Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 1884 To amend the Patient Protection and Affordable Care Act to improve afford- ability of, undo sabotage with respect to, and increase access to health insurance coverage, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 26, 2019 Mr. PALLONE (for himself, Mr. NEAL, Mr. SCOTT of Virginia, Mr. HOYER, Ms. SCHRIER, Mr. CISNEROS, Ms. DEGETTE, Ms. CASTOR of Florida, Mrs. TRAHAN, Mrs. CRAIG, Ms. KUSTER of New Hampshire, Mr. RUIZ, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. ALLRED, Mrs. BUSTOS, Mrs. MCBATH, Mr. LUJA´N, Mr. TED LIEU of California, Mr. PETERS, Ms. WILSON of Florida, Ms. SPANBERGER, Mr. ROUDA, Ms. UNDER- WOOD, Mr. DELGADO, Mrs. LEE of Nevada, Ms. BLUNT ROCHESTER, Mr. DOGGETT, Mr. GOMEZ, Mrs. DINGELL, Ms. SHALALA, Ms. FRANKEL, Ms. ESHOO, Mr. SIRES, Mr. SOTO, Ms. JACKSON LEE, Mr. KEATING, Ms. STEVENS, Ms. SEWELL of Alabama, Mr. TRONE, Mr. ROSE of New York, Mrs. KIRKPATRICK, Mr. LARSON of Connecticut, Mr. LEWIS, Ms. JAYAPAL, Ms. GARCIA of Texas, Mr. COURTNEY, Ms. SA´NCHEZ, Mrs. DEMINGS, Mrs. MURPHY, Ms. DEAN, Mr. COHEN, Mr. THOMPSON of California, Mr. RUSH, Mr. MORELLE, Ms. HILL of Cali- fornia, Mr. HIGGINS of New York, Mrs. DAVIS of California, Ms. BROWNLEY of California, Mr. PASCRELL, Ms. SLOTKIN, Mr. ENGEL, Mr. KIM, Mr. BLUMENAUER, Mrs. HAYES, Mr. COX of California, Mr. TAKANO, Mr. PANETTA, Mr. KILDEE, Mr. MALINOWSKI, Mr. LEVIN of Michigan, Mr. GOLDEN, Mr. VAN DREW, Ms. MUCARSEL-POWELL, Mr. GRIJALVA, Mr. ESPAILLAT, Ms. SCHAKOWSKY, Ms. PINGREE, Ms. NOR- TON, and Mr. SABLAN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Com- mittees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consider- ation of such provisions as fall within the jurisdiction of the committee concerned VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 2 •HR 1884 IH A BILL To amend the Patient Protection and Affordable Care Act to improve affordability of, undo sabotage with respect to, and increase access to health insurance coverage, 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Protecting Pre-Existing Conditions and Making Health 5 Care More Affordable Act of 2019’’. 6 (b) TABLE OF CONTENTS.—The table of contents of 7 this Act is as follows: 8 Sec. 1. Short title; table of contents. TITLE I—EXPANDING AFFORDABILITY Sec. 101. Improve affordability and reduce premium costs for consumers. Sec. 102. Expand affordability for working families. TITLE II—UNDOING SABOTAGE Sec. 201. Protect comprehensive coverage for small businesses and workers. Sec. 202. Short-term limited duration insurance rule prohibition. Sec. 203. Ensure plans provide comprehensive benefits. Sec. 204. Providing for additional requirements with respect to the navigator program. Sec. 205. Federal Exchange outreach and educational activities. Sec. 206. Improve Health Insurance Affordability Fund. Sec. 207. Providing that certain guidance related to waivers for State innova- tion under the Patient Protection and Affordable Care Act shall have no force or effect. TITLE III—STATE INNOVATION AND TRANSPARENCY Sec. 301. Fund State health insurance education programs for consumers. Sec. 302. Fund State innovations to expand coverage. Sec. 303. Preserving State option to implement health care marketplaces. Sec. 304. Promote transparency and accountability in the Administration’s ex- penditures of Exchange user fees. VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 3 •HR 1884 IH TITLE I—EXPANDING 1 AFFORDABILITY 2 SEC. 101. IMPROVE AFFORDABILITY AND REDUCE PRE- 3 MIUM COSTS FOR CONSUMERS. 4 (a) IN GENERAL.—Section 36B(b)(3)(A) of the In- 5 ternal Revenue Code of 1986 is amended to read as fol- 6 lows: 7 ‘‘(A) APPLICABLE PERCENTAGE.—The ap- 8 plicable percentage for any taxable year shall be 9 the percentage such that the applicable percent- 10 age for any taxpayer whose household income is 11 within an income tier specified in the following 12 table shall increase, on a sliding scale in a lin- 13 ear manner, from the initial premium percent- 14 age to the final premium percentage specified in 15 such table for such income tier: 16 ‘‘In the case of household income (expressed as a percent of poverty line) within the following income tier: The initial premium percentage is— The final premium percentage is— Over 100.0 percent up to 133.0 percent .... 0.0 1.0 133.0 percent up to 150.0 percent ............. 1.0 2.0 150.0 percent up to 200.0 percent ............. 2.0 4.0 200.0 percent up to 250.0 percent ............. 4.0 6.0 250.0 percent up to 300.0 percent ............. 6.0 7.0 300.0 percent up to 400.0 percent ............. 7.0 8.5 400.0 percent and higher ........................... 8.5 8.5’’. (b) CONFORMING AMENDMENT.—Section 17 36B(c)(1)(A) of the Internal Revenue Code of 1986 is 18 amended by striking ‘‘but does not exceed 400 percent’’. 19 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 4 •HR 1884 IH (c) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to taxable years beginning after 2 December 31, 2020. 3 SEC. 102. EXPAND AFFORDABILITY FOR WORKING FAMI- 4 LIES. 5 (a) IN GENERAL.—Clause (i) of section 36B(c)(2)(C) 6 of the Internal Revenue Code of 1986 is amended to read 7 as follows: 8 ‘‘(i) COVERAGE MUST BE AFFORD- 9 ABLE.— 10 ‘‘(I) EMPLOYEES.—An employee 11 shall not be treated as eligible for 12 minimum essential coverage if such 13 coverage consists of an eligible em- 14 ployer-sponsored plan (as defined in 15 section 5000A(f)(2)) and the employ- 16 ee’s required contribution (within the 17 meaning of section 5000A(e)(1)(B)) 18 with respect to the plan exceeds 9.5 19 percent of the employee’s household 20 income. 21 ‘‘(II) FAMILY MEMBERS.—An in- 22 dividual who is eligible to enroll in an 23 eligible employer-sponsored plan (as 24 defined in section 5000A(f)(2)) by 25 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 5 •HR 1884 IH reason of a relationship the individual 1 bears to the employee shall not be 2 treated as eligible for minimum essen- 3 tial coverage by reason of such eligi- 4 bility to enroll if the employee’s re- 5 quired contribution (within the mean- 6 ing of section 5000A(e)(1)(B), deter- 7 mined by substituting ‘family’ for 8 ‘self-only’) with respect to the plan ex- 9 ceeds 9.5 percent of the employee’s 10 household income.’’. 11 (b) CONFORMING AMENDMENTS.— 12 (1) Clause (ii) of section 36B(c)(2)(C) of the 13 Internal Revenue Code of 1986 is amended by strik- 14 ing ‘‘Except as provided in clause (iii), an employee’’ 15 and inserting ‘‘An individual’’. 16 (2) Clause (iii) of section 36B(c)(2)(C) of such 17 Code is amended by striking ‘‘the last sentence of 18 clause (i)’’ and inserting ‘‘clause (i)(II)’’. 19 (3) Clause (iv) of section 36B(c)(2)(C) of such 20 Code is amended by striking ‘‘the 9.5 percent under 21 clause (i)(II)’’ and inserting ‘‘the 9.5 percent under 22 clauses (i)(I) and (i)(II)’’. 23 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 6 •HR 1884 IH (c) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to taxable years beginning after 2 December 31, 2020. 3 TITLE II—UNDOING SABOTAGE 4 SEC. 201. PROTECT COMPREHENSIVE COVERAGE FOR 5 SMALL BUSINESSES AND WORKERS. 6 The Secretary of Labor may not take any action to 7 implement, enforce, or otherwise give effect to the rule en- 8 titled ‘‘Definition of ‘Employer’ Under Section 3(5) of 9 ERISA–Association Health Plans’’ (83 Fed. Reg. 28912 10 (June 21, 2018)), and the Secretary may not promulgate 11 any substantially similar rule. 12 SEC. 202. SHORT-TERM LIMITED DURATION INSURANCE 13 RULE PROHIBITION. 14 The Secretary of Health and Human Services, the 15 Secretary of the Treasury, and the Secretary of Labor 16 may not take any action to implement, enforce, or other- 17 wise give effect to the rule entitled ‘‘Short-Term, Limited 18 Duration Insurance’’ (83 Fed. Reg. 38212 (August 3, 19 2018)), and the Secretaries may not promulgate any sub- 20 stantially similar rule. 21 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 7 •HR 1884 IH SEC. 203. ENSURE PLANS PROVIDE COMPREHENSIVE BENE- 1 FITS. 2 (a) ESSENTIAL HEALTH BENEFITS.—Section 3 1302(b)(4) of the Patient Protection and Affordable Care 4 Act (42 U.S.C. 18022(b)(4)) is amended— 5 (1) in subparagraph (A), by inserting ‘‘and so 6 that benefits are included within each of such cat- 7 egories’’ before the semicolon; 8 (2) in subparagraph (G), by striking at the end 9 ‘‘and’’; 10 (3) in subparagraph (H), by striking the period 11 at the end and inserting ‘‘; and’’; and 12 (4) by adding at the end the following new sub- 13 paragraph: 14 ‘‘(I) ensure that, beginning January 1, 15 2020— 16 ‘‘(i) in the case of health benefits that 17 are established as essential health benefits, 18 there shall not be substitution of such ben- 19 efits across benefit categories; 20 ‘‘(ii) a qualified health plan shall not 21 be treated as providing coverage for the es- 22 sential health benefits unless under such 23 plan— 24 ‘‘(I) coverage of prescription 25 drugs provides for access to a wide 26 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 8 •HR 1884 IH variety of classes of drugs within the 1 prescription drug formulary of such 2 plan; and 3 ‘‘(II) in the case that a drug that 4 is medically necessary for an enrollee 5 under such plan is not included within 6 such formulary, such individual has 7 access to such drug through an excep- 8 tions process established by the plan; 9 and 10 ‘‘(iii) habilitative services are covered 11 at parity with rehabilitative services.’’. 12 (b) STANDARD BENEFIT PLANS.—Section 1302(d) of 13 the Patient Protection and Affordable Care Act (42 14 U.S.C. 18022(d)) is amended by adding at the end the 15 following new paragraph: 16 ‘‘(5) STANDARD BENEFIT PLANS.— 17 ‘‘(A) IN GENERAL.—For purposes of pro- 18 viding individuals with the opportunity to make 19 simpler comparisons of health plans offered by 20 different health insurance issuers and simplify 21 the selection process, the Secretary shall, for 22 each plan year beginning with plan year 2020, 23 through rulemaking, specify a structure de- 24 scribed in subparagraph (B)(i) for a standard 25 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 9 •HR 1884 IH benefit plan for such plan year for each of the 1 bronze, silver, and gold levels of coverage and 2 for each actuarial value variation of a silver 3 plan resulting from the application of section 4 1402(c). A standard benefit plan for a plan 5 year for a level of coverage or actuarial value 6 variation of a silver plan shall be modeled on 7 the most commonly purchased plans (deter- 8 mined by enrollments in such plans) during the 9 previous 2 plan years offered in the federally fa- 10 cilitated Exchange operated pursuant to section 11 1321(c) in such level or variation and shall in- 12 clude coverage of deductible-exempt services 13 consistent with actual purchasing patterns of 14 consumers in the previous two plan years. 15 ‘‘(B) STANDARD BENEFIT PLAN.—For 16 purposes of this paragraph, the term ‘standard 17 benefit plan’ means a qualified health plan to 18 be offered through an Exchange on the indi- 19 vidual market that has either— 20 ‘‘(i) a standardized cost-sharing struc- 21 ture specified by the Secretary pursuant to 22 rulemaking; or 23 ‘‘(ii) a standardized cost-sharing 24 structure specified by the Secretary pursu- 25 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 10 •HR 1884 IH ant to rulemaking that is modified by the 1 health insurance issuer of such plan only 2 to the extent necessary to align with high 3 deductible health plan requirements under 4 section 223 of the Internal Revenue Code 5 of 1986 or the applicable annual limitation 6 on cost sharing under subsection (c) and 7 actuarial value requirements specified by 8 the Secretary.’’. 9 SEC. 204. PROVIDING FOR ADDITIONAL REQUIREMENTS 10 WITH RESPECT TO THE NAVIGATOR PRO- 11 GRAM. 12 (a) IN GENERAL.—Section 1311(i) of the Patient 13 Protection and Affordable Care Act (42 U.S.C. 18031(i)) 14 is amended— 15 (1) in paragraph (2), by adding at the end the 16 following new subparagraph: 17 ‘‘(C) SELECTION OF RECIPIENTS.—In the 18 case of an Exchange established and operated 19 by the Secretary within a State pursuant to sec- 20 tion 1321(c), in awarding grants under para- 21 graph (1), the Exchange shall— 22 ‘‘(i) select entities to receive such 23 grants based solely on an entity’s dem- 24 VerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884 pbinns on DSK79D2C42PROD with BILLS 11 •HR 1884 IH onstrated capacity to carry out each of the 1 duties specified in paragraph (3); 2 ‘‘(ii) not take into account whether or 3 not the entity has demonstrated how the 4 entity will provide information to individ- 5 uals relating to group health plans offered 6 by a group or association of employers de- 7 scribed in section 2510.3–5(b) of title 29, 8 Code of Federal Regulations (or any suc- 9 cessor regulation), or short-term limited 10 duration insurance (as defined by the Sec- 11 retary for purposes of section 2791(b)(5) 12 of the Public Health Service Act); and 13 ‘‘(iii) ensure that, each year, the Ex- 14 change awards such a grant to— 15 ‘‘(I) at least one entity described 16 in this paragraph that is a community 17 and consumer-focused nonprofit 18 group; and 19 ‘‘(II) at least one entity described 20 in subparagraph (B), which may in- 21 clude another community and con- 22 sumer-focused nonprofit group in ad- 23 dition to any such group awarded a 24 grant pursuant to subclause (I).’’ [Text truncated for display. 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