Individual Health Insurance Marketplace Improvement Act
This bill establishes, and provides funding for, a reinsurance program for qualified health plans relating to the health insurance claims of high-cost individuals.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4652 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 4652
To establish an Individual Market Reinsurance fund to provide funding
for State individual market stabilization reinsurance programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 11, 2019
Mr. Langevin (for himself, Ms. Judy Chu of California, and Mr. Ruiz)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committee on 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 establish an Individual Market Reinsurance fund to provide funding
for State individual market stabilization reinsurance programs.
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 ``Individual Health Insurance
Marketplace Improvement Act''.
SEC. 2. INDIVIDUAL MARKET REINSURANCE FUND.
(a) Establishment of Fund.--
(1) In general.--There is established the ``Individual
Market Reinsurance Fund'' to be administered by the Secretary
to provide funding for an individual market stabilization
reinsurance program in each State that complies with the
requirements of this section.
(2) Funding.--There is appropriated to the Fund, out of any
moneys in the Treasury not otherwise appropriated, such sums as
are necessary to carry out this section (other than subsection
(c)) for each calendar year beginning with 2020. Amounts
appropriated to the Fund shall remain available without fiscal
or calendar year limitation to carry out this section.
(b) Individual Market Reinsurance Program.--
(1) Use of funds.--The Secretary shall use amounts in the
Fund to establish a reinsurance program under which the
Secretary shall make reinsurance payments to health insurance
issuers with respect to high-cost individuals enrolled in
qualified health plans offered by such issuers that are not
grandfathered health plans or transitional health plans for any
plan year beginning with the 2020 plan year. This subsection
constitutes budget authority in advance of appropriations Acts
and represents the obligation of the Secretary to provide
payments from the Fund in accordance with this subsection.
(2) Amount of payment.--The payment made to a health
insurance issuer under subsection (a) with respect to each
high-cost individual enrolled in a qualified health plan issued
by the issuer that is not a grandfathered health plan or a
transitional health plan shall equal 80 percent of the lesser
of--
(A) the amount (if any) by which the individual's
claims incurred during the plan year exceeds--
(i) in case of the 2020, 2021, or 2022 plan
year, $50,000; and
(ii) in the case of any other plan year,
$100,000; or
(B) for plan years described in--
(i) subparagraph (A)(i), $450,000; and
(ii) subparagraph (A)(ii), $400,000.
(3) Indexing.--In the case of plan years beginning after
2020, the dollar amounts that appear in subparagraphs (A) and
(B) of paragraph (2) shall each be increased by an amount equal
to--
(A) such amount; multiplied by
(B) the premium adjustment percentage specified
under section 1302(c)(4) of the Affordable Care Act,
but determined by substituting ``2020'' for ``2013''.
(4) Payment methods.--
(A) In general.--Payments under this subsection
shall be based on such a method as the Secretary
determines. The Secretary may establish a payment
method by which interim payments of amounts under this
subsection are made during a plan year based on the
Secretary's best estimate of amounts that will be
payable after obtaining all of the information.
(B) Requirement for provision of information.--
(i) Requirement.--Payments under this
subsection to a health insurance issuer are
conditioned upon the furnishing to the
Secretary, in a form and manner specified by
the Secretary, of such information as may be
required to carry out this subsection.
(ii) Restriction on use of information.--
Information disclosed or obtained pursuant to
clause (i) is subject to the HIPAA privacy and
security law, as defined in section 3009(a) of
the Public Health Service Act (42 U.S.C. 300jj-
19(a)).
(5) Secretary flexibility for budget neutral revisions to
reinsurance payment specifications.--If the Secretary
determines appropriate, the Secretary may substitute higher
dollar amounts for the dollar amounts specified under
subparagraphs (A) and (B) of paragraph (2) (and adjusted under
paragraph (3), if applicable) if the Secretary certifies that
such substitutions, considered together, neither increase nor
decease the total projected payments under this subsection.
(c) Outreach and Enrollment.--
(1) In general.--During the period that begins on January
1, 2020, and ends on December 31, 2022, the Secretary shall
award grants to eligible entities for the following purposes:
(A) Outreach and enrollment.--To carry out
outreach, public education activities, and enrollment
activities to raise awareness of the availability of,
and encourage enrollment in, qualified health plans.
(B) Assisting individuals transition to qualified
health plans.--To provide assistance to individuals who
are enrolled in health insurance coverage that is not a
qualified health plan enroll in a qualified health
plan.
(C) Assisting enrollment in public health
programs.--To facilitate the enrollment of eligible
individuals in the Medicare program or in a State
Medicaid program, as appropriate.
(D) Raising awareness of premium assistance and
cost-sharing reductions.--To distribute fair and
impartial information concerning enrollment in
qualified health plans and the availability of premium
assistance tax credits under section 36B of the
Internal Revenue Code of 1986 and cost-sharing
reductions under section 1402 of the Patient Protection
and Affordable Care Act, and to assist eligible
individuals in applying for such tax credits and cost-
sharing reductions.
(2) Eligible entities defined.--
(A) In general.--In this subsection, the term
``eligible entity'' means--
(i) a State; or
(ii) a nonprofit community-based
organization.
(B) Enrollment agents.--Such term includes a
licensed independent insurance agent or broker that has
an arrangement with a State or nonprofit community-
based organization to enroll eligible individuals in
qualified health plans.
(C) Exclusions.--Such term does not include an
entity that--
(i) is a health insurance issuer; or
(ii) receives any consideration, either
directly or indirectly, from any health
insurance issuer in connection with the
enrollment of any qualified individuals or
employees of a qualified employer in a
qualified health plan.
(3) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to awarding grants to States
or eligible entities in States that have geographic rating
areas at risk of having no qualified health plans in the
individual market.
(4) Funding.--Out of any moneys in the Treasury not
otherwise appropriated, $500,000,000 is appropriated to the
Secretary for each of calendar years 2020 through 2022, to
carry out this subsection.
(d) Reports to Congress.--
(1) Annual report.--The Secretary shall submit a report to
Congress, not later than January 21, 2021, and each year
thereafter, that contains the following information for the
most recently ended year:
(A) The number and types of plans in each State's
individual market, specifying the number that are
qualified health plans, grandfathered health plans, or
health insurance coverage that is not a qualified
health plan.
(B) The impact of the reinsurance payments provided
under this section on the availability of coverage,
cost of coverage, and coverage options in each State.
(C) The amount of premiums paid by individuals in
each State by age, family size, geographic area in the
State's individual market, and category of health plan
(as described in subparagraph (A)).
(D) The process used to award funds for outreach
and enrollment activities awarded to eligible entities
under subsection (c), the amount of such funds awarded,
and the activities carried out with such funds.
(E) Such other information as the Secretary deems
relevant.
(2) Evaluation report.--Not later than January 31, 2024,
the Secretary shall submit to Congress a report that--
(A) analyzes the impact of the funds provided under
this section on premiums and enrollment in the
individual market in all States; and
(B) contains a State-by-State comparison of the
design of the programs carried out by States with funds
provided under this section.
(e) Definitions.--In this section:
(1) Secretary.--The term ``Secretary'' means the Secretary
of the Department of Health and Human Services.
(2) Fund.--The term ``Fund'' means the Individual Market
Reinsurance Fund established under subsection (a).
(3) Grandfathered health plan.--The term ``grandfathered
health plan'' has the meaning given that term in section
1251(e) of the Patient Protection and Affordable Care Act.
(4) High-cost individual.--The term ``high-cost
individual'' means an individual enrolled in a qualified health
plan (other than a grandfathered health plan or a transitional
health plan) who incurs claims in excess of $50,000 during a
plan year.
(5) State.--The term ``State'' means each of the 50 States
and the District of Columbia.
(6) Transitional health plan.--The term ``transitional
health plan'' means a plan continued under the letter issued by
the Centers for Medicare & Medicaid Services on November 14,
2013, to the State Insurance Commissioners outlining a
transitional policy for coverage in the individual and small
group markets to which section 1251 of the Patient Protection
and Affordable Care Act does not apply, and under the extension
of the transitional policy for such coverage set forth in the
Insurance Standards Bulletin Series guidance issued by the
Centers for Medicare & Medicaid Services on March 5, 2014,
February 29, 2016, and February 13, 2017.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on 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 Committee on 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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