[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4394 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 4394

To direct the Secretary of Health and Human Services to make available 
a public option for health insurance coverage for individuals residing 
    in an area without a qualified health plan available through an 
                   Exchange, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 14, 2017

  Ms. Titus 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 make available 
a public option for health insurance coverage for individuals residing 
    in an area without a qualified health plan available through an 
                   Exchange, 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 ``Bare County Buy-in Act of 2017''.

SEC. 2. PUBLIC OPTION FOR HEALTH INSURANCE COVERAGE.

    (a) In General.--Part 2 of subtitle D of title I of the Patient 
Protection and Affordable Care Act (Public Law 111-148) is amended by 
adding at the end the following new section:

``SEC. 1314. PUBLIC OPTION FOR HEALTH INSURANCE COVERAGE.

    ``(a) In General.--If the Secretary determines that individuals 
residing in a rating area (as described in section 2701(a) of the 
Public Health Service Act (42 U.S.C. 300gg(a))) eligible to purchase 
individual health insurance coverage through an Exchange will not have 
access to a qualified health plan offered through an Exchange in the 
individual market with respect to a plan year beginning on or after 
January 1, 2018, the Secretary shall make available the public option 
for health insurance coverage described in subsection (b) (in this 
section referred to as the `public option') to such individuals through 
such Exchange for such plan year.
    ``(b) Public Option Requirements.--The public option described in 
subsection (a) shall--
            ``(1) provide the essential health benefits package (as 
        defined in section 1302(a));
            ``(2) comply with the requirements of this title and the 
        amendments made by this title, to the extent practicable, 
        applicable to a health plan offered through an Exchange; and
            ``(3) consist of a plan in the silver level of coverage (as 
        described in section 1302(d)).
    ``(c) Enrollment and Coverage Periods.--The Secretary shall 
establish enrollment and coverage periods for individuals who enroll in 
the public option. Such periods shall be established, to the extent 
practicable, in coordination with the enrollment and coverage periods 
for other plans offered through an Exchange.
    ``(d) Premiums.--
            ``(1) Monthly premium.--The Secretary shall determine a 
        monthly premium for individuals enrolled in the public option. 
        Such monthly premium shall be equal to \1/12\ of the annual 
        premium computed under paragraph (2)(B).
            ``(2) Annual premium.--
                    ``(A) Estimation.--The Secretary shall estimate the 
                average, annual per capita amount for benefits and 
                administrative expenses payable under this section for 
                individuals in each age band specified in subparagraph 
                (C) enrolled in the public option.
                    ``(B) Computation.--The annual premium under this 
                subsection for months in a year is equal to the 
                average, annual per capita amount estimated under 
                paragraph (1) for the year for each age band specified 
                in subparagraph (C), geographically adjusted by rating 
                area.
                    ``(C) Age bands.--The age bands specified in this 
                subparagraph are the age bands defined by the Secretary 
                pursuant to section 2701(a)(3) of the Public Health 
                Service Act (42 U.S.C. 300gg(a)(3)).
            ``(3) Variation in premium rates.--The premium rate charged 
        for the public option may not vary except as provided under 
        section 2701 of such Act (42 U.S.C. 300gg).
    ``(e) Payment of Premiums.--
            ``(1) In general.--Premiums for enrollment in the public 
        option shall be paid to the Secretary at such times, and in 
        such manner, as the Secretary determines appropriate.
            ``(2) Deposit.--Amounts collected by the Secretary under 
        this section shall be deposited in the account established 
        under subsection (f).
    ``(f) Account.--
            ``(1) Establishment.--There is established in the Treasury 
        of the United States an account for the receipts and 
        disbursements attributable to the operation of the public 
        option.
            ``(2) Prohibition of state imposition of taxes.--Section 
        1854(g) of the Social Security Act (42 U.S.C. 1395w-24(g)) 
        shall apply to receipts and disbursements described in 
        paragraph (1) in the same manner as such section applies to 
        payments or premiums described in such section.
    ``(g) Health Care Provider Payment Rates for Items and Services.--
            ``(1) In general.--
                    ``(A) Rates negotiated by the secretary.--Subject 
                to subparagraph (B), the Secretary shall, through a 
                negotiated agreement with health care providers, 
                establish rates for reimbursing health care providers 
                for providing the benefits covered by the public 
                option.
                    ``(B) Medicare reimbursement rates.--If the 
                Secretary and health care providers are unable to reach 
                a negotiated agreement on a reimbursement rate, the 
                Secretary shall reimburse providers at rates determined 
                for equivalent items and services under the original 
                Medicare fee-for-service program under parts A and B of 
                title XVIII of the Social Security Act.
                    ``(C) For new services.--The Secretary shall modify 
                reimbursement rates described in subparagraph (B) in 
                order to accommodate payments for services that are not 
                otherwise covered under the original medicare fee-for-
                service program.
            ``(2) Prescription drugs.--Any payment rate under this 
        subsection for a prescription drug shall be at a rate 
        negotiated by the Secretary. If the Secretary is unable to 
        reach a negotiated agreement on such a reimbursement rate, the 
        Secretary shall use rates determined for equivalent drugs paid 
        for under the original medicare fee-for-service program. The 
        Secretary shall modify such rates in order to accommodate 
        payments for drugs that are not otherwise covered under the 
        original medicare fee-for-service program.
    ``(h) Health Care Provider Participation.--
            ``(1) Provider participation.--
                    ``(A) In general.--The Secretary shall establish 
                conditions of participation for health care providers 
                under the public option.
                    ``(B) Licensure or certification.--The Secretary 
                shall not allow a health care provider to participate 
                in the public option unless such provider is 
                appropriately licensed or certified under State law.
            ``(2) Establishment of a provider network.--
                    ``(A) Medicare and medicaid participating 
                providers.--A health care provider that is a 
                participating provider of services or supplier under 
                the Medicare program under title XVIII of the Social 
                Security Act or under a State Medicaid plan under title 
                XIX of such Act is a participating provider in the 
                public option unless the health care provider opts out 
                of participating in the public option through a process 
                established by the Secretary.
                    ``(B) Additional providers.--The Secretary shall 
                establish a process to allow health care providers not 
                described in subparagraph (A) to become participating 
                providers in the public option.
    ``(i) Administrative Contracting.--
            ``(1) Authorities.--The Secretary may enter into contracts 
        for the purpose of performing administrative functions 
        (including functions described in subsection (a)(4) of section 
        1874A of the Social Security Act) with respect to the public 
        option in the same manner as the Secretary may enter into 
        contracts under subsection (a)(1) of such section. The 
        Secretary shall have the same authority with respect to the 
        public option as the Secretary has under such subsection (a)(1) 
        and subsection (b) of section 1874A of the Social Security Act 
        with respect to title XVIII of such Act.
            ``(2) Transfer of insurance risk.--Any contract under this 
        paragraph shall not involve the transfer of insurance risk from 
        the Secretary to the entity entering into such contract with 
        the Secretary.''.
    (b) Conforming Amendments.--
            (1) Treatment as a qualified health plan.--Section 
        1301(a)(2) of the Patient Protection and Affordable Care Act 
        (42 U.S.C. 18021(a)(2)) is amended--
                    (A) in the paragraph heading, by inserting ``, the 
                public health insurance option,'' before ``and''; and
                    (B) by inserting ``the public health insurance 
                option under section 1314,'' before ``and a multi-State 
                plan''.
            (2) State insurance regulation.--Section 1324(a) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18044(a)) 
        is amended by inserting ``the public health insurance option 
        under section 2795 of the Public Health Service Act,'' before 
        ``or a multi-State qualified health plan''.
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