I 

111TH CONGRESS 

1ST SESSION H. R. 747 

To amend the Social Security Act to provide health insurance coverage for 

children and pregnant women throughout the United States by combining 

the children and pregnant woman health coverage under Medicaid and 

SCHIP into a new All Healthy Children Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 28, 2009 

Mr. SCOTT of Virginia (for himself, Mr. WATT, Mr. THOMPSON of Mississippi, 

Mr. BISHOP of Georgia, Mr. JOHNSON of Georgia, Mr. SARBANES, Mr. 

ROTHMAN of New Jersey, Mr. GRIJALVA, and Ms. MCCOLLUM) introduced the following bill; which was referred to the Committee on Energy 

and Commerce 

A BILL 

To amend the Social Security Act to provide health insurance 

coverage for children and pregnant women throughout 

the United States by combining the children and pregnant woman health coverage under Medicaid and SCHIP 

into a new All Healthy Children Program, and for other 

purposes. 

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; TABLE OF CONTENTS; FINDINGS; 

2 PURPOSE. 

3 (a) SHORT TITLE.—This Act may be cited as the ‘‘All 

4 Healthy Children Act of 2009’’. 

5 (b) TABLE OF CONTENTS.—The table of contents of 

6 this Act is as follows: 

Sec. 1. Short title; table of contents; findings; purpose. 

Sec. 2. Creation of new title XXII of the Social Security Act. 

‘‘TITLE XXII—ALL HEALTHY CHILDREN PROGRAM 

‘‘Sec. 2201. All Healthy Children Program. 

‘‘Sec. 2202. General contents of State All Healthy Children Plan; eligibility; enrollment. 

‘‘Sec. 2203. Benefits; premiums; cost-sharing; provider payment rates. 

‘‘Sec. 2204. Payments to States. 

‘‘Sec. 2205. Application of SCHIP, medicaid and related SSA provisions; 

waivers; administration. 

‘‘Sec. 2206. Definitions. 

‘‘Sec. 2207. Effective dates; transition. 

Sec. 3. Commission on Children’s Health Coverage. 

7 (c) FINDINGS.—Congress finds the following: 

8 (1) More than nine million children in the 

9 United States, one in nine, have no health insurance 

10 coverage. 

11 (2) Every 39 seconds, another baby is born un12 insured in the United States. 

13 (3) Existing health care programs for low-in14 come children vary widely, with different standards 

15 for eligibility, cost-sharing, and benefits in each of 

16 the 50 States and the District of Columbia. 

17 (4) More than six million uninsured children 

18 are eligible for coverage under Medicaid or the State 

19 Children’s Health Insurance Program (SCHIP), but 


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1 are not enrolled in existing programs because of dif2 ferent eligibility and enrollment barriers that make 

3 it difficult to obtain or keep coverage. 

4 (5) Millions more children are underinsured or 

5 at risk of losing coverage if their parents change 

6 jobs or more employers drop family coverage. 

7 (6) Uninsured children are almost 12 times as 

8 likely as insured children to have an untreated med9 ical need and are four times as likely as insured chil10 dren to have an unmet dental need. 

11 (7) Uninsured children are more than five times 

12 as likely as insured children to have gone more than 

13 two years without a doctor visit. 

14 (8) The majority of uninsured children live in 

15 two-parent households and almost 90 percent of 

16 such children live in families where at least one par17 ent works. 

18 (9) An estimated two-thirds of children and 

19 adolescents with mental health needs are not getting 

20 the care they need and only one in five children with 

21 serious emotional disturbances receives specialized 

22 treatment. 

23 (10) It costs less to provide health insurance 

24 coverage to children than to any other group of peo25 ple. 


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1 (11) Increases in private health insurance costs 

2 are dramatically outpacing increases in wages. 

3 (12) The United States spending on health care 

4 per person is more than twice the average spent in 

5 industrialized countries, yet the United States ranks 

6 near the bottom among those countries in infant 

7 mortality rates. 

8 (13) Children enrolled in a health coverage pro9 gram experienced significant improvements in health 

10 after just one year and significant decreases of limi11 tations in their daily activities. 

12 (14) Enrollment in health insurance has been 

13 associated with improvements in school. 

14 (15) When juvenile offenders arrested for minor 

15 offenses had access to intensive and coordinated 

16 mental health services, more than a third fewer were 

17 re-arrested the following year, compared to those 

18 who only had access to basic mental health services. 

19 (d) PURPOSE.—It is the purpose of this Act to sim20 plify and consolidate children’s health coverage under 

21 Medicaid and SCHIP into a single program that guaran22 tees children in all States, territories, and the District of 

23 Columbia all medically necessary services. 


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1 SEC. 2. CREATION OF NEW TITLE XXII OF THE SOCIAL SE2 CURITY ACT. 

3 The Social Security Act is amended by adding at the 

4 end the following new title: 

5 ‘‘TITLE XXII—ALL HEALTHY 

6 CHILDREN PROGRAM 

7 ‘‘SEC. 2201. ALL HEALTHY CHILDREN PROGRAM. 

8 ‘‘(a) IN GENERAL.—There is established under this 

9 title a State-operated program receiving Federal financial 

10 assistance to provide comprehensive health coverage for 

11 children, pregnant women, and post-partum women in 

12 place of benefits previously provided for children, pregnant 

13 women, and post-partum women under the Medicaid pro14 gram under title XIX and the State Children’s Health In15 surance Program under title XXI. 

16 ‘‘(b) STATE ALL HEALTHY CHILDREN PLAN RE17 QUIRED.—A State is not eligible for payment under sec18 tion 2204 unless the State has submitted to the Secretary 

19 under section 2202 a plan that— 

20 ‘‘(1) sets forth how the State intends to use the 

21 funds provided under this title to provide all healthy 

22 children assistance to uninsured children and preg23 nant women consistent with the provisions of this 

24 title; and 

25 ‘‘(2) has been approved under section 2202. 


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1 ‘‘(c) STATE AND INDIVIDUAL ENTITLEMENT.—This 

2 title constitutes budget authority in advance of appropria3 tions Acts and represents the obligation of the Federal 

4 Government to provide for the payment to States of 

5 amounts provided under section 2204. Each individual 

6 who is an all healthy children eligible individual and who 

7 qualifies for benefits under this title has an entitlement 

8 to such benefits in accordance with this title. 

9 ‘‘(d) PRIVATE RIGHT OF ACTION.— 

10 ‘‘(1) IN GENERAL.—Any person aggrieved by a 

11 violation of this title or a failure of an individual or 

12 entity, including a State or Federal agency, to com13 ply with the provisions of this title, including any 

14 regulation promulgated pursuant to this title, may 

15 bring a civil action in any Federal district court, re16 gardless of amount in controversy, or State court of 

17 competent jurisdiction to enforce such person’s 

18 rights. 

19 ‘‘(2) NO EXCLUSION OF OTHER REMEDIES.— 

20 The availability of a private right of action under 

21 this subsection shall not be construed to preclude 

22 the ability of any person aggrieved to obtain relief 

23 for a violation of this title or a failure of an indi24 vidual or entity to comply with the provision of this 

25 title, or any regulations promulgated pursuant to 


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1 this title, under any other applicable statute or other 

2 basis for relief. 

3 ‘‘(3) RELIEF.—In an action under this sub4 section, the court may award all relief allowed by 

5 law, including but not limited to compensatory and 

6 exemplary damages and injunctive relief, and attor7 neys’ fees and court costs. 

8 ‘‘(4) PERSON AGGRIEVED DEFINED.—In this 

9 subsection, the term ‘person aggrieved’ includes a 

10 child or individual entitled to benefits under this 

11 title, the parent or guardian of such child, a provider 

12 of services to children or other individuals entitled to 

13 such benefits, or an association or other entity 

14 whose mission is to ensure that children, pregnant 

15 women, or post-partum women receive adequate 

16 health care services. 

17 ‘‘(e) EFFECTIVE DATE.—No State is eligible for pay18 ments under section 2204 for all healthy children assist19 ance for coverage provided for periods beginning before 

20 October 1, 2010. 

21 ‘‘SEC. 2202. GENERAL CONTENTS OF STATE ALL HEALTHY 

22 CHILDREN PLAN; ELIGIBILITY; ENROLLMENT. 

23 ‘‘(a) GENERAL CONTENTS.—A State all healthy chil24 dren plan shall include a description, consistent with the 

25 requirements of this title, of— 


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1 ‘‘(1) the all healthy children assistance provided 

2 under the plan for all healthy children eligible indi3 viduals, including the proposed methods of delivery 

4 and utilization control systems; 

5 ‘‘(2) eligibility standards consistent with sub6 section (b); 

7 ‘‘(3) enrollment and outreach activities con8 sistent with subsection (c); and 

9 ‘‘(4) methods (including monitoring) used— 

10 ‘‘(A) to assure the quality and appropriate11 ness of care, particularly with respect to pre12 natal care, well-baby care, well-child care, and 

13 immunizations provided under the plan, and 

14 ‘‘(B) to assure access to all medically nec15 essary health care services, including emergency 

16 services. 

17 ‘‘(b) ELIGIBILITY STANDARDS AND METHOD18 OLOGY.— 

19 ‘‘(1) IN GENERAL.—The all healthy children 

20 plan for a State shall provide that all of the fol21 lowing are all healthy children eligible individuals if 

22 they are residents: 

23 ‘‘(A) FULL SUBSIDY INDIVIDUALS.— 

24 ‘‘(i) All children under age 19 whose 

25 family income does not exceed 300 percent 


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1 of the poverty line (as defined in section 

2 2110(c)(5)). 

3 ‘‘(ii) All pregnant women and post4 partum women whose family income does 

5 not exceed 300 percent of the poverty line. 

6 ‘‘(iii) All children under age 19, preg7 nant women, and post-partum women who 

8 would have qualified for medical assistance 

9 under title XIX (as applied in the State as 

10 of October 1, 2005). 

11 ‘‘(iv) All children under age 19 who 

12 meet the requirements of subparagraphs 

13 (A) and (B) of section 1905(w)(1) (relat14 ing to independent foster care adolescents). 

15 ‘‘(B) TRANSITIONAL ASSISTANCE.—An in16 dividual who loses eligibility as an individual de17 scribed in subparagraph (A) because of an in18 crease in family income, but only during the 3- 

19 month period beginning with the first month in 

20 which such eligibility is lost. 

21 ‘‘(C) BUY-IN ELIGIBLE INDIVIDUALS.—In22 dividuals who, but for the amount of family in23 come, would be an individual described in sub24 paragraph (A) and who are not described in 

25 subparagraph (B) if they meet such terms and 


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1 conditions as the Secretary determines appro2 priate. 

3 ‘‘(2) RESIDENCY REQUIREMENT.—For purposes 

4 of this title, an individual is a resident of a State if 

5 the individual is present in the State with intent to 

6 remain, and includes any individual who would be 

7 treated as such a resident under title XIX (as in ef8 fect as of January 1, 2007). 

9 ‘‘(3) POST-PARTUM WOMAN DEFINED.—In this 

10 title, the term ‘post-partum woman’ means a woman 

11 during the period beginning on the date of comple12 tion of pregnancy and ending on the last day of the 

13 first month that ends at least 60 days after such 

14 date. 

15 ‘‘(4) INCOME METHODOLOGY.—The method16 ology for determining income under a State all 

17 healthy children plan shall not be more restrictive 

18 than the income methodology described in section 

19 1931(b)(1)(B), to the extent such methodology is 

20 consistent with the requirements of section 

21 1902(a)(17). 

22 ‘‘(5) COST-SHARING.—Any cost-sharing re23 quired by the State to be paid by an individual 

24 under paragraph (1)(B) during the period described 

25 in that paragraph may not exceed the amount the 


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1 State plan charged for such individual prior to such 

2 period. 

3 ‘‘(6) NO ASSET TEST.—The State plan may not 

4 impose any asset or resource test for eligibility. 

5 ‘‘(7) CONSTRUCTION.—Nothing in this title 

6 shall be construed as preventing a State from cov7 ering individuals under Title XIX (such as individ8 uals who are 19 or 20 years of age) who are not all 

9 healthy children eligible individuals. 

10 ‘‘(8) EXCLUSION OF PUBLIC BENEFIT DEFINI11 TION.—The benefits provided under this title shall 

12 not be deemed to constitute a Federal or State pub13 lic benefit within the meaning of title IV of the Per14 sonal Responsibility and Work Opportunity Rec15 onciliation Act of 1996 (Public Law 104–193) nor 

16 shall any documentation of citizenship be required 

17 for the purpose of securing benefits under this title. 

18 ‘‘(9) SPECIAL RULES FOR TERRITORIES.—In 

19 the case of any State that is not one of the 50 

20 States or the District of Columbia, the Secretary 

21 may, by regulation, adjust the income eligibility lev22 els set forth in this title, taking into account factors 

23 such as average income, cost of living, and avail24 ability of health care coverage in a manner that 

25 assures the level of access to health coverage for 


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1 children, pregnant women, and post-partum women 

2 residing in such a State is comparable to the level 

3 of access for children, pregnant women, and post4 partum women residing in the 50 States or the Dis5 trict of Columbia. 

6 ‘‘(c) ENROLLMENT.— 

7 ‘‘(1) STREAMLINED ENROLLMENT SYSTEM.— 

8 Each State plan shall provide for a system of 

9 streamlined enrollment that includes the following 

10 (as specified by the Secretary): 

11 ‘‘(A) A simple, short application form 

12 translated into multiple languages. 

13 ‘‘(B) Applicant self-attestation of eligi14 bility, subject to verification, random audits, or 

15 both. 

16 ‘‘(C) The option for applications to be sub17 mitted in-person, on-line, by mail, or as part of 

18 applications for other programs. 

19 ‘‘(D) Automatic enrollment, as provided 

20 under paragraph (2). 

21 ‘‘(E) 12-month continuous eligibility for 

22 children. 

23 ‘‘(F) Presumptive eligibility during an in24 terim period of coverage for individuals who apVerDate Nov 24 2008 01:59 Jan 31, 2009 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H747.IH H747

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1 pear to qualify for assistance under this title, 

2 on the basis of preliminary information. 

3 ‘‘(G) A determination of continued eligi4 bility at the end of an individual’s eligibility pe5 riod, based on all data available to the State. If 

6 such determination cannot be made, the indi7 vidual or family shall be contacted for addi8 tional information, but only to the extent such 

9 information is not available to State officials 

10 from other sources. The family shall be notified 

11 of all determinations and findings and given an 

12 opportunity to contest and appeal them. An in13 dividual’s eligibility shall continue until the re14 determination process is complete. 

15 ‘‘(2) AUTOMATIC ENROLLMENT PROCEDURES.— 

16 ‘‘(A) IN GENERAL.—The automatic enroll17 ment procedures under this paragraph shall in18 clude enrollment of any all healthy children eli19 gible individual at the following points, unless 

20 the individual (or parent or guardian on the in21 dividual’s behalf) affirmatively declines such en22 rollment: 

23 ‘‘(i) Unless the individual otherwise 

24 establishes enrollment in a health benefits 


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1 plan or coverage, at the point of a final de2 termination— 

3 ‘‘(I) of individual’s eligibility to 

4 participate in any federally-funded, 

5 means-tested program, regardless of 

6 any differences between the program’s 

7 eligibility or income methodology and 

8 those otherwise used under this title, 

9 or 

10 ‘‘(II) that, based on the income 

11 determinations made as part of such 

12 eligibility determination, the indi13 vidual is eligible to participate under 

14 this title. 

15 ‘‘(ii) Birth of a child in the United 

16 States. 

17 ‘‘(iii) Assignment of a social security 

18 account number for a child. 

19 ‘‘(iv) A visit with any health care pro20 vider eligible to participate in the program 

21 established under this title. 

22 ‘‘(v) Enrollment in any public elemen23 tary or secondary school within the State 

24 or any other elementary or secondary 


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1 school subject to mandatory immunization 

2 requirements. 

3 ‘‘(vi) Enrollment in a publicly sub4 sidized child care program. 

5 ‘‘(vii) Upon discharge of a child from 

6 a public institution or other institution 

7 where the child has been confined. 

8 ‘‘(viii) Such other points of enrollment 

9 as the State or Secretary may establish. 

10 For purposes of this subparagraph, the term 

11 ‘federally-funded, means-tested program’ in12 cludes the National School Lunch Program 

13 under the Richard B. Russell National School 

14 Lunch Act (42 U.S.C. 1751 et seq.), the Food 

15 Stamp Program under the Food and Nutrition 

16 Act of 2008 (7 U.S.C. 2011), the special sup17 plemental nutrition program for women, in18 fants, and children (WIC) under section 17 of 

19 the Child Nutrition Act of 1966 (42 U.S.C. 

20 1786), subsidized child care under the Child 

21 Care Development Block Grant Act of 1990 (42 

22 U.S.C. 9858 et seq.), programs carried out 

23 under the Head Start Act (42 U.S.C. 9831 et 

24 seq.), and other means-tested programs des25 ignated by the Secretary. 


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1 ‘‘(B) OPERATION OF AUTOMATIC ENROLL2 MENT.— 

3 ‘‘(i) IN GENERAL.—In the case of an 

4 individual who is automatically enrolled 

5 under subparagraph (A) who does not pay 

6 any applicable initial premiums, such indi7 vidual shall be deemed to have affirma8 tively declined such enrollment and such 

9 individual shall be disenrolled from cov10 erage under the all healthy children pro11 gram under section 2201. 

12 ‘‘(ii) NOTICE AT TIME OF ENROLL13 MENT.—The State plan shall implement 

14 effective procedures, consistent with the 

15 Secretary’s guidelines, for ensuring that, at 

16 the time of enrollment, each auto-enrolled 

17 individual (or parent or guardian of such 

18 individual) is advised of— 

19 ‘‘(I) the level of premiums and 

20 cost-sharing applicable, consistent 

21 with section 2203; 

22 ‘‘(II) the fact that enrollment is 

23 conditioned upon payment of any ap24 plicable premiums; and 


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1 ‘‘(III) such individual’s right to 

2 decline the coverage made available 

3 through auto-enrollment. 

4 ‘‘(iii) NOTICE AFTER ENROLLMENT.— 

5 The State plan shall implement effective 

6 procedures, consistent with the Secretary’s 

7 guidelines, for ensuring that, after enroll8 ment, each auto-enrolled individual (or 

9 parent or guardian of such individual) re10 ceives confirmation of coverage and infor11 mation on benefits under the title. 

12 ‘‘(iv) EQUAL TREATMENT.—A State 

13 plan shall implement effective procedures 

14 to ensure that individuals covered through 

15 auto-enrollment do not receive fewer serv16 ices, on average, than do similar individ17 uals enrolled through other means. 

18 ‘‘(v) INFORMATION SHARING.—Each 

19 State shall develop the information tech20 nology infrastructure needed for automated 

21 transmission and analysis of data involving 

22 means-tested programs referred to in sub23 paragraph (A) and other sources of data 

24 pertinent to eligibility under this title, in25 cluding State and Federal income tax 


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1 records and information contained in the 

2 National Directory of New Hires. Con3 sistent with standards developed by the 

4 Secretary, the State shall implement effec5 tive safeguards that protect the confiden6 tiality of such data and limit its use to the 

7 effective administration of this title, includ8 ing an identification of potentially eligible 

9 individuals not enrolled in the State plan 

10 as well as eligibility verification. 

11 ‘‘(3) OUTREACH.—Each State plan shall pro12 vide for a system for culturally and linguistically 

13 competent outreach to families of potentially eligible 

14 individuals, which shall— 

15 ‘‘(A) be fully accessible to those whose 

16 ability to communicate is affected by disability; 

17 and 

18 ‘‘(B) incorporate proactive communication 

19 (via telephone or in-person visits) to such fami20 lies, consumer education, a preliminary or final 

21 eligibility determination, and enrollment com22 pleted within a single encounter, whenever pos23 sible, and proactive follow-up, when necessary. 

24 ‘‘(d) AVOIDING CROWD-OUT AND COORDINATION

25 WITH OTHER HEALTH COVERAGE PROGRAMS.— 


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1 ‘‘(1) IN GENERAL.—The State plan shall in2 clude a description of procedures, consistent with 

3 this subsection, to be used to ensure— 

4 ‘‘(A) that benefits provided under the 

5 State all healthy children plan do not substitute 

6 for coverage under group health plans; 

7 ‘‘(B) the provision of all healthy children 

8 assistance to all healthy children eligible indi9 viduals in the State who are Indians (as defined 

10 in section 4(c) of the Indian Health Care Im11 provement Act, 25 U.S.C. 1603(c)); and 

12 ‘‘(C) coordination with other public and 

13 private programs providing creditable coverage 

14 for low-income children and pregnant women. 

15 ‘‘(2) GROUP HEALTH PLAN COVERAGE PER16 MITTED.—Notwithstanding paragraph (1)(A), a 

17 State plan may not deny enrollment under this title 

18 in the case of any of the following individuals or cir19 cumstances: 

20 ‘‘(A) The individual would have qualified 

21 for medical assistance under title XIX under 

22 State law as in effect on October 1, 2005. 

23 ‘‘(B) The individual has family income that 

24 does not exceed 150 percent of the poverty line. 


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1 ‘‘(C) The individual’s enrollment under a 

2 group health plan— 

3 ‘‘(i) ended more than four months be4 fore applying for enrollment under this 

5 title; or 

6 ‘‘(ii) was involuntarily terminated be7 cause of the death of a parent, job loss, or 

8 other circumstance. 

9 ‘‘(D) Other than for the subsidies de10 scribed in section 2203(b)(2)(B) (in the case of 

11 all healthy children eligible individuals with 

12 family income that exceeds 300 percent of the 

13 poverty line), the failure of a parent or other in14 dividual (other than the enrollee) to enroll the 

15 all healthy children eligible individual in an 

16 available group health plan. 

17 ‘‘(3) SUPPLEMENTAL COVERAGE.— 

18 ‘‘(A) IN GENERAL.—In the case of an all 

19 healthy children eligible individual who is en20 rolled in a group health plan, the State plan— 

21 ‘‘(i) must provide full supplemental 

22 coverage (described in subparagraph (B)) 

23 if— 

24 ‘‘(I) the individual would have 

25 qualified for supplemental coverage 


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1 under title XIX under State law as in 

2 effect on October 1, 2005; or 

3 ‘‘(II) the individual is disabled 

4 (as defined for purposes of the supple5 mental security income program 

6 under title XVI); and 

7 ‘‘(ii) may provide some or all of such 

8 coverage to other healthy children eligible 

9 individuals (or to reasonable classifications 

10 of such individuals, as specified under the 

11 State plan). 

12 ‘‘(B) FULL SUPPLEMENTAL COVERAGE DE13 SCRIBED.—Full supplemental coverage de14 scribed in this subparagraph includes the fol15 lowing: 

16 ‘‘(i) Benefits covered by the State 

17 plan that are outside the scope of benefits 

18 offered under the group health plan. 

19 ‘‘(ii) Reimbursement of families’ pre20 mium payments under the group health 

21 plan for all healthy children eligible indi22 viduals so that costs do not exceed levels 

23 otherwise permitted by the State plan. 

24 ‘‘(iii) Coverage of out-of-pocket costs 

25 incurred under the group health plan 


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1 where such coverage prevents those costs 

2 from exceeding the levels otherwise per3 mitted under the State plan. 

4 ‘‘(e) ASSISTANCE FOR CHILDREN WHO AGE OUT OF

5 ASSISTANCE.—The State plan shall provide assistance in 

6 obtaining health benefits to individuals who lose eligibility 

7 under this title because of age. 

8 ‘‘(f) EMERGENCY COVERAGE.—When an all healthy 

9 children eligible individual enrolled in a State plan in one 

10 State moves to another State because of natural disaster 

11 or other reasons, the individual shall receive immediate 

12 and automatic presumptive eligibility under this title in 

13 the State to which the individual moves. 

14 ‘‘SEC. 2203. BENEFITS; PREMIUMS; COST-SHARING; PRO15 VIDER PAYMENT RATES. 

16 ‘‘(a) BENEFITS.— 

17 ‘‘(1) IN GENERAL.—The all healthy children as18 sistance under this title shall include benefits for all 

19 medically necessary health care, including early and 

20 periodic screening, diagnostic, and treatment serv21 ices (as defined in section 1905(r)) consistent with 

22 the requirements of section 1902(a)(43). 

23 ‘‘(2) BENEFIT PROTECTIONS.—The State plan 

24 shall provide for all benefit protections for all 

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1 erwise have applied under title XIX if such individ2 uals were entitled to medical assistance under such 

3 title, including the application of no preexisting con4 dition exclusion as defined in section 2701(b)(1)(A) 

5 of the Public Health Service Act and section 

6 701(b)(1)(A) of the Employee Retirement Income 

7 Security Act of 1974. 

8 ‘‘(b) PREMIUMS.—Subject to subsection (d)— 

9 ‘‘(1) NO PREMIUM FOR LOWER-INCOME INDI10 VIDUALS.—For all healthy children eligible individ11 uals described in subparagraph (A) or (B) of section 

12 2202(b)(1), there shall be no premium imposed for 

13 coverage under this title. 

14 ‘‘(2) REQUIRED PREMIUMS FOR BUY-IN ELIGI15 BLE INDIVIDUALS.— 

16 ‘‘(A) IN GENERAL.—Except as provided in 

17 this paragraph, in the case of all healthy chil18 dren eligible individuals described in section 

19 2202(b)(1)(C), the premium charged to an indi20 vidual for coverage under this title shall be the 

21 applicable percentage specified in subparagraph 

22 (D) of the total premium. The total premium 

23 (as estimated under a methodology specified by 

24 the Secretary) shall be equal to the full average 

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1 dren eligible individuals under the State all 

2 healthy children plan. 

3 ‘‘(B) PROVISION OF PREMIUM SUBSIDY.— 

4 ‘‘(i) IN GENERAL.—Subject to clause 

5 (ii), in no case shall the premium charged 

6 to an individual for coverage under this 

7 title exceed (taking into account any pri8 vate coverage in which the individual is en9 rolled as well as supplemental coverage 

10 purchased under this title)— 

11 ‘‘(I) 7.5 percent of the family in12 come; or 

13 ‘‘(II) in the case of multiple eligi14 ble individuals within the same family, 

15 15 percent of family income. 

16 ‘‘(ii) LIMITATION.—Clause (i) shall 

17 not apply for a healthy child eligible indi18 vidual in a family if— 

19 ‘‘(I) the individual could be cov20 ered under a group health plan for 

21 which the employer (or other plan 

22 sponsor) provides for payment of at 

23 least 50 percent of the premium for 

24 coverage of such individual; and 


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1 ‘‘(II) the individual is not so cov2 ered because of a rejection of such 

3 coverage option by the individual. 

4 ‘‘(C) OPTIONAL SUBSIDIES.—A State plan 

5 may reduce premiums otherwise imposed for 

6 reasonable classifications of all healthy children 

7 eligible individuals described in section 

8 2202(b)(1)(C). Such classifications may in9 clude— 

10 ‘‘(i) individuals with family income 

11 within specific income ranges; 

12 ‘‘(ii) individuals with special health 

13 care needs; and 

14 ‘‘(iii) individuals who could have 

15 qualified for medical assistance under an 

16 optional eligibility category under title XIX 

17 (as in effect as of January 1, 2007). 

18 ‘‘(D) APPLICABLE PERCENTAGE SPECI19 FIED.—For purposes of subparagraph (A), with 

20 respect to all healthy children eligible individ21 uals described in section 2202(b)(1)(C), the ap22 plicable percentage specified in this subpara23 graph is as follows: 

24 ‘‘(i) In the case of such all healthy 

25 children eligible individuals whose income 


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1 exceeds 300, but does not exceed 320 per2 cent of the poverty line, 25 percent. 

3 ‘‘(ii) In the case of such all healthy 

4 children eligible individuals whose income 

5 exceeds 320, but does not exceed 340 per 

6 cent of the poverty line, 35 percent. 

7 ‘‘(iii) In the case of such all healthy 

8 children eligible individuals whose income 

9 exceeds 340, but does not exceed 360 per10 cent of the poverty line, 45 percent. 

11 ‘‘(iv) In the case of such all healthy 

12 children eligible individuals whose income 

13 exceeds 360, but does not exceed 380 per14 cent of the poverty line, 55 percent. 

15 ‘‘(v) In the case of such all healthy 

16 children eligible individuals whose income 

17 exceeds 380, but does not exceed 400 per18 cent of the poverty line, 65 percent. 

19 ‘‘(vi) In the case of such all healthy 

20 children eligible individuals whose income 

21 exceeds 400, but does not exceed 425 per22 cent of the poverty line, 80 percent. 

23 ‘‘(vii) In the case of such all healthy 

24 children eligible individuals whose income 


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1 exceeds 425, but does not exceed 450 per2 cent of the poverty line, 90 percent. 

3 ‘‘(viii) In the case of such all healthy 

4 children eligible individuals whose income 

5 exceeds 450 percent of the poverty line, 

6 100 percent. 

7 ‘‘(3) PREMIUM PAYMENTS.— 

8 ‘‘(A) IN GENERAL.—The State all healthy 

9 children plan shall provide effective measures, 

10 consistent with standards established by the 

11 Secretary, to make premium payment simple 

12 and convenient to parents (or other payers) and 

13 to preserve continuity of coverage. Such meas14 ures shall include— 

15 ‘‘(i) discounts to encourage the pay16 ment of quarterly or annual premiums in 

17 advance; 

18 ‘‘(ii) options to make premium pay19 ments automatically by credit card, debit 

20 account payments, electronic fund trans21 fers, payroll withholding, or otherwise; and 

22 ‘‘(iii) payment opportunities at mul23 tiple, convenient community locations. 

24 ‘‘(B) PROMOTING CONTINUITY OF COV25 ERAGE.—In the case of all healthy children eliVerDate Nov 24 2008 01:59 Jan 31, 2009 Jkt 079200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H747.IH H747

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1 gible individuals for whom premium payments 

2 are required under the State plan, the plan 

3 shall have effective procedures to prevent pre4 mium non-payment from interrupting con5 tinuity of coverage. If there is a default on pre6 mium payments, not including the initial pre7 mium payment, the State plan shall provide 

8 reasonable opportunities to cure such default, 

9 including at least a 60-day period, following no10 tice of default, during which overdue premium 

11 payments may be made without interrupting 

12 coverage or incurring interest charges, late fees, 

13 or other costs. 

14 ‘‘(c) COST-SHARING.— 

15 ‘‘(1) LIMITATIONS.—Subject to subsection (d), 

16 for all healthy children eligible individuals with a 

17 family income that— 

18 ‘‘(A) does not exceed 200 percent of the 

19 poverty line, there shall be no out-of-pocket 

20 cost-sharing imposed; 

21 ‘‘(B) does exceed 200 percent, but does not 

22 exceed 300 percent, of the poverty line, only 

23 nominal out-of-pocket cost-sharing may be im24 posed; or 


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1 ‘‘(C) exceeds 300 percent of the poverty 

2 line, out-of-pocket cost-sharing charged may not 

3 exceed levels the Secretary finds to be con4 sistent with charges under employer-based 

5 health insurance for the majority of employees 

6 enrolled in such coverage nationally. 

7 In no case shall a child described in subparagraph 

8 (A) or (B) of section 2202(b)(1) be denied services 

9 under this title because of failure to pay out-of-pock10 et cost-sharing. 

11 ‘‘(2) WAIVER.—A state may elect to waive or 

12 reduce out-of-pocket cost-sharing otherwise author13 ized under this subsection. 

14 ‘‘(d) LIMITATIONS ON OUT-OF-POCKET COSTS.— 

15 ‘‘(1) CURRENT MEDICAID.—For each all 

16 healthy children eligible individual, premiums and 

17 out-of-pocket cost-sharing may not exceed the levels 

18 that would have been charged for that individual 

19 under State Medicaid and SCHIP law as of October 

20 1, 2005, updated in a manner specified by the Sec21 retary based on changes, after that date, to average 

22 earnings among families with incomes that do not 

23 exceed 200 percent of the poverty line. 

24 ‘‘(2) AFFORDABILITY.—The State plan shall 

25 provide effective measures, consistent with standards 


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1 established by the Secretary, to further limit out-of2 pocket cost-sharing (taking into account both pre3 miums and cost-sharing) of all healthy children eligi4 ble individuals to affordable levels, for both indi5 vidual health care services and total family costs. 

6 Such measures may include coding of each individ7 ual’s enrollment card. Such measures may not in8 clude a requirement that households track incurred 

9 costs. 

10 ‘‘(e) CHOICE OF PLANS.—To the extent feasible, a 

11 State plan must provide, insofar as the plan provides for 

12 benefits through enrollment in a health benefits plan, for 

13 each enrollee to have a choice of at least two health plan 

14 options, consistent with the requirements of section 1932. 

15 ‘‘(f) REIMBURSEMENT RATES.—The State shall es16 tablish under the State plan, in consultation with appro17 priate child health providers and experts— 

18 ‘‘(1) payment rates for providers that are— 

19 ‘‘(A) not less than 80 percent of the aver20 age of payment rates for similar services for 

21 providers under private health insurance plans 

22 within that State; and 

23 ‘‘(B) sufficient in amount to ensure that 

24 enrolled all healthy children eligible individuals 


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1 have adequate access to all services covered 

2 under this title; and 

3 ‘‘(2) payments rates to capitated plans that are 

4 actuarially sound, based on comprehensive encounter 

5 data. 

6 ‘‘SEC. 2204. PAYMENTS TO STATES. 

7 ‘‘(a) PAYMENT.—Subject to the succeeding provisions 

8 of this section, the Secretary shall pay to each State with 

9 a plan approved under this title, an amount for each quar10 ter equal to the Federal all healthy children matching rate 

11 for the State (as determined under subsection (b)) of the 

12 total expenditures under the plan for the quarter, except 

13 that the matching rate for the development and operation 

14 of information technology shall be the same as the Federal 

15 matching percentage in effect for such technology under 

16 subparagraphs (A) and (B) of section 1903(a)(3). 

17 ‘‘(b) COMPUTATION OF FEDERAL ALL HEALTHY

18 CHILDREN MATCHING RATE.— 

19 ‘‘(1) IN GENERAL.—Subject to paragraph (3), 

20 the Federal all healthy children matching rate under 

21 this subsection for a State for a calendar quarter in 

22 a fiscal year is equal to the ratio of— 

23 ‘‘(A) the total expenditures under the 

24 State plan under this title for the quarter that 

25 are attributable to required populations and 


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1 services, less the State share of basic expendi2 tures described in paragraph (2), to 

3 ‘‘(B) the total expenditures referred to in 

4 subparagraph (A). 

5 ‘‘(2) STATE SHARE FOR BASIC EXPENDI6 TURES.— 

7 ‘‘(A) IN GENERAL.—The State share of ex8 penditures attributable to required populations 

9 and services under this title for a quarter in a 

fiscal year is equal to 1 10 ⁄4 of the product of the 

11 following: 

12 ‘‘(i) BASE AMOUNT.—The base FY 

13 2010 amount (specified in subparagraph 

14 (B) for the State). 

15 ‘‘(ii) CHILD INCREASE FACTOR.—One 

16 plus the percentage increase in the number 

17 of children residing in the State, as esti18 mated by the Secretary, from fiscal year 

19 2010 to the fiscal year involved. 

20 ‘‘(iii) COST INCREASE FACTOR.—One 

21 plus the percentage increase in the medical 

22 care component of the consumer price 

23 index for all urban consumers (U.S. city 

24 average), as estimated by the Secretary, 


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1 from fiscal year 2010 to the fiscal year in2 volved. 

3 ‘‘(B) BASE FY 2010 AMOUNT.—For pur4 poses of this paragraph, the ‘base FY 2010 

5 amount’ for a State is equal to the sum of— 

6 ‘‘(i) the total amount of expenditures 

7 made by the State during calendar quar8 ters in fiscal year 2010 under title XIX 

9 (including under any waiver under section 

10 1115) that are attributable to coverage of 

11 individuals who meet the requirement to be 

12 all healthy children eligible individuals, in13 cluding an appropriate portion of adminis14 trative expenses, reduced by the amount of 

15 Federal financial participation provided 

16 with respect to such expenditures; and 

17 ‘‘(ii) the total amount of expenditures 

18 made by the State during calendar quar19 ters in fiscal year 2010 under title XXI 

20 (including under any waiver under section 

21 1115), reduced by the amount of payment 

22 received by the State under such title for 

23 such quarters. 

24 ‘‘(3) COUNTER-CYCLICAL REDUCTION.—The 

25 Secretary shall establish a formula for providing, in 


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1 addition to the base Federal matching amounts, 

2 automatic supplemental assistance to States that ex3 perience a sustained economic downturn, based upon 

4 State’s quarterly unemployment rate exceeding the 

5 State’s average of such rates during a period of pre6 vious calendar quarters (in such number as the Sec7 retary shall specify) and by a percentage to be deter8 mined by the Secretary and in an amount calculated 

9 on the basis of the relationship between changes in 

10 unemployment and anticipated increases in providing 

11 services under this title. The supplemental assistance 

12 shall be distributed quarterly through a supplement 

13 to the State’s Federal payment and shall be for such 

14 duration as the Secretary determines appropriate. 

15 ‘‘(c) BONUS FOR MEETING ENROLLMENT TAR16 GETS.—The Secretary is authorized to establish a system 

17 for providing additional bonus payments for States that 

18 meet or exceed enrollment targets established for each 

19 State by the Secretary, taking into account the cir20 cumstances in each State. 

21 ‘‘(d) ADVANCE PAYMENT; RETROSPECTIVE ADJUST22 MENT.—The Secretary may make payments under this 

23 section for each quarter on the basis of advance estimates 

24 of expenditures submitted by the State and such other in25 vestigation as the Secretary may find necessary, and may 


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1 reduce or increase the payments as necessary to adjust 

2 for any overpayment or underpayment for prior quarters. 

3 ‘‘(e) TREATMENT OF TERRITORIES.—In the case of 

4 any State that is not one of the 50 States or the District 

5 of Columbia, the Secretary shall, by regulation, establish 

6 a formula for allocating funds to provide all healthy chil7 dren assistance in such a State. Such formula shall 

8 produce a funding level for such a State that comparable 

9 to the level of funding for the provision of all healthy chil10 dren assistance in the 50 States or the District of Colum11 bia. 

12 ‘‘SEC. 2205. APPLICATION OF SCHIP, MEDICAID AND RE13 LATED SSA PROVISIONS; WAIVERS; ADMINIS14 TRATION. 

15 ‘‘(a) SCHIP PROVISIONS RELATING TO PLAN SUB16 MISSION, STRATEGIC OBJECTIVES AND PERFORMANCE

17 GOALS, AND AUDITS.—Except to the extent inconsistent 

18 with the provisions of this title, sections 2106, 2107, and 

19 2108(d) shall apply with respect to State plans under this 

20 title in the same manner as they applied with respect to 

21 State plans under title XXI. 

22 ‘‘(b) MEDICAID PROVISIONS.—Except to the extent 

23 inconsistent with the provisions of this title, the provisions 

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1 tion 1115, insofar as they are applicable to title XIX) shall 

2 apply to activities under this title. 

3 ‘‘(c) LIMITATION ON WAIVERS.—No waiver shall be 

4 granted under section 1115 with respect to this title if 

5 it is likely to result in— 

6 ‘‘(1) an increase in health care or health pre7 mium costs for all healthy children eligible individ8 uals under this title; or 

9 ‘‘(2) a reduction in benefits, eligibility, guaran10 teed eligibility, health care access, or health care 

11 quality for such individuals under this title. 

12 ‘‘(d) ANNUAL REPORTS.—The Secretary shall 

13 present annual reports to Congress describing implemen14 tation of this title. Such reports shall include a description 

15 of— 

16 ‘‘(1) optional coverage chosen by States; and 

17 ‘‘(2) for each category of coverage and method 

18 of enrollment, nationwide and State-specific data 

19 showing the number and characteristics of all 

20 healthy children eligible individuals receiving cov21 erage, services provided, categories and amounts of 

22 expenditures. 

23 ‘‘SEC. 2206. DEFINITIONS. 

24 ‘‘(a) IN GENERAL.—For purposes of this title: 


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1 ‘‘(1) ALL HEALTHY CHILDREN ELIGIBLE INDI2 VIDUAL.—The term ‘all healthy children eligible in3 dividual’ means individuals described in section 

4 2202(b)(1). 

5 ‘‘(2) ALL HEALTHY CHILDREN ASSISTANCE.— 

6 The term ‘all healthy children assistance’ means 

7 payment under this title for part or all of the cost 

8 of health benefits coverage for all healthy children 

9 eligible individual. 

10 ‘‘(3) CHILD, GROUP HEALTH PLAN, AND POV11 ERTY LINE.—The terms ‘child’, ‘group health plan’, 

12 and ‘poverty line’ have the meanings given such 

13 terms in section 2110(c). 

14 ‘‘(4) STATE ALL HEALTHY CHILDREN PLAN; 

15 STATE PLAN.—The terms ‘State all healthy children 

16 plan’ and ‘State plan’ mean such a plan as approved 

17 under this title. 

18 ‘‘(5) STATE.—The term ‘State’ has the mean19 ing given such term for purposes of titles XIX and 

20 XXI. 

21 ‘‘SEC. 2207. EFFECTIVE DATES; TRANSITION. 

22 ‘‘(a) EFFECTIVE DATE.—Benefits and payments to 

23 States shall first be available under this title for items and 

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1 tion referred to as the ‘All Healthy Children Program ef2 fective date’). 

3 ‘‘(b) TRANSITION PROVISIONS.— 

4 ‘‘(1) IN GENERAL.—Any child under 19 years 

5 of age, any pregnant woman, or any independent 

6 foster care adolescent (as defined in section 

7 1905(w)(1)) who, as of the day before the All 

8 Healthy Children Program effective date, is enrolled 

9 under title XIX or XXI shall, as of such effective 

10 date, automatically qualify for and be enrolled in the 

11 State plan under this title, with the benefits based 

12 on the family income of the individual as most re13 cently determined for purposes of the title under 

14 which the individual was enrolled. 

15 ‘‘(2) TREATMENT OF SCHIP ADULTS.—In the 

16 case of an individual not described in paragraph (1) 

17 who, as of the day before the All Healthy Children 

18 Program effective date, was enrolled under title XXI 

19 through a program waiver, during the remainder of 

20 such program waiver period, so long as the indi21 vidual continues to meet the conditions for eligibility 

22 under such program waiver, shall be eligible for 

23 medical assistance under the State plan under title 

24 XIX and, with respect to medical assistance to such 

25 individuals, the enhanced FMAP under title XXI 


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1 shall be substituted for the Federal medical assist2 ance percentage (FMAP) for purposes of section 

3 1903(a)(1). 

4 ‘‘(3) GUIDANCE.—The Secretary shall provide 

5 guidance and assistance to the States in carrying 

6 out this section. 

7 ‘‘(c) MEDICAID; SCHIP TRANSITION.—Notwith8 standing any other provision of law, as of the All Healthy 

9 Children Program effective date, any all healthy children 

10 eligible individual shall not be eligible for medical assist11 ance under title XIX or child health assistance under title 

12 XXI and no Federal financial participation shall be avail13 able under either such title with respect to such individ14 uals.’’. 

15 SEC. 3. COMMISSION ON CHILDREN’S HEALTH COVERAGE. 

16 (a) ESTABLISHMENT.—There is hereby established a 

17 Commission on Children’s Health Coverage (in this sec18 tion referred to as the ‘‘Commission’’). 

19 (b) COMPOSITION.— 

20 (1) IN GENERAL.—The Commission shall be 

21 composed of the following: 

22 (A) Four members, one each appointed by 

23 the majority and minority leaders of the House 

24 of Representatives and the majority and minor25 ity leaders of the Senate. 


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1 (B) One member appointed by the Sec2 retary of Health and Human Services. 

3 (C) Two members, one each appointed by 

4 the American Academy of Pediatrics and by the 

5 Institute of Medicine of the National Academies 

6 of Science. 

7 (D) One member appointed by the Sec8 retary of Health and Human Services who is a 

9 representative of parents of children with spe10 cial health care needs. 

11 (E) One member appointed by the Sec12 retary of Health and Human Services who is a 

13 representative of a children’s advocacy group. 

14 (F) Two non-voting advisory members ap15 pointed by the National Governors Association. 

16 Appointment of members of the Commission shall 

17 first be made not later than 60 days after the date 

18 of the enactment of this Act. 

19 (2) TERMS.—The term of each member of the 

20 Commission shall be for 2 years. A vacancy shall be 

21 filled in the same manner as the original appoint22 ment but the member so appointed shall serve for 

23 the remainder of the term of the vacating member. 

24 (3) COMPENSATION.—Members of the Commis25 sion who are not Federal officers or employees shall 


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1 be entitled to compensation, including travel time, at 

2 a per diem rate equivalent of rate for level IV of Ex3 ecutive Schedule under section 5315 of title 5, 

4 United States Code, and for travel expense reim5 bursement, at rates authorized for employees of 

6 agencies under such title. 

7 (4) CHAIR.—The Secretary shall designate a 

8 member to serve as Chair of the Commission. 

9 (5) MEETINGS.—The Commission shall meet at 

10 the call of the Chair. 

11 (6) USE OF COMMITTEES.—The Commission 

12 may establish committees if necessary to carry out 

13 its duties. 

14 (c) SUPERMAJORITY REQUIREMENT FOR ACTIONS.— 

15 Commission actions must be approved by at least six of 

16 the members described in subparagraphs (A) through (E) 

17 of subsection (b)(1). 

18 (d) ADMINISTRATION.— 

19 (1) POWERS.— 

20 (A) HEARINGS.—The Commission may 

21 hold such hearings, sit and act at such times 

22 and places, take such testimony, and receive 

23 such evidence as the Commission considers ad24 visable to carry out this section. 


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1 (B) INFORMATION FROM FEDERAL AGEN2 CIES.—The Commission may secure directly 

3 from any Federal department or agency such 

4 information as the Commission considers nec5 essary to carry out this section. Upon request 

6 of the Chairperson of the Commission, the head 

7 of such department or agency shall furnish such 

8 information to the Commission. 

9 (C) POSTAL SERVICES.—The Commission 

10 may use the United States mails in the same 

11 manner and under the same conditions as other 

12 departments and agencies of the Federal Gov13 ernment. 

14 (D) GIFTS.—The Commission may accept, 

15 use, and dispose of gifts or donations of serv16 ices or property. 

17 (2) COMPENSATION.—While serving on the 

18 business of the Commission (including travel time), 

19 a member of the Commission who is not a Federal 

20 officer or employee shall be entitled to compensation 

21 at the per diem equivalent of the rate provided for 

22 level IV of the Executive Schedule under section 

23 5315 of title 5, United States Code, and while so 

24 serving away from home and the member’s regular 

25 place of business, any member may be allowed travel 


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1 expenses, as authorized by the chairperson of the 

2 Commission. All members of the Commission who 

3 are officers or employees of the United States shall 

4 serve without compensation in addition to that re5 ceived for their services as officers or employees of 

6 the United States. 

7 (3) STAFF.— 

8 (A) IN GENERAL.—The Chair of the Com9 mission may, without regard to the civil service 

10 laws and regulations, appoint and terminate— 

11 (i) subject to the approval of a major12 ity of the Commission, an executive direc13 tor; and 

14 (ii) such other additional personnel as 

15 may be necessary to enable the Commis16 sion to perform its duties. 

17 (B) STAFF COMPENSATION.—The Chair of 

18 the Commission may fix the compensation of 

19 the executive director and other personnel with20 out regard to chapter 51 and subchapter III of 

21 chapter 53 of title 5, United States Code, relat22 ing to classification of positions and General 

23 Schedule pay rates, except that the rate of pay 

24 for the executive director and other personnel 

25 may not exceed the rate payable for level V of 


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1 the Executive Schedule under section 5316 of 

2 such title. 

3 (C) DETAIL OF GOVERNMENT EMPLOY4 EES.—Any Federal Government employee may 

5 be detailed to the Commission without reim6 bursement, and such detail shall be without 

7 interruption or loss of civil service status or 

8 privilege. 

9 (D) PROCUREMENT OF TEMPORARY AND

10 INTERMITTENT SERVICES.—The Chair of the 

11 Commission may procure temporary and inter12 mittent services under section 3109(b) of title 

13 5, United States Code, at rates for individuals 

14 which do not exceed the daily equivalent of the 

15 annual rate of basic pay prescribed for level V 

16 of the Executive Schedule under section 5316 

17 of such title. 

18 (e) REIMBURSEMENT OF COSTS.—The Secretary 

19 shall provide, from general operating funds of the Depart20 ment of Health and Human Services, the Commission 

21 with such funds and support as may be necessary to sup22 port its activities. 

23 (f) ANNUAL REPORTS.—Beginning one year after the 

24 All Healthy Children Program effective date under section 

25 2207(a) of the Social Security Act, the Commission shall 


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1 transmit to Congress an annual report that evaluates the 

2 status of children’s health coverage in the United States, 

3 including an evaluation of the implementation of title 

4 XXII of the such Act and recommendations for policy im5 provements at the State and national levels and in the pri6 vate sector to improve such coverage. 

7 (g) SUBMISSION OF LEGISLATIVE PROPOSAL FOR

8 UNIVERSAL COVERAGE OF CHILDREN.—Not later than 

9 three years after the date of the enactment of this Act, 

10 the Commission shall submit to Congress a report that 

11 contains a legislative proposal that would assure health 

12 benefits coverage for all children in the United States. 

13 Such proposal may include a requirement that parents ob14 tain coverage for their children or that employers fund 

15 coverage for children of their workers. The proposal shall 

16 provide for the following: 

17 (1) Coverage shall include all medically nec18 essary care for all children. 

19 (2) Enrollment shall be simple and seamless. 

20 (3) Unnecessary costs shall be avoided. 

21 (4) Quality, access, and continuity of care shall 

22 be promoted. 

Æ 


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