I 
108TH CONGRESS 
1ST SESSION H. R. 2698
To provide for a system of health insurance certificates to increase the 
number of Americans with health insurance coverage. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 10, 2003
Mr. BILIRAKIS (for himself, Mr. TOWNS, Mr. FLETCHER, and Mr. WALDEN 
of Oregon) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To provide for a system of health insurance certificates to 
increase the number of Americans with 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 ‘‘Health Insurance Cer-
tificate Act of 2003’’. 
SEC. 2. ESTABLISHMENT OF PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
retary’’) shall establish a program for the issuance to eligi-
ble individuals of health insurance certificates which may 
be applied towards the cost of purchasing qualified health 
insurance coverage for such individuals and family mem-
bers. The issuance of such certificates for any fiscal year 
is limited to the amount appropriated under subsection (f) 
for such fiscal year. 
(b) ELIGIBILITY.—
(1) IN GENERAL.—For purposes of this Act, 
the terms ‘‘eligible individual’’ and ‘‘qualified family 
member’’ mean, with respect to a month, an adult 
or family member, respectively, who—
(A) is a citizen or national of the United 
States or an alien permanently residing lawfully 
in the United States as of the first day of the 
month; 
(B) is under 65 years of age as of the last 
day of the month; and 
(C) is not eligible to be covered under pub-
lic coverage described in paragraph (3) as of 
the first day of the month. 
(2) NO
CERTIFICATE
FOR
COVERED
FAMILY 
MEMBERS.—
(A) IN GENERAL.—No certificate shall be 
issued under this section to a member of the 
family of a principal eligible individual if the
family member is covered under the qualified 
health insurance coverage covering the principal 
eligible individual. 
(B) MEMBER OF FAMILY.—For purposes 
of this Act, the term ‘‘member of family’’ has 
the meaning given such term under section 
8901(5) of title 5, United States Code. 
(C) SPOUSE.—For purposes of this Act, 
the term ‘‘married’’ and ‘‘spouse’’ shall have 
the meaning given such term for purposes of 
chapter 89 of title 5, United States Code. 
(D) NO DUPLICATION.—In no case may 
the certificate value of more than one certificate 
take into account any member of a family and, 
with respect to an eligible individual, no more 
than 2 member of the individual’s family (other 
than the spouse of the individual) shall be taken 
into account. 
(3) EXCLUSION FOR THOSE ELIGIBLE FOR COV-
ERAGE UNDER PUBLIC PROGRAM.—Subject to para-
graph (4), an individual is not an eligible individual 
as of the first day of a month if such individual is 
eligible to be covered as of such day under any med-
ical care program described in—
(A) title XVIII, XIX, or XXI of the Social 
Security Act; 
(B) chapter 55 of title 10, United States 
Code; 
(C) chapter 17 of title 38, United States 
Code; 
(D) chapter 89 of title 5, United States 
Code; or 
(E) the Indian Health Care Improvement 
Act. 
(4) TREATMENT OF COBRA CONTINUATION COV-
ERAGE.—In the case of continuation coverage under 
a group health plan which is required to be provided 
by Federal law for an individual during the period 
specified in section 602(2) of the Employee Retire-
ment Income Security Act of 1974, section 
4980B(f)(2)(B) of the Internal Revenue Code of 
1986, or section 2202(2) of the Public Health Serv-
ice Act, or coverage under chapter 89 of title 5, 
United States Code which is required to be provided 
under section 8905a of title 5, United States Code, 
paragraph (3) shall not apply with respect to such
continuation coverage and the coverage shall be 
treated as qualified health insurance coverage. 
(c) HEALTH INSURANCE CERTIFICATES.—
(1) IN GENERAL.—The Secretary shall design 
health insurance certificates to be in a form so that, 
when presented to the issuer of a qualified health in-
surance coverage, the issuer may secure directly 
from the Secretary the value specified in the certifi-
cate towards the cost of purchasing such coverage. 
Once paid, the Secretary may not seek reimburse-
ment from the issuer if there is a finding that any 
relevant information provided by an individual was 
incorrect. A certificate is issued with respect to the 
costs of obtaining health insurance coverage in a 
year for a specified eligible individual (and family 
members) and may not be used for such coverage in 
any other period. 
(2) LIMITATION.—In no case shall the value of 
the certificate, as applied with respect to health in-
surance coverage, be applied towards an amount 
that exceeds—
(A) 70 percent of the premium for cov-
erage for the period involved, or 
(B) in the case of a certificate described in 
subsection (d)(2), 70 percent of the employee’s 
premium for coverage under the group health 
plan involved.
(3) FORM OF CERTIFICATE.—A health insur-
ance certificate for a year shall be valued and paid 
as follows: 
(A) VALUE.—The value of the certificate 
for a year shall be determined based upon a 
methodology for determining income specified 
by the Secretary that is similar to that applied 
for purposes of determining eligibility on the 
basis of income under needs-based Federal pro-
grams and that may be based on the standards 
used under section 1612 for purposes of the 
supplemental security income program. Such 
methodology under this section may allow for 
use of both a Federal methodology and alter-
nate State methodologies where the Secretary 
deems appropriate for ease of administration 
and coordination of programs. The Secretary 
may provide for self-certification of information 
by individuals where the Secretary deems ap-
propriate for administration of the program. 
(B) AVAILABILITY
OF
GROUP
HEALTH 
PLAN COVERAGE.—If an individual is (for the 
individual or for the individual’s family mem-
bers) eligible for coverage under a group health 
plan and the premium charged the individual
for such coverage does not exceed 50 percent of 
the cost of coverage, such an individual is eligi-
ble only for a certificate under section (d)(2) 
and not under subsection (d)(1). 
(C) MINIMUM THRESHOLD FOR ISSUANCE 
OF CERTIFICATE.—No health insurance certifi-
cate shall be issued under this section where the 
annualized value of the certificate is less than 
$200. 
(d) VALUE OF CERTIFICATE.—
(1) IN GENERAL.—The annualized value of a 
health insurance certificate for an eligible individual 
shall be determined as follows (and applied on a 
monthly basis based on 1⁄12 of such annualized 
value): 
(A) UNMARRIED INDIVIDUAL WITH NO DE-
PENDENT FAMILY MEMBERS.—Subject to sub-
paragraph (C)(i), in the case of an eligible indi-
vidual who is not married, who has no depend-
ent family members, who has qualified health 
insurance coverage, and whose income—
(i) is $13,000 or less, the annualized 
value of the certificate is $1,000; or 
(ii) exceeds $13,000, the annualized 
value of the certificate be equal to $1,000