[House Report 115-849]
[From the U.S. Government Publishing Office]
115th Congress } { Rept 115-849
HOUSE OF REPRESENTATIVES
2d Session } { Part 1
======================================================================
THE ``INCREASING ACCESS TO LOWER PREMIUM PLANS ACT OF 2018''
_______
July 19, 2018.--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
[To accompany H.R. 6311]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 6311) to amend the Internal Revenue Code of 1986 and
the Patient Protection and Affordable Care Act to modify the
definition of qualified health plan for purposes of the health
insurance premium tax credit and to allow individuals
purchasing health insurance in the individual market to
purchase a lower premium copper plan, report favorably thereon
with an amendment and recommend that the bill as amended do
pass.
115th Congress } { Rept 115-849
HOUSE OF REPRESENTATIVES
2d Session } { Part 1
======================================================================
INCREASING ACCESS TO LOWER PREMIUM PLANS ACT OF 2018
_______
July 19, 2018.--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. 6311]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 6311) to amend the Internal Revenue Code of 1986 and
the Patient Protection and Affordable Care Act to modify the
definition of qualified health plan for purposes of the health
insurance premium tax credit and to allow individuals
purchasing health insurance in the individual market to
purchase a lower premium copper plan, 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............................................5
II. EXPLANATION OF THE BILL...........................................6
A. Modification of Definition of Qualified Health Plan... 6
III.VOTES OF THE COMMITTEE............................................9
IV. BUDGET EFFECTS OF THE BILL.......................................11
A. Committee Estimate of Budgetary Effects............... 11
B. Statement Regarding New Budget Authority and Tax
Expenditures Budget Authority........................ 13
C. Cost Estimate Prepared by the Congressional Budget
Office............................................... 13
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE.......13
A. Committee Oversight Findings and Recommendations...... 13
B. Statement of General Performance Goals and Objectives. 13
C. Information Relating to Unfunded Mandates............. 13
D. Applicability of House Rule XXI 5(b).................. 14
E. Tax Complexity Analysis............................... 14
F. Congressional Earmarks, Limited Tax Benefits, and
Limited Tariff Benefits.............................. 14
G. Duplication of Federal Programs....................... 14
H. Disclosure of Directed Rule Makings................... 14
VI. CORRESPONDENCE...................................................15
A. Exchange of Letters between Ways and Means and Energy
and Commerce......................................... 15
VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED............17
B. Changes in Existing Law Proposed by the Bill, as
Reported............................................. 17
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 ``Increasing Access to Lower Premium
Plans Act of 2018''.
SEC. 2. MODIFICATION OF DEFINITION OF QUALIFIED HEALTH PLAN.
(a) In General.--Section 36B(c)(3)(A) of the Internal Revenue Code of
1986 is amended--
(1) by inserting ``(determined without regard to
subparagraphs (A), (C)(ii), and (C)(iv) of paragraph (1)
thereof and without regard to whether the plan is offered on an
Exchange)'' after ``1301(a) of the Patient Protection and
Affordable Care Act'', and
(2) by striking ``shall not include'' and all that follows
and inserting ``shall not include any health plan that--
``(i) is a grandfathered health plan or a
grandmothered health plan, or
``(ii) includes 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).''.
(b) Definition of Grandmothered Health Plan.--Section 36B(c)(3) of
such Code is amended by adding at the end the following new
subparagraph:
``(C) Grandmothered health plan.--
``(i) In general.--The term `grandmothered
health plan' means health insurance coverage
which is offered in the individual health
insurance market as of October 1, 2013, and is
permitted to be offered in such market after
January 1, 2014, as a result of CCIIO guidance.
``(ii) CCIIO guidance defined.--The term
`CCIIO guidance' means the letter issued by the
Centers for Medicare & Medicaid Services on
November 14, 2013, to the State Insurance
Commissioners outlining a transitional policy
for non-grandfathered coverage in the
individual health insurance market, as
subsequently extended and modified (including
by a communication entitled `Insurance
Standards Bulletin Series--INFORMATION--
Extension of Transitional Policy through 2019'
issued on April 9, 2018, by the Director of the
Center for Consumer Information and Insurance
Oversight of such Centers).
``(iii) Individual health insurance market.--
The term `individual health insurance market'
means the market for health insurance coverage
(as defined in section 9832(b)) offered to
individuals other than in connection with a
group health plan (within the meaning of
section 5000(b)(1)).''.
(c) Conforming Amendment Related to Abortion Coverage.--Section
36B(c)(3) of such Code, as amended by subsection (b), is amended by
adding at the end the following new subparagraph:
``(D) Certain rules related to abortion.--
``(i) Option to purchase separate coverage or
plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any individual from
purchasing separate coverage for abortions
described in such subparagraph, or a health
plan that includes such abortions, so long as
no credit is allowed under this section with
respect to the premiums for such coverage or
plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
health insurance issuer offering a health plan
from offering separate coverage for abortions
described in such subparagraph, or a plan that
includes such abortions, so long as premiums
for such separate coverage or plan are not paid
for with any amount attributable to the credit
allowed under this section (or the amount of
any advance payment of the credit under section
1412 of the Patient Protection and Affordable
Care Act).
``(iii) Other treatments.--The treatment of
any infection, injury, disease, or disorder
that has been caused by or exacerbated by the
performance of an abortion shall not be treated
as an abortion for purposes of subparagraph
(A).''.
(d) Conforming Amendments Related to Off-Exchange Coverage.--
(1) Advance payment not applicable.--Section 1412 of the
Patient Protection and Affordable Care Act is amended by adding
at the end the following new subsection:
``(f) Exclusion of Off-Exchange Coverage.--Advance payments under
this section, and advance determinations under section 1411, with
respect to any credit allowed under section 36B shall not be made with
respect to any health plan which is not enrolled in through an
Exchange.''.
(2) Reporting.--Section 6055(b) of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
paragraph:
``(3) Information relating to off-exchange premium tax credit
eligible coverage.--If minimum essential coverage provided to
an individual under subsection (a) consists of a qualified
health plan (as defined in section 36B(c)(3)) which is not
enrolled in through an Exchange established under title I of
the Patient Protection and Affordable Care Act, a return
described in this subsection shall include--
``(A) a statement that such plan is a qualified
health plan (as defined in section 36B(c)(3)),
``(B) the premiums paid with respect to such
coverage,
``(C) the months during the calendar year for which
such coverage is provided to the individual,
``(D) the adjusted monthly premium for the applicable
second lowest cost silver plan (as defined in section
36B(b)(3)) for each such month with respect to such
individual, and
``(E) such other information as the Secretary may
prescribe.''.
(3) Other conforming amendments.--
(A) Section 36B(b)(2)(A) of such Code is amended by
striking ``and which were enrolled'' and all that
follows and inserting ``, or''.
(B) Section 36B(b)(3)(B)(i) of such Code is amended
by striking ``the same Exchange'' and all that follows
and inserting ``the Exchange through which such
taxpayer is permitted to obtain coverage, and''.
(C) Section 36B(c)(2)(A)(i) of such Code is amended
by striking ``that was enrolled in through an Exchange
established by the State under section 1311 of the
Patient Protection and Affordable Care Act''.
(e) Effective Date.--
(1) In general.--Except as otherwise provided in this
subsection, the amendments made by this section shall apply to
taxable years beginning after December 31, 2018.
(2) Advance payment not applicable to off-exchange
coverage.--The amendment made by subsection (d)(1) shall take
effect on January 1, 2019.
(3) Reporting.--The amendment made by subsection (d)(2) shall
apply to coverage provided for months beginning after December
31, 2018.
SEC. 3. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH INSURANCE IN THE
INDIVIDUAL MARKET THE OPTION TO PURCHASE A LOWER
PREMIUM COPPER PLAN.
(a) In General.--Section 1302(e) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18022(e)) is amended--
(1) in paragraph (1)--
(A) by redesignating clauses (i) and (ii) of
subparagraph (B) as subparagraphs (A) and (B),
respectively, and adjusting the margins accordingly;
(B) by striking ``plan year if--'' and all that
follows through ``the plan provides--'' and inserting
``plan year if the plan provides--''; and
(C) in subparagraph (A), as redesignated by
subparagraph (A), by striking ``clause (ii)'' and
inserting ``subparagraph (B)'';
(2) by striking paragraph (2); and
(3) by redesignating paragraph (3) as paragraph (2).
(b) Risk Pools.--Section 1312(c)(1) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18032(c)(1)) is amended by inserting
``and enrollees in catastrophic plans described in section 1302(e)''
after ``Exchange''.
(c) Conforming Amendment.--Section 1312(d)(3)(C) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(d)(3)(C)) is
amended by striking ``, except that in the case of a catastrophic plan
described in section 1302(e), a qualified individual may enroll in the
plan only if the individual is eligible to enroll in the plan under
section 1302(e)(2)''.
(d) Effective Date.--The amendments made by this section shall apply
to plan years beginning after December 31, 2018.
I. SUMMARY AND BACKGROUND
A. Purpose and Summary
The bill H.R. 6311, as reported by the Committee on Ways
and Means, provides an off-ramp from Obamacare's rising
premiums and limited choices by allowing the premium tax credit
to be used for qualified plans offered outside of the law's
exchanges and Healthcare.gov. In addition, it expands access to
the lowest-premium plans available (``catastrophic'' plans) for
all individuals purchasing coverage in the individual market
and allows the premium tax credit to be used to offset the cost
of such plans.
B. Background and Need for Legislation
Obamacare's flawed policies have increased the cost of
coverage in the individual market by 105 percent over 2013-2017
on average. As Republicans continue their efforts to reverse
Obamacare's damage, policies such as those included in this
bill will help to lower premiums and increase choices for
Americans.
Obamacare's tax credits are only available to offset the
cost of bronze, silver, gold, and platinum health care plans
that are sold on the law's government-run health insurance
exchanges. Catastrophic plans are not eligible for the premium
tax credit. In addition, catastrophic plans are only available
to those under age 30 or those over age 30 that qualify for a
hardship exemption.
C. Legislative History
Background
H.R. 6311 was introduced on July 6, 2018 and was referred
to the Committee on Energy and Commerce, and in addition to the
Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of
such provisions as fall within the jurisdiction of the
committee concerned.
Committee action
The Committee on Ways and Means marked up H.R. 6311, the
``Increasing Access to Lower Premium Plans Act of 2018,'' on
July 12, 2018, and ordered the bill, as amended, favorably
reported (with a quorum being present).
Committee hearings
The policy issues associated with tax pertaining to health
care and the ACA were discussed at the following Ways and Means
hearings during the 114th and 115th Congresses:
Full Committee Hearing on the Tax Treatment
of Health Care (April 14, 2016)
Subcommittee on Health Member Day Hearing on
Tax-Related Proposals to Improve Health Care (May 17,
2016)
Subcommittee on Health Hearing on Rising
Health Insurance Premiums Under the Affordable Care Act
(July 12, 2016)
Subcommittee on Health Hearing on Lowering
Costs and Expanding Access to Health Care through
Consumer-Directed Health Plans (June 6, 2018)
II. EXPLANATION OF THE BILL
A. Modification of Definition of Qualified Health Plan
PRESENT LAW
In general
A refundable tax credit (the ``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.''\1\ The premium assistance credit is
generally payable in advance directly to the insurer, as
discussed below. However, eligible individuals may choose to
pay their total health insurance premiums out-of-pocket and
claim the credit at the end of the taxable year.
---------------------------------------------------------------------------
\1\Sec. 36B. Section 36B was enacted as part of the Patient
Protection and Affordable Care Act (``PPACA''), Pub. L. No. 111-148,
and modified by the Healthcare and Education Reconciliation Act of 2010
(``HCERA''), Pub. L. No. 111-152. PPACA and HCERA are referred to
collectively as the Affordable Care Act (``ACA'').
---------------------------------------------------------------------------
Qualified health plans generally must meet certain
requirements.\2\ Special rules apply to certain qualified
health plans, referred to as ``catastrophic-only'' qualified
health plans, which are available only to individuals who are
under age 30 or meet other specified requirements.\3\ The
premium assistance credit is not available with respect to
catastrophic-only qualified health plans.\4\ In addition, in
the case of a qualified health plan that provides coverage for
abortions for which Federal funds may not be used, no part of
the premium assistance credit may be used for the portion of
premiums attributable to that coverage.\5\
---------------------------------------------------------------------------
\2\Secs. 1301 and 1302 of PPACA.
\3\Sec. 1302(e) of PPACA.
\4\Under the Public Health Service Act (``PHSA'') as amended by the
ACA, health insurance must meet certain requirements. Section 1251 of
PPACA excepts certain health plans sold at the time of enactment of
PPACA from some of the PHSA requirements (``grandfathered'' plans). The
premium assistance credit is not available with respect to a
grandfathered plan or plans that receive similar treatment under
administrative guidance.
\5\Sec. 1303(b)(2) of PPACA.
---------------------------------------------------------------------------
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. 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),\6\ (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.\7\ 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.
---------------------------------------------------------------------------
\6\Sec. 911.
\7\Under section 86, only a portion of an individual's social
security benefits are included in gross income.
---------------------------------------------------------------------------
An individual who is eligible for minimum essential
coverage from a source other than the individual insurance
market generally is not eligible for the premium assistance
credit.\8\ However, an individual who is offered minimum
essential coverage under an employer-sponsored health plan may
be eligible for the premium assistance credit if an employee's
share of the premium for self-only coverage exceeds 9.56
percent (for 2018) of the employee's household income, or the
plan's share of total allowed costs of benefits provided under
the plan is less than 60 percent of such costs (called
``minimum value''), and the individual declines the employer-
offered coverage. An individual who enrolls in an employer-
sponsored health plan generally is ineligible for the premium
assistance credit, even if the coverage is considered
unaffordable or does not provide minimum value.
---------------------------------------------------------------------------
\8\Minimum essential coverage is defined in section 5000A(f).
---------------------------------------------------------------------------
As part of the process of enrollment in a qualified health
plan through an Exchange, an individual may apply and be
approved in advance for a premium assistance credit.\9\ The
individual must provide information on income, family size,
changes in marital or family status or income, and citizenship
or lawful presence status.\10\ Initial eligibility for the
premium assistance credit is generally based on the
individual's income for the tax year ending two years prior to
the enrollment period. The Exchange process includes a system
through which information provided by the individual is
verified with the Internal Revenue Service (``IRS''), the
Social Security Administration (``SSA'') and the Department of
Homeland Security (``DHS'').\11\ If an individual is approved
for advance premium assistance payments, the Treasury pays the
advance amount directly to the issuer of the health plan in
which the individual is enrolled. The individual then pays to
the issuer of the plan the difference between the advance
payment amount and the total premium charged for the plan.
---------------------------------------------------------------------------
\9\Secs. 1411-1412 of PPACA. Under section 1402 of PPACA, certain
individuals eligible for advance premium assistance payments are
eligible also for a reduction in their share of medical costs, such as
deductibles and copays, under the plan, referred to as reduced cost-
sharing. Eligibility for reduced cost-sharing is also determined as
part of the Exchange enrollment process. The Department of Health and
Human Services (``HHS'') is responsible for rules relating to Exchanges
and the eligibility determination process.
\10\Under section 1312(f)(3) of PPACA, an individual may not enroll
in a qualified health plan through an Exchange if the individual is not
a citizen or national of United States or an alien lawfully present in
the United States. Thus, such an individual is not eligible for the
premium assistance credit.
\11\Under section 6103, except as provided in the Code, returns and
return information are confidential and may not be disclosed by the
IRS, other Federal employees, State employees, and certain others
having access to such information. Under section 6103(l)(21), upon
written request of the Secretary of HHS, the IRS is permitted to
disclose certain return information in connection with a determination
through the Exchange process of an individual's eligibility for advance
premium assistance payments, reduced cost-sharing, or certain other
government-sponsored health programs.
---------------------------------------------------------------------------
REASONS FOR CHANGE
The Committee believes that tax credits provided to offset
the cost of health plans provided on government exchanges
should also be available to offset the cost of similar health
plans offered outside the government exchanges. This would
expand the choices available to individuals and families and
empower them to make decisions based on their specific needs
and budgets.
Furthermore, the Committee believes that Federal assistance
in the form of premium tax credits should not be available for
health plans that cover elective abortion. This would allow
individuals to avoid directly, unwittingly, and unwillingly
subsidizing abortion.
EXPLANATION OF PROVISION
Application of credit to additional coverage
Qualified health plans generally must meet certain
requirements.\12\ Under the proposal, the premium assistance
credit is available with respect to catastrophic plans\13\ that
meet the requirements relating to qualified health plans. Under
the proposal, the premium assistance credit is also available
with respect to health plans that meet the requirements
relating to qualified health plans except that they are not
offered through an Exchange. Thus, an individual who purchases
a qualified health plan in the individual market, but not
through an Exchange, may be eligible for the premium assistance
credit if the requirements for eligibility are otherwise met.
However, advance premium assistance payments are not available
with respect to a qualified health plan that is not purchased
through an Exchange. An individual who purchases such a plan
must claim the premium assistance credit on his or her income
tax return.
---------------------------------------------------------------------------
\12\Section 2 of the proposal amends section 1302(e) of PPACA to
allow all individuals purchasing health insurance in the individual
market the option to purchase a lower premium plan that does not offer
a bronze, silver, gold, or platinum level of coverage.
\13\As described in sec. 1302(e) of PPACA.
---------------------------------------------------------------------------
Under present law, any person that provides minimum
essential coverage to an individual during a calendar year must
report certain information to the IRS.\14\ The proposal
requires additional information reporting for minimum essential
coverage provided to an individual that is not enrolled through
an Exchange.
---------------------------------------------------------------------------
\14\Sec. 6055(b).
---------------------------------------------------------------------------
As under present law, the credit is not available with
respect to grandfathered plans or plans that receive similar
treatment under administrative guidance. In addition, the
proposal specifies that the credit is not available with
respect to grandmothered plans. Under the proposal, a
grandmothered health plan is defined to be health insurance
coverage which is offered in the individual health insurance
market as of October 1, 2013, and is permitted to be offered in
such market after January 1, 2014, as a result of CCIIO
guidance.\15\
---------------------------------------------------------------------------
\15\CCIIO guidance refers to the letters issued by the Centers for
Medicare and Medicaid Services on November 14, 2013, to the State
Insurance Commissioners outlining a transitional policy for non-
grandfathered coverage in the individual health insurance market, as
subsequently extended and modified. Subsequent modifications include a
communication entitled, ``Insurance Standards Bulletin Series--
INFORMATION--Extension of Transitional Policy through Calendar Year
2017,'' issued on February 29, 2016 by the Director of the Center for
Consumer Information and Insurance Oversight of such Centers.
---------------------------------------------------------------------------
Ineligibility of qualified health plans covering abortion
Under the proposal, the premium assistance credit is not
available with respect to a qualified health plan that provides
coverage for abortions for which Federal funds may not be
used.\16\ However, nothing in the proposal prohibits an
individual from purchasing, or a health insurance issuer from
offering separate coverage for abortions, or a health plan that
includes abortions, as long as no premium assistance credit is
allowed with respect to the premiums for such coverage and
premiums are not paid for with any amount attributable to the
premium assistance credit (or the amount of any advance payment
of the credit).
---------------------------------------------------------------------------
\16\This includes 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. The
treatment of any infection, injury, disease, or disorder that has been
caused by or exacerbated by the performance of an abortion shall not be
treated as an abortion for purposes of determining eligibility for the
premium assistance credit.
---------------------------------------------------------------------------
EFFECTIVE DATE
The modifications to the premium assistance credit are
generally effective for taxable years beginning after December
31, 2018. The proposal specifying that advance premium
assistance payments are not available with respect to a
qualified health plan that is not purchased through an Exchange
is effective on January 1, 2019. The proposal amending the
present-law reporting requirements under section 6055 is
effective for coverage provided for months beginning after
December 31, 2018.
III. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the House of
Representatives, the following statement is made concerning the
vote of the Committee on Ways and Means during the markup
consideration of H.R. 6311, the ``Increasing Access to Lower
Premium Plans Act of 2018,'' on July 12, 2018.
The vote on Mr. Reichert's motion to table Mr. Neal's
appeal of the ruling of the Chair that Mr. Thompson's amendment
was non-germane, was agreed to by a roll call vote of 21 yeas
to 15 nays. The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ ........ .........
Mr. Johnson.................... X ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... ........ ........ ......... 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 .........
Ms. Noem....................... X ........ ......... Ms. Chu.......... ........ X .........
Mr. Holding.................... X ........ .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... ........ ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
Mr. Wenstrup................... X ........ .........
----------------------------------------------------------------------------------------------------------------
In compliance with the Rules of the House of
Representatives, the following statement is made concerning the
vote of the Committee on Ways and Means during the markup
consideration of H.R. 6311, the ``Increasing Access to Lower
Premium Plans Act of 2018,'' on July 12, 2018.
The vote on the amendment offered by Ms. DelBene to the
amendment in the nature of a substitute offered by Chairman
Brady to H.R. 6311, which would strike sec 2(a)(2) and
subsection (c) of section 2'', was not agreed to by a rollcall
vote of 15 yeas to 22 nays. The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... ........ X ......... Mr. Neal......... ........ ........ .........
Mr. Johnson.................... ........ X ......... 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)................. ........ ........ ......... 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 ........ .........
Ms. Noem....................... ........ X ......... Ms. Chu.......... X ........ .........
Mr. Holding.................... ........ X .........
Mr. Smith (MO)................. ........ X .........
Mr. Rice....................... ........ X .........
Mr. Schweikert................. ........ X .........
Ms. Walorski................... ........ X .........
Mr. Curbelo.................... ........ X .........
Mr. Bishop..................... ........ X .........
Mr. Wenstrup................... ........ X .........
----------------------------------------------------------------------------------------------------------------
In compliance with the Rules of the House of
Representatives, the following statement is made concerning the
vote of the Committee on Ways and Means during the markup
consideration of H.R. 6311, the ``Increasing Access to Lower
Premium Plans Act of 2018,'' on July 12, 2018.
The vote on the amendment offered by Ms. Sanchez to the
amendment in the nature of a substitute offered by Chairman
Brady to H.R. 6311, which would make plans that are otherwise
eligible for section 2 in the underlying bill contingent on if
that plan issuer does not discriminate or raise premiums on the
basis of gender for any plan, was not agreed to by a rollcall
vote of 16 yeas to 23 nays. The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... ........ X ......... Mr. Neal......... X ........ .........
Mr. Johnson.................... ........ X ......... 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 ........ .........
Ms. Noem....................... ........ X ......... Ms. Chu.......... X ........ .........
Mr. Holding.................... ........ X .........
Mr. Smith (MO)................. ........ X .........
Mr. Rice....................... ........ X .........
Mr. Schweikert................. ........ X .........
Ms. Walorski................... ........ X .........
Mr. Curbelo.................... ........ X .........
Mr. Bishop..................... ........ X .........
Mr. Wenstrup................... ........ X .........
----------------------------------------------------------------------------------------------------------------
In compliance with the Rules of the House of
Representatives, the following statement is made concerning the
vote of the Committee on Ways and Means during the markup
consideration of H.R. 6311, the ``Increasing Access to Lower
Premium Plans Act of 2018,'' on July 12, 2018.
H.R. 6311 was ordered favorably reported to the House of
Representatives as amended by an amendment in the nature of a
substitute offered by Chairman Brady by a rollcall vote of 23
yeas to 16 nays. The vote was as follows:
----------------------------------------------------------------------------------------------------------------
Representative Yea Nay Present Representative Yea Nay Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady...................... X ........ ......... Mr. Neal......... ........ X .........
Mr. Johnson.................... X ........ ......... Mr. Levin........ ........ X .........
Mr. Nunes...................... X ........ ......... Mr. Lewis........ ........ X .........
Mr. Reichert................... X ........ ......... Mr. Doggett...... ........ X .........
Mr. Roskam..................... X ........ ......... Mr. Thompson..... ........ X .........
Mr. Buchanan................... X ........ ......... Mr. Larson....... ........ X .........
Mr. Smith (NE)................. X ........ ......... Mr. Blumenauer... ........ X .........
Ms. Jenkins.................... X ........ ......... Mr. Kind......... ........ X .........
Mr. Paulsen.................... X ........ ......... Mr. Pascrell..... ........ X .........
Mr. Marchant................... X ........ ......... Mr. Crowley...... ........ X .........
Ms. Black...................... ........ ........ ......... Mr. Davis........ ........ X .........
Mr. Reed....................... X ........ ......... Ms. Sanchez...... ........ X .........
Mr. Kelly...................... X ........ ......... Mr. Higgins...... ........ X .........
Mr. Renacci.................... X ........ ......... Ms. Sewell....... ........ X .........
Ms. Noem....................... X ........ ......... Ms. DelBene...... ........ X .........
Mr. Holding.................... X ........ ......... Ms. Chu.......... ........ X .........
Mr. Smith (MO)................. X ........ .........
Mr. Rice....................... X ........ .........
Mr. Schweikert................. X ........ .........
Ms. Walorski................... X ........ .........
Mr. Curbelo.................... X ........ .........
Mr. Bishop..................... X ........ .........
Mr. LaHood..................... X ........ .........
Mr. Wenstrup................... 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. 6311, as
reported.
The bill, as reported, is estimated to have the following
effect on Federal fiscal year budget receipts for the period
2019-2028:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FISCAL YEARS [Millions of Dollars]
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Item 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2019-23 2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Modification of Definition of Qualified Health Plan\1\\2\... -388 -1,288 -1,252 -1,258 -1,295 -1,284 -1,206 -1,265 -1,284 -1,304 -5,481 -11,823
Allow All Individuals Purchasing Health Insurance in the 51 76 85 94 98 99 101 103 106 110 404 923
Individual Market the Option to Purchase a Lower Premium
Copper Plan\1\\2\..........................................
Total................................................... -337 -1,212 -1,167 -1,164 -1,197 -1,185 -1,104 -1,162 -1,178 -1,194 -5,077 -10,901
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE: Details may not add to totals due to rounding.
\1\Estimate provided by the staff of the Joint Committee on Taxation and the Congressional Budget Office.
\2\Estimate includes the following outlay effects:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2019-23 2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Modification of Definition of Qualified Health Plan......... 168 902 848 823 833 810 727 758 738 738 3,574 7,346
Allow All Individuals Purchasing Health Insurance in the -50 -74 -82 -91 -95 -96 -98 -99 -101 -105 -391 -890
Individual Market the Option to Purchase a Lower Premium
Copper Plan................................................
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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-reducing tax
provision involves a new tax expenditure. See Part IV.A.,
above.
C. Cost Estimate Prepared by the Congressional Budget Office
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. 6138, as
reported. As of the filing of this report, the Committee had
not received an estimate prepared by the Congressional Budget
Office (CBO).
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 111139, 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.
VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
B. Changes in Existing Law Proposed by the Bill, as Reported
In compliance with clause 3(e)(1)(B) of rule XIII of the
Rules of the House of Representatives, changes in existing law
proposed 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, 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 (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):
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
* * * * * * *
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], 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] the
Exchange through which such taxpayer is
permitted to obtain coverage, 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).
(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 (determined
without regard to subparagraphs (A), (C)(ii),
and (C)(iv) of paragraph (1) thereof and
without regard to whether the plan is offered
on an Exchange), except that such term [shall
not include a qualified health plan which is a
catastrophic plan described in section 1302(e)
of such Act.] shall not include any health plan
that--
(i) is a grandfathered health plan or
a grandmothered health plan, or
(ii) includes 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).
(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.
(C) Grandmothered health plan.--
(i) In general.--The term
``grandmothered health plan'' means
health insurance coverage which is
offered in the individual health
insurance market as of October 1, 2013,
and is permitted to be offered in such
market after January 1, 2014, as a
result of CCIIO guidance.
(ii) CCIIO guidance defined.--The
term ``CCIIO guidance'' means the
letter issued by the Centers for
Medicare & Medicaid Services on
November 14, 2013, to the State
Insurance Commissioners outlining a
transitional policy for non-
grandfathered coverage in the
individual health insurance market, as
subsequently extended and modified
(including by a communication entitled
``Insurance Standards Bulletin Series--
INFORMATION--Extension of Transitional
Policy through 2019'' issued on April
9, 2018, by the Director of the Center
for Consumer Information and Insurance
Oversight of such Centers).
(iii) Individual health insurance
market.--The term ``individual health
insurance market'' means the market for
health insurance coverage (as defined
in section 9832(b)) offered to
individuals other than in connection
with a group health plan (within the
meaning of section 5000(b)(1)).
(D) Certain rules related to abortion.--
(i) Option to purchase separate
coverage or plan.--Nothing in
subparagraph (A) shall be construed as
prohibiting any individual from
purchasing separate coverage for
abortions described in such
subparagraph, or a health plan that
includes such abortions, so long as no
credit is allowed under this section
with respect to the premiums for such
coverage or plan.
(ii) Option to offer coverage or
plan.--Nothing in subparagraph (A)
shall restrict any health insurance
issuer offering a health plan from
offering separate coverage for
abortions described in such
subparagraph, or a plan that includes
such abortions, so long as premiums for
such separate coverage or plan are not
paid for with any amount attributable
to the credit allowed under this
section (or the amount of any advance
payment of the credit under section
1412 of the Patient Protection and
Affordable Care Act).
(iii) Other treatments.--The
treatment of any infection, injury,
disease, or disorder that has been
caused by or exacerbated by the
performance of an abortion shall not be
treated as an abortion for purposes of
subparagraph (A).
(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
2016'' in subparagraph (A)(ii)
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.
* * * * * * *
Subtitle F--Procedure and Administration
* * * * * * *
CHAPTER 61--INFORMATION AND RETURNS
* * * * * * *
Subchapter A--Returns and Records
* * * * * * *
PART III--INFORMATION RETURNS
* * * * * * *
Subpart D--Information Regarding Health Insurance Coverage
* * * * * * *
SEC. 6055. REPORTING OF HEALTH INSURANCE COVERAGE.
(a) In General.--Every person who provides minimum essential
coverage to an individual during a calendar year shall, at such
time as the Secretary may prescribe, make a return described in
subsection (b).
(b) Form and Manner of Return.--
(1) In general.--A return is described in this
subsection if such return--
(A) is in such form as the Secretary may
prescribe, and
(B) contains--
(i) the name, address and TIN of the
primary insured and the name and TIN of
each other individual obtaining
coverage under the policy,
(ii) the dates during which such
individual was covered under minimum
essential coverage during the calendar
year,
(iii) in the case of minimum
essential coverage which consists of
health insurance coverage, information
concerning--
(I) whether or not the
coverage is a qualified health
plan offered through an
Exchange established under
section 1311 of the Patient
Protection and Affordable Care
Act, and
(II) in the case of a
qualified health plan, the
amount (if any) of any advance
payment under section 1412 of
the Patient Protection and
Affordable Care Act of any
cost-sharing reduction under
section 1402 of such Act or of
any premium tax credit under
section 36B with respect to
such coverage, and
(iv) such other information as the
Secretary may require.
(2) Information relating to employer-provided
coverage.--If minimum essential coverage provided to an
individual under subsection (a) consists of health
insurance coverage of a health insurance issuer
provided through a group health plan of an employer, a
return described in this subsection shall include--
(A) the name, address, and employer
identification number of the employer
maintaining the plan,
(B) the portion of the premium (if any)
required to be paid by the employer, and
(C) if the health insurance coverage is a
qualified health plan in the small group market
offered through an Exchange, such other
information as the Secretary may require for
administration of the credit under section 45R
(relating to credit for employee health
insurance expenses of small employers).
(3) Information relating to off-exchange premium tax
credit eligible coverage.--If minimum essential
coverage provided to an individual under subsection (a)
consists of a qualified health plan (as defined in
section 36B(c)(3)) which is not enrolled in through an
Exchange established under title I of the Patient
Protection and Affordable Care Act, a return described
in this subsection shall include--
(A) a statement that such plan is a qualified
health plan (as defined in section 36B(c)(3)),
(B) the premiums paid with respect to such
coverage,
(C) the months during the calendar year for
which such coverage is provided to the
individual,
(D) the adjusted monthly premium for the
applicable second lowest cost silver plan (as
defined in section 36B(b)(3)) for each such
month with respect to such individual, and
(E) such other information as the Secretary
may prescribe.
(c) Statements to be Furnished to Individuals With Respect to
Whom Information Is Reported.--
(1) In general.--Every person required to make a
return under subsection (a) shall furnish to each
individual whose name is required to be set forth in
such return a written statement showing--
(A) the name and address of the person
required to make such return and the phone
number of the information contact for such
person, and
(B) the information required to be shown on
the return with respect to such individual.
(2) Time for furnishing statements.--The written
statement required under paragraph (1) shall be
furnished on or before January 31 of the year following
the calendar year for which the return under subsection
(a) was required to be made.
(d) Coverage Provided by Governmental Units.--In the case of
coverage provided by any governmental unit or any agency or
instrumentality thereof, the officer or employee who enters
into the agreement to provide such coverage (or the person
appropriately designated for purposes of this section) shall
make the returns and statements required by this section.
(e) Minimum Essential Coverage.--For purposes of this
section, the term ``minimum essential coverage'' has the
meaning given such term by section 5000A(f).
* * * * * * *
----------
PATIENT PROTECTION AND AFFORDABLE CARE ACT
* * * * * * *
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
* * * * * * *
Subtitle D--Available Coverage Choices for All Americans
PART 1--ESTABLISHMENT OF QUALIFIED HEALTH PLANS
* * * * * * *
SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS.
(a) Essential Health Benefits Package.--In this title, the
term ``essential health benefits package'' means, with respect
to any health plan, coverage that--
(1) provides for the essential health benefits
defined by the Secretary under subsection (b);
(2) limits cost-sharing for such coverage in
accordance with subsection (c); and
(3) subject to subsection (e), provides either the
bronze, silver, gold, or platinum level of coverage
described in subsection (d).
(b) Essential Health Benefits.--
(1) In general.--Subject to paragraph (2), the
Secretary shall define the essential health benefits,
except that such benefits shall include at least the
following general categories and the items and services
covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder
services, including behavioral health
treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services
and devices.
(H) Laboratory services.
(I) Preventive and wellness services and
chronic disease management.
(J) Pediatric services, including oral and
vision care.
(2) Limitation.--
(A) In general.--The Secretary shall ensure
that the scope of the essential health benefits
under paragraph (1) is equal to the scope of
benefits provided under a typical employer
plan, as determined by the Secretary. To inform
this determination, the Secretary of Labor
shall conduct a survey of employer-sponsored
coverage to determine the benefits typically
covered by employers, including multiemployer
plans, and provide a report on such survey to
the Secretary.
(B) Certification.--In defining the essential
health benefits described in paragraph (1), and
in revising the benefits under paragraph
(4)(H), the Secretary shall submit a report to
the appropriate committees of Congress
containing a certification from the Chief
Actuary of the Centers for Medicare & Medicaid
Services that such essential health benefits
meet the limitation described in paragraph (2).
(3) Notice and hearing.--In defining the essential
health benefits described in paragraph (1), and in
revising the benefits under paragraph (4)(H), the
Secretary shall provide notice and an opportunity for
public comment.
(4) Required elements for consideration.--In defining
the essential health benefits under paragraph (1), the
Secretary shall--
(A) ensure that such essential health
benefits reflect an appropriate balance among
the categories described in such subsection, so
that benefits are not unduly weighted toward
any category;
(B) not make coverage decisions, determine
reimbursement rates, establish incentive
programs, or design benefits in ways that
discriminate against individuals because of
their age, disability, or expected length of
life;
(C) take into account the health care needs
of diverse segments of the population,
including women, children, persons with
disabilities, and other groups;
(D) ensure that health benefits established
as essential not be subject to denial to
individuals against their wishes on the basis
of the individuals' age or expected length of
life or of the individuals' present or
predicted disability, degree of medical
dependency, or quality of life;
(E) provide that a qualified health plan
shall not be treated as providing coverage for
the essential health benefits described in
paragraph (1) unless the plan provides that--
(i) coverage for emergency department
services will be provided without
imposing any requirement under the plan
for prior authorization of services or
any limitation on coverage where the
provider of services does not have a
contractual relationship with the plan
for the providing of services that is
more restrictive than the requirements
or limitations that apply to emergency
department services received from
providers who do have such a
contractual relationship with the plan;
and
(ii) if such services are provided
out-of-network, the cost-sharing
requirement (expressed as a copayment
amount or coinsurance rate) is the same
requirement that would apply if such
services were provided in-network;
(F) provide that if a plan described in
section 1311(b)(2)(B)(ii) (relating to stand-
alone dental benefits plans) is offered through
an Exchange, another health plan offered
through such Exchange shall not fail to be
treated as a qualified health plan solely
because the plan does not offer coverage of
benefits offered through the stand-alone plan
that are otherwise required under paragraph
(1)(J); and
(G) periodically review the essential health
benefits under paragraph (1), and provide a
report to Congress and the public that
contains--
(i) an assessment of whether
enrollees are facing any difficulty
accessing needed services for reasons
of coverage or cost;
(ii) an assessment of whether the
essential health benefits needs to be
modified or updated to account for
changes in medical evidence or
scientific advancement;
(iii) information on how the
essential health benefits will be
modified to address any such gaps in
access or changes in the evidence base;
(iv) an assessment of the potential
of additional or expanded benefits to
increase costs and the interactions
between the addition or expansion of
benefits and reductions in existing
benefits to meet actuarial limitations
described in paragraph (2); and
(H) periodically update the essential health
benefits under paragraph (1) to address any
gaps in access to coverage or changes in the
evidence base the Secretary identifies in the
review conducted under subparagraph (G).
(5) Rule of construction.--Nothing in this title
shall be construed to prohibit a health plan from
providing benefits in excess of the essential health
benefits described in this subsection.
(c) Requirements Relating to Cost-Sharing.--
(1) Annual limitation on cost-sharing.--
(A) 2014.--The cost-sharing incurred under a
health plan with respect to self-only coverage
or coverage other than self-only coverage for a
plan year beginning in 2014 shall not exceed
the dollar amounts in effect under section
223(c)(2)(A)(ii) of the Internal Revenue Code
of 1986 for self-only and family coverage,
respectively, for taxable years beginning in
2014.
(B) 2015 and later.--In the case of any plan
year beginning in a calendar year after 2014,
the limitation under this paragraph shall--
(i) in the case of self-only
coverage, be equal to the dollar amount
under subparagraph (A) for self-only
coverage for plan years beginning in
2014, increased by an amount equal to
the product of that amount and the
premium adjustment percentage under
paragraph (4) for the calendar year;
and
(ii) in the case of other coverage,
twice the amount in effect under clause
(i).
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) Cost-sharing.--In this title--
(A) In general.--The term ``cost-sharing''
includes--
(i) deductibles, coinsurance,
copayments, or similar charges; and
(ii) any other expenditure required
of an insured individual which is a
qualified medical expense (within the
meaning of section 223(d)(2) of the
Internal Revenue Code of 1986) with
respect to essential health benefits
covered under the plan.
(B) Exceptions.--Such term does not include
premiums, balance billing amounts for non-
network providers, or spending for non-covered
services.
(4) Premium adjustment percentage.--For purposes of
paragraph (1)(B)(i), the premium adjustment percentage
for any calendar year is the percentage (if any) by
which the average per capita premium for health
insurance coverage in the United States for the
preceding calendar year (as estimated by the Secretary
no later than October 1 of such preceding calendar
year) exceeds such average per capita premium for 2013
(as determined by the Secretary).
(d) Levels of Coverage.--
(1) Levels of coverage defined.--The levels of
coverage described in this subsection are as follows:
(A) Bronze level.--A plan in the bronze level
shall provide a level of coverage that is
designed to provide benefits that are
actuarially equivalent to 60 percent of the
full actuarial value of the benefits provided
under the plan.
(B) Silver level.--A plan in the silver level
shall provide a level of coverage that is
designed to provide benefits that are
actuarially equivalent to 70 percent of the
full actuarial value of the benefits provided
under the plan.
(C) Gold level.--A plan in the gold level
shall provide a level of coverage that is
designed to provide benefits that are
actuarially equivalent to 80 percent of the
full actuarial value of the benefits provided
under the plan.
(D) Platinum level.--A plan in the platinum
level shall provide a level of coverage that is
designed to provide benefits that are
actuarially equivalent to 90 percent of the
full actuarial value of the benefits provided
under the plan.
(2) Actuarial value.--
(A) In general.--Under regulations issued by
the Secretary, the level of coverage of a plan
shall be determined on the basis that the
essential health benefits described in
subsection (b) shall be provided to a standard
population (and without regard to the
population the plan may actually provide
benefits to).
(B) Employer contributions.--The Secretary
shall issue regulations under which employer
contributions to a health savings account
(within the meaning of section 223 of the
Internal Revenue Code of 1986) may be taken
into account in determining the level of
coverage for a plan of the employer.
(C) Application.--In determining under this
title, the Public Health Service Act, or the
Internal Revenue Code of 1986 the percentage of
the total allowed costs of benefits provided
under a group health plan or health insurance
coverage that are provided by such plan or
coverage, the rules contained in the
regulations under this paragraph shall apply.
(3) Allowable variance.--The Secretary shall develop
guidelines to provide for a de minimis variation in the
actuarial valuations used in determining the level of
coverage of a plan to account for differences in
actuarial estimates.
(4) Plan reference.--In this title, any reference to
a bronze, silver, gold, or platinum plan shall be
treated as a reference to a qualified health plan
providing a bronze, silver, gold, or platinum level of
coverage, as the case may be.
(e) Catastrophic Plan.--
(1) In general.--A health plan not providing a
bronze, silver, gold, or platinum level of coverage
shall be treated as meeting the requirements of
subsection (d) with respect to any [plan year if--]
[(A) the only individuals who are eligible to
enroll in the plan are individuals described in
paragraph (2); and
[(B) the plan provides--] plan year if the
plan provides--
[(i)] (A) except as provided in [clause (ii)]
subparagraph (B), the essential health benefits
determined under subsection (b), except that
the plan provides no benefits for any plan year
until the individual has incurred cost-sharing
expenses in an amount equal to the annual
limitation in effect under subsection (c)(1)
for the plan year (except as provided for in
section 2713); and
[(ii)] (B) coverage for at least three
primary care visits.
[(2) Individuals eligible for enrollment.--An
individual is described in this paragraph for any plan
year if the individual--
[(A) has not attained the age of 30 before
the beginning of the plan year; or
[(B) has a certification in effect for any
plan year under this title that the individual
is exempt from the requirement under section
5000A of the Internal Revenue Code of 1986 by
reason of--
[(i) section 5000A(e)(1) of such Code
(relating to individuals without
affordable coverage); or
[(ii) section 5000A(e)(5) of such
Code (relating to individuals with
hardships).
[(3)] (2) Restriction to individual market.--If a
health insurance issuer offers a health plan described
in this subsection, the issuer may only offer the plan
in the individual market.
(f) Child-only Plans.--If a qualified health plan is offered
through the Exchange in any level of coverage specified under
subsection (d), the issuer shall also offer that plan through
the Exchange in that level as a plan in which the only
enrollees are individuals who, as of the beginning of a plan
year, have not attained the age of 21, and such plan shall be
treated as a qualified health plan.
(g) Payments to Federally-Qualified Health Centers.--If any
item or service covered by a qualified health plan is provided
by a Federally-qualified health center (as defined in section
1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B)) to an enrollee of the plan, the offeror of the
plan shall pay to the center for the item or service an amount
that is not less than the amount of payment that would have
been paid to the center under section 1902(bb) of such Act (42
U.S.C. 1396a(bb)) for such item or service.
* * * * * * *
PART 2--CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH
BENEFIT EXCHANGES
* * * * * * *
SEC. 1312. CONSUMER CHOICE.
(a) Choice.--
(1) Qualified individuals.--A qualified individual
may enroll in any qualified health plan available to
such individual and for which such individual is
eligible.
(2) Qualified employers.--
(A) Employer may specify level.--A qualified
employer may provide support for coverage of
employees under a qualified health plan by
selecting any level of coverage under section
1302(d) to be made available to employees
through an Exchange.
(B) Employee may choose plans within a
level.--Each employee of a qualified employer
that elects a level of coverage under
subparagraph (A) may choose to enroll in a
qualified health plan that offers coverage at
that level.
(b) Payment of Premiums by Qualified Individuals.--A
qualified individual enrolled in any qualified health plan may
pay any applicable premium owed by such individual to the
health insurance issuer issuing such qualified health plan.
(c) Single Risk Pool.--
(1) Individual market.--A health insurance issuer
shall consider all enrollees in all health plans (other
than grandfathered health plans) offered by such issuer
in the individual market, including those enrollees who
do not enroll in such plans through the Exchange and
enrollees in catastrophic plans described in section
1302(e), to be members of a single risk pool.
(2) Small group market.--A health insurance issuer
shall consider all enrollees in all health plans (other
than grandfathered health plans) offered by such issuer
in the small group market, including those enrollees
who do not enroll in such plans through the Exchange,
to be members of a single risk pool.
(3) Merger of markets.--A State may require the
individual and small group insurance markets within a
State to be merged if the State determines appropriate.
(4) State law.--A State law requiring grandfathered
health plans to be included in a pool described in
paragraph (1) or (2) shall not apply.
(d) Empowering Consumer Choice.--
(1) Continued operation of market outside
Exchanges.--Nothing in this title shall be construed to
prohibit--
(A) a health insurance issuer from offering
outside of an Exchange a health plan to a
qualified individual or qualified employer; and
(B) a qualified individual from enrolling in,
or a qualified employer from selecting for its
employees, a health plan offered outside of an
Exchange.
(2) Continued operation of state benefit
requirements.--Nothing in this title shall be construed
to terminate, abridge, or limit the operation of any
requirement under State law with respect to any policy
or plan that is offered outside of an Exchange to offer
benefits.
(3) Voluntary nature of an Exchange.--
(A) Choice to enroll or not to enroll.--
Nothing in this title shall be construed to
restrict the choice of a qualified individual
to enroll or not to enroll in a qualified
health plan or to participate in an Exchange.
(B) Prohibition against compelled
enrollment.--Nothing in this title shall be
construed to compel an individual to enroll in
a qualified health plan or to participate in an
Exchange.
(C) Individuals allowed to enroll in any
plan.--A qualified individual may enroll in any
qualified health plan[, except that in the case
of a catastrophic plan described in section
1302(e), a qualified individual may enroll in
the plan only if the individual is eligible to
enroll in the plan under section 1302(e)(2)].
(D) Members of Congress in the Exchange.--
(i) Requirement.--Notwithstanding any
other provision of law, after the
effective date of this subtitle, the
only health plans that the Federal
Government may make available to
Members of Congress and congressional
staff with respect to their service as
a Member of Congress or congressional
staff shall be health plans that are--
(I) created under this Act
(or an amendment made by this
Act); or
(II) offered through an
Exchange established under this
Act (or an amendment made by
this Act).
(ii) Definitions.--In this section:
(I) Member of Congress.--The
term ``Member of Congress''
means any member of the House
of Representatives or the
Senate.
(II) Congressional staff.--
The term ``congressional
staff'' means all full-time and
part-time employees employed by
the official office of a Member
of Congress, whether in
Washington, DC or outside of
Washington, DC.
(4) No penalty for transferring to minimum essential
coverage outside exchange.--An Exchange, or a qualified
health plan offered through an Exchange, shall not
impose any penalty or other fee on an individual who
cancels enrollment in a plan because the individual
becomes eligible for minimum essential coverage (as
defined in section 5000A(f) of the Internal Revenue
Code of 1986 without regard to paragraph (1)(C) or (D)
thereof) or such coverage becomes affordable (within
the meaning of section 36B(c)(2)(C) of such Code).
(e) Enrollment Through Agents or Brokers.--The Secretary
shall establish procedures under which a State may allow agents
or brokers--
(1) to enroll individuals and employers in any
qualified health plans in the individual or small group
market as soon as the plan is offered through an
Exchange in the State; and
(2) to assist individuals in applying for premium tax
credits and cost-sharing reductions for plans sold
through an Exchange.
(f) Qualified Individuals and Employers; Access Limited to
Citizens and Lawful Residents.--
(1) Qualified individuals.--In this title:
(A) In general.--The term ``qualified
individual'' means, with respect to an
Exchange, an individual who--
(i) is seeking to enroll in a
qualified health plan in the individual
market offered through the Exchange;
and
(ii) resides in the State that
established the Exchange.
(B) Incarcerated individuals excluded.--An
individual shall not be treated as a qualified
individual if, at the time of enrollment, the
individual is incarcerated, other than
incarceration pending the disposition of
charges.
(2) Qualified employer.--In this title:
(A) In general.--The term ``qualified
employer'' means a small employer that elects
to make all full-time employees of such
employer eligible for 1 or more qualified
health plans offered in the small group market
through an Exchange that offers qualified
health plans.
(B) Extension to large groups.--
(i) In general.--Beginning in 2017,
each State may allow issuers of health
insurance coverage in the large group
market in the State to offer qualified
health plans in such market through an
Exchange. Nothing in this subparagraph
shall be construed as requiring the
issuer to offer such plans through an
Exchange.
(ii) Large employers eligible.--If a
State under clause (i) allows issuers
to offer qualified health plans in the
large group market through an Exchange,
the term ``qualified employer'' shall
include a large employer that elects to
make all full-time employees of such
employer eligible for 1 or more
qualified health plans offered in the
large group market through the
Exchange.
(3) Access limited to lawful residents.--If an
individual is not, or is not reasonably expected to be
for the entire period for which enrollment is sought, a
citizen or national of the United States or an alien
lawfully present in the United States, the individual
shall not be treated as a qualified individual and may
not be covered under a qualified health plan in the
individual market that is offered through an Exchange.
* * * * * * *
Subtitle E--Affordable Coverage Choices for All Americans
PART I--PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS
* * * * * * *
Subpart B--Eligibility Determinations
* * * * * * *
SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND
COST-SHARING REDUCTIONS.
(a) In General.--The Secretary, in consultation with the
Secretary of the Treasury, shall establish a program under
which--
(1) upon request of an Exchange, advance
determinations are made under section 1411 with respect
to the income eligibility of individuals enrolling in a
qualified health plan in the individual market through
the Exchange for the premium tax credit allowable under
section 36B of the Internal Revenue Code of 1986 and
the cost-sharing reductions under section 1402;
(2) the Secretary notifies--
(A) the Exchange and the Secretary of the
Treasury of the advance determinations; and
(B) the Secretary of the Treasury of the name
and employer identification number of each
employer with respect to whom 1 or more
employee of the employer were determined to be
eligible for the premium tax credit under
section 36B of the Internal Revenue Code of
1986 and the cost-sharing reductions under
section 1402 because--
(i) the employer did not provide
minimum essential coverage; or
(ii) the employer provided such
minimum essential coverage but it was
determined under section 36B(c)(2)(C)
of such Code to either be unaffordable
to the employee or not provide the
required minimum actuarial value; and
(3) the Secretary of the Treasury makes advance
payments of such credit or reductions to the issuers of
the qualified health plans in order to reduce the
premiums payable by individuals eligible for such
credit.
(b) Advance Determinations.--
(1) In general.--The Secretary shall provide under
the program established under subsection (a) that
advance determination of eligibility with respect to
any individual shall be made--
(A) during the annual open enrollment period
applicable to the individual (or such other
enrollment period as may be specified by the
Secretary); and
(B) on the basis of the individual's
household income for the most recent taxable
year for which the Secretary, after
consultation with the Secretary of the
Treasury, determines information is available.
(2) Changes in circumstances.--The Secretary shall
provide procedures for making advance determinations on
the basis of information other than that described in
paragraph (1)(B) in cases where information included
with an application form demonstrates substantial
changes in income, changes in family size or other
household circumstances, change in filing status, the
filing of an application for unemployment benefits, or
other significant changes affecting eligibility,
including--
(A) allowing an individual claiming a
decrease of 20 percent or more in income, or
filing an application for unemployment
benefits, to have eligibility for the credit
determined on the basis of household income for
a later period or on the basis of the
individual's estimate of such income for the
taxable year; and
(B) the determination of household income in
cases where the taxpayer was not required to
file a return of tax imposed by this chapter
for the second preceding taxable year.
(c) Payment of Premium Tax Credits and Cost-Sharing
Reductions.--
(1) In general.--The Secretary shall notify the
Secretary of the Treasury and the Exchange through
which the individual is enrolling of the advance
determination under section 1411.
(2) Premium tax credit.--
(A) In general.--The Secretary of the
Treasury shall make the advance payment under
this section of any premium tax credit allowed
under section 36B of the Internal Revenue Code
of 1986 to the issuer of a qualified health
plan on a monthly basis (or such other periodic
basis as the Secretary may provide).
(B) Issuer responsibilities.--An issuer of a
qualified health plan receiving an advance
payment with respect to an individual enrolled
in the plan shall--
(i) reduce the premium charged the
insured for any period by the amount of
the advance payment for the period;
(ii) notify the Exchange and the
Secretary of such reduction;
(iii) include with each billing
statement the amount by which the
premium for the plan has been reduced
by reason of the advance payment; and
(iv) in the case of any nonpayment of
premiums by the insured--
(I) notify the Secretary of
such nonpayment; and
(II) allow a 3-month grace
period for nonpayment of
premiums before discontinuing
coverage.
(3) Cost-sharing reductions.--The Secretary shall
also notify the Secretary of the Treasury and the
Exchange under paragraph (1) if an advance payment of
the cost-sharing reductions under section 1402 is to be
made to the issuer of any qualified health plan with
respect to any individual enrolled in the plan. The
Secretary of the Treasury shall make such advance
payment at such time and in such amount as the
Secretary specifies in the notice.
(d) No Federal Payments for Individuals Not Lawfully
Present.--Nothing in this subtitle or the amendments made by
this subtitle allows Federal payments, credits, or cost-sharing
reductions for individuals who are not lawfully present in the
United States.
(e) State Flexibility.--Nothing in this subtitle or the
amendments made by this subtitle shall be construed to prohibit
a State from making payments to or on behalf of an individual
for coverage under a qualified health plan offered through an
Exchange that are in addition to any credits or cost-sharing
reductions allowable to the individual under this subtitle and
such amendments.
(f) Exclusion of Off-Exchange Coverage.--Advance payments
under this section, and advance determinations under section
1411, with respect to any credit allowed under section 36B
shall not be made with respect to any health plan which is not
enrolled in through an Exchange.
* * * * * * *
DISSENTING VIEWS
H.R. 6311 Increasing Access To Lower Premium Plans Act of 2018
H.R. 6311 (Roskam, R-IL) allows anyone to purchase
catastrophic coverage (currently catastrophic plans can only be
purchased by those under 30 and people with hardship
exemptions), puts all catastrophic plans into the overall risk
pool, allows use of Advance Premium Tax Credits (APTCs) to be
used for catastrophic plans in the exchange, and allows premium
tax credits (but not APTCs) to be used to purchase plans off
exchange. The bill explicitly prohibits tax credits for plans
that offer comprehensive women's health care.
H.R. 6311 continues Republican efforts to undermine and
destabilize the health insurance market increases costs for
consumers, and undermines women's health care, while at the
same time growing our deficit.
H.R. 6311 would likely reduce choice and competition in the
Affordable Care Act (ACA) marketplaces. While the bill would
allow people buying individual-market plans outside the ACA
marketplaces to receive ACA tax credits, the credits are only
be available when individuals file their tax returns the
following year (not upfront to help them pay premiums); this
disadvantages more moderate-income families that do not have
extra disposable income to pay premium costs up front. It also
would eliminate the requirement that insurers selling plans
eligible for the ACA tax credit must offer at least one
``silver'' and one ``gold'' plan through the marketplace--
reducing plan choice for patients. If this bill were enacted,
an insurer could offer coverage only outside the marketplace
(destabilizing the marketplace and undermining marketplace
choice) while still giving consumers access to premium tax
credits.
H.R. 6311 would likely lead to increased premiums for
individuals with preexisting conditions. Reducing the
incentives for insurers to offer marketplace coverage could
make it easier for insurers to engage in strategies to attract
only healthier enrollees, such as offering only bronze or
catastrophic plans, which have higher deductibles and other
cost-sharing expenses for consumers than silver and gold plans.
It also could reduce plan choices for consumers within the
marketplaces if insurers shift to off-marketplace business. And
it could prompt fewer consumers to comparison shop in the
marketplaces--where they can compare premiums and benefits for
multiple insurers--thus reducing competitive pressure on
insurers to hold down premiums.
Legislation busts the deficit to benefit the wealthy,
again. The Joint Committee on Taxation (JCT) estimates the cost
of this bill to be $10.9 billion over 10 years. Altogether the
11 bills this Committee marked up would add another $92 billion
in unoffset tax cuts to the deficit. With this bill,
Republicans are adding more tax cuts and increasing the
deficit. Republicans are using the deficit, which they keep
making larger with cuts for the wealthy, to justify the deep
cuts they plan to make to Medicare and Medicaid. Republicans
already are proposing to cut Medicare and Medicaid by nearly a
trillion dollars to try to pay for the tax cuts they've already
enacted. This bill will only increase Republicans' calls for
further cuts to these critical programs.
Democrats offered three amendments to this bill in an
attempt to better protect consumers. Representative Thompson
(D-CA) offered an amendment to require that plans covered under
the underlying bill be offered by an issuer that does not raise
premiums in connection with a failure to make risk adjustment
payments. This effort to ensure consumers' premiums are not
increased due to Republican sabotage of health care was ruled
non-germane. The appeal of the ruling of the chair was defeated
21-15.
Representative DelBene (D-WA) offered an amendment to
strike language that prohibits premium tax credits from going
toward any health plan that includes coverage for abortion
services. Washington, Oregon, California, and New York all
require health plans to include abortion services in every
health plan, and H.R. 6311 would thereby takeaway premium tax
credits for everyone in those four states.
Coalition members of All* Above All, which includes the
American Civil Liberties Union and the National Partnership for
Women and Families, wrote in opposition to the bill noting,
``We oppose HR 6311 which could drastically impact the quality
and affordability of insurance coverage available to women. . .
. HR 6311 is drafted to achieve anti-abortion politicians' goal
of eliminating abortion coverage in the individual insurance
marketplace. HR 6311 would deny women the tax credits that make
plans affordable merely for choosing comprehensive insurance
that includes abortion coverage. These provisions penalize
individuals who seek plans that cover abortion and companies
that want to provide comprehensive plans to their employees,
and disincentivizes plans from covering abortion. Women should
not be penalized for seeking comprehensive health coverage that
meets their needs.'' The amendment was defeated on party lines
15-22.
Representative Sanchez (D-CA) offered an amendment to
require that plans covered under the underlying bill be offered
by an issuer that does not discriminate or raise premiums on
the basis of gender. This commonsense amendment was also
defeated on party lines, 16-23.
Richard E. Neal,
Ranking Member
[all]