insurance issuer offering health insurance coverage in the group market (currently, individual or group market) in a state to accept every employer and every individual in a group (currently, every employer and every individual) in the state applying for such coverage.
Prohibits a group health plan or a health insurance issuer offering group health insurance coverage from imposing: (1) any preexisting condition exclusion with respect to such plan or coverage, or (2) lifetime or annual limits.
Requires dependent coverage beyond age 18 until the first of either a dependent turning 26, marrying, or no longer residing at home.
Requires plans to offer catastrophic coverage and sets forth coverage requirements.
Directs the Secretary of Health and Human Services (HHS) to make grants to States for planning for the establishment and implementation of health insurance risk adjustment mechanisms.
Sets forth provisions limiting the liability of health care providers.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4242 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 4242
To repeal the Patient Protection and Affordable Care Act, to amend the
Public Health Service Act to provide individual and group market
reforms to protect health insurance consumers, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 22, 2012
Mr. Heck introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Education and the Workforce, the Judiciary, Natural
Resources, Rules, House Administration, and Appropriations, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To repeal the Patient Protection and Affordable Care Act, to amend the
Public Health Service Act to provide individual and group market
reforms to protect health insurance consumers, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Ensuring Quality
Health Care for All Americans Act of 2012''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Repeal of PPACA.
Sec. 3. Prohibiting discrimination based on health status.
Sec. 4. Guaranteed renewability of coverage.
Sec. 5. Prohibition of preexisting condition exclusions and other
discrimination based on health status.
Sec. 6. No lifetime or annual limits.
Sec. 7. Prohibition on rescissions.
Sec. 8. Extension of dependent coverage.
Sec. 9. Application of group market reforms to ERISA and the Internal
Revenue Code of 1986.
Sec. 10. Catastrophic plan.
Sec. 11. Grants for health insurance risk adjustment mechanisms.
Sec. 12. Liability protections for health care providers.
SEC. 2. REPEAL OF PPACA.
(a) PPACA.--Public Law 111-148 is repealed, and the provisions of
law amended or repealed by such Act are restored or revived as if such
Act had not been enacted.
(b) HCERA.--Title I and subtitle B of title II of the Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152) are
repealed, and the provisions of law amended or repealed by such title
or subtitle, respectively, are restored or revived as if such title and
subtitle had not been enacted.
SEC. 3. PROHIBITING DISCRIMINATION BASED ON HEALTH STATUS.
(a) Group Market.--Subpart 3 of part A of title XXVII of the Public
Health Service Act is amended by striking section 2711 and inserting
the following:
``SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE.
``(a) Guaranteed Issuance of Coverage in the Group Market.--
``(1) In general.--Subject to subsections (b) through (e),
each health insurance issuer that offers health insurance
coverage in the group market in a State shall accept every
employer and every individual in a group in the State that
applies for such coverage.
``(2) Special rule for associations.--An association shall
be treated as an employer for purposes of this section if such
association seeks to provide group health insurance coverage to
not less than 200 qualified individuals.
``(b) Enrollment.--
``(1) Restriction.--A health insurance issuer described in
subsection (a) may restrict enrollment in coverage described in
such subsection to open or special enrollment periods.
``(2) Establishment.--A health insurance issuer described
in subsection (a) shall, in accordance with the regulations
promulgated under paragraph (3), establish special enrollment
periods for qualifying events (as such term is defined in
section 603 of the Employee Retirement Income Security Act of
1974).
``(3) Special rules for associations.--
``(A) Qualifying events.--For purposes of applying
paragraph (2) to an association--
``(i) the term `covered employee' in
section 603 of the Employee Retirement Income
Security Act of 1974 shall include a qualified
individual (as such term is defined in section
2701(d)(2)(D));
``(ii) the term `employer' shall include an
association (as such term is defined in section
2701(d)(2)(A)); and
``(iii) the term `termination (other than
by reason of such employee's gross misconduct),
or reduction of hours, of the covered
employee's employment' shall include the
termination of membership to the association.
``(B) Enrollment.--With respect to health insurance
coverage provided to an association under subsection
(a)(2), a health insurance issuer shall permit a
qualified individual who is eligible, but not enrolled
(or a dependent of such individual if the dependent is
eligible, but not enrolled) for such coverage to enroll
for coverage under the terms of such coverage when any
one of the following events occur:
``(i) New members and employees.--A
qualified individual, and any dependent of such
individual, may enroll during the 30-day period
following the end of the period described under
section 2701(d)(2)(D) that applies to such
individual.
``(ii) Annual enrollment.--A qualified
individual, and any dependent of such
individual, may enroll during the annual
enrollment period established under the terms
of the coverage
``(C) Termination of enrollment.--With respect to
group health insurance coverage provided by an
association, a qualified individual or dependent who
terminates enrollment in such coverage may only re-
enroll in such coverage during the annual enrollment
period described under subparagraph (B)(ii).
``(D) Definitions.--For purposes of this section,
the terms `association' and `qualified individual' have
the meaning given such terms in section 2701(d)(2).
``(4) Regulations.--The Secretary shall promulgate
regulations with respect to enrollment periods under this
subsection.
``(c) Special Rules for Network Plans.--
``(1) In general.--In the case of a health insurance issuer
that offers health insurance coverage in the group market in a
State through a network plan, the issuer may--
``(A) limit the employers that may apply for such
coverage to those with eligible individuals who live,
work, or reside in the service area for such network
plan; and
``(B) within the service area of such plan, deny
such coverage to such employers if the issuer has
demonstrated, if required, to the applicable State
authority that--
``(i) it will not have the capacity to
deliver services adequately to enrollees of any
additional groups because of its obligations to
existing group contract holders and enrollees;
and
``(ii) it is applying this paragraph
uniformly to all employers without regard to--
``(I) the claims experience of
those employers and their employees
(and their dependents); or
``(II) any health-status-related
factor relating to such employees and
dependents.
``(2) 180-day suspension upon denial of coverage.--An
issuer, upon denying health insurance coverage in any service
area in accordance with paragraph (1)(B), may not offer
coverage in the group market within such service area for a
period of 180 days after the date such coverage is denied.
``(d) Application of Financial Capacity Limits.--
``(1) In general.--A health insurance issuer may deny
health insurance coverage in the group if the issuer has
demonstrated, if required, to the applicable State authority
that--
``(A) it does not have the financial reserves
necessary to underwrite additional coverage; and
``(B) it is applying this paragraph uniformly to
all employers and individuals in the group market in
the State--
``(i) in a manner that is consistent with
applicable State law; and
``(ii) without regard to--
``(I) the claims experience of
those individuals, employers, and their
employees (and their dependents); or
``(II) any health-status-related
factor relating to such individuals,
employees, and dependents.
``(2) 180-day suspension upon denial of coverage.--A health
insurance issuer upon denying health insurance coverage in
connection with group health plans in accordance with paragraph
(1) in a State may not offer coverage in connection with group
health plans in the group market in the State for a period of
180 days after the date such coverage is denied or until the
issuer has demonstrated to the applicable State authority, if
required under applicable State law, that the issuer has
sufficient financial reserves to underwrite additional
coverage, whichever is later. An applicable State authority may
provide for the application of this subsection on a service-
area-specific basis.''.
(b) Individual Market.--Subpart 1 of part B of title XXVII of the
Public Health Service Act is amended by striking section 2741 and
inserting the following:
``SEC. 2741. GUARANTEED AVAILABILITY OF COVERAGE.
``The provisions of section 2711 (other than subsection (a)(2) and
subsection (b)(3)) shall apply to health insurance coverage offered to
individuals by a health insurance issuer in the individual market in
the same manner as such provisions apply to health insurance coverage
offered to employers by a health insurance issuer in connection with
health insurance coverage in the group market. For purposes of this
section, the Secretary shall treat any reference of the word `employer'
in such section as a reference to the term `individual'.''.
(c) Effective Date.--The amendments made by this section shall be
effective for plan years beginning on or after January 1, 2014.
SEC. 4. GUARANTEED RENEWABILITY OF COVERAGE.
(a) Group Market.--Section 2712 of the Public Health Service Act is
amended--
(1) in subsection (a)--
(A) by inserting ``, including coverage offered''
before ``in connection with a group health plan''; and
(B) by inserting ``employer or other'' before
``plan sponsor of the plan'';
(2) in subsection (b)--
(A) in the matter before paragraph (1), by striking
``health insurance coverage in connection with a group
health plan in the small or large group market'' and
insert ``such health insurance coverage''; and
(B) in paragraph (6) by striking `` one or more
bona fide associations'' and inserting ``one or more
associations (as such term is defined in section
2701(d)(2)(A))'';
(3) in subsection (c)(1)(B), by striking ``to a group
health plan'';
(4) in subsection (d)--
(A) in matter before paragraph (1), by striking
``to a group health plan''; and
(B) in paragraph (2), by striking ``bona fide
associations'' and inserting ``associations (as such
term is defined in section 2701(d)(2)(A))''; and
(5) in subsection (e), by inserting ``(as such term is
defined in section 2701(d)(2)(A))'' after ``one or more
associations''.
(b) Effective Date.--The amendments made by this section shall be
effective for plan years beginning on or after January 1, 2014.
SEC. 5. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS AND OTHER
DISCRIMINATION BASED ON HEALTH STATUS.
(a) Group Market.--Subpart 1 of part A of title XXVII of the Public
Health Service Act (42 U.S.C. 300gg) is amended by striking section
2701 and inserting the following:
``SEC. 2701. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS AND OTHER
DISCRIMINATION BASED ON HEALTH STATUS.
``(a) In General.--A group health plan or a health insurance issuer
offering group health insurance coverage may not impose any preexisting
condition exclusion with respect to such plan or coverage.
``(b) Definitions.--For purposes of this part:
``(1) Preexisting condition exclusion.--
``(A) In general.--The term `preexisting condition
exclusion' means, with respect to a group health plan
or health insurance coverage, a limitation or exclusion
of benefits relating to a condition based on the fact
that the condition was present before the date of
enrollment in such plan or for such coverage, whether
or not any medical advice, diagnosis, care, or
treatment was recommended or received before such date.
``(B) Treatment of genetic information.--Genetic
information shall not be treated as a preexisting
condition in the absence of a diagnosis of the
condition related to such information.
``(2) Date of enrollment.--The term `date of enrollment'
means, with respect to an individual covered under a group
health plan or health insurance coverage, the date of
enrollment of the individual in the plan or coverage or, if
earlier, the first day of the waiting period for such
enrollment.
``(3) Waiting period.--The term `waiting period' means,
with respect to a group health plan and an individual who is a
potential participant or beneficiary in the plan, the period
that must pass with respect to the individual before the
individual is eligible to be covered for benefits under the
terms of the plan.
``(c) Special Enrollment Periods.--
``(1) Individuals losing other coverage.--A group health
plan, and a health insurance issuer offering group health
insurance coverage in connection with a group health plan,
shall permit an employee who is eligible, but not enrolled, for
coverage under the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not enrolled, for
coverage under such terms) to enroll for coverage under the
terms of the plan if each of the following conditions is met:
``(A) The employee or dependent was covered under a
group health plan or had health insurance coverage at
the time coverage was previously offered to the
employee or dependent.
``(B) The employee stated in writing at such time
that coverage under a group health plan or health
insurance coverage was the reason for declining
enrollment, but only if the plan sponsor or issuer (if
applicable) required such a statement at such time and
provided the employee with notice of such requirement
(and the consequences of such requirement) at such
time.
``(C) The employee's or dependent's coverage
described in subparagraph (A)--
``(i) was under a COBRA continuation
provision and the coverage under such provision
was exhausted; or
``(ii) was not under such a provision and
either the coverage was terminated as a result
of loss of eligibility for the coverage
(including as a result of legal separation,
divorce, death, termination of employment, or
reduction in the number of hours of employment)
or employer contributions toward such coverage
were terminated.
``(D) Under the terms of the plan, the employee
requests such enrollment not later than 30 days after
the date of exhaustion of coverage described in
subparagraph (C)(i) or termination of coverage or
employer contribution described in subparagraph
(C)(ii).
``(2) For dependent beneficiaries.--
``(A) In general.--If--
``(i) a group health plan makes coverage
available with respect to a dependent of an
individual;
``(ii) the individual is a participant
under the plan (or has met any waiting period
applicable to becoming a participant under the
plan and is eligible to be enrolled under the
plan but for a failure to enroll during a
previous enrollment period); and
``(iii) a person becomes such a dependent
of the individual through marriage, birth, or
adoption or placement for adoption,
the group health plan shall provide for a dependent
special enrollment period described in subparagraph (B)
during which the person (or, if not otherwise enrolled,
the individual) may be enrolled under the plan as a
dependent of the individual, and in the case of the
birth or adoption of a child, the spouse of the
individual may be enrolled as a dependent of the
individual if such spouse is otherwise eligible for
coverage.
``(B) Dependent special enrollment period.--A
dependent special enrollment period under this
subparagraph shall be a period of not less than 30 days
and shall begin on the later of--
``(i) the date dependent coverage is made
available; or
``(ii) the date of the marriage, birth, or
adoption or placement for adoption (as the case
may be) described in subparagraph (A)(iii).
``(C) No waiting period.--If an individual seeks to
enroll a dependent during the first 30 days of such a
dependent special enrollment period, the coverage of
the dependent shall become effective--
``(i) in the case of marriage, not later
than the first day of the first month beginning
after the date the completed request for
enrollment is received;
``(ii) in the case of a dependent's birth,
as of the date of such birth; or
``(iii) in the case of a dependent's
adoption or placement for adoption, the date of
such adoption or placement for adoption.
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, shall
permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan (or a
dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such
terms) to enroll for coverage under the terms of the
plan or coverage if either of the following conditions
is met:
``(i) Termination of medicaid or chip
coverage.--The employee or dependent is covered
under a Medicaid plan under title XIX of the
Social Security Act or under a State child
health plan under title XXI of such Act and
coverage of the employee or dependent under
such a plan is terminated as a result of loss
of eligibility for such coverage and the
employee requests coverage under the group
health plan (or health insurance coverage) not
later than 60 days after the date of
termination of such coverage.
``(ii) Eligibility for employment
assistance under medicaid or chip.--The
employee or dependent becomes eligible for
assistance, with respect to coverage under the
group health plan or health insurance coverage,
under such Medicaid plan or State child health
plan (including under any waiver or
demonstration project conducted under or in
relation to such a plan), if the employee
requests coverage under the group health plan
or health insurance coverage not later than 60
days after the date the employee or dependent
is determined to be eligible for such
assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding
availability of medicaid and chip coverage.--
``(I) In general.--Each employer
that maintains a group health plan in a
State that provides medical assistance
under a State Medicaid plan under title
XIX of the Social Security Act, or
child health assistance under a State
child health plan under title XXI of
such Act, in the form of premium
assistance for the purchase of coverage
under a group health plan, shall
provide to each employee a written
notice informing the employee of
potential opportunities then currently
available in the State in which the
employee resides for premium assistance
under such plans for health coverage of
the employee or the employee's
dependents. For purposes of compliance
with this subclause, the employer may
use any State-specific model notice
developed in accordance with section
701(f)(3)(B)(i)(II) of the Employee
Retirement Income Security Act of 1974
(29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent
with provision of plan materials to
employee.--An employer may provide the
model notice applicable to the State in
which an employee resides concurrent
with the furnishing of materials
notifying the employee of health plan
eligibility, concurrent with materials
provided to the employee in connection
with an open season or election process
conducted under the plan, or concurrent
with the furnishing of the summary plan
description as provided in section
104(b) of the Employee Retirement
Income Security Act of 1974.
``(ii) Disclosure about group health plan
benefits to states for medicaid- and chip-
eligible individuals.--In the case of an
enrollee in a group health plan who is covered
under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State
child health plan under title XXI of such Act,
the plan administrator of the group health plan
shall disclose to the State, upon request,
information about the benefits available under
the group health plan in sufficient
specificity, as determined under regulations of
the Secretary of Health and Human Services in
consultation with the Secretary that require
use of the model coverage coordination
disclosure form developed under section
311(b)(1)(C) of the Children's Health Insurance
Reauthorization Act of 2009, so as to permit
the State to establish (under paragraph (2)(B),
(3), or (10) of section 2105(c) of the Social
Security Act or otherwise) the cost
effectiveness of the State providing medical or
child health assistance through premium
assistance for the purchase of coverage under
such group health plan and in order for the
State to provide supplemental benefits required
under paragraph (10)(E) of such section or
other authority.
``(d) Application to Association Plans.--
``(1) In general.--A group health plan or health insurance
issuer that provides coverage to an association as required
under section 2711(a)(2) shall accept every qualified
individual that the association seeks health insurance coverage
for, without regard to the health status of such individual.
``(2) Definitions related to associations.--For purposes of
this subsection:
``(A) Association.--The term `association' means an
association that--
``(i) has a constitution and bylaws;
``(ii) is determined by the Secretary to be
an association which is operating in good faith
for a primary purpose other than that of
obtaining insurance; and
``(iii) has been in existence for a period
of at least 5 years.
``(B) Dependent.--The term `dependent', with
respect to a qualified individual, has the meaning
given such term in section 2714, with respect to a
policy holder.
``(C) Qualified actuary.--The term `qualified
actuary' means a member in good standing of the
American Academy of Actuaries, or a successor
organization approved by the Secretary.
``(D) Qualified individuals.--The term `qualified
individual' means, with respect to an association, an
individual who meets any of the following:
``(i) A member of the association who has
been such a member for a period of at least 30
days.
``(ii) An employee of such member who has
been employed by such member for a period of at
least 30 days.
``(iii) An employee of the association who
has been employed by the association for a
period of at least 30 days.''.
(b) Individual Market.--Subpart 1 of part B of title XXVII of the
Public Health Service Act is amended by adding at the end the
following:
``SEC. 2746. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER
DISCRIMINATION BASED ON HEALTH STATUS.
``The provisions of section 2701 (other than subparagraphs (A)(ii)
and (B) of subsection (c)(3)) shall apply to health insurance coverage
offered to individuals by a health insurance issuer in the individual
market in the same manner as it applies to health insurance coverage
offered by a health insurance issuer in the group market.''.
(c) Effective Date.--The amendments made by this section shall be
effective for plan years beginning on or after January 1, 2014, except,
to the extent such amendments apply to enrollees who are under 19 years
of age, such amendments shall become effective for plan years beginning
on or after 6 months after the date of enactment of this Act.
SEC. 6. NO LIFETIME OR ANNUAL LIMITS.
(a) Group Market.--Subpart 2 of part A of title XXVII of the Public
Health Service Act is amended by adding at the end the following:
``SEC. 2708. NO LIFETIME OR ANNUAL LIMITS.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage may not establish--
``(1) lifetime limits on the dollar value of benefits for
any participant or beneficiary; or
``(2) unreasonable annual limits (within the meaning of
section 223 of the Internal Revenue Code of 1986) on the dollar
value of benefits for any participant or beneficiary.
``(b) Per Beneficiary Limits.--A group health plan or health
insurance coverage may not place annual or lifetime per beneficiary
limits on specific covered benefits unless such limits are otherwise
permitted under Federal or State law.''.
(b) Individual Market.--Subpart 2 of part B of title XXVII of the
Public Health Service Act is amended by adding at the end the
following:
``SEC. 2754. NO LIFETIME OR ANNUAL LIMITS.
``The provisions of section 2708 shall apply to health insurance
coverage offered to individuals by a health insurance issuer in the
individual market in the same manner as it applies to health insurance
coverage offered by a health insurance issuer in the group market.''.
(c) Effective Date.--The amendment made by this section shall be
effective for plan years beginning on or after 6 months after the date
of enactment of this Act.
SEC. 7. PROHIBITION ON RESCISSIONS.
(a) Group Market.--Subpart 1 of part A of title XXVII of the Public
Health Service Act is amended by adding at the end the following:
``SEC. 2703. PROHIBITION ON RESCISSIONS.
``A group health plan and a health insurance issuer offering group
health insurance coverage shall not rescind such plan or coverage with
respect to an enrollee once the enrollee is covered under such plan or
coverage involved, except that this section shall not apply to a
covered individual who has performed an act or practice that
constitutes fraud or makes an intentional misrepresentation of material
fact as prohibited by the terms of the plan or coverage. Such plan or
coverage may not be cancelled except with prior notice to the enrollee,
and only as permitted under section 2712(b).''.
(b) Individual Market.--Subpart 1 of part B of title XXVII of the
Public Health Service Act is amended by adding at the end the
following:
``SEC. 2747. PROHIBITION ON RESCISSIONS.
``The provisions of section 2703 shall apply to health insurance
coverage offered to individuals by a health insurance issuer in the
individual market in the same manner as it applies to health insurance
coverage offered by a health insurance issuer in the group market.''.
(c) Effective Date.--The amendment made by this section shall be
effective for plan years beginning on or after 6 months after the date
of enactment of this Act.
SEC. 8. EXTENSION OF DEPENDENT COVERAGE.
(a) Group Market.--
(1) In general.--Subpart 1 of part A of title XXVII of the
Public Health Service Act is amended by adding at the end:
``SEC. 2703A. EXTENSION OF DEPENDENT COVERAGE.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage that provides dependent
coverage of children shall continue to make such coverage available for
such a dependent after such dependent turns 18 years of age until the
first of the following events occurs:
``(1) The dependent turns 26 years of age.
``(2) The dependent marries.
``(3) Subject to subsection (c), the dependent no longer
resides in the home of--
``(A) the policy holder through which such
dependent is eligible for dependent coverage; or
``(B) in the case that the policy holder through
which such dependent is eligible for dependent coverage
provides such coverage subject to an order to provide
child support, the dependent's parent or legal
guardian.
``(b) Exception for College Students.--Paragraph (3) of subsection
(a) shall not apply to a dependent for any period of time during which
such dependent is enrolled as a full-time student at a postsecondary
educational institution (including an institution of higher education
as defined in section 102 of the Higher Education Act of 1965).
``(c) Limitation.--Nothing in this section shall require a plan or
an issuer described in subsection (a) to make coverage available for a
child of an individual receiving dependent coverage pursuant to this
section.
``(d) Rule of Construction.--Nothing in this section shall be
construed to modify the definition of `dependent' as used in the
Internal Revenue Code of 1986 with respect to the tax treatment of the
cost of coverage.''.
(2) Regulations.--Not later than 6 months after the date of
enactment of this Act, the Secretary shall promulgate
regulations to define the dependents to which coverage shall be
made available under section 2703A of the Public Health Service
Act, as added by paragraph (1).
(b) Individual Market.--Subpart 1 of part B of title XXVII of the
Public Health Service Act is amended by adding at the end the
following:
``SEC. 2748. EXTENSION OF DEPENDENT COVERAGE.
``The provisions of section 2703A shall apply to health insurance
coverage offered to individuals by a health insurance issuer in the
individual market in the same manner as it applies to health insurance
coverage offered by a health insurance issuer in the group market.''.
(c) Effective Date.--The amendments made by this section shall be
effective for plan years beginning on or after 6 months after the date
of enactment of this Act.
SEC. 9. APPLICATION OF GROUP MARKET REFORMS TO ERISA AND THE INTERNAL
REVENUE CODE OF 1986.
(a) ERISA.--
(1) In general.--Subpart A of title VII of the Employee
Retirement Income Security Act of 1974 is amended--
(A) by striking sections 701 and 703; and
(B) by inserting before section 702 the following:
``SEC. 701. APPLICATION OF CERTAIN PHSA REQUIREMENTS.
``(a) In General.--Sections 2701, 2703, 2703A, 2708, 2711, and 2712
of the Public Health Service Act shall apply to group health plans, and
health insurance issuers providing health insurance coverage in
connection with group health plans, as if included in this subpart.
``(b) Conflict.--To the extent that any provision of this part
conflicts with a provision of any section of the Public Health Service
Act listed in subsection (a) with respect to group health plans, or
health insurance issuers providing health insurance coverage in
connection with group health plans, the provisions of such sections
shall apply.''.
(2) Conforming amendment.--The table of contents in section
1 of such Act is amended--
(A) by striking the item related to section 701 and
inserting ``Sec. 701. Application of certain PHSA
requirements.''; and
(B) by striking the item related to section 703.
(b) Internal Revenue Code of 1986.--Subchapter A of chapter 100 of
the Internal Revenue Code of 1986 (relating to group health plan
requirements) is amended--
(1) by striking sections 9801 and 9803; and
(2) by inserting before section 9802 the following:
``SEC. 9801. APPLICATION OF CERTAIN PHSA REQUIREMENTS.
``(a) In General.--Sections 2701, 2703, 2703A, 2708, 2711, and 2712
of the Public Health Service Act shall apply to group health plans, and
health insurance issuers providing health insurance coverage in
connection with group health plans, as if included in this subchapter.
``(b) Conflict.--To the extent that any provision of this
subchapter conflicts with a provision of any section of the Public
Health Service Act listed in subsection (a) with respect to group
health plans, or health insurance issuers providing health insurance
coverage in connection with group health plans, the provisions of such
sections shall apply.''.
SEC. 10. CATASTROPHIC PLAN.
(a) In General.--Subpart 1 of part B of title XXVII of the Public
Health Service Act is amended by adding at the end the following:
``SEC. 2749. CATASTROPHIC PLAN.
``(a) In General.--Each health insurance issuer that offers health
insurance coverage in the individual market in a State shall offer a
catastrophic plan in such State in such market.
``(b) Coverage Requirements.--To meet the requirements of this
section, a catastrophic plan must provide for the essential health
benefits, as defined by the Secretary under subsection (c).
``(c) Essential Health Benefits.--The Secretary shall define the
essential health benefits, except that such benefits shall include--
``(1) coverage for at least three primary care visits
during a plan year; and
``(2) at least the following general categories and the
items and services covered within the categories:
``(A) Ambulatory patient services.
``(B) Emergency services.
``(C) Hospitalization.
``(D) Maternity and newborn care.
``(E) Mental health and substance use disorder
services, including behavioral health treatment.
``(F) Prescription drugs.
``(G) Rehabilitative and habilitative services and
devices.
``(H) Laboratory services.
``(I) Preventive and wellness services and chronic
disease management.
``(J) Pediatric services, including oral and vision
care.
``(d) Restriction to Individual Market.--If a health insurance
issuer offers a health plan described in this section, the issuer may
only offer the plan in the individual market.''.
(b) Effective Date.--This section shall be effective for plan years
beginning on or after 6 months after the date of enactment of this Act.
SEC. 11. GRANTS FOR HEALTH INSURANCE RISK ADJUSTMENT MECHANISMS.
(a) In General.--The Secretary of Health and Human Services shall
make grants to States for planning for the establishment and
implementation of health insurance risk adjustment mechanisms.
(b) Amount.--
(1) In general.--The Secretary shall determine the amount
of a grant made to a State under this section pursuant to a
formula, issued by rule not later than January 1, 2013, that
takes into account the number of high-risk individuals in such
State.
(2) Limitation.--The amount of a grant made to a State
under this section shall not exceed $1,000,000 for any fiscal
year.
(c) Use of Funds.--The grant funds made available to a State under
this section may only be used by a State for the cost associated with
planning for the establishment and implementation of health insurance
risk adjustment mechanisms. Such funds may not be used for costs
related to administering such mechanisms.
(d) Definitions.--For purposes of this section:
(1) High-risk individual.--The term ``high-risk
individual'' means an individual who--
(A) is a citizen or national of the United States
or is lawfully present in the United States;
(B) has not been covered under creditable coverage
(as defined in section 2701(c)(1) of the Public Health
Service Act as in effect on March 22, 2010) during the
previous 6-month period; and
(C) has a preexisting condition, as determined in a
manner consistent with guidance issued by the
Secretary.
(2) Health insurance risk-adjustment mechanisms.--
(A) In general.--With respect to a State, the term
``health insurance risk-adjustment mechanism'' shall be
a mechanism that applies to--
(i) all health insurance issuers who offer
health insurance coverage in such State; and
(ii) all covered lives for health insurance
coverage offered in such State that is subject
to the requirements of section 2711 or section
2741 of the Public Health Service Act, as added
by section 3 of this Act.
(B) Further definition.--With respect to a State,
any further definition of such term shall be determined
by the State insurance commissioner, acting in
cooperation with health insurance issuers who offer
health insurance coverage in such State.
(3) State.--The term ``State'' means each of the 50 States
and the District of Columbia.
(e) Sunset Date.--The Secretary may not make any grants under this
section after December 31, 2014.
SEC. 12. LIABILITY PROTECTIONS FOR HEALTH CARE PROVIDERS.
(a) Health Care Providers Protected.--The liability protections in
subsection (c) shall apply in any civil action, including an action
before any court of any State, against a health care provider, arising
from health care goods or services that--
(1) were provided by a health care provider in a hospital
to which the requirements of section 1867 of the Social
Security Act (42 U.S.C. 1395dd) apply; and
(2) were provided only because they were required under
section 1867 of the Social Security Act (42 U.S.C. 1395dd).
(b) Burden of Proof.--In any proceeding under subsection (a), the
burden of proof shall be on the defendant to establish the elements in
paragraphs (1) and (2) of subsection (a).
(c) Liability Protections.--
(1) Cap on noneconomic damages.--The amount of noneconomic
damages, if available, shall not exceed $250,000, regardless of
the number of parties against whom the action is brought with
respect to the same injury. An award for noneconomic damages in
excess of $250,000 shall be reduced either before entry of the
order granting judgment, or by amendment of such order.
(2) Installment payments.--If the award for damages exceeds
$50,000, the defendant may pay such damages in installments, as
determined by the court.
(3) Attorney fees.--Any contingent fee for a party's
attorney shall not exceed--
(A) 40 percent of the portion of the award amount
that does not exceed $50,000;
(B) 33\1/3\ percent of the portion of the award
amount that exceeds $50,000 but does not exceed
$100,000;
(C) 25 percent of the portion of the award amount
that exceeds $100,000 but does not exceed $600,000; and
(D) 15 percent of the portion of the award amount
that exceeds $600,000.
(4) Disclosure of collateral source benefits.--Any person
bringing a civil action described in subsection (a) shall, and
any party may, disclose or introduce evidence of collateral
source benefits.
(5) Preemption.--
(A) In general.--The provisions of this Act
preempt, subject to subparagraphs (B) and (C), State
law to the extent that State law prevents the
application of any provisions of law established by or
under this Act. The provisions governing an action
described in subsection (a) set forth in this Act
supersede chapter 171 of title 28, United States Code,
to the extent that such chapter--
(i) provides for a greater amount of
damages or contingent fees, a longer period in
which a health care lawsuit may be commenced,
or a reduced applicability or scope of periodic
payment of future damages, than provided in
this Act; or
(ii) prohibits the introduction of evidence
regarding collateral source benefits, or
mandates or permits subrogation or a lien on
collateral source benefits.
(B) Greater protections preserved.--This Act shall
not preempt or supersede any State or Federal law that
imposes greater procedural or substantive protections
for health care providers from liability, loss, or
damages than those provided by this Act or create a
cause of action.
(C) Rule of construction.--No provision of this Act
shall be construed to preempt--
(i) any State law (whether effective
before, on, or after the date of the enactment
of this Act) that specifies a particular
monetary amount of compensatory or punitive
damages (or the total amount of damages) that
may be awarded in an action described in
subsection (a), regardless of whether such
monetary amount is greater or lesser than is
provided for under this Act; or
(ii) any defense available to a party in an
action described in subsection (a) under any
other provision of State or Federal law.
(6) Definitions.--
(A) Collateral source benefits.--As used in this
section, the term ``collateral source benefits'' means
any amount paid or reasonably likely to be paid in the
future to or on behalf of the claimant, or any service,
product, or other benefit provided or reasonably likely
to be provided in the future to or on behalf of the
claimant, as a result of the personal harm, pursuant
to--
(i) any State or Federal health, sickness,
income-disability, accident, or workers'
compensation law;
(ii) any health, sickness, income-
disability, or accident insurance that provides
health benefits or income-disability coverage;
(iii) any contract or agreement of any
group, organization, partnership, or
corporation to provide, pay for, or reimburse
the cost of medical, hospital, dental, or
income-disability benefits; and
(iv) any other publicly or privately funded
program.
(B) Noneconomic damages.--As used in this section,
the term ``noneconomic damages'' means damages for
physical and emotional pain, suffering, inconvenience,
physical impairment, mental anguish, disfigurement,
loss of enjoyment of life, loss of society and
companionship, loss of consortium (other than loss of
domestic service), hedonic damages, injury to
reputation, and all other nonpecuniary losses of any
kind or nature.
(C) Health care provider.--As used in this section,
the term ``health care provider'' means any person or
entity required by State or Federal laws or regulations
to be licensed, registered, or certified to provide
health care services, and being either so licensed,
registered, or certified, or exempted from such
requirement by other statute.
(D) Health care goods or services.--As used in this
section, the term ``health care goods or services''
means any goods or services provided by a health care
organization, provider, or by any individual working
under the supervision of a health care provider, that
relates to the diagnosis, prevention, or treatment of
any human disease or impairment, or the assessment or
care of the health of human beings.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on the Constitution.
Referred to the Subcommittee on Health.
Referred to the Subcommittee Indian and Alaska Native Affairs.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health, Employment, Labor, and Pensions.