II 

117TH CONGRESS 

1ST SESSION S. 499 

To amend the Internal Revenue Code of 1986 to expand eligibility for the 

refundable credit for coverage under a qualified health plan, to improve 

cost-sharing subsidies under the Patient Protection and Affordable Care 

Act, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 1, 2021 

Mrs. SHAHEEN (for herself, Mr. CASEY, Mr. BENNET, Ms. HASSAN, Ms. 

BALDWIN, Mr. BLUMENTHAL, Mr. REED, Ms. CORTEZ MASTO, Ms. STABENOW, Ms. SMITH, Mr. TESTER, Mr. MURPHY, Mr. CARDIN, Ms. 

ROSEN, Ms. KLOBUCHAR, and Mr. KAINE) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend the Internal Revenue Code of 1986 to expand 

eligibility for the refundable credit for coverage under 

a qualified health plan, to improve cost-sharing subsidies 

under the Patient Protection and Affordable Care Act, 

and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Improving Health In5 surance Affordability Act of 2021’’. 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 499 IS

1 SEC. 2. INCREASE IN ELIGIBILITY FOR CREDIT. 

2 (a) IN GENERAL.—Subparagraph (A) of section 

3 36B(c)(1) of the Internal Revenue Code of 1986 is amend4 ed by striking ‘‘but does not exceed 400 percent’’. 

5 (b) APPLICABLE PERCENTAGES.— 

6 (1) IN GENERAL.—Subparagraph (A) of section 

7 36B(b)(3) of the Internal Revenue Code of 1986 as 

8 follows the table headings is amended to read as fol9 lows: 

10 ‘‘(A) APPLICABLE PERCENTAGE.—The ap11 plicable percentage for any taxable year shall be 

12 the percentage such that the applicable percent13 age for any taxpayer whose household income is 

14 within an income tier specified in the following 

15 table shall increase, on a sliding scale in a lin16 ear manner, from the initial premium percent17 age to the final premium percentage specified in 

18 such table for such income tier: 

‘‘In the case of household income 

(expressed as a percent of poverty line) 

within the following income tier: 

The initial 

premium 

percentage 

is— 

The final 

premium 

percentage 

is— 

Up to 150 percent .................................................. 0 0

150 percent up to 200 percent ............................... 0 2.0

200 percent up to 250 percent ............................... 2.0 4.0

250 percent up to 300 percent ............................... 4.0 6.0

300 percent up to 400 percent ............................... 6.0 8.5

400 percent and up ................................................ 8.5 8.5.’’. 

19 (2) CONFORMING AMENDMENTS RELATING TO

20 AFFORDABILITY OF COVERAGE.— 


kjohnson on DSK79L0C42PROD with BILLS
3 

•S 499 IS

1 (A) Subparagraph (C) of section 36B(c)(2) 

2 of such Code is amended by striking clause (iv). 

3 (B) Paragraph (4) of section 36B(c) of 

4 such Code is amended by striking subparagraph 

5 (F). 

6 (c) LIMITATION ON RECAPTURE.—Clause (i) of sec7 tion 36B(f)(2)(B) of the Internal Revenue Code of 1986 

8 is amended— 

9 (1) by striking ‘‘400 percent’’ and inserting 

10 ‘‘800 percent’’; 

11 (2) by striking the period at the end of the last 

12 row of the table; and 

13 (3) by adding at the end of the table the fol14 lowing new rows: 

‘‘At least 400 percent but less than 600 percent ........................... $3,500

At least 600 percent but less than 800 percent ........................... $4,500.’’. 

15 (d) PREMIUM COST STANDARD.— 

16 (1) IN GENERAL.—The following provisions of 

17 section 36B of the Internal Revenue Code of 1986 

18 are each amended by striking ‘‘silver’’ each place it 

19 appears and inserting ‘‘gold’’: 

20 (A) Paragraphs (2)(B)(i), (3)(B), and 

21 (3)(C) of subsection (b). 

22 (B) The heading of subparagraph (B) of 

23 subsection (b)(3). 


kjohnson on DSK79L0C42PROD with BILLS
4 

•S 499 IS

1 (C) Subsection (c)(4)(C)(i)(I). 

2 (2) CONFORMING AMENDMENTS TO REDUCED

3 COST-SHARING.—Section 1402(b)(1) of the Patient 

4 Protection and Affordable Care Act (42 U.S.C. 

5 18071(b)(1)) is amended by striking ‘‘silver’’ and in6 serting ‘‘gold’’. 

7 (e) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply to taxable years beginning after 

9 December 31, 2021. 

10 SEC. 3. ENHANCEMENTS FOR REDUCED COST-SHARING. 

11 (a) MODIFICATION OF AMOUNT.— 

12 (1) IN GENERAL.—Section 1402(c)(2) of the 

13 Patient Protection and Affordable Care Act (42 

14 U.S.C. 18071(c)(2)) is amended— 

15 (A) by striking ‘‘150 percent’’ in subpara16 graph (A) and inserting ‘‘200 percent’’, 

17 (B) by striking ‘‘94 percent’’ in subpara18 graph (A) and inserting ‘‘95 percent’’, 

19 (C) by striking ‘‘150 percent but not more 

20 than 200 percent’’ in subparagraph (B) and in21 serting ‘‘200 percent but not more than 300 

22 percent’’, 

23 (D) by striking ‘‘87 percent’’ in subpara24 graph (B) and inserting ‘‘90 percent’’, 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 499 IS

1 (E) by striking ‘‘200 percent’’ in subpara2 graph (C) and inserting ‘‘300 percent’’, 

3 (F) by striking ‘‘250 percent’’ in subpara4 graph (C) and inserting ‘‘400 percent’’, and 

5 (G) by striking ‘‘73 percent’’ in subpara6 graph (C) and inserting ‘‘85 percent’’. 

7 (2) CONFORMING AMENDMENT.—Clause (i) of 

8 section 1402(c)(1)(B) of such Act (42 U.S.C. 

9 18071(c)(1)(B)) is amended to read as follows: 

10 ‘‘(i) IN GENERAL.—The Secretary 

11 shall ensure the reduction under this para12 graph shall not result in an increase in the 

13 plan’s share of the total allowed costs of 

14 benefits provided under the plan above— 

15 ‘‘(I) 95 percent in the case of an 

16 eligible insured described in para17 graph (2)(A); 

18 ‘‘(II) 90 percent in the case of an 

19 eligible insured described in para20 graph (2)(B); and 

21 ‘‘(III) 85 percent in the case of 

22 an eligible insured described in para23 graph (2)(C).’’. 


kjohnson on DSK79L0C42PROD with BILLS
6 

•S 499 IS

1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply to plan years begin3 ning after December 31, 2021. 

4 (b) FUNDING.—Section 1402 of the Patient Protec5 tion and Affordable Care Act (42 U.S.C. 18071) is amend6 ed by adding at the end the following new subsection: 

7 ‘‘(g) FUNDING.—Out of any funds in the Treasury 

8 not otherwise appropriated, there are appropriated to the 

9 Secretary such sums as may be necessary for payments 

10 under this section.’’. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS