‘‘(B) apply such restrictions to enrollees in 
the Medicare Exchange health plan in the same 
manner and to the same extent the restrictions 
are applied to all other individuals seeking 
care.’’. 
SEC. 4. REINSURANCE. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish a mechanism to pool, on 
a nationwide basis, the costs of the highest-cost patients 
enrolled in individual health insurance coverage (as de-
fined in section 2791 of the Public Health Service Act (42 
U.S.C. 300gg–91)) offered on or off the Exchanges, to the 
extent such costs are not already pooled pursuant to sec-
tion 1343 of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18063), for the purpose of reducing pre-
miums for such individual health insurance coverage. 
(b) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of carrying out paragraph (1), there is authorized 
to be appropriated $10,000,000,000 for each of fiscal 
years 2022, 2023, and 2024. 
SEC. 5. EXPANSION OF TAX CREDIT. 
(a) IN GENERAL.—Subparagraph (A) of section 
36B(c)(1) of the Internal Revenue Code of 1986 is amend-
ed by striking ‘‘but does not exceed 400 percent’’. 
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(b) 
APPLICABLE
PERCENTAGES.—Section 
36B(b)(3)(A) of the Internal Revenue Code of 1986 is 
amended to read as follows: 
‘‘(A) APPLICABLE PERCENTAGE.—The ap-
plicable percentage for any taxable year shall be 
the percentage such that the applicable percent-
age for any taxpayer whose household income is 
within an income tier specified in the following 
table shall increase, on a sliding scale in a lin-
ear manner, from the initial premium percent-
age to the final premium percentage specified in 
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 ..................................................
150 percent up to 200 percent ...............................
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.’’. 
(c) LIMITATION ON RECAPTURE.—Clause (i) of sec-
tion 36B(f)(2)(B) of the Internal Revenue Code of 1986 
is amended— 
(1) by striking ‘‘In the case of a taxpayer’’ and 
all that follows through ‘‘the amount of the in-
crease’’ and inserting ‘‘The amount of the increase’’; 
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(2) by striking the period at the end of the last 
row of the table; and 
(3) by adding at the end of the table the fol-
lowing new row: 
‘‘400 percent and up .......................................................................
$5,000.’’. 
(d) FIXING THE FAMILY GLITCH.— 
(1) 
IN
GENERAL.—Clause 
(i) 
of 
section 
36B(c)(2)(C) of the Internal Revenue Code of 1986 
is amended to read as follows: 
‘‘(i) COVERAGE
MUST
BE
AFFORD-
ABLE.— 
‘‘(I) EMPLOYEES.—An employee 
shall not be treated as eligible for 
minimum essential coverage if such 
coverage consists of an eligible em-
ployer-sponsored plan (as defined in 
section 5000A(f)(2)) and the employ-
ee’s required contribution (within the 
meaning of section 5000A(e)(1)(B)) 
with respect to the plan exceeds 9.5 
percent of the employee’s household 
income. 
‘‘(II) FAMILY MEMBERS.—An in-
dividual who is eligible to enroll in an 
eligible employer-sponsored plan (as 
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defined in section 5000A(f)(2)) by 
reason of a relationship the individual 
bears to the employee shall not be 
treated as eligible for minimum essen-
tial coverage by reason of such eligi-
bility to enroll if the employee’s re-
quired contribution (within the mean-
ing of section 5000A(e)(1)(B), deter-
mined by substituting ‘family’ for 
‘self-only’) with respect to the plan ex-
ceeds 9.5 percent of the employee’s 
household income.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Clause (ii) of section 36B(c)(2)(C) of 
the Internal Revenue Code of 1986 is amended 
by striking ‘‘Except as provided in clause (iii), 
an employee’’ and inserting ‘‘An individual’’. 
(B) Clause (iii) of section 36B(c)(2)(C) of 
such Code is amended by striking ‘‘the last sen-
tence of clause (i)’’ and inserting ‘‘clause 
(i)(II)’’. 
(C) Clause (iv) of section 36B(c)(2)(C) of 
such Code is amended by striking ‘‘the 9.5 per-
cent under clause (i)(II)’’ and inserting ‘‘the 
9.5 percent under clauses (i)(I) and (i)(II)’’. 
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(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2021. 
SEC. 6. AUTHORITY TO NEGOTIATE FAIR PRICES FOR MEDI-
CARE PRESCRIPTION DRUGS. 
(a) IN GENERAL.—Section 1860D–11 of the Social 
Security Act (42 U.S.C. 1395w–111) is amended by strik-
ing subsection (i). 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall take effect on the date of the enactment 
of this Act. 
Æ 
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