I 117th CONGRESS 1st Session H. R. 5622 IN THE HOUSE OF REPRESENTATIVES October 19, 2021 Mr. Gallego introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on the Judiciary , 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 title XXVII of the Public Health Service Act to allow for premium rates in the group and individual health insurance markets to vary during the COVID–19 emergency period based on COVID–19 vaccination status, and for other purposes.

1. Short title This Act may be cited as the Vaccine Accountability and Premium Protection Act . 2. Findings Congress finds the following: (1) More than 700,000 COVID–19 deaths have been reported in the United States and many public health experts believe this to be an undercount of the actual death toll of the virus. (2) There are three vaccines that have received either FDA approval or Emergency Use Authorization, have undergone rigorous testing, and have been proven to be safe and highly effective. (3) These vaccines are free and widely available in the United States to protect individuals against COVID–19. (4) Full vaccination has been proven to reduce the risk of moderate to severe COVID–19 infection by five times and hospitalization and death by more than ten times. (5) Over 20 percent of Americans eligible to receive the vaccine remain unvaccinated. (6) COVID–19 hospitalizations of unvaccinated individuals have cost the U.S. health system an estimated $5.7 billion between June 2021 and August 2021. (7) Some health insurers have proposed or predicted increases in premium costs due to higher health care costs and higher utilization because of COVID–19-related services. (8) Evidence shows that the ongoing COVID–19 pandemic continues to impact Americans’ physical and mental health negatively, has increased substance use and drug overdoses, and has led to hospitals rationing care for non-COVID–19-related care. (9) The over 20 percent of eligible Americans who have not been vaccinated against COVID–19 are jeopardizing their own health, the health of their communities, and the ability of local health systems to provide comprehensive, high-quality care to everyone who needs it. (10) The over 20 percent of eligible Americans who have not been vaccinated against COVID–19 are disproportionately responsible for the continuation of community spread of COVID–19 and the public health emergency in America, as well as its associated economic consequences. 3. Allowing premium rates in group and individual health insurance markets to vary based on COVID–19 vaccination status Section 2701(a) of the Public Health Service Act (300gg(a)) is amended— (1) in paragraph (1)(A)— (A) in clause (iii), by striking at the end and ; (B) by adding at the end the following new clause: (v) during any portion of the emergency period (as described in section 1135(g)(1)(B) of the Social Security Act) (beginning on or after the date of the enactment of this clause), consistent with paragraph (6), status as not being fully vaccinated (as defined by the Centers for Disease Control and Prevention) for COVID–19, except that such rate shall not vary by more than 1.5 to 1; and ; (2) in paragraph (4)— (A) in the header, by striking or tobacco use and inserting , tobacco use, or vaccination status ; and (B) by striking clauses (iii) and (iv) and inserting clauses (iii), (iv), and (v) ; and (3) by adding at the end the following new paragraph: (6) Conditions for varying premiums by vaccination status A health insurance issuer offering health insurance coverage in the individual or small group market (or, if applicable under paragraph (5), the large group market), may vary the premium rate with respect to the particular plan or coverage involved by the factor described in paragraph (1)(A)(v) during any portion of the period described in such paragraph only if each of the following conditions are met: (A) An increase pursuant to paragraph (1)(A)(v) may be made to the premium rate of an enrollee with respect to the particular plan or coverage only with respect to months during such portion of such period with respect to which each of the following applies to the enrollee: (i) The enrollee is, based on guidelines of the Food and Drug Administration and of the Centers for Disease Control and Prevention, eligible for a COVID–19 vaccine. (ii) The enrollee is not fully vaccinated (as defined by the Centers for Disease Control and Prevention) for COVID–19. (iii) The enrollee is not an individual who has not been fully vaccinated by reason of a verified medical condition or an objection to the vaccine on the basis of sincerely held religious beliefs. (B) The amount of premium applied with respect to an enrollee with respect to the particular plan or coverage during such portion of such period after application of such paragraph (1)(A)(v) does not result in a premium rate that exceeds an amount equal to 10 percent of the enrollee’s household income for such portion of such period. (C) The issuer pays to the Secretary of the Treasury an amount equal to 25 percent of the amount by which— (i) the total premiums charged with respect to the particular plan or coverage during such portion of such period after application of such paragraph (1)(A)(v); exceeds (ii) the total premiums that would have been charged with respect to such plan or coverage during such portion of such period without application of such paragraph. (D) The issuer certifies to the Secretary of Health and Human Services that the premium rate applied with respect to enrollees who are fully vaccinated (as defined by the Centers for Disease Control and Prevention) for COVID–19 with respect to the particular plan or coverage on vaccinated individuals will not be increased during such portion of such period by reason of increased costs associated with the emergency period described in paragraph (1)(A)(v). (E) Before applying an increase to the premium rate pursuant to paragraph (1)(A)(v), the issuer notifies each enrollee with respect to the particular plan or coverage who will be subject to such increase in premium rate and provides each such enrollee with information on where and how to receive a vaccine for COVID–19 without cost to such enrollee for such vaccine. . 4. Sense of Congress related to the seriousness of presenting, creating, or distributing fraudulent vaccination cards It is the sense of Congress that— (1) any individual falsely representing themselves as vaccinated against COVID–19 undermines mitigation efforts, endangers public health, and puts those around them at increased risk for contracting COVID–19; (2) the presentation, sale, purchase, or distribution of counterfeit COVID–19 vaccination cards appearing to be issued by the Centers for Disease Control and Prevention or official vaccination cards filled out with information falsely indicating that a person who has not received the COVID–19 vaccination is indeed vaccinated is a serious crime in violation of Federal law; (3) an individual guilty of the crime of presenting or purchasing a fraudulent vaccination card should, in accordance with law, be subject to a fine of not less than $5,000; and (4) an individual or organization guilty of the crime of selling or distributing a fraudulent vaccination card should receive the maximum penalty permissible under section 1017 of title 18, United States Code, in accordance with the scope of the crime.