I 

116TH CONGRESS 

1ST SESSION H. R. 4652 

To establish an Individual Market Reinsurance fund to provide funding for 

State individual market stabilization reinsurance programs. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 11, 2019 

Mr. LANGEVIN (for himself, Ms. JUDY CHU of California, and Mr. RUIZ) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, 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 establish an Individual Market Reinsurance fund to provide funding for State individual market stabilization 

reinsurance programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Individual Health In5 surance Marketplace Improvement Act’’. 

6 SEC. 2. INDIVIDUAL MARKET REINSURANCE FUND. 

7 (a) ESTABLISHMENT OF FUND.— 


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1 (1) IN GENERAL.—There is established the ‘‘In2 dividual Market Reinsurance Fund’’ to be adminis3 tered by the Secretary to provide funding for an in4 dividual market stabilization reinsurance program in 

5 each State that complies with the requirements of 

6 this section. 

7 (2) FUNDING.—There is appropriated to the 

8 Fund, out of any moneys in the Treasury not other9 wise appropriated, such sums as are necessary to 

10 carry out this section (other than subsection (c)) for 

11 each calendar year beginning with 2020. Amounts 

12 appropriated to the Fund shall remain available 

13 without fiscal or calendar year limitation to carry 

14 out this section. 

15 (b) INDIVIDUAL MARKET REINSURANCE PRO16 GRAM.— 

17 (1) USE OF FUNDS.—The Secretary shall use 

18 amounts in the Fund to establish a reinsurance pro19 gram under which the Secretary shall make reinsur20 ance payments to health insurance issuers with re21 spect to high-cost individuals enrolled in qualified 

22 health plans offered by such issuers that are not 

23 grandfathered health plans or transitional health 

24 plans for any plan year beginning with the 2020 

25 plan year. This subsection constitutes budget auVerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652

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1 thority in advance of appropriations Acts and rep2 resents the obligation of the Secretary to provide 

3 payments from the Fund in accordance with this 

4 subsection. 

5 (2) AMOUNT OF PAYMENT.—The payment 

6 made to a health insurance issuer under subsection 

7 (a) with respect to each high-cost individual enrolled 

8 in a qualified health plan issued by the issuer that 

9 is not a grandfathered health plan or a transitional 

10 health plan shall equal 80 percent of the lesser of— 

11 (A) the amount (if any) by which the indi12 vidual’s claims incurred during the plan year 

13 exceeds— 

14 (i) in case of the 2020, 2021, or 2022 

15 plan year, $50,000; and 

16 (ii) in the case of any other plan year, 

17 $100,000; or 

18 (B) for plan years described in— 

19 (i) subparagraph (A)(i), $450,000; 

20 and 

21 (ii) subparagraph (A)(ii), $400,000. 

22 (3) INDEXING.—In the case of plan years be23 ginning after 2020, the dollar amounts that appear 

24 in subparagraphs (A) and (B) of paragraph (2) shall 

25 each be increased by an amount equal to— 


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1 (A) such amount; multiplied by 

2 (B) the premium adjustment percentage 

3 specified under section 1302(c)(4) of the Af4 fordable Care Act, but determined by sub5 stituting ‘‘2020’’ for ‘‘2013’’. 

6 (4) PAYMENT METHODS.— 

7 (A) IN GENERAL.—Payments under this 

8 subsection shall be based on such a method as 

9 the Secretary determines. The Secretary may 

10 establish a payment method by which interim 

11 payments of amounts under this subsection are 

12 made during a plan year based on the Sec13 retary’s best estimate of amounts that will be 

14 payable after obtaining all of the information. 

15 (B) REQUIREMENT FOR PROVISION OF IN16 FORMATION.— 

17 (i) REQUIREMENT.—Payments under 

18 this subsection to a health insurance issuer 

19 are conditioned upon the furnishing to the 

20 Secretary, in a form and manner specified 

21 by the Secretary, of such information as 

22 may be required to carry out this sub23 section. 

24 (ii) RESTRICTION ON USE OF INFOR25 MATION.—Information disclosed or obVerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652

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1 tained pursuant to clause (i) is subject to 

2 the HIPAA privacy and security law, as 

3 defined in section 3009(a) of the Public 

4 Health Service Act (42 U.S.C. 300jj– 

5 19(a)). 

6 (5) SECRETARY FLEXIBILITY FOR BUDGET

7 NEUTRAL REVISIONS TO REINSURANCE PAYMENT

8 SPECIFICATIONS.—If the Secretary determines ap9 propriate, the Secretary may substitute higher dollar 

10 amounts for the dollar amounts specified under sub11 paragraphs (A) and (B) of paragraph (2) (and ad12 justed under paragraph (3), if applicable) if the Sec13 retary certifies that such substitutions, considered 

14 together, neither increase nor decease the total pro15 jected payments under this subsection. 

16 (c) OUTREACH AND ENROLLMENT.— 

17 (1) IN GENERAL.—During the period that be18 gins on January 1, 2020, and ends on December 31, 

19 2022, the Secretary shall award grants to eligible 

20 entities for the following purposes: 

21 (A) OUTREACH AND ENROLLMENT.—To 

22 carry out outreach, public education activities, 

23 and enrollment activities to raise awareness of 

24 the availability of, and encourage enrollment in, 

25 qualified health plans. 


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1 (B) ASSISTING INDIVIDUALS TRANSITION

2 TO QUALIFIED HEALTH PLANS.—To provide as3 sistance to individuals who are enrolled in 

4 health insurance coverage that is not a qualified 

5 health plan enroll in a qualified health plan. 

6 (C) ASSISTING ENROLLMENT IN PUBLIC

7 HEALTH PROGRAMS.—To facilitate the enroll8 ment of eligible individuals in the Medicare pro9 gram or in a State Medicaid program, as appro10 priate. 

11 (D) RAISING AWARENESS OF PREMIUM AS12 SISTANCE AND COST-SHARING REDUCTIONS.— 

13 To distribute fair and impartial information 

14 concerning enrollment in qualified health plans 

15 and the availability of premium assistance tax 

16 credits under section 36B of the Internal Rev17 enue Code of 1986 and cost-sharing reductions 

18 under section 1402 of the Patient Protection 

19 and Affordable Care Act, and to assist eligible 

20 individuals in applying for such tax credits and 

21 cost-sharing reductions. 

22 (2) ELIGIBLE ENTITIES DEFINED.— 

23 (A) IN GENERAL.—In this subsection, the 

24 term ‘‘eligible entity’’ means— 

25 (i) a State; or 


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1 (ii) a nonprofit community-based or2 ganization. 

3 (B) ENROLLMENT AGENTS.—Such term 

4 includes a licensed independent insurance agent 

5 or broker that has an arrangement with a State 

6 or nonprofit community-based organization to 

7 enroll eligible individuals in qualified health 

8 plans. 

9 (C) EXCLUSIONS.—Such term does not in10 clude an entity that— 

11 (i) is a health insurance issuer; or 

12 (ii) receives any consideration, either 

13 directly or indirectly, from any health in14 surance issuer in connection with the en15 rollment of any qualified individuals or em16 ployees of a qualified employer in a quali17 fied health plan. 

18 (3) PRIORITY.—In awarding grants under this 

19 subsection, the Secretary shall give priority to 

20 awarding grants to States or eligible entities in 

21 States that have geographic rating areas at risk of 

22 having no qualified health plans in the individual 

23 market. 

24 (4) FUNDING.—Out of any moneys in the 

25 Treasury not otherwise appropriated, $500,000,000 


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1 is appropriated to the Secretary for each of calendar 

2 years 2020 through 2022, to carry out this sub3 section. 

4 (d) REPORTS TO CONGRESS.— 

5 (1) ANNUAL REPORT.—The Secretary shall 

6 submit a report to Congress, not later than January 

7 21, 2021, and each year thereafter, that contains 

8 the following information for the most recently 

9 ended year: 

10 (A) The number and types of plans in each 

11 State’s individual market, specifying the num12 ber that are qualified health plans, grand13 fathered health plans, or health insurance cov14 erage that is not a qualified health plan. 

15 (B) The impact of the reinsurance pay16 ments provided under this section on the avail17 ability of coverage, cost of coverage, and cov18 erage options in each State. 

19 (C) The amount of premiums paid by indi20 viduals in each State by age, family size, geo21 graphic area in the State’s individual market, 

22 and category of health plan (as described in 

23 subparagraph (A)). 

24 (D) The process used to award funds for 

25 outreach and enrollment activities awarded to 


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1 eligible entities under subsection (c), the 

2 amount of such funds awarded, and the activi3 ties carried out with such funds. 

4 (E) Such other information as the Sec5 retary deems relevant. 

6 (2) EVALUATION REPORT.—Not later than Jan7 uary 31, 2024, the Secretary shall submit to Con8 gress a report that— 

9 (A) analyzes the impact of the funds pro10 vided under this section on premiums and en11 rollment in the individual market in all States; 

12 and 

13 (B) contains a State-by-State comparison 

14 of the design of the programs carried out by 

15 States with funds provided under this section. 

16 (e) DEFINITIONS.—In this section: 

17 (1) SECRETARY.—The term ‘‘Secretary’’ means 

18 the Secretary of the Department of Health and 

19 Human Services. 

20 (2) FUND.—The term ‘‘Fund’’ means the Indi21 vidual Market Reinsurance Fund established under 

22 subsection (a). 

23 (3) GRANDFATHERED HEALTH PLAN.—The 

24 term ‘‘grandfathered health plan’’ has the meaning 


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1 given that term in section 1251(e) of the Patient 

2 Protection and Affordable Care Act. 

3 (4) HIGH-COST INDIVIDUAL.—The term ‘‘high4 cost individual’’ means an individual enrolled in a 

5 qualified health plan (other than a grandfathered 

6 health plan or a transitional health plan) who incurs 

7 claims in excess of $50,000 during a plan year. 

8 (5) STATE.—The term ‘‘State’’ means each of 

9 the 50 States and the District of Columbia. 

10 (6) TRANSITIONAL HEALTH PLAN.—The term 

11 ‘‘transitional health plan’’ means a plan continued 

12 under the letter issued by the Centers for Medicare 

13 & Medicaid Services on November 14, 2013, to the 

14 State Insurance Commissioners outlining a transi15 tional policy for coverage in the individual and small 

16 group markets to which section 1251 of the Patient 

17 Protection and Affordable Care Act does not apply, 

18 and under the extension of the transitional policy for 

19 such coverage set forth in the Insurance Standards 

20 Bulletin Series guidance issued by the Centers for 

21 Medicare & Medicaid Services on March 5, 2014, 

22 February 29, 2016, and February 13, 2017. 

Æ 


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