State-Based Universal Health Care Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 5010 To amend title I of the Patient Protection and Affordable Care Act to authorize the establishment of, and provide support for, State-based universal health care systems that provide comprehensive health benefits to State residents, and for other purposes. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 8, 2019 Mr. KHANNA (for himself, Ms. JAYAPAL, Mr. BLUMENAUER, Ms. BONAMICI, Mr. DEFAZIO, Mr. GARCI´A of Illinois, Mr. GRIJALVA, Ms. LEE of Cali- fornia, Ms. OCASIO-CORTEZ, Ms. OMAR, Mr. POCAN, Ms. PRESSLEY, Mr. RASKIN, Ms. SCHAKOWSKY, Mr. SMITH of Washington, and Mrs. WAT- SON COLEMAN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Oversight and Reform, Armed Services, and Edu- cation and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title I of the Patient Protection and Affordable Care Act to authorize the establishment of, and provide support for, State-based universal health care systems that provide comprehensive health benefits to State resi- dents, 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 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 2 •HR 5010 IH SECTION 1. SHORT TITLE; PURPOSE. 1 (a) SHORT TITLE.—This Act may be cited as the 2 ‘‘State-Based Universal Health Care Act of 2019’’. 3 (b) PURPOSE.—The purpose of this Act is to estab- 4 lish a flexible framework under which States can provide 5 comprehensive universal health coverage to their residents. 6 SEC. 2. WAIVER FOR STATE UNIVERSAL HEALTH CARE. 7 (a) IN GENERAL.—Subtitle D of title I of the Patient 8 Protection and Affordable Care Act (42 U.S.C. 18021 et 9 seq.) is amended by inserting after section 1334 the fol- 10 lowing new section: 11 ‘‘SEC. 1335. WAIVER FOR STATE UNIVERSAL HEALTH CARE. 12 ‘‘(a) APPLICATION.— 13 ‘‘(1) IN GENERAL.—Subject to paragraph (6), a 14 State may apply to the Secretary (as defined in sub- 15 section (i)(3)) for the waiver of so much of the re- 16 quirements described in paragraph (2) with respect 17 to health benefits coverage within the State for plan 18 years beginning on or after January 1, 2020, as is 19 necessary to implement a comprehensive State uni- 20 versal health care plan in the State under this sec- 21 tion. Such application shall— 22 ‘‘(A) be filed at such time and in such 23 manner as the Secretary may require; 24 ‘‘(B) contain such information as the Sec- 25 retary may require, including— 26 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 3 •HR 5010 IH ‘‘(i) a comprehensive description of 1 the State legislation, or other State legal 2 authority as applicable, and program to 3 implement a plan meeting the require- 4 ments for a waiver under this section; 5 ‘‘(ii) a plan for how the State will 6 achieve in 5 years health coverage for at 7 least 95 percent of residents of the State; 8 and 9 ‘‘(iii) a 10-fiscal-year budget plan for 10 such plan that is budget neutral for the 11 Federal Government; and 12 ‘‘(C) provide an assurance that the State 13 has legal authority to implement such plan or 14 has enacted the law described in subsection 15 (b)(2). 16 ‘‘(2) REQUIREMENTS.—The requirements de- 17 scribed in this paragraph with respect to health ben- 18 efits coverage within the State for plan years begin- 19 ning on or after January 1, 2020, are as follows: 20 ‘‘(A) Sections 1301 through 1324. 21 ‘‘(B) Section 1402. 22 ‘‘(C) Sections 36B and 4980H of the In- 23 ternal Revenue Code of 1986. 24 ‘‘(D) Title XI of the Social Security Act. 25 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 4 •HR 5010 IH ‘‘(E) Title XVIII of the Social Security 1 Act. 2 ‘‘(F) Title XIX of the Social Security Act. 3 ‘‘(G) Title XXI of the Social Security Act. 4 ‘‘(H) Chapter 89 of title 5, United States 5 Code. 6 ‘‘(I) Chapter 55 of title 10, United States 7 Code, including coverage under the TRICARE 8 program. 9 ‘‘(J) Section 514 of the Employee Retire- 10 ment Income Security Act of 1974. 11 ‘‘(3) PASSTHROUGH OF FUNDING.—With re- 12 spect to a State waiver under paragraph (1), under 13 which the State assumes responsibility for health 14 coverage under one or more of the specified Federal 15 health programs, including under each of the Fed- 16 eral health care or subsidy programs specified in 17 subparagraphs (A), (B), (C), (E), (F), (G), (H), and 18 (I) of paragraph (2), the Secretary shall not spend 19 Federal health or related administrative funds that 20 would otherwise have been spent for such a pro- 21 gram, as applicable, for the time periods covered 22 under the waiver and shall provide for an alternative 23 means by which the aggregate amount of such funds 24 (determined by the Secretary in coordination with 25 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 5 •HR 5010 IH the State), including caseload growth, adjusted for 1 inflation in health care costs within the State, shall 2 be paid to the State for purposes of implementing 3 the State plan under the waiver. Any savings in 4 health care spending, including administrative sav- 5 ings, shall be available to the State for reinvestment 6 in health care services under the State plan. Such 7 amount shall be determined annually by the Sec- 8 retary, taking into account the amount that would 9 otherwise have been spent under each such Federal 10 health program, including for administrative activi- 11 ties and caseload growth, with respect to residents 12 of such State, for those time periods covered under 13 the waiver, adjusted for inflation in health care 14 costs, if such waiver did not apply. Such amount 15 shall include funds equal to the aggregate amount of 16 premium tax credits, cost-sharing reductions, or 17 small-business credits, to the extent applicable to an 18 approved waiver, under sections 36B and 45R of the 19 Internal Revenue Code of 1986 or under section 20 1402 that would have been available to individuals 21 and businesses in the State for those time periods 22 covered under the waiver, including caseload growth, 23 adjusted for inflation in health care costs, if such 24 waiver did not apply. 25 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 6 •HR 5010 IH ‘‘(4) WAIVER CONSIDERATION AND TRANS- 1 PARENCY.— 2 ‘‘(A) IN GENERAL.—An application for a 3 waiver under this section shall be considered by 4 the Secretary, after taking into account rec- 5 ommendations of the Panel under subsection 6 (g), in accordance with the regulations de- 7 scribed in subparagraph (B). 8 ‘‘(B) REGULATIONS.—Not later than 180 9 days after the date of the enactment of the 10 State-Based Universal Health Care Act of 11 2019, the Secretary shall promulgate regula- 12 tions relating to waivers under this section that 13 provide— 14 ‘‘(i) a process for public notice and 15 comment in accordance with the public no- 16 tice and comment requirements applicable 17 under regulations used for Medicaid waiv- 18 ers pursuant to section 1115 of the Social 19 Security Act; 20 ‘‘(ii) a process for the submission of 21 an application that ensures the disclosure 22 of— 23 ‘‘(I) the provisions of law that 24 the State involved seeks to waive; and 25 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 7 •HR 5010 IH ‘‘(II) the specific plans of the 1 State to ensure that the waiver will be 2 in compliance with subsection (b); 3 ‘‘(iii) a process for providing public 4 notice and comment after the application is 5 received by the Secretary that is sufficient 6 to ensure a meaningful level of public 7 input and that does not impose require- 8 ments that are in addition to, or duplica- 9 tive of, requirements imposed under chap- 10 ter 5 of title 5, United States Code (com- 11 monly referred to as the Administrative 12 Procedure Act), or requirements that are 13 unreasonable or unnecessarily burdensome 14 with respect to State compliance; 15 ‘‘(iv) a process for the submission to 16 the Secretary of periodic reports by the 17 State concerning the implementation of the 18 program under the waiver; 19 ‘‘(v) a process for the periodic evalua- 20 tion by the Secretary with respect to waiv- 21 ers granted under this section; and 22 ‘‘(vi) a process for providing technical 23 assistance on— 24 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 8 •HR 5010 IH ‘‘(I) how to develop an applica- 1 tion to any State seeking to submit an 2 application for a waiver relating to de- 3 veloping a program of providing 4 health care for all residents for such 5 State; and 6 ‘‘(II) how to improve such a pro- 7 gram for purposes of a State seeking 8 assistance pursuant to subsection 9 (e)(2). 10 ‘‘(C) REPORT.—The Secretary shall annu- 11 ally report to Congress concerning actions 12 taken by the Secretary with respect to applica- 13 tions for waivers under this section and pro- 14 grams conducted pursuant to such waivers that 15 are approved. 16 ‘‘(5) REGIONAL WAIVER REQUEST AND PLAN.— 17 Nothing in this section shall be construed to prevent 18 two or more States in a region from submitting a 19 single application under this section for a waiver 20 that establishes a plan that is applicable to all of the 21 States included in such application. In the case of 22 such an application and plan, the requirements of 23 this section shall continue to be applicable with re- 24 spect to each State included in such application. 25 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 9 •HR 5010 IH ‘‘(6) COORDINATION WITH 1332 WAIVERS.—A 1 State may not apply for a waiver under this section 2 with respect to a plan year if such State has in ef- 3 fect, with respect to such plan year, a waiver under 4 section 1332. 5 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 6 There is authorized to be appropriated such sums as 7 may be necessary for providing funds to States with 8 a waiver under this section for purposes of carrying 9 out activities described in subsection (b)(1)(E). 10 ‘‘(b) GRANTING OF WAIVERS.— 11 ‘‘(1) IN GENERAL.—The Secretary shall grant a 12 request for a waiver under subsection (a)(1) if the 13 Secretary determines that the State plan— 14 ‘‘(A) will provide, in accordance with sub- 15 paragraph (B), health benefits coverage to ap- 16 plicable State residents that is at least as com- 17 prehensive as the health benefits coverage that 18 such residents would have received under one or 19 more of the specified Federal health programs 20 (as defined in subsection (i)(4)), as applicable, 21 for which such residents would have been eligi- 22 ble, absent such waiver; 23 ‘‘(B) will provide, in the case of such a 24 waiver under subsection (a)(1) for the State to 25 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 10 •HR 5010 IH waive any of the requirements described in sub- 1 section (a)(2)(F), as applicable, health benefits 2 coverage to applicable State residents who 3 would have otherwise received health benefits 4 coverage in the form of medical assistance 5 under the State Federal health program de- 6 scribed in subsection (i)(4)(B) (regardless of 7 whether the State provides for such assistance 8 through a State Medicaid plan under title XIX 9 of the Social Security Act or a waiver of such 10 State Medicaid plan) that includes at least the 11 mandatory benefits under title XIX of the So- 12 cial Security Act that are required of a State 13 without a waiver of a State Medicaid plan 14 under such title, including benefits for early 15 and periodic screening, diagnostic, and treat- 16 ment, benefits for non-emergency transpor- 17 tation, and retroactive coverage; 18 ‘‘(C) will provide coverage and cost-sharing 19 protections against excessive out-of-pocket 20 spending to State residents that are at least as 21 affordable as the coverage and cost-sharing pro- 22 tections under the specified Federal health pro- 23 gram (as defined in subsection (i)(4)) for which 24 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 11 •HR 5010 IH such residents would have been eligible, absent 1 such waiver; 2 ‘‘(D) will provide coverage to all residents 3 of the State, including those otherwise covered 4 under one or more of the Federal health care 5 or subsidy programs specified in subparagraphs 6 (B), (C), (E), (F), (G), and (H) of subsection 7 (a)(2), except individuals who are eligible for 8 benefits through the Indian Health Service or 9 for benefits and services under title 38, United 10 States Code; 11 ‘‘(E) will provide for public education ac- 12 tivities to raise awareness of the availability of 13 qualified health plans and the facilitation of en- 14 rollment in such coverage in a manner similar 15 to an entity that serves as a navigator under a 16 grant under section 1311(i); 17 ‘‘(F) will be publicly administered by an 18 agency or multiple agencies of the State, or an 19 independent public entity within the govern- 20 ment of the State; 21 ‘‘(G) will not preclude the purchase of in- 22 surance that offers coverage for benefits that 23 are not offered under the State plan; and 24 VerDate Sep 11 2014 22:09 Nov 18, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5010.IH H5010 kjohnson on DSK79L0C42 with BILLS 12 •HR 5010 IH ‘‘(H) will provide systems for complaints, 1 appeals, independent review, and other proce- 2 dures for accessing and maintaining benefits 3 that are at least as accessible to applicable 4 State residents as those of one or more of the 5 specified Federal health programs (as defined 6 in subsection (i)(4)) for which such residents 7 would have otherwise been eligible without ap- 8 plication of such waiver under subsection 9 (a)(1). 10 Subparagraph ( [Text truncated for display. 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