I 
111TH CONGRESS 
1ST SESSION 
H. R. 109 
To provide for the offering of Health Benefit Plans to individuals, to increase 
funding for State high risk health insurance pools, and to promote 
best practice protocols for State high risk pools. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 6, 2009 
Mr. FORTENBERRY introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To provide for the offering of Health Benefit Plans to indi-
viduals, to increase funding for State high risk health 
insurance pools, and to promote best practice protocols 
for State 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; FINDINGS AND PURPOSES; 
TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘America’s Affordable Health Care Act of 2009’’. 
(b) FINDINGS AND PURPOSES.— 
(1) FINDINGS.—Congress finds the following: 
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(A) The regulation of the practice of insur-
ance is a State prerogative. 
(B) It is in the interests of health care 
consumers that Congress allows for policies that 
increase the affordability of health insurance 
products. 
(C) The Federal Government provides 
States and the medical community with public 
financing to support the medical needs of the 
uninsured. 
(D) There is a correlation between the 
amount of insurance benefits and the cost of in-
surance products. 
(E) State mandate laws have created bar-
riers to affordable health coverage. 
(F) A number of States allow for the cre-
ation of insurance products that recognize the 
increased costs associated with mandate laws. 
(G) Consumers throughout the United 
States are finding it increasingly hard to secure 
affordable health care coverage which contrib-
utes to the national uninsured rate. 
(2) FEDERAL INSURANCE PRODUCT.—Congress 
further finds that it is in the interests of taxpayers, 
health care purchasers, and the health care provider 
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community, to allow for a class of federally certified 
insurance products that can be purchased in the in-
dividual market without being subject to State ben-
efit mandate laws. 
(3) PURPOSES.—The purposes of this Act 
are— 
(A) to promote increased affordability and 
access to health care coverage for citizens of the 
United States; 
(B) to allow consumers the ability to make 
choices by weighing insurance benefits with the 
cost of insurance; 
(C) to provide incentives to health plans 
and health insurance issuers to offer increas-
ingly affordable insurance policies to all those 
in the individual market; 
(D) to provide low-income and uninsured 
workers with incentives to purchase insurance 
policies; 
(E) to provide incentives to companies and 
States to offer health care solutions for high 
risk beneficiaries; 
(F) to provide for new coverage opportuni-
ties to solve the problems of affordability and 
uninsurance; and 
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(G) to promote the availability of health 
insurance coverage through high risk pools for 
individuals whose health conditions create bar-
riers to such coverage. 
(c) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; findings and purposes; table of contents. 
TITLE I—HEALTH BENEFIT PLANS 
Sec. 101. Certification of Health Benefit Plans. 
Sec. 102. Conditions for certification. 
Sec. 103. Review of implementation. 
Sec. 104. Definitions. 
TITLE II—EXPANSION OF STATE HIGH RISK HEALTH 
INSURANCE POOLS 
Sec. 201. Increasing and expanding funding for State high risk health insur-
ance pools. 
Sec. 202. Qualified high risk pools best practices guidelines and grant program. 
TITLE I—HEALTH BENEFIT 
PLANS 
SEC. 101. CERTIFICATION OF HEALTH BENEFIT PLANS. 
(a) IN GENERAL.—A health insurance issuer may 
apply to the Secretary for up to 3 health insurance cov-
erage policies offered in the individual market in any State 
to be certified as Health Benefit Plans under this title 
with respect to eligible individuals and the policies so cer-
tified may be offered and sold to such individuals without 
regard to any State or local law respecting mandates for 
benefits. 
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(b) CONSTRUCTION.—Except as specifically provided 
under subsection (a) with respect to health insurance ben-
efits, nothing in this title shall be construed as— 
(1) modifying the application of State or local 
requirements relating to matters not described in 
subsection (a), such as underwriting, enrollment, 
and premiums; 
(2) superseding any provision of State or local 
law or regulation relating to the business of insur-
ance, including the regulation of insurers and insur-
ance products, underwriting, enrollment, and pre-
miums; 
(3) preventing a State or local jurisdiction from 
applying fraud and abuse provisions otherwise appli-
cable with respect to the sale and marketing of 
health insurance coverage to the sale and marketing 
of Health Benefit Plans under this title; or 
(4) exempting a Health Benefits Plan, and the 
health insurance issuer offering such a plan, from 
applicable requirements of State law and compliance 
with applicable provisions of title XXVII of the Pub-
lic Health Service Act. 
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SEC. 102. CONDITIONS FOR CERTIFICATION. 
(a) IN GENERAL.—The Secretary shall not certify 
under this title a Health Benefit Plan offered by a health 
insurance issuer unless— 
(1) the Plan includes benefits for items and 
services within each of the categories of basic serv-
ices described in subsection (b); and 
(2) the issuer— 
(A) is licensed under State law to offer 
health insurance coverage in the State involved; 
and 
(B) submits to the Secretary such informa-
tion and assurances as the Secretary may re-
quire to assure compliance of the issuer, and 
Health Benefit Plans offered by the issuer, with 
the applicable requirements of this title. 
(b) CATEGORIES OF BASIC SERVICES.— 
(1) IN GENERAL.—The categories of basic serv-
ices described in this subsection are as follows: 
(A) Inpatient hospital services. 
(B) Physicians’ surgical and medical serv-
ices. 
(2) TREATMENT
OF
OTHER
CATEGORIES.— 
Nothing in this section shall be construed as pre-
venting a Health Benefit Plan from providing cov-
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erage of benefits that are not within a category of 
basic services described in paragraph (1). 
(c) RECIPROCAL ARRANGEMENTS.—Health insur-
ance issuers offering Health Benefit Plans may create re-
ciprocal arrangements with other issuers of such plans in 
order to improve the portability of such plans among eligi-
ble individuals. 
SEC. 103. REVIEW OF IMPLEMENTATION. 
(a) REVIEW.—The Secretary shall review the imple-
mentation of this title and the impact of such implementa-
tion on the availability and purchase of health insurance 
coverage. 
(b) REPORT.—Not later than 3 years after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on this title and its impact on making 
health insurance coverage more affordable. 
SEC. 104. DEFINITIONS. 
In this title: 
(1) The term ‘‘eligible individual’’ means an in-
dividual who is a citizen or national of the United 
States or an alien lawfully residing permanently in 
the United States. 
(2) The terms ‘‘health insurance coverage’’, 
‘‘health insurance issuer’’, and ‘‘individual market’’ 
have the meanings given such terms in section 2791 
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of the Public Health Service Act (42 U.S.C. 300gg– 
91). 
(3) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
TITLE II—EXPANSION OF STATE 
HIGH RISK HEALTH INSUR-
ANCE POOLS 
SEC. 201. INCREASING AND EXPANDING FUNDING FOR 
STATE 
HIGH 
RISK 
HEALTH 
INSURANCE 
POOLS. 
(a) IN GENERAL.—Section 2745(d) of the Public 
Health Service Act (42 U.S.C. 300gg–45(d)) is amend-
ed— 
(1) in paragraph (2)— 
(A) in the heading, by striking ‘‘THROUGH 
2010’’ and inserting ‘‘THROUGH 2009’’; and 
(B) in the matter preceding subparagraph 
(A), by striking ‘‘through 2010’’ and inserting 
‘‘through 2009’’; 
(2) by redesignating paragraphs (3), (4), and 
(5) as paragraphs (4), (5), and (6), respectively; and 
(3) by inserting after paragraph (2) the fol-
lowing new paragraph: 
‘‘(3) AUTHORIZATION OF APPROPRIATIONS FOR 
FISCAL YEARS 2010 THROUGH 2014.—There are au-
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that has established a qualified high risk pool shall 
submit to the Secretary, not later than 120 days 
after the beginning of such fiscal year, evidence- 
based information on the operation of such pool, as 
specified by the Secretary for purposes of creating 
the best practices guidelines described in paragraph 
(2). 
‘‘(2) BEST PRACTICE GUIDELINES.—Not later 
than 120 days after the date of the enactment of the 
America’s Affordable Health Care Act of 2009, the 
Secretary shall, after providing for notice and com-
ment, recommend and post on the public Internet 
site of the Department of Health and Human Serv-
ices a list of best practices with respect to the oper-
ation of qualified high risk pools. The Secretary 
shall provide for notice to the States and insurers 
who manage such qualified high risk pools of the 
proposed development of such practices and shall de-
velop such best practices with input obtained from 
such States and insurers. Such best practices should 
be categorized and applied according to the number 
of individuals enrolled in the qualified high risk pool 
involved. 
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‘‘(3) BONUS
GRANTS
FOR
STATE
QUALIFIED 
HIGH
RISK
POOLS
THAT
FOLLOW
BEST
PRAC-
TICES.— 
‘‘(A) IN GENERAL.—In the case of a State 
that is one of the 50 States or the District of 
Columbia, that has established a qualified high 
risk pool, and that is receiving a grant under 
subsection (b)(1), for each fiscal year for which 
the State demonstrates according to a process 
specified by the Secretary that such qualified 
high risk pool was operated in accordance with 
the best practices posted under paragraph (2), 
the Secretary shall provide a bonus grant from 
the funds appropriated under subparagraph (C) 
and allotted to the State under subparagraph 
(B). 
‘‘(B) ALLOTMENT; LIMITATION.—The Sec-
retary shall allot funds appropriated under sub-
paragraph (C) among States qualifying for a 
bonus grant under subparagraph (A) in a man-
ner specified by the Secretary, but in no case 
shall the amount so allotted to a State for a fis-
cal year exceed 10 percent of the funds so ap-
propriated for the fiscal year. 
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‘‘(C) AUTHORIZATION OF APPROPRIATIONS 
FOR BONUSES.—There are authorized to be ap-
propriated for each of fiscal years 2010 through 
2013 $26,000,000 for allotments under sub-
paragraph (B).’’. 
Æ 
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