Summary: H.R.4594 — 102nd Congress (1991-1992)All Information (Except Text)

There is one summary for H.R.4594. Bill summaries are authored by CRS.

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Introduced in House (03/26/1992)

BasiCare Health Access and Cost Control Act - Title I: Immediate Reforms - Subtitle A: Small Employer Health Insurance Market Reform - Regulates accident and health insurance issued to small employers (defined as having fewer than 51 employees) regarding: (1) price; (2) sales practices; (3) guaranteed issue; (4) core benefits (requiring the same benefits as title XVIII (Medicare) of the Social Security Act); (5) deductibles, out-of-pocket expenses, and copayments; and (6) preventive benefits for children under 23. Preempts inconsistent State and local laws. Regulates: (1) guaranteed eligibility; (2) limited exclusion of preexisting conditions; (3) guaranteed renewability; (4) waiting periods; and (5) rating requirements. Allows the Secretary of Health and Human Services to agree with a State to apply the standards set by that State's laws instead of these requirements, provided the core benefits and sales practices requirements are met.

Amends the Internal Revenue Code (IRC) to prohibit tax deductions for the tax imposed by title II, subtitle E, of this Act on insurers offering plans that do not qualify as BasiCare plans.

Subtitle B: Community Health Services Expansion - Amends the Public Health Service Act (PHSA) to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations regarding infant mortality and referrals for the health management of infants and pregnant women. Links the amount of the allotment to population and need. Describes the services to be included. Earmarks for the allotments specified percentages of appropriations under certain provisions added by this Act.

Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services, as described in specified provisions of title XIX (Medicaid) of the Social Security Act, for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations.

Subtitle C: Expansion of Tax Incentives for Self-Employed Individuals - Amends the IRC to increase to 100 percent (currently 25 percent) the portion of health insurance costs self-employed individuals may deduct. Removes provisions ending the deduction on a specified date.

Subtitle D: Expanding the Supply of Health Professionals in Rural Areas - Amends the PHSA to authorize appropriations to carry out provisions relating to the National Health Service Corps scholarship and loan repayment program. Earmarks certain portions to carry out provisions of this Act relating to FQHCs.

Amends the IRC to allow a tax credit for service by a physician, physician assistant, or nurse practitioner who: (1) provides primary health services to individuals in a rural health professional shortage area; and (2) is not receiving a National Health Service Corps scholarship or loan repayment and is not fulfilling service obligations under such programs.

Excludes National Health Service Corps loan repayments from gross income.

Allows, with regard to elections to expense depreciable business assets, a higher aggregate cost to be taken into account for rural health care property in a rural health professional shortage area.

Allows a deduction for a limited amount of the interest paid on medical education loans by an individual performing services under an agreement with an applicable rural community to perform professional services in the community. Authorizes use of the deduction in computing adjusted gross income.

Subtitle E: Malpractice Reform - Part I: Definitions - Sets forth definitions for purposes of this subtitle.

Part II: Tort Reform of Health Care Liability Actions - Declares that this part applies to any health care liability action brought in any Federal or State court.

Limits the dollar amount of: (1) recovery by an individual and the individual's family members in a health care liability action, regardless of the number of providers or the number of actions; and (2) single payments which may be required. Requires offset for damages paid by a collateral source. Prohibits punitive damages from exceeding the sum of economic and non-economic damages. Regulates the award of attorney's fees and joint and several liability. Sets forth time limits on initiation of actions. Preempts State laws in certain circumstances.

Subtitle F: Joint Ventures - Amends provisions of the National Cooperative Research Act of 1984 allowing, notwithstanding antitrust laws, certain cooperative research agreements to add references to joint health care provider ventures, defined as a group of activities by two or more hospitals for the provision or delivery of health care services.

Title II: Long-Term Reforms - Subtitle A: Establishment of Commission and Advisory Board - Establishes the Commission on National Health Care Access and Reform and the National Advisory Board. Authorizes appropriations.

Subtitle B: Reform and Standardization of Private Insurance - Requires the Commission to submit to the Congress a legislative proposal with specified elements, including: (1) a uniform national health benefits package (BasiCare); (2) a national health care insurance reform plan applicable to all carriers of health insurance in the United States; (3) self-insured plan requirements; and (4) a program to assist low-income individuals in the transfer from coverage under title XIX (Medicaid) of the Social Security Act to BasiCare coverage and financial assistance in obtaining BasiCare coverage.

Sets forth the continuing duties and responsibilities of the Commission, including: (1) submission of a new legislative proposal annually for the next two years if the Congress does not approve the Commission's recommendation; (2) annual review and revision, subject to congressional recision, of benefits and premiums; (3) oversight of provider participation and billing; (4) oversight of the supplemental health insurance market; (5) submission to the Congress of plans for the long-term disposition of Medicaid benefits not covered or subsumed by BasiCare and assimilation of Medicare (title XVIII of the Social Security Act), the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and the Federal employees' health benefits program into the BasiCare system; and (6) submission to the Congress of a legislative proposal for affordable and easy access to prescription drugs.

Includes in BasiCare coverage basic hospitalization, basic outpatient services, prescription drugs, protection against catastrophic out-of-pocket costs, coverage against extraordinary long-term care costs, and coverage for preventive care.

Requires each carrier to offer BasiCare. Preempts inconsistent State and local laws. Prohibits duplication, in whole or part, of BasiCare benefits. Prohibits discrimination based on health status, including preexisting conditions. Requires guaranteed issue, a minimum plan period, guaranteed renewability, and community-wide ratings. Applies these standards to reinsurance policies. Regulates premiums.

Prohibits employment-related BasiCare plans from imposing waiting periods. Requires: (1) such plans to apply equally to employees of all income levels; and (2) total contributions for an employer for low-income employees to equal or exceed the total for other employees.

Regulates self-insured plans.

Mandates development of recommended managed care plan standards regarding benefits, coverage, and delivery systems. Establishes the Managed Care Advisory Committee. Preempts certain State laws regarding managed care plans.

Subtitle C: Low-Income Assistance - Requires the Commission to provide for the termination of Medicaid program coverage which duplicates BasiCare. Terminates, after five years, any remaining Medicaid benefits. Mandates financial assistance, through a voucher system, to low-income individuals for BasiCare premiums, deductibles, and other cost-sharing.

Subtitle D: Congressional Consideration of Commission Recommendation - Declares that these provisions are enacted as an exercise of the rulemaking power of the House of Representatives and the Senate with recognition of the right of either House to change the rules as any other rule of that House. Provides for the introduction and consideration of a joint resolution approving of the Commission's legislative proposal under subtitle B of this title.

Subtitle E: Enforcement Provisions - Amends the Internal Revenue Code to remove provisions relating to a tax on any employer or employee organization that contributes to a group health plan or large group health plan that does not comply with certain Medicare provisions.

Imposes a tax on: (1) insurers offering plans that do not qualify as BasiCare plans; (2) the failure of any service provider under a BasiCare plan to comply with specified provisions of this Act; and (3) the failure of any person to comply with provisions of this Act relating to employer responsibilities and self-insured plan requirements under this Act.

Disallows personal exemptions unless the individual's BasiCare policy number is included in the individual's tax return.

Subtitle F: Financial Provisions - Creates the BasiCare Trust Fund and transfers to the Fund: (1) a specified percentage of wages and self-employment income; (2) all of the taxes imposed by this Act; (3) additional revenues received as the result of amendments made by this Act; (4) the State's Medicaid share; and (5) all unobligated amounts in the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Appropriates to the Fund: (1) the Federal Medicaid share; and (2) amounts equal to appropriations for CHAMPUS and the Federal employees' health benefits program. Authorizes appropriations for additional sums as required to make expenditures under specified provisions of this act.

Amends title II (Old-Age, Survivors and Disability Insurance) of the Social Security Act to exclude amounts under certain provisions of this Act from appropriation to the Federal Old-Age and Survivors Insurance Trust Fund.

Amends the Internal Revenue Code to: (1) exclude from gross income employer-provided coverage under a BasiCare plan (currently, under an accident or health plan); (2) prohibit deductions for employer expenses for a group health plan unless the plan qualifies as a BasiCare plan; and (3) include amounts paid for a BasiCare plan (currently, for insurance) in the definition of "medical care" for provisions relating to medical and dental expenses.

Title III: Containment of Prescription Drug Prices - Amends the Internal Revenue Code to require, in the case of any manufacturer of single source drugs or innovator multiple source drugs, a reduction in the Puerto Rico and possession tax credit according to a specified formula involving the amount of the manufacturer's wages paid to eligible employees in a U.S. possession, the sales of the drug, and price increases.

Requires the Commission to report annually to the Congress regarding national and international drug policy issues.