Title: To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program.
Policy area: Health

Summary:
This bill requires the Centers for Medicare & Medicaid Services to administer a Federal Invisible Risk Sharing Program that pays health insurers for claims by eligible individuals in order to lower health insurance premiums in the individual market.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7003 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 7003

To amend the Public Health Service Act to establish a health insurance 
                Federal Invisible Risk Sharing Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2018

 Mr. Schweikert (for himself, Mr. Webster of Florida, Mr. Messer, and 
 Mr. Fortenberry) introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to establish a health insurance 
                Federal Invisible Risk Sharing Program.

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

SECTION 1. HEALTH INSURANCE FEDERAL INVISIBLE RISK SHARING PROGRAM.

    The Public Health Service Act is amended by adding at the end the 
following new title:

 ``TITLE XXXIV--HEALTH INSURANCE FEDERAL INVISIBLE RISK SHARING PROGRAM

``SEC. 3401. ESTABLISHMENT OF FEDERAL INVISIBLE RISK SHARING PROGRAM.

    ``(a) In General.--There is established a Federal Invisible Risk 
Sharing Program (in this section referred to as the `Program'), to be 
administered by the Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid Services (in this section referred to 
as the `Administrator'), to provide payments to health insurance 
issuers with respect to claims for eligible individuals for the purpose 
of lowering premiums for health insurance coverage offered in the 
individual market.
    ``(b) Funding.--
            ``(1) Appropriations.--For the purpose of providing funding 
        for the Program there is appropriated, out of any money in the 
        Treasury not otherwise appropriated, $15,000,000,000 for the 
        period beginning on January 1, 2019, and ending on December 31, 
        2028. Such funds shall be available to the Secretary for such 
        purpose in such amounts and at such times during such period as 
        specified by the Secretary.
            ``(2) Additional funding.--In addition to amounts 
        appropriated under paragraph (1), out of any money in the 
        Treasury not otherwise appropriated, there shall be 
        appropriated to the Secretary for each year (after 2019) during 
        the period specified in paragraph (1), for purposes of carrying 
        out the Program, an amount equal to the amount by which the 
        actual sum of the premium assistance credits calculated for all 
        taxpayers under section 36B(a) of the Internal Revenue Code of 
        1986 for the previous year was less than the projected sum of 
        the premium assistance credits calculated for all taxpayers 
        under such section for such previous year. Amounts appropriated 
        pursuant to the previous sentence shall remain available until 
        expended.
            ``(3) Limitation.--Amounts appropriated under this 
        subsection are subject to the requirements and limitations 
        under sections 506 and 507 of division H of Public Law 115-31 
        in the same manner and to the same extent as if such amounts 
        were appropriated under such division.
    ``(c) Operation of Program.--
            ``(1) In general.--The Administrator shall establish, after 
        consultation with health care consumers, health insurance 
        issuers, State insurance commissioners, and other stakeholders 
        and after taking into consideration high cost health conditions 
        and other health trends that generate high cost, parameters for 
        the operation of the Program consistent with this section.
            ``(2) Expediting initial operation.--
                    ``(A) Deadline for initial operation.--Not later 
                than 60 days after the date of the enactment of this 
                title, the Administrator shall establish sufficient 
                parameters to specify how the Program will operate for 
                plan year 2019.
                    ``(B) Secretarial discretion.--To ensure the 
                operation of the Program in plan year 2019, 
                notwithstanding paragraph (1), the Secretary may in 
                lieu of basing eligibility for participation in the 
                Program on the parameters described in paragraphs (1) 
                and (2) of subsection (d) and without consultation 
                described in paragraph (1), base such eligibility on 
                dollar amounts of claims and specify actuarial values 
                to be applied for such amounts.
            ``(3) State operation of program.--
                    ``(A) In general.--The Administrator shall 
                establish a process for a State to operate the Program 
                in such State beginning with plan year 2021.
                    ``(B) Immediate waivers.--Such process shall allow 
                a State that, as of March 1, 2018, had in place a fully 
                established high risk sharing pool or fully established 
                reinsurance program (as defined by the Secretary) to 
                continue to operate such pool or program and not have 
                the Program administered by the Secretary under this 
                section apply to such State.
    ``(d) Details of Program.--The parameters for the Program shall 
include the following:
            ``(1) Eligible individuals.--A definition for eligible 
        individuals.
            ``(2) Standards for qualification.--
                    ``(A) Automatic qualification.--The identification 
                of health conditions that automatically qualify 
                individuals as eligible individuals.
                    ``(B) Voluntary qualification.--A process under 
                which health insurance issuers may voluntarily qualify 
                individuals, who do not automatically qualify under 
                subparagraph (A), as eligible individuals.
            ``(3) Percentage of insurance premiums to be applied.--The 
        percentage of the premiums paid, to health insurance issuers 
        for health insurance coverage by eligible individuals, that 
        shall be collected and deposited to the credit (and available 
        for the use) of the Program.
            ``(4) Attachment dollar amount and payment proportion.--The 
        dollar amount of claims for eligible individuals after which 
        the Program will provide payments to health insurance issuers 
        and the proportion of such claims above such dollar amount that 
        the Program will pay.''.
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