Title: Lower Premiums Through Reinsurance Act of 2017
Policy area: Health

Summary:
Lower Premiums Through Reinsurance Act of 2017
This bill amends the Patient Protection and Affordable Care Act to allow a state to apply for funding for a reinsurance program or high-risk pool program.
Programs must meet specified criteria to receive funding. The bill provides funding for FY2018 and FY2019.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1835 Introduced in Senate (IS)]

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115th CONGRESS
  1st Session
                                S. 1835

 To provide support to States to establish invisible high-risk pool or 
                         reinsurance programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 19, 2017

Ms. Collins (for herself and Mr. Nelson) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To provide support to States to establish invisible high-risk pool or 
                         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 ``Lower Premiums Through Reinsurance 
Act of 2017''.

SEC. 2. INVISIBLE HIGH-RISK POOL AND REINSURANCE PROGRAMS.

    Section 1332 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18052) is amended--
            (1) by adding at the end the following:
    ``(f) High-Risk Pools and Reinsurance Programs.--
            ``(1) In general.--
                    ``(A) Application.--Any State may apply to the 
                Secretary for approval to use the funding described in 
                subparagraph (B) to support an invisible high-risk pool 
                or reinsurance program that is described in paragraph 
                (2). The Secretary shall approve a State application 
                under this subparagraph with respect to any program 
                that--
                            ``(i) meets the requirements of 
                        subparagraph (A), (B), (C), or (D) of paragraph 
                        (2); and
                            ``(ii) meets the requirements of 
                        subparagraphs (A) through (D) of subsection 
                        (b)(1).
                    ``(B) Funding.--If a State application under 
                subparagraph (A) is approved, the State may fund such 
                invisible high-risk pool or reinsurance program using 
                one or both of the following:
                            ``(i) Amounts received through a grant 
                        described in subparagraph (C).
                            ``(ii) With respect to a State that has 
                        received a waiver under this section, all of, 
                        or a portion of, the payments made to the State 
                        as described in subsection (a)(3), consistent 
                        with the information the State provides under 
                        subsection (a)(1)(B)(iii).
                    ``(C) Federal funding for invisible high-risk pool 
                and reinsurance programs.--There are authorized to be 
                appropriated, and there are appropriated, to the 
                Secretary, out of monies in the Treasury not otherwise 
                obligated, $2,250,000,000 for each of fiscal years 2018 
                and 2019, to remain available until expended, for 
                purposes of awarding grants to States to support the 
                establishment or maintenance of invisible high-risk 
                pool and reinsurance programs that meet the 
                requirements of paragraph (2). Any funds provided under 
                this subparagraph shall not be considered in 
                determining under subparagraph (A)(ii) whether the 
                State plan increases the Federal deficit.
            ``(2) Program design.--An invisible high-risk pool or 
        reinsurance program described in this paragraph is a program 
        that meets one of the following requirements:
                    ``(A) An invisible high-risk pool under which 
                health insurance issuers, with respect to designated 
                high-risk individuals enrolled in health insurance 
                coverage offered in the individual market, cede risk to 
                the pool, without affecting the premium paid by the 
                designated individuals or their terms of coverage. With 
                respect to such pool, the State, or an entity operating 
                the pool on behalf of the State, shall establish--
                            ``(i) the premium amount the ceding insurer 
                        shall pay to the reinsurance pool;
                            ``(ii) the applicable attachment points or 
                        coinsurance percentages if the ceding insurer 
                        retains any portion of the risk under ceded 
                        policies; and
                            ``(iii) the mechanism by which high-risk 
                        individuals are designated for cession to the 
                        pool, which may include a risk of designated 
                        high-cost health conditions.
                    ``(B) A reinsurance program that assumes a portion 
                of the risk for high-cost claims within the State in a 
                manner substantially similar to the reinsurance program 
                that operated in the State in accordance with section 
                1341.
                    ``(C) A new reinsurance program established by the 
                State.
                    ``(D) A program based on another State's 
                reinsurance program--
                            ``(i) described in subparagraph (A), (B), 
                        or (C), for which an application has been 
                        approved under this subsection; or
                            ``(ii) which was implemented prior to 
                        September 1, 2017, and which the Secretary 
                        determines meets the requirements of 
                        subparagraph (A).
            ``(3) Expedited approval.--
                    ``(A) In general.--The Secretary shall provide an 
                expedited approval process for an application under 
                paragraph (1)(A)--
                            ``(i) with respect to an invisible high-
                        risk pool or reinsurance program described in 
                        subparagraph (A), (B), or (D) of paragraph (2); 
                        or
                            ``(ii) that uses a template form designed 
                        by the Administrator of the Centers for 
                        Medicare & Medicaid Services, in consultation 
                        with the Secretary of the Treasury, for an 
                        application based on a program that is the same 
                        or substantially the same as a program 
                        implemented in accordance with an application 
                        previously approved under this subsection.
                    ``(B) Timeframe.--The Secretary shall make a 
                determination on an application eligible for expedited 
                review under subparagraph (A) not later than 90 days 
                after receipt of such application.
                    ``(C) Standard of review.--Nothing in this 
                paragraph shall be construed as affecting the 
                requirements under clauses (i) and (ii) of paragraph 
                (1)(A) with respect to an application approved in 
                accordance with the process under subparagraph (A).
            ``(4) Single-risk pool.--An invisible high-risk pool or 
        reinsurance program established in accordance with this 
        subsection shall not be considered a separate risk pool for 
        purposes of section 1312(c).''; and
            (2) in subsection (a)--
                    (A) in paragraph (1)(B)--
                            (i) in clause (i), by striking ``; and'' 
                        and inserting a semicolon; and
                            (ii) by adding at the end the following:
                            ``(iii) in the case of a State applying 
                        under subsection (f) to use any portion of the 
                        payments made to the State under paragraph (3) 
                        to support an invisible high-risk pool or 
                        reinsurance program, consistent with subsection 
                        (f), such information about such program as the 
                        Secretary may require, and the portion of such 
                        payments under paragraph (3) such State intends 
                        to use for such program; and'';
                    (B) in paragraph (3)--
                            (i) by inserting ``full amount of'' before 
                        ``premium tax credits''; and
                            (ii) by inserting before the period of the 
                        first sentence the following: ``, or, in the 
                        case of such a State whose invisible high-risk 
                        pool or reinsurance program is approved under 
                        subsection (f)(1) and that has submitted the 
                        information described in paragraph (1)(B)(iii), 
                        supporting such invisible high-risk pool or 
                        reinsurance program''; and
                    (C) in paragraph (6)(A), by inserting ``and with 
                respect to applications under subsection (f)'' before 
                the semicolon.
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