[Congressional Record Volume 163, Number 125 (Tuesday, July 25, 2017)]
[Senate]
[Pages S4220-S4221]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 276. Mr. KAINE (for himself, Mr. Carper, Mr. Coons, Mrs. Shaheen,
Mr. Cardin, Ms. Hassan, Ms. Klobuchar, Ms. Stabenow, Mr. Warner, Ms.
Heitkamp, and Mr. Nelson) submitted an amendment intended to be
proposed by him to the bill H.R. 1628, to provide for reconciliation
pursuant to title II of the concurrent resolution on the budget for
fiscal year 2017; which was ordered to lie on the table; as follows:
In lieu of the matter proposed to be inserted, insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Individual Health Insurance
Marketplace Improvement Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Before the passage of the Patient Protection and
Affordable Care Act (Public Law 114-148) in 2010, Americans
with pre-existing conditions faced unfair barriers to
accessing health insurance coverage and health care costs had
risen rapidly for decades.
(2) Since 2010, the rate of uninsured Americans has
declined to a historic low, with more than 20,000,000
Americans gaining access to health insurance coverage.
(3) Since 2010, America has experienced the slowest growth
in the price of health care in over five decades.
(4) Thanks to the Patient Protection and Affordable Care
Act (Public Law 114-148), Americans can no longer be denied
insurance or charged more on the basis of their health
status, more Americans than ever have insurance, and the
health care they receive is continually improving.
(5) Starting in 2016, independent, non-partisan
organizations, including the Congressional Budget Office,
have determined that the individual health insurance markets
have stabilized and improved.
(6) The cost-sharing reduction payments in the Patient
Protection and Affordable Care Act provide stability in the
individual health insurance market, lower insurance premiums
by nearly 20 percent, and encourage competition among health
insurers. The payments reduce costs for approximately
6,000,000 people with incomes below 250 percent of the
poverty line by an average of about $1,100 per person and
should be increased to help more Americans.
(7) Risk mitigation programs, such as the reinsurance
program for the Medicare Part D prescription drug benefit
program, have provided additional stability to the health
insurance markets, restrained premium growth, and lowered
taxpayer costs by helping health insurers predict and bear
risk associated with managing health care costs for a
population.
(8) From 2014 to 2016, the temporary reinsurance program
established under the Affordable Care Act helped to stabilize
the new insurance marketplaces and reduced insurance premiums
in the individual health insurance market by as much as 10
percent.
(9) Throughout his Presidential campaign, the President of
the United States repeatedly promised the American people
that his health care plan will result in reduced rates of
uninsured, lower costs, and higher quality care, stating on
January 14, 2017, that ``We're going to have insurance for
everybody. There was a philosophy in some circles that if you
can't pay for it, you don't get it. That's not going to
happen with us''; and on January 25, 2017, that ``I can
assure you, we are going to have a better plan, much better
health care, much better service treatment, a plan where you
can have access to the doctor that you want and the plan that
you want. We're
[[Page S4221]]
gonna have a much better health care plan at much less
money''.
(10) The goal of any health care legislation should be to
build on the Affordable Care Act to continue expanding
coverage and make health care more affordable for Americans.
Improving affordability and expanding coverage will also
broaden the individual market risk pool, contributing to
lower premiums and strengthening market stability.
SEC. 3. SENSE OF THE SENATE.
It is the sense of the Senate that, with the reinsurance
program under section 4 bringing additional stability to the
individual marketplace for the 2018 plan year, the Senate
should work in a bipartisan manner to find solutions to
improve the health care system.
SEC. 4. INDIVIDUAL MARKET REINSURANCE FUND.
(a) Establishment of Fund.--
(1) In general.--There is established the ``Individual
Market Reinsurance Fund'' to be administered by the Secretary
to provide funding for an individual market stabilization
reinsurance program in each State that complies with the
requirements of this section.
(2) Funding.--There is appropriated to the Fund, out of any
moneys in the Treasury not otherwise appropriated, such sums
as are necessary to carry out this section (other than
subsection (c)) for each calendar year beginning with 2018.
Amounts appropriated to the Fund shall remain available
without fiscal or calendar year limitation to carry out this
section.
(b) Individual Market Reinsurance Program.--
(1) Use of funds.--The Secretary shall use amounts in the
Fund to establish a reinsurance program under which the
Secretary shall make reinsurance payments to health insurance
issuers with respect to high-cost individuals enrolled in
qualified health plans offered by such issuers that are not
grandfathered health plans or transitional health plans for
any plan year beginning with the 2018 plan year. This
subsection constitutes budget authority in advance of
appropriations Acts and represents the obligation of the
Secretary to provide payments from the Fund in accordance
with this subsection.
(2) Amount of payment.--The payment made to a health
insurance issuer under subsection (a) with respect to each
high-cost individual enrolled in a qualified health plan
issued by the issuer that is not a grandfathered health plan
or a transitional health plan shall equal 80 percent of the
lesser of--
(A) the amount (if any) by which the individual's claims
incurred during the plan year exceeds--
(i) in the case of the 2018, 2019, or 2020 plan year,
$50,000; and
(ii) in the case of any other plan year, $100,000; or
(B) for plan years described in--
(i) subparagraph (A)(i), $450,000; and
(ii) subparagraph (A)(ii), $400,000.
(3) Indexing.--In the case of plan years beginning after
2018, the dollar amounts that appear in subparagraphs (A) and
(B) of paragraph (2) shall each be increased by an amount
equal to--
(A) such amount; multiplied by
(B) the premium adjustment percentage specified under
section 1302(c)(4) of the Affordable Care Act, but determined
by substituting ``2018'' for ``2013''.
(4) Payment methods.--
(A) In general.--Payments under this subsection shall be
based on such a method as the Secretary determines. The
Secretary may establish a payment method by which interim
payments of amounts under this subsection are made during a
plan year based on the Secretary's best estimate of amounts
that will be payable after obtaining all of the information.
(B) Requirement for provision of information.--
(i) Requirement.--Payments under this subsection to a
health insurance issuer are conditioned upon the furnishing
to the Secretary, in a form and manner specified by the
Secretary, of such information as may be required to carry
out this subsection.
(ii) Restriction on use of information.--Information
disclosed or obtained pursuant to clause (i) is subject to
the HIPAA privacy and security law, as defined in section
3009(a) of the Public Health Service Act (42 U.S.C. 300jj-
19(a)).
(5) Secretary flexibility for budget neutral revisions to
reinsurance payment specifications.--If the Secretary
determines appropriate, the Secretary may substitute higher
dollar amounts for the dollar amounts specified under
subparagraphs (A) and (B) of paragraph (2) (and adjusted
under paragraph (3), if applicable) if the Secretary
certifies that such substitutions, considered together,
neither increase nor decease the total projected payments
under this subsection.
(c) Outreach and Enrollment.--
(1) In general.--During the period that begins on January
1, 2018, and ends on December 31, 2020, the Secretary shall
award grants to eligible entities for the following purposes:
(A) Outreach and enrollment.--To carry out outreach, public
education activities, and enrollment activities to raise
awareness of the availability of, and encourage enrollment
in, qualified health plans.
(B) Assisting individuals transition to qualified health
plans.--To provide assistance to individuals who are enrolled
in health insurance coverage that is not a qualified health
plan enroll in a qualified health plan.
(C) Assisting enrollment in public health programs.--To
facilitate the enrollment of eligible individuals in the
Medicare program or in a State Medicaid program, as
appropriate.
(D) Raising awareness of premium assistance and cost-
sharing reductions.--To distribute fair and impartial
information concerning enrollment in qualified health plans
and the availability of premium assistance tax credits under
section 36B of the Internal Revenue Code of 1986 and cost-
sharing reductions under section 1402 of the Patient
Protection and Affordable Care Act, and to assist eligible
individuals in applying for such tax credits and cost-sharing
reductions.
(2) Eligible entities defined.--
(A) In general.--In this subsection, the term ``eligible
entity'' means--
(i) a State; or
(ii) a nonprofit community-based organization.
(B) Enrollment agents.--Such term includes a licensed
independent insurance agent or broker that has an arrangement
with a State or nonprofit community-based organization to
enroll eligible individuals in qualified health plans.
(C) Exclusions.--Such term does not include an entity
that--
(i) is a health insurance issuer; or
(ii) receives any consideration, either directly or
indirectly, from any health insurance issuer in connection
with the enrollment of any qualified individuals or employees
of a qualified employer in a qualified health plan.
(3) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to awarding grants to
States or eligible entities in States that have geographic
rating areas at risk of having no qualified health plans in
the individual market.
(4) Funding.--Out of any moneys in the Treasury not
otherwise appropriated, $500,000,000 is appropriated to the
Secretary for each of calendar years 2018 through 2020, to
carry out this subsection.
(d) Reports to Congress.--
(1) Annual report.--The Secretary shall submit a report to
Congress, not later than January 21, 2019, and each year
thereafter, that contains the following information for the
most recently ended year:
(A) The number and types of plans in each State's
individual market, specifying the number that are qualified
health plans, grandfathered health plans, or health insurance
coverage that is not a qualified health plan.
(B) The impact of the reinsurance payments provided under
this section on the availability of coverage, cost of
coverage, and coverage options in each State.
(C) The amount of premiums paid by individuals in each
State by age, family size, geographic area in the State's
individual market, and category of health plan (as described
in subparagraph (A)).
(D) The process used to award funds for outreach and
enrollment activities awarded to eligible entities under
subsection (c), the amount of such funds awarded, and the
activities carried out with such funds.
(E) Such other information as the Secretary deems relevant.
(2) Evaluation report.--Not later than January 31, 2022,
the Secretary shall submit to Congress a report that--
(A) analyzes the impact of the funds provided under this
section on premiums and enrollment in the individual market
in all States; and
(B) contains a State-by-State comparison of the design of
the programs carried out by States with funds provided under
this section.
(e) Definitions.--In this section:
(1) Secretary.--The term ``Secretary'' means the Secretary
of the Department of Health and Human Services.
(2) Fund.--The term ``Fund'' means the Individual Market
Reinsurance Fund established under subsection (a).
(3) Grandfathered health plan.--The term ``grandfathered
health plan'' has the meaning given that term in section
1251(e) of the Patient Protection and Affordable Care Act.
(4) High-cost individual.--The term ``high-cost
individual'' means an individual enrolled in a qualified
health plan (other than a grandfathered health plan or a
transitional health plan) who incurs claims in excess of
$50,000 during a plan year.
(5) State.--The term ``State'' means each of the 50 States
and the District of Columbia.
(6) Transitional health plan.--The term ``transitional
health plan'' means a plan continued under the letter issued
by the Centers for Medicare & Medicaid Services on November
14, 2013, to the State Insurance Commissioners outlining a
transitional policy for coverage in the individual and small
group markets to which section 1251 of the Patient Protection
and Affordable Care Act does not apply, and under the
extension of the transitional policy for such coverage set
forth in the Insurance Standards Bulletin Series guidance
issued by the Centers for Medicare & Medicaid Services on
March 5, 2014, February 29, 2016, and February 13, 2017.
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