69–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–159 

VETERAN ACT 

JUNE 2, 2017.—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 

together with 

DISSENTING VIEWS 

[To accompany H.R. 2372] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Ways and Means, to whom was referred the 

bill (H.R. 2372) to amend the Internal Revenue Code of 1986 to 

clarify the rules relating to veteran health insurance and eligibility 

for the premium tax credit, 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 ............................................................... 2 

A. Purpose and Summary ..................................................................... 2 

B. Background and Need for Legislation ............................................. 2 

C. Legislative History ............................................................................ 3 

II. EXPLANATION OF THE BILL ................................................................... 3 

A. Clarification Relating to Veteran Health Insurance and Eligibility for Premium Tax Credit ....................................................... 3 

III. VOTES OF THE COMMITTEE .................................................................... 5 

IV. BUDGET EFFECTS OF THE BILL ............................................................ 10 

A. Committee Estimate of Budgetary Effects ...................................... 10 

B. Statement Regarding New Budget Authority and Tax Expenditures Budget Authority .................................................................. 10 

C. Cost Estimate Prepared by the Congressional Budget Office ....... 10 

V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF 

THE HOUSE .............................................................................................. 11 

A. Committee Oversight Findings and Recommendations ................. 11 

B. Statement of General Performance Goals and Objectives ............. 11 

2 

1 All section references herein are to the Internal Revenue Code of 1986, as amended, unless 

otherwise stated. 

C. Information Relating to Unfunded Mandates ................................ 12 

D. Applicability of House Rule XXI 5(b) .............................................. 12 

E. Tax Complexity Analysis .................................................................. 12 

F. Congressional Earmarks, Limited Tax Benefits, and Limited 

Tariff Benefits ................................................................................. 12 

G. Duplication of Federal Programs ..................................................... 12 

H. Disclosure of Directed Rule Makings .............................................. 13 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED 13 

VII. DISSENTING VIEWS ................................................................................... 27 

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 ‘‘Veterans Equal Treatment Ensures Relief and Access Now Act’’ or the ‘‘VETERAN Act’’. 

SEC. 2. CLARIFICATION RELATING TO VETERAN HEALTH INSURANCE AND ELIGIBILITY FOR 

PREMIUM TAX CREDIT. 

(a) AMENDMENT OF PRE-2020 CREDIT.— 

(1) IN GENERAL.—Section 36B(c)(2)(B)(i) of the Internal Revenue Code of 1986, 

prior to any amendment by section 214 of the American Health Care Act of 

2017, is amended by adding at the end the following: ‘‘For purposes of the preceding sentence, an individual shall not be treated as eligible for coverage described in section 5000A(f)(1)(A)(v) unless such individual is enrolled in such 

coverage.’’. 

(2) EFFECTIVE DATE.—The amendment made by this subsection shall apply to 

taxable years ending after December 31, 2013. 

(b) AMENDMENT OF POST-2019 CREDIT.— 

(1) IN GENERAL.—Section 36B(d) of such Code, as amended by section 214 of 

the American Health Care Act of 2017 and in effect for months beginning after 

December 31, 2019, is amended by adding at the end the following: 

‘‘For purposes of paragraph (2)(B), an individual shall not be treated as eligible for 

coverage described in section 5000A(f)(1)(A)(v) unless such individual is enrolled in 

such coverage.’’. 

(2) EFFECTIVE DATE.—The amendment made by this subsection is contingent 

upon the enactment of the American Health Care Act of 2017 and shall apply 

(if at all) to months beginning after December 31, 2019, in taxable years ending 

after such date. 

I. SUMMARY AND BACKGROUND 

A. PURPOSE AND SUMMARY

The bill, H.R. 2372, as reported by the Committee on Ways and 

Means, codifies a Treasury regulation, under which, for purposes of 

eligibility for the premium tax credit under section 36B of the Internal Revenue Code (‘‘Code’’),1 an individual is not considered eligible for certain health care programs of the United States Department of Veterans Affairs (‘‘VA health program’’) unless enrolled in 

the program. In addition, H.R. 2372, as reported by the Committee 

on Ways and Means, amends H.R. 1628, the American Health Care 

Act of 2017, as passed by the House of Representatives on May 4, 

2017, to provide a similar rule with respect to a new credit for the 

purchase of health insurance (effective for months beginning after 

December 31, 2019, in taxable years ending after that date). 

B. BACKGROUND AND NEED FOR LEGISLATION

Under present law and under the American Health Care Act of 

2017, an individual generally may not receive the premium assistance credit if the individual is eligible for certain types of health 

3 

coverage from a source other than the individual insurance market, 

including coverage under certain VA health programs. However, 

under Treasury regulations, an individual is not considered eligible 

for coverage under certain VA health programs (and, therefore, not 

precluded from receiving the premium assistance credit) unless enrolled in the program. The bill amends the Code and the American 

Health Care Act of 2017 to include the rule from the regulations, 

thus assuring its continued application. 

On March 8, 2017, in fulfillment of the reconciliation instructions 

included in section 2002 of the Concurrent Resolution on the Budget for Fiscal Year 2017 (S. Con. Res. 3), the Committee marked up 

Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of Health-Related Tax Policy. This submission included a special rule codifying the Treasury regulations. However, 

that language was later removed at the Committee on Rules in 

order to comply with Senate guidance regarding the Reconciliation 

process. 

C. LEGISLATIVE HISTORY

Background 

H.R. 2372 was introduced on May 4, 2017, and was referred to 

the Committee on Ways and Means. 

Committee action 

The Committee on Ways and Means marked up H.R. 2372, the 

Veterans Equal Treatment Ensures Relief and Access Now Act (the 

VETERAN Act), on May 24, 2017, and ordered the bill, as amended, favorably reported (with a quorum being present). 

Committee hearings 

Since the 112th Congress, the Committee on Ways and Means 

and its subcommittees have held a number of hearings on health 

reform that explored various parts of the health system and informed policy contained in the American Health Care Act. These 

hearings include: 

• March 5, 2013—Hearing on Tax-Related Provisions in the 

President’s Health Care Law 

• December 4, 2013—Hearing on the Challenges of the Affordable Care Act 

• March 14, 2016—Hearing on the Tax Treatment of Health 

Care 

• May 17, 2016—Member Day Hearing on Tax-Related Proposals to Improve Health Care 

II. EXPLANATION OF THE BILL 

A. CLARIFICATION RELATING TO VETERAN HEALTH INSURANCE AND

ELIGIBILITY FOR PREMIUM TAX CREDIT

PRESENT LAW

A refundable tax credit (‘‘premium assistance credit’’) is provided 

for eligible individuals and families to subsidize the purchase of 

health insurance plans through an American Health Benefit ExVerDate Sep 11 2014 05:11 Jun 06, 2017 Jkt 069006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR159.XXX HR159
4 

2Sec. 36B, effective for taxable years ending after December 31, 2013. Under the Affordable 

Care Act, an American Health Benefit Exchange is a source through which individuals can purchase health insurance coverage. As used herein, the Affordable Care Act (or ‘‘ACA’’) refers to 

the combination of the Patient Protection and Affordable Care Act (‘‘PPACA’’), Pub. L. No. 111– 

148, and the Healthcare and Education Reconciliation Act of 2010 (‘‘HCERA’’), Pub. L. No. 111– 

152. Qualified health plan is defined in PPACA section 1301. 3PPACA sections 411–1412 provide rules relating to eligibility for and receipt of advance payments. 4 Federal poverty level refers to the most recently published poverty guidelines determined 

by the Secretary of Health and Human Services. Levels for 2017 and previous years are available at https://aspe.hhs.gov/prior-hhs-poverty-guidelines-and-federal-register-references. 5Sec. 911. 

6 Under section 86, only a portion of an individual’s social security benefits are included in 

gross income. 7Minimum essential coverage is defined in section 5000A(f). 

8 Under section 5000A(f)(1)(A)(v), certain health care programs available to veterans and family members may constitute minimum essential coverage, as determined by the Secretary of Veterans Affairs, in coordination with the Secretary of the Treasury and the Secretary of Health 

and Human Services. Regulations designate certain comprehensive health care programs administered by the Department of Veterans Affairs as minimum essential coverage. Treas. Reg. 

sec.1.5000A–2(b)(v). 9Treas. Reg. sec. 1.36B–2(c)(2)(iii). 

change (‘‘Exchange’’), referred to as ‘‘qualified health plans.’’ 2 In 

general, advance payments with respect to the premium assistance 

credit are made during the year directly to the insurer.3 However, 

eligible individuals may choose to pay their total health insurance 

premiums without advance payments and claim the credit at the 

end of the taxable year. 

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.4 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,5 (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.6

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. 

An individual who is eligible for certain types of health coverage 

(‘‘minimum essential coverage’’) from a source other than the individual insurance market generally may not receive the premium 

assistance credit.7 Coverage under certain government-sponsored 

health programs constitutes minimum essential coverage, including 

coverage under certain comprehensive health care programs administered by the United States Department of Veterans Affairs 

(‘‘designated Veterans Affairs health programs’’).8 Although mere 

eligibility for minimum essential coverage from a source other than 

the individual insurance market generally precludes an individual 

from receiving the premium assistance credit, Treasury regulations 

provide that, in the case of one of the designated Veterans Affairs 

health programs, an individual is not considered eligible for coverage under such a program (and precluded from receiving the premium assistance credit) unless enrolled in the program.9 Thus, an 

individual who may be eligible for a designated Veterans Affairs 

5 

10 H.R. 1628, as passed by the House of Representatives on May 4, 2017. 11 AHCA section 214. AHCA sections 201 and 202 amend the present-law premium assistance 

credit for periods before the new credit becomes effective. 

health program, but is not actually enrolled in the program, may 

receive the premium assistance credit. 

THE AMERICAN HEALTH CARE ACT OF 2017

The American Health Care Act of 2017, as passed by the House 

of Representatives on May 4, 2017 (the ‘‘AHCA’’), amends various 

health-related provisions of the Code.10 Effective for months beginning after December 31, 2019, in taxable years ending after that 

date, the AHCA replaces the present-law premium assistance credit with a new credit and provides a new definition of ‘‘qualified 

health plan’’ to which the new credit applies.11 Similar to the 

present-law credit, under the AHCA, an individual eligible for 

health coverage from other sources, including coverage under a designated Veterans Affairs health program, generally may not receive 

the new premium assistance credit. 

REASONS FOR CHANGE

The Committee agrees with the interpretation contained in the 

Treasury regulations with respect to eligibility for designated Veterans Affairs health programs. The Committee wishes to codify this 

interpretation, thus ensuring its continued application under 

present law and under the AHCA. 

EXPLANATION OF PROVISION

The provision amends the statutory provisions relating to eligibility for the present-law premium assistance credit to codify the 

rule under which an individual is not considered eligible for coverage under a designated Veterans Affairs health program unless 

enrolled in the program. In addition, the provision amends the provision of the AHCA relating to eligibility for the new premium assistance credit to specify that an individual is not considered eligible for coverage under a designated Veterans Affairs health program unless enrolled in the program. 

EFFECTIVE DATE

The provision relating to the present-law premium assistance 

credit is effective for taxable years ending after December 31, 2013. 

The provision relating to the new premium assistance credit under 

the AHCA is contingent on enactment of the AHCA and will apply 

(if at all) to months beginning after December 31, 2019, in taxable 

years ending after that date. 

III. VOTES OF THE COMMITTEE 

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, the following statement is made concerning the vote of the Committee on Ways and Means in its consideration of H.R. 2372, the ‘‘Veterans Equal Treatment Ensures 

Relief and Access Now Act’’ (the ‘‘VETERAN Act’’), on May 24, 

2017. 

6 

Mr. Tiberi’s motion to table Mr. Doggett’s appeal of the ruling of 

the Chair was agreed to by a roll call vote of 23 yeas and 15 nays 

(with a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. 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 ............................... ........... ........... .............

Ms. Jenkins ........................... X ........... ............. Mr. Pascrell .......................... ........... X .............

Mr. Paulsen ........................... X ........... ............. Mr. Crowley .......................... ........... X .............

Mr. Marchant ........................ X ........... ............. Mr. Davis .............................. ........... X .............

Ms. Black .............................. X ........... ............. Ms. Sanchez ......................... ........... X .............

Mr. Reed ............................... X ........... ............. Mr. Higgins .......................... ........... X .............

Mr. Kelly ................................ X ........... ............. Ms. Sewell ............................ ........... X .............

Mr. Renacci ........................... X ........... ............. Ms. DelBene ......................... ........... X .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ X ........... .............

Mr. Tiberi’s motion to table Mr. Thompson’s appeal of the ruling 

of the Chair was agreed to by a roll call vote of 23 yeas and 15 

nays (with a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. 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 .............................. X ........... ............. Ms. Sanchez ......................... ........... X .............

Mr. Reed ............................... X ........... ............. Mr. Higgins .......................... ........... X .............

Mr. Kelly ................................ X ........... ............. Ms. Sewell ............................ ........... X .............

Mr. Renacci ........................... X ........... ............. Ms. DelBene ......................... ........... ........... .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ X ........... .............

The vote on the amendment by Mr. Davis to the amendment in 

the nature of a substitute to H.R. 2372, which would adjust the tax 

credit for certain veteran taxpayers, was not agreed to by a roll call 

vote of 23 nays to 16 yeas (with a quorum being present). The vote 

was as follows: 

7 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. ........... X ............. Mr. Neal ............................... X ........... .............

Mr. Johnson ........................... ........... ........... ............. 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 .............................. ........... X ............. Ms. Sanchez ......................... X ........... .............

Mr. Reed ............................... ........... X ............. Mr. Higgins .......................... X ........... .............

Mr. Kelly ................................ ........... X ............. Ms. Sewell ............................ X ........... .............

Mr. Renacci ........................... ........... X ............. Ms. DelBene ......................... X ........... .............

Mr. Meehan ........................... ........... X ............. Ms. Chu ................................ X ........... .............

Ms. Noem .............................. ........... X .............

Mr. Holding ........................... ........... X .............

Mr. Smith (MO) ..................... ........... X .............

Mr. Rice ................................ ........... X .............

Mr. Schweikert ...................... ........... X .............

Ms. Walorski ......................... ........... X .............

Mr. Curbelo ........................... ........... X .............

Mr. Bishop ............................ ........... X .............

Mr. Nunes’s motion to table Ms. DelBene’s appeal of the ruling 

of the Chair was agreed to by a roll call vote of 22 yeas and 16 

nays (with a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. 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 .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ X ........... .............

Mr. Nunes’s motion to table Ms. Sanchez’s appeal of the ruling 

of the Chair was agreed to by a roll call vote of 22 yeas and 15 

nays (with a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. Mr. Levin .............................. ........... X .............

Mr. Nunes ............................. X ........... ............. Mr. Lewis .............................. ........... X .............

Mr. Tiberi .............................. X ........... ............. Mr. Doggett .......................... ........... X .............

8 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Reichert .......................... X ........... ............. Mr. Thompson ...................... ........... X .............

Mr. Roskam ........................... X ........... ............. Mr. Larson ............................ ........... X .............

Mr. Buchanan ....................... X ........... ............. Mr. Blumenauer ................... ........... ........... .............

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 .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ X ........... .............

Mr. Nunes’s motion to table Ms. Sewell’s appeal of the ruling of 

the Chair was agreed to by a roll call vote of 22 yeas and 13 nays 

(with a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. Mr. Levin .............................. ........... X .............

Mr. Nunes ............................. X ........... ............. Mr. Lewis .............................. ........... ........... .............

Mr. Tiberi .............................. X ........... ............. Mr. Doggett .......................... ........... X .............

Mr. Reichert .......................... X ........... ............. Mr. Thompson ...................... ........... X .............

Mr. Roskam ........................... X ........... ............. Mr. Larson ............................ ........... X .............

Mr. Buchanan ....................... X ........... ............. Mr. Blumenauer ................... ........... ........... .............

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 ......................... ........... ........... .............

Mr. Reed ............................... X ........... ............. Mr. Higgins .......................... ........... X .............

Mr. Kelly ................................ X ........... ............. Ms. Sewell ............................ ........... X .............

Mr. Renacci ........................... X ........... ............. Ms. DelBene ......................... ........... X .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ X ........... .............

Mr. Nunes’s motion to table Ms. Chu’s appeal of the ruling of the 

Chair was agreed to by a roll call vote of 22 yeas and 12 nays (with 

a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. Mr. Levin .............................. ........... X .............

Mr. Nunes ............................. X ........... ............. Mr. Lewis .............................. ........... ........... .............

Mr. Tiberi .............................. X ........... ............. Mr. Doggett .......................... ........... X .............

Mr. Reichert .......................... X ........... ............. Mr. Thompson ...................... ........... X .............

Mr. Roskam ........................... X ........... ............. Mr. Larson ............................ ........... X .............

Mr. Buchanan ....................... X ........... ............. Mr. Blumenauer ................... ........... ........... .............

Mr. Smith (NE) ...................... X ........... ............. Mr. Kind ............................... ........... X .............

9 

Representative Yea Nay Present Representative Yea Nay Present 

Ms. Jenkins ........................... X ........... ............. Mr. Pascrell .......................... ........... X .............

Mr. Paulsen ........................... X ........... ............. Mr. Crowley .......................... ........... X .............

Mr. Marchant ........................ X ........... ............. Mr. Davis .............................. ........... X .............

Ms. Black .............................. ........... ........... ............. Ms. Sanchez ......................... ........... ........... .............

Mr. Reed ............................... X ........... ............. Mr. Higgins .......................... ........... ........... .............

Mr. Kelly ................................ X ........... ............. Ms. Sewell ............................ ........... X .............

Mr. Renacci ........................... X ........... ............. Ms. DelBene ......................... ........... X .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ X ........... .............

Mr. Nunes’s motion to table Mr. Pascrell’s appeal of the ruling 

of the Chair was agreed to by a roll call vote of 22 yeas and 12 

nays (with a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. Mr. Levin .............................. ........... X .............

Mr. Nunes ............................. X ........... ............. Mr. Lewis .............................. ........... ........... .............

Mr. Tiberi .............................. X ........... ............. Mr. Doggett .......................... ........... X .............

Mr. Reichert .......................... X ........... ............. Mr. Thompson ...................... ........... X .............

Mr. Roskam ........................... X ........... ............. Mr. Larson ............................ ........... X .............

Mr. Buchanan ....................... X ........... ............. Mr. Blumenauer ................... ........... ........... .............

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 ......................... ........... ........... .............

Mr. Reed ............................... X ........... ............. Mr. Higgins .......................... ........... ........... .............

Mr. Kelly ................................ X ........... ............. Ms. Sewell ............................ ........... X .............

Mr. Renacci ........................... X ........... ............. Ms. DelBene ......................... ........... X .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ X ........... .............

The legislation was ordered favorably transmitted to the House 

of Representatives as amended by a roll call vote of 22 yeas and 

14 nays (with a quorum being present). The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .............................. X ........... ............. Mr. Neal ............................... ........... X .............

Mr. Johnson ........................... ........... ........... ............. 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 ........................... ........... ........... ............. Mr. Crowley .......................... ........... X .............

Mr. Marchant ........................ X ........... ............. Mr. Davis .............................. ........... X .............

Ms. Black .............................. ........... ........... ............. Ms. Sanchez ......................... ........... X .............

10 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Reed ............................... X ........... ............. Mr. Higgins .......................... ........... X .............

Mr. Kelly ................................ X ........... ............. Ms. Sewell ............................ ........... X .............

Mr. Renacci ........................... X ........... ............. Ms. DelBene ......................... ........... ........... .............

Mr. Meehan ........................... X ........... ............. Ms. Chu ................................ ........... X .............

Ms. Noem .............................. X ........... .............

Mr. Holding ........................... X ........... .............

Mr. Smith (MO) ..................... X ........... .............

Mr. Rice ................................ X ........... .............

Mr. Schweikert ...................... X ........... .............

Ms. Walorski ......................... X ........... .............

Mr. Curbelo ........................... X ........... .............

Mr. Bishop ............................ 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. 2372, as reported. 

The bill, as reported, is estimated to have no effect on Federal 

fiscal year budget receipts for fiscal years 2017–2027. 

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 provisions of the bill do not increase 

or decrease tax expenditures. 

C. COST ESTIMATE PREPARED BY THE CONGRESSIONAL BUDGET

OFFICE

In compliance with clause 3(c)(3) of rule XIII of the Rules of the 

House of Representatives, requiring a cost estimate prepared by 

the CBO, the following statement by CBO is provided. 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, June 1, 2017. 

Hon KEVIN BRADY, Chairman, Committee on Ways and Means, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 2372, the Veterans Equal 

Treatment Ensures Relief and Access Now Act. 

11 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Mark Booth. 

Sincerely, 

KEITH HALL. 

Enclosure. 

H.R. 2372—Veterans Equal Treatment Ensures Relief and Access 

Now Act 

H.R. 2372 would amend the Internal Revenue Code to codify certain health-related regulations affecting veterans. Specifically, the 

bill would codify regulations that allow veterans who are eligible 

for, but do not elect to be covered by, certain Veterans Affairs 

health programs to qualify for premium assistance tax credits. 

Under current law, people can purchase health insurance through 

marketplaces and receive such credits to cover part or all of the 

premiums if, among other criteria, they have income below certain 

amounts and are not eligible for certain types of health coverage. 

H.R. 2372 also contains a contingency under which the provisions 

would apply upon enactment of the American Health Care Act of 

2017, which would provide new credits and eligibility requirements. 

Because H.R. 2372 would in part codify existing regulations and 

in part be contingent upon enactment of subsequent legislation, the 

staff of the Joint Committee on Taxation estimates that the bill 

would have no effect on revenues or direct spending relative to current law; therefore pay-as-you-go procedures do not apply. However, if the American Health Care Act of 2017 was enacted prior 

to this legislation, then relative to such new law the enactment of 

this bill could affect revenues or direct spending and, as a result, 

subsequent estimates of the effects of this legislation could change. 

CBO and JCT estimate that enacting the bill would not increase 

on-budget deficits or net direct spending by more than $5 billion 

in any of the four 10-year periods beginning in 2028. 

JCT has determined that the bill contains no intergovernmental 

or private-sector mandates as defined in the Unfunded Mandates 

Reform Act. 

The CBO staff contact for this estimate is Mark Booth. The estimate was approved by John McClelland, Assistant Director for Tax 

Analysis. 

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 genVerDate Sep 11 2014 05:11 Jun 06, 2017 Jkt 069006 PO 00000 Frm 00011 Fmt 6659 Sfmt 6602 E:\HR\OC\HR159.XXX HR159
12 

eral 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, 

13 

(2) a program included in any report from the Government Accountability Office to Congress pursuant to section 21 of Public 

Law 111–139, 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. 

VI. 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): 

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 (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 

* * * * * * * 

øThe following shows current law section 36B of the Internal Revenue Code of 1986:¿ 

14 

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 

(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 of poverty line) within the following 

income tier: 

The initial premium percentage is-- The final premium percentage is-- 

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 calVerDate Sep 11 2014 05:11 Jun 06, 2017 Jkt 069006 PO 00000 Frm 00014 Fmt 6659 Sfmt 6602 E:\HR\OC\HR159.XXX HR159
15 

endar 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 costsharing 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 

(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 

16 

(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 proVerDate Sep 11 2014 05:11 Jun 06, 2017 Jkt 069006 PO 00000 Frm 00016 Fmt 6659 Sfmt 6602 E:\HR\OC\HR159.XXX HR159
17 

gram 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). For purposes of the 

preceding sentence, an individual shall not be treated 

as eligible for coverage described in section 

5000A(f)(1)(A)(v) unless such individual is enrolled in 

such coverage. 

(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 

18 

(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, 

except that such term shall not include a qualified health 

plan which is a catastrophic plan described in section 

1302(e) of such Act. 

(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. 

(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 reimburseVerDate Sep 11 2014 05:11 Jun 06, 2017 Jkt 069006 PO 00000 Frm 00018 Fmt 6659 Sfmt 6602 E:\HR\OC\HR159.XXX HR159
19 

ment 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 selfonly 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, 

20 

(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 

21 

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 1992’’ in subparagraph (B) 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: 

22 

(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. 

øThe following shows proposed changes to section 36B of the Internal Revenue Code of 1986 as such section is proposed to read after 

amendment by section 214 of the American Health Care Act of 

2017 (H.R. 1628, as engrossed in the House):¿ 

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

HEALTH PLAN. 

(a) ALLOWANCE OF PREMIUM TAX CREDIT.—In the case of an individual, there shall be allowed as a credit against the tax imposed 

by this subtitle for the taxable year the sum of the monthly credit 

amounts with respect to such taxpayer for calendar months during 

such taxable year which are eligible coverage months appropriately 

taken into account under subsection (b)(2) with respect to the taxpayer or any qualifying family member of the taxpayer. 

(b) MONTHLY CREDIT AMOUNTS.— 

(1) IN GENERAL.—The monthly credit amount with respect to 

any taxpayer for any calendar month is the lesser of— 

(A) the sum of the monthly limitation amounts determined under subsection (c) with respect to the taxpayer 

and the taxpayer’s qualifying family members for such 

month, or 

(B) the amount paid for a qualified health plan for the 

taxpayer and the taxpayer’s qualifying family members for 

such month. 

(2) ELIGIBLE COVERAGE MONTH REQUIREMENT.—No amount 

shall be taken into account under subparagraph (A) or (B) of 

paragraph (1) with respect to any individual for any month unless such month is an eligible coverage month with respect to 

such individual. 

(c) MONTHLY LIMITATION AMOUNTS.— 

23 

(1) IN GENERAL.—The monthly limitation amount with respect to any individual for any eligible coverage month during 

any taxable year is 1⁄12 of— 

(A) $2,000 in the case of an individual who has not attained age 30 as of the beginning of such taxable year, (B) $2,500 in the case of an individual who has attained 

age 30 but who has not attained age 40 as of such time, (C) $3,000 in the case of an individual who has attained 

age 40 but who has not attained age 50 as of such time, (D) $3,500 in the case of an individual who has attained 

age 50 but who has not attained age 60 as of such time, 

and 

(E) $4,000 in the case of an individual who has attained 

age 60 as of such time. 

(2) LIMITATION BASED ON MODIFIED ADJUSTED GROSS INCOME.—The credit allowed under subsection (a) with respect to 

any taxpayer for any taxable year shall be reduced (but not 

below zero) by 10 percent of the excess (if any) of— 

(A) the taxpayer’s modified adjusted gross income (as defined in section 36B(d)(2)(B), as in effect for taxable years 

beginning before January 1, 2020) for such taxable year, 

over 

(B) $75,000 (twice such amount in the case of a joint return). 

(3) OTHER LIMITATIONS.— (A) AGGREGATE DOLLAR LIMITATION.—The sum of the 

monthly limitation amounts taken into account under this 

section with respect to any taxpayer for any taxable year 

shall not exceed $14,000. 

(B) MAXIMUM NUMBER OF INDIVIDUALS TAKEN INTO AC- COUNT.—With respect to any taxpayer for any month, 

monthly limitation amounts shall be taken into account 

under this section only with respect to the 5 oldest individuals with respect to whom monthly limitation amounts 

could (without regard to this subparagraph) otherwise be 

so taken into account. 

(d) ELIGIBLE COVERAGE MONTH.—For purposes of this section, 

the term ‘‘eligible coverage month’’ means, with respect to any individual, any month if, as of the first day of such month, the individual meets the following requirements: 

(1) The individual is covered by a health insurance coverage 

which is certified by the State in which such insurance is offered as coverage that meets the requirements for qualified 

health plans under subsection (f). 

(2) The individual is not eligible for— 

(A) coverage under a group health plan (within the 

meaning of section 5000(b)(1)) other than coverage under 

a plan substantially all of the coverage of which is of excepted benefits described in section 9832(c), or 

(B) coverage described in section 5000A(f)(1)(A). 

(3) The individual is either— 

(A) a citizen or national of the United States, or 

(B) a qualified alien (within the meaning of section 431 

of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641)). 

24 

(4) The individual is not incarcerated, other than incarceration pending the disposition of charges. 

For purposes of paragraph (2)(B), an individual shall not be treated 

as eligible for coverage described in section 5000A(f)(1)(A)(v) unless 

such individual is enrolled in such coverage. 

(e) QUALIFYING FAMILY MEMBER.—For purposes of this section, 

the term ‘‘qualifying family member’’ means— 

(1) in the case of a joint return, the taxpayer’s spouse, 

(2) any dependent of the taxpayer, and 

(3) with respect to any eligible coverage month, any child (as 

defined in section 152(f)(1)) of the taxpayer who as of the end 

of the taxable year has not attained age 27 if such child is covered for such month under a qualified health plan which also 

covers the taxpayer (in the case of a joint return, either 

spouse). 

(f) QUALIFIED HEALTH PLAN.—For purposes of this section, the 

term ‘‘qualified health plan’’ means any health insurance coverage 

(as defined in section 9832(b)) if— 

(1) such coverage is offered in the individual health insurance market within a State (within the meaning of section 

5000A(f)(1)(C)), 

(2) substantially all of such coverage is not of excepted benefits described in section 9832(c), 

(3) such coverage does not consist of short-term limited duration insurance (within the meaning of section 2791(b)(5) of the 

Public Health Service Act), 

(4) such coverage is not a grandfathered health plan (as defined in section 1251 of the Patient Protection and Affordable 

Care Act) or a grandmothered health plan (as defined in section 36B(c)(3)(C) as in effect for taxable years beginning before 

January 1, 2020), and 

(5) such coverage does not include 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). 

(g) SPECIAL RULES.— (1) MARRIED COUPLES MUST FILE JOINT RETURN.— (A) IN GENERAL.—Except as provided in subparagraph 

(B), if the taxpayer is married (within the meaning of section 7703) at the close of the taxable year, no credit shall 

be allowed under this section to such taxpayer unless such 

taxpayer and the taxpayer’s spouse file a joint return for 

such taxable year. 

(B) EXCEPTION FOR CERTAIN TAXPAYERS.—Subparagraph 

(A) shall not apply to any married taxpayer who— 

(i) is living apart from the taxpayer’s spouse at the 

time the taxpayer files the tax return, 

(ii) is unable to file a joint return because such taxpayer is a victim of domestic abuse or spousal abandonment, 

(iii) certifies on the tax return that such taxpayer 

meets the requirements of clauses (i) and (ii), and 

(iv) has not met the requirements of clauses (i), (ii), 

and (iii) for each of the 3 preceding taxable years. 

(2) DENIAL OF CREDIT TO DEPENDENTS.— 

25 

(A) IN GENERAL.—No credit shall be allowed under this 

section to any individual who is a dependent with respect 

to another taxpayer for a taxable year beginning in the 

calendar year in which such individual’s taxable year begins. 

(B) COORDINATION WITH RULE FOR OLDER CHILDREN.—In 

the case of any individual who is a qualifying family member described in subsection (e)(3) with respect to another 

taxpayer for any month, in determining the amount of any 

credit allowable to such individual under this section for 

any taxable year of such individual which includes such 

month, the monthly limitation amount with respect to 

such individual for such month shall be zero and no 

amount paid for any qualified health plan with respect to 

such individual for such month shall be taken into account. 

(3) COORDINATION WITH MEDICAL EXPENSE DEDUCTION.— 

Amounts described in subsection (b)(1)(B) with respect to any 

month shall not be taken into account in determining the deduction allowed under section 213 except to the extent that 

such amounts exceed the amount described in subsection 

(b)(1)(A) with respect to such month. 

(4) COORDINATION WITH ADVANCE PAYMENTS OF CREDIT.— 

With respect to any taxable year— 

(A) the amount which would (but for this subsection) be 

allowed as a credit to the taxpayer under subsection (a) 

shall be reduced (but not below zero) by the aggregate 

amount paid on behalf of such taxpayer under section 1412 

of the Patient Protection and Affordable Care Act for 

months beginning in such taxable year, and 

(B) the tax imposed by section 1 for such taxable year 

shall be increased by the excess (if any) of— 

(i) the aggregate amount paid on behalf of such taxpayer under such section 1412 for months beginning 

in such taxable year, over 

(ii) the amount which would (but for this subsection) 

be allowed as a credit to the taxpayer under subsection (a). 

(5) SPECIAL RULES FOR QUALIFIED SMALL EMPLOYER HEALTH

REIMBURSEMENT ARRANGEMENTS.— 

(A) IN GENERAL.—If the taxpayer or any qualifying family member of the taxpayer is provided a qualified small 

employer health reimbursement arrangement for an eligible coverage month, the sum determined under subsection 

(b)(1)(A) with respect to the taxpayer shall be reduced (but 

not below zero) by 1⁄12 of the permitted benefit (as defined 

in section 9831(d)(3)(C)) under such arrangement for each 

such month such arrangement is provided to such taxpayer. 

(B) 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). 

26 

(C) 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 (A) shall be applied by substituting 

‘‘the number of months during the year for which such arrangement was provided’’ for ‘‘12’’. 

(6) CERTAIN RULES RELATED TO NONQUALIFIED HEALTH

PLANS.—The rules of section 36B(c)(3)(D), as in effect for taxable years beginning before January 1, 2020, shall apply with 

respect to subsection (f)(5). 

(7) INFLATION ADJUSTMENT.— (A) IN GENERAL.—In the case of any taxable year beginning in a calendar year after 2020, each dollar amount in 

subsection (c)(1), the $75,000 amount in subsection 

(c)(2)(B), and the dollar amount in subsection (c)(3)(A), 

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 in which the taxable year begins, determined— 

(I) by substituting ‘‘calendar year 2019’’ for ‘‘calendar year 1992’’ in subparagraph (B) thereof, and 

(II) by substituting for the CPI referred to section 1(f)(3)(A) the amount that such CPI would 

have been if the annual percentage increase in 

CPI with respect to each year after 2019 had been 

one percentage point greater. 

(B) TERMS RELATED TO CPI.— 

(i) ANNUAL PERCENTAGE INCREASE.—For purposes of 

subparagraph (A)(ii)(II), the term ‘‘annual percentage 

increase’’ means the percentage (if any) by which CPI 

for any year exceeds CPI for the prior year. 

(ii) OTHER TERMS.—Terms used in this paragraph 

which are also used in section 1(f)(3) shall have the 

same meanings as when used in such section. 

(C) ROUNDING.—Any increase determined under subparagraph (A) shall be rounded to the nearest multiple of 

$50. 

(8) RULES RELATED TO STATE CERTIFICATION OF QUALIFIED

HEALTH PLANS.—A certification shall not be taken into account 

under subsection (d)(1) unless such certification is made available to the public and meets such other requirements as the 

Secretary may provide. 

(9) REGULATIONS.—The Secretary may prescribe such regulations and other guidance as may be necessary or appropriate 

to carry out this section and section 1412 of the Patient Protection and Affordable Care Act. 

* * * * * * * 

(27) 

VII. DISSENTING VIEWS 

H.R. 2372 (Johnson, R–TX) would allow veterans who are not enrolled in military-related coverage to access tax credits (as modified 

by the American Health Care Act (AHCA), H.R. 1628) for the purchase of health insurance in the individual market. This legislation 

amends the AHCA, which, while passed out of the House, is not yet 

law. 

This legislation is only necessary because of gimmickry in the underlying AHCA. Section 2 of H.R. 2372 was originally part of the 

AHCA legislation, but it was removed in the Manager’s Amendment in the Ways and Means Committee. It would have triggered 

a budget process (Byrd Rule), which would have required the Republicans to submit the AHCA to the Veteran’s Affairs Committee. 

H.R. 2372 would reinsert the provision. 

As passed by the House in early May, the AHCA would prohibit 

any veteran eligible for government healthcare (such as VA and 

TRICARE) from receiving a tax credit even if the veteran has a 

non-group health plan. The important word is ‘‘eligible’’—this could 

affect veterans who have never used the VA system and are not enrolled. 

Veterans decline VA or TRICARE health care services for a wide 

variety of reasons, including enrollment requirements (i.e., length 

of consecutive service and time period of service, tiered 

prioritization of enrollment eligibility, and separation from service 

conditions), access issues (e.g., living far from VA services), and 

availability of other coverage options (e.g., employer-sponsored insurance). 

Veterans are already protected under current law; this is a Republican attempt to repeal current law health coverage and protections that has caused the issue. Under current law, veterans are 

protected both if they are eligible for 15949 military-related coverage and do not enroll, or if they enroll in partial benefits, military-related coverage that does not meet the essential health benefits test. The purpose of Mr. Johnson’s bill is to ensure that the 

House-passed AHCA legislation is consistent with current law in 

its treatment of veterans. 

However, it is not clear that H.R. 2372 would protect veterans 

who are enrolled in military-related coverage for limited benefits or 

services, as is provided by current regulations. The Republican 

AHCA does not have a minimum standard for coverage and allows 

states to waive essential health benefits; therefore, veterans enrolled for treatment of service-connected disability could be prohibited from receiving tax credits to help them secure coverage for 

other health care needs. 

H.R. 2372 masquerades as help for veterans, but fails to address 

underlying flaws in the Republican health care bill that harm veterans. H.R. 2372 does not fix any of the problems for veterans 

28 

caused by the AHCA bill, including loss of health insurance coverage, higher out-of-pocket costs, loss of essential benefits and 

treatments, or caps or limits on annual or lifetime coverage. 

According to estimates by the independent, nonpartisan Congressional Budget Office (CBO), the AHCA would result in 23 million 

Americans losing health insurance coverage. This stems from a 

combination of inadequate out-of-pocket assistance, significant reductions in Medicaid enrollment and a change in rating practices 

that would allow insurers to charge significantly more for individuals with pre-existing conditions. 

The Johnson bill does nothing to improve the inadequate tax 

credits under the MICA, which it amends. Under the AHCA, tax 

credits to purchase coverage do not account for the differences in 

the cost of coverage across the country or family incomes—which 

would make coverage completely unaffordable for countless American families. On top of that, this bill does nothing to eliminate the 

age tax in the AHCA, meaning older veterans would face significantly higher premiums. 

The AHCA would allow pre-existing condition discrimination 

under its state waivers. Before Affordable Care Act (ACA) market 

reforms, military service was a condition for underwriting and discrimination. 

The AHCA, as amended by the Johnson bill, would slash Medicaid coverage, jeopardizing affordable health coverage for the more 

than two million veterans who rely on Medicaid for their insurance. 

Millions more spouses and children of veterans rely on Medicaid; 

they too would be harmed. The AHCA cuts $834 billion from Medicaid and the Trump Administration’s budget proposes even deeper 

cuts. More than 40 percent of working-age veterans with Medicaid 

had no other source of coverage. The AHCA would jeopardize basic 

living standards and needed care for veterans who are struggling 

to make ends meet to pay for tax cuts for the rich. Medicaid provides the following that are critical for veterans’ health: mental 

health services; substance abuse and addiction services; physical 

therapy services; and general wellness care. 

Amendments offered during consideration of H.R. 2372. Democrats offered a series of amendments to highlight the shortcomings 

of H.R. 2372 and the larger MICA, all but one were ruled non-germane by Chairman Kevin Brady (R–TX) and all but two of those 

ruled non-germane were appealed by Democratic Members. The appeals were then defeated by party-line votes. The one germane 

amendment offered by Congressman Davis (D–IL) was defeated by 

a party-line vote. 

Congressman Doggett (D–TX) offered an amendment to reinstate 

the fee on brand pharmaceutical manufacturers, which helps fund 

Medicare. In repealing this fee, the Republican health legislation 

would increase Medicare Part B premiums by $8.7 billion. Striking 

the pharma fee from the House Republican plan would protect 

beneficiaries’ Medicare premiums. At a time of rising pharmaceutical profits and limited Social Security cost-of-living increases, 

this amendment would have helped ensure Medicare costs remain 

reasonable for beneficiaries. 

Congressman Thompson (D–CA) offered an amendment to reinstate the tax on high-income earners which directly funds the 

29 

Medicare Part A Trust Fund. The Republican health plan would repeal this tax, shortening the life of Medicare while giving a substantial tax break to the richest Americans. This amendment 

would prevent $75 billion being taken from the Medicare Trust 

Fund, which would reduce the solvency of the Medicare Trust Fund 

by one year. 

Congressman Davis (D–IL) offered an amendment to adjust the 

tax credits in the Republican proposal to protect veterans under 

400 percent of the poverty level to ensure that they would not pay 

more than 10 percent of their annual income toward the cost of 

health insurance premiums. While the Republican legislation gives 

billions of dollars in tax breaks to the wealthiest and most financially secure individuals, Mr. Davis’ amendment would have provided a small measure of protection for middle-income and working-class veterans. Under current law, tax credits are based on income and premium costs for families earning less than 400 percent 

of the poverty level. For instance, between 2016 and 2017, under 

current law, advanced premium tax credits kept premiums paid by 

individuals flat for 83 percent of Marketplace enrollees (about 10.1 

million people) who received them. The Republican health bill 

would repeal this current law protection, which is embedded in the 

design of the tax credit. 

Congressman Higgins (D–NY) offered an amendment to prevent 

veterans from being subject to the five-to-one (5:1) age rating established in the AHCA. Under the AHCA, older individuals could be 

charged 5+ times as much as younger individuals. However, unlike 

the current tax credits, which adjust to the cost of premiums, the 

AHCA tax credits are age adjusted well below the 5:1 ratio. This 

leads to seniors paying much more for health insurance coverage. 

As CBO noted in an updated score released in the middle of our 

mark-up, a 64-year-old senior could see his or her net premiums increase by more than $16,000 under the AHCA due to increased age 

rating and smaller premium tax credits than are available under 

current law. Rather than join with Democrats to protect veterans 

from the age tax, Republican members hid behind parliamentary 

tricks to avoid voting to support the veterans in their Districts. 

Congresswoman DelBene (D–WA) offered an amendment to ensure that the current law protections for individuals with pre-existing conditions remain in place by rescinding the state waiver authority established in the AHCA. This provision of the AHCA 

would allow states to waive essential health benefits and allow insurance companies to, once again, discriminate against people with 

pre-existing conditions. As currently drafted, the Republican health 

bill undermines the guarantee that all health insurance policies 

cover essential health benefits like prescription drugs, mental 

health services, opioid addiction treatment, and maternity care. 

The AHCA threatens to bring back annual and lifetime limits on 

healthcare as prohibition of these limits only apply to essential 

health benefits. Therefore, this AHCA provision threatens not only 

individual market coverage but also employer-sponsored insurance. 

In fact, CBO stated that the waiver provision could have particularly detrimental consequences in their latest analysis: ‘‘However, 

the agencies estimate that about one-sixth of the population resides 

in areas in which the nongroup market would start to become unVerDate Sep 11 2014 05:11 Jun 06, 2017 Jkt 069006 PO 00000 Frm 00029 Fmt 6604 Sfmt 6604 E:\HR\OC\HR159.XXX HR159
30 

stable beginning in 2020. That instability would result from market 

responses to decisions by some states to waive two provisions of 

federal law, as would be permitted under H.R. 1628. One type of 

waiver would allow states to modify the requirements governing essential health benefits (EHBs), which set minimum standards for 

the benefits that insurance in the 15943 nongroup and small-group 

markets must cover. A second type of waiver would allow insurers 

to set premiums on the basis of an individual’s health status if the 

person had not demonstrated continuous coverage. . . .’’ 

Before the ACA, 43 states and the District of Columbia allowed 

insurance companies to charge higher premiums to people with 

pre-existing conditions. As CBO noted, ‘‘In addition, premiums 

would vary significantly according to health status and the types 

of benefits provided, and less healthy people would face extremely 

high premiums, despite the additional funding that would be available under H.R. 1628 to help reduce premiums. Over time, it would 

become more difficult for less healthy people (including people with 

preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly.’’ 

This provision of the AHCA would have disastrous consequences 

for the millions of Americans with pre-existing conditions, including veterans. 

Congresswoman Sanchez (D–CA) offered an amendment to prevent gender discrimination against female veterans under the 

AHCA state-waivers, which would once again allow for insurance 

companies to discriminate against preexisting conditions, including 

being a woman. CBO, in fact, noted that pregnant women could 

face thousands of dollars more in out-of-pocket costs under the Republican health bill. 

Congresswoman Sewell (D–AL) offered an amendment to prevent 

states from enforcing future Medicaid work requirements on veterans receiving Medicaid. Research has shown that Medicaid work 

requirements would cause millions of enrollees with substantial 

health needs to lose coverage. Veterans have worked tirelessly on 

behalf of our country and should not be denied services for lack of 

employment. 

Congresswoman Chu (D–CA) offered an amendment that would 

require qualified health plans purchased with a tax credit under 

the AHCA include mental health, behavioral health, and substance 

abuse treatment benefits. This amendment would insure mental 

health services are not put out of reach for worlcing families because of artificially high premiums or out-of-pocket costs. This need 

is particularly important for veterans. According to a 2015 survey 

from the Iraq and Afghanistan Veterans of America, 58 percent of 

participating veterans reported having a mental health issue as a 

direct result of their service. A study from JAMA Psychiatry found 

the rate of post-traumatic stress disorder (PTSD) among veterans 

to be 15 times higher than civilians. And, according the Department of Veterans Affairs, suicide rates are 41 percent higher than 

the general population for deployed veterans, and 61 percent higher than the general population for non-deployed veterans. But, instead of addressing the dire need for mental health services for this 

vulnerable population, the underlying bill that H.R. 2372 amends 

would allow states to waive current protections and allow insurers 

31 

to offer plans without essential health benefits, including mental 

health benefits. These waivers would permit insurers to charge 

people with pre-existing conditions—like, for example, PTSD—more 

for coverage. 

Congressman Pascrell (D–NJ) offered an amendment to allow 

any individual suffering from Traumatic Brain Injury (TBI) to 

maintain current premium tax credits. TBI is one of the signature 

injuries of the wars in Iraq and Afghanistan, and many of our veterans are grappling with the consequences of these injuries. The 

RAND Corporation estimated that nearly 20 percent of the men 

and women deployed to Iraq and Afghanistan sustained a brain injury while in the line of duty. More than five million Americans are 

living with a life-long disability as a result of a TBI, and individuals that sustain moderate and severe TBIs require substantial 

medical care to recover and cope with their injuries. Access to the 

supports and services that they need to return to school and work 

and continue with their everyday lives often results in significant 

out-of-pocket costs even with health coverage. TBI survivors cannot 

afford to lose their insurance, nor can they afford any additional 

costs. 

Congressman Kind (D–WI) offered an amendment to protect veterans from being charged more for pre-existing conditions under 

states that allow health status to be used for rating. Under current 

law, veterans are not allowed to be charged higher insurance premiums because of a pre-existing condition. The AHCA would allow 

states to apply for a waiver to current law to allow insurance companies charge higher insurance premiums because a person has a 

pre-existing health condition like heart disease, autism, or traumatic brain injury. Before the ACA, 43 states and the District of 

Columbia allowed insurance companies to charge higher premiums 

to people with pre-existing conditions. This provision of the AHCA 

would have disastrous consequences for the millions of Americans 

with preexisting conditions, including veterans. 

The Republicans rejected all of the Democratic amendments that 

would have nominally improved the flawed Republican health care 

bill. The Johnson bill does not fix any of the underlying flaws that 

would cause veterans to lose coverage or pay higher out-of-pocket 

costs. There are numerous actions Congress could take to improve 

health care for veterans. Enacting a technical fix for a bill that 

isn’t even law yet doesn’t pass muster as being a legitimate effort 

to improve care and coverage for America’s veterans. For these reasons, we oppose H.R. 2372. 

RICHARD E. NEAL, 

Ranking Member. 

Æ