Title: Patient Protection and Affordable Care Enhancement Act
Policy area: Health

Summary:
State Health Care Premium Reduction Act
This bill establishes the Improve Health Insurance Affordability Fund. States must use allocated funds to (1) issue reinsurance payments to health insurers (i.e., reimbursements to protect insurers against exceedingly high claims) for individual health insurance coverage, or (2) provide other assistance to reduce out-of-pocket costs (e.g., copayments, coinsurance, and deductibles) for qualified health plans offered in the individual market.
The Centers for Medicare & Medicaid Services must distribute funding to states in accordance with a specified methodology.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1425 Introduced in House (IH)]

<DOC>






116th CONGRESS
  1st Session
                                H. R. 1425

To amend the Patient Protection and Affordable Care Act to provide for 
 a Improve Health Insurance Affordability Fund to provide for certain 
    reinsurance payments to lower premiums in the individual health 
                           insurance market.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 28, 2019

Mrs. Craig (for herself and Mr. Peters) introduced the following bill; 
       which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend the Patient Protection and Affordable Care Act to provide for 
 a Improve Health Insurance Affordability Fund to provide for certain 
    reinsurance payments to lower premiums in the individual health 
                           insurance market.

    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 ``State Health Care Premium Reduction 
Act''.

SEC. 2. IMPROVE HEALTH INSURANCE AFFORDABILITY FUND.

    Subtitle D of title I of the Patient Protection and Affordable Care 
Act is amended by inserting after part 5 (42 U.S.C. 18061 et seq.) the 
following new part:

         ``PART 6--IMPROVE HEALTH INSURANCE AFFORDABILITY FUND

``SEC. 1351. ESTABLISHMENT OF PROGRAM.

    ``There is hereby established the `Improve Health Insurance 
Affordability 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') beginning on January 1, 2020, for the purposes 
described in section 1352.

``SEC. 1352. USE OF FUNDS.

    ``(a) In General.--A State shall use the funds allocated to the 
State under this part for one of the following purposes:
            ``(1) To provide reinsurance payments to health insurance 
        issuers with respect to individuals enrolled under individual 
        health insurance coverage (other than through a plan described 
        in subsection (b)) offered by such issuers.
            ``(2) To provide assistance (other than through payments 
        described in paragraph (1)) to reduce out-of-pocket costs, such 
        as copayments, coinsurance, premiums, and deductibles, of 
        individuals enrolled under qualified health plans offered on 
        the individual market through an Exchange.
    ``(b) Exclusion of Certain Grandfathered and Transitional Plans.--
For purposes of subsection (a), a plan described in this subsection is 
the following:
            ``(1) A grandfathered health plan (as defined in section 
        1251).
            ``(2) A plan (commonly referred to as a `transitional 
        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 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, February 13, 2017, and April 9, 2018, or 
        under any subsequent extensions thereof.

``SEC. 1353. 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 part for a year (beginning with 2020), a State 
        shall submit to the Administrator an application at such time 
        (but, in the case of allocations for 2020, not later than 90 
        days after the date of the enactment of this title and, in the 
        case of allocations for a subsequent year, not later than March 
        31 of the previous year) and in such form and manner as 
        specified by the Administrator containing--
                    ``(A) a description of how the funds will be used; 
                and
                    ``(B) such other information as the Administrator 
                may require.
            ``(2) Automatic approval.--An application so submitted is 
        approved unless the Administrator notifies the State submitting 
        the application, not later than 60 days after the date of the 
        submission of such application, that the application has been 
        denied for not being in compliance with any requirement of this 
        part and of the reason for such denial.
            ``(3) 5-year application approval.--If an application of a 
        State is approved for a purpose described in section 1352 for a 
        year, such application shall be treated as approved for such 
        purpose for each of the subsequent 4 years.
    ``(b) Default Federal Safeguard.--
            ``(1) 2020.--For allocations made under this part for 2020, 
        in the case of a State that does not submit an application 
        under subsection (a) by the 90-day submission date applicable 
        to such year under subsection (a)(1) and in the case of a State 
        that does submit such an application by such date that is not 
        approved, the Administrator, in consultation with the State 
        insurance commissioner, shall use, in accordance with paragraph 
        (3), the allocation that would otherwise be provided to the 
        State under this part for such year for such State.
            ``(2) 2021 and subsequent years.--In the case of a State 
        that does not have in effect an approved application under this 
        section for 2021 or a subsequent year, the Administrator, in 
        consultation with the State insurance commissioner, shall use, 
        in accordance with paragraph (3), the allocation that would 
        otherwise be provided to the State under this part for such 
        year for such State.
            ``(3) Specified use.--An allocation for a State made 
        pursuant to paragraph (1) or (2) for a year shall be used to 
        carry out the purpose described in section 1352(1) in such 
        State by providing reinsurance payments to health insurance 
        issuers with respect to attachment range claims (as defined in 
        section 1354(b)(2), using the dollar amounts specified in 
        subparagraph (B) of such section for such year) in an amount 
        equal to the percentage (specified for such year by the 
        Secretary under such subparagraph) of the amount of such 
        claims.

``SEC. 1354. ALLOCATIONS.

    ``(a) Appropriation.--For the purpose of providing allocations for 
States under this part there is appropriated, out of any money in the 
Treasury not otherwise appropriated $10,000,000,000 for 2020 and each 
subsequent year.
    ``(b) Allocations.--
            ``(1) Payment.--
                    ``(A) In general.--From amounts appropriated under 
                subsection (a) for a year, the Secretary shall, with 
                respect to a State and not later than the date 
                specified under subparagraph (B) for such year, 
                allocate for such State the amount determined for such 
                State and year under paragraph (2).
                    ``(B) Specified date.--For purposes of subparagraph 
                (A), the date specified in this subparagraph is--
                            ``(i) for 2020, the date that is 45 days 
                        after the date of the enactment of this title; 
                        and
                            ``(ii) for 2021 or a subsequent year, 
                        January 1 of the respective year.
                    ``(C) Notifications of allocation amounts.--For 
                2021 and each subsequent year, the Secretary shall 
                notify each State of the amount determined for such 
                State under paragraph (2) for such year by not later 
                than January 1 of the previous year.
            ``(2) Allocation amount determinations.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the amount determined under this paragraph for a year 
                for a State is the amount that the Secretary estimates 
                would be expended under this part for such year on 
                attachment range claims of individuals residing in such 
                State if all States used such funds only for the 
                purpose described in paragraph (1) of section 1352 at 
                the dollar amounts and percentage specified under 
                subparagraph (B) for such year. For purposes of the 
                previous sentence and section 1353(b)(3), the term 
                `attachment range claims' means, with respect to an 
                individual, the claims for such individual that exceed 
                a dollar amount specified by the Secretary for a year, 
                but do not exceed a ceiling dollar amount specified by 
                the Secretary for such year, under subparagraph (B).
                    ``(B) Specifications.--For purposes of subparagraph 
                (A) and section 1353(b)(3), the Secretary shall 
                determine the dollar amounts and the percentage to be 
                specified under subparagraph (A) for a year in a manner 
                to ensure that the total amount of expenditures under 
                this part for such year is estimated to equal the total 
                amount appropriated for such year under subsection (a) 
                if such expenditures were used solely for the purpose 
                described in paragraph (1) of section 1352 for 
                attachment range claims at the dollar amounts and 
                percentage so specified for such year.
            ``(3) Availability.--Funds allocated to a State under this 
        subsection for a year shall remain available through the end of 
        the subsequent year.
    ``(c) Annual Distribution of Previous Year's Remaining Funds.--
            ``(1) In general.-- In carrying out subsection (b), the 
        Secretary shall, with respect to a year (beginning with 2021), 
        not later than March 31 of such year--
                    ``(A) 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
                    ``(B) if the Secretary determines that any funds 
                were not so allocated for such previous year, allocate 
                such remaining funds to States for such year, in 
                accordance with paragraph (2).
            ``(2) Allocation methodology.--For purposes of paragraph 
        (1), of the total remaining funds to be allocated for a year 
        pursuant to such paragraph, the Secretary shall allocate to 
        each State an amount that bears the same ratio to such total 
        remaining funds as the amount allocated pursuant to subsection 
        (b) to such State for such year bears to the total allocations 
        made under such subsection for such year.''.
                                 <all>