To provide for the certification of programs to provide uninsured employees of small businesses access to health coverage, and for other purposes.

April 11, 2003

Ms. STABENOW introduced the following bill; which was read twice and referred to the Committee on Finance

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 2003'.

SEC. 2. FINDINGS.

Congress finds the following:

(1) For most of the past 16 years, the number of Americans without health insurance has been on the rise, reaching more than 41,000,000 in 2002.

(2) People without health insurance are less likely to get preventive care and often delay or forgo needed care. They are therefore more likely than those with health insurance to be hospitalized for conditions that could have been avoided.

(3) Not only are the health and financial circumstances of uninsured Americans adversely affected by the lack of health insurance, their care is ultimately being paid for in the least efficient manner: after they get sick.

(4) People who were uninsured during any part of 2001 received $99,000,000,000 in care, of which $34,500,000,000 was not paid for either out of pocket or by a private or public insurance source. Federal, State, and local governments covered 85 percent of such uncompensated care, amounting to $30,000,000,000.

(5) Private health insurance enrollees also help pay for uncompensated care through higher premiums.

(6) Covering more Americans will not only contribute to better overall health, it will lower the amount of health care costs assumed by taxpayers, businesses, and consumers.

(7) Helping small businesses gain access to affordable health care benefits is essential to insuring more Americans.

(8) Eighty-two percent of uninsured people are part of working families.

(9) More than 1/2 of small businesses with less than 50 employees do not offer their employees health insurance.

(10) Innovative community-based solutions have developed and should serve as a model for insuring more Americans.

SEC. 3. 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) CERTIFICATION-

`(1) IN GENERAL- The Secretary, acting through the Administrator, shall promulgate regulations for the certification of three-share programs for purposes of section 36 of the Internal Revenue Code.

`(2) THREE-SHARE PROGRAM REQUIREMENTS-

`(A) IN GENERAL- The Administrator shall require, for purposes of a certification under regulations under paragraph (1) that each three-share program shall--

`(i) be either a non-profit or local governmental entity;

`(ii) define a 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 community involvement, as determined by the Administrator.

`(B) PAYMENT- To obtain the certification described in 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 thirty percent of such fee shall be paid by a qualified employee desiring coverage under the three-share program.

`(ii) At least seventy percent of such fee shall be paid by the qualified employer of such a qualified employee.

`(3) COVERAGE-

`(A) IN GENERAL- To obtain the certification described in paragraph (1) a 3-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 eligible for certification under paragraph (1) if any individual can be excluded from coverage under such program because of a preexisting health condition.

`(b) STARTUP GRANTS FOR THREE-SHARE PROGRAMS-

`(1) ESTABLISHMENT- The Administrator may award startup grants to eligible entities to establish three-share programs for certification under subsection (a).

`(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 (a).

`(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; and

`(iv) manage all administrative needs.

`(4) NUMBER OF GRANTS- An eligible entity may receive only 1 grant under this subsection for each three-share program and may not receive a grant for such program under both this subsection and subsection (c).

`(c) 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, to assist such programs in meeting the certification requirements of subsection (a).

`(2) NUMBER OF GRANTS- An eligible entity may receive only 1 grant under this subsection for a three-share program and may not receive a grant for such program under both this subsection and subsection (b).

`(3) 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.

`(d) RISK POOL GRANTS-

`(1) IN GENERAL- The Administrator may award grants to eligible entities administering certified three-share programs to enhance the risk pools of such programs.

`(2) NUMBER OF GRANTS- An eligible entity administering a three-share program described in paragraph (1) may receive only 1 grant under this subsection for such three-share program.

`(3) 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 Act 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 Act.

`(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 for any three-share program certified pursuant to 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 (f).

`(4) ELIGIBLE ENTITY- The term `eligible entity' means an entity that meets the requirements of subsection (a)(2)(A).

`(5) FULL TIME- The term `full time', for purposes of employment, means regularly working at least 35 hours per week.

`(6) QUALIFIED EMPLOYEE- The term `qualified employee' means any individual employed by a qualified employer who meets certain criteria including--

`(A) working full time;

`(B) lacking access to health coverage through a family member or common law partner;

`(C) not being eligible for coverage under the medicare program under title XVIII or the medicaid program under title XIX; and

`(D) 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.

`(7) 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) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated to carry out this section $50,000,000 for fiscal year 2004 and such sums as may be necessary for each subsequent fiscal year.'.

SEC. 4. REFUNDABLE CREDIT FOR PORTION OF EMPLOYER COSTS OF THREE-SHARE PROGRAM.

(a) IN GENERAL- Subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to refundable credits) is amended by redesignating section 36 as section 37 and inserting after section 35 the following new section:

`SEC. 36. EMPLOYER COSTS OF THREE-SHARE PROGRAM.

`(a) IN GENERAL- In the case of an eligible employer, there shall be allowed as a credit against the tax imposed by this subtitle an amount equal to 40 percent of the costs of a three-share program resulting from the participation of the taxpayer in such program during the taxable year.

`(b) ELIGIBLE EMPLOYER- For purposes of this section, the term `eligible employer' means any employer which pays or incurs at least 70 percent of the costs of a three-share program resulting from the participation of the taxpayer in such program during the taxable year.

`(c) THREE-SHARE PROGRAM- For purposes of this section, the term `three-share program' means an employee health care coverage program approved for participation by an eligible employer pursuant to title XXII of the Social Security Act.

`(d) DENIAL OF DOUBLE BENEFIT- No deduction or credit under any other provision of this chapter shall be allowed with respect to costs of a three-share program taken into account under subsection (a).

`(e) ADVANCED REFUNDABILITY- The Secretary shall provide for the advanced refundability of the credit allowed under this section to be made in quarterly payments to taxpayers providing such information as the Secretary requires in order to make a proper determination of such payments.

`(f) REGULATIONS- The Secretary may prescribe such regulations and other guidance as may be necessary or appropriate to carry out this section.'.

(b) CONFORMING AMENDMENTS-

(1) Paragraph (2) of section 1324(b) of title 31, United States Code, is amended by inserting before the period `, or from section 36 of such Code'.

(2) The table of sections for subpart C of part IV of chapter 1 of the Internal Revenue Code of 1986 is amended by striking the last item and inserting the following new items:

`Sec. 36. Employer costs of three-share program.

`Sec. 37. Overpayments of tax.'.

(c) EFFECTIVE DATE- The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

END