IB 
Union Calendar No. 334 
116TH CONGRESS 
2D SESSION 
H. R. 1425 
[Report No. 116–414] 
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 insur-
ance market. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 28, 2019 
Ms. CRAIG (for herself and Mr. PETERS) introduced the following bill; which 
was referred to the Committee on Energy and Commerce 
MARCH 9, 2020 
Additional sponsors: Ms. UNDERWOOD, Mr. SCHRADER, Ms. KUSTER of New 
Hampshire, Mr. LIPINSKI, Mr. CARBAJAL, Mr. HECK, Ms. BROWNLEY of 
California, Ms. SCHAKOWSKY, Mr. HIMES, Ms. BLUNT ROCHESTER, Mr. 
CISNEROS, Ms. SCHRIER, Mrs. LEE of Nevada, Mr. LUJA´N, Mr. ALLRED, 
Mr. ROUDA, Ms. HILL of California, Mrs. BUSTOS, Mr. TRONE, Mr. 
BERA, Mr. ROSE of New York, Ms. FINKENAUER, Mr. LARSEN of Wash-
ington, Mr. COSTA, Mrs. DINGELL, Mr. RUIZ, Mr. RUSH, Mr. SCHIFF, 
Mr. PALLONE, Ms. ESHOO, Mr. KENNEDY, Ms. MATSUI, Ms. 
SPANBERGER, Mr. PHILLIPS, Mr. VAN DREW, Mr. CASE, Ms. CLARKE 
of New York, Mr. BRINDISI, Mr. NEGUSE, Ms. MCCOLLUM, Mr. 
MCADAMS, Ms. MOORE, Mr. KILMER, Ms. STEVENS, Ms. MUCARSEL- 
POWELL, Mr. TONKO, Ms. KELLY of Illinois, Ms. BARRAGA´N, Mr. 
CA´RDENAS, Mr. WELCH, Mr. RASKIN, Ms. LOFGREN, Ms. DAVIDS of 
Kansas, Mrs. LURIA, Mr. FORTENBERRY, Mrs. KIRKPATRICK, Miss RICE 
of New York, Ms. WEXTON, Ms. SPEIER, and Mr. CONNOLLY 
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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 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on February 28, 2019] 
A BILL 
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 mar-
ket. 
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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’’. 
SEC. 2. IMPROVE HEALTH INSURANCE AFFORDABILITY 
FUND. 
Subtitle D of title I of the Patient Protection and Af-
fordable Care Act is amended by inserting 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 Serv-
ices (in this section referred to as the ‘Administrator’), to 
provide funding, in accordance with this part, to the 50 
States and the District of Columbia (each referred to in 
this section as a ‘State’) beginning on January 1, 2020, 
for the purposes described in section 1352. 
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‘‘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- 
of-pocket costs, such as copayments, coinsurance, pre-
miums, and deductibles, of individuals enrolled under 
qualified health plans offered on the individual mar-
ket 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 ‘transi-
tional plan’) continued under the letter issued by the 
Centers for Medicare & Medicaid Services on Novem-
ber 14, 2013, to the State Insurance Commissioners 
outlining a transitional policy for coverage in the in-
dividual and small group markets to which section 
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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 Services on 
March 5, 2014, February 29, 2016, February 13, 
2017, April 9, 2018, and March 25, 2019, or under 
any subsequent extensions 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 2020), a State shall submit to the Administrator 
an application at such time (but, in the case of allo-
cations for 2020, not later than 90 days after the date 
of the enactment of this part and, in the case of allo-
cations 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 
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‘‘(B) such other information as the Admin-
istrator may require. 
‘‘(2) AUTOMATIC APPROVAL.—An application so 
submitted is approved unless the Administrator noti-
fies 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-YEAR APPLICATION APPROVAL.—If an ap-
plication of a State is approved for a purpose de-
scribed 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 pur-
pose 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 com-
ply 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 
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that does submit such an application by such date 
that is not approved, the Administrator, in consulta-
tion with the State insurance commissioner, shall, 
from the amount calculated under paragraph (4) for 
such year, carry out the purpose described in para-
graph (3) in such State for such year. 
‘‘(2) 2021 AND SUBSEQUENT YEARS.—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 consulta-
tion with the State insurance commissioner, shall, 
from the amount calculated under paragraph (4) for 
such year, carry out the purpose described in para-
graph (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 para-
graph (1) or (2) for such year, as applicable, by pro-
viding 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 sec-
tion for such year) in an amount equal to, subject to 
paragraph (5), the percentage (specified for such year 
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by the Secretary under such subparagraph) of the 
amount of such claims. 
‘‘(4) AMOUNT
DESCRIBED.—The amount de-
scribed 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 esti-
mate 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 de-
scribed for such year. 
‘‘(5) ADJUSTMENT.—For purposes of this sub-
section, 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 de-
scribed in this subsection for such year at such per-
centage otherwise specified would exceed the amount 
calculated under paragraph (4) for such year. 
‘‘SEC. 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. 
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‘‘(A) IN GENERAL.—For purposes of para-
graph (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 esti-
mates 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 percent-
age specified under subparagraph (B) for 
such year; minus 
‘‘(ii) the amount, if any, by which the 
Secretary determines— 
‘‘(I) the estimated amount of pre-
mium tax credits under section 36B of 
the Internal Revenue Code of 1986 that 
would be attributable to individuals re-
siding in such State for such year 
without application of this part; ex-
ceeds 
‘‘(II) the estimated amount of pre-
mium tax credits under section 36B of 
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the Internal Revenue Code of 1986 that 
would be attributable to individuals re-
siding in such State for such year if 
such State were a State described in 
section 1353(b) for such year. 
For purposes of the previous sentence and section 
1353(b)(3), the term ‘attachment range claims’ 
means, with respect to an individual, the claims 
for such individual that exceed a dollar amount 
specified by the Secretary for a year, but do not 
exceed a ceiling dollar amount specified by the 
Secretary for such year, under subparagraph 
(B). 
‘‘(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 sub-
paragraph 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 sub-
section (a) if such expenditures were used solely 
for the purpose described in paragraph (1) of 
section 1352(a) for attachment range claims at 
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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 avail-
able through the end of the subsequent year.’’. 
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Union Calendar No. 334 
116TH CONGRESS 
2D SESSION 
H. R. 1425 
[Report No. 116–414] 
A BILL 
To amend the Patient Protection and Affordable 
Care Act to provide for a Improve Health Insur-
ance Affordability Fund to provide for certain re-
insurance payments to lower premiums in the in-
dividual health insurance market. 
MARCH 9, 2020 
Reported with an amendment; committed to the Com-
mittee of the Whole House on the State of the Union 
and ordered to be printed 
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