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House health care bill
(h) FUNDING; TERMINATION OF AUTHORITY.—
(1) IN GENERAL.—There is appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $5,000,000,000 to pay claims against (and administrative costs of) the high-risk pool under this section in excess of the premiums collected with respect to eligible individuals enrolled in the high-risk pool. Such funds shall be available without fiscal year limitation.
(2) INSUFFICIENT FUNDS.—If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.
(c) ELIGIBILITY.—For purposes of this section, the term ‘‘eligible individual’’ means an individual—
(A) is not eligible for—
(i) benefits under title XVIII, XIX, or XXI of the Social Security Act; or
(ii) coverage under an employment based health plan (not including coverage under a COBRA continuation provision, as defined in section 107(d)(1)); and
(i) is an eligible individual under section 2741(b) of the Public Health Service Act; or
(ii) is medically eligible for the program by virtue of being an individual described in subsection (d) at any time during the 6-month period ending on the date the individual applies for high-risk pool coverage under this section;
(2) who is the spouse or dependent of an individual who is described in paragraph (1); or
(3) who has not had health insurance coverage or coverage under an employment-based health plan for at least the 6-month period immediately preceding the date of the individual’s application for high-risk pool coverage under this section.
(d) MEDICALLY ELIGIBLE REQUIREMENTS.—For purposes of subsection (c)(1)(B)(ii), an individual described in this subsection is an individual—
(1) who, during the 6-month period ending on the date the individual applies for high-risk pool coverage under this section applied for individual health insurance coverage and—
(A) was denied such coverage because of a preexisting condition or health status; or
(B) was offered such coverage—
(i) under terms that limit the coverage for such a preexisting condition; or
(ii) at a premium rate that is above the premium rate for high risk pool coverage under this section; or
(2) who has an eligible medical condition as defined by the Secretary.