I
106TH CONGRESS
2D SESSION
H. R. 4119
To amend the Public Health Service Act to expand health care access and
choice of coverage through Individiual Membership Associations (IMAs).
IN THE HOUSE OF REPRESENTATIVES
MARCH 29, 2000
Mr. SHADEGG (for himself and Mr. LIPINSKI) introduced the following bill;
which was referred to the Committee on Commerce
A BILL
To amend the Public Health Service Act to expand health
care access and choice of coverage through Individiual
Membership Associations (IMAs).
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; CONSTITUTIONAL AUTHORITY.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Health Care Access and Availability Act of 2000’’.
(b) CONSTITUTIONAL AUTHORITY TO ENACT THIS
LEGISLATION.—The constitutional authority upon which
this Act rests is the power of Congress to regulate com-
merce with foreign nations and among the several States,
set forth in article I, section 8 of the United States Con-
stitution.
SEC. 2. EXPANSION OF ACCESS AND CHOICE THROUGH IN-
DIVIDUAL 
MEMBERSHIP 
ASSOCIATIONS
(IMAs).
The Public Health Service Act is amended by adding
at the end the following new title:
‘‘TITLE XXVIII—INDIVIDUAL MEMBERSHIP
ASSOCIATIONS
‘‘SEC. 2801. DEFINITION OF INDIVIDUAL MEMBERSHIP AS-
SOCIATION (IMA).
‘‘(a) IN GENERAL.—For purposes of this title, the
terms ‘individual membership association’ and ‘IMA’
mean a legal entity that meets the following requirements:
‘‘(1) ORGANIZATION.—The IMA is an organiza-
tion operated under the direction of an association
(as defined in section 2804(1)).
‘‘(2) 
OFFERING
HEALTH
BENEFITS
COV-
ERAGE.—
‘‘(A) DIFFERENT GROUPS.—The IMA, in
conjunction with those health insurance issuers
that offer health benefits coverage through the
IMA, makes available health benefits coverage
in the manner described in subsection (b) to all
members of the IMA and the dependents of
‘‘(C) Coverage in connection with a li-
censed provider-sponsored organization.
‘‘(D) Indemnity coverage through an insur-
ance company.
‘‘(E) Coverage offered in connection with a
contribution into a medical savings account or
flexible spending account.
‘‘(F) Coverage that includes a point-of-
service option.
‘‘(G) Any combination of such types of
coverage.
‘‘(3) 
HEALTH
INSURANCE
COVERAGE
OP-
TIONS.—An IMA shall include a minimum of 2
health insurance coverage options. At least 1 option
shall meet all applicable State benefit mandates.
‘‘(4) WELLNESS BONUSES FOR HEALTH PRO-
MOTION.—Nothing in this title shall be construed as
precluding a health insurance issuer offering health
benefits coverage through an IMA from establishing
premium discounts or rebates for members or from
modifying 
otherwise 
applicable 
copayments 
or
deductibles in return for adherence to programs of
health promotion and disease prevention so long as
such programs are agreed to in advance by the IMA
and comply with all other provisions of this title and
do not discriminate among similarly situated mem-
bers.
‘‘(c) MEMBERS; HEALTH INSURANCE ISSUERS.—
‘‘(1) MEMBERS.—
‘‘(A) IN
GENERAL.—Under rules estab-
lished to carry out this title, with respect to an
individual who is a member of an IMA, the in-
dividual may apply for health benefits coverage
(including coverage for dependents of such indi-
vidual) offered by a health insurance issuer
through the IMA.
‘‘(B) RULES FOR ENROLLMENT.—Nothing
in this paragraph shall preclude an IMA from
establishing rules of enrollment and reenroll-
ment of members. Such rules shall be applied
consistently to all members within the IMA and
shall not be based in any manner on health sta-
tus-related factors.
‘‘(2) HEALTH INSURANCE ISSUERS.—The con-
tract between an IMA and a health insurance issuer
shall provide, with respect to a member enrolled with
health benefits coverage offered by the issuer
through the IMA, for the payment of the premiums
collected by the issuer.
‘‘SEC. 2802. APPLICATION OF CERTAIN LAWS AND REQUIRE-
MENTS.
‘‘State laws insofar as they relate to any of the fol-
lowing are superseded and shall not apply to health bene-
fits coverage made available through an IMA:
‘‘(1) Benefit requirements for health benefits
coverage offered through an IMA, including (but not
limited to) requirements relating to coverage of spe-
cific providers, specific services or conditions, or the
amount, duration, or scope of benefits, but not in-
cluding requirements to the extent required to imple-
ment title XXVII or other Federal law and to the
extent the requirement prohibits an exclusion of a
specific disease from such coverage.
‘‘(2) Any other requirements (including limita-
tions on compensation arrangements) that, directly
or indirectly, preclude (or have the effect of pre-
cluding) the offering of such coverage through an
IMA, if the IMA meets the requirements of this
title.
Any State law or regulation relating to the composition
or organization of an IMA is preempted to the extent the
law or regulation is inconsistent with the provisions of this
title.
‘‘SEC. 2803. ADMINISTRATION.
‘‘(a) IN GENERAL.—The Secretary shall administer
this title and is authorized to issue such regulations as
may be required to carry out this title. Such regulations
shall be subject to Congressional review under the provi-
sions of chapter 8 of title 5, United States Code. The Sec-
retary shall incorporate the process of ‘deemed file and
use’ with respect to the information filed under section
2801(a)(5)(A) and shall determine whether information
filed by an IMA demonstrates compliance with the applica-
ble requirements of this title. The Secretary shall exercise
authority under this title in a manner that fosters and
promotes the development of IMAs in order to improve
access to health care coverage and services.
‘‘(b) PERIODIC REPORTS.—The Secretary shall sub-
mit to Congress a report every 30 months, during the 10-
year period beginning on the effective date of the rules
promulgated by the Secretary to carry out this title, on
the effectiveness of this title in promoting coverage of un-
insured individuals. The Secretary may provide for the
production of such reports through one or more contracts
with appropriate private entities.
‘‘SEC. 2804. DEFINITIONS.
‘‘For purposes of this title:
‘‘(1) ASSOCIATION.—The term ‘association’
means, with respect to health insurance coverage of-
fered in a State, an association which—
‘‘(A) has been actively in existence for at
least 5 years;
‘‘(B) has been formed and maintained in
good faith for purposes other than obtaining in-
surance;
‘‘(C) does not condition membership in the
association on any health status-related factor
relating to an individual (including an employee
of an employer or a dependent of an employee);
and
‘‘(D) does not make health insurance cov-
erage offered through the association available
other than in connection with a member of the
association.
‘‘(2) DEPENDENT.—The term ‘dependent’, as
applied to health insurance coverage offered by a
health insurance issuer licensed (or otherwise regu-
lated) in a State, shall have the meaning applied to
such term with respect to such coverage under the
laws of the State relating to such coverage and such
an issuer. Such term may include the spouse and
children of the individual involved.