[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1868 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 1868
To provide support to States to establish invisible high-risk pool or
reinsurance programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 13, 2019
Ms. Collins (for herself and Mr. Manchin) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide support to States to establish invisible high-risk pool or
reinsurance programs.
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 ``Premium Reduction Act of 2019''.
SEC. 2. INVISIBLE HIGH-RISK POOL AND REINSURANCE PROGRAMS.
(a) State Grants Under Waivers.--Section 1332(a) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18052(a)) is amended--
(1) by redesignating paragraphs (4), (5), and (6) as
paragraphs (6), (7), and (8), respectively; and
(2) by inserting after paragraph (3) the following:
``(4) Federal funding for invisible high-risk pool and
reinsurance programs.--
``(A) Allocations.--
``(i) Methodology.--Not later than 45 days
after the date of enactment of this Act, the
Secretary, in consultation with the National
Association of Insurance Commissioners, shall
specify an allocation methodology for
determining the amount of funds appropriated
under section 2(b) of the Premium Reduction Act
of 2019 for a fiscal year to be allocated for
each State for purposes of subparagraph (B) and
section 2(c) of the Premium Reduction Act of
2019.
``(ii) Annual determinations.--The
Secretary shall determine the allocations to
States described in clause (i) for each
calendar year, using the methodology determined
under clause (i) and taking into consideration
the experiences of other States with respect to
participation in an Exchange and premium tax
credits, cost-sharing reductions, or small
business credits under sections 36B of the
Internal Revenue Code of 1986 or under part I
of subtitle E provided to residents of such
States.
``(B) State grants.--From amounts appropriated
under section 2(b)(1) of the Premium Reduction Act of
2019 for a fiscal year, the Secretary shall award
grants to States for each of fiscal years 2020 through
2023, in amounts determined under subparagraph (A)(ii),
for the following purposes:
``(i) For each of fiscal years 2020 through
2024, out of amounts appropriated under
subparagraph (A) of such section 2(b)(1), for
administrative costs of the State associated
with preparing and submitting information
described in paragraph (1)(B) that includes an
invisible high-risk pool or reinsurance program
that meets the requirements of subsection
(f)(2), or costs associated with the
establishment of such invisible high-risk pool
or reinsurance program.
``(ii) For each of fiscal years 2021
through 2023, out of amounts appropriated under
subparagraph (B) of such section 2(b)(1), for
the establishment or maintenance of invisible
high-risk pools and reinsurance programs that
meet the requirements of subsection (f)(2) and
for which the State has received a waiver under
this section.
``(C) Budget neutrality.--Funds awarded to a State
under a grant awarded under subparagraph (B) shall not
be taken into account for purposes of determining under
paragraph (1) whether the State waiver is budget
neutral, or determining under subsection (b)(1) whether
the State waiver increases the Federal deficit.
``(5) Reconciliation of pass through funding and funding
for invisible high-risk pool and reinsurance programs.--In
allocating amounts under paragraphs (3) and (4), the
Secretary--
``(A) not later than November 1 of each year, shall
estimate the allocation for each State under such
paragraphs for the upcoming calendar year;
``(B) not later than June 1 of each year, shall
revise the estimate of the allocations under
subparagraph (A) for each State for the current
calendar year; and
``(C) shall reconcile amounts to be paid to each
State under such paragraphs for the following calendar
year by adjusting each State's allocation for the
following calendar year to account for the revisions
made under subparagraph (B).''.
(b) Appropriations.--
(1) In general.--There are authorized to be appropriated,
and there are appropriated, to the Secretary of Health and
Human Services (referred to in this section as the
``Secretary''), for the purposes described in section
1332(a)(4)(B) of the Patient Protection and Affordable Care Act
(as amended by subsection (a)) and subsection (c) of this
section, out of any funds in the Treasury not otherwise
appropriated--
(A) $500,000,000 for fiscal year 2020; and
(B) $5,000,000,000 for each of fiscal years 2021
through 2023.
(2) Available until expended.--Amounts appropriated under
this subsection shall remain available until expended.
(c) Default Federal Safeguard.--
(1) In general.--For purposes of plan year 2021, in the
case of a State that does not, by a date specified by the
Secretary for each such year, in consultation with the National
Association of Insurance Commissioners, have in effect a waiver
under section 1332 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18052) that includes an invisible high-risk
pool or reinsurance program that meets the requirements of
subsection (f)(2) of such section 1332, the Secretary shall,
from amounts appropriated under subsection (b), use the
allocation determined for the State under subsection (a)(4)(A)
of such section 1332 for plan year 2021 for the purpose
described in paragraph (2). Such allocation shall be increased
by the amount of pass through funding that would be available
under section 1332(a)(3) of the Patient Protection and
Affordable Care Act if the State obtained a waiver for an
invisible high-risk pool or reinsurance program under such
section.
(2) Required use for market stabilization payments to
issuers.--The Secretary shall use any allocation for a State
made pursuant to paragraph (1) to help stabilize premiums for
health insurance coverage in the individual market in such
State by providing payments to health insurance issuers, using
payment parameters and a methodology determined by the
Secretary.
(d) Invisible High-Risk Pools and Reinsurance Programs.--
(1) In general.--Section 1332 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18052) is amended by adding at
the end the following:
``(f) Invisible High-Risk Pools and Reinsurance Programs.--
``(1) Funding.--With respect to a State that has received a
waiver under this section to establish an invisible high-risk
pool or reinsurance program described in paragraph (2), the
State may fund such program, in whole or in part, using one or
both of the following:
``(A) Amounts received through a grant described in
subsection (a)(4)(B).
``(B) All of, or a portion of, the payments made to
the State as described in subsection (a)(3), consistent
with the information the State provides under
subsection (a)(1)(B).
``(2) Program design.--An invisible high-risk pool or
reinsurance program described in this paragraph is a program
that meets any of the following:
``(A) An invisible high-risk pool, as defined by
the State, under which health insurance issuers, with
respect to designated individuals who experience higher
than average health costs as determined by the State,
and are enrolled in health insurance coverage offered
in the individual market, cede risk to the pool,
without affecting the premium paid by the designated
individuals or their terms of coverage. With respect to
such pool, the State, or an entity operating the pool
on behalf of the State, shall establish--
``(i) the premium amount the ceding issuer
shall pay to the reinsurance pool;
``(ii) the applicable attachment points or
coinsurance percentages if the ceding issuer
retains any portion of the risk under ceded
policies; and
``(iii) the mechanism by which high-risk
individuals are designated for cession to the
pool, which may include a list of designated
high-cost health conditions.
``(B) A reinsurance program, as defined by the
State, that assumes a portion of the risk for
individuals who experience higher than average health
costs as determined by the State, in a manner
substantially similar to the reinsurance program that
operated in the State in accordance with section 1341.
``(C) A reinsurance program established by the
State not otherwise described in this paragraph.
``(D) A program based on another State's
reinsurance program--
``(i) described in subparagraph (A), (B),
or (C), for which an application has been
approved under this subsection; or
``(ii) which was implemented prior to
September 1, 2019, and which the Secretary
determines meets the requirements of
subparagraph (A).
``(3) Expedited approval.--
``(A) In general.--The Secretary shall provide an
expedited approval process for an application under
subsection (a)(1)--
``(i) with respect to an invisible high-
risk pool or reinsurance program described in
subparagraph (A), (B), or (D) of paragraph (2);
or
``(ii) that uses a template form designed
by the Administrator of the Centers for
Medicare & Medicaid Services, in consultation
with the Secretary of the Treasury, for an
application based on a program that is the same
or substantially the same as a program
implemented in accordance with an application
previously approved under this subsection.
``(B) Timeframe.--The Secretary shall make a
determination on an application eligible for expedited
review under subparagraph (A) not later than 90 days
after receipt of such application.
``(C) Standard of review.--Nothing in this
paragraph shall be construed as affecting the
requirements under subsection (a)(1) with respect to an
application approved in accordance with the process
under subparagraph (A).''.
(2) Application.--Section 1332(a)(1)(B)(i) of the Patient
Protection and Affordable Care Act (42 U.S.C.
18052(a)(1)(B)(i)) is amended by inserting ``, including, as
applicable, a description of the State's plan to use any
amounts awarded to the State under paragraph (4) to support an
invisible high-risk pool or reinsurance program consistent with
subsection (f) and such information about such program as the
Secretary may require'' before the semicolon.
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