Health Care for the Unemployed Act of 1983

(Measure passed House, amended, roll call #316 (252-174))

Health Care for the Unemployed Act of 1983 - Title I: Amendments to Social Security Act - Amends the Social Security Act to add a new title, Title XXI - Health Care for the Unemployed: Part A - Block Grants to States - Authorizes appropriations for FY 1983-1985 a sum sufficient to carry out this part. Makes available for allotments for block grants to States under this part specified sums for each such fiscal year for the development and operation of medical benefit plans for the unemployed. Requires a State, in order to receive a payment from its allotment: (1) to have an approved plan; and (2) to provide for any required State contributions. Sets forth a formula that the Secretary of Health and Human Services shall use in making allotments. Prohibits payment of a State's allotment for: (1) 1983 unless the State notifies the Secretary by September 15, 1983, of its intent to have in effect in the State a plan by June 30, 1984; and (2) FY 1984 and 1985 unless an approved plan is in effect by June 30, 1984.

Requires a State plan for medical benefits for the unemployed to provide for making the following medical benefits available (to the extent such benefits are available under the Medicaid program of the Social Security Act) to eligible individuals voluntarily enrolled under the plan: (1) inpatient hospital services; (2) outpatient hospital and rural health clinic services; (3) laboratory and x-ray services; (4) family planning services and supplies; (5) physicians' services; (6) clinic services; (7) nurse-midwife services; and (8) prescribed drugs. Requires the plan to also provide the following medical benefits: (1) prenatal, delivery, post-partum, and well-baby care, without limitations of amount, duration, or scope except as to medical necessity; and (2) at least some ambulatory services. Authorizes a plan to impose: (1) a weekly premium equal to not more than five percent of an individual's unemployment compensation; and (2) a premium equal to not more than two percent of the average monthly unemployment compensation benefit in the State if an eligible individual is not receiving unemployment compensation. Requires a plan to provide for the imposition of a deductible. Permits the waiver of deductions, cost sharing and similar charges in the case of financial hardship. Requires a State to provide for a State contribution towards expenditures under the plan, except for 1983. Sets forth formulas for determining such contribution which take into account a State's unemployment rate and the national unemployment rate. Limits a State's administrative expenses to a maximum of 10 percent of its plan's expenses, except for 1983. Requires each State to prepare and submit to the Secretary and each House of Congress by February 1, 1985, a report of its activities through FY 1984 under the plan. Makes provisions of title V (Maternal and Child Health) of the Act relating to reports and audits and nondiscrimination applicable to expenditure and activities under this part. Makes provisions of title XIX (Medicaid) and part A (General Provisions) of title XI of the Act relating to penalties applicable to State plans under this Act. Prohibits a payment to a provider from exceeding the payment for the same service provided under title XIX. Requires a plan to be secondary in payment to any other insurance or benefit plan providing medical benefits. Requires a State to determine if an applicant for benefits under the plan might be eligible for Medicaid. Requires a plan to meet specified administrative requirements of the State's Medicaid plan. Requires the Secretary to approve any plan meeting the above requirements.

Directs the Secretary to disapprove any plan if the Secretary determines that: (1) the State provided eligibility for Medicaid or AFDC under title XIX or part A (Aid to Families with Dependent Children) of title IV of the Act to dependent children of unemployed parents as of June 1, 1983, and, after such date, discontinued coverage of such children under such plan; or (2) the State has made other significant reductions in eligibility or benefits under its Medicaid plan in order to establish or operate a plan under this part.

Requires each State plan to specify the criteria for determining eligibility for medical benefits under the plan. Requires an individual, in order to be eligible under a State's plan, to be unemployed and: (1) be receiving unemployment compensation or have received unemployment compensation for a week in the previous 104 week period; or (2) have been previously employed (as determined under the plan), and meet such reasonable financial or medical needs standards as the State plan specifies. Requires coverage for a covered individual's immediate family members. Directs a State to specify the uniform minimum length of time an individual must have been previously unemployed in order to be eligible for benefits. Prohibits coverage of an individual under a plan if the individual is: (1) covered under a group health or his or her spouse's group health plan; or (2) eligible for Medicaid. Authorizes a State to limit the coverage period of an eligible individual, but the period may be less than one year for unemployed individuals who are receiving unemployment compensation or who received unemployment compensation for a week in the previous 104 week period. Permits an individual to terminate enrollment at any time.

Authorizes a State plan to provide an enrollee with the voluntary option of electing to receive medical benefits through an arrangement with a health benefits plan rather than under the State plan if: (1) the scope, amount, and duration of benefits are at least equal to the State's; (2) premiums and charges do not exceed the State's; and (3) the amount of payment does not exceed the actuarial value of payments for medical benefits which would have otherwise been made.

Part B: Open Enrollment, Continuation, and Conversion Rights of Individuals - Requires any group health plan offered by an employer of 25 or more individuals to: (1) have an open enrollment period for spouses of unemployed workers; (2) require the continuation of group health care coverage to an involuntarily laidoff employee; and (3) offer unemployed workers covered under insured group health plans the right to convert to individual policies. Requires the open enrollment period to be of at least 30 days duration for each married employee whose spouse loses coverage under a group health plan due to an involuntary layoff. Requires the continuation of coverage period to be at least 90 days in the case of a covered employee (excluding temporary employees) who would otherwise lose coverage because of an involuntary layoff. Provides an individual with up to 31 days to convert to an individual policy following loss coverage under the group health plan.

Part C: Assistance to Hospitals Serving the Unemployed - Directs the Secretary to make grants to hospitals to assist the hospitals in providing services to individuals unable to pay for such services. Directs the Secretary to: (1) give first priority to hospitals which are either public hospitals or hospitals serving areas not served by a public hospital; and (2) then give priority to other hospitals which demonstrate that they serve a significantly disproportionate number of patients who are unemployed and unable to pay for hospital services. Requires a hospital, in order to be eligible for a grant, to: (1) be located in an area experiencing high unemployment or serving primarily medically underserved populations; (2) serve a significantly disproportionate number of patients having low incomes and who are unable to pay for hospital services; (3) provide services to individuals without regard to their ability to pay; (4) provide assurances that if required to make available services to individuals who cannot pay pursuant to an assurance under the Public Health Service Act, the hospital has made the services available; and (5) offer assurances that it will use the sums provided in the grant in addition to, rather than in lieu of, existing Federal, State, and local funds currently available. Requires that an application be submitted for a grant and that the application be approved before a grant is made.

Directs the Secretary to report to Congress concerning the grants. Authorizes appropriations for such grants for FY 1984-1986.

Sets forth effective date provisions.

Authorizes appropriations to carry out title V of the Act for FY 1983 and 1984, with an increase for FY 1984, but requires new funding authority thereafter.

Increases Medicaid funding to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

Title II: Internal Revenue Code Amendment and Miscellaneous Provision - Amends the Internal Revenue Code to impose, until December 31, 1986, a tax on employers of 25 or more individuals equal to ten percent of the amount of the nonqualified employee health expenses paid or incurred annually. Defines "nonqualified employee health expenses" as the expenses paid or incurred by the employer for a group health plan to the extent such expenses are allocable to a period during which such plan does not meet each requirement contained in part B of title XXI.

Amends title XVIII (Medicare) of the Social Security Act to set the "cap amount" used for computing payment for hospice care at $6,500 annually (to be adjusted annually according to the consumer price index).