I 
117TH CONGRESS 
1ST SESSION H. R. 1878 
To amend the Patient Protection and Affordable Care Act to establish a 
health insurance affordability fund, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 12, 2021 
Ms. CRAIG (for herself and Mr. PETERS) introduced the following bill; which 
was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Patient Protection and Affordable Care Act 
to establish a health insurance affordability fund, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘State Health Care Pre-
mium Reduction Act of 2021’’. 
SEC. 2. ESTABLISHING A HEALTH INSURANCE AFFORD-
ABILITY FUND. 
(a) IN GENERAL.—Subtitle D of title I of the Patient 
Protection and Affordable Care Act is amended by insert-
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ing after part 5 (42 U.S.C. 18061 et seq.) the following 
new part: 
‘‘PART 6—IMPROVE HEALTH INSURANCE 
AFFORDABILITY FUND 
‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM. 
‘‘There is hereby established the ‘Improve Health In-
surance Affordability Fund’ to be administered by the Sec-
retary of Health and Human Services, acting through the 
Administrator of the Centers for Medicare & Medicaid 
Services (in this section referred to as the ‘Adminis-
trator’), to provide funding, in accordance with this part, 
to the 50 States and the District of Columbia (each re-
ferred to in this section as a ‘State’) beginning on January 
1, 2023, for the purposes described in section 1352. 
‘‘SEC. 1352. USE OF FUNDS. 
‘‘(a) IN GENERAL.—A State shall use the funds allo-
cated 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)) of-
fered by such issuers. 
‘‘(2) To provide assistance (other than through 
payments described in paragraph (1)) to reduce out- 
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of-pocket costs, such as copayments, coinsurance, 
premiums, and deductibles, of individuals enrolled 
under qualified health plans offered on the indi-
vidual market through an Exchange and of individ-
uals enrolled under standard health plans offered 
through a basic health program established under 
section 1331. 
‘‘(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 ‘transi-
tional plan’) continued under the letter issued by the 
Centers for Medicare & Medicaid Services on No-
vember 14, 2013, to the State Insurance Commis-
sioners outlining a transitional policy for coverage in 
the individual and small group markets to which sec-
tion 1251 does not apply, and under the extension 
of the transitional policy for such coverage set forth 
in the Insurance Standards Bulletin Series guidance 
issued by the Centers for Medicare & Medicaid Serv-
ices on March 5, 2014, February 29, 2016, Feb-
ruary 13, 2017, April 9, 2018, March 25, 2019, and 
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January 31, 2020, or under any subsequent exten-
sions thereof. 
‘‘(3) Student health insurance coverage (as de-
fined in section 147.145 of title 45, Code of Federal 
Regulations). 
‘‘SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT 
SAFEGUARD. 
‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA-
TIONS.— 
‘‘(1) IN GENERAL.—To be eligible for an alloca-
tion of funds under this part for a year (beginning 
with 2023), a State shall submit to the Adminis-
trator an application at such time (but, in the case 
of allocations for 2023, 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 con-
taining— 
‘‘(A) a description of how the funds will be 
used; and 
‘‘(B) such other information as the Admin-
istrator may require. 
‘‘(2) AUTOMATIC APPROVAL.—An application so 
submitted is approved unless the Administrator noti-
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