Retirement Legislative Tracking Chart
Human Resources Legislative Tracking Chart

Patients' Rights
Medicare
Health Benefit Mandates
Health Coverage Incentives
Other Health & Welfare Bill

The chart summarizes selected federal legislation that would affect employer benefit programs. The bills included on the chart are based on judgments regarding the prominence of the issue, the likelihood of enactment, and the influence of the sponsors.

Patients’ Rights
Bill	Summary	Status
Patient Protection Act H.R. 597 Norwood (R-GA)	Patients’ rights. Amends ERISA, the PHSA and the IRC to require employers and insurers to add various patients’ rights provisions to health plans, both insured and self-insured. New standards would be set for 1) utilization review; 2) grievance and appeals procedures; 3) access to care; 4) access to information; and 5) confidentiality provisions. The bill also provides a “federal floor” for external review, giving states the ability to write their own external review laws for fully-insured plans. The bill would permit a state to have a more stringent (but not less) external review provision than the federal law.	Introduced on February 5, 2003, and referred to the House Education and the Workforce, Energy and Commerce, and Ways and Means Committees. The bill includes all of the patient protection provisions in the House-passed PBOR from the 107th Congress, but lacks the expanded liability provisions that essentially created a stalemate on the issue. The bill also does not include the provisions on expansion of Archer MSAs and the authority for the regulation of self-insured association health plans. These provisions are expected to be brought up separately in the next few months.
Health Care Coverage Expansion and Quality Improvement Act S. 10 Daschle (D-SD)	Patients’ rights. Title I of the bill is the Senate Democratic leadership’s patients’ bill of rights. It mandates federal standards for group health plans on utilization review; internal & external appeals; patient access to providers, specialists, emergency care, clinical trials and prescription drugs. Civil remedies available under ERISA to health plan participants would be expanded to include economic and non-economic damages.	Introduced on January 7, 2003 and referred to the Finance Committee. Bill also includes provisions on mental health parity, summarized elsewhere on this chart.
ERISA Clarification Act H.R. 596 Norwood (R-GA)	Patients’ rights. Would allow individuals to sue employers and health plans in state courts for damages over disputes involving “medically reviewable” health claims and sets no limits on the amounts of state court awards. In addition, states would have no restrictions on their ability to enact differing laws imposing their own standards for medically reviewable claims.	Introduced on February 5, 2003 and referred to the House Education and the Workforce Committee.

Medicare
Bill	Summary	Status
Medicare Rx Drug Discount and Security Act of 2003 S. 778 Hagel (R-NE)	Prescription drug benefit. Would amend Medicare to create a prescription drug benefit. Beneficiaries would pay a $25 annual enrollment fee (waived for beneficiaries with incomes under 200% of poverty). Would create a sliding scale pegged to income that would tap out-of-pocket costs – ranging from $1,500 for beneficiaries with income below 200 percent of poverty level to $5,500 for people with an income between 400 percent and 600 percent of poverty level. Above that level the program would cap out of pocket expenses at 20 percent of income. Beneficiaries would also be entitled to purchase prescriptions drugs at a discounted rate from eligible entities.	Introduced on April 3, 2003 and referred to the Senate Finance Committee.
Medicare Rx Now Act of 2003 H.R. 1568 Dooley (D-CA)	Prescription drug benefit. Would amend Medicare to create a drug benefit into the existing Medicare Part B program. Medicare would cover 80 percent of drug costs after a beneficiary has total drug costs of $4,000. Beneficiaries would be eligible for a 10 to 30 percent discount on drug purchases through Medicare-approved plans. Seniors below 200 percent of the federal poverty level would be eligible for additional benefits through a tiered co-pay system.	Introduced on April 2, 2003 and referred to the House Energy and Commerce and House Ways and Means Committees.
Medicare Outpatient Prescription Drug Coverage Act of 2003 H.R. 1045 Engel (D-NY)	Prescription drug benefit. Amends Medicare to provide for coverage of outpatient prescription drugs for Medicare beneficiaries. Would cover up to 80% of drug costs after a $250 deductible.	Introduced on March 3, 2003 and referred to the House Energy and Commerce and the House Ways and Means Committees.
Prescription Drug Benefit and Cost Containment Act of 2003 S. 7 Daschle (D-SD)	Prescription drug benefit. Creates a voluntary, comprehensive drug benefit for Medicare beneficiaries. Major features include a $25 monthly premium for drug coverage, no deductible, stop-loss coverage of $3,700, and full coverage of premiums and cost-sharing for low-income beneficiaries.	Introduced on January 7, 2003 and referred to the Finance Committee. Bill also amends Hatch-Waxman Act on generic drugs, summarized elsewhere on the chart.
Medicare Rx Drug Discount Act of 2003 H.R. 513 Foley (R-FL)	Prescription drug costs. Amends Medicare to authorize the Secretary of HHS to endorse prescription drug discount cards for the use by Medicare beneficiaries. The bill responds to a recent court ruling that the Bush Administration lacks the statutory authority to implement such a program.	Introduced on January 31, 2003 and referred to the House Energy and Commerce and the House Ways and Means Committees.

Health Benefit Mandates
Bill	Summary	Status
Senator Paul Wellstone Mental Health Equitable Treatment Act of 2003 S. 486 Domenici (R-NM) H.R. 953 Kennedy (D-MA)	Mental health parity. Expands the current limited mental health parity requirements in ERISA §712 to mandate equal coverage of mental health benefits with respect to health benefits coverage unless comparable limitations are imposed on other medical and surgical benefits; i.e., so-called “full parity.” Would eliminate the current law exception from the mandate for plans where the standard causes more than a one-percent increase in health care premiums. Would continue to exempt small employers with less than 50 employees.	Introduced on February 27, 2003. The Senate HELP Committees is expected to mark up S. 486 in the late spring or early summer. President Bush gave his general endorsement to mental health parity legislation in an April 2002 speech.
Health Care Coverage Expansion and Quality Improvement Act S. 10 Daschle (D-SD)	Mental health parity. Title II of the bill expands the current limited mental health parity requirements in ERISA §712. It requires that, if a plan includes mental health benefits, treatment limitations and financial requirements must be equal between coverage of mental health benefits and medical or surgical benefits; i.e., so-called “full parity.” Includes an exemption for small employers with less than 50 employees. Applies to plan years beginning on or after January 1, 2004.	Introduced on January 7, 2003 and referred to the Finance Committee. It is part of an omnibus health bill that includes provisions on patients' rights, summarized elsewhere on this chart.

Health Coverage Incentives
Bill	Summary	Status
Small Business Health Fairness Act H.R. 660 Fletcher (R-KY)	Association Health Plans. Would amend ERISA to authorize formation of association health plans (AHPs) that could self-insure without the legal risks (i.e., subject to state insurance regulation) currently associated with operating an uninsured MEWA. While aimed at small employers, participation appears to be available to large employers under certain conditions.	Introduced on February 11, 2003 and approved on April 8, 2003 by the House Education and the Workforce subcommittee on Employer-Employee Relations. The bill now heads to the full Education and the Workforce Committee, where it is likely to be approved. President Bush has indicated that he supports this measure. A similar measure (S.545) was introduced in the Senate on March 6, 2003.
S. 647 Kennedy (D-MA)	COBRA. Would amend COBRA to allow certain reservists to keep their employer-based coverage through COBRA when called to active duty, with the government paying full premiums. Additionally, under the bill, the federal government would pay for the cost of individual insurance for families without employer-sponsored coverage.	Introduced on March 18, 2003 and referred to the Senate Armed Services Committee.
United States National Health Insurance Act H.R. 676 Conyers (D-MI)	Universal health coverage. Would create a national single-payer health system and provide coverage for a variety of services, including primary care, prescription drugs and dental and vision services. The system would expand the current Medicare system to every resident in the U.S. and its territories, and would be funded through the existing Medicare payroll tax and a new payroll tax.	Introduced on February 11, 2003 and referred to the House Energy and Commerce, Resources, Veterans' Affairs and Ways and Means Committees.

Other Health & Welfare Bills
Bill	Summary	Status
Employee Benefits Protection Act of 2003 H.R. 1397 McCarthy (D-NY)	Plan eligibility. Would amend ERISA §402 to forbid an employer or plan sponsor from excluding any person from participation in an employee benefit plan based on the placement or reclassification of such employee in any category of workers (such as temporary employees, leased employees, agency employees, staffing firm employees, contractors, or any similar category), if the employee performs the same work (or substantially the same work) for the employer as other employees who generally are not excluded from participation in the plan and meets the minimum age and service term of the plan.	Introduced on March 20, 2003 and referred to the House Education and the Workforce Committee.
Tax Equity for Health Plan Beneficiaries Act of 2003 H.R. 935 McDermott (D-WA)	Domestic partner coverage. Would amend IRC §106 to expand the income tax exclusion for employer-provided health coverage to all designated eligible beneficiaries of an employee (e.g., domestic partners). Under current law, income spent on health insurance coverage for legal spouses and dependents are not taxed. However, when employers choose to provide coverage for other recipients, including domestic partners, employers are obligated to withhold employee taxes on the fair market value of domestic-partner coverage.	Introduced on February 26, 2003 and referred to the House Ways and Means Committee.
H.R. 176 Royce (R-CA)	Flex. Would amend IRC § 125 to allow employees to carryover up to $2,000 of unused health flexible spending account money to a subsequent year, but on a taxable basis.	Introduced on January 7, 2003 and referred to the House Ways and Means Committee.
Pension Preservation and Savings Expansion Act of 2003 H.R. 1776 Portman (R-OH)	Flex. Would amend IRC § 125 to allow employees to roll up to $500 of unused flexible spending account money into their 401(k), 403(b), 457 or IRA at the end of the year, subject to existing limits on plan and IRA contributions. [For the bill's pension-related provisions, see the Retirement Legislative Tracking Chart.]	Introduced on April 11, 2003 and referred to the House Energy and Commerce and House Ways and Means Committees. H.R. 1776 also includes retiree medical provisions summarized elsewhere on this chart.
Health Flexible Spending Account Enhancement H.R. 1177 DeMint (R-SC)	Flex. Would amend IRC §125 to allow up to $500 of unused funds in a health Flexible Spending Account (FSA) to be carried over to the following year or cashed-out and included in gross income. Unused funds could also be contributed to a 401(k) plan, 403(b) plan, governmental 457(b) plan, or medical savings account (MSA). Amounts contributed to a 401(k) or other specified plan would be subject to the normal contribution limits and other rules applicable to these plans.	Introduced on March 11, 2003 and referred to the House Ways and Means Committee.
Patient Safety and Quality Improvement Act H.R. 663 Bilirakis (R-FL)	Medical errors. Amends Title XI of the SSA to improve patient safety by establishing a voluntary medical errors reporting system. Would create a network of data banks of public and private Patient Safety Organizations (PSOs) that would collect information from hospitals, doctors, nursing homes, other health care facilities and Managed Care + Choice plans. The bill would also provide legal protections in civil or administrative proceedings for information provided to the PSOs.	On March 12, 2003, the House overwhelmingly approved H.R. 663 by a vote of 418-6. The bill is a combination of Energy and Commerce Committee legislation and a bill (HR 877) reported by the House Ways and Means Committee.
Help Efficient Accessible, Low-Cost, Timely Health Care (HEALTH) Act Greenwood (R-PA) H.R. 5	Medical liability. A medical malpractice liability reform bill that would establish a $250,000 cap on non-economic damages but would not limit awards for economic losses. Would limit punitive damages against providers and insurers to twice the economic damages or $250,000, whichever was greater. Would also limit the number of years a plaintiff can wait before filing a health care liability action and allocates damages in proportion to a party’s degree of fault. Additionally, the bill would shield drug or medical device manufacturers from punitive damages if the FDA approved their products.	On March 13, 2003, the House approved H.R. 5 by a vote of 229 to 196. The bill now goes to the Senate, where its fate is uncertain. Many Democrats oppose the bill and supporters likely will need 60 votes to overcome a potential filibuster in the 100-member chamber. Medical liability is one of the key health care issues Congress will take up this year at the urging of President Bush.
The Adoption Tax Relief Guarantee Act H.R. 1057 DeMint (R-SC)	Adoption assistance. Would make permanent the tax cuts in the Economic Growth and Tax Relief Reconciliation Act of 2001 (EGTRRA) relating to the exclusion for employer-provided adoption assistance as well as the adoption tax credit.	Introduced on March 4, 2003 and referred to the House Ways and Means Committee.
Commuter Benefits Equity Act of 2003 S. 661 Schumer (D-NY)	Transportation fringe benefit. Would amend IRC §132(f) qualified transportation fringe benefit to increase the amount of pre-tax income that employees can set aside to $190 a month (thus also providing for a uniform dollar limitation for all types of transportation fringe benefits).	Introduced on March 19, 2003 and referred to the Senate Finance Committee.
H.R. 1052 Blumenauer (D-OR)	Transportation fringe benefit. Would extend the IRC §132(f) transportation fringe benefit to bicycle commuters.	Introduced on March 4, 2003 and referred to the House Ways and Means Committee.
Emergency Retiree Health Benefits Protection Act of 2003 H.R. 1322 Tierney (D-MA)	Retiree health. Would amend ERISA to prohibit group health plans from making post-retirement reductions of retiree health benefits, unless a plan sponsor obtains a waiver from the government upon a showing that the plan sponsor would be unable to continue its business without the waiver. Requires plans to restore benefits reduced after retirement, but allows for exceptions to be made if a plan sponsor can demonstrate that it would experience significant business hardship due to the restoration of benefits. Establishes the Emergency Retiree Health Loan Guarantee Program and Board to assist eligible plan sponsors in meeting these requirements.	Introduced March 18, 2003 and referred to the House Education and the Workforce Committee.
Pension Preservation and Savings Expansion Act of 2003 H.R. 1776 Portman (R-OH)	Retiree health. Would permit retirees to use pre-tax retirement plan distributions to pay for retiree medical premiums. Would also allow employers with defined contribution plans such as 401(k)s to fund a modest portion of retiree medical expenses on a pre-tax basis. For the bill's pension-related provisions, see the Retirement Legislative Tracking Chart.	Introduced on April 11, 2003 and referred to the House Energy and Commerce and House Ways and Means Committees. H.R. 1776 also includes flexible spending account provisions summarized elsewhere on this chart.

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