```

[House Report 115-109]
[From the U.S. Government Publishing Office]

115th Congress   }                                     {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                     {       115-109

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

 
PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 2192) TO AMEND THE PUBLIC 
 HEALTH SERVICE ACT TO ELIMINATE THE NON-APPLICATION OF CERTAIN STATE 
 WAIVER PROVISIONS TO MEMBERS OF CONGRESS AND CONGRESSIONAL STAFF, AND 
PROVIDING FOR FURTHER CONSIDERATION OF THE BILL (H.R. 1628) TO PROVIDE 
FOR RECONCILIATION PURSUANT TO TITLE II OF THE CONCURRENT RESOLUTION ON 
                    THE BUDGET FOR FISCAL YEAR 2017

                                _______
                                

 May 3, 2017.--Referred to the House Calendar and ordered to be printed

                                _______
                                

         Mr. Collins of Georgia, from the Committee on Rules, 
                        submitted the following

                              R E P O R T

                       [To accompany H. Res. 308]

    The Committee on Rules, having had under consideration 
House Resolution 308, by record vote of 8 to 3, report the same 
to the House with the recommendation that the resolution be 
adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 2192, to 
amend the Public Health Service Act to eliminate the non-
application of certain State waiver provisions to Members of 
Congress and congressional staff, under a closed rule. The 
resolution provides one hour of debate equally divided and 
controlled by the chair and ranking minority member of the 
Committee on Energy and Commerce. The resolution waives all 
points of order against consideration of the bill. The 
resolution provides that the bill shall be considered as read. 
The resolution waives all points of order against provisions in 
the bill. The resolution provides one motion to recommit.
    Section 2 of the resolution provides for further 
consideration of H.R. 1628, the American Health Care Act of 
2017. The resolution provides that the further amendments 
printed in this report shall be considered as adopted.

                         EXPLANATION OF WAIVERS

    Although the resolution waives all points of order against 
consideration of H.R. 2192, the Committee is not aware of any 
points of order. The waiver is prophylactic in nature.
    Although the resolution waives all points of order against 
provisions in H.R. 2192, the Committee is not aware of any 
points of order. The waiver is prophylactic in nature.

                            COMMITTEE VOTES

    The results of each record vote on an amendment or motion 
to report, together with the names of those voting for and 
against, are printed below:

Rules Committee record vote No. 54

    Motion by Mr. Hastings to make in order and provide the 
appropriate waivers for every amendment submitted to H.R. 1628 
to the Rules Committee and provide 10 minutes of debate on each 
amendment. Defeated: 3-8

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole........................................          Nay   Ms. Slaughter.....................  ............
Mr. Woodall.....................................          Nay   Mr. McGovern......................          Yea
Mr. Burgess.....................................          Nay   Mr. Hastings of Florida...........          Yea
Mr. Collins.....................................          Nay   Mr. Polis.........................          Yea
Mr. Byrne.......................................          Nay
Mr. Newhouse....................................  ............
Mr. Buck........................................          Nay
Ms. Cheney......................................          Nay
Mr. Sessions, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 55

    Motion by Mr. Cole to report the rule. Adopted: 8-3

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole........................................          Yea   Ms. Slaughter.....................  ............
Mr. Woodall.....................................          Yea   Mr. McGovern......................          Nay
Mr. Burgess.....................................          Yea   Mr. Hastings of Florida...........          Nay
Mr. Collins.....................................          Yea   Mr. Polis.........................          Nay
Mr. Byrne.......................................          Yea
Mr. Newhouse....................................  ............
Mr. Buck........................................          Yea
Ms. Cheney......................................          Yea
Mr. Sessions, Chairman..........................          Yea
----------------------------------------------------------------------------------------------------------------

  SUMMARY OF THE FURTHER AMENDMENTS TO H.R. 1628 CONSIDERED AS ADOPTED

    1. Palmer (AL), Schweikert (AZ): Creates a $15 billion risk 
sharing program to help states lower premiums for health 
coverage offered in the individual market.
    2. MacArthur (NJ): Allows states to waive essential health 
benefits, age rating, and community rating. Health insurers 
would not be allowed to deny coverage, discriminate based on 
gender or limit access based on preexisting conditions. States 
must explain how the waiver will reduce average premiums for 
patients, increase enrollment for residents, stabilize the 
state's health insurance market, stabilize premiums for 
individuals living with preexisting conditions, or increase 
patients' health care plan options.
    3. Upton (MI), Long (MO), Young, David (IA), Valadao (CA), 
Knight (CA), Denham (CA), McMorris Rodgers (WA), McSally (AZ): 
Increases the Patient and State Stability Fund by $8 billion 
from 2018 to 2023 to States with an approved community rating 
waiver, as established by the MacArthur Amendment, for 
providing assistance to reduce premiums or other out-of-pocket 
costs to individuals who may be subject to an increase in their 
monthly premium rates as a result of the States waiver. The 
amendment also resolves two minor technical drafting 
amendments, including the correction of an inaccurate cross-
reference and to ensure proper labeling of subsections.

     TEXT OF FURTHER AMENDMENTS TO H.R. 1628 CONSIDERED AS ADOPTED

  In the section 2204(c)(2)(B) proposed to be added to the 
Social Security Act by section 132, strike ``to carry out the 
purpose described in section 2202(2) in such States by 
providing payments to appropriate entities described in such 
section with respect to claims that exceed $1,000,000'' and 
insert ``to carry out the Federal Invisible Risk Sharing 
Program in such States under section 2205''.
  In title XXII of the Social Security Act, as added by section 
132, add at the end the following:

``SEC. 2205. FEDERAL INVISIBLE RISK SHARING PROGRAM.

  ``(a) In General.--There is established within the Patient 
and State Stability Fund a Federal Invisible Risk Sharing 
Program (in this section referred to as the `Program'), to be 
administered by the Secretary of Health and Human Services, 
acting through the Administrator of the Centers for Medicare & 
Medicaid Services (in this section referred to as the 
`Administrator'), to provide payments to health insurance 
issuers with respect to claims for eligible individuals for the 
purpose of lowering premiums for health insurance coverage 
offered in the individual market.
  ``(b) Funding.--
          ``(1) Appropriation.--For the purpose of providing 
        funding for the Program there is appropriated, out of 
        any money in the Treasury not otherwise appropriated, 
        $15,000,000,000 for the period beginning on January 1, 
        2018, and ending on December 31, 2026.
          ``(2) Use of unallocated funds.--Funds provided under 
        section 2204(c)(2)(B) to carry out this section are in 
        addition to the amount appropriated under paragraph 
        (1).
  ``(c) Operation of Program.--
          ``(1) In general.--The Administrator shall establish, 
        after consultation with health care consumers, health 
        insurance issuers, State insurance commissioners, and 
        other stakeholders and after taking into consideration 
        high cost health conditions and other health trends 
        that generate high cost, parameters for the operation 
        of the Program consistent with this section and 
        consistent with the same limitation on payment with 
        respect to health insurance coverage that applies to 
        payment with respect health benefits coverage under 
        section 2105(c)(7).
          ``(2) Deadline for initial operation.--Not later than 
        60 days after the date of the enactment of this title, 
        the Administrator shall establish sufficient parameters 
        to specify how the Program will operate for plan year 
        2018.
          ``(3) State operation of program.--The Administrator 
        shall establish a process for a State to operate the 
        Program in such State beginning with plan year 2020.
  ``(d) Details of Program.--The parameters for the Program 
shall include the following:
          ``(1) Eligible individuals.--A definition for 
        eligible individuals.
          ``(2) Health status statements.--The development and 
        use of health status statements with respect to such 
        individuals.
          ``(3) Standards for qualification.--
                  ``(A) Automatic qualification.--The 
                identification of health conditions that 
                automatically qualify individuals as eligible 
                individuals at the time of application for 
                health insurance coverage.
                  ``(B) Voluntary qualification.--A process 
                under which health insurance issuers may 
                voluntarily qualify individuals, who do not 
                automatically qualify under subparagraph (A), 
                as eligible individuals at the time of 
                application for such coverage.
          ``(4) Percentage of insurance premiums to be 
        applied.--The percentage of the premiums paid, to 
        health insurance issuers for health insurance coverage 
        by eligible individuals, that shall be collected and 
        deposited to the credit (and available for the use) of 
        the Program.
          ``(5) Attachment dollar amount and payment 
        proportion.--The dollar amount of claims for eligible 
        individuals after which the Program will provide 
        payments to health insurance issuers and the proportion 
        of such claims above such dollar amount that the 
        Program will pay.''.
                              ----------                              

  Strike section 136 and insert the following:

SEC. 136. PERMITTING STATES TO WAIVE CERTAIN ACA REQUIREMENTS TO 
                    ENCOURAGE FAIR HEALTH INSURANCE PREMIUMS.

  (a) In General.--Section 2701 of the Public Health Service 
Act (42 U.S.C. 300gg) is amended by adding at the end the 
following new subsection:
  ``(b) Permissible State Waiver to Encourage Fair Health 
Insurance Premiums.--
          ``(1) In general.--A State may submit an application 
        to the Secretary for one or more of the following 
        purposes:
                  ``(A) In the case of plan years beginning on 
                or after January 1, 2018, to apply, subject to 
                paragraph (5), under subsection (a)(1)(A)(iii), 
                instead of the ratio specified in such 
                subsection, a higher ratio specified by the 
                State (consistent with section 2707(c)).
                  ``(B) In the case of plan years beginning on 
                or after January 1, 2020, for health insurance 
                coverage offered in the individual or small 
                group market in such State, to apply, subject 
                to paragraph (5), instead of the essential 
                health benefits specified under subsection (b) 
                of section 1302 of the Patient Protection and 
                Affordable Care Act, essential health benefits 
                as specified by the State.
                  ``(C) In the case of a State that has in 
                place a program that carries out the purpose 
                described in paragraph (1) or (2) of section 
                2202(a) of the Social Security Act or 
                participates in the program established under 
                section 2205 of such Act, for health insurance 
                offered in the individual market in such State, 
                with respect to an individual who is an 
                applicable policyholder of such coverage with 
                respect to an enforcement period (as defined in 
                section 2710A(b)) applicable to enrollments for 
                a plan year beginning with plan year 2019 (or, 
                in the case of enrollments during a special 
                enrollment period, beginning with plan year 
                2018), to--
                          ``(i) subject to paragraph (5), not 
                        apply any increase to the monthly 
                        premium rate that would otherwise apply 
                        under section 2710A to such individual 
                        for such coverage; and
                          ``(ii) instead, subject to paragraph 
                        (5)--
                                  ``(I) apply subsection (a)(1) 
                                as if health status were 
                                included as a factor described 
                                in subparagraph (A) of such 
                                subsection; and
                                  ``(II) not apply section 
                                2705(b).
          ``(2) Default approval.--An application submitted 
        under paragraph (1) is approved unless the Secretary 
        notifies the State submitting the application, not 
        later than 60 days after the date of the submission of 
        such application, that the application has been denied 
        for not being in compliance with any requirement of 
        paragraph (3) and of the reason for such denial.
          ``(3) Requirements.--The requirements of this 
        paragraph, with respect to an application submitted 
        under paragraph (1), are the following:
                  ``(A) The application is submitted at such 
                time, and in such manner, as the Secretary may 
                require.
                  ``(B) The application specifies how the 
                approval of such application will provide for 
                one or more of the following:
                          ``(i) Reducing average premiums for 
                        health insurance coverage in the State.
                          ``(ii) Increasing enrollment in 
                        health insurance coverage in the State.
                          ``(iii) Stabilizing the market for 
                        health insurance coverage in the State.
                          ``(iv) Stabilizing premiums for 
                        individuals with pre-existing 
                        conditions.
                          ``(v) Increasing the choice of health 
                        plans in the State.
                  ``(C) The application specifies the period 
                for which the waiver is to be effective, 
                consistent with paragraph (4).
                  ``(D) In the case of an application for 
                purposes of paragraph (1)(A), the application 
                specifies the higher ratio to be applied 
                pursuant to such paragraph.
                  ``(E) In the case of an application for 
                purposes of paragraph (1)(B), the application 
                specifies the essential health benefits to be 
                applied pursuant to such paragraph.
                  ``(F) In the case of an application for 
                purposes of paragraph (1)(C), the application 
                demonstrates that the State has in place a 
                program that carries out the purpose described 
                in paragraph (1) or (2) of section 2202(a) of 
                the Social Security Act or participates in the 
                program established under section 2205 of such 
                Act.
          ``(4) Term of waiver.--
                  ``(A) In general.--No waiver for a State 
                under this subsection may extend over a period 
                of longer than 10 years unless the State 
                requests continuation of such waiver, and such 
                request shall be deemed granted unless the 
                Secretary, within 90 days after the date of its 
                submission to the Secretary, either denies such 
                request in writing or informs the State in 
                writing with respect to any additional 
                information which is needed in order to make a 
                final determination with respect to the 
                request.
                  ``(B) Special rule.--A waiver applied for by 
                a State under paragraph (1)(C) may only be 
                effective for a period during which the State--
                          ``(i) has in place a program that 
                        carries out the purpose described in 
                        paragraph (1) or (2) of section 2202(a) 
                        of the Social Security Act; or
                          ``(ii) participates in the program 
                        established under section 2205 of such 
                        Act.
          ``(5) Non-application rules.--
                  ``(A) Specified non-application provisions.--
                In no case may a waiver for purposes of 
                paragraph (1) apply with respect to any of the 
                following provisions:
                          ``(i) Section 1301 of the Patient 
                        Protection and Affordable Care Act, to 
                        the extent that such section applies to 
                        qualified health plans offered through 
                        the CO-OP program under section 1322 of 
                        such Act or multi-State plans under 
                        section 1334 of such Act.
                          ``(ii) Sections 1312(d)(3)(D), 1331, 
                        1332, 1333, and 1334 of such Act.
                  ``(B) Hold harmless.--Any standard or 
                requirement adopted by a State pursuant to the 
                terms of a waiver approved under this 
                subsection shall be deemed to comply with 
                section 1252 of the Patient Protection and 
                Affordable Care Act and subsection (a) of 
                section 1324 of such Act, insofar as such 
                standard or requirement relates to a Federal or 
                State law described in subsection (b)(2) of 
                such section (relating to rating).''.
  (b) Application to Essential Health Benefits.--Section 
1302(a)(1) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18022(a)(1)) is amended by inserting ``(or, in the 
case of health insurance coverage offered in the individual or 
small group market in a State for which there is an applicable 
waiver in effect under section 2701(b) of the Public Health 
Service Act for a plan year, the essential health benefits 
applicable under such waiver)'' after ``subsection (b)''.

SEC. 137. CONSTRUCTIONS.

  (a) No Gender Rating.--Nothing in this Act shall be construed 
as permitting health insurance issuers to discriminate in rates 
for health insurance coverage by gender.
  (b) No Limiting Access to Coverage for Individuals With 
Preexisting Conditions.--Nothing in this Act shall be construed 
as permitting health insurance issuers to limit access to 
health coverage for individuals with preexisting conditions.
  In the section 2710A(a)(1) proposed to be added to the Public 
Health Service Act by section 133, strike ``Notwithstanding 
section 2701, subject'' and insert ``Subject''.
                              ----------                              

  In the amendment proposed to be inserted into section 
2701(a)(1)(A)(iii) of the Public Health Service Act by section 
135, insert after ``or such other ratio for adults (consistent 
with section 2707(c)) as the State involved may provide'' the 
following: ``(or, in the case of a State with a waiver under 
subsection (b) in effect for such a plan year, the ratio 
applied for such plan year in accordance with such waiver)''.
                              ----------                              

  In the section 2202(a) proposed to be added to the Social 
Security Act by section 132, strike ``Subject to subsection 
(b)'' and insert ``Subject to subsections (b) and (c)''.
  Add at the end of the section 2202 proposed to be added to 
the Social Security Act by section 132, the following:
  ``(c) Required Use of Additional Increase to Certain Waiver 
States to Provide Financial Hardship Assistance.--A State shall 
use the additional allocation provided to the State from the 
funds appropriated under the last sentence of section 2204(a) 
only in accordance with such last sentence.
  Insert at the end of the section 2204(a) proposed to be added 
to the Social Security Act by section 132, the following:
``The amount otherwise appropriated under this subsection shall 
be increased by $8,000,000,000 for the period beginning with 
2018 and ending with 2023, to be allocated to States with a 
waiver in effect under section 2701(b) of the Public Health 
Service Act with respect to the purpose described in paragraph 
(1)(C) of such section, in accordance with an allocation 
methodology specified by the Secretary that takes into account 
the relative allocation of other amounts appropriated under 
this subsection among such States, and to be used by (and made 
available under subsection (d), for any year during such period 
that such waiver is in effect, to) such States for the purpose 
of providing assistance to reduce premiums or other out-of-
pocket costs of individuals who are subject to an increase in 
the monthly premium rate for health insurance coverage as a 
result of such waiver.
  In the section 2202(b) proposed to be added to the Social 
Security Act by section 132, strike ``section 2204(b)'' and 
insert ``section 2204(a)''.
  In section 214(b), strike ``Section 1412 of the Patient 
Protection and Affordable Care Act is amended by adding at the 
end the following new subsection:'' and insert ``Section 
1412(f) of the Patient Protection and Affordable Care Act, as 
added by section 202, is amended to read as follows:''

                                  [all]
```