Pre-existing Conditions Protection Act of 2017
This bill sets forth amendments that would take effect in the case of the repeal of the Patient Protection and Affordable Care Act (PPACA) and the health care provisions of the Health Care and Education Reconciliation Act of 2010 and the restoration of the provisions amended by those provisions.
If the amendments take effect, the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and Internal Revenue Code are revised to maintain PPACA consumer protections. Specifically, the bill would maintain the:
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1121 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 1121
To amend the Public Health Service Act to prohibit application of pre-
existing condition exclusions and to guarantee availability of health
insurance coverage in the individual and group market, contingent on
the enactment of legislation repealing the Patient Protection and
Affordable Care Act, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 16, 2017
Mr. Walden (for himself, Mr. Latta, Mr. Walberg, Mr. Guthrie, Mr.
Lance, Mr. McKinley, Mr. Bilirakis, Mrs. Mimi Walters of California,
Mr. Mitchell, Mr. Bishop of Michigan, Mrs. Wagner, Mrs. Brooks of
Indiana, Mr. Knight, Mr. Bucshon, Mr. Cramer, Mr. Rodney Davis of
Illinois, Mr. Poliquin, Ms. Herrera Beutler, Mr. Reichert, Mr. Harper,
Mr. Upton, Mr. Royce of California, Mr. Allen, Mr. Abraham, Mr. Tipton,
Mr. Smucker, Mr. Kelly of Pennsylvania, Mr. Denham, Mr. Donovan, Mr.
Fortenberry, Ms. Jenkins of Kansas, Mr. Collins of New York, Mr.
Stivers, Mrs. McMorris Rodgers, Mr. Costello of Pennsylvania, Mr.
Flores, Mr. Roskam, Mr. Kinzinger, Mr. Shuster, Mr. Tiberi, Mr. Wilson
of South Carolina, Mr. Simpson, and Mr. Murphy of Pennsylvania)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committees on Education and
the Workforce, and Ways and Means, 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 amend the Public Health Service Act to prohibit application of pre-
existing condition exclusions and to guarantee availability of health
insurance coverage in the individual and group market, contingent on
the enactment of legislation repealing the Patient Protection and
Affordable Care Act, 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.
This Act may be cited as the ``Pre-existing Conditions Protection
Act of 2017''.
SEC. 2. PROHIBITION OF PRE-EXISTING CONDITION EXCLUSIONS.
(a) Group Market.--Subject to section 6(a) of this Act, subpart 1
of part A of title XXVII of the Public Health Service Act (42 U.S.C.
300gg et seq.), as restored or revived pursuant to PPACA repeal
legislation described in section 6(b) of this Act, is amended by
striking section 2701 and inserting the following:
``SEC. 2701. PROHIBITION OF PRE-EXISTING CONDITION EXCLUSIONS.
``(a) In General.--A group health plan or a health insurance issuer
offering group health insurance coverage may not impose any pre-
existing condition exclusion with respect to such plan or coverage.
``(b) Definitions.--For purposes of this section:
``(1) Pre-existing condition exclusion.--
``(A) In general.--The term `pre-existing condition
exclusion' means, with respect to a group health plan
or health insurance coverage, a limitation or exclusion
of benefits relating to a condition based on the fact
that the condition was present before the date of
enrollment in such plan or for such coverage, whether
or not any medical advice, diagnosis, care, or
treatment was recommended or received before such date.
``(B) Treatment of genetic information.--Genetic
information shall not be treated as a pre-existing
condition in the absence of a diagnosis of the
condition related to such information.
``(2) Date of enrollment.--The term `date of enrollment'
means, with respect to an individual covered under a group
health plan or health insurance coverage, the date of
enrollment of the individual in the plan or coverage or, if
earlier, the first day of the waiting period for such
enrollment.
``(3) Waiting period.--The term `waiting period' means,
with respect to a group health plan and an individual who is a
potential participant or beneficiary in the plan, the period
that must pass with respect to the individual before the
individual is eligible to be covered for benefits under the
terms of the plan.''.
(b) Individual Market.--Subject to section 6(a) of this Act,
subpart 1 of part B of title XXVII of the Public Health Service Act (42
U.S.C. 300gg-41 et seq.), as restored or revived pursuant to PPACA
repeal legislation described in section 6(b) of this Act, is amended by
adding at the end the following:
``SEC. 2746. PROHIBITION OF PRE-EXISTING CONDITION EXCLUSIONS OR OTHER
DISCRIMINATION BASED ON HEALTH STATUS.
``The provisions of section 2701 shall apply to health insurance
coverage offered to individuals by a health insurance issuer in the
individual market in the same manner as it applies to health insurance
coverage offered by a health insurance issuer in the group market.''.
SEC. 3. GUARANTEED AVAILABILITY OF COVERAGE.
(a) Group Market.--Subject to section 6(a) of this Act, subpart 3
of part A of title XXVII of the Public Health Service Act, as restored
or revived pursuant to PPACA repeal legislation described in section
6(b) of this Act, is amended by striking section 2711 (42 U.S.C. 300gg-
11) and inserting the following:
``SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE.
``(a) Guaranteed Issuance of Coverage in the Group Market.--Subject
to subsection (b), each health insurance issuer that offers health
insurance coverage in the group market in a State shall accept every
employer and every individual in a group in the State that applies for
such coverage.
``(b) Enrollment.--
``(1) Restriction.--A health insurance issuer described in
subsection (a) may restrict enrollment in coverage described in
such subsection to open or special enrollment periods.
``(2) Establishment.--A health insurance issuer described
in subsection (a) shall establish special enrollment periods
for qualifying events (as such term is defined in section 603
of the Employee Retirement Income Security Act of 1974).''.
(b) Individual Market.--Subject to section 6(a) of this Act,
subpart 1 of part B of title XXVII of the Public Health Service Act, as
restored or revived pursuant to PPACA repeal legislation described in
section 6(b) of this Act, is amended by striking section 2741 of such
Act (42 U.S.C. 300gg-41) and inserting the following:
``SEC. 2741. GUARANTEED AVAILABILITY OF COVERAGE.
``The provisions of section 2711 shall apply to health insurance
coverage offered to individuals by a health insurance issuer in the
individual market in the same manner as such provisions apply to health
insurance coverage offered to employers by a health insurance issuer in
connection with health insurance coverage in the group market. For
purposes of this section, the Secretary shall treat any reference of
the word `employer' in such section as a reference to the term
`individual'.''.
SEC. 4. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND
BENEFICIARIES BASED ON HEALTH STATUS.
(a) Group Market.--Subject to section 6(a) of this Act, section
2702 of the Public Health Service Act, as restored or revived pursuant
to PPACA repeal legislation described in section 6(b) of this Act, is
amended to read as follows:
``SEC. 2702. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS
AND BENEFICIARIES BASED ON HEALTH STATUS.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage may not establish rules
for eligibility (including continued eligibility) of any individual to
enroll under the terms of the plan or coverage based on any of the
following health status-related factors in relation to the individual
or a dependent of the individual:
``(1) Health status.
``(2) Medical condition (including both physical and mental
illnesses).
``(3) Claims experience.
``(4) Receipt of health care.
``(5) Medical history.
``(6) Genetic information.
``(7) Evidence of insurability (including conditions
arising out of acts of domestic violence).
``(8) Disability.
``(9) Any other health status-related factor determined
appropriate by the Secretary.
``(b) In Premium Contributions.--
``(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage, may
not require any individual (as a condition of enrollment or
continued enrollment under the plan) to pay a premium or
contribution which is greater than such premium or contribution
for a similarly situated individual enrolled in the plan on the
basis of any health status-related factor in relation to the
individual or to an individual enrolled under the plan as a
dependent of the individual.
``(2) Construction.--Nothing in paragraph (1) shall be
construed--
``(A) to restrict the amount that an employer or
individual may be charged for coverage under a group
health plan except as provided in paragraph (3); or
``(B) to prevent a group health plan, and a health
insurance issuer offering group health insurance
coverage, from establishing premium discounts or
rebates or modifying otherwise applicable copayments or
deductibles in return for adherence to programs of
health promotion and disease prevention.
``(3) No group-based discrimination on basis of genetic
information.--
``(A) In general.--For purposes of this section, a
group health plan, and health insurance issuer offering
group health insurance coverage, may not adjust premium
or contribution amounts for the group covered under
such plan on the basis of genetic information.
``(B) Rule of construction.--Nothing in
subparagraph (A) or in paragraphs (1) and (2) of
subsection (d) shall be construed to limit the ability
of a health insurance issuer offering group health
insurance coverage to increase the premium for an
employer based on the manifestation of a disease or
disorder of an individual who is enrolled in the plan.
In such case, the manifestation of a disease or
disorder in one individual cannot also be used as
genetic information about other group members and to
further increase the premium for the employer.
``(c) Genetic Testing.--
``(1) Limitation on requesting or requiring genetic
testing.--A group health plan, and a health insurance issuer
offering health insurance coverage in connection with a group
health plan, shall not request or require an individual or a
family member of such individual to undergo a genetic test.
``(2) Rule of construction.--Paragraph (1) shall not be
construed to limit the authority of a health care professional
who is providing health care services to an individual to
request that such individual undergo a genetic test.
``(3) Rule of construction regarding payment.--
``(A) In general.--Nothing in paragraph (1) shall
be construed to preclude a group health plan, or a
health insurance issuer offering health insurance
coverage in connection with a group health plan, from
obtaining and using the results of a genetic test in
making a determination regarding payment (as such term
is defined for the purposes of applying the regulations
promulgated by the Secretary under part C of title XI
of the Social Security Act and section 264 of the
Health Insurance Portability and Accountability Act of
1996, as may be revised from time to time) consistent
with subsection (a).
``(B) Limitation.--For purposes of subparagraph
(A), a group health plan, or a health insurance issuer
offering health insurance coverage in connection with a
group health plan, may request only the minimum amount
of information necessary to accomplish the intended
purpose.
``(4) Research exception.--Notwithstanding paragraph (1), a
group health plan, or a health insurance issuer offering health
insurance coverage in connection with a group health plan, may
request, but not require, that a participant or beneficiary
undergo a genetic test if each of the following conditions is
met:
``(A) The request is made pursuant to research that
complies with part 46 of title 45, Code of Federal
Regulations, or equivalent Federal regulations, and any
applicable State or local law or regulations for the
protection of human subjects in research.
``(B) The plan or issuer clearly indicates to each
participant or beneficiary, or in the case of a minor
child, to the legal guardian of such beneficiary, to
whom the request is made that--
``(i) compliance with the request is
voluntary; and
``(ii) non-compliance will have no effect
on enrollment status or premium or contribution
amounts.
``(C) No genetic information collected or acquired
under this paragraph shall be used for underwriting
purposes.
``(D) The plan or issuer notifies the Secretary in
writing that the plan or issuer is conducting
activities pursuant to the exception provided for under
this paragraph, including a description of the
activities conducted.
``(E) The plan or issuer complies with such other
conditions as the Secretary may by regulation require
for activities conducted under this paragraph.
``(d) Prohibition on Collection of Genetic Information.--
``(1) In general.--A group health plan, and a health
insurance issuer offering health insurance coverage in
connection with a group health plan, shall not request,
require, or purchase genetic information for underwriting
purposes (as defined in section 2791).
``(2) Prohibition on collection of genetic information
prior to enrollment.--A group health plan, and a health
insurance issuer offering health insurance coverage in
connection with a group health plan, shall not request,
require, or purchase genetic information with respect to any
individual prior to such individual's enrollment under the plan
or coverage in connection with such enrollment.
``(3) Incidental collection.--If a group health plan, or a
health insurance issuer offering health insurance coverage in
connection with a group health plan, obtains genetic
information incidental to the requesting, requiring, or
purchasing of other information concerning any individual, such
request, requirement, or purchase shall not be considered a
violation of paragraph (2) if such request, requirement, or
purchase is not in violation of paragraph (1).
``(e) Genetic Information of a Fetus or Embryo.--Any reference in
this part to genetic information concerning an individual or family
member of an individual shall--
``(1) with respect to such an individual or family member
of an individual who is a pregnant woman, include genetic
information of any fetus carried by such pregnant woman; and
``(2) with respect to an individual or family member
utilizing an assisted reproductive technology, include genetic
information of any embryo legally held by the individual or
family member.
``(f) Programs of Health Promotion or Disease Prevention.--
``(1) General provisions.--
``(A) General rule.--For purposes of subsection
(b)(2)(B), a program of health promotion or disease
prevention (referred to in this subsection as a
`wellness program') shall be a program offered by an
employer that is designed to promote health or prevent
disease that meets the applicable requirements of this
subsection.
``(B) No conditions based on health status
factor.--If none of the conditions for obtaining a
premium discount or rebate or other reward for
participation in a wellness program is based on an
individual satisfying a standard that is related to a
health status factor, such wellness program shall not
violate this section if participation in the program is
made available to all similarly situated individuals
and the requirements of paragraph (2) are complied
with.
``(C) Conditions based on health status factor.--If
any of the conditions for obtaining a premium discount
or rebate or other reward for participation in a
wellness program is based on an individual satisfying a
standard that is related to a health status factor,
such wellness program shall not violate this section if
the requirements of paragraph (3) are complied with.
``(2) Wellness programs not subject to requirements.--If
none of the conditions for obtaining a premium discount or
rebate or other reward under a wellness program as described in
paragraph (1)(B) are based on an individual satisfying a
standard that is related to a health status factor (or if such
a wellness program does not provide such a reward), the
wellness program shall not violate this section if
participation in the program is made available to all similarly
situated individuals. The following programs shall not have to
comply with the requirements of paragraph (3) if participation
in the program is made available to all similarly situated
individuals:
``(A) A program that reimburses all or part of the
cost for memberships in a fitness center.
``(B) A diagnostic testing program that provides a
reward for participation and does not base any part of
the reward on outcomes.
``(C) A program that encourages preventive care
related to a health condition through the waiver of the
copayment or deductible requirement under group health
plan for the costs of certain items or services related
to a health condition (such as prenatal care or well-
baby visits).
``(D) A program that reimburses individuals for the
costs of smoking cessation programs without regard to
whether the individual quits smoking.
``(E) A program that provides a reward to
individuals for attending a periodic health education
seminar.
``(3) Wellness programs subject to requirements.--If any of
the conditions for obtaining a premium discount, rebate, or
reward under a wellness program as described in paragraph
(1)(C) is based on an individual satisfying a standard that is
related to a health status factor, the wellness program shall
not violate this section if the following requirements are
complied with:
``(A) The reward for the wellness program, together
with the reward for other wellness programs with
respect to the plan that requires satisfaction of a
standard related to a health status factor, shall not
exceed 30 percent of the cost of employee-only coverage
under the plan. If, in addition to employees or
individuals, any class of dependents (such as spouses
or spouses and dependent children) may participate
fully in the wellness program, such reward shall not
exceed 30 percent of the cost of the coverage in which
an employee or individual and any dependents are
enrolled. For purposes of this paragraph, the cost of
coverage shall be determined based on the total amount
of employer and employee contributions for the benefit
package under which the employee is (or the employee
and any dependents are) receiving coverage. A reward
may be in the form of a discount or rebate of a premium
or contribution, a waiver of all or part of a cost-
sharing mechanism (such as deductibles, copayments, or
coinsurance), the absence of a surcharge, or the value
of a benefit that would otherwise not be provided under
the plan. The Secretaries of Labor, Health and Human
Services, and the Treasury may increase the reward
available under this subparagraph to up to 50 percent
of the cost of coverage if the Secretaries determine
that such an increase is appropriate.
``(B) The wellness program shall be reasonably
designed to promote health or prevent disease. A
program complies with the preceding sentence if the
program has a reasonable chance of improving the health
of, or preventing disease in, participating individuals
and it is not overly burdensome, is not a subterfuge
for discriminating based on a health status factor, and
is not highly suspect in the method chosen to promote
health or prevent disease.
``(C) The plan shall give individuals eligible for
the program the opportunity to qualify for the reward
under the program at least once each year.
``(D) The full reward under the wellness program
shall be made available to all similarly situated
individuals. For such purpose, among other things:
``(i) The reward is not available to all
similarly situated individuals for a period
unless the wellness program allows--
``(I) for a reasonable alternative
standard (or waiver of the otherwise
applicable standard) for obtaining the
reward for any individual for whom, for
that period, it is unreasonably
difficult due to a medical condition to
satisfy the otherwise applicable
standard; and
``(II) for a reasonable alternative
standard (or waiver of the otherwise
applicable standard) for obtaining the
reward for any individual for whom, for
that period, it is medically
inadvisable to attempt to satisfy the
otherwise applicable standard.
``(ii) If reasonable under the
circumstances, the plan or issuer may seek
verification, such as a statement from an
individual's physician, that a health status
factor makes it unreasonably difficult or
medically inadvisable for the individual to
satisfy or attempt to satisfy the otherwise
applicable standard.
``(E) The plan or issuer involved shall disclose in
all plan materials describing the terms of the wellness
program the availability of a reasonable alternative
standard (or the possibility of waiver of the otherwise
applicable standard) required under subparagraph (D).
If plan materials disclose that such a program is
available, without describing its terms, the disclosure
under this subparagraph shall not be required.
``(g) Existing Programs.--Nothing in this section shall prohibit a
program of health promotion or disease prevention that was established
prior to the date of enactment of this section and applied with all
applicable regulations, and that is operating on such date, from
continuing to be carried out for as long as such regulations remain in
effect.
``(h) Regulations.--Nothing in this section shall be construed as
prohibiting the Secretaries of Labor, Health and Human Services, or the
Treasury from promulgating regulations in connection with this
section.''.
(b) Individual Market.--Subject to section 6(a) of this Act,
subpart 1 of part B of title XXVII of the Public Health Service Act, as
restored or revived pursuant to PPACA repeal legislation described in
section 6(b) of this Act and amended by section 2(b), is further
amended by adding at the end the following:
``SEC. 2747. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS
AND BENEFICIARIES BASED ON HEALTH STATUS.
``The provisions of section 2702 (other than subsections (b)(2)(B)
and (f) of such section) shall apply to health insurance coverage
offered to individuals by a health insurance issuer in the individual
market in the same manner as such provisions apply to health insurance
coverage offered to employers by a health insurance issuer in
connection with health insurance coverage in the group market.''.
SEC. 5. INCORPORATION INTO ERISA AND INTERNAL REVENUE CODE.
(a) ERISA.--Subpart B of part 7 of subtitle A of title I of the
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 et
seq.) is amended by adding at the end the following:
``SEC. 715. ADDITIONAL MARKET REFORMS.
``Sections 2701, 2702, and 2711 shall apply to group health plans,
and health insurance issuers providing health insurance coverage in
connection with group health plans, as if included in this subpart, and
to the extent that any provision of this part conflicts with a
provision of such a section with respect to group health plans, or
health insurance issuers providing health insurance coverage in
connection with group health plans, the provisions of such section
shall apply.''.
(b) IRC.--Subchapter B of chapter 100 of the Internal Revenue Code
of 1986 is amended by adding at the end the following:
``SEC. 9815. ADDITIONAL MARKET REFORMS.
``Sections 2701, 2702, and 2711 shall apply to group health plans,
and health insurance issuers providing health insurance coverage in
connection with group health plans, as if included in this subchapter,
and to the extent that any provision of this subchapter conflicts with
a provision of such a section with respect to group health plans, or
health insurance issuers providing health insurance coverage in
connection with group health plans, the provisions of such section
shall apply.''.
SEC. 6. EFFECTIVE DATE CONTINGENT ON REPEAL OF PPACA.
(a) In General.--Sections 2, 3, 4, and 5 and the amendments made by
such sections shall take effect upon the enactment of PPACA repeal
legislation described in subsection (b) and such sections and
amendments shall have no force or effect if such PPACA repeal
legislation is not enacted.
(b) PPACA Repeal Legislation Described.--For purposes of subsection
(a), PPACA repeal legislation described in this subsection is
legislation that--
(1) repeals Public Law 111-148, and restores or revives the
provisions of law amended or repealed, respectively, by such
Act as if such Act had not been enacted and without further
amendment to such provisions of law; and
(2) repeals title I and subtitle B of title II of the
Health Care and Education Reconciliation Act of 2010 (Public
Law 111-152), and restores or revives the provisions of law
amended or repealed, respectively, by such title or subtitle,
respectively, as if such title and subtitle had not been
enacted and without further amendment to such provisions of
law.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, 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 Education and the Workforce, and Ways and Means, 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 Education and the Workforce, and Ways and Means, 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 Education and the Workforce, and Ways and Means, 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.
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