Patient Protection and Affordable Care Enhancement Act

To amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market. 1. Short title This Act may be cited as the State Health Care Premium Reduction Act 2. Improve Health Insurance Affordability Fund Subtitle D of title I of the Patient Protection and Affordable Care Act is amended by inserting after part 5 ( 42 U.S.C. 18061 6 Improve Health Insurance Affordability Fund 1351. Establishment of program There is hereby established the Improve Health Insurance Affordability Fund Administrator State 1352. Use of funds (a) In general A State shall use the funds allocated to the State under this part for one of the following purposes: (1) To provide reinsurance payments to health insurance issuers with respect to individuals enrolled under individual health insurance coverage (other than through a plan described in subsection (b)) offered by such issuers. (2) To provide assistance (other than through payments described in paragraph (1)) to reduce out-of-pocket costs, such as copayments, coinsurance, premiums, and deductibles, of individuals enrolled under qualified health plans offered on the individual market through an Exchange. (b) Exclusion of certain grandfathered and transitional plans For purposes of subsection (a), a plan described in this subsection is the following: (1) A grandfathered health plan (as defined in section 1251). (2) A plan (commonly referred to as a transitional plan (3) Student health insurance coverage (as defined in section 147.145 of title 45, Code of Federal Regulations). 1353. State eligibility and approval; Default safeguard (a) Encouraging State options for allocations (1) In general To be eligible for an allocation of funds under this part for a year (beginning with 2020), a State shall submit to the Administrator an application at such time (but, in the case of allocations for 2020, not later than 90 days after the date of the enactment of this part and, in the case of allocations for a subsequent year, not later than March 1 of the previous year) and in such form and manner as specified by the Administrator containing— (A) a description of how the funds will be used; and (B) such other information as the Administrator may require. (2) Automatic approval An application so submitted is approved unless the Administrator notifies the State submitting the application, not later than 60 days after the date of the submission of such application, that the application has been denied for not being in compliance with any requirement of this part and of the reason for such denial. (3) 5 If an application of a State is approved for a purpose described in section 1352 for a year, such application shall be treated as approved for such purpose for each of the subsequent 4 years. (4) Revocation of approval The approval of an application of a State, with respect to a purpose described in section 1352, may be revoked if the State fails to use funds provided to the State under this section for such purpose or otherwise fails to comply with the requirements of this section. (b) Default Federal safeguard (1) 2020 For 2020, in the case of a State that does not submit an application under subsection (a) by the 90-day submission date applicable to such year under subsection (a)(1) and in the case of a State that does submit such an application by such date that is not approved, the Administrator, in consultation with the State insurance commissioner, shall, from the amount calculated under paragraph (4) for such year, carry out the purpose described in paragraph (3) in such State for such year. (2) 2021 For 2021 or a subsequent year, in the case of a State that does not have in effect an approved application under this section for such year, the Administrator, in consultation with the State insurance commissioner, shall, from the amount calculated under paragraph (4) for such year, carry out the purpose described in paragraph (3) in such State for such year. (3) Specified use The amount described in paragraph (4), with respect to 2020 or a subsequent year, shall be used to carry out the purpose described in section 1352(a)(1) in each State described in paragraph (1) or (2) for such year, as applicable, by providing reinsurance payments to health insurance issuers with respect to attachment range claims (as defined in section 1354(b)(2)), using the dollar amounts specified in subparagraph (B) of such section for such year) in an amount equal to, subject to paragraph (5), the percentage (specified for such year by the Secretary under such subparagraph) of the amount of such claims. (4) Amount described The amount described in this paragraph, with respect to 2020 or a subsequent year, is the amount equal to the total sum of amounts that the Secretary would otherwise estimate under section 1354(b)(2)(A)(i) for such year for each State described in paragraph (1) or (2) for such year, as applicable, if each such State were not so described for such year. (5) Adjustment For purposes of this subsection, the Secretary may apply a percentage under paragraph (3) with respect to a year that is less than the percentage otherwise specified in section 1354(b)(2)(B) for such year, if the cost of paying the total eligible attachment range claims for States described in this subsection for such year at such percentage otherwise specified would exceed the amount calculated under paragraph (4) for such year. 1354. Allocations (a) Appropriation For the purpose of providing allocations for States under subsection (b) and payments under section 1353(b) there is appropriated, out of any money in the Treasury not otherwise appropriated, $10,000,000,000 for 2020 and each subsequent year. (b) Allocations (1) Payment (A) In general From amounts appropriated under subsection (a) for a year, the Secretary shall, with respect to a State not described in section 1353(b) for such year and not later than the date specified under subparagraph (B) for such year, allocate for such State the amount determined for such State and year under paragraph (2). (B) Specified date For purposes of subparagraph (A), the date specified in this subparagraph is— (i) for 2020, the date that is 45 days after the date of the enactment of this part; and (ii) for 2021 or a subsequent year, January 1 of the respective year. (C) Notifications of allocation amounts For 2021 and each subsequent year, the Secretary shall notify each State of the amount determined for such State under paragraph (2) for such year by not later than January 1 of the previous year. (2) Allocation amount determinations (A) In general For purposes of paragraph (1), the amount determined under this paragraph for a year for a State described in paragraph (1)(A) for such year is the amount equal to— (i) the amount that the Secretary estimates would be expended under this part for such year on attachment range claims of individuals residing in such State if such State used such funds only for the purpose described in paragraph (1) of section 1352(a) at the dollar amounts and percentage specified under subparagraph (B) for such year; minus (ii) the amount, if any, by which the Secretary determines— (I) the estimated amount of premium tax credits under section 36B (II) the estimated amount of premium tax credits under section 36B For purposes of the previous sentence and section 1353(b)(3), the term attachment range claims (B) Specifications For purposes of subparagraph (A) and section 1353(b)(3), the Secretary shall determine the dollar amounts and the percentage to be specified under this subparagraph for a year in a manner to ensure that the total amount of expenditures under this part for such year is estimated to equal the total amount appropriated for such year under subsection (a) if such expenditures were used solely for the purpose described in paragraph (1) of section 1352(a) for attachment range claims at the dollar amounts and percentage so specified for such year. (3) Availability Funds allocated to a State under this subsection for a year shall remain available through the end of the subsequent year. . March 9, 2020 Reported with an amendment; committed to the Committee of the Whole House on the State of the Union and ordered to be printed

Summary: Patient Protection and Affordable Care Enhancement Act This bill modifies various health insurance programs related to consumer costs for private health insurance plans, Medicaid funding and eligibility, and prescription drug pricing. Specifically, the bill increases the amount and income thresholds for the premium assistance tax credit program and expands access to such tax credit for employees with employer-provided family plans that cost in excess of 9.5% of the employee's household income. Further, the bill provides additional funding for states to establish health insurance exchanges and establishes the Improve Health Insurance Affordability Fund. States must use allocated funds to (1) issue reinsurance payments to health insurers (i.e., reimbursements to protect insurers against exceedingly high claims) for individual health insurance coverage, or (2) provide other assistance to reduce out-of-pocket costs (e.g., copayments, coinsurance, and deductibles) for qualified health plans offered in the individual market through an exchange. The bill also nullifies a rule that expands short-term, limited-duration health insurance plans. Such plans may offer coverage for only a limited amount of time and are exempt from certain coverage requirements. The bill also nullifies guidance that alters how states may satisfy the criteria for approval of State Innovation Waivers from certain health insurance coverage requirements. Additionally, the bill directs the Department of Health and Human Services (HHS) to conduct outreach, education, and reporting activities related to enrollment in plans through health insurance exchanges, particularly in areas with disparities in income or health outcomes. It also establishes and funds grants to states to promote enrollment in health insurance coverage and requires health insurance exchanges to establish network adequacy standards. The bill makes recipients of benefits under the Deferred Action for Childhood Arrivals Program eligible for qualified health plans offered through such exchanges. With respect to Medicaid, the bill increases to 100% the federal share of the cost for states to meet the minimum Medicaid expansion requirements and to cover newly-eligible individuals; the current federal share of such costs is 90%. It also requires states to provide 12 months of continuous coverage to individuals enrolling in Medicaid or the Children's Health Insurance Program (CHIP) and extends postpartum Medicaid and CHIP coverage to 12 months. The bill further reduces federal matching funds for administrative costs and expands reporting requirements for states that have not met specified Medicaid expansion requirements. Additionally, the bill extends through FY2024 the minimum payment requirements for primary care services; permanently extends CHIP funding and eligibility, enrollment, and quality assurance provisions; increases the permissible family income threshold for children whom states may make eligible for Medicaid and CHIP; extends Medicaid coverage to residents of the Freely Associated States (i.e., Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau); and increases the federal medical assistance percentage for services provided through Indian Health Care Services. The bill also establishes the Fair Drug Pricing Program that directs HHS to negotiate with manufacturers to set the price for selected drugs and biological products. HHS must select certain drugs and biological products that are among the most costly based on spending under Medicare and enter a voluntary negotiation with manufacturers to establish a maximum price for each drug or product. The negotiation must consider, among other factors, the cost of research and development of the selected drug or biological product, the cost of production, national sales data, and information about alternative products. The bill establishes an excise tax on manufacturers that do not comply with a negotiated fair price agreement in the amount of specified percentages of the sales of such drug or product. The bill also creates a fund to implement the Fair Drug Pricing Program.