Health Care Fairness for All Act

I 118TH CONGRESS 1ST SESSION H. R. 3129 To ensure health care fairness and affordability for all Americans through universal access to equitable health insurance tax credits, reformed health savings accounts, and strengthened consumer protections, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 9, 2023 Mr. SESSIONS introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, 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 con- cerned A BILL To ensure health care fairness and affordability for all Amer- icans through universal access to equitable health insur- ance tax credits, reformed health savings accounts, and strengthened consumer protections, and for other pur- poses. 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 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3129 IH SECTION 1. SHORT TITLE; PURPOSES; TABLE OF CON- 1 TENTS. 2 (a) SHORT TITLE.—This Act may be cited as the 3 ‘‘Health Care Fairness for All Act’’. 4 (b) PURPOSES.—The purposes of this Act are as fol- 5 lows: 6 (1) ELIMINATION OF INDIVIDUAL AND EM- 7 PLOYER MANDATES.—To eliminate mandates on in- 8 dividuals and employers, and other tax requirements, 9 imposed under Public Law 111–148. 10 (2) PROVIDING STATES WITH ALTERNATIVE, 11 AFFORDABLE COVERAGE OPTIONS.—To provide 12 greater flexibility in providing States with options in 13 making affordable health insurance coverage avail- 14 able by eliminating certain mandates under Public 15 Law 111–148, while retaining essential consumer 16 protections, by promoting health savings accounts to 17 pay for such coverage and long-term care coverage, 18 while permitting States to continue coverage as pro- 19 vided under such public law. 20 (c) TABLE OF CONTENTS.—The table of contents of 21 this Act is as follows: 22 Sec. 1. Short title; purposes; table of contents. Sec. 2. Definitions. TITLE I—REVISION OF FEDERAL HEALTH LAW Subtitle A—Elimination of Employer and Individual Mandates Sec. 101. Repeal of individual health insurance mandate. VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3129 IH Sec. 102. Repeal of employer health insurance mandate. Sec. 103. Clarifying employer’s ability to reimburse employee premiums for purchase of individual health insurance coverage. Subtitle B—Limitation on Application of Federal Health Plan Requirements Sec. 121. Limiting application of requirements to consumer protections. Sec. 122. Offering of basic health insurance; protection of assets from liability or attachment or seizure. Sec. 123. Ensuring access to short-term limited duration insurance. Sec. 124. Making telehealth flexibilities permanent. Subtitle C—Health Insurance Tax Benefit Sec. 131. Health insurance tax benefit. Sec. 132. Application of portion of unused tax credits by States for indigent health care. Sec. 133. Medicaid option of enrollment under private plan and contribution to an HSA. Sec. 134. Repeal of reporting requirements relating to employee health insur- ance premiums and health plan benefits. Sec. 135. Report. Subtitle D—Medicare Reforms Sec. 141. Physician-owned hospitals. Sec. 142. Prohibiting the use of an inpatient-only list in designating hospital outpatient services under the Medicare program. Sec. 143. Promoting Medicare site-neutral payments. Sec. 144. Medicare Advantage contributions to Roth HSAs for chronically ill enrollees. Sec. 145. Extending acute hospital care at home waiver flexibilities. TITLE II—IMPROVING HEALTH SAVINGS ACCOUNTS TO PROMOTE ACCOUNTABILITY Sec. 201. Transition to non-deductible HSAs. Sec. 202. Elimination of medical expense deduction. Sec. 203. Treatment of HSA after death of account beneficiary. Sec. 204. Treatment of direct patient care arrangements. TITLE III—STATE FLEXIBILITY IN REGULATION OF HEALTH INSURANCE COVERAGE Sec. 301. State flexibility in regulation of health insurance coverage. TITLE IV—MEDICAID PAYMENT REFORM Sec. 401. Medicaid payment reform to ensure equitable access to care. TITLE V—PRICE TRANSPARENCY Sec. 501. Promoting transparent hospital prices for consumers. SEC. 2. DEFINITIONS. 1 Except as otherwise provided, in this Act: 2 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3129 IH (1) BASIC HEALTH INSURANCE.—The term 1 ‘‘basic health insurance’’ is defined in section 2 122(a). 3 (2) DEFAULT HEALTH INSURANCE COV- 4 ERAGE.—The term ‘‘default health insurance cov- 5 erage’’ is defined in section 121(b)(4)(B). 6 (3) EXCHANGE.—The term ‘‘Exchange’’ means 7 an Exchange established under title I of Public Law 8 111–148. 9 (4) HEALTH INSURANCE COVERAGE; GROUP 10 HEALTH PLAN, ETC.—The terms defined in section 11 2791 of the Public Health Service Act, including 12 ‘‘health insurance coverage’’, ‘‘group health plan’’ 13 ‘‘individual market’’, shall apply. 14 (5) LIMITED BENEFIT INSURANCE.—The term 15 ‘‘limited benefit insurance’’ is defined in section 16 122(b). 17 (6) SECRETARY.—The term ‘‘Secretary’’ means 18 the Secretary of Health and Human Services. 19 (7) STATE.—The term ‘‘State’’ includes the 20 District of Columbia, Puerto Rico, the United States 21 Virgin Islands, American Samoa, Guam, and the 22 Northern Mariana Islands. 23 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3129 IH TITLE I—REVISION OF FEDERAL 1 HEALTH LAW 2 Subtitle A—Elimination of 3 Employer and Individual Mandates 4 SEC. 101. REPEAL OF INDIVIDUAL HEALTH INSURANCE 5 MANDATE. 6 Section 5000A of the Internal Revenue Code of 1986 7 is amended by adding at the end the following new sub- 8 section: 9 ‘‘(h) TERMINATION.—This section shall not apply to 10 months beginning after December 31, 2022.’’. 11 SEC. 102. REPEAL OF EMPLOYER HEALTH INSURANCE MAN- 12 DATE. 13 (a) IN GENERAL.—Chapter 43 of the Internal Rev- 14 enue Code of 1986 is amended— 15 (1) by striking section 4980H, and 16 (2) by striking the item relating to section 17 4980H from the table of sections for such chapter. 18 (b) REPEAL OF RELATED REPORTING REQUIRE- 19 MENTS.—Subpart D of part III of subchapter A of chap- 20 ter 61 of such Code is amended by striking section 6056 21 and by striking the item relating to section 6056 in the 22 table of sections for such subpart. 23 (c) CONFORMING AMENDMENTS.— 24 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3129 IH (1) Section 6724(d)(1)(B) of such Code is 1 amended by striking clause (xxv). 2 (2) Section 6724(d)(2) of such Code is amend- 3 ed by striking subparagraph (HH). 4 (3) Section 1513 of Public Law 111–148 is 5 amended by striking subsection (c). 6 (d) EFFECTIVE DATES.— 7 (1) IN GENERAL.—Except as otherwise pro- 8 vided in this subsection, the amendments made by 9 this section shall apply to months and other periods 10 beginning more than 30 days after the date of the 11 enactment of this Act. 12 (2) REPEAL OF STUDY AND REPORT.—The 13 amendment made by subsection (c)(3) shall take ef- 14 fect on the date of the enactment of this Act. 15 SEC. 103. CLARIFYING EMPLOYER’S ABILITY TO REIM- 16 BURSE EMPLOYEE PREMIUMS FOR PUR- 17 CHASE OF INDIVIDUAL HEALTH INSURANCE 18 COVERAGE. 19 An employer health care arrangement, such as a 20 health or medical reimbursement arrangement (HRA) or 21 other employment plans, under which an employer reim- 22 burses an employee for the premiums for the purchase of 23 individual health insurance coverage does not constitute 24 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3129 IH a group health plan for any purposes, including for pur- 1 poses of applying any of the following: 2 (1) The Public Health Service Act (including 3 sections 2711 and 2714 of such Act, 42 U.S.C. 4 300gg–11, 300gg–14). 5 (2) Public Law 111–148. 6 (3) The Internal Revenue Code of 1986 (other 7 than for purposes of section 36B of such Code). 8 (4) The Employee Retirement Income Security 9 Act of 1974. 10 (5) The HIPAA privacy regulations (as defined 11 in section 1180(b)(3) of the Social Security Act, 42 12 U.S.C. 1320d–9(b)(3)). 13 (6) The Health Insurance Portability and Ac- 14 countability Act of 1996. 15 (7) COBRA continuation coverage under title 16 XXII of the Public Health Service Act (42 U.S.C. 17 300bb–1 et seq.), section 4980B of the Internal Rev- 18 enue Code of 1986, or title VI of the Employee Re- 19 tirement Income Security Act of 1974 (29 U.S.C. 20 1161 et seq.). 21 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3129 IH Subtitle B—Limitation on Applica- 1 tion of Federal Health Plan Re- 2 quirements 3 SEC. 121. LIMITING APPLICATION OF REQUIREMENTS TO 4 CONSUMER PROTECTIONS. 5 (a) REMOVAL OF PUBLIC LAW 111–148 PLAN RE- 6 QUIREMENTS, OTHER THAN CERTAIN CONSUMER PRO- 7 TECTIONS.— 8 (1) IN GENERAL.—Notwithstanding any other 9 provision of law, with respect to group health plans 10 and health insurance coverage whether or not of- 11 fered through an Exchange, except as provided in 12 paragraphs (2) and (3), the provisions of title 13 XXVII of the Public Health Service Act (42 U.S.C. 14 300gg et seq.) as in effect on the day before the date 15 of the enactment of Public Law 111–148 shall apply 16 instead of the provisions of such title as in effect 17 after such date. 18 (2) PUBLIC LAW 111–148 CONSUMER PROTEC- 19 TIONS CONTINUING TO BE APPLIED.—The following 20 sections of the Public Health Service Act, that were 21 added or amended by subtitles A and C of title I of 22 Public Law 111–148, shall continue to apply to 23 group health plans and to health insurance coverage 24 offered in the individual and group market: 25 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3129 IH (A) NO LIFETIME OR ANNUAL LIMITS.— 1 Section 2711 (42 U.S.C. 300gg–11; relating to 2 no lifetime or annual limits), except in the case 3 of limited benefit insurance (as defined in sec- 4 tion 122(b)). 5 (B) DEPENDENT COVERAGE THROUGH 6 AGE 26.—Section 2714 (42 U.S.C. 300bb–14; 7 relating to extension of dependent coverage). 8 (C) MODIFIED GUARANTEED AVAIL- 9 ABILITY.—Section 2702 (42 U.S.C. 300gg–1; 10 relating to guaranteed availability of coverage), 11 subject to paragraph (3) and subsection (c). 12 (D) GUARANTEED RENEWABILITY.—Sec- 13 tion 2703 (42 U.S.C. 300gg–2; relating to 14 guaranteed renewability of coverage). 15 (E) PROHIBITING PRE-EXISTING CONDI- 16 TION EXCLUSIONS.—Section 2704 (42 U.S.C. 17 300gg–3; relating to prohibition on preexisting 18 conditions). 19 (F) PROHIBITING DISCRIMINATION BASED 20 ON HEALTH STATUS.—Section 2705 (42 U.S.C. 21 300gg–4; relating to prohibiting discrimination 22 against individual participants and beneficiaries 23 based on health status), subject to subsection 24 (c). 25 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3129 IH (G) NON-DISCRIMINATION IN HEALTH 1 CARE.—Section 2706 (42 U.S.C. 300gg–5; re- 2 lating to non-discrimination in health care). 3 (3) APPLICATION OF A LATE ENROLLMENT 4 PENALTY FOR THOSE WITHOUT CONTINUOUS COV- 5 ERAGE.— 6 (A) IN GENERAL.—In the case of an indi- 7 vidual who seeks to enroll in health insurance 8 coverage and who, as of the effective date of 9 such enrollment, does not have a continuous pe- 10 riod of at least 12 months of creditable cov- 11 erage, there shall be imposed a late enrollment 12 penalty in the form of an increase in the 13 monthly premiums for coverage of under the 14 plan of 20 percent of the monthly premium oth- 15 erwise determined for each consecutive full 12- 16 month period (ending before such effective 17 date) in which the individual was not enrolled 18 in creditable coverage. Such increase shall apply 19 during a period, to be specified under regula- 20 tions of the Secretary but in no case longer 21 than 3 times the length of the most recent pe- 22 riod in which the individual did not have contin- 23 uous coverage. 24 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3129 IH (B) STATE WAIVER.—A State may apply 1 to the Secretary for a waiver of the provisions 2 of subparagraph (A) and the application of al- 3 ternative provisions providing incentives for 4 State residents to enroll in creditable coverage 5 and maintain continuous creditable coverage. 6 The Secretary shall approve such waiver if the 7 Secretary determines that the alternative provi- 8 sions provide similar or greater incentives for 9 such enrollment than the incentives otherwise 10 applicable. 11 (4) COORDINATING IMPLEMENTATION OF PRE- 12 PUBLIC LAW 111–148 PHSA PROVISIONS WITH PUBLIC 13 LAW 111–148 CONSUMER PROTECTIONS.— 14 (A) IN GENERAL.—In applying this sub- 15 section, the provisions described in paragraph 16 (2) shall be treated as if they were included in 17 title XXVII of the Public Health Service Act, 18 as in effect before the date of enactment of 19 Public Law 111–148, and, with respect to 20 group health plans and health insurance cov- 21 erage offered in connection with such plans, in 22 part 7 of subtitle B of title I of the Employee 23 Retirement and Income Security Act of 1974 24 (29 U.S.C. 1181 et seq.), and, with respect to 25 VerDate Sep 11 2014 04:03 May 23, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3129.IH H3129 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3129 IH group health plans, in chapter 100 of the Inter- 1 nal Revenue Code of 1986 as follows: 2 (i) LIFETIME LIMITS; DEPENDENT 3 COVERAGE.—The provisions described in 4 paragraphs (2)(A) and (2)(B) shall be 5 treated as included— 6 (I) with respect to group health 7 plans (and health insurance coverage 8 offered with respect to such plans), 9 under subpart 2 of part A of title 10 XXVII of the Public Health Ser [Text truncated for display. 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