Restoring Equity, Saving Coverage, and Undoing Errors Act of 2015 or the RESCUE America's Health Care Act of 2015
This bill applies only: (1) if the Supreme Court determines that the premium tax credit under the Patient Protection and Affordable Care Act (PPACA) is not applicable to health plans purchased through the federal health insurance exchange, and (2) in states without a state health insurance exchange.
This bill amends the Internal Revenue Code to allow a tax credit for individuals with health insurance who are ineligible for federal health care and not enrolled in an employer-subsidized group health plan.
The Department of the Treasury must make payments to health insurers on behalf of taxpayers eligible for the tax credit.
This bill repeals certain provisions of PPACA and the Health Care and Education Reconciliation Act of 2010 relating to health insurance, health savings accounts, and health flexible spending accounts. Provisions amended by the repealed provisions are restored.
Any health plan fulfills an individual's requirement to maintain minimum essential coverage.
Dental plans no longer need to provide pediatric dental benefits to be offered on a health insurance exchange.
This bill amends the Public Health Service Act to define individual health pools (IHPs) as nonprofit entities that form health insurance risk pools. IHPs are prohibited from conditioning membership on an individual's health status and must offer the same coverage to all members. State benefit requirements and restrictions on premium variation do not apply to IHPs.
Health insurers in the individual market must offer coverage to all individuals.
A health insurer may exclude coverage for a preexisting condition or vary premiums based on health status only for individuals who have not had continuous coverage for the last 18 months.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2650 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 2650
To restore equity, save coverage, and undo errors in the case of
individuals who lose health insurance subsidies under King v. Burwell,
and other individuals, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 4, 2015
Mr. Tom Price of Georgia introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Ways and Means and Education and the Workforce, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To restore equity, save coverage, and undo errors in the case of
individuals who lose health insurance subsidies under King v. Burwell,
and other individuals, 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; CONTINGENCY AND LIMITATION
ON APPLICATION.
(a) Short Title.--This Act may be cited as the ``Restoring Equity,
Saving Coverage, and Undoing Errors Act of 2015'' or as the ``RESCUE
America's Health Care Act of 2015''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents; contingency and limitation on
application.
Sec. 2. Refundable tax credit for health insurance coverage.
Sec. 3. Restoring to States the freedom and flexibility to regulate
health insurance markets.
Sec. 4. Pool reform for individual membership expansion.
Sec. 5. Requirements for individual health insurance.
(c) Contingency and Limitation on Application.--
(1) Dependent upon supreme court determination in king v.
burwell.--The succeeding provisions of this Act (including the
amendments made by this Act) shall only apply if the Supreme
Court determines that the premium tax credit under section 36B
of the Internal Revenue Code of 1986 is not available to
individuals who are enrolled in a qualified health plan offered
through the federally operated Exchange established pursuant to
section 1321(c) of the Patient Protection and Affordable Care
Act (42 U.S.C. 18041(c)).
(2) Application in states without a state-operated
exchange.--In the case of a State that has not established an
Exchange under section 1311 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031) for which a premium tax
credit is available pursuant to section 36B(b)(1)(A) of the
Internal Revenue Code of 1986, as interpreted by the Supreme
Court, the succeeding provisions of this Act (including the
amendments made by this Act) shall apply, subject to paragraphs
(1) and (4), to the State and to individuals residing in the
State as of the date on which such credit becomes no longer
available to such individuals pursuant to the Supreme Court
determination described in paragraph (1) (such date referred to
in this Act as the ``King v. Burwell effective date'') .
(3) Option of application in states with a state-operated
exchange.--In the case of a State that has established an
Exchange under section 1311 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031) for which a premium tax
credit is available pursuant to section 36B(b)(1)(A) of the
Internal Revenue Code of 1986, as interpreted by the Supreme
Court--
(A) the State may at any time terminate operation
of such Exchange; and
(B) if the State terminates operation of any such
Exchange established under such section 1311, the
provisions of this Act (including the amendments made
by this Act) shall apply, subject to paragraphs (1) and
(4), to the State and to individuals residing in the
State as of the date on which the operation of such
Exchange is terminated, but in no case shall such
provisions and amendments apply earlier than the King
v. Burwell effective date.
(4) No application to states with an exchange for which
premium credit is available.--The succeeding provisions of this
Act (including the amendments made by this Act) shall not apply
to a State and to individuals residing in a State so long as
there is operating in the State an Exchange for which a premium
tax credit is available pursuant to section 36B(b)(1)(A) of the
Internal Revenue Code of 1986 to such individuals, as
interpreted by the Supreme Court.
SEC. 2. REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE COVERAGE.
(a) In General.--Subpart C of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 is amended by inserting after
section 36B the following new section:
``SEC. 36C. HEALTH INSURANCE COVERAGE.
``(a) In General.--In the case of an individual, there shall be
allowed as a credit against the tax imposed by subtitle A the aggregate
monthly credit amounts determined under subsection (b) with respect to
the taxpayer and the taxpayer's qualifying family members for eligible
coverage months beginning during the taxable year.
``(b) Monthly Credit Amounts.--
``(1) In general.--The monthly credit amount with respect
to any individual for any eligible coverage month is \1/12\
of--
``(A) $900 in the case of an individual who has not
attained age 18 as of the beginning of such month,
``(B) $1,200 in the case of an individual who has
so attained age 18 but who has not so attained age 35,
``(C) $2,100 in the case of an individual who has
so attained age 35, but who has not so attained age 50,
and
``(D) $3,000 in the case of an individual who has
so attained age 50.
``(2) Inflation adjustment.--In the case of any taxable
year beginning in a calendar year after 2016, each dollar
amount contained in paragraph (1) shall be increased by an
amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year in which
the taxable year begins, determined by substituting
`calendar year 2015' for `calendar year 1992' in
subparagraph (B) thereof.
Any increase determined under the preceding sentence shall be
rounded to the nearest multiple of $50.
``(c) Eligible Coverage Month.--For purposes of this section, the
term `eligible coverage month' means, with respect to any individual,
any month if, as of the first day of such month, the individual--
``(1) is covered by qualified health insurance,
``(2) does not have other specified coverage, and
``(3) is not imprisoned under Federal, State, or local
authority.
``(d) Qualifying Family Member.--For purposes of this section, the
term `qualifying family member' means--
``(1) in the case of a joint return, the taxpayer's spouse,
and
``(2) any dependent of the taxpayer.
``(e) Qualified Health Insurance.--For purposes of this section,
the term `qualified health insurance' means health insurance coverage
(other than excepted benefits as defined in section 9832(c)) which
constitutes medical care.
``(f) Other Specified Coverage.--For purposes of this section, an
individual has other specified coverage for any month if, as of the
first day of such month--
``(1) Coverage under medicare, medicaid, or schip.--Such
individual--
``(A) is entitled to benefits under part A of title
XVIII of the Social Security Act or is enrolled under
part B of such title, or
``(B) is enrolled in the program under title XIX or
XXI of such Act (other than under section 1928 of such
Act).
``(2) Certain other coverage.--Such individual--
``(A) is enrolled in a health benefits plan under
chapter 89 of title 5, United States Code,
``(B) is entitled to receive benefits under chapter
55 of title 10, United States Code,
``(C) is entitled to receive benefits under chapter
17 of title 38, United States Code,
``(D) is enrolled in a group health plan (within
the meaning of section 5000(b)(1)) which is subsidized
by the employer, or
``(E) is a member of a health care sharing
ministry.
``(3) Health care sharing ministry.--For purposes of this
subsection, the term `health care sharing ministry' means an
organization--
``(A) which is described in section 501(c)(3) and
is exempt from taxation under section 501(a),
``(B) members of which share a common set of
ethical or religious beliefs and share medical expenses
among members in accordance with those beliefs and
without regard to the State in which a member resides
or is employed,
``(C) members of which retain membership even after
they develop a medical condition,
``(D) which (or a predecessor of which) has been in
existence at all times since December 31, 1999, and
medical expenses of its members have been shared
continuously and without interruption since at least
December 31, 1999, and
``(E) which conducts an annual audit which is
performed by an independent certified public accounting
firm in accordance with generally accepted accounting
principles and which is made available to the public
upon request.
``(g) Special Rules.--
``(1) Credit in excess of premiums only payable to a health
savings account.--
``(A) In general.--If the credit allowed under
subsection (a) (determined without regard to clause
(ii)) for any taxable year exceeds the amount of
premiums paid by the taxpayer for coverage of the
taxpayer and the taxpayer's qualifying family members
under qualified health insurance for eligible coverage
months beginning in the taxable year--
``(i) at the request of the taxpayer, the
Secretary shall pay the amount of such excess
to one or more health savings accounts of the
taxpayer or of any qualifying family member of
the taxpayer, and
``(ii) the credit allowed under subsection
(a) for such taxable year shall not exceed the
amount of such premiums.
``(B) Medical and health savings accounts.--Amounts
distributed from an Archer MSA (as defined in section
220(d)) or from a health savings account (as defined in
section 223(d)) shall not be taken into account as
premiums paid under subparagraph (A).
``(C) Insurance which covers other individuals.--
For purposes of this paragraph, rules similar to the
rules of section 213(d)(6) shall apply with respect to
any contract for qualified health insurance under which
amounts are payable for coverage of an individual other
than the taxpayer and qualifying family members.
``(D) Contributions treated as rollovers, etc.--
``(i) In general.--Any amount paid the
Secretary to a health savings account under
this paragraph shall be treated for purposes of
this title in the same manner as a rollover
contribution described in section 223(f)(5).
``(ii) Coordination with limitation on
rollovers.--Any amount described in clause (i)
shall not be taken into account in applying
section 223(f)(5)(B) with respect to any other
amount and the limitation of section
223(f)(5)(B) shall not apply with respect to
the application of clause (i).
``(iii) Establishment of hsas.--Nothing in
any provision of law shall be construed--
``(I) to prevent an individual from
establishing a health savings account
(as defined in section 223(d)) merely
because such individual is not an
eligible individual (as defined in
section 223(c)), or
``(II) to prevent such an account
from being treated as a health savings
account merely because all or a
substantial portion of the
contributions to such account are
described in this paragraph.
``(2) Coordination with advance payments of credit.--With
respect to any taxable year--
``(A) the amount which would (but for this
subsection) be allowed as a credit to the taxpayer
under subsection (a) shall be reduced (but not below
zero) by the aggregate amount paid on behalf of such
taxpayer under section 7529 for months beginning in
such taxable year, and
``(B) the tax imposed by section 1 for such taxable
year shall be increased by the excess (if any) of--
``(i) the aggregate amount paid on behalf
of such taxpayer under section 7529 for months
beginning in such taxable year, over
``(ii) the amount which would (but for this
subsection) be allowed as a credit to the
taxpayer under subsection (a).
``(3) Coordination with other provisions.--For purposes of
any deduction allowed under section 162(l), 213, or 224, and
any credit allowed under section 35, any health insurance
premiums which would (but for this paragraph) be taken into
account shall be reduced (but not below zero) by the amount of
the credit allowed under this section (determined without
regard to paragraphs (1) and (2) of this subsection).
``(4) Denial of credit to dependents and nonpermanent
resident alien individuals.--No credit shall be allowed under
this section to any individual who is--
``(A) not a citizen or lawful permanent resident of
the United States for the calendar year in which the
taxable year begins, or
``(B) a dependent with respect to another taxpayer
for a taxable year beginning in the calendar year in
which such individual's taxable year begins.
``(5) Regulations.--The Secretary may prescribe such
regulations and other guidance as may be necessary or
appropriate to carry out this section, section 6050W, and
section 7529.''.
(b) Advance Payment of Credit.--
(1) In general.--Chapter 77 of the Internal Revenue Code of
1986 (relating to miscellaneous provisions) is amended by
adding at the end the following:
``SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH INSURANCE COVERAGE.
``(a) General Rule.--Not later than January 1, 2016, the Secretary
shall establish a program for making payments to providers of qualified
health insurance (as defined in section 36C(e)) on behalf of taxpayers
eligible for the credit under section 36C.
``(b) Limitation.--The aggregate payments made under this section
with respect to any taxpayer, determined as of any time during any
calendar year, shall not exceed the monthly credit amounts determined
with respect to such taxpayer under section 36C for months during such
calendar year which have ended as of such time.
``(c) Application of Rule That Credits in Excess of Premiums Only
Payable to a Health Savings Account.--Under rules similar to the rules
of section 36C(g)(1), any amount otherwise payable on behalf of the
taxpayer under subsection (a) with respect to any eligible coverage
month which is in excess of the amount of premiums paid by the taxpayer
for coverage of the taxpayer and the taxpayer's qualifying family
members under qualified health insurance for such month shall be
payable only to one or more health savings accounts of the taxpayer or
of any qualifying family member of the taxpayer.
``(d) Certification Process and Proof of Coverage.--The Secretary
shall establish a process under which individuals are certified as
eligible for payment under this section. Such process shall include an
initial application by the taxpayer to determine eligibility and
thereafter continued eligibility shall be determined, to the maximum
extent feasible, by the Secretary on the basis of information provided
under section 6050X.
``(e) Definitions.--For purposes of this section, terms used in
this section which are also used in section 36C shall have the same
meaning as when used in section 36C.''.
(2) Information reporting.--
(A) In general.--Subpart B of part III of
subchapter A of chapter 61 of such Code (relating to
information concerning transactions with other persons)
is amended by adding at the end the following new
section:
``SEC. 6050X. RETURNS RELATING TO CREDIT FOR HEALTH INSURANCE COVERAGE.
``(a) Requirement of Reporting.--Every person who provides
qualified health insurance for any month of any calendar year with
respect to any individual shall, at such time as the Secretary may
prescribe, make the return described in subsection (b) with respect to
each such individual. With respect to any individual with respect to
whom payments under section 7529 are made by the Secretary, the
Secretary may require that reporting under subsection (b) be made on a
monthly basis.
``(b) Form and Manner of Returns.--A return is described in this
subsection if such return--
``(1) is in such form as the Secretary may prescribe, and
``(2) contains, with respect to each policy of qualified
health insurance--
``(A) the name, address, and TIN of each individual
covered under such policy,
``(B) the premiums paid with respect to such
policy, and
``(C) such other information as the Secretary may
prescribe.
``(c) Statements To Be Furnished to Individuals With Respect to
Whom Information Is Required.--Every person required to make a return
under subsection (a) shall furnish to each individual whose name is
required to be set forth in such return a written statement showing--
``(1) the name and address of the person required to make
such return and the phone number of the information contact for
such person, and
``(2) the information required to be shown on the return
with respect to such individual.
The written statement required under the preceding sentence shall be
furnished on or before January 31 of the year following the calendar
year to which such statement relates.
``(d) Definitions.--For purposes of this section, terms used in
this section which are also used in section 36C shall have the same
meaning as when used in section 36C.''.
(B) Assessable penalties.--
(i) Subparagraph (B) of section 6724(d)(1)
of such Code is amended by striking ``or'' at
the end of clause (xxiv), by striking ``and''
at the end of clause (xxv) and inserting
``or'', and by inserting after clause (xxv) the
following new clause:
``(xxvi) section 6050X (relating to returns
relating to credit for health insurance
coverage), and''.
(ii) Paragraph (2) of section 6724(d) of
such Code is amended by striking ``or'' at the
end of subparagraph (GG), by striking the
period at the end of subparagraph (HH) and
inserting ``, or'', and by adding after
subparagraph (HH) the following new
subparagraph:
``(II) section 6050X (relating to returns relating
to credit for health insurance coverage).''.
(3) Disclosure of return information for purposes of
advance payment of credit as premiums for qualified health
insurance.--
(A) In general.--Subsection (l) of section 6103 of
such Code is amended by adding at the end the following
new paragraph:
``(23) Disclosure of return information related to payments
of the health insurance coverage credit.--The Secretary may, on
behalf of taxpayers eligible for the credit under section 36C,
disclose to a provider of qualified health insurance (as
defined in section 36(e)) or a trustee of a health savings
account (and persons acting on behalf of such provider or such
trustee), return information with respect to any such taxpayer
only to the extent necessary (as prescribed by regulations
issued by the Secretary) to carry out sections 36C(g)(1)
(relating to credit in excess of premiums only payable to a
health savings account) and 7529 (relating to advance payment
of credit for health insurance coverage).''.
(B) Confidentiality of information.--Paragraph (3)
of section 6103(a) of such Code is amended by striking
``or (21)'' and inserting ``(21), or (22)''.
(C) Unauthorized disclosure.--Paragraph (2) of
section 7213(a) of such Code is amended by striking
``or (21)'' and inserting ``(21), or (22)''.
(4) Effective date.--Subject to section 1(c), the
amendments made by this section shall take effect on the date
of the enactment of this Act.
(c) Conforming Amendments.--
(1) Paragraph (2) of section 1324(b) of title 31, United
States Code, is amended by inserting ``36C,'' after ``36B,''.
(2) The table of sections for subpart C of part IV of
subchapter A of chapter 1 of the Internal Revenue Code of 1986
is amended by inserting after the item relating to section 36B
the following new item:
``Sec. 36C. Health insurance coverage.''.
(3) The table of sections for subpart B of part III of
subchapter A of chapter 61 of such Code is amended by adding at
the end the following new item:
``Sec. 6050X. Returns relating to credit for health insurance
coverage.''.
(4) The table of sections for chapter 77 of such Code is
amended by adding at the end the following new item:
``Sec. 7529. Advance payment of credit for health insurance
coverage.''.
(d) Effective Date.--Subject to section 1(c), the amendments made
by this section shall apply with respect to coverage months beginning
on or after the King v. Burwell effective date.
SEC. 3. RESTORING TO STATES THE FREEDOM AND FLEXIBILITY TO REGULATE
HEALTH INSURANCE MARKETS.
(a) Elimination of PPACA Restrictions on the Insurance Market.--Any
provision of title I of the Patient Protection and Affordable Care Act
(Public Law 111-148) or of the Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152) amending title XXVII of the Public
Health Service Act (42 U.S.C. 300gg et seq.), or amending the Internal
Revenue Code of 1986 or the Employee Retirement Income Security Act of
1974 in order to incorporate or apply such an amendment to such title
XXVII, is repealed and the provisions of law amended by such provisions
of title I of the Patient Protection and Affordable Care Act and the
Health Care and Education Reconciliation Act of 2010 are restored or
revived as if such title and Act had not been enacted.
(b) HSAs and FSAs.--Any provision of, or amendment made by, the
Patient Protection and Affordable Care Act (Public Law 111-148) or the
Health Care and Education Reconciliation Act of 2010 (Public Law 111-
152) applying a requirement or restriction on a health savings account
(within the meaning of section 223(d) of the Internal Revenue Code of
1986) or a health flexible spending arrangement (within the meaning of
section 106(c) of the Internal Revenue Code of 1986) is repealed and
the provisions of law amended by such provisions of the Patient
Protection and Affordable Care Act and the Health Care and Education
Reconciliation Act of 2010 are restored or revived as if such Acts had
not been enacted.
(c) Expanded Health Plan Selection.--
(1) In general.--Section 1301(a)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)) is
amended by striking ``a health plan that'' and all that follows
through the period at the end and inserting ``any health plan
(as defined in subsection (b)).''.
(2) Direct primary care medical home plans.--Section
1301(a)(3) of such Act (42 U.S.C. 18021(a)(3)) is amended by
striking ``medical home plan that meets criteria'' and all that
follows through the period at the end and inserting ``medical
home plan.''.
(3) Stand-alone dental benefits.--Section 1311(d)(2)(B)(ii)
of such Act (42 U.S.C. 18031(d)(2)(B)(ii)) is amended by
striking ``health plan) if the plan'' and all that follows
through the period at the end and inserting ``health plan).''.
(4) Conforming amendments.--The following provisions of the
Patient Protection and Affordable Care Act (Public Law 111-148)
shall have no force or effect after the date of the enactment
of this Act:
(A) Section 1301(b)(1)(B) of such Act (42 U.S.C.
18021(b)(1)(B)).
(B) Paragraphs (1), (2), and (6) of section 1311(c)
of such Act (42 U.S.C. 18031(c)).
(C) Section 1311(d)(4)(A) of such Act (42 U.S.C.
18031(d)(4)(A)).
(D) Section 1311(e) of such Act (42 U.S.C.
18031(e)).
(E) Section 1311(j) of such Act (42 U.S.C.
18031(j)).
(F) Subparagraphs (B) and (D) of section 1321(a)(1)
of such Act (42 U.S.C. 18041(a)(1)).
SEC. 4. POOL REFORM FOR INDIVIDUAL MEMBERSHIP EXPANSION.
The Public Health Service Act is further amended by adding at the
end the following:
``TITLE XXXIV--POOL REFORM FOR INDIVIDUAL MEMBERSHIP EXPANSION
``SEC. 3400. PURPOSE.
``The purpose of this title is to provide, through the
establishment of individual health pools (or IHPs), for the reform of,
and expansion of enrollment in, health insurance coverage for
individuals and small employers.
``SEC. 3401. DEFINITION OF INDIVIDUAL HEALTH POOL (IHP).
``(a) In General.--For purposes of this title, the terms
`individual health pool' and `IHP' mean a legal nonprofit entity that
meets the following requirements:
``(1) Organization.--The IHP--
``(A) has been formed and maintained in good faith
for a purpose that includes the formation of a risk
pool in order to offer health insurance coverage to its
members;
``(B) does not condition membership in the IHP on
any health status-related factor relating to an
individual (including an employee of an employer or a
dependent of an employee);
``(C) does not make health insurance coverage
offered through the IHP available other than in
connection with a member of the IHP;
``(D) is not a health insurance issuer; and
``(E) does not receive any consideration directly
or indirectly from any health insurance issuer in
connection with the enrollment of any individuals, or
employees of employers, in any health insurance
coverage, except in conjunction with services offered
through the IHP.
``(2) Offering health benefits coverage.--
``(A) Different groups.--The IHP, in conjunction
with those health insurance issuers that offer health
benefits coverage through the IHP, makes available
health benefits coverage in the manner described in
subsection (b) to all members of the IHP and the
dependents of such members (and, in the case of small
employers, employees and their dependents) in the
manner described in subsection (c)(2) at rates that are
established by the health insurance issuer on a policy
or product specific basis and that may vary for
individuals covered through an IHP.
``(B) Nondiscrimination in coverage offered.--
``(i) In general.--Subject to clause (ii),
the IHP may not offer health benefits coverage
to a member of an IHP unless the same coverage
is offered to all such members of the IHP.
``(ii) Construction.--Nothing in this title
shall be construed as requiring or permitting a
health insurance issuer to provide coverage
outside the service area of the issuer, as
approved under State law, or preventing a
health insurance issuer from underwriting or
from excluding or limiting the coverage on any
individual, subject to the requirement of
section 2741 (relating to guaranteed
availability of individual health insurance
coverage to certain individuals with prior
group coverage).
``(C) No assumption of insurance risk by ihp.--The
IHP provides health benefits coverage only through
contracts with health insurance issuers and does not
assume insurance risk with respect to such coverage.
``(3) Geographic areas.--Nothing in this title shall be
construed as preventing the establishment and operation of more
than one IHP in a geographic area or as limiting the number of
IHPs that may operate in any area.
``(4) Provision of administrative services to purchasers.--
The IHP may provide administrative services for members. Such
services may include accounting, billing, and enrollment
information.
``(b) Health Benefits Coverage Requirements.--
``(1) Compliance with consumer protection requirements.--
Except as provided in section 3402, any health benefits
coverage offered through an IHP--
``(A) shall be issued by a health insurance issuer
that meets all applicable State standards relating to
consumer protection;
``(B) shall be approved or otherwise permitted to
be offered under State law; and
``(C) may not impose any exclusion of a specific
disease from such coverage.
``(2) Wellness bonuses for health promotion.--Nothing in
this title shall be construed as precluding a health insurance
issuer offering health benefits coverage through an IHP from
establishing premium discounts or rebates for members or from
modifying otherwise applicable copayments or deductibles in
return for adherence to programs of health promotion and
disease prevention so long as such programs are agreed to in
advance by the IHP and comply with all other provisions of this
title and do not discriminate among similarly situated members.
``(c) Members; Health Insurance Issuers.--
``(1) Members.--
``(A) In general.--Under rules established to carry
out this title, with respect to an individual or small
employer who is a member of an IHP, the individual may
enroll for health benefits coverage (including coverage
for dependents of such individual) or employer may
enroll employees for health benefits coverage
(including coverage for dependents of such employees)
offered by a health insurance issuer through the IHP.
``(B) Rules for enrollment.--Nothing in this
paragraph shall preclude an IHP from establishing rules
of enrollment and reenrollment of members. Such rules
shall be applied consistently to all members within the
IHP and shall not be based in any manner on health
status-related factors.
``(2) Health insurance issuers.--The contract between an
IHP and a health insurance issuer shall provide, with respect
to a member enrolled with health benefits coverage offered by
the issuer through the IHP, for the payment to the issuer of
the premiums (if any) collected by the IHP for health insurance
coverage offered by the issuer.
``SEC. 3402. APPLICATION OF CERTAIN LAWS AND REQUIREMENTS.
``(a) Preemption of State Laws Restricting Formation of IHPs.--Any
State law or regulation relating to the composition or organization of
an IHP is preempted to the extent the law or regulation is inconsistent
with the provisions of this title.
``(b) Preemption of State Requirements Relating to Health Benefit
Coverage.--
``(1) Benefit requirements.--
``(A) In general.--Subject to subparagraph (B),
State laws are superseded, and shall not apply to
health benefits coverage made available through an IHP,
insofar as such laws impose benefit requirements for
such coverage, including (but not limited to)
requirements relating to coverage of specific
providers, specific services or conditions, or the
amount, duration, or scope of benefits.
``(B) Exception for federally imposed requirements
and for requirements prohibiting disease-specific
exclusions.--Subparagraph (A) shall not apply to a
requirement to the extent the requirement--
``(i) implements title XXVII or other
Federal law; or
``(ii) prohibits imposition of an exclusion
of a specific disease from health benefits
coverage.
``(2) Other requirements preventing offering of coverage
through an ihp.--State laws are superseded, and shall not apply
to health benefits coverage made available through an IHP,
insofar as such laws impose any other requirements (including
limitations on compensation arrangements) that, directly or
indirectly, preclude (or have the effect of precluding) the
offering of such coverage through an IHP, if the IHP meets the
requirements of this title.
``(c) Preemption of State Premium Rating Requirements.--State laws
are superseded, and shall not apply to the premiums imposed for health
benefits coverage made available through an IHP, insofar as such laws
impose restrictions on the variation of premiums among such coverage
offered to members of the IHP.
``SEC. 3403. DEFINITIONS.
``For purposes of this title:
``(1) Dependent.--The term `dependent', as applied to
health insurance coverage offered by a health insurance issuer
licensed (or otherwise regulated) in a State, shall have the
meaning applied to such term with respect to such coverage
under the laws of the State relating to such coverage and such
an issuer. Such term may include the spouse and children of the
individual involved.
``(2) Health benefits coverage.--The term `health benefits
coverage' has the meaning given the term `health insurance
coverage' in section 2791(b)(1), and does not include excepted
benefits (as defined in section 2791(c)).
``(3) Health insurance issuer.--The term `health insurance
issuer' has the meaning given such term in section 2791(b)(2).
``(4) Health status-related factor.--The term `health
status-related factor' has the meaning given such term in
section 2791(d)(9).
``(5) Member.--The term `member' means, with respect to an
IHP, an individual or small employer who is a member of the
legal entity described in section 3401(a)(1) to which the IHP
is offering coverage.
``(6) Small employer.--The term `small employer' has the
meaning given such term in section 712(c)(1)(B) of the Employee
Retirement and Income Security Act of 1974.''.
SEC. 5. REQUIREMENTS FOR INDIVIDUAL HEALTH INSURANCE.
(a) In General.--Section 2741 of the Public Health Service Act (42
U.S.C. 300gg-41), as restored and revived by section 3 of this Act, is
amended--
(1) in subsection (a)--
(A) in the heading, by striking ``to Certain
Individuals With Prior Group Coverage'';
(B) in paragraph (1), by striking ``and section
2744'';
(C) in paragraph (1)(B), by inserting ``unless such
exclusion complies with paragraph (2)'' before the
period; and
(D) by striking paragraph (2) and inserting the
following new paragraphs:
``(2) Limitation on preexisting condition exclusion
period.--
``(A) Limitation.--A health insurance issuer
offering health insurance coverage in the individual
market may not, with respect to an enrollee in such
coverage, impose any preexisting condition exclusion if
such enrollee has at least 18 months of continuous
creditable coverage (as defined in section 2701(c)(1))
immediately preceding the enrollment date.
``(B) Imposition of exclusion.--Notwithstanding
paragraph (1)(B), a health insurance issuer offering
health insurance coverage in the individual market may,
with respect to an enrollee in such coverage who is not
described in subparagraph (A), impose a preexisting
condition exclusion only if--
``(i) such exclusion relates to a condition
(whether physical or mental), regardless of the
cause of the condition, for which medical
advice, diagnosis, care, or treatment was
recommended or received within the 6-month
period ending on the enrollment date;
``(ii) such exclusion extends for a period
of not more than 18 months after the enrollment
date; and
``(iii) the period of any such preexisting
condition exclusion is reduced by the aggregate
of the periods of creditable coverage (if any,
as defined in section 2701(c)(1)) applicable to
the enrollee as of the enrollment date.
``(C) Premium surcharge.--Notwithstanding paragraph
(6), with respect to an enrollee described in
subparagraph (B), a health insurance issuer may charge
a premium for the coverage involved that does not
exceed 150 percent of the applicable standard rate, for
not to exceed 24 months (or 36 months if the health
insurance issuer does not impose any preexisting
condition exclusion with respect to such enrollee),
reduced by the aggregate of the periods of creditable
coverage (if any, as defined in section 2701(c)(1))
applicable to the enrollee as of the enrollment date.
For purposes of this subsection, the term `applicable
standard rate' means the standard premium rate that the
issuer charges for the coverage involved with respect
to an individual described in subparagraph (A) with the
same rating characteristics or rating factors as the
enrollee described in subparagraph (B), provided that
any variations in standard premium rates are based on
the uniform application of rating characteristics or
rating factors that are permitted by State law and are
not otherwise prohibited by paragraph (6).
``(3) Exceptions.--Notwithstanding paragraph (2), and
subject to subparagraph (D), a health insurance issuer offering
health insurance coverage in the individual market, may not
impose any of the following preexisting condition exclusions:
``(A) Exclusion not applicable to certain
newborns.--In the case of an individual who, as of the
last day of the 30-day period beginning with the date
of birth, is a dependent of an enrollee in such
coverage.
``(B) Exclusion not applicable to certain adopted
children.--In the case of a child who is adopted or
placed for adoption before attaining 18 years of age
and who, as of the last day of the 30-day period
beginning on the date of the adoption or placement for
adoption, is a dependent of an enrollee in such
coverage. The previous sentence shall not apply to
coverage before the date of such adoption or placement
for adoption.
``(C) Exclusion not applicable to pregnancy.--
Relating to pregnancy as a preexisting condition.
``(D) Loss if break in coverage.--Subparagraphs (A)
and (B) shall no longer apply to an individual after
the end of the first 63-day period during all of which
the individual was not covered under any creditable
coverage.
``(4) Open enrollment periods.--A health insurance issuer
offering health insurance coverage in the individual market may
limit the applicability of the provisions of paragraph (1) to
scheduled open enrollment periods, provided that--
``(A) any such open enrollment period shall not be
less than 30 days;
``(B) any period between scheduled open enrollment
periods shall not exceed 24 months; and
``(C) such limitation shall not apply to any
individual who qualifies for a special enrollment
period under paragraph (5).
``(5) Special enrollment periods.--Subject to subparagraphs
(E) and (F), a health insurance issuer offering health
insurance coverage in the individual market shall permit an
individual who is an eligible individual or a dependent to
enroll in coverage during a special enrollment period if the
individual experiences any of the following qualifying events:
``(A) For dependent beneficiaries.--The individual
becomes, by reason of marriage, birth, adoption or
placement for adoption, a dependent of an individual
enrolled in a plan offered by the health insurance
issuer and such individual otherwise qualifies, under
the terms of the plan, as eligible for coverage as a
dependent of such enrollee.
``(B) Loss of group coverage.--The individual loses
coverage under a group health plan as a result of--
``(i) loss of eligibility for the coverage
(including as a result of legal separation,
divorce, death, attaining an age at which
eligibility terminates, termination of
employment, or reduction in the number of hours
of employment); or
``(ii) termination of the coverage by the
plan sponsor.
``(C) Loss of individual coverage.--The individual
loses individual market coverage as a result of--
``(i) discontinuation of a plan as a result
of a health insurance issuer ceasing to offer
coverage in the individual market in accordance
with section 2742(c)(2) (42 U.S.C. 300gg-
42(c)(2)) of this title;
``(ii) expiration of COBRA, or other,
continuation coverage;
``(iii) ceasing to qualify, under the terms
of the coverage, as a dependent (including as a
result of legal separation, divorce, death, or
attaining an age at which eligibility
terminates); and
``(iv) permanently moving outside the State
in which the coverage was issued, or in the
case of a network plan, outside the plan's
service area.
``(D) Loss of eligibility for a government coverage
program.--The individual loses coverage by ceasing to
be eligible for coverage under any of the following:
``(i) Part A or part B of title XVIII of
the Social Security Act (42 U.S.C. 1395c et
seq.; 1395j et seq.).
``(ii) Title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.), other than coverage
consisting solely of benefits under section
1928 (42 U.S.C. 1396s).
``(iii) Title XXI of the Social Security
Act (42 U.S.C. 1397aa et seq.).
``(iv) Chapter 55 of title 10.
``(v) Chapter 89 of title 5.
``(vi) A State health benefits risk pool.
``(E) Loss of coverage described.--For purposes of
this paragraph, loss of coverage shall not include any
of the following:
``(i) Voluntary termination of coverage by
an individual, except if such termination is
the result of circumstances described in
subparagraph (C)(iv).
``(ii) Termination of coverage by the
issuer or the plan sponsor of the coverage for
any reason described in paragraph (1) or (2) of
section 2742(b) (300gg-42(b)) of this title.
``(iii) Loss of any coverage that consists
solely of coverage of excepted benefits (as
defined in section 300gg-91(c) of this title).
``(F) Limitation on special enrollment period.--Any
special enrollment period shall not be less than 60
days and shall begin on the date of the qualifying
event.
``(6) Standard premium rates.--With respect to the premium
rate charged by a health insurance issuer for health insurance
coverage offered in the individual market, such rate, with
respect to the particular plan or coverage involved, shall not
vary based on any of the following health status-related
factors in relation to an eligible individual or dependent:
``(A) Health status.
``(B) Medical condition (including both physical
and mental illnesses).
``(C) Claims experience.
``(D) Receipt of health care.
``(E) Medical history.
``(F) Genetic information.
``(G) Evidence of insurability (including
conditions arising out of acts of domestic violence).
``(H) Disability.'';
(2) by amending subsection (b) to read as follows:
``(b) Definitions.--For purposes of this section:
``(1) Eligible individual.--The term `eligible individual'
means an individual who is eligible under applicable State law
to purchase individual health insurance coverage in the State.
``(2) Dependent.--The term `dependent' means an individual
who, under the terms of the coverage and applicable State law,
qualifies to enroll in such coverage as a dependent of an
individual described in paragraph (1).''; and
(3) by striking subsection (c) and redesignating subsection
(d) and the first subsection (e) as subsections (c) and (d),
respectively.
(b) Conforming Amendment.--Section 2744 of the Public Health
Service Act (42 U.S.C. 300gg-44), as restored and revived by section 3
of this Act, is repealed.
(c) Effective Date.--Subject to section 1(c), the amendments made
by this section shall apply with respect to health insurance coverage
offered for plan years beginning on or after the King v. Burwell
effective date.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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