Capping Costs for Consumers Act of 2021
Bill: H.R.4669 | Sponsor: Rep. Schrier, Kim (D-WA)
Policy area: Health

Summary:
Capping Costs for Consumers Act of 2021
This bill expands and provides funding for assistance to certain individuals who enroll in plans through health insurance exchanges.
Specifically, it increases the premium assistance tax credit by revising, from the second-lowest cost silver plan to the second-lowest cost gold plan, the benchmark plan on which the credit amount is based. The bill also requires individuals to enroll in a gold plan to be eligible for cost-sharing reductions and it extends the reductions to individuals with a higher maximum household income.
These changes apply to plan and tax years beginning on or after January 1, 2023.

To expand cost-sharing reductions with respect to qualified health 
       plans offered through an Exchange, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Capping Costs for Consumers Act of 
2021''.

SEC. 2. EXPANDING COST-SHARING REDUCTIONS UNDER EXCHANGE PLANS.

    (a) In General.--Section 1402 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18071) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1), by striking ``who enrolls'' 
                and inserting ``subject to the last sentence of this 
                subsection, who enrolls''; and
                    (B) by adding at the end the following sentence: 
                ``With respect to plan years beginning on or after 
                January 1, 2023, paragraph (1) shall be applied as if 
                the reference to the silver level of coverage were a 
                reference to the gold level of coverage.'';
            (2) in subsection (c)(1)(B)(i)--
                    (A) in subclause (II), by striking ``an eligible 
                insured described in paragraph (2)(B)'' and inserting 
                ``, with respect to plan years beginning before January 
                1, 2023, an eligible insured described in paragraph 
                (2)(B)(i) and, with respect to plan years beginning on 
                or after January 1, 2023, an eligible insured described 
                in paragraph (2)(B)(ii)''; and
                    (B) by amending subclauses (III) and (IV) to read 
                as follows:
                                    ``(III) with respect to plan years 
                                beginning before January 1, 2023--
                                            ``(aa) 73 percent in the 
                                        case of an eligible insured 
                                        whose household income is more 
                                        than 200 percent but not more 
                                        than 250 percent of the poverty 
                                        line for a family of the size 
                                        involved; and
                                            ``(bb) 70 percent in the 
                                        case of an eligible insured 
                                        whose household income is more 
                                        than 250 percent but not more 
                                        than 400 percent of the poverty 
                                        line for a family of the size 
                                        involved; and
                                    ``(IV) with respect to plan years 
                                beginning on or after January 1, 2023, 
                                85 percent in the case of an eligible 
                                insured described in paragraph 
                                (2)(C)(ii).'';
            (3) in subsection (c)(2), by amending subparagraphs (B) and 
        (C) to read as follows:
                    ``(B) in the case of--
                            ``(i) with respect to plan years beginning 
                        before January 1, 2023, an eligible insured 
                        whose household income is more than 150 percent 
                        but not more than 200 percent of the poverty 
                        line for a family of the size involved, 
                        increase the plan's share of the total allowed 
                        costs of benefits provided under the plan to 87 
                        percent of such costs; and
                            ``(ii) with respect to plan years beginning 
                        on or after January 1, 2023, an eligible 
                        insured whose household income is more than 150 
                        percent but not more than 300 percent of the 
                        poverty line for a family of the size involved, 
                        increase the plan's share of the total allowed 
                        costs of benefits provided under the plan to 87 
                        percent of such costs; and
                    ``(C) in the case of--
                            ``(i) with respect to plan years beginning 
                        before January 1, 2023, an eligible insured 
                        whose household income is more than 200 percent 
                        but not more than 250 percent of the poverty 
                        line for a family of the size involved, 
                        increase the plan's share of the total allowed 
                        costs of benefits provided under the plan to 73 
                        percent of such costs; and
                            ``(ii) with respect to plan years beginning 
                        on or after January 1, 2023, an eligible 
                        insured whose household income is more than 300 
                        percent but not more than 400 percent of the 
                        poverty line for a family of the size involved, 
                        increase the plan's share of the total allowed 
                        costs of benefits provided under the plan to 85 
                        percent of such costs.''; and
            (4) by adding at the end the following new subsection:
    ``(h) Funding.--Out of any funds in the Treasury not otherwise 
appropriated, there are appropriated to the Secretary such sums as may 
be necessary for payments under this section.''.
    (b) Conforming Amendments to State Basic Health Programs for 
Certain Low-Income Individuals.--Section 1331(a)(2) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18051(a)(2)) is amended--
            (1) in subparagraph (A)(i), by striking ``the applicable 
        second lowest cost silver plan (as defined in section 
        36B(b)(3)(B) of the Internal Revenue Code of 1986)'' and 
        inserting ``, with respect to plan years beginning before 
        January 1, 2023, the applicable second lowest cost silver plan 
        (as defined in section 36B(b)(3)(B) of the Internal Revenue 
        Code of 1986) and, with respect to plans years beginning on or 
        after January 1, 2023, the applicable second lowest cost gold 
        plan (as defined in such section)''; and
            (2) in the matter following subparagraph (B), by striking 
        ``or the applicable second lowest cost silver plan'' and 
        inserting ``or, with respect to plan years beginning before 
        January 1, 2023, the applicable second lowest cost silver plan 
        (or, with respect to plan years beginning on or after January 
        1, 2023, the applicable second lowest cost gold plan''.

SEC. 3. PREMIUM ASSISTANCE CREDIT AMOUNT DETERMINED USING APPLICABLE 
              SECOND LOWEST COST GOLD PLAN.

    (a) In General.--Section 36B of the Internal Revenue Code of 1986 
is amended--
            (1) by striking ``silver'' each place it appears and 
        inserting ``gold''; and
            (2) in the header of subsection (b)(3)(B), by striking 
        ``silver'' and inserting ``gold''.
    (b) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2022.
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