[Congressional Record Volume 163, Number 127 (Thursday, July 27, 2017)]
[Senate]
[Page S4471]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 476. Mr. SULLIVAN (for himself, Mr. Hoeven, Ms. Murkowski, and Mr. 
Rounds) submitted an amendment intended to be proposed to amendment SA 
267 proposed by Mr. McConnell 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:

       On page 18, strike lines 7 through 26 and insert the 
     following:

     SEC. 204. FUNDING FOR COST-SHARING PAYMENTS.

       There is appropriated to the Secretary of Health and Human 
     Services, out of any money in the Treasury not otherwise 
     appropriated, such sums as may be necessary for payments for 
     cost-sharing reductions authorized by the Patient Protection 
     and Affordable Care Act (including adjustments to any prior 
     obligations for such payments) for the period beginning on 
     the date of enactment of this Act and (except for payments 
     authorized by section 1402 of such Act, as amended by section 
     209) ending on December 31, 2019. Notwithstanding any other 
     provision of this Act, payments and other actions for 
     adjustments to any obligations incurred for plan years 2018 
     and 2019 may be made through December 31, 2020.

     SEC. 205. REPEAL OF COST-SHARING SUBSIDY PROGRAM.

       (a) In General.--The Patient Protection and Affordable Care 
     Act is amended by striking section 1402.
       (b) Preservation of Cost-sharing for Indians.--The Patient 
     Protection and Affordable Care Act, as amended by subsection 
     (a), is amended by inserting after section 1401 the 
     following:

     ``SEC. 1402. REDUCED COST-SHARING FOR CERTAIN INDIVIDUALS.

       ``(a) In General.--In the case of an eligible insured 
     enrolled in a qualified health plan in the individual market 
     through an Exchange--
       ``(1) the Secretary shall notify the issuer of the plan of 
     such eligibility; and
       ``(2) the issuer shall reduce the cost-sharing under the 
     plan at the level and in the manner specified in subsection 
     (c).
       ``(b) Eligible Insured.--For purposes of this section, the 
     term `eligible insured' means an Indian (as defined in 
     section 4(d) of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 450b(d))) whose household income is 
     not more than 300 percent of the poverty line for a family of 
     the size involved.
       ``(c) Reduction of Cost-sharing.--
       ``(1) In general.--The issuer of the plan described in 
     subsection (a) in which an eligible insured is enrolled shall 
     eliminate any cost-sharing under the plan.
       ``(2) Items or services furnished through indian health 
     providers.--If an Indian (as so defined) enrolled in a 
     qualified health plan is furnished an item or service 
     directly by the Indian Health Service, an Indian Tribe, 
     Tribal Organization, or Urban Indian Organization or through 
     referral under contract health services--
       ``(A) no cost-sharing under the plan shall be imposed under 
     the plan for such item or service; and
       ``(B) the issuer of the plan shall not reduce the payment 
     to any such entity for such item or service by the amount of 
     any cost-sharing that would be due from the Indian but for 
     subparagraph (A).
       ``(d) Payment.--The Secretary shall pay to the issuer of a 
     qualified health plan the amount necessary to reflect the 
     increase in actuarial value of the plan required by reason of 
     this section.
       ``(e) Definitions and Special Rules.--In this section:
       ``(1) In general.--Any term used in this section which is 
     also used in section 36B of the Internal Revenue Code of 1986 
     shall have the meaning given such term by such section.
       ``(2) Limitations on reduction.--No cost-sharing reduction 
     shall be allowed under this section with respect to coverage 
     for any month unless the month is a coverage month with 
     respect to which a credit is allowed to the insured (or an 
     applicable taxpayer on behalf of the insured) under section 
     36B of such Code.
       ``(3) Data used for eligibility.--Any determination under 
     this section shall be made on the basis of the taxable year 
     for which the advance determination is made under section 
     1412 and not the taxable year for which the credit under 
     section 36B of such Code is allowed.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to cost-sharing reductions (and payments to 
     issuers for such reductions) for plan years beginning after 
     December 31, 2019.
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