I 
111TH CONGRESS 
1ST SESSION H. R. 3824 
To allow States to establish interstate compacts for the purpose of expanding 
health insurance options. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 15, 2009 
Mr. DEAL of Georgia (for himself, Mr. BURGESS, Mr. PITTS, Mr. BLUNT, Mr. 
BARTON of Texas, and Mr. BUYER) introduced the following bill; which 
was referred to the Committee on Energy and Commerce 
A BILL 
To allow States to establish interstate compacts for the 
purpose of expanding health insurance options. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Expanded Health In-
surance Options Act of 2009’’. 
SEC. 2. EXPANDING HEALTH INSURANCE OPTIONS. 
(a) 
MORE
AFFORDABLE
HEALTH
COVERAGE 
THROUGH STATE COMPACTS.— 
(1) AUTHORIZING
COMPACTS.—States 
may 
enter into arrangements with other States for the 
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purposes of forming one or more interstate com-
pacts— 
(A) that meet the requirements of this sub-
section; and 
(B) under which health insurance issuers 
would offer health insurance coverage meeting 
the requirements of this subsection under a uni-
fied regulatory structure to residents of the 
States that are parties to the compact. 
(2) REGULATORY STRUCTURE.—The regulatory 
structure under such a compact may include regula-
tions relating to the issuance, renewal, rating, man-
dated benefits, and similar items with respect to 
health insurance coverage. 
(3) REGULATION; GRIEVANCES.—Health insur-
ance coverage offered in a State that is a party to 
such a compact shall be regulated by the State in-
volved in the manner specified in the compact and 
any grievances with respect to such coverage shall be 
handled in the State in which the covered individual 
resides. 
(4) CONTINUATION
OF
ANTI-FRAUD
ACTIVI-
TIES.—Nothing in this section shall be construed to 
prohibit a State from engaging in anti-fraud activi-
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ties for the purposes of enforcing regulations or 
other provisions within such a compact. 
(5) INDEPENDENT EXTERNAL APPEALS.—Each 
interstate compact shall ensure that individuals who 
are insured in a State that participates in an inter-
state compact are able to access an independent ex-
ternal appeals process to review decisions made by 
health insurance issuers relating to the health insur-
ance coverage of such individual. 
(b) RESPONSIBILITY OF PRIMARY STATE.—In the 
case of an activity described in paragraph (1)(A) that oc-
curs in a State that is participating in an interstate com-
pact, the primary State, or the State in which the insur-
ance issuer is licensed, is responsible for the enforcement 
of applicable laws, regulations, agreements, and orders 
governing the health insurance issuers and health insur-
ance coverage involved, including laws relating to the fol-
lowing: 
(1) The offer, sale, rating, renewal, and 
issuance of individual health insurance coverage. 
(2) The coverage of health care and insurance 
related services. 
(3) Management, operations, and investment 
activities of a health insurance issuer. 
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(4) Liability loss control and claims administra-
tion. 
(c) RESPONSIBILITY OF SECONDARY STATE.—The 
secondary State that is participating in an interstate com-
pact, or the State in which the individual resides, may re-
quire a health insurance issuer— 
(1) to pay premiums and taxes; 
(2) to submit to examination of financial condi-
tion; 
(3) to comply with State laws regarding fraud 
and abuse; and 
(4) to comply with laws regarding unfair claims 
practices. 
(d) DISCLOSURE.—The health insurance issuer must 
provide a clear disclosure to the individual that the issuer 
is in a secondary State and all laws and regulations of 
the secondary State are applicable. 
(e) EFFECTIVE DATE.—This subsection shall apply 
beginning 1 year after the date of the enactment of this 
Act. 
(f) DEFINITIONS.—In this section: 
(1) The terms ‘‘health insurance coverage’’ and 
‘‘health insurance issuer’’ have the meanings given 
such terms in section 2791 of the Public Health 
Service Act. 
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(2) The term ‘‘State’’ means each of the 50 
States and the District of Columbia. 
Æ 
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