I 
117TH CONGRESS 
1ST SESSION H. R. 5622 
To amend title XXVII of the Public Health Service Act to allow for premium 
rates in the group and individual health insurance markets to vary 
during the COVID–19 emergency period based on COVID–19 vaccination 
status, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 19, 2021 
Mr. GALLEGO introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
the Judiciary, 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 title XXVII of the Public Health Service Act 
to allow for premium rates in the group and individual 
health insurance markets to vary during the COVID– 
19 emergency period based on COVID–19 vaccination 
status, and for other purposes. 
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 ‘‘Vaccine Accountability 
and Premium Protection Act’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) More than 700,000 COVID–19 deaths have 
been reported in the United States and many public 
health experts believe this to be an undercount of 
the actual death toll of the virus. 
(2) There are three vaccines that have received 
either FDA approval or Emergency Use Authoriza-
tion, have undergone rigorous testing, and have been 
proven to be safe and highly effective. 
(3) These vaccines are free and widely available 
in the United States to protect individuals against 
COVID–19. 
(4) Full vaccination has been proven to reduce 
the risk of moderate to severe COVID–19 infection 
by five times and hospitalization and death by more 
than ten times. 
(5) Over 20 percent of Americans eligible to re-
ceive the vaccine remain unvaccinated. 
(6) COVID–19 hospitalizations of unvaccinated 
individuals have cost the U.S. health system an esti-
mated $5.7 billion between June 2021 and August 
2021. 
(7) Some health insurers have proposed or pre-
dicted increases in premium costs due to higher 
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health care costs and higher utilization because of 
COVID–19-related services. 
(8) Evidence shows that the ongoing COVID– 
19 pandemic continues to impact Americans’ phys-
ical and mental health negatively, has increased sub-
stance use and drug overdoses, and has led to hos-
pitals rationing care for non-COVID–19-related 
care. 
(9) The over 20 percent of eligible Americans 
who have not been vaccinated against COVID–19 
are jeopardizing their own health, the health of their 
communities, and the ability of local health systems 
to provide comprehensive, high-quality care to every-
one who needs it. 
(10) The over 20 percent of eligible Americans 
who have not been vaccinated against COVID–19 
are disproportionately responsible for the continu-
ation of community spread of COVID–19 and the 
public health emergency in America, as well as its 
associated economic consequences. 
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SEC. 3. ALLOWING PREMIUM RATES IN GROUP AND INDI-
VIDUAL HEALTH INSURANCE MARKETS TO 
VARY BASED ON COVID–19 VACCINATION STA-
TUS. 
Section 2701(a) of the Public Health Service Act 
(300gg(a)) is amended— 
(1) in paragraph (1)(A)— 
(A) in clause (iii), by striking at the end 
‘‘and’’; 
(B) by adding at the end the following new 
clause: 
‘‘(v) during any portion of the emer-
gency period (as described in section 
1135(g)(1)(B) of the Social Security Act) 
(beginning on or after the date of the en-
actment of this clause), consistent with 
paragraph (6), status as not being fully 
vaccinated (as defined by the Centers for 
Disease 
Control 
and 
Prevention) 
for 
COVID–19, except that such rate shall not 
vary by more than 1.5 to 1; and’’; 
(2) in paragraph (4)— 
(A) in the header, by striking ‘‘OR
TO-
BACCO USE’’ and inserting ‘‘, TOBACCO USE, OR 
VACCINATION STATUS’’; and 
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(B) by striking ‘‘clauses (iii) and (iv)’’ and 
inserting ‘‘clauses (iii), (iv), and (v)’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(6) CONDITIONS FOR VARYING PREMIUMS BY 
VACCINATION
STATUS.—A health insurance issuer 
offering health insurance coverage in the individual 
or small group market (or, if applicable under para-
graph (5), the large group market), may vary the 
premium rate with respect to the particular plan or 
coverage involved by the factor described in para-
graph (1)(A)(v) during any portion of the period de-
scribed in such paragraph only if each of the fol-
lowing conditions are met: 
‘‘(A) An increase pursuant to paragraph 
(1)(A)(v) may be made to the premium rate of 
an enrollee with respect to the particular plan 
or coverage only with respect to months during 
such portion of such period with respect to 
which each of the following applies to the en-
rollee: 
‘‘(i) The enrollee is, based on guide-
lines of the Food and Drug Administration 
and of the Centers for Disease Control and 
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Prevention, eligible for a COVID–19 vac-
cine. 
‘‘(ii) The enrollee is not fully vac-
cinated (as defined by the Centers for Dis-
ease Control and Prevention) for COVID– 
19. 
‘‘(iii) The enrollee is not an individual 
who has not been fully vaccinated by rea-
son of a verified medical condition or an 
objection to the vaccine on the basis of sin-
cerely held religious beliefs. 
‘‘(B) The amount of premium applied with 
respect to an enrollee with respect to the par-
ticular plan or coverage during such portion of 
such period after application of such paragraph 
(1)(A)(v) does not result in a premium rate 
that exceeds an amount equal to 10 percent of 
the enrollee’s household income for such portion 
of such period. 
‘‘(C) The issuer pays to the Secretary of 
the Treasury an amount equal to 25 percent of 
the amount by which— 
‘‘(i) the total premiums charged with 
respect to the particular plan or coverage 
during such portion of such period after 
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application of such paragraph (1)(A)(v); 
exceeds 
‘‘(ii) the total premiums that would 
have been charged with respect to such 
plan or coverage during such portion of 
such period without application of such 
paragraph. 
‘‘(D) The issuer certifies to the Secretary 
of Health and Human Services that the pre-
mium rate applied with respect to enrollees who 
are fully vaccinated (as defined by the Centers 
for Disease Control and Prevention) for 
COVID–19 with respect to the particular plan 
or coverage on vaccinated individuals will not be 
increased during such portion of such period by 
reason of increased costs associated with the 
emergency 
period 
described 
in 
paragraph 
(1)(A)(v). 
‘‘(E) Before applying an increase to the 
premium rate pursuant to paragraph (1)(A)(v), 
the issuer notifies each enrollee with respect to 
the particular plan or coverage who will be sub-
ject to such increase in premium rate and pro-
vides each such enrollee with information on 
where and how to receive a vaccine for COVID– 
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19 without cost to such enrollee for such vac-
cine.’’. 
SEC. 4. SENSE OF CONGRESS RELATED TO THE SERIOUS-
NESS OF PRESENTING, CREATING, OR DIS-
TRIBUTING 
FRAUDULENT 
VACCINATION 
CARDS. 
It is the sense of Congress that— 
(1) any individual falsely representing them-
selves as vaccinated against COVID–19 undermines 
mitigation efforts, endangers public health, and puts 
those around them at increased risk for contracting 
COVID–19; 
(2) the presentation, sale, purchase, or distribu-
tion of counterfeit COVID–19 vaccination cards ap-
pearing to be issued by the Centers for Disease Con-
trol and Prevention or official vaccination cards 
filled out with information falsely indicating that a 
person who has not received the COVID–19 vaccina-
tion is indeed vaccinated is a serious crime in viola-
tion of Federal law; 
(3) an individual guilty of the crime of pre-
senting or purchasing a fraudulent vaccination card 
should, in accordance with law, be subject to a fine 
of not less than $5,000; and 
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(4) an individual or organization guilty of the 
crime of selling or distributing a fraudulent vaccina-
tion card should receive the maximum penalty per-
missible under section 1017 of title 18, United 
States Code, in accordance with the scope of the 
crime. 
Æ 
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