II 

117TH CONGRESS 

1ST SESSION S. 386 

To establish a public health plan. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 23, 2021 

Mr. BENNET (for himself, Mr. KAINE, Ms. DUCKWORTH, Mr. DURBIN, Mr. 

CARDIN, Ms. STABENOW, Mr. LEAHY, Mr. WARNOCK, Mr. 

HICKENLOOPER, Ms. KLOBUCHAR, Ms. SMITH, Mrs. SHAHEEN, and Mr. 

PETERS) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To establish a public health plan. 

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 ‘‘Medicare-X Choice Act 

5 of 2021’’. 

6 SEC. 2. ESTABLISHMENT AND ADMINISTRATION OF A PUB7 LIC HEALTH PLAN. 

8 The Social Security Act is amended by adding at the 

9 end the following new title: 


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1 ‘‘TITLE XXII—MEDICARE 

2 EXCHANGE HEALTH PLAN 

3 ‘‘SEC. 2201. ESTABLISHMENT. 

4 ‘‘(a) ESTABLISHMENT OF PLAN.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall estab6 lish a coordinated and low-cost health plan, to be 

7 known as the ‘Medicare Exchange health plan’ (re8 ferred to in this section as the ‘health plan’) to pro9 vide access to quality health care for enrollees. 

10 ‘‘(2) TIMEFRAME.— 

11 ‘‘(A) INDIVIDUAL MARKET AVAIL12 ABILITY.— 

13 ‘‘(i) IN GENERAL.—In accordance 

14 with clause (ii), the Secretary shall make 

15 the health plan available in the individual 

16 market, in certain rating areas, for plan 

17 year 2022 and each subsequent plan year, 

18 and increase the availability such that the 

19 plan is available in the individual market 

20 to all residents of all rating areas in the 

21 United States for plan year 2025 and each 

22 subsequent plan year. 

23 ‘‘(ii) PRIORITY AREAS.—In deter24 mining in which rating areas the Secretary 

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1 able, the Secretary shall give priority to 

2 rating areas in which— 

3 ‘‘(I) not more than 1 health in4 surance issuer offers plans on the ap5 plicable State or Federal American 

6 Health Benefit Exchange (referred to 

7 in this title as the ‘Exchange’); or 

8 ‘‘(II) there is a shortage of 

9 health providers or lack of competition 

10 that results in a high cost of health 

11 care services, including health profes12 sional shortage areas and rural areas. 

13 ‘‘(B) SMALL GROUP MARKET.—The Sec14 retary shall make the health plan available in 

15 the small group market in all rating areas for 

16 plan year 2025. 

17 ‘‘(b) ESTABLISHMENT OF FUNDS.— 

18 ‘‘(1) PLAN RESERVE FUND.— 

19 ‘‘(A) IN GENERAL.—There is established in 

20 the Treasury of the United States a ‘Plan Re21 serve Fund’, to be administered by the Sec22 retary of Health and Human Services, for pur23 poses of establishing the Medicare Exchange 

24 health plan and administering such plan, con25 sisting of amounts appropriated to such fund 


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1 during the period of fiscal years 2021 through 

2 2030. 

3 ‘‘(B) APPROPRIATION.—There is appro4 priated $1,000,000,000, out of monies in the 

5 Treasury not otherwise obligated, to the Plan 

6 Reserve Fund for fiscal year 2021, to remain 

7 available until expended. 

8 ‘‘(2) DATA AND TECHNOLOGY FUND.— 

9 ‘‘(A) IN GENERAL.—There is established in 

10 the Treasury of the United States a ‘Data and 

11 Technology Fund’, to be administered by the 

12 Secretary of Health and Human Services, act13 ing through the Chief Actuary of the Centers 

14 for Medicare & Medicaid Services, for purposes 

15 of updating technology and performing data 

16 collection under section 2205 in order to estab17 lish appropriate premiums for all geographic re18 gions of the United States, consisting of 

19 amounts appropriated to such fund during the 

20 period of fiscal years 2021 through 2030. 

21 ‘‘(B) APPROPRIATION.—There is appro22 priated $1,000,000,000, out of amounts in the 

23 Treasury not otherwise appropriated, to the 

24 Data and Technology Fund for fiscal year 

25 2021, to remain available until expended. 


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1 ‘‘(c) RULEMAKING.—Not later than 180 days after 

2 the date of enactment of this Act, the Secretary shall pro3 mulgate such regulations as may be necessary to carry out 

4 this title. Rules promulgated under this subsection shall 

5 be finalized not later than 270 days after the date of en6 actment of this Act. 

7 ‘‘SEC. 2202. AVAILABILITY OF PLAN. 

8 ‘‘(a) ELIGIBILITY.—An individual shall be eligible to 

9 enroll in the health plan if such individual, for the entire 

10 period for which enrollment is sought— 

11 ‘‘(1) is a qualified individual within the mean12 ing of section 1312 of the Patient Protection and 

13 Affordable Care Act (42 U.S.C. 18032); and 

14 ‘‘(2) is not eligible for benefits under the Medi15 care program under title XVIII. 

16 ‘‘(b) EXCHANGES.—In accordance with the time17 frame under section 2201(a)(2), the health plan shall be 

18 made available through the American Health Benefit Ex19 changes described in sections 1311 and 1321 of the Pa20 tient Protection and Affordable Care Act (42 U.S.C. 

21 18031, 18041), including the Small Business Health Op22 tions Program Exchange. 

23 ‘‘SEC. 2203. PLAN REQUIREMENTS. 

24 ‘‘(a) GENERAL REQUIREMENTS.—The health plan 

25 shall comply with all requirements, as applicable, of subVerDate Sep 11 2014 02:57 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S386.IS S386

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1 title D of title I of the Patient Protection and Affordable 

2 Care Act (42 U.S.C. 18021 et seq.) and title XXVII of 

3 the Public Health Service Act (42 U.S.C. 300gg et seq.) 

4 applicable to qualified health plans, and such health plan 

5 shall be a qualified health plan, including for purposes of 

6 the Internal Revenue Code of 1986. 

7 ‘‘(b) LEVELS OF COVERAGE.—The Secretary— 

8 ‘‘(1) shall make available a silver level and gold 

9 level version of the plan, in accordance with section 

10 1301(a)(1)(C)(ii); and 

11 ‘‘(2) may make available no more than 2 

12 versions of the plan for each of the 4 levels of cov13 erage described in subparagraphs (A) through (D) of 

14 section 1302(d)(1) of the Patient Protection and Af15 fordable Care Act (42 U.S.C. 18022(d)(1)). 

16 ‘‘(c) PRIMARY CARE SERVICES.—The health plan 

17 shall provide coverage for primary care services, and shall 

18 not impose any cost-sharing requirements for such serv19 ices. 

20 ‘‘SEC. 2204. ADMINISTRATIVE CONTRACTING. 

21 ‘‘(a) IN GENERAL.—The Secretary may enter into 

22 contracts for the purpose of performing administrative 

23 functions (including functions described in subsection 

24 (a)(4) of section 1874A) with respect to the health plan 

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1 tracts under subsection (a)(1) of such section. The Sec2 retary shall have the same authority with respect to the 

3 public health insurance option as the Secretary has under 

4 such subsection (a)(1) and subsection (b) of section 1874A 

5 with respect to title XVIII. 

6 ‘‘(b) TRANSFER OF INSURANCE RISK.—Any contract 

7 under subsection (a) shall not involve the transfer of in8 surance risk from the Secretary to the entity entering into 

9 such contract with the Secretary, except in the case of an 

10 alternative payment model under section 2209(h). 

11 ‘‘SEC. 2205. DATA COLLECTION. 

12 ‘‘Subject to all applicable privacy requirements, in13 cluding the requirements under the regulations promul14 gated pursuant to section 264(c) of the Health Insurance 

15 Portability and Accountability Act of 1996 (42 U.S.C. 

16 1320d–2 note), the Secretary may collect data from State 

17 insurance commissioners and other relevant entities to es18 tablish rates for premiums and for other purposes includ19 ing to improve quality, and reduce racial, ethnic, socio20 economic, geographic, gender, sexual identity, and other 

21 health disparities, including such disparities experienced 

22 by people with disabilities and older adults, with respect 

23 to the health plan. 

24 ‘‘SEC. 2206. PREMIUMS; RISK POOL. 

25 ‘‘(a) SETTING PREMIUMS.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall estab2 lish premiums for the health plan that cover the full 

3 actuarial cost of offering such plan, including the 

4 administrative costs of offering such plan. Such pre5 miums shall vary geographically and between the 

6 small group market and the individual market in ac7 cordance with differences in the cost of providing 

8 such coverage. If, for any plan year, the amount col9 lected in premiums exceeds the amount required for 

10 health care benefits and administrative costs in that 

11 plan year, such excess amounts shall remain avail12 able to the Secretary to administer the health plan 

13 and finance beneficiary costs in subsequent years. 

14 ‘‘(2) INITIAL PLAN YEAR.—For plan year 2022, 

15 the Secretary shall set premiums for the health plan 

16 for each rating area in which the health plan is 

17 available for such plan year, taking into consider18 ation the premium rates for plans offered in each 

19 such rating area for plan year 2021. 

20 ‘‘(b) RISK POOL.—After plan year 2022, all enrollees 

21 in the health plan within a State shall be members of a 

22 single risk pool, except that the Secretary may establish 

23 separate risk pools for the individual market and small 

24 group market if the State has not exercised its authority 


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1 under section 1312(c)(3) of the Patient Protection and Af2 fordable Care Act. 

3 ‘‘SEC. 2207. REIMBURSEMENT RATES. 

4 ‘‘(a) MEDICARE RATES.— 

5 ‘‘(1) IN GENERAL.—Except as provided in para6 graph (2) and subsections (b) and (c) and subject to 

7 subsection (d), the Secretary shall reimburse health 

8 care providers furnishing items and services under 

9 the health plan at rates determined for equivalent 

10 items and services under the original Medicare fee11 for-service program under parts A and B of title 

12 XVIII. 

13 ‘‘(2) AUTHORITY TO INCREASE PAYMENTS

14 RATES IN RURAL AREAS.—If the Secretary deter15 mines appropriate, the Secretary may increase the 

16 reimbursements rates described in paragraph (1) by 

17 up to 50 percent for items and services furnished in 

18 rural areas (as defined in section 1886(d)(2)(D)). 

19 ‘‘(b) PRESCRIPTION DRUGS.—Subject to subsection 

20 (d), payment rates for prescription drugs shall be at a rate 

21 negotiated by the Secretary. Such negotiations may be in 

22 conjunction with negotiations for covered part D drugs 

23 under part D of title XVIII. 

24 ‘‘(c) ADDITIONAL ITEMS AND SERVICES.—Subject to 

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1 ment rates for any items and services provided under the 

2 health plan that are not items and services provided under 

3 the original Medicare fee-for-service program under parts 

4 A and B of title XVIII. 

5 ‘‘(d) INNOVATIVE PAYMENT METHODS.—The Sec6 retary may utilize innovative payment methods, including 

7 value-based payment arrangements, in making payments 

8 for items and services (including prescription drugs) fur9 nished under the health plan. 

10 ‘‘(e) COMPREHENSIVE STUDY ON COVERING ADDI11 TIONAL SERVICES.— 

12 ‘‘(1) IN GENERAL.—The Secretary, acting 

13 through the Administrator of the Centers for Medi14 care & Medicaid Services, shall conduct a com15 prehensive study, in consultation with stakeholders, 

16 and develop recommendations for Congress on the 

17 need for, and cost of providing coverage for, addi18 tional services under the health plan. 

19 ‘‘(2) CONTENT.—The study shall under para20 graph (1) shall include— 

21 ‘‘(A) consideration of providing coverage 

22 for long-term services and supports, home and 

23 community based services, assistive and ena24 bling technologies, and vision, hearing, and den25 tal services; 


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1 ‘‘(B) consideration of providing coverage 

2 for other services in addition to the services de3 scribed in subparagraph (A) that could most 

4 benefit the health and financial well-being of 

5 beneficiaries, including by reducing health dis6 parities, if included for coverage under the plan; 

7 ‘‘(C) the costs associated with covering ad8 ditional services described in subparagraphs (A) 

9 and (B), for beneficiaries through cost-sharing 

10 and premiums, and for the Federal Govern11 ment; and 

12 ‘‘(D) an assessment of the implications of 

13 covering such additional services for the risk 

14 pool of the health plan and for the individual 

15 and small group markets. 

16 ‘‘(3) SUBMISSION OF REPORT.—Not later than 

17 2 years after the date of enactment of this title, the 

18 Secretary shall submit to Congress a report on the 

19 findings and recommendations of the study under 

20 this subsection and shall make such report publicly 

21 available on the website of the Department of 

22 Health and Human Services. 

23 ‘‘SEC. 2208. PARTICIPATING PROVIDERS. 

24 ‘‘(a) REQUIREMENT TO PARTICIPATE IN ORDER TO

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1 section (d), beginning January 1, 2022, a health care pro2 vider may not be enrolled under the Medicare program 

3 under section 1866(j) unless the provider is also a partici4 pating provider under the health plan. 

5 ‘‘(b) REQUIREMENT TO PARTICIPATE IN ORDER TO

6 PARTICIPATE IN MEDICAID.—Subject to subsection (d), 

7 beginning January 1, 2022, a health care provider may 

8 not be a participating provider under a State Medicaid 

9 plan under title XIX unless the provider is also a partici10 pating provider under the health plan. 

11 ‘‘(c) ADDITIONAL PROVIDERS.—The Secretary shall 

12 establish a process to allow health care providers not de13 scribed in subsection (a) or (b) to become a participating 

14 provider under the health plan. 

15 ‘‘(d) OPT-OUT.—The Secretary shall establish a 

16 process by which a health care provider described in sub17 section (a) or (b) may opt out of being a participating 

18 provider under the health plan, under exceptional cir19 cumstances where participation in the health plan threat20 ens the provider’s ability to operate. 

21 ‘‘SEC. 2209. DELIVERY SYSTEM REFORM FOR AN ENHANCED 

22 HEALTH PLAN. 

23 ‘‘(a) IN GENERAL.—For plan years beginning with 

24 plan year 2022, the Secretary may utilize innovative pay25 ment mechanisms and policies to determine payments for 


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1 items and services under the health plan. The payment 

2 mechanisms and policies under this section may include 

3 patient-centered medical home and other care manage4 ment payments, accountable care organizations, account5 able communities for health, value-based purchasing, bun6 dling of services, differential payment rates, performance 

7 or utilization based payments, telehealth, remote patient 

8 monitoring, partial capitation, and direct contracting with 

9 providers. 

10 ‘‘(b) REQUIREMENTS FOR INNOVATIVE PAYMENTS.— 

11 The Secretary shall design and implement the payment 

12 mechanisms and policies under this section in a manner 

13 that— 

14 ‘‘(1) seeks to— 

15 ‘‘(A) improve health outcomes; 

16 ‘‘(B) reduce health disparities (including 

17 racial, ethnic, socioeconomic, geographic, gen18 der, sexual identity, and other disparities, in19 cluding such disparities experienced by people 

20 with disabilities and older adults); 

21 ‘‘(C) improve coordination to provide more 

22 efficient and affordable quality care; 

23 ‘‘(D) address geographic variation in the 

24 provision of health services; or 

25 ‘‘(E) prevent or manage chronic illness; 


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1 ‘‘(2) promotes care that is integrated, patient2 centered, quality, and efficient; 

3 ‘‘(3) implements patient feedback mechanisms, 

4 including culturally- and disability-competent mecha5 nisms; and 

6 ‘‘(4) uses person-reported experiences to im7 prove service delivery. 

8 ‘‘(c) ENCOURAGING THE USE OF HIGH-VALUE SERV9 ICES.—To the extent allowed by the benefit standards ap10 plied to all health benefits plans participating in the Ex11 changes (as described in section 2202(b)), the health plan 

12 may modify cost-sharing and payment rates to encourage 

13 the use of services that promote health and value. 

14 ‘‘(d) PROMOTION OF DELIVERY SYSTEM REFORM.— 

15 The Secretary shall monitor and evaluate the progress of 

16 payment and delivery system reforms under this section 

17 and shall seek to implement such reforms subject to the 

18 following: 

19 ‘‘(1) To the extent that the Secretary finds a 

20 payment and delivery system reform successful in 

21 improving quality and reducing costs, the Secretary 

22 shall implement such reform on as large a geo23 graphic scale as practical and economical. 

24 ‘‘(2) The Secretary may delay the implementa25 tion of such a reform in geographic areas in which 


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1 such implementation would place the public health 

2 insurance option at a competitive disadvantage. 

3 ‘‘(3) The Secretary may prioritize implementa4 tion of such a reform in high-cost geographic areas 

5 or otherwise in order to reduce total program costs 

6 or to promote high-value care. 

7 ‘‘(4) The Secretary may prioritize implementa8 tion of such a reform to reduce racial, ethnic, socio9 economic, geographic, gender, sexual identity, or 

10 other health disparities, including such disparities 

11 experienced by people with disabilities or older 

12 adults. 

13 ‘‘(e) NON-UNIFORMITY PERMITTED.—Nothing in 

14 this section shall prevent the Secretary from varying pay15 ments based on different payment structure models (such 

16 as accountable care organizations and medical homes) 

17 under the health plan for different geographic areas. 

18 ‘‘(f) INTEGRATION WITH SOCIAL SERVICES.— 

19 ‘‘(1) IN GENERAL.—The Secretary shall estab20 lish processes and, when appropriate, collaborate 

21 with other agencies to integrate medical care under 

22 the health plan with food, housing, transportation, 

23 and income assistance if the Secretary determines 

24 that such integration is expected to— 


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1 ‘‘(A) reduce spending without reducing the 

2 quality of patient care; 

3 ‘‘(B) improve the quality of patient care 

4 without increasing spending; or 

5 ‘‘(C) reduce racial, ethnic, socioeconomic, 

6 geographic, gender, sexual identity, or other 

7 health disparities, including any such disparities 

8 experienced by people with disabilities or older 

9 adults. 

10 ‘‘(2) AUTHORIZATION OF A GRANT PROGRAM.— 

11 ‘‘(A) IN GENERAL.—The Secretary may es12 tablish a grant program to permit broader ex13 perimentation with accountable communities for 

14 health model. 

15 ‘‘(B) ELIGIBLE RECIPIENTS.—The Sec16 retary may award a grant under this section 

17 to— 

18 ‘‘(i) an institution of higher learning 

19 (as defined in section 3452(f) of title 38, 

20 United States Code); 

21 ‘‘(ii) a local educational agency (as de22 fined in section 8101 of the Elementary 

23 and Secondary Education Act of 1965) or 

24 health care agency; 


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1 ‘‘(iii) a nonprofit entity that the Sec2 retary determines has a demonstrated his3 tory of community engagement; or 

4 ‘‘(iv) any other entity, as the Sec5 retary determines appropriate. 

6 ‘‘(C) USE OF FUNDS.—A recipient of a 

7 grant under this section may use the grant to— 

8 ‘‘(i) support community needs assess9 ment; 

10 ‘‘(ii) establish social service partner11 ships; or 

12 ‘‘(iii) establish interactive data sys13 tems across health and social service pro14 viders. 

15 ‘‘(D) AUTHORIZATION OF APPROPRIA16 TIONS.—There are authorized to be appro17 priated such sums as may be necessary to carry 

18 out this paragraph. 

19 ‘‘(3) REGULATIONS.—If the Secretary estab20 lishes a grant program under this section, the Sec21 retary shall promulgate regulations on— 

22 ‘‘(A) the evaluation of applications for 

23 grants under the program; and 

24 ‘‘(B) administration of the program. 


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1 ‘‘(g) TELEHEALTH.—The Secretary shall ensure the 

2 integration of telehealth tools, including technology-en3 abled collaborative learning and capacity building models, 

4 that increase patient access to medical care (including spe5 cialty care), particularly in remote or underserved areas, 

6 if the Secretary determines that such integration is ex7 pected to— 

8 ‘‘(1) reduce spending without reducing the qual9 ity of patient care; or 

10 ‘‘(2) improve the quality of patient care without 

11 increasing spending. 

12 ‘‘(h) ALTERNATIVE PAYMENT MODEL.— 

13 ‘‘(1) IN GENERAL.—The Secretary shall evalu14 ate the possibility of providing incentives, and, if ap15 propriate, apply incentives, for enrollees in the 

16 health plan who receive services from providers who 

17 are participating in an alternative payment model 

18 (as defined in section 1833(z)(3)(C)). 

19 ‘‘(2) AUTHORITY TO USE APMS IN USE UNDER

20 TRADITIONAL MEDICARE.—Nothing in this section 

21 shall preclude the Secretary from using alternative 

22 payment models (as so defined) under this title that 

23 are in use under title XVIII. 


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1 ‘‘SEC. 2210. NO EFFECT ON MEDICARE BENEFITS OR MEDI2 CARE TRUST FUNDS. 

3 ‘‘Nothing in this title shall— 

4 ‘‘(1) affect the benefits available under title 

5 XVIII; or 

6 ‘‘(2) impact the Federal Hospital Insurance 

7 Trust Fund under section 1817 or the Federal Sup8 plementary Medical Insurance Trust Fund under 

9 section 1841 (including the Medicare Prescription 

10 Drug Account within such Trust Fund).’’. 

11 SEC. 3. EXCLUSION OF PROVIDERS THAT PLACE ADDI12 TIONAL RESTRICTIONS ON MEDICARE EX13 CHANGE HEALTH PLAN PATIENTS FROM FED14 ERAL HEALTH CARE PROGRAMS. 

15 Section 1128(b) of the Social Security Act (42 U.S.C. 

16 1320a–7(b)) is amended by adding at the end the fol17 lowing new paragraph: 

18 ‘‘(18) PLACEMENT OF RESTRICTIONS ON MEDI19 CARE EXCHANGE HEALTH PLAN PATIENTS.—Any in20 dividual or entity that places restrictions on the indi21 viduals the individual or provider will accept for 

22 treatment and fails to either— 

23 ‘‘(A) exempt enrollees in the Medicare Ex24 change health plan established under title XXII 

25 from such restrictions; or 


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1 ‘‘(B) apply such restrictions to enrollees in 

2 the Medicare Exchange health plan in the same 

3 manner and to the same extent the restrictions 

4 are applied to all other individuals seeking 

5 care.’’. 

6 SEC. 4. REINSURANCE. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services shall establish a mechanism to pool, on 

9 a nationwide basis, the costs of the highest-cost patients 

10 enrolled in individual health insurance coverage (as de11 fined in section 2791 of the Public Health Service Act (42 

12 U.S.C. 300gg–91)) offered on or off the Exchanges, to the 

13 extent such costs are not already pooled pursuant to sec14 tion 1343 of the Patient Protection and Affordable Care 

15 Act (42 U.S.C. 18063), for the purpose of reducing pre16 miums for such individual health insurance coverage. 

17 (b) AUTHORIZATION OF APPROPRIATIONS.—For pur18 poses of carrying out paragraph (1), there is authorized 

19 to be appropriated $10,000,000,000 for each of fiscal 

20 years 2022, 2023, and 2024. 

21 SEC. 5. EXPANSION OF TAX CREDIT. 

22 (a) IN GENERAL.—Subparagraph (A) of section 

23 36B(c)(1) of the Internal Revenue Code of 1986 is amend24 ed by striking ‘‘but does not exceed 400 percent’’. 


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1 (b) APPLICABLE PERCENTAGES.—Section 

2 36B(b)(3)(A) of the Internal Revenue Code of 1986 is 

3 amended to read as follows: 

4 ‘‘(A) APPLICABLE PERCENTAGE.—The ap5 plicable percentage for any taxable year shall be 

6 the percentage such that the applicable percent7 age for any taxpayer whose household income is 

8 within an income tier specified in the following 

9 table shall increase, on a sliding scale in a lin10 ear manner, from the initial premium percent11 age to the final premium percentage specified in 

12 such table for such income tier: 

‘‘In the case of household income 

(expressed as a percent of poverty line) 

within the following income tier: 

The initial 

premium 

percentage 

is— 

The final 

premium 

percentage 

is— 

Up to 150 percent .................................................. 0 0

150 percent up to 200 percent ............................... 0 2.0

200 percent up to 250 percent ............................... 2.0 4.0

250 percent up to 300 percent ............................... 4.0 6.0

300 percent up to 400 percent ............................... 6.0 8.5

400 percent and up ................................................ 8.5 8.5.’’. 

13 (c) LIMITATION ON RECAPTURE.—Clause (i) of sec14 tion 36B(f)(2)(B) of the Internal Revenue Code of 1986 

15 is amended— 

16 (1) by striking ‘‘In the case of a taxpayer’’ and 

17 all that follows through ‘‘the amount of the in18 crease’’ and inserting ‘‘The amount of the increase’’; 


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1 (2) by striking the period at the end of the last 

2 row of the table; and 

3 (3) by adding at the end of the table the fol4 lowing new row: 

‘‘400 percent and up ....................................................................... $5,000.’’. 

5 (d) FIXING THE FAMILY GLITCH.— 

6 (1) IN GENERAL.—Clause (i) of section 

7 36B(c)(2)(C) of the Internal Revenue Code of 1986 

8 is amended to read as follows: 

9 ‘‘(i) COVERAGE MUST BE AFFORD10 ABLE.— 

11 ‘‘(I) EMPLOYEES.—An employee 

12 shall not be treated as eligible for 

13 minimum essential coverage if such 

14 coverage consists of an eligible em15 ployer-sponsored plan (as defined in 

16 section 5000A(f)(2)) and the employ17 ee’s required contribution (within the 

18 meaning of section 5000A(e)(1)(B)) 

19 with respect to the plan exceeds 9.5 

20 percent of the employee’s household 

21 income. 

22 ‘‘(II) FAMILY MEMBERS.—An in23 dividual who is eligible to enroll in an 

24 eligible employer-sponsored plan (as 


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1 defined in section 5000A(f)(2)) by 

2 reason of a relationship the individual 

3 bears to the employee shall not be 

4 treated as eligible for minimum essen5 tial coverage by reason of such eligi6 bility to enroll if the employee’s re7 quired contribution (within the mean8 ing of section 5000A(e)(1)(B), deter9 mined by substituting ‘family’ for 

10 ‘self-only’) with respect to the plan ex11 ceeds 9.5 percent of the employee’s 

12 household income.’’. 

13 (2) CONFORMING AMENDMENTS.— 

14 (A) Clause (ii) of section 36B(c)(2)(C) of 

15 the Internal Revenue Code of 1986 is amended 

16 by striking ‘‘Except as provided in clause (iii), 

17 an employee’’ and inserting ‘‘An individual’’. 

18 (B) Clause (iii) of section 36B(c)(2)(C) of 

19 such Code is amended by striking ‘‘the last sen20 tence of clause (i)’’ and inserting ‘‘clause 

21 (i)(II)’’. 

22 (C) Clause (iv) of section 36B(c)(2)(C) of 

23 such Code is amended by striking ‘‘the 9.5 per24 cent under clause (i)(II)’’ and inserting ‘‘the 

25 9.5 percent under clauses (i)(I) and (i)(II)’’. 


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1 (e) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to taxable years beginning after 

3 December 31, 2021. 

4 SEC. 6. AUTHORITY TO NEGOTIATE FAIR PRICES FOR MEDI5 CARE PRESCRIPTION DRUGS. 

6 (a) IN GENERAL.—Section 1860D–11 of the Social 

7 Security Act (42 U.S.C. 1395w–111) is amended by strik8 ing subsection (i). 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 this section shall take effect on the date of the enactment 

11 of this Act. 

12 SEC. 7. STRENGTHENING ANTITRUST ENFORCEMENT IN 

13 HEALTH CARE MARKETS. 

14 There are authorized to be appropriated for the pur15 pose of studying healthcare markets, including anti16 competitive practices within those markets, and taking ap17 propriate antitrust enforcement action for each of fiscal 

18 years 2021 through 2025, to remain available until ex19 pended— 

20 (1) $50,000,000 to the Antitrust Division of 

21 the Department of Justice; and 

22 (2) $100,000,000 to the Federal Trade Com23 mission. 


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25 

•S 386 IS

1 SEC. 8. REPORTS. 

2 The Antitrust Division of the Department of Justice 

3 and the Federal Trade Commission shall submit to Con4 gress a report— 

5 (1) not later than the date that is 1 year after 

6 the date of enactment of this Act, detailing the ac7 tivities on which the Antitrust Division or the Com8 mission spent funds authorized under section 7; and 

9 (2) not later than September 30, 2026, that in10 cludes— 

11 (A) the findings of any study conducted by 

12 the Antitrust Division or the Commission on or 

13 after the date of enactment of this Act; 

14 (B) the activities on which the Antitrust 

15 Division or the Commission spent funds author16 ized under section 7; and 

17 (C) the impact of any enforcement action 

18 taken on or after the date of enactment of this 

19 Act by the Antitrust Division or the Commis20 sion on improving consumer access to afford21 able health care. 

Æ 


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