I 
111TH CONGRESS 
1ST SESSION H. R. 3741 
To provide Federal matching funding for State insurance expenditures for 
high-risk pools. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 7, 2009 
Mr. HOEKSTRA introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To provide Federal matching funding for State insurance 
expenditures for high-risk pools. 
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 ‘‘Assuring Coverage for 
Americans with Pre-existing Conditions Act of 2009’’. 
SEC. 2. FEDERAL MATCHING FUNDING FOR STATE INSUR-
ANCE EXPENDITURES. 
(a) IN GENERAL.—Subject to the succeeding provi-
sions of this section, each State shall receive from the Sec-
retary of Health and Human Services an amount equal 
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to 50 percent of the funds expended by the State in pro-
viding for the use, in connection with providing health ben-
efits coverage, of a high-risk pool, a reinsurance pool, or 
other risk-adjustment mechanism used for the purpose of 
subsidizing the purchase of private health insurance. 
(b) FUNDING LIMITATION.—A State shall not receive 
under this section for a fiscal year more than a total of 
50 cents multiplied by the average number of residents 
(as estimated by the Secretary) in the State in the fiscal 
year. 
(c) ADMINISTRATION.—The Secretary of Health and 
Human Services shall provide for the administration of 
this section and may establish such terms and conditions, 
including the requirement of an application, as may be ap-
propriate to carry out this section. 
(d) CONSTRUCTION.—Nothing in this section shall be 
construed as requiring a State to operate a reinsurance 
pool (or other risk-adjustment mechanism) under this sec-
tion or as preventing a State from operating such a pool 
or mechanism through one or more private entities. 
(e) HIGH-RISK POOL.—For purposes of this section, 
the term ‘‘high-risk pool’’ means any qualified high risk 
pool (as defined in section 2744(c)(2) of the Public Health 
Service Act). 
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(f) REINSURANCE POOL OR OTHER RISK-ADJUST-
MENT MECHANISM DEFINED.—For purposes of this sec-
tion, the term ‘‘reinsurance pool or other risk-adjustment 
mechanism’’ means any State-based risk spreading mecha-
nism to subsidize the purchase of private health insurance 
for the high-risk population. 
(g) HIGH-RISK POPULATION.—For purposes of this 
section, the term ‘‘high-risk population’’ means— 
(1) individuals who, by reason of the existence 
or history of a medical condition, are able to acquire 
health coverage only at rates which are at least 150 
percent of the standard risk rates for such coverage, 
and 
(2) individuals who are provided health cov-
erage by a high-risk pool. 
(h) STATE DEFINED.—For purposes of this section, 
the term ‘‘State’’ includes the District of Columbia, Puer-
to Rico, the Virgin Islands, Guam, American Samoa, and 
the Northern Mariana Islands. 
Æ 
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