I 
116TH CONGRESS 
1ST SESSION H. R. 4652 
To establish an Individual Market Reinsurance fund to provide funding for 
State individual market stabilization reinsurance programs. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 11, 2019 
Mr. LANGEVIN (for himself, Ms. JUDY CHU of California, and Mr. RUIZ) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on Ways and 
Means, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To establish an Individual Market Reinsurance fund to pro-
vide funding for State individual market stabilization 
reinsurance programs. 
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 ‘‘Individual Health In-
surance Marketplace Improvement Act’’. 
SEC. 2. INDIVIDUAL MARKET REINSURANCE FUND. 
(a) ESTABLISHMENT OF FUND.— 
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(1) IN GENERAL.—There is established the ‘‘In-
dividual Market Reinsurance Fund’’ to be adminis-
tered by the Secretary to provide funding for an in-
dividual market stabilization reinsurance program in 
each State that complies with the requirements of 
this section. 
(2) FUNDING.—There is appropriated to the 
Fund, out of any moneys in the Treasury not other-
wise appropriated, such sums as are necessary to 
carry out this section (other than subsection (c)) for 
each calendar year beginning with 2020. Amounts 
appropriated to the Fund shall remain available 
without fiscal or calendar year limitation to carry 
out this section. 
(b) 
INDIVIDUAL
MARKET
REINSURANCE
PRO-
GRAM.— 
(1) USE OF FUNDS.—The Secretary shall use 
amounts in the Fund to establish a reinsurance pro-
gram under which the Secretary shall make reinsur-
ance payments to health insurance issuers with re-
spect to high-cost individuals enrolled in qualified 
health plans offered by such issuers that are not 
grandfathered health plans or transitional health 
plans for any plan year beginning with the 2020 
plan year. This subsection constitutes budget au-
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thority in advance of appropriations Acts and rep-
resents the obligation of the Secretary to provide 
payments from the Fund in accordance with this 
subsection. 
(2) AMOUNT
OF
PAYMENT.—The payment 
made to a health insurance issuer under subsection 
(a) with respect to each high-cost individual enrolled 
in a qualified health plan issued by the issuer that 
is not a grandfathered health plan or a transitional 
health plan shall equal 80 percent of the lesser of— 
(A) the amount (if any) by which the indi-
vidual’s claims incurred during the plan year 
exceeds— 
(i) in case of the 2020, 2021, or 2022 
plan year, $50,000; and 
(ii) in the case of any other plan year, 
$100,000; or 
(B) for plan years described in— 
(i) subparagraph (A)(i), $450,000; 
and 
(ii) subparagraph (A)(ii), $400,000. 
(3) INDEXING.—In the case of plan years be-
ginning after 2020, the dollar amounts that appear 
in subparagraphs (A) and (B) of paragraph (2) shall 
each be increased by an amount equal to— 
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(A) such amount; multiplied by 
(B) the premium adjustment percentage 
specified under section 1302(c)(4) of the Af-
fordable Care Act, but determined by sub-
stituting ‘‘2020’’ for ‘‘2013’’. 
(4) PAYMENT METHODS.— 
(A) IN
GENERAL.—Payments under this 
subsection shall be based on such a method as 
the Secretary determines. The Secretary may 
establish a payment method by which interim 
payments of amounts under this subsection are 
made during a plan year based on the Sec-
retary’s best estimate of amounts that will be 
payable after obtaining all of the information. 
(B) REQUIREMENT FOR PROVISION OF IN-
FORMATION.— 
(i) REQUIREMENT.—Payments under 
this subsection to a health insurance issuer 
are conditioned upon the furnishing to the 
Secretary, in a form and manner specified 
by the Secretary, of such information as 
may be required to carry out this sub-
section. 
(ii) RESTRICTION ON USE OF INFOR-
MATION.—Information disclosed or ob-
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