Medicare Buy-In and Health Care Stabilization Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 1346 To amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 25, 2019 Mr. HIGGINS of New York (for himself, Mr. LARSON of Connecticut, Mr. COURTNEY, Mr. WELCH, Mr. AGUILAR, Ms. BONAMICI, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. CLAY, Mr. DEUTCH, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. HECK, Mr. KRISHNAMOORTHI, Ms. KUSTER of New Hampshire, Mr. LANGEVIN, Mr. LARSEN of Washington, Mr. LOWENTHAL, Mr. SEAN PATRICK MALONEY of New York, Mr. MEEKS, Ms. NORTON, Mr. PERLMUTTER, Mr. PETERSON, Mr. SCHIFF, Ms. TITUS, Mr. TONKO, Ms. WASSERMAN SCHULTZ, Ms. WILD, and Mr. MCGOVERN) introduced the following bill; which was referred to the Com- mittee 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 amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, 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 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 2 •HR 1346 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Medicare Buy-In and 2 Health Care Stabilization Act of 2019’’. 3 SEC. 2. FINDINGS. 4 Congress finds as follows: 5 (1) Medicare has coverage gaps and should pro- 6 vide more comprehensive coverage, including increas- 7 ing coverage for the medical needs of beneficiaries 8 relating to hearing, dental, and vision care. 9 (2) Special needs populations face financial 10 challenges to secure coverage for Medicare’s out of 11 pocket costs and other hurdles. 12 (3) Medicare Buy-In is a step in the right di- 13 rection as Congress considers additional needed leg- 14 islation to address these and other coverage issues 15 and beneficiary financial challenges in Medicare and 16 Medicare Buy-In. 17 SEC. 3. MEDICARE BUY-IN OPTION. 18 (a) IN GENERAL.—Title XVIII of the Social Security 19 Act (42 U.S.C. 1395c et seq.) is amended by adding at 20 the end the following new section: 21 ‘‘MEDICARE BUY-IN OPTION 22 ‘‘SEC. 1899C. (a) OPTION.— 23 ‘‘(1) IN GENERAL.—Every individual who meets 24 the requirements described in paragraph (2) shall be 25 eligible to enroll under this section. 26 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 3 •HR 1346 IH ‘‘(2) ELIGIBILITY.—An individual who meets 1 the following requirements is eligible to enroll under 2 this section: 3 ‘‘(A) AGE.—The individual has attained 50 4 years of age, but has not attained 65 years of 5 age. 6 ‘‘(B) MEDICARE ELIGIBILITY (BUT FOR 7 AGE).—The individual is not otherwise entitled 8 to benefits under part A or eligible to enroll 9 under part A or part B but would be eligible for 10 benefits under part A or part B if the indi- 11 vidual were 65 years of age. 12 ‘‘(3) PART A, B, AND D BENEFITS AND PROTEC- 13 TIONS.—An individual enrolled under this section is 14 entitled to the same benefits (and shall receive the 15 same protections) under this title as an individual 16 who is entitled to benefits under part A and enrolled 17 under parts B and D, including the ability to enroll 18 in a Medicare Advantage plan that provides qualified 19 prescription drug coverage (an MA–PD plan) and 20 including access to the Medicare Beneficiary Om- 21 budsman under section 1808(c). 22 ‘‘(b) ENROLLMENT AND COVERAGE PERIODS.—The 23 Secretary shall establish enrollment and coverage periods 24 for individuals who enroll under this section. Such periods 25 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 4 •HR 1346 IH shall be established in coordination with the enrollment 1 and coverage periods for plans offered under an Exchange 2 established under title I of the Patient Protection and Af- 3 fordable Care Act. The Secretary shall establish such peri- 4 ods so that coverage under this section shall first begin 5 on January 1 of the first year beginning at least one year 6 after the date of the enactment of this section and shall 7 include special enrollment periods, in accordance with sec- 8 tion 155.420 of title 45 of the Code of Federal Regula- 9 tions, that are applicable to qualified health plans offered 10 through an Exchange. 11 ‘‘(c) BUY-IN PREMIUM.— 12 ‘‘(1) AMOUNT OF MONTHLY PREMIUMS.—The 13 Secretary shall (beginning for the first year that be- 14 gins more than 1 year after the date of the enact- 15 ment of this section), during September of the pre- 16 ceding year, determine a monthly premium for indi- 17 viduals enrolled under this section. Such monthly 18 premium shall be equal to 1⁄12 of the annual pre- 19 mium computed under paragraph (2)(B), which 20 shall apply with respect to coverage provided under 21 this section for any month in such year. 22 ‘‘(2) ANNUAL PREMIUM.— 23 ‘‘(A) COMBINED NATIONAL, PER CAPITA 24 AVERAGE FOR PARTS A, B, AND D BENEFITS.— 25 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 5 •HR 1346 IH The Secretary shall estimate the average, an- 1 nual per capita amount for benefits and admin- 2 istrative expenses that will be payable under 3 parts A, B, and D in the year for all individuals 4 enrolled under this section. 5 ‘‘(B) ANNUAL PREMIUM.—Subject to sub- 6 paragraphs (C) and (D), the annual premium 7 under this subsection for months in a year is 8 equal to the average, annual per capita amount 9 estimated under subparagraph (A) for the year. 10 ‘‘(C) ADJUSTMENTS.—The Secretary shall 11 adjust the annual premium under this sub- 12 section as necessary— 13 ‘‘(i) to ensure that expenditures under 14 this title for any year are not increased by 15 reason of this section; and 16 ‘‘(ii) by a geographic adjustment fac- 17 tor to address regional affordability con- 18 cerns. 19 ‘‘(D) AUTHORITY TO CALCULATE 20 AMOUNTS OF MONTHLY PREMIUMS SEPARATELY 21 FOR DIFFERENT AGES.—In determining the an- 22 nual premium amount under this paragraph for 23 months in a year, the Secretary may make sep- 24 arate determinations of such amount for indi- 25 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 6 •HR 1346 IH viduals by age, if the Secretary determines that 1 making such separate determinations would in- 2 crease enrollment under this section and reduce 3 the risk of adverse selection. 4 ‘‘(3) ADDITIONAL PREMIUM FOR CERTAIN PART 5 D PLANS.—Nothing in this section shall preclude an 6 individual from choosing a prescription drug plan 7 which requires the individual to pay an additional 8 amount (because of the inclusion of supplemental 9 prescription drug benefits or because the plan is a 10 more expensive plan, pursuant to section 1860D– 11 13(a)(1)). In such case, the monthly premium under 12 paragraph (1) shall be increased with respect to 13 such individual. 14 ‘‘(d) PAYMENT OF PREMIUMS.— 15 ‘‘(1) PAYMENT.—Premiums for enrollment 16 under this section shall be paid to the Secretary at 17 such times, and in such manner, as the Secretary 18 determines appropriate. 19 ‘‘(2) DEPOSIT.—Amounts collected by the Sec- 20 retary under this section shall be deposited in the 21 Medicare Buy-In Trust Fund established under sub- 22 section (e). 23 ‘‘(e) MEDICARE BUY-IN TRUST FUND.— 24 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 7 •HR 1346 IH ‘‘(1) IN GENERAL.—There is hereby created on 1 the books of the Treasury of the United States a 2 trust fund to be known as the ‘Medicare Buy-In 3 Trust Fund’ (in this subsection referred to as the 4 ‘Trust Fund’). The Trust Fund shall consist of such 5 gifts and bequests as may be made as provided in 6 section 201(i)(1) and such amounts as may be de- 7 posited in, or appropriated to, such fund as provided 8 in this title. 9 ‘‘(2) PREMIUMS.—Premiums collected under 10 subsection (d) shall be transferred to the Trust 11 Fund. 12 ‘‘(3) INCORPORATION OF PROVISIONS.—Sub- 13 sections (b) through (i) of section 1841 shall apply 14 with respect to the Trust Fund and this title in the 15 same manner as they apply with respect to the Fed- 16 eral Supplementary Medical Insurance Trust Fund 17 and part B, respectively, except that in applying 18 such section 1841, any reference in such section to 19 ‘this part’ shall be construed to be a reference to 20 this section and any reference in section 1841(h) to 21 section 1840(d) and in section 1841(i) to sections 22 1840(b)(1) and 1842(g) are deemed to be references 23 to comparable authority exercised under this section. 24 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 8 •HR 1346 IH ‘‘(f) CLARIFICATION.—Nothing in this section shall 1 affect the benefits or eligibility under this title of individ- 2 uals who would otherwise be entitled to or eligible for ben- 3 efits under this title or title XIX, or both. 4 ‘‘(g) ELIGIBILITY FOR FINANCIAL ASSISTANCE.— 5 ‘‘(1) IN GENERAL.—Individuals enrolled in cov- 6 erage under this section shall, from amounts trans- 7 ferred under paragraph (2), receive financial assist- 8 ance for such coverage that is substantially similar 9 to the assistance the individual would have received 10 if the individual were enrolled in a qualified health 11 plan through an Exchange. 12 ‘‘(2) TRANSFER OF FUNDS TO MEDICARE BUY- 13 IN TRUST FUND.— 14 ‘‘(A) IN GENERAL.—The Secretary shall 15 transfer to the Medicare Buy-In Trust Fund 16 under subsection (d) for each plan year the 17 amount determined under paragraph (C) for 18 such year. 19 ‘‘(B) USE OF FUNDS.—The amounts 20 transferred to the Medicare Buy-In Trust Fund 21 under subparagraph (A) shall only be used to 22 reduce the premiums and cost-sharing for cov- 23 erage under this section of individuals enrolled 24 under such coverage who would be eligible for 25 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 9 •HR 1346 IH cost-sharing reductions under section 1402 of 1 the Patient Protection and Affordable Care Act 2 and premium assistance under section 36B of 3 the Internal Revenue Code of 1986 if such indi- 4 vidual were enrolled in a qualified health plan. 5 ‘‘(C) AMOUNT OF TRANSFER.— 6 ‘‘(i) IN GENERAL.—The amount de- 7 termined under this subparagraph for any 8 plan year is the aggregate amount the Sec- 9 retary determines is equal to 100 percent 10 of the premium tax credits under section 11 36B of the Internal Revenue Code of 12 1986, and 100 percent of the cost-sharing 13 reductions under section 1402 of the Pa- 14 tient Protection and Affordable Care Act, 15 that would have been provided for the plan 16 year to eligible individuals who meet speci- 17 fied income criteria and are enrolled for 18 such plan year in coverage provided 19 through enrollment under this section if 20 such individuals were enrolled for such 21 year in a qualified health plan through an 22 Exchange. 23 ‘‘(ii) SPECIFIC REQUIREMENTS.—The 24 Secretary shall make the determination 25 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 10 •HR 1346 IH under clause (i) on a per enrollee basis and 1 shall take into account all relevant factors 2 necessary to determine the value of the 3 premium tax credits and cost-sharing re- 4 ductions that would have been provided to 5 eligible individuals described in section 6 1331 of the Patient Protection and Afford- 7 able Care Act, including the age and in- 8 come of the enrollee, geographic differences 9 in average spending for health care across 10 rating areas, the health status of the en- 11 rollee for purposes of determining risk ad- 12 justment payments and reinsurance pay- 13 ments that would have been made if the 14 enrollee had enrolled in a qualified health 15 plan through an Exchange, and whether 16 any reconciliation of the credit or cost- 17 sharing reductions would have occurred if 18 the enrollee had been so enrolled. This de- 19 termination shall take into consideration 20 the experience of other States with respect 21 to participation in an Exchange and such 22 credits and reductions provided to resi- 23 dents of the other States, with a special 24 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 11 •HR 1346 IH focus on enrollees with income below 200 1 percent of poverty. 2 ‘‘(D) CERTIFICATION.— 3 ‘‘(i) IN GENERAL.—The Chief Actuary 4 of the Centers for Medicare & Medicaid 5 Services, in consultation with the Office of 6 Tax Analysis of the Department of the 7 Treasury, shall certify whether the method- 8 ology used to make determinations under 9 subparagraph (C), and such determina- 10 tions, meet the requirements of this para- 11 graph. Such certifications shall be based 12 on sufficient data from the federal ex- 13 change and from comparable States about 14 their experience with programs created by 15 the Basic Health Plan. 16 ‘‘(ii) CORRECTIONS.—The Secretary 17 shall adjust the payment to the Trust 18 Fund for any plan year to reflect any error 19 in the determinations under subparagraph 20 (C) for any preceding plan year. 21 ‘‘(iii) APPLICATION.—Coverage pro- 22 vided through enrollment under this part 23 and parts B and D pursuant to this sec- 24 tion shall be treated as coverage under a 25 VerDate Sep 11 2014 20:29 Mar 06, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1346.IH H1346 khammond on DSKBBV9HB2PROD with BILLS 12 •HR 1346 IH qualified health plan in the silver level of 1 coverage in the individual market offered 2 through an Exchange and the Secretary 3 shall be treated as the issuer of such plan. 4 ‘‘(h) TREATMENT IN RELATION TO THE AFFORD- 5 ABLE CARE ACT.— 6 ‘‘(1) TREATMENT AS [Text truncated for display. 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