I 
115TH CONGRESS 
2D SESSION 
H. R. 4894 
To amend the Patient Protection and Affordable Care Act to provide 
temporary relief from the annual fee imposed on health insurance providers. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 29, 2018 
Mrs. NOEM introduced the following bill; which was referred to the Committee 
on Energy 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 juris-
diction of the committee concerned 
A BILL 
To amend the Patient Protection and Affordable Care Act 
to provide temporary relief from the annual fee imposed 
on health insurance providers. 
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 ‘‘Harmful Tax Preven-
tion Act’’. 
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SEC. 2. PARTIAL RELIEF FROM ANNUAL FEE ON HEALTH 
INSURANCE PROVIDERS. 
(a) IN GENERAL.—Section 9010 of the Patient Pro-
tection and Affordable Care Act is amended by adding at 
the end the following new subsection: 
‘‘(k) OPTIONAL RELIEF FOR 2018.— 
‘‘(1) IN GENERAL.—In the case of a covered en-
tity that meets the requirements of paragraph (2), 
the fee described in subsection (a)(1) shall be re-
duced by the sum of the premium rebates provided 
pursuant to paragraph (2). 
‘‘(2) REBATES FOR INDIVIDUALS.—A covered 
entity meets the requirements of this paragraph if 
such entity demonstrates to the satisfaction of the 
Secretary of the Treasury (in consultation with the 
Secretary of Health and Human Services, Adminis-
trator of the Centers for Medicare and Medicaid 
Services, and the National Association of Insurance 
Commissioners, as appropriate) that such entity will 
provide— 
‘‘(A) not later than April 30, 2019, to each 
individual enrolled in calendar year 2018 in a 
qualified rebate plan offered by such entity a 
premium rebate equal to the lesser of— 
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tion in premiums owed by an individual for a month 
shall be treated as a premium rebate paid to such 
individual on the first day of such month. 
‘‘(l) MEDICAID MANAGED CARE PLANS REDUCTION 
FOR 2018.—In the case of a medicaid managed care orga-
nization (as defined in section 1903(m)(1)(A) of the Social 
Security Act), the fee described in subsection (a)(1) shall 
be reduced by an amount equal to 2 percent of the net 
premiums written for coverage under a medicaid managed 
care plan (under section 1903(m) or section 1932 of such 
Act) for calendar year 2018.’’. 
(b) MEDICAL LOSS RATIO.—Section 2718 of the 
Public Health Service Act is amended by adding at the 
end the following new subsection: 
‘‘(f) AMOUNTS EXPENDED FOR PREMIUM REBATES 
NOT INCLUDED.—No amount expended pursuant to sub-
sections (k) or (l) of section 9010 of the Patient Protec-
tion and Affordable Care Act shall be taken into account 
for purposes of this section.’’. 
(c) CONFORMING AMENDMENT.—Section 9010(b)(1) 
of the Patient Protection and Affordable Care Act is 
amended by striking ‘‘the fee under this section’’ and in-
serting ‘‘the amount determined under this subsection’’. 
(d) EFFECTIVE DATE.— 
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(1) IN
GENERAL.—Except as otherwise pro-
vided in this subsection, the amendments made by 
this section shall apply with respect to calendar 
years beginning after December 31, 2017. 
(2) MEDICAL
LOSS
RATIO.—The amendment 
made by subsection (b) shall apply with respect to 
plan years beginning after December 31, 2017. 
Æ 
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