I 

109TH CONGRESS 

2D SESSION H. R. 5475 

To amend title XXVII of the Public Health Service Act to permit a health 

insurance issuer an alternative to guaranteed issue of health insurance 

coverage in the small group market in order to promote affordable 

access to portable health insurance coverage. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 24, 2006 

Mr. ROGERS of Michigan (for himself, Mr. MILLER of Florida, Ms. GINNY

BROWN-WAITE of Florida, Mr. SOUDER, Mr. WICKER, and Mrs. CAPITO) 

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

A BILL 

To amend title XXVII of the Public Health Service Act 

to permit a health insurance issuer an alternative to 

guaranteed issue of health insurance coverage in the 

small group market in order to promote affordable access 

to portable 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 ‘‘HSA Accessibility and 

5 Portability Act of 2006’’. 


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1 SEC. 2. PROMOTING ACCESSIBILITY AND AFFORDABILITY 

2 OF COVERAGE IN THE SMALL GROUP MAR3 KET. 

4 Section 2711 of the Public Health Service Act (42 

5 U.S.C. 300gg–11) is amended— 

6 (1) in subsection (a)(1), by striking ‘‘(f)’’ and 

7 inserting ‘‘(g)’’; and 

8 (2) by adding at the end the following new sub9 section: 

10 ‘‘(g) ELECTION OF ALTERNATIVE TO GUARANTEED

11 ISSUE REQUIREMENT.— 

12 ‘‘(1) ELECTION.— 

13 ‘‘(A) IN GENERAL.—A health insurance 

14 issuer may elect, with respect to any small em15 ployer (as defined in section 2791(e)(4)), to 

16 meet the requirements of paragraphs (2) and 

17 (3) instead of complying with the guaranteed 

18 issue requirement of subsection (a). 

19 ‘‘(B) REQUIREMENT OF ACCEPTING OR RE20 JECTING ALL ELIGIBLE INDIVIDUALS WITHIN

21 ENTIRE GROUP AT TIME OF ELECTION.—An 

22 election made under subparagraph (A) with re23 spect to a small employer shall apply with re24 spect to all eligible individuals of that small em25 ployer at the time of such election. 


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1 ‘‘(C) SUBSEQUENT ELIGIBLE INDIVID2 UALS.—In the case of an individual who be3 comes an eligible individual with respect to a 

4 small employer after an election has been made 

5 under subparagraph (A), the health insurance 

6 issuer is not required to provide group health 

7 insurance coverage for such individual. 

8 ‘‘(2) PORTABILITY FOR INDIVIDUALS COV9 ERED.—If an election is made under paragraph 

10 (1)(A) and under such election group health insur11 ance coverage is provided by a health insurance 

12 issuer for an eligible individual of a small employer, 

13 the health insurance issuer shall guarantee continu14 ation of coverage to the individual (and to covered 

15 dependents), through issuance of individual health 

16 insurance coverage, after the date the individual no 

17 longer qualifies as an eligible individual of such em18 ployer, at a rate that does not exceed 150 percent 

19 of the standard individual rate applicable to such in20 dividual coverage in the State in which the policy 

21 was initially issued. 

22 ‘‘(3) INFORMATION ON ELECTIONS.—Any 

23 health insurance issuer making an election under 

24 paragraph (1)(A) shall furnish to the Secretary such 

25 information as the Secretary may require in order to 


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1 monitor the impact of such election on access to, 

2 and affordability, of health insurance coverage in the 

3 small group market and in the individual market. 

4 Such information shall include at least information 

5 relating to the following: 

6 ‘‘(A) REJECTION RATE.—The characteris7 tics of small employers denied health insurance 

8 coverage because of this subsection. 

9 ‘‘(B) PREMIUM RATES.—The rates charged 

10 for coverage offered under an election made 

11 under this subsection (in comparison to rates 

12 that are otherwise charged if this subsection 

13 were not in effect). 

14 ‘‘(4) LIMITATION.—An election under para15 graph (1)(A) may only be made with respect to cov16 erage of a small employer under health insurance 

17 coverage that consists of a high deductible health 

18 plan (as defined in section 223(c)(2) of the Internal 

19 Revenue Code of 1986) and a contribution to a 

20 health savings account (as defined in section 223(d) 

21 of such Code). 

22 ‘‘(5) REPORT.—At least 6 months before the 

23 end of the 5-year period beginning on the date of the 

24 enactment of this subsection, the Secretary shall 

25 submit to Congress a report on the impact of this 


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1 subsection on the availability and affordability of 

2 health insurance coverage in the small group market 

3 and in the individual market. Such report shall in4 clude recommendations on whether this subsection 

5 should be extended beyond such period and whether 

6 it should be expanded to cover health insurance cov7 erage in addition to the coverage described in para8 graph (4). 

9 ‘‘(6) CONTINGENT SUNSET.—This subsection 

10 shall not apply to elections for small employers made 

11 by a health insurance issuer after the end of the 5- 

12 year period described in paragraph (5) if the Sec13 retary, in the report to Congress under such para14 graph, recommends that this subsection should not 

15 be extended beyond such period. If the Secretary 

16 makes such a recommendation, this subsection shall 

17 still continue to apply to elections made before the 

18 end of such 5-year period.’’. 

Æ 


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