I 

114TH CONGRESS 

1ST SESSION H. R. 1886 

To amend section 1341 of the Patient Protection and Affordable Care Act 

to repeal the funding mechanism for the transitional reinsurance program 

in the individual market, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 16, 2015 

Mr. TIBERI (for himself, Mr. MCKINLEY, Mrs. BLACKBURN, Mr. JOYCE, Mr. 

BOUSTANY, and Mr. LIPINSKI) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL 

To amend section 1341 of the Patient Protection and Affordable Care Act to repeal the funding mechanism for the 

transitional reinsurance program in the individual market, 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. FINDINGS; PURPOSE. 

4 (a) FINDINGS.—Congress makes the following find5 ings: 

6 (1) According to the most recent United States 

7 Census, employer-based health insurance is the larg8 est source of health insurance coverage in the 


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1 United States. Of those employed, 70 percent receive 

2 employment-based health insurance. Of unemployed 

3 Americans, 30 percent receive employer-sponsored 

4 health insurance. 

5 (2) Despite the large percentages of coverage, 

6 as health care costs climb, the percentage of Ameri7 cans who receive health insurance through employers 

8 has fallen significantly over the last decade—from 

9 70 percent nationwide in 2000 to 60 percent in 

10 2011, according to a report by the Robert Wood 

11 Johnson Foundation. 

12 (3) According to recent surveys done by the Na13 tional Business Group on Health and the Kaiser 

14 Family Foundation, most companies continue to 

15 provide health insurance for employees and wish to 

16 continue doing so into the future. 

17 (4) Employers who offer insurance will not con18 tribute additional risk to the health insurance ex19 changes established in the Patient Protection and 

20 Affordable Care Act (in this Act referred to as 

21 ‘‘PPACA’’). 

22 (5) The transitional reinsurance program, es23 tablished in section 1341 of PPACA, is intended to 

24 stabilize risk in the individual health insurance marVerDate Sep 11 2014 00:34 Apr 25, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1886.IH H1886

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1 ket during the first three years of the health insur2 ance exchanges, as established by that Act. 

3 (6) PPACA also requires that the Treasury col4 lect a fee for each employer-sponsored covered life in 

5 order to pay for the transitional reinsurance pro6 gram. 

7 (7) This fee is a disincentive for employers to 

8 continue offering coverage to all employees, and does 

9 not give employers any benefits of the transitional 

10 reinsurance program. 

11 (b) PURPOSE.—It is the purpose of this Act to re12 move the current funding mechanism for the transitional 

13 reinsurance program. Employer-sponsored insurance 

14 should be supported so that Americans can sustain quality 

15 health coverage. 

16 SEC. 2. CHANGES IN FUNDING FOR TRANSITIONAL REIN17 SURANCE PROGRAM IN THE INDIVIDUAL 

18 MARKET. 

19 Section 1341(b) of the Patient Protection and Af20 fordable Care Act (Public Law 111–148; 42 U.S.C. 

21 18061(b)) is amended— 

22 (1) in paragraph (1), by striking ‘‘3-year pe23 riod’’ and inserting ‘‘1-year period’’ each place it ap24 pears; 


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1 (2) in paragraph (3)(A), by striking ‘‘36-month 

2 period’’ and inserting ‘‘12-month period’’; 

3 (3) in paragraph (3)(B)(iii), by striking ‘‘, 

4 $6,000,000,000 for plan years beginning 2015, and 

5 $4,000,000,000 for plan years beginning in 2016’’; 

6 (4) in paragraph (3)(B)(iv), by striking ‘‘, an 

7 additional $2,000,000,000 for 2015, and an addi8 tional $1,000,000,000 for 2016’’; 

9 (5) in paragraph (4)(A), by striking ‘‘used in 

10 any of the three calendar years for which amounts 

11 are collected based on the reinsurance needs of a 

12 particular period or to reflect experience in a prior 

13 period’’ and inserting ‘‘only used with respect to the 

14 calendar year for which amounts are collected based 

15 on the reinsurance needs for that year, as deter16 mined by the Secretary’’; 

17 (6) in paragraph (4), by amending subpara18 graph (B) to read as follows: 

19 ‘‘(B) amounts remaining unexpended as of 

20 December, 31, 2015, shall be deposited into the 

21 general fund of the Treasury of the United 

22 States.’’; and 

23 (7) by adding at the end the following new 

24 paragraphs: 


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1 ‘‘(5) AVAILABILITY OF FUNDING FOR STATES

2 FOR 2015 AND 2016.— 

3 ‘‘(A) AUTHORIZATION OF APPROPRIA4 TIONS; PAYMENT FORMULA.—There are hereby 

5 authorized to be appropriated, based on the 

6 best estimates of the NAIC, $6,000,000,000 for 

7 plan years beginning in 2015 and 

8 $4,000,000,000 for plan years beginning in 

9 2016 to make reinsurance payments to health 

10 insurance issuers that cover high-risk individ11 uals in the individual market (excluding grand12 fathered health plans) that insure high-risk in13 dividuals consistent with this paragraph. 

14 ‘‘(B) FUND AVAILABILITY.—The amounts 

15 appropriated under subparagraph (A) for plans 

16 years beginning in a calendar year shall be allo17 cated among States and only used with respect 

18 to the calendar year for which amounts are col19 lected based on the reinsurance needs for that 

20 particular year, as determined by the Secretary 

21 and the amounts remaining unexpended as of 

22 December 31 of the following year shall be de23 posited into the general fund of the Treasury of 

24 the United States. 


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1 ‘‘(6) GAO AUDIT OF USE OF 2014 FUNDS.—The 

2 Comptroller General of the United States shall pro3 vide for an audit of expenditures made under this 

4 subsection with respect plans years beginning during 

5 2014. Such audit shall include a determination of 

6 the number of claims submitted by health insurance 

7 issuers, the amount of such claims, a comparison of 

8 the amount of such claims and the amounts collected 

9 to cover such claims, and the amount of reinsurance 

10 payments made under this section to health insur11 ance issuers. The Comptroller General shall submit 

12 a report on such audit to Congress not later than 3 

13 months after the last date that such reinsurance 

14 payments are made, but not later than July 1, 

15 2016.’’. 

Æ 


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