I 
111TH CONGRESS 
1ST SESSION H. R. 1558 
To amend title I of the Employee Retirement Income Security Act of 1974, 
title XXVII of the Public Health Service Act, and the Internal Revenue 
Code of 1986 to prohibit preexisting condition exclusions in group health 
plans and health insurance coverage in the group and individual markets. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 17, 2009 
Mr. COURTNEY (for himself, Mr. SCHIFF, Mrs. CAPPS, Ms. DELAURO, Ms. 
CLARKE, Mr. LANGEVIN, Ms. SCHAKOWSKY, Ms. SCHWARTZ, Mr. MASSA, 
Ms. BALDWIN, Ms. ROS-LEHTINEN, Ms. PINGREE of Maine, and Mrs. 
DAVIS of California) introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Commit-
tees on Ways and Means and Education and Labor, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee con-
cerned 
A BILL 
To amend title I of the Employee Retirement Income Secu-
rity Act of 1974, title XXVII of the Public Health Serv-
ice Act, and the Internal Revenue Code of 1986 to pro-
hibit preexisting condition exclusions in group health 
plans and health insurance coverage in the group and 
individual markets. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Preexisting Condition 
Patient Protection Act of 2009’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
(1) According to the United States Census Bu-
reau, 45.7 million people were uninsured in 2007. 
(2) According to a recent study by the Com-
monwealth Fund, the number of underinsured adults 
aged 19 to 64 has jumped 60 percent over the last 
4 years, from 16,000,000 in 2003 to 25,000,000 in 
2007. 
(3) According to the Centers for Disease Con-
trol and Prevention (CDC), approximately 45 per-
cent of Americans have at least one chronic condi-
tion. 
(4) Forty-four States currently allow insurance 
companies to deny coverage for, limit coverage for, 
or charge increased premiums for a preexisting con-
dition. 
(5) Over 26 million people were enrolled in pri-
vate individual market health plans in 2007. Under 
the Health Insurance Portability and Accountability 
Act of 1996 (HIPAA), these individuals have no 
protections against pre-existing condition exclusions 
or waiting periods. 
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(6) When a child or adult has a 63-day gap in 
insurance coverage, pre-existing condition exclusions, 
such as limiting coverage or instituting a waiting pe-
riod, can be placed on them when they become in-
sured under a new health insurance policy. 
(7) Eliminating pre-existing condition exclu-
sions for all is a vital safeguard to ensuring that all 
Americans have access to health care when in need. 
(8) According to a Kaiser Family Foundation/ 
Harvard School of Public Health public opinion poll, 
58 percent of Americans strongly favor the Federal 
Government requiring health insurance companies to 
cover anyone who applies for health coverage, even 
if they have a prior illness. 
SEC. 3. AMENDMENTS RELATING TO PREEXISTING CONDI-
TION EXCLUSIONS UNDER GROUP HEALTH 
PLANS. 
(a) AMENDMENTS TO THE EMPLOYEE RETIREMENT 
INCOME SECURITY ACT OF 1974.— 
(1) ELIMINATION OF PREEXISTING CONDITION 
EXCLUSIONS.—Section 701 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 1181) 
is amended— 
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(A) by amending the heading to read as 
follows: ‘‘ELIMINATION
OF
PREEXISTING 
CONDITION EXCLUSIONS’’; 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, with respect to a participant or beneficiary— 
‘‘(1) may not impose any preexisting condition 
exclusion; and 
‘‘(2) in the case of a group health plan that of-
fers medical care through health insurance coverage 
offered by a health maintenance organization, may 
not provide for an affiliation period with respect to 
coverage through the organization.’’; 
(C) in subsection (b), by striking para-
graph (3) and inserting the following: 
‘‘(3) AFFILIATION
PERIOD.—The term ‘affili-
ation period’ means a period which, under the terms 
of the health insurance coverage offered by the 
health maintenance organization, must expire before 
the health insurance coverage becomes effective.’’; 
(D) by striking subsections (c), (d), (e), 
and (g); and 
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(E) by redesignating subsection (f) (relat-
ing to special enrollment periods) as subsection 
(c). 
(2) CLERICAL AMENDMENT.—The item in the 
table of contents of such Act relating to section 701 
is amended to read as follows: 
‘‘Sec. 701. Elimination of preexisting condition exclusions.’’. 
(b) AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT.— 
(1) IN GENERAL.—Section 2701 of the Public 
Health Service Act (42 U.S.C. 300gg) is amended— 
(A) by amending the heading to read as 
follows: ‘‘ELIMINATION
OF
PREEXISTING 
CONDITION EXCLUSIONS’’; 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, with respect to a participant or beneficiary— 
‘‘(1) may not impose any preexisting condition 
exclusion; and 
‘‘(2) in the case of a group health plan that of-
fers medical care through health insurance coverage 
offered by a health maintenance organization, may 
not provide for an affiliation period with respect to 
coverage through the organization.’’; 
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(C) in subsection (b), by striking para-
graph (3) and inserting the following: 
‘‘(3) AFFILIATION
PERIOD.—The term ‘affili-
ation period’ means a period which, under the terms 
of the health insurance coverage offered by the 
health maintenance organization, must expire before 
the health insurance coverage becomes effective.’’; 
(D) by striking subsections (c), (d), (e), 
and (g); and 
(E) by redesignating subsection (f) (relat-
ing to special enrollment periods) as subsection 
(c). 
(2) TECHNICAL
AMENDMENTS
RELATING
TO 
EMPLOYER
SIZE.—Section 2711 of such Act (42 
U.S.C. 300gg–11) is amended— 
(A) in subsection (a)— 
(i) 
in 
the 
heading, 
by 
striking 
‘‘SMALL’’; 
(ii) in paragraph (1)— 
(I) in the matter before subpara-
graph (A), by striking ‘‘(c) through 
(f)’’ and inserting ‘‘(b) through (d)’’ 
and by striking ‘‘small’’; and 
(II) in subparagraph (A), by 
striking ‘‘small employer (as defined 
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in section 2791(e)(4))’’ and inserting 
‘‘employer’’; and 
(iii) in paragraph (2)— 
(I) by striking ‘‘small’’ each place 
it appears; and 
(II) by striking ‘‘coverage to a’’ 
and inserting ‘‘coverage to an’’; 
(B) by striking subsection (b); 
(C) in subsections (c), (d), and (e), by 
striking ‘‘small’’ each place it appears; and 
(D) by striking subsection (f). 
(c) AMENDMENTS
TO
THE INTERNAL REVENUE 
CODE OF 1986.— 
(1) ELIMINATION OF PREEXISTING CONDITION 
EXCLUSIONS.—Section 9801 of the Internal Revenue 
Code of 1986 is amended— 
(A) by amending the heading to read as 
follows: ‘‘ELIMINATION
OF
PREEXISTING 
CONDITION EXCLUSIONS’’; 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) IN GENERAL.—A group health plan with respect 
to a participant or beneficiary may not impose any pre-
existing condition exclusion.’’; 
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(C) by striking paragraph (3) of subsection 
(b); 
(D) by striking subsections (c), (d), and 
(e); and 
(E) by redesignating subsection (f) (relat-
ing to special enrollment periods) as subsection 
(c). 
(2) CLERICAL AMENDMENT.—The item in the 
table of sections of chapter 100 of such Code relat-
ing to section 9801 is amended to read as follows: 
‘‘Sec. 9801. Elimination of preexisting condition exclusions.’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply with respect to group health plans for 
plan years beginning after the end of the 12th cal-
endar month following the date of the enactment of 
this Act. 
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group 
health plan maintained pursuant to one or more col-
lective bargaining agreements between employee rep-
resentatives and one or more employers ratified be-
fore the date of the enactment of this Act, the 
amendments made by this section shall not apply to 
plan years beginning before the later of— 
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(A) the date on which the last of the col-
lective bargaining agreements relating to the 
plan terminates (determined without regard to 
any extension thereof agreed to after the date 
of the enactment of this Act), or 
(B) the date that is after the end of the 
12th calendar month following the date of the 
enactment of this Act. 
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining 
agreement relating to the plan which amends the 
plan solely to conform to any requirement added by 
the amendments made by this section shall not be 
treated as a termination of such collective bar-
gaining agreement. 
SEC. 4. PROHIBITION OF PREEXISTING CONDITION EXCLU-
SIONS IN HEALTH INSURANCE COVERAGE IN 
THE INDIVIDUAL MARKET. 
(a) IN GENERAL.—Section 2741 of the Public Health 
Service Act (42 U.S.C. 300gg–41) is amended— 
(1) in subsection (a)(1), by striking ‘‘with re-
spect to an eligible individual’’ and all that follows 
and inserting the following: ‘‘with respect to— 
‘‘(A) an eligible individual (as defined in 
subsection (b)) desiring to enroll in individual 
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health insurance coverage decline to offer such 
coverage to, or deny enrollment of, such indi-
vidual; and 
‘‘(B) any individual desiring to enroll in 
such coverage impose any preexisting condition 
exclusion (as defined in section 2701(b)(1)(A)) 
with respect to such coverage.’’; and 
(2) in subsection (a)(2), by striking ‘‘paragraph 
(1)’’ and inserting ‘‘paragraph (1)(A)’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to health insurance 
coverage offered, sold, issued, renewed, in effect, or oper-
ated in the individual market on or after the end of the 
12th month following the date of the enactment of this 
Act. 
SEC. 5. TRANSPARENCY IN CLAIMS DATA. 
(a) IN GENERAL.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall submit to Congress a report 
on the impact of this Act on health benefits coverage. 
(b) EXAMINATION
OF CLAIMS EXPERIENCE
AND 
OTHER DATA.—In preparing the report under subsection 
(a), the Secretary may request from group health plans 
and health insurance issuers— 
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(1) data on claims experience under the plan or 
health insurance coverage issued by such issuers, 
such as the number, nature, and dollar amount of 
claims made by enrollees during the period involved; 
(2) data relating to enrollees in the plan or 
under such coverage, such as number of new enroll-
ees, number of individuals reenrolling (or dis-
continuing enrollment) after the first year of cov-
erage, and changes in the demographic composition 
of enrollees; and 
(3) such other information as the Secretary 
deems appropriate. 
The provisions of section 2722(b) of the Public Health 
Service Act shall apply to a failure of a group health plan 
or health insurance issuer to provide data or information 
requested by the Secretary under this subsection in the 
same manner as such provisions apply to the enforcement 
of a provision of part A of title XXVIII of such Act, except 
that any reference to an individual in paragraph (1)(C)(i) 
of such section shall be deemed for this purpose a ref-
erence to a covered life under the plan or health insurance 
coverage involved. 
SEC. 6. GAO REPORT. 
Not later than 1 year after the date of the enactment 
of this Act, the Comptroller General of the United States 
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shall submit to Congress a report on the impact of this 
Act (and other Federal laws regarding the regulation of 
health insurance and health benefits coverage) on the re-
duction in the number of uninsured and underinsured in-
dividuals in the group market and the individual market 
and on the affordability of coverage in such markets. 
Æ 
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