I 
109TH CONGRESS 
2D SESSION 
H. R. 5475 
To amend title XXVII of the Public Health Service Act to permit a health 
insurance issuer an alternative to guaranteed issue of health insurance 
coverage in the small group market in order to promote affordable 
access to portable health insurance coverage. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 24, 2006 
Mr. ROGERS of Michigan (for himself, Mr. MILLER of Florida, Ms. GINNY 
BROWN-WAITE of Florida, Mr. SOUDER, Mr. WICKER, and Mrs. CAPITO) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend title XXVII of the Public Health Service Act 
to permit a health insurance issuer an alternative to 
guaranteed issue of health insurance coverage in the 
small group market in order to promote affordable access 
to portable health insurance coverage. 
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 ‘‘HSA Accessibility and 
Portability Act of 2006’’. 
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SEC. 2. PROMOTING ACCESSIBILITY AND AFFORDABILITY 
OF COVERAGE IN THE SMALL GROUP MAR-
KET. 
Section 2711 of the Public Health Service Act (42 
U.S.C. 300gg–11) is amended— 
(1) in subsection (a)(1), by striking ‘‘(f)’’ and 
inserting ‘‘(g)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(g) ELECTION OF ALTERNATIVE TO GUARANTEED 
ISSUE REQUIREMENT.— 
‘‘(1) ELECTION.— 
‘‘(A) IN
GENERAL.—A health insurance 
issuer may elect, with respect to any small em-
ployer (as defined in section 2791(e)(4)), to 
meet the requirements of paragraphs (2) and 
(3) instead of complying with the guaranteed 
issue requirement of subsection (a). 
‘‘(B) REQUIREMENT OF ACCEPTING OR RE-
JECTING
ALL
ELIGIBLE
INDIVIDUALS
WITHIN 
ENTIRE
GROUP
AT
TIME
OF
ELECTION.—An 
election made under subparagraph (A) with re-
spect to a small employer shall apply with re-
spect to all eligible individuals of that small em-
ployer at the time of such election. 
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‘‘(C) SUBSEQUENT
ELIGIBLE
INDIVID-
UALS.—In the case of an individual who be-
comes an eligible individual with respect to a 
small employer after an election has been made 
under subparagraph (A), the health insurance 
issuer is not required to provide group health 
insurance coverage for such individual. 
‘‘(2) PORTABILITY
FOR
INDIVIDUALS
COV-
ERED.—If an election is made under paragraph 
(1)(A) and under such election group health insur-
ance coverage is provided by a health insurance 
issuer for an eligible individual of a small employer, 
the health insurance issuer shall guarantee continu-
ation of coverage to the individual (and to covered 
dependents), through issuance of individual health 
insurance coverage, after the date the individual no 
longer qualifies as an eligible individual of such em-
ployer, at a rate that does not exceed 150 percent 
of the standard individual rate applicable to such in-
dividual coverage in the State in which the policy 
was initially issued. 
‘‘(3) 
INFORMATION
ON
ELECTIONS.—Any 
health insurance issuer making an election under 
paragraph (1)(A) shall furnish to the Secretary such 
information as the Secretary may require in order to 
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monitor the impact of such election on access to, 
and affordability, of health insurance coverage in the 
small group market and in the individual market. 
Such information shall include at least information 
relating to the following: 
‘‘(A) REJECTION RATE.—The characteris-
tics of small employers denied health insurance 
coverage because of this subsection. 
‘‘(B) PREMIUM RATES.—The rates charged 
for coverage offered under an election made 
under this subsection (in comparison to rates 
that are otherwise charged if this subsection 
were not in effect). 
‘‘(4) LIMITATION.—An election under para-
graph (1)(A) may only be made with respect to cov-
erage of a small employer under health insurance 
coverage that consists of a high deductible health 
plan (as defined in section 223(c)(2) of the Internal 
Revenue Code of 1986) and a contribution to a 
health savings account (as defined in section 223(d) 
of such Code). 
‘‘(5) REPORT.—At least 6 months before the 
end of the 5-year period beginning on the date of the 
enactment of this subsection, the Secretary shall 
submit to Congress a report on the impact of this 
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subsection on the availability and affordability of 
health insurance coverage in the small group market 
and in the individual market. Such report shall in-
clude recommendations on whether this subsection 
should be extended beyond such period and whether 
it should be expanded to cover health insurance cov-
erage in addition to the coverage described in para-
graph (4). 
‘‘(6) CONTINGENT
SUNSET.—This subsection 
shall not apply to elections for small employers made 
by a health insurance issuer after the end of the 5- 
year period described in paragraph (5) if the Sec-
retary, in the report to Congress under such para-
graph, recommends that this subsection should not 
be extended beyond such period. If the Secretary 
makes such a recommendation, this subsection shall 
still continue to apply to elections made before the 
end of such 5-year period.’’. 
Æ 
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