I 

111TH CONGRESS 

1ST SESSION H. R. 1619 

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 pre-existing condition exclusions for children 

in group health plans and health insurance coverage in the group and 

individual markets. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2009 

Ms. SCHWARTZ (for herself, Ms. BERKLEY, Mr. BERMAN, Mr. BISHOP of New 

York, Mr. BLUMENAUER, Mr. BRADY of Pennsylvania, Mr. CARNEY, Ms. 

CLARKE, Mr. CLAY, Mr. CLEAVER, Mr. DEFAZIO, Ms. DELAURO, Mr. 

DOGGETT, Mr. ENGEL, Mr. FARR, Mr. FATTAH, Mr. ISRAEL, Ms. EDDIE

BERNICE JOHNSON of Texas, Ms. KAPTUR, Ms. KILPATRICK of Michigan, Mrs. LOWEY, Mr. MCDERMOTT, Mr. MORAN of Virginia, Mr. NADLER of New York, Ms. SCHAKOWSKY, Mr. SERRANO, Ms. SLAUGHTER, 

Ms. SUTTON, Ms. WASSERMAN SCHULTZ, Ms. WATSON, Ms. WOOLSEY, 

Mr. WU, Ms. BALDWIN, Mrs. CAPPS, Mr. LANGEVIN, Ms. PINGREE of 

Maine, Mr. MURPHY of Connecticut, Mr. PATRICK J. MURPHY of Pennsylvania, Mr. BARROW, Ms. MOORE of Wisconsin, Mr. TIERNEY, Mr. 

MURTHA, Mr. CROWLEY, Mr. ALTMIRE, Ms. LEE of California, Mr. 

LARSON of Connecticut, Mr. PALLONE, Mr. MICHAUD, Mr. CLYBURN, 

Mr. CONNOLLY of Virginia, Mr. WATT, Mr. ARCURI, Ms. EDWARDS of 

Maryland, Ms. DEGETTE, Mr. COHEN, Mr. WAXMAN, Mrs. HALVORSON, 

Ms. KILROY, Mr. THOMPSON of Mississippi, Mr. BRALEY of Iowa, Mr. 

HOLT, Mr. YARMUTH, Mr. SIRES, Ms. RICHARDSON, Ms. MATSUI, Mr. 

TONKO, Ms. FUDGE, Mr. HASTINGS of Florida, Mr. PERLMUTTER, Mr. 

BUTTERFIELD, Mr. KUCINICH, Mr. LOEBSACK, Ms. CORRINE BROWN of 

Florida, Ms. HIRONO, Ms. ROS-LEHTINEN, Mr. BOUCHER, Mr. DOYLE, 

Mr. MCGOVERN, Ms. LINDA T. SA ́NCHEZ of California, Mr. KAGEN, Mr. 

SCHIFF, Mr. WEINER, and Mr. ELLISON) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committees on Education and Labor and Ways and 

Means, 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 concerned 


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A BILL 

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 pre-existing condition exclusions for children in 

group health plans and health insurance coverage in 

the group and individual markets. 

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 ‘‘Children’s Health Pro5 tection Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) According to the Bureau of the Census, 

9 8,100,000 children and young adults are uninsured 

10 at some point during the year. Young adults between 

11 the ages of 18 and 25 years old make up 21 percent 

12 of the total uninsured population. 

13 (2) According to a recent study, approximately 

14 20 percent of school-aged children suffer from a 

15 chronic illness. 

16 (3) Thirteen States have passed legislation that 

17 increased the age of dependency for young adults for 

18 purposes of private insurance coverage to age 25. 


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1 (4) When a child or young adult has a 63-day 

2 gap in insurance coverage, pre-existing condition ex3 clusions, such as coverage limits or waiting periods, 

4 can be applied when the child or young adult be5 comes insured under a new health insurance policy. 

6 (5) Eliminating pre-existing condition exclu7 sions for children is a vital safeguard to ensure all 

8 children have access to health care when in need. 

9 (6) High-risk pools were created to help individ10 uals with pre-existing conditions purchase insurance 

11 with the assistance of government subsidies. How12 ever, State high-risk pools are often underfunded, 

13 unaffordable for patients, have long waiting lists and 

14 impose pre-existing condition waiting periods once 

15 enrolled. 

16 (7) Pre-existing condition limitation periods for 

17 children in the private market discourage families 

18 from moving off Medicaid or the Children’s Health 

19 Insurance Program. 

20 SEC. 3. PROHIBITION OF PRE-EXISTING CONDITION EXCLU21 SIONS FOR CHILDREN UNDER GROUP 

22 HEALTH PLANS. 

23 (a) AMENDMENTS TO THE EMPLOYEE RETIREMENT

24 INCOME SECURITY ACT OF 1974.—Section 701(d) of the 


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1 Employee Retirement Income Security Act of 1974 (29 

2 U.S.C. 1181(d)) is amended— 

3 (1) by striking paragraph (1) and inserting the 

4 following: 

5 ‘‘(1) EXCLUSION NOT APPLICABLE TO CHIL6 DREN.—A group health plan, and a health insurance 

7 issuer offering group health insurance coverage, may 

8 not impose any pre-existing condition exclusion in 

9 the case of an individual who has not attained 25 

10 years of age.’’; 

11 (2) by striking paragraphs (2) and (4); and 

12 (3) by redesignating paragraph (3) as para13 graph (2). 

14 (b) AMENDMENTS TO THE PUBLIC HEALTH SERVICE

15 ACT.—Section 2701(d) of the Public Health Service Act 

16 (42 U.S.C. 300gg(d)) is amended— 

17 (1) by striking paragraph (1) and inserting the 

18 following: 

19 ‘‘(1) EXCLUSION NOT APPLICABLE TO CHIL20 DREN.—A group health plan, and a health insurance 

21 issuer offering group health insurance coverage, may 

22 not impose any pre-existing condition exclusion in 

23 the case of an individual who has not attained 25 

24 years of age.’’; 

25 (2) by striking paragraphs (2) and (4); and 


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1 (3) by redesignating paragraph (3) as para2 graph (2). 

3 (c) AMENDMENTS TO THE INTERNAL REVENUE

4 CODE OF 1986.—Subsection (d) of section 9801 of the 

5 Internal Revenue Code of 1986 (relating to exceptions) is 

6 amended— 

7 (1) by striking paragraph (1) and inserting the 

8 following: 

9 ‘‘(1) EXCLUSION NOT APPLICABLE TO CHIL10 DREN.—A group health plan may not impose any 

11 pre-existing condition exclusion in the case of an in12 dividual who has not attained 25 years of age.’’; 

13 (2) by striking paragraphs (2) and (4); and 

14 (3) by redesignating paragraph (3) as para15 graph (2). 

16 (d) EFFECTIVE DATE.— 

17 (1) IN GENERAL.—Except as provided in para18 graph (2), the amendments made by this section 

19 shall apply with respect to group health plans for 

20 plan years beginning after the end of the 12th cal21 endar month following the date of the enactment of 

22 this Act. 

23 (2) SPECIAL RULE FOR COLLECTIVE BAR24 GAINING AGREEMENTS.—In the case of a group 

25 health plan maintained pursuant to one or more colVerDate Nov 24 2008 02:22 Mar 21, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1619.IH H1619

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1 lective bargaining agreements between employee rep2 resentatives and one or more employers ratified be3 fore the date of the enactment of this Act, the 

4 amendments made by this section shall not apply to 

5 plan years beginning before the later of— 

6 (A) the date on which the last of the col7 lective bargaining agreements relating to the 

8 plan terminates (determined without regard to 

9 any extension thereof agreed to after the date 

10 of the enactment of this Act); or 

11 (B) the date that is after the end of the 

12 12th calendar month following the date of en13 actment of this Act. 

14 For purposes of subparagraph (A), any plan amend15 ment made pursuant to a collective bargaining 

16 agreement relating to the plan which amends the 

17 plan solely to conform to any requirement added by 

18 the amendments made by this section shall not be 

19 treated as a termination of such collective bar20 gaining agreement. 


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1 SEC. 4. PROHIBITION OF PRE-EXISTING CONDITION EXCLU2 SIONS FOR CHILDREN IN HEALTH INSUR3 ANCE COVERAGE IN THE INDIVIDUAL MAR4 KET. 

5 (a) IN GENERAL.—Section 2741 of the Public Health 

6 Service Act (42 U.S.C. 300gg–41) is amended— 

7 (1) by redesignating the second subsection (e) 

8 (relating to market requirements) and subsection (f) 

9 as subsections (f) and (g), respectively; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘(h) PROHIBITION OF PRE-EXISTING CONDITION

13 EXCLUSIONS FOR CHILDREN.—Each health insurance 

14 issuer that offers health insurance coverage in the indi15 vidual market may not impose any pre-existing condition 

16 exclusion (as defined in section 2701(b)(1)(A)) in the case 

17 of an individual who has not attained 25 years of age.’’. 

18 (b) CONFORMING AMENDMENT.—Section 2744(a)(1) 

19 of such Act (42 U.S.C. 300gg–44(a)(1)) is amended by 

20 inserting ‘‘(other than subsection (h))’’ after ‘‘section 

21 2741’’. 

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply with respect to health insurance 

24 coverage offered, sold, issued, renewed, in effect, or oper25 ated in the individual market after the end of the 12th 


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1 calendar month following the date of the enactment of this 

2 Act. 

Æ 


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