,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #eaee ,,in ,,the ,,house ,,of ,,representatives ,march #e1 #bjah,mr4 ,pallone 7for himself1 ,mr4 ,scott of ,virginia1 and ,mr4 ,neal7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and ,education and the ,workforce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,patient ,protection and ,affordable ,care ,act to improve affordability of1 undo sabotage with respect to1 and increase access to health insurance coverage1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,undo ,sabotage and ,expand ,affordability of ,health ,insurance ,act of #bjah4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,title ,i--,expanding ,affordability ,sec4 #aja4 ,improve affordability and reduce premium costs for consumers4 ,sec4 #ajb4 ,lower out-of-pocket costs for consumers4 ,sec4 #ajc4 ,expand affordability for working families4 ,title ,,ii--,undoing ,sabotage ,sec4 #bja4 ,protect comprehensive coverage for small businesses and workers4 ,sec4 #bjb4 ,prevent junk plans and continue protections for consumers with preexisting conditions4 ,sec4 #bjc4 ,ensure plans provide comprehensive benefits4 ,sec4 #bjd4 ,undo ,administration sabotage by requiring open enrollment outreach1 education1 and funding for navigators4 ,sec4 #bje4 ,improve marketplace stability to prevent sabotage from raising premiums4 ,title ,,iii--,state ,innovation and ,transparency ,sec4 #cja4 ,fund ,state health insurance education programs for consumers4 ,sec4 #cjb4 ,fund ,state innovations to expand coverage4 ,sec4 #cjc4 ,preserve ,state option to implement health care marketplaces4 ,sec4 #cjd4 ,promote transparency and accountability in the ,administration's expenditures of ,exchange user fees4 ,i ,expanding ,affordability #aja4 ,improve affordability and reduce premium costs for consumers 7a7 ,in general ,section #cf;,b7b77#c77;,a7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7,a7 ,applicable percentage ,the applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase1 on a sliding scale in a linear manner1 from the initial premium percentage to the final premium percentage specified in such table for such income tier3 ,in the case of household income 7expressed as a percent of poverty line7 within the following income tier3,the initial premiumpercentage is--,the final premium percentage is--,over #ajj4j up to #acc4jj4ja4jacc4j up to #aej4ja4jb4jaej4j up to #bjj4jb4jd4jbjj4j up to #bej4jd4jf4jbej4j up to #cjj4jf4jg4jcjj4j up to #djj4jg4jh4edjj4j and higher#h4eh4e 4 7b7 ,conforming amendment ,section #cf;,b7c77#a77;,a7 of the ,internal ,revenue ,code of #aihf is amended by striking but does not exceed #djj percent4 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjai4 #ajb4 ,lower out-of-pocket costs for consumers 7a7 ,expansion of eligibility 7#a7 ,in general ,section #adjb7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7;c77 is amended-- 7,a7 by striking paragraphs 7#a7 and 7#b7 and inserting the following3 7#a7 ,in general ,the reduction in cost-sharing under this subsection shall be achieved1 with respect to an issuer of a qualified health plan to which this section applies1 by reducing cost-sharing under the plan 7and the applicable out-of pocket limit under section #acjb7;c77#a77 in a manner and amount sufficient to-- 7,a7 in the case of an eligible insured whose household income is not less than #ajj percent but not more than #bej percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #id percent of such costs2 and 7,b7 in the case of an eligible insured whose household income is more than #bej percent but not more than #djj percent of the poverty line for a family of the size involved1 increase the plan's share of the total allowed costs of benefits provided under the plan to #hg percent of such costs4 2 and 7,b7 by redesignating paragraphs 7#c71 7#d71 and 7#e7 as paragraphs 7#b71 7#c71 and 7#d71 respectively4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply with respect to plan years beginning after ,december #ca1 #bjai4 7b7 ,funding cost sharing reductions ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 is amended by adding at the end the following new subsection3 7g7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there is hereby appropriated to the ,secretary such sums as may be necessary for payments under this section4 4 #ajc4 ,expand affordability for working families 7a7 ,in general ,clause 7i7 of section #cf;,b7c77#b77;,c7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7i7 ,coverage must be affordable 7,i7 ,employees ,an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b77 and the employee's required contribution 7within the meaning of section #ejjj;,a7e77#a77;,b77 with respect to the plan exceeds #i4e percent of the employee's household income4 7,,ii7 ,family members ,an individual who is eligible to enroll in an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b77 by reason of a relationship the individual bears to the employee shall not be treated as eligible for minimum essential coverage by reason of such eligibility to enroll if the employee's required contribution 7within the meaning of section #ejjj;,a7e77#a77;,b71 determined by substituting family for self-only7 with respect to the plan exceeds #i4e percent of the employee's household income4 4 7b7 ,conforming amendments 7#a7 ,clause 7ii7 of section #cf;,b7c77#b77;,c7 of the ,internal ,revenue ,code of #aihf is amended by striking ,except as provided in clause 7iii71 an employee and inserting ,an individual4 7#b7 ,clause 7iii7 of section #cf;,b7c77#b77;,c7 of such ,code is amended by striking the last sentence of clause 7i7 and inserting clause 7i77,,ii74 7#c7 ,clause 7iv7 of section #cf;,b7c77#b77;,c7 of such ,code is amended by striking #i4e percent under clause 7i77,,ii7 and inserting the #i4e percent under clauses 7i77,i7 and 7i77,,ii74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjai4 ,,ii ,undoing ,sabotage #bja4 ,protect comprehensive coverage for small businesses and workers ,notwithstanding any other provision of law1 the ,secretary of ,labor may not take any action to implement1 finalize1 or enforce the proposed rule published on ,january #e1 #bjah1 on pages #fad through #fcf of volume #hc of the ,federal ,register1 or any substantially similar proposed rule4 #bjb4 ,prevent junk plans and continue protections for consumers with preexisting conditions 7a7 ,including short-,term limited duration insurance as individual health insurance coverage ,section #bgia7;b77#e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;g-#ia7;b77#e77 is amended by striking but does not include short-term limited duration insurance and inserting 1 including short-term limited duration insurance4 7b7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning after ,december #ca1 #bjah4 #bjc4 ,ensure plans provide comprehensive benefits 7a7 ,essential health benefits ,section #acjb7;b77#d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#d77 is amended-- 7#a7 in subparagraph 7,a71 by inserting and so that benefits are included within each of such categories2 7#b7 in subparagraph 7,g71 by striking at the end and2 7#c7 in subparagraph 7,h71 by striking the period at the end and inserting 2 and2 and 7#d7 by adding at the end the following new subparagraph3 7,i7 ensure that1 beginning ,january #a1 #bjai-- 7i7 in the case of health benefits that are established as essential health benefits1 there shall not be substitution of such benefits across benefit categories2 7ii7 a qualified health plan shall not be treated as providing coverage for the essential health benefits unless under such plan-- 7,i7 coverage of prescription drugs provides for access to a wide variety of classes of drugs within the prescription drug formulary of such plan2 and 7,,ii7 in the case that a drug that is medically necessary for an enrollee under such plan is not included within such formulary1 such individual has access to such drug through an exceptions process established by the plan2 and 7iii7 habilitative services are covered at parity with rehabilitative services4 4 7b7 ,standard benefit plans ,section #acjb7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;d77 is amended by adding at the end the following new paragraph3 7#e7 ,standard benefit plans 7,a7 ,in general ,for purposes of providing individuals with the opportunity to make simpler comparisons of health plans offered by different health insurance issuers and simplify the selection process1 the ,secretary shall1 for each plan year beginning with plan year #bjbj1 through rulemaking1 specify a structure described in subparagraph 7,b77i7 for a standard benefit plan for such plan year for each of the bronze1 silver1 and gold levels of coverage and for each actuarial value variation of a silver plan resulting from the application of section #adjb7;c74 ,a standard benefit plan for a plan year for a level of coverage or actuarial value variation of a silver plan shall be modeled on the most commonly purchased plans 7determined by enrollments in such plans7 during the previous #b plan years offered in the federally facilitated ,exchange operated pursuant to section #acba7;c7 in such level or variation and shall include coverage of deductible-exempt services consistent with actual purchasing patterns of consumers in the previous two plan years4 7,b7 ,standard benefit plan ,for purposes of this paragraph1 the term standard benefit plan means a qualified health plan to be offered through an ,exchange on the individual market that has either-- 7i7 a standardized cost-sharing structure specified by the ,secretary pursuant to rulemaking2 or 7ii7 a standardized cost-sharing structure specified by the ,secretary pursuant to rulemaking that is modified by the health insurance issuer of such plan only to the extent necessary to align with high deductible health plan requirements under section #bbc of the ,internal ,revenue ,code of #aihf or the applicable annual limitation on cost sharing under subsection 7c7 and actuarial value requirements specified by the ,secretary4 4 #bjd4 ,undo ,administration sabotage by requiring open enrollment outreach1 education1 and funding for navigators ,section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 is amended by adding at the end the following new paragraph3 7#c7 ,navigator program and outreach and enrollment activities 7,a7 ,navigator program 7i7 ,in general ,in the case of an ,exchange established or operated by the ,secretary pursuant to this subsection1 the ,secretary shall establish a program under which it awards grants to entities that would be described in paragraph 7#b7 of section #acaa7;i7 to carry out the duties that would be described in paragraph 7#c7 of such section if the references in such section #acaa7;i7 to this subsection and paragraph 7#a7 were each instead a reference to paragraph 7#c77;,a7 of section #acba7;c74 7ii7 ,application of ,state ,exchange navigator provisions ,for purposes of carrying out this subparagraph1 the provisions of paragraphs 7#b7 through 7#e7 of section #acaa7;i7 shall apply to the ,secretary with respect to an ,exchange described in clause 7i7 and the program under this subparagraph in the same manner as such provisions apply to a ,state with respect to an ,exchange described in section #acaa7;i7 and the program established under such section4 7iii7 ,funding ,for purposes of carrying out this subparagraph1 the ,secretary shall obligate #ajj1jjj1jjj out of amounts collected through the user fees on participating health insurance issuers pursuant to section #aef4ej of title #de1 ,code of ,federal ,regulations 7or any successor regulations7 for each of fiscal years #bjai through #bjba4 ,such amount shall remain available without fiscal year limitation until expended4 7,b7 ,outreach and educational activities 7i7 ,in general ,in the case of an ,exchange established or operated by the ,secretary pursuant to this subsection1 the ,secretary shall carry out outreach and educational activities for purposes of informing potential enrollees in qualified health plans offered through the ,exchange of the availability of coverage under such plans and financial assistance for coverage under such plans4 7ii7 ,funding ,for purposes of carrying out this subparagraph1 the ,secretary shall obligate #ajj1jjj1jjj out of the amounts collected through the user fees on participating health insurance issuers pursuant to section #aef4ej of title #de1 ,code of ,federal ,regulations 7or any successor regulations7 for each of fiscal years #bjai through #bjba4 ,such amount shall remain available without fiscal year limitation until expended4 4 #bje4 ,improve ,marketplace stability to prevent sabotage from raising premiums 7a7 ,fund 7#a7 ,in general ,there is hereby established the ,national ,reinsurance ,program ,fund to be administered by the ,secretary of ,health and ,human ,services for purposes of carrying out a national reinsurance program to make reinsurance payments1 in accordance with this section4 7#b7 ,appropriation ,there is hereby appropriated to the ,fund established under paragraph 7#a71 out of any funds in the ,treasury not otherwise appropriated1 such sums as are necessary for carrying out the purpose described in such paragraph4 7b7 ,payments 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall use amounts available in the ,fund to establish a national reinsurance program under which the ,secretary makes reinsurance payments to health insurance issuers with respect to claims for individuals enrolled under qualifying reinsurance plans offered by such issuers for plan year #bjai or a subsequent plan year that exceed1 subject to paragraph 7#b71 #ej1jjj in an amount equal to #ge percent of the amount of such claims1 but not to exceed #a1jjj1jjj4 7#b7 ,indexing ,for plan year #bjbj or subsequent plan year1 in lieu of each dollar amount specified in paragraph 7#a71 each such dollar amount applied under this subsection for such plan year shall be the dollar amount applied under this subsection for the previous year1 increased by the annual percentage increase in the ,consumer ,price ,index for ,all ,urban ,consumers 7all items2 ,united ,states city average as of ,june of the previous fiscal year74 7#c7 ,methods ,payments under this subsection shall be based on such a method as the ,secretary determines4 ,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 necessary information4 7c7 ,qualifying reinsurance plan 7#a7 ,in general ,for purposes of this section1 the term qualifying reinsurance plan means1 with respect to a health insurance issuer a qualified health plan 7as defined in section #acja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba77 offered by such issuer on the individual market4 ,such term does not include a grandfathered health plan 7as defined in section #abea of such ,act 7#db ,u4,s4,c4 #ahjaa771 transitional health plan1 or a standard health plan offered in connection with a basic health program established under section #acca of such ,act 7#db ,u4,s4,c4 #ahjea74 7#b7 ,transitional health plan ,for purposes of paragraph 7#a71 the term transitional health plan means a plan continued under the letter issued by the ,centers for ,medicare ,medicaid ,services on ,november #ad1 #bjac1 to the ,state ,insurance ,commissioners outlining a transitional policy for coverage in the individual and small group markets to which section #abea of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjaa7 does not apply1 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 #e1 #bjad1 ,february #bi1 #bjaf1 and ,february #ac1 #bjag1 or under any subsequent extensions thereof4 7d7 ,coordination with risk adjustment ,the ,secretary shall make adjustments to the risk adjustment program operated under section #acdc of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjfc71 as appropriate1 to account for the effects of this section on the actuarial risk of enrollees4 ,,iii ,state ,innovation and ,transparency #cja4 ,fund ,state health insurance education programs for consumers ,section #bgic7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ic7;e77 is amended by adding at the end the following new paragraph3 7#c7 ,appropriations ,for purposes of carrying out this section1 there is hereby appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 #ajj1jjj1jjj for each of the fiscal years #bjai through #bjba4 ,such amount shall remain available until expended4 4 #cjb4 ,fund ,state innovations to expand coverage 7a7 ,in general ,subject to subsection 7d71 the ,secretary of ,health and ,human ,services shall award grants to eligible ,state agencies to enable such ,states to explore innovative solutions to promote greater enrollment in health insurance coverage in the individual and small group markets1 including activities described in subsection 7c74 7b7 ,eligibility ,for purposes of subsection 7a71 eligible ,state agencies are ,exchanges established by a ,state under title ,i of the ,patient ,protection and ,affordable ,care ,act and ,state agencies with primary responsibility over health and human services for the ,state involved4 7c7 ,use of funds ,for purposes of subsection 7a71 the activities described in this subsection are the following3 7#a7 ,state efforts to streamline health insurance enrollment procedures in order to reduce burdens on consumers and facilitate greater enrollment in health insurance coverage in the individual and small group markets1 including automatic enrollment and reenrollment of1 or pre-populated applications for1 individuals without health insurance who are eligible for tax credits under section #cf;,b of the ,internal ,revenue ,code of #aihf1 with the ability to opt out of such enrollment4 7#b7 ,state investment in technology to improve data sharing and collection for the purposes of facilitating greater enrollment in health insurance coverage in such markets4 7#c7 ,implementation of a ,state version of an individual mandate to be enrolled in health insurance coverage4 7#d7 ,feasibility studies to develop comprehensive and coherent ,state plan for increasing enrollment in the individual and small group market4 7d7 ,funding ,for purposes of carrying out this section1 there is hereby appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #bjj1jjj1jjj for each of the fiscal years #bjai through #bjba4 ,such amount shall remain available until expended4 #cjc4 ,preserve ,state option to implement health care ,marketplaces ,section #acaa7;a77#d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;a77#d77 is amended-- 7#a7 by striking subparagraph 7,b72 7#b7 by striking ,renewability of grant and all that follows through ,subject to subsection 7d77#d7 and inserting ,renewability of grant4--,subject to subsection 7d77#d72 7#c7 by redesignating clauses 7i7 and 7ii7 as subparagraphs 7,a7 and 7,b71 respectively1 with appropriate indentation2 and 7#d7 in subparagraph 7,a71 as redesignated by paragraph 7#c71 by redesignating subclauses 7,i7 and 7,,ii7 as clauses 7i7 and 7ii71 respectively1 with appropriate indentation4 #cjd4 ,promote transparency and accountability in the ,administration's expenditures of ,exchange user fees ,for each of plan years #bjah1 #bjai1 and #bjbj1 not later than the date that is #c months after of the end of such fiscal year1 the ,secretary of ,health and ,human ,services shall submit to the appropriate committees of ,congress and make available to the public an annual report on the expenditure by the ,department of ,health and ,human ,services of user fees collected pursuant to section #aef4ej of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 ,each such report for a plan year shall include a detailed accounting of the amount of such user fees collected during such plan year and of the amount of such expenditures used during such plan year for the federally facilitated ,exchange operated pursuant to section #acba7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 on outreach and enrollment activities1 navigators1 maintenance of ,healthcare4gov1 and operation of call centers4