SEC. 2. SHIFT IN THE COLLECTION OF THE PAYMENT FOR 
THE 
TRANSITIONAL 
REINSURANCE 
PRO-
GRAM. 
(a) IN GENERAL.—Section 1341(b) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18061(b)) 
is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) by inserting ‘‘beginning on Janu-
ary 1, 2018,’’ after ‘‘required to make pay-
ments’’; and 
(ii) by striking ‘‘any plan year begin-
ning in the 3-year period’’ and all that fol-
lows through the end and inserting ‘‘pay-
ments made under subparagraph (C) (as 
specified in paragraph (3));’’; 
(B) in subparagraph (B), by striking ‘‘and 
uses’’ and all that follows through the period 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(C) the applicable reinsurance entity 
makes reinsurance payments to health insur-
ance issuers described in subparagraph (A) that 
cover high risk individuals in the individual 
market (excluding grandfathered health plans) 
for any plan year beginning in the 3-year period 
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beginning January 1, 2014, in an aggregate 
amount of up to the total of the aggregate con-
tribution amounts described in paragraph 
(3)(B)(iv), subject to paragraph (4).’’; 
(2) in paragraph (2), by striking ‘‘paragraph 
(1)(B)’’ and inserting ‘‘paragraph (1)(C)’’; 
(3) in paragraph (3)— 
(A) in subparagraph (A), by striking 
‘‘2014’’ and inserting ‘‘2018’’; and 
(B) in subparagraph (B)— 
(i) in clause (ii), by striking ‘‘adminis-
trative’’ and inserting ‘‘operational’’; 
(ii) by redesignating clauses (iii) and 
(iv) as clauses (iv) and (v), respectively; 
(iii) by inserting after clause (ii), the 
following: 
‘‘(iii) 
the 
aggregate 
contribution 
amount for all States shall be based on the 
total amount of reinsurance payments 
made under paragraph (1)(C);’’; 
(iv) by striking clause (iv), as so re-
designated, and inserting the following: 
‘‘(iv) 
the 
aggregate 
contribution 
amount collected under clause (iii) shall, 
without regard to amounts described in 
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clause (ii), be limited to $10,000,000,000 
based on the plan years beginning in 2014, 
$6,000,000,000 based on the plan years 
beginning in 2015, and $4,000,000,000 
based on the plan years beginning in 
2016;’’; 
(v) in clause (v), as so redesignated, 
by striking ‘‘clause (iii)’’ each place that 
such term appears and inserting ‘‘clause 
(iv)’’; and 
(vi) by inserting after clause (v), the 
following: 
‘‘(vi) in addition to the contribution 
amounts under clauses (iii), (iv), and (v), 
each issuer’s contribution amount— 
‘‘(I) shall reflect its proportionate 
share of an additional $20,300,000 
for operational expenses for reinsur-
ance payments for calendar year 2014 
and for reinsurance collections for cal-
endar year 2018; 
‘‘(II) shall reflect its propor-
tionate share of operational expenses 
for reinsurance payments for calendar 
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year 2015 and for reinsurance collec-
tions for calendar year 2019; and 
‘‘(III) shall reflect its propor-
tionate share of operational expenses 
for reinsurance payments for calendar 
year 2016 and for reinsurance collec-
tions for calendar year 2020; and 
‘‘(vii) collection of the contribution 
amounts provided for in clauses (ii) 
through (vi) shall be initiated— 
‘‘(I) for calendar year 2014, not 
earlier than January 1, 2018; 
‘‘(II) for calendar year 2015, not 
earlier than January 1, 2019; and 
‘‘(III) for calendar year 2016, 
not earlier than January 1, 2020.’’; 
(4) in paragraph (4)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘contribution amounts 
collected for any calendar year’’ and insert-
ing ‘‘amount provided under paragraph (5) 
for reinsurance payments described in 
paragraph (1)(C)’’; and 
(ii) by striking ‘‘; and’’ and inserting 
a period; 
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(B) by striking subparagraph (B); 
(C) by striking ‘‘that—’’ and all that fol-
lows through ‘‘the contribution’’ in subpara-
graph (A) and inserting ‘‘that the contribu-
tion’’; and 
(D) in the flush matter at the end, by 
striking ‘‘paragraph (3)(B)(iv)’’ and inserting 
the following: ‘‘paragraph (3)(B)(v) and any 
amounts collected under clause (ii) of para-
graph (3)(B) that, when combined with the 
funding provided for under paragraph (5), ex-
ceed the aggregate amount permitted for mak-
ing the reinsurance payments described in para-
graph (1)(C) and to fund the operational ex-
penses of applicable reinsurance entities,’’; and 
(5) by adding at the end the following: 
‘‘(5) FUNDING.—To carry out this section, 
there is appropriated, out of any money in the 
Treasury not otherwise appropriated, an amount 
equal to the aggregate amount to be collected for 
plan years beginning in 2014 set forth in paragraph 
(3)(B)(iv) for reinsurance payments described in 
paragraph (1)(C), and an amount equal to the con-
tribution amounts set forth in paragraph (3)(B)(vi) 
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to fund operational expenses of applicable reinsur-
ance entities.’’. 
(b) RULE
OF
CONSTRUCTION.—Nothing in the 
amendments made by this section shall be construed to 
increase the amount of payments to be collected under 
subsection (b)(1)(A) or to decrease the amount of the rein-
surance payments to be made under subsection (b)(1)(C) 
of section 1341 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18061). 
(c) MEDICAL LOSS RATIO.—The Secretary of Health 
and Human Services shall promulgate regulations or guid-
ance to ensure that health insurance issuers reflect 
changes made in section 1341 of the Patient Protection 
and Affordable Care Act with section 2718 of the Public 
Health Service Act (42 U.S.C. 300gg–18) and sections 
1342 and 1312(c) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18063 and 18032(c)). 
Æ 
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