Summary: H.R.3205 — 102nd Congress (1991-1992)All Information (Except Text)

There is one summary for H.R.3205. Bill summaries are authored by CRS.

Shown Here:
Introduced in House (08/02/1991)

Health Insurance Coverage and Cost Containment Act of 1991 - Title I: Requiring Employers to Provide Health Insurance Coverage for Employees and Dependents or to Pay for Coverage Through the Public Health Plan - Amends the Social Security Act and the Internal Revenue Code to, respectively: (1) add a new title XXI under which employers are required to either enroll their employees and family members under a qualified employer health plan or provide information to the Secretary of Health and Human Services for enrollment instead in the public health plan created under a new title XXII of the Social Security Act and discussed under title II of this Act; and (2) impose a premium tax (set at nine percent of the employment wage base for 1993 and indexed to the rate of growth in public health plan benefits) on employers who fail to enroll their employees and family members under a qualified employer health plan and on such employers' employees, with employers paying 80 percent of the tax and employees paying the remaining 20 percent in order to pay for the basic health insurance coverage provided under the public health plan, impose an excise tax (set at $100 per day) on those employers who fail to provide the information necessary for enrollment under the public health plan, and set forth special rules and exceptions applicable in the imposition of such premium and excise taxes.

Sets forth, under new title XXI of the Social Security Act, the rules for the enrollment of full- and part-time, seasonal, and temporary employees, including rules applicable in cases of families with more than one worker and where both employers offer enrollment under a qualified employer health plan.

Phases in implementation of enrollment and tax payment requirements beginning on January 1, 1993 for employers with more than 100 employees. Requires that as of January 1, 1996 all employers must provide coverage or pay the premium tax for coverage under the public health plan.

Allows the qualified employer health plan under which the employer must provide such benefit package to be either a private health plan or a self-insured plan, depending upon the size of the employer. Allows employers to charge employees up to 20 percent of the premium for such basic coverage. Outlines additional requirements for qualified employer health plan premiums and cost-sharing.

Sets forth requirements for which the Secretary is to develop standards to certify a health plan as a qualified employer health plan. Requires the Secretary to: (1) establish procedures for the periodic review and recertification of plans as qualified employer health plans; and (2) terminate the certification of any such plan that no longer meets such standards.

Requires employers to provide their employees and family members with a basic health benefit package that at least mirrors the benefits provided under the public health plan.

Amends the Internal Revenue Code, the Employee Retirement Income Security Act of 1974, and the Public Health Service Act to repeal certain health insurance continuation requirements.

Title II: Provision of Health Insurance Through a Public Health Plan - Amends the Social Security Act to add a new title XXII under which is created a public health plan similar to Medicare (title XVIII of the Social Security Act) under which those U.S. citizens who are not Medicare beneficiaries or enrolled under a qualified employer health plan under title I of this Act or under a Federal health plan are eligible to enroll for the basic health insurance benefits outlined below.

Makes low-income individuals who enroll in the plan eligible for assistance to limit or eliminate their financial obligations for premiums, deductibles, and co-payments under the plan.

Sets forth provisions detailing the application process for enrollment under the public health plan. Requires individuals who are eligible to enroll under the public health plan but have not applied for enrollment by January 1, 1996 to be automatically enrolled on a retroactive basis and subjected to a penalty of twice any premiums otherwise due.

Provides that the benefits under the public health plan will generally be the same as those currently covered under Medicare, except that: (1) plan benefits will include the preventive services added to the Medicare program under title V of this Act, without co-payments or limits on days of care per spell of illness; (2) plan benefits will include hospital care for children, without co-payments or limits on days of care per spell of illness; (3) plan benefits will include specified pregnancy-related services, subject to a required periodicity schedule and prior authorization for certain services; and (4) there will be a single annual deductible of $250 per individual/$500 per family with an overall annual limit on deductibles and co-payments of $2,500 per individual/$3,000 per family indexed to the annual increases in the contribution and benefit base. Requires payments for services under the public health plan to be based on rates established by the Secretary, and approved by the Health Care Cost Containment Commission, under title III of this Act. Directs the Secretary to establish a global fee schedule for payment of obstetrical services with a disincentive for cesarean sections.

Sets forth provisions for: (1) determining the amount of premiums to be charged individuals not connected to the work force and individuals who are employed on a part-time, seasonal, or temporary basis; and (2) collecting current and delinquent premium payments.

Creates in the Treasury the Public Health Trust Fund to receive the funds generated from the premium and excise taxes imposed under this Act as well as from other specified revenues dedicated to the support of the plan.

Directs the Secretary to provide for the: (1) submission of claims under new titles XXII and XVIII using uniform forms developed by the Health Care Cost Containment Commission established under title III of this Act; and (2) reporting to the Commission of information on required health services provided under such new titles pursuant to standards to be developed by the Commission.

Sets forth administrative provisions applicable to the public health plan.

Requires that the Secretary establish a toll-free telephone number for information on the public health plan.

Authorizes the Secretary to conduct demonstration projects to: (1) improve the delivery and quality of health care services under new title XXII; and (2) increase the efficiency and effectiveness of the methods for paying for such services.

Title III: Cost Containment - Sets a national limit on the health expenditures of the public health plan and qualified employer health plans for the services required to be covered for each year beginning in 1993. Indexes the limit each year to the rate of growth in the gross national product plus: (1) four percent for 1993 and 1994; (2) three percent for 1995 and 1996; (3) two percent for 1997 and 1998; (4) 1 percent for 1999 and 2000; and (5) zero percent for each year after 2000.

Establishes the Health Care Cost Containment Commission to: (1) negotiate with health care providers to allocate national expenditures under the limit among the different classes of health care providers; (2) report annually to the Secretary on negotiation results and on the specific dollar amounts to be allocated to each class of providers; (3) review and approve or disapprove the ceilings for provider payment rates established below; (4) develop uniform reporting standards with respect to information involving the services required to be covered under the public health plan and under qualified employer health plans; (5) develop uniform claims forms for use under the public health plan, qualified employer health plans, and Medicare; (6) report periodically to the Congress and the public on the effect of this title on the delivery of such services; and (7) develop a national capital budget for health care facilities and equipment needed for the provision of such services. Authorizes appropriations.

Directs the Secretary to establish maximum payment rates that may be charged by providers under the public health plan or under qualified employer health plans for the services such plans are required to cover.

Allows the use of State uniform payment rates for services under the public health plan, qualified employer health plans, and Medicare, under certain conditions.

Title IV: Group Health Insurance Reform - Amends the Social Security Act and the Internal Revenue Code to, respectively: (1) add a new title XXIII under which the Secretary is required to develop specific standards to implement requirements which group health insurance plans provided by employers must be certified as meeting in order to be issued, and to maintain, their qualified status; and (2) impose an excise tax (set at 50 percent of the gross premiums received during the taxable year) on the issuer of such a group plan which fails to meet such standards, with specified exceptions.

Requires that no such group plans discriminate on the basis of health status, claims experience, receipt of health care, medical history, or lack of evidence of insurability. Requires the same treatment for pre-existing condition exclusions as is required for qualified employer health plans. Requires any health insurance carrier which offers small employer health plans to register with the Secretary. Requires such carriers to offer such plans to all small employers within their community on a continuous, year-round basis. Allows a carrier to refuse to issue or renew or terminate a plan only for nonpayment of premiums and fraud or misrepresentation. Disallows a carrier from offering to, or issuing with respect to, a small employer a small employer health plan with a term of less than 12 months. Requires such carriers to offer a benefit package which contains only the basic benefits all other employers are required to provide to their employees and dependents. Prohibits a small employer carrier from varying the remuneration paid a broker for the sale or renewal of any small employer health plan based on the claims experience associated with the group to which the plan was sold.

Details notice and other requirements applicable to renewals. Requires that premiums and age-sex adjustments for all small employer plans of the same entity must be: (1) established based on a single cohesive rating system which is applied consistently for all employer groups and is not designed to treat groups differently based on health or risk status; and (2) actuarially certified each year. Prescribes beneficiary classes for enrollment. Requires premiums to be community-rated for a particular geographic area. Details disclosure and recordkeeping requirements for small employer plans. Sets forth requirements for health maintenance organizations.

Directs the Secretary to provide for the establishment of a toll-free telephone information and complaint system which provides for: (1) a system for the receipt and disposition of consumer complaints or inquiries regarding the compliance of health plans with the requirements of this title; and (2) information to small employers about carriers that offer small employer health plans in the area covered by the regulatory authority.

Directs the Secretary to periodically publish the names of issuers of insured employment-related small employer health plans that have been found to meet the applicable requirements of this title.

Title V: Changes in Medicare Program - Amends the Medicare program to: (1) reduce the age of eligibility for Medicare by one year in each year beginning on January 1, 1993 until the age for eligibility reaches 60 on January 1, 1997; (2) add annual screenings for colorectal cancer for individuals over age 50 and for breast cancer for women over age 64, vaccinations for influenza and tetanus-diphtheria, and well-child care services as program benefits; and (3) make technical and conforming changes in provisions with respect to Medicare enrollment and participation agreements that reflect the additions of new titles XXI and XXII and to ensure the coordination of low-income assistance for Medicare beneficiaries.

Directs the Secretary to establish and provide for ongoing demonstration projects providing for the coverage of other specified preventive services under Medicare to determine whether to include the coverage of such services for all individuals enrolled under Medicare part B (Supplementary Medical Insurance). Requires reports to specified congressional committees describing the findings made under such demonstration projects and the Secretary's plans for future such demonstration projects. Authorizes appropriations.

Directs the Director of the Office of Technology Assessment (OTA) to conduct a study to develop a process for the regular review of Medicare coverage of preventive services. Requires an OTA report to specified congressional committees on such study.

Title VI: Financing Provisions - Amends the Internal Revenue Code to provide additional funding for universal health insurance coverage through the imposition of: (1) a surtax applicable to the regular income tax or alternative minimum tax owed by individuals, corporations, and estates and trusts beginning in taxable year 1993 at six percent of such taxpayer's tax liability and reaching nine percent after taxable year 1995; (2) an increase in the hospital insurance taxable wage base from $125,000 to $200,000; (3) an increase in the hospital insurance payroll tax imposed on both employers and employees from 1.45 percent to 1.55 percent in 1993 and to 1.65 percent in 1966 and thereafter; and (4) an increase in the self-employment tax from 2.90 percent to 3.10 percent in 1993 and to 3.30 percent in 1996 and thereafter. Sets forth special rules applicable to estate and trust and corporate liability for the health surtax.

Extends the current deduction for health insurance costs of self-employed individuals for 1992 and modifies such deduction for subsequent years to entitle self-employed individuals and owners of personal service corporations to deduct 100 percent of their health insurance costs if they provide to all their employees who work 17 1/2 hours or more per week health coverage under a plan that would qualify as a qualified employer health plan under new title XXI of the Social Security Act. Provides that if such coverage is not provided, then the deduction for health insurance expenses of such individuals is limited to 25 percent, until after 1996 when the deduction is set unconditionally at 100 percent of the costs of health insurance coverage.

Title VII: Medicaid Provisions - Amends title XIX (Medicaid) of the Social Security Act to: (1) limit Federal financial participation for services covered under the public health plan; (2) provide for the continuation of Medicaid benefits not covered under the public health plan and the nonduplication of benefits with the public health plan; and (3) require payments under State Medicaid programs to hospitals and physicians to be increased during the transition period to full implementation of universal health insurance coverage.