I 115th CONGRESS 2d Session H. R. 5491 IN THE HOUSE OF REPRESENTATIVES April 12, 2018 Mr. Fortenberry introduced the following bill; which was referred to the Committee on Agriculture A BILL To provide loans and grants to qualified agricultural associations to assist in the establishment of agricultural association health plans.

1. Short title This Act may be cited as the Rural Health Insurance Act of 2018 . 2. Supporting agricultural association health plans (a) In general The Secretary of Agriculture may establish a loan program and a grant program to assist in the establishment of agricultural association health plans, in order to help bring new health options and lower priced health care coverage to rural Americans. (b) Loans (1) In general With respect to plan years 2019 through 2022, the Secretary of Agriculture, in consultation with the Secretary of Labor, may make not more than 10 loans under this section, for purposes of establishing agricultural association health plans, to qualified agricultural associations that have not received a loan under this section. (2) Use of funds The proceeds of a loan made under this section may only be used to finance costs associated with establishing and carrying out an agricultural association health plan. (3) Loan terms A loan made under this section shall— (A) bear interest at an annual rate equivalent to the cost of borrowing to the Department of the Treasury for obligations of comparable maturities; (B) have a term of such length, not exceeding 20 years, as the borrower may request; (C) be in an amount not to exceed $15,000,000; (D) require that the borrower submit annual audited financial statements to the Secretary; and (E) include any other requirements or documentation the Secretary deems necessary to carry out this section. (c) Grants The Secretary may make grants to agricultural trade associations or industry associations which have been in existence for at least three years prior to applying for such a grant to provide for technical assistance in establishing an agricultural association health plan. (d) Authorization of appropriations (1) In general There are authorized to be appropriated to carry out this section $65,000,000 for the period of fiscal years 2019 through 2022, to be available until expended. (2) Reservation of funds Of the funds made available under paragraph (1), not more than 15 percent of such funds shall be made available to make grants under subsection (c). (e) Definitions In this section: (1) Agricultural association health plan The term agricultural association health plan means a group health plan within the meaning of section 733(a)(1) of the Employee Retirement Income Security Act of 1974 ( 42 U.S.C. 1191b )— (A) that is sponsored by a qualified agricultural association; and (B) with respect to which the Secretary has received a letter from the relevant State insurance commissioner certifying that such association may offer such plan in such State. (2) Qualified agricultural association The term qualified agricultural association means an association— (A) composed of members that operate a farm or ranch or operate an agribusiness; (B) that qualifies as an association health plan within the meaning of guidance or regulation issued by the Department of Labor; (C) that acts directly or indirectly in the interest of its members in relation to the plan; (D) that is able to demonstrate an ability to implement and manage a group health plan; and (E) that meets any other criteria the Secretary deems necessary to meet the intent of this section.