To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program.

I 116TH CONGRESS 1ST SESSION H. R. 2789 To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program. IN THE HOUSE OF REPRESENTATIVES MAY 16, 2019 Mr. SCHWEIKERT (for himself, Mr. FORTENBERRY, and Mr. WEBSTER of Florida) introduced the following bill; which was referred to the Com- mittee on Energy and Commerce A BILL To amend the Public Health Service Act to establish a health insurance Federal Invisible Risk Sharing Program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. HEALTH INSURANCE FEDERAL INVISIBLE RISK 3 SHARING PROGRAM. 4 The Public Health Service Act is amended by adding 5 at the end the following new title: 6 VerDate Sep 11 2014 04:44 May 29, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2789.IH H2789 kjohnson on DSK79L0C42 with BILLS 2 •HR 2789 IH ‘‘TITLE XXXIV—HEALTH INSUR- 1 ANCE FEDERAL INVISIBLE 2 RISK SHARING PROGRAM 3 ‘‘SEC. 3401. ESTABLISHMENT OF FEDERAL INVISIBLE RISK 4 SHARING PROGRAM. 5 ‘‘(a) IN GENERAL.—There is established a Federal 6 Invisible Risk Sharing Program (in this section referred 7 to as the ‘Program’), to be administered by the Secretary, 8 acting through the Administrator of the Centers for Medi- 9 care & Medicaid Services (in this section referred to as 10 the ‘Administrator’), to provide payments to health insur- 11 ance issuers with respect to claims for eligible individuals 12 for the purpose of lowering premiums for health insurance 13 coverage offered in the individual market. 14 ‘‘(b) FUNDING.— 15 ‘‘(1) APPROPRIATIONS.—For the purpose of 16 providing funding for the Program there is appro- 17 priated, out of any money in the Treasury not other- 18 wise appropriated, $15,000,000,000 for the period 19 beginning on January 1, 2021, and ending on De- 20 cember 31, 2030. Such funds shall be available to 21 the Secretary for such purpose in such amounts and 22 at such times during such period as specified by the 23 Secretary. 24 VerDate Sep 11 2014 04:44 May 29, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2789.IH H2789 kjohnson on DSK79L0C42 with BILLS 3 •HR 2789 IH ‘‘(2) ADDITIONAL FUNDING.—In addition to 1 amounts appropriated under paragraph (1), out of 2 any money in the Treasury not otherwise appro- 3 priated, there shall be appropriated to the Secretary 4 for each year (after 2021) during the period speci- 5 fied in paragraph (1), for purposes of carrying out 6 the Program, an amount equal to the amount by 7 which the actual sum of the premium assistance 8 credits calculated for all taxpayers under section 9 36B(a) of the Internal Revenue Code of 1986 for 10 the previous year was less than the projected sum of 11 the premium assistance credits calculated for all tax- 12 payers under such section for such previous year. 13 Amounts appropriated pursuant to the previous sen- 14 tence shall remain available until expended. 15 ‘‘(3) LIMITATION.—Amounts appropriated 16 under this subsection are subject to the require- 17 ments and limitations under sections 506 and 507 of 18 division H of Public Law 115–31 in the same man- 19 ner and to the same extent as if such amounts were 20 appropriated under such division. 21 ‘‘(c) OPERATION OF PROGRAM.— 22 ‘‘(1) IN GENERAL.—The Administrator shall es- 23 tablish, after consultation with health care con- 24 sumers, health insurance issuers, State insurance 25 VerDate Sep 11 2014 04:44 May 29, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2789.IH H2789 kjohnson on DSK79L0C42 with BILLS 4 •HR 2789 IH commissioners, and other stakeholders, and after 1 taking into consideration high-cost health conditions 2 and other health trends that generate high cost, pa- 3 rameters for the operation of the Program consistent 4 with this section. 5 ‘‘(2) EXPEDITING INITIAL OPERATION.— 6 ‘‘(A) DEADLINE FOR INITIAL OPER- 7 ATION.—Not later than 60 days after the date 8 of the enactment of this title, the Administrator 9 shall establish sufficient parameters to specify 10 how the Program will operate for plan year 11 2021. 12 ‘‘(B) SECRETARIAL DISCRETION.—To en- 13 sure the operation of the Program in plan year 14 2021, notwithstanding paragraph (1), the Sec- 15 retary may in lieu of basing eligibility for par- 16 ticipation in the Program on the parameters de- 17 scribed in paragraphs (1) and (2) of subsection 18 (d) and without consultation described in para- 19 graph (1), base such eligibility on dollar 20 amounts of claims and specify actuarial values 21 to be applied for such amounts. 22 ‘‘(3) STATE OPERATION OF PROGRAM.— 23 ‘‘(A) IN GENERAL.—The Administrator 24 shall establish a process for a State to operate 25 VerDate Sep 11 2014 04:44 May 29, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2789.IH H2789 kjohnson on DSK79L0C42 with BILLS 5 •HR 2789 IH the Program in such State beginning with plan 1 year 2023. 2 ‘‘(B) IMMEDIATE WAIVERS.—Such process 3 shall allow a State that, as of March 1, 2020, 4 had in place a fully established high risk shar- 5 ing pool or fully established reinsurance pro- 6 gram (as defined by the Secretary) to continue 7 to operate such pool or program and not have 8 the Program administered by the Secretary 9 under this section apply to such State. 10 ‘‘(d) DETAILS OF PROGRAM.—The parameters for 11 the Program shall include the following: 12 ‘‘(1) ELIGIBLE INDIVIDUALS.—A definition for 13 eligible individuals. 14 ‘‘(2) STANDARDS FOR QUALIFICATION.— 15 ‘‘(A) AUTOMATIC QUALIFICATION.—The 16 identification of health conditions that auto- 17 matically qualify individuals as eligible individ- 18 uals. 19 ‘‘(B) VOLUNTARY QUALIFICATION.—A 20 process under which health insurance issuers 21 may voluntarily qualify individuals, who do not 22 automatically qualify under subparagraph (A), 23 as eligible individuals. 24 VerDate Sep 11 2014 04:44 May 29, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2789.IH H2789 kjohnson on DSK79L0C42 with BILLS 6 •HR 2789 IH ‘‘(3) PERCENTAGE OF INSURANCE PREMIUMS 1 TO BE APPLIED.—The percentage of the premiums 2 paid, to health insurance issuers for health insur- 3 ance coverage by eligible individuals, that shall be 4 collected and deposited to the credit (and available 5 for the use) of the Program. 6 ‘‘(4) ATTACHMENT DOLLAR AMOUNT AND PAY- 7 MENT PROPORTION.—The dollar amount of claims 8 for eligible individuals after which the Program will 9 provide payments to health insurance issuers and 10 the proportion of such claims above such dollar 11 amount that the Program will pay.’’. 12 Æ VerDate Sep 11 2014 04:44 May 29, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H2789.IH H2789 kjohnson on DSK79L0C42 with BILLS