I
107TH CONGRESS
2D SESSION
H. R. 4021
To provide incentives to States to apply for section 1115 waivers to use
Federal funds to provide for affordable employer-based health insurance
coverage for the uninsured workers of small businesses in the State.
IN THE HOUSE OF REPRESENTATIVES
MARCH 20, 2002
Mr. ALLEN (for himself, Mr. BALDACCI, Mr. BARRETT of Wisconsin, Ms.
CARSON of Indiana, Mr. CUMMINGS, Mr. CONYERS, Mr. FROST, Mr.
LANGEVIN, and Mr. SHOWS) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To provide incentives to States to apply for section 1115
waivers to use Federal funds to provide for affordable
employer-based health insurance coverage for the unin-
sured workers of small businesses in the State.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Small Business Health Insurance Relief Act of 2002’’.
(b) FINDINGS.—The Congress finds the following:
(1) Of the 39,000,000 uninsured Americans, 72
percent are either full-time workers or dependents of
those workers.
(2) Of the uninsured working population, 56
percent are employed by small businesses.
(3) Of the working population, more than 74
percent are covered by employer-sponsored health in-
surance.
(4) Small businesses are less likely to offer
health insurance to their employees, and employees
of those small businesses are less likely to partici-
pate in a health plan when it is offered to them,
when compared with larger businesses and employ-
ees of larger businesses.
(5) Implementation of the policy set forth in
this Act in participating States will reduce the num-
ber of low-income workers without health insurance
in those States.
(6) Because individuals without health insur-
ance do not seek preventive care or early interven-
tion, when those individuals suffer from a serious
medical condition, they are often faced with large
medical bills which they cannot pay.
(7) The costs of unpaid medical bills by individ-
uals without health insurance are often shifted to
private and Government payers.
(8) By increasing access to affordable health in-
surance for low-income workers, this Act will con-
tribute to the health and well-being of those individ-
uals, as well as reduce costs for those who bear the
burden of uncompensated care.
SEC. 2. INCENTIVES TO PROVIDE HEALTH INSURANCE COV-
ERAGE FOR THE WORKING UNINSURED.
(a) IN GENERAL.—For each State that applies for
a waiver under section 1115 of the Social Security Act
(42 U.S.C. 1315) that includes, as a part of that waiver,
the use of funds otherwise paid to the State under the
medicaid program or the State children’s health insurance
program to provide eligible uninsured employees health in-
surance coverage that meets the requirements of sub-
section (b), the Secretary may award the State, upon ap-
proval of that waiver, an incentive payment (not to exceed
$1,000,000) to assist the State in carrying out the waiver.
(b) REQUIREMENTS.—To be eligible for an incentive
payment under subsection (a), an application for a section
1115 waiver, with respect to health insurance coverage,
shall meet the following requirements:
(ii) In the case of health insurance cov-
erage provided by purchasing coverage through
the medicaid program, provides for a benefit
package that is at least actuarially equivalent to
the required scope of medical assistance (as de-
fined in section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)) under the State plan
of the State.
(B) LIMIT
ON
EMPLOYEE
COST
SHAR-
ING.—Provide that an employee covered under
the program pay no more than a nominal
amount of the employee’s income (as deter-
mined by the State) for costs of premiums,
deductibles, coinsurance, and copayments under
the plan.
(4) CONSULTATION
WITH
AFFECTED
ENTI-
TIES.—Provide for consultation with representatives
of affected entities and organizations, both public
and private, in developing a plan to provide such
health insurance coverage.
(5) OUTREACH
MECHANISMS.—Describe the
outreach mechanisms to be used to assure coverage
of all eligible individuals, including measures to as-
sure coverage of individuals in hard-to-reach popu-
lations and to assure benefits are provided to eligible
individuals located in underserved areas.
(6) QUALITY
ASSURANCE.—Provide, and de-
scribe, mechanisms to be used to assure, monitor,
and maintain the quality of items and services fur-
nished under the waiver.
(7) MAINTENANCE OF EFFORT.—Provide that
employers who, as of the date of the enactment of
this Act, offer health insurance coverage to or pay
a percentage of premiums for such health insurance
coverage for employees and who participate under
the demonstration project maintain or increase levels
of coverage or contributions to employees health in-
surance over those levels in effect before the imple-
mentation of the waiver.
(8) BUDGET.—Incorporate a budget. Such
budget shall include a description (and an estimate
of costs) of transitional activities to be undertaken
in implementing the proposed plan.
(9) IMPLEMENTATION.—Describe the method
(including a timetable and period of transition) for
implementing the waiver.
(c) CONSTRUCTION.—Nothing in this Act shall be
construed as preempting State laws that provide greater
protections or benefits than the protections or benefits re-
quired under this Act.
(d) DEFINITIONS.—As used in this Act:
(1) ELIGIBLE
UNINSURED
EMPLOYEES.—The
term ‘‘eligible uninsured employees’’ means—
(A) any resident of the United States—
(i) who is a citizen or national of the
United States, or lawful resident alien;
(ii) who resides in any particular
State;
(iii) who is employed in a work site of
an employer that is a small business lo-
cated in the State;
(iv)(I) whose employer does not offer
employer-sponsored health insurance; or
(II) whose employer offers such insur-
ance but at a cost that is not affordable
for the resident (as determined by the
State); and
(v) who is not entitled to benefits
under title XIX or XXI of the Social Secu-
rity Act based on eligibility requirements
under those titles in effect on or after the
date of the enactment of this Act; and
(B) the spouse and dependent children of
such resident
(2) LAWFUL
RESIDENT
ALIEN.—The term
‘‘lawful resident alien’’ means an alien lawfully ad-
mitted for permanent residence and any other alien
lawfully residing permanently in the United States
under color of law, including an alien granted asy-
lum or with lawful temporary resident status under
section 210, 210A, or 245A of the Immigration and
Nationality Act.
(3) SMALL BUSINESS.—The term ‘‘small busi-
ness’’ means an employer who employs 50 or fewer
employees.
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
(5) STATE.—The term ‘‘State’’ means a State,
the District of Columbia, the Commonwealth of
Puerto Rico, the United States Virgin Islands,
Guam, American Samoa, and the Commonwealth of
the Northern Mariana Islands.
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