I 

108TH CONGRESS 

2D SESSION H. R. 5341

To amend title XXVII of the Public Health Service Act to extend Federal 

funding for the establishment and operation of State high risk health 

insurance pools. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 8, 2004

Mr. SHADEGG (for himself and Mr. NETHERCUTT) 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 extend Federal funding for the establishment and 

operation of State high risk health insurance pools.

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 ‘‘State High Risk Pool 

5 Funding Extension Act of 2004’’. 
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1 SEC. 2. EXTENSION OF FUNDING FOR ESTABLISHMENT AND 

2 OPERATION OF STATE HIGH RISK HEALTH IN3 SURANCE POOLS. 

4 (a) EXTENSION OF AVAILABILITY OF SEED FUNDING

5 FOR ADDITIONAL YEAR.—The second sentence of sub6 section (c) of section 2745 of the Public Health Service 

7 Act (42 U.S.C. 300gg–45) is amended by striking ‘‘under 

8 this subsection for a fiscal year’’ and inserting ‘‘under 

9 paragraph (1) shall be available for obligation through the 

10 end of fiscal year 2005 and funds appropriated under 

11 paragraph (2) for a fiscal year’’. 

12 (b) FUNDING FOR OPERATION OF STATE HIGH RISK

13 POOLS IN FISCAL YEAR 2005.—Subsection (c)(2) of such 

14 section is amended by inserting ‘‘and $50,000,000 for fis15 cal year 2005’’ after ‘‘2004’’. 

16 (c) CHANGE IN REQUIREMENTS FOR QUALIFIED

17 HIGH RISK POOLS.—

18 (1) CHANGE IN REQUIREMENT FOR OPER19 ATIONAL GRANTS.—Subsection (b)(1)(A) of such 

20 section is amended by striking ‘‘150 percent’’ and 

21 inserting ‘‘200 percent’’. 

22 (2) CHANGE IN DEFINITION OF QUALIFIED

23 HIGH RISK POOL.—Subsection (d) of such section is 

24 amended to read as follows: 

25 ‘‘(d) DEFINITIONS.—In this section: 
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1 ‘‘(1) QUALIFIED HIGH RISK POOL.—The term 

2 ‘qualified high risk pool’ has the meaning given such 

3 term in section 2744(c)(2), except that a State may 

4 elect to meet the requirement of subparagraph (A) 

5 of such section (insofar as it requires the provision 

6 of coverage to all eligible individuals) through pro7 viding for the enrollment of eligible individuals 

8 through an acceptable alternative mechanism (as de9 fined for purposes of section 2744) that includes a 

10 high risk pool as a component. 

11 ‘‘(2) STANDARD RISK RATE.—The term ‘stand12 ard risk rate’ means a rate that—

13 ‘‘(A) is determined under the State high 

14 risk pool by considering the premium rates 

15 charged by other health insurers offering health 

16 insurance coverage to individuals in the insur17 ance market served; 

18 ‘‘(B) is established using reasonable actu19 arial techniques; and 

20 ‘‘(C) reflects anticipated claims experience 

21 and expenses for the coverage involved. 

22 ‘‘(3) STATE.—The term ‘State’ means any of 

23 the 50 States and the District of Columbia.’’. 
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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply to grants for fiscal 

3 years beginning with fiscal year 2005. 

4 (d) CHANGE IN ALLOTMENT FORMULA FOR OPER5 ATIONAL GRANTS.—Subsection (b)(2) of such section is 

6 amended—

7 (1) by inserting ‘‘(before fiscal year 2005)’’ 

8 after ‘‘for a fiscal year’’; and 

9 (2) by adding at the end the following: ‘‘The 

10 amount appropriated under subsection (c)(2) for a 

11 fiscal year beginning with fiscal year 2005 shall be 

12 made available to the States (including entities that 

13 operate the high risk pool under applicable State law 

14 in a State) that qualify for a grant under subsection 

15 (b) as follows: 

16 ‘‘(A) An amount equal to 50 percent of the 

17 amount shall be allocated in equal amounts 

18 among such qualifying States. 

19 ‘‘(B) An amount equal to 25 percent of the 

20 amount shall be allocated among such States so 

21 that the amount provided to a State bears the 

22 same ratio to such available amount as the 

23 number of uninsured individuals in the State 

24 bears to the total number of uninsured individ-
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1 uals in all such States (as determined by the 

2 Secretary). 

3 ‘‘(C) An amount equal to 25 percent of the 

4 amount shall be allocated among such States so 

5 that the amount provided to a State bears the 

6 same ratio to such available amount as the 

7 number of individuals enrolled in health care 

8 coverage through the qualified high risk pool of 

9 the State bears to the total number of individ10 uals so enrolled through qualified high risk 

11 pools in all such States (as determined by the 

12 Secretary).’’. 

13 (e) ADMINISTRATIVE PROVISIONS.—Such section is 

14 amended by adding at the end the following new sub15 section: 

16 ‘‘(e) ADMINISTRATIVE PROVISIONS.—

17 ‘‘(1) APPLICATIONS.—To be eligible for a grant 

18 under this section, a State shall submit to the Sec19 retary an application at such time, in such manner, 

20 and containing such information as the secretary 

21 may require. 

22 ‘‘(2) NO ENTITLEMENT.—Nothing in this sec23 tion shall be construed as providing a State with an 

24 entitlement to a grant under this section.’’.

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