H.R.5341 - State High Risk Pool Funding Extension Act of 2004108th Congress (2003-2004)
Summary: H.R.5341 — 108th Congress (2003-2004)
Introduced in House (10/08/2004)
State High Risk Pool Funding Extension Act of 2004 - Amends the Public Health Service Act to reauthorize funds for States to create and to operate existing high risk health insurance pools.
Increases the maximum allowable premium in a qualified high risk pool to 200 percent of the premium for applicable standard risk rates. Defines "standard risk rate" as a rate that: (1) is determined under the State high risk pool by considering the premiums charged by other health insurers in the same market; (2) is established using reasonable actuarial techniques; and (3) reflects anticipated claims experience and expenses.
Expands the definition of "qualified high risk pool" to allow a State to meet the requirement to provide all eligible individuals with health insurance coverage by utilizing an acceptable alternative mechanism that includes a high risk pool as a component and: (1) that provides for risk adjustment, risk spreading, or a risk spreading mechanism (among issuers or policies of an issuer) or for some financial subsidization for eligible individuals, including through assistance to participating issuers; or (2) under which each eligible individual is provided a choice of all individual health insurance coverage otherwise available.
Amends the formula for appropriating funds to States to operate such pools to give one-half of the funds to eligible States equally and apportion the other half based on the number of uninsured individuals in each State and the number of enrollees in the State's qualified high risk pool. (Currently, all funds are allotted based solely on the number of uninsured individuals in the State.)