[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5155 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 5155

  To amend the Patient Protection and Affordable Care Act to improve 
affordability of, undo sabotage with respect to, and increase access to 
           health insurance coverage, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 5, 2018

    Mr. Pallone (for himself, Mr. Scott of Virginia, and Mr. Neal) 
 introduced the following bill; which was referred to the Committee 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 concerned

_______________________________________________________________________

                                 A BILL


 
  To amend the Patient Protection and Affordable Care Act to improve 
affordability of, undo sabotage with respect to, and increase access to 
           health insurance coverage, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Undo Sabotage and 
Expand Affordability of Health Insurance Act of 2018''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                    TITLE I--EXPANDING AFFORDABILITY

Sec. 101. Improve affordability and reduce premium costs for consumers.
Sec. 102. Lower out-of-pocket costs for consumers.
Sec. 103. Expand affordability for working families.
                       TITLE II--UNDOING SABOTAGE

Sec. 201. Protect comprehensive coverage for small businesses and 
                            workers.
Sec. 202. Prevent junk plans and continue protections for consumers 
                            with preexisting conditions.
Sec. 203. Ensure plans provide comprehensive benefits.
Sec. 204. Undo Administration sabotage by requiring open enrollment 
                            outreach, education, and funding for 
                            navigators.
Sec. 205. Improve marketplace stability to prevent sabotage from 
                            raising premiums.
              TITLE III--STATE INNOVATION AND TRANSPARENCY

Sec. 301. Fund State health insurance education programs for consumers.
Sec. 302. Fund State innovations to expand coverage.
Sec. 303. Preserve State option to implement health care marketplaces.
Sec. 304. Promote transparency and accountability in the 
                            Administration's expenditures of Exchange 
                            user fees.

                    TITLE I--EXPANDING AFFORDABILITY

SEC. 101. IMPROVE AFFORDABILITY AND REDUCE PREMIUM COSTS FOR CONSUMERS.

    (a) In General.--Section 36B(b)(3)(A) of the Internal Revenue Code 
of 1986 is amended to read as follows:
                    ``(A) Applicable percentage.--The applicable 
                percentage for any taxable year shall be the percentage 
                such that the applicable percentage for any taxpayer 
                whose household income is within an income tier 
                specified in the following table shall increase, on a 
                sliding scale in a linear manner, from the initial 
                premium percentage to the final premium percentage 
                specified in such table for such income tier:


------------------------------------------------------------------------
    ``In the case of household
 income (expressed as  a percent      The initial      The final premium
   of poverty line)  within the         premium         percentage is--
      following income tier:        percentage is--
------------------------------------------------------------------------
Over 100.0% up to 133.0%.........               0.0%               1.0%
133.0% up to 150.0%..............               1.0%               2.0%
150.0% up to 200.0%..............               2.0%               4.0%
200.0% up to 250.0%..............               4.0%               6.0%
250.0% up to 300.0%..............               6.0%               7.0%
300.0% up to 400.0%..............               7.0%               8.5%
400.0% and higher................               8.5%            8.5%''.
------------------------------------------------------------------------

    (b) Conforming Amendment.--Section 36B(c)(1)(A) of the Internal 
Revenue Code of 1986 is amended by striking ``but does not exceed 400 
percent''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2019.

SEC. 102. LOWER OUT-OF-POCKET COSTS FOR CONSUMERS.

    (a) Expansion of Eligibility.--
            (1) In general.--Section 1402(c) of the Patient Protection 
        and Affordable Care Act (42 U.S.C. 18071(c)) is amended--
                    (A) by striking paragraphs (1) and (2) and 
                inserting the following:
            ``(1) In general.--The reduction in cost-sharing under this 
        subsection shall be achieved, with respect to an issuer of a 
        qualified health plan to which this section applies, by 
        reducing cost-sharing under the plan (and the applicable out-of 
        pocket limit under section 1302(c)(1)) in a manner and amount 
        sufficient to--
                    ``(A) in the case of an eligible insured whose 
                household income is not less than 100 percent but not 
                more than 250 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 94 percent of such costs; and
                    ``(B) in the case of an eligible insured whose 
                household income is more than 250 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 87 percent of such costs.''; and
                    (B) by redesignating paragraphs (3), (4), and (5) 
                as paragraphs (2), (3), and (4), respectively.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply with respect to plan years beginning after December 
        31, 2019.
    (b) Funding Cost Sharing Reductions.--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 is hereby appropriated to the Secretary such sums 
as may be necessary for payments under this section.''.

SEC. 103. EXPAND AFFORDABILITY FOR WORKING FAMILIES.

    (a) In General.--Clause (i) of section 36B(c)(2)(C) of the Internal 
Revenue Code of 1986 is amended to read as follows:
                            ``(i) Coverage must be affordable.--
                                    ``(I) Employees.--An employee shall 
                                not be treated as eligible for minimum 
                                essential coverage if such coverage 
                                consists of an eligible employer-
                                sponsored plan (as defined in section 
                                5000A(f)(2)) and the employee's 
                                required contribution (within the 
                                meaning of section 5000A(e)(1)(B)) with 
                                respect to the plan exceeds 9.5 percent 
                                of the employee's household income.
                                    ``(II) Family members.--An 
                                individual who is eligible to enroll in 
                                an eligible employer-sponsored plan (as 
                                defined in section 5000A(f)(2)) by 
                                reason of a relationship the individual 
                                bears to the employee shall not be 
                                treated as eligible for minimum 
                                essential coverage by reason of such 
                                eligibility to enroll if the employee's 
                                required contribution (within the 
                                meaning of section 5000A(e)(1)(B), 
                                determined by substituting `family' for 
                                `self-only') with respect to the plan 
                                exceeds 9.5 percent of the employee's 
                                household income.''.
    (b) Conforming Amendments.--
            (1) Clause (ii) of section 36B(c)(2)(C) of the Internal 
        Revenue Code of 1986 is amended by striking ``Except as 
        provided in clause (iii), an employee'' and inserting ``An 
        individual''.
            (2) Clause (iii) of section 36B(c)(2)(C) of such Code is 
        amended by striking ``the last sentence of clause (i)'' and 
        inserting ``clause (i)(II)''.
            (3) Clause (iv) of section 36B(c)(2)(C) of such Code is 
        amended by striking ``9.5 percent under clause (i)(II)'' and 
        inserting ``the 9.5 percent under clauses (i)(I) and (i)(II)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2019.

                       TITLE II--UNDOING SABOTAGE

SEC. 201. PROTECT COMPREHENSIVE COVERAGE FOR SMALL BUSINESSES AND 
              WORKERS.

    Notwithstanding any other provision of law, the Secretary of Labor 
may not take any action to implement, finalize, or enforce the proposed 
rule published on January 5, 2018, on pages 614 through 636 of volume 
83 of the Federal Register, or any substantially similar proposed rule.

SEC. 202. PREVENT JUNK PLANS AND CONTINUE PROTECTIONS FOR CONSUMERS 
              WITH PREEXISTING CONDITIONS.

    (a) Including Short-Term Limited Duration Insurance as Individual 
Health Insurance Coverage.--Section 2791(b)(5) of the Public Health 
Service Act (42 U.S.C. 300g-91(b)(5)) is amended by striking ``but does 
not include short-term limited duration insurance'' and inserting ``, 
including short-term limited duration insurance''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning after December 31, 2018.

SEC. 203. ENSURE PLANS PROVIDE COMPREHENSIVE BENEFITS.

    (a) Essential Health Benefits.--Section 1302(b)(4) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(b)(4)) is amended--
            (1) in subparagraph (A), by inserting ``and so that 
        benefits are included within each of such categories'';
            (2) in subparagraph (G), by striking at the end ``and'';
            (3) in subparagraph (H), by striking the period at the end 
        and inserting ``; and''; and
            (4) by adding at the end the following new subparagraph:
                    ``(I) ensure that, beginning January 1, 2019--
                            ``(i) in the case of health benefits that 
                        are established as essential health benefits, 
                        there shall not be substitution of such 
                        benefits across benefit categories;
                            ``(ii) a qualified health plan shall not be 
                        treated as providing coverage for the essential 
                        health benefits unless under such plan--
                                    ``(I) coverage of prescription 
                                drugs provides for access to a wide 
                                variety of classes of drugs within the 
                                prescription drug formulary of such 
                                plan; and
                                    ``(II) in the case that a drug that 
                                is medically necessary for an enrollee 
                                under such plan is not included within 
                                such formulary, such individual has 
                                access to such drug through an 
                                exceptions process established by the 
                                plan; and
                            ``(iii) habilitative services are covered 
                        at parity with rehabilitative services.''.
    (b) Standard Benefit Plans.--Section 1302(d) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(d)) is amended by 
adding at the end the following new paragraph:
            ``(5) Standard benefit plans.--
                    ``(A) In general.--For purposes of providing 
                individuals with the opportunity to make simpler 
                comparisons of health plans offered by different health 
                insurance issuers and simplify the selection process, 
                the Secretary shall, for each plan year beginning with 
                plan year 2020, through rulemaking, specify a structure 
                described in subparagraph (B)(i) for a standard benefit 
                plan for such plan year for each of the bronze, silver, 
                and gold levels of coverage and for each actuarial 
                value variation of a silver plan resulting from the 
                application of section 1402(c). A standard benefit plan 
                for a plan year for a level of coverage or actuarial 
                value variation of a silver plan shall be modeled on 
                the most commonly purchased plans (determined by 
                enrollments in such plans) during the previous 2 plan 
                years offered in the federally facilitated Exchange 
                operated pursuant to section 1321(c) in such level or 
                variation and shall include coverage of deductible-
                exempt services consistent with actual purchasing 
                patterns of consumers in the previous two plan years.
                    ``(B) Standard benefit plan.--For purposes of this 
                paragraph, the term `standard benefit plan' means a 
                qualified health plan to be offered through an Exchange 
                on the individual market that has either--
                            ``(i) a standardized cost-sharing structure 
                        specified by the Secretary pursuant to 
                        rulemaking; or
                            ``(ii) a standardized cost-sharing 
                        structure specified by the Secretary pursuant 
                        to rulemaking that is modified by the health 
                        insurance issuer of such plan only to the 
                        extent necessary to align with high deductible 
                        health plan requirements under section 223 of 
                        the Internal Revenue Code of 1986 or the 
                        applicable annual limitation on cost sharing 
                        under subsection (c) and actuarial value 
                        requirements specified by the Secretary.''.

SEC. 204. UNDO ADMINISTRATION SABOTAGE BY REQUIRING OPEN ENROLLMENT 
              OUTREACH, EDUCATION, AND FUNDING FOR NAVIGATORS.

    Section 1321(c) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18041(c)) is amended by adding at the end the following new 
paragraph:
            ``(3) Navigator program and outreach and enrollment 
        activities.--
                    ``(A) Navigator program.--
                            ``(i) In general.--In the case of an 
                        Exchange established or operated by the 
                        Secretary pursuant to this subsection, the 
                        Secretary shall establish a program under which 
                        it awards grants to entities that would be 
                        described in paragraph (2) of section 1311(i) 
                        to carry out the duties that would be described 
                        in paragraph (3) of such section if the 
                        references in such section 1311(i) to `this 
                        subsection' and `paragraph (1)' were each 
                        instead a reference to `paragraph (3)(A) of 
                        section 1321(c)'.
                            ``(ii) Application of state exchange 
                        navigator provisions.--For purposes of carrying 
                        out this subparagraph, the provisions of 
                        paragraphs (2) through (5) of section 1311(i) 
                        shall apply to the Secretary with respect to an 
                        Exchange described in clause (i) and the 
                        program under this subparagraph in the same 
                        manner as such provisions apply to a State with 
                        respect to an Exchange described in section 
                        1311(i) and the program established under such 
                        section.
                            ``(iii) Funding.--For purposes of carrying 
                        out this subparagraph, the Secretary shall 
                        obligate $100,000,000 out of amounts collected 
                        through the user fees on participating health 
                        insurance issuers pursuant to section 156.50 of 
                        title 45, Code of Federal Regulations (or any 
                        successor regulations) for each of fiscal years 
                        2019 through 2021. Such amount shall remain 
                        available without fiscal year limitation until 
                        expended.
                    ``(B) Outreach and educational activities.--
                            ``(i) In general.--In the case of an 
                        Exchange established or operated by the 
                        Secretary pursuant to this subsection, the 
                        Secretary shall carry out outreach and 
                        educational activities for purposes of 
                        informing potential enrollees in qualified 
                        health plans offered through the Exchange of 
                        the availability of coverage under such plans 
                        and financial assistance for coverage under 
                        such plans.
                            ``(ii) Funding.--For purposes of carrying 
                        out this subparagraph, the Secretary shall 
                        obligate $100,000,000 out of the amounts 
                        collected through the user fees on 
                        participating health insurance issuers pursuant 
                        to section 156.50 of title 45, Code of Federal 
                        Regulations (or any successor regulations) for 
                        each of fiscal years 2019 through 2021. Such 
                        amount shall remain available without fiscal 
                        year limitation until expended.''.

SEC. 205. IMPROVE MARKETPLACE STABILITY TO PREVENT SABOTAGE FROM 
              RAISING PREMIUMS.

    (a) Fund.--
            (1) In general.--There is hereby established the National 
        Reinsurance Program Fund to be administered by the Secretary of 
        Health and Human Services for purposes of carrying out a 
        national reinsurance program to make reinsurance payments, in 
        accordance with this section.
            (2) Appropriation.--There is hereby appropriated to the 
        Fund established under paragraph (1), out of any funds in the 
        Treasury not otherwise appropriated, such sums as are necessary 
        for carrying out the purpose described in such paragraph.
    (b) Payments.--
            (1) In general.--The Secretary of Health and Human Services 
        shall use amounts available in the Fund to establish a national 
        reinsurance program under which the Secretary makes reinsurance 
        payments to health insurance issuers with respect to claims for 
        individuals enrolled under qualifying reinsurance plans offered 
        by such issuers for plan year 2019 or a subsequent plan year 
        that exceed, subject to paragraph (2), $50,000 in an amount 
        equal to 75 percent of the amount of such claims, but not to 
        exceed $1,000,000.
            (2) Indexing.--For plan year 2020 or subsequent plan year, 
        in lieu of each dollar amount specified in paragraph (1), each 
        such dollar amount applied under this subsection for such plan 
        year shall be the dollar amount applied under this subsection 
        for the previous year, increased by the annual percentage 
        increase in the Consumer Price Index for All Urban Consumers 
        (all items; United States city average as of June of the 
        previous fiscal year).
            (3) Methods.--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 necessary information.
    (c) Qualifying Reinsurance Plan.--
            (1) In general.--For purposes of this section, the term 
        ``qualifying reinsurance plan'' means, with respect to a health 
        insurance issuer a qualified health plan (as defined in section 
        1301 of the Patient Protection and Affordable Care Act (42 
        U.S.C. 18021)) offered by such issuer on the individual market. 
        Such term does not include a grandfathered health plan (as 
        defined in section 1251 of such Act (42 U.S.C. 18011)), 
        transitional health plan, or a standard health plan offered in 
        connection with a basic health program established under 
        section 1331 of such Act (42 U.S.C. 18051).
            (2) Transitional health plan.--For purposes of paragraph 
        (1), 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 (42 U.S.C. 
        18011) 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, or under any 
        subsequent extensions thereof.
    (d) Coordination With Risk Adjustment.--The Secretary shall make 
adjustments to the risk adjustment program operated under section 1343 
of the Patient Protection and Affordable Care Act (42 U.S.C. 18063), as 
appropriate, to account for the effects of this section on the 
actuarial risk of enrollees.

              TITLE III--STATE INNOVATION AND TRANSPARENCY

SEC. 301. FUND STATE HEALTH INSURANCE EDUCATION PROGRAMS FOR CONSUMERS.

    Section 2793(e) of the Public Health Service Act (42 U.S.C. 300gg-
93(e)) is amended by adding at the end the following new paragraph:
            ``(3) Appropriations.--For purposes of carrying out this 
        section, there is hereby appropriated to the Secretary, out of 
        any funds in the Treasury not otherwise appropriated, 
        $100,000,000 for each of the fiscal years 2019 through 2021. 
        Such amount shall remain available until expended.''.

SEC. 302. FUND STATE INNOVATIONS TO EXPAND COVERAGE.

    (a) In General.--Subject to subsection (d), the Secretary of Health 
and Human Services shall award grants to eligible State agencies to 
enable such States to explore innovative solutions to promote greater 
enrollment in health insurance coverage in the individual and small 
group markets, including activities described in subsection (c).
    (b) Eligibility.--For purposes of subsection (a), eligible State 
agencies are Exchanges established by a State under title I of the 
Patient Protection and Affordable Care Act and State agencies with 
primary responsibility over health and human services for the State 
involved.
    (c) Use of Funds.--For purposes of subsection (a), the activities 
described in this subsection are the following:
            (1) State efforts to streamline health insurance enrollment 
        procedures in order to reduce burdens on consumers and 
        facilitate greater enrollment in health insurance coverage in 
        the individual and small group markets, including automatic 
        enrollment and reenrollment of, or pre-populated applications 
        for, individuals without health insurance who are eligible for 
        tax credits under section 36B of the Internal Revenue Code of 
        1986, with the ability to opt out of such enrollment.
            (2) State investment in technology to improve data sharing 
        and collection for the purposes of facilitating greater 
        enrollment in health insurance coverage in such markets.
            (3) Implementation of a State version of an individual 
        mandate to be enrolled in health insurance coverage.
            (4) Feasibility studies to develop comprehensive and 
        coherent State plan for increasing enrollment in the individual 
        and small group market.
    (d) Funding.--For purposes of carrying out this section, there is 
hereby appropriated, out of any funds in the Treasury not otherwise 
appropriated, $200,000,000 for each of the fiscal years 2019 through 
2021. Such amount shall remain available until expended.

SEC. 303. PRESERVE STATE OPTION TO IMPLEMENT HEALTH CARE MARKETPLACES.

    Section 1311(a)(4) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031(a)(4)) is amended--
            (1) by striking subparagraph (B);
            (2) by striking ``Renewability of grant'' and all that 
        follows through ``Subject to subsection (d)(4)'' and inserting 
        ``Renewability of grant.--Subject to subsection (d)(4)'';
            (3) by redesignating clauses (i) and (ii) as subparagraphs 
        (A) and (B), respectively, with appropriate indentation; and
            (4) in subparagraph (A), as redesignated by paragraph (3), 
        by redesignating subclauses (I) and (II) as clauses (i) and 
        (ii), respectively, with appropriate indentation.

SEC. 304. PROMOTE TRANSPARENCY AND ACCOUNTABILITY IN THE 
              ADMINISTRATION'S EXPENDITURES OF EXCHANGE USER FEES.

    For each of plan years 2018, 2019, and 2020, not later than the 
date that is 3 months after of the end of such fiscal year, the 
Secretary of Health and Human Services shall submit to the appropriate 
committees of Congress and make available to the public an annual 
report on the expenditure by the Department of Health and Human 
Services of user fees collected pursuant to section 156.50 of title 45, 
Code of Federal Regulations (or any successor regulations). Each such 
report for a plan year shall include a detailed accounting of the 
amount of such user fees collected during such plan year and of the 
amount of such expenditures used during such plan year for the 
federally facilitated Exchange operated pursuant to section 1321(c) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)) on 
outreach and enrollment activities, navigators, maintenance of 
Healthcare.gov, and operation of call centers.
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