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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2650 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 2650

   To restore equity, save coverage, and undo errors in the case of 
individuals who lose health insurance subsidies under King v. Burwell, 
             and other individuals, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              June 4, 2015

   Mr. Tom Price of Georgia introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means and Education and the Workforce, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL

 
   To restore equity, save coverage, and undo errors in the case of 
individuals who lose health insurance subsidies under King v. Burwell, 
             and other individuals, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; CONTINGENCY AND LIMITATION 
              ON APPLICATION.

    (a) Short Title.--This Act may be cited as the ``Restoring Equity, 
Saving Coverage, and Undoing Errors Act of 2015'' or as the ``RESCUE 
America's Health Care Act of 2015''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents; contingency and limitation on 
                            application.
Sec. 2. Refundable tax credit for health insurance coverage.
Sec. 3. Restoring to States the freedom and flexibility to regulate 
                            health insurance markets.
Sec. 4. Pool reform for individual membership expansion.
Sec. 5. Requirements for individual health insurance.
    (c) Contingency and Limitation on Application.--
            (1) Dependent upon supreme court determination in king v. 
        burwell.--The succeeding provisions of this Act (including the 
        amendments made by this Act) shall only apply if the Supreme 
        Court determines that the premium tax credit under section 36B 
        of the Internal Revenue Code of 1986 is not available to 
        individuals who are enrolled in a qualified health plan offered 
        through the federally operated Exchange established pursuant to 
        section 1321(c) of the Patient Protection and Affordable Care 
        Act (42 U.S.C. 18041(c)).
            (2) Application in states without a state-operated 
        exchange.--In the case of a State that has not established an 
        Exchange under section 1311 of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18031) for which a premium tax 
        credit is available pursuant to section 36B(b)(1)(A) of the 
        Internal Revenue Code of 1986, as interpreted by the Supreme 
        Court, the succeeding provisions of this Act (including the 
        amendments made by this Act) shall apply, subject to paragraphs 
        (1) and (4), to the State and to individuals residing in the 
        State as of the date on which such credit becomes no longer 
        available to such individuals pursuant to the Supreme Court 
        determination described in paragraph (1) (such date referred to 
        in this Act as the ``King v. Burwell effective date'') .
            (3) Option of application in states with a state-operated 
        exchange.--In the case of a State that has established an 
        Exchange under section 1311 of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18031) for which a premium tax 
        credit is available pursuant to section 36B(b)(1)(A) of the 
        Internal Revenue Code of 1986, as interpreted by the Supreme 
        Court--
                    (A) the State may at any time terminate operation 
                of such Exchange; and
                    (B) if the State terminates operation of any such 
                Exchange established under such section 1311, the 
                provisions of this Act (including the amendments made 
                by this Act) shall apply, subject to paragraphs (1) and 
                (4), to the State and to individuals residing in the 
                State as of the date on which the operation of such 
                Exchange is terminated, but in no case shall such 
                provisions and amendments apply earlier than the King 
                v. Burwell effective date.
            (4) No application to states with an exchange for which 
        premium credit is available.--The succeeding provisions of this 
        Act (including the amendments made by this Act) shall not apply 
        to a State and to individuals residing in a State so long as 
        there is operating in the State an Exchange for which a premium 
        tax credit is available pursuant to section 36B(b)(1)(A) of the 
        Internal Revenue Code of 1986 to such individuals, as 
        interpreted by the Supreme Court.

SEC. 2. REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE COVERAGE.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 is amended by inserting after 
section 36B the following new section:

``SEC. 36C. HEALTH INSURANCE COVERAGE.

    ``(a) In General.--In the case of an individual, there shall be 
allowed as a credit against the tax imposed by subtitle A the aggregate 
monthly credit amounts determined under subsection (b) with respect to 
the taxpayer and the taxpayer's qualifying family members for eligible 
coverage months beginning during the taxable year.
    ``(b) Monthly Credit Amounts.--
            ``(1) In general.--The monthly credit amount with respect 
        to any individual for any eligible coverage month is \1/12\ 
        of--
                    ``(A) $900 in the case of an individual who has not 
                attained age 18 as of the beginning of such month,
                    ``(B) $1,200 in the case of an individual who has 
                so attained age 18 but who has not so attained age 35,
                    ``(C) $2,100 in the case of an individual who has 
                so attained age 35, but who has not so attained age 50, 
                and
                    ``(D) $3,000 in the case of an individual who has 
                so attained age 50.
            ``(2) Inflation adjustment.--In the case of any taxable 
        year beginning in a calendar year after 2016, each dollar 
        amount contained in paragraph (1) shall be increased by an 
        amount equal to--
                    ``(A) such dollar amount, multiplied by
                    ``(B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year in which 
                the taxable year begins, determined by substituting 
                `calendar year 2015' for `calendar year 1992' in 
                subparagraph (B) thereof.
        Any increase determined under the preceding sentence shall be 
        rounded to the nearest multiple of $50.
    ``(c) 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--
            ``(1) is covered by qualified health insurance,
            ``(2) does not have other specified coverage, and
            ``(3) is not imprisoned under Federal, State, or local 
        authority.
    ``(d) 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, 
        and
            ``(2) any dependent of the taxpayer.
    ``(e) Qualified Health Insurance.--For purposes of this section, 
the term `qualified health insurance' means health insurance coverage 
(other than excepted benefits as defined in section 9832(c)) which 
constitutes medical care.
    ``(f) Other Specified Coverage.--For purposes of this section, an 
individual has other specified coverage for any month if, as of the 
first day of such month--
            ``(1) Coverage under medicare, medicaid, or schip.--Such 
        individual--
                    ``(A) is entitled to benefits under part A of title 
                XVIII of the Social Security Act or is enrolled under 
                part B of such title, or
                    ``(B) is enrolled in the program under title XIX or 
                XXI of such Act (other than under section 1928 of such 
                Act).
            ``(2) Certain other coverage.--Such individual--
                    ``(A) is enrolled in a health benefits plan under 
                chapter 89 of title 5, United States Code,
                    ``(B) is entitled to receive benefits under chapter 
                55 of title 10, United States Code,
                    ``(C) is entitled to receive benefits under chapter 
                17 of title 38, United States Code,
                    ``(D) is enrolled in a group health plan (within 
                the meaning of section 5000(b)(1)) which is subsidized 
                by the employer, or
                    ``(E) is a member of a health care sharing 
                ministry.
            ``(3) Health care sharing ministry.--For purposes of this 
        subsection, the term `health care sharing ministry' means an 
        organization--
                    ``(A) which is described in section 501(c)(3) and 
                is exempt from taxation under section 501(a),
                    ``(B) members of which share a common set of 
                ethical or religious beliefs and share medical expenses 
                among members in accordance with those beliefs and 
                without regard to the State in which a member resides 
                or is employed,
                    ``(C) members of which retain membership even after 
                they develop a medical condition,
                    ``(D) which (or a predecessor of which) has been in 
                existence at all times since December 31, 1999, and 
                medical expenses of its members have been shared 
                continuously and without interruption since at least 
                December 31, 1999, and
                    ``(E) which conducts an annual audit which is 
                performed by an independent certified public accounting 
                firm in accordance with generally accepted accounting 
                principles and which is made available to the public 
                upon request.
    ``(g) Special Rules.--
            ``(1) Credit in excess of premiums only payable to a health 
        savings account.--
                    ``(A) In general.--If the credit allowed under 
                subsection (a) (determined without regard to clause 
                (ii)) for any taxable year exceeds the amount of 
                premiums paid by the taxpayer for coverage of the 
                taxpayer and the taxpayer's qualifying family members 
                under qualified health insurance for eligible coverage 
                months beginning in the taxable year--
                            ``(i) at the request of the taxpayer, the 
                        Secretary shall pay the amount of such excess 
                        to one or more health savings accounts of the 
                        taxpayer or of any qualifying family member of 
                        the taxpayer, and
                            ``(ii) the credit allowed under subsection 
                        (a) for such taxable year shall not exceed the 
                        amount of such premiums.
                    ``(B) Medical and health savings accounts.--Amounts 
                distributed from an Archer MSA (as defined in section 
                220(d)) or from a health savings account (as defined in 
                section 223(d)) shall not be taken into account as 
                premiums paid under subparagraph (A).
                    ``(C) Insurance which covers other individuals.--
                For purposes of this paragraph, rules similar to the 
                rules of section 213(d)(6) shall apply with respect to 
                any contract for qualified health insurance under which 
                amounts are payable for coverage of an individual other 
                than the taxpayer and qualifying family members.
                    ``(D) Contributions treated as rollovers, etc.--
                            ``(i) In general.--Any amount paid the 
                        Secretary to a health savings account under 
                        this paragraph shall be treated for purposes of 
                        this title in the same manner as a rollover 
                        contribution described in section 223(f)(5).
                            ``(ii) Coordination with limitation on 
                        rollovers.--Any amount described in clause (i) 
                        shall not be taken into account in applying 
                        section 223(f)(5)(B) with respect to any other 
                        amount and the limitation of section 
                        223(f)(5)(B) shall not apply with respect to 
                        the application of clause (i).
                            ``(iii) Establishment of hsas.--Nothing in 
                        any provision of law shall be construed--
                                    ``(I) to prevent an individual from 
                                establishing a health savings account 
                                (as defined in section 223(d)) merely 
                                because such individual is not an 
                                eligible individual (as defined in 
                                section 223(c)), or
                                    ``(II) to prevent such an account 
                                from being treated as a health savings 
                                account merely because all or a 
                                substantial portion of the 
                                contributions to such account are 
                                described in this paragraph.
            ``(2) 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 7529 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 section 7529 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).
            ``(3) Coordination with other provisions.--For purposes of 
        any deduction allowed under section 162(l), 213, or 224, and 
        any credit allowed under section 35, any health insurance 
        premiums which would (but for this paragraph) be taken into 
        account shall be reduced (but not below zero) by the amount of 
        the credit allowed under this section (determined without 
        regard to paragraphs (1) and (2) of this subsection).
            ``(4) Denial of credit to dependents and nonpermanent 
        resident alien individuals.--No credit shall be allowed under 
        this section to any individual who is--
                    ``(A) not a citizen or lawful permanent resident of 
                the United States for the calendar year in which the 
                taxable year begins, or
                    ``(B) a dependent with respect to another taxpayer 
                for a taxable year beginning in the calendar year in 
                which such individual's taxable year begins.
            ``(5) Regulations.--The Secretary may prescribe such 
        regulations and other guidance as may be necessary or 
        appropriate to carry out this section, section 6050W, and 
        section 7529.''.
    (b) Advance Payment of Credit.--
            (1) In general.--Chapter 77 of the Internal Revenue Code of 
        1986 (relating to miscellaneous provisions) is amended by 
        adding at the end the following:

``SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH INSURANCE COVERAGE.

    ``(a) General Rule.--Not later than January 1, 2016, the Secretary 
shall establish a program for making payments to providers of qualified 
health insurance (as defined in section 36C(e)) on behalf of taxpayers 
eligible for the credit under section 36C.
    ``(b) Limitation.--The aggregate payments made under this section 
with respect to any taxpayer, determined as of any time during any 
calendar year, shall not exceed the monthly credit amounts determined 
with respect to such taxpayer under section 36C for months during such 
calendar year which have ended as of such time.
    ``(c) Application of Rule That Credits in Excess of Premiums Only 
Payable to a Health Savings Account.--Under rules similar to the rules 
of section 36C(g)(1), any amount otherwise payable on behalf of the 
taxpayer under subsection (a) with respect to any eligible coverage 
month which is in excess of the amount of premiums paid by the taxpayer 
for coverage of the taxpayer and the taxpayer's qualifying family 
members under qualified health insurance for such month shall be 
payable only to one or more health savings accounts of the taxpayer or 
of any qualifying family member of the taxpayer.
    ``(d) Certification Process and Proof of Coverage.--The Secretary 
shall establish a process under which individuals are certified as 
eligible for payment under this section. Such process shall include an 
initial application by the taxpayer to determine eligibility and 
thereafter continued eligibility shall be determined, to the maximum 
extent feasible, by the Secretary on the basis of information provided 
under section 6050X.
    ``(e) Definitions.--For purposes of this section, terms used in 
this section which are also used in section 36C shall have the same 
meaning as when used in section 36C.''.
            (2) Information reporting.--
                    (A) In general.--Subpart B of part III of 
                subchapter A of chapter 61 of such Code (relating to 
                information concerning transactions with other persons) 
                is amended by adding at the end the following new 
                section:

``SEC. 6050X. RETURNS RELATING TO CREDIT FOR HEALTH INSURANCE COVERAGE.

    ``(a) Requirement of Reporting.--Every person who provides 
qualified health insurance for any month of any calendar year with 
respect to any individual shall, at such time as the Secretary may 
prescribe, make the return described in subsection (b) with respect to 
each such individual. With respect to any individual with respect to 
whom payments under section 7529 are made by the Secretary, the 
Secretary may require that reporting under subsection (b) be made on a 
monthly basis.
    ``(b) Form and Manner of Returns.--A return is described in this 
subsection if such return--
            ``(1) is in such form as the Secretary may prescribe, and
            ``(2) contains, with respect to each policy of qualified 
        health insurance--
                    ``(A) the name, address, and TIN of each individual 
                covered under such policy,
                    ``(B) the premiums paid with respect to such 
                policy, and
                    ``(C) such other information as the Secretary may 
                prescribe.
    ``(c) Statements To Be Furnished to Individuals With Respect to 
Whom Information Is Required.--Every person required to make a return 
under subsection (a) shall furnish to each individual whose name is 
required to be set forth in such return a written statement showing--
            ``(1) the name and address of the person required to make 
        such return and the phone number of the information contact for 
        such person, and
            ``(2) the information required to be shown on the return 
        with respect to such individual.
The written statement required under the preceding sentence shall be 
furnished on or before January 31 of the year following the calendar 
year to which such statement relates.
    ``(d) Definitions.--For purposes of this section, terms used in 
this section which are also used in section 36C shall have the same 
meaning as when used in section 36C.''.
                    (B) Assessable penalties.--
                            (i) Subparagraph (B) of section 6724(d)(1) 
                        of such Code is amended by striking ``or'' at 
                        the end of clause (xxiv), by striking ``and'' 
                        at the end of clause (xxv) and inserting 
                        ``or'', and by inserting after clause (xxv) the 
                        following new clause:
                            ``(xxvi) section 6050X (relating to returns 
                        relating to credit for health insurance 
                        coverage), and''.
                            (ii) Paragraph (2) of section 6724(d) of 
                        such Code is amended by striking ``or'' at the 
                        end of subparagraph (GG), by striking the 
                        period at the end of subparagraph (HH) and 
                        inserting ``, or'', and by adding after 
                        subparagraph (HH) the following new 
                        subparagraph:
                    ``(II) section 6050X (relating to returns relating 
                to credit for health insurance coverage).''.
            (3) Disclosure of return information for purposes of 
        advance payment of credit as premiums for qualified health 
        insurance.--
                    (A) In general.--Subsection (l) of section 6103 of 
                such Code is amended by adding at the end the following 
                new paragraph:
            ``(23) Disclosure of return information related to payments 
        of the health insurance coverage credit.--The Secretary may, on 
        behalf of taxpayers eligible for the credit under section 36C, 
        disclose to a provider of qualified health insurance (as 
        defined in section 36(e)) or a trustee of a health savings 
        account (and persons acting on behalf of such provider or such 
        trustee), return information with respect to any such taxpayer 
        only to the extent necessary (as prescribed by regulations 
        issued by the Secretary) to carry out sections 36C(g)(1) 
        (relating to credit in excess of premiums only payable to a 
        health savings account) and 7529 (relating to advance payment 
        of credit for health insurance coverage).''.
                    (B) Confidentiality of information.--Paragraph (3) 
                of section 6103(a) of such Code is amended by striking 
                ``or (21)'' and inserting ``(21), or (22)''.
                    (C) Unauthorized disclosure.--Paragraph (2) of 
                section 7213(a) of such Code is amended by striking 
                ``or (21)'' and inserting ``(21), or (22)''.
            (4) Effective date.--Subject to section 1(c), the 
        amendments made by this section shall take effect on the date 
        of the enactment of this Act.
    (c) Conforming Amendments.--
            (1) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting ``36C,'' after ``36B,''.
            (2) The table of sections for subpart C of part IV of 
        subchapter A of chapter 1 of the Internal Revenue Code of 1986 
        is amended by inserting after the item relating to section 36B 
        the following new item:

``Sec. 36C. Health insurance coverage.''.
            (3) The table of sections for subpart B of part III of 
        subchapter A of chapter 61 of such Code is amended by adding at 
        the end the following new item:

``Sec. 6050X. Returns relating to credit for health insurance 
                            coverage.''.
            (4) The table of sections for chapter 77 of such Code is 
        amended by adding at the end the following new item:

``Sec. 7529. Advance payment of credit for health insurance 
                            coverage.''.
    (d) Effective Date.--Subject to section 1(c), the amendments made 
by this section shall apply with respect to coverage months beginning 
on or after the King v. Burwell effective date.

SEC. 3. RESTORING TO STATES THE FREEDOM AND FLEXIBILITY TO REGULATE 
              HEALTH INSURANCE MARKETS.

    (a) Elimination of PPACA Restrictions on the Insurance Market.--Any 
provision of title I of the Patient Protection and Affordable Care Act 
(Public Law 111-148) or of the Health Care and Education Reconciliation 
Act of 2010 (Public Law 111-152) amending title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.), or amending the Internal 
Revenue Code of 1986 or the Employee Retirement Income Security Act of 
1974 in order to incorporate or apply such an amendment to such title 
XXVII, is repealed and the provisions of law amended by such provisions 
of title I of the Patient Protection and Affordable Care Act and the 
Health Care and Education Reconciliation Act of 2010 are restored or 
revived as if such title and Act had not been enacted.
    (b) HSAs and FSAs.--Any provision of, or amendment made by, the 
Patient Protection and Affordable Care Act (Public Law 111-148) or the 
Health Care and Education Reconciliation Act of 2010 (Public Law 111-
152) applying a requirement or restriction on a health savings account 
(within the meaning of section 223(d) of the Internal Revenue Code of 
1986) or a health flexible spending arrangement (within the meaning of 
section 106(c) of the Internal Revenue Code of 1986) is repealed and 
the provisions of law amended by such provisions of the Patient 
Protection and Affordable Care Act and the Health Care and Education 
Reconciliation Act of 2010 are restored or revived as if such Acts had 
not been enacted.
    (c) Expanded Health Plan Selection.--
            (1) In general.--Section 1301(a)(1) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)) is 
        amended by striking ``a health plan that'' and all that follows 
        through the period at the end and inserting ``any health plan 
        (as defined in subsection (b)).''.
            (2) Direct primary care medical home plans.--Section 
        1301(a)(3) of such Act (42 U.S.C. 18021(a)(3)) is amended by 
        striking ``medical home plan that meets criteria'' and all that 
        follows through the period at the end and inserting ``medical 
        home plan.''.
            (3) Stand-alone dental benefits.--Section 1311(d)(2)(B)(ii) 
        of such Act (42 U.S.C. 18031(d)(2)(B)(ii)) is amended by 
        striking ``health plan) if the plan'' and all that follows 
        through the period at the end and inserting ``health plan).''.
            (4) Conforming amendments.--The following provisions of the 
        Patient Protection and Affordable Care Act (Public Law 111-148) 
        shall have no force or effect after the date of the enactment 
        of this Act:
                    (A) Section 1301(b)(1)(B) of such Act (42 U.S.C. 
                18021(b)(1)(B)).
                    (B) Paragraphs (1), (2), and (6) of section 1311(c) 
                of such Act (42 U.S.C. 18031(c)).
                    (C) Section 1311(d)(4)(A) of such Act (42 U.S.C. 
                18031(d)(4)(A)).
                    (D) Section 1311(e) of such Act (42 U.S.C. 
                18031(e)).
                    (E) Section 1311(j) of such Act (42 U.S.C. 
                18031(j)).
                    (F) Subparagraphs (B) and (D) of section 1321(a)(1) 
                of such Act (42 U.S.C. 18041(a)(1)).

SEC. 4. POOL REFORM FOR INDIVIDUAL MEMBERSHIP EXPANSION.

    The Public Health Service Act is further amended by adding at the 
end the following:

     ``TITLE XXXIV--POOL REFORM FOR INDIVIDUAL MEMBERSHIP EXPANSION

``SEC. 3400. PURPOSE.

    ``The purpose of this title is to provide, through the 
establishment of individual health pools (or IHPs), for the reform of, 
and expansion of enrollment in, health insurance coverage for 
individuals and small employers.

``SEC. 3401. DEFINITION OF INDIVIDUAL HEALTH POOL (IHP).

    ``(a) In General.--For purposes of this title, the terms 
`individual health pool' and `IHP' mean a legal nonprofit entity that 
meets the following requirements:
            ``(1) Organization.--The IHP--
                    ``(A) has been formed and maintained in good faith 
                for a purpose that includes the formation of a risk 
                pool in order to offer health insurance coverage to its 
                members;
                    ``(B) does not condition membership in the IHP on 
                any health status-related factor relating to an 
                individual (including an employee of an employer or a 
                dependent of an employee);
                    ``(C) does not make health insurance coverage 
                offered through the IHP available other than in 
                connection with a member of the IHP;
                    ``(D) is not a health insurance issuer; and
                    ``(E) does not receive any consideration directly 
                or indirectly from any health insurance issuer in 
                connection with the enrollment of any individuals, or 
                employees of employers, in any health insurance 
                coverage, except in conjunction with services offered 
                through the IHP.
            ``(2) Offering health benefits coverage.--
                    ``(A) Different groups.--The IHP, in conjunction 
                with those health insurance issuers that offer health 
                benefits coverage through the IHP, makes available 
                health benefits coverage in the manner described in 
                subsection (b) to all members of the IHP and the 
                dependents of such members (and, in the case of small 
                employers, employees and their dependents) in the 
                manner described in subsection (c)(2) at rates that are 
                established by the health insurance issuer on a policy 
                or product specific basis and that may vary for 
                individuals covered through an IHP.
                    ``(B) Nondiscrimination in coverage offered.--
                            ``(i) In general.--Subject to clause (ii), 
                        the IHP may not offer health benefits coverage 
                        to a member of an IHP unless the same coverage 
                        is offered to all such members of the IHP.
                            ``(ii) Construction.--Nothing in this title 
                        shall be construed as requiring or permitting a 
                        health insurance issuer to provide coverage 
                        outside the service area of the issuer, as 
                        approved under State law, or preventing a 
                        health insurance issuer from underwriting or 
                        from excluding or limiting the coverage on any 
                        individual, subject to the requirement of 
                        section 2741 (relating to guaranteed 
                        availability of individual health insurance 
                        coverage to certain individuals with prior 
                        group coverage).
                    ``(C) No assumption of insurance risk by ihp.--The 
                IHP provides health benefits coverage only through 
                contracts with health insurance issuers and does not 
                assume insurance risk with respect to such coverage.
            ``(3) Geographic areas.--Nothing in this title shall be 
        construed as preventing the establishment and operation of more 
        than one IHP in a geographic area or as limiting the number of 
        IHPs that may operate in any area.
            ``(4) Provision of administrative services to purchasers.--
        The IHP may provide administrative services for members. Such 
        services may include accounting, billing, and enrollment 
        information.
    ``(b) Health Benefits Coverage Requirements.--
            ``(1) Compliance with consumer protection requirements.--
        Except as provided in section 3402, any health benefits 
        coverage offered through an IHP--
                    ``(A) shall be issued by a health insurance issuer 
                that meets all applicable State standards relating to 
                consumer protection;
                    ``(B) shall be approved or otherwise permitted to 
                be offered under State law; and
                    ``(C) may not impose any exclusion of a specific 
                disease from such coverage.
            ``(2) Wellness bonuses for health promotion.--Nothing in 
        this title shall be construed as precluding a health insurance 
        issuer offering health benefits coverage through an IHP from 
        establishing premium discounts or rebates for members or from 
        modifying otherwise applicable copayments or deductibles in 
        return for adherence to programs of health promotion and 
        disease prevention so long as such programs are agreed to in 
        advance by the IHP and comply with all other provisions of this 
        title and do not discriminate among similarly situated members.
    ``(c) Members; Health Insurance Issuers.--
            ``(1) Members.--
                    ``(A) In general.--Under rules established to carry 
                out this title, with respect to an individual or small 
                employer who is a member of an IHP, the individual may 
                enroll for health benefits coverage (including coverage 
                for dependents of such individual) or employer may 
                enroll employees for health benefits coverage 
                (including coverage for dependents of such employees) 
                offered by a health insurance issuer through the IHP.
                    ``(B) Rules for enrollment.--Nothing in this 
                paragraph shall preclude an IHP from establishing rules 
                of enrollment and reenrollment of members. Such rules 
                shall be applied consistently to all members within the 
                IHP and shall not be based in any manner on health 
                status-related factors.
            ``(2) Health insurance issuers.--The contract between an 
        IHP and a health insurance issuer shall provide, with respect 
        to a member enrolled with health benefits coverage offered by 
        the issuer through the IHP, for the payment to the issuer of 
        the premiums (if any) collected by the IHP for health insurance 
        coverage offered by the issuer.

``SEC. 3402. APPLICATION OF CERTAIN LAWS AND REQUIREMENTS.

    ``(a) Preemption of State Laws Restricting Formation of IHPs.--Any 
State law or regulation relating to the composition or organization of 
an IHP is preempted to the extent the law or regulation is inconsistent 
with the provisions of this title.
    ``(b) Preemption of State Requirements Relating to Health Benefit 
Coverage.--
            ``(1) Benefit requirements.--
                    ``(A) In general.--Subject to subparagraph (B), 
                State laws are superseded, and shall not apply to 
                health benefits coverage made available through an IHP, 
                insofar as such laws impose benefit requirements for 
                such coverage, including (but not limited to) 
                requirements relating to coverage of specific 
                providers, specific services or conditions, or the 
                amount, duration, or scope of benefits.
                    ``(B) Exception for federally imposed requirements 
                and for requirements prohibiting disease-specific 
                exclusions.--Subparagraph (A) shall not apply to a 
                requirement to the extent the requirement--
                            ``(i) implements title XXVII or other 
                        Federal law; or
                            ``(ii) prohibits imposition of an exclusion 
                        of a specific disease from health benefits 
                        coverage.
            ``(2) Other requirements preventing offering of coverage 
        through an ihp.--State laws are superseded, and shall not apply 
        to health benefits coverage made available through an IHP, 
        insofar as such laws impose any other requirements (including 
        limitations on compensation arrangements) that, directly or 
        indirectly, preclude (or have the effect of precluding) the 
        offering of such coverage through an IHP, if the IHP meets the 
        requirements of this title.
    ``(c) Preemption of State Premium Rating Requirements.--State laws 
are superseded, and shall not apply to the premiums imposed for health 
benefits coverage made available through an IHP, insofar as such laws 
impose restrictions on the variation of premiums among such coverage 
offered to members of the IHP.

``SEC. 3403. DEFINITIONS.

    ``For purposes of this title:
            ``(1) Dependent.--The term `dependent', as applied to 
        health insurance coverage offered by a health insurance issuer 
        licensed (or otherwise regulated) in a State, shall have the 
        meaning applied to such term with respect to such coverage 
        under the laws of the State relating to such coverage and such 
        an issuer. Such term may include the spouse and children of the 
        individual involved.
            ``(2) Health benefits coverage.--The term `health benefits 
        coverage' has the meaning given the term `health insurance 
        coverage' in section 2791(b)(1), and does not include excepted 
        benefits (as defined in section 2791(c)).
            ``(3) Health insurance issuer.--The term `health insurance 
        issuer' has the meaning given such term in section 2791(b)(2).
            ``(4) Health status-related factor.--The term `health 
        status-related factor' has the meaning given such term in 
        section 2791(d)(9).
            ``(5) Member.--The term `member' means, with respect to an 
        IHP, an individual or small employer who is a member of the 
        legal entity described in section 3401(a)(1) to which the IHP 
        is offering coverage.
            ``(6) Small employer.--The term `small employer' has the 
        meaning given such term in section 712(c)(1)(B) of the Employee 
        Retirement and Income Security Act of 1974.''.

SEC. 5. REQUIREMENTS FOR INDIVIDUAL HEALTH INSURANCE.

    (a) In General.--Section 2741 of the Public Health Service Act (42 
U.S.C. 300gg-41), as restored and revived by section 3 of this Act, is 
amended--
            (1) in subsection (a)--
                    (A) in the heading, by striking ``to Certain 
                Individuals With Prior Group Coverage'';
                    (B) in paragraph (1), by striking ``and section 
                2744'';
                    (C) in paragraph (1)(B), by inserting ``unless such 
                exclusion complies with paragraph (2)'' before the 
                period; and
                    (D) by striking paragraph (2) and inserting the 
                following new paragraphs:
            ``(2) Limitation on preexisting condition exclusion 
        period.--
                    ``(A) Limitation.--A health insurance issuer 
                offering health insurance coverage in the individual 
                market may not, with respect to an enrollee in such 
                coverage, impose any preexisting condition exclusion if 
                such enrollee has at least 18 months of continuous 
                creditable coverage (as defined in section 2701(c)(1)) 
                immediately preceding the enrollment date.
                    ``(B) Imposition of exclusion.--Notwithstanding 
                paragraph (1)(B), a health insurance issuer offering 
                health insurance coverage in the individual market may, 
                with respect to an enrollee in such coverage who is not 
                described in subparagraph (A), impose a preexisting 
                condition exclusion only if--
                            ``(i) such exclusion relates to a condition 
                        (whether physical or mental), regardless of the 
                        cause of the condition, for which medical 
                        advice, diagnosis, care, or treatment was 
                        recommended or received within the 6-month 
                        period ending on the enrollment date;
                            ``(ii) such exclusion extends for a period 
                        of not more than 18 months after the enrollment 
                        date; and
                            ``(iii) the period of any such preexisting 
                        condition exclusion is reduced by the aggregate 
                        of the periods of creditable coverage (if any, 
                        as defined in section 2701(c)(1)) applicable to 
                        the enrollee as of the enrollment date.
                    ``(C) Premium surcharge.--Notwithstanding paragraph 
                (6), with respect to an enrollee described in 
                subparagraph (B), a health insurance issuer may charge 
                a premium for the coverage involved that does not 
                exceed 150 percent of the applicable standard rate, for 
                not to exceed 24 months (or 36 months if the health 
                insurance issuer does not impose any preexisting 
                condition exclusion with respect to such enrollee), 
                reduced by the aggregate of the periods of creditable 
                coverage (if any, as defined in section 2701(c)(1)) 
                applicable to the enrollee as of the enrollment date. 
                For purposes of this subsection, the term `applicable 
                standard rate' means the standard premium rate that the 
                issuer charges for the coverage involved with respect 
                to an individual described in subparagraph (A) with the 
                same rating characteristics or rating factors as the 
                enrollee described in subparagraph (B), provided that 
                any variations in standard premium rates are based on 
                the uniform application of rating characteristics or 
                rating factors that are permitted by State law and are 
                not otherwise prohibited by paragraph (6).
            ``(3) Exceptions.--Notwithstanding paragraph (2), and 
        subject to subparagraph (D), a health insurance issuer offering 
        health insurance coverage in the individual market, may not 
        impose any of the following preexisting condition exclusions:
                    ``(A) Exclusion not applicable to certain 
                newborns.--In the case of an individual who, as of the 
                last day of the 30-day period beginning with the date 
                of birth, is a dependent of an enrollee in such 
                coverage.
                    ``(B) Exclusion not applicable to certain adopted 
                children.--In the case of a child who is adopted or 
                placed for adoption before attaining 18 years of age 
                and who, as of the last day of the 30-day period 
                beginning on the date of the adoption or placement for 
                adoption, is a dependent of an enrollee in such 
                coverage. The previous sentence shall not apply to 
                coverage before the date of such adoption or placement 
                for adoption.
                    ``(C) Exclusion not applicable to pregnancy.--
                Relating to pregnancy as a preexisting condition.
                    ``(D) Loss if break in coverage.--Subparagraphs (A) 
                and (B) shall no longer apply to an individual after 
                the end of the first 63-day period during all of which 
                the individual was not covered under any creditable 
                coverage.
            ``(4) Open enrollment periods.--A health insurance issuer 
        offering health insurance coverage in the individual market may 
        limit the applicability of the provisions of paragraph (1) to 
        scheduled open enrollment periods, provided that--
                    ``(A) any such open enrollment period shall not be 
                less than 30 days;
                    ``(B) any period between scheduled open enrollment 
                periods shall not exceed 24 months; and
                    ``(C) such limitation shall not apply to any 
                individual who qualifies for a special enrollment 
                period under paragraph (5).
            ``(5) Special enrollment periods.--Subject to subparagraphs 
        (E) and (F), a health insurance issuer offering health 
        insurance coverage in the individual market shall permit an 
        individual who is an eligible individual or a dependent to 
        enroll in coverage during a special enrollment period if the 
        individual experiences any of the following qualifying events:
                    ``(A) For dependent beneficiaries.--The individual 
                becomes, by reason of marriage, birth, adoption or 
                placement for adoption, a dependent of an individual 
                enrolled in a plan offered by the health insurance 
                issuer and such individual otherwise qualifies, under 
                the terms of the plan, as eligible for coverage as a 
                dependent of such enrollee.
                    ``(B) Loss of group coverage.--The individual loses 
                coverage under a group health plan as a result of--
                            ``(i) loss of eligibility for the coverage 
                        (including as a result of legal separation, 
                        divorce, death, attaining an age at which 
                        eligibility terminates, termination of 
                        employment, or reduction in the number of hours 
                        of employment); or
                            ``(ii) termination of the coverage by the 
                        plan sponsor.
                    ``(C) Loss of individual coverage.--The individual 
                loses individual market coverage as a result of--
                            ``(i) discontinuation of a plan as a result 
                        of a health insurance issuer ceasing to offer 
                        coverage in the individual market in accordance 
                        with section 2742(c)(2) (42 U.S.C. 300gg-
                        42(c)(2)) of this title;
                            ``(ii) expiration of COBRA, or other, 
                        continuation coverage;
                            ``(iii) ceasing to qualify, under the terms 
                        of the coverage, as a dependent (including as a 
                        result of legal separation, divorce, death, or 
                        attaining an age at which eligibility 
                        terminates); and
                            ``(iv) permanently moving outside the State 
                        in which the coverage was issued, or in the 
                        case of a network plan, outside the plan's 
                        service area.
                    ``(D) Loss of eligibility for a government coverage 
                program.--The individual loses coverage by ceasing to 
                be eligible for coverage under any of the following:
                            ``(i) Part A or part B of title XVIII of 
                        the Social Security Act (42 U.S.C. 1395c et 
                        seq.; 1395j et seq.).
                            ``(ii) Title XIX of the Social Security Act 
                        (42 U.S.C. 1396 et seq.), other than coverage 
                        consisting solely of benefits under section 
                        1928 (42 U.S.C. 1396s).
                            ``(iii) Title XXI of the Social Security 
                        Act (42 U.S.C. 1397aa et seq.).
                            ``(iv) Chapter 55 of title 10.
                            ``(v) Chapter 89 of title 5.
                            ``(vi) A State health benefits risk pool.
                    ``(E) Loss of coverage described.--For purposes of 
                this paragraph, loss of coverage shall not include any 
                of the following:
                            ``(i) Voluntary termination of coverage by 
                        an individual, except if such termination is 
                        the result of circumstances described in 
                        subparagraph (C)(iv).
                            ``(ii) Termination of coverage by the 
                        issuer or the plan sponsor of the coverage for 
                        any reason described in paragraph (1) or (2) of 
                        section 2742(b) (300gg-42(b)) of this title.
                            ``(iii) Loss of any coverage that consists 
                        solely of coverage of excepted benefits (as 
                        defined in section 300gg-91(c) of this title).
                    ``(F) Limitation on special enrollment period.--Any 
                special enrollment period shall not be less than 60 
                days and shall begin on the date of the qualifying 
                event.
            ``(6) Standard premium rates.--With respect to the premium 
        rate charged by a health insurance issuer for health insurance 
        coverage offered in the individual market, such rate, with 
        respect to the particular plan or coverage involved, shall not 
        vary based on any of the following health status-related 
        factors in relation to an eligible individual or dependent:
                    ``(A) Health status.
                    ``(B) Medical condition (including both physical 
                and mental illnesses).
                    ``(C) Claims experience.
                    ``(D) Receipt of health care.
                    ``(E) Medical history.
                    ``(F) Genetic information.
                    ``(G) Evidence of insurability (including 
                conditions arising out of acts of domestic violence).
                    ``(H) Disability.'';
            (2) by amending subsection (b) to read as follows:
    ``(b) Definitions.--For purposes of this section:
            ``(1) Eligible individual.--The term `eligible individual' 
        means an individual who is eligible under applicable State law 
        to purchase individual health insurance coverage in the State.
            ``(2) Dependent.--The term `dependent' means an individual 
        who, under the terms of the coverage and applicable State law, 
        qualifies to enroll in such coverage as a dependent of an 
        individual described in paragraph (1).''; and
            (3) by striking subsection (c) and redesignating subsection 
        (d) and the first subsection (e) as subsections (c) and (d), 
        respectively.
    (b) Conforming Amendment.--Section 2744 of the Public Health 
Service Act (42 U.S.C. 300gg-44), as restored and revived by section 3 
of this Act, is repealed.
    (c) Effective Date.--Subject to section 1(c), the amendments made 
by this section shall apply with respect to health insurance coverage 
offered for plan years beginning on or after the King v. Burwell 
effective date.
                                 <all>
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