Republican House members have come up with a bill that would try to use mechanisms such as risk pools, reinsurance programs and interstate insurance sales to hold down costs and help the uninsured.

House Minority Leader John Boehner, R-Ohio, has offered the proposal as an “amendment in the nature of a substitute” to H.R. 3962, the 1,990-page Affordable Health Care For America Act bill. an “amendment in the nature of a substitute” to H.R. 3962, the 1,990-page Affordable Health Care For America Act bill.

The 219-page includes some sections that are comparable to existing H.R. 3962 provisions. The Republican bill would, for example, prohibit health insurers from imposing annual or lifetime caps on claims, and it would restrict their ability to rescind policies already in force.

The bill also would encourage use of wellness programs and quality improvement programs.

But the bill makes “reducing health care premiums” a primary goal and part of a title heading, and it would not impose new limits on use of medical underwriting in the sale or pricing of health insurance.

Section 102 of the bill appears to remove the existing individual health insurance access requirement created by the Health Insurance Portability and Accountability Act of 1996.

Instead, Section 101 of the bill would create a new reinsurance system to help health insurers share the risk of insuring people with serious health problems, and it would expand the risk pool program to ensure that people with health problems can buy coverage.

Premiums at a risk pool that wanted to qualify for federal subsidies could cost no more than 150% of the standard rate, and the pool would have to eliminate all waiting periods, so that anyone who was willing to pay for coverage could have coverage.

Section 211 would require group health plans that offer dependent health coverage to permit children to stay on as dependents up until age 25.

Section 221 would create a regulatory mechanism that insurers could use to sell health insurance approved in one state to individuals living in other states.

A cluster of sections starting at Section 201 would create an association health plan program for small businesses. The AHP program would free small businesses from having to abide by state coverage mandates.

Other sections would change health savings account and medical malpractice laws.

Section 232, for example, would let HSA holders whose employers did not provide health coverage to use HSA assets to buy coverage.

Section 305 would allow medical malpractice punitive damages, but only if there was “clear and convincing evidence that [a provider] acted with malicious intent to injure the claimant, or that such person deliberately failed to avoid unnecessary injury that such person knew the claimant was substantially certain to suffer.”