[House Report 115-159]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-159
======================================================================
VETERAN ACT
_______
June 2, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Brady of Texas, from the Committee on Ways and Means, submitted the
following
R E P O R T
together with
DISSENTING VIEWS
[To accompany H.R. 2372]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 2372) to amend the Internal Revenue Code of 1986 to
clarify the rules relating to veteran health insurance and
eligibility for the premium tax credit, having considered the
same, report favorably thereon with an amendment and recommend
that the bill as amended do pass.
CONTENTS
Page
I. SUMMARY AND BACKGROUND...........................................2
A. Purpose and Summary................................. 2
B. Background and Need for Legislation................. 2
C. Legislative History................................. 3
II. EXPLANATION OF THE BILL..........................................3
A. Clarification Relating to Veteran Health Insurance
and Eligibility for Premium Tax Credit............. 3
III. VOTES OF THE COMMITTEE...........................................5
IV. BUDGET EFFECTS OF THE BILL......................................10
A. Committee Estimate of Budgetary Effects............. 10
B. Statement Regarding New Budget Authority and Tax
Expenditures Budget Authority...................... 10
C. Cost Estimate Prepared by the Congressional Budget
Office............................................. 10
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE......11
A. Committee Oversight Findings and Recommendations.... 11
B. Statement of General Performance Goals and
Objectives......................................... 11
C. Information Relating to Unfunded Mandates........... 12
D. Applicability of House Rule XXI 5(b)................ 12
E. Tax Complexity Analysis............................. 12
F. Congressional Earmarks, Limited Tax Benefits, and
Limited Tariff Benefits............................ 12
G. Duplication of Federal Programs..................... 12
H. Disclosure of Directed Rule Makings................. 13
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED...........13
VII. DISSENTING VIEWS................................................27
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Equal Treatment Ensures
Relief and Access Now Act'' or the ``VETERAN Act''.
SEC. 2. CLARIFICATION RELATING TO VETERAN HEALTH INSURANCE AND
ELIGIBILITY FOR PREMIUM TAX CREDIT.
(a) Amendment of Pre-2020 Credit.--
(1) In general.--Section 36B(c)(2)(B)(i) of the Internal
Revenue Code of 1986, prior to any amendment by section 214 of
the American Health Care Act of 2017, is amended by adding at
the end the following: ``For purposes of the preceding
sentence, an individual shall not be treated as eligible for
coverage described in section 5000A(f)(1)(A)(v) unless such
individual is enrolled in such coverage.''.
(2) Effective date.--The amendment made by this subsection
shall apply to taxable years ending after December 31, 2013.
(b) Amendment of Post-2019 Credit.--
(1) In general.--Section 36B(d) of such Code, as amended by
section 214 of the American Health Care Act of 2017 and in
effect for months beginning after December 31, 2019, is amended
by adding at the end the following:
``For purposes of paragraph (2)(B), an individual shall not be treated
as eligible for coverage described in section 5000A(f)(1)(A)(v) unless
such individual is enrolled in such coverage.''.
(2) Effective date.--The amendment made by this subsection is
contingent upon the enactment of the American Health Care Act
of 2017 and shall apply (if at all) to months beginning after
December 31, 2019, in taxable years ending after such date.
I. SUMMARY AND BACKGROUND
A. Purpose and Summary
The bill, H.R. 2372, as reported by the Committee on Ways
and Means, codifies a Treasury regulation, under which, for
purposes of eligibility for the premium tax credit under
section 36B of the Internal Revenue Code (``Code''),\1\ an
individual is not considered eligible for certain health care
programs of the United States Department of Veterans Affairs
(``VA health program'') unless enrolled in the program. In
addition, H.R. 2372, as reported by the Committee on Ways and
Means, amends H.R. 1628, the American Health Care Act of 2017,
as passed by the House of Representatives on May 4, 2017, to
provide a similar rule with respect to a new credit for the
purchase of health insurance (effective for months beginning
after December 31, 2019, in taxable years ending after that
date).
---------------------------------------------------------------------------
\1\All section references herein are to the Internal Revenue Code
of 1986, as amended, unless otherwise stated.
---------------------------------------------------------------------------
B. Background and Need for Legislation
Under present law and under the American Health Care Act of
2017, an individual generally may not receive the premium
assistance credit if the individual is eligible for certain
types of health coverage from a source other than the
individual insurance market, including coverage under certain
VA health programs. However, under Treasury regulations, an
individual is not considered eligible for coverage under
certain VA health programs (and, therefore, not precluded from
receiving the premium assistance credit) unless enrolled in the
program. The bill amends the Code and the American Health Care
Act of 2017 to include the rule from the regulations, thus
assuring its continued application.
On March 8, 2017, in fulfillment of the reconciliation
instructions included in section 2002 of the Concurrent
Resolution on the Budget for Fiscal Year 2017 (S. Con. Res. 3),
the Committee marked up Budget Reconciliation Legislative
Recommendations Relating to Repeal and Replace of Health-
Related Tax Policy. This submission included a special rule
codifying the Treasury regulations. However, that language was
later removed at the Committee on Rules in order to comply with
Senate guidance regarding the Reconciliation process.
C. Legislative History
Background
H.R. 2372 was introduced on May 4, 2017, and was referred
to the Committee on Ways and Means.
Committee action
The Committee on Ways and Means marked up H.R. 2372, the
Veterans Equal Treatment Ensures Relief and Access Now Act (the
VETERAN Act), on May 24, 2017, and ordered the bill, as
amended, favorably reported (with a quorum being present).
Committee hearings
Since the 112th Congress, the Committee on Ways and Means
and its subcommittees have held a number of hearings on health
reform that explored various parts of the health system and
informed policy contained in the American Health Care Act.
These hearings include:
March 5, 2013--Hearing on Tax-Related
Provisions in the President's Health Care Law
December 4, 2013--Hearing on the Challenges
of the Affordable Care Act
March 14, 2016--Hearing on the Tax Treatment
of Health Care
May 17, 2016--Member Day Hearing on Tax-
Related Proposals to Improve Health Care
II. EXPLANATION OF THE BILL
A. Clarification Relating to Veteran Health Insurance and Eligibility
for Premium Tax Credit
PRESENT LAW
A refundable tax credit (``premium assistance credit'') is
provided for eligible individuals and families to subsidize the
purchase of health insurance plans through an American Health
Benefit Exchange (``Exchange''), referred to as ``qualified
health plans.''\2\ In general, advance payments with respect to
the premium assistance credit are made during the year directly
to the insurer.\3\ However, eligible individuals may choose to
pay their total health insurance premiums without advance
payments and claim the credit at the end of the taxable year.
---------------------------------------------------------------------------
\2\Sec. 36B, effective for taxable years ending after December 31,
2013. Under the Affordable Care Act, an American Health Benefit
Exchange is a source through which individuals can purchase health
insurance coverage. As used herein, the Affordable Care Act (or
``ACA'') refers to the combination of the Patient Protection and
Affordable Care Act (``PPACA''), Pub. L. No. 111-148, and the
Healthcare and Education Reconciliation Act of 2010 (``HCERA''), Pub.
L. No. 111-152. Qualified health plan is defined in PPACA section 1301.
\3\PPACA sections 411-1412 provide rules relating to eligibility
for and receipt of advance payments.
---------------------------------------------------------------------------
The premium assistance credit is generally available for
individuals (single or joint filers) with household incomes
between 100 and 400 percent of the Federal poverty level
(``FPL'') for the family size involved.\4\ Household income is
defined as the sum of: (1) the individual's modified adjusted
gross income, plus (2) the aggregate modified adjusted gross
incomes of all other individuals taken into account in
determining the individual's family size (but only if the other
individuals are required to file a tax return for the taxable
year). Modified adjusted gross income is defined as adjusted
gross income increased by: (1) any amount excluded from gross
income for citizens or residents living abroad,\5\ (2) any tax-
exempt interest received or accrued during the tax year, and
(3) the portion of the individual's social security benefits
not included in gross income.\6\ To be eligible for the premium
assistance credit, individuals who are married must file a
joint return. Individuals who are listed as dependents on a
return are not eligible for the premium assistance credit.
---------------------------------------------------------------------------
\4\ Federal poverty level refers to the most recently published
poverty guidelines determined by the Secretary of Health and Human
Services. Levels for 2017 and previous years are available at https://
aspe.hhs.gov/prior-hhs-poverty-guidelines-and-federal-register-
references.
\5\Sec. 911.
\6\Under section 86, only a portion of an individual's social
security benefits are included in gross income.
---------------------------------------------------------------------------
An individual who is eligible for certain types of health
coverage (``minimum essential coverage'') from a source other
than the individual insurance market generally may not receive
the premium assistance credit.\7\ Coverage under certain
government-sponsored health programs constitutes minimum
essential coverage, including coverage under certain
comprehensive health care programs administered by the United
States Department of Veterans Affairs (``designated Veterans
Affairs health programs'').\8\ Although mere eligibility for
minimum essential coverage from a source other than the
individual insurance market generally precludes an individual
from receiving the premium assistance credit, Treasury
regulations provide that, in the case of one of the designated
Veterans Affairs health programs, an individual is not
considered eligible for coverage under such a program (and
precluded from receiving the premium assistance credit) unless
enrolled in the program.\9\ Thus, an individual who may be
eligible for a designated Veterans Affairs health program, but
is not actually enrolled in the program, may receive the
premium assistance credit.
---------------------------------------------------------------------------
\7\Minimum essential coverage is defined in section 5000A(f).
\8\Under section 5000A(f)(1)(A)(v), certain health care programs
available to veterans and family members may constitute minimum
essential coverage, as determined by the Secretary of Veterans Affairs,
in coordination with the Secretary of the Treasury and the Secretary of
Health and Human Services. Regulations designate certain comprehensive
health care programs administered by the Department of Veterans Affairs
as minimum essential coverage. Treas. Reg. sec.1.5000A-2(b)(v).
\9\Treas. Reg. sec. 1.36B-2(c)(2)(iii).
---------------------------------------------------------------------------
THE AMERICAN HEALTH CARE ACT OF 2017
The American Health Care Act of 2017, as passed by the
House of Representatives on May 4, 2017 (the ``AHCA''), amends
various health-related provisions of the Code.\10\ Effective
for months beginning after December 31, 2019, in taxable years
ending after that date, the AHCA replaces the present-law
premium assistance credit with a new credit and provides a new
definition of ``qualified health plan'' to which the new credit
applies.\11\ Similar to the present-law credit, under the AHCA,
an individual eligible for health coverage from other sources,
including coverage under a designated Veterans Affairs health
program, generally may not receive the new premium assistance
credit.
---------------------------------------------------------------------------
\10\H.R. 1628, as passed by the House of Representatives on May 4,
2017.
\11\AHCA section 214. AHCA sections 201 and 202 amend the present-
law premium assistance credit for periods before the new credit becomes
effective.
---------------------------------------------------------------------------
REASONS FOR CHANGE
The Committee agrees with the interpretation contained in
the Treasury regulations with respect to eligibility for
designated Veterans Affairs health programs. The Committee
wishes to codify this interpretation, thus ensuring its
continued application under present law and under the AHCA.
EXPLANATION OF PROVISION
The provision amends the statutory provisions relating to
eligibility for the present-law premium assistance credit to
codify the rule under which an individual is not considered
eligible for coverage under a designated Veterans Affairs
health program unless enrolled in the program. In addition, the
provision amends the provision of the AHCA relating to
eligibility for the new premium assistance credit to specify
that an individual is not considered eligible for coverage
under a designated Veterans Affairs health program unless
enrolled in the program.
EFFECTIVE DATE
The provision relating to the present-law premium
assistance credit is effective for taxable years ending after
December 31, 2013. The provision relating to the new premium
assistance credit under the AHCA is contingent on enactment of
the AHCA and will apply (if at all) to months beginning after
December 31, 2019, in taxable years ending after that date.
III. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the vote of the Committee on Ways and Means in its
consideration of H.R. 2372, the ``Veterans Equal Treatment
Ensures Relief and Access Now Act'' (the ``VETERAN Act''), on
May 24, 2017.
Mr. Tiberi's motion to table Mr. Doggett's appeal of the
ruling of the Chair was agreed to by a roll call vote of 23
yeas and 15 nays (with a quorum being present). The vote was as
follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ X .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ X .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... ........ ........ .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... X ........ ......... Ms. Sanchez...... ........ X .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ X .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ X .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
Mr. Tiberi's motion to table Mr. Thompson's appeal of the
ruling of the Chair was agreed to by a roll call vote of 23
yeas and 15 nays (with a quorum being present). The vote was as
follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ X .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ X .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... ........ X .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... X ........ ......... Ms. Sanchez...... ........ X .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ X .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ ........ .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
The vote on the amendment by Mr. Davis to the amendment in
the nature of a substitute to H.R. 2372, which would adjust the
tax credit for certain veteran taxpayers, was not agreed to by
a roll call vote of 23 nays to 16 yeas (with a quorum being
present). The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... ........ X ......... Mr. Neal......... X ........ .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ X ........ .........
Mr. Nunes...................... ........ X ......... Mr. Lewis........ X ........ .........
Mr. Tiberi..................... ........ X ......... Mr. Doggett...... X ........ .........
Mr. Reichert................... ........ X ......... Mr. Thompson..... X ........ .........
Mr. Roskam..................... ........ X ......... Mr. Larson....... X ........ .........
Mr. Buchanan................... ........ X ......... Mr. Blumenauer... X ........ .........
Mr. Smith (NE)................. ........ X ......... Mr. Kind......... X ........ .........
Ms. Jenkins.................... ........ X ......... Mr. Pascrell..... X ........ .........
Mr. Paulsen.................... ........ X ......... Mr. Crowley...... X ........ .........
Mr. Marchant................... ........ X ......... Mr. Davis........ X ........ .........
Ms. Black...................... ........ X ......... Ms. Sanchez...... X ........ .........
Mr. Reed....................... ........ X ......... Mr. Higgins...... X ........ .........
Mr. Kelly...................... ........ X ......... Ms. Sewell....... X ........ .........
Mr. Renacci.................... ........ X ......... Ms. DelBene...... X ........ .........
Mr. Meehan..................... ........ X ......... Ms. Chu.......... X ........ .........
Ms. Noem....................... ........ X .........
Mr. Holding.................... ........ X .........
Mr. Smith (MO)................. ........ X .........
Mr. Rice....................... ........ X .........
Mr. Schweikert................. ........ X .........
Ms. Walorski................... ........ X .........
Mr. Curbelo.................... ........ X .........
Mr. Bishop..................... ........ X .........
----------------------------------------------------------------------------------------------------------------
Mr. Nunes's motion to table Ms. DelBene's appeal of the
ruling of the Chair was agreed to by a roll call vote of 22
yeas and 16 nays (with a quorum being present). The vote was as
follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ X .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ X .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... ........ X .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... ........ ........ ......... Ms. Sanchez...... ........ X .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ X .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ X .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
Mr. Nunes's motion to table Ms. Sanchez's appeal of the
ruling of the Chair was agreed to by a roll call vote of 22
yeas and 15 nays (with a quorum being present). The vote was as
follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ X .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ ........ .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... ........ X .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... ........ ........ ......... Ms. Sanchez...... ........ X .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ X .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ X .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
Mr. Nunes's motion to table Ms. Sewell's appeal of the
ruling of the Chair was agreed to by a roll call vote of 22
yeas and 13 nays (with a quorum being present). The vote was as
follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ ........ .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ ........ .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... ........ X .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... ........ ........ ......... Ms. Sanchez...... ........ ........ .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ X .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ X .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
Mr. Nunes's motion to table Ms. Chu's appeal of the ruling
of the Chair was agreed to by a roll call vote of 22 yeas and
12 nays (with a quorum being present). The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ ........ .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ ........ .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... ........ X .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... ........ ........ ......... Ms. Sanchez...... ........ ........ .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ ........ .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ X .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
Mr. Nunes's motion to table Mr. Pascrell's appeal of the
ruling of the Chair was agreed to by a roll call vote of 22
yeas and 12 nays (with a quorum being present). The vote was as
follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ ........ .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ ........ .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... ........ X .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... ........ ........ ......... Ms. Sanchez...... ........ ........ .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ ........ .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ X .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
The legislation was ordered favorably transmitted to the
House of Representatives as amended by a roll call vote of 22
yeas and 14 nays (with a quorum being present). The vote was as
follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... ........ ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ X .........
Mr. Tiberi..................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Reichert................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Blumenauer... ........ X .........
Mr. Smith (NE)................. X ........ ......... Mr. Kind......... X ........ .........
Ms. Jenkins.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Paulsen.................... ........ ........ ......... Mr. Crowley...... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Davis........ ........ X .........
Ms. Black...................... ........ ........ ......... Ms. Sanchez...... ........ X .........
Mr. Reed....................... X ........ ......... Mr. Higgins...... ........ X .........
Mr. Kelly...................... X ........ ......... Ms. Sewell....... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. DelBene...... ........ ........ .........
Mr. Meehan..................... X ........ ......... Ms. Chu.......... ........ X .........
Ms. Noem....................... X ........ .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
----------------------------------------------------------------------------------------------------------------
IV. BUDGET EFFECTS OF THE BILL
A. Committee Estimate of Budgetary Effects
In compliance with clause 3(d) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the effects on the budget of the bill, H.R. 2372, as
reported.
The bill, as reported, is estimated to have no effect on
Federal fiscal year budget receipts for fiscal years 2017-2027.
Pursuant to clause 8 of rule XIII of the Rules of the House
of Representatives, the following statement is made by the
Joint Committee on Taxation with respect to the provisions of
the bill amending the Internal Revenue Code of 1986: The gross
budgetary effect (before incorporating macroeconomic effects)
in any fiscal year is less than 0.25 percent of the current
projected gross domestic product of the United States for that
fiscal year; therefore, the bill is not ``major legislation''
for purposes of requiring that the estimate include the
budgetary effects of changes in economic output, employment,
capital stock and other macroeconomic variables.
B. Statement Regarding New Budget Authority and Tax Expenditures Budget
Authority
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee states that the
bill involves no new or increased budget authority. The
Committee further states that the revenue provisions of the
bill do not increase or decrease tax expenditures.
C. Cost Estimate Prepared by the Congressional Budget Office
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, requiring a cost estimate
prepared by the CBO, the following statement by CBO is
provided.
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 1, 2017.
Hon Kevin Brady,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 2372, the Veterans
Equal Treatment Ensures Relief and Access Now Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Mark Booth.
Sincerely,
Keith Hall.
Enclosure.
H.R. 2372--Veterans Equal Treatment Ensures Relief and Access Now Act
H.R. 2372 would amend the Internal Revenue Code to codify
certain health-related regulations affecting veterans.
Specifically, the bill would codify regulations that allow
veterans who are eligible for, but do not elect to be covered
by, certain Veterans Affairs health programs to qualify for
premium assistance tax credits. Under current law, people can
purchase health insurance through marketplaces and receive such
credits to cover part or all of the premiums if, among other
criteria, they have income below certain amounts and are not
eligible for certain types of health coverage. H.R. 2372 also
contains a contingency under which the provisions would apply
upon enactment of the American Health Care Act of 2017, which
would provide new credits and eligibility requirements.
Because H.R. 2372 would in part codify existing regulations
and in part be contingent upon enactment of subsequent
legislation, the staff of the Joint Committee on Taxation
estimates that the bill would have no effect on revenues or
direct spending relative to current law; therefore pay-as-you-
go procedures do not apply. However, if the American Health
Care Act of 2017 was enacted prior to this legislation, then
relative to such new law the enactment of this bill could
affect revenues or direct spending and, as a result, subsequent
estimates of the effects of this legislation could change.
CBO and JCT estimate that enacting the bill would not
increase on-budget deficits or net direct spending by more than
$5 billion in any of the four 10-year periods beginning in
2028.
JCT has determined that the bill contains no
intergovernmental or private-sector mandates as defined in the
Unfunded Mandates Reform Act.
The CBO staff contact for this estimate is Mark Booth. The
estimate was approved by John McClelland, Assistant Director
for Tax Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
A. Committee Oversight Findings and Recommendations
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee advises that the
findings and recommendations of the Committee, based on
oversight activities under clause 2(b)(1) of rule X of the
Rules of the House of Representatives, are incorporated into
the description portions of this report.
B. Statement of General Performance Goals and Objectives
With respect to clause 3(c)(4) of rule XIII of the Rules of
the House of Representatives, the Committee advises that the
bill contains no measure that authorizes funding, so no
statement of general performance goals and objectives for which
any measure authorizes funding is required.
C. Information Relating to Unfunded Mandates
This information is provided in accordance with section 423
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
The Committee has determined that the bill does not contain
Federal mandates on the private sector. The Committee has
determined that the bill does not impose a Federal
intergovernmental mandate on State, local, or tribal
governments.
D. Applicability of House Rule XXI 5(b)
Rule XXI 5(b) of the Rules of the House of Representatives
provides, in part, that ``A bill or joint resolution,
amendment, or conference report carrying a Federal income tax
rate increase may not be considered as passed or agreed to
unless so determined by a vote of not less than three-fifths of
the Members voting, a quorum being present.'' The Committee has
carefully reviewed the bill and states that the bill does not
involve any Federal income tax rate increases within the
meaning of the rule.
E. Tax Complexity Analysis
Section 4022(b) of the Internal Revenue Service
Restructuring and Reform Act of 1998 (``IRS Reform Act'')
requires the staff of the Joint Committee on Taxation (in
consultation with the Internal Revenue Service and the Treasury
Department) to provide a tax complexity analysis. The
complexity analysis is required for all legislation reported by
the Senate Committee on Finance, the House Committee on Ways
and Means, or any committee of conference if the legislation
includes a provision that directly or indirectly amends the
Internal Revenue Code of 1986 and has widespread applicability
to individuals or small businesses.
Pursuant to clause 3(h)(1) of rule XIII of the Rules of the
House of Representatives, the staff of the Joint Committee on
Taxation has determined that a complexity analysis is not
required under section 4022(b) of the IRS Reform Act because
the bill contains no provisions that amend the Internal Revenue
Code of 1986 and that have ``widespread applicability'' to
individuals or small businesses, within the meaning of the
rule.
F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff
Benefits
With respect to clause 9 of rule XXI of the Rules of the
House of Representatives, the Committee has carefully reviewed
the provisions of the bill and states that the provisions of
the bill do not contain any congressional earmarks, limited tax
benefits, or limited tariff benefits within the meaning of the
rule.
G. Duplication of Federal Programs
In compliance with Sec. 3(c)(5) of rule XIII of the Rules
of the House of Representatives, the Committee states that no
provision of the bill establishes or reauthorizes: (1) a
program of the Federal Government known to be duplicative of
another Federal program, (2) a program included in any report
from the Government Accountability Office to Congress pursuant
to section 21 of Public Law 111-139, or (3) a program related
to a program identified in the most recent Catalog of Federal
Domestic Assistance, published pursuant to section 6104 of
title 31, United States Code.
H. Disclosure of Directed Rule Makings
In compliance with Sec. 3(i) of H. Res. 5 (115th Congress),
the following statement is made concerning directed rule
makings: The Committee advises that the bill requires no
directed rule makings within the meaning of such section.
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic, and existing law in which no change is
proposed is shown in roman):
INTERNAL REVENUE CODE OF 1986
* * * * * * *
Subtitle A--Income Taxes
* * * * * * *
CHAPTER 1--NORMAL TAXES AND SURTAXES
* * * * * * *
Subchapter A--Determination of Tax Liability
* * * * * * *
PART IV--CREDITS AGAINST TAX
* * * * * * *
Subpart C--Refundable Credits
* * * * * * *
[The following shows current law section 36B of the Internal
Revenue Code of 1986:]
SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.
(a) In General.--In the case of an applicable taxpayer, there
shall be allowed as a credit against the tax imposed by this
subtitle for any taxable year an amount equal to the premium
assistance credit amount of the taxpayer for the taxable year.
(b) Premium Assistance Credit Amount.--For purposes of this
section--
(1) In general.--The term ``premium assistance credit
amount'' means, with respect to any taxable year, the
sum of the premium assistance amounts determined under
paragraph (2) with respect to all coverage months of
the taxpayer occurring during the taxable year.
(2) Premium assistance amount.--The premium
assistance amount determined under this subsection with
respect to any coverage month is the amount equal to
the lesser of--
(A) the monthly premiums for such month for 1
or more qualified health plans offered in the
individual market within a State which cover
the taxpayer, the taxpayer's spouse, or any
dependent (as defined in section 152) of the
taxpayer and which were enrolled in through an
Exchange established by the State under 1311 of
the Patient Protection and Affordable Care Act,
or
(B) the excess (if any) of--
(i) the adjusted monthly premium for
such month for the applicable second
lowest cost silver plan with respect to
the taxpayer, over
(ii) an amount equal to 1/12 of the
product of the applicable percentage
and the taxpayer's household income for
the taxable year.
(3) Other terms and rules relating to premium
assistance amounts.--For purposes of paragraph (2)--
(A) Applicable percentage.--
(i) In general.--Except as provided
in clause (ii), 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 increase, on a sliding
scale in a linear manner, from the
initial premium percentage to the final
premium percentage specified in such
table for such income tier:
------------------------------------------------------------------------
In the case of
household income
(expressed as a percent The initial premium The final premium
of poverty line) within percentage is-- percentage is--
the following income
tier:
------------------------------------------------------------------------
Up to 133% 2.0% 2.0%
133% up to 150% 3.0% 4.0%
150% up to 200% 4.0% 6.3%
200% up to 250% 6.3% 8.05%
250% up to 300% 8.05% 9.5%
300% up to 400% 9.5% 9.5%
------------------------------------------------------------------------
(ii) Indexing.--
(I) In general.--Subject to
subclause (II), in the case of
taxable years beginning in any
calendar year after 2014, the
initial and final applicable
percentages under clause (i)
(as in effect for the preceding
calendar year after application
of this clause) shall be
adjusted to reflect the excess
of the rate of premium growth
for the preceding calendar year
over the rate of income growth
for the preceding calendar
year.
(II) Additional adjustment.--
Except as provided in subclause
(III), in the case of any
calendar year after 2018, the
percentages described in
subclause (I) shall, in
addition to the adjustment
under subclause (I), be
adjusted to reflect the excess
(if any) of the rate of premium
growth estimated under
subclause (I) for the preceding
calendar year over the rate of
growth in the consumer price
index for the preceding
calendar year.
(III) Failsafe.--Subclause
(II) shall apply for any
calendar year only if the
aggregate amount of premium tax
credits under this section and
cost-sharing reductions under
section 1402 of the Patient
Protection and Affordable Care
Act for the preceding calendar
year exceeds an amount equal to
0.504 percent of the gross
domestic product for the
preceding calendar year.
(B) Applicable second lowest cost silver
plan.--The applicable second lowest cost silver
plan with respect to any applicable taxpayer is
the second lowest cost silver plan of the
individual market in the rating area in which
the taxpayer resides which--
(i) is offered through the same
Exchange through which the qualified
health plans taken into account under
paragraph (2)(A) were offered, and
(ii) provides--
(I) self-only coverage in the
case of an applicable
taxpayer--
(aa) whose tax for
the taxable year is
determined under
section 1(c) (relating
to unmarried
individuals other than
surviving spouses and
heads of households)
and who is not allowed
a deduction under
section 151 for the
taxable year with
respect to a dependent,
or
(bb) who is not
described in item (aa)
but who purchases only
self-only coverage, and
(II) family coverage in the
case of any other applicable
taxpayer.
If a taxpayer files a joint return and no
credit is allowed under this section with
respect to 1 of the spouses by reason of
subsection (e), the taxpayer shall be treated
as described in clause (ii)(I) unless a
deduction is allowed under section 151 for the
taxable year with respect to a dependent other
than either spouse and subsection (e) does not
apply to the dependent.
(C) Adjusted monthly premium.--The adjusted
monthly premium for an applicable second lowest
cost silver plan is the monthly premium which
would have been charged (for the rating area
with respect to which the premiums under
paragraph (2)(A) were determined) for the plan
if each individual covered under a qualified
health plan taken into account under paragraph
(2)(A) were covered by such silver plan and the
premium was adjusted only for the age of each
such individual in the manner allowed under
section 2701 of the Public Health Service Act.
In the case of a State participating in the
wellness discount demonstration project under
section 2705(d) of the Public Health Service
Act, the adjusted monthly premium shall be
determined without regard to any premium
discount or rebate under such project.
(D) Additional benefits.--If--
(i) a qualified health plan under
section 1302(b)(5) of the Patient
Protection and Affordable Care Act
offers benefits in addition to the
essential health benefits required to
be provided by the plan, or
(ii) a State requires a qualified
health plan under section 1311(d)(3)(B)
of such Act to cover benefits in
addition to the essential health
benefits required to be provided by the
plan,
the portion of the premium for the plan
properly allocable (under rules prescribed by
the Secretary of Health and Human Services) to
such additional benefits shall not be taken
into account in determining either the monthly
premium or the adjusted monthly premium under
paragraph (2).
(E) Special rule for pediatric dental
coverage.--For purposes of determining the
amount of any monthly premium, if an individual
enrolls in both a qualified health plan and a
plan described in section 1311(d)(2)(B)(ii) (I)
of the Patient Protection and Affordable Care
Act for any plan year, the portion of the
premium for the plan described in such section
that (under regulations prescribed by the
Secretary) is properly allocable to pediatric
dental benefits which are included in the
essential health benefits required to be
provided by a qualified health plan under
section 1302(b)(1)(J) of such Act shall be
treated as a premium payable for a qualified
health plan.
(c) Definition and Rules Relating to Applicable Taxpayers,
Coverage Months, and Qualified Health Plan.--For purposes of
this section--
(1) Applicable taxpayer.--
(A) In general.--The term ``applicable
taxpayer'' means, with respect to any taxable
year, a taxpayer whose household income for the
taxable year equals or exceeds 100 percent but
does not exceed 400 percent of an amount equal
to the poverty line for a family of the size
involved.
(B) Special rule for certain individuals
lawfully present in the United States.--If--
(i) a taxpayer has a household income
which is not greater than 100 percent
of an amount equal to the poverty line
for a family of the size involved, and
(ii) the taxpayer is an alien
lawfully present in the United States,
but is not eligible for the medicaid
program under title XIX of the Social
Security Act by reason of such alien
status,
the taxpayer shall, for purposes of the credit
under this section, be treated as an applicable
taxpayer with a household income which is equal
to 100 percent of the poverty line for a family
of the size involved.
(C) Married couples must file joint return.--
If the taxpayer is married (within the meaning
of section 7703) at the close of the taxable
year, the taxpayer shall be treated as an
applicable taxpayer only if the taxpayer and
the taxpayer's spouse file a joint return for
the taxable year.
(D) Denial of credit to dependents.--No
credit shall be allowed under this section to
any individual with respect to whom a deduction
under section 151 is allowable to another
taxpayer for a taxable year beginning in the
calendar year in which such individual's
taxable year begins.
(2) Coverage month.--For purposes of this
subsection--
(A) In general.--The term ``coverage month''
means, with respect to an applicable taxpayer,
any month if--
(i) as of the first day of such month
the taxpayer, the taxpayer's spouse, or
any dependent of the taxpayer is
covered by a qualified health plan
described in subsection (b)(2)(A) that
was enrolled in through an Exchange
established by the State under section
1311 of the Patient Protection and
Affordable Care Act, and
(ii) the premium for coverage under
such plan for such month is paid by the
taxpayer (or through advance payment of
the credit under subsection (a) under
section 1412 of the Patient Protection
and Affordable Care Act).
(B) Exception for minimum essential
coverage.--
(i) In general.--The term ``coverage
month'' shall not include any month
with respect to an individual if for
such month the individual is eligible
for minimum essential coverage other
than eligibility for coverage described
in section 5000A(f)(1)(C) (relating to
coverage in the individual market). For
purposes of the preceding sentence, an
individual shall not be treated as
eligible for coverage described in
section 5000A(f)(1)(A)(v) unless such
individual is enrolled in such
coverage.
(ii) Minimum essential coverage.--The
term ``minimum essential coverage'' has
the meaning given such term by section
5000A(f).
(C) Special rule for employer-sponsored
minimum essential coverage.--For purposes of
subparagraph (B)--
(i) Coverage must be affordable.--
Except as provided in clause (iii), an
employee shall not be treated as
eligible for minimum essential coverage
if such coverage--
(I) consists of an eligible
employer-sponsored plan (as
defined in section
5000A(f)(2)), and
(II) the employee's required
contribution (within the
meaning of section
5000A(e)(1)(B)) with respect to
the plan exceeds 9.5 percent of
the applicable taxpayer's
household income.
This clause shall also apply to an
individual who is eligible to enroll in
the plan by reason of a relationship
the individual bears to the employee.
(ii) Coverage must provide minimum
value.--Except as provided in clause
(iii), an employee shall not be treated
as eligible for minimum essential
coverage if such coverage consists of
an eligible employer-sponsored plan (as
defined in section 5000A(f)(2)) and the
plan's share of the total allowed costs
of benefits provided under the plan is
less than 60 percent of such costs.
(iii) Employee or family must not be
covered under employer plan.--Clauses
(i) and (ii) shall not apply if the
employee (or any individual described
in the last sentence of clause (i)) is
covered under the eligible employer-
sponsored plan or the grandfathered
health plan.
(iv) Indexing.--In the case of plan
years beginning in any calendar year
after 2014, the Secretary shall adjust
the 9.5 percent under clause (i)(II) in
the same manner as the percentages are
adjusted under subsection
(b)(3)(A)(ii).
(3) Definitions and other rules.--
(A) Qualified health plan.--The term
``qualified health plan'' has the meaning given
such term by section 1301(a) of the Patient
Protection and Affordable Care Act, except that
such term shall not include a qualified health
plan which is a catastrophic plan described in
section 1302(e) of such Act.
(B) Grandfathered health plan.--The term
``grandfathered health plan'' has the meaning
given such term by section 1251 of the Patient
Protection and Affordable Care Act.
(4) Special rules for qualified small employer health
reimbursement arrangements.--
(A) In general.--The term ``coverage month''
shall not include any month with respect to an
employee (or any spouse or dependent of such
employee) if for such month the employee is
provided a qualified small employer health
reimbursement arrangement which constitutes
affordable coverage.
(B) Denial of double benefit.--In the case of
any employee who is provided a qualified small
employer health reimbursement arrangement for
any coverage month (determined without regard
to subparagraph (A)), the credit otherwise
allowable under subsection (a) to the taxpayer
for such month shall be reduced (but not below
zero) by the amount described in subparagraph
(C)(i)(II) for such month.
(C) Affordable coverage.--For purposes of
subparagraph (A), a qualified small employer
health reimbursement arrangement shall be
treated as constituting affordable coverage for
a month if--
(i) the excess of--
(I) the amount that would be
paid by the employee as the
premium for such month for
self-only coverage under the
second lowest cost silver plan
offered in the relevant
individual health insurance
market, over
(II) \1/12\ of the employee's
permitted benefit (as defined
in section 9831(d)(3)(C)) under
such arrangement, does not
exceed--
(ii) \1/12\ of 9.5 percent of the
employee's household income.
(D) Qualified small employer health
reimbursement arrangement.--For purposes of
this paragraph, the term ``qualified small
employer health reimbursement arrangement'' has
the meaning given such term by section
9831(d)(2).
(E) Coverage for less than entire year.--In
the case of an employee who is provided a
qualified small employer health reimbursement
arrangement for less than an entire year,
subparagraph (C)(i)(II) shall be applied by
substituting ``the number of months during the
year for which such arrangement was provided''
for ``12''.
(F) Indexing.--In the case of plan years
beginning in any calendar year after 2014, the
Secretary shall adjust the 9.5 percent amount
under subparagraph (C)(ii) in the same manner
as the percentages are adjusted under
subsection (b)(3)(A)(ii).
(d) Terms Relating to Income and Families.--For purposes of
this section--
(1) Family size.--The family size involved with
respect to any taxpayer shall be equal to the number of
individuals for whom the taxpayer is allowed a
deduction under section 151 (relating to allowance of
deduction for personal exemptions) for the taxable
year.
(2) Household income.--
(A) Household income.--The term ``household
income'' means, with respect to any taxpayer,
an amount equal to the sum of--
(i) the modified adjusted gross
income of the taxpayer, plus
(ii) the aggregate modified adjusted
gross incomes of all other individuals
who--
(I) were taken into account
in determining the taxpayer's
family size under paragraph
(1), and
(II) were required to file a
return of tax imposed by
section 1 for the taxable year.
(B) Modified adjusted gross income.--The term
``modified adjusted gross income'' means
adjusted gross income increased by--
(i) any amount excluded from gross
income under section 911,
(ii) any amount of interest received
or accrued by the taxpayer during the
taxable year which is exempt from tax,
and
(iii) an amount equal to the portion
of the taxpayer's social security
benefits (as defined in section 86(d))
which is not included in gross income
under section 86 for the taxable year.
(3) Poverty line.--
(A) In general.--The term ``poverty line''
has the meaning given that term in section
2110(c)(5) of the Social Security Act (42
U.S.C. 1397jj(c)(5)).
(B) Poverty line used.--In the case of any
qualified health plan offered through an
Exchange for coverage during a taxable year
beginning in a calendar year, the poverty line
used shall be the most recently published
poverty line as of the 1st day of the regular
enrollment period for coverage during such
calendar year.
(e) Rules for Individuals Not Lawfully Present.--
(1) In general.--If 1 or more individuals for whom a
taxpayer is allowed a deduction under section 151
(relating to allowance of deduction for personal
exemptions) for the taxable year (including the
taxpayer or his spouse) are individuals who are not
lawfully present--
(A) the aggregate amount of premiums
otherwise taken into account under clauses (i)
and (ii) of subsection (b)(2)(A) shall be
reduced by the portion (if any) of such
premiums which is attributable to such
individuals, and
(B) for purposes of applying this section,
the determination as to what percentage a
taxpayer's household income bears to the
poverty level for a family of the size involved
shall be made under one of the following
methods:
(i) A method under which--
(I) the taxpayer's family
size is determined by not
taking such individuals into
account, and
(II) the taxpayer's household
income is equal to the product
of the taxpayer's household
income (determined without
regard to this subsection) and
a fraction--
(aa) the numerator of
which is the poverty
line for the taxpayer's
family size determined
after application of
subclause (I), and
(bb) the denominator
of which is the poverty
line for the taxpayer's
family size determined
without regard to
subclause (I).
(ii) A comparable method reaching the
same result as the method under clause
(i).
(2) Lawfully present.--For purposes of this section,
an individual shall be treated as lawfully present only
if the individual is, and is reasonably expected to be
for the entire period of enrollment for which the
credit under this section is being claimed, a citizen
or national of the United States or an alien lawfully
present in the United States.
(3) Secretarial authority.--The Secretary of Health
and Human Services, in consultation with the Secretary,
shall prescribe rules setting forth the methods by
which calculations of family size and household income
are made for purposes of this subsection. Such rules
shall be designed to ensure that the least burden is
placed on individuals enrolling in qualified health
plans through an Exchange and taxpayers eligible for
the credit allowable under this section.
(f) Reconciliation of Credit and Advance Credit.--
(1) In general.--The amount of the credit allowed
under this section for any taxable year shall be
reduced (but not below zero) by the amount of any
advance payment of such credit under section 1412 of
the Patient Protection and Affordable Care Act.
(2) Excess advance payments.--
(A) In general.--If the advance payments to a
taxpayer under section 1412 of the Patient
Protection and Affordable Care Act for a
taxable year exceed the credit allowed by this
section (determined without regard to paragraph
(1)), the tax imposed by this chapter for the
taxable year shall be increased by the amount
of such excess.
(B) Limitation on increase.--
(i) In general.--In the case of a
taxpayer whose household income is less
than 400 percent of the poverty line
for the size of the family involved for
the taxable year, the amount of the
increase under subparagraph (A) shall
in no event exceed the applicable
dollar amount determined in accordance
with the following table (one-half of
such amount in the case of a taxpayer
whose tax is determined under section
1(c) for the taxable year):
------------------------------------------------------------------------
If the household income (expressed
as a percent of poverty line) is: The applicable dollar amount is:
------------------------------------------------------------------------
Less than 200% $600
At least 200% but less than 300% $1,500
At least 300% but less than 400% $2,500
------------------------------------------------------------------------
(ii) Indexing of amount.--In the case
of any calendar year beginning after
2014, each of the dollar amounts in the
table contained under clause (i) shall
be increased by an amount equal to--
(I) such dollar amount,
multiplied by
(II) the cost-of-living
adjustment determined under
section 1(f)(3) for the
calendar year, determined by
substituting ``calendar year
2013'' for ``calendar year
1992'' in subparagraph (B)
thereof.
If the amount of any increase under
clause (i) is not a multiple of $50,
such increase shall be rounded to the
next lowest multiple of $50.
(3) Information requirement.--Each Exchange (or any
person carrying out 1 or more responsibilities of an
Exchange under section 1311(f)(3) or 1321(c) of the
Patient Protection and Affordable Care Act) shall
provide the following information to the Secretary and
to the taxpayer with respect to any health plan
provided through the Exchange:
(A) The level of coverage described in
section 1302(d) of the Patient Protection and
Affordable Care Act and the period such
coverage was in effect.
(B) The total premium for the coverage
without regard to the credit under this section
or cost-sharing reductions under section 1402
of such Act.
(C) The aggregate amount of any advance
payment of such credit or reductions under
section 1412 of such Act.
(D) The name, address, and TIN of the primary
insured and the name and TIN of each other
individual obtaining coverage under the policy.
(E) Any information provided to the Exchange,
including any change of circumstances,
necessary to determine eligibility for, and the
amount of, such credit.
(F) Information necessary to determine
whether a taxpayer has received excess advance
payments.
(g) Regulations.--The Secretary shall prescribe such
regulations as may be necessary to carry out the provisions of
this section, including regulations which provide for--
(1) the coordination of the credit allowed under this
section with the program for advance payment of the
credit under section 1412 of the Patient Protection and
Affordable Care Act, and
(2) the application of subsection (f) where the
filing status of the taxpayer for a taxable year is
different from such status used for determining the
advance payment of the credit.
[The following shows proposed changes to section 36B of the
Internal Revenue Code of 1986 as such section is proposed to
read after amendment by section 214 of the American Health Care
Act of 2017 (H.R. 1628, as engrossed in the House):]
SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN.
(a) Allowance of Premium Tax Credit.--In the case of an
individual, there shall be allowed as a credit against the tax
imposed by this subtitle for the taxable year the sum of the
monthly credit amounts with respect to such taxpayer for
calendar months during such taxable year which are eligible
coverage months appropriately taken into account under
subsection (b)(2) with respect to the taxpayer or any
qualifying family member of the taxpayer.
(b) Monthly Credit Amounts.--
(1) In general.--The monthly credit amount with
respect to any taxpayer for any calendar month is the
lesser of--
(A) the sum of the monthly limitation amounts
determined under subsection (c) with respect to
the taxpayer and the taxpayer's qualifying
family members for such month, or
(B) the amount paid for a qualified health
plan for the taxpayer and the taxpayer's
qualifying family members for such month.
(2) Eligible coverage month requirement.--No amount
shall be taken into account under subparagraph (A) or
(B) of paragraph (1) with respect to any individual for
any month unless such month is an eligible coverage
month with respect to such individual.
(c) Monthly Limitation Amounts.--
(1) In general.--The monthly limitation amount with
respect to any individual for any eligible coverage
month during any taxable year is \1/12\ of--
(A) $2,000 in the case of an individual who
has not attained age 30 as of the beginning of
such taxable year,
(B) $2,500 in the case of an individual who
has attained age 30 but who has not attained
age 40 as of such time,
(C) $3,000 in the case of an individual who
has attained age 40 but who has not attained
age 50 as of such time,
(D) $3,500 in the case of an individual who
has attained age 50 but who has not attained
age 60 as of such time, and
(E) $4,000 in the case of an individual who
has attained age 60 as of such time.
(2) Limitation based on modified adjusted gross
income.--The credit allowed under subsection (a) with
respect to any taxpayer for any taxable year shall be
reduced (but not below zero) by 10 percent of the
excess (if any) of--
(A) the taxpayer's modified adjusted gross
income (as defined in section 36B(d)(2)(B), as
in effect for taxable years beginning before
January 1, 2020) for such taxable year, over
(B) $75,000 (twice such amount in the case of
a joint return).
(3) Other limitations.--
(A) Aggregate dollar limitation.--The sum of
the monthly limitation amounts taken into
account under this section with respect to any
taxpayer for any taxable year shall not exceed
$14,000.
(B) Maximum number of individuals taken into
account.--With respect to any taxpayer for any
month, monthly limitation amounts shall be
taken into account under this section only with
respect to the 5 oldest individuals with
respect to whom monthly limitation amounts
could (without regard to this subparagraph)
otherwise be so taken into account.
(d) Eligible Coverage Month.--For purposes of this section,
the term ``eligible coverage month'' means, with respect to any
individual, any month if, as of the first day of such month,
the individual meets the following requirements:
(1) The individual is covered by a health insurance
coverage which is certified by the State in which such
insurance is offered as coverage that meets the
requirements for qualified health plans under
subsection (f).
(2) The individual is not eligible for--
(A) coverage under a group health plan
(within the meaning of section 5000(b)(1))
other than coverage under a plan substantially
all of the coverage of which is of excepted
benefits described in section 9832(c), or
(B) coverage described in section
5000A(f)(1)(A).
(3) The individual is either--
(A) a citizen or national of the United
States, or
(B) a qualified alien (within the meaning of
section 431 of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (8
U.S.C. 1641)).
(4) The individual is not incarcerated, other than
incarceration pending the disposition of charges.
For purposes of paragraph (2)(B), an individual shall not be
treated as eligible for coverage described in section
5000A(f)(1)(A)(v) unless such individual is enrolled in such
coverage.
(e) Qualifying Family Member.--For purposes of this section,
the term ``qualifying family member'' means--
(1) in the case of a joint return, the taxpayer's
spouse,
(2) any dependent of the taxpayer, and
(3) with respect to any eligible coverage month, any
child (as defined in section 152(f)(1)) of the taxpayer
who as of the end of the taxable year has not attained
age 27 if such child is covered for such month under a
qualified health plan which also covers the taxpayer
(in the case of a joint return, either spouse).
(f) Qualified Health Plan.--For purposes of this section, the
term ``qualified health plan'' means any health insurance
coverage (as defined in section 9832(b)) if--
(1) such coverage is offered in the individual health
insurance market within a State (within the meaning of
section 5000A(f)(1)(C)),
(2) substantially all of such coverage is not of
excepted benefits described in section 9832(c),
(3) such coverage does not consist of short-term
limited duration insurance (within the meaning of
section 2791(b)(5) of the Public Health Service Act),
(4) such coverage is not a grandfathered health plan
(as defined in section 1251 of the Patient Protection
and Affordable Care Act) or a grandmothered health plan
(as defined in section 36B(c)(3)(C) as in effect for
taxable years beginning before January 1, 2020), and
(5) such coverage does not include coverage for
abortions (other than any abortion necessary to save
the life of the mother or any abortion with respect to
a pregnancy that is the result of an act of rape or
incest).
(g) Special Rules.--
(1) Married couples must file joint return.--
(A) In general.--Except as provided in
subparagraph (B), if the taxpayer is married
(within the meaning of section 7703) at the
close of the taxable year, no credit shall be
allowed under this section to such taxpayer
unless such taxpayer and the taxpayer's spouse
file a joint return for such taxable year.
(B) Exception for certain taxpayers.--
Subparagraph (A) shall not apply to any married
taxpayer who--
(i) is living apart from the
taxpayer's spouse at the time the
taxpayer files the tax return,
(ii) is unable to file a joint return
because such taxpayer is a victim of
domestic abuse or spousal abandonment,
(iii) certifies on the tax return
that such taxpayer meets the
requirements of clauses (i) and (ii),
and
(iv) has not met the requirements of
clauses (i), (ii), and (iii) for each
of the 3 preceding taxable years.
(2) Denial of credit to dependents.--
(A) In general.--No credit shall be allowed
under this section to any individual who is a
dependent with respect to another taxpayer for
a taxable year beginning in the calendar year
in which such individual's taxable year begins.
(B) Coordination with rule for older
children.--In the case of any individual who is
a qualifying family member described in
subsection (e)(3) with respect to another
taxpayer for any month, in determining the
amount of any credit allowable to such
individual under this section for any taxable
year of such individual which includes such
month, the monthly limitation amount with
respect to such individual for such month shall
be zero and no amount paid for any qualified
health plan with respect to such individual for
such month shall be taken into account.
(3) Coordination with medical expense deduction.--
Amounts described in subsection (b)(1)(B) with respect
to any month shall not be taken into account in
determining the deduction allowed under section 213
except to the extent that such amounts exceed the
amount described in subsection (b)(1)(A) with respect
to such month.
(4) Coordination with advance payments of credit.--
With respect to any taxable year--
(A) the amount which would (but for this
subsection) be allowed as a credit to the
taxpayer under subsection (a) shall be reduced
(but not below zero) by the aggregate amount
paid on behalf of such taxpayer under section
1412 of the Patient Protection and Affordable
Care Act for months beginning in such taxable
year, and
(B) the tax imposed by section 1 for such
taxable year shall be increased by the excess
(if any) of--
(i) the aggregate amount paid on
behalf of such taxpayer under such
section 1412 for months beginning in
such taxable year, over
(ii) the amount which would (but for
this subsection) be allowed as a credit
to the taxpayer under subsection (a).
(5) Special rules for qualified small employer health
reimbursement arrangements.--
(A) In general.--If the taxpayer or any
qualifying family member of the taxpayer is
provided a qualified small employer health
reimbursement arrangement for an eligible
coverage month, the sum determined under
subsection (b)(1)(A) with respect to the
taxpayer shall be reduced (but not below zero)
by \1/12\ of the permitted benefit (as defined
in section 9831(d)(3)(C)) under such
arrangement for each such month such
arrangement is provided to such taxpayer.
(B) Qualified small employer health
reimbursement arrangement.--For purposes of
this paragraph, the term ``qualified small
employer health reimbursement arrangement'' has
the meaning given such term by section
9831(d)(2).
(C) Coverage for less than entire year.--In
the case of an employee who is provided a
qualified small employer health reimbursement
arrangement for less than an entire year,
subparagraph (A) shall be applied by
substituting ``the number of months during the
year for which such arrangement was provided''
for ``12''.
(6) Certain rules related to nonqualified health
plans.--The rules of section 36B(c)(3)(D), as in effect
for taxable years beginning before January 1, 2020,
shall apply with respect to subsection (f)(5).
(7) Inflation adjustment.--
(A) In general.--In the case of any taxable
year beginning in a calendar year after 2020,
each dollar amount in subsection (c)(1), the
$75,000 amount in subsection (c)(2)(B), and the
dollar amount in subsection (c)(3)(A), shall be
increased by an amount equal to--
(i) such dollar amount, multiplied by
(ii) the cost-of-living adjustment
determined under section 1(f)(3) for
the calendar year in which the taxable
year begins, determined--
(I) by substituting
``calendar year 2019'' for
``calendar year 1992'' in
subparagraph (B) thereof, and
(II) by substituting for the
CPI referred to section
1(f)(3)(A) the amount that such
CPI would have been if the
annual percentage increase in
CPI with respect to each year
after 2019 had been one
percentage point greater.
(B) Terms related to CPI.--
(i) Annual percentage increase.--For
purposes of subparagraph (A)(ii)(II),
the term ``annual percentage increase''
means the percentage (if any) by which
CPI for any year exceeds CPI for the
prior year.
(ii) Other terms.--Terms used in this
paragraph which are also used in
section 1(f)(3) shall have the same
meanings as when used in such section.
(C) Rounding.--Any increase determined under
subparagraph (A) shall be rounded to the
nearest multiple of $50.
(8) Rules related to State certification of qualified
health plans.--A certification shall not be taken into
account under subsection (d)(1) unless such
certification is made available to the public and meets
such other requirements as the Secretary may provide.
(9) Regulations.--The Secretary may prescribe such
regulations and other guidance as may be necessary or
appropriate to carry out this section and section 1412
of the Patient Protection and Affordable Care Act.
* * * * * * *
VII. DISSENTING VIEWS
H.R. 2372 (Johnson, R-TX) would allow veterans who are not
enrolled in military-related coverage to access tax credits (as
modified by the American Health Care Act (AHCA), H.R. 1628) for
the purchase of health insurance in the individual market. This
legislation amends the AHCA, which, while passed out of the
House, is not yet law.
This legislation is only necessary because of gimmickry in
the underlying AHCA. Section 2 of H.R. 2372 was originally part
of the AHCA legislation, but it was removed in the Manager's
Amendment in the Ways and Means Committee. It would have
triggered a budget process (Byrd Rule), which would have
required the Republicans to submit the AHCA to the Veteran's
Affairs Committee. H.R. 2372 would reinsert the provision.
As passed by the House in early May, the AHCA would
prohibit any veteran eligible for government healthcare (such
as VA and TRICARE) from receiving a tax credit even if the
veteran has a non-group health plan. The important word is
``eligible''--this could affect veterans who have never used
the VA system and are not enrolled.
Veterans decline VA or TRICARE health care services for a
wide variety of reasons, including enrollment requirements
(i.e., length of consecutive service and time period of
service, tiered prioritization of enrollment eligibility, and
separation from service conditions), access issues (e.g.,
living far from VA services), and availability of other
coverage options (e.g., employer-sponsored insurance).
Veterans are already protected under current law; this is a
Republican attempt to repeal current law health coverage and
protections that has caused the issue. Under current law,
veterans are protected both if they are eligible for 15949
military-related coverage and do not enroll, or if they enroll
in partial benefits, military-related coverage that does not
meet the essential health benefits test. The purpose of Mr.
Johnson's bill is to ensure that the House-passed AHCA
legislation is consistent with current law in its treatment of
veterans.
However, it is not clear that H.R. 2372 would protect
veterans who are enrolled in military-related coverage for
limited benefits or services, as is provided by current
regulations. The Republican AHCA does not have a minimum
standard for coverage and allows states to waive essential
health benefits; therefore, veterans enrolled for treatment of
service-connected disability could be prohibited from receiving
tax credits to help them secure coverage for other health care
needs.
H.R. 2372 masquerades as help for veterans, but fails to
address underlying flaws in the Republican health care bill
that harm veterans. H.R. 2372 does not fix any of the problems
for veterans caused by the AHCA bill, including loss of health
insurance coverage, higher out-of-pocket costs, loss of
essential benefits and treatments, or caps or limits on annual
or lifetime coverage.
According to estimates by the independent, nonpartisan
Congressional Budget Office (CBO), the AHCA would result in 23
million Americans losing health insurance coverage. This stems
from a combination of inadequate out-of-pocket assistance,
significant reductions in Medicaid enrollment and a change in
rating practices that would allow insurers to charge
significantly more for individuals with pre-existing
conditions.
The Johnson bill does nothing to improve the inadequate tax
credits under the MICA, which it amends. Under the AHCA, tax
credits to purchase coverage do not account for the differences
in the cost of coverage across the country or family incomes--
which would make coverage completely unaffordable for countless
American families. On top of that, this bill does nothing to
eliminate the age tax in the AHCA, meaning older veterans would
face significantly higher premiums.
The AHCA would allow pre-existing condition discrimination
under its state waivers. Before Affordable Care Act (ACA)
market reforms, military service was a condition for
underwriting and discrimination.
The AHCA, as amended by the Johnson bill, would slash
Medicaid coverage, jeopardizing affordable health coverage for
the more than two million veterans who rely on Medicaid for
their insurance. Millions more spouses and children of veterans
rely on Medicaid; they too would be harmed. The AHCA cuts $834
billion from Medicaid and the Trump Administration's budget
proposes even deeper cuts. More than 40 percent of working-age
veterans with Medicaid had no other source of coverage. The
AHCA would jeopardize basic living standards and needed care
for veterans who are struggling to make ends meet to pay for
tax cuts for the rich. Medicaid provides the following that are
critical for veterans' health: mental health services;
substance abuse and addiction services; physical therapy
services; and general wellness care.
Amendments offered during consideration of H.R. 2372.
Democrats offered a series of amendments to highlight the
shortcomings of H.R. 2372 and the larger MICA, all but one were
ruled non-germane by Chairman Kevin Brady (R-TX) and all but
two of those ruled non-germane were appealed by Democratic
Members. The appeals were then defeated by party-line votes.
The one germane amendment offered by Congressman Davis (D-IL)
was defeated by a party-line vote.
Congressman Doggett (D-TX) offered an amendment to
reinstate the fee on brand pharmaceutical manufacturers, which
helps fund Medicare. In repealing this fee, the Republican
health legislation would increase Medicare Part B premiums by
$8.7 billion. Striking the pharma fee from the House Republican
plan would protect beneficiaries' Medicare premiums. At a time
of rising pharmaceutical profits and limited Social Security
cost-of-living increases, this amendment would have helped
ensure Medicare costs remain reasonable for beneficiaries.
Congressman Thompson (D-CA) offered an amendment to
reinstate the tax on high-income earners which directly funds
the Medicare Part A Trust Fund. The Republican health plan
would repeal this tax, shortening the life of Medicare while
giving a substantial tax break to the richest Americans. This
amendment would prevent $75 billion being taken from the
Medicare Trust Fund, which would reduce the solvency of the
Medicare Trust Fund by one year.
Congressman Davis (D-IL) offered an amendment to adjust the
tax credits in the Republican proposal to protect veterans
under 400 percent of the poverty level to ensure that they
would not pay more than 10 percent of their annual income
toward the cost of health insurance premiums. While the
Republican legislation gives billions of dollars in tax breaks
to the wealthiest and most financially secure individuals, Mr.
Davis' amendment would have provided a small measure of
protection for middle-income and working-class veterans. Under
current law, tax credits are based on income and premium costs
for families earning less than 400 percent of the poverty
level. For instance, between 2016 and 2017, under current law,
advanced premium tax credits kept premiums paid by individuals
flat for 83 percent of Marketplace enrollees (about 10.1
million people) who received them. The Republican health bill
would repeal this current law protection, which is embedded in
the design of the tax credit.
Congressman Higgins (D-NY) offered an amendment to prevent
veterans from being subject to the five-to-one (5:1) age rating
established in the AHCA. Under the AHCA, older individuals
could be charged 5+ times as much as younger individuals.
However, unlike the current tax credits, which adjust to the
cost of premiums, the AHCA tax credits are age adjusted well
below the 5:1 ratio. This leads to seniors paying much more for
health insurance coverage. As CBO noted in an updated score
released in the middle of our mark-up, a 64-year-old senior
could see his or her net premiums increase by more than $16,000
under the AHCA due to increased age rating and smaller premium
tax credits than are available under current law. Rather than
join with Democrats to protect veterans from the age tax,
Republican members hid behind parliamentary tricks to avoid
voting to support the veterans in their Districts.
Congresswoman DelBene (D-WA) offered an amendment to ensure
that the current law protections for individuals with pre-
existing conditions remain in place by rescinding the state
waiver authority established in the AHCA. This provision of the
AHCA would allow states to waive essential health benefits and
allow insurance companies to, once again, discriminate against
people with pre-existing conditions. As currently drafted, the
Republican health bill undermines the guarantee that all health
insurance policies cover essential health benefits like
prescription drugs, mental health services, opioid addiction
treatment, and maternity care. The AHCA threatens to bring back
annual and lifetime limits on healthcare as prohibition of
these limits only apply to essential health benefits.
Therefore, this AHCA provision threatens not only individual
market coverage but also employer-sponsored insurance.
In fact, CBO stated that the waiver provision could have
particularly detrimental consequences in their latest analysis:
``However, the agencies estimate that about one-sixth of the
population resides in areas in which the nongroup market would
start to become unstable beginning in 2020. That instability
would result from market responses to decisions by some states
to waive two provisions of federal law, as would be permitted
under H.R. 1628. One type of waiver would allow states to
modify the requirements governing essential health benefits
(EHBs), which set minimum standards for the benefits that
insurance in the 15943 nongroup and small-group markets must
cover. A second type of waiver would allow insurers to set
premiums on the basis of an individual's health status if the
person had not demonstrated continuous coverage. . . .''
Before the ACA, 43 states and the District of Columbia
allowed insurance companies to charge higher premiums to people
with pre-existing conditions. As CBO noted, ``In addition,
premiums would vary significantly according to health status
and the types of benefits provided, and less healthy people
would face extremely high premiums, despite the additional
funding that would be available under H.R. 1628 to help reduce
premiums. Over time, it would become more difficult for less
healthy people (including people with preexisting medical
conditions) in those states to purchase insurance because their
premiums would continue to increase rapidly.'' This provision
of the AHCA would have disastrous consequences for the millions
of Americans with pre-existing conditions, including veterans.
Congresswoman Sanchez (D-CA) offered an amendment to
prevent gender discrimination against female veterans under the
AHCA state-waivers, which would once again allow for insurance
companies to discriminate against preexisting conditions,
including being a woman. CBO, in fact, noted that pregnant
women could face thousands of dollars more in out-of-pocket
costs under the Republican health bill.
Congresswoman Sewell (D-AL) offered an amendment to prevent
states from enforcing future Medicaid work requirements on
veterans receiving Medicaid. Research has shown that Medicaid
work requirements would cause millions of enrollees with
substantial health needs to lose coverage. Veterans have worked
tirelessly on behalf of our country and should not be denied
services for lack of employment.
Congresswoman Chu (D-CA) offered an amendment that would
require qualified health plans purchased with a tax credit
under the AHCA include mental health, behavioral health, and
substance abuse treatment benefits. This amendment would insure
mental health services are not put out of reach for worlcing
families because of artificially high premiums or out-of-pocket
costs. This need is particularly important for veterans.
According to a 2015 survey from the Iraq and Afghanistan
Veterans of America, 58 percent of participating veterans
reported having a mental health issue as a direct result of
their service. A study from JAMA Psychiatry found the rate of
post-traumatic stress disorder (PTSD) among veterans to be 15
times higher than civilians. And, according the Department of
Veterans Affairs, suicide rates are 41 percent higher than the
general population for deployed veterans, and 61 percent higher
than the general population for non-deployed veterans. But,
instead of addressing the dire need for mental health services
for this vulnerable population, the underlying bill that H.R.
2372 amends would allow states to waive current protections and
allow insurers to offer plans without essential health
benefits, including mental health benefits. These waivers would
permit insurers to charge people with pre-existing conditions--
like, for example, PTSD--more for coverage.
Congressman Pascrell (D-NJ) offered an amendment to allow
any individual suffering from Traumatic Brain Injury (TBI) to
maintain current premium tax credits. TBI is one of the
signature injuries of the wars in Iraq and Afghanistan, and
many of our veterans are grappling with the consequences of
these injuries. The RAND Corporation estimated that nearly 20
percent of the men and women deployed to Iraq and Afghanistan
sustained a brain injury while in the line of duty. More than
five million Americans are living with a life-long disability
as a result of a TBI, and individuals that sustain moderate and
severe TBIs require substantial medical care to recover and
cope with their injuries. Access to the supports and services
that they need to return to school and work and continue with
their everyday lives often results in significant out-of-pocket
costs even with health coverage. TBI survivors cannot afford to
lose their insurance, nor can they afford any additional costs.
Congressman Kind (D-WI) offered an amendment to protect
veterans from being charged more for pre-existing conditions
under states that allow health status to be used for rating.
Under current law, veterans are not allowed to be charged
higher insurance premiums because of a pre-existing condition.
The AHCA would allow states to apply for a waiver to current
law to allow insurance companies charge higher insurance
premiums because a person has a pre-existing health condition
like heart disease, autism, or traumatic brain injury. Before
the ACA, 43 states and the District of Columbia allowed
insurance companies to charge higher premiums to people with
pre-existing conditions. This provision of the AHCA would have
disastrous consequences for the millions of Americans with
preexisting conditions, including veterans.
The Republicans rejected all of the Democratic amendments
that would have nominally improved the flawed Republican health
care bill. The Johnson bill does not fix any of the underlying
flaws that would cause veterans to lose coverage or pay higher
out-of-pocket costs. There are numerous actions Congress could
take to improve health care for veterans. Enacting a technical
fix for a bill that isn't even law yet doesn't pass muster as
being a legitimate effort to improve care and coverage for
America's veterans. For these reasons, we oppose H.R. 2372.
Richard E. Neal,
Ranking Member.
[all]