Patient Freedom Act of 2015
This bill provides states with three options regarding title I (provisions on health insurance reform, exchanges, and subsidies) of the Patient Protection and Affordable Care Act (PPACA): (1) continue implementing PPACA, (2) do not apply title I of PPACA except to prohibit lifetime or annual limits on health insurance benefits and require coverage of dependents up to 26 years old, or (3) the second option plus implementation of a health savings account (HSA) deposit system.
In states implementing an HSA deposit system, residents who are enrolled in health insurance coverage that meets state standards receive monthly deposits in their HSAs either from states administering federal funds or as a tax credit paid in advance. States that administer deposits are entitled to payments from the Department of Health and Human Services for population health initiatives.
States with an HSA deposit system must offer a health insurance plan that is continually available for enrollment and penalize residents who have a break in coverage.
This bill amends title XIX (Medicaid) of the Social Security Act (SSAct) to disregard assets in an HSA for purposes of determining Medicaid eligibility and benefits except for long-term care services.
This bill amends SSAct title XVIII (Medicare) to require participating hospitals to limit costs to individuals for uncovered emergency medical care.
This bill amends the Internal Revenue Code to eliminate the requirement that an individual have a high deductible health plan to be eligible for the tax benefits of an HSA.
HSAs can be used to pay premiums for health insurance that meets specified requirements.
HSA tax benefits only apply to payments for health care for which the provider publishes the price.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2756 Introduced in House (IH)]
114th CONGRESS
1st Session
H. R. 2756
To reform the provision of health insurance coverage by promoting
health savings accounts, State-based alternatives to coverage under the
Affordable Care Act, and price transparency, in order to promote a more
market-based health care system, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 12, 2015
Mr. Abraham 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 reform the provision of health insurance coverage by promoting
health savings accounts, State-based alternatives to coverage under the
Affordable Care Act, and price transparency, in order to promote a more
market-based health care system, 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.
(a) Short Title.--This Act may be cited as the ``Patient Freedom
Act of 2015''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Sense of Congress.
TITLE I--HEALTH REFORM
Sec. 100. Definitions.
Subtitle A--Insurance Reforms
Sec. 101. State options in response to Burwell decision.
Sec. 102. State alternative option.
Sec. 103. Computation of monthly HSA deposit amount for deposit
qualifying residents.
Sec. 104. State options for improved access to health insurance
coverage in each State.
Sec. 105. Expanded access and patient protections.
Sec. 106. Sunsetting certain ACA provisions; continuation of policies
of covering adult children and not applying
lifetime or annual limits.
Subtitle B--Medicaid
Sec. 111. Application of health savings accounts in relation to
Medicaid.
Subtitle C--Provider Price Transparency
Sec. 121. Ensuring access to emergency services without excessive
charges for out-of-network services.
TITLE II--REFORM OF TAX PROVISIONS RELATING TO HEALTH CARE
Subtitle A--Promotion of Health Savings Accounts
Sec. 201. Repeal of high deductible health plan requirement.
Sec. 202. Treatment of HSA after death of account beneficiary.
Sec. 203. Purchase of health insurance from HSA account.
Sec. 204. Publishing of cash price for care paid through health savings
accounts.
Subtitle B--Health Care Tax Credits
Sec. 211. Limited application of PPACA health premium credit.
Sec. 212. New HSA credit.
SEC. 2. SENSE OF CONGRESS.
It is the sense of Congress that there is a need for legislation
providing temporary transition funding for those who lose health
insurance subsidies in the aftermath of a Supreme Court decision in
favor of the plaintiffs-appellants in the case of King v. Burwell.
TITLE I--HEALTH REFORM
SEC. 100. DEFINITIONS.
In this title:
(1) Patient-grant electing state.--The term ``patient-grant
electing State'' means an electing State that specifies under
section 102(a)(4)(B) that it will carry out section 102(b)
itself (and not to have section 102(b) carried out by means of
the credit under section 36C of the Internal Revenue Code of
1986).
(2) CHIP.--The term ``CHIP'' means the children's health
insurance program established under title XXI of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) Creditable coverage.--The term ``creditable coverage''
has the meaning given such term in section 2704(c)(1) of the
Public Health Service Act (42 U.S.C. 300gg-3(c)(1)), as in
effect as of the day before the date of the enactment of this
Act.
(4) Default health insurance coverage.--The term ``default
health insurance coverage'' has the meaning given such term in
section 104(c)(2).
(5) Deposit qualifying resident.--The term ``deposit
qualifying resident'' has the meaning given such term in
section 102(b)(2).
(6) Electing state.--The term ``electing State'' means a
State that elects under section 101(a)(3) the alternative
option described in section 102.
(7) Health insurance coverage.--The term ``health insurance
coverage'' has the meaning given such term in section
2791(b)(1) of the Public Health Service Act (42 U.S.C. 300gg-
91(b)(1)).
(8) Health savings account; hsa.--The terms ``health
savings account'' and ``HSA'' mean a health savings account
established under section 223 of the Internal Revenue Code of
1986.
(9) Health savings deposit.--The term ``health savings
deposit'' means a deposit made into a health savings account
pursuant to section 102.
(10) Medicaid.--The term ``Medicaid'' means the program
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.).
(11) Medicare.--The term ``Medicare'' means the program
under part A or B of title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.).
(12) PPACA.--The term ``PPACA'' means the Patient
Protection and Affordable Care Act (Public Law 111-148), as in
effect before the date of the enactment of this Act, unless
otherwise specified.
(13) Qualified health plan coverage.--The term ``qualified
health plan coverage'' means, with respect to residents of a
State, health insurance coverage that meets applicable
standards under State law, which standards need not be the same
as that previously required of qualified health plans under
title I of PPACA, and includes a high deductible health plan
(as defined in section 223(c)(2) of the Internal Revenue Code
of 1986) and includes coverage under a group health plan.
(14) Qualified resident.--The term ``qualified resident''
means, with respect to a State for a month, an individual who
is a resident of the State as of the first day of the month and
is a citizen or national of the United States or otherwise
lawfully residing in the State under color of law.
(15) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(16) State.--The term ``State'' means the 50 States and the
District of Columbia.
(17) Uninsured.--The term ``uninsured'' means, with respect
to an individual, that the individual does not have creditable
coverage.
Subtitle A--Insurance Reforms
SEC. 101. STATE OPTIONS IN RESPONSE TO BURWELL DECISION.
(a) In General.--Each State may elect, through written notice to
the Secretary after the date of the enactment of this Act and in
accordance with this subtitle, one of the following three options in
relation to the implementation of title I of the Patient Protection and
Affordable Care Act after the decision of the Supreme Court in King v.
Burwell:
(1) Continuing implementation of ppaca, including federal
subsidies through a state-established exchange.--Under current
law, the State establishing a health insurance Exchange under
title I of PPACA, which thereby permits the continuation of
Federal premium and cost-sharing subsidies for coverage offered
through the Exchange as well as continuation of insurance and
other requirements under such title.
(2) Rejection of ppaca, including elimination of federal
subsidies now provided through federally established
exchange.--Under current law, the State not establishing such
an Exchange, potentially resulting, post-Burwell, in the loss
of such Federal premium and cost-sharing subsidies and the
continued application of other requirements under such title.
(3) Establishing new state and market-based alternative,
with alternative per capita federal deposit system.--The State
implementing the alternative option described in section 102,
which includes--
(A) the waiver of most requirements imposed under
such title; and
(B) the provision of a new, HSA- and market-based
deposit system for individuals who do not otherwise
qualify for Federal or State subsidies for health
benefits coverage.
If a State fails to make an election described in this subsection, the
State shall be deemed to have made the election described in paragraph
(2). A State may, through written notice to the Secretary, change an
election previously made under this subsection.
(b) Relation to Current Medicaid ACA Coverage Option.--Nothing in
this section shall be construed to change the option of a State with
respect to the implementation of Medicaid ACA coverage under section
1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C.
1395a(a)(10)(A)(i)(VIII)), except that a State that elects not to
provide medical assistance to individuals under such section may make
such individuals deposit qualifying residents under this title.
SEC. 102. STATE ALTERNATIVE OPTION.
(a) In General.--In the case of a State that elects under section
101(a)(3) the alternative option under this section, subject to
subsection (d) and section 105, the following shall apply:
(1) No federal exchange.--The Federal Government shall not
establish or maintain an Exchange in the State under title I of
PPACA.
(2) Elimination of individual and employer shared
responsibility for health care tax requirements for residents
and employees in state.--The individual and employer health
care responsibilities under the amendments made by title I of
PPACA (including under sections 5000A and 4980H of the Internal
Revenue Code of 1986) shall no longer apply pursuant to section
106 with respect to individuals who are residents of such State
and with respect to individuals who are employed in such State,
respectively.
(3) Modification of insurance requirements.--Except as
specifically provided in this title, the requirements under
title I of PPACA (including amendments made by such title)
relating to health insurance coverage offered in the State
shall not apply except to the extent specified by the State.
(4) New deposit system through funding hsas.--
(A) In general.--Deposit qualifying residents (as
defined in subsection (b)(2)) who are residing in the
State are eligible for a deposit to a health savings
account that may be used for premiums and cost-sharing
for health insurance coverage in accordance with
subsection (b).
(B) State specification of manner of carrying out
hsa deposit system (patient-grant electing state).--In
making the election under this subsection, a State
shall specify whether the State will carry out
subsection (b) or if such subsection shall be carried
out by means of the credit under section 36C of the
Internal Revenue Code of 1986.
(5) Additional amounts for population health initiatives
for state administered hsa deposit system.--A patient-grant
electing State (as defined in section 100(1)) is entitled to
receive additional funding under subsection (c) for population
health initiatives.
(b) Deposit Through Payment Into HSA for Deposit Qualifying
Residents.--
(1) In general.--The subsidies described in subsection
(a)(4) for an electing State shall be furnished for each
deposit qualifying resident through the deposit of a
contribution into an HSA of the individual in the amount
determined under section 103.
(2) Deposit qualifying resident defined.--In this title,
the term ``deposit qualifying resident'' means, with respect to
a State and a month, an individual--
(A) who is a qualified resident (as defined in
section 100(14)) of the State as of the first day of
the month (or such other day in the month as the
Secretary may specify);
(B) with respect to whom an HSA has been
established, which HSA may have been established by the
State in carrying out this section;
(C) who is enrolled in qualified health plan
coverage (as defined in section 100(13)), which
enrollment may have been effected by the State in
carrying out this section; and
(D) who is not eligible for coverage under
Medicare, is not enrolled for benefits under Medicaid
or CHIP, and is not enrolled for benefits under chapter
55 of title 10, United States Code (relating to
TRICARE), or title 39 of such Code (relating to
veterans' benefits) or chapter 89 of title 5 of such
Code (relating to the Federal Employees Health Benefits
Program).
(3) Payment administration.--
(A) State.--In the case of an electing State that
elects to carry out this subsection through the State,
the Secretary shall provide for payment to the State in
amounts and in a time and manner sufficient to permit
the State to make timely monthly contributions to HSAs
under this subsection. The Secretary may provide for
payment to the State using the payment methodology
described in subsection (d) of section 1903 of the
Social Security Act for payments under subsection (a)
of such section (applied without regard to any State
matching requirement) and may condition such payments
upon the provision of such information as the Secretary
may require to ensure the proper payments under this
subsection. As a condition of receiving payment under
this section, a State shall submit such information, in
such form, and manner, as the Secretary shall specify,
including information necessary to make the
computations of amounts under this section.
(B) Federal.--In the case of a State electing to
carry out this subsection other than through the State,
subsidies described in subsection (a)(4) shall be
provided through a refundable tax credit under section
36C of the Internal Revenue Code of 1986.
(4) Construction.--Nothing in this subsection shall be
construed--
(A) to prevent an individual from affirmatively
electing not to have an HSA established on the
individual's behalf and not to be enrolled under health
insurance coverage;
(B) subject to subparagraph (A), to prevent a State
from establishing an HSA for each deposit qualifying
resident who does not otherwise have an HSA;
(C) subject to subparagraph (A), to prevent a State
from establishing a mechanism whereby individuals who
would be deposit qualifying residents but for paragraph
(2)(C) are enrolled under health insurance coverage;
and
(D) to prevent a State from changing its State
Medicaid plan to eliminate coverage under section
1902(a)(10)(A)(i)(VIII) of the Social Security Act (42
U.S.C. 1396a(a)(10)(A)(i)(VIII)), in order that
individuals otherwise covered under such section may
qualify for subsidies under this section.
(c) Population Health Initiative Funding.--
(1) In general.--In the case of an electing State for a
year, the State is entitled to receive payment from the
Secretary of Health and Human Services after the end of such
year in an amount equal to 2 percent of the actual aggregate
amount deposited under subsection (b) into HSAs for residents
of the State for the year.
(2) Use of funds.--Amounts paid to a State under paragraph
(1) may only be used for population health initiatives (as
defined by the Secretary).
(3) Entitlement.--Paragraph (1) constitutes budget
authority in advance of appropriations Acts and represents the
obligation of the Federal Government to provide for the payment
to States of amounts provided under such paragraph.
(d) Requiring Rules for Computing Usual, Customary, and Reasonable
(UCR) Prices.--As a condition for a State's election of the alternative
option under this section, the State must provide, through its
department of insurance or equivalent agency, for establishment of
rules to carry out section 1867(j)(1)(A)(ii) of the Social Security
Act, as added by section 121(a)(2).
SEC. 103. COMPUTATION OF MONTHLY HSA DEPOSIT AMOUNT FOR DEPOSIT
QUALIFYING RESIDENTS.
(a) Computation.--
(1) In general.--The Secretary shall develop a standardized
methodology to determine consistent with this section a monthly
HSA deposit amount for deposit qualifying residents in each
State for months in each year. Subject to paragraphs (3) and
(4), such amount shall be equal to \1/12\ of the average per
capita annual amount computed under subsection (b) for the
State for the year, as adjusted for the deposit qualifying
resident involved--
(A) for age and geographic area under subsection
(c); and
(B) for income under subsection (d).
(2) No variation based on how deposit amount distributed.--
Such amount shall be the same for a deposit qualifying
individual without regard to whether the contribution to the
individual's HSA is made by a State under this section or by
the Federal Government through the operation of section 36C of
the Internal Revenue Code of 1986.
(3) Patient-grant electing state has flexibility to
maintain level of benefits for current aca beneficiaries.--A
patient-grant electing State may elect to increase the amount
of the deposit for all deposit qualifying individuals under
this section to the amounts that the Secretary estimates would
have been paid with respect to such individuals under section
36B of the Internal Revenue Code of 1986 and section 1402 of
PPACA if those sections had remained in effect in the State
with respect to such individuals. Such election shall be made
for a year and shall continue from year to year until the State
elects to terminate such election.
(4) Special rule for partial deposit for low-income
individuals with employer-sponsored insurance (esi).--In the
case of an individual who is covered under a group health plan
and with respect to such coverage there is a contribution by an
employer which is excluded from the individual's gross income
under the Internal Revenue Code of 1986, insofar as the
individual is a deposit qualifying resident, the amount of the
deposit with respect to the individual shall be reduced, in a
manner specified by the Secretary in consultation with the
Secretary of the Treasury and taking into account the income of
the individual's household, by an amount that is approximately
equivalent to the estimated amount of the reduction in the
amount of income tax resulting from such exclusion (and any
reduction in taxes imposed by chapter 21 or chapter 2 of such
Code by reason of any exclusion of such contributions from
wages and self employment income).
(b) Computation of Unadjusted Per Capita.--
(1) For states that continue ppaca medicaid coverage.--
(A) In general.--In the case of a State that
provides medical assistance under section
1902(a)(10)(A)(i)(VIII) of the Social Security Act (42
U.S.C. 1396b(a)(10)(A)(i)(VIII)) during a year, subject
to paragraphs (3) and (4), the Secretary shall compute
an average per capita annual amount for the State for
the year equal to--
(i) the amount specified in subparagraph
(B), divided by
(ii) the average monthly number of deposit
qualifying residents of the State in the year.
(B) Amount based on ppaca projected federal
expenditures.--The amount specified in this
subparagraph for a State for a year is 95 percent of
the Secretary's estimate of the total payments that
would have been made (assuming the existence of a State
established Exchange in the State) under section 36B of
the Internal Revenue Code of 1986 and under section
1402 of PPACA with respect to all qualified residents
in the State in the year (or taxable year ending with
such year, if applicable).
(2) For states that do not provide ppaca medicaid
coverage.--
(A) In general.--In the case of a State not
described in paragraph (1) for a year, subject to
paragraphs (3) and (4), the Secretary shall compute an
average per capita annual amount for the State for the
year equal to--
(i) the amount specified in subparagraph
(B) for the State and year, divided by
(ii) the average monthly number of deposit
qualifying residents of the State in the year.
(B) Amount based on ppaca and medicaid projected
federal expenditures.--The amount specified in this
subparagraph for a State for a year is equal to the sum
of--
(i) 95 percent of the Secretary's estimate
of the total payments that would have been made
(assuming the existence of a State-established
Exchange in the State) under section 36B of the
Internal Revenue Code of 1986 and under section
1402 of PPACA with respect to all qualified
residents in the year (or taxable year ending
with such year, if applicable); and
(ii) the Secretary's estimate of the total
payments that would have been made to the State
under title XIX of the Social Security Act for
individuals eligible to be covered under
section 1902(a)(10)(A)(i)(VIII) of the Social
Security Act assuming the election of a State
to provide Medicaid coverage under such section
and assuming the applicable Federal medical
assistance percentage were 95 percent with
respect to such individuals.
(3) Budget neutral adjustment in payments to take into
account election of higher deposits to maintain aca subsidy
levels.--If a State makes the election described in subsection
(a)(3) with respect to providing higher deposit amounts for
certain individuals described in such subsection, then the
Secretary shall adjust the average per capita annual amount
under paragraph (1) or (2), as applicable to the State, by--
(A) reducing the amount described in paragraph
(1)(B) (or, if applicable, paragraph (2)(B)(i)) by an
amount equal to 95 percent of the aggregate increased
deposit level attributable to subsection (a)(3); and
(B) not counting such an individual as a qualifying
resident for purposes of paragraph (1)(A)(ii) (or, if
applicable, paragraph (2)(A)(ii)).
(4) Adjustment for costs of partial deposits for low-income
esi individuals.--The Secretary shall adjust the average per
capita annual amount under paragraph (1) or (2), as applicable
to the State, by--
(A) reducing the amount described in paragraph
(1)(B) (or, if applicable, paragraph (2)(B)(i)) by an
amount equal to 95 percent of the amount of payments
under this section that are attributable to individuals
described in subsection (a)(4); and
(B) not counting any individual described in
subsection (a)(4) as a qualifying resident for purposes
of paragraph (1)(A)(ii) (or, if applicable, paragraph
(2)(A)(ii)).
(c) Adjustment for Age, Geographic Area, and Income Distribution
Within State.--
(1) In general.--The Secretary shall apply such adjustments
to the per capita amount computed under subsection (b) as is
designed to take into account, in a budget neutral manner and
based on the costs estimated under paragraph (2), actuarial
differences in health care costs attributable to individuals in
different age categories and different geographic locations of
primary residences in the State and the reductions based on
income under subsection (d). No such adjustment shall be made
based on sex.
(2) Data on average costs of services.--Not later than
December 15 before the beginning of each year, the Agency for
Healthcare Research and Quality shall estimate the average cost
of health care for such year for individuals under 65 years of
age and may estimate how such average varies for different
populations of individuals under age 65. The adjustments under
paragraph (1) for age categories for a year shall be based on
such estimates made. Not later than such date, the Secretary
shall prescribe tables for purposes of making adjustments based
on age under paragraph (1) based on such determination which
shall apply for taxable years beginning in the succeeding
calendar year.
(d) Income-Related Phase-Out.--
(1) In general.--The per capita amount as computed under
subsection (b) and adjusted and applied to a deposit qualifying
individual under subsection (c) shall be multiplied by a phase-
out percentage equal to 100 percent reduced by 1 percentage
point for each $1,000 (or fraction thereof) by which the
taxpayer's modified adjusted gross income for the taxable year
exceeds $90,000 (or, in the case of a joint return, $150,000),
multiplied, for a taxable year ending in a year beginning after
December 31, 2015, by the cost-of-living adjustment for the
year as described in section 1(f)(3) of the Internal Revenue
Code of 1986, but substituting ``2015'' for ``1992'' in
subparagraph (B) of such section.
(2) Zero per capita amount for married filing separately.--
The per capita amount under this section shall be zero in the
case of a married couple filing separately.
SEC. 104. STATE OPTIONS FOR IMPROVED ACCESS TO HEALTH INSURANCE
COVERAGE IN EACH STATE.
(a) State Options To Improve Access.--
(1) In general.--Each State may carry out any of the
functions described in succeeding subsections in order to
improve the access of residents of the State to health
insurance coverage.
(2) Repurposing state exchanges.--A State may use or adapt
an Exchange that the State has established under title I of
PPACA to carry out the any of such functions.
(3) Repurposing federal exchange.--The Federal Government
shall make available to States current capabilities of the
Federal Exchange, including the Federal Data Services Hub and
Agent Broker Portal, to the extent requested by a State for
activities related to enrollment of citizens of the State into
health insurance coverage.
(b) Transparency Portal.--Each State may establish and operate an
open and transparent marketplace mechanism whereby qualified residents
of the State can readily compare, through the use of the Internet, the
benefits and prices between different health insurance coverage options
made available to them.
(c) Enrollment, Subject to Individual Opt-Out.--
(1) In general.--Subject to paragraph (2), a State may
provide for the enrollment of qualified residents of the State
who are uninsured in default health insurance coverage offered
under section 105(c) and establishing an HSA for such residents
who do not have an HSA unless the resident has affirmatively
elected not to be so enrolled and not to have an HSA,
respectively. Any such enrollment under this paragraph shall be
coordinated with the annual open enrollment periods provided
under section 105(b).
(2) Simple process for individuals to opt-out.--As a
condition of a State providing for the enrollment function
described in paragraph (1), the State must establish an easy-
to-use and transparent means by which individuals may elect not
to be enrolled in default health insurance coverage or to have
an HSA established on the individual's behalf, or both.
(d) Risk Mitigation Mechanisms and Reinsurance and Risk-Corridor
Programs.--
(1) In general.--Notwithstanding any other provision of
this title or section 223(c)(2) of the Internal Revenue Code of
1986, a State may establish--
(A) mechanisms for risk mitigation or risk
adjustment in order to limit volatility in the premiums
based on health experience to class-average premiums;
and
(B) a reinsurance and risk-corridor program that
involves no Federal funds with respect to coverage both
in the individual market and in the small group market.
(2) Basis for risk adjustment.--Mechanisms and programs
under paragraph (1) may be based on the health status score of
each individual enrolled in health insurance coverage in the
individual market and not solely based on the aggregate risk of
the risk pool with respect to each plan of health insurance
coverage.
SEC. 105. EXPANDED ACCESS AND PATIENT PROTECTIONS.
(a) In General.--As a condition for the election of the alternative
option under section 102 in a State, the State must meet the
requirements of this section.
(b) Annual and Other Open Enrollment Periods.--
(1) In general.--The State shall require, in connection
with the offering of health insurance coverage in the
individual market in the State, that there are uniform annual
and other open enrollment periods (such as those for changes in
life events, changes in State residency, and involuntary
changes in eligibility for coverage under a group health plan)
in order to permit qualified residents to enroll in qualified
health plan coverage in a manner that promotes continuity of
coverage. Such periods shall be consistent with the open
enrollment periods established under title I of PPACA, as in
effect before the date of the enactment of this Act.
(2) Initial open enrollment period.--In addition, the State
shall establish an initial open enrollment period during which
qualified residents may enroll in qualified health plan
coverage without the imposition of any underwriting described
in subsection (d)(1)(B). Such period shall be a period of not
less than 45 days and shall provide for enrollment to become
effective on January 1 of the year specified by the State in
which such State election first becomes effective.
(c) Offering of Default Health Insurance Coverage.--
(1) In general.--The State shall provide for the offering,
through one or more contracts with one or more health insurance
issuers in the State, of default health insurance coverage (as
defined in paragraph (2)) to qualified residents of the State
who are otherwise uninsured. Such default coverage shall be
made available on a continuous basis during a year. Failure of
a qualified resident to enroll in such default coverage or
other creditable coverage during a year results in adverse
consequences described in subsection (d)(1)(B) to the resident.
(2) Default health insurance plan defined.--In this title,
the term ``default health insurance plan'' means, with respect
to a State, health insurance coverage that--
(A) is a high deductible health plan (within the
meaning of section 223(c)(2) of the Internal Revenue
Code of 1986) with prescription drug coverage limited
to generic drugs for a limited number of chronic
conditions (commonly referred to as tier I pharmacy
benefit);
(B) meets such requirements as may apply to qualify
for the payment of plan premiums from a health savings
account under section 223 of such Code (such as age-
related premiums and limitation on imposition of
preexisting condition exclusions);
(C) has a provider network for covered benefits
that is adequate (as determined consistent with
guidelines issued by the Secretary) to ensure access to
health benefits under such plan;
(D) provides for coverage of childhood
immunizations without cost sharing requirements to the
extent such immunizations have in effect a
recommendation from the Advisory Committee on
Immunization Practices of the Centers for Disease
Control and Prevention with respect to the individual
involved; and
(E) meets such other requirements as the State may
specify.
(d) Consequences Respecting Continuous Coverage.--
(1) Consequences for not maintaining continuous coverage.--
(A) Avoidance of consequences by maintaining
continuous coverage.--All qualified residents of a
State are eligible during the initial open enrollment
period provided under subsection (b)(2) to enroll in
qualified health plan coverage and, thereafter, to
maintain continuous coverage in order to avoid the
adverse consequences described in the succeeding
provisions of this paragraph.
(B) Underwriting permitted.--In the case of a
qualified resident of the State who fails to maintain
continuous creditable coverage (not including any
breaks in coverage of less than 63 days), the State
shall--
(i) permit health insurance issuers for the
period specified in subparagraph (C) to
medically underwrite (through denial of health
insurance coverage, application of preexisting
condition limitations, differential premiums,
or otherwise) the issuance of health insurance
coverage, other than with respect to the
issuance of default health insurance coverage
under subsection (c); and
(ii) require health insurance issuers,
during the subsequent 2-year period in the case
of issuance of health insurance coverage other
than such default health insurance coverage, to
impose a monthly late enrollment penalty in the
amount specified in subparagraph (D)(i) and to
remit the amount of such penalty collected to
the Federal Treasury in accordance with
subparagraph (D)(ii).
(C) Period for application of underwriting.--For
purposes of subparagraph (B)(i), the period specified
in this subparagraph is, with respect to an uninsured
individual as of a date, a period (not to exceed 18
months) equivalent to number of months in the previous
18-month period in which the individual did not have
continuous creditable coverage described in
subparagraph (B).
(D) Monthly late enrollment penalty amount.--
(i) In general.--The monthly late
enrollment penalty amount specified in this
clause for a month is equal to the lesser of 10
percent or the product of--
(I) 1 percent of the monthly
premium amount for default health
insurance coverage with respect to the
individual and month; and
(II) the number of months during
the 2-year period (preceding the 18-
month period described in subparagraph
(B)(i)) in which the resident failed to
maintain the continuous coverage
described in paragraph (1)(D).
(ii) Payment of penalty amount to federal
treasury.--The amount of the monthly late
enrollment penalty collected under this
subparagraph shall be paid to the Treasury of
the United States in a form and manner
specified by the Secretary of the Treasury.
(2) Changes in enrollment permitted without medical
underwriting during annual open enrollment periods for those
maintaining continuous coverage.--
(A) During second open enrollment period.--In the
case of a qualified resident who maintains continuous
coverage (not including any breaks in coverage of less
than 63 days) during the period after the initial open
enrollment period under subsection (b)(2) and through
the second annual open enrollment period established by
the State consistent with subsection (b)(1), the State
shall require health insurance issuers to permit such
residents during such second annual open enrollment
period to change the qualified health plan coverage in
which the individual is enrolled without medical
underwriting.
(B) During third and subsequent open enrollment
periods.--In the case of a qualified resident who
maintains continuous coverage for a period of 18 months
or longer (not including any breaks in coverage of less
than 63 days) as of the initial date of a third or
subsequent annual open enrollment period established by
the State under subsection (b)(1), the State shall
require health insurance issuers to permit such
residents during such an open enrollment period to
change the qualified health plan coverage in which the
individual is enrolled without medical underwriting.
SEC. 106. SUNSETTING CERTAIN ACA PROVISIONS; CONTINUATION OF POLICIES
OF COVERING ADULT CHILDREN AND NOT APPLYING LIFETIME OR
ANNUAL LIMITS.
(a) In General.--Subject to subsections (b) and (c), title I of the
Patient Protection and Affordable Care Act (including the amendments
made by such title) shall not apply (and the provisions of law amended
by such title are restored as if such title had not been enacted) in
the case of any State that does not have in effect the election
described in section 101(a)(1).
(b) Continuation of Policies for Extension of Dependent Coverage
for Adult Children and Prohibition of Lifetime and Annual Coverage
Limits.--Subsection (a) shall not apply with respect to the following:
(1) Section 2711 of the Public Health Service Act (relating
to no lifetime or annual limits).
(2) Section 2714 of such Act (relating to extension of
dependent coverage).
(c) Continuation of Policies for Certain States Operating
Exchanges.--Subsection (a) shall not apply with respect to health
insurance coverage in a State that has in effect the election described
in section 101(a)(1).
Subtitle B--Medicaid
SEC. 111. APPLICATION OF HEALTH SAVINGS ACCOUNTS IN RELATION TO
MEDICAID.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by adding at the end the following new
section:
``SEC. 1947. PROVISIONS RELATING TO HEALTH SAVINGS ACCOUNTS.
``(a) Disregarding HSA in Determining Assets and Income for
Medicaid Eligibility Determinations Other Than for Long-Term Care
Services.--The assets in a health savings account under section 223 of
the Internal Revenue Code of 1986, and any income from such assets in
such account, shall be disregarded for purposes of determining
eligibility and amount of medical assistance under this title, other
than for purposes of determining eligibility and the amount of medical
assistance for long-term care services (described in section
1917(c)(1)(C)(i)).
``(b) Notifications of Treasury of Medicaid Eligibility.--In order
to meet the requirements of this subsection (for purposes of section
1902(a)(78)), a State shall provide such notice to the Secretary of the
Treasury, in such form and manner as such Secretary shall specify, as
may be necessary to identify individuals who are eligible for, and
receiving, medical assistance under this title in a month in order to
carry out section 223 of the Internal Revenue Code of 1986.''.
(b) Implementation of Notification Requirement Through State
Plan.--Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a))
is amended by inserting after paragraph (77) the following new
paragraph:
``(78) provide for notice in accordance with section
1947(b) to the Secretary of the Treasury of the identity of
individuals who are determined eligible for (and receiving)
medical assistance under this title;''.
(c) Effective Date.--The amendments made by this section shall
apply to eligibility determinations with respect to medical assistance
for periods beginning on or after January 1, 2016.
Subtitle C--Provider Price Transparency
SEC. 121. ENSURING ACCESS TO EMERGENCY SERVICES WITHOUT EXCESSIVE
CHARGES FOR OUT-OF-NETWORK SERVICES.
(a) In General.--Section 1867 of the Social Security Act (42 U.S.C.
1395dd) is amended--
(1) in subsection (d), by adding at the end the following
new paragraph:
``(5) Enforcement with respect to excessive charges.--A
hospital, physician, or other entity that violates the
requirements of subsection (j)(1) with respect to the
furnishing of items and services is subject to a civil money
penalty of not more than $25,000 for each such violation. The
provisions of section 1128A (other than subsections (a) and
(b)) shall apply to a civil money penalty under this paragraph
in the same manner as such provisions apply with respect to a
penalty or proceeding under section 1128A(a).''; and
(2) by adding at the end the following new subsection:
``(j) Protections Against Excessive Out-of-Network Charges for
Emergency Services.--
``(1) In general.--If items or services to screen or treat
an emergency medical condition are furnished under this section
in a participating hospital with respect to an individual and
the individual has not, directly or through a health insurance
issuer, group health plan, or other third party, negotiated a
payment rate for such items and services, subject to paragraph
(2), the charges imposed for such items and services may not be
in excess of the following:
``(A) Physicians' and other professional
services.--For physicians' services or services of a
health care provider to which section 223(e)(9) of the
Internal Revenue Code of 1986 applies (and including
drugs and biologicals furnished in conjunction with and
billed as part of such services), the lesser of--
``(i) the cash price for such services
posted pursuant to such section; or
``(ii) 85 percent of the usual, customary,
and reasonable (UCR) charge for such services,
as determined under rules established by the
department of insurance for the State in which
the services are furnished.
``(B) Hospital services.--For inpatient and
outpatient hospital services for which payment rates
are established under this title (and including drugs
and biologicals furnished in conjunction with and
billed as part of such services), the lesser of--
``(i) the cash price for such services
posted pursuant to section 223(e)(9) of the
Internal Revenue Code of 1986; or
``(ii) 110 percent of the payment rate
applicable to such services in the case of an
individual entitled to benefits under part A
and enrolled under part B.
``(C) Drugs and biologicals.--For drugs and other
pharmaceuticals furnished to which a previous
subparagraph does not apply, the lesser of--
``(i) twice the acquisition cost to the
hospital or other provider for the dose
involved; or
``(ii) the acquisition cost to the hospital
or other provider plus $250.
The dollar amount in clause (ii) shall be increased
from year to year (beginning with the year after the
first year in which this subsection applies) by the
same percentage as the percentage increase in the
consumer price index for all urban consumers (all
items; U.S. city average) for the year involved (as
determined by the Secretary). Any such dollar amount as
so increased that is not a multiple of $5 shall be
rounded to the nearest multiple of $5 (or, if a
multiple of $2.50, to the next highest multiple of $5).
``(D) Other items and services.--For any other
items or services, the lesser of--
``(i) the cash price for such items and
services posted pursuant to section 223(e)(9)
of the Internal Revenue Code of 1986; or
``(ii) 110 percent of the payment basis
that would be applicable to payment for such
items and services under this title in the case
of an individual entitled to benefits under
part A and enrolled under part B.
``(2) Special rule for items and services furnished as a
bundle.--In the case of items and services for which there is a
single price for a group or bundle of such items and services,
the maximum charge permitted under paragraph (1) may not exceed
the lesser of--
``(A) the price charged for such bundled services;
or
``(B) the aggregate of the maximum charges
permitted under paragraph (1) with respect to items and
services included in such bundle.''.
(b) Reference to Price Disclosure Provision.--For requirements
relating to the posting of health care prices on the Internet, see
section 223(e)(9) of the Internal Revenue Code of 1986, as added by
section 204(a).
(c) Effective Date.--The amendments made by this section shall
apply to charges imposed for items and services furnished on or after
January 1, 2016.
TITLE II--REFORM OF TAX PROVISIONS RELATING TO HEALTH CARE
Subtitle A--Promotion of Health Savings Accounts
SEC. 201. REPEAL OF HIGH DEDUCTIBLE HEALTH PLAN REQUIREMENT.
(a) In General.--Section 223(a) of the Internal Revenue Code of
1986 is amended to read as follows:
``(a) Deduction Allowed.--In the case of an individual, there shall
be allowed as a deduction for a taxable year an amount equal to the
aggregate amount paid in cash during such taxable year by or on behalf
of such individual to a health savings account of such individual.''.
(b) Conforming Amendments.--
(1) Section 223(b)(1) of such Code is amended by striking
``that the individual is an eligible individual''.
(2) Section 223(b)(2) of such Code is amended by striking
``under a high deductible health plan'' each place it appears.
(3) Section 223(b) of such Code is amended by striking
paragraph (8).
(4) Section 223 of such Code is amended by striking
subsection (c) and redesignating subsections (d) through (h) as
subsections (c) through (g), respectively.
(5) Section 223(c)(1)(A) of such Code, as redesignated by
this Act, is amended by striking ``subsection (f)(5)'' and
inserting ``subsection (e)(5)''.
(6) Section 223(f)(1) of such Code, as redesignated by this
Act, is amended--
(A) by striking ``subsections (b)(2) and
(c)(2)(A)'' and inserting ``subsection (b)(2)'',
(B) by striking ``subparagraph (B) thereof--'' and
all that follows through the end of subparagraph (B)
and inserting ``subparagraph (B) thereof `calendar year
1997'.'', and
(C) by striking ``amounts under subsections (b)(2)
and (c)(2)(A)'' in the second sentence and inserting
``amounts under subsection (b)(2)''.
(7) Section 26(b)(2)(U) of such Code is amended by striking
``section 223(f)(4)'' and inserting ``section 223(e)(4)''.
(8) Sections 35(g)(3), 220(f)(5)(A), 848(e)(1)(B)(v),
4973(a)(5), and 6051(a)(12) of such Code are each amended by
striking ``section 223(d)'' each place it appears and inserting
``section 223(c)''.
(9) Section 106(d)(1) of such Code is amended--
(A) by striking ``who is an eligible individual (as
defined in section 223(c)(1))'', and
(B) by striking ``section 223(d)'' and inserting
``section 223(c)''.
(10) Section 408(d)(9) of such Code is amended--
(A) in subparagraph (A) by striking ``who is an
eligible individual (as defined in section 223(c))
and'', and
(B) in subparagraph (C) by striking ``computed on
the basis of the type of coverage under the high
deductible health plan covering the individual at the
time of the qualified HSA funding distribution''.
(11) Section 877A(g)(6) of such Code is amended by striking
``223(f)(4)'' and inserting ``223(e)(4)''.
(12) Section 4973(g) of such Code is amended--
(A) by striking ``section 223(d)'' and inserting
``section 223(c)'',
(B) by striking ``223(f)(5)'' in paragraph (1) and
inserting ``223(e)(5)'',
(C) by striking ``section 223(f)(2)'' in paragraph
(2) and inserting ``section 223(e)(2)'', and
(D) by striking ``section 223(f)(3)'' in the second
sentence and inserting ``section 223(e)(3)''.
(13) Section 4975 of such Code is amended--
(A) in subsection (c)(6)--
(i) by striking ``section 223(d)'' and
inserting ``section 223(c)'', and
(ii) by striking ``section 223(e)(2)'' and
inserting ``section 223(d)(2)'', and
(B) in subsection (e)(1)(E), by striking ``section
223(d)'' and inserting ``section 223(c)''.
(14) Section 6693(a)(2)(C) of such Code is amended by
striking ``section 223(h)'' and inserting ``section 223(g)''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2015.
SEC. 202. TREATMENT OF HSA AFTER DEATH OF ACCOUNT BENEFICIARY.
(a) In General.--Section 223(e)(8) of the Internal Revenue Code of
1986, as redesignated by section 201(c)(3) of this Act, is amended to
read as follows:
``(8) Treatment after death of account beneficiary.--If an
individual acquires an account beneficiary's interest in a
health savings account by reason of the death of the account
beneficiary, such health savings account shall be treated as if
the individual were the account beneficiary.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to interests acquired after the date of the enactment of
this Act.
SEC. 203. PURCHASE OF HEALTH INSURANCE FROM HSA ACCOUNT.
(a) In General.--Section 223(c)(2) of the Internal Revenue Code of
1986, as redesignated by section 201(c)(3), is amended--
(1) in subparagraph (C)--
(A) by striking ``or'' at the end of clause (iii),
(B) by striking the period at the end of clause
(iv) and inserting ``, and'', and
(C) by adding at the end the following new clause:
``(v) in the case of health insurance that
meets the requirements of subparagraph (D).'';
and
(2) by adding at the end the following new subparagraphs:
``(D) Requirements.--The requirements of this
subparagraph are as follows:
``(i) Open enrollment without preexisting
condition exclusions.--The health insurance
coverage or group health plan must permit,
during uniform initial and annual open
enrollment periods and for special enrollment
periods (such as the loss of coverage through
the loss of employment) specified in carrying
out section 105(b) of the Patient Freedom Act
of 2015, any individual who has period of
continuous coverage of not less than 18 months
who is otherwise eligible to enroll under such
coverage or plan to be so enrolled without the
imposition of any preexisting condition
exclusion (as defined for purposes of title
XXVII of the Public Health Service Act).
``(ii) Class based premiums for basic
benefits.--
``(I) In general.--The premium for
such coverage or plan shall be
established based on class-average
status and may vary by age and
geographic area, but may not vary based
upon the health status of the
individual, except that in the case of
an individual without continuous
coverage for a period of 42 months,
such premium may be increased above the
class-average in the manner and for the
time period specified in section
105(d)(1)(A)(ii) of the Patient Freedom
Act of 2015.
``(II) Establishment of actuarial
tables.--In carrying out subclause (I),
the Secretary shall enter into a
contract with a qualified organization,
such as the Academy of Actuaries, for
the development of actuarial tables to
calculate class-average rates based on
age and geography.
``(E) Continuous coverage.--For purposes of this
paragraph, an individual shall be considered to have
continuous coverage as of a time if the individual has
no continuous period in which the individual is
uninsured (as defined in section 100 of the Patient
Freedom Act of 2015) for longer than 63 days beginning
after the date of the enactment of such Act.''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2015.
SEC. 204. PUBLISHING OF CASH PRICE FOR CARE PAID THROUGH HEALTH SAVINGS
ACCOUNTS.
(a) In General.--Section 223(e) of the Internal Revenue Code of
1986, as redesignated by section 201(c)(3), is amended by adding at the
end the following new paragraph:
``(9) Cash price transparency required for payments to
health care providers.--
``(A) In general.--A payment to a health care
provider with respect to the furnishing of health care
items and services by such provider shall not be
treated as a qualified medical expense unless the
health care provider provides for continuing disclosure
(such as through posting on a publicly accessible
website) of the cash price the health care provider
charges for the furnishing of such items and services.
``(B) Form of disclosure.--The disclosure of prices
under this subsection shall be in a form and manner
specified by the Secretary of Health and Human
Services, in consultation with the Secretary, and shall
be designed--
``(i) to establish a single price for
related items and services in a manner similar
to the manner in which pricing and payment for
such items and services is provided under the
Medicare program under title XVIII of the
Social Security Act, and
``(ii) to make it easy for consumers to
compare the prices for similar items and
services furnished by different providers.
``(C) Failure to furnish services or charge in
excess of stated price.--A health care provider shall
be treated as not meeting the requirement of
subparagraph (A), in the case of items and services for
which the provider is disclosing a cash price, if the
provider--
``(i) refuses to furnish such items or
services at the price listed, or
``(ii) charges more than the price listed
for the furnishing of the items and
services.''.
(b) Enforcement.--If the Secretary of Health and Human Services
determines that a health care provider has not provided for continuing
disclosure of the cash price of health care provider charges under
section 223(e)(9) of the Internal Revenue Code of 1986, the Secretary
may instruct the Secretary of the Treasury that payments made to such
provider shall be not treated, for purposes of section 223 of the
Internal Revenue Code of 1986, as an amount used for a qualified
medical expense for a period of not to exceed 1 year.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2015.
Subtitle B--Health Care Tax Credits
SEC. 211. LIMITED APPLICATION OF PPACA HEALTH PREMIUM CREDIT.
(a) In General.--Section 36B(c)(1) of the Internal Revenue Code of
1986 is amended by adding at the end the following:
``(E) Special rule for residents of states
continuing ppaca implementation.--No credit shall be
allowed under this section to any individual who is not
a qualified resident (as defined in section 100(14) of
the Patient Freedom Act of 2015) of a State that has
elected the option under section 101(a)(1) of such Act
in relation to the implementation of title I of the
Patient Protection and Affordable Care Act.''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2015.
SEC. 212. NEW HSA CREDIT.
(a) In General.--Subpart C of part IV of subchapter A of chapter 1
of the Internal Revenue Code of 1986 is amended by adding at the end
the following new section:
``SEC. 36C. HSA CREDIT.
``(a) In General.--In the case of a qualified individual, there
shall be allowed as a credit against the tax imposed by this subtitle
for any taxable year, an amount equal to the HSA credit amount of the
individual for the taxable year.
``(b) Qualifying Individual.--For purposes of this section, the
term `qualifying individual' means, with respect to any month, any
individual who for such month is deposit qualifying resident (as
defined in section 102(b)(2) of the Patient Freedom Act of 2015) of a
State described in section 101(a)(3) of such Act that elects to have
section 102(b) of such Act carried out by way of the credit determined
under this section.
``(c) HSA Credit Amount.--For purposes of this section, the term
`HSA credit amount' means, with respect to any taxable year, the sum of
the HSA deposit amounts determined under section 103 of the Patient
Freedom Act of 2015 with respect to the individual for all months
ending during the taxable year.
``(d) Special Rules.--For purposes of this section--
``(1) Reconciliation of credit and advance credit.--
``(A) Excess advance payments.--If the advance
payments to an individual for a taxable year under
subsection (e) exceed the credit allowed by this
section with respect to such individual for such
taxable year, the tax imposed by this chapter for the
taxable year shall be increased by the amount of such
excess.
``(B) Advance payment shortfall.--If the credit
allowed by this section (determined without regard to
this subparagraph) with respect to an individual for a
taxable year exceeds the advance payments to such
individual for such taxable year under subsection (e),
the Secretary shall, in lieu of a credit allowed
against the tax imposed by this subtitle, make a
payment on behalf of such individual to such
individual's health savings account in an amount equal
to such excess.
``(2) Married couples must file joint return.--If the
taxpayer is married (within the meaning of section 7703) at the
close of the taxable year, the credit shall be allowed under
this section only if the taxpayer and the taxpayer's spouse
file a joint return for the taxable year.
``(e) Advance Payment Program.--
``(1) In general.--The Secretary of the Treasury, in
consultation with the Secretary of Health and Human Services,
shall establish a program--
``(A) to make advance determinations with respect
to the eligibility of individuals for the credit
allowed under this section, and
``(B) to make advance payments of the credit
allowed under this section directly to the health
savings account of any such individual so eligible.
``(2) Program requirements.--Such program shall be
established under rules similar to the rules of section 1412 of
the Patient Protection and Affordable Care Act, except that
advance determinations and advance payments shall be made on
request of the individual with respect to whom the
determination is to be made and taking into account the
enrollment process (including any opt-out election under such
process) established under section 104(c)(1) of the Patient
Freedom Act of 2015.''.
(b) Clerical Amendment.--The table of sections for such subpart is
amended by adding at the end the following:
``Sec. 36C. HSA credit.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2015.
<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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