I 

111TH CONGRESS 

1ST SESSION H. R. 1558 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 17, 2009 

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 concerned 

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 preexisting condition exclusions 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Preexisting Condition 

3 Patient Protection Act of 2009’’. 

4 SEC. 2. FINDINGS. 

5 The Congress finds as follows: 

6 (1) According to the United States Census Bu7 reau, 45.7 million people were uninsured in 2007. 

8 (2) According to a recent study by the Com9 monwealth Fund, the number of underinsured adults 

10 aged 19 to 64 has jumped 60 percent over the last 

11 4 years, from 16,000,000 in 2003 to 25,000,000 in 

12 2007. 

13 (3) According to the Centers for Disease Con14 trol and Prevention (CDC), approximately 45 per15 cent of Americans have at least one chronic condi16 tion. 

17 (4) Forty-four States currently allow insurance 

18 companies to deny coverage for, limit coverage for, 

19 or charge increased premiums for a preexisting con20 dition. 

21 (5) Over 26 million people were enrolled in pri22 vate individual market health plans in 2007. Under 

23 the Health Insurance Portability and Accountability 

24 Act of 1996 (HIPAA), these individuals have no 

25 protections against pre-existing condition exclusions 

26 or waiting periods. 


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1 (6) When a child or adult has a 63-day gap in 

2 insurance coverage, pre-existing condition exclusions, 

3 such as limiting coverage or instituting a waiting pe4 riod, can be placed on them when they become in5 sured under a new health insurance policy. 

6 (7) Eliminating pre-existing condition exclu7 sions for all is a vital safeguard to ensuring that all 

8 Americans have access to health care when in need. 

9 (8) According to a Kaiser Family Foundation/ 

10 Harvard School of Public Health public opinion poll, 

11 58 percent of Americans strongly favor the Federal 

12 Government requiring health insurance companies to 

13 cover anyone who applies for health coverage, even 

14 if they have a prior illness. 

15 SEC. 3. AMENDMENTS RELATING TO PREEXISTING CONDI16 TION EXCLUSIONS UNDER GROUP HEALTH 

17 PLANS. 

18 (a) AMENDMENTS TO THE EMPLOYEE RETIREMENT

19 INCOME SECURITY ACT OF 1974.— 

20 (1) ELIMINATION OF PREEXISTING CONDITION

21 EXCLUSIONS.—Section 701 of the Employee Retire22 ment Income Security Act of 1974 (29 U.S.C. 1181) 

23 is amended— 


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1 (A) by amending the heading to read as 

2 follows: ‘‘ELIMINATION OF PREEXISTING

3 CONDITION EXCLUSIONS’’; 

4 (B) by amending subsection (a) to read as 

5 follows: 

6 ‘‘(a) IN GENERAL.—A group health plan, and a 

7 health insurance issuer offering group health insurance 

8 coverage, with respect to a participant or beneficiary— 

9 ‘‘(1) may not impose any preexisting condition 

10 exclusion; and 

11 ‘‘(2) in the case of a group health plan that of12 fers medical care through health insurance coverage 

13 offered by a health maintenance organization, may 

14 not provide for an affiliation period with respect to 

15 coverage through the organization.’’; 

16 (C) in subsection (b), by striking para17 graph (3) and inserting the following: 

18 ‘‘(3) AFFILIATION PERIOD.—The term ‘affili19 ation period’ means a period which, under the terms 

20 of the health insurance coverage offered by the 

21 health maintenance organization, must expire before 

22 the health insurance coverage becomes effective.’’; 

23 (D) by striking subsections (c), (d), (e), 

24 and (g); and 


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1 (E) by redesignating subsection (f) (relat2 ing to special enrollment periods) as subsection 

3 (c). 

4 (2) CLERICAL AMENDMENT.—The item in the 

5 table of contents of such Act relating to section 701 

6 is amended to read as follows: 

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

7 (b) AMENDMENTS TO THE PUBLIC HEALTH SERVICE

8 ACT.— 

9 (1) IN GENERAL.—Section 2701 of the Public 

10 Health Service Act (42 U.S.C. 300gg) is amended— 

11 (A) by amending the heading to read as 

12 follows: ‘‘ELIMINATION OF PREEXISTING

13 CONDITION EXCLUSIONS’’; 

14 (B) by amending subsection (a) to read as 

15 follows: 

16 ‘‘(a) IN GENERAL.—A group health plan, and a 

17 health insurance issuer offering group health insurance 

18 coverage, with respect to a participant or beneficiary— 

19 ‘‘(1) may not impose any preexisting condition 

20 exclusion; and 

21 ‘‘(2) in the case of a group health plan that of22 fers medical care through health insurance coverage 

23 offered by a health maintenance organization, may 

24 not provide for an affiliation period with respect to 

25 coverage through the organization.’’; 


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1 (C) in subsection (b), by striking para2 graph (3) and inserting the following: 

3 ‘‘(3) AFFILIATION PERIOD.—The term ‘affili4 ation period’ means a period which, under the terms 

5 of the health insurance coverage offered by the 

6 health maintenance organization, must expire before 

7 the health insurance coverage becomes effective.’’; 

8 (D) by striking subsections (c), (d), (e), 

9 and (g); and 

10 (E) by redesignating subsection (f) (relat11 ing to special enrollment periods) as subsection 

12 (c). 

13 (2) TECHNICAL AMENDMENTS RELATING TO

14 EMPLOYER SIZE.—Section 2711 of such Act (42 

15 U.S.C. 300gg–11) is amended— 

16 (A) in subsection (a)— 

17 (i) in the heading, by striking 

18 ‘‘SMALL’’; 

19 (ii) in paragraph (1)— 

20 (I) in the matter before subpara21 graph (A), by striking ‘‘(c) through 

22 (f)’’ and inserting ‘‘(b) through (d)’’ 

23 and by striking ‘‘small’’; and 

24 (II) in subparagraph (A), by 

25 striking ‘‘small employer (as defined 


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1 in section 2791(e)(4))’’ and inserting 

2 ‘‘employer’’; and 

3 (iii) in paragraph (2)— 

4 (I) by striking ‘‘small’’ each place 

5 it appears; and 

6 (II) by striking ‘‘coverage to a’’ 

7 and inserting ‘‘coverage to an’’; 

8 (B) by striking subsection (b); 

9 (C) in subsections (c), (d), and (e), by 

10 striking ‘‘small’’ each place it appears; and 

11 (D) by striking subsection (f). 

12 (c) AMENDMENTS TO THE INTERNAL REVENUE

13 CODE OF 1986.— 

14 (1) ELIMINATION OF PREEXISTING CONDITION

15 EXCLUSIONS.—Section 9801 of the Internal Revenue 

16 Code of 1986 is amended— 

17 (A) by amending the heading to read as 

18 follows: ‘‘ELIMINATION OF PREEXISTING

19 CONDITION EXCLUSIONS’’; 

20 (B) by amending subsection (a) to read as 

21 follows: 

22 ‘‘(a) IN GENERAL.—A group health plan with respect 

23 to a participant or beneficiary may not impose any pre24 existing condition exclusion.’’; 


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1 (C) by striking paragraph (3) of subsection 

2 (b); 

3 (D) by striking subsections (c), (d), and 

4 (e); and 

5 (E) by redesignating subsection (f) (relat6 ing to special enrollment periods) as subsection 

7 (c). 

8 (2) CLERICAL AMENDMENT.—The item in the 

9 table of sections of chapter 100 of such Code relat10 ing to section 9801 is amended to read as follows: 

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

11 (d) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—Except as provided in para13 graph (2), the amendments made by this section 

14 shall apply with respect to group health plans for 

15 plan years beginning after the end of the 12th cal16 endar month following the date of the enactment of 

17 this Act. 

18 (2) SPECIAL RULE FOR COLLECTIVE BAR19 GAINING AGREEMENTS.—In the case of a group 

20 health plan maintained pursuant to one or more col21 lective bargaining agreements between employee rep22 resentatives and one or more employers ratified be23 fore the date of the enactment of this Act, the 

24 amendments made by this section shall not apply to 

25 plan years beginning before the later of— 


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1 (A) the date on which the last of the col2 lective bargaining agreements relating to the 

3 plan terminates (determined without regard to 

4 any extension thereof agreed to after the date 

5 of the enactment of this Act), or 

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

7 12th calendar month following the date of the 

8 enactment of this Act. 

9 For purposes of subparagraph (A), any plan amend10 ment made pursuant to a collective bargaining 

11 agreement relating to the plan which amends the 

12 plan solely to conform to any requirement added by 

13 the amendments made by this section shall not be 

14 treated as a termination of such collective bar15 gaining agreement. 

16 SEC. 4. PROHIBITION OF PREEXISTING CONDITION EXCLU17 SIONS IN HEALTH INSURANCE COVERAGE IN 

18 THE INDIVIDUAL MARKET. 

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

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

21 (1) in subsection (a)(1), by striking ‘‘with re22 spect to an eligible individual’’ and all that follows 

23 and inserting the following: ‘‘with respect to— 

24 ‘‘(A) an eligible individual (as defined in 

25 subsection (b)) desiring to enroll in individual 


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1 health insurance coverage decline to offer such 

2 coverage to, or deny enrollment of, such indi3 vidual; and 

4 ‘‘(B) any individual desiring to enroll in 

5 such coverage impose any preexisting condition 

6 exclusion (as defined in section 2701(b)(1)(A)) 

7 with respect to such coverage.’’; and 

8 (2) in subsection (a)(2), by striking ‘‘paragraph 

9 (1)’’ and inserting ‘‘paragraph (1)(A)’’. 

10 (b) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply with respect to health insurance 

12 coverage offered, sold, issued, renewed, in effect, or oper13 ated in the individual market on or after the end of the 

14 12th month following the date of the enactment of this 

15 Act. 

16 SEC. 5. TRANSPARENCY IN CLAIMS DATA. 

17 (a) IN GENERAL.—Not later than 2 years after the 

18 date of the enactment of this Act, the Secretary of Health 

19 and Human Services shall submit to Congress a report 

20 on the impact of this Act on health benefits coverage. 

21 (b) EXAMINATION OF CLAIMS EXPERIENCE AND

22 OTHER DATA.—In preparing the report under subsection 

23 (a), the Secretary may request from group health plans 

24 and health insurance issuers— 


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1 (1) data on claims experience under the plan or 

2 health insurance coverage issued by such issuers, 

3 such as the number, nature, and dollar amount of 

4 claims made by enrollees during the period involved; 

5 (2) data relating to enrollees in the plan or 

6 under such coverage, such as number of new enroll7 ees, number of individuals reenrolling (or dis8 continuing enrollment) after the first year of cov9 erage, and changes in the demographic composition 

10 of enrollees; and 

11 (3) such other information as the Secretary 

12 deems appropriate. 

13 The provisions of section 2722(b) of the Public Health 

14 Service Act shall apply to a failure of a group health plan 

15 or health insurance issuer to provide data or information 

16 requested by the Secretary under this subsection in the 

17 same manner as such provisions apply to the enforcement 

18 of a provision of part A of title XXVIII of such Act, except 

19 that any reference to an individual in paragraph (1)(C)(i) 

20 of such section shall be deemed for this purpose a ref21 erence to a covered life under the plan or health insurance 

22 coverage involved. 

23 SEC. 6. GAO REPORT. 

24 Not later than 1 year after the date of the enactment 

25 of this Act, the Comptroller General of the United States 


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1 shall submit to Congress a report on the impact of this 

2 Act (and other Federal laws regarding the regulation of 

3 health insurance and health benefits coverage) on the re4 duction in the number of uninsured and underinsured in5 dividuals in the group market and the individual market 

6 and on the affordability of coverage in such markets. 

Æ 


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