Consumer Health Insurance Protection Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1213 To provide health insurance reform, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 11, 2019 Ms. WARREN (for herself, Mrs. GILLIBRAND, Ms. HARRIS, Ms. BALDWIN, Ms. KLOBUCHAR, Mr. BOOKER, and Mr. BLUMENTHAL) introduced the fol- lowing bill; which was read twice and referred to the Committee on Fi- nance A BILL To provide health insurance reform, 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 In- 4 surance Protection Act of 2019’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents for this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. TITLE I—LIMITING INSURER PROFITS AND PREVENTING UNREASONABLE PREMIUM INCREASES Sec. 101. Medical loss ratio. Sec. 102. Ensuring that consumers get value for their dollars. VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 2 •S 1213 IS Sec. 103. Effective date. TITLE II—MAKING HEALTH INSURANCE COVERAGE AFFORDABLE Sec. 201. Enhancement of premium assistance credit. Sec. 202. Enhancements for reduced cost-sharing. Sec. 203. Cap on prescription drug cost-sharing. Sec. 204. Standardized options in the bronze, silver, and gold levels of coverage. Sec. 205. Deductible-exempt services for group health plans and group health insurance coverage. Sec. 206. Clarification regarding determination of affordability of employer- sponsored minimum essential coverage. TITLE III—ENSURING ACCESS TO CARE Sec. 301. Network adequacy requirements. Sec. 302. Ensuring adequate coverage in areas with fewer than 3 health insur- ance issuers offering qualified health plans on the State Ex- change. Sec. 303. Enrollment in Exchanges. Sec. 304. Marketing and outreach for Exchanges operated by the Secretary. Sec. 305. Navigator program. TITLE IV—STRENGTHENING CONSUMER HEALTH INSURANCE PROTECTIONS Sec. 401. Prohibiting discriminatory premiums based on tobacco use. Sec. 402. Health insurance consumer information. Sec. 403. Patient protections. Sec. 404. Limitation on balance billing for emergency services. Sec. 405. Notification of provider terminations. Sec. 406. Short-term limited duration health insurance coverage. Sec. 407. Protecting essential health benefits and coverage of pediatric services. Sec. 408. Association health plans. TITLE I—LIMITING INSURER 1 PROFITS AND PREVENTING 2 UNREASONABLE PREMIUM 3 INCREASES 4 SEC. 101. MEDICAL LOSS RATIO. 5 Section 2718(b)(1)(A)(ii) of the Public Health Serv- 6 ice Act (42 U.S.C. 300gg–18(b)(1)(A)(ii)) is amended by 7 striking ‘‘80’’ each place it appears and inserting ‘‘85’’. 8 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 3 •S 1213 IS SEC. 102. ENSURING THAT CONSUMERS GET VALUE FOR 1 THEIR DOLLARS. 2 The first section 2794 of the Public Health Service 3 Act (42 U.S.C. 300gg–94), added by section 1003 of the 4 Patient Protection and Affordable Care Act (Public Law 5 111–148), is amended— 6 (1) in subsection (a)— 7 (A) in paragraph (1), by striking ‘‘sub- 8 section (b)(2)(A)’’ and inserting ‘‘subsections 9 (b)(2)(A) and (b)(3)’’; and 10 (B) in paragraph (2), by adding at the end 11 the following: ‘‘Notwithstanding any other pro- 12 vision of law, a health insurance issuer may not 13 exclude from such disclosure information that is 14 a trade secret or commercial or financial infor- 15 mation described in section 552(b)(4) of title 5, 16 United States Code.’’; 17 (2) in subsection (b)— 18 (A) in paragraph (2)(A), by inserting ‘‘and 19 paragraph (3)’’ after ‘‘subsection (a)(2)’’; and 20 (B) by adding at the end the following: 21 ‘‘(3) PROHIBITING UNREASONABLE PREMIUM 22 INCREASES.— 23 ‘‘(A) IN GENERAL.—Beginning with plan 24 years beginning in 2021, the Secretary, or a 25 State pursuant to an effective rate review pro- 26 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 4 •S 1213 IS gram meeting the requirements under para- 1 graph (4)— 2 ‘‘(i) shall, consistent with subsection 3 (a)(2) and paragraph (2), review increases 4 in premiums for health insurance coverage 5 that are subject to review pursuant to sec- 6 tion 154.200 of title 45, Code of Federal 7 Regulations (or any successor regulation), 8 and determine whether such increases are 9 unreasonable; and 10 ‘‘(ii) may prohibit a health insurance 11 issuer from implementing such an increase 12 that is unreasonable. 13 ‘‘(B) UNREASONABLE INCREASES.—In de- 14 termining whether an increase in premiums for 15 health insurance coverage is unreasonable 16 under subparagraph (A)(i)— 17 ‘‘(i) the Secretary shall consider 18 whether the increase is excessive, unjusti- 19 fied, discriminatory, or inadequate; and 20 ‘‘(ii) the State, pursuant to an effec- 21 tive rate review program meeting the re- 22 quirements under paragraph (4), shall 23 apply applicable State law for making such 24 determination. 25 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 5 •S 1213 IS ‘‘(4) STATE EFFECTIVE RATE REVIEW PRO- 1 GRAMS.—A State effective rate review program 2 meets the requirements under this paragraph if— 3 ‘‘(A) the program carries out the reviews 4 described in paragraph (3)(A)(i) and ensures 5 that such reviews are meaningful, effective, and 6 timely reviews of the data and documentation 7 (including any contracts or documents described 8 in subparagraph (E)) submitted by health in- 9 surance issuers in support of proposed increases 10 in premiums for health insurance coverage; 11 ‘‘(B) such reviews include an examination 12 of— 13 ‘‘(i) the affordability of proposed in- 14 creases in premiums for health insurance 15 coverage; 16 ‘‘(ii) the quality improvement activi- 17 ties carried out by health insurance issuers 18 proposing the increases; 19 ‘‘(iii) the cost containment activities 20 of health insurance issuers proposing the 21 increases; and 22 ‘‘(iv) the solvency of the health insur- 23 ance coverage; 24 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 6 •S 1213 IS ‘‘(C) the program establishes a mechanism 1 for receiving public comments on proposed in- 2 creases in premiums for health insurance cov- 3 erage reviewed by the State; 4 ‘‘(D) such reviews include a review of all 5 public comments received under subparagraph 6 (C); 7 ‘‘(E) the program requires each health in- 8 surance issuer proposing an increase in pre- 9 miums for health insurance coverage to submit 10 to the State any provider contracts that may be 11 affected, including any documents incorporated 12 by reference into such contracts; and 13 ‘‘(F) the program requires the State to 14 provide the Secretary its determination of 15 whether each increase reviewed is unreasonable, 16 in a form and manner prescribed by the Sec- 17 retary.’’; and 18 (3) in subsection (c)— 19 (A) in paragraph (1)— 20 (i) in the heading, by striking ‘‘2010 21 THROUGH 2014’’ and inserting ‘‘2021 22 THROUGH 2025’’; and 23 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 7 •S 1213 IS (ii) in the matter preceding subpara- 1 graph (A), by striking ‘‘2010’’ and insert- 2 ing ‘‘2021’’; and 3 (B) in paragraph (2)(B), by striking 4 ‘‘2014’’ and inserting ‘‘2025’’. 5 SEC. 103. EFFECTIVE DATE. 6 The amendments made by this title shall apply to 7 plan years beginning after December 31, 2020. 8 TITLE II—MAKING HEALTH IN- 9 SURANCE COVERAGE AF- 10 FORDABLE 11 SEC. 201. ENHANCEMENT OF PREMIUM ASSISTANCE CRED- 12 IT. 13 (a) USE OF GOLD LEVEL PLAN FOR BENCHMARK.— 14 (1) IN GENERAL.—Clause (i) of section 15 36B(b)(2)(B) of the Internal Revenue Code of 1986 16 is amended by striking ‘‘applicable second lowest 17 cost silver plan’’ and inserting ‘‘applicable second 18 lowest cost gold plan’’. 19 (2) CONFORMING AMENDMENT RELATED TO 20 AFFORDABILITY.—Section 36B(c)(4)(C)(i)(I) of 21 such Code is amended by striking ‘‘second lowest 22 cost silver plan’’ and inserting ‘‘second lowest cost 23 gold plan’’. 24 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 8 •S 1213 IS (3) OTHER CONFORMING AMENDMENTS.—Sub- 1 paragraphs (B) and (C) of section 36B(b)(3) of such 2 Code are each amended by striking ‘‘silver plan’’ 3 each place it appears in the text and the heading 4 and inserting ‘‘gold plan’’. 5 (b) EXPANSION OF ELIGIBILITY FOR REFUNDABLE 6 CREDITS FOR COVERAGE UNDER QUALIFIED HEALTH 7 PLANS.— 8 (1) IN GENERAL.—Section 36B(c)(1)(A) of the 9 Internal Revenue Code of 1986 is amended by strik- 10 ing ‘‘but does not exceed 400 percent’’. 11 (2) CONFORMING AMENDMENTS RELATING TO 12 RECAPTURE OF EXCESS ADVANCED PAYMENTS.— 13 Clause (i) of section 36B(f)(2)(B) of such Code is 14 amended— 15 (A) by striking ‘‘In the case of’’ and all 16 that follows through ‘‘the amount of’’ and in- 17 serting ‘‘The amount of’’, and 18 (B) by striking ‘‘but less than 400%’’ in 19 the table therein. 20 (c) DETERMINATION OF APPLICABLE PERCENT- 21 AGE.— 22 (1) IN GENERAL.—Subparagraph (A) of section 23 36B(b)(3) of the Internal Revenue Code of 1986 is 24 amended to read as follows: 25 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 9 •S 1213 IS ‘‘(A) APPLICABLE PERCENTAGE.—The ap- 1 plicable percentage for any taxable year shall be 2 the percentage such that the applicable percent- 3 age for any taxpayer whose household income is 4 within an income tier specified in the following 5 table shall increase, on a sliding scale in a lin- 6 ear manner, from the initial premium percent- 7 age to the final premium percentage specified in 8 such table for such income tier: 9 ‘‘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— 100% through 133% .................. 0% 1.0% 133% through 150% .................. 1.0% 2.0% 150% through 200% .................. 2.0% 4.0% 200% through 250% .................. 4.0% 6.0% 250% through 300% .................. 6.0% 7.0% 300% through 400% .................. 7.0% 8.5% Over 400% .................................. 8.5% 8.5%’’. (2) CONFORMING AMENDMENTS.—Subsections 10 (c)(2)(C)(iv) and (c)(4)(F) of section 36B of the In- 11 ternal Revenue Code of 1986 are each amended by 12 inserting ‘‘(as in effect before the date of the enact- 13 ment of the Consumer Health Insurance Protection 14 Act of 2019)’’ after ‘‘subsection (b)(3)(A)(ii)’’. 15 (d) RECONCILIATION OF PREMIUM ASSISTANCE 16 CREDIT AND ADVANCE CREDIT FOR SINGLE-PARENT 17 HOUSEHOLDS.— 18 (1) IN GENERAL.—Clause (i) of section 19 36B(f)(2)(B) of the Internal Revenue Code of 1986 20 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 10 •S 1213 IS is amended by striking ‘‘section 1(c)’’ and inserting 1 ‘‘subsection (b) or (c) of section 1’’. 2 (2) EFFECTIVE DATE.—The amendment made 3 by this subsection shall apply to taxable years begin- 4 ning after December 31, 2019. 5 (e) DETERMINATION OF PREMIUM ASSISTANCE 6 CREDIT FOR DISABLED WORKERS.— 7 (1) IN GENERAL.—Section 36B(d)(2) of the In- 8 ternal Revenue Code of 1986 is amended by insert- 9 ing at the end the following new subparagraph: 10 ‘‘(C) EXCLUSION OF CERTAIN AMOUNTS 11 RECEIVED AS LUMP-SUM PAYMENT.—For pur- 12 poses of subparagraph (B), such amount shall 13 not include any portion of a lump-sum payment 14 of disability insurance benefits under section 15 223 of the Social Security Act (42 U.S.C. 423) 16 which is— 17 ‘‘(i) received during the taxable year, 18 and 19 ‘‘(ii) attributable to prior taxable 20 years.’’. 21 (2) EFFECTIVE DATE.—The amendment made 22 by this subsection shall apply to taxable years begin- 23 ning after December 31, 2019. 24 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 11 •S 1213 IS (f) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to taxable years beginning after 2 December 31, 2020. 3 SEC. 202. ENHANCEMENTS FOR REDUCED COST-SHARING. 4 (a) MODIFICATION OF AMOUNT.— 5 (1) IN GENERAL.—Section 1402 of the Patient 6 Protection and Affordable Care Act (42 U.S.C. 7 18071) is amended— 8 (A) in subsection (b)(1), by striking ‘‘sil- 9 ver’’ and inserting ‘‘gold’’; 10 (B) by amending subsection (c)(1)(B) to 11 read as follows: 12 ‘‘(B) COORDINATION WITH ACTUARIAL 13 LIMITS.—The Secretary shall ensure the reduc- 14 tion under this paragraph shall not result in the 15 plan’s share of the total allowed costs of bene- 16 fits provided under the plan becoming less 17 than— 18 ‘‘(i) 95 percent in the case of an eligi- 19 ble insured described in paragraph (2)(A); 20 ‘‘(ii) 90 percent in the case of an eli- 21 gible insured described in paragraph 22 (2)(B); and 23 VerDate Sep 11 2014 01:51 Apr 24, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1213.IS S1213 SSpencer on DSKBBXCHB2PROD with BILLS 12 •S 1213 IS ‘‘(iii) 85 percent in the case of an eli- 1 gible insured described in paragraph 2 (2)(C).’’; and 3 (C) by amending subsection (c)(2) to read 4 as follows: 5 ‘‘(2) ADDITIONAL REDUCTION.—The Secretary 6 shall establish procedures under which the issuer of 7 a qualified health plan to which this section applies 8 shall further reduce cost-sharing under the plan in 9 a manner sufficient to— 10 ‘‘(A) in the case of an eligible insured 11 whose household income is not less than 100 12 percent but not more than 200 percent of the 13 poverty line for a family of the size involved, in- 14 crease the plan’s share of the total allowed 15 costs of benefits provided under the plan to 95 16 percent of such costs; 17 ‘‘(B) in the case of an eligible insured 18 whose household income is more than 200 per- 19 cent but not more than 300 percent of the pov- 20 erty line for a family of the size involved, in- 21 crease the plan’s share of the total allowed 22 costs of benefits provided under the plan to 90 23 percent of such [Text truncated for display. 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