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

Summary: Pre-existing Condition Patient Protection Act of 2009 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to prohibit a group health plan from: (1) imposing any preexisting condition exclusion; or (2) providing for an affiliation period for coverage offered by a health maintenance organization (HMO). Defines an "affiliation period" as a period of time before health insurance coverage becomes effective.

Requires each health insurance issuer offering coverage in the group market in a state to accept every employer in the state that applies for such coverage.

Revises provisions governing individual health insurance coverage to apply certain prohibitions related to denying coverage and preexisting condition exclusions to coverage offered in an area (currently, a state).

Requires the Secretary of Health and Human Services to report to Congress concerning the occurrence of adverse selection as a result of this Act. Requires health insurance issuers to which this Act applies to submit to the Secretary specified information on enrollees and claims.

Directs the Secretary to require that group health plans and health insurance issuers provide data to the Secretary for compliance purposes. Sets forth civil penalties for violations.

Directs the Government Accountability Office (GAO) to report to the Secretary on: (1) the impact of this Act and other relevant federal laws; and (2) this Act's effect on the affordability of health insurance coverage and on the expansion of coverage and reductions in the number of uninsured and underinsured.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Pre-existing Condition Patient 
Protection Act of 2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) According to the United States Census Bureau, 
        45,700,000 individuals were uninsured in 2007.
            (2) According to a recent study by the Commonwealth Fund, 
        the number of underinsured adults ages 19 to 64 has jumped 60 
        percent over the last 4 years, from 16,000,000 in 2003 to 
        25,000,000 in 2007.
            (3) According to the Center for Disease Control and 
        Prevention, approximately 45 percent of Americans have at least 
        1 chronic condition.
            (4) Forty-four States currently allow insurance companies 
        to deny coverage for, limit coverage for, or charge increased 
        premiums for a pre-existing condition.
            (5) Over 26,000,000 individuals were enrolled in private 
        individual market health plans in 2007. Under the amendments 
        made by the Health Insurance Portability and Accountability Act 
        of 1996, these individuals have no protections against pre-
        existing condition exclusions or waiting periods.
            (6) When an individual has a 63-day gap in health insurance 
        coverage, pre-existing condition exclusions, such as limiting 
        coverage, can be placed on them when they become insured under 
        a new health insurance policy.
            (7) Eliminating pre-existing condition exclusions for all 
        individuals is a vital safeguard to ensuring all Americans have 
        access to health care when in need.
            (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.

SEC. 3. ELIMINATION OF PRE-EXISTING CONDITION EXCLUSIONS UNDER GROUP 
              HEALTH PLANS.

    (a) Application Under the Employee Retirement Income Security Act 
of 1974.--
            (1) Elimination of pre-existing condition exclusions.--
        Section 701 of the Employee Retirement Income Security Act of 
        1974 (29 U.S.C. 1181) is amended--
                    (A) by amending the heading to read as follows: 
                ``elimination of pre-existing condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, with respect to a 
participant or beneficiary--
            ``(1) may not impose any pre-existing condition exclusion; 
        and
            ``(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.'';
                    (C) in subsection (b), by striking paragraph (3) 
                and inserting the following:
            ``(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.'';
                    (D) by striking subsections (c), (d), (e), and (g); 
                and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Clerical amendment.--The item in the table of contents 
        of such Act relating to section 701 is amended to read as 
        follows:

``Sec. 701. Elimination of pre-existing condition exclusions.''.
    (b) Application Under Public Health Service Act.--
            (1) Elimination of pre-existing condition exclusions.--
        Section 2701 of the Public Health Service Act (42 U.S.C. 300gg) 
        is amended--
                    (A) by amending the heading to read as follows: 
                ``Elimination of pre-existing condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, with respect to a 
participant or beneficiary--
            ``(1) may not impose any pre-existing condition exclusion; 
        and
            ``(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.'';
                    (C) in subsection (b), by striking paragraph (3) 
                and inserting the following:
            ``(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.'';
                    (D) by striking subsections (c), (d), (e), and (g); 
                and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Technical amendments relating to employer size.--
        Section 2711 of such Act (42 U.S.C. 300gg-11) is amended--
                    (A) in subsection (a)--
                            (i) in the heading, by striking ``Small'';
                            (ii) in paragraph (1)--
                                    (I) by striking ``(c) through (f)'' 
                                and inserting ``(b) through (d)'';
                                    (II) in the matter before 
                                subparagraph (A), by striking 
                                ``small''; and
                                    (III) in subparagraph (A), by 
                                striking ``small employer (as defined 
                                in section 2791(e)(4))'' and inserting 
                                ``employer''; and
                            (iii) in paragraph (2)--
                                    (I) by striking ``small'' each 
                                place it appears; and
                                    (II) by striking ``coverage to a'' 
                                and inserting ``coverage to an'';
                    (B) by striking subsection (b);
                    (C) in subsections (c), (d), and (e), by striking 
                ``small'' each place it appears; and
                    (D) by striking subsection (f).
    (c) Application Under the Internal Revenue Code of 1986.--
            (1) Elimination of pre-existing condition exclusions.--
        Section 9801 of the Internal Revenue Code of 1986 is amended--
                    (A) by amending the heading to read as follows: 
                ``Elimination of pre-existing condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan with respect to a 
participant or beneficiary may not impose any pre-existing condition 
exclusion.'';
                    (C) by striking paragraph (3) of subsection (b);
                    (D) by striking subsections (c), (d), and (e); and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (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:

``Sec. 9801. Elimination of pre-existing condition exclusions.''.
    (d) Effective Date.--
            (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.
            (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--
                    (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); 
                or
                    (B) the date that is after the end of the 12th 
                calendar month following the date of enactment of this 
                Act.
        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.

SEC. 4. NONDISCRIMINATION IN INDIVIDUAL HEALTH INSURANCE.

    (a) In General.--Section 2741 of the Public Health Service Act (42 
U.S.C. 300gg-41) is amended by striking subsection (a) and inserting 
the following:
    ``(a) In General.--
            ``(1) Guaranteed issue.--Subject to the succeeding 
        subsections of this section, each health insurance issuer that 
        offers health insurance coverage (as defined in section 
        2791(b)(1)) in the individual market to individuals residing in 
        an area may not, with respect to an eligible individual (as 
        defined in subsection (b)) residing in the area who desires to 
        enroll in individual health insurance coverage--
                    ``(A) decline to offer such coverage to, or deny 
                enrollment of, such individual; or
                    ``(B) impose any pre-existing condition exclusion 
                (as defined in section 2701(b)(1)(A)) with respect to 
                such coverage.''.
    (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 after the end 
of the 12th calendar month following the date of the enactment of this 
Act.

SEC. 5. TRANSPARENCY IN CLAIMS DATA.

    (a) Report on Adverse Selection.--Not later than 2 years after the 
date of enactment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report concerning the occurrence of 
adverse selection as a result of the enactment of this Act. Such report 
shall be based on the data reported under subsection (b).
    (b) Mandatory Reporting.--A health insurance issuer to which this 
Act applies, shall upon the request of the Secretary, submit to the 
Secretary of Health and Human Services, data concerning--
            (1) the number of new enrollees in health plans offered by 
        the issuer during the year involved;
            (2) the number of enrollees who re-enrolled in health plans 
        offered by the issuer during the year involved;
            (3) the demographic characteristics of enrollees;
            (4) the number, nature, and dollar amount of claims made by 
        enrollees during the year involved;
            (5) the number of enrollees who disenrolled or declined to 
        be re-enrolled during the year involved; and
            (6) any other information determined appropriate by such 
        Secretary.
    (c) Enforcement.--Part C of title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg-91 et seq.) is amended by adding at the 
end the following:

``SEC. 2793. PROVISION OF INFORMATION.

    ``(a) In General.--The Secretary shall require that group health 
plans and health insurance issuers to which this Act applies provide 
data to the Secretary, at such times and in such manner as the 
Secretary may require, in order to permit the Secretary to monitor 
compliance with the requirements of this Act (including requirements 
imposed under the Pre-existing Condition Patient Protection Act of 2009 
(and the amendment made by that Act)).
    ``(b) Civil Penalties.--
            ``(1) In general.--A group health plan or health insurance 
        issuer that fails to provide information as required under 
        subsection (a) shall be subject to a civil money penalty under 
        this section.
            ``(2) Amount of penalty.--
                    ``(A) In general.--The maximum amount of penalty 
                imposed under this paragraph is $100 per covered life 
                for each day that the plan or issuer fails to comply 
                with this section.
                    ``(B) Consideration in imposition.--In determining 
                the amount of any penalty to be assessed under this 
                paragraph, the Secretary shall take into account the 
                previous record of compliance of the entity being 
                assessed with this section and the gravity of the 
                violation.''.

SEC. 6. REPORT ON AFFORDABLE HEALTH INSURANCE COVERAGE.

    Not later than 12 months after the date of enactment of this Act, 
the Government Accountability Office shall submit to the Secretary of 
Health and Human Services a report concerning the impact of this Act 
and other Federal laws relating to the regulation of health insurance 
and its effect on the affordability of health insurance coverage for 
individuals in all insurance markets and a description of the effect of 
this Act on the expansion of coverage and reductions in the number of 
uninsured and underinsured.