I 
110TH CONGRESS 
1ST SESSION H. R. 2132 
To amend the Public Health Service Act to establish a small business health 
benefits program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 3, 2007 
Mr. ALLEN (for himself, Mrs. CAPPS, Mr. CARNAHAN, Mr. DOGGETT, Ms. 
SCHAKOWSKY, Mr. WAXMAN, Ms. BALDWIN, Mr. EMANUEL, Mr. GENE 
GREEN of Texas, Ms. MCCOLLUM of Minnesota, and Ms. DELAURO) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on 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 jurisdic-
tion of the committee concerned 
A BILL 
To amend the Public Health Service Act to establish a small 
business health benefits program. 
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 ‘‘Small Business Health 
Plans Act of 2007’’. 
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SEC. 2. SMALL BUSINESS HEALTH BENEFITS PROGRAM 
(SBHBP). 
Title XXVII of the Public Health Service Act is 
amended— 
(1) by redesignating part C as part D; and 
(2) by inserting after part B the following new 
part: 
‘‘PART C—SMALL BUSINESS HEALTH BENEFITS 
PROGRAM (SBHBP) 
‘‘SEC. 2771. SMALL BUSINESS HEALTH BENEFITS PROGRAM. 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish a small business health benefits program under which 
small employers may offer health insurance coverage to 
employees and their dependents. 
‘‘(b) PROGRAM ELEMENTS.—Under the SBHBP: 
‘‘(1) ACCESS TO INSURANCE.—Small employers 
are provided access, for years beginning on or after 
January 1, 2007, to qualified health pooling ar-
rangements under which their employees may elect 
self-only or family health insurance coverage under 
at least 2 health insurance coverage policies, regard-
less of whether premium assistance referred to in 
paragraph (2) is available with respect to such em-
ployer. 
‘‘(2) PREMIUM
ASSISTANCE
FOR
SMALL
EM-
PLOYERS.—Premium assistance is available under 
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subsection (c) to assist small employers in the pay-
ment of premiums for the health insurance coverage 
provided. 
‘‘(3) EMPLOYER SHARE OF PREMIUMS.— 
‘‘(A) IN GENERAL.—Small employers are 
provided access to health insurance coverage, 
and may be eligible for premium assistance 
under subsection (c), only if they pay (before 
the application of any premium assistance 
under subsection (c)) at least 50 percent of the 
premiums for coverage of their employees, but 
such employers are not required to pay for the 
portion of the premiums for dependents of em-
ployees. 
‘‘(B) CONSTRUCTION.—Nothing in this 
section shall be construed as preventing an em-
ployee from applying the payment described in 
subparagraph (A) towards the payment of pre-
miums for family health insurance coverage. 
‘‘(4) HEALTH INSURANCE COVERAGE.— 
‘‘(A) IN GENERAL.—Health insurance cov-
erage offered under SBHBP shall meet the fol-
lowing requirements: 
‘‘(i) The Secretary determines that 
the coverage is substantially similar to 
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health benefits coverage in any of the four 
largest health benefit plans (determined by 
enrollment) offered under chapter 89 of 
title 5, United States Code. 
‘‘(ii) The coverage complies with State 
laws and regulations (including applicable 
benefit mandates, rating requirements, and 
other consumer protections) for group 
health insurance coverage for the State in 
which the coverage is offered. 
‘‘(iii) The Secretary determines that 
the coverage provided to employees is co-
ordinated, in accordance with regulations 
prescribed by the Secretary, with other 
coverage provided under governmental 
health benefits programs under which 
health benefits coverage is available to 
such employees. 
‘‘(B) STANDARDS
FOR
PARTICIPATING 
HEALTH INSURERS.—In administering the pro-
gram, the Secretary may consider the solvency 
and claims payment history of health insurers 
and shall promote participation by qualified 
health insurers that establish— 
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‘‘(i) integration of health information 
technology tools to promote quality; 
‘‘(ii) chronic disease management; 
‘‘(iii) preventive health care services; 
and 
‘‘(iv) evidence-based medicine consid-
erations of prescription drugs and other 
treatment that take into account the indi-
vidual medical circumstances of individuals 
enrolled in the program. 
‘‘(5) ENROLLMENT.—In administering the pro-
gram, the Secretary shall provide that employee en-
rollment (and changes in enrollment) are limited to 
an annual open enrollment period, except in the case 
of change of employment status (including new a 
new employee) that affects eligibility for coverage 
and in the case of qualifying events (such as change 
in family status) specified by the Secretary and con-
sistent with section 2701(f). 
‘‘(c) PREMIUM ASSISTANCE.—Under the SBHBP, 
the Secretary shall establish a program of premium assist-
ance for small employers. Such program shall provide for 
a sliding scale of assistance to such employers taking into 
account the following: 
‘‘(1) The number of employees of the employer. 
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‘‘(2) The average wage level of such employees 
relative to the average wage level for employees in 
the same geographic area. 
‘‘(3) The profit margin of the employer. 
‘‘(d) REINSURANCE FOR CATASTROPHIC COSTS FOR 
CERTAIN HEALTH INSURANCE ISSUERS.— 
‘‘(1) IN GENERAL.—In the case of health insur-
ance coverage offered under the SBHBP by a health 
insurance issuer that participates in a qualified 
health pooling arrangement, the Secretary shall pro-
vide for reinsurance coverage for 75 percent of cov-
ered claims that exceed, for an individual for a year, 
an amount determined by the Secretary for such 
year which is not less than the minimum amount 
specified in paragraph (2). 
‘‘(2) 
MINIMUM
AMOUNT.—The 
minimum 
amount specified in this paragraph is— 
‘‘(A) for the first year in which this section 
is in effect, $100,000; or 
‘‘(B) for a subsequent year is the min-
imum amount specified in this paragraph for a 
previous year, increased by the Secretary’s esti-
mate of the average annual percentage increase 
in health insurance coverage with a median 
level of premiums for the previous year. 
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Any amount determined under subparagraph (B) 
which is not a multiple of $1,000 shall be rounded 
to the nearest multiple of $1,000. 
‘‘(e) QUALIFIED
HEALTH
POOLING
ARRANGE-
MENT.—For purposes of this section, the term ‘qualified 
health pooling arrangement’ means, with respect to em-
ployees employed in any State for any year— 
‘‘(1) except as provided in subparagraph (B), 
an arrangement established by (and operating under 
the oversight of) such State for purposes of this sec-
tion, in accordance with regulations of the Secretary, 
which provides for pooling of health insurance cov-
erage offered for such year in such State, and 
‘‘(2) in any case in which there is not in effect 
for any year an arrangement described in subpara-
graph (A) established by such State, the national 
health pooling arrangement established under sec-
tion 3. 
The Secretary shall determine, within a reasonable time 
prior to each year, whether there is a qualified health pool-
ing arrangement described in paragraph (1) with respect 
to employees employed in any State. 
‘‘(f) SMALL EMPLOYER DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of this part, 
except as otherwise provided in this subsection, the 
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term ‘small employer’ means an employer with 50 or 
fewer employees, as determined under regulations 
promulgated by the Secretary. 
‘‘(2) CONTINUATION
OF
PARTICIPATION.—An 
employer whose employees are provided health insur-
ance coverage under the SBHBP while the employer 
is a small employer as defined in paragraph (1) and 
who thereafter has more than 50 employees shall 
continue to be treated as a small employer. 
‘‘(3) EMPLOYERS NOT IN EXISTENCE IN PRE-
CEDING YEAR.—In the case of an employer which 
was not in existence for the full year prior to the 
date on which the employer applies to participate in 
SBHBP, the determination of whether such em-
ployer meets the requirements of paragraph (1) shall 
be based on the average number of employees that 
it is reasonably expected such employer will employ 
on business days in the employer’s first full year. 
‘‘(4) WAIVER.—The Secretary may waive the 
limitations relating to the size of an employer which 
may participate under SBHBP on a case by case 
basis if the Secretary determines that such employer 
makes a compelling case for such a waiver. In mak-
ing determinations under this paragraph, the Sec-
retary shall consider the effects of the employment 
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of temporary and seasonal workers and other related 
factors. 
‘‘(g) OTHER DEFINITIONS.—For purposes of this 
part: 
‘‘(1) The terms ‘employee’ and ‘dependent’ have 
the meanings given such terms by the Secretary in 
regulations and shall be based upon the definitions 
of such terms used for purposes of the Federal em-
ployee health benefits program established under 
chapter 89 of title 5, United States Code. The term 
‘employee’ includes, in the case of a partnership or 
sole proprietorship, a partner in the partnership or 
the sole proprietor, including an individual employer 
who has no employees. Such may include, with re-
spect to an employer and at the employer’s option, 
part-time and seasonal employees. 
‘‘(2) The term ‘SBHBP’ means the small busi-
ness health benefits program established under this 
section. 
‘‘(h) GRANTS FOR STATE QUALIFIED HEALTH POOL-
ING ARRANGEMENTS.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
grants to States for the establishment, initial admin-
istration, and operations of qualified health pooling 
arrangements described in subsection (e)(1). 
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‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as may be necessary to carry out this subsection. 
‘‘SEC. 2772. ESTABLISHMENT OF NATIONAL HEALTH POOL-
ING ARRANGEMENT. 
‘‘(a) IN GENERAL.—The Secretary and the Secretary 
of Labor, acting jointly and in consultation with the Direc-
tor of the Office of Personnel Management, shall provide 
for— 
‘‘(1) the offering on a timely basis consistent 
with section 2771 of a national health pooling ar-
rangement to eligible small employers; and 
‘‘(2) appropriate oversight over any such ar-
rangement. 
‘‘(b) SPECIFIC REQUIREMENTS.—In carrying out 
subsection (a), the Secretary and the Secretary of Labor 
shall— 
‘‘(1) model the national health pooling arrange-
ment on the Federal employees health benefits pro-
gram under chapter 89 of title 5, United States 
Code, to the extent practicable and consistent with 
the other requirements of this part; 
‘‘(2) consistent with paragraph (1), negotiate 
the most affordable and substantial coverage pos-
sible for small employers; and 
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‘‘(3) not offer any health plan under such ar-
rangement unless the plan meets the restrictions re-
lating to premium rates contained in the most recent 
‘Small Employer Health Insurance Availability 
Model Act’ of the National Association of Insurance 
Commissioners . 
‘‘(c) DEFINITIONS.—For purposes of this section— 
‘‘(1) the term ‘national health pooling arrange-
ment’ means an arrangement which provides for 
pooling of health insurance coverage offered for any 
year in all States which do not have in effect for 
such year an arrangement for pooling of health in-
surance coverage offered in such States; and 
‘‘(2) in connection with the national health 
pooling arrangement offered pursuant to this sec-
tion, an individual employer shall be taken into ac-
count as an employee under this section.’’. 
Æ 
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