CHOICE Act

I 116TH CONGRESS 1ST SESSION H. R. 2085 To amend the Public Health Service Act to establish a public health insurance option, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 4, 2019 Ms. SCHAKOWSKY (for herself, Ms. DELAURO, Mr. GRIJALVA, Ms. MATSUI, Mr. YARMUTH, Ms. NORTON, Mr. SCHIFF, Mr. GARAMENDI, Mr. QUIGLEY, Ms. MOORE, and Mr. COHEN) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Public Health Service Act to establish a public health insurance option, 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 ‘‘Consumer Health Op- 4 tions and Insurance Competition Enhancement Act’’ or 5 the ‘‘CHOICE Act’’. 6 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 2085 IH SEC. 2. PUBLIC HEALTH INSURANCE OPTION. 1 (a) IN GENERAL.—Part C of title XXVII of the Pub- 2 lic Health Service Act (42 U.S.C. 300gg–91) is amended 3 by adding at the end the following: 4 ‘‘SEC. 2795. PUBLIC HEALTH INSURANCE OPTION. 5 ‘‘(a) ESTABLISHMENT.— 6 ‘‘(1) IN GENERAL.—For plan years beginning 7 in 2020, the Secretary shall establish, and provide 8 for the offering through the Exchanges, of a quali- 9 fied health plan (in this Act referred to as the ‘pub- 10 lic health insurance option’) that provides value, 11 choice, competition, and stability of affordable, high- 12 quality coverage throughout the United States in ac- 13 cordance with this section. 14 ‘‘(2) PRIMARY RESPONSIBILITY.—In designing 15 the public health insurance option, the primary re- 16 sponsibility of the Secretary shall be to create an af- 17 fordable health plan without compromising quality 18 or access to care. 19 ‘‘(b) ADMINISTRATING THE PUBLIC HEALTH INSUR- 20 ANCE OPTION.— 21 ‘‘(1) OFFERED THROUGH EXCHANGES.— 22 ‘‘(A) EXCLUSIVE TO EXCHANGES.—The 23 public health insurance option shall be made 24 available through the Exchanges. 25 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 2085 IH ‘‘(B) ENSURING A LEVEL PLAYING 1 FIELD.—Consistent with this section, the public 2 health insurance option shall— 3 ‘‘(i) comply with requirements under 4 title I of the Patient Protection and Af- 5 fordable Care Act, and the amendments 6 made by that title, that are applicable to 7 health plans offered through the Ex- 8 changes, including provider networks, no- 9 tices, consumer protections, and cost-shar- 10 ing; and 11 ‘‘(ii) provide a benefit package that is 12 comprehensive and meets the health care 13 needs of patients, including benefits de- 14 scribed in section 1302(b) of the Patient 15 Protection and Affordable Care Act. 16 ‘‘(C) PREEMPTION.—Notwithstanding sec- 17 tion 1303(a)(1) of the Patient Protection and 18 Affordable Care Act, a State law that prohibits 19 the public health insurance option from offering 20 the coverage described in subparagraph (B) 21 shall be preempted. 22 ‘‘(D) PROVISION OF BENEFIT LEVELS.— 23 The public health insurance option shall offer 24 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 2085 IH silver and gold plans and may offer bronze 1 plans. 2 ‘‘(2) ADMINISTRATIVE CONTRACTING.— 3 ‘‘(A) AUTHORITIES.—The Secretary may 4 enter into contracts for the purpose of per- 5 forming administrative functions (including 6 functions described in subsection (a)(4) of sec- 7 tion 1874A of the Social Security Act) with re- 8 spect to the public health insurance option in 9 the same manner as the Secretary may enter 10 into contracts under subsection (a)(1) of such 11 section. The Secretary shall have the same au- 12 thority with respect to the public health insur- 13 ance option as the Secretary has under such 14 subsection (a)(1) and subsection (b) of section 15 1874A of the Social Security Act with respect 16 to title XVIII of such Act. 17 ‘‘(B) TRANSFER OF INSURANCE RISK.— 18 Any contract under this paragraph shall not in- 19 volve the transfer of insurance risk from the 20 Secretary to the entity entering into such con- 21 tract with the Secretary. 22 ‘‘(3) STATE ADVISORY COUNCIL.— 23 ‘‘(A) ESTABLISHMENT.—A State may es- 24 tablish a public or nonprofit entity to serve as 25 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 2085 IH the State Advisory Council to provide rec- 1 ommendations to the Secretary on the oper- 2 ations and policies of the public health insur- 3 ance option offered through the Exchange oper- 4 ating in the State. 5 ‘‘(B) RECOMMENDATIONS.—A State Advi- 6 sory Council established under subparagraph 7 (A) shall provide recommendations on at least 8 the following: 9 ‘‘(i) Policies and procedures to inte- 10 grate quality improvement and cost con- 11 tainment mechanisms into the health care 12 delivery system. 13 ‘‘(ii) Mechanisms to facilitate public 14 awareness of the availability of the public 15 health insurance option. 16 ‘‘(iii) Alternative payment models and 17 value-based insurance design under the 18 public health insurance option that encour- 19 age quality improvement and cost control. 20 ‘‘(C) MEMBERS.—The members of any 21 State Advisory Council shall be representatives 22 of the public and include health care consumers 23 and health care providers. 24 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 2085 IH ‘‘(D) APPLICABILITY OF RECOMMENDA- 1 TIONS.—The Secretary may apply the rec- 2 ommendations of a State Advisory Council to 3 the public health insurance option in that State, 4 in any other State, or in all States. 5 ‘‘(4) DATA COLLECTION.—The Secretary shall 6 collect such data as may be required— 7 ‘‘(A) to establish rates for premiums and 8 health care provider reimbursement under sub- 9 section (c); and 10 ‘‘(B) for other purposes under this section, 11 including to improve quality, and reduce racial, 12 ethnic, socioeconomic, and other disparities, in 13 health and health care. 14 ‘‘(c) FINANCING THE PUBLIC HEALTH INSURANCE 15 OPTION.— 16 ‘‘(1) PREMIUMS.— 17 ‘‘(A) ESTABLISHMENT.—The Secretary 18 shall establish geographically adjusted premium 19 rates for the public health insurance option— 20 ‘‘(i) in a manner that complies with 21 the requirement for premium rates under 22 subparagraph (C) and considers the data 23 collected under subsection (b)(4); and 24 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 2085 IH ‘‘(ii) at a level sufficient to fully fi- 1 nance— 2 ‘‘(I) the costs of health benefits 3 provided by the public health insur- 4 ance option; and 5 ‘‘(II) administrative costs related 6 to operating the public health insur- 7 ance option. 8 ‘‘(B) CONTINGENCY MARGIN.—In estab- 9 lishing premium rates under subparagraph (A), 10 the Secretary shall include an appropriate 11 amount for a contingency margin. 12 ‘‘(C) VARIATIONS IN PREMIUM RATES.— 13 The premium rate charged for the public health 14 insurance option may not vary except as pro- 15 vided under section 2701. 16 ‘‘(2) HEALTH CARE PROVIDER PAYMENT RATES 17 FOR ITEMS AND SERVICES.— 18 ‘‘(A) IN GENERAL.— 19 ‘‘(i) RATES NEGOTIATED BY THE SEC- 20 RETARY.—Not later than January 1, 2020, 21 and except as provided in clause (ii), the 22 Secretary shall, through a negotiated 23 agreement with health care providers, es- 24 tablish rates for reimbursing health care 25 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 2085 IH providers for providing the benefits covered 1 by the public health insurance option. 2 ‘‘(ii) MEDICARE REIMBURSEMENT 3 RATES.—If the Secretary and health care 4 providers are unable to reach a negotiated 5 agreement on a reimbursement rate, the 6 Secretary shall reimburse providers at 7 rates determined for equivalent items and 8 services under the original Medicare fee- 9 for-service program under parts A and B 10 of title XVIII of the Social Security Act. 11 ‘‘(iii) FOR NEW SERVICES.—The Sec- 12 retary shall modify reimbursement rates 13 described in clause (ii) in order to accom- 14 modate payments for services, such as 15 well-child visits, that are not otherwise cov- 16 ered under the original Medicare fee-for- 17 service program. 18 ‘‘(B) PRESCRIPTION DRUGS.—Any pay- 19 ment rate under this subsection for a prescrip- 20 tion drug shall be at a rate negotiated by the 21 Secretary. If the Secretary is unable to reach a 22 negotiated agreement on such a reimbursement 23 rate, the Secretary shall use rates determined 24 for equivalent drugs paid for under the original 25 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 2085 IH Medicare fee-for-service program. The Secretary 1 shall modify such rates in order to accommo- 2 date payments for drugs that are not otherwise 3 covered under the original Medicare fee-for- 4 service program. 5 ‘‘(3) ACCOUNT.— 6 ‘‘(A) ESTABLISHMENT.—There is estab- 7 lished in the Treasury of the United States an 8 account for the receipts and disbursements at- 9 tributable to the operation of the public health 10 insurance option, including the startup funding 11 under subparagraph (C) and appropriations au- 12 thorized under subparagraph (D). 13 ‘‘(B) PROHIBITION OF STATE IMPOSITION 14 OF TAXES.—Section 1854(g) of the Social Se- 15 curity Act shall apply to receipts and disburse- 16 ments described in subparagraph (A) in the 17 same manner as such section applies to pay- 18 ments or premiums described in such section. 19 ‘‘(C) STARTUP FUNDING.— 20 ‘‘(i) AUTHORIZATION OF FUNDING.— 21 There are authorized to be appropriated 22 such sums as may be necessary to estab- 23 lish the public health insurance option and 24 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 2085 IH cover 90 days of claims reserves based on 1 projected enrollment. 2 ‘‘(ii) AMORTIZATION OF STARTUP 3 FUNDING.—The Secretary shall provide for 4 the repayment of the startup funding pro- 5 vided under clause (i) to the Treasury in 6 an amortized manner over the 10-year pe- 7 riod beginning on January 1, 2020. 8 ‘‘(D) ADDITIONAL AUTHORIZATION OF AP- 9 PROPRIATIONS.—To carry out paragraph (2) of 10 subsection (b), there are authorized to be ap- 11 propriated such sums as may be necessary. 12 ‘‘(E) LIMITATION.—Any provision of law 13 restricting the use of Federal funds with re- 14 spect to any reproductive health service shall 15 not apply to funds appropriated under this sub- 16 section. 17 ‘‘(d) HEALTH CARE PROVIDER PARTICIPATION.— 18 ‘‘(1) PROVIDER PARTICIPATION.— 19 ‘‘(A) IN GENERAL.—The Secretary shall 20 establish conditions of participation for health 21 care providers under the public health insurance 22 option. 23 ‘‘(B) LICENSURE OR CERTIFICATION.— 24 The Secretary shall not allow a health care pro- 25 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 2085 IH vider to participate in the public health insur- 1 ance option unless such provider is appro- 2 priately licensed or certified under State law. 3 ‘‘(C) CLARIFICATION.—Notwithstanding 4 subparagraph (A), a health care provider may 5 not be prohibited from participating in the pub- 6 lic health insurance option for reasons other 7 than the ability of such provider to provide cov- 8 ered services. 9 ‘‘(2) ESTABLISHMENT OF A PROVIDER NET- 10 WORK.— 11 ‘‘(A) MEDICARE AND MEDICAID PARTICI- 12 PATING PROVIDERS.—A health care provider 13 that is a participating provider of services or 14 supplier under the Medicare program under 15 title XVIII of the Social Security Act or under 16 a State Medicaid plan under title XIX of such 17 Act is a participating provider in the public 18 health insurance option unless the health care 19 provider opts out of participating in the public 20 health insurance option through a process es- 21 tablished by the Secretary. 22 ‘‘(B) ADDITIONAL PROVIDERS.—The Sec- 23 retary shall establish a process to allow health 24 care providers not described in subparagraph 25 VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS 12 •HR 2085 IH (A) to become participating providers in the 1 public health insurance option.’’. 2 (b) CONFORMING AMENDMENTS.— 3 (1) TREATMENT AS A QUALIFIED HEALTH 4 PLAN.—Section 1301(a)(2) of the Patient Protection 5 and Affordable Care Act (42 U.S.C. 18021(a)(2)) is 6 amended— 7 (A) in the paragraph heading, by inserting 8 ‘‘, THE PUBLIC HEALTH INSURANCE OPTION,’’ 9 before ‘‘AND’’; and 10 (B) by inserting ‘‘the public health insur- 11 ance option under section 2795 of the Public 12 Health Service Act,’’ before ‘‘and a multi-State 13 plan’’. 14 (2) LEVEL PLAYING FIELD.—Section 1324(a) 15 of the Patient Protection and Affordable Care Act 16 (42 U.S.C. 18044(a)) is amended by inserting ‘‘the 17 public health insurance option under section 2795 of 18 the Public Health Service Act,’’ before ‘‘or a multi- 19 State qualified health plan’’. 20 Æ VerDate Sep 11 2014 00:28 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H2085.IH H2085 pamtmann on DSKBFK8HB2PROD with BILLS