[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3748 Introduced in House (IH)]

<DOC>






115th CONGRESS
  1st Session
                                H. R. 3748

   To amend title XVIII of the Social Security Act to provide for an 
 option for individuals who are ages 50 to 64 to buy into Medicare, to 
   provide for health insurance market stabilization, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 12, 2017

 Mr. Higgins of New York (for himself, Mr. Larson of Connecticut, Mr. 
Courtney, Mr. Carson of Indiana, Mr. Cicilline, Mr. Cohen, Ms. DeLauro, 
   Mr. Deutch, Mr. Huffman, Ms. Kaptur, Mr. Keating, Mr. Khanna, Mr. 
     Krishnamoorthi, Ms. McCollum, Mr. McEachin, Mr. McGovern, Mr. 
Perlmutter, Mr. Price of North Carolina, Mr. Quigley, Mr. Ryan of Ohio, 
Ms. Titus, Mr. Tonko, Mr. Welch, Mr. Delaney, Ms. Pingree, Ms. Esty of 
   Connecticut, Mr. Lowenthal, Mr. Kihuen, Mrs. Napolitano, Mr. Sean 
   Patrick Maloney of New York, Mr. Garamendi, Ms. Shea-Porter, Mr. 
Peterson, Mr. Polis, and Mr. Heck) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
  to the Committee on Ways and Means, 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 XVIII of the Social Security Act to provide for an 
 option for individuals who are ages 50 to 64 to buy into Medicare, to 
   provide for health insurance market stabilization, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Buy-In and Health Care 
Stabilization Act of 2017''.

SEC. 2. MEDICARE BUY-IN OPTION.

    (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
1395c et seq.) is amended by adding at the end the following new 
section:

                        ``medicare buy-in option

    ``Sec. 1899C.  (a) Option.--
            ``(1) Eligibility.--Every individual who meets the 
        requirements described in paragraph (3) shall be eligible to 
        enroll under this section.
            ``(2) In general.--An individual who meets the following 
        requirements is eligible to enroll under this section:
                    ``(A) Age.--The individual has attained 50 years of 
                age, but has not attained 65 years of age.
                    ``(B) Medicare eligibility (but for age).--The 
                individual is not otherwise entitled to benefits under 
                part A or eligible to enroll under part A or part B but 
                would be eligible for benefits under part A or part B 
                if the individual were 65 years of age.
            ``(3) Benefits.--An individual enrolled under this section 
        is entitled to the same benefits under this title as an 
        individual who is entitled to benefits under part A and 
        enrolled under parts B and D.
    ``(b) Enrollment and Coverage Periods.--The Secretary shall 
establish enrollment and coverage periods for individuals who enroll 
under this section. Such periods shall be established in coordination 
with the enrollment and coverage periods for plans offered under an 
Exchange established under title I of the Patient Protection and 
Affordable Care Act. The Secretary shall establish such periods so that 
coverage under this section shall first begin on January 1 of the first 
year beginning at least one year after the date of the enactment of 
this section.
    ``(c) Buy-In Premium.--
            ``(1) Amount of monthly premiums.--The Secretary shall 
        (beginning for the first year that begins more than 1 year 
        after the date of the enactment of this section), during 
        September of the preceding year, determine a monthly premium 
        for individuals enrolled under this section. Such monthly 
        premium shall be equal to \1/12\ of the annual premium computed 
        under paragraph (2)(B), which shall apply with respect to 
        coverage provided under this section for any month in such 
        year.
            ``(2) Annual premium.--
                    ``(A) Combined national, per capita average for 
                parts a, b, and d benefits.--The Secretary shall 
                estimate the average, annual per capita amount for 
                benefits and administrative expenses that will be 
                payable under parts A, B, and D in the year for all 
                individuals enrolled under this section.
                    ``(B) Annual premium.--The annual premium under 
                this subsection for months in a year is equal to the 
                average, annual per capita amount estimated under 
                subparagraph (A) for the year.
                    ``(C) Adjustments.--The Secretary shall adjust the 
                annual premium under this subsection as necessary--
                            ``(i) to ensure that expenditures under 
                        this title for any year are not increased by 
                        reason of this section; and
                            ``(ii) by a geographic adjustment factor to 
                        address regional affordability concerns.
            ``(3) Additional premium for certain d plans.--Nothing in 
        this section shall preclude an individual from choosing a 
        prescription drug plan which requires the individual to pay an 
        additional amount (because of the inclusion of supplemental 
        prescription drug benefits or because the plan is a more 
        expensive plan, pursuant to section 1860D-13(a)(1)). In such 
        case, the monthly premium under paragraph (1) shall be 
        increased with respect to such individual.
    ``(d) Payment of Premiums.--
            ``(1) Payment.--
                    ``(A) In general.--Premiums for enrollment under 
                this section shall be paid to the Secretary at such 
                times, and in such manner, as the Secretary determines 
                appropriate.
                    ``(B) Payment of premiums by employers on behalf of 
                employees.--An employer of an individual who enrolls 
                under this section may make payments for the premiums 
                for such enrollment on behalf of such individual 
                pursuant to a process established by the Secretary. 
                Such process shall ensure that enrollment under this 
                section is the choice of the individual and not the 
                employer.
            ``(2) Deposit.--Amounts collected by the Secretary under 
        this section shall be deposited in the Medicare Buy-In Trust 
        Fund established under subsection (e).
    ``(e) Medicare Buy-In Trust Fund.--
            ``(1) In general.--There is hereby created on the books of 
        the Treasury of the United States a trust fund to be known as 
        the `Medicare Buy-In Trust Fund' (in this subsection referred 
        to as the `Trust Fund'). The Trust Fund shall consist of such 
        gifts and bequests as may be made as provided in section 
        201(i)(1) and such amounts as may be deposited in, or 
        appropriated to, such fund as provided in this title.
            ``(2) Premiums.--Premiums collected under subsection (d) 
        shall be transferred to the Trust Fund.
            ``(3) Incorporation of provisions.--Subsections (b) through 
        (i) of section 1841 shall apply with respect to the Trust Fund 
        and this title in the same manner as they apply with respect to 
        the Federal Supplementary Medical Insurance Trust Fund and part 
        B, respectively, except that in applying such section 1841, any 
        reference in such section to `this part' shall be construed to 
        be a reference to this section and any reference in section 
        1841(h) to section 1840(d) and in section 1841(i) to sections 
        1840(b)(1) and 1842(g) are deemed to be references to 
        comparable authority exercised under this section.
    ``(f) Clarification.--Nothing in this section shall affect the 
benefits or eligibility under this title of individuals who would 
otherwise be entitled to or eligible for benefits under this title or 
title XIX, or both.
    ``(g) Treatment in Relation to the Affordable Care Act.--
            ``(1) Satisfaction of individual mandate.--For purposes of 
        applying section 5000A of the Internal Revenue Code of 1986, 
        the coverage provided through enrollment under this section 
        constitutes minimum essential coverage under subsection 
        (f)(1)(A)(i) of such section.
            ``(2) Eligibility for premium assistance.--Coverage 
        provided through enrollment under this section--
                    ``(A) shall be treated as coverage under a 
                qualified health plan in the individual market enrolled 
                in through the Exchange where the individual resides 
                for all purposes of section 36B of the Internal Revenue 
                Code of 1986 other than subsection (c)(2)(B) thereof; 
                and
                    ``(B) shall not be treated as eligibility for other 
                minimum essential coverage for purposes of subsection 
                (c)(2)(B) of such section 36B.
        The Secretary shall determine the applicable second lowest cost 
        silver plan which shall apply to coverage provided through 
        enrollment under this section for purposes of section 36B of 
        such Code.
            ``(3) Eligibility for cost-sharing subsidies.--For purposes 
        of applying section 1402 of the Patient Protection and 
        Affordable Care Act--
                    ``(A) coverage provided through enrollment under 
                this part and parts B and D pursuant to this section 
                shall be treated as coverage under a qualified health 
                plan in the silver level of coverage in the individual 
                market offered through an Exchange; and
                    ``(B) the Secretary shall be treated as the issuer 
                of such plan.
            ``(4) Use of exchanges.--Coverage provided through 
        enrollment under this section shall be deemed to be coverage 
        under a qualified health plan for purposes of section 
        1311(d)(4)(C) of the Patient Protection and Affordable Care Act 
        and shall be made available for enrollment, information 
        comparison, and otherwise as such a plan through any Internet 
        website maintained by an Exchange established under title I of 
        such Act (as described in such section).
            ``(5) Access to medigap.--Coverage provided through 
        medicare supplemental policies certified under section 1882 
        shall be made available to individuals eligible for enrollment 
        pursuant to this section for enrollment, information, 
        comparison, and otherwise as such a policy through any Internet 
        website described in paragraph (4).
    ``(h) Oversight.--There is established an advisory committee to be 
known as the `Medicare Buy In Oversight Board' to monitor and oversee 
the implementation of this section, including the experience of the 
individuals enrolling under this section. The Medicare Buy In Oversight 
Board shall make periodic recommendations for the continual improvement 
of the implementation of this section as well as the relationship of 
enrollment under this section to other health care programs.
    ``(i) Outreach and Enrollment.--
            ``(1) In general.--During the period that begins on January 
        1, 2018, and ends on December 31, 2020, the Secretary shall 
        award grants to eligible entities for the following purposes:
                    ``(A) Outreach and enrollment.--To carry out 
                outreach, public education activities, and enrollment 
                activities to raise awareness of the availability of, 
                and encourage, enrollment under this section.
                    ``(B) Assisting individuals transition under this 
                section.--To provide assistance to individuals to 
                enroll under this section.
                    ``(C) Raising awareness of premium assistance and 
                cost-sharing reductions.--To distribute fair and 
                impartial information concerning enrollment under this 
                section and the availability of premium assistance tax 
                credits under section 36B of the Internal Revenue Code 
                of 1986 and cost-sharing reductions under section 1402 
                of the Patient Protection and Affordable Care Act, and 
                to assist eligible individuals in applying for such tax 
                credits and cost-sharing reductions.
            ``(2) Eligible entities.--
                    ``(A) In general.--In this subsection, the term 
                `eligible entity' means--
                            ``(i) a State; or
                            ``(ii) a nonprofit community-based 
                        organization.
                    ``(B) Enrollment agents.--Such term includes a 
                licensed independent insurance agent or broker that has 
                an arrangement with a State or nonprofit community-
                based organization to enroll eligible individuals under 
                this section.
                    ``(C) Exclusions.--Such term does not include an 
                entity that--
                            ``(i) is a health insurance issuer; or
                            ``(ii) receives any consideration, either 
                        directly or indirectly, from any health 
                        insurance issuer in connection with the 
                        enrollment of any individuals under this 
                        section.
            ``(3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to awarding grants to States 
        or eligible entities in States that have geographic rating 
        areas at risk of having no qualified health plans in the 
        individual market.
            ``(4) Funding.--Out of any moneys in the Treasury not 
        otherwise appropriated, $500,000,000 is appropriated to the 
        Secretary for each of calendar years 2018 through 2020, to 
        carry out this subsection.
    ``(j) Implementation.--
            ``(1) Consultation.--In carrying out this section, the 
        Secretary shall--
                    ``(A) consult with other Federal agencies, 
                including the Department of the Treasury, the 
                Department of Labor, the Department of Veterans 
                Affairs, the Department of Defense, and the Office of 
                Personnel Management; and
                    ``(B) incorporate significant public consultation 
                and feedback, through public forums, notice and comment 
                rulemaking, and any other appropriate mediums.
            ``(2) Report.--No later than one year after the date of the 
        enactment of this section, the Secretary shall submit to 
        Congress a report establishing the administrative parameters 
        for the implementation of this section.
    ``(k) Feasibility Study.--The Secretary shall conduct a study on 
the feasibility of applying this section with respect to individuals 
residing in States that are not within the 50 States or the District of 
Columbia.''.
    (b) Medigap.--Section 1882 of the Social Security Act is amended by 
adding at the end the following new subsection:
    ``(aa) Development of New Standards for Certain Medicare 
Supplemental Policies Relating to Buy-In Option.--The Secretary shall 
request the National Association of Insurance Commissioners to review 
and revise the standards for benefit packages described in subsection 
(p)(1), to otherwise update standards to include requirements for each 
medicare supplemental policy that offers such a policy in a State, with 
respect to each year, to accept every individual in the State who is 
eligible for enrollment pursuant to section 1899C and who applies for 
such coverage for such year if the individual applies for enrollment in 
such policy during the 30-day period following the date of enrollment 
pursuant to section 1899C and to accept every such individual during a 
period of transition from enrollment pursuant to such section to 
enrollment under this title pursuant to eligibility other than under 
such section. Such revisions shall be made consistent with the rules 
applicable under subsection (p)(1)(E) with the reference to the `1991 
NAIC Model Regulation' deemed a reference to the NAIC Model Regulation 
as published in the Federal Register on December 4, 1998, and as 
subsequently updated by the National Association of Insurance 
Commissioners to reflect previous changes in law and the reference to 
`date of enactment of this subsection' deemed a reference to the date 
of enactment of this subsection (aa).''.

SEC. 3. NEGOTIATION OF LOWER COVERED PART D DRUG PRICES ON BEHALF OF 
              MEDICARE BENEFICIARIES.

    (a) Negotiation by Secretary.--Section 1860D-11 of the Social 
Security Act (42 U.S.C. 1395w-111) is amended by striking subsection 
(i) (relating to noninterference) and inserting the following:
    ``(i) Negotiation of Lower Drug Prices.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Secretary shall negotiate with pharmaceutical 
        manufacturers the prices (including discounts, rebates, and 
        other price concessions) that may be charged to PDP sponsors 
        and MA organizations for covered part D drugs for part D 
        eligible individuals who are enrolled under a prescription drug 
        plan or under an MA-PD plan.
            ``(2) No change in rules for formularies.--
                    ``(A) In general.--Nothing in paragraph (1) shall 
                be construed to authorize the Secretary to establish or 
                require a particular formulary.
                    ``(B) Construction.--Subparagraph (A) shall not be 
                construed as affecting the Secretary's authority to 
                ensure appropriate and adequate access to covered part 
                D drugs under prescription drug plans and under MA-PD 
                plans, including compliance of such plans with 
                formulary requirements under section 1860D-4(b)(3).
            ``(3) Construction.--Nothing in this subsection shall be 
        construed as preventing the sponsor of a prescription drug 
        plan, or an organization offering an MA-PD plan, from obtaining 
        a discount or reduction of the price for a covered part D drug 
        below the price negotiated under paragraph (1).
            ``(4) Semi-annual reports to congress.--Not later than June 
        1, 2018, and every 6 months thereafter, the Secretary shall 
        submit to the Committees on Ways and Means, Energy and 
        Commerce, and Oversight and Government Reform of the House of 
        Representatives and the Committee on Finance of the Senate a 
        report on negotiations conducted by the Secretary to achieve 
        lower prices for Medicare beneficiaries, and the prices and 
        price discounts achieved by the Secretary as a result of such 
        negotiations.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and shall first 
apply to negotiations and prices for plan years beginning on January 1, 
2018.

SEC. 4. INDIVIDUAL MARKET REINSURANCE FUND.

    (a) Establishment of Fund.--
            (1) In general.--There is established the ``Individual 
        Market Reinsurance Fund'' (in this section referred to as the 
        ``Fund'') to be administered by the Secretary to provide 
        funding for an individual market stabilization reinsurance 
        program in each State that complies with the requirements of 
        this section.
            (2) Funding.--Amounts made available to the Fund shall 
        consist of the funds deposited into the Fund under paragraph 
        (3) and shall be used to carry out this section (other than 
        subsection (c)) for each calendar year beginning with 2018. 
        Amounts made available to the Fund shall remain available 
        without fiscal or calendar year limitation to carry out this 
        section.
            (3) Cost-sharing in costs of program.--
                    (A) In general.--A qualified health plan that 
                participates in the reinsurance program established 
                under subsection (b) shall pay the fee established 
                under subparagraph (B).
                    (B) Authorization.--The Secretary is authorized to 
                charge a fee to each qualified health plan that 
                participates in the reinsurance program established 
                under subsection (b). Any amounts collected pursuant to 
                this paragraph shall be deposited into the Fund for 
                purposes of payments under subsection (b).
                    (C) Requirements.--In establishing the fee under 
                subparagraph (B)--
                            (i) the Secretary shall consult with 
                        interested parties; and
                            (ii) shall ensure that the amount of such 
                        fee is not excessive so as to unduly discourage 
                        qualified health plans from participating in 
                        the reinsurance program.
    (b) Individual Market Reinsurance Program.--
            (1) Use of funds.--The Secretary shall use amounts in the 
        Fund to establish a reinsurance program under which the 
        Secretary shall make reinsurance payments, subject to 
        subsection (a)(3), to health insurance issuers with respect to 
        high-cost individuals enrolled in qualified health plans 
        offered by such issuers that are not grandfathered health plans 
        or transitional health plans for any plan year beginning with 
        the 2018 plan year. This subsection constitutes budget 
        authority in advance of appropriations Acts and represents the 
        obligation of the Secretary to provide payments from the Fund 
        in accordance with this subsection.
            (2) Amount of payment.--The payment made to a health 
        insurance issuer under paragraph (1) with respect to each high-
        cost individual enrolled in a qualified health plan issued by 
        the issuer that is not a grandfathered health plan or a 
        transitional health plan shall equal 80 percent of the lesser 
        of--
                    (A) the amount (if any) by which the individual's 
                claims incurred during the plan year exceeds--
                            (i) in the case of the 2018, 2019, or 2020 
                        plan year, $50,000; and
                            (ii) in the case of any other plan year, 
                        $100,000; or
                    (B) for plan years described in--
                            (i) subparagraph (A)(i), $450,000; and
                            (ii) subparagraph (A)(ii), $400,000.
            (3) Indexing.--In the case of plan years beginning after 
        2018, the dollar amounts that appear in subparagraphs (A) and 
        (B) of paragraph (2) shall each be increased by an amount equal 
        to--
                    (A) such amount; multiplied by
                    (B) the premium adjustment percentage specified 
                under section 1302(c)(4) of the Affordable Care Act, 
                but determined by substituting ``2018'' for ``2013''.
            (4) Payment methods.--
                    (A) In general.--Payments under this subsection 
                shall be based on such a method as the Secretary 
                determines. The Secretary may establish a payment 
                method by which interim payments of amounts under this 
                subsection are made during a plan year based on the 
                Secretary's best estimate of amounts that will be 
                payable after obtaining all of the information.
                    (B) Requirement for provision of information.--
                            (i) Requirement.--Payments under this 
                        subsection to a health insurance issuer are 
                        conditioned upon the furnishing to the 
                        Secretary, in a form and manner specified by 
                        the Secretary, of such information as may be 
                        required to carry out this subsection.
                            (ii) Restriction on use of information.--
                        Information disclosed or obtained pursuant to 
                        clause (i) is subject to the HIPAA privacy and 
                        security law, as defined in section 3009(a) of 
                        the Public Health Service Act (42 U.S.C. 300jj-
                        19(a)).
            (5) Secretary flexibility for budget neutral revisions to 
        reinsurance payment specifications.--If the Secretary 
        determines appropriate, the Secretary may substitute higher 
        dollar amounts for the dollar amounts specified under 
        subparagraphs (A) and (B) of paragraph (2) (and adjusted under 
        paragraph (3), if applicable) if the Secretary certifies that 
        such substitutions, considered together, neither increase nor 
        decease the total projected payments under this subsection.
    (c) Reports to Congress.--
            (1) Annual report.--The Secretary shall submit a report to 
        Congress, not later than January 21, 2019, and each year 
        thereafter, that contains the following information for the 
        most recently ended year:
                    (A) The number and types of plans in each State's 
                individual market, specifying the number that are 
                qualified health plans, grandfathered health plans, or 
                health insurance coverage that is not a qualified 
                health plan.
                    (B) The impact of the reinsurance payments provided 
                under this section on the availability of coverage, 
                cost of coverage, and coverage options in each State.
                    (C) The amount of premiums paid by individuals in 
                each State by age, family size, geographic area in the 
                State's individual market, and category of health plan 
                (as described in subparagraph (A)).
                    (D) The process used to award funds for outreach 
                and enrollment activities awarded to eligible entities 
                under subsection (c), the amount of such funds awarded, 
                and the activities carried out with such funds.
                    (E) Such other information as the Secretary deems 
                relevant.
            (2) Evaluation report.--Not later than January 31, 2022, 
        the Secretary shall submit to Congress a report that--
                    (A) analyzes the impact of the funds provided under 
                this section on premiums and enrollment in the 
                individual market in all States; and
                    (B) contains a State-by-State comparison of the 
                design of the programs carried out by States with funds 
                provided under this section.
    (d) Definitions.--In this section:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of the Department of Health and Human Services.
            (2) Fund.--The term ``Fund'' means the Individual Market 
        Reinsurance Fund established under subsection (a).
            (3) Grandfathered health plan.--The term ``grandfathered 
        health plan'' has the meaning given that term in section 
        1251(e) of the Patient Protection and Affordable Care Act.
            (4) High-cost individual.--The term ``high-cost 
        individual'' means an individual enrolled in a qualified health 
        plan (other than a grandfathered health plan or a transitional 
        health plan) who incurs claims in excess of $50,000 during a 
        plan year.
            (5) State.--The term ``State'' means each of the 50 States 
        and the District of Columbia.
            (6) Transitional health plan.--The term ``transitional 
        health plan'' means a plan continued under the letter issued by 
        the Centers for Medicare & Medicaid Services on November 14, 
        2013, to the State Insurance Commissioners outlining a 
        transitional policy for coverage in the individual and small 
        group markets to which section 1251 of the Patient Protection 
        and Affordable Care Act does not apply, and under the extension 
        of the transitional policy for such coverage set forth in the 
        Insurance Standards Bulletin Series guidance issued by the 
        Centers for Medicare & Medicaid Services on March 5, 2014, 
        February 29, 2016, and February 13, 2017.

SEC. 5. REAUTHORIZATION OF RISK CORRIDORS.

    Section 1342(a) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18062(a)) is amended by inserting ``and calendar years 2018 
through 2020'' after ``2016''.

SEC. 6. ENHANCEMENTS FOR REDUCED COST SHARING.

    (a) Modification of Amount.--
            (1) In general.--Section 1402(c)(2) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18071(c)(2)) is 
        amended to read as follows:
            ``(2) Additional reduction.--The Secretary shall establish 
        procedures under which the issuer of a qualified health plan to 
        which this section applies shall further reduce cost-sharing 
        under the plan in a manner sufficient to--
                    ``(A) in the case of an eligible insured whose 
                household income is not less than 100 percent but not 
                more than 200 percent of the poverty line for a family 
                of the size involved, increase the plan's share of the 
                total allowed costs of benefits provided under the plan 
                to 95 percent of such costs;
                    ``(B) in the case of an eligible insured whose 
                household income is more than 200 percent but not more 
                than 300 percent of the poverty line for a family of 
                the size involved, increase the plan's share of the 
                total allowed costs of benefits provided under the plan 
                to 90 percent of such costs; and
                    ``(C) in the case of an eligible insured whose 
                household income is more than 300 percent but not more 
                than 400 percent of the poverty line for a family of 
                the size involved, increase the plan's share of the 
                total allowed costs of benefits provided under the plan 
                to 85 percent of such costs.''.
            (2) Conforming amendment.--Clause (i) of section 
        1402(c)(1)(B) of such Act (42 U.S.C. 18071(c)(1)(B)) is amended 
        to read as follows:
                            ``(i) In general.--The Secretary shall 
                        ensure the reduction under this paragraph shall 
                        not result in an increase in the plan's share 
                        of the total allowed costs of benefits provided 
                        under the plan above--
                                    ``(I) 95 percent in the case of an 
                                eligible insured described in paragraph 
                                (2)(A);
                                    ``(II) 90 percent in the case of an 
                                eligible insured described in paragraph 
                                (2)(B); and
                                    ``(III) 85 percent in the case of 
                                an eligible insured described in 
                                paragraph (2)(C).''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to plan years beginning after December 31, 2017.
    (b) Funding.--Section 1402 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18071) is amended by adding at the end the 
following new subsection:
    ``(g) Funding.--Out of any funds in the Treasury not otherwise 
appropriated, there are appropriated to the Secretary such sums as may 
be necessary for payments under this section.''.

SEC. 7. TECHNICAL ADVISORY COMMITTEE ON HEALTH CARE DELIVERY SYSTEM 
              REFORM AND PROGRAM INTEGRITY.

    (a) Establishment.--There is established a committee to be known as 
the Committee on Delivery System Reform and Program Integrity.
    (b) Membership.--The Committee shall be composed of 11 members 
appointed by the Comptroller General of the United States. Such members 
shall include individuals with national recognition for their expertise 
in health care delivery system reform and the related delivery of 
health care. Health care providers and patient advocates shall have 
adequate representation on the Committee.
    (c) Duties.--The Committee shall periodically submit to the 
Secretary of Health and Human Services and the Congress written 
recommendations, provided in a comprehensive report format, to further 
the goals of health care delivery system reform that generally aim to 
improve the quality of patient care, improve the health of populations, 
and reduce the cost of care. The origin of these proposals can be 
derived from any initiative underway between the Department of Health 
and Human Services and any party, or other initiatives, national or 
regional in scope, that offer promise to accelerate the goals of 
delivery system reform or improve program integrity toward the goal of 
providing further stability to the appropriate Trust Funds under title 
XVIII of the Social Security Act.
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