Individual Health Insurance Marketplace Improvement Act

I 116TH CONGRESS 1ST SESSION H. R. 4652 To establish an Individual Market Reinsurance fund to provide funding for State individual market stabilization reinsurance programs. IN THE HOUSE OF REPRESENTATIVES OCTOBER 11, 2019 Mr. LANGEVIN (for himself, Ms. JUDY CHU of California, and Mr. RUIZ) in- troduced the following bill; which was referred to the Committee on En- ergy 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 jurisdic- tion of the committee concerned A BILL To establish an Individual Market Reinsurance fund to pro- vide funding for State individual market stabilization reinsurance programs. 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 ‘‘Individual Health In- 4 surance Marketplace Improvement Act’’. 5 SEC. 2. INDIVIDUAL MARKET REINSURANCE FUND. 6 (a) ESTABLISHMENT OF FUND.— 7 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 2 •HR 4652 IH (1) IN GENERAL.—There is established the ‘‘In- 1 dividual Market Reinsurance Fund’’ to be adminis- 2 tered by the Secretary to provide funding for an in- 3 dividual market stabilization reinsurance program in 4 each State that complies with the requirements of 5 this section. 6 (2) FUNDING.—There is appropriated to the 7 Fund, out of any moneys in the Treasury not other- 8 wise appropriated, such sums as are necessary to 9 carry out this section (other than subsection (c)) for 10 each calendar year beginning with 2020. Amounts 11 appropriated to the Fund shall remain available 12 without fiscal or calendar year limitation to carry 13 out this section. 14 (b) INDIVIDUAL MARKET REINSURANCE PRO- 15 GRAM.— 16 (1) USE OF FUNDS.—The Secretary shall use 17 amounts in the Fund to establish a reinsurance pro- 18 gram under which the Secretary shall make reinsur- 19 ance payments to health insurance issuers with re- 20 spect to high-cost individuals enrolled in qualified 21 health plans offered by such issuers that are not 22 grandfathered health plans or transitional health 23 plans for any plan year beginning with the 2020 24 plan year. This subsection constitutes budget au- 25 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 3 •HR 4652 IH thority in advance of appropriations Acts and rep- 1 resents the obligation of the Secretary to provide 2 payments from the Fund in accordance with this 3 subsection. 4 (2) AMOUNT OF PAYMENT.—The payment 5 made to a health insurance issuer under subsection 6 (a) with respect to each high-cost individual enrolled 7 in a qualified health plan issued by the issuer that 8 is not a grandfathered health plan or a transitional 9 health plan shall equal 80 percent of the lesser of— 10 (A) the amount (if any) by which the indi- 11 vidual’s claims incurred during the plan year 12 exceeds— 13 (i) in case of the 2020, 2021, or 2022 14 plan year, $50,000; and 15 (ii) in the case of any other plan year, 16 $100,000; or 17 (B) for plan years described in— 18 (i) subparagraph (A)(i), $450,000; 19 and 20 (ii) subparagraph (A)(ii), $400,000. 21 (3) INDEXING.—In the case of plan years be- 22 ginning after 2020, the dollar amounts that appear 23 in subparagraphs (A) and (B) of paragraph (2) shall 24 each be increased by an amount equal to— 25 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 4 •HR 4652 IH (A) such amount; multiplied by 1 (B) the premium adjustment percentage 2 specified under section 1302(c)(4) of the Af- 3 fordable Care Act, but determined by sub- 4 stituting ‘‘2020’’ for ‘‘2013’’. 5 (4) PAYMENT METHODS.— 6 (A) IN GENERAL.—Payments under this 7 subsection shall be based on such a method as 8 the Secretary determines. The Secretary may 9 establish a payment method by which interim 10 payments of amounts under this subsection are 11 made during a plan year based on the Sec- 12 retary’s best estimate of amounts that will be 13 payable after obtaining all of the information. 14 (B) REQUIREMENT FOR PROVISION OF IN- 15 FORMATION.— 16 (i) REQUIREMENT.—Payments under 17 this subsection to a health insurance issuer 18 are conditioned upon the furnishing to the 19 Secretary, in a form and manner specified 20 by the Secretary, of such information as 21 may be required to carry out this sub- 22 section. 23 (ii) RESTRICTION ON USE OF INFOR- 24 MATION.—Information disclosed or ob- 25 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 5 •HR 4652 IH tained pursuant to clause (i) is subject to 1 the HIPAA privacy and security law, as 2 defined in section 3009(a) of the Public 3 Health Service Act (42 U.S.C. 300jj– 4 19(a)). 5 (5) SECRETARY FLEXIBILITY FOR BUDGET 6 NEUTRAL REVISIONS TO REINSURANCE PAYMENT 7 SPECIFICATIONS.—If the Secretary determines ap- 8 propriate, the Secretary may substitute higher dollar 9 amounts for the dollar amounts specified under sub- 10 paragraphs (A) and (B) of paragraph (2) (and ad- 11 justed under paragraph (3), if applicable) if the Sec- 12 retary certifies that such substitutions, considered 13 together, neither increase nor decease the total pro- 14 jected payments under this subsection. 15 (c) OUTREACH AND ENROLLMENT.— 16 (1) IN GENERAL.—During the period that be- 17 gins on January 1, 2020, and ends on December 31, 18 2022, the Secretary shall award grants to eligible 19 entities for the following purposes: 20 (A) OUTREACH AND ENROLLMENT.—To 21 carry out outreach, public education activities, 22 and enrollment activities to raise awareness of 23 the availability of, and encourage enrollment in, 24 qualified health plans. 25 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 6 •HR 4652 IH (B) ASSISTING INDIVIDUALS TRANSITION 1 TO QUALIFIED HEALTH PLANS.—To provide as- 2 sistance to individuals who are enrolled in 3 health insurance coverage that is not a qualified 4 health plan enroll in a qualified health plan. 5 (C) ASSISTING ENROLLMENT IN PUBLIC 6 HEALTH PROGRAMS.—To facilitate the enroll- 7 ment of eligible individuals in the Medicare pro- 8 gram or in a State Medicaid program, as appro- 9 priate. 10 (D) RAISING AWARENESS OF PREMIUM AS- 11 SISTANCE AND COST-SHARING REDUCTIONS.— 12 To distribute fair and impartial information 13 concerning enrollment in qualified health plans 14 and the availability of premium assistance tax 15 credits under section 36B of the Internal Rev- 16 enue Code of 1986 and cost-sharing reductions 17 under section 1402 of the Patient Protection 18 and Affordable Care Act, and to assist eligible 19 individuals in applying for such tax credits and 20 cost-sharing reductions. 21 (2) ELIGIBLE ENTITIES DEFINED.— 22 (A) IN GENERAL.—In this subsection, the 23 term ‘‘eligible entity’’ means— 24 (i) a State; or 25 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 7 •HR 4652 IH (ii) a nonprofit community-based or- 1 ganization. 2 (B) ENROLLMENT AGENTS.—Such term 3 includes a licensed independent insurance agent 4 or broker that has an arrangement with a State 5 or nonprofit community-based organization to 6 enroll eligible individuals in qualified health 7 plans. 8 (C) EXCLUSIONS.—Such term does not in- 9 clude an entity that— 10 (i) is a health insurance issuer; or 11 (ii) receives any consideration, either 12 directly or indirectly, from any health in- 13 surance issuer in connection with the en- 14 rollment of any qualified individuals or em- 15 ployees of a qualified employer in a quali- 16 fied health plan. 17 (3) PRIORITY.—In awarding grants under this 18 subsection, the Secretary shall give priority to 19 awarding grants to States or eligible entities in 20 States that have geographic rating areas at risk of 21 having no qualified health plans in the individual 22 market. 23 (4) FUNDING.—Out of any moneys in the 24 Treasury not otherwise appropriated, $500,000,000 25 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 8 •HR 4652 IH is appropriated to the Secretary for each of calendar 1 years 2020 through 2022, to carry out this sub- 2 section. 3 (d) REPORTS TO CONGRESS.— 4 (1) ANNUAL REPORT.—The Secretary shall 5 submit a report to Congress, not later than January 6 21, 2021, and each year thereafter, that contains 7 the following information for the most recently 8 ended year: 9 (A) The number and types of plans in each 10 State’s individual market, specifying the num- 11 ber that are qualified health plans, grand- 12 fathered health plans, or health insurance cov- 13 erage that is not a qualified health plan. 14 (B) The impact of the reinsurance pay- 15 ments provided under this section on the avail- 16 ability of coverage, cost of coverage, and cov- 17 erage options in each State. 18 (C) The amount of premiums paid by indi- 19 viduals in each State by age, family size, geo- 20 graphic area in the State’s individual market, 21 and category of health plan (as described in 22 subparagraph (A)). 23 (D) The process used to award funds for 24 outreach and enrollment activities awarded to 25 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 9 •HR 4652 IH eligible entities under subsection (c), the 1 amount of such funds awarded, and the activi- 2 ties carried out with such funds. 3 (E) Such other information as the Sec- 4 retary deems relevant. 5 (2) EVALUATION REPORT.—Not later than Jan- 6 uary 31, 2024, the Secretary shall submit to Con- 7 gress a report that— 8 (A) analyzes the impact of the funds pro- 9 vided under this section on premiums and en- 10 rollment in the individual market in all States; 11 and 12 (B) contains a State-by-State comparison 13 of the design of the programs carried out by 14 States with funds provided under this section. 15 (e) DEFINITIONS.—In this section: 16 (1) SECRETARY.—The term ‘‘Secretary’’ means 17 the Secretary of the Department of Health and 18 Human Services. 19 (2) FUND.—The term ‘‘Fund’’ means the Indi- 20 vidual Market Reinsurance Fund established under 21 subsection (a). 22 (3) GRANDFATHERED HEALTH PLAN.—The 23 term ‘‘grandfathered health plan’’ has the meaning 24 VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS 10 •HR 4652 IH given that term in section 1251(e) of the Patient 1 Protection and Affordable Care Act. 2 (4) HIGH-COST INDIVIDUAL.—The term ‘‘high- 3 cost individual’’ means an individual enrolled in a 4 qualified health plan (other than a grandfathered 5 health plan or a transitional health plan) who incurs 6 claims in excess of $50,000 during a plan year. 7 (5) STATE.—The term ‘‘State’’ means each of 8 the 50 States and the District of Columbia. 9 (6) TRANSITIONAL HEALTH PLAN.—The term 10 ‘‘transitional health plan’’ means a plan continued 11 under the letter issued by the Centers for Medicare 12 & Medicaid Services on November 14, 2013, to the 13 State Insurance Commissioners outlining a transi- 14 tional policy for coverage in the individual and small 15 group markets to which section 1251 of the Patient 16 Protection and Affordable Care Act does not apply, 17 and under the extension of the transitional policy for 18 such coverage set forth in the Insurance Standards 19 Bulletin Series guidance issued by the Centers for 20 Medicare & Medicaid Services on March 5, 2014, 21 February 29, 2016, and February 13, 2017. 22 Æ VerDate Sep 11 2014 01:08 Oct 12, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H4652.IH H4652 kjohnson on DSK79L0C42 with BILLS