109TH CONGRESS 
1ST SESSION H. R. 4519
AN ACT 
To amend the Public Health Service Act to extend funding 
for the operation of State high risk health insurance pools.
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 ‘‘State High Risk Pool 
Funding Extension Act of 2005’’. 
SEC. 2. EXTENSION OF FUNDING FOR OPERATION OF 
STATE 
HIGH 
RISK 
HEALTH 
INSURANCE 
POOLS. 
Section 2745 of the Public Health Service Act (42 
U.S.C. 300gg–45) is amended to read as follows: 
‘‘SEC. 2745. RELIEF FOR HIGH RISK POOLS. 
‘‘(a) SEED GRANTS TO STATES.—The Secretary shall 
provide from the funds appropriated under subsection 
(d)(1)(A) a grant of up to $1,000,000 to each State that 
has not created a qualified high risk pool as of the date 
of enactment of the State High Risk Pool Funding Exten-
sion Act of 2005 for the State’s costs of creation and ini-
tial operation of such a pool. 
‘‘(b) GRANTS FOR OPERATIONAL LOSSES.—
‘‘(1) IN GENERAL.—In the case of a State that 
has established a qualified high risk pool that—
‘‘(A) restricts premiums charged under the 
pool to no more than 200 percent of the pre-
mium for applicable standard risk rates; 
‘‘(B) offers a choice of two or more cov-
erage options through the pool; and 
‘‘(C) has in effect a mechanism reasonably 
designed to ensure continued funding of losses
incurred by the State in connection with oper-
ation of the pool after the end of the last fiscal 
year for which a grant is provided under this 
paragraph; 
the Secretary shall provide, from the funds appro-
priated under paragraphs (1)(B)(i) and (2)(A) of 
subsection (d) and allotted to the State under para-
graph (2), a grant for the losses incurred by the 
State in connection with the operation of the pool. 
‘‘(2) ALLOTMENT.—Subject to paragraph (4), 
the 
amounts 
appropriated 
under 
paragraphs 
(1)(B)(i) and (2)(A) of subsection (d) for a fiscal 
year shall be allotted and made available to the 
States (or the entities that operate the high risk pool 
under applicable State law) that qualify for a grant 
under paragraph (1) as follows: 
‘‘(A) An amount equal to 40 percent of 
such appropriated amount for the fiscal year 
shall be allotted in equal amounts to each quali-
fying State that is one of the 50 States or the 
District of Columbia and that applies for a 
grant under this subsection. 
‘‘(B) An amount equal to 30 percent of 
such appropriated amount for the fiscal year 
shall be allotted among qualifying States that
apply for such a grant so that the amount allot-
ted to such a State bears the same ratio to such 
appropriated amount as the number of unin-
sured individuals in the State bears to the total 
number of uninsured individuals (as determined 
by the Secretary) in all qualifying States that 
so apply. 
‘‘(C) An amount equal to 30 percent of 
such appropriated amount for the fiscal year 
shall be allotted among qualifying States that 
apply for such a grant so that the amount allot-
ted to a State bears the same ratio to such ap-
propriated amount as the number of individuals 
enrolled in health care coverage through the 
qualified high risk pool of the State bears to the 
total number of individuals so enrolled through 
qualified high risk pools (as determined by the 
Secretary) in all qualifying States that so apply. 
‘‘(3) SPECIAL
RULE
FOR
POOLS
CHARGING 
HIGHER PREMIUMS.—In the case of a qualified high 
risk pool of a State which charges premiums that ex-
ceed 150 percent of the premium for applicable 
standard risks, the State shall use at least 50 per-
cent of the amount of the grant provided to the
State to carry out this subsection to reduce pre-
miums for enrollees. 
‘‘(4) LIMITATION
FOR
TERRITORIES.—In no 
case shall the aggregate amount allotted and made 
available under paragraph (2) for a fiscal year to 
States that are not the 50 States or the District of 
Columbia exceed $1,000,000. 
‘‘(c) BONUS GRANTS
FOR SUPPLEMENTAL CON-
SUMER BENEFITS.—
‘‘(1) IN GENERAL.—In the case of a State that 
is one of the 50 States or the District of Columbia, 
that has established a qualified high risk pool, and 
that is receiving a grant under subsection (b)(1), the 
Secretary shall provide, from the funds appropriated 
under paragraphs (1)(B)(ii) and (2)(B) of sub-
section (d) and allotted to the State under para-
graph (3), a grant to be used to provide supple-
mental consumer benefits to enrollees or potential 
enrollees (or defined subsets of such enrollees or po-
tential enrollees) in qualified high risk pools. 
‘‘(2) BENEFITS.—A State shall use amounts re-
ceived under a grant under this subsection to pro-
vide one or more of the following benefits: 
‘‘(A) Low-income premium subsidies.