II 

115TH CONGRESS 

1ST SESSION S. 1835 

To provide support to States to establish invisible high-risk pool or 

reinsurance programs. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 19, 2017 

Ms. COLLINS (for herself and Mr. NELSON) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To provide support to States to establish invisible high-risk 

pool or reinsurance programs. 

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 ‘‘Lower Premiums 

5 Through Reinsurance Act of 2017’’. 

6 SEC. 2. INVISIBLE HIGH-RISK POOL AND REINSURANCE 

7 PROGRAMS. 

8 Section 1332 of the Patient Protection and Afford9 able Care Act (42 U.S.C. 18052) is amended— 

10 (1) by adding at the end the following: 


ethrower on DSK3G9T082PROD with BILLS
2 

•S 1835 IS

1 ‘‘(f) HIGH-RISK POOLS AND REINSURANCE PRO2 GRAMS.— 

3 ‘‘(1) IN GENERAL.— 

4 ‘‘(A) APPLICATION.—Any State may apply 

5 to the Secretary for approval to use the funding 

6 described in subparagraph (B) to support an in7 visible high-risk pool or reinsurance program 

8 that is described in paragraph (2). The Sec9 retary shall approve a State application under 

10 this subparagraph with respect to any program 

11 that— 

12 ‘‘(i) meets the requirements of sub13 paragraph (A), (B), (C), or (D) of para14 graph (2); and 

15 ‘‘(ii) meets the requirements of sub16 paragraphs (A) through (D) of subsection 

17 (b)(1). 

18 ‘‘(B) FUNDING.—If a State application 

19 under subparagraph (A) is approved, the State 

20 may fund such invisible high-risk pool or rein21 surance program using one or both of the fol22 lowing: 

23 ‘‘(i) Amounts received through a 

24 grant described in subparagraph (C). 


ethrower on DSK3G9T082PROD with BILLS
3 

•S 1835 IS

1 ‘‘(ii) With respect to a State that has 

2 received a waiver under this section, all of, 

3 or a portion of, the payments made to the 

4 State as described in subsection (a)(3), 

5 consistent with the information the State 

6 provides under subsection (a)(1)(B)(iii). 

7 ‘‘(C) FEDERAL FUNDING FOR INVISIBLE

8 HIGH-RISK POOL AND REINSURANCE PRO9 GRAMS.—There are authorized to be appro10 priated, and there are appropriated, to the Sec11 retary, out of monies in the Treasury not other12 wise obligated, $2,250,000,000 for each of fis13 cal years 2018 and 2019, to remain available 

14 until expended, for purposes of awarding grants 

15 to States to support the establishment or main16 tenance of invisible high-risk pool and reinsur17 ance programs that meet the requirements of 

18 paragraph (2). Any funds provided under this 

19 subparagraph shall not be considered in deter20 mining under subparagraph (A)(ii) whether the 

21 State plan increases the Federal deficit. 

22 ‘‘(2) PROGRAM DESIGN.—An invisible high-risk 

23 pool or reinsurance program described in this para24 graph is a program that meets one of the following 

25 requirements: 


ethrower on DSK3G9T082PROD with BILLS
4 

•S 1835 IS

1 ‘‘(A) An invisible high-risk pool under 

2 which health insurance issuers, with respect to 

3 designated high-risk individuals enrolled in 

4 health insurance coverage offered in the indi5 vidual market, cede risk to the pool, without af6 fecting the premium paid by the designated in7 dividuals or their terms of coverage. With re8 spect to such pool, the State, or an entity oper9 ating the pool on behalf of the State, shall es10 tablish— 

11 ‘‘(i) the premium amount the ceding 

12 insurer shall pay to the reinsurance pool; 

13 ‘‘(ii) the applicable attachment points 

14 or coinsurance percentages if the ceding 

15 insurer retains any portion of the risk 

16 under ceded policies; and 

17 ‘‘(iii) the mechanism by which high18 risk individuals are designated for cession 

19 to the pool, which may include a risk of 

20 designated high-cost health conditions. 

21 ‘‘(B) A reinsurance program that assumes 

22 a portion of the risk for high-cost claims within 

23 the State in a manner substantially similar to 

24 the reinsurance program that operated in the 

25 State in accordance with section 1341. 


ethrower on DSK3G9T082PROD with BILLS
5 

•S 1835 IS

1 ‘‘(C) A new reinsurance program estab2 lished by the State. 

3 ‘‘(D) A program based on another State’s 

4 reinsurance program— 

5 ‘‘(i) described in subparagraph (A), 

6 (B), or (C), for which an application has 

7 been approved under this subsection; or 

8 ‘‘(ii) which was implemented prior to 

9 September 1, 2017, and which the Sec10 retary determines meets the requirements 

11 of subparagraph (A). 

12 ‘‘(3) EXPEDITED APPROVAL.— 

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

14 provide an expedited approval process for an 

15 application under paragraph (1)(A)— 

16 ‘‘(i) with respect to an invisible high17 risk pool or reinsurance program described 

18 in subparagraph (A), (B), or (D) of para19 graph (2); or 

20 ‘‘(ii) that uses a template form de21 signed by the Administrator of the Centers 

22 for Medicare & Medicaid Services, in con23 sultation with the Secretary of the Treas24 ury, for an application based on a program 

25 that is the same or substantially the same 


ethrower on DSK3G9T082PROD with BILLS
6 

•S 1835 IS

1 as a program implemented in accordance 

2 with an application previously approved 

3 under this subsection. 

4 ‘‘(B) TIMEFRAME.—The Secretary shall 

5 make a determination on an application eligible 

6 for expedited review under subparagraph (A) 

7 not later than 90 days after receipt of such ap8 plication. 

9 ‘‘(C) STANDARD OF REVIEW.—Nothing in 

10 this paragraph shall be construed as affecting 

11 the requirements under clauses (i) and (ii) of 

12 paragraph (1)(A) with respect to an application 

13 approved in accordance with the process under 

14 subparagraph (A). 

15 ‘‘(4) SINGLE-RISK POOL.—An invisible high-risk 

16 pool or reinsurance program established in accord17 ance with this subsection shall not be considered a 

18 separate risk pool for purposes of section 1312(c).’’; 

19 and 

20 (2) in subsection (a)— 

21 (A) in paragraph (1)(B)— 

22 (i) in clause (i), by striking ‘‘; and’’ 

23 and inserting a semicolon; and 

24 (ii) by adding at the end the fol25 lowing: 


ethrower on DSK3G9T082PROD with BILLS
7 

•S 1835 IS

1 ‘‘(iii) in the case of a State applying 

2 under subsection (f) to use any portion of 

3 the payments made to the State under 

4 paragraph (3) to support an invisible high5 risk pool or reinsurance program, con6 sistent with subsection (f), such informa7 tion about such program as the Secretary 

8 may require, and the portion of such pay9 ments under paragraph (3) such State in10 tends to use for such program; and’’; 

11 (B) in paragraph (3)— 

12 (i) by inserting ‘‘full amount of’’ be13 fore ‘‘premium tax credits’’; and 

14 (ii) by inserting before the period of 

15 the first sentence the following: ‘‘, or, in 

16 the case of such a State whose invisible 

17 high-risk pool or reinsurance program is 

18 approved under subsection (f)(1) and that 

19 has submitted the information described in 

20 paragraph (1)(B)(iii), supporting such in21 visible high-risk pool or reinsurance pro22 gram’’; and 


ethrower on DSK3G9T082PROD with BILLS
8 

•S 1835 IS

1 (C) in paragraph (6)(A), by inserting ‘‘and 

2 with respect to applications under subsection 

3 (f)’’ before the semicolon. 

Æ 


ethrower on DSK3G9T082PROD with BILLS