Title: Bipartisan Market Stabilization and Innovation Act of 2017
Policy area: Health

Summary:
Bipartisan Market Stabilization and Innovation Act of 2017
This bill makes a series of changes relating to health insurance coverage and costs. Among other things, the bill establishes a specific fund to support state initiatives that reduce costs and terminates the medical device excise tax.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4695 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 4695

To amend the Patient Protection and Affordable Care Act to provide for 
stabilization in the individual health insurance market, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 20, 2017

  Mr. Schrader (for himself, Mr. Reed, Mr. Gottheimer, Mr. Lance, Mr. 
Bera, Mr. Trott, Mrs. Murphy of Florida, Mr. Thompson of Pennsylvania, 
Mr. O'Halleran, Mr. Costello of Pennsylvania, Mr. Suozzi, Mr. Dent, Mr. 
Panetta, Mr. Curbelo of Florida, Ms. Sinema, Mr. Fitzpatrick, Mr. Soto, 
Mr. Katko, Mr. Lipinski, Mr. Faso, Ms. Esty of Connecticut, Mr. Costa, 
  Mr. Nolan, Mr. Schneider, Mr. Peters, and Mr. Welch) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend the Patient Protection and Affordable Care Act to provide for 
stabilization in the individual health insurance market, 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 ``Bipartisan Market Stabilization and 
Innovation Act of 2017''.

SEC. 2. FUNDING FOR PPACA EXCHANGE PLANS COST-SHARING REDUCTIONS.

    Section 1402 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18071) is amended by adding at the end the following new 
subsection:
    ``(g) Funding.--
            ``(1) In general.--Out of any funds in the Treasury not 
        otherwise appropriated, there is appropriated such sums as may 
        be necessary for payments under this section, including through 
        advance payment under section 1412(c)(3). Funds appropriated 
        under this paragraph shall remain available for obligation 
        until expended.
            ``(2) Reports.--The Secretary shall for 2017 and each 
        subsequent year submit to the Committee on Energy and Commerce, 
        the Committee on Ways and Means, and the Committee on 
        Appropriations of the House of Representatives and the 
        Committee on Finance, the Committee on Health, Education, 
        Labor, and Pensions, and the Committee on Appropriations of the 
        Senate an annual report on--
                    ``(A) the amount of payments made under this 
                section with respect to such year;
                    ``(B) the effects of such payments on the costs of 
                health insurance in the individual market; and
                    ``(C) the projected costs of health insurance in 
                the individual market over the subsequent year.''.

SEC. 3. PATIENT AND STATE STABILITY FUND.

    The Social Security Act (42 U.S.C. 301 et seq.) is amended by 
adding at the end the following new title:

             ``TITLE XXII--PATIENT AND STATE STABILITY FUND

``SEC. 2201. ESTABLISHMENT OF PROGRAM.

    ``There is hereby established the `Patient and State Stability 
Fund' to be administered by the Secretary of Health and Human Services, 
acting through the Administrator of the Centers for Medicare & Medicaid 
Services (in this section referred to as the `Administrator'), to 
provide funding, in accordance with this title, to the 50 States and 
the District of Columbia (each referred to in this section as a 
`State') during the period, subject to section 2204(c), beginning on 
January 1, 2019, and ending on December 31, 2028, for the purposes 
described in section 2202.

``SEC. 2202. USE OF FUNDS.

    ``A State may use the funds allocated to the State under this title 
for any of the following purposes:
            ``(1) Helping, through the provision of financial 
        assistance, high-risk individuals who do not have access to 
        health insurance coverage offered through an employer enroll in 
        health insurance coverage.
            ``(2) Providing incentives to appropriate entities to enter 
        into arrangements with the State to help stabilize premiums for 
        health insurance coverage in the individual market, as such 
        markets are defined by the State.
            ``(3) Reducing the cost for providing health insurance 
        coverage in the individual market and small group market to 
        individuals who have, or are projected to have, a high rate of 
        utilization of health services (as measured by cost) and to 
        individuals who have high costs of health insurance coverage 
        due to the low density population of the State in which they 
        reside.
            ``(4) Promoting participation in the individual market and 
        small group market in the State and increasing health insurance 
        options available through such market.
            ``(5) Providing assistance to reduce out-of-pocket costs, 
        such as copayments, coinsurance, premiums, and deductibles, of 
        individuals enrolled in health insurance coverage in the State.

``SEC. 2203. STATE ELIGIBILITY AND APPROVAL; DEFAULT SAFEGUARD.

    ``(a) Encouraging State Options for Allocations.--
            ``(1) In general.--To be eligible for an allocation of 
        funds under this title for a year during the period described 
        in section 2201 for use for one or more purposes described in 
        section 2202, a State shall submit to the Administrator an 
        application at such time (not later than March 31 of the 
        previous year) and in such form and manner as specified by the 
        Administrator and containing--
                    ``(A) a description of how the funds will be used 
                for such purposes;
                    ``(B) a certification that the State will make, 
                from non-Federal funds, expenditures for such purposes 
                in an amount that is not less than the State percentage 
                required for the year under section 2204(e)(1); and
                    ``(C) such other information as the Administrator 
                may require.
            ``(2) Administrator determination timeline.--
                    ``(A) In general.--The Administrator shall make a 
                determination as to the approval or disapproval of an 
                application not later than 90 days after the receipt of 
                such application.
                    ``(B)  Expedited determination.--The Administrator 
                shall make a determination as to the approval or 
                disapproval of an application not later than 45 days 
                after the receipt of such application if such 
                application--
                            ``(i) is submitted in response to an urgent 
                        situation, with respect to areas in the State 
                        that the Administrator determines are at risk 
                        for excessive premium increases or having no 
                        health plans offered in the applicable health 
                        insurance market for the current or following 
                        plan year; or
                            ``(ii) resembles an application that is the 
                        same or substantially similar to an application 
                        that the Administrator has already approved for 
                        another State.
            ``(3) Period of approval.--If an application of a State is 
        approved for a year, with respect to a purpose described in 
        section 2202, such application shall also be treated as 
        approved, with respect to such purpose, for each of the 
        subsequent 4 years, but in no case shall an application be 
        approved for a year after 2028.
            ``(4) Treatment as a state health care program.--Any 
        program receiving funds from an allocation for a State under 
        this title, including pursuant to subsection (b), shall be 
        considered to be a `State health care program' for purposes of 
        sections 1128, 1128A, and 1128B.
    ``(b) Default Federal Safeguard.--
            ``(1) In general.--In the case of a State that does not 
        have in effect an approved application under this section for 
        2019 or a subsequent year beginning during the period described 
        in section 2201, subject to section 2204(e), the Administrator, 
        in consultation with the State insurance commissioner, shall 
        use the allocation that would otherwise be provided to the 
        State under this title for such year, in accordance with 
        paragraph (2), for such State.
            ``(2) Required use for market stabilization payments to 
        issuers.--Subject to section 2204(a), an allocation for a State 
        made pursuant to paragraph (1) for a year shall be used to 
        carry out the purpose described in section 2202(2) in such 
        State by providing payments to appropriate entities described 
        in such section with respect to claims that exceed $50,000 (or, 
        with respect to allocations made under this title for 2020 or a 
        subsequent year during the period specified in section 2201, 
        such dollar amount specified by the Administrator), but do not 
        exceed $350,000 (or, with respect to allocations made under 
        this title for 2020 or a subsequent year during such period, 
        such dollar amount specified by the Administrator), in an 
        amount equal to 75 percent (or, with respect to allocations 
        made under this title for 2020 or a subsequent year during such 
        period, such percentage specified by the Administrator) of the 
        amount of such claims.

``SEC. 2204. ALLOCATIONS.

    ``(a) Appropriation.--For the purpose of providing allocations for 
States (including pursuant to section 2203(b)) under this title there 
is appropriated, out of any money in the Treasury not otherwise 
appropriated, $11,500,000,000 for each of 2019 through 2028.
    ``(b) Allocations.--
            ``(1) Payment.--From amounts appropriated under subsection 
        (a) for a year, the Administrator shall, with respect to a 
        State and not later than January 1 of such year, allocate, 
        subject to subsection (e), for such State (including pursuant 
        to section 2203(b)) the amount determined for such State and 
        year under paragraph (2).
            ``(2) Allocation amount determinations.--
                    ``(A) For 2019 through 2021.--
                            ``(i) In general.--For purposes of 
                        paragraph (1), the amount determined under this 
                        paragraph for each of 2019 through 2021 for a 
                        State is an amount equal to the sum of--
                                    ``(I) the relative incurred claims 
                                amount described in clause (ii) for 
                                such State and year; and
                                    ``(II) the relative uninsured and 
                                issuer participation amount described 
                                in clause (iv) for such State and year.
                            ``(ii) Relative incurred claims amount.--
                        For purposes of clause (i), the relative 
                        incurred claims amount described in this clause 
                        for a State for 2019, 2020, and 2021 is the 
                        product of--
                                    ``(I) 90 percent of the amount 
                                appropriated under subsection (a) for 
                                the year; and
                                    ``(II) the relative State incurred 
                                claims proportion described in clause 
                                (iii) for such State and year.
                            ``(iii) Relative state incurred claims 
                        proportion.--The relative State incurred claims 
                        proportion described in this clause for a State 
                        and year is the amount equal to the ratio of--
                                    ``(I) the adjusted incurred claims 
                                by the State, as reported through the 
                                medical loss ratio annual reporting 
                                under section 2718 of the Public Health 
                                Service Act for the third previous 
                                year; to
                                    ``(II) the sum of such adjusted 
                                incurred claims for all States, as so 
                                reported, for such third previous year.
                            ``(iv) Relative uninsured and issuer 
                        participation amount.--For purposes of clause 
                        (i), the relative uninsured and issuer 
                        participation amount described in this clause 
                        for a State for 2019, 2020, and 2021 is the 
                        product of--
                                    ``(I) 10 percent of the amount 
                                appropriated under subsection (a) for 
                                the year; and
                                    ``(II) the relative State uninsured 
                                and issuer participation proportion 
                                described in clause (v) for such State 
                                and year.
                            ``(v) Relative state uninsured and issuer 
                        participation proportion.--The relative State 
                        uninsured and issuer participation proportion 
                        described in this clause for a State and year 
                        is--
                                    ``(I) in the case of a State not 
                                described in clause (vi) for such year, 
                                0; and
                                    ``(II) in the case of a State 
                                described in clause (vi) for such year, 
                                the amount equal to the ratio of--
                                            ``(aa) the number of 
                                        individuals residing in such 
                                        State who for the third 
                                        preceding year were not 
                                        enrolled in a health plan or 
                                        otherwise did not have health 
                                        insurance coverage (including 
                                        through a Federal or State 
                                        health program) and whose 
                                        income is below 100 percent of 
                                        the poverty line applicable to 
                                        a family of the size involved; 
                                        to
                                            ``(bb) the sum of the 
                                        number of such individuals for 
                                        all States described in clause 
                                        (vi) for the third preceding 
                                        year.
                            ``(vi) States described.--For purposes of 
                        clause (v), a State is described in this 
                        clause, with respect to 2019, 2020, and 2021, 
                        if the State satisfies either of the following 
                        criterion:
                                    ``(I) The ratio described in 
                                subclause (II) of clause (v) that would 
                                be determined for such State by 
                                substituting `2015' for each reference 
                                in such subclause to `the third 
                                preceding year' and by substituting 
                                `all such States' for the reference in 
                                item (bb) of such subclause to `all 
                                States described in clause (vi)' is 
                                greater than the ratio described in 
                                such subclause that would be determined 
                                for such State by substituting `2013' 
                                for each reference in such subclause to 
                                `the third preceding year' and by 
                                substituting `all such States' for the 
                                reference in item (bb) of such 
                                subclause to `all States described in 
                                clause (vi)'.
                                    ``(II) The State has fewer than 
                                three health insurance issuers offering 
                                qualified health plans through the 
                                Exchange for 2017.
                    ``(B) For 2022 through 2028.--For purposes of 
                paragraph (1), the amount determined under this 
                paragraph for a year (beginning with 2022) during the 
                period described in section 2201 for a State is an 
                amount determined in accordance with an allocation 
                methodology specified by the Administrator which--
                            ``(i) takes into consideration the adjusted 
                        incurred claims of such State, the number of 
                        residents of such State who for the previous 
                        year were not enrolled in a health plan or 
                        otherwise did not have health insurance 
                        coverage (including through a Federal or State 
                        health program) and whose income is below 100 
                        percent of the poverty line applicable to a 
                        family of the size involved, and the number of 
                        health insurance issuers participating in the 
                        insurance market in such State for such year;
                            ``(ii) is established after consultation 
                        with health care consumers, health insurance 
                        issuers, State insurance commissioners, and 
                        other stakeholders and after taking into 
                        consideration additional cost and risk factors 
                        that may inhibit health care consumer and 
                        health insurance issuer participation; and
                            ``(iii) reflects the goals of improving the 
                        health insurance risk pool, promoting a more 
                        competitive health insurance market, and 
                        increasing choice for health care consumers.
    ``(c) Annual Distribution of Previous Year's Remaining Funds.-- In 
carrying out subsection (b), the Administrator shall, with respect to a 
year (beginning with 2022 and ending with 2028), not later than March 
31 of such year--
            ``(1) determine the amount of funds, if any, from the 
        amounts appropriated under subsection (a) for the previous year 
        but not allocated for such previous year; and
            ``(2) if the Administrator determines that any funds were 
        not so allocated for such previous year, allocate such 
        remaining funds, in accordance with the allocation methodology 
        specified pursuant to subsection (b)(2)(B), with, respect to a 
        year before 2028, any remaining funds being made available for 
        allocations to States for the subsequent year.
    ``(d) Availability.--Amounts appropriated under subsection (a) for 
a year and allocated to States in accordance with this section shall 
remain available for expenditure through December 31, 2028.
    ``(e) Conditions for and Limitations on Receipt of Funds.--The 
Secretary may not make an allocation under this title for a State, with 
respect to a purpose described in section 2202 in the case of an 
allocation that would be made to a State pursuant to section 2203(a), 
if the State does not agree that the State will make available non-
Federal contributions towards such purpose in an amount equal to--
            ``(1) for 2020, 5 percent of the amount allocated under 
        this subsection to such State for such year and purpose; and
            ``(2) for 2021 and each subsequent year through 2028, 10 
        percent of the amount allocated under this subsection to such 
        State for such year and purpose.''.

SEC. 4. MODIFICATIONS TO WAIVER FOR STATE INNOVATION.

    Section 1332 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18052) is amended--
            (1) in subsection (a)(3), in the first sentence, by 
        striking ``individuals and small employers'' and all that 
        follows through ``the State had not received such waiver'' and 
        inserting ``the Secretary determines that there would be a 
        reduction in the Federal deficit during the waiver period, the 
        Secretary shall provide for a means by which the amount of such 
        reduction''; and
            (2) in subsection (d)--
                    (A) in paragraph (1), by striking ``180 days'' and 
                inserting ``subject to paragraph (3), 90 days''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(3) Expedited determination.--With respect to any 
        application under subsection (a)(1) submitted on or after the 
        date of enactment of this paragraph (or any such application 
        submitted prior to such date of enactment and under review by 
        the Secretary as of such date of enactment), the Secretary 
        shall make a determination on such application, using the 
        criteria for approval otherwise applicable under this section, 
        not later than 45 days after the receipt of such application, 
        and shall allow the public notice and comment at the State and 
        Federal levels described under subsection (a)(4) to occur 
        concurrently if such State application--
                    ``(A) is submitted in response to an urgent 
                situation, with respect to areas in the State that the 
                Secretary determines are at risk for excessive premium 
                increases or having no health plans offered in the 
                applicable health insurance market for the current or 
                following plan year; or
                    ``(B) is for a waiver that is the same or 
                substantially similar to a waiver that the Secretary 
                already has approved for another State.''.

SEC. 5. EMPLOYER MANDATE ADJUSTMENT.

    (a) Increasing the Size of Applicable Large Employers.--Paragraph 
(2) of section 4980H(c) of the Internal Revenue Code of 1986 is amended 
by striking ``50'' and inserting ``500'' each place such term appears.
    (b) Increasing the Hours Required To Qualify as Full-Time 
Employees.--
            (1) In general.--Subparagraph (A) of section 4980H(c)(4) of 
        the Internal Revenue Code of 1986 is amended by striking ``30'' 
        and inserting ``40''.
            (2) Full-time equivalents.--Subparagraph (E) of section 
        4980H(c)(2) of the Internal Revenue Code of 1986 is amended by 
        striking ``120'' and inserting ``160''.
    (c) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2017.

SEC. 6. REPEAL OF MEDICAL DEVICE EXCISE TAX.

    Section 4191 is amended by adding at the end the following new 
subsection:
    ``(d) Applicability.--The tax imposed under subsection (a) shall 
not apply to sales after December 31, 2017.''.

SEC. 7. OFFERING HEALTH PLANS IN MORE THAN ONE STATE.

    Not later than 1 year after the date of enactment of this Act, the 
Secretary of Health and Human Services, in consultation with the 
National Association of Insurance Commissioners, shall issue 
regulations for the implementation of health care choice compacts 
established under section 1333 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18053) to allow for the offering of health plans in 
more than one State.

SEC. 8. SENSE OF CONGRESS.

    It is the sense of Congress that the provisions of this Act should 
not increase the deficit, and any projected costs of such provisions 
should be offset with policies to negate any projected deficit 
increase.
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