Protecting Americans with Preexisting Conditions Act of 2019

II Calendar No. 90 116TH CONGRESS 1ST SESSION H. R. 986 IN THE SENATE OF THE UNITED STATES MAY 14, 2019 Received; read the first time MAY 15, 2019 Read the second time and placed on the calendar AN ACT To provide that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act shall have no force or effect. 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 ‘‘Protecting Americans 4 with Preexisting Conditions Act of 2019’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 (1) On October 24, 2018, the administration 8 published new guidance to carry out section 1332 of 9 VerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H986.PCS H986 pbinns on DSK79D2C42PROD with BILLS 2 HR 986 PCS the Patient Protection and Affordable Care Act (42 1 U.S.C. 18052) entitled ‘‘State Relief and Empower- 2 ment Waivers’’ (83 Fed. Reg. 53575). 3 (2) The new guidance encourages States to pro- 4 vide health insurance coverage through insurance 5 plans that may discriminate against individuals with 6 preexisting health conditions, including the one in 7 four Americans living with a disability. 8 (3) The implementation and enforcement of the 9 new guidance weakens protections for the millions of 10 Americans living with preexisting health conditions 11 and jeopardizes Americans’ access to quality, afford- 12 able health insurance coverage. 13 SEC. 3. PROVIDING THAT CERTAIN GUIDANCE RELATED TO 14 WAIVERS FOR STATE INNOVATION UNDER 15 THE PATIENT PROTECTION AND AFFORD- 16 ABLE CARE ACT SHALL HAVE NO FORCE OR 17 EFFECT. 18 Beginning April 1, 2019, the Secretary of Health and 19 Human Services and the Secretary of the Treasury may 20 not take any action to implement, enforce, or otherwise 21 give effect to the guidance entitled ‘‘State Relief and Em- 22 powerment Waivers’’ (83 Fed. Reg. 53575 (October 24, 23 2018)), including any such action that would result in in- 24 dividuals losing health insurance coverage that includes 25 VerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H986.PCS H986 pbinns on DSK79D2C42PROD with BILLS 3 HR 986 PCS the essential health benefits package (as defined in sub- 1 section (a) of section 1302 of the Patient Protection and 2 Affordable Care Act (42 U.S.C. 18022(a)) without regard 3 to any waiver of any provision of such package under a 4 waiver under such section 1332), including the maternity 5 and newborn care essential health benefit described in sub- 6 section (b)(1)(D) of such section, including any such ac- 7 tion that would result in a decrease in the number of such 8 individuals enrolled in coverage that is at least as com- 9 prehensive as the coverage defined in section 1302(a) of 10 the Patient Protection and Affordable Care Act (42 11 U.S.C. 18022(a)) compared to the number of such individ- 12 uals who would have been so enrolled in such coverage 13 had such action not been taken, including any such action 14 that would, with respect to individuals with substance use 15 disorders, including opioid use disorders, reduce the avail- 16 ability or affordability of coverage that is at least as com- 17 prehensive as the coverage defined in section 1302(a) of 18 the Patient Protection and Affordable Care Act (42 19 U.S.C. 18022(a)) compared to the availability or afford- 20 ability, respectively, of such coverage had such action not 21 been taken, including any such action that would result, 22 with respect to vulnerable populations (including low-in- 23 come individuals, elderly individuals, and individuals with 24 serious health issues or who have a greater risk of devel- 25 VerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H986.PCS H986 pbinns on DSK79D2C42PROD with BILLS 4 HR 986 PCS oping serious health issues), in a decrease in the avail- 1 ability of coverage that is at least as comprehensive as 2 the coverage defined in section 1302(a) of the Patient Pro- 3 tection and Affordable Care Act (42 U.S.C. 18022(a)) 4 with coverage and cost sharing protections required under 5 section 1332(b)(1)(B) of such Act (42 U.S.C. 6 18052(b)(1)(B)), including any such action that would, 7 with respect to individuals with preexisting conditions, re- 8 duce the affordability of coverage that is at least as com- 9 prehensive as the coverage defined in section 1302(a) of 10 the Patient Protection and Affordable Care Act (42 11 U.S.C. 18022(a)) compared to the affordability of such 12 coverage had such action not been taken, including any 13 such action that would result in higher health insurance 14 premiums for individuals enrolled in health insurance cov- 15 erage that is at least as comprehensive as the coverage 16 defined in section 1302(b) of such Act (42 U.S.C. 17 18022(b)), and the Secretaries may not promulgate any 18 substantially similar guidance or rule. Nothing in the pre- 19 vious sentence shall be construed to affect the approval 20 of waivers under section 1332 of the Patient Protection 21 and Affordable Care Act (42 U.S.C. 18052) that establish 22 reinsurance programs that are consistent with the require- 23 ments under subsection (b)(1) of such section (42 U.S.C. 24 18052(b)(1)), lower health insurance premiums, and pro- 25 VerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H986.PCS H986 pbinns on DSK79D2C42PROD with BILLS 5 HR 986 PCS tect health insurance coverage for people with preexisting 1 conditions. 2 SEC. 4. GAO REPORT ON AFFECT OF STATE INNOVATION 3 WAIVERS ON COVERAGE OF INDIVIDUALS 4 AND ON MENTAL HEALTH HEALTH CARE 5 TREATMENT. 6 Not later than 1 year after the date of the enactment 7 of this Act, the Comptroller General of the United States 8 shall submit to Congress a report on the number of indi- 9 viduals expected to lose access to health insurance cov- 10 erage (as defined in section 2791 of the Public Health 11 Service Act (42 U.S.C. 300gg–91)) if section 2 were not 12 enacted and waivers under section 1332 of the Patient 13 Protection and Affordable Care Act (42 U.S.C. 18052) 14 were approved under the guidance described in such sec- 15 tion 2. Such report shall include an analysis of the ex- 16 pected effect such waivers approved under such guidance 17 would have on mental health care treatment. 18 Passed the House of Representatives May 9, 2019. Attest: CHERYL L. JOHNSON, Clerk. VerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H986.PCS H986 pbinns on DSK79D2C42PROD with BILLS Calendar No. 90 116TH CONGRESS 1ST SESSION H. R. 986 AN ACT To provide that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act shall have no force or effect. MAY 15, 2019 Read the second time and placed on the calendar VerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6651 Sfmt 6651 E:\BILLS\H986.PCS H986 pbinns on DSK79D2C42PROD with BILLS