A bill to provide for the certification of programs to provide uninsured employees of small business access to health coverage, and for other purposes.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care Access for Small 
Businesses Act of 2003''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) For most of the past 16 years, the number of Americans 
        without health insurance has been on the rise, reaching more 
        than 41,000,000 in 2002.
            (2) People without health insurance are less likely to get 
        preventive care and often delay or forgo needed care. They are 
        therefore more likely than those with health insurance to be 
        hospitalized for conditions that could have been avoided.
            (3) Not only are the health and financial circumstances of 
        uninsured Americans adversely affected by the lack of health 
        insurance, their care is ultimately being paid for in the least 
        efficient manner: after they get sick.
            (4) People who were uninsured during any part of 2001 
        received $99,000,000,000 in care, of which $34,500,000,000 was 
        not paid for either out of pocket or by a private or public 
        insurance source. Federal, State, and local governments covered 
        85 percent of such uncompensated care, amounting to 
        $30,000,000,000.
            (5) Private health insurance enrollees also help pay for 
        uncompensated care through higher premiums.
            (6) Covering more Americans will not only contribute to 
        better overall health, it will lower the amount of health care 
        costs assumed by taxpayers, businesses, and consumers.
            (7) Helping small businesses gain access to affordable 
        health care benefits is essential to insuring more Americans.
            (8) Eighty-two percent of uninsured people are part of 
        working families.
            (9) More than \1/2\ of small businesses with less than 50 
        employees do not offer their employees health insurance.
            (10) Innovative community-based solutions have developed 
        and should serve as a model for insuring more Americans.

SEC. 3. THREE-SHARE PROGRAMS.

    The Social Security Act (42 U.S.C. 301 et seq.) is amended by 
adding at the end the following:

               ``TITLE XXII--PROVIDING FOR THE UNINSURED

``SEC. 2201. THREE-SHARE PROGRAMS.

    ``(a) Certification.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator, shall promulgate regulations for the 
        certification of three-share programs for purposes of section 
        36 of the Internal Revenue Code.
            ``(2) Three-share program requirements.--
                    ``(A) In general.--The Administrator shall require, 
                for purposes of a certification under regulations under 
                paragraph (1) that each three-share program shall--
                            ``(i) be either a non-profit or local 
                        governmental entity;
                            ``(ii) define a region in which such 
                        program will provide services;
                            ``(iii) have the capacity to carry out 
                        administrative functions of managing health 
                        plans, including monthly billings, 
                        verification/enrollment of eligible employers 
                        and employees, maintenance of membership 
                        rosters, development of member materials (such 
                        as handbooks and identification cards), 
                        customer service, and claims processing; and
                            ``(iv) have community involvement, as 
                        determined by the Administrator.
                    ``(B) Payment.--To obtain the certification 
                described in paragraph (1), a three-share program shall 
                pay the costs of services provided under subparagraph 
                (A)(ii) by charging a monthly premium for each covered 
                individual to be divided as follows:
                            ``(i) Not more than thirty percent of such 
                        fee shall be paid by a qualified employee 
                        desiring coverage under the three-share 
                        program.
                            ``(ii) At least seventy percent of such fee 
                        shall be paid by the qualified employer of such 
                        a qualified employee.
            ``(3) Coverage.--
                    ``(A) In general.--To obtain the certification 
                described in paragraph (1) a 3-share program shall 
                provide at least the following benefits:
                            ``(i) Physicians services.
                            ``(ii) In-patient hospital services.
                            ``(iii) Out-patient services.
                            ``(iv) Emergency room visits.
                            ``(v) Emergency ambulance services.
                            ``(vi) Diagnostic lab fees and x-rays.
                            ``(vii) Prescription drug benefits.
                    ``(B) Limitation.--Nothing in subparagraph (A) 
                shall be construed to require that a three-share 
                program provide coverage for services performed outside 
                the region described in paragraph (2)(A)(i).
                    ``(C) Preexisting conditions.--A program described 
                in subparagraph (A) shall not be eligible for 
                certification under paragraph (1) if any individual can 
                be excluded from coverage under such program because of 
                a preexisting health condition.
    ``(b) Startup Grants for Three-Share Programs.--
            ``(1) Establishment.--The Administrator may award startup 
        grants to eligible entities to establish three-share programs 
        for certification under subsection (a).
            ``(2) Three-share program plan.--Each entity desiring a 
        grant under this subsection shall develop a plan for the 
        establishment and operation of a three-share program that meets 
        the requirements of paragraphs (2) and (3) of subsection (a).
            ``(3) Application.--Each entity desiring a grant under this 
        subsection shall submit an application to the Administrator at 
        such time, in such manner and containing such information as 
        the Administrator may require, including--
                    ``(A) the three-share program plan described in 
                paragraph (2); and
                    ``(B) an assurance that the eligible entity will--
                            ``(i) determine a benefit package;
                            ``(ii) recruit businesses and employees for 
                        the three-share program;
                            ``(iii) build and manage a network of 
                        health providers or contract with an existing 
                        network or licensed insurance provider; and
                            ``(iv) manage all administrative needs.
            ``(4) Number of grants.--An eligible entity may receive 
        only 1 grant under this subsection for each three-share program 
        and may not receive a grant for such program under both this 
        subsection and subsection (c).
    ``(c) Grants for Existing Three-Share Programs To Meet 
Certification Requirements.--
            ``(1) In general.--The Administrator may award grants to 
        three-share programs that are operating on the date of 
        enactment of this section, to assist such programs in meeting 
        the certification requirements of subsection (a).
            ``(2) Number of grants.--An eligible entity may receive 
        only 1 grant under this subsection for a three-share program 
        and may not receive a grant for such program under both this 
        subsection and subsection (b).
            ``(3) Application.--Each eligible entity desiring a grant 
        under this subsection shall submit an application to the 
        Administrator at such time, in such manner, and containing such 
        information as the Administrator may require.
    ``(d) Risk Pool Grants.--
            ``(1) In general.--The Administrator may award grants to 
        eligible entities administering certified three-share programs 
        to enhance the risk pools of such programs.
            ``(2) Number of grants.--An eligible entity administering a 
        three-share program described in paragraph (1) may receive only 
        1 grant under this subsection for such three-share program.
            ``(3) Application.--Each eligible entity desiring a grant 
        under this subsection shall submit an application to the 
        Administrator at such time, in such manner, and containing such 
        information as the Administrator may require.
    ``(e) Application of State Laws.--Nothing in this Act shall be 
construed to preempt State law.
    ``(f) Distressed Business Formula.--
            ``(1) In general.--Not later than 60 days after the date of 
        enactment of this section, the Administrator of the Health 
        Resources and Services Administration shall develop a formula 
        to determine which businesses qualify as distressed businesses 
        for purposes of this Act.
            ``(2) Effect on insurance market.--Granting eligibility to 
        a distressed business using the formula under paragraph (1) 
        shall not interfere with the insurance market. Any business 
        found to have reduced benefits to qualify as a distressed 
        business under the formula under paragraph (1) shall not be 
        eligible for any three-share program certified pursuant to this 
        section.
    ``(g) Definitions.--In this section:
            ``(1) Administrator.--The term `Administrator' means the 
        Administrator of the Health Resources and Services 
        Administration.
            ``(2) Covered individual.--The term `covered individual' 
        means--
                    ``(A) a qualified employee; or
                    ``(B) a child under the age of 23 or a spouse of 
                such qualified employee who--
                            ``(i) lacks access to health care coverage 
                        through their employment or employer;
                            ``(ii) lacks access to health coverage 
                        through a family member;
                            ``(iii) is not eligible for coverage under 
                        the medicare program under title XVIII or the 
                        medicaid program under title XIX; and
                            ``(iv) does not qualify for benefits under 
                        the State Children's Health Insurance Program 
                        under title XXI.
            ``(3) Distressed business.--The term `distressed business' 
        means a business that--
                    ``(A) in light of economic hardship and rising 
                health care premiums may be forced to discontinue or 
                scale back its health care coverage; and
                    ``(B) qualifies as a distressed business according 
                to the formula under subsection (f).
            ``(4) Eligible entity.--The term `eligible entity' means an 
        entity that meets the requirements of subsection (a)(2)(A).
            ``(5) Full time.--The term `full time', for purposes of 
        employment, means regularly working at least 35 hours per week.
            ``(6) Qualified employee.--The term `qualified employee' 
        means any individual employed by a qualified employer who meets 
        certain criteria including--
                    ``(A) working full time;
                    ``(B) lacking access to health coverage through a 
                family member or common law partner;
                    ``(C) not being eligible for coverage under the 
                medicare program under title XVIII or the medicaid 
                program under title XIX; and
                    ``(D) agreeing that the share of fees described in 
                subsection (a)(2)(B)(i) shall be paid in the form of 
                payroll deductions from the wages of such individual.
            ``(7) Qualified employer.--The term `qualified employer' 
        means an employer as defined in section 3(d) of the Fair Labor 
        Standards Act of 1938 (29 U.S.C. 203(d)) who--
                    ``(A) is a small business concern as defined in 
                section 3(a) of the Small Business Act (15 U.S.C. 632);
                    ``(B) is located in the region described in 
                subsection (a)(2)(A)(i); and
                    ``(C) has not contributed to the health care 
                benefits of its employees for at least 12 months 
                consecutively or currently provides insurance but is 
                classified as a distressed business.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $50,000,000 for fiscal year 2004 
and such sums as may be necessary for each subsequent fiscal year.''.

SEC. 4. REFUNDABLE CREDIT FOR PORTION OF EMPLOYER COSTS OF THREE-SHARE 
              PROGRAM.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to refundable credits) 
is amended by redesignating section 36 as section 37 and inserting 
after section 35 the following new section:

``SEC. 36. EMPLOYER COSTS OF THREE-SHARE PROGRAM.

    ``(a) In General.--In the case of an eligible employer, there shall 
be allowed as a credit against the tax imposed by this subtitle an 
amount equal to 40 percent of the costs of a three-share program 
resulting from the participation of the taxpayer in such program during 
the taxable year.
    ``(b) Eligible Employer.--For purposes of this section, the term 
`eligible employer' means any employer which pays or incurs at least 70 
percent of the costs of a three-share program resulting from the 
participation of the taxpayer in such program during the taxable year.
    ``(c) Three-Share Program.--For purposes of this section, the term 
`three-share program' means an employee health care coverage program 
approved for participation by an eligible employer pursuant to title 
XXII of the Social Security Act.
    ``(d) Denial of Double Benefit.--No deduction or credit under any 
other provision of this chapter shall be allowed with respect to costs 
of a three-share program taken into account under subsection (a).
    ``(e) Advanced Refundability.--The Secretary shall provide for the 
advanced refundability of the credit allowed under this section to be 
made in quarterly payments to taxpayers providing such information as 
the Secretary requires in order to make a proper determination of such 
payments.
    ``(f) Regulations.--The Secretary may prescribe such regulations 
and other guidance as may be necessary or appropriate to carry out this 
section.''.
    (b) Conforming Amendments.--
            (1) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting before the period ``, or 
        from section 36 of such Code''.
            (2) The table of sections for subpart C of part IV of 
        chapter 1 of the Internal Revenue Code of 1986 is amended by 
        striking the last item and inserting the following new items:

                              ``Sec. 36. Employer costs of three-share 
                                        program.
                              ``Sec. 37. Overpayments of tax.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after the date of the enactment of 
this Act.

Summary: Health Care Access for Small Business Act of 2003 - Amends the Social Security Act to add a new title XXII (Providing for the Uninsured) to direct the Secretary of Health and Human Services to promulgate regulations for the certification of three-share programs for purposes of offering a refundable tax credit to small businesses who participate in such programs where: (1) not more than 30 percent of the cost of the monthly premium for health coverage (including prescription drug benefits) is paid by the qualified employee who lacks access to health coverage and desires coverage; and (2) at least 70 percent of such cost is paid by the qualified employer of such a qualified employee.Authorizes the Administrator to award startup grants to eligible entities to establish three-share programs for certification.Amends the Internal Revenue Code to provide for a refundable tax credit in the case of an eligible employer in an amount equal to 40 percent of the costs of a three-share program resulting from the participation of the taxpayer in such program during the taxable year.