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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Preexisting Condition Patient
Protection Act of 2009''.

SEC. 2. FINDINGS.

The Congress finds as follows:
(1) According to the United States Census Bureau, 45.7
million people were uninsured in 2007.
(2) According to a recent study by the Commonwealth Fund,
the number of underinsured adults aged 19 to 64 has jumped 60
percent over the last 4 years, from 16,000,000 in 2003 to
25,000,000 in 2007.
(3) According to the Centers for Disease Control and
Prevention (CDC), approximately 45 percent of Americans have at
least one chronic condition.
(4) Forty-four States currently allow insurance companies
to deny coverage for, limit coverage for, or charge increased
premiums for a preexisting condition.
(5) Over 26 million people were enrolled in private
individual market health plans in 2007. Under the Health
Insurance Portability and Accountability Act of 1996 (HIPAA),
these individuals have no protections against pre-existing
condition exclusions or waiting periods.
(6) When a child or adult has a 63-day gap in insurance
coverage, pre-existing condition exclusions, such as limiting
coverage or instituting a waiting period, can be placed on them
when they become insured under a new health insurance policy.
(7) Eliminating pre-existing condition exclusions for all
is a vital safeguard to ensuring that all Americans have access
to health care when in need.
(8) According to a Kaiser Family Foundation/Harvard School
of Public Health public opinion poll, 58 percent of Americans
strongly favor the Federal Government requiring health
insurance companies to cover anyone who applies for health
coverage, even if they have a prior illness.

SEC. 3. AMENDMENTS RELATING TO PREEXISTING CONDITION EXCLUSIONS UNDER
GROUP HEALTH PLANS.

(a) Amendments to the Employee Retirement Income Security Act of
1974.--
(1) Elimination of preexisting condition exclusions.--
Section 701 of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1181) is amended--
(A) by amending the heading to read as follows:
''elimination of preexisting condition exclusions'';
(B) by amending subsection (a) to read as follows:
''(a) In General.--A group health plan, and a health insurance
issuer offering group health insurance coverage, with respect to a
participant or beneficiary--
''(1) may not impose any preexisting condition exclusion;
and
''(2) in the case of a group health plan that offers
medical care through health insurance coverage offered by a
health maintenance organization, may not provide for an
affiliation period with respect to coverage through the
organization.'';
(C) in subsection (b), by striking paragraph (3)
and inserting the following:
''(3) Affiliation period.--The term 'affiliation period'
means a period which, under the terms of the health insurance
coverage offered by the health maintenance organization, must
expire before the health insurance coverage becomes
effective.'';
(D) by striking subsections (c), (d), (e), and (g);
and
(E) by redesignating subsection (f) (relating to
special enrollment periods) as subsection (c).
(2) Clerical amendment.--The item in the table of contents
of such Act relating to section 701 is amended to read as
follows:

''Sec. 701. Elimination of preexisting condition exclusions.''.
(b) Amendments to the Public Health Service Act.--
(1) In general.--Section 2701 of the Public Health Service
Act (42 U.S.C. 300gg) is amended--
(A) by amending the heading to read as follows:
''elimination of preexisting condition exclusions'';
(B) by amending subsection (a) to read as follows:
''(a) In General.--A group health plan, and a health insurance
issuer offering group health insurance coverage, with respect to a
participant or beneficiary--
''(1) may not impose any preexisting condition exclusion;
and
''(2) in the case of a group health plan that offers
medical care through health insurance coverage offered by a
health maintenance organization, may not provide for an
affiliation period with respect to coverage through the
organization.'';
(C) in subsection (b), by striking paragraph (3)
and inserting the following:
''(3) Affiliation period.--The term 'affiliation period'
means a period which, under the terms of the health insurance
coverage offered by the health maintenance organization, must
expire before the health insurance coverage becomes
effective.'';
(D) by striking subsections (c), (d), (e), and (g);
and
(E) by redesignating subsection (f) (relating to
special enrollment periods) as subsection (c).
(2) Technical amendments relating to employer size.--
Section 2711 of such Act (42 U.S.C. 300gg-11) is amended--
(A) in subsection (a)--
(i) in the heading, by striking ''Small'';
(ii) in paragraph (1)--
(I) in the matter before
subparagraph (A), by striking ''(c)
through (f)'' and inserting ''(b)
through (d)'' and by striking
''small''; and
(II) in subparagraph (A), by
striking ''small employer (as defined
in section 2791(e)(4))'' and inserting
''employer''; and
(iii) in paragraph (2)--
(I) by striking ''small'' each
place it appears; and
(II) by striking ''coverage to a''
and inserting ''coverage to an'';
(B) by striking subsection (b);
(C) in subsections (c), (d), and (e), by striking
''small'' each place it appears; and
(D) by striking subsection (f).
(c) Amendments to the Internal Revenue Code of 1986.--
(1) Elimination of preexisting condition exclusions.--
Section 9801 of the Internal Revenue Code of 1986 is amended--
(A) by amending the heading to read as follows:
''elimination of preexisting condition exclusions'';
(B) by amending subsection (a) to read as follows:
''(a) In General.--A group health plan with respect to a
participant or beneficiary may not impose any preexisting condition
exclusion.'';
(C) by striking paragraph (3) of subsection (b);
(D) by striking subsections (c), (d), and (e); and
(E) by redesignating subsection (f) (relating to
special enrollment periods) as subsection (c).
(2) Clerical amendment.--The item in the table of sections
of chapter 100 of such Code relating to section 9801 is amended
to read as follows:

''Sec. 9801. Elimination of preexisting condition exclusions.''.
(d) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply with respect to
group health plans for plan years beginning after the end of
the 12th calendar month following the date of the enactment of
this Act.
(2) Special rule for collective bargaining agreements.--In
the case of a group health plan maintained pursuant to one or
more collective bargaining agreements between employee
representatives and one or more employers ratified before the
date of the enactment of this Act, the amendments made by this
section shall not apply to plan years beginning before the
later of--
(A) the date on which the last of the collective
bargaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of the enactment of this Act),
or
(B) the date that is after the end of the 12th
calendar month following the date of the enactment of
this Act.
For purposes of subparagraph (A), any plan amendment made
pursuant to a collective bargaining agreement relating to the
plan which amends the plan solely to conform to any requirement
added by the amendments made by this section shall not be
treated as a termination of such collective bargaining
agreement.

SEC. 4. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS IN HEALTH
INSURANCE COVERAGE IN THE INDIVIDUAL MARKET.

(a) In General.--Section 2741 of the Public Health Service Act (42
U.S.C. 300gg-41) is amended--
(1) in subsection (a)(1), by striking ''with respect to an
eligible individual'' and all that follows and inserting the
following: ''with respect to--
''(A) an eligible individual (as defined in
subsection (b)) desiring to enroll in individual health
insurance coverage decline to offer such coverage to,
or deny enrollment of, such individual; and
''(B) any individual desiring to enroll in such
coverage impose any preexisting condition exclusion (as
defined in section 2701(b)(1)(A)) with respect to such
coverage.''; and
(2) in subsection (a)(2), by striking ''paragraph (1)'' and
inserting ''paragraph (1)(A)''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market on or after
the end of the 12th month following the date of the enactment of this
Act.

SEC. 5. TRANSPARENCY IN CLAIMS DATA.

(a) In General.--Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
submit to Congress a report on the impact of this Act on health
benefits coverage.
(b) Examination of Claims Experience and Other Data.--In preparing
the report under subsection (a), the Secretary may request from group
health plans and health insurance issuers--
(1) data on claims experience under the plan or health
insurance coverage issued by such issuers, such as the number,
nature, and dollar amount of claims made by enrollees during
the period involved;
(2) data relating to enrollees in the plan or under such
coverage, such as number of new enrollees, number of
individuals reenrolling (or discontinuing enrollment) after the
first year of coverage, and changes in the demographic
composition of enrollees; and
(3) such other information as the Secretary deems
appropriate.
The provisions of section 2722(b) of the Public Health Service Act
shall apply to a failure of a group health plan or health insurance
issuer to provide data or information requested by the Secretary under
this subsection in the same manner as such provisions apply to the
enforcement of a provision of part A of title XXVIII of such Act,
except that any reference to an individual in paragraph (1)(C)(i) of
such section shall be deemed for this purpose a reference to a covered
life under the plan or health insurance coverage involved.

SEC. 6. GAO REPORT.

Not later than 1 year after the date of the enactment of this Act,
the Comptroller General of the United States shall submit to Congress a
report on the impact of this Act (and other Federal laws regarding the
regulation of health insurance and health benefits coverage) on the
reduction in the number of uninsured and underinsured individuals in
the group market and the individual market and on the affordability of
coverage in such markets.
Output:
Preexisting Condition Patient Protection Act of 2009 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to prohibit a group health plan from: (1) imposing any preexisting condition exclusion; or (2) providing for an affiliation period for coverage offered by a health maintenance organization (HMO). Defines an "affiliation period" as a period of time before health insurance coverage becomes effective.

Requires each health insurance issuer offering coverage in the group market in a state to accept every employer in the state that applies for such coverage.

Prohibits preexisting condition exclusions for individual health insurance coverage.

Requires the Secretary of Health and Human Services to report to Congress on the impact of this Act on health benefits coverage. Authorizes the Secretary to request claims data, enrollee data, and other appropriate information from group health plans and health insurance issuers.

Directs the Comptroller General to report to Congress on the impact of this Act and other relevant federal laws on the reduction in the number of uninsured and underinsured individuals and on the affordability of coverage.