Home > 108th Congressional Bills > H.R. 297 (ih) To require any amounts remaining in a Member's Representational Allowance at the end of a fiscal year to be deposited in the Treasury and used for deficit reduction or to reduce the Federal debt. [Introduced in House] ...H.R. 297 (ih) To require any amounts remaining in a Member's Representational Allowance at the end of a fiscal year to be deposited in the Treasury and used for deficit reduction or to reduce the Federal debt. [Introduced in House] ...
108th CONGRESS
1st Session
H. R. 2979
To amend the Social Security Act to provide grants and flexibility
through demonstration projects for States to provide universal,
comprehensive, cost-effective systems of health care coverage, with
simplified administration.
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IN THE HOUSE OF REPRESENTATIVES
July 25, 2003
Mr. Tierney (for himself, Mr. Sanders, Ms. Millender-McDonald, Ms.
Jackson-Lee of Texas, Mr. Kildee, Mr. Kucinich, Mr. Owens, Mr. Nadler,
Ms. Norton, Mr. Conyers, Mr. Hinchey, Mr. George Miller of California,
Ms. Schakowsky, Mr. McDermott, Mr. Stark, Mr. Olver, Mr. Brady of
Pennsylvania, Mr. Evans, Ms. Waters, Ms. Baldwin, Mr. Udall of New
Mexico, Mr. Markey, Ms. Lee, Mrs. Christensen, Mr. Capuano, Mr.
McGovern, Mr. Kennedy of Rhode Island, Mrs. Maloney, Mr. Davis of
Illinois, Ms. Solis, Mr. Weiner, Mr. Lantos, Mr. Payne, Ms. Carson of
Indiana, Mr. Filner, Mr. Meehan, Mr. Lynch, Mr. Thompson of
Mississippi, Mr. Hastings of Florida, Mr. DeFazio, Mr. Gutierrez, Mr.
Lewis of Georgia, Mr. Delahunt, Mr. Fattah, and Mrs. Jones of Ohio)
introduced the following bill; which was referred to the Committee on
Energy and Commerce
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A BILL
To amend the Social Security Act to provide grants and flexibility
through demonstration projects for States to provide universal,
comprehensive, cost-effective systems of health care coverage, with
simplified administration.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``States' Right To
Innovate in Health Care Act of 2003''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
Sec. 3. Amendment to Social Security Act.
``TITLE XXII--STATE COMPREHENSIVE HEALTH CARE AND COST CONTAINMENT
DEMONSTRATION PROJECTS
``Sec. 2201. Planning grants.
``Sec. 2202. Demonstration grants.
``Sec. 2203. State plan requirements.
``Sec. 2204. Interstate arrangements.
``Sec. 2205. Definitions.''.
SEC. 2. FINDINGS AND PURPOSES.
(a) Findings.--Congress finds the following:
(1) In 1998, annual health care expenditures in the United
States totaled $1.15 trillion, or $4,094 per person.
(2) In 1998, health care expenditures represented 13.5
percent of the gross domestic product (GDP) in the United
States and grew at the rate of 5.6 percent while the gross
domestic product grew only at the rate of 4.9 percent.
(3) Businesses, and consumers, would save approximately
$562.8 billion over 7 years if health care expenditures were
increasing at the same rate as GDP growth.
(4) Because many individuals do not have health insurance
coverage, they may incur health care costs which they do not
fully reimburse, resulting in cost-shifting to others.
(5) As a consequence of the piecemeal health care system in
the United States, administrative overhead costs approximately
$1,000 per person annually while other Western industrialized
nations with universal health care systems spend approximately
$200 per person annually for administrative overhead.
(b) Purpose.--It is the purpose of this Act to encourage States--
(1) to develop plans for universal, comprehensive, cost-
effective systems of health care with simplified administration
to individuals residing in such States; and
(2) to implement such plans by offering transitional grants
and by removing Federal statutory and administrative barriers
that may inhibit or discourage efforts by States to provide
such health care while maintaining Federal payments for health
care under Federal health care programs.
SEC. 3. AMENDMENT TO SOCIAL SECURITY ACT.
The Social Security Act (42 U.S.C. 301 et seq.) is amended by
adding at the end the following new title:
``TITLE XXII--STATE COMPREHENSIVE HEALTH CARE AND COST CONTAINMENT
DEMONSTRATION PROJECTS
``SEC. 2201. PLANNING GRANTS.
``(a) Application.--A State may apply to the Secretary for a State
planning grant under this section to develop a State plan to offer
universal comprehensive health care, with simplified administration,
and to improve the cost-effectiveness of the health care delivery
system.
``(b) Contents.--The Secretary may not approve such a State
planning grant for a State unless the application for the grant
includes or provides for the following:
``(1) Budget.--A budget and a budget justification.
``(2) Planning process.--A description of how under the
grant the State shall--
``(A) identify options to provide a universal,
comprehensive, and cost-effective system of health
care, with simplified administration, that is
affordable and accessible to all eligible beneficiaries
in the State; and
``(B) conduct an analysis that compares projected
overall health expenditures over a 7-year period under
the proposed system with the projected overall health
expenditures that would otherwise occur during such
period.
``(3) Opportunity for public participation.--Assurances
that the State will include a process for public contribution
and participation in the planning process.
``(c) Number of States; Period of Grant.--The Secretary may not
award State planning grants under this section to more than 10 States.
A State planning grant under this section shall be effective for a
period of up to 30 months. In awarding State planning grants under this
section the Secretary shall give preference to States from a variety of
geographic areas in the United States.
``(d) Amount.--The amount of a State planning grant under this
section to a State may not exceed $3,750,000.
``(e) Technical Assistance.--The Secretary shall provide States
with technical assistance in applying for and implementing State
planning grants under this section. At the request of the Secretary,
other Departments and Offices of the Federal Government shall provide
States with such technical assistance.
``SEC. 2202. DEMONSTRATION GRANTS.
``(a) Application.--A State that has developed a State plan may
apply to the Secretary for approval of a demonstration grant under this
section to achieve a cost-effective delivery system of universal,
comprehensive health care with simplified administration. The Secretary
shall notify the chief executive officer of all States of the
availability of demonstration grants under this section.
``(b) Approval.--The Secretary shall approve the applications of
not more than 5 States under this section. In approving grants under
this section the Secretary shall give preference to States from a
variety of geographic areas in the United States. If the Secretary
determines that a State no longer meets the conditions for approval of
the grant, the Secretary shall notify the State of such determination
and provide the State with an opportunity to correct deficiencies in a
timely manner. If the Secretary further determines that a State has not
corrected such deficiencies in a timely manner, the Secretary shall
terminate the grant (including waivers authorized under the grant).
``(c) Period.--A demonstration grant approved under this section
shall be effective for 7 years from the date of final approval of the
demonstration grant application under subsection (b).
``(d) State Plan Required.--The Secretary may not approve a
demonstration grant under this section unless the State has a State
plan to carry out the grant consistent with the requirements of section
2203.
``(e) Funding.--
``(1) Transitional grant amount.--The amount awarded under
this section to a State with a demonstration grant approved
under this section may not exceed an aggregate amount of
$10,000,000 plus $3 multiplied by the number of eligible State
residents of the State, to assist the State in the transition
of the health care delivery and financing infrastructure. Such
amount shall be made available to a State during the period of
transition, as provided in the State plan. The number of
eligible State residents of a State shall be determined based
on the best available Census Bureau data as of the July 1
before the date the grant under this section is approved.
``(2) Maintenance of federal funds under waivers.--Pursuant
to the waivers under subsection (f), the Federal Government
shall pay to a State amounts for health care under Federal
health care programs that would otherwise have been payable by
the Federal Government but for the State's universal,
comprehensive health care system under this section.
``(3) General 3 percentage points increase in fmap for
calendar quarters occurring during the period of the
demonstration grant.--
``(A) In general.--Notwithstanding any other
provision of law, for each State for which a
demonstration grant is approved under this section, the
FMAP of the State shall be increased by 3 percentage
points for each calendar quarter occurring during the
period referred to in subsection (c).
``(B) FMAP.--In this paragraph, the term `FMAP'
means the Federal medical assistance percentage, as
defined in section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b)).
``(f) Waiver of ERISA Preemption and Waivers to Pool Funds.--As
part of a demonstration grant under this section and subject to the
benefit maintenance requirements applicable under section 2203(b), a
State may request (and the Secretary may grant) the following waivers
of requirements and provisions to the extent necessary to carry out the
State plan under section 2203:
``(1) ERISA.--Waiving application of section 514 of the
Employee Retirement Income Security Act of 1974.
``(2) Medicare.--Waiving provisions necessary to permit the
State--
``(A) to use funds otherwise paid under title XVIII
for beneficiaries residing in the State; and
``(B) to permit the State to enter into an
arrangement with the Secretary under which eligible
State residents who are not otherwise enrolled for
benefits under parts A and B of such title are enrolled
for such benefits under such title and the State
provides for such actuarially appropriate reimbursement
to the Secretary with respect to coverage of such
benefits for such residents as is necessary to assure
that the Trust Funds under such title are not adversely
affected by virtue of such waiver, such reimbursement
subject to--
``(i) an independent audit, to be reviewed
by the Comptroller General of the United
States, assuring that such reimbursement does
not adversely affect in any way the Trust Funds
for medicare eligible beneficiaries, and
``(ii) in the case that the audit
determines that additional reimbursement to the
Secretary is required, such additional
reimbursement, with appropriate adjustments for
interest attributable to the late
reimbursement.
``(3) Medicaid.--Waiving provisions necessary to permit the
State to use funds otherwise paid to the State under title XIX.
``(4) SCHIP.--Waiving provisions necessary to permit the
State to use funds otherwise paid to the State under title XXI.
``(5) FEHBP.--Waiving provisions necessary to permit the
State to use funds otherwise paid under chapter 89 of title 5,
United States Code, or allowing the Office of Personnel
Management to purchase health care coverage for Federal
employees and retirees in the State under the State plan.
``(6) Use of other funds.--Waiving provisions necessary to
permit the State to use funds otherwise provided under other
Federal programs for the provision of health care coverage or
services, identified by the State.
``(7) Other laws.--Waiving of other provisions of Federal
law identified by the State under section 2203(e)(3) only if
the Secretary determines such a waiver to be appropriate after
consultation with the head of the Federal agency or department
concerned.
The Secretary may grant a waiver under this subsection only if the
State provides the Secretary with satisfactory assurances that
necessary safeguards have been taken to protect the health and welfare
of individuals provided services under the waiver and that financial
accountability is maintained for any funds expended under the waiver.
The Secretary may grant a waiver under paragraph (1) only with the
concurrence of the Secretary of Labor.
``(g) Reenrollment of Eligible State Residents Who Move From a
Participating State.--In the case of an eligible State resident who is
covered under a State plan under section 2203, who (but for such
coverage) is eligible to be enrolled in a program described in
subsection (f) (including the medicare and medicaid programs), and who
is not enrolled in such a program because of such coverage, if the
resident leaves the State to reside in a State that does not have such
a State plan in effect, the resident shall be permitted,
notwithstanding any other provision of law, to enroll immediately in
such a program if the resident is still otherwise eligible to be so
enrolled. In the case of such enrollment in the medicare program, the
resident shall be treated for purposes of section 1882(s)(2) (relating
to availability of medigap policies without underwriting) as if the
resident had turned 65 years of age on the date the resident enrolls in
the medicare program.
``(h) Duties of the Secretary.--
``(1) Guidance and information.--The Secretary shall--
``(A) provide guidance to State health care
authorities regarding applications for grants under
this title and exchange information with, and otherwise
assist, such authorities upon the request of the
authorities;
``(B) set application procedures;
``(C) review and approve applications for
demonstration grants under this section, including
providing for appropriate waivers described in
subsection (f);
``(D) provide appropriate levels of funding for
such approved applications consistent with such
section;
``(E) conduct such evaluation, monitoring,
compliance, and other review functions as may be
appropriate;
``(F) develop guidelines, standards, and formats
for States to follow in evaluating, reporting, and
collecting data in order to enable the Commission to
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