[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
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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
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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.''.
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