II 

108TH CONGRESS 

2D SESSION S. 2544 

To provide for the certification of programs to provide uninsured employees 

of small businesses access to health coverage, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 17, 2004 

Ms. STABENOW (for herself, Mrs. LINCOLN, and Mr. LEVIN) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To provide for the certification of programs to provide uninsured employees of small businesses access to health 

coverage, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Care Access 

5 for Small Businesses Act of 2004’’. 

6 SEC. 2. THREE-SHARE PROGRAMS. 

7 The Social Security Act (42 U.S.C. 301 et seq.) is 

8 amended by adding at the end the following: 
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1 ‘‘TITLE XXII—PROVIDING FOR 

2 THE UNINSURED 

3 ‘‘SEC. 2201. THREE-SHARE PROGRAMS. 

4 ‘‘(a) PILOT PROGRAMS.—The Secretary, acting 

5 through the Administrator, shall award grants under this 

6 section for the startup and operation of 50 eligible three7 share pilot programs for a 5-year period. 

8 ‘‘(b) GRANTS FOR THREE-SHARE PROGRAMS.— 

9 ‘‘(1) ESTABLISHMENT.—The Administrator 

10 may award grants to eligible entities— 

11 ‘‘(A) to establish three-share programs; 

12 ‘‘(B) to provide for contributions to the 

13 premiums assessed for coverage under a three14 share program as provided for in subsection 

15 (c)(2)(B)(iii); and 

16 ‘‘(C) to establish risk pools. 

17 ‘‘(2) THREE-SHARE PROGRAM PLAN.—Each en18 tity desiring a grant under this subsection shall de19 velop a plan for the establishment and operation of 

20 a three-share program that meets the requirements 

21 of paragraphs (2) and (3) of subsection (c). 

22 ‘‘(3) APPLICATION.—Each entity desiring a 

23 grant under this subsection shall submit an applica24 tion to the Administrator at such time, in such man-
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1 ner and containing such information as the Adminis2 trator may require, including— 

3 ‘‘(A) the three-share program plan de4 scribed in paragraph (2); and 

5 ‘‘(B) an assurance that the eligible entity 

6 will— 

7 ‘‘(i) determine a benefit package; 

8 ‘‘(ii) recruit businesses and employees 

9 for the three-share program; 

10 ‘‘(iii) build and manage a network of 

11 health providers or contract with an exist12 ing network or licensed insurance provider; 

13 ‘‘(iv) manage all administrative needs; 

14 and 

15 ‘‘(v) establish relationships among 

16 community, business, and provider inter17 ests. 

18 ‘‘(4) PRIORITY.—In awarding grants under this 

19 section the Secretary shall give priority to an appli20 cant— 

21 ‘‘(A) that is an existing three-share pro22 gram; 

23 ‘‘(B) that is an eligible three-share pro24 gram that has demonstrated community sup25 port; or 
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1 ‘‘(C) that is located in a State with insur2 ance laws and regulations that permit three3 share program expansion. 

4 ‘‘(c) GRANT ELIGIBILITY.— 

5 ‘‘(1) IN GENERAL.—The Secretary, acting 

6 through the Administrator, shall promulgate regula7 tions providing for the eligibility of three-share pro8 grams for participation in the pilot program under 

9 this section. 

10 ‘‘(2) THREE-SHARE PROGRAM REQUIRE11 MENTS.— 

12 ‘‘(A) IN GENERAL.—To be determined to 

13 be an eligible three-share program for purposes 

14 of participation in the pilot program under this 

15 section a three-share program shall— 

16 ‘‘(i) be either a non-profit or local 

17 governmental entity; 

18 ‘‘(ii) define the region in which such 

19 program will provide services; 

20 ‘‘(iii) have the capacity to carry out 

21 administrative functions of managing 

22 health plans, including monthly billings, 

23 verification/enrollment of eligible employers 

24 and employees, maintenance of member25 ship rosters, development of member mate-
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1 rials (such as handbooks and identification 

2 cards), customer service, and claims proc3 essing; and 

4 ‘‘(iv) have demonstrated community 

5 involvement. 

6 ‘‘(B) PAYMENT.—To be eligible under 

7 paragraph (1), a three-share program shall pay 

8 the costs of services provided under subpara9 graph (A)(ii) by charging a monthly premium 

10 for each covered individual to be divided as fol11 lows: 

12 ‘‘(i) Not more than 30 percent of such 

13 premium shall be paid by a qualified em14 ployee desiring coverage under the three15 share program. 

16 ‘‘(ii) Not more than 30 percent of 

17 such premium shall be paid by the quali18 fied employer of such a qualified employee. 

19 ‘‘(iii) At least 40 percent of such pre20 mium shall be paid from amounts provided 

21 under a grant under this section. 

22 ‘‘(iv) Any remaining amount shall be 

23 paid by the three-share program from 

24 other public, private, or charitable sources. 
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1 ‘‘(C) PROGRAM FLEXIBILITY.—A three2 share program may set an income eligibility 

3 guideline for enrollment purposes. 

4 ‘‘(3) COVERAGE.— 

5 ‘‘(A) IN GENERAL.—To be an eligible 

6 three-share program under this section, the 

7 three-share program shall provide at least the 

8 following benefits: 

9 ‘‘(i) Physicians services. 

10 ‘‘(ii) In-patient hospital services. 

11 ‘‘(iii) Out-patient services. 

12 ‘‘(iv) Emergency room visits. 

13 ‘‘(v) Emergency ambulance services. 

14 ‘‘(vi) Diagnostic lab fees and x-rays. 

15 ‘‘(vii) Prescription drug benefits. 

16 ‘‘(B) LIMITATION.—Nothing in subpara17 graph (A) shall be construed to require that a 

18 three-share program provide coverage for serv19 ices performed outside the region described in 

20 paragraph (2)(A)(i). 

21 ‘‘(C) PREEXISTING CONDITIONS.—A pro22 gram described in subparagraph (A) shall not 

23 be an eligible three-share program under para24 graph (1) if any individual can be excluded 
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1 from coverage under such program because of 

2 a preexisting health condition. 

3 ‘‘(d) GRANTS FOR EXISTING THREE-SHARE PRO4 GRAMS TO MEET CERTIFICATION REQUIREMENTS.— 

5 ‘‘(1) IN GENERAL.—The Administrator may 

6 award grants to three-share programs that are oper7 ating on the date of enactment of this section. 

8 ‘‘(2) APPLICATION.—Each eligible entity desir9 ing a grant under this subsection shall submit an 

10 application to the Administrator at such time, in 

11 such manner, and containing such information as 

12 the Administrator may require. 

13 ‘‘(e) APPLICATION OF STATE LAWS.—Nothing in this 

14 section shall be construed to preempt State law. 

15 ‘‘(f) DISTRESSED BUSINESS FORMULA.— 

16 ‘‘(1) IN GENERAL.—Not later than 60 days 

17 after the date of enactment of this section, the Ad18 ministrator of the Health Resources and Services 

19 Administration shall develop a formula to determine 

20 which businesses qualify as distressed businesses for 

21 purposes of this section. 

22 ‘‘(2) EFFECT ON INSURANCE MARKET.—Grant23 ing eligibility to a distressed business using the for24 mula under paragraph (1) shall not interfere with 

25 the insurance market. Any business found to have 
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1 reduced benefits to qualify as a distressed business 

2 under the formula under paragraph (1) shall not be 

3 eligible to be a three-share program for purposes of 

4 this section. 

5 ‘‘(g) DEFINITIONS.—In this section: 

6 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis7 trator’ means the Administrator of the Health Re8 sources and Services Administration. 

9 ‘‘(2) COVERED INDIVIDUAL.—The term ‘cov10 ered individual’ means— 

11 ‘‘(A) a qualified employee; or 

12 ‘‘(B) a child under the age of 23 or a 

13 spouse of such qualified employee who— 

14 ‘‘(i) lacks access to health care cov15 erage through their employment or em16 ployer; 

17 ‘‘(ii) lacks access to health coverage 

18 through a family member; 

19 ‘‘(iii) is not eligible for coverage under 

20 the medicare program under title XVIII or 

21 the medicaid program under title XIX; and 

22 ‘‘(iv) does not qualify for benefits 

23 under the State Children’s Health Insur24 ance Program under title XXI. 
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1 ‘‘(3) DISTRESSED BUSINESS.—The term ‘dis2 tressed business’ means a business that— 

3 ‘‘(A) in light of economic hardship and ris4 ing health care premiums may be forced to dis5 continue or scale back its health care coverage; 

6 and 

7 ‘‘(B) qualifies as a distressed business ac8 cording to the formula under subsection (g). 

9 ‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en10 tity’ means an entity that meets the requirements of 

11 subsection (a)(2)(A). 

12 ‘‘(5) QUALIFIED EMPLOYEE.—The term ‘quali13 fied employee’ means any individual employed by a 

14 qualified employer who meets certain criteria includ15 ing— 

16 ‘‘(A) lacking access to health coverage 

17 through a family member or common law part18 ner; 

19 ‘‘(B) not being eligible for coverage under 

20 the medicare program under title XVIII or the 

21 medicaid program under title XIX; and 

22 ‘‘(C) agreeing that the share of fees de23 scribed in subsection (a)(2)(B)(i) shall be paid 

24 in the form of payroll deductions from the 

25 wages of such individual. 
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1 ‘‘(6) QUALIFIED EMPLOYER.—The term ‘quali2 fied employer’ means an employer as defined in sec3 tion 3(d) of the Fair Labor Standards Act of 1938 

4 (29 U.S.C. 203(d)) who— 

5 ‘‘(A) is a small business concern as defined 

6 in section 3(a) of the Small Business Act (15 

7 U.S.C. 632); 

8 ‘‘(B) is located in the region described in 

9 subsection (a)(2)(A)(i); and 

10 ‘‘(C) has not contributed to the health care 

11 benefits of its employees for at least 12 months 

12 consecutively or currently provides insurance 

13 but is classified as a distressed business. 

14 ‘‘(h) EVALUATION.—Not later than 90 days after the 

15 end of the 5-year period during which grants are available 

16 under this section, the General Accounting Office shall 

17 submit to the Secretary and the appropriate committees 

18 of Congress a report concerning— 

19 ‘‘(1) the effectiveness of the programs estab20 lished under this section; 

21 ‘‘(2) the number of individuals covered under 

22 such programs; 

23 ‘‘(3) any resulting best practices; and 

24 ‘‘(4) the level of community involvement. 
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1 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $100,000,000 for each of fiscal years 2005 through 

4 2010.’’. 

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