I 
108TH CONGRESS 
2D SESSION 
H. R. 5341
To amend title XXVII of the Public Health Service Act to extend Federal 
funding for the establishment and operation of State high risk health 
insurance pools. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 8, 2004
Mr. SHADEGG (for himself and Mr. NETHERCUTT) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XXVII of the Public Health Service Act 
to extend Federal funding for the establishment and 
operation of State high risk health insurance 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 ‘‘State High Risk Pool 
Funding Extension Act of 2004’’.
SEC. 2. EXTENSION OF FUNDING FOR ESTABLISHMENT AND 
OPERATION OF STATE HIGH RISK HEALTH IN-
SURANCE POOLS. 
(a) EXTENSION OF AVAILABILITY OF SEED FUNDING 
FOR ADDITIONAL YEAR.—The second sentence of sub-
section (c) of section 2745 of the Public Health Service 
Act (42 U.S.C. 300gg–45) is amended by striking ‘‘under 
this subsection for a fiscal year’’ and inserting ‘‘under 
paragraph (1) shall be available for obligation through the 
end of fiscal year 2005 and funds appropriated under 
paragraph (2) for a fiscal year’’. 
(b) FUNDING FOR OPERATION OF STATE HIGH RISK 
POOLS IN FISCAL YEAR 2005.—Subsection (c)(2) of such 
section is amended by inserting ‘‘and $50,000,000 for fis-
cal year 2005’’ after ‘‘2004’’. 
(c) CHANGE
IN REQUIREMENTS
FOR QUALIFIED 
HIGH RISK POOLS.—
(1) CHANGE
IN
REQUIREMENT
FOR
OPER-
ATIONAL
GRANTS.—Subsection (b)(1)(A) of such 
section is amended by striking ‘‘150 percent’’ and 
inserting ‘‘200 percent’’. 
(2) CHANGE
IN
DEFINITION
OF
QUALIFIED 
HIGH RISK POOL.—Subsection (d) of such section is 
amended to read as follows: 
‘‘(d) DEFINITIONS.—In this section:
‘‘(1) QUALIFIED HIGH RISK POOL.—The term 
‘qualified high risk pool’ has the meaning given such 
term in section 2744(c)(2), except that a State may 
elect to meet the requirement of subparagraph (A) 
of such section (insofar as it requires the provision 
of coverage to all eligible individuals) through pro-
viding for the enrollment of eligible individuals 
through an acceptable alternative mechanism (as de-
fined for purposes of section 2744) that includes a 
high risk pool as a component. 
‘‘(2) STANDARD RISK RATE.—The term ‘stand-
ard risk rate’ means a rate that—
‘‘(A) is determined under the State high 
risk pool by considering the premium rates 
charged by other health insurers offering health 
insurance coverage to individuals in the insur-
ance market served; 
‘‘(B) is established using reasonable actu-
arial techniques; and 
‘‘(C) reflects anticipated claims experience 
and expenses for the coverage involved. 
‘‘(3) STATE.—The term ‘State’ means any of 
the 50 States and the District of Columbia.’’.
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to grants for fiscal 
years beginning with fiscal year 2005. 
(d) CHANGE IN ALLOTMENT FORMULA FOR OPER-
ATIONAL GRANTS.—Subsection (b)(2) of such section is 
amended—
(1) by inserting ‘‘(before fiscal year 2005)’’ 
after ‘‘for a fiscal year’’; and 
(2) by adding at the end the following: ‘‘The 
amount appropriated under subsection (c)(2) for a 
fiscal year beginning with fiscal year 2005 shall be 
made available to the States (including entities that 
operate the high risk pool under applicable State law 
in a State) that qualify for a grant under subsection 
(b) as follows: 
‘‘(A) An amount equal to 50 percent of the 
amount shall be allocated in equal amounts 
among such qualifying States. 
‘‘(B) An amount equal to 25 percent of the 
amount shall be allocated among such States so 
that the amount provided to a State bears the 
same ratio to such available amount as the 
number of uninsured individuals in the State 
bears to the total number of uninsured individ-
uals in all such States (as determined by the 
Secretary). 
‘‘(C) An amount equal to 25 percent of the 
amount shall be allocated among such States so 
that the amount provided to a State bears the 
same ratio to such available amount as the 
number of individuals enrolled in health care 
coverage through the qualified high risk pool of 
the State bears to the total number of individ-
uals so enrolled through qualified high risk 
pools in all such States (as determined by the 
Secretary).’’. 
(e) ADMINISTRATIVE PROVISIONS.—Such section is 
amended by adding at the end the following new sub-
section: 
‘‘(e) ADMINISTRATIVE PROVISIONS.—
‘‘(1) APPLICATIONS.—To be eligible for a grant 
under this section, a State shall submit to the Sec-
retary an application at such time, in such manner, 
and containing such information as the secretary 
may require. 
‘‘(2) NO ENTITLEMENT.—Nothing in this sec-
tion shall be construed as providing a State with an 
entitlement to a grant under this section.’’.
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