text: 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.
target: Health Care Access for Small Business Act of 2003 - Amends the Social Security Act to add a new title XXII (Providing for the Uninsured) to direct the Secretary of Health and Human Services to promulgate regulations for the certification of three-share programs for purposes of offering a refundable tax credit to small businesses who participate in such programs where: (1) not more than 30 percent of the cost of the monthly premium for health coverage (including prescription drug benefits) is paid by the qualified employee who lacks access to health coverage and desires coverage; and (2) at least 70 percent of such cost is paid by the qualified employer of such a qualified employee.Authorizes the Administrator to award startup grants to eligible entities to establish three-share programs for certification.Amends the Internal Revenue Code to provide for a refundable tax credit in the case of an eligible employer in 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.
feat_title: A bill to provide for the certification of programs to provide uninsured employees of small business access to health coverage, and for other purposes.