I 

108TH CONGRESS 

1ST SESSION H. R. 2698

To provide for a system of health insurance certificates to increase the 

number of Americans with health insurance coverage. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 10, 2003

Mr. BILIRAKIS (for himself, Mr. TOWNS, Mr. FLETCHER, and Mr. WALDEN

of Oregon) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To provide for a system of health insurance certificates to 

increase the number of Americans with health insurance 

coverage.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Insurance Cer5 tificate Act of 2003’’. 

6 SEC. 2. ESTABLISHMENT OF PROGRAM. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services (in this Act referred to as the ‘‘Sec9 retary’’) shall establish a program for the issuance to eligi-
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1 ble individuals of health insurance certificates which may 

2 be applied towards the cost of purchasing qualified health 

3 insurance coverage for such individuals and family mem4 bers. The issuance of such certificates for any fiscal year 

5 is limited to the amount appropriated under subsection (f) 

6 for such fiscal year. 

7 (b) ELIGIBILITY.—

8 (1) IN GENERAL.—For purposes of this Act, 

9 the terms ‘‘eligible individual’’ and ‘‘qualified family 

10 member’’ mean, with respect to a month, an adult 

11 or family member, respectively, who—

12 (A) is a citizen or national of the United 

13 States or an alien permanently residing lawfully 

14 in the United States as of the first day of the 

15 month; 

16 (B) is under 65 years of age as of the last 

17 day of the month; and 

18 (C) is not eligible to be covered under pub19 lic coverage described in paragraph (3) as of 

20 the first day of the month. 

21 (2) NO CERTIFICATE FOR COVERED FAMILY

22 MEMBERS.—

23 (A) IN GENERAL.—No certificate shall be 

24 issued under this section to a member of the 

25 family of a principal eligible individual if the 
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1 family member is covered under the qualified 

2 health insurance coverage covering the principal 

3 eligible individual. 

4 (B) MEMBER OF FAMILY.—For purposes 

5 of this Act, the term ‘‘member of family’’ has 

6 the meaning given such term under section 

7 8901(5) of title 5, United States Code. 

8 (C) SPOUSE.—For purposes of this Act, 

9 the term ‘‘married’’ and ‘‘spouse’’ shall have 

10 the meaning given such term for purposes of 

11 chapter 89 of title 5, United States Code. 

12 (D) NO DUPLICATION.—In no case may 

13 the certificate value of more than one certificate 

14 take into account any member of a family and, 

15 with respect to an eligible individual, no more 

16 than 2 member of the individual’s family (other 

17 than the spouse of the individual) shall be taken 

18 into account. 

19 (3) EXCLUSION FOR THOSE ELIGIBLE FOR COV20 ERAGE UNDER PUBLIC PROGRAM.—Subject to para21 graph (4), an individual is not an eligible individual 

22 as of the first day of a month if such individual is 

23 eligible to be covered as of such day under any med24 ical care program described in—
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1 (A) title XVIII, XIX, or XXI of the Social 

2 Security Act; 

3 (B) chapter 55 of title 10, United States 

4 Code; 

5 (C) chapter 17 of title 38, United States 

6 Code; 

7 (D) chapter 89 of title 5, United States 

8 Code; or 

9 (E) the Indian Health Care Improvement 

10 Act. 

11 (4) TREATMENT OF COBRA CONTINUATION COV12 ERAGE.—In the case of continuation coverage under 

13 a group health plan which is required to be provided 

14 by Federal law for an individual during the period 

15 specified in section 602(2) of the Employee Retire16 ment Income Security Act of 1974, section 

17 4980B(f)(2)(B) of the Internal Revenue Code of 

18 1986, or section 2202(2) of the Public Health Serv19 ice Act, or coverage under chapter 89 of title 5, 

20 United States Code which is required to be provided 

21 under section 8905a of title 5, United States Code, 

22 paragraph (3) shall not apply with respect to such

23 continuation coverage and the coverage shall be 

24 treated as qualified health insurance coverage. 

25 (c) HEALTH INSURANCE CERTIFICATES.—
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1 (1) IN GENERAL.—The Secretary shall design 

2 health insurance certificates to be in a form so that, 

3 when presented to the issuer of a qualified health in4 surance coverage, the issuer may secure directly 

5 from the Secretary the value specified in the certifi6 cate towards the cost of purchasing such coverage. 

7 Once paid, the Secretary may not seek reimburse8 ment from the issuer if there is a finding that any 

9 relevant information provided by an individual was 

10 incorrect. A certificate is issued with respect to the 

11 costs of obtaining health insurance coverage in a 

12 year for a specified eligible individual (and family 

13 members) and may not be used for such coverage in 

14 any other period. 

15 (2) LIMITATION.—In no case shall the value of 

16 the certificate, as applied with respect to health in17 surance coverage, be applied towards an amount 

18 that exceeds—

19 (A) 70 percent of the premium for cov20 erage for the period involved, or 

21 (B) in the case of a certificate described in 

22 subsection (d)(2), 70 percent of the employee’s 

23 premium for coverage under the group health 

24 plan involved. 
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1 (3) FORM OF CERTIFICATE.—A health insur2 ance certificate for a year shall be valued and paid 

3 as follows: 

4 (A) VALUE.—The value of the certificate 

5 for a year shall be determined based upon a 

6 methodology for determining income specified 

7 by the Secretary that is similar to that applied 

8 for purposes of determining eligibility on the 

9 basis of income under needs-based Federal pro10 grams and that may be based on the standards 

11 used under section 1612 for purposes of the 

12 supplemental security income program. Such 

13 methodology under this section may allow for 

14 use of both a Federal methodology and alter15 nate State methodologies where the Secretary 

16 deems appropriate for ease of administration 

17 and coordination of programs. The Secretary 

18 may provide for self-certification of information 

19 by individuals where the Secretary deems ap20 propriate for administration of the program. 

21 (B) AVAILABILITY OF GROUP HEALTH

22 PLAN COVERAGE.—If an individual is (for the 

23 individual or for the individual’s family mem24 bers) eligible for coverage under a group health 

25 plan and the premium charged the individual 
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1 for such coverage does not exceed 50 percent of 

2 the cost of coverage, such an individual is eligi3 ble only for a certificate under section (d)(2) 

4 and not under subsection (d)(1). 

5 (C) MINIMUM THRESHOLD FOR ISSUANCE

6 OF CERTIFICATE.—No health insurance certifi7 cate shall be issued under this section where the 

8 annualized value of the certificate is less than 

9 $200. 

10 (d) VALUE OF CERTIFICATE.—

11 (1) IN GENERAL.—The annualized value of a 

12 health insurance certificate for an eligible individual 

13 shall be determined as follows (and applied on a 

monthly basis based on 1 14 ⁄12 of such annualized 

15 value): 

16 (A) UNMARRIED INDIVIDUAL WITH NO DE17 PENDENT FAMILY MEMBERS.—Subject to sub18 paragraph (C)(i), in the case of an eligible indi19 vidual who is not married, who has no depend20 ent family members, who has qualified health 

21 insurance coverage, and whose income—

22 (i) is $13,000 or less, the annualized 

23 value of the certificate is $1,000; or 

24 (ii) exceeds $13,000, the annualized 

25 value of the certificate be equal to $1,000 
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1 minus 15 percent of such amount for every 

2 $1000 of the amount by which such in3 come exceeds $12,001. 

4 (B) INDIVIDUAL WITH DEPENDENT FAM5 ILY MEMBERS.—Subject to subparagraph 

6 (C)(ii), in the case of an eligible individual who 

7 has dependent family members and who has 

8 qualified health insurance coverage that covers 

9 the individual, such family members, or both, if 

10 the family’s income—

11 (i) is $25,000 or less, the annualized 

12 value of the certificate is the sum of—

13 (I) $1,000, for the individual; 

14 (II) $750, if such a family mem15 ber is the individual’s spouse; and 

16 (III) $500 for each other family 

17 member, but not to exceed a total of 

18 $1,000 under this subclause; or 

19 (ii) exceeds $25,000, the annualized 

20 value of the certificate shall be the amount 

21 determined under clause (i) minus 10 per22 cent of such amount for each $1,000 by 

23 which such income exceeds $24,001. 

24 Each of two eligible individuals who are mar25 ried to each other may receive the appropriate 
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1 amount designated for an individual, as opposed 

2 to the amount designated for a spouse, where 

3 they choose separate insurance coverage. 

4 (C) APPLICATION OF ASSETS TEST.—

5 (i) SELF ONLY COVERAGE.—In the 

6 case of an individual described in clause (i) 

7 or (ii) of subparagraph (A) whose re8 sources (as determined under a method9 ology that is similar to the methodology 

10 under section 1613 for purposes of the 

11 supplemental security income program) ex12 ceed $12,500, the annualized value of the 

13 certificate shall be 0. 

14 (ii) SELF AND FAMILY COVERAGE.—

15 In the case of an individual described in 

16 clause (i) or (ii) of subparagraph (B) 

17 whose family resources (as determined 

18 under a methodology that is similar to the 

19 methodology under section 1613 for pur20 poses of the supplemental security income 

21 program) exceed $20,000, the annualized 

22 value of the certificate shall be 0. 

23 (D) ROUNDING.—Any amount determined 

24 under subparagraph (A) or (B) which is not a 
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1 multiple of $12 shall be rounded to the next 

2 lowest $12. 

3 (2) CERTIFICATES FOR USE IN GROUP HEALTH

4 PLANS.—In the case of an eligible individual who is 

5 covered under a group health plan—

6 (A) subparagraph (C) of subsection (b)(1) 

7 shall not apply; 

8 (B) the exclusion with respect to such cov9 erage under subsection (e)(2)(C) shall not 

10 apply; 

11 (C) the value of the certificate shall be 40 

12 percent of the value determined otherwise deter13 mined under paragraph (1) (before the applica14 tion of subparagraph (D) thereof); and 

15 (D) certificates under this paragraph may 

16 be used for qualified health insurance under 

17 any group health plan available to any family 

18 member by virtue of that member’s employment 

19 status. 

20 (e) QUALIFIED HEALTH INSURANCE COVERAGE.—

21 For purposes of this section—

22 (1) IN GENERAL.—The term ‘‘qualified health 

23 insurance coverage’’ means health benefits coverage 

24 (including individual health insurance coverage or 

25 coverage through a State high risk pool) that is 
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1 creditable coverage (as defined in section 2701(c)(1) 

2 of the Public Health Service Act), which does not 

3 consist entirely of excepted benefits (as defined in 

4 section 2791(c) of such Act). 

5 (2) EXCEPTION.—The term ‘qualified health in6 surance coverage’ does not include—

7 (A) a flexible spending or similar arrange8 ment; 

9 (B) any insurance if substantially all of its 

10 coverage is of excepted benefits described in 

11 section 9832(c) of the Internal Revenue Code of 

12 1986; 

13 (C) except as provided in subsection (d)(2), 

14 insurance provided through any group health 

15 plan related to employment, other than COBRA 

16 continuation coverage; or 

17 (D) any medical program described in sec18 tion 2(b)(3). 

19 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

20 out this section and section 2745 of the Public Health 

21 Service Act (as amended by section 3), there are author22 ized to be appropriated such sums as may be necessary 

23 not to exceed—

24 (1) $28,457,000,000 for the period of fiscal 

25 years 2004 through 2008; and 
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1 (2) $49,965,000,000 for the period of fiscal 

2 years 2004 through 2013. 

3 SEC. 3. EXTENSION OF FUNDING FOR OPERATION OF 

4 STATE HIGH RISK HEALTH INSURANCE 

5 POOLS. 

6 Section 2745 of the Public Health Service Act, as in7 serted by section 201 of the Trade Act of 2002 (Public 

8 Law 107–210), is amended—

9 (1) in subsection (b)(1), by striking ‘‘estab10 lished a qualified health risk pool that’’ and all that 

11 follows through the end of subparagraph (C) and in12 serting ‘‘established a qualified health risk pool that 

13 provides for premium rates and covered benefits for 

14 such coverage consistent with standards included in 

15 the NAIC Model Health Plan for Uninsurable Indi16 viduals’’; 

17 (2) in subsection (b)(2), by striking ‘‘number of 

18 uninsured individuals’’ and inserting ‘‘enrollees in 

19 qualified high risk pools’’; and 

20 (3) in subsection (c)(2), by striking 

21 ‘‘$40,000,000 for each of fiscal years 2003 and 

22 2004’’ and inserting ‘‘$40,000,000 for fiscal year 

23 2003 and, subject to availability of funds under sec24 tion 2(f) of the Health Insurance Certificate Act of 
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1 2003, $75,000,000 for each of fiscal years 2004 

2 through 2009’’.

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