S. 1169 (Feingold)

Target population(s)
Uninsured in states receiving grants.

State Grant Approval Authority

State Grant approval authority
Health Care Coverage Task Force

Structure and membership
The Secretary of HHS and up to 16 members. Must include 2 individuals appointed by the Speaker of the House; 2 by the House Minority Leader; 2 by the Senate Majority Leader; 2 by the Senate Minority Leader, and no more than 8 appointed by the Comptroller General. The latter must include at least 2 representatives of consumers who are uninsured and who have had a chronic illness, one of whom shall represent people with disabilities. Others must include representatives of business and labor, health care provider representatives, those with a broad geographic representation and representatives of Indian tribes or tribal organizations. Task Force members would be appointed for 5 years; a chairperson would be selected by the Commission. The negotiations with states must be conducted in a public forum to the extent practicable.

Duties
Reviews and approves state applications for grants and submits a legislative proposal concerning such approvals to Congress together with recommendations on the level of funding required. The recommendations must be politically balanced and include a variety of approaches to covering the uninsured. The Task Force also: establishes minimum performance measures on coverage quality and cost; conducts discussions and negotiations with state applicants concerning modifications and adjustments; and monitors and reports to the public on status and progress of approved state programs. It is prohibited from approving a state application that: (1) proposes to adopt more restrictive income or resource eligibility criteria for Medicaid, SCHIP, Medicare or any state and local program that provides health care to low-income or targeted populations than those applied as of this bill’s enactment, (2) proposes more restrictive requirements for participation in Medicaid, SCHIP, or Medicare; or 3) would result in making current or future categories of enrolled individuals ineligible.

At the end of the 5-year period of state grants, the Task Force would be required to report to Congress on recommendations for future actions, including continuation of the program, evaluation of state program results, recommendations regarding federal financial assistance for future state health program initiatives, and recommendations as to whether a particular state program should serve as a model for national health reform.

Administration/Staffing
Chairperson would appoint personnel. Annual appropriations of $4 million authorized to fund Task Force activities.

State Grant Approval Process

State Plan Requirements
State plans submitted to the Task Force must designate a lead state entity; describe the minimum benefits to be provided (“see State Plan Benefits”) under the program; provide a methodology for demonstrating that the choice of benefits is based in medical evidence; describe state reform programs that the state will implement (e.g., Medicaid or SCHIP expansion; tax credits; establishment of a purchasing pool, etc.) that have been approved by the Task Force; describe the number and percentage of currently uninsured individuals who will achieve coverage under the state health program; provide and describe the manner in which the state will ensure that an increased number of individuals in the state will have expanded access to coverage within a specific 5-year target; identify the governmental and private programs currently providing health care services in the states and describe how (1) they could be coordinated with the new state health program to the extent practicable and (2) current governmental expenditures for the identified programs that utilize public financing. The plan must also provide for improvements in the availability of appropriate health services to increase access to care to medically underserved populations, including those without adequate access to providers. In addition, a state plan must include provisions to improve the effectiveness and efficiency of health care in the state, including provisions aimed at reducing administrative costs. It must describe the financing; estimate the federal, state and local expenditures as well as costs to individuals and businesses under the state health program; and describe how the state will ensure the financial solvency of the program. State must contribute toward the program an amount equal to the grant times one minus the federal matching percentage provided to the state under SCHIP plus 5 percent.

State Plan Benefits
State program benefits must at a minimum be comparable to any of the plans offered under the FEHBP or to those required under SCHIP (with exceptions), and must meet specified cost sharing limits: for individuals under 100% of the poverty line, no premiums can be required and annual cost sharing may not exceed 0.5% of family income; between 100-200% of poverty, premiums may not exceed 20% of total or 3% of annual income, and cost sharing up to 7% of family income; between 200-300% of poverty, premiums may not exceed 20% of total or 5% of annual income and cost sharing up to 7% of family income. Premiums and cost sharing may only vary based on income in a manner that does not favor higher income individuals. In general, a state may not permit the use of preexisting condition exclusions for covered benefits under a grant-funded program. For group health plans and group health insurance, any use of preexisting condition exclusions would have to be consistent with requirements under the Health Insurance Portability and Accountability Act (HIPAA). The state program would also have to comply with other HIPAA requirements related to issuers of group health insurance.

Application and approval process
Secretary and Task Force make initial review of application within 90 days and advise the state of the need for additional information. Final determination within 90 days of completion of initial review; a state plan requires 2/3 vote of Task Force to be recommended to Congress for final approval. States may apply for the entire state or for regions of two or more states. Local governments may apply if state does not or Secretary permits.

Terms of Grants
Grants for up to 5 years; may be extended for subsequent 5-year periods if approved by the Task Force and Congress. State must maintain its expenditures for health care coverage (including those for Medicaid and SCHIP) not less than those for the year prior to receiving the grant. Such expenditures would have to increase annually by the percentage increase in the Consumer Price Index (CPI)-Urban.

Federal waivers
No provision. Nothing in the bill should be construed as authorizing changes to Medicaid or SCHIP. States may not apply more restrictive Medicaid eligibility than current law.

State Reporting Requirements
Annual reports to Task Force describing results of the state program with respect to coverage, quality, and costs. The Secretary may withhold grant payments from a state failing to comply with the reporting requirements.

Expedited legislative procedure
Provides for an expedited consideration by Congress of the Task Force's state plan recommendations, which would be in the form of a joint resolution.

Financing
Up to $40 billion appropriated for fiscal years 2007-2016; amount equal to savings from specific provisions to increase required Medicaid drug rebates, changes to federal student loans; increasing aviation passenger security fees; extending the Federal Communications Commission (FCC) spectrum auction authority; extending certain custom fees; and reducing the Medicare Part D premium subsidy for higher-income beneficiaries.

Effective date
Task Force to be appointed within 180 days after enactment.

Other provisions in bill
None