Most commented sections:

• Paragraph 11 (1 comments)

S 79 ISCommentsClose CommentsPermalink

To amend the Social Security Act to establish a Federal Reinsurance Program for Catastrophic Health Care Costs.CommentsClose CommentsPermalink

January 6, 2009CommentsClose CommentsPermalink

Mr. KERRY introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend the Social Security Act to establish a Federal Reinsurance Program for Catastrophic Health Care Costs.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 ‘Healthy Businesses, Healthy Workers Reinsurance Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. FINDINGS.

Congress finds the following:CommentsClose CommentsPermalink





(1) The cost of health insurance premiums for families has risen 100 percent since 2000, 4 times the growth in overall inflation and workers’ earnings.CommentsClose CommentsPermalink





(2) Health insurance premium increases have resulted in a nearly 6 percentage point drop in the number of firms choosing to offer coverage to their workers over that time period.CommentsClose CommentsPermalink





(3) Today, just 49 percent of firms with between 3 and 9 employees offer health insurance benefits, down from 58 percent in 2001.CommentsClose CommentsPermalink





(4) The decline in employer-sponsored coverage has added to the growing problem of the uninsured. An additional 5,000,000 Americans have been added to the ranks of the uninsured since 2001.CommentsClose CommentsPermalink





(5) Health care costs are highly concentrated. Catastrophically or chronically ill individuals account for nearly 80 percent of health care spending, with 10 percent of individuals accounting for over 60 percent of spending, and just 1 percent driving over 20 percent of health care costs.CommentsClose CommentsPermalink

SEC. 3. FEDERAL REINSURANCE PROGRAM FOR CATASTROPHIC HEALTH CARE COSTS.

(a) Program- The Social Security Act (42 U.S.C. 301 et seq.) is amended by adding at the end the following new title:CommentsClose CommentsPermalink

‘TITLE XXII--FEDERAL REINSURANCE PROGRAM FOR CATASTROPHIC HEALTH CARE COSTSCommentsClose CommentsPermalink

‘SEC. 2201. OFFICE OF FEDERAL REINSURANCE.

‘(a) In General- There is established within the Department of Health and Human Services an office to be known as the ‘Office of Federal Reinsurance’.CommentsClose CommentsPermalink





‘(b) Duty- The Office of Federal Reinsurance shall establish and administer the Federal Reinsurance Program for Catastrophic Health Care Costs in accordance with the provisions of this title.CommentsClose CommentsPermalink

‘SEC. 2202. PROGRAM.

‘(a) Establishment-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Office shall establish and administer a Federal Reinsurance Program for Catastrophic Health Care Costs under which reinsurance payments are provided to eligible health plans that experience catastrophic health care costs during a year with respect to an individual covered under the plan. For purposes of this title, the term ‘individual covered under the plan’ includes employees, retirees, spouses, and dependants.CommentsClose CommentsPermalink





‘(2) PROGRAM TO BEGIN IN 2010- The Office shall establish the Program in a manner so that reinsurance payments are made with respect to catastrophic health care costs occurring on or after January 1, 2010.CommentsClose CommentsPermalink





‘(3) ELIGIBLE HEALTH PLAN-CommentsClose CommentsPermalink





‘(A) IN GENERAL- In this title, the term ‘eligible health plan’ means any of the following:CommentsClose CommentsPermalink





‘(i) A group health plan that meets the requirements described in subparagraph (B).CommentsClose CommentsPermalink





‘(ii) A governmental plan (as defined in section 3(32) of the Employee Retirement Income Security Act of 1974) that meets the requirements described in subparagraph (B).CommentsClose CommentsPermalink





‘(iii) A multiemployer plan (as defined in section 3(37) of the Employee Retirement Income Security Act of 1974) that meets the requirements described in subparagraph (B).CommentsClose CommentsPermalink





‘(iv) A plan that offers coverage through health purchasing cooperatives in conjunction with a State health program that makes available health insurance coverage to the small group market and the individual market on the same terms and that meets the requirements described in subparagraph (B).CommentsClose CommentsPermalink





‘(B) REQUIREMENTS- The requirements described in this subparagraph are that--CommentsClose CommentsPermalink





‘(i) the plan involved--CommentsClose CommentsPermalink





‘(I) provides eligibility for health insurance coverage (after any waiting period (as defined in section 9801(b)(4))) to all full-time employees of the employer maintaining or contributing to the plan;CommentsClose CommentsPermalink





‘(II) ensures that if there is a deductible under the plan, such deductible does not exceed $1,000 for an individual and $2,000 for a family;CommentsClose CommentsPermalink





‘(III) ensures that the plan offers preventative benefits; andCommentsClose CommentsPermalink





‘(IV) ensures that the plan employs effective high-cost case management tools (in accordance with the definition of disease management by the Disease Management Association of America) in order to reduce costs over time; andCommentsClose CommentsPermalink





‘(ii) the employer maintaining or contributing to the plan involved pays at least 50 percent of the costs of health insurance coverage for each employee covered under the plan (regardless of whether the employee is a full-time or part-time employee).CommentsClose CommentsPermalink





‘(C) COST-OF-LIVING ADJUSTMENT-CommentsClose CommentsPermalink





‘(i) IN GENERAL- In the case of any calendar year after 2010. each dollar amount in subparagraph (B)(ii) shall be increased by an amount equal to--CommentsClose CommentsPermalink





‘(I) such dollar amount, multiplied byCommentsClose CommentsPermalink





‘(II) the cost-of-living adjustment determined under section 1(f)(3) of the Internal Revenue Code of 1986 for such calendar year determined by substituting ‘calendar year 2009’ for ‘calendar year 1992’ in subparagraph (B) thereof.CommentsClose CommentsPermalink





‘(ii) DATE FOR DETERMINATION- For purposes of clause (i), section 1(f)(4) of such Code shall be applied by substituting ‘March 31’ for ‘August 31’, and the Secretary of the Treasury shall publish the adjusted amounts under subparagraph (B)(ii) for the calendar year not later than June 1 of the preceding calendar year.CommentsClose CommentsPermalink





‘(iii) ROUNDING- If any increase under clause (i) is not a multiple of $50, such increase shall be rounded to the nearest multiple of $50.CommentsClose CommentsPermalink





‘(D) EMPLOYER- For purposes of this title, the term ‘employer’ includes the Federal government and any other governmental entity (within the meaning of section 5000(d) of Internal Revenue Code of 1986).CommentsClose CommentsPermalink





‘(b) Enrollment-CommentsClose CommentsPermalink





‘(1) PROCEDURES- The Office shall establish procedures for the enrollment of eligible health plans in the Program.CommentsClose CommentsPermalink





‘(2) APPLICATION AND ANNUAL RECERTIFICATION-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The procedures established under paragraph (1) shall include a process for an eligible health plan--CommentsClose CommentsPermalink





‘(i) to submit an application to the Office for enrollment in the Program; andCommentsClose CommentsPermalink





‘(ii) to be annually recertified for enrollment in the Program.CommentsClose CommentsPermalink





‘(B) REQUIREMENT- The application and recertification process under subparagraph (A) shall require that an eligible health plan submit to the Office--CommentsClose CommentsPermalink





‘(i) a detailed description of the projected and actual reduction in total costs under the plan that are a result of the Program, including both individual and employer portions; andCommentsClose CommentsPermalink





‘(ii) such other information determined appropriate by the Office.CommentsClose CommentsPermalink





‘(3) APPROVAL-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The procedures established under paragraph (1) shall provide for the approval or disapproval of applications and requests for recertification submitted by eligible health plans under paragraph (2).CommentsClose CommentsPermalink





‘(B) SPECIFIC REQUIREMENT- The Office shall not approve an application or a request for recertification unless the Office finds that the eligible health plan is reducing total costs under the plan, based on the information submitted under paragraph (2)(B) and audits conducted under paragraph (4).CommentsClose CommentsPermalink





‘(4) AUDITS- The Office shall conduct audits of claims data of eligible health plans in order to ensure that the eligible health plan is in compliance with the requirements under the Program, including the requirement under paragraph (3)(B). An eligible health plan shall not be eligible for reinsurance payments unless it provides the Office with access to such data.CommentsClose CommentsPermalink





‘(c) Cost-Sharing in Costs of Program-CommentsClose CommentsPermalink





‘(1) IN GENERAL- An eligible health plan that participates in the Program shall pay the fee established by the Office under paragraph (2).CommentsClose CommentsPermalink





‘(2) AUTHORIZATION- The Office is authorized to charge a fee to each eligible health plan that participates in the Program. Any amounts collected shall be deposited into the Trust Fund.CommentsClose CommentsPermalink





‘(3) REQUIREMENTS- In establishing the fee under paragraph (2)--CommentsClose CommentsPermalink





‘(A) the Office shall consult with interested parties; andCommentsClose CommentsPermalink





‘(B) shall ensure that the amount of such fee is not excessive so as to unduly discourage eligible health plans from enrolling in the Program.CommentsClose CommentsPermalink





‘(d) Appeals Process- The Office shall establish an appeals process under the Program.CommentsClose CommentsPermalink





‘(e) Procedures To Protect Against Fraud, Waste, and Abuse- The Office shall establish procedures to protect against fraud, waste, and abuse under the Program.CommentsClose CommentsPermalink

‘SEC. 2203. REINSURANCE PAYMENTS.

‘(a) Amount-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The amount of a reinsurance payment under the Program to an eligible health plan that experiences catastrophic health care costs in a year with respect to an individual covered under the plan shall be an amount equal to 75 percent of such costs.CommentsClose CommentsPermalink





‘(2) CATASTROPHIC HEALTH CARE COSTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- In this title, the term ‘catastrophic health care costs’ means, with respect to a year, costs for medical care (as defined in section 9832(d)(3) of the Internal Revenue Code of 1986) provided under an eligible health plan to an individual covered under the plan, but only with respect to such costs which exceed $50,000.CommentsClose CommentsPermalink





‘(B) NEGOTIATED PRICES- In determining the amount of catastrophic health care costs under the Program, the eligible health care plan shall take into account any negotiated price concessions, such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunerations, obtained by the plan.CommentsClose CommentsPermalink





‘(C) INFLATION ADJUSTMENT-CommentsClose CommentsPermalink





‘(i) IN GENERAL- In the case of a calendar year after 2010, the $50,000 amount in subparagraph (A) shall be increased by an amount equal to--CommentsClose CommentsPermalink





‘(I) such dollar amount; multiplied byCommentsClose CommentsPermalink





‘(II) the percentage (if any) by which the average of the medical care component of the Consumer Price Index for all urban consumers (United States city average) for the 12-month period ending with August of the preceding calendar year exceeds such average for the 12-month period ending with August 2009.CommentsClose CommentsPermalink





‘(ii) ROUNDING- If any dollar amount after being increased under clause (i) is not a multiple of $1,000, such dollar amount shall be rounded to the nearest multiple of $1,000.CommentsClose CommentsPermalink





‘(b) Requests for Payment- To be eligible for a reinsurance payment with respect to an individual for a year, an eligible health plan shall submit to the Office, at a time and in a manner determined appropriate by the Office, a request for payment that contains--CommentsClose CommentsPermalink





‘(1) a certification--CommentsClose CommentsPermalink





‘(A) that the plan paid or incurred catastrophic health care costs during the year with respect to the individual; andCommentsClose CommentsPermalink





‘(B) of the amount of such costs; andCommentsClose CommentsPermalink





‘(2) such other information determined appropriate by the Office.CommentsClose CommentsPermalink





‘(c) Payments From Trust Fund-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Payments to eligible health plans under the Program shall be made from the Trust Fund.CommentsClose CommentsPermalink





‘(2) TAX TREATMENT- For purposes of the Internal Revenue Code of 1986--CommentsClose CommentsPermalink





‘(A) payments from the Trust Fund to the eligible health plan shall not be included in gross income; andCommentsClose CommentsPermalink





‘(B) no deduction shall be allowed to the eligible health plan with respect to the payment of any catastrophic health care costs for the portion of such costs which was reimbursed from the Trust Fund.CommentsClose CommentsPermalink

‘SEC. 2204. FEDERAL REINSURANCE FOR CATASTROPHIC HEALTH CARE COSTS TRUST FUND.

‘(a) Creation of Trust Fund- There is established in the Treasury of the United States a trust fund to be known as the ‘Federal Reinsurance for Catastrophic Health Care Costs Trust Fund’, consisting of such amounts as may be appropriated or credited to the Trust Fund (including any fees deposited under section 2202(c)).CommentsClose CommentsPermalink





‘(b) Mandatory Appropriations- There are appropriated to the Trust Fund such sums as may be necessary in order to make the reinsurance payments required under section 2203.CommentsClose CommentsPermalink





‘(c) Rules Regarding Transfers to and Management of Trust Fund- For purposes of this section, rules similar to the rules of sections 9601 and 9602 of the Internal Revenue Code of 1986 shall apply.CommentsClose CommentsPermalink





‘(d) Distribution of Amounts in Trust Fund- Amounts in the Trust Fund shall be available for making payments under section 2203.CommentsClose CommentsPermalink

‘SEC. 2205. REPORTS.

‘(a) Secretary-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Not later than March 1, 2012, and biennially thereafter, the Secretary shall submit to Congress a report on the Program.CommentsClose CommentsPermalink





‘(2) REQUIREMENTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Each report submitted under paragraph (1) shall contain--CommentsClose CommentsPermalink





‘(i) a detailed description of the Program, including a detailed description of the impact the Program has had on reducing premiums for health insurance coverage and increasing the number of individuals with health insurance coverage; andCommentsClose CommentsPermalink





‘(ii) any other information or recommendations determined appropriate by the Secretary.CommentsClose CommentsPermalink





‘(B) INDIVIDUAL MARKET- The first report submitted under paragraph (1) shall also contain recommendations regarding expanding the Program to the individual market.CommentsClose CommentsPermalink





‘(C) CONSULTATION- The Secretary shall consult with the National Association of Insurance Commissioners in preparing each report under paragraph (1).CommentsClose CommentsPermalink





‘(b) GAO-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Not later than March 1, 2012, and biennially thereafter, the Comptroller General of the United States shall submit to Congress and the Secretary a report on the Program.CommentsClose CommentsPermalink





‘(2) REQUIREMENTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Each report submitted under paragraph (1) shall contain--CommentsClose CommentsPermalink





‘(i) a detailed description of the Program, including a detailed description of the impact the Program has had on reducing premiums for health insurance coverage and increasing the number of individuals with health insurance coverage; andCommentsClose CommentsPermalink





‘(ii) any other information or recommendations determined appropriate by the Comptroller General.CommentsClose CommentsPermalink





‘(B) INDIVIDUAL MARKET- The first report submitted under paragraph (1) shall also contain recommendations regarding expanding the Program to the individual market.CommentsClose CommentsPermalink

‘SEC. 2206. DEFINITIONS.

‘In this title:CommentsClose CommentsPermalink





‘(1) GROUP HEALTH PLAN- The term ‘group health plan’ has the meaning given such term by section 5000(b)(1) of the Internal Revenue Code of 1986.CommentsClose CommentsPermalink





‘(2) INDIVIDUAL MARKET; SMALL GROUP MARKET- The terms ‘individual market’ and ‘small group market’ have the meanings given such terms by section 2791 of the Public Health Service Act.CommentsClose CommentsPermalink





‘(3) OFFICE- The term ‘Office’ means the Office of Federal Reinsurance established under section 2201.CommentsClose CommentsPermalink





‘(4) PROGRAM- The term ‘Program’ means the Federal Reinsurance Program for Catastrophic Health Care Costs under this title.CommentsClose CommentsPermalink





‘(5) TRUST FUND- The term ‘Trust Fund’ means the Federal Reinsurance for Catastrophic Health Care Costs Trust Fund established under section 2204.’.CommentsClose CommentsPermalink





(b) Funding Start-Up Administrative Costs for Program-CommentsClose CommentsPermalink





(1) IN GENERAL- There are appropriated to the Secretary of Health and Human Services $200,000,000 to carry out the provisions of, and amendments made by, this Act.CommentsClose CommentsPermalink





(2) AVAILABILITY- Amounts appropriated under paragraph (1) shall remain available until September 30, 2010.CommentsClose CommentsPermalink