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108th CONGRESS
2d Session
S. 2544
To provide for the certification of programs to provide uninsured
employees of small businesses access to health coverage, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 17, 2004
Ms. Stabenow (for herself, Mrs. Lincoln, and Mr. Levin) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To provide for the certification of programs to provide uninsured
employees of small businesses access to health coverage, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Care Access for Small
Businesses Act of 2004''.
SEC. 2. 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) Pilot Programs.--The Secretary, acting through the
Administrator, shall award grants under this section for the startup
and operation of 50 eligible three-share pilot programs for a 5-year
period.
``(b) Grants for Three-Share Programs.--
``(1) Establishment.--The Administrator may award grants to
eligible entities--
``(A) to establish three-share programs;
``(B) to provide for contributions to the premiums
assessed for coverage under a three-share program as
provided for in subsection (c)(2)(B)(iii); and
``(C) to establish risk pools.
``(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 (c).
``(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;
``(iv) manage all administrative needs; and
``(v) establish relationships among
community, business, and provider interests.
``(4) Priority.--In awarding grants under this section the
Secretary shall give priority to an applicant--
``(A) that is an existing three-share program;
``(B) that is an eligible three-share program that
has demonstrated community support; or
``(C) that is located in a State with insurance
laws and regulations that permit three-share program
expansion.
``(c) Grant Eligibility.--
``(1) In general.--The Secretary, acting through the
Administrator, shall promulgate regulations providing for the
eligibility of three-share programs for participation in the
pilot program under this section.
``(2) Three-share program requirements.--
``(A) In general.--To be determined to be an
eligible three-share program for purposes of
participation in the pilot program under this section a
three-share program shall--
``(i) be either a non-profit or local
governmental entity;
``(ii) define the 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 demonstrated community
involvement.
``(B) Payment.--To be eligible under 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 30 percent of such
premium shall be paid by a qualified employee
desiring coverage under the three-share
program.
``(ii) Not more than 30 percent of such
premium shall be paid by the qualified employer
of such a qualified employee.
``(iii) At least 40 percent of such premium
shall be paid from amounts provided under a
grant under this section.
``(iv) Any remaining amount shall be paid
by the three-share program from other public,
private, or charitable sources.
``(C) Program flexibility.--A three-share program
may set an income eligibility guideline for enrollment
purposes.
``(3) Coverage.--
``(A) In general.--To be an eligible three-share
program under this section, the three-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 an eligible three-
share program under paragraph (1) if any individual can
be excluded from coverage under such program because of
a preexisting health condition.
``(d) 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.
``(2) 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 section 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 section.
``(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 to be a three-share program for purposes of 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 (g).
``(4) Eligible entity.--The term `eligible entity' means an
entity that meets the requirements of subsection (a)(2)(A).
``(5) Qualified employee.--The term `qualified employee'
means any individual employed by a qualified employer who meets
certain criteria including--
``(A) lacking access to health coverage through a
family member or common law partner;
``(B) not being eligible for coverage under the
medicare program under title XVIII or the medicaid
program under title XIX; and
``(C) 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.
``(6) 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) Evaluation.--Not later than 90 days after the end of the 5-
year period during which grants are available under this section, the
General Accounting Office shall submit to the Secretary and the
appropriate committees of Congress a report concerning--
``(1) the effectiveness of the programs established under
this section;
``(2) the number of individuals covered under such
programs;
``(3) any resulting best practices; and
``(4) the level of community involvement.
``(i) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $100,000,000 for each of fiscal
years 2005 through 2010.''.
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