State Health Care Premium Reduction Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1878 To amend the Patient Protection and Affordable Care Act to establish a health insurance affordability fund, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 12, 2021 Ms. 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 establish a health insurance affordability fund, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘State Health Care Pre- 4 mium Reduction Act of 2021’’. 5 SEC. 2. ESTABLISHING A HEALTH INSURANCE AFFORD- 6 ABILITY FUND. 7 (a) IN GENERAL.—Subtitle D of title I of the Patient 8 Protection and Affordable Care Act is amended by insert- 9 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1878 IH ing after part 5 (42 U.S.C. 18061 et seq.) the following 1 new part: 2 ‘‘PART 6—IMPROVE HEALTH INSURANCE 3 AFFORDABILITY FUND 4 ‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM. 5 ‘‘There is hereby established the ‘Improve Health In- 6 surance Affordability Fund’ to be administered by the Sec- 7 retary of Health and Human Services, acting through the 8 Administrator of the Centers for Medicare & Medicaid 9 Services (in this section referred to as the ‘Adminis- 10 trator’), to provide funding, in accordance with this part, 11 to the 50 States and the District of Columbia (each re- 12 ferred to in this section as a ‘State’) beginning on January 13 1, 2023, for the purposes described in section 1352. 14 ‘‘SEC. 1352. USE OF FUNDS. 15 ‘‘(a) IN GENERAL.—A State shall use the funds allo- 16 cated to the State under this part for one of the following 17 purposes: 18 ‘‘(1) To provide reinsurance payments to health 19 insurance issuers with respect to individuals enrolled 20 under individual health insurance coverage (other 21 than through a plan described in subsection (b)) of- 22 fered by such issuers. 23 ‘‘(2) To provide assistance (other than through 24 payments described in paragraph (1)) to reduce out- 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1878 IH of-pocket costs, such as copayments, coinsurance, 1 premiums, and deductibles, of individuals enrolled 2 under qualified health plans offered on the indi- 3 vidual market through an Exchange and of individ- 4 uals enrolled under standard health plans offered 5 through a basic health program established under 6 section 1331. 7 ‘‘(b) EXCLUSION OF CERTAIN GRANDFATHERED AND 8 TRANSITIONAL PLANS.—For purposes of subsection (a), 9 a plan described in this subsection is the following: 10 ‘‘(1) A grandfathered health plan (as defined in 11 section 1251). 12 ‘‘(2) A plan (commonly referred to as a ‘transi- 13 tional plan’) continued under the letter issued by the 14 Centers for Medicare & Medicaid Services on No- 15 vember 14, 2013, to the State Insurance Commis- 16 sioners outlining a transitional policy for coverage in 17 the individual and small group markets to which sec- 18 tion 1251 does not apply, and under the extension 19 of the transitional policy for such coverage set forth 20 in the Insurance Standards Bulletin Series guidance 21 issued by the Centers for Medicare & Medicaid Serv- 22 ices on March 5, 2014, February 29, 2016, Feb- 23 ruary 13, 2017, April 9, 2018, March 25, 2019, and 24 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1878 IH January 31, 2020, or under any subsequent exten- 1 sions thereof. 2 ‘‘(3) Student health insurance coverage (as de- 3 fined in section 147.145 of title 45, Code of Federal 4 Regulations). 5 ‘‘SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT 6 SAFEGUARD. 7 ‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA- 8 TIONS.— 9 ‘‘(1) IN GENERAL.—To be eligible for an alloca- 10 tion of funds under this part for a year (beginning 11 with 2023), a State shall submit to the Adminis- 12 trator an application at such time (but, in the case 13 of allocations for 2023, not later than 90 days after 14 the date of the enactment of this part and, in the 15 case of allocations for a subsequent year, not later 16 than March 1 of the previous year) and in such form 17 and manner as specified by the Administrator con- 18 taining— 19 ‘‘(A) a description of how the funds will be 20 used; and 21 ‘‘(B) such other information as the Admin- 22 istrator may require. 23 ‘‘(2) AUTOMATIC APPROVAL.—An application so 24 submitted is approved unless the Administrator noti- 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1878 IH fies the State submitting the application, not later 1 than 60 days after the date of the submission of 2 such application, that the application has been de- 3 nied for not being in compliance with any require- 4 ment of this part and of the reason for such denial. 5 ‘‘(3) 5-YEAR APPLICATION APPROVAL.—If an 6 application of a State is approved for a purpose de- 7 scribed in section 1352 for a year, such application 8 shall be treated as approved for such purpose for 9 each of the subsequent 4 years. 10 ‘‘(4) REVOCATION OF APPROVAL.—The ap- 11 proval of an application of a State, with respect to 12 a purpose described in section 1352, may be revoked 13 if the State fails to use funds provided to the State 14 under this section for such purpose or otherwise fails 15 to comply with the requirements of this section. 16 ‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 17 ‘‘(1) 2023.—For 2023, in the case of a State 18 that does not submit an application under subsection 19 (a) by the 90-day submission date applicable to such 20 year under subsection (a)(1) and in the case of a 21 State that does submit such an application by such 22 date that is not approved, the Administrator, in con- 23 sultation with the State insurance commissioner, 24 shall, from the amount calculated under paragraph 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1878 IH (4) for such year, carry out the purpose described in 1 paragraph (3) in such State for such year. 2 ‘‘(2) 2024 AND SUBSEQUENT YEARS.—For 3 2024 or a subsequent year, in the case of a State 4 that does not have in effect an approved application 5 under this section for such year, the Administrator, 6 in consultation with the State insurance commis- 7 sioner, shall, from the amount calculated under 8 paragraph (4) for such year, carry out the purpose 9 described in paragraph (3) in such State for such 10 year. 11 ‘‘(3) SPECIFIED USE.—The amount described 12 in paragraph (4), with respect to 2023 or a subse- 13 quent year, shall be used to carry out the purpose 14 described in section 1352(a)(1) in each State de- 15 scribed in paragraph (1) or (2) for such year, as ap- 16 plicable, by providing reinsurance payments to 17 health insurance issuers with respect to attachment 18 range claims (as defined in section 1354(b)(2)), 19 using the dollar amounts specified in subparagraph 20 (B) of such section for such year) in an amount 21 equal to, subject to paragraph (5), the percentage 22 (specified for such year by the Secretary under such 23 subparagraph) of the amount of such claims. 24 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1878 IH ‘‘(4) AMOUNT DESCRIBED.—The amount de- 1 scribed in this paragraph, with respect to 2023 or 2 a subsequent year, is the amount equal to the total 3 sum of amounts that the Secretary would otherwise 4 estimate under section 1354(b)(2)(A)(i) for such 5 year for each State described in paragraph (1) or 6 (2) for such year, as applicable, if each such State 7 were not so described for such year. 8 ‘‘(5) ADJUSTMENT.—For purposes of this sub- 9 section, the Secretary may apply a percentage under 10 paragraph (3) with respect to a year that is less 11 than the percentage otherwise specified in section 12 1354(b)(2)(B) for such year, if the cost of paying 13 the total eligible attachment range claims for States 14 described in this subsection for such year at such 15 percentage otherwise specified would exceed the 16 amount calculated under paragraph (4) for such 17 year. 18 ‘‘SEC. 1354. ALLOCATIONS. 19 ‘‘(a) APPROPRIATION.—For the purpose of providing 20 allocations for States under subsection (b) and payments 21 under section 1353(b) there is appropriated, out of any 22 money in the Treasury not otherwise appropriated, 23 $10,000,000,000 for 2023 and each subsequent year. 24 ‘‘(b) ALLOCATIONS.— 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1878 IH ‘‘(1) PAYMENT.— 1 ‘‘(A) IN GENERAL.—From amounts appro- 2 priated under subsection (a) for a year, the 3 Secretary shall, with respect to a State not de- 4 scribed in section 1353(b) for such year and 5 not later than the date specified under subpara- 6 graph (B) for such year, allocate for such State 7 the amount determined for such State and year 8 under paragraph (2). 9 ‘‘(B) SPECIFIED DATE.—For purposes of 10 subparagraph (A), the date specified in this 11 subparagraph is— 12 ‘‘(i) for 2023, the date that is 45 days 13 after the date of the enactment of this 14 part; and 15 ‘‘(ii) for 2024 or a subsequent year, 16 January 1 of the respective year. 17 ‘‘(C) NOTIFICATIONS OF ALLOCATION 18 AMOUNTS.—For 2024 and each subsequent 19 year, the Secretary shall notify each State of 20 the amount determined for such State under 21 paragraph (2) for such year by not later than 22 January 1 of the previous year. 23 ‘‘(2) ALLOCATION AMOUNT DETERMINA- 24 TIONS.— 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 1878 IH ‘‘(A) IN GENERAL.—For purposes of para- 1 graph (1), the amount determined under this 2 paragraph for a year for a State described in 3 paragraph (1)(A) for such year is the amount 4 equal to— 5 ‘‘(i) the amount that the Secretary es- 6 timates would be expended under this part 7 for such year on attachment range claims 8 of individuals residing in such State if such 9 State used such funds only for the purpose 10 described in paragraph (1) of section 11 1352(a) at the dollar amounts and per- 12 centage specified under subparagraph (B) 13 for such year; minus 14 ‘‘(ii) the amount, if any, by which the 15 Secretary determines— 16 ‘‘(I) the estimated amount of 17 premium tax credits under section 18 36B of the Internal Revenue Code of 19 1986 that would be attributable to in- 20 dividuals residing in such State for 21 such year without application of this 22 part; exceeds 23 ‘‘(II) the estimated amount of 24 premium tax credits under section 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 1878 IH 36B of the Internal Revenue Code of 1 1986 that would be attributable to in- 2 dividuals residing in such State for 3 such year if such State were a State 4 described in section 1353(b) for such 5 year. 6 For purposes of the previous sentence and sec- 7 tion 1353(b)(3), the term ‘attachment range 8 claims’ means, with respect to an individual, the 9 claims for such individual that exceed a dollar 10 amount specified by the Secretary for a year, 11 but do not exceed a ceiling dollar amount speci- 12 fied by the Secretary for such year, under sub- 13 paragraph (B). 14 ‘‘(B) SPECIFICATIONS.—For purposes of 15 subparagraph (A) and section 1353(b)(3), the 16 Secretary shall determine the dollar amounts 17 and the percentage to be specified under this 18 subparagraph for a year in a manner to ensure 19 that the total amount of expenditures under 20 this part for such year is estimated to equal the 21 total amount appropriated for such year under 22 subsection (a) if such expenditures were used 23 solely for the purpose described in paragraph 24 (1) of section 1352(a) for attachment range 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 1878 IH claims at the dollar amounts and percentage so 1 specified for such year. 2 ‘‘(3) AVAILABILITY.—Funds allocated to a 3 State under this subsection for a year shall remain 4 available through the end of the subsequent year.’’. 5 (b) BASIC HEALTH PROGRAM FUNDING ADJUST- 6 MENTS.—Section 1331 of the Patient Protection and Af- 7 fordable Care Act (42 U.S.C. 18051) is amended— 8 (1) in subsection (a), by adding at the end the 9 following new paragraph: 10 ‘‘(3) PROVISION OF INFORMATION ON QUALI- 11 FIED HEALTH PLAN PREMIUMS.— 12 ‘‘(A) IN GENERAL.—The program de- 13 scribed in paragraph (1) shall provide that a 14 State may not establish a basic health program 15 unless such State furnishes to the Secretary, 16 with respect to each qualified health plan of- 17 fered in such State during a year that receives 18 any reinsurance payment from funds made 19 available under part 6 for such year, the ad- 20 justed premium amount (as defined in subpara- 21 graph (B)) for each such plan and year. 22 ‘‘(B) ADJUSTED PREMIUM AMOUNT DE- 23 FINED.—For purposes of subparagraph (A), the 24 term ‘adjusted premium amount’ means, with 25 VerDate Sep 11 2014 22:17 May 12, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1878.IH H1878 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 1878 IH respect to a qualified health plan and a year, 1 the monthly premium for such plan and year 2 that would have applied had such plan not re- 3 ceived any payments described in subparagraph 4 (A) for such year.’’; and 5 (2) in subsection (d)(3)(A)(ii), by adding at the 6 end the following new sentence: ‘‘In making such de- 7 termination, the Secretary shall calculate the value 8 of such premium tax credits that would have been 9 provided to such individuals enrolled through a basic 10 health program established by a State during a year 11 using the adjusted premium amounts (as defined in 12 subsection (a)(3)(B)) for qualified health plans of- 13 fered in such State during such year.’’. 14 Æ VerDate Sep 11 [Text truncated for display. 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