[Congressional Record Volume 168, Number 133 (Saturday, August 6, 2022)]
[Senate]
[Pages S4250-S4252]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 5262. Mr. WARNOCK (for himself, Ms. Baldwin, and Mr. Ossoff) 
submitted an amendment intended to be proposed by him to the bill H.R. 
5376, to provide for reconciliation pursuant to title II of S. Con. 
Res. 14; as follows:

        At the appropriate place, insert the following:

           Subtitle __--Addressing the Medicaid Coverage Gap

     SEC. ___. ENSURING AFFORDABILITY OF COVERAGE FOR CERTAIN LOW-
                   INCOME POPULATIONS.

       (a) Reducing Cost Sharing Under Qualified Health Plans.--
     Section 1402 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18071) is amended--
       (1) in subsection (b)--
       (A) in paragraph (2), by inserting ``(or, with respect to 
     plan years 2024 and 2025, whose household income does not 
     exceed 400 percent of the poverty line for a family of the 
     size involved)'' before the period; and
       (B) in the matter following paragraph (2), by adding at the 
     end the following new sentence: ``In the case of an 
     individual who is determined at any point to have a household 
     income for 2022 or 2023 that does not exceed 138 percent of 
     the poverty line for a family of the size involved, such 
     individual shall, for each month during the year for which 
     such determination is made, be treated as having a household 
     income equal to 100 percent of the poverty line for purposes 
     of applying this section.''; and
       (2) in subsection (c)--
       (A) in paragraph (1)(A), in the matter preceding clause 
     (i), by inserting ``, with respect to eligible insureds 
     (other than, with respect to plan years 2024 and 2025, 
     specified enrollees (as defined in paragraph (6)(C))),'' 
     after ``first be achieved'';
       (B) in paragraph (2), in the matter preceding subparagraph 
     (A), by inserting ``with respect to eligible insureds (other 
     than, with respect to plan years 2024 and 2025, specified 
     enrollees)'' after ``under the plan'';
       (C) in paragraph (3)--
       (i) in subparagraph (A), by striking ``this subsection'' 
     and inserting ``paragraph (1) or (2)''; and
       (ii) in subparagraph (B), by striking ``this section'' and 
     inserting ``paragraphs (1) and (2)''; and
       (D) by adding at the end the following new paragraph:
       ``(6) Special rule for specified enrollees.--
       ``(A) In general.--The Secretary shall establish procedures 
     under which the issuer of a qualified health plan to which 
     this section applies shall reduce cost-sharing under the plan 
     with respect to months occurring during plan years 2024 and 
     2025 for enrollees who are specified enrollees (as defined in 
     subparagraph (C)) in a manner sufficient to increase the 
     plan's share of the total allowed costs of

[[Page S4251]]

     benefits provided under the plan to 99 percent of such costs.
       ``(B) Methods for reducing cost sharing.--
       ``(i) In general.--An issuer of a qualified health plan 
     making reductions under this paragraph shall notify the 
     Secretary of such reductions and the Secretary shall, out of 
     funds made available under clause (ii), make periodic and 
     timely payments to the issuer equal to 12 percent of the 
     total allowed costs of benefits provided under each such plan 
     to specified enrollees during plan years 2024 and 2025.
       ``(ii) Appropriation.--In addition to amounts otherwise 
     available, there are appropriated, out of any money in the 
     Treasury not otherwise appropriated, such sums as may be 
     necessary to the Secretary to make payments under clause (i).
       ``(C) Specified enrollee defined.--For purposes of this 
     section, the term `specified enrollee' means, with respect to 
     a plan year, an eligible insured who is determined at any 
     point to have a household income for such plan year that does 
     not exceed 138 percent of the poverty line for a family of 
     the size involved. Such insured shall be deemed to be a 
     specified enrollee for each month in such plan year.''.
       (b) Open Enrollments Applicable to Certain Lower-income 
     Populations.--Section 1311(c) of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18031(c)) is amended--
       (1) in paragraph (6)--
       (A) in subparagraph (C), by striking at the end ``and'';
       (B) in subparagraph (D), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(E) with respect to a qualified health plan with respect 
     to which section 1402 applies, for months occurring during 
     the period beginning on January 1, 2023, and ending on 
     December 31, 2025, enrollment periods described in 
     subparagraph (A) of paragraph (8) for individuals described 
     in subparagraph (B) of such paragraph.''; and
       (2) by adding at the end the following new paragraph:
       ``(8) Special enrollment period for certain low-income 
     populations.--
       ``(A) In general.--The enrollment period described in this 
     paragraph is, in the case of an individual described in 
     subparagraph (B), the continuous period beginning on the 
     first day that such individual is so described.
       ``(B) Individual described.--For purposes of subparagraph 
     (A), an individual described in this subparagraph is an 
     individual--
       ``(i) with a household income that does not exceed 138 
     percent of the poverty line for a family of the size 
     involved; and
       ``(ii) who is not eligible for minimum essential coverage 
     (as defined in section 5000A(f) of the Internal Revenue Code 
     of 1986), other than for coverage described in any of 
     subparagraphs (B) through (E) of paragraph (1) of such 
     section.''.
       (c) Additional Benefits for Certain Low-income Individuals 
     for Plan Year 2025.--Section 1301(a) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18021(a)) is 
     amended--
       (1) in paragraph (1)--
       (A) in subparagraph (B), by striking ``and'' at the end;
       (B) in subparagraph (C)(iv), by striking the period and 
     inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(D) provides, with respect to a plan offered in the 
     silver level of coverage to which section 1402 applies during 
     plan year 2025, for benefits described in paragraph (5) in 
     the case of an individual who has a household income that 
     does not exceed 138 percent of the poverty line for a family 
     of the size involved, and who is eligible to receive cost-
     sharing reductions under section 1402.''; and
       (2) by adding at the end the following new paragraph:
       ``(5) Additional benefits for certain low-income 
     individuals for plan year 2025.--
       ``(A) In general.--
       ``(i) Benefits.--For purposes of paragraph (1)(D), the 
     benefits described in this paragraph to be provided by a 
     qualified health plan are benefits consisting of--

       ``(I) non-emergency medical transportation services (as 
     described in section 1902(a)(4) of the Social Security Act) 
     for which Federal payments would have been available under 
     title XIX of the Social Security Act had such services been 
     furnished to an individual enrolled under a State plan (or 
     waiver of such plan) under such title; and
       ``(II) services described in subsection (a)(4)(C) of 
     section 1905 of such Act for which Federal payments would 
     have been so available;

     which are not otherwise provided under such plan as part of 
     the essential health benefits package described in section 
     1302(a).
       ``(ii) Condition on provision of benefits.--Benefits 
     described in this paragraph shall be provided--

       ``(I) without any restriction on the choice of a qualified 
     provider from whom an individual may receive such benefits; 
     and
       ``(II) without any imposition of cost sharing.

       ``(B) Payments for additional benefits.--
       ``(i) In general.--An issuer of a qualified health plan 
     making payments for services described in subparagraph (A) 
     furnished to individuals described in paragraph (1)(D) during 
     plan year 2025 shall notify the Secretary of such payments 
     and the Secretary shall, out of funds made available under 
     clause (ii), make periodic and timely payments to the issuer 
     equal to payments for such services so furnished.
       ``(ii) Appropriation.--In addition to amounts otherwise 
     available, there is appropriated, out of any money in the 
     Treasury not otherwise appropriated, such sums as may be 
     necessary to the Secretary to make payments under clause 
     (i).''.
       (d) Education and Outreach Activities.--
       (1) 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 new paragraph:
       ``(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 
     described in section 1902(a)(10)(A)(i)(VIII) of the Social 
     Security Act who reside in States that have not expended 
     amounts under a State plan (or waiver of such plan) under 
     title XIX of such Act for all such 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 residing 
     in areas where the unemployment rates exceeds the national 
     average unemployment rate, individuals in rural areas, 
     veterans, and young adults).
       ``(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 health insurance coverage, or a group health 
     plan, that is not a qualified health plan.
       ``(ii) Such term includes the following:

       ``(I) An association health plan.
       ``(II) Short-term limited duration insurance.

       ``(D) Funding.--In addition to amounts otherwise available, 
     there is appropriated, out of any money in the Treasury not 
     otherwise appropriated, to remain available until expended, 
     $105,000,000 for fiscal year 2022 to carry out this 
     paragraph, of which--
       ``(i) $15,000,000 shall be used to carry out this paragraph 
     in fiscal year 2022; and
       ``(ii) $30,000,000 shall be used to carry out this 
     paragraph for each of fiscal years 2023 through 2025.''.
       (2) Navigator program.--Section 1311(i)(6) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18031(i)(6)) is 
     amended--
       (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 not less than 
     $10,000,000 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 not less 
     than $20,000,000 for each of fiscal years 2023, 2024, and 
     2025. Such amount so obligated for a fiscal year shall remain 
     available until expended.''.
       (e) Funding.--In addition to amounts otherwise available, 
     there is appropriated to the Secretary of Health and Human 
     Services for fiscal year 2022, out of any money in the 
     Treasury not otherwise appropriated, $65,000,000, to remain 
     available until expended, for purposes of carrying out the 
     provisions of, and the amendments made by, this section.

     SEC. ___. TEMPORARY EXPANSION OF HEALTH INSURANCE PREMIUM TAX 
                   CREDITS FOR CERTAIN LOW-INCOME POPULATIONS.

       (a) In General.--Section 36B is amended by redesignating 
     subsection (h) as subsection (i) and by inserting after 
     subsection (g) the following new subsection:
       ``(h) Certain Temporary Rules Beginning in 2022.--With 
     respect to any taxable year beginning after December 31, 
     2021, and before January 1, 2026--
       ``(1) Eligibility for credit not limited based on income.--
     Section 36B(c)(1)(A) shall be disregarded in determining 
     whether a taxpayer is an applicable taxpayer.
       ``(2) Credit allowed to certain low-income employees 
     offered employer-provided coverage.--Subclause (II) of 
     subsection (c)(2)(C)(i) shall not apply if the taxpayer's 
     household income does not exceed 138 percent of the poverty 
     line for a family of the size involved. Subclause (II) of 
     subsection (c)(2)(C)(i) shall also not apply to an individual 
     described in the last sentence of such subsection if the 
     taxpayer's household income does not exceed 138 percent of 
     the poverty line for a family of the size involved.
       ``(3) Credit allowed to certain low-income employees 
     offered qualified small

[[Page S4252]]

     employer health reimbursement arrangements.--A qualified 
     small employer health reimbursement arrangement shall not be 
     treated as constituting affordable coverage for an employee 
     (or any spouse or dependent of such employee) for any months 
     of a taxable year if the employee's household income for such 
     taxable year does not exceed 138 percent of the poverty line 
     for a family of the size involved.
       ``(4) Limitations on recapture.--
       ``(A) In general.--In the case of a taxpayer whose 
     household income is less than 200 percent of the poverty line 
     for the size of the family involved for the taxable year, the 
     amount of the increase under subsection (f)(2)(A) shall in no 
     event exceed $300 (one-half of such amount in the case of a 
     taxpayer whose tax is determined under section 1(c) for the 
     taxable year).
       ``(B) Limitation on increase for certain non-filers.--In 
     the case of any taxpayer who would not be required to file a 
     return of tax for the taxable year but for any requirement to 
     reconcile advance credit payments under subsection (f), if an 
     Exchange established under title I of the Patient Protection 
     and Affordable Care Act has determined that--
       ``(i) such taxpayer is eligible for advance payments under 
     section 1412 of such Act for any portion of such taxable 
     year, and
       ``(ii) such taxpayer's household income for such taxable 
     year is projected to not exceed 138 percent of the poverty 
     line for a family of the size involved,
     subsection (f)(2)(A) shall not apply to such taxpayer for 
     such taxable year and such taxpayer shall not be required to 
     file such return of tax.
       ``(C) Information provided by exchange.--The information 
     required to be provided by an Exchange to the Secretary and 
     to the taxpayer under subsection (f)(3) shall include such 
     information as is necessary to determine whether such 
     Exchange has made the determinations described in clauses (i) 
     and (ii) of subparagraph (B) with respect to such 
     taxpayer.''.
       (b) Employer Shared Responsibility Provision Not Applicable 
     With Respect to Certain Low-income Taxpayers Receiving 
     Premium Assistance.--Section 4980H(c)(3) is amended to read 
     as follows:
       ``(3) Applicable premium tax credit and cost-sharing 
     reduction.--
       ``(A) In general.--The term `applicable premium tax credit 
     and cost-sharing reduction' means--
       ``(i) any premium tax credit allowed under section 36B,
       ``(ii) any cost-sharing reduction under section 1402 of the 
     Patient Protection and Affordable Care Act, and
       ``(iii) any advance payment of such credit or reduction 
     under section 1412 of such Act.
       ``(B) Exception with respect to certain low-income 
     taxpayers.--Such term shall not include any premium tax 
     credit, cost-sharing reduction, or advance payment otherwise 
     described in subparagraph (A) if such credit, reduction, or 
     payment is allowed or paid for a taxable year of an employee 
     (beginning after December 31, 2021, and before January 1, 
     2026) with respect to which--
       ``(i) an Exchange established under title I of the Patient 
     Protection and Affordable Care Act has determined that such 
     employee's household income for such taxable year is 
     projected to not exceed 138 percent of the poverty line for a 
     family of the size involved, or
       ``(ii) such employee's household income for such taxable 
     year does not exceed 138 percent of the poverty line for a 
     family of the size involved.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2021.

     SEC. ___. FURTHER INCREASE IN FMAP FOR MEDICAL ASSISTANCE FOR 
                   NEWLY ELIGIBLE MANDATORY INDIVIDUALS.

       Section 1905(y)(1) of the Social Security Act (42 U.S.C. 
     1396d(y)(1)) is amended--
       (1) in subparagraph (D), by striking at the end ``and'';
       (2) in subparagraph (E), by striking ``2020 and each year 
     thereafter.'' and inserting ``2020, 2021, and 2022; and''; 
     and
       (3) by adding at the end the following new subparagraphs:
       ``(F) 93 percent for calendar quarters in 2023, 2024, and 
     2025; and
       ``(G) 90 percent for calendar quarters in 2026 and each 
     year thereafter.''.
                                 ______