Temporary Health Insurance Risk Pool Act
The Temporary Health Insurance Risk Pool Act is a draft model policy considered by ALEC's Health and Human Services Task Force at the Spring Task Force Summit on May 5, 2017. Due to incomplete information, it is not known if the bill passed in a vote by legislators and lobbyists at ALEC task force meetings, if ALEC sought to distance itself from the bill as the public increased scrutiny of its pay-to-play activities, or if key operative language from the bill has been introduced by an ALEC legislator in a state legislature in the ensuing period or became binding law.
ALEC Bill Text
Summary
This act creates a temporary health insurance state risk pool.
Model Policy
Relating to the creation of a temporary health insurance risk pool.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF {Fill in state]:
SECTION 1 Insurance Code, is amended by adding Chapter [Fill in appropriate chapter] to read as follows:
CHAPTER [XX]. TEMPORARY HEALTH INSURANCE RISK POOL
Sec. 1510.001. DEFINITION. In this chapter, “pool” means a temporary health insurance risk pool that is established and administered by the commissioner under this chapter.
Sec. 1510.002. ESTABLISHMENT OF TEMPORARY HEALTH INSURANCE RISK POOL. To the extent that federal funds become available under federal law, regulation, or executive action after [Fill in date], the commissioner may:
(1) apply for such funds; and
(2) use such funds to establish and administer a temporary health insurance risk pool for the purposes of this chapter.
Sec. [XX]. PURPOSE OF POOL. (a) The exclusive purpose of the pool is to provide a temporary mechanism for maximizing available federal funding to assist residents of this state in obtaining access to quality health care at minimum cost to the public.
(b) The pool may not be used to expand the Medicaid program, including the program administered under Chapter [XX], Human Resources Code, and the program administered under Chapter [XX], Government Code.
Sec. [XX] PROVISION OF COVERAGE. Subject to any requirements for obtaining federal funds held in the pool, the commissioner may use pool funds:
(1) to provide alternative individual health insurance coverage to eligible individuals that does not diminish the availability of traditional commercial health care coverage;
(2) to provide funding to individual health benefit plan issuers that cover individuals with certain health or cost characteristics in exchange for lower enrollee premium rates; or
(3) to provide a reinsurance program for health benefit plan issuers in the individual market in exchange for lower enrollee premium rates.
Sec. [XX]. CONTRACTS AND AGREEMENTS. (a) The commissioner may enter into a contract or agreement that the commissioner determines is appropriate to carry out this chapter, including a contract or agreement with:
(1) a similar pool in another state for the joint performance of common administrative functions;
(2) another organization for the performance of administrative functions; or
(3) a federal agency.
(b) The commissioner may contract for stop-loss insurance for risks incurred under this chapter.
Sec. [XX]. FUNDING. (a) The commissioner may use funds appropriated to the department to:
(1) apply for federal funding and grants; and
(2) administer this chapter.
(b) Notwithstanding Section [XX], Chapter [XX], Acts of the [XX] Legislature, Session [XX], the commissioner may use money appropriated to the department from the [XX program] small employer premium stabilization fund for the exclusive purposes of this chapter, other than for paying salaries and salary related benefits.
(c) Notwithstanding Section [XX], Chapter [XX], Acts of the [XX] Legislature, Regular Session, 20[XX], the commissioner shall transfer money from the [XX program] small employer premium stabilization fund to the [Insert state] Department of Insurance operating account in an amount equal to the amount of money appropriated to the department from that fund, as described by Subsection [XX], for the direct and indirect costs of the exclusive purposes of this chapter.
(d) Except as provided by Subsections [XX], the commissioner may not use any state funds to fund the pool unless the funds are specifically appropriated for that purpose.
(e) The commissioner may use federal funds to administer this chapter, as appropriate.
Sec. [XX]. PUBLIC EDUCATION AND OUTREACH. (a) The commissioner may use funds appropriated to the department for the exclusive purposes of this chapter to develop and implement public education, outreach, and facilitated enrollment strategies under this chapter.
(b) The commissioner may contract with marketing organizations to perform or provide assistance with the strategies described by Subsection (a).
Sec. [XX] WAIVER. (a) The commissioner may apply to the United States secretary of health and human services under 42 U.S.C. Section 18052 for a waiver of applicable provisions of the Patient Protection and Affordable Care Act (Pub. L. No. 111-148) and any applicable regulations or guidance with respect to health insurance coverage in this state for a plan year beginning on or after January 1, 2017.
(b) The commissioner may take any action the commissioner considers appropriate to make an application under this section.
(c) The commissioner may implement a state plan that meets the requirements of a waiver granted in response to an application under Subsection (a) if the plan is:
(1) consistent with state and federal law; and
(2) approved by the United States secretary of health and human services.
Sec. [XX] ADDITIONAL AUTHORITY. In addition to the powers granted to the commissioner under this chapter, the commissioner may exercise any authority that may be exercised under the law of this state by:
(1) a reinsurer; or
(2) a health benefit plan issuer authorized to write health benefit plans in this state.
Sec.[XX] RULES. The commissioner may adopt rules necessary to implement this chapter, including rules to administer the pool and distribute money from the pool.
Sec. [XX] EXEMPTION FROM STATE TAXES AND FEES. Notwithstanding any other law, a program created under this chapter is not subject to any state tax, regulatory fee, or surcharge, including a premium or maintenance tax or fee.
Sec. [XX] ANNUAL REPORT OF POOL ACTIVITIES. (a) Beginning June 1, 2018, not later than June 1 of each year, the department shall submit a report to the governor, the lieutenant governor, and the speaker of the house of representatives.
(b) The report submitted under Subsection (a) must:
(1) summarize the activities conducted under this chapter in the calendar year preceding the year in which the report is submitted; and
(2) include information relating to:
(A) net written and earned premiums;
(B) plan enrollment;
(C) administration expenses; and
(D) paid and incurred losses.
Sec. [XX] EXPIRATION OF CHAPTER. This chapter expires August 31, 2019.
SECTION 2 Notwithstanding Section [XX], Chapter [XX], Acts of the [XX] Legislature, Regular Session, 20[XX], on the effective date of this Act, the commissioner of insurance shall transfer any money remaining outside the state treasury in the [Insert state} Treasury Safekeeping Trust Company account established under Section 6(c), Chapter 615 (S.B. 1367), Acts of the [XX] Legislature, Regular Session, 20[XX], to the [Insert program name] small employer premium stabilization fund.
SECTION 3 This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section [XX], Article [XX], [Insert state] Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2017.
