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115th Congress }                                          { Rept 115-849
                        HOUSE OF REPRESENTATIVES
  2d Session   }                                          { Part 1

======================================================================

      THE ``INCREASING ACCESS TO LOWER PREMIUM PLANS ACT OF 2018''

                                _______
                                

 July 19, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 6311]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6311) to amend the Internal Revenue Code of 1986 and 
the Patient Protection and Affordable Care Act to modify the 
definition of qualified health plan for purposes of the health 
insurance premium tax credit and to allow individuals 
purchasing health insurance in the individual market to 
purchase a lower premium copper plan, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.




115th Congress }                                          { Rept 115-849
                        HOUSE OF REPRESENTATIVES
  2d Session   }                                          { Part 1

======================================================================
 
          INCREASING ACCESS TO LOWER PREMIUM PLANS ACT OF 2018

                                _______
                                

                 July 19, 2018.--Ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 6311]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 6311) to amend the Internal Revenue Code of 1986 and 
the Patient Protection and Affordable Care Act to modify the 
definition of qualified health plan for purposes of the health 
insurance premium tax credit and to allow individuals 
purchasing health insurance in the individual market to 
purchase a lower premium copper plan, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
 I. SUMMARY AND BACKGROUND............................................5
II. EXPLANATION OF THE BILL...........................................6
        A. Modification of Definition of Qualified Health Plan...     6
III.VOTES OF THE COMMITTEE............................................9

IV. BUDGET EFFECTS OF THE BILL.......................................11
        A. Committee Estimate of Budgetary Effects...............    11
        B. Statement Regarding New Budget Authority and Tax 
            Expenditures Budget Authority........................    13
        C. Cost Estimate Prepared by the Congressional Budget 
            Office...............................................    13
 V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE.......13
        A. Committee Oversight Findings and Recommendations......    13
        B. Statement of General Performance Goals and Objectives.    13
        C. Information Relating to Unfunded Mandates.............    13
        D. Applicability of House Rule XXI 5(b)..................    14
        E. Tax Complexity Analysis...............................    14
        F. Congressional Earmarks, Limited Tax Benefits, and 
            Limited Tariff Benefits..............................    14
        G. Duplication of Federal Programs.......................    14
        H. Disclosure of Directed Rule Makings...................    14
VI. CORRESPONDENCE...................................................15
        A. Exchange of Letters between Ways and Means and Energy 
            and Commerce.........................................    15
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED............17
        B. Changes in Existing Law Proposed by the Bill, as 
            Reported.............................................    17

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Increasing Access to Lower Premium 
Plans Act of 2018''.

SEC. 2. MODIFICATION OF DEFINITION OF QUALIFIED HEALTH PLAN.

  (a) In General.--Section 36B(c)(3)(A) of the Internal Revenue Code of 
1986 is amended--
          (1) by inserting ``(determined without regard to 
        subparagraphs (A), (C)(ii), and (C)(iv) of paragraph (1) 
        thereof and without regard to whether the plan is offered on an 
        Exchange)'' after ``1301(a) of the Patient Protection and 
        Affordable Care Act'', and
          (2) by striking ``shall not include'' and all that follows 
        and inserting ``shall not include any health plan that--
                          ``(i) is a grandfathered health plan or a 
                        grandmothered health plan, or
                          ``(ii) includes coverage for abortions (other 
                        than any abortion necessary to save the life of 
                        the mother or any abortion with respect to a 
                        pregnancy that is the result of an act of rape 
                        or incest).''.
  (b) Definition of Grandmothered Health Plan.--Section 36B(c)(3) of 
such Code is amended by adding at the end the following new 
subparagraph:
                  ``(C) Grandmothered health plan.--
                          ``(i) In general.--The term `grandmothered 
                        health plan' means health insurance coverage 
                        which is offered in the individual health 
                        insurance market as of October 1, 2013, and is 
                        permitted to be offered in such market after 
                        January 1, 2014, as a result of CCIIO guidance.
                          ``(ii) CCIIO guidance defined.--The term 
                        `CCIIO guidance' means the letter issued by the 
                        Centers for Medicare & Medicaid Services on 
                        November 14, 2013, to the State Insurance 
                        Commissioners outlining a transitional policy 
                        for non-grandfathered coverage in the 
                        individual health insurance market, as 
                        subsequently extended and modified (including 
                        by a communication entitled `Insurance 
                        Standards Bulletin Series--INFORMATION--
                        Extension of Transitional Policy through 2019' 
                        issued on April 9, 2018, by the Director of the 
                        Center for Consumer Information and Insurance 
                        Oversight of such Centers).
                          ``(iii) Individual health insurance market.--
                        The term `individual health insurance market' 
                        means the market for health insurance coverage 
                        (as defined in section 9832(b)) offered to 
                        individuals other than in connection with a 
                        group health plan (within the meaning of 
                        section 5000(b)(1)).''.
  (c) Conforming Amendment Related to Abortion Coverage.--Section 
36B(c)(3) of such Code, as amended by subsection (b), is amended by 
adding at the end the following new subparagraph:
                  ``(D) Certain rules related to abortion.--
                          ``(i) Option to purchase separate coverage or 
                        plan.--Nothing in subparagraph (A) shall be 
                        construed as prohibiting any individual from 
                        purchasing separate coverage for abortions 
                        described in such subparagraph, or a health 
                        plan that includes such abortions, so long as 
                        no credit is allowed under this section with 
                        respect to the premiums for such coverage or 
                        plan.
                          ``(ii) Option to offer coverage or plan.--
                        Nothing in subparagraph (A) shall restrict any 
                        health insurance issuer offering a health plan 
                        from offering separate coverage for abortions 
                        described in such subparagraph, or a plan that 
                        includes such abortions, so long as premiums 
                        for such separate coverage or plan are not paid 
                        for with any amount attributable to the credit 
                        allowed under this section (or the amount of 
                        any advance payment of the credit under section 
                        1412 of the Patient Protection and Affordable 
                        Care Act).
                          ``(iii) Other treatments.--The treatment of 
                        any infection, injury, disease, or disorder 
                        that has been caused by or exacerbated by the 
                        performance of an abortion shall not be treated 
                        as an abortion for purposes of subparagraph 
                        (A).''.
  (d) Conforming Amendments Related to Off-Exchange Coverage.--
          (1) Advance payment not applicable.--Section 1412 of the 
        Patient Protection and Affordable Care Act is amended by adding 
        at the end the following new subsection:
  ``(f) Exclusion of Off-Exchange Coverage.--Advance payments under 
this section, and advance determinations under section 1411, with 
respect to any credit allowed under section 36B shall not be made with 
respect to any health plan which is not enrolled in through an 
Exchange.''.
          (2) Reporting.--Section 6055(b) of the Internal Revenue Code 
        of 1986 is amended by adding at the end the following new 
        paragraph:
          ``(3) Information relating to off-exchange premium tax credit 
        eligible coverage.--If minimum essential coverage provided to 
        an individual under subsection (a) consists of a qualified 
        health plan (as defined in section 36B(c)(3)) which is not 
        enrolled in through an Exchange established under title I of 
        the Patient Protection and Affordable Care Act, a return 
        described in this subsection shall include--
                  ``(A) a statement that such plan is a qualified 
                health plan (as defined in section 36B(c)(3)),
                  ``(B) the premiums paid with respect to such 
                coverage,
                  ``(C) the months during the calendar year for which 
                such coverage is provided to the individual,
                  ``(D) the adjusted monthly premium for the applicable 
                second lowest cost silver plan (as defined in section 
                36B(b)(3)) for each such month with respect to such 
                individual, and
                  ``(E) such other information as the Secretary may 
                prescribe.''.
          (3) Other conforming amendments.--
                  (A) Section 36B(b)(2)(A) of such Code is amended by 
                striking ``and which were enrolled'' and all that 
                follows and inserting ``, or''.
                  (B) Section 36B(b)(3)(B)(i) of such Code is amended 
                by striking ``the same Exchange'' and all that follows 
                and inserting ``the Exchange through which such 
                taxpayer is permitted to obtain coverage, and''.
                  (C) Section 36B(c)(2)(A)(i) of such Code is amended 
                by striking ``that was enrolled in through an Exchange 
                established by the State under section 1311 of the 
                Patient Protection and Affordable Care Act''.
  (e) Effective Date.--
          (1) In general.--Except as otherwise provided in this 
        subsection, the amendments made by this section shall apply to 
        taxable years beginning after December 31, 2018.
          (2) Advance payment not applicable to off-exchange 
        coverage.--The amendment made by subsection (d)(1) shall take 
        effect on January 1, 2019.
          (3) Reporting.--The amendment made by subsection (d)(2) shall 
        apply to coverage provided for months beginning after December 
        31, 2018.

SEC. 3. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH INSURANCE IN THE 
                    INDIVIDUAL MARKET THE OPTION TO PURCHASE A LOWER 
                    PREMIUM COPPER PLAN.

  (a) In General.--Section 1302(e) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(e)) is amended--
          (1) in paragraph (1)--
                  (A) by redesignating clauses (i) and (ii) of 
                subparagraph (B) as subparagraphs (A) and (B), 
                respectively, and adjusting the margins accordingly;
                  (B) by striking ``plan year if--'' and all that 
                follows through ``the plan provides--'' and inserting 
                ``plan year if the plan provides--''; and
                  (C) in subparagraph (A), as redesignated by 
                subparagraph (A), by striking ``clause (ii)'' and 
                inserting ``subparagraph (B)'';
          (2) by striking paragraph (2); and
          (3) by redesignating paragraph (3) as paragraph (2).
  (b) Risk Pools.--Section 1312(c)(1) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18032(c)(1)) is amended by inserting 
``and enrollees in catastrophic plans described in section 1302(e)'' 
after ``Exchange''.
  (c) Conforming Amendment.--Section 1312(d)(3)(C) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18032(d)(3)(C)) is 
amended by striking ``, except that in the case of a catastrophic plan 
described in section 1302(e), a qualified individual may enroll in the 
plan only if the individual is eligible to enroll in the plan under 
section 1302(e)(2)''.
  (d) Effective Date.--The amendments made by this section shall apply 
to plan years beginning after December 31, 2018.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    The bill H.R. 6311, as reported by the Committee on Ways 
and Means, provides an off-ramp from Obamacare's rising 
premiums and limited choices by allowing the premium tax credit 
to be used for qualified plans offered outside of the law's 
exchanges and Healthcare.gov. In addition, it expands access to 
the lowest-premium plans available (``catastrophic'' plans) for 
all individuals purchasing coverage in the individual market 
and allows the premium tax credit to be used to offset the cost 
of such plans.

                 B. Background and Need for Legislation

    Obamacare's flawed policies have increased the cost of 
coverage in the individual market by 105 percent over 2013-2017 
on average. As Republicans continue their efforts to reverse 
Obamacare's damage, policies such as those included in this 
bill will help to lower premiums and increase choices for 
Americans.
    Obamacare's tax credits are only available to offset the 
cost of bronze, silver, gold, and platinum health care plans 
that are sold on the law's government-run health insurance 
exchanges. Catastrophic plans are not eligible for the premium 
tax credit. In addition, catastrophic plans are only available 
to those under age 30 or those over age 30 that qualify for a 
hardship exemption.

                         C. Legislative History


Background

    H.R. 6311 was introduced on July 6, 2018 and was referred 
to the Committee on Energy and Commerce, and in addition to the 
Committee on Ways and Means, 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.

Committee action

    The Committee on Ways and Means marked up H.R. 6311, the 
``Increasing Access to Lower Premium Plans Act of 2018,'' on 
July 12, 2018, and ordered the bill, as amended, favorably 
reported (with a quorum being present).

Committee hearings

    The policy issues associated with tax pertaining to health 
care and the ACA were discussed at the following Ways and Means 
hearings during the 114th and 115th Congresses:
           Full Committee Hearing on the Tax Treatment 
        of Health Care (April 14, 2016)
           Subcommittee on Health Member Day Hearing on 
        Tax-Related Proposals to Improve Health Care (May 17, 
        2016)
           Subcommittee on Health Hearing on Rising 
        Health Insurance Premiums Under the Affordable Care Act 
        (July 12, 2016)
           Subcommittee on Health Hearing on Lowering 
        Costs and Expanding Access to Health Care through 
        Consumer-Directed Health Plans (June 6, 2018)

                      II. EXPLANATION OF THE BILL


         A. Modification of Definition of Qualified Health Plan


                              PRESENT LAW

In general

    A refundable tax credit (the ``premium assistance credit'') 
is provided for eligible individuals and families to subsidize 
the purchase of health insurance plans through an American 
Health Benefit Exchange (``Exchange''), referred to as 
``qualified health plans.''\1\ The premium assistance credit is 
generally payable in advance directly to the insurer, as 
discussed below. However, eligible individuals may choose to 
pay their total health insurance premiums out-of-pocket and 
claim the credit at the end of the taxable year.
---------------------------------------------------------------------------
    \1\Sec. 36B. Section 36B was enacted as part of the Patient 
Protection and Affordable Care Act (``PPACA''), Pub. L. No. 111-148, 
and modified by the Healthcare and Education Reconciliation Act of 2010 
(``HCERA''), Pub. L. No. 111-152. PPACA and HCERA are referred to 
collectively as the Affordable Care Act (``ACA'').
---------------------------------------------------------------------------
    Qualified health plans generally must meet certain 
requirements.\2\ Special rules apply to certain qualified 
health plans, referred to as ``catastrophic-only'' qualified 
health plans, which are available only to individuals who are 
under age 30 or meet other specified requirements.\3\ The 
premium assistance credit is not available with respect to 
catastrophic-only qualified health plans.\4\ In addition, in 
the case of a qualified health plan that provides coverage for 
abortions for which Federal funds may not be used, no part of 
the premium assistance credit may be used for the portion of 
premiums attributable to that coverage.\5\
---------------------------------------------------------------------------
    \2\Secs. 1301 and 1302 of PPACA.
    \3\Sec. 1302(e) of PPACA.
    \4\Under the Public Health Service Act (``PHSA'') as amended by the 
ACA, health insurance must meet certain requirements. Section 1251 of 
PPACA excepts certain health plans sold at the time of enactment of 
PPACA from some of the PHSA requirements (``grandfathered'' plans). The 
premium assistance credit is not available with respect to a 
grandfathered plan or plans that receive similar treatment under 
administrative guidance.
    \5\Sec. 1303(b)(2) of PPACA.
---------------------------------------------------------------------------
    The premium assistance credit is generally available for 
individuals (single or joint filers) with household incomes 
between 100 and 400 percent of the Federal poverty level 
(``FPL'') for the family size involved. Household income is 
defined as the sum of: (1) the individual's modified adjusted 
gross income, plus (2) the aggregate modified adjusted gross 
incomes of all other individuals taken into account in 
determining the individual's family size (but only if the other 
individuals are required to file a tax return for the taxable 
year). Modified adjusted gross income is defined as adjusted 
gross income increased by: (1) any amount excluded from gross 
income for citizens or residents living abroad),\6\ (2) any 
tax-exempt interest received or accrued during the tax year, 
and (3) the portion of the individual's social security 
benefits not included in gross income.\7\ To be eligible for 
the premium assistance credit, individuals who are married must 
file a joint return. Individuals who are listed as dependents 
on a return are not eligible for the premium assistance credit.
---------------------------------------------------------------------------
    \6\Sec. 911.
    \7\Under section 86, only a portion of an individual's social 
security benefits are included in gross income.
---------------------------------------------------------------------------
    An individual who is eligible for minimum essential 
coverage from a source other than the individual insurance 
market generally is not eligible for the premium assistance 
credit.\8\ However, an individual who is offered minimum 
essential coverage under an employer-sponsored health plan may 
be eligible for the premium assistance credit if an employee's 
share of the premium for self-only coverage exceeds 9.56 
percent (for 2018) of the employee's household income, or the 
plan's share of total allowed costs of benefits provided under 
the plan is less than 60 percent of such costs (called 
``minimum value''), and the individual declines the employer-
offered coverage. An individual who enrolls in an employer-
sponsored health plan generally is ineligible for the premium 
assistance credit, even if the coverage is considered 
unaffordable or does not provide minimum value.
---------------------------------------------------------------------------
    \8\Minimum essential coverage is defined in section 5000A(f).
---------------------------------------------------------------------------
    As part of the process of enrollment in a qualified health 
plan through an Exchange, an individual may apply and be 
approved in advance for a premium assistance credit.\9\ The 
individual must provide information on income, family size, 
changes in marital or family status or income, and citizenship 
or lawful presence status.\10\ Initial eligibility for the 
premium assistance credit is generally based on the 
individual's income for the tax year ending two years prior to 
the enrollment period. The Exchange process includes a system 
through which information provided by the individual is 
verified with the Internal Revenue Service (``IRS''), the 
Social Security Administration (``SSA'') and the Department of 
Homeland Security (``DHS'').\11\ If an individual is approved 
for advance premium assistance payments, the Treasury pays the 
advance amount directly to the issuer of the health plan in 
which the individual is enrolled. The individual then pays to 
the issuer of the plan the difference between the advance 
payment amount and the total premium charged for the plan.
---------------------------------------------------------------------------
    \9\Secs. 1411-1412 of PPACA. Under section 1402 of PPACA, certain 
individuals eligible for advance premium assistance payments are 
eligible also for a reduction in their share of medical costs, such as 
deductibles and copays, under the plan, referred to as reduced cost-
sharing. Eligibility for reduced cost-sharing is also determined as 
part of the Exchange enrollment process. The Department of Health and 
Human Services (``HHS'') is responsible for rules relating to Exchanges 
and the eligibility determination process.
    \10\Under section 1312(f)(3) of PPACA, an individual may not enroll 
in a qualified health plan through an Exchange if the individual is not 
a citizen or national of United States or an alien lawfully present in 
the United States. Thus, such an individual is not eligible for the 
premium assistance credit.
    \11\Under section 6103, except as provided in the Code, returns and 
return information are confidential and may not be disclosed by the 
IRS, other Federal employees, State employees, and certain others 
having access to such information. Under section 6103(l)(21), upon 
written request of the Secretary of HHS, the IRS is permitted to 
disclose certain return information in connection with a determination 
through the Exchange process of an individual's eligibility for advance 
premium assistance payments, reduced cost-sharing, or certain other 
government-sponsored health programs.
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes that tax credits provided to offset 
the cost of health plans provided on government exchanges 
should also be available to offset the cost of similar health 
plans offered outside the government exchanges. This would 
expand the choices available to individuals and families and 
empower them to make decisions based on their specific needs 
and budgets.
    Furthermore, the Committee believes that Federal assistance 
in the form of premium tax credits should not be available for 
health plans that cover elective abortion. This would allow 
individuals to avoid directly, unwittingly, and unwillingly 
subsidizing abortion.

                        EXPLANATION OF PROVISION

Application of credit to additional coverage

    Qualified health plans generally must meet certain 
requirements.\12\ Under the proposal, the premium assistance 
credit is available with respect to catastrophic plans\13\ that 
meet the requirements relating to qualified health plans. Under 
the proposal, the premium assistance credit is also available 
with respect to health plans that meet the requirements 
relating to qualified health plans except that they are not 
offered through an Exchange. Thus, an individual who purchases 
a qualified health plan in the individual market, but not 
through an Exchange, may be eligible for the premium assistance 
credit if the requirements for eligibility are otherwise met. 
However, advance premium assistance payments are not available 
with respect to a qualified health plan that is not purchased 
through an Exchange. An individual who purchases such a plan 
must claim the premium assistance credit on his or her income 
tax return.
---------------------------------------------------------------------------
    \12\Section 2 of the proposal amends section 1302(e) of PPACA to 
allow all individuals purchasing health insurance in the individual 
market the option to purchase a lower premium plan that does not offer 
a bronze, silver, gold, or platinum level of coverage.
    \13\As described in sec. 1302(e) of PPACA.
---------------------------------------------------------------------------
    Under present law, any person that provides minimum 
essential coverage to an individual during a calendar year must 
report certain information to the IRS.\14\ The proposal 
requires additional information reporting for minimum essential 
coverage provided to an individual that is not enrolled through 
an Exchange.
---------------------------------------------------------------------------
    \14\Sec. 6055(b).
---------------------------------------------------------------------------
    As under present law, the credit is not available with 
respect to grandfathered plans or plans that receive similar 
treatment under administrative guidance. In addition, the 
proposal specifies that the credit is not available with 
respect to grandmothered plans. Under the proposal, a 
grandmothered health plan is defined to be health insurance 
coverage which is offered in the individual health insurance 
market as of October 1, 2013, and is permitted to be offered in 
such market after January 1, 2014, as a result of CCIIO 
guidance.\15\
---------------------------------------------------------------------------
    \15\CCIIO guidance refers to the letters issued by the Centers for 
Medicare and Medicaid Services on November 14, 2013, to the State 
Insurance Commissioners outlining a transitional policy for non-
grandfathered coverage in the individual health insurance market, as 
subsequently extended and modified. Subsequent modifications include a 
communication entitled, ``Insurance Standards Bulletin Series--
INFORMATION--Extension of Transitional Policy through Calendar Year 
2017,'' issued on February 29, 2016 by the Director of the Center for 
Consumer Information and Insurance Oversight of such Centers.
---------------------------------------------------------------------------

Ineligibility of qualified health plans covering abortion

    Under the proposal, the premium assistance credit is not 
available with respect to a qualified health plan that provides 
coverage for abortions for which Federal funds may not be 
used.\16\ However, nothing in the proposal prohibits an 
individual from purchasing, or a health insurance issuer from 
offering separate coverage for abortions, or a health plan that 
includes abortions, as long as no premium assistance credit is 
allowed with respect to the premiums for such coverage and 
premiums are not paid for with any amount attributable to the 
premium assistance credit (or the amount of any advance payment 
of the credit).
---------------------------------------------------------------------------
    \16\This includes coverage for abortions other than any abortion 
necessary to save the life of the mother or any abortion with respect 
to a pregnancy that is the result of an act of rape or incest. The 
treatment of any infection, injury, disease, or disorder that has been 
caused by or exacerbated by the performance of an abortion shall not be 
treated as an abortion for purposes of determining eligibility for the 
premium assistance credit.
---------------------------------------------------------------------------

                             EFFECTIVE DATE

    The modifications to the premium assistance credit are 
generally effective for taxable years beginning after December 
31, 2018. The proposal specifying that advance premium 
assistance payments are not available with respect to a 
qualified health plan that is not purchased through an Exchange 
is effective on January 1, 2019. The proposal amending the 
present-law reporting requirements under section 6055 is 
effective for coverage provided for months beginning after 
December 31, 2018.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6311, the ``Increasing Access to Lower 
Premium Plans Act of 2018,'' on July 12, 2018.
    The vote on Mr. Reichert's motion to table Mr. Neal's 
appeal of the ruling of the Chair that Mr. Thompson's amendment 
was non-germane, was agreed to by a roll call vote of 21 yeas 
to 15 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................        X   ........  .........  Mr. Neal.........  ........  ........  .........
Mr. Johnson....................        X   ........  .........  Mr. Levin........  ........        X   .........
Mr. Nunes......................  ........  ........  .........  Mr. Lewis........  ........        X   .........
Mr. Tiberi.....................        X   ........  .........  Mr. Doggett......  ........        X   .........
Mr. Reichert...................        X   ........  .........  Mr. Thompson.....  ........        X   .........
Mr. Roskam.....................        X   ........  .........  Mr. Larson.......  ........        X   .........
Mr. Buchanan...................        X   ........  .........  Mr. Blumenauer...  ........        X   .........
Mr. Smith (NE).................        X   ........  .........  Mr. Kind.........  ........        X   .........
Ms. Jenkins....................        X   ........  .........  Mr. Pascrell.....  ........        X   .........
Mr. Paulsen....................        X   ........  .........  Mr. Crowley......  ........        X   .........
Mr. Marchant...................        X   ........  .........  Mr. Davis........  ........        X   .........
Ms. Black......................  ........  ........  .........  Ms. Sanchez......  ........        X   .........
Mr. Reed.......................        X   ........  .........  Mr. Higgins......  ........        X   .........
Mr. Kelly......................        X   ........  .........  Ms. Sewell.......  ........        X   .........
Mr. Renacci....................        X   ........  .........  Ms. DelBene......  ........        X   .........
Ms. Noem.......................        X   ........  .........  Ms. Chu..........  ........        X   .........
Mr. Holding....................        X   ........  .........
Mr. Smith (MO).................        X   ........  .........
Mr. Rice.......................  ........  ........  .........
Mr. Schweikert.................        X   ........  .........
Ms. Walorski...................        X   ........  .........
Mr. Curbelo....................        X   ........  .........
Mr. Bishop.....................        X   ........  .........
Mr. Wenstrup...................        X   ........  .........
----------------------------------------------------------------------------------------------------------------

    In compliance with the Rules of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6311, the ``Increasing Access to Lower 
Premium Plans Act of 2018,'' on July 12, 2018.
    The vote on the amendment offered by Ms. DelBene to the 
amendment in the nature of a substitute offered by Chairman 
Brady to H.R. 6311, which would strike sec 2(a)(2) and 
subsection (c) of section 2'', was not agreed to by a rollcall 
vote of 15 yeas to 22 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................  ........        X   .........  Mr. Neal.........  ........  ........  .........
Mr. Johnson....................  ........        X   .........  Mr. Levin........        X   ........  .........
Mr. Nunes......................  ........        X   .........  Mr. Lewis........        X   ........  .........
Mr. Tiberi.....................  ........        X   .........  Mr. Doggett......        X   ........  .........
Mr. Reichert...................  ........        X   .........  Mr. Thompson.....        X   ........  .........
Mr. Roskam.....................  ........        X   .........  Mr. Larson.......        X   ........  .........
Mr. Buchanan...................  ........        X   .........  Mr. Blumenauer...        X   ........  .........
Mr. Smith (NE).................  ........  ........  .........  Mr. Kind.........        X   ........  .........
Ms. Jenkins....................  ........        X   .........  Mr. Pascrell.....        X   ........  .........
Mr. Paulsen....................  ........        X   .........  Mr. Crowley......        X   ........  .........
Mr. Marchant...................  ........        X   .........  Mr. Davis........        X   ........  .........
Ms. Black......................  ........  ........  .........  Ms. Sanchez......        X   ........  .........
Mr. Reed.......................  ........        X   .........  Mr. Higgins......        X   ........  .........
Mr. Kelly......................  ........        X   .........  Ms. Sewell.......        X   ........  .........
Mr. Renacci....................  ........        X   .........  Ms. DelBene......        X   ........  .........
Ms. Noem.......................  ........        X   .........  Ms. Chu..........        X   ........  .........
Mr. Holding....................  ........        X   .........
Mr. Smith (MO).................  ........        X   .........
Mr. Rice.......................  ........        X   .........
Mr. Schweikert.................  ........        X   .........
Ms. Walorski...................  ........        X   .........
Mr. Curbelo....................  ........        X   .........
Mr. Bishop.....................  ........        X   .........
Mr. Wenstrup...................  ........        X   .........
----------------------------------------------------------------------------------------------------------------

    In compliance with the Rules of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6311, the ``Increasing Access to Lower 
Premium Plans Act of 2018,'' on July 12, 2018.
    The vote on the amendment offered by Ms. Sanchez to the 
amendment in the nature of a substitute offered by Chairman 
Brady to H.R. 6311, which would make plans that are otherwise 
eligible for section 2 in the underlying bill contingent on if 
that plan issuer does not discriminate or raise premiums on the 
basis of gender for any plan, was not agreed to by a rollcall 
vote of 16 yeas to 23 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................  ........        X   .........  Mr. Neal.........        X   ........  .........
Mr. Johnson....................  ........        X   .........  Mr. Levin........        X   ........  .........
Mr. Nunes......................  ........        X   .........  Mr. Lewis........        X   ........  .........
Mr. Tiberi.....................  ........        X   .........  Mr. Doggett......        X   ........  .........
Mr. Reichert...................  ........        X   .........  Mr. Thompson.....        X   ........  .........
Mr. Roskam.....................  ........        X   .........  Mr. Larson.......        X   ........  .........
Mr. Buchanan...................  ........        X   .........  Mr. Blumenauer...        X   ........  .........
Mr. Smith (NE).................  ........        X   .........  Mr. Kind.........        X   ........  .........
Ms. Jenkins....................  ........        X   .........  Mr. Pascrell.....        X   ........  .........
Mr. Paulsen....................  ........        X   .........  Mr. Crowley......        X   ........  .........
Mr. Marchant...................  ........        X   .........  Mr. Davis........        X   ........  .........
Ms. Black......................  ........  ........  .........  Ms. Sanchez......        X   ........  .........
Mr. Reed.......................  ........        X   .........  Mr. Higgins......        X   ........  .........
Mr. Kelly......................  ........        X   .........  Ms. Sewell.......        X   ........  .........
Mr. Renacci....................  ........        X   .........  Ms. DelBene......        X   ........  .........
Ms. Noem.......................  ........        X   .........  Ms. Chu..........        X   ........  .........
Mr. Holding....................  ........        X   .........
Mr. Smith (MO).................  ........        X   .........
Mr. Rice.......................  ........        X   .........
Mr. Schweikert.................  ........        X   .........
Ms. Walorski...................  ........        X   .........
Mr. Curbelo....................  ........        X   .........
Mr. Bishop.....................  ........        X   .........
Mr. Wenstrup...................  ........        X   .........
----------------------------------------------------------------------------------------------------------------

    In compliance with the Rules of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 6311, the ``Increasing Access to Lower 
Premium Plans Act of 2018,'' on July 12, 2018.
    H.R. 6311 was ordered favorably reported to the House of 
Representatives as amended by an amendment in the nature of a 
substitute offered by Chairman Brady by a rollcall vote of 23 
yeas to 16 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
         Representative             Yea       Nay     Present     Representative      Yea       Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady......................        X   ........  .........  Mr. Neal.........  ........        X   .........
Mr. Johnson....................        X   ........  .........  Mr. Levin........  ........        X   .........
Mr. Nunes......................        X   ........  .........  Mr. Lewis........  ........        X   .........
Mr. Reichert...................        X   ........  .........  Mr. Doggett......  ........        X   .........
Mr. Roskam.....................        X   ........  .........  Mr. Thompson.....  ........        X   .........
Mr. Buchanan...................        X   ........  .........  Mr. Larson.......  ........        X   .........
Mr. Smith (NE).................        X   ........  .........  Mr. Blumenauer...  ........        X   .........
Ms. Jenkins....................        X   ........  .........  Mr. Kind.........  ........        X   .........
Mr. Paulsen....................        X   ........  .........  Mr. Pascrell.....  ........        X   .........
Mr. Marchant...................        X   ........  .........  Mr. Crowley......  ........        X   .........
Ms. Black......................  ........  ........  .........  Mr. Davis........  ........        X   .........
Mr. Reed.......................        X   ........  .........  Ms. Sanchez......  ........        X   .........
Mr. Kelly......................        X   ........  .........  Mr. Higgins......  ........        X   .........
Mr. Renacci....................        X   ........  .........  Ms. Sewell.......  ........        X   .........
Ms. Noem.......................        X   ........  .........  Ms. DelBene......  ........        X   .........
Mr. Holding....................        X   ........  .........  Ms. Chu..........  ........        X   .........
Mr. Smith (MO).................        X   ........  .........
Mr. Rice.......................        X   ........  .........
Mr. Schweikert.................        X   ........  .........
Ms. Walorski...................        X   ........  .........
Mr. Curbelo....................        X   ........  .........
Mr. Bishop.....................        X   ........  .........
Mr. LaHood.....................        X   ........  .........
Mr. Wenstrup...................        X   ........  .........
----------------------------------------------------------------------------------------------------------------

                     IV. BUDGET EFFECTS OF THE BILL


               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6311, as 
reported.
    The bill, as reported, is estimated to have the following 
effect on Federal fiscal year budget receipts for the period 
2019-2028:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                               FISCAL YEARS  [Millions of Dollars]
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                            Item                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Modification of Definition of Qualified Health Plan\1\\2\...       -388     -1,288     -1,252     -1,258     -1,295     -1,284     -1,206     -1,265     -1,284     -1,304     -5,481    -11,823
Allow All Individuals Purchasing Health Insurance in the             51         76         85         94         98         99        101        103        106        110        404        923
 Individual Market the Option to Purchase a Lower Premium
 Copper Plan\1\\2\..........................................
    Total...................................................       -337     -1,212     -1,167     -1,164     -1,197     -1,185     -1,104     -1,162     -1,178     -1,194     -5,077   -10,901
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE: Details may not add to totals due to rounding.
\1\Estimate provided by the staff of the Joint Committee on Taxation and the Congressional Budget Office.
\2\Estimate includes the following outlay effects:


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 2019       2020       2021       2022       2023       2024       2025       2026       2027       2028     2019-23    2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Modification of Definition of Qualified Health Plan.........        168        902        848        823        833        810        727        758        738        738      3,574      7,346
Allow All Individuals Purchasing Health Insurance in the            -50        -74        -82        -91        -95        -96        -98        -99       -101       -105       -391       -890
 Individual Market the Option to Purchase a Lower Premium
 Copper Plan................................................
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    Pursuant to clause 8 of rule XIII of the Rules of the House 
of Representatives, the following statement is made by the 
Joint Committee on Taxation with respect to the provisions of 
the bill amending the Internal Revenue Code of 1986: The gross 
budgetary effect (before incorporating macroeconomic effects) 
in any fiscal year is less than 0.25 percent of the current 
projected gross domestic product of the United States for that 
fiscal year; therefore, the bill is not ``major legislation'' 
for purposes of requiring that the estimate include the 
budgetary effects of changes in economic output, employment, 
capital stock and other macroeconomic variables.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill involves no new or increased budget authority. The 
Committee further states that the revenue-reducing tax 
provision involves a new tax expenditure. See Part IV.A., 
above.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 6138, as 
reported. As of the filing of this report, the Committee had 
not received an estimate prepared by the Congressional Budget 
Office (CBO).

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE


          A. Committee Oversight Findings and Recommendations

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated into 
the description portions of this report.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes funding, so no 
statement of general performance goals and objectives for which 
any measure authorizes funding is required.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

                D. Applicability of House Rule XXI 5(b)

    Rule XXI 5(b) of the Rules of the House of Representatives 
provides, in part, that ``A bill or joint resolution, 
amendment, or conference report carrying a Federal income tax 
rate increase may not be considered as passed or agreed to 
unless so determined by a vote of not less than three-fifths of 
the Members voting, a quorum being present.'' The Committee has 
carefully reviewed the bill and states that the bill does not 
involve any Federal income tax rate increases within the 
meaning of the rule.

                       E. Tax Complexity Analysis

    Section 4022(b) of the Internal Revenue Service 
Restructuring and Reform Act of 1998 (``IRS Reform Act'') 
requires the staff of the Joint Committee on Taxation (in 
consultation with the Internal Revenue Service and the Treasury 
Department) to provide a tax complexity analysis. The 
complexity analysis is required for all legislation reported by 
the Senate Committee on Finance, the House Committee on Ways 
and Means, or any committee of conference if the legislation 
includes a provision that directly or indirectly amends the 
Internal Revenue Code of 1986 and has widespread applicability 
to individuals or small businesses.
    Pursuant to clause 3(h)(1) of rule XIII of the Rules of the 
House of Representatives, the staff of the Joint Committee on 
Taxation has determined that a complexity analysis is not 
required under section 4022(b) of the IRS Reform Act because 
the bill contains no provisions that amend the Internal Revenue 
Code of 1986 and that have ``widespread applicability'' to 
individuals or small businesses, within the meaning of the 
rule.

  F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   G. Duplication of Federal Programs

    In compliance with Sec. 3(c)(5) of rule XIII of the Rules 
of the House of Representatives, the Committee states that no 
provision of the bill establishes or reauthorizes: (1) a 
program of the Federal Government known to be duplicative of 
another Federal program, (2) a program included in any report 
from the Government Accountability Office to Congress pursuant 
to section 21 of Public Law 111139, or (3) a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance, published pursuant to section 6104 
of title 31, United States Code.

                 H. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (115th Congress), 
the following statement is made concerning directed rule 
makings: The Committee advises that the bill requires no 
directed rule makings within the meaning of such section. 


       VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED


      B. Changes in Existing Law Proposed by the Bill, as Reported

    In compliance with clause 3(e)(1)(B) of rule XIII of the 
Rules of the House of Representatives, changes in existing law 
proposed by the bill, as reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                     INTERNAL REVENUE CODE OF 1986




           *       *       *       *       *       *       *
Subtitle A--Income Taxes

           *       *       *       *       *       *       *


CHAPTER 1--NORMAL TAXES AND SURTAXES

           *       *       *       *       *       *       *


Subchapter A--Determination of Tax Liability

           *       *       *       *       *       *       *


PART IV--CREDITS AGAINST TAX

           *       *       *       *       *       *       *



Subpart C--Refundable Credits

           *       *       *       *       *       *       *



SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.

  (a) In general.--In the case of an applicable taxpayer, there 
shall be allowed as a credit against the tax imposed by this 
subtitle for any taxable year an amount equal to the premium 
assistance credit amount of the taxpayer for the taxable year.
  (b) Premium assistance credit amount.--For purposes of this 
section--
          (1) In general.--The term ``premium assistance credit 
        amount'' means, with respect to any taxable year, the 
        sum of the premium assistance amounts determined under 
        paragraph (2) with respect to all coverage months of 
        the taxpayer occurring during the taxable year.
          (2) Premium assistance amount.--The premium 
        assistance amount determined under this subsection with 
        respect to any coverage month is the amount equal to 
        the lesser of--
                  (A) the monthly premiums for such month for 1 
                or more qualified health plans offered in the 
                individual market within a State which cover 
                the taxpayer, the taxpayer's spouse, or any 
                dependent (as defined in section 152) of the 
                taxpayer [and which were enrolled in through an 
                Exchange established by the State under 1311 of 
                the Patient Protection and Affordable Care Act, 
                or], or
                  (B) the excess (if any) of--
                          (i) the adjusted monthly premium for 
                        such month for the applicable second 
                        lowest cost silver plan with respect to 
                        the taxpayer, over
                          (ii) an amount equal to \1/12\ of the 
                        product of the applicable percentage 
                        and the taxpayer's household income for 
                        the taxable year.
          (3) Other terms and rules relating to premium 
        assistance amounts.--For purposes of paragraph (2)--
                  (A) Applicable percentage.--
                          (i) In general.--Except as provided 
                        in clause (ii), the applicable 
                        percentage for any taxable year shall 
                        be the percentage such that the 
                        applicable percentage for any taxpayer 
                        whose household income is within an 
                        income tier specified in the following 
                        table shall increase, on a sliding 
                        scale in a linear manner, from the 
                        initial premium percentage to the final 
                        premium percentage specified in such 
                        table for such income tier:


 
------------------------------------------------------------------------
     In the case of
    household income
(expressed as a percent    The initial premium       The final premium
of poverty line) within      percentage is--          percentage is--
  the following income
         tier:
------------------------------------------------------------------------
Up to 133%               2.0%                     2.0%
133% up to 150%          3.0%                     4.0%
150% up to 200%          4.0%                     6.3%
200% up to 250%          6.3%                     8.05%
250% up to 300%          8.05%                    9.5%
300% up to 400%          9.5%                     9.5%
------------------------------------------------------------------------

                          (ii) Indexing.--
                                  (I) In general.--Subject to 
                                subclause (II), in the case of 
                                taxable years beginning in any 
                                calendar year after 2014, the 
                                initial and final applicable 
                                percentages under clause (i) 
                                (as in effect for the preceding 
                                calendar year after application 
                                of this clause) shall be 
                                adjusted to reflect the excess 
                                of the rate of premium growth 
                                for the preceding calendar year 
                                over the rate of income growth 
                                for the preceding calendar 
                                year.
                                  (II) Additional adjustment.--
                                Except as provided in subclause 
                                (III), in the case of any 
                                calendar year after 2018, the 
                                percentages described in 
                                subclause (I) shall, in 
                                addition to the adjustment 
                                under subclause (I), be 
                                adjusted to reflect the excess 
                                (if any) of the rate of premium 
                                growth estimated under 
                                subclause (I) for the preceding 
                                calendar year over the rate of 
                                growth in the consumer price 
                                index for the preceding 
                                calendar year.
                                  (III) Failsafe.--Subclause 
                                (II) shall apply for any 
                                calendar year only if the 
                                aggregate amount of premium tax 
                                credits under this section and 
                                cost-sharing reductions under 
                                section 1402 of the Patient 
                                Protection and Affordable Care 
                                Act for the preceding calendar 
                                year exceeds an amount equal to 
                                0.504 percent of the gross 
                                domestic product for the 
                                preceding calendar year.
                  (B) Applicable second lowest cost silver 
                plan.--The applicable second lowest cost silver 
                plan with respect to any applicable taxpayer is 
                the second lowest cost silver plan of the 
                individual market in the rating area in which 
                the taxpayer resides which--
                          (i) is offered through [the same 
                        Exchange through which the qualified 
                        health plans taken into account under 
                        paragraph (2)(A) were offered, and] the 
                        Exchange through which such taxpayer is 
                        permitted to obtain coverage, and
                          (ii) provides--
                                  (I) self-only coverage in the 
                                case of an applicable 
                                taxpayer--
                                          (aa) whose tax for 
                                        the taxable year is 
                                        determined under 
                                        section 1(c) (relating 
                                        to unmarried 
                                        individuals other than 
                                        surviving spouses and 
                                        heads of households) 
                                        and who is not allowed 
                                        a deduction under 
                                        section 151 for the 
                                        taxable year with 
                                        respect to a dependent, 
                                        or
                                          (bb) who is not 
                                        described in item (aa) 
                                        but who purchases only 
                                        self-only coverage, and
                                  (II) family coverage in the 
                                case of any other applicable 
                                taxpayer.
                If a taxpayer files a joint return and no 
                credit is allowed under this section with 
                respect to 1 of the spouses by reason of 
                subsection (e), the taxpayer shall be treated 
                as described in clause (ii)(I) unless a 
                deduction is allowed under section 151 for the 
                taxable year with respect to a dependent other 
                than either spouse and subsection (e) does not 
                apply to the dependent.
                  (C) Adjusted monthly premium.--The adjusted 
                monthly premium for an applicable second lowest 
                cost silver plan is the monthly premium which 
                would have been charged (for the rating area 
                with respect to which the premiums under 
                paragraph (2)(A) were determined) for the plan 
                if each individual covered under a qualified 
                health plan taken into account under paragraph 
                (2)(A) were covered by such silver plan and the 
                premium was adjusted only for the age of each 
                such individual in the manner allowed under 
                section 2701 of the Public Health Service Act. 
                In the case of a State participating in the 
                wellness discount demonstration project under 
                section 2705(d) of the Public Health Service 
                Act, the adjusted monthly premium shall be 
                determined without regard to any premium 
                discount or rebate under such project.
                  (D) Additional benefits.--If--
                          (i) a qualified health plan under 
                        section 1302(b)(5) of the Patient 
                        Protection and Affordable Care Act 
                        offers benefits in addition to the 
                        essential health benefits required to 
                        be provided by the plan, or
                          (ii) a State requires a qualified 
                        health plan under section 1311(d)(3)(B) 
                        of such Act to cover benefits in 
                        addition to the essential health 
                        benefits required to be provided by the 
                        plan,
                the portion of the premium for the plan 
                properly allocable (under rules prescribed by 
                the Secretary of Health and Human Services) to 
                such additional benefits shall not be taken 
                into account in determining either the monthly 
                premium or the adjusted monthly premium under 
                paragraph (2).
                  (E) Special rule for pediatric dental 
                coverage.--For purposes of determining the 
                amount of any monthly premium, if an individual 
                enrolls in both a qualified health plan and a 
                plan described in section 1311(d)(2)(B)(ii) (I) 
                of the Patient Protection and Affordable Care 
                Act for any plan year, the portion of the 
                premium for the plan described in such section 
                that (under regulations prescribed by the 
                Secretary) is properly allocable to pediatric 
                dental benefits which are included in the 
                essential health benefits required to be 
                provided by a qualified health plan under 
                section 1302(b)(1)(J) of such Act shall be 
                treated as a premium payable for a qualified 
                health plan.
  (c) Definition and rules relating to applicable taxpayers, 
coverage months, and qualified health plan.--For purposes of 
this section--
          (1) Applicable taxpayer.--
                  (A) In general.--The term ``applicable 
                taxpayer'' means, with respect to any taxable 
                year, a taxpayer whose household income for the 
                taxable year equals or exceeds 100 percent but 
                does not exceed 400 percent of an amount equal 
                to the poverty line for a family of the size 
                involved.
                  (B) Special rule for certain individuals 
                lawfully present in the United States.--If--
                          (i) a taxpayer has a household income 
                        which is not greater than 100 percent 
                        of an amount equal to the poverty line 
                        for a family of the size involved, and
                          (ii) the taxpayer is an alien 
                        lawfully present in the United States, 
                        but is not eligible for the medicaid 
                        program under title XIX of the Social 
                        Security Act by reason of such alien 
                        status,
                the taxpayer shall, for purposes of the credit 
                under this section, be treated as an applicable 
                taxpayer with a household income which is equal 
                to 100 percent of the poverty line for a family 
                of the size involved.
                  (C) Married couples must file joint return.--
                If the taxpayer is married (within the meaning 
                of section 7703) at the close of the taxable 
                year, the taxpayer shall be treated as an 
                applicable taxpayer only if the taxpayer and 
                the taxpayer's spouse file a joint return for 
                the taxable year.
                  (D) Denial of credit to dependents.--No 
                credit shall be allowed under this section to 
                any individual with respect to whom a deduction 
                under section 151 is allowable to another 
                taxpayer for a taxable year beginning in the 
                calendar year in which such individual's 
                taxable year begins.
          (2) Coverage month.--For purposes of this 
        subsection--
                  (A) In general.--The term ``coverage month'' 
                means, with respect to an applicable taxpayer, 
                any month if--
                          (i) as of the first day of such month 
                        the taxpayer, the taxpayer's spouse, or 
                        any dependent of the taxpayer is 
                        covered by a qualified health plan 
                        described in subsection (b)(2)(A) [that 
                        was enrolled in through an Exchange 
                        established by the State under section 
                        1311 of the Patient Protection and 
                        Affordable Care Act], and
                          (ii) the premium for coverage under 
                        such plan for such month is paid by the 
                        taxpayer (or through advance payment of 
                        the credit under subsection (a) under 
                        section 1412 of the Patient Protection 
                        and Affordable Care Act).
                  (B) Exception for minimum essential 
                coverage.--
                          (i) In general.--The term ``coverage 
                        month'' shall not include any month 
                        with respect to an individual if for 
                        such month the individual is eligible 
                        for minimum essential coverage other 
                        than eligibility for coverage described 
                        in section 5000A(f)(1)(C) (relating to 
                        coverage in the individual market).
                          (ii) Minimum essential coverage.--The 
                        term ``minimum essential coverage'' has 
                        the meaning given such term by section 
                        5000A(f).
                  (C) Special rule for employer-sponsored 
                minimum essential coverage.--For purposes of 
                subparagraph (B)--
                          (i) Coverage must be affordable.--
                        Except as provided in clause (iii), an 
                        employee shall not be treated as 
                        eligible for minimum essential coverage 
                        if such coverage--
                                  (I) consists of an eligible 
                                employer-sponsored plan (as 
                                defined in section 
                                5000A(f)(2)), and
                                  (II) the employee's required 
                                contribution (within the 
                                meaning of section 
                                5000A(e)(1)(B)) with respect to 
                                the plan exceeds 9.5 percent of 
                                the applicable taxpayer's 
                                household income.
                        This clause shall also apply to an 
                        individual who is eligible to enroll in 
                        the plan by reason of a relationship 
                        the individual bears to the employee.
                          (ii) Coverage must provide minimum 
                        value.--Except as provided in clause 
                        (iii), an employee shall not be treated 
                        as eligible for minimum essential 
                        coverage if such coverage consists of 
                        an eligible employer-sponsored plan (as 
                        defined in section 5000A(f)(2)) and the 
                        plan's share of the total allowed costs 
                        of benefits provided under the plan is 
                        less than 60 percent of such costs.
                          (iii) Employee or family must not be 
                        covered under employer plan.--Clauses 
                        (i) and (ii) shall not apply if the 
                        employee (or any individual described 
                        in the last sentence of clause (i)) is 
                        covered under the eligible employer-
                        sponsored plan or the grandfathered 
                        health plan.
                          (iv) Indexing.--In the case of plan 
                        years beginning in any calendar year 
                        after 2014, the Secretary shall adjust 
                        the 9.5 percent under clause (i)(II) in 
                        the same manner as the percentages are 
                        adjusted under subsection 
                        (b)(3)(A)(ii).
          (3) Definitions and other rules.--
                  (A) Qualified health plan.--The term 
                ``qualified health plan'' has the meaning given 
                such term by section 1301(a) of the Patient 
                Protection and Affordable Care Act (determined 
                without regard to subparagraphs (A), (C)(ii), 
                and (C)(iv) of paragraph (1) thereof and 
                without regard to whether the plan is offered 
                on an Exchange), except that such term [shall 
                not include a qualified health plan which is a 
                catastrophic plan described in section 1302(e) 
                of such Act.] shall not include any health plan 
                that--
                          (i) is a grandfathered health plan or 
                        a grandmothered health plan, or 
                          (ii) includes coverage for abortions 
                        (other than any abortion necessary to 
                        save the life of the mother or any 
                        abortion with respect to a pregnancy 
                        that is the result of an act of rape or 
                        incest). 
                  (B) Grandfathered health plan.--The term 
                ``grandfathered health plan'' has the meaning 
                given such term by section 1251 of the Patient 
                Protection and Affordable Care Act.
                  (C) Grandmothered health plan.--
                          (i) In general.--The term 
                        ``grandmothered health plan'' means 
                        health insurance coverage which is 
                        offered in the individual health 
                        insurance market as of October 1, 2013, 
                        and is permitted to be offered in such 
                        market after January 1, 2014, as a 
                        result of CCIIO guidance.
                          (ii) CCIIO guidance defined.--The 
                        term ``CCIIO guidance'' means the 
                        letter issued by the Centers for 
                        Medicare & Medicaid Services on 
                        November 14, 2013, to the State 
                        Insurance Commissioners outlining a 
                        transitional policy for non-
                        grandfathered coverage in the 
                        individual health insurance market, as 
                        subsequently extended and modified 
                        (including by a communication entitled 
                        ``Insurance Standards Bulletin Series--
                        INFORMATION--Extension of Transitional 
                        Policy through 2019'' issued on April 
                        9, 2018, by the Director of the Center 
                        for Consumer Information and Insurance 
                        Oversight of such Centers).
                          (iii) Individual health insurance 
                        market.--The term ``individual health 
                        insurance market'' means the market for 
                        health insurance coverage (as defined 
                        in section 9832(b)) offered to 
                        individuals other than in connection 
                        with a group health plan (within the 
                        meaning of section 5000(b)(1)).
                  (D) Certain rules related to abortion.--
                          (i) Option to purchase separate 
                        coverage or plan.--Nothing in 
                        subparagraph (A) shall be construed as 
                        prohibiting any individual from 
                        purchasing separate coverage for 
                        abortions described in such 
                        subparagraph, or a health plan that 
                        includes such abortions, so long as no 
                        credit is allowed under this section 
                        with respect to the premiums for such 
                        coverage or plan.
                          (ii) Option to offer coverage or 
                        plan.--Nothing in subparagraph (A) 
                        shall restrict any health insurance 
                        issuer offering a health plan from 
                        offering separate coverage for 
                        abortions described in such 
                        subparagraph, or a plan that includes 
                        such abortions, so long as premiums for 
                        such separate coverage or plan are not 
                        paid for with any amount attributable 
                        to the credit allowed under this 
                        section (or the amount of any advance 
                        payment of the credit under section 
                        1412 of the Patient Protection and 
                        Affordable Care Act).
                          (iii) Other treatments.--The 
                        treatment of any infection, injury, 
                        disease, or disorder that has been 
                        caused by or exacerbated by the 
                        performance of an abortion shall not be 
                        treated as an abortion for purposes of 
                        subparagraph (A).
          (4) Special rules for qualified small employer health 
        reimbursement arrangements.--
                  (A) In general.--The term ``coverage month'' 
                shall not include any month with respect to an 
                employee (or any spouse or dependent of such 
                employee) if for such month the employee is 
                provided a qualified small employer health 
                reimbursement arrangement which constitutes 
                affordable coverage.
                  (B) Denial of double benefit.--In the case of 
                any employee who is provided a qualified small 
                employer health reimbursement arrangement for 
                any coverage month (determined without regard 
                to subparagraph (A)), the credit otherwise 
                allowable under subsection (a) to the taxpayer 
                for such month shall be reduced (but not below 
                zero) by the amount described in subparagraph 
                (C)(i)(II) for such month.
                  (C) Affordable coverage.--For purposes of 
                subparagraph (A), a qualified small employer 
                health reimbursement arrangement shall be 
                treated as constituting affordable coverage for 
                a month if--
                          (i) the excess of--
                                  (I) the amount that would be 
                                paid by the employee as the 
                                premium for such month for 
                                self-only coverage under the 
                                second lowest cost silver plan 
                                offered in the relevant 
                                individual health insurance 
                                market, over
                                  (II) \1/12\ of the employee's 
                                permitted benefit (as defined 
                                in section 9831(d)(3)(C)) under 
                                such arrangement, does not 
                                exceed--
                          (ii) \1/12\ of 9.5 percent of the 
                        employee's household income.
                  (D) Qualified small employer health 
                reimbursement arrangement.--For purposes of 
                this paragraph, the term ``qualified small 
                employer health reimbursement arrangement'' has 
                the meaning given such term by section 
                9831(d)(2).
                  (E) Coverage for less than entire year.--In 
                the case of an employee who is provided a 
                qualified small employer health reimbursement 
                arrangement for less than an entire year, 
                subparagraph (C)(i)(II) shall be applied by 
                substituting "the number of months during the 
                year for which such arrangement was provided" 
                for "12'.
                  (F) Indexing.--In the case of plan years 
                beginning in any calendar year after 2014, the 
                Secretary shall adjust the 9.5 percent amount 
                under subparagraph (C)(ii) in the same manner 
                as the percentages are adjusted under 
                subsection (b)(3)(A)(ii).
  (d) Terms relating to income and families.--For purposes of 
this section--
          (1) Family size.--The family size involved with 
        respect to any taxpayer shall be equal to the number of 
        individuals for whom the taxpayer is allowed a 
        deduction under section 151 (relating to allowance of 
        deduction for personal exemptions) for the taxable 
        year.
          (2) Household income.--
                  (A) Household income.--The term ``household 
                income'' means, with respect to any taxpayer, 
                an amount equal to the sum of--
                          (i) the modified adjusted gross 
                        income of the taxpayer, plus
                          (ii) the aggregate modified adjusted 
                        gross incomes of all other individuals 
                        who--
                                  (I) were taken into account 
                                in determining the taxpayer's 
                                family size under paragraph 
                                (1), and
                                  (II) were required to file a 
                                return of tax imposed by 
                                section 1 for the taxable year.
                  (B) Modified adjusted gross income.--The term 
                ``modified adjusted gross income'' means 
                adjusted gross income increased by--
                          (i) any amount excluded from gross 
                        income under section 911,
                          (ii) any amount of interest received 
                        or accrued by the taxpayer during the 
                        taxable year which is exempt from tax, 
                        and
                          (iii) an amount equal to the portion 
                        of the taxpayer's social security 
                        benefits (as defined in section 86(d)) 
                        which is not included in gross income 
                        under section 86 for the taxable year.
          (3) Poverty line.--
                  (A) In general.--The term ``poverty line'' 
                has the meaning given that term in section 
                2110(c)(5) of the Social Security Act (42 
                U.S.C. 1397jj(c)(5)).
                  (B) Poverty line used.--In the case of any 
                qualified health plan offered through an 
                Exchange for coverage during a taxable year 
                beginning in a calendar year, the poverty line 
                used shall be the most recently published 
                poverty line as of the 1st day of the regular 
                enrollment period for coverage during such 
                calendar year.
  (e) Rules for individuals not lawfully present.--
          (1) In general.--If 1 or more individuals for whom a 
        taxpayer is allowed a deduction under section 151 
        (relating to allowance of deduction for personal 
        exemptions) for the taxable year (including the 
        taxpayer or his spouse) are individuals who are not 
        lawfully present--
                  (A) the aggregate amount of premiums 
                otherwise taken into account under clauses (i) 
                and (ii) of subsection (b)(2)(A) shall be 
                reduced by the portion (if any) of such 
                premiums which is attributable to such 
                individuals, and
                  (B) for purposes of applying this section, 
                the determination as to what percentage a 
                taxpayer's household income bears to the 
                poverty level for a family of the size involved 
                shall be made under one of the following 
                methods:
                          (i) A method under which--
                                  (I) the taxpayer's family 
                                size is determined by not 
                                taking such individuals into 
                                account, and
                                  (II) the taxpayer's household 
                                income is equal to the product 
                                of the taxpayer's household 
                                income (determined without 
                                regard to this subsection) and 
                                a fraction--
                                          (aa) the numerator of 
                                        which is the poverty 
                                        line for the taxpayer's 
                                        family size determined 
                                        after application of 
                                        subclause (I), and
                                          (bb) the denominator 
                                        of which is the poverty 
                                        line for the taxpayer's 
                                        family size determined 
                                        without regard to 
                                        subclause (I).
                          (ii) A comparable method reaching the 
                        same result as the method under clause 
                        (i).
          (2) Lawfully present.--For purposes of this section, 
        an individual shall be treated as lawfully present only 
        if the individual is, and is reasonably expected to be 
        for the entire period of enrollment for which the 
        credit under this section is being claimed, a citizen 
        or national of the United States or an alien lawfully 
        present in the United States.
          (3) Secretarial authority.--The Secretary of Health 
        and Human Services, in consultation with the Secretary, 
        shall prescribe rules setting forth the methods by 
        which calculations of family size and household income 
        are made for purposes of this subsection. Such rules 
        shall be designed to ensure that the least burden is 
        placed on individuals enrolling in qualified health 
        plans through an Exchange and taxpayers eligible for 
        the credit allowable under this section.
  (f) Reconciliation of credit and advance credit.--
          (1) In general.--The amount of the credit allowed 
        under this section for any taxable year shall be 
        reduced (but not below zero) by the amount of any 
        advance payment of such credit under section 1412 of 
        the Patient Protection and Affordable Care Act.
          (2) Excess advance payments.--
                  (A) In general.--If the advance payments to a 
                taxpayer under section 1412 of the Patient 
                Protection and Affordable Care Act for a 
                taxable year exceed the credit allowed by this 
                section (determined without regard to paragraph 
                (1)), the tax imposed by this chapter for the 
                taxable year shall be increased by the amount 
                of such excess.
                  (B) Limitation on increase.--
                          (i) In general.--In the case of a 
                        taxpayer whose household income is less 
                        than 400 percent of the poverty line 
                        for the size of the family involved for 
                        the taxable year, the amount of the 
                        increase under subparagraph (A) shall 
                        in no event exceed the applicable 
                        dollar amount determined in accordance 
                        with the following table (one-half of 
                        such amount in the case of a taxpayer 
                        whose tax is determined under section 
                        1(c) for the taxable year):


 
------------------------------------------------------------------------
 If the household income (expressed
 as a percent of poverty line) is:     The applicable dollar amount is:
------------------------------------------------------------------------
Less than 200%                       $600
At least 200% but less than 300%     $1,500
At least 300% but less than 400%     $2,500
------------------------------------------------------------------------

                          (ii) Indexing of amount.--In the case 
                        of any calendar year beginning after 
                        2014, each of the dollar amounts in the 
                        table contained under clause (i) shall 
                        be increased by an amount equal to--
                                  (I) such dollar amount, 
                                multiplied by
                                  (II) the cost-of-living 
                                adjustment determined under 
                                section 1(f)(3) for the 
                                calendar year, determined by 
                                substituting ``calendar year 
                                2013'' for ``calendar year 
                                2016'' in subparagraph (A)(ii) 
                                thereof.
                        If the amount of any increase under 
                        clause (i) is not a multiple of $50, 
                        such increase shall be rounded to the 
                        next lowest multiple of $50.
          (3) Information requirement.--Each Exchange (or any 
        person carrying out 1 or more responsibilities of an 
        Exchange under section 1311(f)(3) or 1321(c) of the 
        Patient Protection and Affordable Care Act) shall 
        provide the following information to the Secretary and 
        to the taxpayer with respect to any health plan 
        provided through the Exchange:
                  (A) The level of coverage described in 
                section 1302(d) of the Patient Protection and 
                Affordable Care Act and the period such 
                coverage was in effect.
                  (B) The total premium for the coverage 
                without regard to the credit under this section 
                or cost-sharing reductions under section 1402 
                of such Act.
                  (C) The aggregate amount of any advance 
                payment of such credit or reductions under 
                section 1412 of such Act.
                  (D) The name, address, and TIN of the primary 
                insured and the name and TIN of each other 
                individual obtaining coverage under the policy.
                  (E) Any information provided to the Exchange, 
                including any change of circumstances, 
                necessary to determine eligibility for, and the 
                amount of, such credit.
                  (F) Information necessary to determine 
                whether a taxpayer has received excess advance 
                payments.
  (g) Regulations.--The Secretary shall prescribe such 
regulations as may be necessary to carry out the provisions of 
this section, including regulations which provide for--
          (1) the coordination of the credit allowed under this 
        section with the program for advance payment of the 
        credit under section 1412 of the Patient Protection and 
        Affordable Care Act, and
          (2) the application of subsection (f) where the 
        filing status of the taxpayer for a taxable year is 
        different from such status used for determining the 
        advance payment of the credit.

           *       *       *       *       *       *       *


Subtitle F--Procedure and Administration

           *       *       *       *       *       *       *


CHAPTER 61--INFORMATION AND RETURNS

           *       *       *       *       *       *       *


Subchapter A--Returns and Records

           *       *       *       *       *       *       *


PART III--INFORMATION RETURNS

           *       *       *       *       *       *       *



Subpart D--Information Regarding Health Insurance Coverage

           *       *       *       *       *       *       *



SEC. 6055. REPORTING OF HEALTH INSURANCE COVERAGE.

  (a) In General.--Every person who provides minimum essential 
coverage to an individual during a calendar year shall, at such 
time as the Secretary may prescribe, make a return described in 
subsection (b).
  (b) Form and Manner of Return.--
          (1) In general.--A return is described in this 
        subsection if such return--
                  (A) is in such form as the Secretary may 
                prescribe, and
                  (B) contains--
                          (i) the name, address and TIN of the 
                        primary insured and the name and TIN of 
                        each other individual obtaining 
                        coverage under the policy,
                          (ii) the dates during which such 
                        individual was covered under minimum 
                        essential coverage during the calendar 
                        year,
                          (iii) in the case of minimum 
                        essential coverage which consists of 
                        health insurance coverage, information 
                        concerning--
                                  (I) whether or not the 
                                coverage is a qualified health 
                                plan offered through an 
                                Exchange established under 
                                section 1311 of the Patient 
                                Protection and Affordable Care 
                                Act, and
                                  (II) in the case of a 
                                qualified health plan, the 
                                amount (if any) of any advance 
                                payment under section 1412 of 
                                the Patient Protection and 
                                Affordable Care Act of any 
                                cost-sharing reduction under 
                                section 1402 of such Act or of 
                                any premium tax credit under 
                                section 36B with respect to 
                                such coverage, and
                          (iv) such other information as the 
                        Secretary may require.
          (2) Information relating to employer-provided 
        coverage.--If minimum essential coverage provided to an 
        individual under subsection (a) consists of health 
        insurance coverage of a health insurance issuer 
        provided through a group health plan of an employer, a 
        return described in this subsection shall include--
                  (A) the name, address, and employer 
                identification number of the employer 
                maintaining the plan,
                  (B) the portion of the premium (if any) 
                required to be paid by the employer, and
                  (C) if the health insurance coverage is a 
                qualified health plan in the small group market 
                offered through an Exchange, such other 
                information as the Secretary may require for 
                administration of the credit under section 45R 
                (relating to credit for employee health 
                insurance expenses of small employers).
          (3) Information relating to off-exchange premium tax 
        credit eligible coverage.--If minimum essential 
        coverage provided to an individual under subsection (a) 
        consists of a qualified health plan (as defined in 
        section 36B(c)(3)) which is not enrolled in through an 
        Exchange established under title I of the Patient 
        Protection and Affordable Care Act, a return described 
        in this subsection shall include--
                  (A) a statement that such plan is a qualified 
                health plan (as defined in section 36B(c)(3)),
                  (B) the premiums paid with respect to such 
                coverage,
                  (C) the months during the calendar year for 
                which such coverage is provided to the 
                individual,
                  (D) the adjusted monthly premium for the 
                applicable second lowest cost silver plan (as 
                defined in section 36B(b)(3)) for each such 
                month with respect to such individual, and
                  (E) such other information as the Secretary 
                may prescribe.
  (c) Statements to be Furnished to Individuals With Respect to 
Whom Information Is Reported.--
          (1) In general.--Every person required to make a 
        return under subsection (a) shall furnish to each 
        individual whose name is required to be set forth in 
        such return a written statement showing--
                  (A) the name and address of the person 
                required to make such return and the phone 
                number of the information contact for such 
                person, and
                  (B) the information required to be shown on 
                the return with respect to such individual.
          (2) Time for furnishing statements.--The written 
        statement required under paragraph (1) shall be 
        furnished on or before January 31 of the year following 
        the calendar year for which the return under subsection 
        (a) was required to be made.
  (d) Coverage Provided by Governmental Units.--In the case of 
coverage provided by any governmental unit or any agency or 
instrumentality thereof, the officer or employee who enters 
into the agreement to provide such coverage (or the person 
appropriately designated for purposes of this section) shall 
make the returns and statements required by this section.
  (e) Minimum Essential Coverage.--For purposes of this 
section, the term ``minimum essential coverage'' has the 
meaning given such term by section 5000A(f).

           *       *       *       *       *       *       *

                              ----------                              


               PATIENT PROTECTION AND AFFORDABLE CARE ACT




           *       *       *       *       *       *       *
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

           *       *       *       *       *       *       *


        Subtitle D--Available Coverage Choices for All Americans

PART 1--ESTABLISHMENT OF QUALIFIED HEALTH PLANS

           *       *       *       *       *       *       *


SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS.

  (a) Essential Health Benefits Package.--In this title, the 
term ``essential health benefits package'' means, with respect 
to any health plan, coverage that--
          (1) provides for the essential health benefits 
        defined by the Secretary under subsection (b);
          (2) limits cost-sharing for such coverage in 
        accordance with subsection (c); and
          (3) subject to subsection (e), provides either the 
        bronze, silver, gold, or platinum level of coverage 
        described in subsection (d).
  (b) Essential Health Benefits.--
          (1) In general.--Subject to paragraph (2), the 
        Secretary shall define the essential health benefits, 
        except that such benefits shall include at least the 
        following general categories and the items and services 
        covered within the categories:
                  (A) Ambulatory patient services.
                  (B) Emergency services.
                  (C) Hospitalization.
                  (D) Maternity and newborn care.
                  (E) Mental health and substance use disorder 
                services, including behavioral health 
                treatment.
                  (F) Prescription drugs.
                  (G) Rehabilitative and habilitative services 
                and devices.
                  (H) Laboratory services.
                  (I) Preventive and wellness services and 
                chronic disease management.
                  (J) Pediatric services, including oral and 
                vision care.
          (2) Limitation.--
                  (A) In general.--The Secretary shall ensure 
                that the scope of the essential health benefits 
                under paragraph (1) is equal to the scope of 
                benefits provided under a typical employer 
                plan, as determined by the Secretary. To inform 
                this determination, the Secretary of Labor 
                shall conduct a survey of employer-sponsored 
                coverage to determine the benefits typically 
                covered by employers, including multiemployer 
                plans, and provide a report on such survey to 
                the Secretary.
                  (B) Certification.--In defining the essential 
                health benefits described in paragraph (1), and 
                in revising the benefits under paragraph 
                (4)(H), the Secretary shall submit a report to 
                the appropriate committees of Congress 
                containing a certification from the Chief 
                Actuary of the Centers for Medicare & Medicaid 
                Services that such essential health benefits 
                meet the limitation described in paragraph (2).
          (3) Notice and hearing.--In defining the essential 
        health benefits described in paragraph (1), and in 
        revising the benefits under paragraph (4)(H), the 
        Secretary shall provide notice and an opportunity for 
        public comment.
          (4) Required elements for consideration.--In defining 
        the essential health benefits under paragraph (1), the 
        Secretary shall--
                  (A) ensure that such essential health 
                benefits reflect an appropriate balance among 
                the categories described in such subsection, so 
                that benefits are not unduly weighted toward 
                any category;
                  (B) not make coverage decisions, determine 
                reimbursement rates, establish incentive 
                programs, or design benefits in ways that 
                discriminate against individuals because of 
                their age, disability, or expected length of 
                life;
                  (C) take into account the health care needs 
                of diverse segments of the population, 
                including women, children, persons with 
                disabilities, and other groups;
                  (D) ensure that health benefits established 
                as essential not be subject to denial to 
                individuals against their wishes on the basis 
                of the individuals' age or expected length of 
                life or of the individuals' present or 
                predicted disability, degree of medical 
                dependency, or quality of life;
                  (E) provide that a qualified health plan 
                shall not be treated as providing coverage for 
                the essential health benefits described in 
                paragraph (1) unless the plan provides that--
                          (i) coverage for emergency department 
                        services will be provided without 
                        imposing any requirement under the plan 
                        for prior authorization of services or 
                        any limitation on coverage where the 
                        provider of services does not have a 
                        contractual relationship with the plan 
                        for the providing of services that is 
                        more restrictive than the requirements 
                        or limitations that apply to emergency 
                        department services received from 
                        providers who do have such a 
                        contractual relationship with the plan; 
                        and
                          (ii) if such services are provided 
                        out-of-network, the cost-sharing 
                        requirement (expressed as a copayment 
                        amount or coinsurance rate) is the same 
                        requirement that would apply if such 
                        services were provided in-network;
                  (F) provide that if a plan described in 
                section 1311(b)(2)(B)(ii) (relating to stand-
                alone dental benefits plans) is offered through 
                an Exchange, another health plan offered 
                through such Exchange shall not fail to be 
                treated as a qualified health plan solely 
                because the plan does not offer coverage of 
                benefits offered through the stand-alone plan 
                that are otherwise required under paragraph 
                (1)(J); and
                  (G) periodically review the essential health 
                benefits under paragraph (1), and provide a 
                report to Congress and the public that 
                contains--
                          (i) an assessment of whether 
                        enrollees are facing any difficulty 
                        accessing needed services for reasons 
                        of coverage or cost;
                          (ii) an assessment of whether the 
                        essential health benefits needs to be 
                        modified or updated to account for 
                        changes in medical evidence or 
                        scientific advancement;
                          (iii) information on how the 
                        essential health benefits will be 
                        modified to address any such gaps in 
                        access or changes in the evidence base;
                          (iv) an assessment of the potential 
                        of additional or expanded benefits to 
                        increase costs and the interactions 
                        between the addition or expansion of 
                        benefits and reductions in existing 
                        benefits to meet actuarial limitations 
                        described in paragraph (2); and
                  (H) periodically update the essential health 
                benefits under paragraph (1) to address any 
                gaps in access to coverage or changes in the 
                evidence base the Secretary identifies in the 
                review conducted under subparagraph (G).
          (5) Rule of construction.--Nothing in this title 
        shall be construed to prohibit a health plan from 
        providing benefits in excess of the essential health 
        benefits described in this subsection.
  (c) Requirements Relating to Cost-Sharing.--
          (1) Annual limitation on cost-sharing.--
                  (A) 2014.--The cost-sharing incurred under a 
                health plan with respect to self-only coverage 
                or coverage other than self-only coverage for a 
                plan year beginning in 2014 shall not exceed 
                the dollar amounts in effect under section 
                223(c)(2)(A)(ii) of the Internal Revenue Code 
                of 1986 for self-only and family coverage, 
                respectively, for taxable years beginning in 
                2014.
                  (B) 2015 and later.--In the case of any plan 
                year beginning in a calendar year after 2014, 
                the limitation under this paragraph shall--
                          (i) in the case of self-only 
                        coverage, be equal to the dollar amount 
                        under subparagraph (A) for self-only 
                        coverage for plan years beginning in 
                        2014, increased by an amount equal to 
                        the product of that amount and the 
                        premium adjustment percentage under 
                        paragraph (4) for the calendar year; 
                        and
                          (ii) in the case of other coverage, 
                        twice the amount in effect under clause 
                        (i).
                If the amount of any increase under clause (i) 
                is not a multiple of $50, such increase shall 
                be rounded to the next lowest multiple of $50.
          (3) Cost-sharing.--In this title--
                  (A) In general.--The term ``cost-sharing'' 
                includes--
                          (i) deductibles, coinsurance, 
                        copayments, or similar charges; and
                          (ii) any other expenditure required 
                        of an insured individual which is a 
                        qualified medical expense (within the 
                        meaning of section 223(d)(2) of the 
                        Internal Revenue Code of 1986) with 
                        respect to essential health benefits 
                        covered under the plan.
                  (B) Exceptions.--Such term does not include 
                premiums, balance billing amounts for non-
                network providers, or spending for non-covered 
                services.
          (4) Premium adjustment percentage.--For purposes of 
        paragraph (1)(B)(i), the premium adjustment percentage 
        for any calendar year is the percentage (if any) by 
        which the average per capita premium for health 
        insurance coverage in the United States for the 
        preceding calendar year (as estimated by the Secretary 
        no later than October 1 of such preceding calendar 
        year) exceeds such average per capita premium for 2013 
        (as determined by the Secretary).
  (d) Levels of Coverage.--
          (1) Levels of coverage defined.--The levels of 
        coverage described in this subsection are as follows:
                  (A) Bronze level.--A plan in the bronze level 
                shall provide a level of coverage that is 
                designed to provide benefits that are 
                actuarially equivalent to 60 percent of the 
                full actuarial value of the benefits provided 
                under the plan.
                  (B) Silver level.--A plan in the silver level 
                shall provide a level of coverage that is 
                designed to provide benefits that are 
                actuarially equivalent to 70 percent of the 
                full actuarial value of the benefits provided 
                under the plan.
                  (C) Gold level.--A plan in the gold level 
                shall provide a level of coverage that is 
                designed to provide benefits that are 
                actuarially equivalent to 80 percent of the 
                full actuarial value of the benefits provided 
                under the plan.
                  (D) Platinum level.--A plan in the platinum 
                level shall provide a level of coverage that is 
                designed to provide benefits that are 
                actuarially equivalent to 90 percent of the 
                full actuarial value of the benefits provided 
                under the plan.
          (2) Actuarial value.--
                  (A) In general.--Under regulations issued by 
                the Secretary, the level of coverage of a plan 
                shall be determined on the basis that the 
                essential health benefits described in 
                subsection (b) shall be provided to a standard 
                population (and without regard to the 
                population the plan may actually provide 
                benefits to).
                  (B) Employer contributions.--The Secretary 
                shall issue regulations under which employer 
                contributions to a health savings account 
                (within the meaning of section 223 of the 
                Internal Revenue Code of 1986) may be taken 
                into account in determining the level of 
                coverage for a plan of the employer.
                  (C) Application.--In determining under this 
                title, the Public Health Service Act, or the 
                Internal Revenue Code of 1986 the percentage of 
                the total allowed costs of benefits provided 
                under a group health plan or health insurance 
                coverage that are provided by such plan or 
                coverage, the rules contained in the 
                regulations under this paragraph shall apply.
          (3) Allowable variance.--The Secretary shall develop 
        guidelines to provide for a de minimis variation in the 
        actuarial valuations used in determining the level of 
        coverage of a plan to account for differences in 
        actuarial estimates.
          (4) Plan reference.--In this title, any reference to 
        a bronze, silver, gold, or platinum plan shall be 
        treated as a reference to a qualified health plan 
        providing a bronze, silver, gold, or platinum level of 
        coverage, as the case may be.
  (e) Catastrophic Plan.--
          (1) In general.--A health plan not providing a 
        bronze, silver, gold, or platinum level of coverage 
        shall be treated as meeting the requirements of 
        subsection (d) with respect to any [plan year if--]
                  [(A) the only individuals who are eligible to 
                enroll in the plan are individuals described in 
                paragraph (2); and
                  [(B) the plan provides--] plan year if the 
                plan provides-- 
                  [(i)] (A) except as provided in [clause (ii)] 
                subparagraph (B), the essential health benefits 
                determined under subsection (b), except that 
                the plan provides no benefits for any plan year 
                until the individual has incurred cost-sharing 
                expenses in an amount equal to the annual 
                limitation in effect under subsection (c)(1) 
                for the plan year (except as provided for in 
                section 2713); and
                  [(ii)] (B) coverage for at least three 
                primary care visits.
          [(2) Individuals eligible for enrollment.--An 
        individual is described in this paragraph for any plan 
        year if the individual--
                  [(A) has not attained the age of 30 before 
                the beginning of the plan year; or
                  [(B) has a certification in effect for any 
                plan year under this title that the individual 
                is exempt from the requirement under section 
                5000A of the Internal Revenue Code of 1986 by 
                reason of--
                          [(i) section 5000A(e)(1) of such Code 
                        (relating to individuals without 
                        affordable coverage); or
                          [(ii) section 5000A(e)(5) of such 
                        Code (relating to individuals with 
                        hardships).
          [(3)] (2) Restriction to individual market.--If a 
        health insurance issuer offers a health plan described 
        in this subsection, the issuer may only offer the plan 
        in the individual market.
  (f) Child-only Plans.--If a qualified health plan is offered 
through the Exchange in any level of coverage specified under 
subsection (d), the issuer shall also offer that plan through 
the Exchange in that level as a plan in which the only 
enrollees are individuals who, as of the beginning of a plan 
year, have not attained the age of 21, and such plan shall be 
treated as a qualified health plan.
  (g) Payments to Federally-Qualified Health Centers.--If any 
item or service covered by a qualified health plan is provided 
by a Federally-qualified health center (as defined in section 
1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
1396d(l)(2)(B)) to an enrollee of the plan, the offeror of the 
plan shall pay to the center for the item or service an amount 
that is not less than the amount of payment that would have 
been paid to the center under section 1902(bb) of such Act (42 
U.S.C. 1396a(bb)) for such item or service.

           *       *       *       *       *       *       *


   PART 2--CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH 
BENEFIT EXCHANGES

           *       *       *       *       *       *       *


SEC. 1312. CONSUMER CHOICE.

  (a) Choice.--
          (1) Qualified individuals.--A qualified individual 
        may enroll in any qualified health plan available to 
        such individual and for which such individual is 
        eligible.
          (2) Qualified employers.--
                  (A) Employer may specify level.--A qualified 
                employer may provide support for coverage of 
                employees under a qualified health plan by 
                selecting any level of coverage under section 
                1302(d) to be made available to employees 
                through an Exchange.
                  (B) Employee may choose plans within a 
                level.--Each employee of a qualified employer 
                that elects a level of coverage under 
                subparagraph (A) may choose to enroll in a 
                qualified health plan that offers coverage at 
                that level.
  (b) Payment of Premiums by Qualified Individuals.--A 
qualified individual enrolled in any qualified health plan may 
pay any applicable premium owed by such individual to the 
health insurance issuer issuing such qualified health plan.
  (c) Single Risk Pool.--
          (1) Individual market.--A health insurance issuer 
        shall consider all enrollees in all health plans (other 
        than grandfathered health plans) offered by such issuer 
        in the individual market, including those enrollees who 
        do not enroll in such plans through the Exchange and 
        enrollees in catastrophic plans described in section 
        1302(e), to be members of a single risk pool.
          (2) Small group market.--A health insurance issuer 
        shall consider all enrollees in all health plans (other 
        than grandfathered health plans) offered by such issuer 
        in the small group market, including those enrollees 
        who do not enroll in such plans through the Exchange, 
        to be members of a single risk pool.
          (3) Merger of markets.--A State may require the 
        individual and small group insurance markets within a 
        State to be merged if the State determines appropriate.
          (4) State law.--A State law requiring grandfathered 
        health plans to be included in a pool described in 
        paragraph (1) or (2) shall not apply.
  (d) Empowering Consumer Choice.--
          (1) Continued operation of market outside 
        Exchanges.--Nothing in this title shall be construed to 
        prohibit--
                  (A) a health insurance issuer from offering 
                outside of an Exchange a health plan to a 
                qualified individual or qualified employer; and
                  (B) a qualified individual from enrolling in, 
                or a qualified employer from selecting for its 
                employees, a health plan offered outside of an 
                Exchange.
          (2) Continued operation of state benefit 
        requirements.--Nothing in this title shall be construed 
        to terminate, abridge, or limit the operation of any 
        requirement under State law with respect to any policy 
        or plan that is offered outside of an Exchange to offer 
        benefits.
          (3) Voluntary nature of an Exchange.--
                  (A) Choice to enroll or not to enroll.--
                Nothing in this title shall be construed to 
                restrict the choice of a qualified individual 
                to enroll or not to enroll in a qualified 
                health plan or to participate in an Exchange.
                  (B) Prohibition against compelled 
                enrollment.--Nothing in this title shall be 
                construed to compel an individual to enroll in 
                a qualified health plan or to participate in an 
                Exchange.
                  (C) Individuals allowed to enroll in any 
                plan.--A qualified individual may enroll in any 
                qualified health plan[, except that in the case 
                of a catastrophic plan described in section 
                1302(e), a qualified individual may enroll in 
                the plan only if the individual is eligible to 
                enroll in the plan under section 1302(e)(2)].
                  (D) Members of Congress in the Exchange.--
                          (i) Requirement.--Notwithstanding any 
                        other provision of law, after the 
                        effective date of this subtitle, the 
                        only health plans that the Federal 
                        Government may make available to 
                        Members of Congress and congressional 
                        staff with respect to their service as 
                        a Member of Congress or congressional 
                        staff shall be health plans that are--
                                  (I) created under this Act 
                                (or an amendment made by this 
                                Act); or
                                  (II) offered through an 
                                Exchange established under this 
                                Act (or an amendment made by 
                                this Act).
                          (ii) Definitions.--In this section:
                                  (I) Member of Congress.--The 
                                term ``Member of Congress'' 
                                means any member of the House 
                                of Representatives or the 
                                Senate.
                                  (II) Congressional staff.--
                                The term ``congressional 
                                staff'' means all full-time and 
                                part-time employees employed by 
                                the official office of a Member 
                                of Congress, whether in 
                                Washington, DC or outside of 
                                Washington, DC.
          (4) No penalty for transferring to minimum essential 
        coverage outside exchange.--An Exchange, or a qualified 
        health plan offered through an Exchange, shall not 
        impose any penalty or other fee on an individual who 
        cancels enrollment in a plan because the individual 
        becomes eligible for minimum essential coverage (as 
        defined in section 5000A(f) of the Internal Revenue 
        Code of 1986 without regard to paragraph (1)(C) or (D) 
        thereof) or such coverage becomes affordable (within 
        the meaning of section 36B(c)(2)(C) of such Code).
  (e) Enrollment Through Agents or Brokers.--The Secretary 
shall establish procedures under which a State may allow agents 
or brokers--
          (1) to enroll individuals and employers in any 
        qualified health plans in the individual or small group 
        market as soon as the plan is offered through an 
        Exchange in the State; and
          (2) to assist individuals in applying for premium tax 
        credits and cost-sharing reductions for plans sold 
        through an Exchange.
  (f) Qualified Individuals and Employers; Access Limited to 
Citizens and Lawful Residents.--
          (1) Qualified individuals.--In this title:
                  (A) In general.--The term ``qualified 
                individual'' means, with respect to an 
                Exchange, an individual who--
                          (i) is seeking to enroll in a 
                        qualified health plan in the individual 
                        market offered through the Exchange; 
                        and
                          (ii) resides in the State that 
                        established the Exchange.
                  (B) Incarcerated individuals excluded.--An 
                individual shall not be treated as a qualified 
                individual if, at the time of enrollment, the 
                individual is incarcerated, other than 
                incarceration pending the disposition of 
                charges.
          (2) Qualified employer.--In this title:
                  (A) In general.--The term ``qualified 
                employer'' means a small employer that elects 
                to make all full-time employees of such 
                employer eligible for 1 or more qualified 
                health plans offered in the small group market 
                through an Exchange that offers qualified 
                health plans.
                  (B) Extension to large groups.--
                          (i) In general.--Beginning in 2017, 
                        each State may allow issuers of health 
                        insurance coverage in the large group 
                        market in the State to offer qualified 
                        health plans in such market through an 
                        Exchange. Nothing in this subparagraph 
                        shall be construed as requiring the 
                        issuer to offer such plans through an 
                        Exchange.
                          (ii) Large employers eligible.--If a 
                        State under clause (i) allows issuers 
                        to offer qualified health plans in the 
                        large group market through an Exchange, 
                        the term ``qualified employer'' shall 
                        include a large employer that elects to 
                        make all full-time employees of such 
                        employer eligible for 1 or more 
                        qualified health plans offered in the 
                        large group market through the 
                        Exchange.
          (3) Access limited to lawful residents.--If an 
        individual is not, or is not reasonably expected to be 
        for the entire period for which enrollment is sought, a 
        citizen or national of the United States or an alien 
        lawfully present in the United States, the individual 
        shall not be treated as a qualified individual and may 
        not be covered under a qualified health plan in the 
        individual market that is offered through an Exchange.

           *       *       *       *       *       *       *


       Subtitle E--Affordable Coverage Choices for All Americans

PART I--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS

           *       *       *       *       *       *       *


Subpart B--Eligibility Determinations

           *       *       *       *       *       *       *


SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND 
                    COST-SHARING REDUCTIONS.

  (a) In General.--The Secretary, in consultation with the 
Secretary of the Treasury, shall establish a program under 
which--
          (1) upon request of an Exchange, advance 
        determinations are made under section 1411 with respect 
        to the income eligibility of individuals enrolling in a 
        qualified health plan in the individual market through 
        the Exchange for the premium tax credit allowable under 
        section 36B of the Internal Revenue Code of 1986 and 
        the cost-sharing reductions under section 1402;
          (2) the Secretary notifies--
                  (A) the Exchange and the Secretary of the 
                Treasury of the advance determinations; and
                  (B) the Secretary of the Treasury of the name 
                and employer identification number of each 
                employer with respect to whom 1 or more 
                employee of the employer were determined to be 
                eligible for the premium tax credit under 
                section 36B of the Internal Revenue Code of 
                1986 and the cost-sharing reductions under 
                section 1402 because--
                          (i) the employer did not provide 
                        minimum essential coverage; or
                          (ii) the employer provided such 
                        minimum essential coverage but it was 
                        determined under section 36B(c)(2)(C) 
                        of such Code to either be unaffordable 
                        to the employee or not provide the 
                        required minimum actuarial value; and
          (3) the Secretary of the Treasury makes advance 
        payments of such credit or reductions to the issuers of 
        the qualified health plans in order to reduce the 
        premiums payable by individuals eligible for such 
        credit.
  (b) Advance Determinations.--
          (1) In general.--The Secretary shall provide under 
        the program established under subsection (a) that 
        advance determination of eligibility with respect to 
        any individual shall be made--
                  (A) during the annual open enrollment period 
                applicable to the individual (or such other 
                enrollment period as may be specified by the 
                Secretary); and
                  (B) on the basis of the individual's 
                household income for the most recent taxable 
                year for which the Secretary, after 
                consultation with the Secretary of the 
                Treasury, determines information is available.
          (2) Changes in circumstances.--The Secretary shall 
        provide procedures for making advance determinations on 
        the basis of information other than that described in 
        paragraph (1)(B) in cases where information included 
        with an application form demonstrates substantial 
        changes in income, changes in family size or other 
        household circumstances, change in filing status, the 
        filing of an application for unemployment benefits, or 
        other significant changes affecting eligibility, 
        including--
                  (A) allowing an individual claiming a 
                decrease of 20 percent or more in income, or 
                filing an application for unemployment 
                benefits, to have eligibility for the credit 
                determined on the basis of household income for 
                a later period or on the basis of the 
                individual's estimate of such income for the 
                taxable year; and
                  (B) the determination of household income in 
                cases where the taxpayer was not required to 
                file a return of tax imposed by this chapter 
                for the second preceding taxable year.
  (c) Payment of Premium Tax Credits and Cost-Sharing 
Reductions.--
          (1) In general.--The Secretary shall notify the 
        Secretary of the Treasury and the Exchange through 
        which the individual is enrolling of the advance 
        determination under section 1411.
          (2) Premium tax credit.--
                  (A) In general.--The Secretary of the 
                Treasury shall make the advance payment under 
                this section of any premium tax credit allowed 
                under section 36B of the Internal Revenue Code 
                of 1986 to the issuer of a qualified health 
                plan on a monthly basis (or such other periodic 
                basis as the Secretary may provide).
                  (B) Issuer responsibilities.--An issuer of a 
                qualified health plan receiving an advance 
                payment with respect to an individual enrolled 
                in the plan shall--
                          (i) reduce the premium charged the 
                        insured for any period by the amount of 
                        the advance payment for the period;
                          (ii) notify the Exchange and the 
                        Secretary of such reduction;
                          (iii) include with each billing 
                        statement the amount by which the 
                        premium for the plan has been reduced 
                        by reason of the advance payment; and
                          (iv) in the case of any nonpayment of 
                        premiums by the insured--
                                  (I) notify the Secretary of 
                                such nonpayment; and
                                  (II) allow a 3-month grace 
                                period for nonpayment of 
                                premiums before discontinuing 
                                coverage.
          (3) Cost-sharing reductions.--The Secretary shall 
        also notify the Secretary of the Treasury and the 
        Exchange under paragraph (1) if an advance payment of 
        the cost-sharing reductions under section 1402 is to be 
        made to the issuer of any qualified health plan with 
        respect to any individual enrolled in the plan. The 
        Secretary of the Treasury shall make such advance 
        payment at such time and in such amount as the 
        Secretary specifies in the notice.
  (d) No Federal Payments for Individuals Not Lawfully 
Present.--Nothing in this subtitle or the amendments made by 
this subtitle allows Federal payments, credits, or cost-sharing 
reductions for individuals who are not lawfully present in the 
United States.
  (e) State Flexibility.--Nothing in this subtitle or the 
amendments made by this subtitle shall be construed to prohibit 
a State from making payments to or on behalf of an individual 
for coverage under a qualified health plan offered through an 
Exchange that are in addition to any credits or cost-sharing 
reductions allowable to the individual under this subtitle and 
such amendments.
  (f) Exclusion of Off-Exchange Coverage.--Advance payments 
under this section, and advance determinations under section 
1411, with respect to any credit allowed under section 36B 
shall not be made with respect to any health plan which is not 
enrolled in through an Exchange.

           *       *       *       *       *       *       *


                            DISSENTING VIEWS

     H.R. 6311 Increasing Access To Lower Premium Plans Act of 2018

    H.R. 6311 (Roskam, R-IL) allows anyone to purchase 
catastrophic coverage (currently catastrophic plans can only be 
purchased by those under 30 and people with hardship 
exemptions), puts all catastrophic plans into the overall risk 
pool, allows use of Advance Premium Tax Credits (APTCs) to be 
used for catastrophic plans in the exchange, and allows premium 
tax credits (but not APTCs) to be used to purchase plans off 
exchange. The bill explicitly prohibits tax credits for plans 
that offer comprehensive women's health care.
    H.R. 6311 continues Republican efforts to undermine and 
destabilize the health insurance market increases costs for 
consumers, and undermines women's health care, while at the 
same time growing our deficit.
    H.R. 6311 would likely reduce choice and competition in the 
Affordable Care Act (ACA) marketplaces. While the bill would 
allow people buying individual-market plans outside the ACA 
marketplaces to receive ACA tax credits, the credits are only 
be available when individuals file their tax returns the 
following year (not upfront to help them pay premiums); this 
disadvantages more moderate-income families that do not have 
extra disposable income to pay premium costs up front. It also 
would eliminate the requirement that insurers selling plans 
eligible for the ACA tax credit must offer at least one 
``silver'' and one ``gold'' plan through the marketplace--
reducing plan choice for patients. If this bill were enacted, 
an insurer could offer coverage only outside the marketplace 
(destabilizing the marketplace and undermining marketplace 
choice) while still giving consumers access to premium tax 
credits.
    H.R. 6311 would likely lead to increased premiums for 
individuals with preexisting conditions. Reducing the 
incentives for insurers to offer marketplace coverage could 
make it easier for insurers to engage in strategies to attract 
only healthier enrollees, such as offering only bronze or 
catastrophic plans, which have higher deductibles and other 
cost-sharing expenses for consumers than silver and gold plans. 
It also could reduce plan choices for consumers within the 
marketplaces if insurers shift to off-marketplace business. And 
it could prompt fewer consumers to comparison shop in the 
marketplaces--where they can compare premiums and benefits for 
multiple insurers--thus reducing competitive pressure on 
insurers to hold down premiums.
    Legislation busts the deficit to benefit the wealthy, 
again. The Joint Committee on Taxation (JCT) estimates the cost 
of this bill to be $10.9 billion over 10 years. Altogether the 
11 bills this Committee marked up would add another $92 billion 
in unoffset tax cuts to the deficit. With this bill, 
Republicans are adding more tax cuts and increasing the 
deficit. Republicans are using the deficit, which they keep 
making larger with cuts for the wealthy, to justify the deep 
cuts they plan to make to Medicare and Medicaid. Republicans 
already are proposing to cut Medicare and Medicaid by nearly a 
trillion dollars to try to pay for the tax cuts they've already 
enacted. This bill will only increase Republicans' calls for 
further cuts to these critical programs.
    Democrats offered three amendments to this bill in an 
attempt to better protect consumers. Representative Thompson 
(D-CA) offered an amendment to require that plans covered under 
the underlying bill be offered by an issuer that does not raise 
premiums in connection with a failure to make risk adjustment 
payments. This effort to ensure consumers' premiums are not 
increased due to Republican sabotage of health care was ruled 
non-germane. The appeal of the ruling of the chair was defeated 
21-15.
    Representative DelBene (D-WA) offered an amendment to 
strike language that prohibits premium tax credits from going 
toward any health plan that includes coverage for abortion 
services. Washington, Oregon, California, and New York all 
require health plans to include abortion services in every 
health plan, and H.R. 6311 would thereby takeaway premium tax 
credits for everyone in those four states.
    Coalition members of All* Above All, which includes the 
American Civil Liberties Union and the National Partnership for 
Women and Families, wrote in opposition to the bill noting, 
``We oppose HR 6311 which could drastically impact the quality 
and affordability of insurance coverage available to women. . . 
. HR 6311 is drafted to achieve anti-abortion politicians' goal 
of eliminating abortion coverage in the individual insurance 
marketplace. HR 6311 would deny women the tax credits that make 
plans affordable merely for choosing comprehensive insurance 
that includes abortion coverage. These provisions penalize 
individuals who seek plans that cover abortion and companies 
that want to provide comprehensive plans to their employees, 
and disincentivizes plans from covering abortion. Women should 
not be penalized for seeking comprehensive health coverage that 
meets their needs.'' The amendment was defeated on party lines 
15-22.
    Representative Sanchez (D-CA) offered an amendment to 
require that plans covered under the underlying bill be offered 
by an issuer that does not discriminate or raise premiums on 
the basis of gender. This commonsense amendment was also 
defeated on party lines, 16-23.
                                   Richard E. Neal,
                                           Ranking Member

                                  [all]