[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1878 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 1878
To amend the Patient Protection and Affordable Care Act to establish a
health insurance affordability fund, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 12, 2021
Ms. Craig (for herself and Mr. Peters) introduced the following bill;
which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Patient Protection and Affordable Care Act to establish a
health insurance affordability fund, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``State Health Care Premium Reduction
Act of 2021''.
SEC. 2. ESTABLISHING A HEALTH INSURANCE AFFORDABILITY FUND.
(a) In General.--Subtitle D of title I of the Patient Protection
and Affordable Care Act is amended by inserting after part 5 (42 U.S.C.
18061 et seq.) the following new part:
``PART 6--IMPROVE HEALTH INSURANCE AFFORDABILITY FUND
``SEC. 1351. ESTABLISHMENT OF PROGRAM.
``There is hereby established the `Improve Health Insurance
Affordability Fund' to be administered by the Secretary of Health and
Human Services, acting through the Administrator of the Centers for
Medicare & Medicaid Services (in this section referred to as the
`Administrator'), to provide funding, in accordance with this part, to
the 50 States and the District of Columbia (each referred to in this
section as a `State') beginning on January 1, 2023, for the purposes
described in section 1352.
``SEC. 1352. USE OF FUNDS.
``(a) In General.--A State shall use the funds allocated to the
State under this part for one of the following purposes:
``(1) To provide reinsurance payments to health insurance
issuers with respect to individuals enrolled under individual
health insurance coverage (other than through a plan described
in subsection (b)) offered by such issuers.
``(2) To provide assistance (other than through payments
described in paragraph (1)) to reduce out-of-pocket costs, such
as copayments, coinsurance, premiums, and deductibles, of
individuals enrolled under qualified health plans offered on
the individual market through an Exchange and of individuals
enrolled under standard health plans offered through a basic
health program established under section 1331.
``(b) Exclusion of Certain Grandfathered and Transitional Plans.--
For purposes of subsection (a), a plan described in this subsection is
the following:
``(1) A grandfathered health plan (as defined in section
1251).
``(2) A plan (commonly referred to as a `transitional
plan') continued under the letter issued by the Centers for
Medicare & Medicaid Services on November 14, 2013, to the State
Insurance Commissioners outlining a transitional policy for
coverage in the individual and small group markets to which
section 1251 does not apply, and under the extension of the
transitional policy for such coverage set forth in the
Insurance Standards Bulletin Series guidance issued by the
Centers for Medicare & Medicaid Services on March 5, 2014,
February 29, 2016, February 13, 2017, April 9, 2018, March 25,
2019, and January 31, 2020, or under any subsequent extensions
thereof.
``(3) Student health insurance coverage (as defined in
section 147.145 of title 45, Code of Federal Regulations).
``SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT SAFEGUARD.
``(a) Encouraging State Options for Allocations.--
``(1) In general.--To be eligible for an allocation of
funds under this part for a year (beginning with 2023), a State
shall submit to the Administrator an application at such time
(but, in the case of allocations for 2023, not later than 90
days after the date of the enactment of this part and, in the
case of allocations for a subsequent year, not later than March
1 of the previous year) and in such form and manner as
specified by the Administrator containing--
``(A) a description of how the funds will be used;
and
``(B) such other information as the Administrator
may require.
``(2) Automatic approval.--An application so submitted is
approved unless the Administrator notifies the State submitting
the application, not later than 60 days after the date of the
submission of such application, that the application has been
denied for not being in compliance with any requirement of this
part and of the reason for such denial.
``(3) 5-year application approval.--If an application of a
State is approved for a purpose described in section 1352 for a
year, such application shall be treated as approved for such
purpose for each of the subsequent 4 years.
``(4) Revocation of approval.--The approval of an
application of a State, with respect to a purpose described in
section 1352, may be revoked if the State fails to use funds
provided to the State under this section for such purpose or
otherwise fails to comply with the requirements of this
section.
``(b) Default Federal Safeguard.--
``(1) 2023.--For 2023, in the case of a State that does not
submit an application under subsection (a) by the 90-day
submission date applicable to such year under subsection (a)(1)
and in the case of a State that does submit such an application
by such date that is not approved, the Administrator, in
consultation with the State insurance commissioner, shall, from
the amount calculated under paragraph (4) for such year, carry
out the purpose described in paragraph (3) in such State for
such year.
``(2) 2024 and subsequent years.--For 2024 or a subsequent
year, in the case of a State that does not have in effect an
approved application under this section for such year, the
Administrator, in consultation with the State insurance
commissioner, shall, from the amount calculated under paragraph
(4) for such year, carry out the purpose described in paragraph
(3) in such State for such year.
``(3) Specified use.--The amount described in paragraph
(4), with respect to 2023 or a subsequent year, shall be used
to carry out the purpose described in section 1352(a)(1) in
each State described in paragraph (1) or (2) for such year, as
applicable, by providing reinsurance payments to health
insurance issuers with respect to attachment range claims (as
defined in section 1354(b)(2)), using the dollar amounts
specified in subparagraph (B) of such section for such year) in
an amount equal to, subject to paragraph (5), the percentage
(specified for such year by the Secretary under such
subparagraph) of the amount of such claims.
``(4) Amount described.--The amount described in this
paragraph, with respect to 2023 or a subsequent year, is the
amount equal to the total sum of amounts that the Secretary
would otherwise estimate under section 1354(b)(2)(A)(i) for
such year for each State described in paragraph (1) or (2) for
such year, as applicable, if each such State were not so
described for such year.
``(5) Adjustment.--For purposes of this subsection, the
Secretary may apply a percentage under paragraph (3) with
respect to a year that is less than the percentage otherwise
specified in section 1354(b)(2)(B) for such year, if the cost
of paying the total eligible attachment range claims for States
described in this subsection for such year at such percentage
otherwise specified would exceed the amount calculated under
paragraph (4) for such year.
``SEC. 1354. ALLOCATIONS.
``(a) Appropriation.--For the purpose of providing allocations for
States under subsection (b) and payments under section 1353(b) there is
appropriated, out of any money in the Treasury not otherwise
appropriated, $10,000,000,000 for 2023 and each subsequent year.
``(b) Allocations.--
``(1) Payment.--
``(A) In general.--From amounts appropriated under
subsection (a) for a year, the Secretary shall, with
respect to a State not described in section 1353(b) for
such year and not later than the date specified under
subparagraph (B) for such year, allocate for such State
the amount determined for such State and year under
paragraph (2).
``(B) Specified date.--For purposes of subparagraph
(A), the date specified in this subparagraph is--
``(i) for 2023, the date that is 45 days
after the date of the enactment of this part;
and
``(ii) for 2024 or a subsequent year,
January 1 of the respective year.
``(C) Notifications of allocation amounts.--For
2024 and each subsequent year, the Secretary shall
notify each State of the amount determined for such
State under paragraph (2) for such year by not later
than January 1 of the previous year.
``(2) Allocation amount determinations.--
``(A) In general.--For purposes of paragraph (1),
the amount determined under this paragraph for a year
for a State described in paragraph (1)(A) for such year
is the amount equal to--
``(i) the amount that the Secretary
estimates would be expended under this part for
such year on attachment range claims of
individuals residing in such State if such
State used such funds only for the purpose
described in paragraph (1) of section 1352(a)
at the dollar amounts and percentage specified
under subparagraph (B) for such year; minus
``(ii) the amount, if any, by which the
Secretary determines--
``(I) the estimated amount of
premium tax credits under section 36B
of the Internal Revenue Code of 1986
that would be attributable to
individuals residing in such State for
such year without application of this
part; exceeds
``(II) the estimated amount of
premium tax credits under section 36B
of the Internal Revenue Code of 1986
that would be attributable to
individuals residing in such State for
such year if such State were a State
described in section 1353(b) for such
year.
For purposes of the previous sentence and section
1353(b)(3), the term `attachment range claims' means,
with respect to an individual, the claims for such
individual that exceed a dollar amount specified by the
Secretary for a year, but do not exceed a ceiling
dollar amount specified by the Secretary for such year,
under subparagraph (B).
``(B) Specifications.--For purposes of subparagraph
(A) and section 1353(b)(3), the Secretary shall
determine the dollar amounts and the percentage to be
specified under this subparagraph for a year in a
manner to ensure that the total amount of expenditures
under this part for such year is estimated to equal the
total amount appropriated for such year under
subsection (a) if such expenditures were used solely
for the purpose described in paragraph (1) of section
1352(a) for attachment range claims at the dollar
amounts and percentage so specified for such year.
``(3) Availability.--Funds allocated to a State under this
subsection for a year shall remain available through the end of
the subsequent year.''.
(b) Basic Health Program Funding Adjustments.--Section 1331 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18051) is
amended--
(1) in subsection (a), by adding at the end the following
new paragraph:
``(3) Provision of information on qualified health plan
premiums.--
``(A) In general.--The program described in
paragraph (1) shall provide that a State may not
establish a basic health program unless such State
furnishes to the Secretary, with respect to each
qualified health plan offered in such State during a
year that receives any reinsurance payment from funds
made available under part 6 for such year, the adjusted
premium amount (as defined in subparagraph (B)) for
each such plan and year.
``(B) Adjusted premium amount defined.--For
purposes of subparagraph (A), the term `adjusted
premium amount' means, with respect to a qualified
health plan and a year, the monthly premium for such
plan and year that would have applied had such plan not
received any payments described in subparagraph (A) for
such year.''; and
(2) in subsection (d)(3)(A)(ii), by adding at the end the
following new sentence: ``In making such determination, the
Secretary shall calculate the value of such premium tax credits
that would have been provided to such individuals enrolled
through a basic health program established by a State during a
year using the adjusted premium amounts (as defined in
subsection (a)(3)(B)) for qualified health plans offered in
such State during such year.''.
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