I 

113TH CONGRESS 

1ST SESSION H. R. 1076 

To amend the Patient Protection and Affordable Care Act to provide for 

savings to the Federal Government by permitting pass-through funding 

for State authorized public entity health benefits pools. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 12, 2013 

Mr. HALL (for himself and Mr. THORNBERRY) 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 amend the Patient Protection and Affordable Care Act 

to provide for savings to the Federal Government by 

permitting pass-through funding for State authorized 

public entity health benefits pools. 

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

3 SECTION 1. SAVINGS FROM STATE AUTHORIZED PUBLIC 

4 ENTITY HEALTH BENEFITS POOLS. 

5 The Patient Protection and Affordable Care Act 

6 (Public Law 111–148) is amended by inserting after sec7 tion 1332 (42 U.S.C. 18052) the following new section 


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1 (and inserting a corresponding item in the table of con2 tents of the Act): 

3 ‘‘SEC. 1332A. SAVINGS FROM STATE AUTHORIZED PUBLIC 

4 ENTITY BENEFITS POOLS. 

5 ‘‘(a) APPLICATION.— 

6 ‘‘(1) IN GENERAL.—A State authorized public 

7 entity health benefits pool (in this section referred to 

8 as a ‘pool’) may apply to the Secretary for a pass 

9 through of funding described in subsection (b) with 

10 respect to health care benefits provided through that 

11 pool for coverage years beginning on or after Janu12 ary 1, 2014. 

13 ‘‘(2) APPROVAL OF APPLICATION.—The Sec14 retary shall approve such an application of a pool if 

15 the Secretary determines that health care benefits 

16 provided through the pool— 

17 ‘‘(A) will provide coverage that is at least 

18 as comprehensive as the coverage defined in 

19 section 1302(b); 

20 ‘‘(B) will provide coverage and cost sharing 

21 protections against excessive out-of-pocket 

22 spending that are at least as affordable as the 

23 provisions of this title would provide; and 

24 ‘‘(C) will result in cost savings to the Fed25 eral Government because the cost of providing 


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1 health care benefits to individuals through the 

2 pool will be less than the cost of providing 

3 health care benefits to such individuals had 

4 they become participants in a qualified health 

5 plan offered through an Exchange, and so the 

6 payment amount under subsection (b) will be 

7 less than the total of premium tax credits, cost8 sharing reductions, or small business credits 

9 that would otherwise be required if individuals 

10 and small employers in the pool were instead 

11 participants in an Exchange. 

12 ‘‘(3) CONSIDERATION.—Not later than 90 days 

13 after the date of the enactment of this section, the 

14 Secretary shall promulgate regulations relating to 

15 pass through of funding under this section. The Sec16 retary shall begin accepting applications under this 

17 section no later than 180 days after such date of en18 actment. 

19 ‘‘(4) ADDITIONAL CONSEQUENCES OF AP20 PROVAL.—An individual receiving health care bene21 fits through such a pool for which such an applica22 tion is approved under this section shall be treated, 

23 for purposes of section 5000A of the Internal Rev24 enue Code of 1986, as being covered under minVerDate Mar 14 2013 16:07 Mar 14, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1076.IH H1076

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1 imum essential coverage described in subsection 

2 (f)(1)(E) of such section. 

3 ‘‘(b) PASS THROUGH OF FUNDING.— 

4 ‘‘(1) IN GENERAL.—With respect to a pool ap5 plication under subsection (a)(1), under which indi6 viduals and small employers in the pool would not 

7 qualify for the premium tax credits, cost-sharing re8 ductions, or small business credits under sections 

9 36B or 45R of the Internal Revenue Code of 1986 

10 for which they would otherwise be eligible if they 

11 had entered an Exchange, the Secretary shall pro12 vide for an alternative means by which an aggregate 

13 amount determined under paragraph (2) shall be 

14 paid to the pool for purposes of implementing the 

15 application. 

16 ‘‘(2) PAYMENT DETERMINATION.—The amount 

17 to be paid under paragraph (1) shall be deter18 mined— 

19 ‘‘(A) based on the sum of premium tax 

20 credits, cost-sharing reductions, and small busi21 ness credits under sections 36B or 45R of the 

22 Internal Revenue Code of 1986 that would have 

23 been provided with respect to individuals in the 

24 pool had the health care benefits provided by 

25 the pool been a qualified health plan offered in 


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1 an Exchange, but taking into account the lower 

2 cost of providing health care benefits to individ3 uals through the pool; and 

4 ‘‘(B) annually by the Secretary, taking into 

5 consideration the experience of individuals and 

6 small employers participating in Exchanges. 

7 ‘‘(c) TIMELY DETERMINATION BY SECRETARY.—The 

8 Secretary shall make a determination under subsection 

9 (a)(1) with respect to the application of a pool not later 

10 than 180 days after the date of receipt of such application, 

11 and shall notify the pool involved of such determination. 

12 ‘‘(d) DEFINITIONS.—In this section: 

13 ‘‘(1) The term ‘public entity’ means a county, 

14 municipality, special district, school district, junior 

15 college district, housing authority, or other political 

16 subdivision or public entity defined under State law. 

17 ‘‘(2) The term ‘State authorized public entity 

18 health benefits pool’ means a risk pool authorized or 

19 permitted by State statute or otherwise regulated by 

20 a State agency under which— 

21 ‘‘(A) a public entity or group of public en22 tities, directly or through a pool, provide health 

23 care benefits primarily for public entity offi24 cials, employees, and retirees and their depend25 ents; and officials, employees, and retirees and 


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1 dependents of affiliated service contractors of 

2 such public entities; and 

3 ‘‘(B) such pool may provide health care 

4 benefits from the assets of the pool or its mem5 ber public entities through any combination of 

6 self-funded arrangements or fully insured prod7 ucts. 

8 ‘‘(3) The term ‘affiliated service contractor’ 

9 means an organization that provides governmental 

10 or quasi-governmental services on behalf of a public 

11 entity when such contractor is eligible to obtain 

12 health care benefits through a state authorized pub13 lic entity health benefits pool for its officials, em14 ployees, retirees and their dependents.’’. 

Æ 


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