[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5011 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 5011
To provide for the establishment of Medicare part E public health
plans, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 13, 2021
Mr. Gomez (for himself, Mr. Beyer, Mr. Brendan F. Boyle of
Pennsylvania, Mr. Payne, Mr. Huffman, Mr. Evans, and Mr. Larson of
Connecticut) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, and Education and Labor, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To provide for the establishment of Medicare part E public health
plans, 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 ``Choose Medicare Act''.
SEC. 2. PUBLIC HEALTH PLAN.
The Social Security Act is amended by adding at the end the
following:
``title xxii--medicare part e public health plans
``Sec. 2201. Public Health Plans.--
``(a) Establishment.--The Secretary shall establish public health
plans (to be known as `Medicare part E plans') that are available in
the individual market, small group market, and large group market.
``(b) Benefits.--
``(1) In general.--Each Medicare part E plan, regardless of
whether the plan is offered in the individual market, small
group market, or large group market, shall be a qualified
health plan within the meaning of section 1301(a) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18021(a))
that--
``(A) meets all requirements applicable to
qualified health plans under subtitle D of title I of
the Patient Protection and Affordable Care Act (42
U.S.C. 18021 et seq.) (other than the requirement under
section 1301(a)(1)(C)(ii) of such Act) and title XXVII
of the Public Health Service Act (42 U.S.C. 300gg et
seq.);
``(B) provides coverage of--
``(i) the essential health benefits
described in section 1302(b) of the Patient
Protection and Affordable Care Act (42 U.S.C.
18022(b)); and
``(ii) all items and services for which
benefits are available under title XVIII;
``(C) provides gold-level coverage described in
section 1302(d)(1)(C) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18022(d)(1)(C)); and
``(D) provides coverage of abortions and all other
reproductive services.
``(2) Preemption.--Notwithstanding section 1303(a)(1) of
the Patient Protection and Affordable Care Act (42 U.S.C.
18023(a)(1))--
``(A) a State may not prohibit a Medicare part E
plan from offering the coverage described in paragraph
(1)(D); and
``(B) no State law that would prohibit such a plan
from offering such coverage shall apply to such plan.
``(c) Eligibility; Enrollment.--
``(1) Availability on the exchanges.--The Medicare part E
plans offered in the individual and small group markets shall
be offered through the Federal and State Exchanges, including
the Small Business Health Options Program Exchanges (commonly
referred to as the `SHOP Exchanges').
``(2) Eligibility.--
``(A) In general.--Any individual who is a resident
of the United States, as determined by the Secretary
under subparagraph (C), and who is not an individual
described in subparagraph (B), is eligible to enroll in
a Medicare part E plan.
``(B) Exclusions.--An individual described in this
subparagraph is any individual who is--
``(i) entitled to, or enrolled for,
benefits under title XVIII;
``(ii) eligible for medical assistance
under a State plan under title XIX; or
``(iii) enrolled for child health
assistance or pregnancy-related assistance
under a State plan under title XXI.
``(C) Regulations.--The Secretary shall promulgate
a rule for determining residency for purposes of
subparagraph (A).
``(3) Employer-sponsored plans.--
``(A) Employer enrollment.--Effective with respect
to the first plan year that begins 1 year after the
date of enactment of the Choose Medicare Act and each
plan year thereafter, the Secretary shall provide
options for Medicare part E plans in the small group
market and large group market that are voluntary, and
available to all employers.
``(B) Group health plans.--The Secretary, acting
through the Administrator for the Centers for Medicare
& Medicaid Services, at the request of a plan sponsor,
shall serve as a third party administrator of a group
health plan that is a Medicare part E plan offered by
such sponsor.
``(C) Portability for employer-sponsored plans.--
The Secretary shall develop a process for allowing
individuals enrolled in a Medicare part E plan offered
in the small group market or large group market to
maintain health insurance coverage through a Medicare
part E plan if the individual subsequently loses
eligibility for enrollment in such a plan based on
termination of the employment relationship. The ability
to maintain such coverage shall exist regardless of
whether the individual has the option to enroll in
other health insurance coverage, including coverage
offered in the individual market or through a
subsequent employer.
``(d) Premiums.--The Secretary shall establish premium rates for
the Medicare part E plans that--
``(1) are adjusted based on--
``(A) whether the plan is offered in the individual
market, small group market, or large group market; and
``(B) the applicable rating area;
``(2) are at a level sufficient to fully finance--
``(A) the costs of health benefits provided by such
plans; and
``(B) administrative costs related to operating the
plans; and
``(3) comply with the requirements under section 2701 of
the Public Health Service Act, including for such plans that
are offered in the large group market.
``(e) Providers and Reimbursement Rates.--
``(1) In general.--The Secretary shall establish a rate
schedule for reimbursing types of health care providers
furnishing items and services under the Medicare part E plans
at rates that are consistent with the negotiations described in
paragraph (2) and are necessary to maintain network adequacy.
``(2) Manner of negotiation.--The Secretary shall negotiate
the rates described in paragraph (1) in a manner that results
in payment rates that are not lower, in the aggregate, than
rates under title XVIII, and not higher, in the aggregate, than
the average rates paid by other health insurance issuers
offering health insurance coverage through an Exchange.
``(3) Participating providers.--
``(A) In general.--A health care provider that is a
participating provider of services or supplier under
the Medicare program under title XVIII on the date of
enactment of Choose Medicare Act shall be a
participating provider for Medicare part E plans.
``(B) Additional providers.--The Secretary shall
establish a process to allow health care providers not
described in subparagraph (A) to become participating
providers for Medicare part E plans.
``(4) Limitations on balance billing.--The limitations on
balance billing pursuant to the provisions of section
1866(a)(1)(A) of the Social Security Act (42 U.S.C.
1395cc(a)(1)(A)) shall apply to participating providers for
Medicare part E plans in the same manner as such provisions
apply to participating providers under the Medicare program.
``(f) Encouraging Use of Alternative Payment Models.--The Secretary
shall, as applicable, utilize alternative payment models, including
those described in section 1833(z)(3)(C), as added by section 101(e)(2)
of the Medicare Access and CHIP Reauthorization Act of 2015 (Public Law
114-10), in making payments for items and services (including
prescription drugs) furnished under Medicare part E plans. The payment
rates under such alternative payment models shall comply with the
requirement for negotiated rates under subsection (e)(2).
``(g) Prescription Drugs.--The Secretary shall apply the provisions
of section 1860D-11(i) to prescription drugs under Medicare part E
plans in the same manner as such provisions apply with respect to
applicable covered part D drugs under such section.
``(h) Appropriations.--
``(1) Start up funding.--For purposes of establishing the
Medicare part E plans, there is appropriated to the Secretary,
out of any funds in the Treasury not otherwise obligated,
$2,000,000,000, for fiscal year 2022.
``(2) Initial reserves.--There is appropriated to the
Secretary, out of any funds in the Treasury not otherwise
obligated, such sums as may be necessary, based on projected
enrollment in the Medicare part E plans in the first plan year
in which such plans are offered, to provide reserves for the
purpose of paying claims filed during the initial 90-day period
of such plan year.
``(3) Clarification.--Any provision of law restricting the
use of Federal funds with respect to any reproductive health
service shall not apply to funds appropriated under paragraph
(1) or (2).
``(i) Health Insurance Issuer.--With respect to any Medicare part E
plan, the Secretary shall be considered a health insurance issuer,
within the meaning of section 2791(b) of the Public Health Service
Act.''.
SEC. 3. NOTICE AND NAVIGATOR REFERRAL FOR EMPLOYEES UNDER THE FAIR
LABOR STANDARDS ACT OF 1938.
(a) In General.--Section 18B of the Fair Labor Standards Act of
1938 (29 U.S.C. 218b) is amended--
(1) in the heading, by striking ``to'' and inserting ``and
navigator referral for'';
(2) by redesignating subsection (b) as subsection (c);
(3) by inserting after subsection (a) the following:
``(b) Navigator Referral.--
``(1) In general.--An employer described in paragraph (3)
shall refer each full-time employee (as defined in section
4980H of the Internal Revenue Code of 1986) to--
``(A) an entity that serves as a navigator under
section 1311(i) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(i)) for the
Exchange operating in the State of the employer; or
``(B) if the Exchange operating in the State of the
employer does not have an entity serving as such a
navigator, another entity that shall carry out
equivalent activities as such a navigator.
``(2) Referral.--The referral described in paragraph (1)
shall occur--
``(A) at the time the employer hires the employee;
or
``(B) on the effective date described in subsection
(c)(2) with respect to an employee who is currently
employed by the employer on such date.
``(3) Employer.--An employer described in this paragraph is
any employer that--
``(A) does not provide an eligible employer-
sponsored plan as defined in section 5000A(f)(2) of the
Internal Revenue Code of 1986; or
``(B) provides such an eligible employer-sponsored
plan, but the plan is determined under section
36B(c)(2)(C) of such Code--
``(i) to be unaffordable to the employee;
or
``(ii) to not provide the required minimum
actuarial value.''; and
(4) in subsection (c), as so redesignated--
(A) in the heading, by striking ``Effective Date''
and inserting ``Effective Dates'';
(B) by striking ``Subsection (a)'' and inserting
the following:
``(1) Notice.--Subsection (a);''; and
(C) by adding at the end the following:
``(2) Navigator referral.--Subsection (b) shall take effect
with respect to employers in a State beginning on the date that
is 2 years after the date of enactment of the Choose Medicare
Act.''.
(b) Study.--Not later than January 1, 2026, the Comptroller General
of the United States shall conduct a study on the impact of the
requirements under section 18B of the Fair Labor Standards Act of 1938
(29 U.S.C. 218b), including the amendments made by subsection (a), on
the rate of individuals without minimum essential coverage as defined
in section 5000A of the Internal Revenue Code of 1986 in the United
States and in each State.
(c) Funding for Navigator Program.--Section 1311(i)(6) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18031(i)(6)) is
amended--
(1) by striking ``Grants'' and inserting the following:
``(A) In general.--Grants''; and
(2) by adding at the end the following:
``(B) Authorization of appropriations.--There is
authorized to be appropriated such sums as may be
necessary to address capacity limitations of entities
serving as navigators through a grant under this
subsection.''.
SEC. 4. PROTECTING AGAINST HIGH OUT-OF-POCKET EXPENDITURES FOR MEDICARE
FEE-FOR-SERVICE BENEFITS.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by adding at the end the following new section:
``protection against high out-of-pocket expenditures
``Sec. 1899C. (a) In General.--Notwithstanding any other provision
of this title, in the case of an individual entitled to, or enrolled
for, benefits under part A or enrolled in part B, if the amount of the
out-of-pocket cost-sharing of such individual for a year (beginning
with 2023) equals or exceeds the annual out-of-pocket limit under
subsection (b) for that year, the individual shall not be responsible
for additional out-of-pocket cost-sharing incurred during that year.
``(b) Annual Out-of-Pocket Limit.--
``(1) In general.--The amount of the annual out-of-pocket
limit under this subsection shall be--
``(A) for 2023, $6,700; or
``(B) for a subsequent year, the amount specified
in this subsection for the preceding year increased or
decreased by the percentage change in the medical care
component of the Consumer Price Index for All Urban
Consumers for the 12-month period ending with June of
such preceding year.
``(2) Rounding.--If any amount determined under paragraph
(1)(B) is not a multiple of $5, such amount shall be rounded to
the nearest multiple of $5.
``(c) Out-of-Pocket Cost-Sharing Defined.--
``(1) In general.--Subject to paragraphs (2) and (3), in
this section, the term `out-of-pocket cost-sharing' means, with
respect to an individual, the amount of the expenses incurred
by the individual that are attributable to--
``(A) deductibles, coinsurance, and copayments
applicable under part A or B; or
``(B) for items and services that would have
otherwise been covered under part A or B but for the
exhaustion of those benefits.
``(2) Certain costs not included.--
``(A) Non-covered items and services.--Expenses
incurred for items and services which are not covered
under part A or B shall not be considered incurred
expenses for purposes of determining out-of-pocket
cost-sharing under paragraph (1).
``(B) Items and services not furnished on an
assignment-related basis.--If an item or service is
furnished to an individual under this title and is not
furnished on an assignment-related basis, any
additional expenses the individual incurs above the
amount the individual would have incurred if the item
or service was furnished on an assignment-related basis
shall not be considered incurred expenses for purposes
of determining out-of-pocket cost-sharing under
paragraph (1).
``(3) Source of payment.--For purposes of paragraph (1),
the Secretary shall consider expenses to be incurred by the
individual without regard to whether the individual or another
person, including a State program, an employer, a medicare
supplemental policy, or other third-party coverage, has paid
for such expenses.
``(d) Announcement of the Annual Out-of-Pocket Limit.--The
Secretary shall (beginning in 2020) announce (in a manner intended to
provide notice to all interested parties) the annual out-of-pocket
limit under this section that will be applicable for the succeeding
year.''.
SEC. 5. NEGOTIATING FAIR PRICES FOR MEDICARE PRESCRIPTION DRUGS.
(a) In General.--Section 1860D-11 of the Social Security Act (42
U.S.C. 1395w-111) is amended by striking subsection (i) (relating to
noninterference) and by inserting the following:
``(i) Negotiating Fair Prices With Drug Manufacturers.--
``(1) In general.--Notwithstanding any other provision of
law, in furtherance of the goals of providing quality care and
containing costs under this part, the Secretary shall, with
respect to applicable covered part D drugs, and may, with
respect to other covered part D drugs, negotiate, using the
negotiation technique or techniques that the Secretary
determines will maximize savings and value to the government
for prescription drug plans and MA-PD plans and for plan
enrollees (in a manner that may be similar to Federal entities
and that may include, but is not limited to, formularies,
reference pricing, discounts, rebates, other price concessions,
and coverage determinations), with drug manufacturers the
prices that may be charged to PDP sponsors and MA organizations
for such drugs for part D eligible individuals who are enrolled
in a prescription drug plan or in an MA-PD plan. In conducting
such negotiations, the Secretary shall consider the drug's
current price, initial launch price, prevalence of disease and
usage, and approved indications, the number of similarly
effective alternative treatments for each approved use of the
drug, the budgetary impact of providing coverage under this
part for such drug for all individuals who would likely benefit
from the drug, evidence on the drug's effectiveness and safety
compared to similar drugs, and the quality and quantity of
clinical data and rigor of the applicable process of approval
of a drug under section 505 of the Federal Food, Drug, and
Cosmetic Act or a biological product under section 351 of the
Public Health Service Act.
``(2) Use of lower of va or big four price if negotiations
fail.--If, after attempting to negotiate for a price with
respect to a covered part D drug under paragraph (1) for a
period of 1 year, the Secretary is not successful in obtaining
an appropriate price for the drug (as determined by the
Secretary), the Secretary shall establish the price that may be
charged to PDP sponsors and MA organizations for such drug for
part D eligible individuals who are enrolled in a prescription
drug plan or in an MA-PD plan at an amount equal to the lesser
of--
``(A) the price paid by the Secretary of Veterans
Affairs to procure the drug under the laws administered
by the Secretary of Veterans Affairs; or
``(B) the price paid to procure the drug under
section 8126 of title 38, United States Code.
``(3) Applicable covered part d drug defined.--For purposes
of this subsection, the term `applicable covered part D drug'
means a covered part D drug that the Secretary determines to be
appropriate for negotiation under paragraph (1) based on one or
more of the following factors as applied to such drug:
``(A) Spending on a per beneficiary basis.
``(B) The proportion of total spending under this
title.
``(C) Unit price increases over the preceding 5
years.
``(D) Initial launch price.
``(E) Availability of less expensive, similarly
effective alternative treatments.
``(F) Status of the drug as a follow-on to
previously approved drugs.
``(G) Any other criteria determined by the
Secretary.
``(4) PDP sponsors and ma organization may negotiate lower
prices.--Nothing in this subsection shall be construed as
preventing the sponsor of a prescription drug plan, or an
organization offering an MA-PD plan, from obtaining a discount
or reduction of the price for a covered part D drug below the
price negotiated under paragraph (1) or the price established
under paragraph (2).
``(5) No effect on existing appeals process.--Nothing in
this subsection shall be construed to affect the appeals
procedures under subsections (g) and (h) of section 1860D-4.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date of the enactment of this Act and shall first apply
to negotiations and prices for plan years beginning on January 1, 2022.
SEC. 6. ENHANCEMENT OF PREMIUM ASSISTANCE CREDIT.
(a) Use of Gold Level Plan for Benchmark.--
(1) In general.--Clause (i) of section 36B(b)(2)(B) of the
Internal Revenue Code of 1986 is amended by striking
``applicable second lowest cost silver plan'' and inserting
``applicable second lowest cost gold plan''.
(2) Conforming amendment related to affordability.--Section
36B(c)(4)(C)(i)(I) of such Code is amended by striking ``second
lowest cost silver plan'' and inserting ``second lowest cost
gold plan''.
(3) Other conforming amendments.--Subparagraphs (B) and (C)
of section 36B(b)(3) of such Code are each amended by striking
``silver plan'' each place it appears in the text and the
heading and inserting ``gold plan''.
(b) Expansion of Eligibility for Refundable Credits for Coverage
Under Qualified Health Plans.--
(1) In general.--Section 36B(c)(1)(A) of the Internal
Revenue Code of 1986 is amended by striking ``400 percent'' and
inserting ``600 percent''.
(2) Conforming amendment.--The last line of the table
contained in section 36B(b)(3)(A)(i) of such Code is amended by
striking ``400%'' and inserting ``600%''.
(3) Conforming amendments relating to recapture of excess
advanced payments.--Clause (i) of section 36B(f)(2)(B) of such
Code is amended--
(A) by striking ``400 percent'' and inserting ``600
percent''; and
(B) by striking ``400%'' in the table therein and
inserting ``600%''.
(c) Elimination of Failsafe.--Section 36B(b)(3)(A)(ii) of the
Internal Revenue Code of 1986 is amended by striking subclause (III).
(d) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2020.
SEC. 7. ENHANCEMENTS FOR REDUCED COST SHARING.
(a) Definition of Eligible Individual.--Section 1402(b)(1) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18071(b)(1)) is
amended by striking ``silver level'' and inserting ``gold level''.
(b) Modification of Amount.--
(1) In general.--Section 1402(c)(2) of the Patient
Protection and Affordable Care Act is amended to read as
follows:
``(2) Additional reduction.--The Secretary shall establish
procedures under which the issuer of a qualified health plan to
which this section applies shall further reduce cost-sharing
under the plan in a manner sufficient to--
``(A) in the case of an eligible insured whose
household income is not less than 100 percent but not
more than 133 percent of the poverty line for a family
of the size involved, increase the plan's share of the
total allowed costs of benefits provided under the plan
to 94 percent of such costs;
``(B) in the case of an eligible insured whose
household income is more than 133 percent but not more
than 150 percent of the poverty line for a family of
the size involved, increase the plan's share of the
total allowed costs of benefits provided under the plan
to 92 percent of such costs;
``(C) in the case of an eligible insured whose
household income is more than 150 percent but not more
than 200 percent of the poverty line for a family of
the size involved, increase the plan's share of the
total allowed costs of benefits provided under the plan
to 90 percent of such costs;
``(D) in the case of an eligible insured whose
household income is more than 200 percent but not more
than 300 percent of the poverty line for a family of
the size involved, increase the plan's share of the
total allowed costs of benefits provided under the plan
to 85 percent of such costs; and
``(E) in the case of an eligible insured whose
household income is more than 300 percent but not more
than 400 percent of the poverty line for a family of
the size involved, increase the plan's share of the
total allowed costs of benefits provided under the plan
to 80 percent of such costs.''.
(2) Conforming amendment.--Clause (i) of section
1402(c)(1)(B) of such Act is amended to read as follows:
``(i) In general.--The Secretary shall
ensure the reduction under this paragraph shall
not result in an increase in the plan's share
of the total allowed costs of benefits provided
under the plan above--
``(I) 94 percent in the case of an
eligible insured described in paragraph
(2)(A);
``(II) 92 percent in the case of an
eligible insured described in paragraph
(2)(B);
``(III) 90 percent in the case of
an eligible insured described in
paragraph (2)(C);
``(IV) 85 percent in the case of an
eligible insured described in paragraph
(2)(D); and
``(V) 80 percent in the case of an
eligible insured described in paragraph
(2)(E).''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning after December 31, 2021.
SEC. 8. REINSURANCE AND AFFORDABILITY FUND.
Part 5 of subtitle D of title I of the Patient Protection and
Affordable Care Act is amended by inserting after section 1341 (42
U.S.C. 18061) the following:
``SEC. 1341A. REINSURANCE AND AFFORDABILITY FUND FOR THE INDIVIDUAL
MARKET IN EACH STATE.
``(a) In General.--The Secretary, in consultation with the National
Association of Insurance Commissioners, shall establish a program to
enable each State, for any plan year beginning in the 3-year period
beginning January 1, 2022, to--
``(1) provide reinsurance payments to health insurance
issuers with respect to individuals enrolled under individual
health insurance coverage offered by such issuers; or
``(2) 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 in
the individual market through an Exchange.
``(b) Appropriations.--There is appropriated, out of any money in
the Treasury not otherwise appropriated, $30,000,000,000 for the period
of fiscal years 2022 to 2024 for purposes of establishing and
administering the program established under this section. Such amount
shall remain available until expended.''.
SEC. 9. EXPANDING RATING RULES TO LARGE GROUP MARKET.
(a) In General.--Section 2701(a) of the Public Health Service Act
(42 U.S.C. 300gg(a)) is amended--
(1) in paragraph (1), by striking ``small''; and
(2) by striking paragraph (5).
(b) Effective Date.--The amendments made by subsection (a) shall
apply to plans offered in the first plan year beginning after the date
of enactment of this Act and any plan year thereafter.
SEC. 10. PROTECTION OF CONSUMERS FROM EXCESSIVE, UNJUSTIFIED, OR
UNFAIRLY DISCRIMINATORY RATES.
(a) Protection From Excessive, Unjustified, or Unfairly
Discriminatory Rates.--The first section 2794 of the Public Health
Service Act (42 U.S.C. 300gg-94), as added by section 1003 of the
Patient Protection and Affordable Care Act (Public Law 111-148), is
amended by adding at the end the following new subsection:
``(e) Protection From Excessive, Unjustified, or Unfairly
Discriminatory Rates.--
``(1) Authority of states.--Nothing in this section shall
be construed to prohibit a State from imposing requirements
(including requirements relating to rate review standards and
procedures and information reporting) on health insurance
issuers with respect to rates that are in addition to the
requirements of this section and are more protective of
consumers than such requirements.
``(2) Consultation in rate review process.--In carrying out
this section, the Secretary shall consult with the National
Association of Insurance Commissioners and consumer groups.
``(3) Determination of who conducts reviews for each
state.--The Secretary shall determine, after the date of
enactment of this subsection and periodically thereafter, the
following:
``(A) In which markets in each State the State
insurance commissioner or relevant State regulator
shall undertake the corrective actions under paragraph
(4), based on the Secretary's determination that the
State insurance commissioner or relevant State
regulator is adequately undertaking and utilizing such
actions in that market.
``(B) In which markets in each State the Secretary
shall undertake the corrective actions under paragraph
(4), in cooperation with the relevant State insurance
commissioner or State regulator, based on the
Secretary's determination that the State is not
adequately undertaking and utilizing such actions in
that market.
``(4) Corrective action for excessive, unjustified, or
unfairly discriminatory rates.--In accordance with the process
established under this section, the Secretary or the relevant
State insurance commissioner or State regulator shall take
corrective actions to ensure that any excessive, unjustified,
or unfairly discriminatory rates are corrected prior to
implementation, or as soon as possible thereafter, through
mechanisms such as--
``(A) denying rates;
``(B) modifying rates; or
``(C) requiring rebates to consumers.
``(5) Noncompliance.--Failure to comply with any corrective
action taken by the Secretary under this subsection may result
in the application of civil monetary penalties and, if the
Secretary determines appropriate, make the plan involved
ineligible for classification as a qualified health plan.''.
(b) Clarification of Regulatory Authority.--Such section is further
amended--
(1) in subsection (a)--
(A) in the subsection heading, by striking
``Premium'' and inserting ``Rate'';
(B) in paragraph (1), by striking ``unreasonable
increases in premiums'' and inserting ``potentially
excessive, unjustified, or unfairly discriminatory
rates, including premiums,''; and
(C) in paragraph (2)--
(i) by striking ``an unreasonable premium
increase'' and inserting ``a potentially
excessive, unjustified, or unfairly
discriminatory rate'';
(ii) by striking ``the increase'' and
inserting ``the rate''; and
(iii) by striking ``such increases'' and
inserting ``such rates''; and
(2) in subsection (b)--
(A) in the subsection heading, by striking
``Premium'' and inserting ``Rate'';
(B) by striking ``premium increases'' each place it
appears and inserting ``rates'';
(C) in paragraph (1), in the paragraph heading, by
striking ``Premium increase'' and inserting ``Rate'';
and
(D) in paragraph (2)--
(i) in the paragraph heading, by striking
``Premium increases'' and inserting ``Rates'';
and
(ii) in subparagraph (B), by striking
``premium'' and inserting ``rate''.
(c) Conforming Amendments.--
(1) Public health service act.--Title XXVII of the Public
Health Service Act (42 U.S.C. 300gg et seq.) is amended--
(A) in section 2723 (42 U.S.C. 300gg-22)--
(i) in subsection (a)--
(I) in paragraph (1), by inserting
``, section 2794 (relating to ensuring
that consumers get value for their
dollars),'' after ``this part''; and
(II) in paragraph (2), by inserting
``, such section 2794,'' after ``this
part''; and
(ii) in subsection (b)--
(I) in paragraph (1), by inserting
``, section 2794 (relating to ensuring
that consumers get value for their
dollars),'' after ``this part''; and
(II) in paragraph (2)--
(aa) in subparagraph (A),
by inserting ``, such section
2794,'' after ``this part'';
and
(bb) in subparagraph
(C)(ii), by inserting ``, such
section 2794,'' after ``this
part''; and
(B) in section 2761 (42 U.S.C. 300gg-61)--
(i) in subsection (a)--
(I) in paragraph (1), by inserting
``and section 2794 (relating to
ensuring that consumers get value for
their dollars)'' after ``this part'';
and
(II) in paragraph (2)--
(aa) by inserting ``or such
section 2794'' after ``set
forth in this part''; and
(bb) by inserting ``and
such section 2794'' after ``the
requirements of this part'';
and
(ii) in subsection (b), by inserting ``and
such section 2794'' after ``this part''.
(2) Patient protection and affordable care act.--Section
1311(e)(2) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031(e)(2)) is amended by striking ``unjustified
premium increases'' and inserting ``unjustified rates''.
(d) Applicability to Grandfathered Plans.--Section 1251(a)(4)(A) of
the Patient Protection and Affordable Care Act (42 U.S.C.
18011(a)(4)(A)) is amended by adding at the end the following:
``(v) Section 2794 (relating to ensuring
that consumers get value for their dollars).''.
(e) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act and shall be implemented
with respect to health plans beginning not later than January 1, 2022.
SEC. 11. SENSE OF CONGRESS.
It is the sense of the Congress that--
(1) the Federal Government, acting in its capacity as an
insurer, employer, or health care provider, should serve as a
model for the Nation to ensure coverage of all reproductive
services; and
(2) all restrictions on coverage of reproductive services
in the private insurance market should end.
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