I 

115TH CONGRESS 

1ST SESSION H. R. 4394 

To direct the Secretary of Health and Human Services to make available 

a public option for health insurance coverage for individuals residing 

in an area without a qualified health plan available through an Exchange, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 14, 2017 

Ms. TITUS introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To direct the Secretary of Health and Human Services to 

make available a public option for health insurance coverage for individuals residing in an area without a qualified health plan available through an Exchange, 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 ‘‘Bare County Buy-in 

5 Act of 2017’’. 


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1 SEC. 2. PUBLIC OPTION FOR HEALTH INSURANCE COV2 ERAGE. 

3 (a) IN GENERAL.—Part 2 of subtitle D of title I of 

4 the Patient Protection and Affordable Care Act (Public 

5 Law 111–148) is amended by adding at the end the fol6 lowing new section: 

7 ‘‘SEC. 1314. PUBLIC OPTION FOR HEALTH INSURANCE COV8 ERAGE. 

9 ‘‘(a) IN GENERAL.—If the Secretary determines that 

10 individuals residing in a rating area (as described in sec11 tion 2701(a) of the Public Health Service Act (42 U.S.C. 

12 300gg(a))) eligible to purchase individual health insurance 

13 coverage through an Exchange will not have access to a 

14 qualified health plan offered through an Exchange in the 

15 individual market with respect to a plan year beginning 

16 on or after January 1, 2018, the Secretary shall make 

17 available the public option for health insurance coverage 

18 described in subsection (b) (in this section referred to as 

19 the ‘public option’) to such individuals through such Ex20 change for such plan year. 

21 ‘‘(b) PUBLIC OPTION REQUIREMENTS.—The public 

22 option described in subsection (a) shall— 

23 ‘‘(1) provide the essential health benefits pack24 age (as defined in section 1302(a)); 

25 ‘‘(2) comply with the requirements of this title 

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1 tent practicable, applicable to a health plan offered 

2 through an Exchange; and 

3 ‘‘(3) consist of a plan in the silver level of cov4 erage (as described in section 1302(d)). 

5 ‘‘(c) ENROLLMENT AND COVERAGE PERIODS.—The 

6 Secretary shall establish enrollment and coverage periods 

7 for individuals who enroll in the public option. Such peri8 ods shall be established, to the extent practicable, in co9 ordination with the enrollment and coverage periods for 

10 other plans offered through an Exchange. 

11 ‘‘(d) PREMIUMS.— 

12 ‘‘(1) MONTHLY PREMIUM.—The Secretary shall 

13 determine a monthly premium for individuals en14 rolled in the public option. Such monthly premium 

shall be equal to 1 15 ⁄12 of the annual premium com16 puted under paragraph (2)(B). 

17 ‘‘(2) ANNUAL PREMIUM.— 

18 ‘‘(A) ESTIMATION.—The Secretary shall 

19 estimate the average, annual per capita amount 

20 for benefits and administrative expenses pay21 able under this section for individuals in each 

22 age band specified in subparagraph (C) enrolled 

23 in the public option. 

24 ‘‘(B) COMPUTATION.—The annual pre25 mium under this subsection for months in a 


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1 year is equal to the average, annual per capita 

2 amount estimated under paragraph (1) for the 

3 year for each age band specified in subpara4 graph (C), geographically adjusted by rating 

5 area. 

6 ‘‘(C) AGE BANDS.—The age bands speci7 fied in this subparagraph are the age bands de8 fined by the Secretary pursuant to section 

9 2701(a)(3) of the Public Health Service Act (42 

10 U.S.C. 300gg(a)(3)). 

11 ‘‘(3) VARIATION IN PREMIUM RATES.—The pre12 mium rate charged for the public option may not 

13 vary except as provided under section 2701 of such 

14 Act (42 U.S.C. 300gg). 

15 ‘‘(e) PAYMENT OF PREMIUMS.— 

16 ‘‘(1) IN GENERAL.—Premiums for enrollment 

17 in the public option shall be paid to the Secretary 

18 at such times, and in such manner, as the Secretary 

19 determines appropriate. 

20 ‘‘(2) DEPOSIT.—Amounts collected by the Sec21 retary under this section shall be deposited in the 

22 account established under subsection (f). 

23 ‘‘(f) ACCOUNT.— 

24 ‘‘(1) ESTABLISHMENT.—There is established in 

25 the Treasury of the United States an account for 


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1 the receipts and disbursements attributable to the 

2 operation of the public option. 

3 ‘‘(2) PROHIBITION OF STATE IMPOSITION OF

4 TAXES.—Section 1854(g) of the Social Security Act 

5 (42 U.S.C. 1395w–24(g)) shall apply to receipts and 

6 disbursements described in paragraph (1) in the 

7 same manner as such section applies to payments or 

8 premiums described in such section. 

9 ‘‘(g) HEALTH CARE PROVIDER PAYMENT RATES FOR

10 ITEMS AND SERVICES.— 

11 ‘‘(1) IN GENERAL.— 

12 ‘‘(A) RATES NEGOTIATED BY THE SEC13 RETARY.—Subject to subparagraph (B), the 

14 Secretary shall, through a negotiated agreement 

15 with health care providers, establish rates for 

16 reimbursing health care providers for providing 

17 the benefits covered by the public option. 

18 ‘‘(B) MEDICARE REIMBURSEMENT

19 RATES.—If the Secretary and health care pro20 viders are unable to reach a negotiated agree21 ment on a reimbursement rate, the Secretary 

22 shall reimburse providers at rates determined 

23 for equivalent items and services under the 

24 original Medicare fee-for-service program under 


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1 parts A and B of title XVIII of the Social Secu2 rity Act. 

3 ‘‘(C) FOR NEW SERVICES.—The Secretary 

4 shall modify reimbursement rates described in 

5 subparagraph (B) in order to accommodate 

6 payments for services that are not otherwise 

7 covered under the original medicare fee-for8 service program. 

9 ‘‘(2) PRESCRIPTION DRUGS.—Any payment rate 

10 under this subsection for a prescription drug shall be 

11 at a rate negotiated by the Secretary. If the Sec12 retary is unable to reach a negotiated agreement on 

13 such a reimbursement rate, the Secretary shall use 

14 rates determined for equivalent drugs paid for under 

15 the original medicare fee-for-service program. The 

16 Secretary shall modify such rates in order to accom17 modate payments for drugs that are not otherwise 

18 covered under the original medicare fee-for-service 

19 program. 

20 ‘‘(h) HEALTH CARE PROVIDER PARTICIPATION.— 

21 ‘‘(1) PROVIDER PARTICIPATION.— 

22 ‘‘(A) IN GENERAL.—The Secretary shall 

23 establish conditions of participation for health 

24 care providers under the public option. 


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1 ‘‘(B) LICENSURE OR CERTIFICATION.— 

2 The Secretary shall not allow a health care pro3 vider to participate in the public option unless 

4 such provider is appropriately licensed or cer5 tified under State law. 

6 ‘‘(2) ESTABLISHMENT OF A PROVIDER NET7 WORK.— 

8 ‘‘(A) MEDICARE AND MEDICAID PARTICI9 PATING PROVIDERS.—A health care provider 

10 that is a participating provider of services or 

11 supplier under the Medicare program under 

12 title XVIII of the Social Security Act or under 

13 a State Medicaid plan under title XIX of such 

14 Act is a participating provider in the public op15 tion unless the health care provider opts out of 

16 participating in the public option through a 

17 process established by the Secretary. 

18 ‘‘(B) ADDITIONAL PROVIDERS.—The Sec19 retary shall establish a process to allow health 

20 care providers not described in subparagraph 

21 (A) to become participating providers in the 

22 public option. 

23 ‘‘(i) ADMINISTRATIVE CONTRACTING.— 

24 ‘‘(1) AUTHORITIES.—The Secretary may enter 

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1 istrative functions (including functions described in 

2 subsection (a)(4) of section 1874A of the Social Se3 curity Act) with respect to the public option in the 

4 same manner as the Secretary may enter into con5 tracts under subsection (a)(1) of such section. The 

6 Secretary shall have the same authority with respect 

7 to the public option as the Secretary has under such 

8 subsection (a)(1) and subsection (b) of section 

9 1874A of the Social Security Act with respect to 

10 title XVIII of such Act. 

11 ‘‘(2) TRANSFER OF INSURANCE RISK.—Any 

12 contract under this paragraph shall not involve the 

13 transfer of insurance risk from the Secretary to the 

14 entity entering into such contract with the Sec15 retary.’’. 

16 (b) CONFORMING AMENDMENTS.— 

17 (1) TREATMENT AS A QUALIFIED HEALTH

18 PLAN.—Section 1301(a)(2) of the Patient Protection 

19 and Affordable Care Act (42 U.S.C. 18021(a)(2)) is 

20 amended— 

21 (A) in the paragraph heading, by inserting 

22 ‘‘, THE PUBLIC HEALTH INSURANCE OPTION,’’ 

23 before ‘‘AND’’; and 


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1 (B) by inserting ‘‘the public health insur2 ance option under section 1314,’’ before ‘‘and a 

3 multi-State plan’’. 

4 (2) STATE INSURANCE REGULATION.—Section 

5 1324(a) of the Patient Protection and Affordable 

6 Care Act (42 U.S.C. 18044(a)) is amended by in7 serting ‘‘the public health insurance option under 

8 section 2795 of the Public Health Service Act,’’ be9 fore ‘‘or a multi-State qualified health plan’’. 

Æ 


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