I 

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. 

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; TABLE OF CONTENTS; CONTIN4 GENCY AND LIMITATION ON APPLICATION. 

5 (a) SHORT TITLE.—This Act may be cited as the 

6 ‘‘Restoring Equity, Saving Coverage, and Undoing Errors 


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1 Act of 2015’’ or as the ‘‘RESCUE America’s Health Care 

2 Act of 2015’’. 

3 (b) TABLE OF CONTENTS.—The table of contents of 

4 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. 

5 (c) CONTINGENCY AND LIMITATION ON APPLICA6 TION.— 

7 (1) DEPENDENT UPON SUPREME COURT DE8 TERMINATION IN KING V. BURWELL.—The suc9 ceeding provisions of this Act (including the amend10 ments made by this Act) shall only apply if the Su11 preme Court determines that the premium tax credit 

12 under section 36B of the Internal Revenue Code of 

13 1986 is not available to individuals who are enrolled 

14 in a qualified health plan offered through the feder15 ally operated Exchange established pursuant to sec16 tion 1321(c) of the Patient Protection and Afford17 able Care Act (42 U.S.C. 18041(c)). 

18 (2) APPLICATION IN STATES WITHOUT A

19 STATE-OPERATED EXCHANGE.—In the case of a 

20 State that has not established an Exchange under 

21 section 1311 of the Patient Protection and Afford22 able Care Act (42 U.S.C. 18031) for which a preVerDate Sep 11 2014 02:17 Jun 05, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2650.IH H2650

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1 mium tax credit is available pursuant to section 

2 36B(b)(1)(A) of the Internal Revenue Code of 1986, 

3 as interpreted by the Supreme Court, the succeeding 

4 provisions of this Act (including the amendments 

5 made by this Act) shall apply, subject to paragraphs 

6 (1) and (4), to the State and to individuals residing 

7 in the State as of the date on which such credit be8 comes no longer available to such individuals pursu9 ant to the Supreme Court determination described 

10 in paragraph (1) (such date referred to in this Act 

11 as the ‘‘King v. Burwell effective date’’) . 

12 (3) OPTION OF APPLICATION IN STATES WITH

13 A STATE-OPERATED EXCHANGE.—In the case of a 

14 State that has established an Exchange under sec15 tion 1311 of the Patient Protection and Affordable 

16 Care Act (42 U.S.C. 18031) for which a premium 

17 tax credit is available pursuant to section 

18 36B(b)(1)(A) of the Internal Revenue Code of 1986, 

19 as interpreted by the Supreme Court— 

20 (A) the State may at any time terminate 

21 operation of such Exchange; and 

22 (B) if the State terminates operation of 

23 any such Exchange established under such sec24 tion 1311, the provisions of this Act (including 

25 the amendments made by this Act) shall apply, 


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1 subject to paragraphs (1) and (4), to the State 

2 and to individuals residing in the State as of 

3 the date on which the operation of such Ex4 change is terminated, but in no case shall such 

5 provisions and amendments apply earlier than 

6 the King v. Burwell effective date. 

7 (4) NO APPLICATION TO STATES WITH AN EX8 CHANGE FOR WHICH PREMIUM CREDIT IS AVAIL9 ABLE.—The succeeding provisions of this Act (in10 cluding the amendments made by this Act) shall not 

11 apply to a State and to individuals residing in a 

12 State so long as there is operating in the State an 

13 Exchange for which a premium tax credit is avail14 able pursuant to section 36B(b)(1)(A) of the Inter15 nal Revenue Code of 1986 to such individuals, as in16 terpreted by the Supreme Court. 

17 SEC. 2. REFUNDABLE TAX CREDIT FOR HEALTH INSUR18 ANCE COVERAGE. 

19 (a) IN GENERAL.—Subpart C of part IV of sub20 chapter A of chapter 1 of the Internal Revenue Code of 

21 1986 is amended by inserting after section 36B the fol22 lowing new section: 

23 ‘‘SEC. 36C. HEALTH INSURANCE COVERAGE. 

24 ‘‘(a) IN GENERAL.—In the case of an individual, 

25 there shall be allowed as a credit against the tax imposed 


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1 by subtitle A the aggregate monthly credit amounts deter2 mined under subsection (b) with respect to the taxpayer 

3 and the taxpayer’s qualifying family members for eligible 

4 coverage months beginning during the taxable year. 

5 ‘‘(b) MONTHLY CREDIT AMOUNTS.— 

6 ‘‘(1) IN GENERAL.—The monthly credit amount 

7 with respect to any individual for any eligible coverage month is 1 8 ⁄12 of— 

9 ‘‘(A) $900 in the case of an individual who 

10 has not attained age 18 as of the beginning of 

11 such month, 

12 ‘‘(B) $1,200 in the case of an individual 

13 who has so attained age 18 but who has not so 

14 attained age 35, 

15 ‘‘(C) $2,100 in the case of an individual 

16 who has so attained age 35, but who has not 

17 so attained age 50, and 

18 ‘‘(D) $3,000 in the case of an individual 

19 who has so attained age 50. 

20 ‘‘(2) INFLATION ADJUSTMENT.—In the case of 

21 any taxable year beginning in a calendar year after 

22 2016, each dollar amount contained in paragraph 

23 (1) shall be increased by an amount equal to— 

24 ‘‘(A) such dollar amount, multiplied by 


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1 ‘‘(B) the cost-of-living adjustment deter2 mined under section 1(f)(3) for the calendar 

3 year in which the taxable year begins, deter4 mined by substituting ‘calendar year 2015’ for 

5 ‘calendar year 1992’ in subparagraph (B) 

6 thereof. 

7 Any increase determined under the preceding sen8 tence shall be rounded to the nearest multiple of 

9 $50. 

10 ‘‘(c) ELIGIBLE COVERAGE MONTH.—For purposes of 

11 this section, the term ‘eligible coverage month’ means, 

12 with respect to any individual, any month if, as of the first 

13 day of such month, the individual— 

14 ‘‘(1) is covered by qualified health insurance, 

15 ‘‘(2) does not have other specified coverage, and 

16 ‘‘(3) is not imprisoned under Federal, State, or 

17 local authority. 

18 ‘‘(d) QUALIFYING FAMILY MEMBER.—For purposes 

19 of this section, the term ‘qualifying family member’ 

20 means— 

21 ‘‘(1) in the case of a joint return, the taxpayer’s 

22 spouse, and 

23 ‘‘(2) any dependent of the taxpayer. 

24 ‘‘(e) QUALIFIED HEALTH INSURANCE.—For pur25 poses of this section, the term ‘qualified health insurance’ 


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1 means health insurance coverage (other than excepted 

2 benefits as defined in section 9832(c)) which constitutes 

3 medical care. 

4 ‘‘(f) OTHER SPECIFIED COVERAGE.—For purposes of 

5 this section, an individual has other specified coverage for 

6 any month if, as of the first day of such month— 

7 ‘‘(1) COVERAGE UNDER MEDICARE, MEDICAID, 

8 OR SCHIP.—Such individual— 

9 ‘‘(A) is entitled to benefits under part A of 

10 title XVIII of the Social Security Act or is en11 rolled under part B of such title, or 

12 ‘‘(B) is enrolled in the program under title 

13 XIX or XXI of such Act (other than under sec14 tion 1928 of such Act). 

15 ‘‘(2) CERTAIN OTHER COVERAGE.—Such indi16 vidual— 

17 ‘‘(A) is enrolled in a health benefits plan 

18 under chapter 89 of title 5, United States Code, 

19 ‘‘(B) is entitled to receive benefits under 

20 chapter 55 of title 10, United States Code, 

21 ‘‘(C) is entitled to receive benefits under 

22 chapter 17 of title 38, United States Code, 

23 ‘‘(D) is enrolled in a group health plan 

24 (within the meaning of section 5000(b)(1)) 

25 which is subsidized by the employer, or 


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1 ‘‘(E) is a member of a health care sharing 

2 ministry. 

3 ‘‘(3) HEALTH CARE SHARING MINISTRY.—For 

4 purposes of this subsection, the term ‘health care 

5 sharing ministry’ means an organization— 

6 ‘‘(A) which is described in section 

7 501(c)(3) and is exempt from taxation under 

8 section 501(a), 

9 ‘‘(B) members of which share a common 

10 set of ethical or religious beliefs and share med11 ical expenses among members in accordance 

12 with those beliefs and without regard to the 

13 State in which a member resides or is em14 ployed, 

15 ‘‘(C) members of which retain membership 

16 even after they develop a medical condition, 

17 ‘‘(D) which (or a predecessor of which) has 

18 been in existence at all times since December 

19 31, 1999, and medical expenses of its members 

20 have been shared continuously and without 

21 interruption since at least December 31, 1999, 

22 and 

23 ‘‘(E) which conducts an annual audit 

24 which is performed by an independent certified 

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1 erally accepted accounting principles and which 

2 is made available to the public upon request. 

3 ‘‘(g) SPECIAL RULES.— 

4 ‘‘(1) CREDIT IN EXCESS OF PREMIUMS ONLY

5 PAYABLE TO A HEALTH SAVINGS ACCOUNT.— 

6 ‘‘(A) IN GENERAL.—If the credit allowed 

7 under subsection (a) (determined without re8 gard to clause (ii)) for any taxable year exceeds 

9 the amount of premiums paid by the taxpayer 

10 for coverage of the taxpayer and the taxpayer’s 

11 qualifying family members under qualified 

12 health insurance for eligible coverage months 

13 beginning in the taxable year— 

14 ‘‘(i) at the request of the taxpayer, 

15 the Secretary shall pay the amount of such 

16 excess to one or more health savings ac17 counts of the taxpayer or of any qualifying 

18 family member of the taxpayer, and 

19 ‘‘(ii) the credit allowed under sub20 section (a) for such taxable year shall not 

21 exceed the amount of such premiums. 

22 ‘‘(B) MEDICAL AND HEALTH SAVINGS AC23 COUNTS.—Amounts distributed from an Archer 

24 MSA (as defined in section 220(d)) or from a 

25 health savings account (as defined in section 


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1 223(d)) shall not be taken into account as pre2 miums paid under subparagraph (A). 

3 ‘‘(C) INSURANCE WHICH COVERS OTHER

4 INDIVIDUALS.—For purposes of this paragraph, 

5 rules similar to the rules of section 213(d)(6) 

6 shall apply with respect to any contract for 

7 qualified health insurance under which amounts 

8 are payable for coverage of an individual other 

9 than the taxpayer and qualifying family mem10 bers. 

11 ‘‘(D) CONTRIBUTIONS TREATED AS ROLL12 OVERS, ETC.— 

13 ‘‘(i) IN GENERAL.—Any amount paid 

14 the Secretary to a health savings account 

15 under this paragraph shall be treated for 

16 purposes of this title in the same manner 

17 as a rollover contribution described in sec18 tion 223(f)(5). 

19 ‘‘(ii) COORDINATION WITH LIMITA20 TION ON ROLLOVERS.—Any amount de21 scribed in clause (i) shall not be taken into 

22 account in applying section 223(f)(5)(B) 

23 with respect to any other amount and the 

24 limitation of section 223(f)(5)(B) shall not 


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1 apply with respect to the application of 

2 clause (i). 

3 ‘‘(iii) ESTABLISHMENT OF HSAS.— 

4 Nothing in any provision of law shall be 

5 construed— 

6 ‘‘(I) to prevent an individual 

7 from establishing a health savings ac8 count (as defined in section 223(d)) 

9 merely because such individual is not 

10 an eligible individual (as defined in 

11 section 223(c)), or 

12 ‘‘(II) to prevent such an account 

13 from being treated as a health savings 

14 account merely because all or a sub15 stantial portion of the contributions to 

16 such account are described in this 

17 paragraph. 

18 ‘‘(2) COORDINATION WITH ADVANCE PAYMENTS

19 OF CREDIT.—With respect to any taxable year— 

20 ‘‘(A) the amount which would (but for this 

21 subsection) be allowed as a credit to the tax22 payer under subsection (a) shall be reduced 

23 (but not below zero) by the aggregate amount 

24 paid on behalf of such taxpayer under section 


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1 7529 for months beginning in such taxable 

2 year, and 

3 ‘‘(B) the tax imposed by section 1 for such 

4 taxable year shall be increased by the excess (if 

5 any) of— 

6 ‘‘(i) the aggregate amount paid on be7 half of such taxpayer under section 7529 

8 for months beginning in such taxable year, 

9 over 

10 ‘‘(ii) the amount which would (but for 

11 this subsection) be allowed as a credit to 

12 the taxpayer under subsection (a). 

13 ‘‘(3) COORDINATION WITH OTHER PROVI14 SIONS.—For purposes of any deduction allowed 

15 under section 162(l), 213, or 224, and any credit al16 lowed under section 35, any health insurance pre17 miums which would (but for this paragraph) be 

18 taken into account shall be reduced (but not below 

19 zero) by the amount of the credit allowed under this 

20 section (determined without regard to paragraphs 

21 (1) and (2) of this subsection). 

22 ‘‘(4) DENIAL OF CREDIT TO DEPENDENTS AND

23 NONPERMANENT RESIDENT ALIEN INDIVIDUALS.— 

24 No credit shall be allowed under this section to any 

25 individual who is— 


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1 ‘‘(A) not a citizen or lawful permanent 

2 resident of the United States for the calendar 

3 year in which the taxable year begins, or 

4 ‘‘(B) a dependent with respect to another 

5 taxpayer for a taxable year beginning in the 

6 calendar year in which such individual’s taxable 

7 year begins. 

8 ‘‘(5) REGULATIONS.—The Secretary may pre9 scribe such regulations and other guidance as may 

10 be necessary or appropriate to carry out this section, 

11 section 6050W, and section 7529.’’. 

12 (b) ADVANCE PAYMENT OF CREDIT.— 

13 (1) IN GENERAL.—Chapter 77 of the Internal 

14 Revenue Code of 1986 (relating to miscellaneous 

15 provisions) is amended by adding at the end the fol16 lowing: 

17 ‘‘SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH 

18 INSURANCE COVERAGE. 

19 ‘‘(a) GENERAL RULE.—Not later than January 1, 

20 2016, the Secretary shall establish a program for making 

21 payments to providers of qualified health insurance (as de22 fined in section 36C(e)) on behalf of taxpayers eligible for 

23 the credit under section 36C. 

24 ‘‘(b) LIMITATION.—The aggregate payments made 

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1 mined as of any time during any calendar year, shall not 

2 exceed the monthly credit amounts determined with re3 spect to such taxpayer under section 36C for months dur4 ing such calendar year which have ended as of such time. 

5 ‘‘(c) APPLICATION OF RULE THAT CREDITS IN EX6 CESS OF PREMIUMS ONLY PAYABLE TO A HEALTH SAV7 INGS ACCOUNT.—Under rules similar to the rules of sec8 tion 36C(g)(1), any amount otherwise payable on behalf 

9 of the taxpayer under subsection (a) with respect to any 

10 eligible coverage month which is in excess of the amount 

11 of premiums paid by the taxpayer for coverage of the tax12 payer and the taxpayer’s qualifying family members under 

13 qualified health insurance for such month shall be payable 

14 only to one or more health savings accounts of the tax15 payer or of any qualifying family member of the taxpayer. 

16 ‘‘(d) CERTIFICATION PROCESS AND PROOF OF COV17 ERAGE.—The Secretary shall establish a process under 

18 which individuals are certified as eligible for payment 

19 under this section. Such process shall include an initial 

20 application by the taxpayer to determine eligibility and 

21 thereafter continued eligibility shall be determined, to the 

22 maximum extent feasible, by the Secretary on the basis 

23 of information provided under section 6050X. 

24 ‘‘(e) DEFINITIONS.—For purposes of this section, 

25 terms used in this section which are also used in section 


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1 36C shall have the same meaning as when used in section 

2 36C.’’. 

3 (2) INFORMATION REPORTING.— 

4 (A) IN GENERAL.—Subpart B of part III 

5 of subchapter A of chapter 61 of such Code (re6 lating to information concerning transactions 

7 with other persons) is amended by adding at 

8 the end the following new section: 

9 ‘‘SEC. 6050X. RETURNS RELATING TO CREDIT FOR HEALTH 

10 INSURANCE COVERAGE. 

11 ‘‘(a) REQUIREMENT OF REPORTING.—Every person 

12 who provides qualified health insurance for any month of 

13 any calendar year with respect to any individual shall, at 

14 such time as the Secretary may prescribe, make the return 

15 described in subsection (b) with respect to each such indi16 vidual. With respect to any individual with respect to 

17 whom payments under section 7529 are made by the Sec18 retary, the Secretary may require that reporting under 

19 subsection (b) be made on a monthly basis. 

20 ‘‘(b) FORM AND MANNER OF RETURNS.—A return 

21 is described in this subsection if such return— 

22 ‘‘(1) is in such form as the Secretary may pre23 scribe, and 

24 ‘‘(2) contains, with respect to each policy of 

25 qualified health insurance— 


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1 ‘‘(A) the name, address, and TIN of each 

2 individual covered under such policy, 

3 ‘‘(B) the premiums paid with respect to 

4 such policy, and 

5 ‘‘(C) such other information as the Sec6 retary may prescribe. 

7 ‘‘(c) STATEMENTS TO BE FURNISHED TO INDIVID8 UALS WITH RESPECT TO WHOM INFORMATION IS RE9 QUIRED.—Every person required to make a return under 

10 subsection (a) shall furnish to each individual whose name 

11 is required to be set forth in such return a written state12 ment showing— 

13 ‘‘(1) the name and address of the person re14 quired to make such return and the phone number 

15 of the information contact for such person, and 

16 ‘‘(2) the information required to be shown on 

17 the return with respect to such individual. 

18 The written statement required under the preceding sen19 tence shall be furnished on or before January 31 of the 

20 year following the calendar year to which such statement 

21 relates. 

22 ‘‘(d) DEFINITIONS.—For purposes of this section, 

23 terms used in this section which are also used in section 

24 36C shall have the same meaning as when used in section 

25 36C.’’. 


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1 (B) ASSESSABLE PENALTIES.— 

2 (i) Subparagraph (B) of section 

3 6724(d)(1) of such Code is amended by 

4 striking ‘‘or’’ at the end of clause (xxiv), 

5 by striking ‘‘and’’ at the end of clause 

6 (xxv) and inserting ‘‘or’’, and by inserting 

7 after clause (xxv) the following new clause: 

8 ‘‘(xxvi) section 6050X (relating to re9 turns relating to credit for health insur10 ance coverage), and’’. 

11 (ii) Paragraph (2) of section 6724(d) 

12 of such Code is amended by striking ‘‘or’’ 

13 at the end of subparagraph (GG), by strik14 ing the period at the end of subparagraph 

15 (HH) and inserting ‘‘, or’’, and by adding 

16 after subparagraph (HH) the following 

17 new subparagraph: 

18 ‘‘(II) section 6050X (relating to returns 

19 relating to credit for health insurance cov20 erage).’’. 

21 (3) DISCLOSURE OF RETURN INFORMATION

22 FOR PURPOSES OF ADVANCE PAYMENT OF CREDIT

23 AS PREMIUMS FOR QUALIFIED HEALTH INSUR24 ANCE.— 


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1 (A) IN GENERAL.—Subsection (l) of sec2 tion 6103 of such Code is amended by adding 

3 at the end the following new paragraph: 

4 ‘‘(23) DISCLOSURE OF RETURN INFORMATION

5 RELATED TO PAYMENTS OF THE HEALTH INSUR6 ANCE COVERAGE CREDIT.—The Secretary may, on 

7 behalf of taxpayers eligible for the credit under sec8 tion 36C, disclose to a provider of qualified health 

9 insurance (as defined in section 36(e)) or a trustee 

10 of a health savings account (and persons acting on 

11 behalf of such provider or such trustee), return in12 formation with respect to any such taxpayer only to 

13 the extent necessary (as prescribed by regulations 

14 issued by the Secretary) to carry out sections 

15 36C(g)(1) (relating to credit in excess of premiums 

16 only payable to a health savings account) and 7529 

17 (relating to advance payment of credit for health in18 surance coverage).’’. 

19 (B) CONFIDENTIALITY OF INFORMA20 TION.—Paragraph (3) of section 6103(a) of 

21 such Code is amended by striking ‘‘or (21)’’ 

22 and inserting ‘‘(21), or (22)’’. 

23 (C) UNAUTHORIZED DISCLOSURE.—Para24 graph (2) of section 7213(a) of such Code is 


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1 amended by striking ‘‘or (21)’’ and inserting 

2 ‘‘(21), or (22)’’. 

3 (4) EFFECTIVE DATE.—Subject to section 1(c), 

4 the amendments made by this section shall take ef5 fect on the date of the enactment of this Act. 

6 (c) CONFORMING AMENDMENTS.— 

7 (1) Paragraph (2) of section 1324(b) of title 

8 31, United States Code, is amended by inserting 

9 ‘‘36C,’’ after ‘‘36B,’’. 

10 (2) The table of sections for subpart C of part 

11 IV of subchapter A of chapter 1 of the Internal Rev12 enue Code of 1986 is amended by inserting after the 

13 item relating to section 36B the following new item: 

‘‘Sec. 36C. Health insurance coverage.’’. 

14 (3) The table of sections for subpart B of part 

15 III of subchapter A of chapter 61 of such Code is 

16 amended by adding at the end the following new 

17 item: 

‘‘Sec. 6050X. Returns relating to credit for health insurance coverage.’’. 

18 (4) The table of sections for chapter 77 of such 

19 Code is amended by adding at the end the following 

20 new item: 

‘‘Sec. 7529. Advance payment of credit for health insurance coverage.’’. 

21 (d) EFFECTIVE DATE.—Subject to section 1(c), the 

22 amendments made by this section shall apply with respect 


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1 to coverage months beginning on or after the King v. 

2 Burwell effective date. 

3 SEC. 3. RESTORING TO STATES THE FREEDOM AND FLEXI4 BILITY TO REGULATE HEALTH INSURANCE 

5 MARKETS. 

6 (a) ELIMINATION OF PPACA RESTRICTIONS ON THE

7 INSURANCE MARKET.—Any provision of title I of the Pa8 tient Protection and Affordable Care Act (Public Law 

9 111–148) or of the Health Care and Education Reconcili10 ation Act of 2010 (Public Law 111–152) amending title 

11 XXVII of the Public Health Service Act (42 U.S.C. 300gg 

12 et seq.), or amending the Internal Revenue Code of 1986 

13 or the Employee Retirement Income Security Act of 1974 

14 in order to incorporate or apply such an amendment to 

15 such title XXVII, is repealed and the provisions of law 

16 amended by such provisions of title I of the Patient Pro17 tection and Affordable Care Act and the Health Care and 

18 Education Reconciliation Act of 2010 are restored or re19 vived as if such title and Act had not been enacted. 

20 (b) HSAS AND FSAS.—Any provision of, or amend21 ment made by, the Patient Protection and Affordable Care 

22 Act (Public Law 111–148) or the Health Care and Edu23 cation Reconciliation Act of 2010 (Public Law 111–152) 

24 applying a requirement or restriction on a health savings 

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1 ternal Revenue Code of 1986) or a health flexible spending 

2 arrangement (within the meaning of section 106(c) of the 

3 Internal Revenue Code of 1986) is repealed and the provi4 sions of law amended by such provisions of the Patient 

5 Protection and Affordable Care Act and the Health Care 

6 and Education Reconciliation Act of 2010 are restored or 

7 revived as if such Acts had not been enacted. 

8 (c) EXPANDED HEALTH PLAN SELECTION.— 

9 (1) IN GENERAL.—Section 1301(a)(1) of the 

10 Patient Protection and Affordable Care Act (42 

11 U.S.C. 18021(a)(1)) is amended by striking ‘‘a 

12 health plan that’’ and all that follows through the 

13 period at the end and inserting ‘‘any health plan (as 

14 defined in subsection (b)).’’. 

15 (2) DIRECT PRIMARY CARE MEDICAL HOME

16 PLANS.—Section 1301(a)(3) of such Act (42 U.S.C. 

17 18021(a)(3)) is amended by striking ‘‘medical home 

18 plan that meets criteria’’ and all that follows 

19 through the period at the end and inserting ‘‘medical 

20 home plan.’’. 

21 (3) STAND-ALONE DENTAL BENEFITS.—Section 

22 1311(d)(2)(B)(ii) of such Act (42 U.S.C. 

23 18031(d)(2)(B)(ii)) is amended by striking ‘‘health 

24 plan) if the plan’’ and all that follows through the 

25 period at the end and inserting ‘‘health plan).’’. 


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1 (4) CONFORMING AMENDMENTS.—The fol2 lowing provisions of the Patient Protection and Af3 fordable Care Act (Public Law 111–148) shall have 

4 no force or effect after the date of the enactment of 

5 this Act: 

6 (A) Section 1301(b)(1)(B) of such Act (42 

7 U.S.C. 18021(b)(1)(B)). 

8 (B) Paragraphs (1), (2), and (6) of section 

9 1311(c) of such Act (42 U.S.C. 18031(c)). 

10 (C) Section 1311(d)(4)(A) of such Act (42 

11 U.S.C. 18031(d)(4)(A)). 

12 (D) Section 1311(e) of such Act (42 

13 U.S.C. 18031(e)). 

14 (E) Section 1311(j) of such Act (42 U.S.C. 

15 18031(j)). 

16 (F) Subparagraphs (B) and (D) of section 

17 1321(a)(1) of such Act (42 U.S.C. 

18 18041(a)(1)). 

19 SEC. 4. POOL REFORM FOR INDIVIDUAL MEMBERSHIP EX20 PANSION. 

21 The Public Health Service Act is further amended by 

22 adding at the end the following: 


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1 ‘‘TITLE XXXIV—POOL REFORM 

2 FOR INDIVIDUAL MEMBER3 SHIP EXPANSION 

4 ‘‘SEC. 3400. PURPOSE. 

5 ‘‘The purpose of this title is to provide, through the 

6 establishment of individual health pools (or IHPs), for the 

7 reform of, and expansion of enrollment in, health insur8 ance coverage for individuals and small employers. 

9 ‘‘SEC. 3401. DEFINITION OF INDIVIDUAL HEALTH POOL 

10 (IHP). 

11 ‘‘(a) IN GENERAL.—For purposes of this title, the 

12 terms ‘individual health pool’ and ‘IHP’ mean a legal non13 profit entity that meets the following requirements: 

14 ‘‘(1) ORGANIZATION.—The IHP— 

15 ‘‘(A) has been formed and maintained in 

16 good faith for a purpose that includes the for17 mation of a risk pool in order to offer health in18 surance coverage to its members; 

19 ‘‘(B) does not condition membership in the 

20 IHP on any health status-related factor relating 

21 to an individual (including an employee of an 

22 employer or a dependent of an employee); 

23 ‘‘(C) does not make health insurance cov24 erage offered through the IHP available other 

25 than in connection with a member of the IHP; 


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1 ‘‘(D) is not a health insurance issuer; and 

2 ‘‘(E) does not receive any consideration di3 rectly or indirectly from any health insurance 

4 issuer in connection with the enrollment of any 

5 individuals, or employees of employers, in any 

6 health insurance coverage, except in conjunction 

7 with services offered through the IHP. 

8 ‘‘(2) OFFERING HEALTH BENEFITS COV9 ERAGE.— 

10 ‘‘(A) DIFFERENT GROUPS.—The IHP, in 

11 conjunction with those health insurance issuers 

12 that offer health benefits coverage through the 

13 IHP, makes available health benefits coverage 

14 in the manner described in subsection (b) to all 

15 members of the IHP and the dependents of 

16 such members (and, in the case of small em17 ployers, employees and their dependents) in the 

18 manner described in subsection (c)(2) at rates 

19 that are established by the health insurance 

20 issuer on a policy or product specific basis and 

21 that may vary for individuals covered through 

22 an IHP. 

23 ‘‘(B) NONDISCRIMINATION IN COVERAGE

24 OFFERED.— 


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1 ‘‘(i) IN GENERAL.—Subject to clause 

2 (ii), the IHP may not offer health benefits 

3 coverage to a member of an IHP unless 

4 the same coverage is offered to all such 

5 members of the IHP. 

6 ‘‘(ii) CONSTRUCTION.—Nothing in 

7 this title shall be construed as requiring or 

8 permitting a health insurance issuer to 

9 provide coverage outside the service area of 

10 the issuer, as approved under State law, or 

11 preventing a health insurance issuer from 

12 underwriting or from excluding or limiting 

13 the coverage on any individual, subject to 

14 the requirement of section 2741 (relating 

15 to guaranteed availability of individual 

16 health insurance coverage to certain indi17 viduals with prior group coverage). 

18 ‘‘(C) NO ASSUMPTION OF INSURANCE RISK

19 BY IHP.—The IHP provides health benefits cov20 erage only through contracts with health insur21 ance issuers and does not assume insurance 

22 risk with respect to such coverage. 

23 ‘‘(3) GEOGRAPHIC AREAS.—Nothing in this title 

24 shall be construed as preventing the establishment 

25 and operation of more than one IHP in a geographic 


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1 area or as limiting the number of IHPs that may 

2 operate in any area. 

3 ‘‘(4) PROVISION OF ADMINISTRATIVE SERVICES

4 TO PURCHASERS.—The IHP may provide adminis5 trative services for members. Such services may in6 clude accounting, billing, and enrollment informa7 tion. 

8 ‘‘(b) HEALTH BENEFITS COVERAGE REQUIRE9 MENTS.— 

10 ‘‘(1) COMPLIANCE WITH CONSUMER PROTEC11 TION REQUIREMENTS.—Except as provided in sec12 tion 3402, any health benefits coverage offered 

13 through an IHP— 

14 ‘‘(A) shall be issued by a health insurance 

15 issuer that meets all applicable State standards 

16 relating to consumer protection; 

17 ‘‘(B) shall be approved or otherwise per18 mitted to be offered under State law; and 

19 ‘‘(C) may not impose any exclusion of a 

20 specific disease from such coverage. 

21 ‘‘(2) WELLNESS BONUSES FOR HEALTH PRO22 MOTION.—Nothing in this title shall be construed as 

23 precluding a health insurance issuer offering health 

24 benefits coverage through an IHP from establishing 

25 premium discounts or rebates for members or from 


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1 modifying otherwise applicable copayments or 

2 deductibles in return for adherence to programs of 

3 health promotion and disease prevention so long as 

4 such programs are agreed to in advance by the IHP 

5 and comply with all other provisions of this title and 

6 do not discriminate among similarly situated mem7 bers. 

8 ‘‘(c) MEMBERS; HEALTH INSURANCE ISSUERS.— 

9 ‘‘(1) MEMBERS.— 

10 ‘‘(A) IN GENERAL.—Under rules estab11 lished to carry out this title, with respect to an 

12 individual or small employer who is a member 

13 of an IHP, the individual may enroll for health 

14 benefits coverage (including coverage for de15 pendents of such individual) or employer may 

16 enroll employees for health benefits coverage 

17 (including coverage for dependents of such em18 ployees) offered by a health insurance issuer 

19 through the IHP. 

20 ‘‘(B) RULES FOR ENROLLMENT.—Nothing 

21 in this paragraph shall preclude an IHP from 

22 establishing rules of enrollment and reenroll23 ment of members. Such rules shall be applied 

24 consistently to all members within the IHP and 


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1 shall not be based in any manner on health sta2 tus-related factors. 

3 ‘‘(2) HEALTH INSURANCE ISSUERS.—The con4 tract between an IHP and a health insurance issuer 

5 shall provide, with respect to a member enrolled with 

6 health benefits coverage offered by the issuer 

7 through the IHP, for the payment to the issuer of 

8 the premiums (if any) collected by the IHP for 

9 health insurance coverage offered by the issuer. 

10 ‘‘SEC. 3402. APPLICATION OF CERTAIN LAWS AND REQUIRE11 MENTS. 

12 ‘‘(a) PREEMPTION OF STATE LAWS RESTRICTING

13 FORMATION OF IHPS.—Any State law or regulation relat14 ing to the composition or organization of an IHP is pre15 empted to the extent the law or regulation is inconsistent 

16 with the provisions of this title. 

17 ‘‘(b) PREEMPTION OF STATE REQUIREMENTS RE18 LATING TO HEALTH BENEFIT COVERAGE.— 

19 ‘‘(1) BENEFIT REQUIREMENTS.— 

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), State laws are superseded, and shall 

22 not apply to health benefits coverage made 

23 available through an IHP, insofar as such laws 

24 impose benefit requirements for such coverage, 

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1 lating to coverage of specific providers, specific 

2 services or conditions, or the amount, duration, 

3 or scope of benefits. 

4 ‘‘(B) EXCEPTION FOR FEDERALLY IM5 POSED REQUIREMENTS AND FOR REQUIRE6 MENTS PROHIBITING DISEASE-SPECIFIC EXCLU7 SIONS.—Subparagraph (A) shall not apply to a 

8 requirement to the extent the requirement— 

9 ‘‘(i) implements title XXVII or other 

10 Federal law; or 

11 ‘‘(ii) prohibits imposition of an exclu12 sion of a specific disease from health bene13 fits coverage. 

14 ‘‘(2) OTHER REQUIREMENTS PREVENTING OF15 FERING OF COVERAGE THROUGH AN IHP.—State 

16 laws are superseded, and shall not apply to health 

17 benefits coverage made available through an IHP, 

18 insofar as such laws impose any other requirements 

19 (including limitations on compensation arrange20 ments) that, directly or indirectly, preclude (or have 

21 the effect of precluding) the offering of such cov22 erage through an IHP, if the IHP meets the re23 quirements of this title. 

24 ‘‘(c) PREEMPTION OF STATE PREMIUM RATING RE25 QUIREMENTS.—State laws are superseded, and shall not 


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1 apply to the premiums imposed for health benefits cov2 erage made available through an IHP, insofar as such 

3 laws impose restrictions on the variation of premiums 

4 among such coverage offered to members of the IHP. 

5 ‘‘SEC. 3403. DEFINITIONS. 

6 ‘‘For purposes of this title: 

7 ‘‘(1) DEPENDENT.—The term ‘dependent’, as 

8 applied to health insurance coverage offered by a 

9 health insurance issuer licensed (or otherwise regu10 lated) in a State, shall have the meaning applied to 

11 such term with respect to such coverage under the 

12 laws of the State relating to such coverage and such 

13 an issuer. Such term may include the spouse and 

14 children of the individual involved. 

15 ‘‘(2) HEALTH BENEFITS COVERAGE.—The term 

16 ‘health benefits coverage’ has the meaning given the 

17 term ‘health insurance coverage’ in section 

18 2791(b)(1), and does not include excepted benefits 

19 (as defined in section 2791(c)). 

20 ‘‘(3) HEALTH INSURANCE ISSUER.—The term 

21 ‘health insurance issuer’ has the meaning given such 

22 term in section 2791(b)(2). 

23 ‘‘(4) HEALTH STATUS-RELATED FACTOR.—The 

24 term ‘health status-related factor’ has the meaning 

25 given such term in section 2791(d)(9). 


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1 ‘‘(5) MEMBER.—The term ‘member’ means, 

2 with respect to an IHP, an individual or small em3 ployer who is a member of the legal entity described 

4 in section 3401(a)(1) to which the IHP is offering 

5 coverage. 

6 ‘‘(6) SMALL EMPLOYER.—The term ‘small em7 ployer’ has the meaning given such term in section 

8 712(c)(1)(B) of the Employee Retirement and In9 come Security Act of 1974.’’. 

10 SEC. 5. REQUIREMENTS FOR INDIVIDUAL HEALTH INSUR11 ANCE. 

12 (a) IN GENERAL.—Section 2741 of the Public Health 

13 Service Act (42 U.S.C. 300gg–41), as restored and revived 

14 by section 3 of this Act, is amended— 

15 (1) in subsection (a)— 

16 (A) in the heading, by striking ‘‘TO CER17 TAIN INDIVIDUALS WITH PRIOR GROUP COV18 ERAGE’’; 

19 (B) in paragraph (1), by striking ‘‘and sec20 tion 2744’’; 

21 (C) in paragraph (1)(B), by inserting ‘‘un22 less such exclusion complies with paragraph 

23 (2)’’ before the period; and 

24 (D) by striking paragraph (2) and insert25 ing the following new paragraphs: 


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1 ‘‘(2) LIMITATION ON PREEXISTING CONDITION

2 EXCLUSION PERIOD.— 

3 ‘‘(A) LIMITATION.—A health insurance 

4 issuer offering health insurance coverage in the 

5 individual market may not, with respect to an 

6 enrollee in such coverage, impose any pre7 existing condition exclusion if such enrollee has 

8 at least 18 months of continuous creditable cov9 erage (as defined in section 2701(c)(1)) imme10 diately preceding the enrollment date. 

11 ‘‘(B) IMPOSITION OF EXCLUSION.—Not12 withstanding paragraph (1)(B), a health insur13 ance issuer offering health insurance coverage 

14 in the individual market may, with respect to 

15 an enrollee in such coverage who is not de16 scribed in subparagraph (A), impose a pre17 existing condition exclusion only if— 

18 ‘‘(i) such exclusion relates to a condi19 tion (whether physical or mental), regard20 less of the cause of the condition, for which 

21 medical advice, diagnosis, care, or treat22 ment was recommended or received within 

23 the 6-month period ending on the enroll24 ment date; 


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1 ‘‘(ii) such exclusion extends for a pe2 riod of not more than 18 months after the 

3 enrollment date; and 

4 ‘‘(iii) the period of any such pre5 existing condition exclusion is reduced by 

6 the aggregate of the periods of creditable 

7 coverage (if any, as defined in section 

8 2701(c)(1)) applicable to the enrollee as of 

9 the enrollment date. 

10 ‘‘(C) PREMIUM SURCHARGE.—Notwith11 standing paragraph (6), with respect to an en12 rollee described in subparagraph (B), a health 

13 insurance issuer may charge a premium for the 

14 coverage involved that does not exceed 150 per15 cent of the applicable standard rate, for not to 

16 exceed 24 months (or 36 months if the health 

17 insurance issuer does not impose any pre18 existing condition exclusion with respect to such 

19 enrollee), reduced by the aggregate of the peri20 ods of creditable coverage (if any, as defined in 

21 section 2701(c)(1)) applicable to the enrollee as 

22 of the enrollment date. For purposes of this 

23 subsection, the term ‘applicable standard rate’ 

24 means the standard premium rate that the 

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1 spect to an individual described in subpara2 graph (A) with the same rating characteristics 

3 or rating factors as the enrollee described in 

4 subparagraph (B), provided that any variations 

5 in standard premium rates are based on the 

6 uniform application of rating characteristics or 

7 rating factors that are permitted by State law 

8 and are not otherwise prohibited by paragraph 

9 (6). 

10 ‘‘(3) EXCEPTIONS.—Notwithstanding para11 graph (2), and subject to subparagraph (D), a 

12 health insurance issuer offering health insurance 

13 coverage in the individual market, may not impose 

14 any of the following preexisting condition exclusions: 

15 ‘‘(A) EXCLUSION NOT APPLICABLE TO

16 CERTAIN NEWBORNS.—In the case of an indi17 vidual who, as of the last day of the 30-day pe18 riod beginning with the date of birth, is a de19 pendent of an enrollee in such coverage. 

20 ‘‘(B) EXCLUSION NOT APPLICABLE TO

21 CERTAIN ADOPTED CHILDREN.—In the case of 

22 a child who is adopted or placed for adoption 

23 before attaining 18 years of age and who, as of 

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1 tion, is a dependent of an enrollee in such cov2 erage. The previous sentence shall not apply to 

3 coverage before the date of such adoption or 

4 placement for adoption. 

5 ‘‘(C) EXCLUSION NOT APPLICABLE TO

6 PREGNANCY.—Relating to pregnancy as a pre7 existing condition. 

8 ‘‘(D) LOSS IF BREAK IN COVERAGE.—Sub9 paragraphs (A) and (B) shall no longer apply 

10 to an individual after the end of the first 63- 

11 day period during all of which the individual 

12 was not covered under any creditable coverage. 

13 ‘‘(4) OPEN ENROLLMENT PERIODS.—A health 

14 insurance issuer offering health insurance coverage 

15 in the individual market may limit the applicability 

16 of the provisions of paragraph (1) to scheduled open 

17 enrollment periods, provided that— 

18 ‘‘(A) any such open enrollment period shall 

19 not be less than 30 days; 

20 ‘‘(B) any period between scheduled open 

21 enrollment periods shall not exceed 24 months; 

22 and 

23 ‘‘(C) such limitation shall not apply to any 

24 individual who qualifies for a special enrollment 

25 period under paragraph (5). 


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1 ‘‘(5) SPECIAL ENROLLMENT PERIODS.—Subject 

2 to subparagraphs (E) and (F), a health insurance 

3 issuer offering health insurance coverage in the indi4 vidual market shall permit an individual who is an 

5 eligible individual or a dependent to enroll in cov6 erage during a special enrollment period if the indi7 vidual experiences any of the following qualifying 

8 events: 

9 ‘‘(A) FOR DEPENDENT BENEFICIARIES.— 

10 The individual becomes, by reason of marriage, 

11 birth, adoption or placement for adoption, a de12 pendent of an individual enrolled in a plan of13 fered by the health insurance issuer and such 

14 individual otherwise qualifies, under the terms 

15 of the plan, as eligible for coverage as a depend16 ent of such enrollee. 

17 ‘‘(B) LOSS OF GROUP COVERAGE.—The in18 dividual loses coverage under a group health 

19 plan as a result of— 

20 ‘‘(i) loss of eligibility for the coverage 

21 (including as a result of legal separation, 

22 divorce, death, attaining an age at which 

23 eligibility terminates, termination of em24 ployment, or reduction in the number of 

25 hours of employment); or 


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1 ‘‘(ii) termination of the coverage by 

2 the plan sponsor. 

3 ‘‘(C) LOSS OF INDIVIDUAL COVERAGE.— 

4 The individual loses individual market coverage 

5 as a result of— 

6 ‘‘(i) discontinuation of a plan as a re7 sult of a health insurance issuer ceasing to 

8 offer coverage in the individual market in 

9 accordance with section 2742(c)(2) (42 

10 U.S.C. 300gg–42(c)(2)) of this title; 

11 ‘‘(ii) expiration of COBRA, or other, 

12 continuation coverage; 

13 ‘‘(iii) ceasing to qualify, under the 

14 terms of the coverage, as a dependent (in15 cluding as a result of legal separation, di16 vorce, death, or attaining an age at which 

17 eligibility terminates); and 

18 ‘‘(iv) permanently moving outside the 

19 State in which the coverage was issued, or 

20 in the case of a network plan, outside the 

21 plan’s service area. 

22 ‘‘(D) LOSS OF ELIGIBILITY FOR A GOV23 ERNMENT COVERAGE PROGRAM.—The indi24 vidual loses coverage by ceasing to be eligible 

25 for coverage under any of the following: 


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1 ‘‘(i) Part A or part B of title XVIII 

2 of the Social Security Act (42 U.S.C. 

3 1395c et seq.; 1395j et seq.). 

4 ‘‘(ii) Title XIX of the Social Security 

5 Act (42 U.S.C. 1396 et seq.), other than 

6 coverage consisting solely of benefits under 

7 section 1928 (42 U.S.C. 1396s). 

8 ‘‘(iii) Title XXI of the Social Security 

9 Act (42 U.S.C. 1397aa et seq.). 

10 ‘‘(iv) Chapter 55 of title 10. 

11 ‘‘(v) Chapter 89 of title 5. 

12 ‘‘(vi) A State health benefits risk pool. 

13 ‘‘(E) LOSS OF COVERAGE DESCRIBED.— 

14 For purposes of this paragraph, loss of cov15 erage shall not include any of the following: 

16 ‘‘(i) Voluntary termination of coverage 

17 by an individual, except if such termination 

18 is the result of circumstances described in 

19 subparagraph (C)(iv). 

20 ‘‘(ii) Termination of coverage by the 

21 issuer or the plan sponsor of the coverage 

22 for any reason described in paragraph (1) 

23 or (2) of section 2742(b) (300gg–42(b)) of 

24 this title. 


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1 ‘‘(iii) Loss of any coverage that con2 sists solely of coverage of excepted benefits 

3 (as defined in section 300gg–91(c) of this 

4 title). 

5 ‘‘(F) LIMITATION ON SPECIAL ENROLL6 MENT PERIOD.—Any special enrollment period 

7 shall not be less than 60 days and shall begin 

8 on the date of the qualifying event. 

9 ‘‘(6) STANDARD PREMIUM RATES.—With re10 spect to the premium rate charged by a health insur11 ance issuer for health insurance coverage offered in 

12 the individual market, such rate, with respect to the 

13 particular plan or coverage involved, shall not vary 

14 based on any of the following health status-related 

15 factors in relation to an eligible individual or de16 pendent: 

17 ‘‘(A) Health status. 

18 ‘‘(B) Medical condition (including both 

19 physical and mental illnesses). 

20 ‘‘(C) Claims experience. 

21 ‘‘(D) Receipt of health care. 

22 ‘‘(E) Medical history. 

23 ‘‘(F) Genetic information. 


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1 ‘‘(G) Evidence of insurability (including 

2 conditions arising out of acts of domestic vio3 lence). 

4 ‘‘(H) Disability.’’; 

5 (2) by amending subsection (b) to read as fol6 lows: 

7 ‘‘(b) DEFINITIONS.—For purposes of this section: 

8 ‘‘(1) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

9 individual’ means an individual who is eligible under 

10 applicable State law to purchase individual health in11 surance coverage in the State. 

12 ‘‘(2) DEPENDENT.—The term ‘dependent’ 

13 means an individual who, under the terms of the 

14 coverage and applicable State law, qualifies to enroll 

15 in such coverage as a dependent of an individual de16 scribed in paragraph (1).’’; and 

17 (3) by striking subsection (c) and redesignating 

18 subsection (d) and the first subsection (e) as sub19 sections (c) and (d), respectively. 

20 (b) CONFORMING AMENDMENT.—Section 2744 of the 

21 Public Health Service Act (42 U.S.C. 300gg–44), as re22 stored and revived by section 3 of this Act, is repealed. 

23 (c) EFFECTIVE DATE.—Subject to section 1(c), the 

24 amendments made by this section shall apply with respect 


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1 to health insurance coverage offered for plan years begin2 ning on or after the King v. Burwell effective date. 

Æ 


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