Title: Pathway to Universal Coverage Act of 2019
Policy area: Health

Summary:
Pathway to Universal Coverage Act of 2019
This bill requires the Department of Health and Human Services (HHS) to award grants for states to promote health insurance enrollment. Specifically, states may use grants to (1) automatically enroll individuals who are eligible for a premium assistance tax credit, (2) invest in data-collection technology, (3) establish a statewide requirement to purchase minimum coverage, and (4) study the feasibility of developing a state plan to increase health insurance enrollment.  Private insurance issuers and states must report monthly to HHS about individuals who disenroll from coverage, including Medicaid and the Children's Health Insurance Program.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2061 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 2061

   To facilitate the efforts of States to establish auto-enrollment 
systems to enroll certain individuals in health insurance coverage, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 3, 2019

    Mr. Bera (for himself, Mr. Carbajal, Miss Rice of New York, Mr. 
 Cisneros, Ms. Wild, and Mr. Schrader) 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 facilitate the efforts of States to establish auto-enrollment 
systems to enroll certain individuals in health insurance coverage, 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 ``Pathway to Universal Coverage Act of 
2019''.

SEC. 2. ENCOURAGEMENT OF AUTO-ENROLLMENT FOR STATES.

    (a) State Innovations To Expand Coverage.--
            (1) In general.--Subject to paragraph (4), the Secretary of 
        Health and Human Services shall award grants to eligible State 
        agencies to enable such States to explore innovative solutions 
        to promote greater enrollment in health insurance coverage in 
        the individual and small group markets, including activities 
        described in paragraph (3).
            (2) Eligibility.--For purposes of paragraph (1), eligible 
        State agencies are Exchanges established by a State under title 
        I of the Patient Protection and Affordable Care Act and State 
        agencies with primary responsibility over health and human 
        services for the State involved.
            (3) Use of funds.--For purposes of paragraph (1), the 
        activities described in this subsection are the following:
                    (A) State efforts to streamline health insurance 
                enrollment procedures in order to reduce burdens on 
                consumers and facilitate greater enrollment in health 
                insurance coverage in the individual and small group 
                markets, including automatic enrollment and 
                reenrollment of, or pre-populated applications for, 
                individuals without health insurance who are eligible 
                for tax credits under section 36B of the Internal 
                Revenue Code of 1986, with the ability to opt out of 
                such enrollment.
                    (B) State investment in technology to improve data 
                sharing and collection for the purposes of facilitating 
                greater enrollment in health insurance coverage in such 
                markets.
                    (C) Implementation of a State version of an 
                individual mandate to be enrolled in health insurance 
                coverage.
                    (D) Feasibility studies to develop comprehensive 
                and coherent State plan for increasing enrollment in 
                the individual and small group market.
            (4) Funding.--For purposes of carrying out this subsection, 
        there is hereby appropriated, out of any funds in the Treasury 
        not otherwise appropriated, $200,000,000 for each of the fiscal 
        years 2020 through 2022. Such amount shall remain available 
        until expended.
    (b) Availability of Subsidy Information.--The information available 
under section 1411 of the Patient Protection and Affordable Care Act 
for determination of eligibility for and amount of credit against tax 
allowed under section 36B shall be made available to State agencies for 
determining eligibility for automatic enrollment described in 
subsection (f)(1).
    (c) Reconciliation of Advanced Payments for Auto-Enrolled 
Individuals.--Paragraph (2) of section 36B(f) of the Internal Revenue 
Code of 1986 is amended by adding at the end the following new 
subparagraph:
                    ``(C) Exception for auto-enrolled individuals.--In 
                the case of an individual who is enrolled through an 
                auto-enrollment system (as defined in subsection (f) of 
                the Pathway to Universal Coverage Act of 2019), 
                subparagraph (A) shall not apply.''.
    (d) Facilitation of State Auto-Enrollment.--
            (1) Provision of eligibility information.--Section 1411 of 
        the Patient Protection and Affordable Care Act (42 U.S.C. 
        18081) is amended--
                    (A) in subsection (b)--
                            (i) in the header, by striking ``by 
                        Applicants''; and
                            (ii) in paragraph (1), by inserting ``(or, 
                        in the case of an individual to be enrolled in 
                        such plan under an auto-enrollment system (as 
                        defined in subsection (f)(1) of the Pathway to 
                        Universal Coverage Act of 2018), a State)'' 
                        after ``individual market''; and
                    (B) in subsection (c)(1), by striking ``provided by 
                an applicant under'' and inserting ``described in''.
            (2) Medicaid enrollment.--The requirement specified in 
        section 435.907(f) of title 42, Code of Federal Regulations, 
        shall not apply with respect to an individual enrolled under a 
        State plan under title XIX of the Social Security Act (or under 
        a waiver of such plan) through an auto-enrollment system.
            (3) Reporting of terminated coverage.--
                    (A) Group health plans and health insurance 
                issuers.--The first subpart II of part A of title XXVII 
                of the Public Health Service Act (42 U.S.C. 300gg-11 et 
                seq.) is amended by adding at the end the following new 
                section:

``SEC. 2729. REPORTING OF TERMINATED COVERAGE.

    ``For each month occurring in a plan year beginning on or after 
January 1, 2021, a group health plan and a health insurance issuer 
offering group or individual health insurance coverage shall notify the 
Secretary, in a time and manner specified by the Secretary, of each 
individual whose enrollment under such coverage or such plan was 
terminated during such month.''.
                    (B) Medicaid.--Section 1902 of the Social Security 
                Act (42 U.S.C. 1396a) is amended by adding at the end 
                the following new subsection:
    ``(nn) Reporting on Disenrollment of Medicaid Enrollees.--For each 
month beginning on or after January 1, 2021, a State shall submit to 
the Secretary a report, at such time, in such manner, and containing 
such information as the Secretary may require, on each individual who 
was disenrolled from the State plan (or a waiver of such plan) during 
such month.''.
                    (C) CHIP.--Section 2107(e)(1) of the Social 
                Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
                            (i) by redesignating subparagraphs (L) 
                        through (S) as subparagraphs (M) through (T), 
                        respectively; and
                            (ii) by inserting after subparagraph (K) 
                        the following new subparagraph:
                    ``(L) Section 1902(nn) (relating to reporting on 
                disenrollment of enrollees).''.
    (e) Report.--Not later than 6 months after the date of enactment of 
this Act, the Secretary of Health and Human Services, in coordination 
with the Commissioner of the Internal Revenue Service, shall submit to 
Congress a report with best practice recommendations on how a State may 
establish an auto-enrollment system (as defined in subsection (f)). 
Such report shall include the following:
            (1) Identification of any statutory barriers to 
        establishing such a system, including data-sharing, 
        administrative, and technological barriers.
            (2) How such a system would interact with enrollment 
        periods for qualified health plans (as defined in section 1301 
        of the Patient Protection and Affordable Care Act (42 U.S.C. 
        18021)) and income eligibility determinations for premium 
        assistance tax credits under section 36B of the Internal 
        Revenue Code, the impact of such system on enrollment in health 
        insurance coverage in a State establishing such system, and the 
        effects of changing the enrollment periods for such system to 
        align with the filing of individual Federal tax returns.
            (3) An evaluation of prior outreach efforts targeted to 
        individuals without health insurance coverage eligible for such 
        tax credits.
    (f) Definitions.--For purposes of this Act:
            (1) Auto-enrollment system.--The term ``auto-enrollment 
        system'' means a system designed and operated by a State that 
        provides for an eligible individual residing in such State to 
        be automatically enrolled in a qualified health plan offered 
        through an Exchange in the State, or, if eligible, in the State 
        plan under title XIX of the Social Security Act (or under a 
        waiver of such plan), provided that the system exempts such 
        individual from paying any premium imposed by the State under 
        such plan (or waiver). Such automatic enrollment shall be void 
        if within 60 days after first being notified of the automatic 
        enrollment the eligible individual declines such coverage.
            (2) Eligible individual.--
                    (A) In general.--Subject to subparagraph (B), the 
                term ``eligible individual'' means, with respect to a 
                taxable year, an individual who is not eligible for 
                minimum essential coverage, other than minimum 
                essential coverage described in subparagraph (A)(ii) or 
                (C) of section 5000A(f)(1) of the Internal Revenue Code 
                of 1986, for such year.
                    (B) Limitation.--An individual who is only eligible 
                for minimum essential coverage described in section 
                5000A(f)(1)(C) of the Internal Revenue Code of 1986 may 
                only be treated as an eligible individual for purposes 
                of this section if the amount that would be calculated 
                under section 36B(b)(2)(B) of such Code for such 
                individual for a coverage month is not less than the 
                monthly premium for the least expensive plan offered on 
                the Exchange for which such individual is eligible. 
                This subclause shall be calculated on the basis of the 
                individual's household income for the most recent 
                taxable year for which the Secretary determines 
                information is available.
            (3) State.--The term ``State'' means each of the several 
        States, the District of Columbia, and each territory or 
        possession of the United States.
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