II 

113TH CONGRESS 

2D SESSION S. 2253 

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

a temporary shift in the scheduled collection of the transitional reinsurance program payments. 

IN THE SENATE OF THE UNITED STATES 

APRIL 10, 2014 

Mr. FRANKEN (for himself, Mr. KIRK, and Ms. KLOBUCHAR) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To amend the Patient Protection and Affordable Care Act 

to provide for a temporary shift in the scheduled collection of the transitional reinsurance program payments. 

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 ‘‘Health Care Fairness 

5 and Stability Act’’. 


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1 SEC. 2. SHIFT IN THE COLLECTION OF THE PAYMENT FOR 

2 THE TRANSITIONAL REINSURANCE PRO3 GRAM. 

4 (a) IN GENERAL.—Section 1341(b) of the Patient 

5 Protection and Affordable Care Act (42 U.S.C. 18061(b)) 

6 is amended— 

7 (1) in paragraph (1)— 

8 (A) in subparagraph (A)— 

9 (i) by inserting ‘‘beginning on Janu10 ary 1, 2018,’’ after ‘‘required to make pay11 ments’’; and 

12 (ii) by striking ‘‘any plan year begin13 ning in the 3-year period’’ and all that fol14 lows through the end and inserting ‘‘pay15 ments made under subparagraph (C) (as 

16 specified in paragraph (3));’’; 

17 (B) in subparagraph (B), by striking ‘‘and 

18 uses’’ and all that follows through the period 

19 and inserting ‘‘; and’’; and 

20 (C) by adding at the end the following: 

21 ‘‘(C) the applicable reinsurance entity 

22 makes reinsurance payments to health insur23 ance issuers described in subparagraph (A) that 

24 cover high risk individuals in the individual 

25 market (excluding grandfathered health plans) 

26 for any plan year beginning in the 3-year period 


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1 beginning January 1, 2014, in an aggregate 

2 amount of up to the total of the aggregate con3 tribution amounts described in paragraph 

4 (3)(B)(iv), subject to paragraph (4).’’; 

5 (2) in paragraph (2), by striking ‘‘paragraph 

6 (1)(B)’’ and inserting ‘‘paragraph (1)(C)’’; 

7 (3) in paragraph (3)— 

8 (A) in subparagraph (A), by striking 

9 ‘‘2014’’ and inserting ‘‘2018’’; and 

10 (B) in subparagraph (B)— 

11 (i) in clause (ii), by striking ‘‘adminis12 trative’’ and inserting ‘‘operational’’; 

13 (ii) by redesignating clauses (iii) and 

14 (iv) as clauses (iv) and (v), respectively; 

15 (iii) by inserting after clause (ii), the 

16 following: 

17 ‘‘(iii) the aggregate contribution 

18 amount for all States shall be based on the 

19 total amount of reinsurance payments 

20 made under paragraph (1)(C);’’; 

21 (iv) by striking clause (iv), as so re22 designated, and inserting the following: 

23 ‘‘(iv) the aggregate contribution 

24 amount collected under clause (iii) shall, 

25 without regard to amounts described in 


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1 clause (ii), be limited to $10,000,000,000 

2 based on the plan years beginning in 2014, 

3 $6,000,000,000 based on the plan years 

4 beginning in 2015, and $4,000,000,000 

5 based on the plan years beginning in 

6 2016;’’; 

7 (v) in clause (v), as so redesignated, 

8 by striking ‘‘clause (iii)’’ each place that 

9 such term appears and inserting ‘‘clause 

10 (iv)’’; and 

11 (vi) by inserting after clause (v), the 

12 following: 

13 ‘‘(vi) in addition to the contribution 

14 amounts under clauses (iii), (iv), and (v), 

15 each issuer’s contribution amount— 

16 ‘‘(I) shall reflect its proportionate 

17 share of an additional $20,300,000 

18 for operational expenses for reinsur19 ance payments for calendar year 2014 

20 and for reinsurance collections for cal21 endar year 2018; 

22 ‘‘(II) shall reflect its propor23 tionate share of operational expenses 

24 for reinsurance payments for calendar 


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1 year 2015 and for reinsurance collec2 tions for calendar year 2019; and 

3 ‘‘(III) shall reflect its propor4 tionate share of operational expenses 

5 for reinsurance payments for calendar 

6 year 2016 and for reinsurance collec7 tions for calendar year 2020; and 

8 ‘‘(vii) collection of the contribution 

9 amounts provided for in clauses (ii) 

10 through (vi) shall be initiated— 

11 ‘‘(I) for calendar year 2014, not 

12 earlier than January 1, 2018; 

13 ‘‘(II) for calendar year 2015, not 

14 earlier than January 1, 2019; and 

15 ‘‘(III) for calendar year 2016, 

16 not earlier than January 1, 2020.’’; 

17 (4) in paragraph (4)— 

18 (A) in subparagraph (A)— 

19 (i) by striking ‘‘contribution amounts 

20 collected for any calendar year’’ and insert21 ing ‘‘amount provided under paragraph (5) 

22 for reinsurance payments described in 

23 paragraph (1)(C)’’; and 

24 (ii) by striking ‘‘; and’’ and inserting 

25 a period; 


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1 (B) by striking subparagraph (B); 

2 (C) by striking ‘‘that—’’ and all that fol3 lows through ‘‘the contribution’’ in subpara4 graph (A) and inserting ‘‘that the contribu5 tion’’; and 

6 (D) in the flush matter at the end, by 

7 striking ‘‘paragraph (3)(B)(iv)’’ and inserting 

8 the following: ‘‘paragraph (3)(B)(v) and any 

9 amounts collected under clause (ii) of para10 graph (3)(B) that, when combined with the 

11 funding provided for under paragraph (5), ex12 ceed the aggregate amount permitted for mak13 ing the reinsurance payments described in para14 graph (1)(C) and to fund the operational ex15 penses of applicable reinsurance entities,’’; and 

16 (5) by adding at the end the following: 

17 ‘‘(5) FUNDING.—To carry out this section, 

18 there is appropriated, out of any money in the 

19 Treasury not otherwise appropriated, an amount 

20 equal to the aggregate amount to be collected for 

21 plan years beginning in 2014 set forth in paragraph 

22 (3)(B)(iv) for reinsurance payments described in 

23 paragraph (1)(C), and an amount equal to the con24 tribution amounts set forth in paragraph (3)(B)(vi) 


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1 to fund operational expenses of applicable reinsur2 ance entities.’’. 

3 (b) RULE OF CONSTRUCTION.—Nothing in the 

4 amendments made by this section shall be construed to 

5 increase the amount of payments to be collected under 

6 subsection (b)(1)(A) or to decrease the amount of the rein7 surance payments to be made under subsection (b)(1)(C) 

8 of section 1341 of the Patient Protection and Affordable 

9 Care Act (42 U.S.C. 18061). 

10 (c) MEDICAL LOSS RATIO.—The Secretary of Health 

11 and Human Services shall promulgate regulations or guid12 ance to ensure that health insurance issuers reflect 

13 changes made in section 1341 of the Patient Protection 

14 and Affordable Care Act with section 2718 of the Public 

15 Health Service Act (42 U.S.C. 300gg–18) and sections 

16 1342 and 1312(c) of the Patient Protection and Afford17 able Care Act (42 U.S.C. 18063 and 18032(c)). 

Æ 


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