HR 1558 IHCommentsClose CommentsPermalink

To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets.CommentsClose CommentsPermalink

March 17, 2009CommentsClose CommentsPermalink

Mr. COURTNEY (for himself, Mr. SCHIFF, Mrs. CAPPS, Ms. DELAURO, Ms. CLARKE, Mr. LANGEVIN, Ms. SCHAKOWSKY, Ms. SCHWARTZ, Mr. MASSA, Ms. BALDWIN, Ms. ROS-LEHTINEN, Ms. PINGREE of Maine, and Mrs. DAVIS of California) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and Education and Labor, 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 concernedCommentsClose CommentsPermalink

To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Preexisting Condition Patient Protection Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. FINDINGS.

The Congress finds as follows:CommentsClose CommentsPermalink





(1) According to the United States Census Bureau, 45.7 million people were uninsured in 2007.CommentsClose CommentsPermalink





(2) According to a recent study by the Commonwealth Fund, the number of underinsured adults aged 19 to 64 has jumped 60 percent over the last 4 years, from 16,000,000 in 2003 to 25,000,000 in 2007.CommentsClose CommentsPermalink





(3) According to the Centers for Disease Control and Prevention (CDC), approximately 45 percent of Americans have at least one chronic condition.CommentsClose CommentsPermalink





(4) Forty-four States currently allow insurance companies to deny coverage for, limit coverage for, or charge increased premiums for a preexisting condition.CommentsClose CommentsPermalink





(5) Over 26 million people were enrolled in private individual market health plans in 2007. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), these individuals have no protections against pre-existing condition exclusions or waiting periods.CommentsClose CommentsPermalink





(6) When a child or adult has a 63-day gap in insurance coverage, pre-existing condition exclusions, such as limiting coverage or instituting a waiting period, can be placed on them when they become insured under a new health insurance policy.CommentsClose CommentsPermalink





(7) Eliminating pre-existing condition exclusions for all is a vital safeguard to ensuring that all Americans have access to health care when in need.CommentsClose CommentsPermalink





(8) According to a Kaiser Family Foundation/Harvard School of Public Health public opinion poll, 58 percent of Americans strongly favor the Federal Government requiring health insurance companies to cover anyone who applies for health coverage, even if they have a prior illness.CommentsClose CommentsPermalink

SEC. 3. AMENDMENTS RELATING TO PREEXISTING CONDITION EXCLUSIONS UNDER GROUP HEALTH PLANS.

(a) Amendments to the Employee Retirement Income Security Act of 1974-CommentsClose CommentsPermalink





(1) ELIMINATION OF PREEXISTING CONDITION EXCLUSIONS- Section 701 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181) is amended--CommentsClose CommentsPermalink





(A) by amending the heading to read as follows: ‘elimination of preexisting condition exclusions’;CommentsClose CommentsPermalink





(B) by amending subsection (a) to read as follows:CommentsClose CommentsPermalink





‘(a) In General- A group health plan, and a health insurance issuer offering group health insurance coverage, with respect to a participant or beneficiary--CommentsClose CommentsPermalink





‘(1) may not impose any preexisting condition exclusion; andCommentsClose CommentsPermalink





‘(2) in the case of a group health plan that offers medical care through health insurance coverage offered by a health maintenance organization, may not provide for an affiliation period with respect to coverage through the organization.’;CommentsClose CommentsPermalink





(C) in subsection (b), by striking paragraph (3) and inserting the following:CommentsClose CommentsPermalink





‘(3) AFFILIATION PERIOD- The term ‘affiliation period’ means a period which, under the terms of the health insurance coverage offered by the health maintenance organization, must expire before the health insurance coverage becomes effective.’;CommentsClose CommentsPermalink





(D) by striking subsections (c), (d), (e), and (g); andCommentsClose CommentsPermalink





(E) by redesignating subsection (f) (relating to special enrollment periods) as subsection (c).CommentsClose CommentsPermalink





(2) CLERICAL AMENDMENT- The item in the table of contents of such Act relating to section 701 is amended to read as follows:CommentsClose CommentsPermalink





‘Sec. 701. Elimination of preexisting condition exclusions.’.CommentsClose CommentsPermalink





(b) Amendments to the Public Health Service Act-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 2701 of the Public Health Service Act (42 U.S.C. 300gg) is amended--CommentsClose CommentsPermalink





(A) by amending the heading to read as follows: ‘elimination of preexisting condition exclusions’;CommentsClose CommentsPermalink





(B) by amending subsection (a) to read as follows:CommentsClose CommentsPermalink





‘(a) In General- A group health plan, and a health insurance issuer offering group health insurance coverage, with respect to a participant or beneficiary--CommentsClose CommentsPermalink





‘(1) may not impose any preexisting condition exclusion; andCommentsClose CommentsPermalink





‘(2) in the case of a group health plan that offers medical care through health insurance coverage offered by a health maintenance organization, may not provide for an affiliation period with respect to coverage through the organization.’;CommentsClose CommentsPermalink





(C) in subsection (b), by striking paragraph (3) and inserting the following:CommentsClose CommentsPermalink





‘(3) AFFILIATION PERIOD- The term ‘affiliation period’ means a period which, under the terms of the health insurance coverage offered by the health maintenance organization, must expire before the health insurance coverage becomes effective.’;CommentsClose CommentsPermalink





(D) by striking subsections (c), (d), (e), and (g); andCommentsClose CommentsPermalink





(E) by redesignating subsection (f) (relating to special enrollment periods) as subsection (c).CommentsClose CommentsPermalink





(2) TECHNICAL AMENDMENTS RELATING TO EMPLOYER SIZE- Section 2711 of such Act (42 U.S.C. 300gg-11) is amended--CommentsClose CommentsPermalink





(A) in subsection (a)--CommentsClose CommentsPermalink





(i) in the heading, by striking ‘Small’;CommentsClose CommentsPermalink





(ii) in paragraph (1)--CommentsClose CommentsPermalink





(I) in the matter before subparagraph (A), by striking ‘(c) through (f)’ and inserting ‘(b) through (d)’ and by striking ‘small’; andCommentsClose CommentsPermalink





(II) in subparagraph (A), by striking ‘small employer (as defined in section 2791(e)(4))’ and inserting ‘employer’; andCommentsClose CommentsPermalink





(iii) in paragraph (2)--CommentsClose CommentsPermalink





(I) by striking ‘small’ each place it appears; andCommentsClose CommentsPermalink





(II) by striking ‘coverage to a’ and inserting ‘coverage to an’;CommentsClose CommentsPermalink





(B) by striking subsection (b);CommentsClose CommentsPermalink





(C) in subsections (c), (d), and (e), by striking ‘small’ each place it appears; andCommentsClose CommentsPermalink





(D) by striking subsection (f).CommentsClose CommentsPermalink





(c) Amendments to the Internal Revenue Code of 1986-CommentsClose CommentsPermalink





(1) ELIMINATION OF PREEXISTING CONDITION EXCLUSIONS- Section 9801 of the Internal Revenue Code of 1986 is amended--CommentsClose CommentsPermalink





(A) by amending the heading to read as follows: ‘elimination of preexisting condition exclusions’;CommentsClose CommentsPermalink





(B) by amending subsection (a) to read as follows:CommentsClose CommentsPermalink





‘(a) In General- A group health plan with respect to a participant or beneficiary may not impose any preexisting condition exclusion.’;CommentsClose CommentsPermalink





(C) by striking paragraph (3) of subsection (b);CommentsClose CommentsPermalink





(D) by striking subsections (c), (d), and (e); andCommentsClose CommentsPermalink





(E) by redesignating subsection (f) (relating to special enrollment periods) as subsection (c).CommentsClose CommentsPermalink





(2) CLERICAL AMENDMENT- The item in the table of sections of chapter 100 of such Code relating to section 9801 is amended to read as follows:CommentsClose CommentsPermalink





‘Sec. 9801. Elimination of preexisting condition exclusions.’.CommentsClose CommentsPermalink





(d) Effective Date-CommentsClose CommentsPermalink





(1) IN GENERAL- Except as provided in paragraph (2), the amendments made by this section shall apply with respect to group health plans for plan years beginning after the end of the 12th calendar month following the date of the enactment of this Act.CommentsClose CommentsPermalink





(2) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS- In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act, the amendments made by this section shall not apply to plan years beginning before the later of--CommentsClose CommentsPermalink





(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), orCommentsClose CommentsPermalink





(B) the date that is after the end of the 12th calendar month following the date of the enactment of this Act.CommentsClose CommentsPermalink





For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by the amendments made by this section shall not be treated as a termination of such collective bargaining agreement.CommentsClose CommentsPermalink

SEC. 4. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS IN HEALTH INSURANCE COVERAGE IN THE INDIVIDUAL MARKET.

(a) In General- Section 2741 of the Public Health Service Act (42 U.S.C. 300gg-41) is amended--CommentsClose CommentsPermalink





(1) in subsection (a)(1), by striking ‘with respect to an eligible individual’ and all that follows and inserting the following: ‘with respect to--CommentsClose CommentsPermalink





‘(A) an eligible individual (as defined in subsection (b)) desiring to enroll in individual health insurance coverage decline to offer such coverage to, or deny enrollment of, such individual; andCommentsClose CommentsPermalink





‘(B) any individual desiring to enroll in such coverage impose any preexisting condition exclusion (as defined in section 2701(b)(1)(A)) with respect to such coverage.’; andCommentsClose CommentsPermalink





(2) in subsection (a)(2), by striking ‘paragraph (1)’ and inserting ‘paragraph (1)(A)’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after the end of the 12th month following the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 5. TRANSPARENCY IN CLAIMS DATA.

(a) In General- Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report on the impact of this Act on health benefits coverage.CommentsClose CommentsPermalink





(b) Examination of Claims Experience and Other Data- In preparing the report under subsection (a), the Secretary may request from group health plans and health insurance issuers--CommentsClose CommentsPermalink





(1) data on claims experience under the plan or health insurance coverage issued by such issuers, such as the number, nature, and dollar amount of claims made by enrollees during the period involved;CommentsClose CommentsPermalink





(2) data relating to enrollees in the plan or under such coverage, such as number of new enrollees, number of individuals reenrolling (or discontinuing enrollment) after the first year of coverage, and changes in the demographic composition of enrollees; andCommentsClose CommentsPermalink





(3) such other information as the Secretary deems appropriate.CommentsClose CommentsPermalink





The provisions of section 2722(b) of the Public Health Service Act shall apply to a failure of a group health plan or health insurance issuer to provide data or information requested by the Secretary under this subsection in the same manner as such provisions apply to the enforcement of a provision of part A of title XXVIII of such Act, except that any reference to an individual in paragraph (1)(C)(i) of such section shall be deemed for this purpose a reference to a covered life under the plan or health insurance coverage involved.CommentsClose CommentsPermalink

SEC. 6. GAO REPORT.

Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the impact of this Act (and other Federal laws regarding the regulation of health insurance and health benefits coverage) on the reduction in the number of uninsured and underinsured individuals in the group market and the individual market and on the affordability of coverage in such markets.CommentsClose CommentsPermalink