115 HR 1628 PCS: American Health Care Act of 2017 U.S. House of Representatives text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

II Calendar No. 120115th CONGRESS 1st Session H. R. 1628 IN THE SENATE OF THE UNITED STATES June 7, 2017Received; read the first timeJune 8, 2017Read twice and placed on the calendarAN ACT To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017.

1.

Short title

This Act may be cited as the American Health Care Act of 2017.

2.

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title. Sec. 2. Table of contents. Title I—Energy and Commerce Subtitle A—Patient Access to Public Health Programs Sec. 101. The Prevention and Public Health Fund. Sec. 102. Community health center program. Sec. 103. Federal payments to States. Subtitle B—Medicaid Program Enhancement Sec. 111. Repeal of Medicaid provisions. Sec. 112. Repeal of Medicaid expansion. Sec. 113. Elimination of DSH cuts. Sec. 114. Reducing State Medicaid costs. Sec. 115. Safety net funding for non-expansion States. Sec. 116. Providing incentives for increased frequency of eligibility redeterminations. Sec. 117. Permitting States to apply a work requirement for nondisabled, nonelderly, nonpregnant adults under Medicaid. Subtitle C—Per Capita Allotment for Medical Assistance Sec. 121. Per capita allotment for medical assistance. Subtitle D—Patient Relief and Health Insurance Market Stability Sec. 131. Repeal of cost-sharing subsidy. Sec. 132. Patient and State Stability Fund. Sec. 133. Continuous health insurance coverage incentive. Sec. 134. Increasing coverage options. Sec. 135. Change in permissible age variation in health insurance premium rates. Subtitle E—Implementation Funding Sec. 141. American Health Care Implementation Fund. Title II—Committee on Ways and Means Subtitle A—Repeal and Replace of Health-Related Tax Policy Sec. 201. Recapture excess advance payments of premium tax credits. Sec. 202. Additional modifications to premium tax credit. Sec. 203. Small business tax credit. Sec. 204. Individual mandate. Sec. 205. Employer mandate. Sec. 206. Repeal of the tax on employee health insurance premiums and health plan benefits. Sec. 207. Repeal of tax on over-the-counter medications. Sec. 208. Repeal of increase of tax on health savings accounts. Sec. 209. Repeal of limitations on contributions to flexible spending accounts. Sec. 210. Repeal of medical device excise tax. Sec. 211. Repeal of elimination of deduction for expenses allocable to medicare part D subsidy. Sec. 212. Reduction of income threshold for determining medical care deduction. Sec. 213. Repeal of Medicare tax increase. Sec. 214. Refundable tax credit for health insurance coverage. Sec. 215. Maximum contribution limit to health savings account increased to amount of deductible and out-of-pocket limitation. Sec. 216. Allow both spouses to make catch-up contributions to the same health savings account. Sec. 217. Special rule for certain medical expenses incurred before establishment of health savings account. Subtitle B—Repeal of certain consumer taxes Sec. 221. Repeal of tax on prescription medications. Sec. 222. Repeal of health insurance tax. Subtitle C—Repeal of Tanning Tax Sec. 231. Repeal of tanning tax. Subtitle D—Remuneration from Certain Insurers Sec. 241. Remuneration from certain insurers. Subtitle E—Repeal of Net Investment Income Tax Sec. 251. Repeal of net investment income tax.

.

133.

Continuous health insurance coverage incentive

Subpart I of part A of title XXVII of the Public Health Service Act is amended— (1)in section 2701(a)(1)(B), by striking such rate and inserting subject to section 2710A, such rate; (2)by redesignating the second section 2709 as section 2710; and (3)by adding at the end the following new section:

2710A.

Encouraging continuous health insurance coverage

(a)

Penalty applied

(1)

In general

Subject to the succeeding provisions of this section, a health insurance issuer offering health insurance coverage in the individual market shall, in the case of an individual who is an applicable policyholder of such coverage with respect to an enforcement period applicable to enrollments for a plan year beginning with plan year 2019 (or, in the case of enrollments during a special enrollment period, beginning with plan year 2018), increase the monthly premium rate otherwise applicable to such individual for such coverage during each month of such period, by an amount determined under paragraph (2). (2)

Amount of penalty

The amount determined under this paragraph for an applicable policyholder enrolling in health insurance coverage described in paragraph (1) for a plan year, with respect to each month during the enforcement period applicable to enrollments for such plan year, is the amount that is equal to 30 percent of the monthly premium rate otherwise applicable to such applicable policyholder for such coverage during such month. (b)

Definitions

For purposes of this section: (1)

Applicable policyholder

The term applicable policyholder means, with respect to months of an enforcement period and health insurance coverage, an individual who— (A)is a policyholder of such coverage for such months; (B)cannot demonstrate that (through presentation of certifications described in section 2704(e) or in such other manner as may be specified in regulations, such as a return or statement made under section 6055(d) or 36B of the Internal Revenue Code of 1986), during the look-back period that is with respect to such enforcement period, there was not a period of at least 63 continuous days during which the individual did not have creditable coverage (as defined in paragraph (1) of section 2704(c) and credited in accordance with paragraphs (2) and (3) of such section); and (C)in the case of an individual who had been enrolled under dependent coverage under a group health plan or health insurance coverage by reason of section 2714 and such dependent coverage of such individual ceased because of the age of such individual, is not enrolling during the first open enrollment period following the date on which such coverage so ceased. (2)

Look-back period

The term look-back period means, with respect to an enforcement period applicable to an enrollment of an individual for a plan year beginning with plan year 2019 (or, in the case of an enrollment of an individual during a special enrollment period, beginning with plan year 2018) in health insurance coverage described in subsection (a)(1), the 12-month period ending on the date the individual enrolls in such coverage for such plan year. (3)

Enforcement period

The term enforcement period means— (A)with respect to enrollments during a special enrollment period for plan year 2018, the period beginning with the first month that is during such plan year and that begins subsequent to such date of enrollment, and ending with the last month of such plan year; and (B)with respect to enrollments for plan year 2019 or a subsequent plan year, the 12-month period beginning on the first day of the respective plan year.

.

134.

Increasing coverage options

Section 1302 of the Patient Protection and Affordable Care Act (42 U.S.C. 18022) is amended— (1)in subsection (a)(3), by inserting and with respect to a plan year before plan year 2020 after subsection (e); and (2)in subsection (d), by adding at the end the following: (5)

Sunset

The provisions of this subsection shall not apply after December 31, 2019, and after such date any reference to this subsection or level of coverage or plan described in this subsection and any requirement under law applying such a level of coverage or plan shall have no force or effect (and such a requirement shall be applied as if this section had been repealed)..

135.

Change in permissible age variation in health insurance premium rates

Section 2701(a)(1)(A)(iii) of the Public Health Service Act (42 U.S.C. 300gg(a)(1)(A)(iii)), as inserted by section 1201(4) of the Patient Protection and Affordable Care Act, is amended by inserting after (consistent with section 2707(c)) the following: or, for plan years beginning on or after January 1, 2018, as the Secretary may implement through interim final regulation, 5 to 1 for adults (consistent with section 2707(c)) or such other ratio for adults (consistent with section 2707(c)) as the State involved may provide (or, in the case of a State with a waiver under subsection (b) in effect for such a plan year, the ratio applied for such plan year in accordance with such waiver).

136.

Permitting States to waive certain ACA requirements to encourage fair health insurance premiums

(a)

In general

Section 2701 of the Public Health Service Act (42 U.S.C. 300gg) is amended by adding at the end the following new subsection: (b)

Permissible State waiver to encourage fair health insurance premiums

(1)

In general

A State may submit an application to the Secretary for one or more of the following purposes: (A)In the case of plan years beginning on or after January 1, 2018, to apply, subject to paragraph (5), under subsection (a)(1)(A)(iii), instead of the ratio specified in such subsection, a higher ratio specified by the State (consistent with section 2707(c)). (B)In the case of plan years beginning on or after January 1, 2020, for health insurance coverage offered in the individual or small group market in such State, to apply, subject to paragraph (5), instead of the essential health benefits specified under subsection (b) of section 1302 of the Patient Protection and Affordable Care Act, essential health benefits as specified by the State. (C)In the case of a State that has in place a program that carries out the purpose described in paragraph (1) or (2) of section 2202(a) of the Social Security Act or participates in the program established under section 2205 of such Act, for health insurance offered in the individual market in such State, with respect to an individual who is an applicable policyholder of such coverage with respect to an enforcement period (as defined in section 2710A(b)) applicable to enrollments for a plan year beginning with plan year 2019 (or, in the case of enrollments during a special enrollment period, beginning with plan year 2018), to— (i)subject to paragraph (5), not apply any increase to the monthly premium rate that would otherwise apply under section 2710A to such individual for such coverage; and (ii)instead, subject to paragraph (5)— (I)apply subsection (a)(1) as if health status were included as a factor described in subparagraph (A) of such subsection; and (II)not apply section 2705(b). (2)

Default approval

An application submitted under paragraph (1) is approved unless the Secretary notifies the State submitting the application, not later than 60 days after the date of the submission of such application, that the application has been denied for not being in compliance with any requirement of paragraph (3) and of the reason for such denial. (3)

Requirements

The requirements of this paragraph, with respect to an application submitted under paragraph (1), are the following: (A)The application is submitted at such time, and in such manner, as the Secretary may require. (B)The application specifies how the approval of such application will provide for one or more of the following: (i)Reducing average premiums for health insurance coverage in the State. (ii)Increasing enrollment in health insurance coverage in the State. (iii)Stabilizing the market for health insurance coverage in the State. (iv)Stabilizing premiums for individuals with pre-existing conditions. (v)Increasing the choice of health plans in the State. (C)The application specifies the period for which the waiver is to be effective, consistent with paragraph (4). (D)In the case of an application for purposes of paragraph (1)(A), the application specifies the higher ratio to be applied pursuant to such paragraph. (E)In the case of an application for purposes of paragraph (1)(B), the application specifies the essential health benefits to be applied pursuant to such paragraph. (F)In the case of an application for purposes of paragraph (1)(C), the application demonstrates that the State has in place a program that carries out the purpose described in paragraph (1) or (2) of section 2202(a) of the Social Security Act or participates in the program established under section 2205 of such Act. (4)

Term of waiver

(A)

In general

No waiver for a State under this subsection may extend over a period of longer than 10 years unless the State requests continuation of such waiver, and such request shall be deemed granted unless the Secretary, within 90 days after the date of its submission to the Secretary, either denies such request in writing or informs the State in writing with respect to any additional information which is needed in order to make a final determination with respect to the request. (B)

Special rule

A waiver applied for by a State under paragraph (1)(C) may only be effective for a period during which the State— (i)has in place a program that carries out the purpose described in paragraph (1) or (2) of section 2202(a) of the Social Security Act; or (ii)participates in the program established under section 2205 of such Act. (5)

Non-application rules

(A)

Specified non-application provisions

In no case may a waiver for purposes of paragraph (1) apply with respect to any of the following provisions: (i)Section 1301 of the Patient Protection and Affordable Care Act, to the extent that such section applies to qualified health plans offered through the CO-OP program under section 1322 of such Act or multi-State plans under section 1334 of such Act. (ii)Sections 1312(d)(3)(D), 1331, 1332, 1333, and 1334 of such Act. (B)

Hold harmless

Any standard or requirement adopted by a State pursuant to the terms of a waiver approved under this subsection shall be deemed to comply with section 1252 of the Patient Protection and Affordable Care Act and subsection (a) of section 1324 of such Act, insofar as such standard or requirement relates to a Federal or State law described in subsection (b)(2) of such section (relating to rating).. (b)

Application to essential health benefits

Section 1302(a)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(a)(1)) is amended by inserting (or, in the case of health insurance coverage offered in the individual or small group market in a State for which there is an applicable waiver in effect under section 2701(b) of the Public Health Service Act for a plan year, the essential health benefits applicable under such waiver) after subsection (b).

137.

Constructions

(a)

No gender rating

Nothing in this Act shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender. (b)

No limiting access to coverage for individuals with preexisting conditions

Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.

E

Implementation Funding

141.

American Health Care Implementation Fund

(a)

In general

There is hereby established an American Health Care Implementation Fund (referred to in this section as the Fund) within the Department of Health and Human Services to carry out sections 121, 132, 202, and 214 (including the amendments made by such sections). (b)

Funding

There is appropriated to the Fund, out of any funds in the Treasury not otherwise appropriated, $1,000,000,000 for Federal administrative expenses to carry out the sections described in subsection (a) (including the amendments made by such sections).

Passed the House of Representatives May 4, 2017.Karen L. Haas,Clerk June 8, 2017Read twice and placed on the calendar