I 
116TH CONGRESS 
1ST SESSION H. R. 2789 
To amend the Public Health Service Act to establish a health insurance 
Federal Invisible Risk Sharing Program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 16, 2019 
Mr. SCHWEIKERT (for himself, Mr. FORTENBERRY, and Mr. WEBSTER of 
Florida) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to establish a health 
insurance Federal Invisible Risk Sharing Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. HEALTH INSURANCE FEDERAL INVISIBLE RISK 
SHARING PROGRAM. 
The Public Health Service Act is amended by adding 
at the end the following new title: 
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‘‘TITLE XXXIV—HEALTH INSUR-
ANCE 
FEDERAL 
INVISIBLE 
RISK SHARING PROGRAM 
‘‘SEC. 3401. ESTABLISHMENT OF FEDERAL INVISIBLE RISK 
SHARING PROGRAM. 
‘‘(a) IN GENERAL.—There is established a Federal 
Invisible Risk Sharing Program (in this section referred 
to as the ‘Program’), to be administered by the Secretary, 
acting through the Administrator of the Centers for Medi-
care & Medicaid Services (in this section referred to as 
the ‘Administrator’), to provide payments to health insur-
ance issuers with respect to claims for eligible individuals 
for the purpose of lowering premiums for health insurance 
coverage offered in the individual market. 
‘‘(b) FUNDING.— 
‘‘(1) APPROPRIATIONS.—For the purpose of 
providing funding for the Program there is appro-
priated, out of any money in the Treasury not other-
wise appropriated, $15,000,000,000 for the period 
beginning on January 1, 2021, and ending on De-
cember 31, 2030. Such funds shall be available to 
the Secretary for such purpose in such amounts and 
at such times during such period as specified by the 
Secretary. 
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‘‘(2) ADDITIONAL
FUNDING.—In addition to 
amounts appropriated under paragraph (1), out of 
any money in the Treasury not otherwise appro-
priated, there shall be appropriated to the Secretary 
for each year (after 2021) during the period speci-
fied in paragraph (1), for purposes of carrying out 
the Program, an amount equal to the amount by 
which the actual sum of the premium assistance 
credits calculated for all taxpayers under section 
36B(a) of the Internal Revenue Code of 1986 for 
the previous year was less than the projected sum of 
the premium assistance credits calculated for all tax-
payers under such section for such previous year. 
Amounts appropriated pursuant to the previous sen-
tence shall remain available until expended. 
‘‘(3) 
LIMITATION.—Amounts 
appropriated 
under this subsection are subject to the require-
ments and limitations under sections 506 and 507 of 
division H of Public Law 115–31 in the same man-
ner and to the same extent as if such amounts were 
appropriated under such division. 
‘‘(c) OPERATION OF PROGRAM.— 
‘‘(1) IN GENERAL.—The Administrator shall es-
tablish, after consultation with health care con-
sumers, health insurance issuers, State insurance 
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commissioners, and other stakeholders, and after 
taking into consideration high-cost health conditions 
and other health trends that generate high cost, pa-
rameters for the operation of the Program consistent 
with this section. 
‘‘(2) EXPEDITING INITIAL OPERATION.— 
‘‘(A) 
DEADLINE
FOR
INITIAL
OPER-
ATION.—Not later than 60 days after the date 
of the enactment of this title, the Administrator 
shall establish sufficient parameters to specify 
how the Program will operate for plan year 
2021. 
‘‘(B) SECRETARIAL DISCRETION.—To en-
sure the operation of the Program in plan year 
2021, notwithstanding paragraph (1), the Sec-
retary may in lieu of basing eligibility for par-
ticipation in the Program on the parameters de-
scribed in paragraphs (1) and (2) of subsection 
(d) and without consultation described in para-
graph (1), base such eligibility on dollar 
amounts of claims and specify actuarial values 
to be applied for such amounts. 
‘‘(3) STATE OPERATION OF PROGRAM.— 
‘‘(A) IN
GENERAL.—The Administrator 
shall establish a process for a State to operate 
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the Program in such State beginning with plan 
year 2023. 
‘‘(B) IMMEDIATE WAIVERS.—Such process 
shall allow a State that, as of March 1, 2020, 
had in place a fully established high risk shar-
ing pool or fully established reinsurance pro-
gram (as defined by the Secretary) to continue 
to operate such pool or program and not have 
the Program administered by the Secretary 
under this section apply to such State. 
‘‘(d) DETAILS OF PROGRAM.—The parameters for 
the Program shall include the following: 
‘‘(1) ELIGIBLE INDIVIDUALS.—A definition for 
eligible individuals. 
‘‘(2) STANDARDS FOR QUALIFICATION.— 
‘‘(A) AUTOMATIC
QUALIFICATION.—The 
identification of health conditions that auto-
matically qualify individuals as eligible individ-
uals. 
‘‘(B) 
VOLUNTARY
QUALIFICATION.—A 
process under which health insurance issuers 
may voluntarily qualify individuals, who do not 
automatically qualify under subparagraph (A), 
as eligible individuals. 
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‘‘(3) PERCENTAGE
OF
INSURANCE
PREMIUMS 
TO BE APPLIED.—The percentage of the premiums 
paid, to health insurance issuers for health insur-
ance coverage by eligible individuals, that shall be 
collected and deposited to the credit (and available 
for the use) of the Program. 
‘‘(4) ATTACHMENT DOLLAR AMOUNT AND PAY-
MENT PROPORTION.—The dollar amount of claims 
for eligible individuals after which the Program will 
provide payments to health insurance issuers and 
the proportion of such claims above such dollar 
amount that the Program will pay.’’. 
Æ 
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