[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1002 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  1st Session
                                S. 1002

   To prohibit false or misleading advertising for health insurance 
       coverage, require warnings and reporting with respect to 
 noncomprehensive health plans, encourage enrollment in health plans, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 25, 2021

 Mr. Casey (for himself, Ms. Baldwin, and Ms. Stabenow) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To prohibit false or misleading advertising for health insurance 
       coverage, require warnings and reporting with respect to 
 noncomprehensive health plans, encourage enrollment in health plans, 
                        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 ``Junk Plan 
Accountability and Disclosure Act of 2021''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
  TITLE I--PROHIBITION OF FALSE OR MISLEADING ONLINE ADVERTISING FOR 
                       HEALTH INSURANCE COVERAGE

Sec. 101. Definitions.
Sec. 102. FTC oversight of online health insurance advertisements.
  TITLE II--WARNINGS AND REPORTING REQUIREMENTS FOR NONCOMPREHENSIVE 
                              HEALTH PLANS

Sec. 201. Definitions.
Sec. 202. Requirements for notice regarding benefits.
Sec. 203. Reporting requirements.
Sec. 204. Enforcement.
Sec. 205. Regulations.
           TITLE III--ENCOURAGING ENROLLMENT IN HEALTH PLANS

Sec. 301. Sense of Congress.
Sec. 302. Requiring Marketplace outreach, educational activities, and 
                            annual enrollment targets.
Sec. 303. Report on effects of website maintenance during open 
                            enrollment.
Sec. 304. Promoting consumer outreach and education.
Sec. 305. Improving transparency and accountability in the Marketplace.
Sec. 306. Improving awareness of health coverage options.
Sec. 307. Promoting State innovations to expand coverage.

  TITLE I--PROHIBITION OF FALSE OR MISLEADING ONLINE ADVERTISING FOR 
                       HEALTH INSURANCE COVERAGE

SEC. 101. DEFINITIONS.

    In this title:
            (1) Commission.--The term ``Commission'' means the Federal 
        Trade Commission.
            (2) Health insurance coverage.--The term ``health insurance 
        coverage'' means benefits consisting of medical care (provided 
        directly, through insurance or reimbursement, or otherwise and 
        including items and services paid for as medical care, but 
        excluding any group health plan) that are offered to 
        individuals, including--
                    (A) a plan offered through an association;
                    (B) short-term limited duration insurance;
                    (C) a policy for such benefits that is not offered 
                by a health insurance issuer (as such term is defined 
                in section 2791(b)(2) of the Public Health Service Act 
                (42 U.S.C. 300gg-91(b)(2)); and
                    (D) other health care arrangements that are not 
                health plans.
            (3) Non-ACA compliant health insurance coverage.--The term 
        ``non-ACA compliant health insurance coverage'' has the meaning 
        given such term in paragraph (3) of section 1321(c) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)) 
        (as added by section 302).
            (4) Online platform.--The term ``online platform'' means 
        any public-facing website, web application, or digital 
        application, including a search engine or social network.
            (5) Qualified health plan.--The term ``qualified health 
        plan'' has the meaning given such term in section 1301(a) of 
        the Patient Protection and Affordable Care Act (42 U.S.C. 
        18021(a)).

SEC. 102. FTC OVERSIGHT OF ONLINE HEALTH INSURANCE ADVERTISEMENTS.

    (a) Prohibitions for Online Private Health Insurance 
Advertisement.--
            (1) In general.--Subject to paragraph (3), a person may not 
        post, publish, or otherwise display on the internet a deceptive 
        advertisement for health insurance coverage.
            (2) Deceptive.--An online advertisement for health 
        insurance coverage shall be considered deceptive if it--
                    (A) is likely to mislead, or has the effect of 
                misleading, a reasonable individual to believe that 
                such advertisement is made by, through, or on behalf 
                of--
                            (i) Healthcare.gov;
                            (ii) a State or Federal American Health 
                        Benefit Exchange described in sections 1311 and 
                        1321 of the Patient Protection and Affordable 
                        Care Act (42 U.S.C. 18031, 18041); or
                            (iii) any other Federal, State, or local 
                        government entity;
                    (B) is likely to mislead, or has the effect of 
                misleading, a reasonable individual about--
                            (i) the relative cost of enrolling in non-
                        ACA compliant health insurance coverage as 
                        compared to the cost of enrolling in a 
                        qualified health plan;
                            (ii) the relative actuarial value of non-
                        ACA compliant health insurance coverage as 
                        compared to a qualified health plan; or
                            (iii) the relative scope of benefits of 
                        non-ACA compliant health insurance coverage as 
                        compared to a qualified health plan;
                    (C) is likely to mislead, or has the effect of 
                misleading, a reasonable individual to believe that the 
                health insurance coverage advertised--
                            (i) complies with the requirements for 
                        qualified health plans under the Patient 
                        Protection and Affordable Care Act (Public Law 
                        111-148), although the health insurance 
                        coverage does not meet such requirements; or
                            (ii) provides coverage for benefits that 
                        are not covered by such health insurance 
                        coverage; or
                    (D) is likely to mislead, or has the effect of 
                misleading, a reasonable individual regarding the 
                scope, cost, or duration of coverage of the health 
                insurance coverage being advertised.
            (3) Liability of online platforms.--If a person who is 
        unrelated to the operator of an online platform pays or 
        arranges to post, publish, or otherwise display an 
        advertisement that violates paragraph (1) on the online 
        platform--
                    (A) such person shall be deemed to have committed 
                the violation of such paragraph; and
                    (B) the operator of the online platform shall not 
                be liable for a violation of such paragraph.
    (b) Enforcement by the Commission.--
            (1) Unfair or deceptive acts or practice.--A violation of 
        this section or a regulation promulgated under this section 
        shall be treated as a violation of a rule defining an unfair or 
        deceptive act or practice under section 18(a)(1)(B) of the 
        Federal Trade Commission Act (15 U.S.C. 57a(a)(1)(B)).
            (2) Powers of the federal trade commission.--
                    (A) In general.--Except as provided in subparagraph 
                (C), the Commission shall enforce this section in the 
                same manner, by the same means, and with the same 
                jurisdiction, powers, and duties as though all 
                applicable terms and provisions of the Federal Trade 
                Commission Act (15 U.S.C. 41 et seq.) were incorporated 
                into and made a part of this section.
                    (B) Privileges and immunities.--Any person who 
                violates this section or a regulation promulgated under 
                this section shall be subject to the penalties and 
                entitled to the privileges and immunities provided in 
                the Federal Trade Commission Act (15 U.S.C. 41 et 
                seq.).
                    (C) Nonprofit organizations and insurance.--
                Notwithstanding section 4 or 6 of the Federal Trade 
                Commission Act (15 U.S.C. 44, 46), section 2 of 
                McCarran-Ferguson Act (15 U.S.C. 1012), or any other 
                jurisdictional limitation of the Commission, the 
                Commission shall also enforce this section and the 
                regulations promulgated under this section, in the same 
                manner provided in subparagraphs (A) and (B) of this 
                paragraph, with respect to--
                            (i) organizations not organized to carry on 
                        business for their own profit or that of their 
                        members; and
                            (ii) the business of insurance, and persons 
                        engaged in such business.
                    (D) Continued applicability of state law.--
                            (i) In general.--This section shall only 
                        supersede a State law to the extent that this 
                        section is inconsistent with otherwise 
                        applicable State law.
                            (ii) Clarification.--A State law that 
                        provides additional protections to consumers 
                        than those protections provided in this Act 
                        shall not be considered inconsistent with this 
                        Act for purposes of clause (i).
            (3) Rulemaking.--The Commission shall promulgate in 
        accordance with section 553 of title 5, United States Code, 
        such rules as may be necessary to carry out this Act.
            (4) Authority preserved.--Nothing in this Act shall be 
        construed to limit the authority of the Commission under any 
        other provision of law.
    (c) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study on the effectiveness of the Commission's 
        oversight of online advertisements for health insurance 
        coverage pursuant to this section during the period which 
        begins on the date of enactment of this Act and ends 3 years 
        thereafter. Such study shall include the following:
                    (A) The number of enforcement actions during such 
                period taken by the Commission related to the oversight 
                of online advertisements for health insurance coverage 
                under this section.
                    (B) A description of the outcome of any such 
                enforcement action.
                    (C) A description of any barrier to the 
                Commission's enforcement authority under this section 
                in relation to such advertisements.
                    (D) A description of how the Commission's oversight 
                of online advertisements for health insurance coverage 
                has protected consumers, including through means other 
                than enforcement actions.
            (2) Report.--Not later than 4 years after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report containing the results 
        of the study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Comptroller General determines appropriate.

  TITLE II--WARNINGS AND REPORTING REQUIREMENTS FOR NONCOMPREHENSIVE 
                              HEALTH PLANS

SEC. 201. DEFINITIONS.

    In this title:
            (1) Applicable health plan.--The term ``applicable health 
        plan''--
                    (A) means (except as provided in subparagraph 
                (B))--
                            (i) health insurance coverage in the 
                        individual market providing excepted benefits, 
                        excluding--
                                    (I) automobile liability insurance 
                                described in paragraph (1)(C) of 
                                section 2791(c) of the Public Health 
                                Service Act (42 U.S.C. 300gg-91(c));
                                    (II) automobile medical payment 
                                insurance described in paragraph (1)(E) 
                                of such section;
                                    (III) limited scope dental or 
                                vision benefits described in paragraph 
                                (2)(A) of such section;
                                    (IV) workers' compensation, or 
                                similar insurance, described in 
                                paragraph (1)(D) of such section;
                                    (V) coverage for on-site medical 
                                clinics described in paragraph (1)(G) 
                                of such section; or
                                    (VI) medicare supplemental health 
                                insurance (as defined under section 
                                1882(g)(1) of the Social Security Act) 
                                or coverage supplemental to the 
                                coverage provided under chapter 55 of 
                                title 10, United States Code;
                            (ii) student health insurance coverage, as 
                        defined in section 147.145(a) of title 45, Code 
                        of Federal Regulations (or a successor 
                        regulation);
                            (iii) short-term limited duration 
                        insurance, as defined in section 144.103 of 
                        title 45, Code of Federal Regulations (or a 
                        successor regulation);
                            (iv) any health care arrangement for 
                        benefits or payments for medical care offered 
                        to individuals through an association; and
                            (v) any other health care arrangement for 
                        benefits or payments for medical care (other 
                        than under a Federal health care program) that 
                        is not health insurance coverage, or a group 
                        health plan, for purposes of title XXVII of the 
                        Public Health Service Act (42 U.S.C. 300gg et 
                        seq.), part 7 of subtitle B of title I of the 
                        Employee Retirement Income Security Act of 1974 
                        (29 U.S.C. 1181 et seq.), or chapter 100 of the 
                        Internal Revenue Code of 1986, including such 
                        an arrangement offered by a State farm bureau 
                        or a health care sharing ministry; and
                    (B) does not include--
                            (i) any group health plan;
                            (ii) any grandfathered health plan; and
                            (iii) any health insurance coverage to 
                        which the transitional policy, described in the 
                        letter issued on November 14, 2013, by the 
                        Centers for Medicare & Medicaid Services to 
                        insurance commissioners, or an extension of 
                        such policy, applies.
            (2) Applicable state authority; excepted benefits; 
        exchange.--The terms ``applicable State authority'', ``excepted 
        benefits'', and ``Exchange'' have the meanings given such terms 
        in section 2791 of the Public Health Service Act (42 U.S.C. 
        300gg-91).
            (3) Federal health care program.--The term ``Federal health 
        care program'' has the meaning given such term under section 
        1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)), 
        except that such term includes the health insurance program 
        under chapter 89 of title 5, United States Code.
            (4) Grandfathered health plan.--The term ``grandfathered 
        health plan'' has the meaning given such term in section 
        1251(e) of the Patient Protection and Affordable Care Act (42 
        U.S.C. 18011(e)).
            (5) Group health plan.--The term ``group health plan'' has 
        the meaning given such term in section 2791 of the Public 
        Health Service Act (42 U.S.C. 300gg-91).
            (6) Health care sharing ministry.--The term ``health care 
        sharing ministry'' has the meaning given such term in section 
        5000A(d)(2)(B)(ii) of the Internal Revenue Code of 1986.
            (7) Health insurance coverage; health insurance issuer; 
        individual market.--The terms ``health insurance coverage'', 
        ``health insurance issuer'', and ``individual market'' have the 
        meanings given such terms in section 2791 of the Public Health 
        Service Act.
            (8) Non-ACA compliant health insurance coverage.--The term 
        ``non-ACA compliant health insurance coverage'' has the meaning 
        given such term in paragraph (3) of section 1321(c) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)) 
        (as added by section 302), except that such term shall not 
        include any Federal health care program.
            (9) Plain language.--The term ``plain language'' has the 
        meaning given the term plain writing in section 3 of the Plain 
        Writing Act of 2010 (5 U.S.C. 301 note).
            (10) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 202. REQUIREMENTS FOR NOTICE REGARDING BENEFITS.

    (a) In General.--Each applicable health plan shall offer to 
consumers, prior to enrollment, enrollment material that includes--
            (1) a plain language explanation of the benefits included 
        in such plan, including through forms that are culturally and 
        linguistically appropriate for such consumers; and
            (2) a warning page regarding such benefits in accordance 
        with subsection (b).
    (b) Warning Page.--
            (1) In general.--The warning page required under subsection 
        (a)(2) shall include--
                    (A) a clear statement indicating that the 
                applicable health plan is not a comprehensive health 
                plan because it is not required to comply with certain 
                requirements under the Patient Protection and 
                Affordable Care Act (Public Law 111-148) and title 
                XXVII of the Public Health Service Act (42 U.S.C. 300gg 
                et seq.);
                    (B) a statement encouraging the consumer to review 
                the plan documents carefully to ensure the individual 
                is aware of--
                            (i) any exclusions or limitations regarding 
                        coverage of preexisting conditions or health 
                        benefits (such as hospitalization, emergency 
                        services, maternity care, preventive care, 
                        prescription drugs, and mental health and 
                        substance use disorder services); and
                            (ii) any lifetime or annual dollar limits 
                        on health benefits;
                    (C) a statement notifying the consumer that, if the 
                plan expires or the individual loses eligibility for 
                the plan, the individual may have to wait until the 
                beginning of an open enrollment period to enroll in 
                another plan;
                    (D) a statement notifying the consumer of the 
                option to enroll in a qualified health plan, which is 
                generally a more comprehensive health plan, through the 
                Exchange operating in the State, including--
                            (i) a statement that most consumers who 
                        enroll in a qualified health plan receive help 
                        paying for their monthly premiums;
                            (ii) a statement that special enrollment 
                        periods are available through the Exchange;
                            (iii) a link to Healthcare.gov (or a 
                        successor website) or another website for the 
                        Exchange operating in the State; and
                            (iv) the phone number for the Exchange 
                        operating in the State; and
                    (E) a line for the signature of the consumer to 
                acknowledge that the consumer has read and understands 
                the provisions in the warning page, and for the date on 
                which such signature is provided.
            (2) Accessibility.--
                    (A) In general.--The warning page required under 
                subsection (a)(2) shall be--
                            (i) located at the beginning of the 
                        enrollment material,
                            (ii) accessible to people with 
                        disabilities, including a physical, cognitive, 
                        or sensory disability, including accessibility 
                        to such people through the use of computers and 
                        other technology for receiving consumer 
                        information; and
                            (iii) written in plain language that is 
                        easily understood by individuals with an 
                        intellectual or other cognitive or processing 
                        disability.
                    (B) Multiple languages.--An applicable health plan 
                shall make the warning page required under subsection 
                (a)(2) available in the top 15 languages spoken by 
                individuals with limited English proficiency in the 
                State in which the plan is offered.
                    (C) Restriction on promoting enrollment in non-aca 
                compliant health insurance coverage.--The warning page 
                required under subsection (a)(2) shall not include any 
                provision--
                            (i) promoting enrollment in any non-ACA 
                        compliant health insurance coverage; or
                            (ii) directing consumers to a source that 
                        could enroll the consumer in any non-ACA 
                        compliant health insurance coverage.
            (3) Additional state requirements.--A State may require 
        applicable health plans to include information, in addition to 
        the information required under this section, in the warning 
        page required under subsection (a)(2), except that any such 
        additional information shall not--
                    (A) replace the information required under this 
                section;
                    (B) promote enrollment in any non-ACA compliant 
                health insurance coverage;
                    (C) direct consumers to a source that could enroll 
                the consumer in any non-ACA compliant health insurance 
                coverage; or
                    (D) otherwise conflict with a requirement under 
                this section.
    (c) Records of Signatures.--
            (1) In general.--An administrator of an applicable health 
        plan shall maintain a record of the signature of a consumer 
        obtained under subsection (b)(1)(E) while the consumer is 
        enrolled in the plan and for, at a minimum, 2 years after the 
        consumer is no longer enrolled in such plan. The Secretary may, 
        through regulations under section 205, require an applicable 
        health plan to maintain such record for a period longer than 2 
        years after the consumer is no longer enrolled in the plan.
            (2) Reimbursement.--
                    (A) In general.--In the case that a consumer 
                claims, within the period and in accordance with the 
                procedures described in subparagraph (C), that an 
                applicable health plan did not cover a health benefit 
                while the consumer was enrolled in such plan and the 
                administrator of such plan is not able to provide proof 
                of the record required under paragraph (1) with respect 
                to that consumer, the plan shall reimburse the 
                consumer, in an amount determined under subparagraph 
                (B), for such benefit.
                    (B) Amount.--
                            (i) In general.--Except as provided under 
                        clause (ii), such reimbursement shall be equal 
                        to (the greater of)--
                                    (I) the amount the applicable 
                                second lowest cost silver plan (as 
                                defined in section 36B(b)(3)(B) of the 
                                Internal Revenue Code of 1986), 
                                available in the Exchange operating in 
                                the State in which the consumer resided 
                                at the time of enrollment, would have 
                                paid for the health benefit if the 
                                consumer were enrolled in such plan and 
                                the health benefit was provided in-
                                network; or
                                    (II) if applicable, an amount 
                                determined by the State in which the 
                                consumer resides at the time of 
                                enrollment.
                            (ii) Coverage required by plan documents.--
                        In the case described in subparagraph (A), if 
                        the Secretary or applicable State authority 
                        determines that the applicable health plan was 
                        required to provide coverage of the health 
                        benefit claimed by the consumer based on 
                        statements included in the plan documents, the 
                        applicable health plan shall reimburse the 
                        consumer in an amount determined in accordance 
                        with such plan documents.
                    (C) Claims.--The Secretary shall, through 
                regulations under section 205, establish procedures for 
                the filing of claims under subparagraph (A), including 
                by setting the period during which a claim under such 
                subparagraph shall be filed. Such period shall be not 
                less than 2 years after the consumer is no longer 
                enrolled in the plan.
            (3) Liability under other applicable laws.--The ability of 
        an applicable health plan to produce proof of a record required 
        under paragraph (1) shall not shield the plan, including any 
        administrator, insurance broker, or operator of the plan, from 
        liability under other applicable State or Federal law for any 
        deceptive practice that the plan, including any such 
        administrator, insurance broker, or operator, engaged in while 
        enrolling a consumer in the plan.

SEC. 203. REPORTING REQUIREMENTS.

    (a) In General.--Not later than November 1 of the first calendar 
year following the date of enactment of this Act, and November 1 of 
each year thereafter, an applicable health plan shall submit to the 
Secretary a report containing each of the following (with respect to 
the plan year covered by the reporting period):
            (1) The total enrollment in the applicable health plan.
            (2)(A) A statement of whether the applicable health plan 
        used an insurance broker.
            (B) If such plan used an insurance broker, an indication of 
        the number of consumers who were enrolled in the plan through 
        an insurance broker.
            (3) The total amount of claims submitted for payment to the 
        applicable health plan.
            (4) The total amount of claims denied by the applicable 
        health plan.
            (5) Information on any marketing materials the applicable 
        health plan used to enroll consumers in the plan, including--
                    (A) an indication of whether the plan used any 
                online advertisements; and
                    (B) a copy of any marketing material used, 
                including any online advertisement.
            (6) Any other information regarding enrollment, coverage, 
        or advertising the Secretary determines appropriate through 
        regulations issued under section 205.
    (b) Exemptions.--An applicable health plan shall be exempt from the 
requirement under subsection (a) if--
            (1) the plan is required under the law of each State in 
        which the plan is offered to submit all information required 
        under subsection (a) to the applicable State authority in each 
        such State; and
            (2) the applicable State authority in each such State 
        reviews such information and has a process for addressing any 
        such information that is misleading or incorrect.
    (c) Transmittal to States.--Not later than 2 months after receiving 
a report under subsection (a) from an applicable health plan, the 
Secretary shall transmit the report to the applicable State authority 
of each State in which the plan is offered.
    (d) Public Availability.--
            (1) In general.--The Secretary shall make all information 
        submitted under subsection (a) available to the public through 
        a publicly accessible website.
            (2) Publicizing website.--The Secretary shall publicize the 
        website under paragraph (1), including through agreements with 
        applicable State authorities and national and State 
        organizations representing consumers.

SEC. 204. ENFORCEMENT.

    The Secretary shall have the authority to enforce the requirements 
under section 202 (except the additional State requirements under 
subsection (b)(3) of such section) and section 203 against an 
applicable health plan in the same manner as the Secretary may under 
section 2723(b) (without regard to the limitation under paragraph 
(1)(A) of such section) enforce a requirement under parts A and D of 
title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) 
against a health insurance issuer that violates a provision of such 
part, including through civil money penalties and procedures for 
administrative and judicial review under section 2723(b)(2) of such Act 
(42 U.S.C. 300gg-22(b)(2)).

SEC. 205. REGULATIONS.

    (a) In General.--The Secretary may issue regulations to carry out 
this title, including--
            (1) regulations to establish enforcement procedures 
        authorized under section 204; and
            (2) subject to subsection (b), regulations for establishing 
        requirements for the warning page required under section 
        202(a)(2) that are in addition to the requirements provided 
        under section 202.
    (b) Limitation on Requirements for Warning Page.--A requirement in 
a regulation described in subsection (a)(2) shall not--
            (1) use any language to promote enrollment in any non-ACA 
        compliant health insurance coverage;
            (2) direct consumers to a source that could enroll the 
        consumer in any non-ACA compliant health insurance coverage; or
            (3) otherwise conflict with a requirement under this title.

           TITLE III--ENCOURAGING ENROLLMENT IN HEALTH PLANS

SEC. 301. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) when individuals search for phrases related to health 
        insurance, internet search engines, including Google, Bing, and 
        Yahoo, should display an answer box that directs individuals 
        to--
                    (A) Healthcare.gov and the associated toll free 
                number, 1-800-318-2596, with respect to searches 
                originating in States in which a Federal Exchange is 
                operating; and
                    (B) a link and phone number for the appropriate 
                State-based Exchange, with respect to searches 
                originating in States in which a State Exchange is 
                operating; and
            (2) the answer box related to Healthcare.Gov in response to 
        a search described in paragraph (1) should be placed in 
        ``position zero'', above all other content, including 
        advertisements.

SEC. 302. REQUIRING MARKETPLACE OUTREACH, EDUCATIONAL ACTIVITIES, AND 
              ANNUAL ENROLLMENT TARGETS.

    (a) In General.--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:
            ``(3) Outreach and educational activities.--
                    ``(A) In general.--In the case of an Exchange 
                established or operated by the Secretary within a State 
                pursuant to this subsection, the Secretary shall carry 
                out outreach and educational activities for purposes of 
                informing individuals about qualified health plans 
                offered through the Exchange, including by informing 
                such individuals of the availability of coverage under 
                such plans and financial assistance for coverage under 
                such plans. Such outreach and educational activities 
                shall be provided in a manner that is culturally and 
                linguistically appropriate to the needs of the 
                populations being served by the Exchange (including 
                hard-to-reach populations, such as racial and sexual 
                minorities, limited English proficient populations, 
                individuals in rural areas, veterans, and young adults) 
                and shall be provided to populations residing in high 
                health disparity areas (as defined in subparagraph (E)) 
                served by the Exchange, in addition to other 
                populations served by the Exchange.
                    ``(B) Limitation on use of funds.--No funds 
                appropriated under this paragraph shall be used for 
                expenditures for promoting non-ACA compliant health 
                insurance coverage.
                    ``(C) Non-ACA compliant health insurance 
                coverage.--For purposes of subparagraph (B):
                            ``(i) The term `non-ACA compliant health 
                        insurance coverage' means--
                                    ``(I) health insurance coverage, or 
                                a group health plan, that is not a 
                                qualified health plan; and
                                    ``(II) other health care 
                                arrangements that are not health plans.
                            ``(ii) Such term includes the following:
                                    ``(I) An association health plan.
                                    ``(II) Short-term limited duration 
                                insurance (as defined in section 
                                144.103 of title 45, Code of Federal 
                                Regulations (or a successor 
                                regulation)).
                    ``(D) Funding.--Out of any funds in the Treasury 
                not otherwise appropriated, there are hereby 
                appropriated for fiscal year 2023 and each subsequent 
                fiscal year, $100,000,000 to carry out this paragraph. 
                Funds appropriated under this subparagraph shall remain 
                available until expended.
                    ``(E) High health disparity area defined.--For 
                purposes of subparagraph (A), the term `high health 
                disparity area' means a contiguous geographic area 
                that--
                            ``(i) is located in one census tract or ZIP 
                        code;
                            ``(ii) has measurable and documented 
                        racial, ethnic, or geographic health 
                        disparities;
                            ``(iii) has a low-income population, as 
                        demonstrated by--
                                    ``(I) average income below 138 
                                percent of the Federal poverty line; or
                                    ``(II) a rate of participation in 
                                the special supplemental nutrition 
                                program under section 17 of the Child 
                                Nutrition Act of 1966 (42 U.S.C. 1786) 
                                that is higher than the national 
                                average rate of participation in such 
                                program;
                            ``(iv) has poor health outcomes, as 
                        demonstrated by--
                                    ``(I) lower life expectancy than 
                                the national average; or
                                    ``(II) a higher percentage of 
                                instances of low birth weight than the 
                                national average; and
                            ``(v) is part of a Metropolitan Statistical 
                        Area identified by the Office of Management and 
                        Budget.
            ``(4) Annual enrollment targets.--For plan year 2022 and 
        each subsequent plan year, in the case of an Exchange 
        established or operated by the Secretary within a State 
        pursuant to this subsection, the Secretary shall establish 
        annual enrollment targets for such Exchange for such year.''.
    (b) Grants for State Exchanges.--Section 1311 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031) is amended by 
adding at the end the following:
    ``(l) Open Enrollment Outreach Grants.--
            ``(1) In general.--The Secretary shall award grants to 
        States that have established an Exchange pursuant to this 
        section, for purposes of assisting such States in conducting 
        open enrollment outreach with respect to qualified health 
        plans.
            ``(2) Applications.--A State desiring a grant under this 
        subsection shall submit an application to the Secretary at such 
        time, in such manner, and containing such information as the 
        Secretary may require, including a plan demonstrating how the 
        State will use the grant funds to carry out outreach and 
        educational activities consistent with the requirements under 
        section 1321(c)(3).
            ``(3) Awards.--
                    ``(A) In general.--The Secretary shall award grants 
                under this subsection as follows:
                            ``(i) The Secretary shall award an initial 
                        round of grants to each qualifying State in the 
                        amount of $1,000,000.
                            ``(ii) If amounts remain available under 
                        this subsection after awards are made under 
                        clause (i), the Secretary shall award eligible 
                        States that received an award under clause (i) 
                        an amount determined appropriate by the 
                        Secretary based on--
                                    ``(I) the State's total population;
                                    ``(II) the percentage of the 
                                State's population that is uninsured;
                                    ``(III) the percentage of the 
                                State's population that is difficult to 
                                insure; and
                                    ``(IV) such other factors as the 
                                Secretary determines appropriate.
                    ``(B) Available until expended.--With respect to a 
                State receiving a grant under this subsection, the 
                grant funds shall remain available until expended.
                    ``(C) Matching requirement.--
                            ``(i) In general.--Subject to clause (iii), 
                        as a condition for receiving a grant under this 
                        section, a State shall be required to expend 
                        non-Federal funds, at minimum, in an amount 
                        equal to the lesser of--
                                    ``(I) 25 percent of the amount 
                                received under the grant for the 
                                purpose described in paragraph (1); or
                                    ``(II) $1,000,000.
                            ``(ii) Previous allocations.--A State may 
                        apply funding allocated to the purpose 
                        described in paragraph (1) prior to receipt of 
                        the grant to satisfy the requirement of clause 
                        (i).
                            ``(iii) Waiver.--The Secretary may waive 
                        the requirement under clause (i) in response 
                        to--
                                    ``(I) a public health emergency or 
                                a disaster; or
                                    ``(II) an economic recession or 
                                other economic hardship that results in 
                                an increase in uninsured individuals.
            ``(4) Limitation on use of funds.--No funds appropriated 
        under this subsection shall be used for expenditures for 
        promoting non-ACA compliant health insurance coverage (as such 
        term is defined in section 1321(c)(3)(C)).
            ``(5) Application to medicaid and chip outreach and 
        enrollment grants.--Funds received by a State under a grant 
        awarded under this subsection--
                    ``(A) shall not be taken into consideration by the 
                Secretary when determining whether to award the State a 
                grant under section 2113 of the Social Security Act (42 
                U.S.C. 1397mm); and
                    ``(B) may not be used by the State to satisfy the 
                maintenance of effort requirement under subsection (e) 
                of such section.
            ``(6) Funding.--To carry out this subsection, there are 
        appropriated, out of amounts in the Treasury not otherwise 
        appropriated, $50,000,000 for fiscal year 2023 and each 
        subsequent fiscal year.''.
    (c) Study and Report.--Not later than 30 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
release to Congress all aggregated documents relating to studies and 
data sets that were created on or after January 1, 2014, and related to 
marketing and outreach with respect to qualified health plans offered 
through Exchanges under title I of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18001 et seq.).

SEC. 303. REPORT ON EFFECTS OF WEBSITE MAINTENANCE DURING OPEN 
              ENROLLMENT.

    Not later than 1 year after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit to Congress a 
report examining whether the Department of Health and Human Services 
has been conducting maintenance on the website commonly referred to as 
``HealthCare.gov'' during annual open enrollment periods (as described 
in section 1311(c)(6)(B) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031(c)(6)(B)) in such a manner so as to minimize any 
disruption to the use of such website resulting from such maintenance.

SEC. 304. PROMOTING CONSUMER OUTREACH AND EDUCATION.

    (a) In General.--Section 1311(i) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18031(i)) is amended--
            (1) in paragraph (2), by adding at the end the following 
        new subparagraph:
                    ``(C) Selection of recipients.--In the case of an 
                Exchange established and operated by the Secretary 
                within a State pursuant to section 1321(c), in awarding 
                grants under paragraph (1), the Exchange shall--
                            ``(i) select entities to receive such 
                        grants based on an entity's demonstrated 
                        capacity to carry out each of the duties 
                        specified in paragraph (3);
                            ``(ii) not take into account whether or not 
                        the entity has demonstrated how the entity will 
                        provide information to individuals relating to 
                        group health plans offered by a group or 
                        association of employers described in section 
                        2510.3-5(b) of title 29, Code of Federal 
                        Regulations (or any successor regulation), or 
                        short-term limited duration insurance (as 
                        defined in section 144.103 of title 45, Code of 
                        Federal Regulations (or a successor 
                        regulation)); and
                            ``(iii) ensure that, each year, the 
                        Exchange awards such a grant to--
                                    ``(I) at least one entity described 
                                in this paragraph that is a community 
                                and consumer-focused nonprofit group; 
                                and
                                    ``(II) at least one entity 
                                described in subparagraph (B), which 
                                may include another community and 
                                consumer-focused nonprofit group in 
                                addition to any such group awarded a 
                                grant pursuant to subclause (I).
                In awarding such grants, an Exchange may consider an 
                entity's record with respect to waste, fraud, and abuse 
                for purposes of maintaining the integrity of such 
                Exchange.'';
            (2) in paragraph (3)--
                    (A) by amending subparagraph (C) to read as 
                follows:
                    ``(C) facilitate enrollment, including with respect 
                to individuals with limited English proficiency and 
                individuals with chronic illnesses, in qualified health 
                plans, State Medicaid plans under title XIX of the 
                Social Security Act, and State child health plans under 
                title XXI of such Act;'';
                    (B) in subparagraph (D), by striking ``and'' at the 
                end;
                    (C) in subparagraph (E), by striking the period at 
                the end and inserting ``; and'';
                    (D) by inserting after subparagraph (E) the 
                following new subparagraph:
                    ``(F) provide referrals to community-based 
                organizations that address social needs related to 
                health outcomes.''; and
                    (E) by adding at the end the following flush left 
                sentence:
        ``The duties specified in the preceding sentence may be carried 
        out by such a navigator at any time during a year.'';
            (3) in paragraph (4)(A)--
                    (A) in the matter preceding clause (i), by striking 
                ``not'';
                    (B) in clause (i)--
                            (i) by inserting ``not'' before ``be''; and
                            (ii) by striking ``; or'' and inserting a 
                        semicolon;
                    (C) in clause (ii)--
                            (i) by inserting ``not'' before 
                        ``receive''; and
                            (ii) by striking the period and inserting a 
                        semicolon; and
                    (D) by adding at the end the following:
                            ``(iii) maintain physical presence in the 
                        State of the Exchange so as to allow in-person 
                        assistance to consumers; and
                            ``(iv) receive opioid specific education 
                        and training that ensures the navigator can 
                        best educate individuals on qualified health 
                        plans offered through an Exchange, specifically 
                        coverage under such plans for opioid health 
                        care treatment.''; and
            (4) in paragraph (6)--
                    (A) by striking ``Funding.--Grants under'' and 
                inserting ``Funding.--
                    ``(A) State exchanges.--Grants under''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(B) Federal exchanges.--For purposes of carrying 
                out this subsection, with respect to an Exchange 
                established and operated by the Secretary within a 
                State pursuant to section 1321(c), 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 fiscal 
                year 2022 and each subsequent fiscal year. Such amount 
                for a fiscal year shall remain available until 
                expended.''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2022.

SEC. 305. IMPROVING TRANSPARENCY AND ACCOUNTABILITY IN THE MARKETPLACE.

    (a) Open Enrollment Reports.--For plan year 2022 and each 
subsequent year, the Secretary of Health and Human Services (referred 
to in this section as the ``Secretary''), in coordination with the 
Secretary of the Treasury and the Secretary of Labor, shall issue 
biweekly public reports during the annual open enrollment period on the 
performance of the federally facilitated Exchange operated pursuant to 
section 1321(c) of the Patient Protection and Affordable Care Act (42 
U.S.C. 18041(c)). Each such report shall include a summary, including 
information on a State-by-State basis where available, of--
            (1) the number of unique website visits;
            (2) the number of individuals who create an account;
            (3) the number of calls to the call center;
            (4) the average wait time for callers contacting the call 
        center;
            (5) with respect to applications for enrollment--
                    (A) the number of such applications submitted;
                    (B) the total number of individuals on submitted 
                applications for enrollment;
                    (C) the number of individuals on such submitted 
                applications who are determined eligible for enrollment 
                in a qualified health plan;
                    (D) the number of individuals on such submitted 
                applications who are determined or assessed eligible 
                for the Medicaid program under title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.);
                    (E) the number of individuals on such submitted 
                applications who are determined or assessed eligible 
                for the State Children's Health Insurance Program under 
                title XXI of the Social Security Act (42 U.S.C. 1397aa 
                et seq.);
                    (F) the number of individuals on such submitted 
                applications who are determined eligible for a premium 
                assistance credit under section 36B of the Internal 
                Revenue Code of 1986;
                    (G) The number of individuals on such submitted 
                applications who are determined eligible for cost-
                sharing reduction under section 1402 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18071); 
                and
                    (H) a breakdown of the data described in 
                subparagraphs (A) through (G) by age, sex, race and 
                preferred language, where such information is 
                available;
            (6) the number of individuals who enroll in a qualified 
        health plan; and
            (7) the percentage of individuals who enroll in a qualified 
        health plan through each of--
                    (A) the website;
                    (B) the call center;
                    (C) navigators;
                    (D) agents and brokers;
                    (E) the enrollment assistant program;
                    (F) directly from issuers or web brokers; and
                    (G) other means.
    (b) Open Enrollment After Action Report.--For plan year 2022 and 
each subsequent year, the Secretary, in coordination with the Secretary 
of the Treasury and the Secretary of Labor, shall publish an after 
action report not later than 3 months after the completion of the 
annual open enrollment period regarding the performance of the Exchange 
described in subsection (a) for the applicable plan year. Each such 
report shall include a summary, including information on a State-by-
State basis where available, of--
            (1) the open enrollment data reported under subsection (a) 
        for the entirety of the enrollment period; and
            (2) activities related to patient navigators described in 
        section 1311(i) of the Patient Protection and Affordable Care 
        Act (42 U.S.C. 18031(i)), including--
                    (A) the performance objectives established by the 
                Secretary for such patient navigators;
                    (B) the number of consumers enrolled by such a 
                patient navigator;
                    (C) an assessment of how such patient navigators 
                have met established performance metrics, including a 
                detailed list of all patient navigators, funding 
                received by patient navigators, and whether established 
                performance objectives of patient navigators were met; 
                and
                    (D) with respect to the performance objectives 
                described in subparagraph (A)--
                            (i) whether such objectives assess the full 
                        scope of patient navigator responsibilities, 
                        including general education, plan selection, 
                        and determination of eligibility for tax 
                        credits, cost-sharing reductions, or other 
                        coverage;
                            (ii) how the Secretary worked with patient 
                        navigators to establish such objectives; and
                            (iii) how the Secretary adjusted such 
                        objectives for case complexity and other 
                        contextual factors.
    (c) Report on Advertising and Consumer Outreach.--Not later than 3 
months after the completion of the annual open enrollment period for 
plan year 2022, the Secretary shall issue a report on advertising and 
outreach to consumers for the open enrollment period for plan year 
2022. Such report shall include a description of--
            (1) the division of spending on individual advertising 
        platforms, including television and radio advertisements and 
        digital media, to raise consumer awareness of open enrollment;
            (2) the division of spending on individual outreach 
        platforms, including email and text messages, to raise consumer 
        awareness of open enrollment; and
            (3) whether the Secretary conducted targeted outreach to 
        specific demographic groups and geographic areas.
    (d) Promoting Transparency and Accountability in the 
Administration's Expenditures of Exchange User Fees.--For plan year 
2022 and each subsequent plan year, not later than the date that is 3 
months after the end of such plan 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 expenditures 
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.

SEC. 306. IMPROVING AWARENESS OF HEALTH COVERAGE OPTIONS.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Secretary of Labor, in consultation with the 
Secretary of Health and Human Services, shall update, and make publicly 
available in a prominent location on the website of the Department of 
Labor, the model Consolidated Omnibus Budget Reconciliation Act of 1985 
(referred to in this section as ``COBRA'') continuation coverage 
general notice and the model COBRA continuation coverage election 
notice developed by the Secretary of Labor for purposes of facilitating 
compliance of group health plans with the notification requirements 
under section 606 of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1166). In updating each such notice, the Secretary of 
Labor shall include information regarding any Exchange established 
under title I of the Patient Protection and Affordable Care Act (42 
U.S.C. 18001 et seq.) through which a qualified beneficiary may be 
eligible to enroll in a qualified health plan, including--
            (1) the publicly accessible Internet website address for 
        such Exchange;
            (2) the publicly accessible Internet website address for 
        the Find Local Help directory maintained by the Department of 
        Health and Human Services on the healthcare.gov Internet 
        website (or a successor website);
            (3) a clear explanation that--
                    (A) an individual who is eligible for continuation 
                coverage may also be eligible to enroll, with financial 
                assistance, in a qualified health plan offered through 
                such Exchange, but, in the case that such individual 
                elects to enroll in such continuation coverage and 
                subsequently elects to terminate such continuation 
                coverage before the period of such continuation 
                coverage expires, such individual will not be eligible 
                to enroll in a qualified health plan offered through 
                such Exchange during a special enrollment period; and
                    (B) an individual who elects to enroll in 
                continuation coverage will remain eligible to enroll in 
                a qualified health plan offered through such Exchange 
                during an open enrollment period and may be eligible 
                for financial assistance with respect to enrolling in 
                such a qualified health plan;
            (4) information on consumer protections with respect to 
        enrolling in a qualified health plan offered through such 
        Exchange, including the requirement for such a qualified health 
        plan to provide coverage for essential health benefits (as 
        defined in section 1302(b) of such Act (42 U.S.C. 18022(b)) and 
        the requirements applicable to such a qualified health plan 
        under parts A and D of title XXVII of the Public Health Service 
        Act (42 U.S.C. 300gg et seq.); and
            (5) information on the availability of financial assistance 
        with respect to enrolling in a qualified health plan, including 
        the maximum income limit for eligibility for a premium tax 
        credit under section 36B of the Internal Revenue Code of 1986.
    (b) Name of Notices.--In addition to updating the model COBRA 
continuation coverage general notice and the model COBRA continuation 
coverage election notice under paragraph (1), the Secretary of Labor 
shall rename each such notice as the ``model COBRA continuation 
coverage and Affordable Care Act coverage general notice'' and the 
``model COBRA continuation coverage and Affordable Care Act coverage 
election notice'', respectively.
    (c) Consumer Testing.--Prior to making publicly available the model 
COBRA continuation coverage general notice and the model COBRA 
continuation coverage election notice updated under paragraph (1), the 
Secretary of Labor shall provide an opportunity for consumer testing of 
each such notice, as so updated, to ensure that each such notice is 
clear and understandable to the average participant or beneficiary of a 
group health plan.
    (d) Definitions.--In this subsection:
            (1) Continuation coverage.--The term ``continuation 
        coverage'', with respect to a group health plan, has the 
        meaning given such term in section 602 of the Employee 
        Retirement Income Security Act of 1974 (29 U.S.C. 1162).
            (2) Group health plan.--The term ``group health plan'' has 
        the meaning given such term in section 607 of such Act (29 
        U.S.C. 1167).
            (3) Qualified beneficiary.--The term ``qualified 
        beneficiary'' has the meaning given such term in such section 
        607.
            (4) Qualified health plan.--The term ``qualified health 
        plan'' has the meaning given such term in section 1301 of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18021).

SEC. 307. PROMOTING 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 (42 U.S.C. 18001 et seq.) 
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) 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 2022 through 
2024. Such amount shall remain available until expended.
                                 <all>