I 
111TH CONGRESS 
1ST SESSION H. R. 2360 
To amend the Public Health Service Act to establish a nationwide health 
insurance purchasing pool for small businesses and the self-employed 
that would offer a choice of private health plans and make health cov-
erage more affordable, predictable, and accessible. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 12, 2009 
Mr. KIND (for himself, Mr. GERLACH, Mr. BARROW, Mr. YOUNG of Florida, 
Mr. ADLER of New Jersey, Mrs. EMERSON, Ms. KOSMAS, Mr. BARTLETT, 
Mrs. HALVORSON, Mr. SCHOCK, Mr. ALTMIRE, Ms. GINNY BROWN- 
WAITE of Florida, Mr. PETERS, Ms. GRANGER, Mr. MCMAHON, Mr. 
DENT, Ms. BEAN, Mr. JOHNSON of Illinois, Ms. SCHWARTZ, Mr. 
COURTNEY, and Mr. CARNAHAN) introduced the following bill; which was 
referred to the Committee on Energy and Commerce, and in addition to 
the Committees on Education and Labor, Ways and Means, and Rules, 
for a period to be subsequently determined 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 Public Health Service Act to establish a na-
tionwide health insurance purchasing pool for small busi-
nesses and the self-employed that would offer a choice 
of private health plans and make health coverage more 
affordable, predictable, and accessible. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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clude employers who employed an average of at least 
1 but not more than 100 employees (who worked an 
average of at least 35 hours per week) on business 
days during the year preceding the date of applica-
tion, and shall include self-employed individuals with 
either not less than $5,000 in net earnings or not 
less than $15,000 in gross earnings from self-em-
ployment in the preceding taxable year. Such term 
shall not include the Federal Government. 
‘‘(5) HEALTH
INSURANCE
COVERAGE.—The 
term ‘health insurance coverage’ has the meaning 
given such term in section 2791. 
‘‘(6) HEALTH INSURANCE ISSUER.—The term 
‘health insurance issuer’ has the meaning given such 
term in section 2791. 
‘‘(7) HEALTH STATUS-RELATED FACTOR.—The 
term ‘health status-related factor’ has the meaning 
given such term in section 2791(d)(9). 
‘‘(8) PARTICIPATING
EMPLOYER.—The term 
‘participating employer’ means an employer that— 
‘‘(A) elects to provide health insurance cov-
erage under this title to its employees; and 
‘‘(B) is not offering other comprehensive 
health insurance coverage to such employees. 
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‘‘(b) APPLICATION OF CERTAIN RULES IN DETER-
MINATION OF EMPLOYER SIZE.—For purposes of sub-
section (a)(3): 
‘‘(1) APPLICATION OF AGGREGATION RULE FOR 
EMPLOYERS.—All persons treated as a single em-
ployer under subsection (b), (c), (m), or (o) of sec-
tion 414 of the Internal Revenue Code of 1986 shall 
be treated as 1 employer. 
‘‘(2) EMPLOYERS NOT IN EXISTENCE IN PRE-
CEDING YEAR.—In the case of an employer which 
was not in existence for the full year prior to the 
date on which the employer applies to participate, 
the determination of whether such employer meets 
the requirements of subsection (a)(4) shall be based 
on the average number of employees that it is rea-
sonably expected such employer will employ on busi-
ness days in the employer’s first full year. 
‘‘(3) PREDECESSORS.—Any reference in this 
subsection to an employer shall include a reference 
to any predecessor of such employer. 
‘‘(c) WAIVER
AND CONTINUATION
OF PARTICIPA-
TION.— 
‘‘(1) WAIVER.—The Administrator may waive 
the limitations relating to the size of an employer 
which may participate in the health insurance pro-
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gram established under this title on a case by case 
basis if the Administrator determines that such em-
ployer makes a compelling case for such a waiver. In 
making determinations under this paragraph, the 
Administrator may consider the effects of the em-
ployment of temporary and seasonal workers and 
other factors. 
‘‘(2) CONTINUATION
OF
PARTICIPATION.—An 
employer participating in the program under this 
title that experiences an increase in the number of 
employees so that such employer has in excess of 
100 employees, may not be excluded from participa-
tion solely as a result of such increase in employees. 
‘‘(d) TREATMENT
OF HEALTH INSURANCE COV-
ERAGE AS GROUP HEALTH PLAN.—Health insurance cov-
erage offered under this title shall be treated as a group 
health plan for purposes of applying the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 1001 et 
seq.) except to the extent that a provision of this title ex-
pressly provides otherwise. 
‘‘(e) APPLICATION OF HIPAA RULES.—Subject to 
the provisions of this title, parts A and C of title XXVII 
shall apply to health insurance coverage offered under this 
title by health insurance issuers. Subject to section 2723, 
a State may modify State law as appropriate to provide 
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for the enforcement of such provisions for health insur-
ance coverage offered in the State under this title. Part 
7 of subtitle B of title I of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1181 et seq.) shall 
continue to apply to group health plans offering coverage 
under this title. Subtitle K of the Internal Revenue Code 
of 1986 shall continue to apply to covered employers and 
group health plans offering coverage under this title. 
‘‘SEC. 3102. ADMINISTRATION OF SMALL BUSINESS HEALTH 
INSURANCE POOL. 
‘‘(a) OFFICE AND ADMINISTRATOR.—The Secretary 
shall designate an office within the Department of Health 
and Human Services to administer the program under this 
title. Such office shall be headed by an Administrator to 
be appointed by the Secretary. 
‘‘(b) QUALIFICATIONS.—The Secretary shall ensure 
that the individual appointed to serve as the Administrator 
under subsection (a) has an appropriate background with 
experience in health insurance, healthcare management, or 
health policy. 
‘‘(c) DUTIES.—The Administrator shall— 
‘‘(1) enter into contracts with health insurance 
issuers to provide health insurance coverage to indi-
viduals and employees who enroll in health insurance 
coverage in accordance with this title; 
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‘‘(2) maintain the contracts for health insur-
ance policies when an employee elects which health 
plan offered under this title to enroll in as permitted 
under section 3107(d)(7); 
‘‘(3) ensure that health insurance issuers com-
ply with the requirements of this title; 
‘‘(4) ensure that employers meet eligibility re-
quirements for participation in the health insurance 
pool established under this title; 
‘‘(5) enter into agreements with entities to 
serve as navigators, as defined in section 3103; 
‘‘(6) collect premiums from employers and em-
ployees and make payments for health insurance 
coverage; 
‘‘(7) collect other information needed to admin-
ister the program under this title; 
‘‘(8) compile, produce, and distribute informa-
tion (which shall not be subject to review or modi-
fication by the States) to employers and employees 
(directly and through navigators) concerning the 
open enrollment process, the health insurance cov-
erage available through the pool, and standardized 
comparative information concerning such coverage, 
which shall be available through an interactive Inter-
net website, including a description of the coverage 
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plans available in each State and comparative infor-
mation, about premiums, index rates, benefits, qual-
ity, and consumer satisfaction under such plans; 
‘‘(9) provide information to health insurance 
issuers, including, at the discretion of the Adminis-
trator, notification when proposed rates are not in a 
competitive range; 
‘‘(10) conduct public education activities (di-
rectly and through navigators) to raise the aware-
ness of the public of the program under this title 
and the associated tax credit under the Internal 
Revenue Code of 1986; 
‘‘(11) develop methods to facilitate enrollment 
in health insurance coverage under this title, includ-
ing through the use of the Internet; 
‘‘(12) if appropriate, enter into contracts for 
the performance of administrative functions under 
this title as permitted under section 3109; 
‘‘(13) carefully consider benefit recommenda-
tions that are endorsed by at least two-thirds of the 
members of the Small Business Health Board; 
‘‘(14) establish and administer a contingency 
fund for risk corridors as provided for in section 
3108; 
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‘‘(15) coordinate with State insurance regu-
lators to ensure timely and effective consideration of 
complaints, grievances, and appeals; and 
‘‘(16) carry out any other activities necessary to 
administer this title. 
‘‘(d) LIMITATIONS.—The Administrator shall not— 
‘‘(1) negotiate premiums with participating 
health insurance issuers; or 
‘‘(2) exclude health insurance issuers from par-
ticipating in the program under this title except for 
violating contracts or the requirements of this title. 
‘‘(e) SMALL BUSINESS HEALTH BOARD.— 
‘‘(1) IN GENERAL.—There shall be established 
a Small Business Health Board to monitor the im-
plementation of the program under this title and to 
make recommendations to the Administrator con-
cerning improvements in the program. 
‘‘(2) APPOINTMENT.—The Comptroller General 
shall appoint 13 individuals who have expertise in 
healthcare benefits, financing, economics, actuarial 
science, or other related fields, to serve as members 
of the Small Business Health Board. In appointing 
members under the preceding sentence, the Comp-
troller General shall ensure that such members in-
clude— 
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‘‘(A) a mix of different types of profes-
sionals; 
‘‘(B) a broad geographic representation; 
‘‘(C) not less than 3 individuals with an 
employee perspective; 
‘‘(D) not less than 3 individuals with a 
small business perspective, at least 1 of whom 
shall have a self-employed perspective; 
‘‘(E) not less than 1 individual with a 
background in insurance regulation; and 
‘‘(F) not less than 1 individual with a pa-
tient perspective. 
‘‘(3) TERMS.—Members of the Small Business 
Health Board shall serve for a term of 3 years, such 
terms to end on March 15 of the applicable year, ex-
cept as provided in paragraph (4). The Comptroller 
General shall stagger the terms for members first 
appointed. A member may be reappointed after the 
expiration of a term. A member may serve after ex-
piration of a term until a successor has been ap-
pointed. 
‘‘(4) SMALL
BUSINESS
REPRESENTATIVES.— 
Beginning on March 16, 2013, 3 of the individuals 
the Comptroller General appoints to the Small Busi-
ness Health Board shall be representatives of the 3 
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navigators through which the largest number of indi-
viduals have enrolled for health insurance coverage 
over the previous 2-year period. Such appointees 
shall serve for 1 year. The Comptroller General shall 
consider for appointment in years prior to the date 
specified in this paragraph, individuals who are rep-
resentatives of entities that may serve as navigators. 
‘‘(5) CHAIRPERSON; VICE CHAIRPERSON.—The 
Comptroller General shall designate a member of the 
Small Business Health Board, at the time of ap-
pointment of such member, to serve as Chairperson 
and a member to serve as Vice Chairperson for the 
term of the appointment, except that in the case of 
a vacancy of either such position, the Comptroller 
General may designate another member to serve in 
such position for the remainder of such member’s 
term. 
‘‘(6) COMPENSATION.—While serving on the 
business of the Small Business Health Board (in-
cluding travel time), a member of the Small Busi-
ness Health Board shall be entitled to compensation 
at the per diem equivalent of the rate provided for 
level IV of the Executive Schedule under section 
5315 of title 5, United States Code, and while so 
serving away from home and the member’s regular 
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place of business, a member may be allowed travel 
expenses, as authorized by the Chairperson of the 
Small Business Health Board. 
‘‘(7) DISCLOSURE.—The Comptroller General 
shall establish a system for the public disclosure, by 
members of the Small Business Health Board, of fi-
nancial and other potential conflicts of interest. 
‘‘(8) MEETINGS.—The Small Business Health 
Board shall meet at the call of the Chairperson. 
Each such meeting shall be open to the public. 
‘‘(9) DUTIES.—The Small Business Health 
Board shall— 
‘‘(A) provide general oversight of the pro-
gram under this title and make recommenda-
tions to the Administrator; 
‘‘(B) monitor, review, seek public input on, 
and make recommendations to the Adminis-
trator on the benefit requirements for nation-
wide plans in this title; 
‘‘(C) make recommendations concerning 
information that the Administrator, health 
plans, and navigators should distribute to em-
ployers and employees participating in the pro-
gram under this title; and 
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‘‘(D) monitor and make recommendations 
to the Administrator on adverse selection within 
the program under this title and between the 
coverage provided under the program and the 
State-regulated health insurance market. 
‘‘(10) APPROVAL
OF
RECOMMENDATIONS.—A 
recommendation shall require approval by not less 
than two-thirds of the members of the Board. 
‘‘(11) PUBLIC NOTICE AND COMMENT ON REC-
OMMENDATIONS.—The Administrator shall— 
‘‘(A) publish recommendations by the 
Small Business Health Board in the Federal 
Register; 
‘‘(B) solicit written comments concerning 
such recommendations; and 
‘‘(C) provide an opportunity for the pres-
entation of oral comments concerning such rec-
ommendations at a public meeting. 
‘‘SEC. 3103. NAVIGATORS. 
‘‘(a) IN GENERAL.—The Administrator shall enter 
into agreements with private and public entities, beginning 
a reasonable period prior to the beginning of the first cal-
endar year in which health insurance coverage is offered 
under this title, under which such entities will serve as 
navigators. 
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‘‘(b) ELIGIBILITY.—To be eligible to enter into an 
agreement under subsection (a), an entity shall dem-
onstrate to the Administrator that the entity has existing 
relationships with, or could readily establish relationships 
with, employers or employees and self-employed individ-
uals, likely to be eligible to participate in the program 
under this title. Such entities may include trade, industry 
and professional associations, chambers of commerce, 
unions, small business development centers, and other en-
tities that the Administrator determines to be capable of 
carrying out the duties described in subsection (c). 
‘‘(c) DUTIES.—An entity that serves as a navigator 
under an agreement under subsection (a) shall— 
‘‘(1) coordinate with the Administrator on pub-
lic education activities to raise awareness of the pro-
gram under this title; 
‘‘(2) distribute information developed by the 
Administrator on the open enrollment process, pri-
vate health plans available through the program 
under this title, and standardized comparative infor-
mation about the health insurance coverage under 
the program; 
‘‘(3) distribute information about the avail-
ability of the tax credit under section 36 of the In-
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ternal Revenue Code of 1986 as added by the Small 
Business Health Options Program Act of 2009; 
‘‘(4) provide referrals to the applicable State 
agency or agencies for any enrollee with a grievance, 
complaint, or question regarding their health insur-
ance issuer, their coverage or plan, or a determina-
tion under such coverage or plan; 
‘‘(5) assist employers and employees in enroll-
ing in the program under this title; and 
‘‘(6) respond to questions about the program 
under this title and participating plans. 
‘‘(d) SUPPLEMENTAL MATERIALS.—In addition to 
information developed by the Administrator under sub-
section (c)(2), a navigator may develop and distribute 
other information that is related to the health insurance 
program established under this title, subject to review and 
approval by the Administrator and filing in each State in 
which the navigator operates. 
‘‘(e) STANDARDS.— 
‘‘(1) IN GENERAL.—The Administrator shall es-
tablish standards for navigators under this section, 
including provisions to avoid conflicts of interest. 
Under such standards, a navigator may not— 
‘‘(A) be a health insurance issuer; or 
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‘‘(B) receive any consideration directly or 
indirectly from any health insurance issuer in 
connection with the participation of any em-
ployer in the program under this title or the en-
rollment of any eligible employee in health in-
surance coverage under this title. 
‘‘(2) FAIR AND IMPARTIAL INFORMATION AND 
SERVICES.—The Administrator shall consult with 
the Small Business Health Board concerning the 
standards necessary to ensure that a navigator will 
provide fair and impartial information and services. 
An agreement between the Administrator and a nav-
igator may include specific provisions with respect to 
such navigator to ensure that such navigator will 
provide fair and impartial information and services. 
If a navigator, or entity seeking to become a navi-
gator, is a party to any arrangement with any health 
insurance issuer to receive compensation related to 
other healthcare programs not covered under this 
title, the entity shall disclose the terms of such com-
pensation arrangements to the Administrator, and 
the Administrator shall take such information into 
account in determining the appropriate standards 
and agreement terms for such navigator. 
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‘‘SEC. 
3104. 
CONTRACTS 
WITH 
HEALTH 
INSURANCE 
ISSUERS. 
‘‘(a) IN GENERAL.—The Administrator may enter 
into contracts with qualified health insurance issuers, 
without regard to section 5 of title 41, United States Code, 
or other statutes requiring competitive bidding, to provide 
health benefits plans to employees of participating employ-
ers and self-employed individuals under this title. Each 
contract shall be for a uniform term of at least 1 year, 
but may be made automatically renewable from term to 
term in the absence of notice of termination by either 
party. In entering into such contracts, the Administrator 
shall ensure that health benefits coverage is provided for 
an individual only, 2 adults in a household, 1 adult and 
1 or more children, and a family. 
‘‘(b) ELIGIBILITY.—A health insurance issuer shall 
be eligible to enter into a contract under subsection (a) 
if such issuer— 
‘‘(1) is licensed to offer health benefits plan 
coverage in each State in which the plan is offered; 
and 
‘‘(2) meets such other reasonable requirements 
as determined appropriate by the Administrator, 
after an opportunity for public comment and publi-
cation in the Federal Register. 
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‘‘(c) COST-SHARING AND NETWORKS.—The Adminis-
trator shall ensure that health benefits plans with a range 
of cost-sharing and network arrangements are available 
under this title. 
‘‘(d) REVOCATION.—Approval of a health benefits 
plan participating in the program under this title may be 
withdrawn or revoked by the Administrator only after no-
tice to the health insurance issuer involved and an oppor-
tunity for a hearing without regard to subchapter II of 
chapter 5 and chapter 7 of title 5, United States Code. 
‘‘(e) CONVERSION.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), a contract may not be made or a plan ap-
proved under this section if the health insurance 
issuer under such contract or plan does not provide 
to each enrollee whose coverage under the plan is 
terminated, including a termination due to dis-
continuance of the contract or plan, the option to 
have issued to that individual a nongroup policy 
without evidence of insurability. A health insurance 
issuer shall provide a notice of such option to indi-
viduals who enroll in the plan. An enrollee who exer-
cises such conversion option shall pay the full peri-
odic charges for the nongroup policy. 
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‘‘(2) EXCEPTIONS.—A health insurance issuer 
shall not be required to offer a nongroup policy 
under paragraph (1) if the termination under the 
plan occurred because— 
‘‘(A) the enrollee failed to pay any required 
monthly premiums under the plan; 
‘‘(B) the enrollee performed an act or 
practice that constitutes fraud in connection 
with the coverage under the plan; 
‘‘(C) the enrollee made an intentional mis-
representation of a material fact under the 
terms of coverage of the plan; or 
‘‘(D) the terminated coverage under the 
plan was replaced by similar coverage within 31 
days after the effective date of such termi-
nation. 
‘‘(f) PAYMENT OF PREMIUMS.— 
‘‘(1) IN GENERAL.—Employers shall collect pre-
mium payments from their employees through pay-
roll deductions or other payments from employees 
and shall forward such payments and the contribu-
tion of the employer (if any) to the Administrator. 
The Administrator shall develop procedures through 
which such payments shall be received and for-
warded to the health insurance issuer involved. 
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