I 

111TH CONGRESS 

1ST SESSION H. R. 4020 

To enable States to establish reinsurance programs or high risk pools to 

ensure that high risk individuals are able to access health insurance. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 4, 2009 

Mr. BURGESS (for himself, Mr. DEAL of Georgia, Mr. PITTS, Mr. BUYER, and 

Mr. BLUNT) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To enable States to establish reinsurance programs or high 

risk pools to ensure that high risk individuals are able 

to access health insurance. 

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 ‘‘Guaranteed Access to 

5 Health Insurance Act of 2009’’. 

6 SEC. 2. ENSURING AFFORDABILITY FOR ALL THROUGH 

7 SPECIAL POOLING OF THE COST OF HIGH 

8 RISK INDIVIDUALS. 

9 (a) STATE REQUIREMENT.— 


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1 (1) IN GENERAL.—Not later than 2 years after 

2 the date of the enactment of this Act, each State is 

3 encouraged to ensure that an adequate financial 

4 backstop exists to mitigate the cost of high risk indi5 viduals in the State, through establishing either— 

6 (A) a qualified State reinsurance program 

7 described in subsection (b); or 

8 (B) a qualifying State high risk pool de9 scribed in subsection (c)(1). 

10 (2) PREFERENCE.—Beginning 3 years after the 

11 date of the enactment of this Act, in the case of a 

12 competitive grant for which the only eligible entities 

13 are States, the Secretary, in awarding such grant to 

14 a State, shall give preference to any State with a 

15 program that meets the requirements of paragraph 

16 (1)(A). 

17 (b) QUALIFIED STATE REINSURANCE PROGRAM.— 

18 (1) IN GENERAL.—For purposes of this section, 

19 the term ‘‘qualified State reinsurance program’’ 

20 means a program operated by a State or a State au21 thorized program that provides reinsurance for 

22 health insurance coverage offered in the individual, 

23 small group market, or in both markets. 

24 (2) FORM OF PROGRAM.—A qualified State re25 insurance program may provide reinsurance— 


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1 (A) on a prospective or retrospective basis; 

2 (B) that protects health insurance issuers 

3 against the annual aggregate spending of their 

4 enrollees; and 

5 (C) that provides purchase protection 

6 against individual catastrophic costs. 

7 (c) QUALIFYING STATE HIGH RISK POOL.— 

8 (1) IN GENERAL.—A qualifying State high risk 

9 pool described in this subsection means a section 

10 2745 qualified high risk pool that meets the fol11 lowing requirements: 

12 (A) The high risk pool does not have a life13 time coverage cap. 

14 (B) The high risk pool incorporates appli15 cable Federal or State programs (such as cov16 erage under title XIX of the Social Security 

17 Act) for eligible low-income individuals. 

18 (C) The high risk pool provides a variety 

19 of types of coverage, including at least one high 

20 deductible health plan that is combined with a 

21 health savings account. 

22 (D) The high risk pool eliminates any 

23 waiting list and pre-existing condition exclu24 sionary periods so that all eligible residents who 


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1 are seeking coverage through the pool can re2 ceive coverage through the pool. 

3 (E) The high risk pool allows for coverage 

4 of individuals who, but for the 24-month dis5 ability waiting period under section 226(b) of 

6 the Social Security Act, would be eligible for 

7 Medicare during the period of such waiting pe8 riod. 

9 (F) The high risk pool must not charge 

10 participants more than 150 percent of the aver11 age premium in the individual market for 

12 health insurance coverage in that State. 

13 (G) The high risk pool conducts education 

14 and outreach initiatives so that residents and 

15 insurance brokers understand that the pool is 

16 available to eligible residents. 

17 (2) USE OF FUNDS FOR THE TRANSITION.—A 

18 State may use any funding sources available to it as 

19 of the date of the enactment of this Act to transition 

20 from operating a section 2745 high risk pool, to op21 erating a qualified State reinsurance program de22 scribed in paragraph (1). 

23 (3) FUNDING SOURCE.—The high risk pool de24 scribed in this subsection is also encouraged to have 


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1 stable funding source that is not solely dependent on 

2 an appropriation from the State legislature. 

3 (d) RELATION TO SECTION 2745.—Section 2745 of 

4 the Public Health Service Act is amended— 

5 (1) in subsection (a)(2)— 

6 (A) in subparagraph (A), strike ‘‘40’’ and 

7 insert ‘‘30’’; and 

8 (B) add at the end the following new sub9 paragraph: 

10 ‘‘(D) An amount equal to 10 percent of 

11 such appropriated amount for the fiscal year 

12 shall be allotted among qualifying States that 

13 apply for such a grant so that the amount allot14 ted to a State bears the same ratio to such ap15 propriated amount as the amount of funds con16 tributed to the operation of the qualified high 

17 risk pool of the State by funding sources other 

18 than grants under this subsection.’’; and 

19 (2) in subsection (g)(1)— 

20 (A) in subparagraph (A), by striking ‘‘The 

21 term’’ and inserting ‘‘Subject to subparagraph 

22 (B), the term’’; and 

23 (B) by adding at the end the following new 

24 subparagraph: 


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1 ‘‘(B) UPDATED DEFINITION.—Beginning 

2 on the last day of the 2-year period beginning 

3 in the date of the enactment of the Guaranteed 

4 Access to Health Insurance Act of 2009, the 

5 term ‘qualified high risk pool’ means— 

6 ‘‘(i) a pool that meets the require7 ments of subparagraph (A) of this para8 graph and the requirements of section 

9 2(c)(1) of such Act; or 

10 ‘‘(ii) a qualified State reinsurance pro11 gram as such term is defined in section 

12 2(b) of such Act.’’. 

13 (e) WAIVERS.— 

14 (1) IN GENERAL.—In order to accommodate 

15 new and innovative programs, the Secretary may 

16 waive such requirements of this section for qualified 

17 State reinsurance programs and for qualifying State 

18 high risk pools as the Secretary deems appropriate. 

19 (2) COVERAGE OF HIGH RISK INDIVIDUALS.— 

20 The Secretary may waive the requirement under 

21 subsection (a)(1) in the case of a State that dem22 onstrates, to the satisfaction of the Secretary, that 

23 the State has provided an adequate financial back24 stop to mitigate the cost of high risk individuals in 

25 the State in a manner that is better than, as deterVerDate Nov 24 2008 02:16 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4020.IH H4020

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1 mined by the Secretary, the requirements under 

2 such subsection. 

3 (f) SEED GRANTS TO STATES.—The Secretary shall 

4 provide, from the funds appropriated, a grant of up to 

5 $5,000,000 to each State that has not created a qualified 

6 high risk pool as of the date of enactment of this Act. 

7 Such grants shall be made in the same manner, for the 

8 same purpose, but are in addition to, grants to States 

9 made under Section 2745(a) of the Public Health Service 

10 Act. 

11 (g) VERIFICATION OF CITIZENSHIP OR ALIEN QUALI12 FICATION.— 

13 (1) IN GENERAL.—Only citizens and nationals 

14 of the United States shall be eligible to participate 

15 in a qualifying State high risk pool or qualifying 

16 State reinsurance program receiving funding under 

17 this section. 

18 (2) GRANT CONDITIONS.—As a condition of re19 ceiving grants under this section, the Secretary shall 

20 require any State that applies to receive grant fund21 ing under this section to certify to the satisfaction 

22 of the Secretary that such State requires all appli23 cants for coverage in a qualifying State high risk to 

24 pool or a qualifying State reinsurance program to 

25 provide satisfactory documentation of such citizenVerDate Nov 24 2008 02:16 Nov 05, 2009 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4020.IH H4020

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1 ship or nationality and identity in a manner con2 sistent with section 1903(x) of the Social Security 

3 Act. The Secretary shall keep sufficient records such 

4 that a determination of citizenship or nationality has 

5 to be made once for any individual. 

6 (h) DEFINITIONS.—In this section: 

7 (1) The terms ‘‘health insurance coverage’’ and 

8 ‘‘health insurance issuer’’ have the meanings given 

9 such terms in section 2791 of the Public Health 

10 Service Act. 

11 (2) The term ‘‘section 2745 qualified high risk 

12 pool’’ has the meaning given the term ‘‘qualified 

13 high risk pool’’ under section 2745(g)(1) of the Pub14 lic Health Service Act as such section is in effect on 

15 the date of the enactment of this Act. 

16 (3) The term ‘‘Secretary’’ means Secretary of 

17 Health and Human Services. 

18 (4) The term ‘‘State’’ has the meaning given 

19 such term for purposes of title XIX of the Social Se20 curity Act. 

21 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 

22 purposes of carrying out section 2745 of the Public Health 

23 Service Act and this section, in addition to any other 

24 amounts authorized to be appropriated, there is author25 ized to be appropriated, $20,000,000,000 beginning with 


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1 2010. Any funds that are authorized under this subsection 

2 that are used for purposes of carrying out section 2745 

3 of the Public Health Service Act shall be allocated to the 

4 allotments under such section in the proportions required 

5 under subsection (d)(2) of such section. 

Æ 


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