What This Bill Does
This bill changes how health insurance subsidies work for people buying coverage through the health insurance marketplace. It expands who qualifies for financial help paying for health insurance premiums and reduces the costs people have to pay out of pocket for doctor visits, hospital stays and other medical services.
Who It Affects
People who buy health insurance through the health insurance marketplace. The Secretary of Health and Human Services (the government official in charge of health programs). The U.S. Treasury.
Key Provisions
* The income limit for getting a refundable credit (money back) for health insurance premiums increases so people earning more money can qualify. (Sec. 2(a))
* The amount of income a person can earn and still get help paying premiums changes based on sliding income brackets, ranging from no premium payment for those earning up to 150 percent of the poverty line to 8.5 percent of income for those earning 400 percent of the poverty line and above. (Sec. 2(b)(1))
* Health insurance plans must now be compared based on gold-level plans instead of silver-level plans when calculating subsidy amounts. (Sec. 2(d))
* The income ranges for getting help paying out-of-pocket medical costs expand, and the percentages of costs the insurance plan pays increase for people in these income ranges. (Sec. 3(a)(1))
* The government will provide whatever money is needed to pay for these reduced cost-sharing benefits. (Sec. 3(b))
What Changes
If this becomes law, more people earning higher incomes will qualify for help paying health insurance premiums. People already qualifying will pay lower premiums based on the new income brackets. People will have to pay less out of pocket for medical services like doctor visits and hospital care. Health insurance plans will be measured against gold-level plans rather than silver-level plans.
Important Definitions
None defined in bill text.
Effective Date
The premium changes apply to tax years beginning after December 31, 2023. The out-of-pocket cost changes apply to insurance plan years beginning after December 31, 2023.
II
118TH CONGRESS
1ST SESSION
S. 8
To amend the Internal Revenue Code of 1986 to expand eligibility for the
refundable credit for coverage under a qualified health plan, to improve
cost-sharing subsidies under the Patient Protection and Affordable Care
Act, and for other purposes.
IN THE SENATE OF THE UNITED STATES
JANUARY 23 (legislative day, JANUARY 3), 2023
Mrs. SHAHEEN (for herself, Mr. BLUMENTHAL, Ms. SMITH, Ms. BALDWIN,
Mr. KAINE, Mr. REED, Mr. CASEY, Ms. STABENOW, Ms. KLOBUCHAR,
Mr. CARDIN, Ms. HASSAN, Mr. BENNET, Ms. CORTEZ MASTO, and Mrs.
GILLIBRAND) introduced the following bill; which was read twice and re-
ferred to the Committee on Finance
A BILL
To amend the Internal Revenue Code of 1986 to expand
eligibility for the refundable credit for coverage under
a qualified health plan, to improve cost-sharing subsidies
under the Patient Protection and Affordable Care Act,
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 ‘‘Improving Health In-
4
surance Affordability Act of 2023’’.
5
VerDate Sep 11 2014
02:05 Jan 24, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\S8.IS
S8
kjohnson on DSK79L0C42PROD with BILLS
2
•S 8 IS
SEC. 2. INCREASE IN ELIGIBILITY FOR CREDIT.
1
(a) IN GENERAL.—Subparagraph (A) of section
2
36B(c)(1) of the Internal Revenue Code of 1986 is amend-
3
ed by striking ‘‘but does not exceed 400 percent’’.
4
(b) APPLICABLE PERCENTAGES.—
5
(1) IN GENERAL.—Subparagraph (A) of section
6
36B(b)(3) of the Internal Revenue Code of 1986 is
7
amended to read as follows:
8
‘‘(A) APPLICABLE PERCENTAGE.—The ap-
9
plicable percentage for any taxable year shall be
10
the percentage such that the applicable percent-
11
age for any taxpayer whose household income is
12
within an income tier specified in the following
13
table shall increase, on a sliding scale in a lin-
14
ear manner, from the initial premium percent-
15
age to the final premium percentage specified in
16
such table for such income tier:
17
‘‘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—
Up to 150 percent ..................................................
0
0
150 percent up to 200 percent ...............................
0
2.0
200 percent up to 250 percent ...............................
2.0
4.0
250 percent up to 300 percent ...............................
4.0
6.0
300 percent up to 400 percent ...............................
6.0
8.5
400 percent and up ................................................
8.5
8.5.’’.
(2) CONFORMING AMENDMENTS RELATING TO
18
AFFORDABILITY OF COVERAGE.—
19
VerDate Sep 11 2014
02:05 Jan 24, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\S8.IS
S8
kjohnson on DSK79L0C42PROD with BILLS
3
•S 8 IS
(A) Subparagraph (C) of section 36B(c)(2)
1
of such Code is amended by striking clause (iv).
2
(B) Paragraph (4) of section 36B(c) of
3
such Code is amended by striking subparagraph
4
(F).
5
(c) LIMITATION ON RECAPTURE.—Clause (i) of sec-
6
tion 36B(f)(2)(B) of the Internal Revenue Code of 1986
7
is amended—
8
(1) by striking ‘‘400 percent’’ and inserting
9
‘‘800 percent’’;
10
(2) by striking the period at the end of the last
11
row of the table; and
12
(3) by adding at the end of the table the fol-
13
lowing new rows:
14
‘‘At least 400 percent but less than 600 percent ...........................
$3,500
At least 600 percent but less than 800 percent ............................
$4,500.’’.
(d) PREMIUM COST STANDARD.—
15
(1) IN GENERAL.—The following provisions of
16
section 36B of the Internal Revenue Code of 1986
17
are each amended by striking ‘‘silver’’ each place it
18
appears and inserting ‘‘gold’’:
19
(A) Paragraphs (2)(B)(i), (3)(B), and
20
(3)(C) of subsection (b).
21
(B) The heading of subparagraph (B) of
22
subsection (b)(3).
23
VerDate Sep 11 2014
02:05 Jan 24, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\S8.IS
S8
kjohnson on DSK79L0C42PROD with BILLS
4
•S 8 IS
(C) Subsection (c)(4)(C)(i)(I).
1
(2) CONFORMING AMENDMENTS TO REDUCED
2
COST-SHARING.—Section 1402(b)(1) of the Patient
3
Protection and Affordable Care Act (42 U.S.C.
4
18071(b)(1)) is amended by striking ‘‘silver’’ and in-
5
serting ‘‘gold’’.
6
(e) EFFECTIVE DATE.—The amendments made by
7
this section shall apply to taxable years beginning after
8
December 31, 2023.
9
SEC. 3. ENHANCEMENTS FOR REDUCED COST-SHARING.
10
(a) MODIFICATION OF AMOUNT.—
11
(1) IN
GENERAL.—Section 1402(c)(2) of the
12
Patient Protection and Affordable Care Act (42
13
U.S.C. 18071(c)(2)) is amended—
14
(A) by striking ‘‘150 percent’’ in subpara-
15
graph (A) and inserting ‘‘200 percent’’,
16
(B) by striking ‘‘94 percent’’ in subpara-
17
graph (A) and inserting ‘‘95 percent’’,
18
(C) by striking ‘‘150 percent but not more
19
than 200 percent’’ in subparagraph (B) and in-
20
serting ‘‘200 percent but not more than 300
21
percent’’,
22
(D) by striking ‘‘87 percent’’ in subpara-
23
graph (B) and inserting ‘‘90 percent’’,
24
VerDate Sep 11 2014
02:05 Jan 24, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\S8.IS
S8
kjohnson on DSK79L0C42PROD with BILLS
5
•S 8 IS
(E) by striking ‘‘200 percent’’ in subpara-
1
graph (C) and inserting ‘‘300 percent’’,
2
(F) by striking ‘‘250 percent’’ in subpara-
3
graph (C) and inserting ‘‘400 percent’’, and
4
(G) by striking ‘‘73 percent’’ in subpara-
5
graph (C) and inserting ‘‘85 percent’’.
6
(2) CONFORMING AMENDMENT.—Clause (i) of
7
section 1402(c)(1)(B) of such Act (42 U.S.C.
8
18071(c)(1)(B)) is amended to read as follows:
9
‘‘(i) IN
GENERAL.—The Secretary
10
shall ensure the reduction under this para-
11
graph shall not result in an increase in the
12
plan’s share of the total allowed costs of
13
benefits provided under the plan above—
14
‘‘(I) 95 percent in the case of an
15
eligible insured described in para-
16
graph (2)(A);
17
‘‘(II) 90 percent in the case of an
18
eligible insured described in para-
19
graph (2)(B); and
20
‘‘(III) 85 percent in the case of
21
an eligible insured described in para-
22
graph (2)(C).’’.
23
VerDate Sep 11 2014
02:05 Jan 24, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\S8.IS
S8
kjohnson on DSK79L0C42PROD with BILLS
6
•S 8 IS
(3) EFFECTIVE DATE.—The amendments made
1
by this subsection shall apply to plan years begin-
2
ning after December 31, 2023.
3
(b) FUNDING.—Section 1402 of the Patient Protec-
4
tion and Affordable Care Act (42 U.S.C. 18071) is amend-
5
ed by adding at the end the following new subsection:
6
‘‘(g) FUNDING.—Out of any funds in the Treasury
7
not otherwise appropriated, there are appropriated to the
8
Secretary such sums as may be necessary for payments
9
under this section.’’.
10
Æ
VerDate Sep 11 2014
02:05 Jan 24, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6301
E:\BILLS\S8.IS
S8
kjohnson on DSK79L0C42PROD with BILLS