Stop Health Premium Spikes Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 6518 To direct the Secretary of Health and Human Services to establish a program of risk corridors for health insurance issuers offering health insurance coverage in the individual or small group market for certain plan years. IN THE HOUSE OF REPRESENTATIVES APRIL 17, 2020 Mr. PETERS (for himself and Ms. CRAIG) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To direct the Secretary of Health and Human Services to establish a program of risk corridors for health insurance issuers offering health insurance coverage in the indi- vidual or small group market for certain plan years. 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 ‘‘Stop Health Premium 4 Spikes Act of 2020’’. 5 VerDate Sep 11 2014 00:34 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6518.IH H6518 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6518 IH SEC. 2. ESTABLISHING A PROGRAM OF RISK CORRIDORS 1 FOR HEALTH INSURANCE ISSUERS OFFERING 2 HEALTH INSURANCE COVERAGE IN THE INDI- 3 VIDUAL OR SMALL GROUP MARKET FOR CER- 4 TAIN PLAN YEARS. 5 (a) IN GENERAL.—The Secretary of Health and 6 Human Services (in this section referred to as the ‘‘Sec- 7 retary’’) shall establish and administer a program of risk 8 corridors for plan years 2020 and 2021 under which the 9 Secretary shall make payments to health insurance issuers 10 offering health insurance coverage in the individual or 11 small group market based on the ratio of the allowable 12 costs of the coverage to the aggregate premiums of the 13 coverage. 14 (b) PAYMENT METHODOLOGY.—The Secretary shall 15 provide under the program established under subsection 16 (a) that if the allowable costs for a health insurance issuer 17 offering health insurance coverage in the individual or 18 small group market for any plan year are more than 105 19 percent of the target amount, the Secretary shall pay to 20 the issuer an amount equal to 75 percent of the allowable 21 costs in excess of 105 percent of the target amount. 22 (c) INFORMATION COLLECTION.—The Secretary shall 23 establish a process under which information is collected 24 from health insurance issuers offering health insurance 25 VerDate Sep 11 2014 00:34 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6518.IH H6518 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6518 IH coverage in the individual or small group market for pur- 1 poses of carrying out this section. 2 (d) DEFINITIONS.— 3 (1) ALLOWABLE COSTS.— 4 (A) IN GENERAL.—The amount of allow- 5 able costs of a health insurance issuer offering 6 health insurance coverage in the individual or 7 small group market for any year is an amount 8 equal to the total costs (other than administra- 9 tive costs) of such issuer in providing benefits 10 covered by such coverage. 11 (B) CERTAIN REDUCTIONS.—Allowable 12 costs shall be reduced by any— 13 (i) risk adjustment payments received 14 under section 1341 of the Patient Protec- 15 tion and Affordable Care Act (42 U.S.C. 16 18061); and 17 (ii) reinsurance payments received 18 pursuant to a waiver approved under sec- 19 tion 1332 of such Act (42 U.S.C. 18052). 20 (2) ADDITIONAL TERMS.—For purposes of this 21 section, the terms ‘‘health insurance issuer’’, ‘‘health 22 insurance coverage’’, ‘‘individual market’’, and 23 ‘‘small group market’’ have the meanings given such 24 VerDate Sep 11 2014 00:34 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6518.IH H6518 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6518 IH terms in section 2791 of the Public Health Service 1 Act (42 U.S.C. 300gg–91). 2 (3) TARGET AMOUNT.—The target amount of 3 health insurance coverage offered in the individual 4 or small group market for any year is an amount 5 equal to the total premiums (including any premium 6 subsidies under any governmental program), reduced 7 by the administrative costs of the coverage. 8 (e) IMPLEMENTATION.—The Secretary of Health and 9 Human Services may implement the provisions of this sec- 10 tion by subregulatory guidance, program instruction, or 11 otherwise. 12 (f) APPROPRIATION.—There are appropriated, out of 13 any monies in the Treasury not otherwise obligated, such 14 sums as may be necessary to carry out this section. 15 Æ VerDate Sep 11 2014 00:34 Apr 22, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H6518.IH H6518 pamtmann on DSKBC07HB2PROD with BILLS