Title: Stop Health Premium Spikes Act of 2020
Policy area: Health

Summary:
Stop Health Premium Spikes Act of 2020
This bill establishes a temporary risk corridor program to reimburse health insurers for medical costs that are greater than expected. Specifically, the program requires the Department of Health and Human Services to pay insurers 75% of the cost of providing benefits under a plan that exceeds 105% of the total annual premiums for the plan, reduced by administrative expenses. The program applies to plan years 2020 and 2021.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6518 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 6518

  To direct the Secretary of Health and Human Services to establish a 
program of risk corridors for health insurance issuers offering health 
insurance coverage in the individual or small group market for certain 
                              plan years.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 17, 2020

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

_______________________________________________________________________

                                 A BILL


 
  To direct the Secretary of Health and Human Services to establish a 
program of risk corridors for health insurance issuers offering health 
insurance coverage in the individual or small group market for certain 
                              plan years.

    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 ``Stop Health Premium Spikes Act of 
2020''.

SEC. 2. ESTABLISHING A PROGRAM OF RISK CORRIDORS FOR HEALTH INSURANCE 
              ISSUERS OFFERING HEALTH INSURANCE COVERAGE IN THE 
              INDIVIDUAL OR SMALL GROUP MARKET FOR CERTAIN PLAN YEARS.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish and 
administer a program of risk corridors for plan years 2020 and 2021 
under which the Secretary shall make payments to health insurance 
issuers offering health insurance coverage in the individual or small 
group market based on the ratio of the allowable costs of the coverage 
to the aggregate premiums of the coverage.
    (b) Payment Methodology.--The Secretary shall provide under the 
program established under subsection (a) that if the allowable costs 
for a health insurance issuer offering health insurance coverage in the 
individual or small group market for any plan year are more than 105 
percent of the target amount, the Secretary shall pay to the issuer an 
amount equal to 75 percent of the allowable costs in excess of 105 
percent of the target amount.
    (c) Information Collection.--The Secretary shall establish a 
process under which information is collected from health insurance 
issuers offering health insurance coverage in the individual or small 
group market for purposes of carrying out this section.
    (d) Definitions.--
            (1) Allowable costs.--
                    (A) In general.--The amount of allowable costs of a 
                health insurance issuer offering health insurance 
                coverage in the individual or small group market for 
                any year is an amount equal to the total costs (other 
                than administrative costs) of such issuer in providing 
                benefits covered by such coverage.
                    (B) Certain reductions.--Allowable costs shall be 
                reduced by any--
                            (i) risk adjustment payments received under 
                        section 1341 of the Patient Protection and 
                        Affordable Care Act (42 U.S.C. 18061); and
                            (ii) reinsurance payments received pursuant 
                        to a waiver approved under section 1332 of such 
                        Act (42 U.S.C. 18052).
            (2) Additional terms.--For purposes of this section, the 
        terms ``health insurance issuer'', ``health insurance 
        coverage'', ``individual market'', and ``small group market'' 
        have the meanings given such terms in section 2791 of the 
        Public Health Service Act (42 U.S.C. 300gg-91).
            (3) Target amount.--The target amount of health insurance 
        coverage offered in the individual or small group market for 
        any year is an amount equal to the total premiums (including 
        any premium subsidies under any governmental program), reduced 
        by the administrative costs of the coverage.
    (e) Implementation.--The Secretary of Health and Human Services may 
implement the provisions of this section by subregulatory guidance, 
program instruction, or otherwise.
    (f) Appropriation.--There are appropriated, out of any monies in 
the Treasury not otherwise obligated, such sums as may be necessary to 
carry out this section.
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