To enable States to establish reinsurance programs or high risk pools to ensure that high risk individuals are able to access health insurance.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Guaranteed Access to Health 
Insurance Act of 2009''.

SEC. 2. ENSURING AFFORDABILITY FOR ALL THROUGH SPECIAL POOLING OF THE 
              COST OF HIGH RISK INDIVIDUALS.

    (a) State Requirement.--
            (1) In general.--Not later than 2 years after the date of 
        the enactment of this Act, each State is encouraged to ensure 
        that an adequate financial backstop exists to mitigate the cost 
        of high risk individuals in the State, through establishing 
        either--
                    (A) a qualified State reinsurance program described 
                in subsection (b); or
                    (B) a qualifying State high risk pool described in 
                subsection (c)(1).
            (2) Preference.--Beginning 3 years after the date of the 
        enactment of this Act, in the case of a competitive grant for 
        which the only eligible entities are States, the Secretary, in 
        awarding such grant to a State, shall give preference to any 
        State with a program that meets the requirements of paragraph 
        (1)(A).
    (b) Qualified State Reinsurance Program.--
            (1) In general.--For purposes of this section, the term 
        ``qualified State reinsurance program'' means a program 
        operated by a State or a State authorized program that provides 
        reinsurance for health insurance coverage offered in the 
        individual, small group market, or in both markets.
            (2) Form of program.--A qualified State reinsurance program 
        may provide reinsurance--
                    (A) on a prospective or retrospective basis;
                    (B) that protects health insurance issuers against 
                the annual aggregate spending of their enrollees; and
                    (C) that provides purchase protection against 
                individual catastrophic costs.
    (c) Qualifying State High Risk Pool.--
            (1) In general.--A qualifying State high risk pool 
        described in this subsection means a section 2745 qualified 
        high risk pool that meets the following requirements:
                    (A) The high risk pool does not have a lifetime 
                coverage cap.
                    (B) The high risk pool incorporates applicable 
                Federal or State programs (such as coverage under title 
                XIX of the Social Security Act) for eligible low-income 
                individuals.
                    (C) The high risk pool provides a variety of types 
                of coverage, including at least one high deductible 
                health plan that is combined with a health savings 
                account.
                    (D) The high risk pool eliminates any waiting list 
                and pre-existing condition exclusionary periods so that 
                all eligible residents who are seeking coverage through 
                the pool can receive coverage through the pool.
                    (E) The high risk pool allows for coverage of 
                individuals who, but for the 24-month disability 
                waiting period under section 226(b) of the Social 
                Security Act, would be eligible for Medicare during the 
                period of such waiting period.
                    (F) The high risk pool must not charge participants 
                more than 150 percent of the average premium in the 
                individual market for health insurance coverage in that 
                State.
                    (G) The high risk pool conducts education and 
                outreach initiatives so that residents and insurance 
                brokers understand that the pool is available to 
                eligible residents.
            (2) Use of funds for the transition.--A State may use any 
        funding sources available to it as of the date of the enactment 
        of this Act to transition from operating a section 2745 high 
        risk pool, to operating a qualified State reinsurance program 
        described in paragraph (1).
            (3) Funding source.--The high risk pool described in this 
        subsection is also encouraged to have stable funding source 
        that is not solely dependent on an appropriation from the State 
        legislature.
    (d) Relation to Section 2745.--Section 2745 of the Public Health 
Service Act is amended--
            (1) in subsection (a)(2)--
                    (A) in subparagraph (A), strike ``40'' and insert 
                ``30''; and
                    (B) add at the end the following new subparagraph:
                    ``(D) An amount equal to 10 percent of such 
                appropriated amount for the fiscal year shall be 
                allotted among qualifying States that apply for such a 
                grant so that the amount allotted to a State bears the 
                same ratio to such appropriated amount as the amount of 
                funds contributed to the operation of the qualified 
                high risk pool of the State by funding sources other 
                than grants under this subsection.''; and
            (2) in subsection (g)(1)--
                    (A) in subparagraph (A), by striking ``The term'' 
                and inserting ``Subject to subparagraph (B), the 
                term''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(B) Updated definition.--Beginning on the last 
                day of the 2-year period beginning in the date of the 
                enactment of the Guaranteed Access to Health Insurance 
                Act of 2009, the term `qualified high risk pool' 
                means--
                            ``(i) a pool that meets the requirements of 
                        subparagraph (A) of this paragraph and the 
                        requirements of section 2(c)(1) of such Act; or
                            ``(ii) a qualified State reinsurance 
                        program as such term is defined in section 2(b) 
                        of such Act.''.
    (e) Waivers.--
            (1) In general.--In order to accommodate new and innovative 
        programs, the Secretary may waive such requirements of this 
        section for qualified State reinsurance programs and for 
        qualifying State high risk pools as the Secretary deems 
        appropriate.
            (2) Coverage of high risk individuals.--The Secretary may 
        waive the requirement under subsection (a)(1) in the case of a 
        State that demonstrates, to the satisfaction of the Secretary, 
        that the State has provided an adequate financial backstop to 
        mitigate the cost of high risk individuals in the State in a 
        manner that is better than, as determined by the Secretary, the 
        requirements under such subsection.
    (f) Seed Grants to States.--The Secretary shall provide, from the 
funds appropriated, a grant of up to $5,000,000 to each State that has 
not created a qualified high risk pool as of the date of enactment of 
this Act. Such grants shall be made in the same manner, for the same 
purpose, but are in addition to, grants to States made under Section 
2745(a) of the Public Health Service Act.
    (g) Verification of Citizenship or Alien Qualification.--
            (1) In general.--Only citizens and nationals of the United 
        States shall be eligible to participate in a qualifying State 
        high risk pool or qualifying State reinsurance program 
        receiving funding under this section.
            (2) Grant conditions.--As a condition of receiving grants 
        under this section, the Secretary shall require any State that 
        applies to receive grant funding under this section to certify 
        to the satisfaction of the Secretary that such State requires 
        all applicants for coverage in a qualifying State high risk to 
        pool or a qualifying State reinsurance program to provide 
        satisfactory documentation of such citizenship or nationality 
        and identity in a manner consistent with section 1903(x) of the 
        Social Security Act. The Secretary shall keep sufficient 
        records such that a determination of citizenship or nationality 
        has to be made once for any individual.
    (h) Definitions.--In this section:
            (1) The terms ``health insurance coverage'' and ``health 
        insurance issuer'' have the meanings given such terms in 
        section 2791 of the Public Health Service Act.
            (2) The term ``section 2745 qualified high risk pool'' has 
        the meaning given the term ``qualified high risk pool'' under 
        section 2745(g)(1) of the Public Health Service Act as such 
        section is in effect on the date of the enactment of this Act.
            (3) The term ``Secretary'' means Secretary of Health and 
        Human Services.
            (4) The term ``State'' has the meaning given such term for 
        purposes of title XIX of the Social Security Act.
    (i) Authorization of Appropriations.--For the purposes of carrying 
out section 2745 of the Public Health Service Act and this section, in 
addition to any other amounts authorized to be appropriated, there is 
authorized to be appropriated, $20,000,000,000 beginning with 2010. Any 
funds that are authorized under this subsection that are used for 
purposes of carrying out section 2745 of the Public Health Service Act 
shall be allocated to the allotments under such section in the 
proportions required under subsection (d)(2) of such section.

Summary: Guaranteed Access to Health Insurance Act of 2009 - Directs the Secretary of Health and Human Services (HHS) to provide grants to states that adopt a program that provides reinsurance for health insurance coverage or a high risk pool to mitigate the health care costs of high risk individuals in such states. Limits participation in such reinsurance programs or high risk pools to citizens and nationals of the United States.