Title: Individual Health Insurance Marketplace Improvement Act
Policy area: Health

Summary:
Individual Health Insurance Marketplace Improvement Act
This bill establishes and provides funds for an individual market stabilization reinsurance program to be administered in each state by the Department of Health and Human Services (HHS). Under the program, HHS shall make reinsurance payments to health insurance issuers with respect to high-cost individuals enrolled in certain qualified health plans offered by the issuers.
HHS shall award grants to states or nonprofit community-based organizations to raise awareness of, and encourage enrollment in, qualified health plans.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1354 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 1354

 To establish an Individual Market Reinsurance fund to provide funding 
    for State individual market stabilization reinsurance programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 14, 2017

   Mr. Carper (for himself, Mr. Kaine, Mrs. Shaheen, Mr. Nelson, Ms. 
 Hassan, and Mr. Cardin) introduced the following bill; which was read 
 twice and referred to the Committee on Health, Education, Labor, and 
                                Pensions

_______________________________________________________________________

                                 A BILL


 
 To establish an Individual Market Reinsurance fund to provide funding 
    for State individual market stabilization reinsurance programs.

    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 ``Individual Health Insurance 
Marketplace Improvement Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Before the passage of the Patient Protection and 
        Affordable Care Act (Public Law 114-148) in 2010, Americans 
        with pre-existing conditions faced unfair barriers to accessing 
        health insurance coverage and health care costs had risen 
        rapidly for decades.
            (2) Since 2010, the rate of uninsured Americans has 
        declined to a historic low, with more than 20,000,000 Americans 
        gaining access to health insurance coverage.
            (3) Since 2010, America has experienced the slowest growth 
        in the price of health care in over five decades.
            (4) Thanks to the Patient Protection and Affordable Care 
        Act (Public Law 114-148), Americans can no longer be denied 
        insurance or charged more on the basis of their health status, 
        more Americans than ever have insurance, and the health care 
        they receive is continually improving.
            (5) Starting in 2016, independent, non-partisan 
        organizations, including the Congressional Budget Office, have 
        determined that the individual health insurance markets have 
        stabilized and improved.
            (6) The cost-sharing reduction payments in the Patient 
        Protection and Affordable Care Act provide stability in the 
        individual health insurance market, lower insurance premiums by 
        nearly 20 percent, and encourage competition among health 
        insurers. The payments reduce costs for approximately 6,000,000 
        people with incomes below 250 percent of the poverty line by an 
        average of about $1,100 per person and should be increased to 
        help more Americans.
            (7) Risk mitigation programs, such as the reinsurance 
        program for the Medicare Part D prescription drug benefit 
        program, have provided additional stability to the health 
        insurance markets, restrained premium growth, and lowered 
        taxpayer costs by helping health insurers predict and bear risk 
        associated with managing health care costs for a population.
            (8) From 2014 to 2016, the temporary reinsurance program 
        established under the Affordable Care Act helped to stabilize 
        the new insurance marketplaces and reduced insurance premiums 
        in the individual health insurance market by as much as 10 
        percent.
            (9) Throughout his Presidential campaign, the President of 
        the United States repeatedly promised the American people that 
        his health care plan will result in reduced rates of uninsured, 
        lower costs, and higher quality care, stating on January 14, 
        2017, that ``We're going to have insurance for everybody. There 
        was a philosophy in some circles that if you can't pay for it, 
        you don't get it. That's not going to happen with us''; and on 
        January 25, 2017, that ``I can assure you, we are going to have 
        a better plan, much better health care, much better service 
        treatment, a plan where you can have access to the doctor that 
        you want and the plan that you want. We're gonna have a much 
        better health care plan at much less money''.
            (10) The goal of any health care legislation should be to 
        build on the Affordable Care Act to continue expanding coverage 
        and make health care more affordable for Americans. Improving 
        affordability and expanding coverage will also broaden the 
        individual market risk pool, contributing to lower premiums and 
        strengthening market stability.

SEC. 3. INDIVIDUAL MARKET REINSURANCE FUND.

    (a) Establishment of Fund.--
            (1) In general.--There is established the ``Individual 
        Market Reinsurance Fund'' to be administered by the Secretary 
        to provide funding for an individual market stabilization 
        reinsurance program in each State that complies with the 
        requirements of this section.
            (2) Funding.--There is appropriated to the Fund, out of any 
        moneys in the Treasury not otherwise appropriated, such sums as 
        are necessary to carry out this section (other than subsection 
        (c)) for each calendar year beginning with 2018. Amounts 
        appropriated to the Fund shall remain available without fiscal 
        or calendar year limitation to carry out this section.
    (b) Individual Market Reinsurance Program.--
            (1) Use of funds.--The Secretary shall use amounts in the 
        Fund to establish a reinsurance program under which the 
        Secretary shall make reinsurance payments to health insurance 
        issuers with respect to high-cost individuals enrolled in 
        qualified health plans offered by such issuers that are not 
        grandfathered health plans or transitional health plans for any 
        plan year beginning with the 2018 plan year. This subsection 
        constitutes budget authority in advance of appropriations Acts 
        and represents the obligation of the Secretary to provide 
        payments from the Fund in accordance with this subsection.
            (2) Amount of payment.--The payment made to a health 
        insurance issuer under subsection (a) with respect to each 
        high-cost individual enrolled in a qualified health plan issued 
        by the issuer that is not a grandfathered health plan or a 
        transitional health plan shall equal 80 percent of the lesser 
        of--
                    (A) the amount (if any) by which the individual's 
                claims incurred during the plan year exceeds--
                            (i) in the case of the 2018, 2019, or 2020 
                        plan year, $50,000; and
                            (ii) in the case of any other plan year, 
                        $100,000; or
                    (B) for plan years described in--
                            (i) subparagraph (A)(i), $450,000; and
                            (ii) subparagraph (A)(ii), $400,000.
            (3) Indexing.--In the case of plan years beginning after 
        2018, the dollar amounts that appear in subparagraphs (A) and 
        (B) of paragraph (2) shall each be increased by an amount equal 
        to--
                    (A) such amount; multiplied by
                    (B) the premium adjustment percentage specified 
                under section 1302(c)(4) of the Affordable Care Act, 
                but determined by substituting ``2018'' for ``2013''.
            (4) Payment methods.--
                    (A) In general.--Payments under this subsection 
                shall be based on such a method as the Secretary 
                determines. The Secretary may establish a payment 
                method by which interim payments of amounts under this 
                subsection are made during a plan year based on the 
                Secretary's best estimate of amounts that will be 
                payable after obtaining all of the information.
                    (B) Requirement for provision of information.--
                            (i) Requirement.--Payments under this 
                        subsection to a health insurance issuer are 
                        conditioned upon the furnishing to the 
                        Secretary, in a form and manner specified by 
                        the Secretary, of such information as may be 
                        required to carry out this subsection.
                            (ii) Restriction on use of information.--
                        Information disclosed or obtained pursuant to 
                        clause (i) is subject to the HIPAA privacy and 
                        security law, as defined in section 3009(a) of 
                        the Public Health Service Act (42 U.S.C. 300jj-
                        19(a)).
            (5) Secretary flexibility for budget neutral revisions to 
        reinsurance payment specifications.--If the Secretary 
        determines appropriate, the Secretary may substitute higher 
        dollar amounts for the dollar amounts specified under 
        subparagraphs (A) and (B) of paragraph (2) (and adjusted under 
        paragraph (3), if applicable) if the Secretary certifies that 
        such substitutions, considered together, neither increase nor 
        decease the total projected payments under this subsection.
    (c) Outreach and Enrollment.--
            (1) In general.--During the period that begins on January 
        1, 2018, and ends on December 31, 2020, the Secretary shall 
        award grants to eligible entities for the following purposes:
                    (A) Outreach and enrollment.--To carry out 
                outreach, public education activities, and enrollment 
                activities to raise awareness of the availability of, 
                and encourage enrollment in, qualified health plans.
                    (B) Assisting individuals transition to qualified 
                health plans.--To provide assistance to individuals who 
                are enrolled in health insurance coverage that is not a 
                qualified health plan enroll in a qualified health 
                plan.
                    (C) Assisting enrollment in public health 
                programs.--To facilitate the enrollment of eligible 
                individuals in the Medicare program or in a State 
                Medicaid program, as appropriate.
                    (D) Raising awareness of premium assistance and 
                cost-sharing reductions.--To distribute fair and 
                impartial information concerning enrollment in 
                qualified health plans and the availability of premium 
                assistance tax credits under section 36B of the 
                Internal Revenue Code of 1986 and cost-sharing 
                reductions under section 1402 of the Patient Protection 
                and Affordable Care Act, and to assist eligible 
                individuals in applying for such tax credits and cost-
                sharing reductions.
            (2) Eligible entities defined.--
                    (A) In general.--In this subsection, the term 
                ``eligible entity'' means--
                            (i) a State; or
                            (ii) a nonprofit community-based 
                        organization.
                    (B) Enrollment agents.--Such term includes a 
                licensed independent insurance agent or broker that has 
                an arrangement with a State or nonprofit community-
                based organization to enroll eligible individuals in 
                qualified health plans.
                    (C) Exclusions.--Such term does not include an 
                entity that--
                            (i) is a health insurance issuer; or
                            (ii) receives any consideration, either 
                        directly or indirectly, from any health 
                        insurance issuer in connection with the 
                        enrollment of any qualified individuals or 
                        employees of a qualified employer in a 
                        qualified health plan.
            (3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to awarding grants to States 
        or eligible entities in States that have geographic rating 
        areas at risk of having no qualified health plans in the 
        individual market.
            (4) Funding.--Out of any moneys in the Treasury not 
        otherwise appropriated, $500,000,000 is appropriated to the 
        Secretary for each of calendar years 2018 through 2020, to 
        carry out this subsection.
    (d) Reports to Congress.--
            (1) Annual report.--The Secretary shall submit a report to 
        Congress, not later than January 21, 2019, and each year 
        thereafter, that contains the following information for the 
        most recently ended year:
                    (A) The number and types of plans in each State's 
                individual market, specifying the number that are 
                qualified health plans, grandfathered health plans, or 
                health insurance coverage that is not a qualified 
                health plan.
                    (B) The impact of the reinsurance payments provided 
                under this section on the availability of coverage, 
                cost of coverage, and coverage options in each State.
                    (C) The amount of premiums paid by individuals in 
                each State by age, family size, geographic area in the 
                State's individual market, and category of health plan 
                (as described in subparagraph (A)).
                    (D) The process used to award funds for outreach 
                and enrollment activities awarded to eligible entities 
                under subsection (c), the amount of such funds awarded, 
                and the activities carried out with such funds.
                    (E) Such other information as the Secretary deems 
                relevant.
            (2) Evaluation report.--Not later than January 31, 2022, 
        the Secretary shall submit to Congress a report that--
                    (A) analyzes the impact of the funds provided under 
                this section on premiums and enrollment in the 
                individual market in all States; and
                    (B) contains a State-by-State comparison of the 
                design of the programs carried out by States with funds 
                provided under this section.
    (e) Definitions.--In this section:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of the Department of Health and Human Services.
            (2) Fund.--The term ``Fund'' means the Individual Market 
        Reinsurance Fund established under subsection (a).
            (3) Grandfathered health plan.--The term ``grandfathered 
        health plan'' has the meaning given that term in section 
        1251(e) of the Patient Protection and Affordable Care Act.
            (4) High-cost individual.--The term ``high-cost 
        individual'' means an individual enrolled in a qualified health 
        plan (other than a grandfathered health plan or a transitional 
        health plan) who incurs claims in excess of $50,000 during a 
        plan year.
            (5) State.--The term ``State'' means each of the 50 States 
        and the District of Columbia.
            (6) Transitional health plan.--The term ``transitional 
        health plan'' means a plan continued under the letter issued by 
        the Centers for Medicare & Medicaid Services on November 14, 
        2013, to the State Insurance Commissioners outlining a 
        transitional policy for coverage in the individual and small 
        group markets to which section 1251 of the Patient Protection 
        and Affordable Care Act does not apply, and under the extension 
        of the transitional policy for such coverage set forth in the 
        Insurance Standards Bulletin Series guidance issued by the 
        Centers for Medicare & Medicaid Services on March 5, 2014, 
        February 29, 2016, and February 13, 2017.
                                 <all>