Medicare Buy-In and Health Care Stabilization Act of 2021
This bill establishes a Medicare buy-in option for certain qualifying individuals and makes a series of other changes relating to health care costs.
Specifically, the bill allows individuals aged 50 to 64 to enroll in Medicare if such individuals would otherwise qualify for Medicare at the age of 65. The Centers for Medicare & Medicaid Services (CMS) must determine enrollment periods and set premiums for the buy-in option established under the bill, in accordance with specified requirements. The CMS must also award grants to states and nonprofit organizations for outreach and enrollment activities relating to the buy-in option.
The bill also (1) establishes a supplemental option under Medicare to cover cost-sharing for beneficiaries; (2) repeals provisions that prohibit the CMS from negotiating the prices of prescription drugs; (3) establishes an individual market reinsurance program relating to coverage of high-cost individuals, as specified; and (4) makes permanent certain increases and expansions of the premium tax credit.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2881 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 2881
To amend title XVIII of the Social Security Act to provide for an
option for individuals who are ages 50 to 64 to buy into Medicare, to
provide for health insurance market stabilization, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 28, 2021
Mr. Higgins of New York (for himself, Mr. Larson of Connecticut, Mr.
Courtney, and Mr. Welch) 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 amend title XVIII of the Social Security Act to provide for an
option for individuals who are ages 50 to 64 to buy into Medicare, to
provide for health insurance market stabilization, 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 ``Medicare Buy-In and Health Care
Stabilization Act of 2021''.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) Medicare has coverage gaps and should provide more
comprehensive coverage, including increasing coverage for the
medical needs of beneficiaries relating to hearing, dental, and
vision care.
(2) Special needs populations face financial challenges to
secure coverage for Medicare's out of pocket costs and other
hurdles.
(3) Medicare Buy-In is a step in the right direction as
Congress considers additional needed legislation to address
these and other coverage issues and beneficiary financial
challenges in Medicare and Medicare Buy-In.
SEC. 3. MEDICARE BUY-IN OPTION.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395c et seq.) is amended by adding at the end the following new
section:
``medicare buy-in option
``Sec. 1899C. (a) Option.--
``(1) In general.--Every individual who meets the
requirements described in paragraph (2) shall be eligible to
enroll under this section.
``(2) Eligibility.--An individual who meets the following
requirements is eligible to enroll under this section:
``(A) Age.--The individual has attained 50 years of
age, but has not attained 65 years of age.
``(B) Medicare eligibility (but for age).--The
individual is not otherwise entitled to benefits under
part A or eligible to enroll under part A or part B but
would be eligible for benefits under part A or part B
if the individual were 65 years of age.
``(3) Part a, b, and d benefits and protections.--An
individual enrolled under this section is entitled to the same
benefits (and shall receive the same protections) under this
title as an individual who is entitled to benefits under part A
and enrolled under parts B and D, including the ability to
enroll in a Medicare Advantage plan that provides qualified
prescription drug coverage (an MA-PD plan) and including access
to the Medicare Beneficiary Ombudsman under section 1808(c).
``(b) Enrollment and Coverage Periods.--The Secretary shall
establish enrollment and coverage periods for individuals who enroll
under this section. Such periods shall be established in coordination
with the enrollment and coverage periods for plans offered under an
Exchange established under title I of the Patient Protection and
Affordable Care Act. The Secretary shall establish such periods so that
coverage under this section shall first begin on January 1 of the first
year beginning at least one year after the date of the enactment of
this section and shall include special enrollment periods, in
accordance with section 155.420 of title 45 of the Code of Federal
Regulations, that are applicable to qualified health plans offered
through an Exchange.
``(c) Buy-In Premium.--
``(1) Amount of monthly premiums.--The Secretary shall
(beginning for the first year that begins more than 1 year
after the date of the enactment of this section), during
September of the preceding year, determine a monthly premium
for individuals enrolled under this section. Such monthly
premium shall be equal to \1/12\ of the annual premium computed
under paragraph (2)(B), which shall apply with respect to
coverage provided under this section for any month in such
year.
``(2) Annual premium.--
``(A) Combined national, per capita average for
parts a, b, and d benefits.--The Secretary shall
estimate the average, annual per capita amount for
benefits and administrative expenses that will be
payable under parts A, B, and D in the year for all
individuals enrolled under this section.
``(B) Annual premium.--Subject to subparagraphs (C)
and (D), the annual premium under this subsection for
months in a year is equal to the average, annual per
capita amount estimated under subparagraph (A) for the
year.
``(C) Adjustments.--The Secretary shall adjust the
annual premium under this subsection as necessary--
``(i) to ensure that expenditures under
this title for any year are not increased by
reason of this section; and
``(ii) by a geographic adjustment factor to
address regional affordability concerns.
``(D) Authority to calculate amounts of monthly
premiums separately for different ages.--In determining
the annual premium amount under this paragraph for
months in a year, the Secretary may make separate
determinations of such amount for individuals by age,
if the Secretary determines that making such separate
determinations would increase enrollment under this
section and reduce the risk of adverse selection.
``(3) Additional premium for certain part d plans.--Nothing
in this section shall preclude an individual from choosing a
prescription drug plan which requires the individual to pay an
additional amount (because of the inclusion of supplemental
prescription drug benefits or because the plan is a more
expensive plan, pursuant to section 1860D-13(a)(1)). In such
case, the monthly premium under paragraph (1) shall be
increased with respect to such individual.
``(d) Payment of Premiums.--
``(1) Payment.--Premiums for enrollment under this section
shall be paid to the Secretary at such times, and in such
manner, as the Secretary determines appropriate.
``(2) Deposit.--Amounts collected by the Secretary under
this section shall be deposited in the Medicare Buy-In Trust
Fund established under subsection (e).
``(e) Medicare Buy-In Trust Fund.--
``(1) In general.--There is hereby created on the books of
the Treasury of the United States a trust fund to be known as
the `Medicare Buy-In Trust Fund' (in this subsection referred
to as the `Trust Fund'). The Trust Fund shall consist of such
gifts and bequests as may be made as provided in section
201(i)(1) and such amounts as may be deposited in, or
appropriated to, such fund as provided in this title.
``(2) Premiums.--Premiums collected under subsection (d)
shall be transferred to the Trust Fund.
``(3) Incorporation of provisions.--Subsections (b) through
(i) of section 1841 shall apply with respect to the Trust Fund
and this title in the same manner as they apply with respect to
the Federal Supplementary Medical Insurance Trust Fund and part
B, respectively, except that in applying such section 1841, any
reference in such section to `this part' shall be construed to
be a reference to this section and any reference in section
1841(h) to section 1840(d) and in section 1841(i) to sections
1840(b)(1) and 1842(g) are deemed to be references to
comparable authority exercised under this section.
``(f) Clarification.--Nothing in this section shall affect the
benefits or eligibility under this title of individuals who would
otherwise be entitled to or eligible for benefits under this title or
title XIX, or both.
``(g) Eligibility for Financial Assistance.--
``(1) In general.--Individuals enrolled in coverage under
this section shall, from amounts transferred under paragraph
(2), receive financial assistance for such coverage that is
substantially similar to the assistance the individual would
have received if the individual were enrolled in a qualified
health plan through an Exchange.
``(2) Transfer of funds to medicare buy-in trust fund.--
``(A) In general.--The Secretary shall transfer to
the Medicare Buy-In Trust Fund under subsection (d) for
each plan year the amount determined under paragraph
(C) for such year.
``(B) Use of funds.--The amounts transferred to the
Medicare Buy-In Trust Fund under subparagraph (A) shall
only be used to reduce the premiums and cost-sharing
for coverage under this section of individuals enrolled
under such coverage who would be eligible for cost-
sharing reductions under section 1402 of the Patient
Protection and Affordable Care Act and premium
assistance under section 36B of the Internal Revenue
Code of 1986 if such individual were enrolled in a
qualified health plan.
``(C) Amount of transfer.--
``(i) In general.--The amount determined
under this subparagraph for any plan year is
the aggregate amount the Secretary determines
is equal to 100 percent of the premium tax
credits under section 36B of the Internal
Revenue Code of 1986, and 100 percent of the
cost-sharing reductions under section 1402 of
the Patient Protection and Affordable Care Act,
that would have been provided for the plan year
to eligible individuals who meet specified
income criteria and are enrolled for such plan
year in coverage provided through enrollment
under this section if such individuals were
enrolled for such year in a qualified health
plan through an Exchange.
``(ii) Specific requirements.--The
Secretary shall make the determination under
clause (i) on a per enrollee basis and shall
take into account all relevant factors
necessary to determine the value of the premium
tax credits and cost-sharing reductions that
would have been provided to eligible
individuals described in section 1331 of the
Patient Protection and Affordable Care Act,
including the age and income of the enrollee,
geographic differences in average spending for
health care across rating areas, the health
status of the enrollee for purposes of
determining risk adjustment payments and
reinsurance payments that would have been made
if the enrollee had enrolled in a qualified
health plan through an Exchange, and whether
any reconciliation of the credit or cost-
sharing reductions would have occurred if the
enrollee had been so enrolled. This
determination shall take into consideration the
experience of other States with respect to
participation in an Exchange and such credits
and reductions provided to residents of the
other States, with a special focus on enrollees
with income below 200 percent of poverty.
``(D) Certification.--
``(i) In general.--The Chief Actuary of the
Centers for Medicare & Medicaid Services, in
consultation with the Office of Tax Analysis of
the Department of the Treasury, shall certify
whether the methodology used to make
determinations under subparagraph (C), and such
determinations, meet the requirements of this
paragraph. Such certifications shall be based
on sufficient data from the federal exchange
and from comparable States about their
experience with programs created by the Basic
Health Plan.
``(ii) Corrections.--The Secretary shall
adjust the payment to the Trust Fund for any
plan year to reflect any error in the
determinations under subparagraph (C) for any
preceding plan year.
``(iii) Application.--Coverage provided
through enrollment under this part and parts B
and D pursuant to this section shall be treated
as coverage under a qualified health plan in
the silver level of coverage in the individual
market offered through an Exchange and the
Secretary shall be treated as the issuer of
such plan.
``(h) Treatment in Relation to the Affordable Care Act.--
``(1) Treatment as minimum essential coverage.--For
purposes of applying section 5000A of the Internal Revenue Code
of 1986, the coverage provided through enrollment under this
section constitutes minimum essential coverage under subsection
(f)(1)(A)(i) of such section.
``(2) Use of exchanges.--Coverage provided through
enrollment under this section shall be deemed to be coverage
under a qualified health plan for purposes of section
1311(d)(4)(C) of the Patient Protection and Affordable Care Act
and shall be made available for enrollment, information
comparison, and otherwise as such a plan through any internet
website maintained by an Exchange established under title I of
such Act (as described in such section).
``(3) Medicaid managed care.--States are prohibited from
buying their Medicaid beneficiaries ages 50 to 64 into Medicare
under this section, and individuals otherwise eligible for
enrollment under a State plan under title XIX are prohibited
from coverage under this title pursuant to enrollment under
this section. The preceding sentence shall not apply to
Medicaid beneficiaries whose Medicaid coverage or eligibility
does not meet the definition of minimum essential coverage
under a government-sponsored program under section 1.5000A-2 of
title 26, Code of Federal Regulations (or any successor
regulation).
``(4) Access to medigap.--Coverage provided through
medicare supplemental policies certified under section 1882
shall be made available to individuals eligible for enrollment
pursuant to this section for enrollment, information,
comparison, and otherwise as such a policy through any internet
website described in paragraph (2).
``(i) Oversight.--There is established an advisory committee to be
known as the `Medicare Buy In Oversight Board' to monitor and oversee
the implementation of this section, including the experience of the
individuals enrolling under this section. The Medicare Buy In Oversight
Board shall make periodic recommendations for the continual improvement
of the implementation of this section as well as the relationship of
enrollment under this section to other health care programs.
``(j) Outreach and Enrollment.--
``(1) In general.--During the period that begins on January
1, 2021, and ends on December 31, 2023, 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 under this section.
``(B) Assisting individuals transition under this
section.--To provide assistance to individuals to
enroll under this section.
``(C) Raising awareness of premium assistance and
cost-sharing reductions.--To distribute fair and
impartial information concerning enrollment under this
section 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.--
``(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 under
this section.
``(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 individuals under this
section.
``(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 2021 through 2023, to
carry out this subsection.
``(k) Implementation.--
``(1) Consultation.--In carrying out this section, the
Secretary shall--
``(A) consult with other Federal agencies,
including the Department of the Treasury, the
Department of Labor, the Department of Veterans
Affairs, the Department of Defense, and the Office of
Personnel Management; and
``(B) incorporate significant public consultation
and feedback, through public forums, notice and comment
rulemaking, and any other appropriate mediums.
``(2) Report.--No later than one year after the date of the
enactment of this section, the Secretary shall submit to
Congress a report establishing the administrative parameters
for the implementation of this section.
``(l) Feasibility Study.--The Secretary shall conduct a study on
the feasibility of applying this section with respect to individuals
residing in States that are not within the 50 States or the District of
Columbia.''.
(b) Medigap.--Section 1882 of the Social Security Act is amended by
adding at the end the following new subsection:
``(aa) Development of New Standards for Certain Medicare
Supplemental Policies Relating to Buy-In Option.--The Secretary shall
request the National Association of Insurance Commissioners to review
and revise the standards for benefit packages described in subsection
(p)(1), to otherwise update standards to include requirements for each
medicare supplemental policy that offers such a policy in a State, with
respect to each year, to accept every individual in the State who is
eligible for enrollment pursuant to section 1899C and who applies for
such coverage for such year if the individual applies for enrollment in
such policy during the 30-day period following the date of enrollment
pursuant to section 1899C and to accept every such individual during a
period of transition from enrollment pursuant to such section to
enrollment under this title pursuant to eligibility other than under
such section. Such revisions shall be made consistent with the rules
applicable under subsection (p)(1)(E) with the reference to the `1991
NAIC Model Regulation' deemed a reference to the NAIC Model Regulation
as published in the Federal Register on December 4, 1998, and as
subsequently updated by the National Association of Insurance
Commissioners to reflect previous changes in law and the reference to
`date of enactment of this subsection' deemed a reference to the date
of enactment of this subsection (aa).''.
SEC. 4. MEDICARE DIRECT SUPPLEMENTAL INSURANCE OPTION.
(a) In General.--Title XVIII of the Social Security Act is amended
by inserting after section 1882 (42 U.S.C. 1395ss) the following new
section:
``SEC. 1882A. MEDICARE DIRECT SUPPLEMENTAL INSURANCE OPTION.
``(a) In General.--The Secretary shall provide for the offering
under this section of a voluntary program to supplement the benefits
provided to individuals under parts A and B of this title.
``(b) Eligibility; Enrollment.--The Secretary shall provide
procedures for the enrollment under the program under this section of
individuals who are entitled to benefits under part A and enrolled
under part B, but who are not enrolled in a Medicare Advantage plan (or
in a plan under section 1876). Such procedures shall be consistent with
the following:
``(1) There shall be an initial enrollment period during
the last calendar quarter of 2022 that permits all individuals
who are eligible to enroll at that time under this subsection
to enroll and obtain benefits effective on January 1, 2023.
``(2) For individuals who are not eligible to enroll at
such time but who subsequently become eligible, there shall be
an individual enrollment period which is the 6-month period
described in section 1882(s)(2)(A).
``(3) The Secretary shall permit eligible individuals to
enroll at other times (and not less frequently than annually)
in a uniform manner, but such enrollment shall be subject to a
late enrollment penalty under subsection (d)(2)(B).
``(c) Benefits.--
``(1) In general.--The benefits provided under the program
under this section shall consist of payment of the cost of
deductibles, copayments, and other cost-sharing amounts
(including amounts attributable to and permitted as balance
billing) otherwise imposed or permitted under this title,
subject to an annual deductible of $100.
``(2) Administration.--The Secretary shall coordinate
payment of benefits under this part with those under parts A
and B and may, for such purpose, enter into appropriate
arrangements with qualified entities (which may include fiscal
intermediaries and carriers).
``(3) No pre-existing condition limitations.--The benefits
under this section shall not be subject to any pre-existing
condition or similar underwriting limitation.
``(d) Premiums.--
``(1) Actuarial cost.--The Secretary shall, during
September of each year beginning with 2022, determine a monthly
actuarial rate for all enrollees under this section, which rate
shall be applicable for months in the succeeding calendar year.
Such actuarial rate shall be the amount the Secretary estimates
to be necessary so that the aggregate amount for such calendar
year with respect to those enrollees will equal the total
amount which the Secretary estimates will be payable under this
section for benefits accrued (including services performed and
related administrative costs incurred) in such calendar year
under the program under this section. In calculating the
monthly actuarial rate, the Secretary shall make adjustments to
take into account errors in estimations under this paragraph
for previous years and shall include an appropriate amount for
a contingency margin.
``(2) Premium.--
``(A) In general.--The monthly premium of each
individual enrolled under this section for a month in a
year shall be the monthly actuarial rate determined
under paragraph (1) for months in such year. Such
premium shall be community-rated and shall not vary
among enrollees based upon the age, place of residence,
or any other factors, except as provided under
subparagraph (B).
``(B) Penalty for late enrollment.--In the case of
an individual who does not enroll under this section in
a period provided under paragraph (1) or (2) of
subsection (b), the Secretary shall increase the
monthly premium (in a manner similar to that applied
under part B pursuant to section 1839(b)) of 10 percent
for each full 12 months in which the individual could
have been but was not so enrolled. In applying such an
increase--
``(i) the aggregate percentage increase may
not exceed 100 percent; and
``(ii) periods of time in which an
individual is enrolled under an employee
welfare benefit plan described in section
1882(s)(3)(B)(i), under a Medicare Advantage
plan, with an organization described in section
1882(s)(3)(B)(iii), or under a PACE program
under section 1894 shall not be taken into
account.
``(3) Collection.--The Secretary shall provide for the
collection of premiums for enrollees under this part in the
same manner as premiums under part B are collected under
section 1840, except that any reference in such section to the
Federal Supplementary Medical Insurance Trust Fund shall be
deemed a reference to an account (to be known as the `Direct
Medicare Supplemental Insurance Account') to be established in
the Treasury by the Secretary to carry out the program under
this section. Amounts in such account may be invested and draw
interest in the same manner as such Trust Fund under section
1840(c).
``(4) Use of funds.--Premium amounts deposited into the
account established under paragraph (3) shall be available
without regard to appropriations to the Secretary to make
payment for benefits and administrative costs incurred in
carrying out this section.
``(e) Nonduplication of Coverage.--For purposes of applying section
1882(d)(3)(A), coverage under this section shall be treated as coverage
under a Medicare supplemental policy.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act and shall apply to
benefits for months beginning with January 2022.
SEC. 5. NEGOTIATION OF LOWER COVERED PART D DRUG PRICES ON BEHALF OF
MEDICARE BENEFICIARIES.
(a) Negotiation by Secretary.--Section 1860D-11 of the Social
Security Act (42 U.S.C. 1395w-111) is amended by striking subsection
(i) (relating to noninterference) and inserting the following:
``(i) Negotiation of Lower Drug Prices.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary shall negotiate with pharmaceutical
manufacturers the prices (including discounts, rebates, and
other price concessions) that may be charged to PDP sponsors
and MA organizations for covered part D drugs for part D
eligible individuals who are enrolled under a prescription drug
plan or under an MA-PD plan.
``(2) No change in rules for formularies.--
``(A) In general.--Nothing in paragraph (1) shall
be construed to authorize the Secretary to establish or
require a particular formulary.
``(B) Construction.--Subparagraph (A) shall not be
construed as affecting the Secretary's authority to
ensure appropriate and adequate access to covered part
D drugs under prescription drug plans and under MA-PD
plans, including compliance of such plans with
formulary requirements under section 1860D-4(b)(3).
``(3) Construction.--Nothing in this subsection shall be
construed as preventing the sponsor of a prescription drug
plan, or an organization offering an MA-PD plan, from obtaining
a discount or reduction of the price for a covered part D drug
below the price negotiated under paragraph (1).
``(4) Semi-annual reports to congress.--Not later than June
1, 2024, and every 6 months thereafter, the Secretary shall
submit to the Committees on Ways and Means, Energy and
Commerce, and Oversight and Reform of the House of
Representatives and the Committee on Finance of the Senate a
report on negotiations conducted by the Secretary to achieve
lower prices for Medicare beneficiaries, and the prices and
price discounts achieved by the Secretary as a result of such
negotiations.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act and shall first
apply to negotiations and prices for plan years beginning on January 1,
2024.
SEC. 6. INDIVIDUAL MARKET REINSURANCE FUND.
(a) Establishment of Fund.--
(1) In general.--There is established the ``Individual
Market Reinsurance Fund'' (in this section referred to as the
``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.--Amounts made available to the Fund shall
consist of the funds deposited into the Fund under paragraph
(3) and shall be used to carry out this section (other than
subsection (c)) for each calendar year beginning with 2023.
Amounts made available to the Fund shall remain available
without fiscal or calendar year limitation to carry out this
section.
(3) Cost-sharing in costs of program.--
(A) In general.--A qualified health plan that
participates in the reinsurance program established
under subsection (b) shall pay the fee established
under subparagraph (B).
(B) Authorization.--The Secretary is authorized to
charge a fee to each qualified health plan that
participates in the reinsurance program established
under subsection (b). Any amounts collected pursuant to
this paragraph shall be deposited into the Fund for
purposes of payments under subsection (b).
(C) Requirements.--In establishing the fee under
subparagraph (B)--
(i) the Secretary shall consult with
interested parties; and
(ii) shall ensure that the amount of such
fee is not excessive so as to unduly discourage
qualified health plans from participating in
the reinsurance program.
(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, subject to
subsection (a)(3), 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 paragraph (1) 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 the case of the 2021, 2022, or 2023
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
2021, 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 ``2019'' 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) 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.
(d) 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.
SEC. 7. REAUTHORIZATION OF RISK CORRIDORS.
Section 1342(a) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18062(a)) is amended by inserting ``and calendar years 2023
through 2026'' after ``2016''.
SEC. 8. INTEGRATION OF INDIVIDUALS AGED 50 TO 64 INTO HEALTH
DEMONSTRATIONS.
The Center for Medicare and Medicaid Innovation under section 1115A
of the Social Security Act (42 U.S.C. 1315a) is authorized to include
the individuals enrolled under title XVIII of the Social Security Act
pursuant to section 1899C of such Act, as added by section 3, into
existing and future demonstrations conducted by such Center.
SEC. 9. QUALIFIED HEALTH PLAN TAX CREDIT EXPANSION MADE PERMANENT.
(a) In General.--Section 36B of the Internal Revenue Code of 1986
is amended--
(1) in subsection (b)(3)(A)(iii)--
(A) by striking the header and inserting
``Percentages for taxable years beginning after 2020'',
and
(B) by striking ``beginning in 2021 or 2022'' and
inserting ``beginning after 2020'', and
(2) in subsection (c)(1)(E)--
(A) by striking the header and inserting ``Rule for
taxable years after 2020'', and
(B) by striking ``beginning in 2021 or 2022'' and
inserting ``beginning after 2020''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2020.
<all>
Introduced in House
Introduced in House
Referred to the Subcommittee on Social Security.
Referred to the Subcommittee on Health.
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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