I 
108TH CONGRESS 
1ST SESSION H. R. 1937
To amend the Internal Revenue Code of 1986 to provide tax incentives 
to encourage small business health plans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 1, 2003
Mr. MOORE introduced the following bill; which was referred to the Committee 
on Ways and Means, and in addition to the Committees on Energy and 
Commerce and Small Business, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Internal Revenue Code of 1986 to provide 
tax incentives to encourage small business health plans, 
and for other purposes.
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 
Insurance Affordability Act of 2003’’.
SEC. 2. DEDUCTION FOR 100 PERCENT OF HEALTH INSUR-
ANCE COSTS OF SELF-EMPLOYED INDIVID-
UALS. 
(a) IN GENERAL.—Paragraph (1) of section 162(l) 
is amended to read as follows: 
‘‘(1) ALLOWANCE OF DEDUCTION.—In the case 
of an individual who is an employee within the 
meaning of section 401(c)(1), there shall be allowed 
as a deduction under this section an amount equal 
to 100 percent of the amount paid during the tax-
able year for insurance which constitutes medical 
care for the taxpayer and the taxpayer’s spouse and 
dependents.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
December 31, 2003. 
SEC. 3. CREDIT FOR HEALTH INSURANCE EXPENSES OF 
SMALL BUSINESSES. 
(a) IN GENERAL.—Subpart D of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to business-related credits) is amended by 
adding at the end the following: 
‘‘SEC. 45G. SMALL BUSINESS HEALTH INSURANCE EX-
PENSES. 
‘‘(a) GENERAL RULE.—For purposes of section 38, 
in the case of a small employer, the health insurance credit
determined under this section for the taxable year is an 
amount equal to the applicable percentage of the expenses 
paid by the taxpayer during the taxable year for health 
insurance coverage for such year for employees of such 
employer. 
‘‘(b) APPLICABLE PERCENTAGE.—For purposes of 
subsection (a), the applicable percentage is—
‘‘(1) in the case of insurance purchased as a 
member of a qualified health benefit purchasing coa-
lition (as defined in section 9841), 40 percent, and 
‘‘(2) in the case of insurance not described in 
paragraph (1), 30 percent. 
‘‘(c) LIMITATIONS.—
‘‘(1) PER
EMPLOYEE
DOLLAR
LIMITATION.—
The amount of expenses taken into account under 
subsection (a) with respect to any employee for any 
taxable year shall not exceed—
‘‘(A) in the case of insurance purchased as 
a member of a coalition referred to in sub-
section (b)(1)—
‘‘(i) $800 in the case of self-only cov-
erage, and 
‘‘(ii) $2,000 in the case of family cov-
erage, and 
‘‘(B) in any other case—
‘‘(i) $600 in the case of self-only cov-
erage, and 
‘‘(ii) $1,500 in the case of family cov-
erage. 
In the case of an employee who is covered for only 
a portion of such taxable year, the limitation under 
the preceding sentence shall be an amount which 
bears the same ratio to such limitation (determined 
without regard to this sentence) as such portion 
bears to the entire taxable year. 
‘‘(2) PERIOD OF COVERAGE.—Expenses may be 
taken into account under subsection (a) only with 
respect to coverage for the 4-year period beginning 
on the later of—
‘‘(A) the date of the enactment of this sec-
tion, or 
‘‘(B) the earliest date that the employee is 
covered under the plan. 
‘‘(3) EMPLOYER MUST BEAR 65 PERCENT OF 
COST AND COVER 70 PERCENT OF QUALIFIED EM-
PLOYEES.—Expenses may be taken into account 
under subsection (a) only if—
‘‘(A) at least 65 percent of the cost of the 
coverage (without regard to this section) is 
borne by the employer, and
‘‘(B) the plan provides health insurance 
coverage to at least 70 percent of the qualified 
employees of such employer. 
‘‘(d) DEFINITIONS.—For purposes of this section—
‘‘(1) HEALTH
INSURANCE
COVERAGE.—The 
term ‘health insurance coverage’ has the meaning 
given such term by section 9832(b)(1). 
‘‘(2) QUALIFIED EMPLOYEE.—
‘‘(A) IN
GENERAL.—The term ‘qualified 
employee’ means any employee of an employer 
if the annual rate of such employee’s compensa-
tion (as defined in section 414(s)) does not ex-
ceed $40,000. 
‘‘(B) TREATMENT
OF
CERTAIN
EMPLOY-
EES.—The term ‘employee’ shall include a 
leased employee within the meaning of section 
414(n). 
‘‘(C) REDUCTION OF CREDIT FOR EMPLOY-
EES EARNING MORE THAN $30,000.—If the an-
nual rate of an employee’s compensation (as de-
fined in section 414(s)) exceeds $30,000, the 
limitation under subsection (c)(1) (determined 
without regard to this clause) shall be reduced 
(but not below zero) by an amount which bears
the same ratio to such limitation as such excess 
bears to $10,000. 
‘‘(D) EMPLOYEES
HAVING
FAMILY
COV-
ERAGE.—In the case of an employee who has 
family coverage—
‘‘(i) subparagraph (A) shall be applied 
by substituting ‘$50,000’ for ‘$40,000’, 
and 
‘‘(ii) subparagraph (C) shall be ap-
plied 
by 
substituting 
‘$40,000’ 
for 
‘$30,000’. 
‘‘(3) SMALL EMPLOYER.—The term ‘small em-
ployer’ has the meaning given to such term by sec-
tion 4980D(d)(2); except that only qualified employ-
ees shall be taken into account. 
‘‘(e) SPECIAL RULES.—
‘‘(1) CERTAIN RULES MADE APPLICABLE.—For 
purposes of this section, rules similar to the rules of 
section 52 shall apply. 
‘‘(2) AMOUNTS
PAID
UNDER
SALARY
REDUC-
TION ARRANGEMENTS.—No amount paid or incurred 
pursuant to a salary reduction arrangement shall be 
taken into account under subsection (a). 
‘‘(3) INFLATION ADJUSTMENT.—In the case of 
any taxable year beginning in a calendar year after
2004, each dollar amount contained in subsections 
(c)(1) and (d)(2)(B) shall be increased by an 
amount equal to—
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar 
year in which the taxable year begins, deter-
mined by substituting ‘calendar year 2003’ for 
‘calendar year 1992’ in subparagraph (B) 
thereof. 
Any increase determined under the preceding sen-
tence shall be rounded to the nearest multiple of 
$50. 
‘‘(f) TERMINATION.—This section shall not apply to 
expenses paid or incurred by an employer with respect to 
any arrangement established on or after January 1, 
2010.’’. 
(b) CREDIT TO BE PART OF GENERAL BUSINESS 
CREDIT.—Section 38(b) of such Code (relating to current 
year business credit) is amended by striking ‘‘plus’’ at the 
end of paragraph (13), by striking the period at the end 
of paragraph (14) and inserting ‘‘, plus’’, and by adding 
at the end the following:
‘‘(15) in the case of a small employer (as de-
fined in section 45G(d)(3)), the health insurance 
credit determined under section 45G(a).’’
(c) NO CARRYBACKS.—Subsection (d) of section 39 
of such Code (relating to carryback and carryforward of 
unused credits) is amended by adding at the end the fol-
lowing: 
‘‘(11) NO CARRYBACK OF SECTION 45G CREDIT 
BEFORE EFFECTIVE DATE.—No portion of the un-
used business credit for any taxable year which is 
attributable to the employee health insurance ex-
penses credit determined under section 45G may be 
carried back to a taxable year beginning before Jan-
uary 1, 2004.’’
(d) DENIAL OF DOUBLE BENEFIT.—Section 280C of 
such Code is amended by adding at the end the following 
new subsection: 
‘‘(d) CREDIT FOR SMALL BUSINESS HEALTH INSUR-
ANCE EXPENSES.—
‘‘(1) IN GENERAL.—No deduction shall be al-
lowed for that portion of the expenses (otherwise al-
lowable as a deduction) taken into account in deter-
mining the credit under section 45G for the taxable 
year which is equal to the amount of the credit de-
termined for such taxable year under section 
45G(a). 
‘‘(2) CONTROLLED
GROUPS.—Persons treated 
as a single employer under subsection (a) or (b) of 
section 52 shall be treated as 1 person for purposes 
of this section.’’
(e) CLERICAL AMENDMENT.—The table of sections 
for subpart D of part IV of subchapter A of chapter 1 
of such Code is amended by adding at the end the fol-
lowing:
‘‘Sec. 45G. Small business health insurance expenses.’’
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to amounts paid or incurred in tax-
able years beginning after December 31, 2003, for ar-
rangements established after the date of the enactment 
of this Act. 
SEC. 4. CERTAIN GRANTS BY PRIVATE FOUNDATIONS TO 
QUALIFIED HEALTH BENEFIT PURCHASING
COALITIONS. 
(a) IN GENERAL.—Section 4942 of the Internal Rev-
enue Code of 1986 (relating to taxes on failure to dis-
tribute income) is amended by adding at the end the fol-
lowing: 
‘‘(k) CERTAIN QUALIFIED HEALTH BENEFIT PUR-
CHASING COALITION DISTRIBUTIONS.—
‘‘(1) IN GENERAL.—For purposes of subsection 
(g), sections 170, 501, 507, 509, and 2522, and this 
chapter, a qualified health benefit purchasing coali-
tion distribution by a private foundation shall be 
considered to be a distribution for a charitable pur-
pose. 
‘‘(2) 
QUALIFIED
HEALTH
BENEFIT
PUR-
CHASING COALITION DISTRIBUTION.—For purposes 
of paragraph (1)—
‘‘(A) IN
GENERAL.—The term ‘qualified 
health benefit purchasing coalition distribution’ 
means any amount paid or incurred by a pri-
vate foundation to or on behalf of a qualified 
health benefit purchasing coalition (as defined 
in section 9841) for purposes of payment or re-
imbursement of amounts paid or incurred in 
connection with the establishment and mainte-
nance of such coalition. 
‘‘(B) EXCLUSIONS.—Such term shall not 
include any amount used by a qualified health 
benefit purchasing coalition (as so defined)—
‘‘(i) for the purchase of real property, 
‘‘(ii) as payment to, or for the benefit 
of, members (or employees or affiliates of 
such members) of such coalition, or
‘‘(iii) for any expense paid or incurred 
more than 48 months after the date of es-
tablishment of such coalition. 
‘‘(3) TERMINATION.—This subsection shall not 
apply—
‘‘(A) to qualified health benefit purchasing 
coalition distributions paid or incurred after 
December 31, 2010, and 
‘‘(B) with respect to start-up costs of a co-
alition which are paid or incurred after Decem-
ber 31, 2012.’’. 
(b) QUALIFIED HEALTH BENEFIT PURCHASING CO-
ALITION.—
(1) IN GENERAL.—Chapter 100 of such Code 
(relating to group health plan requirements) is 
amended by adding at the end the following new 
subchapter: 
‘‘Subchapter D—Qualified Health Benefit 
Purchasing Coalition
‘‘Sec.
9841.
Qualified health benefit purchasing coalition.
‘‘SEC. 9841. QUALIFIED HEALTH BENEFIT PURCHASING
COALITION. 
‘‘(a) IN GENERAL.—A qualified health benefit pur-
chasing coalition is a private not-for-profit corporation 
which—
‘‘(1) sells health insurance through State li-
censed health insurance issuers in the State in which 
the employers to which such coalition is providing 
insurance are located, and 
‘‘(2) establishes to the Secretary, under State 
certification procedures or other procedures as the 
Secretary may provide by regulation, that such coali-
tion meets the requirements of this section. 
‘‘(b) BOARD OF DIRECTORS.—
‘‘(1) IN GENERAL.—Each purchasing coalition 
under this section shall be governed by a Board of 
Directors. 
‘‘(2) ELECTION.—The Secretary shall establish 
procedures governing election of such Board. 
‘‘(3) MEMBERSHIP.—The Board of Directors 
shall—
‘‘(A) be composed of representatives of the 
members of the coalition, in equal number, in-
cluding small employers and employee rep-
resentatives of such employers, but 
‘‘(B) not include other interested parties, 
such as health care service providers, health in-
surers, or insurance agents or brokers which 
may have a conflict of interest with the pur-
poses of the coalition.
‘‘(c) MEMBERSHIP OF COALITION.—
‘‘(1) IN
GENERAL.—A purchasing coalition 
shall accept all small employers residing within the 
area served by the coalition as members if such em-
ployers request such membership. 
‘‘(2) OTHER MEMBERS.—The coalition, at the 
discretion of its Board of Directors, may be open to 
individuals and large employers.
‘‘(3) VOTING.—Members of a purchasing coali-
tion shall have voting rights consistent with the rules 
established by the State. 
‘‘(d) DUTIES OF PURCHASING COALITIONS.—Each 
purchasing coalition shall—
‘‘(1) enter into agreements with small employ-
ers (and, at the discretion of its Board, with individ-
uals and other employers) to provide health insur-
ance benefits to employees and retirees of such em-
ployers, 
‘‘(2) where it is feasible and advisable, enter 
into agreements with 3 or more unaffiliated, quali-
fied licensed health plans, to offer benefits to mem-
bers, 
‘‘(3) offer to members at least 1 open enroll-
ment period of at least 30 days per calendar year,