I 

117TH CONGRESS 

1ST SESSION H. R. 1878 

To amend the Patient Protection and Affordable Care Act to establish a 

health insurance affordability fund, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 12, 2021 

Ms. CRAIG (for herself and Mr. PETERS) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Patient Protection and Affordable Care Act 

to establish a health insurance affordability fund, and 

for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘State Health Care Pre5 mium Reduction Act of 2021’’. 

6 SEC. 2. ESTABLISHING A HEALTH INSURANCE AFFORD7 ABILITY FUND. 

8 (a) IN GENERAL.—Subtitle D of title I of the Patient 

9 Protection and Affordable Care Act is amended by insertVerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878

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1 ing after part 5 (42 U.S.C. 18061 et seq.) the following 

2 new part: 

3 ‘‘PART 6—IMPROVE HEALTH INSURANCE 

4 AFFORDABILITY FUND 

5 ‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM. 

6 ‘‘There is hereby established the ‘Improve Health In7 surance Affordability Fund’ to be administered by the Sec8 retary of Health and Human Services, acting through the 

9 Administrator of the Centers for Medicare & Medicaid 

10 Services (in this section referred to as the ‘Adminis11 trator’), to provide funding, in accordance with this part, 

12 to the 50 States and the District of Columbia (each re13 ferred to in this section as a ‘State’) beginning on January 

14 1, 2023, for the purposes described in section 1352. 

15 ‘‘SEC. 1352. USE OF FUNDS. 

16 ‘‘(a) IN GENERAL.—A State shall use the funds allo17 cated to the State under this part for one of the following 

18 purposes: 

19 ‘‘(1) To provide reinsurance payments to health 

20 insurance issuers with respect to individuals enrolled 

21 under individual health insurance coverage (other 

22 than through a plan described in subsection (b)) of23 fered by such issuers. 

24 ‘‘(2) To provide assistance (other than through 

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1 of-pocket costs, such as copayments, coinsurance, 

2 premiums, and deductibles, of individuals enrolled 

3 under qualified health plans offered on the indi4 vidual market through an Exchange and of individ5 uals enrolled under standard health plans offered 

6 through a basic health program established under 

7 section 1331. 

8 ‘‘(b) EXCLUSION OF CERTAIN GRANDFATHERED AND

9 TRANSITIONAL PLANS.—For purposes of subsection (a), 

10 a plan described in this subsection is the following: 

11 ‘‘(1) A grandfathered health plan (as defined in 

12 section 1251). 

13 ‘‘(2) A plan (commonly referred to as a ‘transi14 tional plan’) continued under the letter issued by the 

15 Centers for Medicare & Medicaid Services on No16 vember 14, 2013, to the State Insurance Commis17 sioners outlining a transitional policy for coverage in 

18 the individual and small group markets to which sec19 tion 1251 does not apply, and under the extension 

20 of the transitional policy for such coverage set forth 

21 in the Insurance Standards Bulletin Series guidance 

22 issued by the Centers for Medicare & Medicaid Serv23 ices on March 5, 2014, February 29, 2016, Feb24 ruary 13, 2017, April 9, 2018, March 25, 2019, and 


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1 January 31, 2020, or under any subsequent exten2 sions thereof. 

3 ‘‘(3) Student health insurance coverage (as de4 fined in section 147.145 of title 45, Code of Federal 

5 Regulations). 

6 ‘‘SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT 

7 SAFEGUARD. 

8 ‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA9 TIONS.— 

10 ‘‘(1) IN GENERAL.—To be eligible for an alloca11 tion of funds under this part for a year (beginning 

12 with 2023), a State shall submit to the Adminis13 trator an application at such time (but, in the case 

14 of allocations for 2023, not later than 90 days after 

15 the date of the enactment of this part and, in the 

16 case of allocations for a subsequent year, not later 

17 than March 1 of the previous year) and in such form 

18 and manner as specified by the Administrator con19 taining— 

20 ‘‘(A) a description of how the funds will be 

21 used; and 

22 ‘‘(B) such other information as the Admin23 istrator may require. 

24 ‘‘(2) AUTOMATIC APPROVAL.—An application so 

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1 fies the State submitting the application, not later 

2 than 60 days after the date of the submission of 

3 such application, that the application has been de4 nied for not being in compliance with any require5 ment of this part and of the reason for such denial. 

6 ‘‘(3) 5-YEAR APPLICATION APPROVAL.—If an 

7 application of a State is approved for a purpose de8 scribed in section 1352 for a year, such application 

9 shall be treated as approved for such purpose for 

10 each of the subsequent 4 years. 

11 ‘‘(4) REVOCATION OF APPROVAL.—The ap12 proval of an application of a State, with respect to 

13 a purpose described in section 1352, may be revoked 

14 if the State fails to use funds provided to the State 

15 under this section for such purpose or otherwise fails 

16 to comply with the requirements of this section. 

17 ‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 

18 ‘‘(1) 2023.—For 2023, in the case of a State 

19 that does not submit an application under subsection 

20 (a) by the 90-day submission date applicable to such 

21 year under subsection (a)(1) and in the case of a 

22 State that does submit such an application by such 

23 date that is not approved, the Administrator, in con24 sultation with the State insurance commissioner, 

25 shall, from the amount calculated under paragraph 


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1 (4) for such year, carry out the purpose described in 

2 paragraph (3) in such State for such year. 

3 ‘‘(2) 2024 AND SUBSEQUENT YEARS.—For 

4 2024 or a subsequent year, in the case of a State 

5 that does not have in effect an approved application 

6 under this section for such year, the Administrator, 

7 in consultation with the State insurance commis8 sioner, shall, from the amount calculated under 

9 paragraph (4) for such year, carry out the purpose 

10 described in paragraph (3) in such State for such 

11 year. 

12 ‘‘(3) SPECIFIED USE.—The amount described 

13 in paragraph (4), with respect to 2023 or a subse14 quent year, shall be used to carry out the purpose 

15 described in section 1352(a)(1) in each State de16 scribed in paragraph (1) or (2) for such year, as ap17 plicable, by providing reinsurance payments to 

18 health insurance issuers with respect to attachment 

19 range claims (as defined in section 1354(b)(2)), 

20 using the dollar amounts specified in subparagraph 

21 (B) of such section for such year) in an amount 

22 equal to, subject to paragraph (5), the percentage 

23 (specified for such year by the Secretary under such 

24 subparagraph) of the amount of such claims. 


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1 ‘‘(4) AMOUNT DESCRIBED.—The amount de2 scribed in this paragraph, with respect to 2023 or 

3 a subsequent year, is the amount equal to the total 

4 sum of amounts that the Secretary would otherwise 

5 estimate under section 1354(b)(2)(A)(i) for such 

6 year for each State described in paragraph (1) or 

7 (2) for such year, as applicable, if each such State 

8 were not so described for such year. 

9 ‘‘(5) ADJUSTMENT.—For purposes of this sub10 section, the Secretary may apply a percentage under 

11 paragraph (3) with respect to a year that is less 

12 than the percentage otherwise specified in section 

13 1354(b)(2)(B) for such year, if the cost of paying 

14 the total eligible attachment range claims for States 

15 described in this subsection for such year at such 

16 percentage otherwise specified would exceed the 

17 amount calculated under paragraph (4) for such 

18 year. 

19 ‘‘SEC. 1354. ALLOCATIONS. 

20 ‘‘(a) APPROPRIATION.—For the purpose of providing 

21 allocations for States under subsection (b) and payments 

22 under section 1353(b) there is appropriated, out of any 

23 money in the Treasury not otherwise appropriated, 

24 $10,000,000,000 for 2023 and each subsequent year. 

25 ‘‘(b) ALLOCATIONS.— 


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1 ‘‘(1) PAYMENT.— 

2 ‘‘(A) IN GENERAL.—From amounts appro3 priated under subsection (a) for a year, the 

4 Secretary shall, with respect to a State not de5 scribed in section 1353(b) for such year and 

6 not later than the date specified under subpara7 graph (B) for such year, allocate for such State 

8 the amount determined for such State and year 

9 under paragraph (2). 

10 ‘‘(B) SPECIFIED DATE.—For purposes of 

11 subparagraph (A), the date specified in this 

12 subparagraph is— 

13 ‘‘(i) for 2023, the date that is 45 days 

14 after the date of the enactment of this 

15 part; and 

16 ‘‘(ii) for 2024 or a subsequent year, 

17 January 1 of the respective year. 

18 ‘‘(C) NOTIFICATIONS OF ALLOCATION

19 AMOUNTS.—For 2024 and each subsequent 

20 year, the Secretary shall notify each State of 

21 the amount determined for such State under 

22 paragraph (2) for such year by not later than 

23 January 1 of the previous year. 

24 ‘‘(2) ALLOCATION AMOUNT DETERMINA25 TIONS.— 


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1 ‘‘(A) IN GENERAL.—For purposes of para2 graph (1), the amount determined under this 

3 paragraph for a year for a State described in 

4 paragraph (1)(A) for such year is the amount 

5 equal to— 

6 ‘‘(i) the amount that the Secretary es7 timates would be expended under this part 

8 for such year on attachment range claims 

9 of individuals residing in such State if such 

10 State used such funds only for the purpose 

11 described in paragraph (1) of section 

12 1352(a) at the dollar amounts and per13 centage specified under subparagraph (B) 

14 for such year; minus 

15 ‘‘(ii) the amount, if any, by which the 

16 Secretary determines— 

17 ‘‘(I) the estimated amount of 

18 premium tax credits under section 

19 36B of the Internal Revenue Code of 

20 1986 that would be attributable to in21 dividuals residing in such State for 

22 such year without application of this 

23 part; exceeds 

24 ‘‘(II) the estimated amount of 

25 premium tax credits under section 


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1 36B of the Internal Revenue Code of 

2 1986 that would be attributable to in3 dividuals residing in such State for 

4 such year if such State were a State 

5 described in section 1353(b) for such 

6 year. 

7 For purposes of the previous sentence and sec8 tion 1353(b)(3), the term ‘attachment range 

9 claims’ means, with respect to an individual, the 

10 claims for such individual that exceed a dollar 

11 amount specified by the Secretary for a year, 

12 but do not exceed a ceiling dollar amount speci13 fied by the Secretary for such year, under sub14 paragraph (B). 

15 ‘‘(B) SPECIFICATIONS.—For purposes of 

16 subparagraph (A) and section 1353(b)(3), the 

17 Secretary shall determine the dollar amounts 

18 and the percentage to be specified under this 

19 subparagraph for a year in a manner to ensure 

20 that the total amount of expenditures under 

21 this part for such year is estimated to equal the 

22 total amount appropriated for such year under 

23 subsection (a) if such expenditures were used 

24 solely for the purpose described in paragraph 

25 (1) of section 1352(a) for attachment range 


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1 claims at the dollar amounts and percentage so 

2 specified for such year. 

3 ‘‘(3) AVAILABILITY.—Funds allocated to a 

4 State under this subsection for a year shall remain 

5 available through the end of the subsequent year.’’. 

6 (b) BASIC HEALTH PROGRAM FUNDING ADJUST7 MENTS.—Section 1331 of the Patient Protection and Af8 fordable Care Act (42 U.S.C. 18051) is amended— 

9 (1) in subsection (a), by adding at the end the 

10 following new paragraph: 

11 ‘‘(3) PROVISION OF INFORMATION ON QUALI12 FIED HEALTH PLAN PREMIUMS.— 

13 ‘‘(A) IN GENERAL.—The program de14 scribed in paragraph (1) shall provide that a 

15 State may not establish a basic health program 

16 unless such State furnishes to the Secretary, 

17 with respect to each qualified health plan of18 fered in such State during a year that receives 

19 any reinsurance payment from funds made 

20 available under part 6 for such year, the ad21 justed premium amount (as defined in subpara22 graph (B)) for each such plan and year. 

23 ‘‘(B) ADJUSTED PREMIUM AMOUNT DE24 FINED.—For purposes of subparagraph (A), the 

25 term ‘adjusted premium amount’ means, with 


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1 respect to a qualified health plan and a year, 

2 the monthly premium for such plan and year 

3 that would have applied had such plan not re4 ceived any payments described in subparagraph 

5 (A) for such year.’’; and 

6 (2) in subsection (d)(3)(A)(ii), by adding at the 

7 end the following new sentence: ‘‘In making such de8 termination, the Secretary shall calculate the value 

9 of such premium tax credits that would have been 

10 provided to such individuals enrolled through a basic 

11 health program established by a State during a year 

12 using the adjusted premium amounts (as defined in 

13 subsection (a)(3)(B)) for qualified health plans of14 fered in such State during such year.’’. 

Æ 


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