text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Covering People With Pre-Existing 
  Conditions Act of 2014''.
  
  SEC. 2. ESTABLISHING UNIVERSAL ACCESS PROGRAMS TO IMPROVE HIGH RISK 
                POOLS AND REINSURANCE MARKETS FOR INDIVIDUALS WITH PRE-
                EXISTING CONDITIONS.
  
      (a) State Requirement.--
              (1) In general.--Not later than January 1, 2015, each State 
          shall--
                      (A) subject to paragraph (3), operate--
                              (i) a qualified State reinsurance program 
                          described in subsection (b); or
                              (ii) qualifying State high risk pool 
                          described in subsection (c)(1); and
                      (B) subject to paragraph (3), apply to the 
                  operation of such a program from State funds an amount 
                  equivalent to the portion of State funds derived from 
                  State premium assessments (as defined by the Secretary) 
                  that are not otherwise used on State health care 
                  programs.
              (2) Relation to current qualified high risk pool program.--
                      (A) States not operating a qualified high risk 
                  pool.--In the case of a State that is not operating a 
                  current section 2745 qualified high risk pool as of the 
                  date of the enactment of this Act--
                              (i) the State may only meet the requirement 
                          of paragraph (1) through the operation of a 
                          qualified State reinsurance program described 
                          in subsection (b); and
                              (ii) the State's operation of such a 
                          reinsurance program shall be treated, for 
                          purposes of section 2745 of the Public Health 
                          Service Act, as the operation of a qualified 
                          high risk pool described in such section.
                      (B) State operating a qualified high risk pool.--In 
                  the case of a State that is operating a current section 
                  2745 qualified high risk pool as of the date of the 
                  enactment of this Act--
                              (i) as of January 1, 2015, such a pool 
                          shall not be treated as a qualified high risk 
                          pool under section 2745 of the Public Health 
                          Service Act unless the pool is a qualifying 
                          State high risk pool described in subsection 
                          (c)(1); and
                              (ii) the State may use premium assessment 
                          funds described in paragraph (1)(B) to 
                          transition from operation of such a pool to 
                          operation of a qualified State reinsurance 
                          program described in subsection (b).
              (3) Application of funds.--If the program or pool operated 
          under paragraph (1)(A) is in strong fiscal health, as 
          determined in accordance with standards established by the 
          National Association of Insurance Commissioners and as approved 
          by the State Insurance Commissioner involved, the requirement 
          of paragraph (1)(B) shall be deemed to be met.
      (b) Qualified State Reinsurance Program.--
              (1) In general.--For purposes of this section, a 
          ``qualified State reinsurance program'' means a program 
          operated by a State program that provides reinsurance for 
          health insurance coverage offered in the small group market in 
          accordance with the model for such a program established (as of 
          the date of the enactment of this Act).
              (2) Form of program.--A qualified State reinsurance program 
          may provide reinsurance--
                      (A) on a prospective or retrospective basis; and
                      (B) on a basis that protects health insurance 
                  issuers against the annual aggregate spending of their 
                  enrollees as well as purchase protection against 
                  individual catastrophic costs.
              (3) Satisfaction of hipaa requirement.--A qualified State 
          reinsurance program shall be deemed, for purposes of section 
          2745 of the Public Health Service Act, to be a qualified high 
          risk pool under such section.
      (c) Qualifying State High Risk Pool.--
              (1) In general.--A qualifying State high risk pool 
          described in this subsection means a current section 2745 
          qualified high risk pool that meets the following requirements:
                      (A) The pool must provide at least two coverage 
                  options, one of which must be a high deductible health 
                  plan coupled with a health savings account.
                      (B) The pool must be funded with a stable funding 
                  source.
                      (C) The pool must eliminate any waiting lists so 
                  that all eligible residents who are seeking coverage 
                  through the pool should be allowed to receive coverage 
                  through the pool.
                      (D) The pool must allow for coverage of individuals 
                  who, but for the 24-month disability waiting period 
                  under section 226(b) of the Social Security Act, would 
                  be eligible for Medicare during the period of such 
                  waiting period.
                      (E) The pool must limit the pool premiums to no 
                  more than 150 percent of the average premium for 
                  applicable standard risk rates in that State.
                      (F) The pool must conduct education and outreach 
                  initiatives so that residents and brokers understand 
                  that the pool is available to eligible residents.
                      (G) The pool must provide coverage for preventive 
                  services and disease management for chronic diseases.
              (2) Verification of citizenship or alien qualification.--
                      (A) In general.--Notwithstanding any other 
                  provision of law, only citizens and nationals of the 
                  United States shall be eligible to participate in a 
                  qualifying State high risk pool that receives funds 
                  under section 2745 of the Public Health Service Act or 
                  this section.
                      (B) Condition of participation.--As a condition of 
                  a State receiving such funds, the Secretary shall 
                  require the State to certify, to the satisfaction of 
                  the Secretary, that such State requires all applicants 
                  for coverage in the qualifying State high risk pool to 
                  provide satisfactory documentation of citizenship or 
                  nationality in a manner consistent with section 1903(x) 
                  of the Social Security Act.
                      (C) Records.--The Secretary shall keep sufficient 
                  records such that a determination of citizenship or 
                  nationality only has to be made once for any individual 
                  under this paragraph.
              (3) Relation to section 2745.--As of January 1, 2015, a 
          pool shall not qualify as qualified high risk pool under 
          section 2745 of the Public Health Service Act unless the pool 
          is a qualifying State high risk pool described in paragraph 
          (1).
      (d) Waivers.--In order to accommodate new and innovative programs, 
  the Secretary may waive such requirements of this section for qualified 
  State reinsurance programs and for qualifying State high risk pools as 
  the Secretary deems appropriate.
      (e) Funding.--In addition to any other amounts appropriated, there 
  is appropriated to carry out section 2745 of the Public Health Service 
  Act (including through a program or pool described in subsection 
  (a)(1))--
              (1) $15,000,000,000 for the period of fiscal years 2015 
          through 2024; and
              (2) an additional $10,000,000,000 for the period of fiscal 
          years 2020 through 2024.
      (f) Definitions.--In this section:
              (1) Health insurance coverage; health insurance issuer.--
          The terms ``health insurance coverage'' and ``health insurance 
          issuer'' have the meanings given such terms in section 2791 of 
          the Public Health Service Act.
              (2) Current section 2745 qualified high risk pool.--The 
          term ``current section 2745 qualified high risk pool'' has the 
          meaning given the term ``qualified high risk pool'' under 
          section 2745(g) of the Public Health Service Act as in effect 
          as of the date of the enactment of this Act.
              (3) Secretary.--The term ``Secretary'' means the Secretary 
          of Health and Human Services.
              (4) Standard risk rate.--The term ``standard risk rate'' 
          means a rate that--
                      (A) is determined under the State high risk pool by 
                  considering the premium rates charged by other health 
                  insurance issuers offering health insurance coverage to 
                  individuals in the insurance market served;
                      (B) is established using reasonable actuarial 
                  techniques; and
                      (C) reflects anticipated claims experience and 
                  expenses for the coverage involved.
              (5) State.--The term ``State'' means any of the 50 States 
          or the District of Columbia.
target: Covering People With Pre-Existing Conditions Act of 2014 - Requires each state to mitigate the health costs of high risk individuals in the state through a state reinsurance program or a state high risk pool. 
feat_title: Covering People With Pre-Existing Conditions Act of 2014