H. R. 1628

115

CONGRESS

ESSION

H. R. 1628

AN ACT

To provide for reconciliation pursuant to title II of the

concurrent resolution on the budget for fiscal year 2017.

Be it enacted by the Senate and House of Representa-1

tives of the United States of America in Congress assembled, 2

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SECTION 1. SHORT TITLE. 1

This Act may be cited as the ‘‘American Health Care 2

Act of 2017’’. 3

SEC. 2. TABLE OF CONTENTS. 4

The table of contents of this Act is as follows: 5

Sec. 1. Short title.

Sec. 2. Table of contents.

TITLE I—ENERGY AND COMMERCE

Subtitle A—Patient Access to Public Health Programs

Sec. 101. The Prevention and Public Health Fund.

Sec. 102. Community health center program.

Sec. 103. Federal payments to States.

Subtitle B—Medicaid Program Enhancement

Sec. 111. Repeal of Medicaid provisions.

Sec. 112. Repeal of Medicaid expansion.

Sec. 113. Elimination of DSH cuts.

Sec. 114. Reducing State Medicaid costs.

Sec. 115. Safety net funding for non-expansion States.

Sec. 116. Providing incentives for increased frequency of eligibility redetermina-

tions.

Sec. 117. Permitting States to apply a work requirement for nondisabled, non-

elderly, nonpregnant adults under Medicaid.

Subtitle C—Per Capita Allotment for Medical Assistance

Sec. 121. Per capita allotment for medical assistance.

Subtitle D—Patient Relief and Health Insurance Market Stability

Sec. 131. Repeal of cost-sharing subsidy.

Sec. 132. Patient and State Stability Fund.

Sec. 133. Continuous health insurance coverage incentive.

Sec. 134. Increasing coverage options.

Sec. 135. Change in permissible age variation in health insurance premium

rates.

Subtitle E—Implementation Funding

Sec. 141. American Health Care Implementation Fund.

TITLE II—COMMITTEE ON WAYS AND MEANS

Subtitle A—Repeal and Replace of Health-Related Tax Policy

Sec. 201. Recapture excess advance payments of premium tax credits.

Sec. 202. Additional modifications to premium tax credit.

Sec. 203. Small business tax credit.

Sec. 204. Individual mandate.

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Sec. 205. Employer mandate.

Sec. 206. Repeal of the tax on employee health insurance premiums and health

plan benefits.

Sec. 207. Repeal of tax on over-the-counter medications.

Sec. 208. Repeal of increase of tax on health savings accounts.

Sec. 209. Repeal of limitations on contributions to flexible spending accounts.

Sec. 210. Repeal of medical device excise tax.

Sec. 211. Repeal of elimination of deduction for expenses allocable to medicare

part D subsidy.

Sec. 212. Reduction of income threshold for determining medical care deduc-

tion.

Sec. 213. Repeal of Medicare tax increase.

Sec. 214. Refundable tax credit for health insurance coverage.

Sec. 215. Maximum contribution limit to health savings account increased to

amount of deductible and out-of-pocket limitation.

Sec. 216. Allow both spouses to make catch-up contributions to the same health

savings account.

Sec. 217. Special rule for certain medical expenses incurred before establish-

ment of health savings account.

Subtitle B—Repeal of Certain Consumer Taxes

Sec. 221. Repeal of tax on prescription medications.

Sec. 222. Repeal of health insurance tax.

Subtitle C—Repeal of Tanning Tax

Sec. 231. Repeal of tanning tax.

Subtitle D—Remuneration From Certain Insurers

Sec. 241. Remuneration from certain insurers.

Subtitle E—Repeal of Net Investment Income Tax

Sec. 251. Repeal of net investment income tax.

TITLE I—ENERGY AND 1

COMMERCE 2

Subtitle A—Patient Access to 3

Public Health Programs 4

SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND. 5

(a) I

ENERAL

.—Subsection (b) of section 4002 of 6

the Patient Protection and Affordable Care Act (42 7

U.S.C. 300u–11), as amended by section 5009 of the 21st 8

Century Cures Act, is amended— 9

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(1) in paragraph (2), by adding ‘‘and’’ at the 1

end; 2

(2) in paragraph (3)— 3

(A) by striking ‘‘each of fiscal years 2018 4

and 2019’’ and inserting ‘‘fiscal year 2018’’; 5

and 6

(B) by striking the semicolon at the end 7

and inserting a period; and 8

(3) by striking paragraphs (4) through (8). 9

(b) R

ESCISSION OF

NOBLIGATED

UNDS

.—Of the 10

funds made available by such section 4002, the unobli-11

gated balance at the end of fiscal year 2018 is rescinded. 12

SEC. 102. COMMUNITY HEALTH CENTER PROGRAM. 13

Effective as if included in the enactment of the Medi-14

care Access and CHIP Reauthorization Act of 2015 (Pub-15

lic Law 114–10, 129 Stat. 87), paragraph (1) of section 16

221(a) of such Act is amended by inserting ‘‘, and an ad-17

ditional $422,000,000 for fiscal year 2017’’ after ‘‘2017’’. 18

SEC. 103. FEDERAL PAYMENTS TO STATES. 19

(a) I

ENERAL

.—Notwithstanding section 504(a), 20

1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 21

2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 22

1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 23

1397bb(a)(7), 1397ee(a)(1)), or the terms of any Med-24

icaid waiver in effect on the date of enactment of this Act 25

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that is approved under section 1115 or 1915 of the Social 1

Security Act (42 U.S.C. 1315, 1396n), for the 1-year pe-2

riod beginning on the date of the enactment of this Act, 3

no Federal funds provided from a program referred to in 4

this subsection that is considered direct spending for any 5

year may be made available to a State for payments to 6

a prohibited entity, whether made directly to the prohib-7

ited entity or through a managed care organization under 8

contract with the State. 9

(b) D

EFINITIONS

.—In this section: 10

(1) P

ROHIBITED ENTITY

.—The term ‘‘prohib-11

ited entity’’ means an entity, including its affiliates, 12

subsidiaries, successors, and clinics— 13

(A) that, as of the date of enactment of 14

this Act— 15

(i) is an organization described in sec-16

tion 501(c)(3) of the Internal Revenue 17

Code of 1986 and exempt from tax under 18

section 501(a) of such Code; 19

(ii) is an essential community provider 20

described in section 156.235 of title 45, 21

Code of Federal Regulations (as in effect 22

on the date of enactment of this Act), that 23

is primarily engaged in family planning 24

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services, reproductive health, and related 1

medical care; and 2

(iii) provides for abortions, other than 3

an abortion— 4

(I) if the pregnancy is the result 5

of an act of rape or incest; or 6

(II) in the case where a woman 7

suffers from a physical disorder, phys-8

ical injury, or physical illness that 9

would, as certified by a physician, 10

place the woman in danger of death 11

unless an abortion is performed, in-12

cluding a life-endangering physical 13

condition caused by or arising from 14

the pregnancy itself; and 15

(B) for which the total amount of Federal 16

and State expenditures under the Medicaid pro-17

gram under title XIX of the Social Security Act 18

in fiscal year 2014 made directly to the entity 19

and to any affiliates, subsidiaries, successors, or 20

clinics of the entity, or made to the entity and 21

to any affiliates, subsidiaries, successors, or 22

clinics of the entity as part of a nationwide 23

health care provider network, exceeded 24

$350,000,000. 25

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(2) D

IRECT SPENDING

.—The term ‘‘direct 1

spending’’ has the meaning given that term under 2

section 250(c) of the Balanced Budget and Emer-3

gency Deficit Control Act of 1985 (2 U.S.C. 900(c)). 4

Subtitle B—Medicaid Program 5

Enhancement 6

SEC. 111. REPEAL OF MEDICAID PROVISIONS. 7

The Social Security Act is amended— 8

(1) in section 1902 (42 U.S.C. 1396a)— 9

(A) in subsection (a)(47)(B), by inserting 10

‘‘and provided that any such election shall cease 11

to be effective on January 1, 2020, and no such 12

election shall be made after that date’’ before 13

the semicolon at the end; and 14

(B) in subsection (l)(2)(C), by inserting 15

‘‘and ending December 31, 2019,’’ after ‘‘Janu-16

ary 1, 2014,’’; 17

(2) in section 1915(k)(2) (42 U.S.C. 18

1396n(k)(2)), by striking ‘‘during the period de-19

scribed in paragraph (1)’’ and inserting ‘‘on or after 20

the date referred to in paragraph (1) and before 21

January 1, 2020’’; and 22

(3) in section 1920(e) (42 U.S.C. 1396r–1(e)), 23

by striking ‘‘under clause (i)(VIII), clause (i)(IX), or 24

clause (ii)(XX) of subsection (a)(10)(A)’’ and insert-25

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ing ‘‘under clause (i)(VIII) or clause (ii)(XX) of sec-1

tion 1902(a)(10)(A) before January 1, 2020, section 2

1902(a)(10)(A)(i)(IX),’’. 3

SEC. 112. REPEAL OF MEDICAID EXPANSION. 4

(a) I

ENERAL

.—Title XIX of the Social Security 5

Act (42 U.S.C. 1396 et seq.) is amended— 6

(1) in section 1902 (42 U.S.C. 1396a)— 7

(A) in subsection (a)(10)(A)— 8

(i) in clause (i)(VIII), by inserting 9

‘‘and ending December 31, 2019,’’ after 10

‘‘2014,’’; 11

(ii) in clause (ii)(XX), by inserting 12

‘‘and ending December 31, 2017,’’ after 13

‘‘2014,’’; and 14

(iii) in clause (ii), by adding at the 15

end the following new subclause: 16

‘‘(XXIII) beginning January 1, 17

2020— 18

‘‘(aa) who are expansion enrollees 19

(as defined in subsection (nn)(1)); or 20

‘‘(bb) who are grandfathered ex-21

pansion enrollees (as defined in sub-22

section (nn)(2));’’; and 23

(B) by adding at the end the following new 24

subsection: 25

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‘‘(nn) E

XPANSION

NROLLEES

.—In this title: 1

‘‘(1) I

N GENERAL

.—The term ‘expansion en-2

rollee’ means an individual— 3

‘‘(A) who is under 65 years of age; 4

‘‘(B) who is not pregnant; 5

‘‘(C) who is not entitled to, or enrolled for, 6

benefits under part A of title XVIII, or enrolled 7

for benefits under part B of title XVIII; 8

‘‘(D) who is not described in any of sub-9

clauses (I) through (VII) of subsection 10

(a)(10)(A)(i); and 11

‘‘(E) whose income (as determined under 12

subsection (e)(14)) does not exceed 133 percent 13

of the poverty line (as defined in section 14

2110(c)(5)) applicable to a family of the size in-15

volved. 16

‘‘(2) G

RANDFATHERED EXPANSION ENROLL

-17

EES

.—The term ‘grandfathered expansion enrollee’ 18

means an expansion enrollee who— 19

‘‘(A) was enrolled under the State plan 20

under this title (or under a waiver of such plan) 21

as of December 31, 2019; and 22

‘‘(B) does not have a break in eligibility 23

for medical assistance under such State plan 24

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(or waiver) for more than one month after such 1

date. 2

‘‘(3) A

PPLICATION OF RELATED PROVISIONS

.— 3

Any reference in subsection (a)(10)(G), (k), or (gg) 4

of this section or in section 1903, 1905(a), 1920(e), 5

or 1937(a)(1)(B) to individuals described in sub-6

clause (VIII) of subsection (a)(10)(A)(i) shall be 7

deemed to include a reference to expansion enrollees 8

(including grandfathered expansion enrollees).’’; and 9

(2) in section 1905 (42 U.S.C. 1396d)— 10

(A) in subsection (y)(1), in the matter pre-11

ceding subparagraph (A)— 12

(i) by inserting ‘‘and that has elected 13

to cover newly eligible individuals before 14

March 1, 2017’’ after ‘‘that is one of the 15

50 States or the District of Columbia’’; 16

and 17

(ii) by inserting after ‘‘subclause 18

(VIII) of section 1902(a)(10)(A)(i)’’ the 19

following: ‘‘who, for periods after Decem-20

ber 31, 2019, are grandfathered expansion 21

enrollees (as defined in section 22

1902(nn)(2))’’; and 23

(B) in subsection (z)(2)— 24

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(i) in subparagraph (A), by inserting 1

after ‘‘section 1937’’ the following: ‘‘and, 2

for periods after December 31, 2019, who 3

are grandfathered expansion enrollees (as 4

defined in section 1902(nn)(2))’’; and 5

(ii) in subparagraph (B)(ii)— 6

(I) in subclause (III), by adding 7

‘‘and’’ at the end; and 8

(II) by striking subclauses (IV), 9

(V), and (VI) and inserting the fol-10

lowing new subclause: 11

‘‘(IV) 2017 and each subsequent year is 80 12

percent.’’. 13

(b) S

UNSET OF

SSENTIAL

EALTH

ENEFITS

-14

QUIREMENT

.—Section 1937(b)(5) of the Social Security 15

Act (42 U.S.C. 1396u–7(b)(5)) is amended by adding at 16

the end the following: ‘‘This paragraph shall not apply 17

after December 31, 2019.’’. 18

SEC. 113. ELIMINATION OF DSH CUTS. 19

Section 1923(f) of the Social Security Act (42 U.S.C. 20

1396r–4(f)) is amended— 21

(1) in paragraph (7)— 22

(A) in subparagraph (A)— 23

(i) in clause (i)— 24

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(I) in the matter preceding sub-1

clause (I), by striking ‘‘2025’’ and in-2

serting ‘‘2019’’; and 3

(ii) in clause (ii)— 4

(I) in subclause (I), by adding 5

‘‘and’’ at the end; 6

(II) in subclause (II), by striking 7

the semicolon at the end and inserting 8

a period; and 9

(III) by striking subclauses (III) 10

through (VIII); and 11

(B) by adding at the end the following new 12

subparagraph: 13

‘‘(C) E

XEMPTION FROM REDUCTION FOR

NON

EXPANSION STATES

.— 15

‘‘(i) I

N GENERAL

.—In the case of a 16

State that is a non-expansion State for a 17

fiscal year, subparagraph (A)(i) shall not 18

apply to the DSH allotment for such State 19

and fiscal year. 20

‘‘(ii) N

O CHANGE IN REDUCTION FOR

EXPANSION STATES

.—In the case of a 22

State that is an expansion State for a fis-23

cal year, the DSH allotment for such State 24

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and fiscal year shall be determined as if 1

clause (i) did not apply. 2

‘‘(iii) N

EXPANSION AND EXPAN

-3

SION STATE DEFINED

.— 4

‘‘(I) The term ‘expansion State’ 5

means with respect to a fiscal year, a 6

State that, as of July 1 of the pre-7

ceding fiscal year, provides for eligi-8

bility under clause (i)(VIII) or 9

(ii)(XX) of section 1902(a)(10)(A) for 10

medical assistance under this title (or 11

a waiver of the State plan approved 12

under section 1115). 13

‘‘(II) The term ‘non-expansion 14

State’ means, with respect to a fiscal 15

year, a State that is not an expansion 16

State.’’; and 17

(2) in paragraph (8), by striking ‘‘fiscal year 18

2025’’ and inserting ‘‘fiscal year 2019’’. 19

SEC. 114. REDUCING STATE MEDICAID COSTS. 20

(a) L

ETTING

TATES

ISENROLL

IGH

OLLAR

OTTERY

INNERS

.— 22

(1) I

N GENERAL

.—Section 1902 of the Social 23

Security Act (42 U.S.C. 1396a) is amended— 24

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(A) in subsection (a)(17), by striking 1

‘‘(e)(14), (e)(14)’’ and inserting ‘‘(e)(14), 2

(e)(15)’’; and 3

(B) in subsection (e)— 4

(i) in paragraph (14) (relating to 5

modified adjusted gross income), by adding 6

at the end the following new subparagraph: 7

‘‘(J) T

REATMENT OF CERTAIN LOTTERY

WINNINGS AND INCOME RECEIVED AS A LUMP

SUM

.— 10

‘‘(i) I

N GENERAL

.—In the case of an 11

individual who is the recipient of qualified 12

lottery winnings (pursuant to lotteries oc-13

curring on or after January 1, 2020) or 14

qualified lump sum income (received on or 15

after such date) and whose eligibility for 16

medical assistance is determined based on 17

the application of modified adjusted gross 18

income under subparagraph (A), a State 19

shall, in determining such eligibility, in-20

clude such winnings or income (as applica-21

ble) as income received— 22

‘‘(I) in the month in which such 23

winnings or income (as applicable) is 24

received if the amount of such 25

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winnings or income is less than 1

$80,000; 2

‘‘(II) over a period of 2 months 3

if the amount of such winnings or in-4

come (as applicable) is greater than or 5

equal to $80,000 but less than 6

$90,000; 7

‘‘(III) over a period of 3 months 8

if the amount of such winnings or in-9

come (as applicable) is greater than or 10

equal to $90,000 but less than 11

$100,000; and 12

‘‘(IV) over a period of 3 months 13

plus 1 additional month for each in-14

crement of $10,000 of such winnings 15

or income (as applicable) received, not 16

to exceed a period of 120 months (for 17

winnings or income of $1,260,000 or 18

more), if the amount of such winnings 19

or income is greater than or equal to 20

$100,000. 21

‘‘(ii) C

OUNTING IN EQUAL INSTALL

-22

MENTS

.—For purposes of subclauses (II), 23

(III), and (IV) of clause (i), winnings or 24

income to which such subclause applies 25

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shall be counted in equal monthly install-1

ments over the period of months specified 2

under such subclause. 3

‘‘(iii) H

ARDSHIP EXEMPTION

.—An in-4

dividual whose income, by application of 5

clause (i), exceeds the applicable eligibility 6

threshold established by the State, may 7

continue to be eligible for medical assist-8

ance to the extent that the State deter-9

mines, under procedures established by the 10

State under the State plan (or in the case 11

of a waiver of the plan under section 1115, 12

incorporated in such waiver), or as other-13

wise established by such State in accord-14

ance with such standards as may be speci-15

fied by the Secretary, that the denial of eli-16

gibility of the individual would cause an 17

undue medical or financial hardship as de-18

termined on the basis of criteria estab-19

lished by the Secretary. 20

‘‘(iv) N

OTIFICATIONS AND ASSIST

-21

ANCE REQUIRED IN CASE OF LOSS OF ELI

-22

GIBILITY

.—A State shall, with respect to 23

an individual who loses eligibility for med-24

ical assistance under the State plan (or a 25

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waiver of such plan) by reason of clause 1

(i), before the date on which the individual 2

loses such eligibility, inform the individual 3

of the date on which the individual would 4

no longer be considered ineligible by reason 5

of such clause to receive medical assistance 6

under the State plan or under any waiver 7

of such plan and the date on which the in-8

dividual would be eligible to reapply to re-9

ceive such medical assistance. 10

‘‘(v) Q

UALIFIED LOTTERY WINNINGS

DEFINED

.—In this subparagraph, the term 12

‘qualified lottery winnings’ means winnings 13

from a sweepstakes, lottery, or pool de-14

scribed in paragraph (3) of section 4402 of 15

the Internal Revenue Code of 1986 or a 16

lottery operated by a multistate or multi-17

jurisdictional lottery association, including 18

amounts awarded as a lump sum payment. 19

‘‘(vi) Q

UALIFIED LUMP SUM INCOME

DEFINED

.—In this subparagraph, the term 21

‘qualified lump sum income’ means income 22

that is received as a lump sum from one 23

of the following sources: 24

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‘‘(I) Monetary winnings from 1

gambling (as defined by the Secretary 2

and including monetary winnings from 3

gambling activities described in sec-4

tion 1955(b)(4) of title 18, United 5

States Code). 6

‘‘(II) Income received as liquid 7

assets from the estate (as defined in 8

section 1917(b)(4)) of a deceased in-9

dividual.’’; and 10

(ii) by striking ‘‘(14) E

XCLUSION

’’ 11

and inserting ‘‘(15) E

XCLUSION

’’. 12

(2) R

ULES OF CONSTRUCTION

.— 13

(A) I

NTERCEPTION OF LOTTERY WINNINGS

ALLOWED

.—Nothing in the amendment made 15

by paragraph (1)(B)(i) shall be construed as 16

preventing a State from intercepting the State 17

lottery winnings awarded to an individual in the 18

State to recover amounts paid by the State 19

under the State Medicaid plan under title XIX 20

of the Social Security Act for medical assistance 21

furnished to the individual. 22

(B) A

PPLICABILITY LIMITED TO ELIGI

-23

BILITY OF RECIPIENT OF LOTTERY WINNINGS

OR LUMP SUM INCOME

.—Nothing in the amend-25

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ment made by paragraph (1)(B)(i) shall be con-1

strued, with respect to a determination of 2

household income for purposes of a determina-3

tion of eligibility for medical assistance under 4

the State plan under title XIX of the Social Se-5

curity Act (42 U.S.C. 1396 et seq.) (or a waiver 6

of such plan) made by applying modified ad-7

justed gross income under subparagraph (A) of 8

section 1902(e)(14) of such Act (42 U.S.C. 9

1396a(e)(14)), as limiting the eligibility for 10

such medical assistance of any individual that is 11

a member of the household other than the indi-12

vidual (or the individual’s spouse) who received 13

qualified lottery winnings or qualified lump-sum 14

income (as defined in subparagraph (J) of such 15

section 1902(e)(14), as added by paragraph 16

(1)(B)(i) of this subsection). 17

(b) R

EPEAL OF

ETROACTIVE

LIGIBILITY

.— 18

(1) I

N GENERAL

.— 19

(A) S

TATE PLAN REQUIREMENTS

.—Section 20

1902(a)(34) of the Social Security Act (42 21

U.S.C. 1396a(a)(34)) is amended by striking 22

‘‘in or after the third month before the month 23

in which he made application’’ and inserting ‘‘in 24

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or after the month in which the individual made 1

application’’. 2

(B) D

EFINITION OF MEDICAL ASSIST

-3

ANCE

.—Section 1905(a) of the Social Security 4

Act (42 U.S.C. 1396d(a)) is amended by strik-5

ing ‘‘in or after the third month before the 6

month in which the recipient makes application 7

for assistance’’ and inserting ‘‘in or after the 8

month in which the recipient makes application 9

for assistance’’. 10

(2) E

FFECTIVE DATE

.—The amendments made 11

by paragraph (1) shall apply to medical assistance 12

with respect to individuals whose eligibility for such 13

assistance is based on an application for such assist-14

ance made (or deemed to be made) on or after Octo-15

ber 1, 2017. 16

PDATING

LLOWABLE

OME

QUITY

IMITS IN

EDICAID

.— 18

(1) I

N GENERAL

.—Section 1917(f)(1) of the 19

Social Security Act (42 U.S.C. 1396p(f)(1)) is 20

amended— 21

(A) in subparagraph (A), by striking ‘‘sub-22

paragraphs (B) and (C)’’ and inserting ‘‘sub-23

paragraph (B)’’; 24

(B) by striking subparagraph (B); 25

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subparagraph (B); and 2

(D) in subparagraph (B), as so redesig-3

nated, by striking ‘‘dollar amounts specified in 4

this paragraph’’ and inserting ‘‘dollar amount 5

specified in subparagraph (A)’’. 6

(2) E

FFECTIVE DATE

.— 7

(A) I

N GENERAL

.—The amendments made 8

by paragraph (1) shall apply with respect to eli-9

gibility determinations made after the date that 10

is 180 days after the date of the enactment of 11

this section. 12

(B) E

XCEPTION FOR STATE LEGISLA

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TION

.—In the case of a State plan under title 14

XIX of the Social Security Act that the Sec-15

retary of Health and Human Services deter-16

mines requires State legislation in order for the 17

respective plan to meet any requirement im-18

posed by amendments made by this subsection, 19

the respective plan shall not be regarded as fail-20

ing to comply with the requirements of such 21

title solely on the basis of its failure to meet 22

such an additional requirement before the first 23

day of the first calendar quarter beginning after 24

the close of the first regular session of the 25

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State legislature that begins after the date of 1

the enactment of this Act. For purposes of the 2

previous sentence, in the case of a State that 3

has a 2-year legislative session, each year of the 4

session shall be considered to be a separate reg-5

ular session of the State legislature. 6

SEC. 115. SAFETY NET FUNDING FOR NON-EXPANSION 7

STATES. 8

Title XIX of the Social Security Act is amended by 9

inserting after section 1923 (42 U.S.C. 1396r–4) the fol-10

lowing new section: 11

‘‘

ADJUSTMENT IN PAYMENT FOR SERVICES OF SAFETY

NET PROVIDERS IN NON

EXPANSION STATES

‘‘S

. 1923A. (a) I

ENERAL

.—Subject to the limi-14

tations of this section, for each year during the period be-15

ginning with fiscal year 2018 and ending with fiscal year 16

2022, each State that is one of the 50 States or the Dis-17

trict of Columbia and that, as of July 1 of the preceding 18

fiscal year, did not provide for eligibility under clause 19

(i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) for medical 20

assistance under this title (or a waiver of the State plan 21

approved under section 1115) (each such State or District 22

referred to in this section for the fiscal year as a ‘non- 23

expansion State’) may adjust the payment amounts other-24

wise provided under the State plan under this title (or a 25

waiver of such plan) to health care providers that provide 26

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health care services to individuals enrolled under this title 1

(in this section referred to as ‘eligible providers’) so long 2

as the payment adjustment to such an eligible provider 3

does not exceed the provider’s costs in furnishing health 4

care services (as determined by the Secretary and net of 5

payments under this title, other than under this section, 6

and by uninsured patients) to individuals who either are 7

eligible for medical assistance under the State plan (or 8

under a waiver of such plan) or have no health insurance 9

or health plan coverage for such services. 10

‘‘(b) I

NCREASE IN

PPLICABLE

FMAP.—Notwith-11

standing section 1905(b), the Federal medical assistance 12

percentage applicable with respect to expenditures attrib-13

utable to a payment adjustment under subsection (a) for 14

which payment is permitted under subsection (c) shall be 15

equal to— 16

‘‘(1) 100 percent for calendar quarters in fiscal 17

years 2018, 2019, 2020, and 2021; and 18

‘‘(2) 95 percent for calendar quarters in fiscal 19

year 2022. 20

‘‘(c) A

NNUAL

LLOTMENT

IMITATION

.—Payment 21

under section 1903(a) shall not be made to a State with 22

respect to any payment adjustment made under this sec-23

tion for all calendar quarters in a fiscal year in excess 24

of the $2,000,000,000 multiplied by the ratio of— 25

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‘‘(1) the population of the State with income 1

below 138 percent of the poverty line in 2015 (as de-2

termined based the table entitled ‘Health Insurance 3

Coverage Status and Type by Ratio of Income to 4

Poverty Level in the Past 12 Months by Age’ for the 5

universe of the civilian noninstitutionalized popu-6

lation for whom poverty status is determined based 7

on the 2015 American Community Survey 1–Year 8

Estimates, as published by the Bureau of the Cen-9

sus), to 10

‘‘(2) the sum of the populations under para-11

graph (1) for all non-expansion States. 12

‘‘(d) D

ISQUALIFICATION IN

ASE OF

TATE

-13

ERAGE

XPANSION

.—If a State is a non-expansion for a 14

fiscal year and provides eligibility for medical assistance 15

described in subsection (a) during the fiscal year, the 16

State shall no longer be treated as a non-expansion State 17

under this section for any subsequent fiscal years.’’. 18

SEC. 116. PROVIDING INCENTIVES FOR INCREASED FRE-19

QUENCY OF ELIGIBILITY REDETERMINA-20

TIONS. 21

(a) I

ENERAL

.—Section 1902(e)(14) of the Social 22

Security Act (42 U.S.C. 1396a(e)(14)) (relating to modi-23

fied adjusted gross income), as amended by section 24

•HR 1628 EH

114(a)(1), is further amended by adding at the end the 1

following: 2

‘‘(K) F

REQUENCY OF ELIGIBILITY REDE

-3

TERMINATIONS

.—Beginning on October 1, 4

2017, and notwithstanding subparagraph (H), 5

in the case of an individual whose eligibility for 6

medical assistance under the State plan under 7

this title (or a waiver of such plan) is deter-8

mined based on the application of modified ad-9

justed gross income under subparagraph (A) 10

and who is so eligible on the basis of clause 11

(i)(VIII) or clause (ii)(XX) of subsection 12

(a)(10)(A), a State shall redetermine such indi-13

vidual’s eligibility for such medical assistance 14

no less frequently than once every 6 months.’’. 15

(b) I

NCREASED

DMINISTRATIVE

ATCHING

-16

CENTAGE

.—For each calendar quarter during the period 17

beginning on October 1, 2017, and ending on December 18

31, 2019, the Federal matching percentage otherwise ap-19

plicable under section 1903(a) of the Social Security Act 20

(42 U.S.C. 1396b(a)) with respect to State expenditures 21

during such quarter that are attributable to meeting the 22

requirement of section 1902(e)(14) (relating to determina-23

tions of eligibility using modified adjusted gross income) 24

of such Act shall be increased by 5 percentage points with 25

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respect to State expenditures attributable to activities car-1

ried out by the State (and approved by the Secretary) to 2

increase the frequency of eligibility redeterminations re-3

quired by subparagraph (K) of such section (relating to 4

eligibility redeterminations made on a 6-month basis) (as 5

added by subsection (a)). 6

SEC. 117. PERMITTING STATES TO APPLY A WORK RE-7

QUIREMENT FOR NONDISABLED, NON-8

ELDERLY, NONPREGNANT ADULTS UNDER 9

MEDICAID. 10

(a) I

ENERAL

.—Section 1902 of the Social Secu-11

rity Act (42 U.S.C. 1396a), as previously amended, is fur-12

ther amended by adding at the end the following new sub-13

section: 14

‘‘(oo) W

ORK

EQUIREMENT

PTION FOR

-15

DISABLED

, N

ONELDERLY

, N

ONPREGNANT

DULTS

.— 16

‘‘(1) I

N GENERAL

.—Beginning October 1, 17

2017, subject to paragraph (3), a State may elect to 18

condition medical assistance to a nondisabled, non-19

elderly, nonpregnant individual under this title upon 20

such an individual’s satisfaction of a work require-21

ment (as defined in paragraph (2)). 22

‘‘(2) W

ORK REQUIREMENT DEFINED

.—In this 23

section, the term ‘work requirement’ means, with re-24

spect to an individual, the individual’s participation 25

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in work activities (as defined in section 407(d)) for 1

such period of time as determined by the State, and 2

as directed and administered by the State. 3

‘‘(3) R

EQUIRED EXCEPTIONS

.—States admin-4

istering a work requirement under this subsection 5

may not apply such requirement to— 6

‘‘(A) a woman during pregnancy through 7

the end of the month in which the 60-day pe-8

riod (beginning on the last day of her preg-9

nancy) ends; 10

‘‘(B) an individual who is under 19 years 11

of age; 12

‘‘(C) an individual who is the only parent 13

or caretaker relative in the family of a child 14

who has not attained 6 years of age or who is 15

the only parent or caretaker of a child with dis-16

abilities; or 17

‘‘(D) an individual who is married or a 18

head of household and has not attained 20 19

years of age and who— 20

‘‘(i) maintains satisfactory attendance 21

at secondary school or the equivalent; or 22

‘‘(ii) participates in education directly 23

related to employment.’’. 24

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(b) I

NCREASE IN

ATCHING

ATE FOR

MPLEMEN

-1

TATION

.—Section 1903 of the Social Security Act (42 2

U.S.C. 1396b) is amended by adding at the end the fol-3

lowing: 4

‘‘(aa) The Federal matching percentage otherwise ap-5

plicable under subsection (a) with respect to State admin-6

istrative expenditures during a calendar quarter for which 7

the State receives payment under such subsection shall, 8

in addition to any other increase to such Federal matching 9

percentage, be increased for such calendar quarter by 5 10

percentage points with respect to State expenditures at-11

tributable to activities carried out by the State (and ap-12

proved by the Secretary) to implement subsection (oo) of 13

section 1902.’’. 14

Subtitle C—Per Capita Allotment 15

for Medical Assistance 16

SEC. 121. PER CAPITA ALLOTMENT FOR MEDICAL ASSIST-17

ANCE. 18

Title XIX of the Social Security Act is amended— 19

(1) in section 1903 (42 U.S.C. 1396b)— 20

(A) in subsection (a), in the matter before 21

paragraph (1), by inserting ‘‘and section 22

1903A(a)’’ after ‘‘except as otherwise provided 23

in this section’’; and 24

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(B) in subsection (d)(1), by striking ‘‘to 1

which’’ and inserting ‘‘to which, subject to sec-2

tion 1903A(a),’’; and 3

(2) by inserting after such section 1903 the fol-4

lowing new section: 5

‘‘SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR 6

MEDICAL ASSISTANCE. 7

‘‘(a) A

PPLICATION OF

APITA

AP ON

-8

MENTS FOR

EDICAL

SSISTANCE

XPENDITURES

.— 9

‘‘(1) I

N GENERAL

.—If a State has excess ag-10

gregate medical assistance expenditures (as defined 11

in paragraph (2)) for a fiscal year (beginning with 12

fiscal year 2020), the amount of payment to the 13

State under section 1903(a)(1) for each quarter in 14

the following fiscal year shall be reduced by

⁄

of 15

the excess aggregate medical assistance payments 16

(as defined in paragraph (3)) for that previous fiscal 17

year. In this section, the term ‘State’ means only the 18

50 States and the District of Columbia. 19

‘‘(2) E

XCESS AGGREGATE MEDICAL ASSISTANCE

EXPENDITURES

.—In this subsection, the term ‘ex-21

cess aggregate medical assistance expenditures’ 22

means, for a State for a fiscal year, the amount (if 23

any) by which— 24

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‘‘(A) the amount of the adjusted total med-1

ical assistance expenditures (as defined in sub-2

section (b)(1)) for the State and fiscal year; ex-3

ceeds 4

‘‘(B) the amount of the target total med-5

ical assistance expenditures (as defined in sub-6

section (c)) for the State and fiscal year. 7

‘‘(3) E

XCESS AGGREGATE MEDICAL ASSISTANCE

PAYMENTS

.—In this subsection, the term ‘excess ag-9

gregate medical assistance payments’ means, for a 10

State for a fiscal year, the product of— 11

‘‘(A) the excess aggregate medical assist-12

ance expenditures (as defined in paragraph (2)) 13

for the State for the fiscal year; and 14

‘‘(B) the Federal average medical assist-15

ance matching percentage (as defined in para-16

graph (4)) for the State for the fiscal year. 17

‘‘(4) F

EDERAL AVERAGE MEDICAL ASSISTANCE

MATCHING PERCENTAGE

.—In this subsection, the 19

term ‘Federal average medical assistance matching 20

percentage’ means, for a State for a fiscal year, the 21

ratio (expressed as a percentage) of— 22

‘‘(A) the amount of the Federal payments 23

that would be made to the State under section 24

1903(a)(1) for medical assistance expenditures 25

•HR 1628 EH

for calendar quarters in the fiscal year if para-1

graph (1) did not apply; to 2

‘‘(B) the amount of the medical assistance 3

expenditures for the State and fiscal year. 4

‘‘(b) A

DJUSTED

OTAL

EDICAL

SSISTANCE

-5

PENDITURES

.—Subject to subsection (g), the following 6

shall apply: 7

‘‘(1) I

N GENERAL

.—In this section, the term 8

‘adjusted total medical assistance expenditures’ 9

means, for a State— 10

‘‘(A) for fiscal year 2016, the product of— 11

‘‘(i) the amount of the medical assist-12

ance expenditures (as defined in paragraph 13

(2)) for the State and fiscal year, reduced 14

by the amount of any excluded expendi-15

tures (as defined in paragraph (3)) for the 16

State and fiscal year otherwise included in 17

such medical assistance expenditures; and 18

‘‘(ii) the 1903A FY16 population per-19

centage (as defined in paragraph (4)) for 20

the State; or 21

‘‘(B) for fiscal year 2019 or a subsequent 22

fiscal year, the amount of the medical assist-23

ance expenditures (as defined in paragraph (2)) 24

for the State and fiscal year that is attributable 25

•HR 1628 EH

to 1903A enrollees, reduced by the amount of 1

any excluded expenditures (as defined in para-2

graph (3)) for the State and fiscal year other-3

wise included in such medical assistance ex-4

penditures and includes non-DSH supplemental 5

payments (as defined in subsection 6

(d)(4)(A)(ii)) and payments described in sub-7

section (d)(4)(A)(iii) but shall not be construed 8

as including any expenditures attributable to 9

the program under section 1928. In applying 10

subparagraph (B), non-DSH supplemental pay-11

ments (as defined in subsection (d)(4)(A)(ii)) 12

and payments described in subsection 13

(d)(4)(A)(iii) shall be treated as fully attrib-14

utable to 1903A enrollees. 15

‘‘(2) M

EDICAL ASSISTANCE EXPENDITURES

.— 16

In this section, the term ‘medical assistance expendi-17

tures’ means, for a State and fiscal year, the med-18

ical assistance payments as reported by medical 19

service category on the Form CMS-64 quarterly ex-20

pense report (or successor to such a report form, 21

and including enrollment data and subsequent ad-22

justments to any such report, in this section referred 23

to collectively as a ‘CMS-64 report’) for which pay-24

•HR 1628 EH

ment is (or may otherwise be) made pursuant to sec-1

tion 1903(a)(1). 2

‘‘(3) E

XCLUDED EXPENDITURES

.—In this sec-3

tion, the term ‘excluded expenditures’ means, for a 4

State and fiscal year, expenditures under the State 5

plan (or under a waiver of such plan) that are at-6

tributable to any of the following: 7

‘‘(A) DSH.—Payment adjustments made 8

for disproportionate share hospitals under sec-9

tion 1923. 10

‘‘(B) M

EDICARE COST

SHARING

.—Pay-11

ments made for medicare cost-sharing (as de-12

fined in section 1905(p)(3)). 13

‘‘(C) S

AFETY NET PROVIDER PAYMENT AD

-14

JUSTMENTS IN NON

EXPANSION STATES

.—Pay-15

ment adjustments under subsection (a) of sec-16

tion 1923A for which payment is permitted 17

under subsection (c) of such section. 18

‘‘(4) 1903A

FY 16 POPULATION PERCENTAGE

.— 19

In this subsection, the term ‘1903A FY16 popu-20

lation percentage’ means, for a State, the Sec-21

retary’s calculation of the percentage of the actual 22

medical assistance expenditures, as reported by the 23

State on the CMS–64 reports for calendar quarters 24

•HR 1628 EH

in fiscal year 2016, that are attributable to 1903A 1

enrollees (as defined in subsection (e)(1)). 2

‘‘(c) T

ARGET

OTAL

EDICAL

SSISTANCE

XPEND

-3

ITURES

.— 4

‘‘(1) C

ALCULATION

.—In this section, the term 5

‘target total medical assistance expenditures’ means, 6

for a State for a fiscal year and subject to para-7

graph (4), the sum of the products, for each of the 8

1903A enrollee categories (as defined in subsection 9

(e)(2)), of— 10

‘‘(A) the target per capita medical assist-11

ance expenditures (as defined in paragraph (2)) 12

for the enrollee category, State, and fiscal year; 13

and 14

‘‘(B) the number of 1903A enrollees for 15

such enrollee category, State, and fiscal year, as 16

determined under subsection (e)(4). 17

‘‘(2) T

ARGET PER CAPITA MEDICAL ASSISTANCE

EXPENDITURES

.—In this subsection, the term ‘tar-19

get per capita medical assistance expenditures’ 20

means, for a 1903A enrollee category and State— 21

‘‘(A) for fiscal year 2020, an amount equal 22

to— 23

‘‘(i) the provisional FY19 target per 24

capita amount for such enrollee category 25

•HR 1628 EH

(as calculated under subsection (d)(5)) for 1

the State; increased by 2

‘‘(ii) the applicable annual inflation 3

factor (as defined in paragraph (3)) for 4

fiscal year 2020; and 5

‘‘(B) for each succeeding fiscal year, an 6

amount equal to— 7

‘‘(i) the target per capita medical as-8

sistance expenditures (under subparagraph 9

(A) or this subparagraph) for the 1903A 10

enrollee category and State for the pre-11

ceding fiscal year, increased by 12

‘‘(ii) the applicable annual inflation 13

factor for that succeeding fiscal year. 14

‘‘(3) A

PPLICABLE ANNUAL INFLATION FAC

-15

TOR

.—In paragraph (2), the term ‘applicable annual 16

inflation factor’ means, for a fiscal year— 17

‘‘(A) for each of the 1903A enrollee cat-18

egories described in subparagraphs (C), (D), 19

and (E) of subsection (e)(2), the percentage in-20

crease in the medical care component of the 21

consumer price index for all urban consumers 22

(U.S. city average) from September of the pre-23

vious fiscal year to September of the fiscal year 24

involved; and 25

•HR 1628 EH

‘‘(B) for each of the 1903A enrollee cat-1

egories described in subparagraphs (A) and (B) 2

of subsection (e)(2), the percentage increase de-3

scribed in subparagraph (A) plus 1 percentage 4

point. 5

‘‘(4) D

ECREASE IN TARGET EXPENDITURES

FOR REQUIRED EXPENDITURES BY CERTAIN POLIT

-7

ICAL SUBDIVISIONS

.— 8

‘‘(A) I

N GENERAL

.—In the case of a State 9

that had a DSH allotment under section 10

1923(f) for fiscal year 2016 that was more than 11

6 times the national average of such allotments 12

for all the States for such fiscal year and that 13

requires political subdivisions within the State 14

to contribute funds towards medical assistance 15

or other expenditures under the State plan 16

under this title (or under a waiver of such plan) 17

for a fiscal year (beginning with fiscal year 18

2020), the target total medical assistance ex-19

penditures for such State and fiscal year shall 20

be decreased by the amount that political sub-21

divisions in the State are required to contribute 22

under the plan (or waiver) without reimburse-23

ment from the State for such fiscal year, other 24

•HR 1628 EH

than contributions described in subparagraph 1

(B). 2

‘‘(B) E

XCEPTIONS

.—The contributions de-3

scribed in this subparagraph are the following: 4

‘‘(i) Contributions required by a State 5

from a political subdivision that, as of the 6

first day of the calendar year in which the 7

fiscal year involved begins— 8

‘‘(I) has a population of more 9

than 5,000,000, as estimated by the 10

Bureau of the Census; and 11

‘‘(II) imposes a local income tax 12

upon its residents. 13

‘‘(ii) Contributions required by a 14

State from a political subdivision for ad-15

ministrative expenses if the State required 16

such contributions from such subdivision 17

without reimbursement from the State as 18

of January 1, 2017. 19

‘‘(d) C

ALCULATION OF

FY19 P

ROVISIONAL

ARGET

MOUNT FOR

ACH

1903A E

NROLLEE

ATEGORY

.—Sub-21

ject to subsection (g), the following shall apply: 22

‘‘(1) C

ALCULATION OF BASE AMOUNTS FOR FIS

-23

CAL YEAR 2016

.—For each State the Secretary shall 24

•HR 1628 EH

calculate (and provide notice to the State not later 1

than April 1, 2018, of) the following: 2

‘‘(A) The amount of the adjusted total 3

medical assistance expenditures (as defined in 4

subsection (b)(1)) for the State for fiscal year 5

2016. 6

‘‘(B) The number of 1903A enrollees for 7

the State in fiscal year 2016 (as determined 8

under subsection (e)(4)). 9

‘‘(C) The average per capita medical as-10

sistance expenditures for the State for fiscal 11

year 2016 equal to— 12

‘‘(i) the amount calculated under sub-13

paragraph (A); divided by 14

‘‘(ii) the number calculated under sub-15

paragraph (B). 16

‘‘(2) F

ISCAL YEAR 2019 AVERAGE PER CAPITA

AMOUNT BASED ON INFLATING THE FISCAL YEAR

2016 AMOUNT TO FISCAL YEAR 2019 BY CPI

MED

-19

ICAL

.—The Secretary shall calculate a fiscal year 20

2019 average per capita amount for each State 21

equal to— 22

‘‘(A) the average per capita medical assist-23

ance expenditures for the State for fiscal year 24

•HR 1628 EH

2016 (calculated under paragraph (1)(C)); in-1

creased by 2

‘‘(B) the percentage increase in the med-3

ical care component of the consumer price index 4

for all urban consumers (U.S. city average) 5

from September, 2016 to September, 2019. 6

‘‘(3) A

GGREGATE AND AVERAGE EXPENDI

-7

TURES PER CAPITA FOR FISCAL YEAR 2019

.—The 8

Secretary shall calculate for each State the fol-9

lowing: 10

‘‘(A) The amount of the adjusted total 11

medical assistance expenditures (as defined in 12

subsection (b)(1)) for the State for fiscal year 13

2019. 14

‘‘(B) The number of 1903A enrollees for 15

the State in fiscal year 2019 (as determined 16

under subsection (e)(4)). 17

‘‘(4) P

ER CAPITA EXPENDITURES FOR FISCAL

YEAR 2019 FOR EACH 1903A ENROLLEE CATEGORY

.— 19

The Secretary shall calculate (and provide notice to 20

each State not later than January 1, 2020, of) the 21

following: 22

‘‘(A)(i) For each 1903A enrollee category, 23

the amount of the adjusted total medical assist-24

ance expenditures (as defined in subsection 25

•HR 1628 EH

(b)(1)) for the State for fiscal year 2019 for in-1

dividuals in the enrollee category, calculated by 2

excluding from medical assistance expenditures 3

those expenditures attributable to expenditures 4

described in clause (iii) or non-DSH supple-5

mental expenditures (as defined in clause (ii)). 6

‘‘(ii) In this paragraph, the term ‘non- 7

DSH supplemental expenditure’ means a pay-8

ment to a provider under the State plan (or 9

under a waiver of the plan) that— 10

‘‘(I) is not made under section 1923; 11

‘‘(II) is not made with respect to a 12

specific item or service for an individual; 13

‘‘(III) is in addition to any payments 14

made to the provider under the plan (or 15

waiver) for any such item or service; and 16

‘‘(IV) complies with the limits for ad-17

ditional payments to providers under the 18

plan (or waiver) imposed pursuant to sec-19

tion 1902(a)(30)(A), including the regula-20

tions specifying upper payment limits 21

under the State plan in part 447 of title 22

42, Code of Federal Regulations (or any 23

successor regulations). 24

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‘‘(iii) An expenditure described in this 1

clause is an expenditure that meets the criteria 2

specified in subclauses (I), (II), and (III) of 3

clause (ii) and is authorized under section 1115 4

for the purposes of funding a delivery system 5

reform pool, uncompensated care pool, a des-6

ignated state health program, or any other 7

similar expenditure (as defined by the Sec-8

retary). 9

‘‘(B) For each 1903A enrollee category, 10

the number of 1903A enrollees for the State in 11

fiscal year 2019 in the enrollee category (as de-12

termined under subsection (e)(4)). 13

‘‘(C) For fiscal year 2016, the State’s non- 14

DSH supplemental and pool payment percent-15

age is equal to the ratio (expressed as a per-16

centage) of— 17

‘‘(i) the total amount of non-DSH 18

supplemental expenditures (as defined in 19

subparagraph (A)(ii)) and payments de-20

scribed in subparagraph (A)(iii) for the 21

State for fiscal year 2016; to 22

‘‘(ii) the amount described in sub-23

section (b)(1)(A) for the State for fiscal 24

year 2016. 25

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‘‘(D) For each 1903A enrollee category an 1

average medical assistance expenditures per 2

capita for the State for fiscal year 2019 for the 3

enrollee category equal to— 4

‘‘(i) the amount calculated under sub-5

paragraph (A) for the State, increased by 6

the non-DSH supplemental and pool pay-7

ment percentage for the State (as cal-8

culated under subparagraph (C)); divided 9

by 10

‘‘(ii) the number calculated under sub-11

paragraph (B) for the State for the en-12

rollee category. 13

‘‘(5) P

ROVISIONAL FY19 PER CAPITA TARGET

AMOUNT FOR EACH 1903A ENROLLEE CATEGORY

.— 15

Subject to subsection (f)(2), the Secretary shall cal-16

culate for each State a provisional FY19 per capita 17

target amount for each 1903A enrollee category 18

equal to the average medical assistance expenditures 19

per capita for the State for fiscal year 2019 (as cal-20

culated under paragraph (4)(D)) for such enrollee 21

category multiplied by the ratio of— 22

‘‘(A) the product of— 23

•HR 1628 EH

‘‘(i) the fiscal year 2019 average per 1

capita amount for the State, as calculated 2

under paragraph (2); and 3

‘‘(ii) the number of 1903A enrollees 4

for the State in fiscal year 2019, as cal-5

culated under paragraph (3)(B); to 6

‘‘(B) the amount of the adjusted total 7

medical assistance expenditures for the State 8

for fiscal year 2019, as calculated under para-9

graph (3)(A). 10

‘‘(e) 1903A E

NROLLEE

; 1903A E

NROLLEE

-11

EGORY

.—Subject to subsection (g), for purposes of this 12

section, the following shall apply: 13

‘‘(1) 1903A

ENROLLEE

.—The term ‘1903A en-14

rollee’ means, with respect to a State and a month 15

and subject to subsection (i)(1)(B), any Medicaid 16

enrollee (as defined in paragraph (3)) for the month, 17

other than such an enrollee who for such month is 18

in any of the following categories of excluded indi-19

viduals: 20

‘‘(A) CHIP.—An individual who is pro-21

vided, under this title in the manner described 22

in section 2101(a)(2), child health assistance 23

under title XXI. 24

•HR 1628 EH

‘‘(B) IHS.—An individual who receives 1

any medical assistance under this title for serv-2

ices for which payment is made under the third 3

sentence of section 1905(b). 4

‘‘(C) B

REAST AND CERVICAL CANCER

SERVICES ELIGIBLE INDIVIDUAL

.—An indi-6

vidual who is entitled to medical assistance 7

under this title only pursuant to section 8

1902(a)(10)(A)(ii)(XVIII). 9

‘‘(D) P

ARTIAL

BENEFIT ENROLLEES

.—An 10

individual who— 11

‘‘(i) is an alien who is entitled to med-12

ical assistance under this title only pursu-13

ant to section 1903(v)(2); 14

‘‘(ii) is entitled to medical assistance 15

under this title only pursuant to subclause 16

(XII) or (XXI) of section 17

1902(a)(10)(A)(ii) (or pursuant to a waiv-18

er that provides only comparable benefits); 19

‘‘(iii) is a dual eligible individual (as 20

defined in section 1915(h)(2)(B)) and is 21

entitled to medical assistance under this 22

title (or under a waiver) only for some or 23

all of medicare cost-sharing (as defined in 24

section 1905(p)(3)); or 25

•HR 1628 EH

‘‘(iv) is entitled to medical assistance 1

under this title and for whom the State is 2

providing a payment or subsidy to an em-3

ployer for coverage of the individual under 4

a group health plan pursuant to section 5

1906 or section 1906A (or pursuant to a 6

waiver that provides only comparable bene-7

fits). 8

‘‘(2) 1903A

ENROLLEE CATEGORY

.—The term 9

‘1903A enrollee category’ means each of the fol-10

lowing: 11

‘‘(A) E

LDERLY

.—A category of 1903A en-12

rollees who are 65 years of age or older. 13

‘‘(B) B

LIND AND DISABLED

.—A category 14

of 1903A enrollees (not described in the pre-15

vious subparagraph) who are eligible for med-16

ical assistance under this title on the basis of 17

being blind or disabled. 18

‘‘(C) C

HILDREN

.—A category of 1903A 19

enrollees (not described in a previous subpara-20

graph) who are children under 19 years of age. 21

‘‘(D) E

XPANSION ENROLLEES

.—A cat-22

egory of 1903A enrollees (not described in a 23

previous subparagraph) for whom the amounts 24

expended for medical assistance are subject to 25

•HR 1628 EH

an increase or change in the Federal medical 1

assistance percentage under subsection (y) or 2

(z)(2), respectively, of section 1905. 3

‘‘(E) O

THER NONELDERLY

NONDISABLED

, 4

NON

EXPANSION ADULTS

.—A category of 5

1903A enrollees who are not described in any 6

previous subparagraph. 7

‘‘(3) M

EDICAID ENROLLEE

.—The term ‘Med-8

icaid enrollee’ means, with respect to a State for a 9

month, an individual who is eligible for medical as-10

sistance for items or services under this title and en-11

rolled under the State plan (or a waiver of such 12

plan) under this title for the month. 13

‘‘(4) D

ETERMINATION OF NUMBER OF 1903A

ENROLLEES

.—The number of 1903A enrollees for a 15

State and fiscal year, and, if applicable, for a 1903A 16

enrollee category, is the average monthly number of 17

Medicaid enrollees for such State and fiscal year 18

(and, if applicable, in such category) that are re-19

ported through the CMS–64 report under (and sub-20

ject to audit under) subsection (h). 21

‘‘(f) S

PECIAL

AYMENT

ULES

.— 22

‘‘(1) A

PPLICATION IN CASE OF RESEARCH AND

DEMONSTRATION PROJECTS AND OTHER WAIVERS

.— 24

In the case of a State with a waiver of the State 25

•HR 1628 EH

plan approved under section 1115, section 1915, or 1

another provision of this title, this section shall 2

apply to medical assistance expenditures and medical 3

assistance payments under the waiver, in the same 4

manner as if such expenditures and payments had 5

been made under a State plan under this title and 6

the limitations on expenditures under this section 7

shall supersede any other payment limitations or 8

provisions (including limitations based on a per cap-9

ita limitation) otherwise applicable under such a 10

waiver. 11

‘‘(2) T

REATMENT OF STATES EXPANDING COV

-12

ERAGE AFTER FISCAL YEAR 2016

.—In the case of a 13

State that did not provide for medical assistance for 14

the 1903A enrollee category described in subsection 15

(e)(2)(D) during fiscal year 2016 but which provides 16

for such assistance for such category in a subse-17

quent year, the provisional FY19 per capita target 18

amount for such enrollee category under subsection 19

(d)(5) shall be equal to the provisional FY19 per 20

capita target amount for the 1903A enrollee cat-21

egory described in subsection (e)(2)(E). 22

‘‘(3) I

N CASE OF STATE FAILURE TO REPORT

NECESSARY DATA

.—If a State for any quarter in a 24

fiscal year (beginning with fiscal year 2019) fails to 25

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satisfactorily submit data on expenditures and en-1

rollees in accordance with subsection (h)(1), for such 2

fiscal year and any succeeding fiscal year for which 3

such data are not satisfactorily submitted— 4

‘‘(A) the Secretary shall calculate and 5

apply subsections (a) through (e) with respect 6

to the State as if all 1903A enrollee categories 7

for which such expenditure and enrollee data 8

were not satisfactorily submitted were a single 9

1903A enrollee category; and 10

‘‘(B) the growth factor otherwise applied 11

under subsection (c)(2)(B) shall be decreased 12

by 1 percentage point. 13

‘‘(g) R

ECALCULATION OF

ERTAIN

MOUNTS FOR

ATA

RRORS

.—The amounts and percentage calculated 15

under paragraphs (1) and (4)(C) of subsection (d) for a 16

State for fiscal year 2016, and the amounts of the ad-17

justed total medical assistance expenditures calculated 18

under subsection (b) and the number of Medicaid enrollees 19

and 1903A enrollees determined under subsection (e)(4) 20

for a State for fiscal year 2016, fiscal year 2019, and any 21

subsequent fiscal year, may be adjusted by the Secretary 22

based upon an appeal (filed by the State in such a form, 23

manner, and time, and containing such information relat-24

ing to data errors that support such appeal, as the Sec-25

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retary specifies) that the Secretary determines to be valid, 1

except that any adjustment by the Secretary under this 2

subsection for a State may not result in an increase of 3

the target total medical assistance expenditures exceeding 4

2 percent. 5

‘‘(h) R

EQUIRED

EPORTING AND

UDITING OF

CMS–64 D

ATA

; T

RANSITIONAL

NCREASE IN

EDERAL

ATCHING

ERCENTAGE FOR

ERTAIN

DMINISTRATIVE

XPENSES

.— 9

‘‘(1) R

EPORTING

.—In addition to the data re-10

quired on form Group VIII on the CMS–64 report 11

form as of January 1, 2017, in each CMS-64 report 12

required to be submitted (for each quarter beginning 13

on or after October 1, 2018), the State shall include 14

data on medical assistance expenditures within such 15

categories of services and categories of enrollees (in-16

cluding each 1903A enrollee category and each cat-17

egory of excluded individuals under subsection 18

(e)(1)) and the numbers of enrollees within each of 19

such enrollee categories, as the Secretary determines 20

are necessary (including timely guidance published 21

as soon as possible after the date of the enactment 22

of this section) in order to implement this section 23

and to enable States to comply with the requirement 24

of this paragraph on a timely basis. 25

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‘‘(2) A

UDITING

.—The Secretary shall conduct 1

for each State an audit of the number of individuals 2

and expenditures reported through the CMS–64 re-3

port for fiscal year 2016, fiscal year 2019, and each 4

subsequent fiscal year, which audit may be con-5

ducted on a representative sample (as determined by 6

the Secretary). 7

‘‘(3) T

EMPORARY INCREASE IN FEDERAL

MATCHING PERCENTAGE TO SUPPORT IMPROVED

DATA REPORTING SYSTEMS FOR FISCAL YEARS 2018

AND 2019

.—For amounts expended during calendar 11

quarters beginning on or after October 1, 2017, and 12

before October 1, 2019— 13

‘‘(A) the Federal matching percentage ap-14

plied under section 1903(a)(3)(A)(i) shall be in-15

creased by 10 percentage points to 100 percent; 16

‘‘(B) the Federal matching percentage ap-17

plied under section 1903(a)(3)(B) shall be in-18

creased by 25 percentage points to 100 percent; 19

and 20

‘‘(C) the Federal matching percentage ap-21

plied under section 1903(a)(7) shall be in-22

creased by 10 percentage points to 60 percent 23

but only with respect to amounts expended that 24

are attributable to a State’s additional adminis-25

•HR 1628 EH

trative expenditures to implement the data re-1

quirements of paragraph (1). 2

‘‘(i) F

LEXIBLE

LOCK

RANT

PTION FOR

TATES

.— 4

‘‘(1) I

N GENERAL

.—In the case of a State that 5

elects the option of applying this subsection for a 6

10-fiscal-year period (beginning no earlier than fiscal 7

year 2020 and, at the State option, for any suc-8

ceeding 10-fiscal-year period) and that has a plan 9

approved by the Secretary under paragraph (2) to 10

carry out the option for such period— 11

‘‘(A) the State shall receive, instead of 12

amounts otherwise payable to the State under 13

this title for medical assistance for block grant 14

individuals within the applicable block grant 15

category (as defined in paragraph (6)) for the 16

State during the period in which the election is 17

in effect, the amount specified in paragraph 18

(4); 19

‘‘(B) the previous provisions of this section 20

shall be applied as if— 21

‘‘(i) block grant individuals within the 22

applicable block grant category for the 23

State and period were not section 1903A 24

enrollees for each 10-fiscal year period for 25

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which the State elects to apply this sub-1

section; and 2

‘‘(ii) if such option is not extended at 3

the end of a 10-fiscal-year-period, the per 4

capita limitations under such previous pro-5

visions shall again apply after such period 6

and such limitations shall be applied as if 7

the election under this subsection had 8

never taken place; 9

‘‘(C) the payment under this subsection 10

may only be used consistent with the State plan 11

under paragraph (2) for block grant health care 12

assistance (as defined in paragraph (7)); and 13

‘‘(D) with respect to block grant individ-14

uals within the applicable block grant category 15

for the State for which block grant health care 16

assistance is made available under this sub-17

section, such assistance shall be instead of med-18

ical assistance otherwise provided to the indi-19

vidual under this title. 20

‘‘(2) S

TATE PLAN FOR ADMINISTERING BLOCK

GRANT OPTION

.— 22

‘‘(A) I

N GENERAL

.—No payment shall be 23

made under this subsection to a State pursuant 24

to an election for a 10-fiscal-year period under 25

•HR 1628 EH

paragraph (1) unless the State has a plan, ap-1

proved under subparagraph (B), for such period 2

that specifies— 3

‘‘(i) the applicable block grant cat-4

egory with respect to which the State will 5

apply the option under this subsection for 6

such period; 7

‘‘(ii) the conditions for eligibility of 8

block grant individuals within such appli-9

cable block grant category for block grant 10

health care assistance under the option, 11

which shall be instead of other conditions 12

for eligibility under this title, except that 13

in the case of a State that has elected the 14

applicable block grant category described 15

in— 16

‘‘(I) subparagraph (A) of para-17

graph (6), the plan must provide for 18

eligibility for pregnant women and 19

children required to be provided med-20

ical assistance under subsections 21

(a)(10)(A)(i) and (e)(4) of section 22

1902; or 23

‘‘(II) subparagraph (B) of para-24

graph (6), the plan must provide for 25

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eligibility for pregnant women re-1

quired to be provided medical assist-2

ance under subsection (a)(10)(A)(i); 3

and 4

‘‘(iii) the types of items and services, 5

the amount, duration, and scope of such 6

services, the cost-sharing with respect to 7

such services, and the method for delivery 8

of block grant health care assistance under 9

this subsection, which shall be instead of 10

the such types, amount, duration, and 11

scope, cost-sharing, and methods of deliv-12

ery for medical assistance otherwise re-13

quired under this title, except that the plan 14

must provide for assistance for— 15

‘‘(I) hospital care; 16

‘‘(II) surgical care and treat-17

ment; 18

‘‘(III) medical care and treat-19

ment; 20

‘‘(IV) obstetrical and prenatal 21

care and treatment; 22

‘‘(V) prescribed drugs, medicines, 23

and prosthetic devices; 24

•HR 1628 EH

‘‘(VI) other medical supplies and 1

services; and 2

‘‘(VII) health care for children 3

under 18 years of age. 4

‘‘(B) R

EVIEW AND APPROVAL

.—A plan de-5

scribed in subparagraph (A) shall be deemed 6

approved by the Secretary unless the Secretary 7

determines, within 30 days after the date of the 8

Secretary’s receipt of the plan, that the plan is 9

incomplete or actuarially unsound and, with re-10

spect to such plan and its implementation 11

under this subsection, the requirements of para-12

graphs (1), (10)(B), (17), and (23) of section 13

1902(a) shall not apply. 14

‘‘(3) A

MOUNT OF BLOCK GRANT FUNDS

.— 15

‘‘(A) F

OR INITIAL FISCAL YEAR

.—The 16

block grant amount under this paragraph for a 17

State for the initial fiscal year in the first 10- 18

fiscal-year period is equal to the sum of the 19

products (for each applicable block grant cat-20

egory for such State and period) of— 21

‘‘(i) the target per capita medical as-22

sistance expenditures for such State for 23

such fiscal year (under subsection (c)(2)); 24

•HR 1628 EH

‘‘(ii) the number of 1903A enrollees 1

for such category and State for fiscal year 2

2019, as determined under subsection 3

(e)(4); and 4

‘‘(iii) the Federal average medical as-5

sistance matching percentage (as defined 6

in subsection (a)(4)) for the State for fis-7

cal year 2019. 8

‘‘(B) F

OR ANY SUBSEQUENT FISCAL

YEAR

.—The block grant amount under this 10

paragraph for a State for each succeeding fiscal 11

year (in any 10-fiscal-year period) is equal to 12

the block grant amount under subparagraph 13

(A) (or this subparagraph) for the State for the 14

previous fiscal year increased by the annual in-15

crease in the consumer price index for all urban 16

consumers (all items; U.S. city average) for the 17

fiscal year involved. 18

‘‘(C) A

VAILABILITY OF ROLLOVER

FUNDS

.—The block grant amount under this 20

paragraph for a State for a fiscal year shall re-21

main available to the State for expenditures 22

under this subsection for the succeeding fiscal 23

year but only if an election is in effect under 24

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this subsection for the State in such succeeding 1

fiscal year. 2

‘‘(4) F

EDERAL PAYMENT AND STATE RESPONSI

-3

BILITY

.—The Secretary shall pay to each State with 4

an election in effect under this subsection for a fiscal 5

year, from its block grant amount under paragraph 6

(3) available for such fiscal year, an amount for 7

each quarter of such fiscal year equal to the en-8

hanced FMAP described in the first sentence of sec-9

tion 2105(b) of the total amount expended under the 10

State plan under this subsection during such quar-11

ter, and the State is responsible for the balance of 12

funds to carry out such plan. 13

‘‘(5) B

LOCK GRANT INDIVIDUAL DEFINED

.—In 14

this subsection, the term ‘block grant individual’ 15

means, with respect to a State for a 10-fiscal-year 16

period, an individual who is not disabled (as defined 17

for purposes of the State plan) and who is within an 18

applicable block grant category for the State and 19

such period. 20

‘‘(6) A

PPLICABLE BLOCK GRANT CATEGORY DE

-21

FINED

.—In this subsection, the term ‘applicable 22

block grant category’ means with respect to a State 23

for a 10-fiscal-year period, either of the following as 24

•HR 1628 EH

specified by the State for such period in its plan 1

under paragraph (2)(A)(i): 2

‘‘(A) 2

ENROLLEE CATEGORIES

.—Both of 3

the following 1903A enrollee categories: 4

‘‘(i) C

HILDREN

.—The 1903A enrollee 5

category specified in subparagraph (C) of 6

subsection (e)(2). 7

‘‘(ii) O

THER NONELDERLY

NON

-8

DISABLED

NON

EXPANSION ADULTS

.—The 9

1903A enrollee category specified in sub-10

paragraph (E) of such subsection. 11

‘‘(B) O

THER NONELDERLY

NONDISABLED

, 12

NON

EXPANSION ADULTS

.—Only the 1903A en-13

rollee category specified in subparagraph (E) of 14

subsection (e)(2). 15

‘‘(7) B

LOCK GRANT HEALTH CARE ASSIST

-16

ANCE

.—In this subsection, the term ‘block grant 17

health care assistance’ means assistance for health- 18

care-related items and medical services for block 19

grant individuals within the applicable block grant 20

category for the State and 10-fiscal-year period in-21

volved who are low-income individuals (as defined by 22

the State). 23

‘‘(8) A

UDITING

.—As a condition of receiving 24

funds under this subsection, a State shall contract 25

•HR 1628 EH

with an independent entity to conduct audits of its 1

expenditures made with respect to activities funded 2

under this subsection for each fiscal year for which 3

the State elects to apply this subsection to ensure 4

that such funds are used consistent with this sub-5

section and shall make such audits available to the 6

Secretary upon the request of the Secretary.’’. 7

Subtitle D—Patient Relief and 8

Health Insurance Market Stability 9

SEC. 131. REPEAL OF COST-SHARING SUBSIDY. 10

(a) I

ENERAL

.—Section 1402 of the Patient Pro-11

tection and Affordable Care Act is repealed. 12

(b) E

FFECTIVE

ATE

.—The repeal made by sub-13

section (a) shall apply to cost-sharing reductions (and pay-14

ments to issuers for such reductions) for plan years begin-15

ning after December 31, 2019. 16

SEC. 132. PATIENT AND STATE STABILITY FUND. 17

The Social Security Act (42 U.S.C. 301 et seq.) is 18

amended by adding at the end the following new title: 19

‘‘TITLE XXII—PATIENT AND 20

STATE STABILITY FUND 21

‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM. 22

‘‘There is hereby established the ‘Patient and State 23

Stability Fund’ to be administered by the Secretary of 24

Health and Human Services, acting through the Adminis-25

•HR 1628 EH

trator of the Centers for Medicare & Medicaid Services 1

(in this section referred to as the ‘Administrator’), to pro-2

vide funding, in accordance with this title, to the 50 States 3

and the District of Columbia (each referred to in this sec-4

tion as a ‘State’) during the period, subject to section 5

2204(c), beginning on January 1, 2018, and ending on 6

December 31, 2026, for the purposes described in section 7

2202. 8

‘‘SEC. 2202. USE OF FUNDS. 9

‘‘(a) I

ENERAL

.—Subject to subsections (b) and 10

(c), a State may use the funds allocated to the State under 11

this title for any of the following purposes: 12

‘‘(1) Helping, through the provision of financial 13

assistance, high-risk individuals who do not have ac-14

cess to health insurance coverage offered through an 15

employer enroll in health insurance coverage in the 16

individual market in the State, as such market is de-17

fined by the State (whether through the establish-18

ment of a new mechanism or maintenance of an ex-19

isting mechanism for such purpose). 20

‘‘(2) Providing incentives to appropriate entities 21

to enter into arrangements with the State to help 22

stabilize premiums for health insurance coverage in 23

the individual market, as such markets are defined 24

by the State. 25

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‘‘(3) Reducing the cost for providing health in-1

surance coverage in the individual market and small 2

group market, as such markets are defined by the 3

State, to individuals who have, or are projected to 4

have, a high rate of utilization of health services (as 5

measured by cost) and to individuals who have high 6

costs of health insurance coverage due to the low 7

density population of the State in which they reside. 8

‘‘(4) Promoting participation in the individual 9

market and small group market in the State and in-10

creasing health insurance options available through 11

such market. 12

‘‘(5) Promoting access to preventive services; 13

dental care services (whether preventive or medically 14

necessary); vision care services (whether preventive 15

or medically necessary); or any combination of such 16

services. 17

‘‘(6) Maternity coverage and newborn care. 18

‘‘(7) Prevention, treatment, or recovery support 19

services for individuals with mental or substance use 20

disorders, focused on either or both of the following: 21

‘‘(A) Direct inpatient or outpatient clinical 22

care for treatment of addiction and mental ill-23

ness. 24

•HR 1628 EH

‘‘(B) Early identification and intervention 1

for children and young adults with serious men-2

tal illness. 3

‘‘(8) Providing payments, directly or indirectly, 4

to health care providers for the provision of such 5

health care services as are specified by the Adminis-6

trator. 7

‘‘(9) Providing assistance to reduce out-of-pock-8

et costs, such as copayments, coinsurance, pre-9

miums, and deductibles, of individuals enrolled in 10

health insurance coverage in the State. 11

‘‘(b) R

EQUIRED

SE OF

NCREASE IN

LLOT

-12

MENT

.—A State shall use the additional allocation pro-13

vided to the State from the funds appropriated under the 14

second sentence of section 2204(a) for each year only for 15

the purposes described in paragraphs (6) and (7) of sub-16

section (a). 17

‘‘(c) R

EQUIRED

SE OF

DDITIONAL

NCREASE TO

ERTAIN

AIVER

TATES TO

ROVIDE

INANCIAL

ARDSHIP

SSISTANCE

.—A State shall use the additional 20

allocation provided to the State from the funds appro-21

priated under the last sentence of section 2204(a) only 22

in accordance with such last sentence. 23

•HR 1628 EH

‘‘SEC. 2203. STATE ELIGIBILITY AND APPROVAL; DEFAULT 1

SAFEGUARD. 2

‘‘(a) E

NCOURAGING

TATE

PTIONS FOR

LLOCA

-3

TIONS

.— 4

‘‘(1) I

N GENERAL

.—To be eligible for an alloca-5

tion of funds under this title for a year during the 6

period described in section 2201 for use for one or 7

more purposes described in section 2202, a State 8

shall submit to the Administrator an application at 9

such time (but, in the case of allocations for 2018, 10

not later than 45 days after the date of the enact-11

ment of this title and, in the case of allocations for 12

a subsequent year, not later than March 31 of the 13

previous year) and in such form and manner as 14

specified by the Administrator and containing— 15

‘‘(A) a description of how the funds will be 16

used for such purposes; 17

‘‘(B) a certification that the State will 18

make, from non-Federal funds, expenditures for 19

such purposes in an amount that is not less 20

than the State percentage required for the year 21

under section 2204(e)(1); and 22

‘‘(C) such other information as the Admin-23

istrator may require. 24

‘‘(2) A

UTOMATIC APPROVAL

.—An application so 25

submitted is approved unless the Administrator noti-26

•HR 1628 EH

fies the State submitting the application, not later 1

than 60 days after the date of the submission of 2

such application, that the application has been de-3

nied for not being in compliance with any require-4

ment of this title and of the reason for such denial. 5

‘‘(3) O

TIME APPLICATION

.—If an applica-6

tion of a State is approved for a year, with respect 7

to a purpose described in section 2202, such applica-8

tion shall be treated as approved, with respect to 9

such purpose, for each subsequent year through 10

2026. 11

‘‘(4) T

REATMENT AS A STATE HEALTH CARE

PROGRAM

.—Any program receiving funds from an 13

allocation for a State under this title, including pur-14

suant to subsection (b), shall be considered to be a 15

‘State health care program’ for purposes of sections 16

1128, 1128A, and 1128B. 17

‘‘(b) D

EFAULT

EDERAL

AFEGUARD

.— 18

‘‘(1) I

N GENERAL

.— 19

‘‘(A) 2018.—For allocations made under 20

this title for 2018, in the case of a State that 21

does not submit an application under subsection 22

(a) by the 45-day submission date applicable to 23

such year under subsection (a)(1) and in the 24

case of a State that does submit such an appli-25

•HR 1628 EH

cation by such date that is not approved, sub-1

ject to section 2204(e), the Administrator, in 2

consultation with the State insurance commis-3

sioner, shall use the allocation that would other-4

wise be provided to the State under this title 5

for such year, in accordance with paragraph 6

(2), for such State. 7

‘‘(B) 2019

THROUGH 2026

.—In the case of 8

a State that does not have in effect an approved 9

application under this section for 2019 or a 10

subsequent year beginning during the period 11

described in section 2201, subject to section 12

2204(e), the Administrator, in consultation with 13

the State insurance commissioner, shall use the 14

allocation that would otherwise be provided to 15

the State under this title for such year, in ac-16

cordance with paragraph (2), for such State. 17

‘‘(2) R

EQUIRED USE FOR MARKET STABILIZA

-18

TION PAYMENTS TO ISSUERS

.—Subject to section 19

2204(a), an allocation for a State made pursuant to 20

paragraph (1) for a year shall be used to carry out 21

the purpose described in section 2202(2) in such 22

State by providing payments to appropriate entities 23

described in such section with respect to claims that 24

exceed $50,000 (or, with respect to allocations made 25

•HR 1628 EH

under this title for 2020 or a subsequent year dur-1

ing the period specified in section 2201, such dollar 2

amount specified by the Administrator), but do not 3

exceed $350,000 (or, with respect to allocations 4

made under this title for 2020 or a subsequent year 5

during such period, such dollar amount specified by 6

the Administrator), in an amount equal to 75 per-7

cent (or, with respect to allocations made under this 8

title for 2020 or a subsequent year during such pe-9

riod, such percentage specified by the Administrator) 10

of the amount of such claims. 11

‘‘SEC. 2204. ALLOCATIONS. 12

‘‘(a) A

PPROPRIATION

.—For the purpose of providing 13

allocations for States (including pursuant to section 14

2203(b)) under this title there is appropriated, out of any 15

money in the Treasury not otherwise appropriated— 16

‘‘(1) for 2018, $15,000,000,000; 17

‘‘(2) for 2019, $15,000,000,000; 18

‘‘(3) for 2020, $10,000,000,000; 19

‘‘(4) for 2021, $10,000,000,000; 20

‘‘(5) for 2022, $10,000,000,000; 21

‘‘(6) for 2023, $10,000,000,000; 22

‘‘(7) for 2024, $10,000,000,000; 23

‘‘(8) for 2025, $10,000,000,000; and 24

‘‘(9) for 2026, $10,000,000,000. 25

•HR 1628 EH

The amount otherwise appropriated under the previous 1

sentence for 2020 shall be increased by $15,000,000,000, 2

to be used and available under subsection (d) only for the 3

purposes described in paragraphs (6) and (7) of section 4

2202(a). The amount otherwise appropriated under this 5

subsection shall be increased by $8,000,000,000 for the 6

period beginning with 2018 and ending with 2023, to be 7

allocated to States with a waiver in effect under section 8

2701(b) of the Public Health Service Act with respect to 9

the purpose described in paragraph (1)(C) of such section, 10

in accordance with an allocation methodology specified by 11

the Secretary that takes into account the relative alloca-12

tion of other amounts appropriated under this subsection 13

among such States, and to be used by (and made available 14

under subsection (d), for any year during such period that 15

such waiver is in effect, to) such States for the purpose 16

of providing assistance to reduce premiums or other out- 17

of-pocket costs of individuals who are subject to an in-18

crease in the monthly premium rate for health insurance 19

coverage as a result of such waiver. 20

‘‘(b) A

LLOCATIONS

.— 21

‘‘(1) P

AYMENT

.— 22

‘‘(A) I

N GENERAL

.—From amounts appro-23

priated under subsection (a) for a year, the Ad-24

ministrator shall, with respect to a State and 25

•HR 1628 EH

not later than the date specified under subpara-1

graph (B) for such year, allocate, subject to 2

subsection (e), for such State (including pursu-3

ant to section 2203(b)) the amount determined 4

for such State and year under paragraph (2). 5

‘‘(B) S

PECIFIED DATE

.—For purposes of 6

subparagraph (A), the date specified in this 7

subparagraph is— 8

‘‘(i) for 2018, the date that is 45 days 9

after the date of the enactment of this 10

title; and 11

‘‘(ii) for 2019 and subsequent years, 12

January 1 of the respective year. 13

‘‘(2) A

LLOCATION AMOUNT DETERMINA

-14

TIONS

.— 15

‘‘(A) F

OR 2018 AND 2019

.— 16

‘‘(i) I

N GENERAL

.—For purposes of 17

paragraph (1), the amount determined 18

under this paragraph for 2018 and 2019 19

for a State is an amount equal to the sum 20

of— 21

‘‘(I) the relative incurred claims 22

amount described in clause (ii) for 23

such State and year; and 24

•HR 1628 EH

‘‘(II) the relative uninsured and 1

issuer participation amount described 2

in clause (iv) for such State and year. 3

‘‘(ii) R

ELATIVE INCURRED CLAIMS

AMOUNT

.—For purposes of clause (i), the 5

relative incurred claims amount described 6

in this clause for a State for 2018 and 7

2019 is the product of— 8

‘‘(I) 85 percent of the amount 9

appropriated under subsection (a) for 10

the year; and 11

‘‘(II) the relative State incurred 12

claims proportion described in clause 13

(iii) for such State and year. 14

‘‘(iii) R

ELATIVE STATE INCURRED

CLAIMS PROPORTION

.—The relative State 16

incurred claims proportion described in 17

this clause for a State and year is the 18

amount equal to the ratio of— 19

‘‘(I) the adjusted incurred claims 20

by the State, as reported through the 21

medical loss ratio annual reporting 22

under section 2718 of the Public 23

Health Service Act for the third pre-24

vious year; to 25

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‘‘(II) the sum of such adjusted 1

incurred claims for all States, as so 2

reported, for such third previous year. 3

‘‘(iv) R

ELATIVE UNINSURED AND

ISSUER PARTICIPATION AMOUNT

.—For 5

purposes of clause (i), the relative unin-6

sured and issuer participation amount de-7

scribed in this clause for a State for 2018 8

and 2019 is the product of— 9

‘‘(I) 15 percent of the amount 10

appropriated under subsection (a) for 11

the year; and 12

‘‘(II) the relative State uninsured 13

and issuer participation proportion de-14

scribed in clause (v) for such State 15

and year. 16

‘‘(v) R

ELATIVE STATE UNINSURED

AND ISSUER PARTICIPATION PROPOR

-18

TION

.—The relative State uninsured and 19

issuer participation proportion described in 20

this clause for a State and year is— 21

‘‘(I) in the case of a State not 22

described in clause (vi) for such year, 23

0; and 24

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‘‘(II) in the case of a State de-1

scribed in clause (vi) for such year, 2

the amount equal to the ratio of— 3

‘‘(aa) the number of individ-4

uals residing in such State who 5

for the third preceding year were 6

not enrolled in a health plan or 7

otherwise did not have health in-8

surance coverage (including 9

through a Federal or State 10

health program) and whose in-11

come is below 100 percent of the 12

poverty line applicable to a family 13

of the size involved; to 14

‘‘(bb) the sum of the num-15

ber of such individuals for all 16

States described in clause (vi) for 17

the third preceding year. 18

‘‘(vi) S

TATES DESCRIBED

.—For pur-19

poses of clause (v), a State is described in 20

this clause, with respect to 2018 and 2019, 21

if the State satisfies either of the following 22

criterion: 23

‘‘(I) The ratio described in sub-24

clause (II) of clause (v) that would be 25

•HR 1628 EH

determined for such State by sub-1

stituting ‘2015’ for each reference in 2

such subclause to ‘the third preceding 3

year’ and by substituting ‘all such 4

States’ for the reference in item (bb) 5

of such subclause to ‘all States de-6

scribed in clause (vi)’ is greater than 7

the ratio described in such subclause 8

that would be determined for such 9

State by substituting ‘2013’ for each 10

reference in such subclause to ‘the 11

third preceding year’ and by sub-12

stituting ‘all such States’ for the ref-13

erence in item (bb) of such subclause 14

to ‘all States described in clause (vi)’. 15

‘‘(II) The State has fewer than 16

three health insurance issuers offering 17

qualified health plans through the Ex-18

change for 2017. 19

‘‘(B) F

OR 2020 THROUGH 2026

.—For pur-20

poses of paragraph (1), the amount determined 21

under this paragraph for a year (beginning with 22

2020) during the period described in section 23

2201 for a State is an amount determined in 24

•HR 1628 EH

accordance with an allocation methodology spec-1

ified by the Administrator which— 2

‘‘(i) takes into consideration the ad-3

justed incurred claims of such State, the 4

number of residents of such State who for 5

the previous year were not enrolled in a 6

health plan or otherwise did not have 7

health insurance coverage (including 8

through a Federal or State health pro-9

gram) and whose income is below 100 per-10

cent of the poverty line applicable to a 11

family of the size involved, and the number 12

of health insurance issuers participating in 13

the insurance market in such State for 14

such year; 15

‘‘(ii) is established after consultation 16

with health care consumers, health insur-17

ance issuers, State insurance commis-18

sioners, and other stakeholders and after 19

taking into consideration additional cost 20

and risk factors that may inhibit health 21

care consumer and health insurance issuer 22

participation; and 23

‘‘(iii) reflects the goals of improving 24

the health insurance risk pool, promoting a 25

•HR 1628 EH

more competitive health insurance market, 1

and increasing choice for health care con-2

sumers. 3

‘‘(c) A

NNUAL

ISTRIBUTION OF

REVIOUS

EAR

’

EMAINING

UNDS

.— In carrying out subsection (b), the 5

Administrator shall, with respect to a year (beginning with 6

2020 and ending with 2027), not later than March 31 of 7

such year— 8

‘‘(1) determine the amount of funds, if any, 9

from the amounts appropriated under subsection (a) 10

for the previous year but not allocated for such pre-11

vious year; and 12

‘‘(2) if the Administrator determines that any 13

funds were not so allocated for such previous year, 14

allocate such remaining funds, in accordance with 15

the allocation methodology specified pursuant to 16

subsection (b)(2)(B)— 17

‘‘(A) to States that have submitted an ap-18

plication approved under section 2203(a) for 19

such previous year for any purpose for which 20

such an application was approved; and 21

‘‘(B) for States for which allocations were 22

made pursuant to section 2203(b) for such pre-23

vious year, to be used by the Administrator for 24

such States, to carry out the Federal Invisible 25

•HR 1628 EH

Risk Sharing Program in such States under 1

section 2205; 2

with, respect to a year before 2027, any remaining 3

funds being made available for allocations to States 4

for the subsequent year. 5

‘‘(d) A

VAILABILITY

.—Amounts appropriated under 6

subsection (a) for a year and allocated to States in accord-7

ance with this section shall remain available for expendi-8

ture through December 31, 2027. 9

‘‘(e) C

ONDITIONS FOR AND

IMITATIONS ON

-10

CEIPT OF

UNDS

.—The Secretary may not make an allo-11

cation under this title for a State, with respect to a pur-12

pose described in section 2202— 13

‘‘(1) in the case of an allocation that would be 14

made to a State pursuant to section 2203(a), if the 15

State does not agree that the State will make avail-16

able non-Federal contributions towards such purpose 17

in an amount equal to— 18

‘‘(A) for 2020, 7 percent of the amount al-19

located under this subsection to such State for 20

such year and purpose; 21

‘‘(B) for 2021, 14 percent of the amount 22

allocated under this subsection to such State 23

for such year and purpose; 24

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‘‘(C) for 2022, 21 percent of the amount 1

allocated under this subsection to such State 2

for such year and purpose; 3

‘‘(D) for 2023, 28 percent of the amount 4

allocated under this subsection to such State 5

for such year and purpose; 6

‘‘(E) for 2024, 35 percent of the amount 7

allocated under this subsection to such State 8

for such year and purpose; 9

‘‘(F) for 2025, 42 percent of the amount 10

allocated under this subsection to such State 11

for such year and purpose; and 12

‘‘(G) for 2026, 50 percent of the amount 13

allocated under this subsection to such State 14

for such year and purpose; 15

‘‘(2) in the case of an allocation that would be 16

made for a State pursuant to section 2203(b), if the 17

State does not agree that the State will make avail-18

able non-Federal contributions towards such purpose 19

in an amount equal to— 20

‘‘(A) for 2020, 10 percent of the amount 21

allocated under this subsection to such State 22

for such year and purpose; 23

•HR 1628 EH

‘‘(B) for 2021, 20 percent of the amount 1

allocated under this subsection to such State 2

for such year and purpose; and 3

‘‘(C) for 2022, 30 percent of the amount 4

allocated under this subsection to such State 5

for such year and purpose; 6

‘‘(D) for 2023, 40 percent of the amount 7

allocated under this subsection to such State 8

for such year and purpose; 9

‘‘(E) for 2024, 50 percent of the amount 10

allocated under this subsection to such State 11

for such year and purpose; 12

‘‘(F) for 2025, 50 percent of the amount 13

allocated under this subsection to such State 14

for such year and purpose; and 15

‘‘(G) for 2026, 50 percent of the amount 16

allocated under this subsection to such State 17

for such year and purpose; or 18

‘‘(3) if such an allocation for such purpose 19

would not be permitted under subsection (c)(7) of 20

section 2105 if such allocation were payment made 21

under such section. 22

‘‘SEC. 2205. FEDERAL INVISIBLE RISK SHARING PROGRAM. 23

‘‘(a) I

ENERAL

.—There is established within the 24

Patient and State Stability Fund a Federal Invisible Risk 25

•HR 1628 EH

Sharing Program (in this section referred to as the ‘Pro-1

gram’), to be administered by the Secretary of Health and 2

Human Services, acting through the Administrator of the 3

Centers for Medicare & Medicaid Services (in this section 4

referred to as the ‘Administrator’), to provide payments 5

to health insurance issuers with respect to claims for eligi-6

ble individuals for the purpose of lowering premiums for 7

health insurance coverage offered in the individual market. 8

‘‘(b) F

UNDING

.— 9

‘‘(1) A

PPROPRIATION

.—For the purpose of pro-10

viding funding for the Program there is appro-11

priated, out of any money in the Treasury not other-12

wise appropriated, $15,000,000,000 for the period 13

beginning on January 1, 2018, and ending on De-14

cember 31, 2026. 15

‘‘(2) U

SE OF UNALLOCATED FUNDS

.—Funds 16

provided under section 2204(c)(2)(B) to carry out 17

this section are in addition to the amount appro-18

priated under paragraph (1). 19

‘‘(c) O

PERATION OF

ROGRAM

.— 20

‘‘(1) I

N GENERAL

.—The Administrator shall es-21

tablish, after consultation with health care con-22

sumers, health insurance issuers, State insurance 23

commissioners, and other stakeholders and after tak-24

ing into consideration high cost health conditions 25

•HR 1628 EH

and other health trends that generate high cost, pa-1

rameters for the operation of the Program consistent 2

with this section and consistent with the same limi-3

tation on payment with respect to health insurance 4

coverage that applies to payment with respect health 5

benefits coverage under section 2105(c)(7). 6

‘‘(2) D

EADLINE FOR INITIAL OPERATION

.—Not 7

later than 60 days after the date of the enactment 8

of this title, the Administrator shall establish suffi-9

cient parameters to specify how the Program will op-10

erate for plan year 2018. 11

‘‘(3) S

TATE OPERATION OF PROGRAM

.—The 12

Administrator shall establish a process for a State to 13

operate the Program in such State beginning with 14

plan year 2020. 15

‘‘(d) D

ETAILS OF

ROGRAM

.—The parameters for 16

the Program shall include the following: 17

‘‘(1) E

LIGIBLE INDIVIDUALS

.—A definition for 18

eligible individuals. 19

‘‘(2) H

EALTH STATUS STATEMENTS

.—The de-20

velopment and use of health status statements with 21

respect to such individuals. 22

‘‘(3) S

TANDARDS FOR QUALIFICATION

.— 23

‘‘(A) A

UTOMATIC QUALIFICATION

.—The 24

identification of health conditions that auto-25

•HR 1628 EH

matically qualify individuals as eligible individ-1

uals at the time of application for health insur-2

ance coverage. 3

‘‘(B) V

OLUNTARY QUALIFICATION

.—A 4

process under which health insurance issuers 5

may voluntarily qualify individuals, who do not 6

automatically qualify under subparagraph (A), 7

as eligible individuals at the time of application 8

for such coverage. 9

‘‘(4) P

ERCENTAGE OF INSURANCE PREMIUMS

TO BE APPLIED

.—The percentage of the premiums 11

paid, to health insurance issuers for health insur-12

ance coverage by eligible individuals, that shall be 13

collected and deposited to the credit (and available 14

for the use) of the Program. 15

‘‘(5) A

TTACHMENT DOLLAR AMOUNT AND PAY

-16

MENT PROPORTION

.—The dollar amount of claims 17

for eligible individuals after which the Program will 18

provide payments to health insurance issuers and 19

the proportion of such claims above such dollar 20

amount that the Program will pay.’’. 21

SEC. 133. CONTINUOUS HEALTH INSURANCE COVERAGE IN-22

CENTIVE. 23

Subpart I of part A of title XXVII of the Public 24

Health Service Act is amended— 25

•HR 1628 EH

(1) in section 2701(a)(1)(B), by striking ‘‘such 1

rate’’ and inserting ‘‘subject to section 2710A, such 2

rate’’; 3

(2) by redesignating the second section 2709 as 4

section 2710; and 5

(3) by adding at the end the following new sec-6

tion: 7

‘‘SEC. 2710A. ENCOURAGING CONTINUOUS HEALTH INSUR-8

ANCE COVERAGE. 9

‘‘(a) P

ENALTY

PPLIED

.— 10

‘‘(1) I

N GENERAL

.—Subject to the succeeding 11

provisions of this section, a health insurance issuer 12

offering health insurance coverage in the individual 13

market shall, in the case of an individual who is an 14

applicable policyholder of such coverage with respect 15

to an enforcement period applicable to enrollments 16

for a plan year beginning with plan year 2019 (or, 17

in the case of enrollments during a special enroll-18

ment period, beginning with plan year 2018), in-19

crease the monthly premium rate otherwise applica-20

ble to such individual for such coverage during each 21

month of such period, by an amount determined 22

under paragraph (2). 23

‘‘(2) A

MOUNT OF PENALTY

.—The amount de-24

termined under this paragraph for an applicable pol-25

•HR 1628 EH

icyholder enrolling in health insurance coverage de-1

scribed in paragraph (1) for a plan year, with re-2

spect to each month during the enforcement period 3

applicable to enrollments for such plan year, is the 4

amount that is equal to 30 percent of the monthly 5

premium rate otherwise applicable to such applicable 6

policyholder for such coverage during such month. 7

‘‘(b) D

EFINITIONS

.—For purposes of this section: 8

‘‘(1) A

PPLICABLE POLICYHOLDER

.—The term 9

‘applicable policyholder’ means, with respect to 10

months of an enforcement period and health insur-11

ance coverage, an individual who— 12

‘‘(A) is a policyholder of such coverage for 13

such months; 14

‘‘(B) cannot demonstrate that (through 15

presentation of certifications described in sec-16

tion 2704(e) or in such other manner as may 17

be specified in regulations, such as a return or 18

statement made under section 6055(d) or 36B 19

of the Internal Revenue Code of 1986), during 20

the look-back period that is with respect to such 21

enforcement period, there was not a period of 22

at least 63 continuous days during which the 23

individual did not have creditable coverage (as 24

defined in paragraph (1) of section 2704(c) and 25

•HR 1628 EH

credited in accordance with paragraphs (2) and 1

(3) of such section); and 2

‘‘(C) in the case of an individual who had 3

been enrolled under dependent coverage under a 4

group health plan or health insurance coverage 5

by reason of section 2714 and such dependent 6

coverage of such individual ceased because of 7

the age of such individual, is not enrolling dur-8

ing the first open enrollment period following 9

the date on which such coverage so ceased. 10

‘‘(2) L

OOK

BACK PERIOD

.—The term ‘look-back 11

period’ means, with respect to an enforcement period 12

applicable to an enrollment of an individual for a 13

plan year beginning with plan year 2019 (or, in the 14

case of an enrollment of an individual during a spe-15

cial enrollment period, beginning with plan year 16

2018) in health insurance coverage described in sub-17

section (a)(1), the 12-month period ending on the 18

date the individual enrolls in such coverage for such 19

plan year. 20

‘‘(3) E

NFORCEMENT PERIOD

.—The term ‘en-21

forcement period’ means— 22

‘‘(A) with respect to enrollments during a 23

special enrollment period for plan year 2018, 24

the period beginning with the first month that 25

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is during such plan year and that begins subse-1

quent to such date of enrollment, and ending 2

with the last month of such plan year; and 3

‘‘(B) with respect to enrollments for plan 4

year 2019 or a subsequent plan year, the 12- 5

month period beginning on the first day of the 6

respective plan year.’’. 7

SEC. 134. INCREASING COVERAGE OPTIONS. 8

Section 1302 of the Patient Protection and Afford-9

able Care Act (42 U.S.C. 18022) is amended— 10

(1) in subsection (a)(3), by inserting ‘‘and with 11

respect to a plan year before plan year 2020’’ after 12

‘‘subsection (e)’’; and 13

(2) in subsection (d), by adding at the end the 14

following: 15

‘‘(5) S

UNSET

.—The provisions of this sub-16

section shall not apply after December 31, 2019, 17

and after such date any reference to this subsection 18

or level of coverage or plan described in this sub-19

section and any requirement under law applying 20

such a level of coverage or plan shall have no force 21

or effect (and such a requirement shall be applied as 22

if this section had been repealed).’’. 23

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SEC. 135. CHANGE IN PERMISSIBLE AGE VARIATION IN 1

HEALTH INSURANCE PREMIUM RATES. 2

Section 2701(a)(1)(A)(iii) of the Public Health Serv-3

ice Act (42 U.S.C. 300gg(a)(1)(A)(iii)), as inserted by sec-4

tion 1201(4) of the Patient Protection and Affordable 5

Care Act, is amended by inserting after ‘‘(consistent with 6

section 2707(c))’’ the following: ‘‘or, for plan years begin-7

ning on or after January 1, 2018, as the Secretary may 8

implement through interim final regulation, 5 to 1 for 9

adults (consistent with section 2707(c)) or such other 10

ratio for adults (consistent with section 2707(c)) as the 11

State involved may provide (or, in the case of a State with 12

a waiver under subsection (b) in effect for such a plan 13

year, the ratio applied for such plan year in accordance 14

with such waiver)’’. 15

SEC. 136. PERMITTING STATES TO WAIVE CERTAIN ACA RE-16

QUIREMENTS TO ENCOURAGE FAIR HEALTH 17

INSURANCE PREMIUMS. 18

(a) I

ENERAL

.—Section 2701 of the Public Health 19

Service Act (42 U.S.C. 300gg) is amended by adding at 20

the end the following new subsection: 21

‘‘(b) P

ERMISSIBLE

TATE

AIVER TO

NCOURAGE

AIR

EALTH

NSURANCE

REMIUMS

.— 23

‘‘(1) I

N GENERAL

.—A State may submit an ap-24

plication to the Secretary for one or more of the fol-25

lowing purposes: 26

•HR 1628 EH

‘‘(A) In the case of plan years beginning 1

on or after January 1, 2018, to apply, subject 2

to paragraph (5), under subsection 3

(a)(1)(A)(iii), instead of the ratio specified in 4

such subsection, a higher ratio specified by the 5

State (consistent with section 2707(c)). 6

‘‘(B) In the case of plan years beginning 7

on or after January 1, 2020, for health insur-8

ance coverage offered in the individual or small 9

group market in such State, to apply, subject to 10

paragraph (5), instead of the essential health 11

benefits specified under subsection (b) of sec-12

tion 1302 of the Patient Protection and Afford-13

able Care Act, essential health benefits as speci-14

fied by the State. 15

‘‘(C) In the case of a State that has in 16

place a program that carries out the purpose 17

described in paragraph (1) or (2) of section 18

2202(a) of the Social Security Act or partici-19

pates in the program established under section 20

2205 of such Act, for health insurance offered 21

in the individual market in such State, with re-22

spect to an individual who is an applicable pol-23

icyholder of such coverage with respect to an 24

enforcement period (as defined in section 25

•HR 1628 EH

2710A(b)) applicable to enrollments for a plan 1

year beginning with plan year 2019 (or, in the 2

case of enrollments during a special enrollment 3

period, beginning with plan year 2018), to— 4

‘‘(i) subject to paragraph (5), not 5

apply any increase to the monthly premium 6

rate that would otherwise apply under sec-7

tion 2710A to such individual for such cov-8

erage; and 9

‘‘(ii) instead, subject to paragraph 10

(5)— 11

‘‘(I) apply subsection (a)(1) as if 12

health status were included as a fac-13

tor described in subparagraph (A) of 14

such subsection; and 15

‘‘(II) not apply section 2705(b). 16

‘‘(2) D

EFAULT APPROVAL

.—An application sub-17

mitted under paragraph (1) is approved unless the 18

Secretary notifies the State submitting the applica-19

tion, not later than 60 days after the date of the 20

submission of such application, that the application 21

has been denied for not being in compliance with 22

any requirement of paragraph (3) and of the reason 23

for such denial. 24

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‘‘(3) R

EQUIREMENTS

.—The requirements of 1

this paragraph, with respect to an application sub-2

mitted under paragraph (1), are the following: 3

‘‘(A) The application is submitted at such 4

time, and in such manner, as the Secretary may 5

require. 6

‘‘(B) The application specifies how the ap-7

proval of such application will provide for one 8

or more of the following: 9

‘‘(i) Reducing average premiums for 10

health insurance coverage in the State. 11

‘‘(ii) Increasing enrollment in health 12

insurance coverage in the State. 13

‘‘(iii) Stabilizing the market for health 14

insurance coverage in the State. 15

‘‘(iv) Stabilizing premiums for individ-16

uals with pre-existing conditions. 17

‘‘(v) Increasing the choice of health 18

plans in the State. 19

‘‘(C) The application specifies the period 20

for which the waiver is to be effective, con-21

sistent with paragraph (4). 22

‘‘(D) In the case of an application for pur-23

poses of paragraph (1)(A), the application 24

•HR 1628 EH

specifies the higher ratio to be applied pursuant 1

to such paragraph. 2

‘‘(E) In the case of an application for pur-3

poses of paragraph (1)(B), the application 4

specifies the essential health benefits to be ap-5

plied pursuant to such paragraph. 6

‘‘(F) In the case of an application for pur-7

poses of paragraph (1)(C), the application dem-8

onstrates that the State has in place a program 9

that carries out the purpose described in para-10

graph (1) or (2) of section 2202(a) of the So-11

cial Security Act or participates in the program 12

established under section 2205 of such Act. 13

‘‘(4) T

ERM OF WAIVER

.— 14

‘‘(A) I

N GENERAL

.—No waiver for a State 15

under this subsection may extend over a period 16

of longer than 10 years unless the State re-17

quests continuation of such waiver, and such re-18

quest shall be deemed granted unless the Sec-19

retary, within 90 days after the date of its sub-20

mission to the Secretary, either denies such re-21

quest in writing or informs the State in writing 22

with respect to any additional information 23

which is needed in order to make a final deter-24

mination with respect to the request. 25

•HR 1628 EH

‘‘(B) S

PECIAL RULE

.—A waiver applied for 1

by a State under paragraph (1)(C) may only be 2

effective for a period during which the State— 3

‘‘(i) has in place a program that car-4

ries out the purpose described in para-5

graph (1) or (2) of section 2202(a) of the 6

Social Security Act; or 7

‘‘(ii) participates in the program es-8

tablished under section 2205 of such Act. 9

‘‘(5) N

APPLICATION RULES

.— 10

‘‘(A) S

PECIFIED NON

APPLICATION PROVI

-11

SIONS

.—In no case may a waiver for purposes 12

of paragraph (1) apply with respect to any of 13

the following provisions: 14

‘‘(i) Section 1301 of the Patient Pro-15

tection and Affordable Care Act, to the ex-16

tent that such section applies to qualified 17

health plans offered through the CO-OP 18

program under section 1322 of such Act or 19

multi-State plans under section 1334 of 20

such Act. 21

‘‘(ii) Sections 1312(d)(3)(D), 1331, 22

1332, 1333, and 1334 of such Act. 23

‘‘(B) H

OLD HARMLESS

.—Any standard or 24

requirement adopted by a State pursuant to the 25

•HR 1628 EH

terms of a waiver approved under this sub-1

section shall be deemed to comply with section 2

1252 of the Patient Protection and Affordable 3

Care Act and subsection (a) of section 1324 of 4

such Act, insofar as such standard or require-5

ment relates to a Federal or State law de-6

scribed in subsection (b)(2) of such section (re-7

lating to rating).’’. 8

(b) A

PPLICATION TO

SSENTIAL

EALTH

ENE

-9

FITS

.—Section 1302(a)(1) of the Patient Protection and 10

Affordable Care Act (42 U.S.C. 18022(a)(1)) is amended 11

by inserting ‘‘(or, in the case of health insurance coverage 12

offered in the individual or small group market in a State 13

for which there is an applicable waiver in effect under sec-14

tion 2701(b) of the Public Health Service Act for a plan 15

year, the essential health benefits applicable under such 16

waiver)’’ after ‘‘subsection (b)’’. 17

SEC. 137. CONSTRUCTIONS. 18

(a) N

ENDER

ATING

.—Nothing in this Act shall 19

be construed as permitting health insurance issuers to dis-20

criminate in rates for health insurance coverage by gender. 21

(b) N

IMITING

CCESS TO

OVERAGE FOR

NDI

-22

VIDUALS

ITH

REEXISTING

ONDITIONS

.—Nothing in 23

this Act shall be construed as permitting health insurance 24

•HR 1628 EH

issuers to limit access to health coverage for individuals 1

with preexisting conditions. 2

Subtitle E—Implementation 3

Funding 4

SEC. 141. AMERICAN HEALTH CARE IMPLEMENTATION 5

FUND. 6

(a) I

ENERAL

.—There is hereby established an 7

American Health Care Implementation Fund (referred to 8

in this section as the ‘‘Fund’’) within the Department of 9

Health and Human Services to carry out sections 121, 10

132, 202, and 214 (including the amendments made by 11

such sections). 12

(b) F

UNDING

.—There is appropriated to the Fund, 13

out of any funds in the Treasury not otherwise appro-14

priated, $1,000,000,000 for Federal administrative ex-15

penses to carry out the sections described in subsection 16

(a) (including the amendments made by such sections). 17

•HR 1628 EH

TITLE II—COMMITTEE ON WAYS 1

AND MEANS 2

Subtitle A—Repeal and Replace of 3

Health-Related Tax Policy 4

SEC. 201. RECAPTURE EXCESS ADVANCE PAYMENTS OF 5

PREMIUM TAX CREDITS. 6

Subparagraph (B) of section 36B(f)(2) of the Inter-7

nal Revenue Code of 1986 is amended by adding at the 8

end the following new clause: 9

‘‘(iii) N

ONAPPLICABILITY OF LIMITA

-10

TION

.—This subparagraph shall not apply 11

to taxable years beginning after December 12

31, 2017, and before January 1, 2020.’’. 13

SEC. 202. ADDITIONAL MODIFICATIONS TO PREMIUM TAX 14

CREDIT. 15

(a) M

ODIFICATION OF

EFINITION OF

UALIFIED

EALTH

LAN

.— 17

(1) I

N GENERAL

.—Section 36B(c)(3)(A) of the 18

Internal Revenue Code of 1986 is amended— 19

(A) by inserting ‘‘(determined without re-20

gard to subparagraphs (A), (C)(ii), and (C)(iv) 21

of paragraph (1) thereof and without regard to 22

whether the plan is offered on an Exchange)’’ 23

after ‘‘1301(a) of the Patient Protection and 24

Affordable Care Act’’, and 25

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(B) by striking ‘‘shall not include’’ and all 1

that follows and inserting ‘‘shall not include any 2

health plan that— 3

‘‘(i) is a grandfathered health plan or 4

a grandmothered health plan, or 5

‘‘(ii) includes coverage for abortions 6

(other than any abortion necessary to save 7

the life of the mother or any abortion with 8

respect to a pregnancy that is the result of 9

an act of rape or incest).’’. 10

(2) D

EFINITION OF GRANDMOTHERED HEALTH

PLAN

.—Section 36B(c)(3) of such Code is amended 12

by adding at the end the following new subpara-13

graph: 14

‘‘(C) G

RANDMOTHERED HEALTH PLAN

.— 15

‘‘(i) I

N GENERAL

.—The term 16

‘grandmothered health plan’ means health 17

insurance coverage which is offered in the 18

individual health insurance market as of 19

October 1, 2013, and is permitted to be of-20

fered in such market after January 1, 21

2014, as a result of CCIIO guidance. 22

‘‘(ii) CCIIO

GUIDANCE DEFINED

.— 23

The term ‘CCIIO guidance’ means the let-24

ter issued by the Centers for Medicare & 25

•HR 1628 EH

Medicaid Services on November 14, 2013, 1

to the State Insurance Commissioners out-2

lining a transitional policy for non-grand-3

fathered coverage in the individual health 4

insurance market, as subsequently ex-5

tended and modified (including by a com-6

munication entitled ‘Insurance Standards 7

Bulletin Series—INFORMATION—Ex-8

tension of Transitional Policy through Cal-9

endar Year 2017’ issued on February 29, 10

2016, by the Director of the Center for 11

Consumer Information & Insurance Over-12

sight of such Centers). 13

‘‘(iii) I

NDIVIDUAL HEALTH INSUR

-14

ANCE MARKET

.—The term ‘individual 15

health insurance market’ means the mar-16

ket for health insurance coverage (as de-17

fined in section 9832(b)) offered to individ-18

uals other than in connection with a group 19

health plan (within the meaning of section 20

5000(b)(1)).’’. 21

(3) C

ONFORMING AMENDMENT RELATED TO

ABORTION COVERAGE

.—Section 36B(c)(3) of such 23

Code, as amended by paragraph (2), is amended by 24

adding at the end the following new subparagraph: 25

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‘‘(D) C

ERTAIN RULES RELATED TO ABOR

-1

TION

.— 2

‘‘(i) O

PTION TO PURCHASE SEPARATE

COVERAGE OR PLAN

.—Nothing in subpara-4

graph (A) shall be construed as prohibiting 5

any individual from purchasing separate 6

coverage for abortions described in such 7

subparagraph, or a health plan that in-8

cludes such abortions, so long as no credit 9

is allowed under this section with respect 10

to the premiums for such coverage or plan. 11

‘‘(ii) O

PTION TO OFFER COVERAGE OR

PLAN

.—Nothing in subparagraph (A) shall 13

restrict any health insurance issuer offer-14

ing a health plan from offering separate 15

coverage for abortions described in such 16

subparagraph, or a plan that includes such 17

abortions, so long as premiums for such 18

separate coverage or plan are not paid for 19

with any amount attributable to the credit 20

allowed under this section (or the amount 21

of any advance payment of the credit 22

under section 1412 of the Patient Protec-23

tion and Affordable Care Act). 24

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‘‘(iii) O

THER TREATMENTS

.—The 1

treatment of any infection, injury, disease, 2

or disorder that has been caused by or ex-3

acerbated by the performance of an abor-4

tion shall not be treated as an abortion for 5

purposes of subparagraph (A).’’. 6

(4) C

ONFORMING AMENDMENTS RELATED TO

OFF

EXCHANGE COVERAGE

.— 8

(A) A

DVANCE PAYMENT NOT APPLICA

-9

BLE

.—Section 1412 of the Patient Protection 10

and Affordable Care Act is amended by adding 11

at the end the following new subsection: 12

‘‘(f) E

XCLUSION OF

-E

XCHANGE

OVERAGE

.— 13

Advance payments under this section, and advance deter-14

minations under section 1411, with respect to any credit 15

allowed under section 36B shall not be made with respect 16

to any health plan which is not enrolled in through an 17

Exchange.’’. 18

(B) R

EPORTING

.—Section 6055(b) of the 19

Internal Revenue Code of 1986 is amended by 20

adding at the end the following new paragraph: 21

‘‘(3) I

NFORMATION RELATING TO OFF

-22

CHANGE PREMIUM CREDIT ELIGIBLE COVERAGE

.—If 23

minimum essential coverage provided to an indi-24

vidual under subsection (a) consists of a qualified 25

•HR 1628 EH

health plan (as defined in section 36B(c)(3)) which 1

is not enrolled in through an Exchange established 2

under title I of the Patient Protection and Afford-3

able Care Act, a return described in this subsection 4

shall include— 5

‘‘(A) a statement that such plan is a quali-6

fied health plan (as defined in section 7

36B(c)(3)), 8

‘‘(B) the premiums paid with respect to 9

such coverage, 10

‘‘(C) the months during which such cov-11

erage is provided to the individual, 12

‘‘(D) the adjusted monthly premium for 13

the applicable second lowest cost silver plan (as 14

defined in section 36B(b)(3)) for each such 15

month with respect to such individual, and 16

‘‘(E) such other information as the Sec-17

retary may prescribe.’’. 18

THER CONFORMING AMENDMENTS

.— 19

(i) Section 36B(b)(2)(A) of such Code 20

is amended by striking ‘‘and which were 21

enrolled’’ and all that follows and inserting 22

‘‘, or’’. 23

(ii) Section 36B(b)(3)(B)(i) of such 24

Code is amended by striking ‘‘the same 25

•HR 1628 EH

Exchange’’ and all that follows and insert-1

ing ‘‘the Exchange through which such 2

taxpayer is permitted to obtain coverage, 3

and’’. 4

(iii) Section 36B(c)(2)(A)(i) of such 5

Code is amended by striking ‘‘that was en-6

rolled in through an Exchange established 7

by the State under section 1311 of the Pa-8

tient Protection and Affordable Care Act’’. 9

(b) M

ODIFICATION OF

PPLICABLE

ERCENTAGE

.— 10

Section 36B(b)(3)(A) of such Code is amended to read 11

as follows: 12

‘‘(A) A

PPLICABLE PERCENTAGE

.— 13

‘‘(i) I

N GENERAL

.—The applicable 14

percentage for any taxable year shall be 15

the percentage such that the applicable 16

percentage for any taxpayer whose house-17

hold income is within an income tier speci-18

fied in the following table shall increase, on 19

a sliding scale in a linear manner, from the 20

initial percentage to the final percentage 21

specified in such table for such income tier 22

with respect to a taxpayer of the age in-23

volved: 24

100

•HR 1628 EH

‘‘In the case of

household income

(expressed as a

percent of the

poverty line)

within the fol-

lowing income

tier:

Up to Age 29 Age 30-39 Age 40-49 Age 50-59 Over Age 59

Initial

Final

Initial

Final

Initial

Final

Initial

Final

Initial

Final

Up to 133% 2 2 2 2 2 2 2 2 2 2

133%-150% 3 4 3 4 3 4 3 4 3 4

150%-200% 4 4.3 4 5.3 4 6.3 4 7.3 4 8.3

200%-250% 4.3 4.3 5.3 5.9 6.3 8.05 7.3 9 8.3 10

250%-300% 4.3 4.3 5.9 5.9 8.05 8.35 9 10.5 10 11.5

300%-400% 4.3 4.3 5.9 5.9 8.35 8.35 10.5 10.5 11.5 11.5

‘‘(ii) A

GE DETERMINATIONS

.— 1

‘‘(I) I

N GENERAL

.—For purposes 2

of clause (i), the age of the taxpayer 3

taken into account under clause (i) 4

with respect to any taxable year is the 5

age attained by such taxpayer before 6

the close of such taxable year. 7

‘‘(II) J

OINT RETURNS

.—In the 8

case of a joint return, the age of the 9

older spouse shall be taken into ac-10

count under clause (i). 11

‘‘(iii) I

NDEXING

.—In the case of any 12

taxable year beginning in calendar year 13

2019, the initial and final percentages con-14

tained in clause (i) shall be adjusted to re-15

flect— 16

‘‘(I) the excess (if any) of the 17

rate of premium growth for the period 18

beginning with calendar year 2013 19

and ending with calendar year 2018, 20

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over the rate of income growth for 1

such period, and 2

‘‘(II) in addition to any adjust-3

ment under subclause (I), the excess 4

(if any) of the rate of premium 5

growth for calendar year 2018, over 6

the rate of growth in the consumer 7

price index for calendar year 2018. 8

‘‘(iv) F

AILSAFE

.—Clause (iii)(II) shall 9

apply only if the aggregate amount of pre-10

mium tax credits under this section and 11

cost-sharing reductions under section 1402 12

of the Patient Protection and Affordable 13

Care Act for calendar year 2018 exceeds 14

an amount equal to 0.504 percent of the 15

gross domestic product for such calendar 16

year.’’. 17

FFECTIVE

ATE

.— 18

(1) I

N GENERAL

.—Except as otherwise pro-19

vided in this subsection, the amendments made by 20

this section shall apply to taxable years beginning 21

after December 31, 2017. 22

(2) A

DVANCE PAYMENT NOT APPLICABLE TO

OFF

EXCHANGE COVERAGE

.—The amendment made 24

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•HR 1628 EH

by subsection (a)(4)(A) shall take effect on January 1

1, 2018. 2

(3) R

EPORTING

.—The amendment made by 3

subsection (a)(4)(B) shall apply to coverage provided 4

for months beginning after December 31, 2017. 5

(4) M

ODIFICATION OF APPLICABLE PERCENT

-6

AGE

.—The amendment made by subsection (b) shall 7

apply to taxable years beginning after December 31, 8

2018. 9

SEC. 203. SMALL BUSINESS TAX CREDIT. 10

(a) I

ENERAL

.—Section 45R of the Internal Rev-11

enue Code of 1986 is amended by adding at the end the 12

following new subsection: 13

‘‘(j) S

HALL

PPLY

.—This section shall not 14

apply with respect to amounts paid or incurred in taxable 15

years beginning after December 31, 2019.’’. 16

(b) D

ISALLOWANCE OF

MALL

MPLOYER

EALTH

NSURANCE

XPENSE

REDIT FOR

LAN

HICH

-18

CLUDES

OVERAGE FOR

BORTION

.—Subsection (h) of 19

section 45R of the Internal Revenue Code of 1986 is 20

amended— 21

(1) by striking ‘‘Any term’’ and inserting the 22

following: 23

‘‘(1) I

N GENERAL

.—Any term’’; and 24

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(2) by adding at the end the following new 1

paragraph: 2

‘‘(2) E

XCLUSION OF HEALTH PLANS INCLUDING

COVERAGE FOR ABORTION

.— 4

‘‘(A) I

N GENERAL

.—The term ‘qualified 5

health plan’ does not include any health plan 6

that includes coverage for abortions (other than 7

any abortion necessary to save the life of the 8

mother or any abortion with respect to a preg-9

nancy that is the result of an act of rape or in-10

cest). 11

‘‘(B) C

ERTAIN RULES RELATED TO ABOR

-12

TION

.— 13

‘‘(i) O

PTION TO PURCHASE SEPARATE

COVERAGE OR PLAN

.—Nothing in subpara-15

graph (A) shall be construed as prohibiting 16

any employer from purchasing for its em-17

ployees separate coverage for abortions de-18

scribed in such subparagraph, or a health 19

plan that includes such abortions, so long 20

as no credit is allowed under this section 21

with respect to the employer contributions 22

for such coverage or plan. 23

‘‘(ii) O

PTION TO OFFER COVERAGE OR

PLAN

.—Nothing in subparagraph (A) shall 25

104

•HR 1628 EH

restrict any health insurance issuer offer-1

ing a health plan from offering separate 2

coverage for abortions described in such 3

subparagraph, or a plan that includes such 4

abortions, so long as such separate cov-5

erage or plan is not paid for with any em-6

ployer contribution eligible for the credit 7

allowed under this section. 8

‘‘(iii) O

THER TREATMENTS

.—The 9

treatment of any infection, injury, disease, 10

or disorder that has been caused by or ex-11

acerbated by the performance of an abor-12

tion shall not be treated as an abortion for 13

purposes of subparagraph (A).’’. 14

FFECTIVE

ATES

.— 15

(1) I

N GENERAL

.—The amendment made by 16

subsection (a) shall apply to taxable years beginning 17

after December 31, 2019. 18

(2) D

ISALLOWANCE OF SMALL EMPLOYER

HEALTH INSURANCE EXPENSE CREDIT FOR PLAN

WHICH INCLUDES COVERAGE FOR ABORTION

.—The 21

amendments made by subsection (b) shall apply to 22

taxable years beginning after December 31, 2017. 23

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SEC. 204. INDIVIDUAL MANDATE. 1

(a) I

ENERAL

.—Section 5000A(c) of the Internal 2

Revenue Code of 1986 is amended— 3

(1) in paragraph (2)(B)(iii), by striking ‘‘2.5 4

percent’’ and inserting ‘‘Zero percent’’, and 5

(2) in paragraph (3)— 6

(A) by striking ‘‘$695’’ in subparagraph 7

(A) and inserting ‘‘$0’’, and 8

(B) by striking subparagraph (D). 9

(b) E

FFECTIVE

ATE

.—The amendments made by 10

this section shall apply to months beginning after Decem-11

ber 31, 2015. 12

SEC. 205. EMPLOYER MANDATE. 13

(a) I

ENERAL

.— 14

(1) Paragraph (1) of section 4980H(c) of the 15

Internal Revenue Code of 1986 is amended by in-16

serting ‘‘($0 in the case of months beginning after 17

December 31, 2015)’’ after ‘‘$2,000’’. 18

(2) Paragraph (1) of section 4980H(b) of the 19

Internal Revenue Code of 1986 is amended by in-20

serting ‘‘($0 in the case of months beginning after 21

December 31, 2015)’’ after ‘‘$3,000’’. 22

(b) E

FFECTIVE

ATE

.—The amendments made by 23

this section shall apply to months beginning after Decem-24

ber 31, 2015. 25

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•HR 1628 EH

SEC. 206. REPEAL OF THE TAX ON EMPLOYEE HEALTH IN-1

SURANCE PREMIUMS AND HEALTH PLAN 2

BENEFITS. 3

Section 4980I of the Internal Revenue Code of 1986 4

is amended by adding at the end the following new sub-5

section: 6

‘‘(h) S

HALL

PPLY

.—No tax shall be imposed 7

under this section with respect to any taxable period be-8

ginning after December 31, 2019, and before January 1, 9

2026.’’. 10

SEC. 207. REPEAL OF TAX ON OVER-THE-COUNTER MEDICA-11

TIONS. 12

(a) HSA

.—Subparagraph (A) of section 223(d)(2) 13

of the Internal Revenue Code of 1986 is amended by strik-14

ing ‘‘Such term’’ and all that follows through the period. 15

(b) A

RCHER

MSA

.—Subparagraph (A) of section 16

220(d)(2) of the Internal Revenue Code of 1986 is amend-17

ed by striking ‘‘Such term’’ and all that follows through 18

the period. 19

EALTH

LEXIBLE

PENDING

RRANGEMENTS

AND

EALTH

EIMBURSEMENT

RRANGEMENTS

.—Sec-21

tion 106 of the Internal Revenue Code of 1986 is amended 22

by striking subsection (f) and by redesignating subsection 23

(g) as subsection (f). 24

(d) E

FFECTIVE

ATES

.— 25

107

•HR 1628 EH

(1) D

ISTRIBUTIONS FROM SAVINGS AC

-1

COUNTS

.—The amendments made by subsections (a) 2

and (b) shall apply to amounts paid with respect to 3

taxable years beginning after December 31, 2016. 4

(2) R

EIMBURSEMENTS

.—The amendment made 5

by subsection (c) shall apply to expenses incurred 6

with respect to taxable years beginning after Decem-7

ber 31, 2016. 8

SEC. 208. REPEAL OF INCREASE OF TAX ON HEALTH SAV-9

INGS ACCOUNTS. 10

(a) HSA

.—Section 223(f)(4)(A) of the Internal 11

Revenue Code of 1986 is amended by striking ‘‘20 per-12

cent’’ and inserting ‘‘10 percent’’. 13

(b) A

RCHER

MSA

.—Section 220(f)(4)(A) of the In-14

ternal Revenue Code of 1986 is amended by striking ‘‘20 15

percent’’ and inserting ‘‘15 percent’’. 16

FFECTIVE

ATE

.—The amendments made by 17

this section shall apply to distributions made after Decem-18

ber 31, 2016. 19

SEC. 209. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO 20

FLEXIBLE SPENDING ACCOUNTS. 21

(a) I

ENERAL

.—Section 125 of the Internal Rev-22

enue Code of 1986 is amended by striking subsection (i). 23

108

•HR 1628 EH

(b) E

FFECTIVE

ATE

.—The amendment made by 1

this section shall apply to taxable years beginning after 2

December 31, 2016. 3

SEC. 210. REPEAL OF MEDICAL DEVICE EXCISE TAX. 4

Section 4191 of the Internal Revenue Code of 1986 5

is amended by adding at the end the following new sub-6

section: 7

‘‘(d) A

PPLICABILITY

.—The tax imposed under sub-8

section (a) shall not apply to sales after December 31, 9

2016.’’. 10

SEC. 211. REPEAL OF ELIMINATION OF DEDUCTION FOR 11

EXPENSES ALLOCABLE TO MEDICARE PART D 12

SUBSIDY. 13

(a) I

ENERAL

.—Section 139A of the Internal Rev-14

enue Code of 1986 is amended by adding at the end the 15

following new sentence: ‘‘This section shall not be taken 16

into account for purposes of determining whether any de-17

duction is allowable with respect to any cost taken into 18

account in determining such payment.’’. 19

(b) E

FFECTIVE

ATE

.—The amendment made by 20

this section shall apply to taxable years beginning after 21

December 31, 2016. 22

109

•HR 1628 EH

SEC. 212. REDUCTION OF INCOME THRESHOLD FOR DETER-1

MINING MEDICAL CARE DEDUCTION. 2

(a) I

ENERAL

.—Subsection (a) of section 213 of 3

the Internal Revenue Code of 1986 is amended by striking 4

‘‘10 percent’’ and inserting ‘‘5.8 percent’’. 5

(b) E

FFECTIVE

ATE

.—The amendment made by 6

this section shall apply to taxable years beginning after 7

December 31, 2016. 8

SEC. 213. REPEAL OF MEDICARE TAX INCREASE. 9

(a) I

ENERAL

.—Subsection (b) of section 3101 of 10

the Internal Revenue Code of 1986 is amended to read 11

as follows: 12

‘‘(b) H

OSPITAL

NSURANCE

.—In addition to the tax 13

imposed by the preceding subsection, there is hereby im-14

posed on the income of every individual a tax equal to 1.45 15

percent of the wages (as defined in section 3121(a)) re-16

ceived by such individual with respect to employment (as 17

defined in section 3121(b)).’’. 18

(b) SECA.—Subsection (b) of section 1401 of the In-19

ternal Revenue Code of 1986 is amended to read as fol-20

lows: 21

‘‘(b) H

OSPITAL

NSURANCE

.—In addition to the tax 22

imposed by the preceding subsection, there shall be im-23

posed for each taxable year, on the self-employment in-24

come of every individual, a tax equal to 2.9 percent of the 25

110

•HR 1628 EH

amount of the self-employment income for such taxable 1

year.’’. 2

FFECTIVE

ATE

.—The amendments made by 3

this section shall apply with respect to remuneration re-4

ceived after, and taxable years beginning after, December 5

31, 2022. 6

SEC. 214. REFUNDABLE TAX CREDIT FOR HEALTH INSUR-7

ANCE COVERAGE. 8

(a) I

ENERAL

.—Section 36B of the Internal Rev-9

enue Code of 1986 is amended to read as follows: 10

‘‘SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A 11

QUALIFIED HEALTH PLAN. 12

‘‘(a) A

LLOWANCE OF

REMIUM

REDIT

.—In the 13

case of an individual, there shall be allowed as a credit 14

against the tax imposed by this subtitle for the taxable 15

year the sum of the monthly credit amounts with respect 16

to such taxpayer for calendar months during such taxable 17

year which are eligible coverage months appropriately 18

taken into account under subsection (b)(2) with respect 19

to the taxpayer or any qualifying family member of the 20

taxpayer. 21

‘‘(b) M

ONTHLY

REDIT

MOUNTS

.— 22

‘‘(1) I

N GENERAL

.—The monthly credit amount 23

with respect to any taxpayer for any calendar month 24

is the lesser of— 25

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•HR 1628 EH

‘‘(A) the sum of the monthly limitation 1

amounts determined under subsection (c) with 2

respect to the taxpayer and the taxpayer’s 3

qualifying family members for such month, or 4

‘‘(B) the amount paid for a qualified 5

health plan for the taxpayer and the taxpayer’s 6

qualifying family members for such month. 7

‘‘(2) E

LIGIBLE COVERAGE MONTH REQUIRE

-8

MENT

.—No amount shall be taken into account 9

under subparagraph (A) or (B) of paragraph (1) 10

with respect to any individual for any month unless 11

such month is an eligible coverage month with re-12

spect to such individual. 13

‘‘(c) M

ONTHLY

IMITATION

MOUNTS

.— 14

‘‘(1) I

N GENERAL

.—The monthly limitation 15

amount with respect to any individual for any eligi-16

ble coverage month during any taxable year is

⁄

of— 18

‘‘(A) $2,000 in the case of an individual 19

who has not attained age 30 as of the begin-20

ning of such taxable year, 21

‘‘(B) $2,500 in the case of an individual 22

who has attained age 30 but who has not at-23

tained age 40 as of such time, 24

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•HR 1628 EH

‘‘(C) $3,000 in the case of an individual 1

who has attained age 40 but who has not at-2

tained age 50 as of such time, 3

‘‘(D) $3,500 in the case of an individual 4

who has attained age 50 but who has not at-5

tained age 60 as of such time, and 6

‘‘(E) $4,000 in the case of an individual 7

who has attained age 60 as of such time. 8

‘‘(2) L

IMITATION BASED ON MODIFIED AD

-9

JUSTED GROSS INCOME

.—The credit allowed under 10

subsection (a) with respect to any taxpayer for any 11

taxable year shall be reduced (but not below zero) by 12

10 percent of the excess (if any) of— 13

‘‘(A) the taxpayer’s modified adjusted 14

gross income (as defined in section 15

36B(d)(2)(B), as in effect for taxable years be-16

ginning before January 1, 2020) for such tax-17

able year, over 18

‘‘(B) $75,000 (twice such amount in the 19

case of a joint return). 20

‘‘(3) O

THER LIMITATIONS

.— 21

‘‘(A) A

GGREGATE DOLLAR LIMITATION

.— 22

The sum of the monthly limitation amounts 23

taken into account under this section with re-24

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•HR 1628 EH

spect to any taxpayer for any taxable year shall 1

not exceed $14,000. 2

‘‘(B) M

AXIMUM NUMBER OF INDIVIDUALS

TAKEN INTO ACCOUNT

.—With respect to any 4

taxpayer for any month, monthly limitation 5

amounts shall be taken into account under this 6

section only with respect to the 5 oldest individ-7

uals with respect to whom monthly limitation 8

amounts could (without regard to this subpara-9

graph) otherwise be so taken into account. 10

‘‘(d) E

LIGIBLE

OVERAGE

ONTH

.—For purposes of 11

this section, the term ‘eligible coverage month’ means, 12

with respect to any individual, any month if, as of the first 13

day of such month, the individual meets the following re-14

quirements: 15

‘‘(1) The individual is covered by a health in-16

surance coverage which is certified by the State in 17

which such insurance is offered as coverage that 18

meets the requirements for qualified health plans 19

under subsection (f). 20

‘‘(2) The individual is not eligible for— 21

‘‘(A) coverage under a group health plan 22

(within the meaning of section 5000(b)(1)) 23

other than coverage under a plan substantially 24

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all of the coverage of which is of excepted bene-1

fits described in section 9832(c), or 2

‘‘(B) coverage described in section 3

5000A(f)(1)(A). 4

‘‘(3) The individual is either— 5

‘‘(A) a citizen or national of the United 6

States, or 7

‘‘(B) a qualified alien (within the meaning 8

of section 431 of the Personal Responsibility 9

and Work Opportunity Reconciliation Act of 10

1996 (8 U.S.C. 1641)). 11

‘‘(4) The individual is not incarcerated, other 12

than incarceration pending the disposition of 13

charges. 14

‘‘(e) Q

UALIFYING

AMILY

EMBER

.—For purposes 15

of this section, the term ‘qualifying family member’ 16

means— 17

‘‘(1) in the case of a joint return, the taxpayer’s 18

spouse, 19

‘‘(2) any dependent of the taxpayer, and 20

‘‘(3) with respect to any eligible coverage 21

month, any child (as defined in section 152(f)(1)) of 22

the taxpayer who as of the end of the taxable year 23

has not attained age 27 if such child is covered for 24

such month under a qualified health plan which also 25

115

•HR 1628 EH

covers the taxpayer (in the case of a joint return, ei-1

ther spouse). 2

‘‘(f) Q

UALIFIED

EALTH

LAN

.—For purposes of 3

this section, the term ‘qualified health plan’ means any 4

health insurance coverage (as defined in section 9832(b)) 5

if— 6

‘‘(1) such coverage is offered in the individual 7

health insurance market within a State (within the 8

meaning of section 5000A(f)(1)(C)), 9

‘‘(2) substantially all of such coverage is not of 10

excepted benefits described in section 9832(c), 11

‘‘(3) such coverage does not consist of short- 12

term limited duration insurance (within the meaning 13

of section 2791(b)(5) of the Public Health Service 14

Act), 15

‘‘(4) such coverage is not a grandfathered 16

health plan (as defined in section 1251 of the Pa-17

tient Protection and Affordable Care Act) or a 18

grandmothered health plan (as defined in section 19

36B(c)(3)(C) as in effect for taxable years beginning 20

before January 1, 2020), and 21

‘‘(5) such coverage does not include coverage 22

for abortions (other than any abortion necessary to 23

save the life of the mother or any abortion with re-24

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•HR 1628 EH

spect to a pregnancy that is the result of an act of 1

rape or incest). 2

‘‘(g) S

PECIAL

ULES

.— 3

‘‘(1) M

ARRIED COUPLES MUST FILE JOINT RE

-4

TURN

.— 5

‘‘(A) I

N GENERAL

.—Except as provided in 6

subparagraph (B), if the taxpayer is married 7

(within the meaning of section 7703) at the 8

close of the taxable year, no credit shall be al-9

lowed under this section to such taxpayer unless 10

such taxpayer and the taxpayer’s spouse file a 11

joint return for such taxable year. 12

‘‘(B) E

XCEPTION FOR CERTAIN TAX

-13

PAYERS

.—Subparagraph (A) shall not apply to 14

any married taxpayer who— 15

‘‘(i) is living apart from the taxpayer’s 16

spouse at the time the taxpayer files the 17

tax return, 18

‘‘(ii) is unable to file a joint return be-19

cause such taxpayer is a victim of domestic 20

abuse or spousal abandonment, 21

‘‘(iii) certifies on the tax return that 22

such taxpayer meets the requirements of 23

clauses (i) and (ii), and 24

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‘‘(iv) has not met the requirements of 1

clauses (i), (ii), and (iii) for each of the 3 2

preceding taxable years. 3

‘‘(2) D

ENIAL OF CREDIT TO DEPENDENTS

.— 4

‘‘(A) I

N GENERAL

.—No credit shall be al-5

lowed under this section to any individual who 6

is a dependent with respect to another taxpayer 7

for a taxable year beginning in the calendar 8

year in which such individual’s taxable year be-9

gins. 10

‘‘(B) C

OORDINATION WITH RULE FOR

OLDER CHILDREN

.—In the case of any indi-12

vidual who is a qualifying family member de-13

scribed in subsection (e)(3) with respect to an-14

other taxpayer for any month, in determining 15

the amount of any credit allowable to such indi-16

vidual under this section for any taxable year of 17

such individual which includes such month, the 18

monthly limitation amount with respect to such 19

individual for such month shall be zero and no 20

amount paid for any qualified health plan with 21

respect to such individual for such month shall 22

be taken into account. 23

‘‘(3) C

OORDINATION WITH MEDICAL EXPENSE

DEDUCTION

.—Amounts described in subsection 25

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(b)(1)(B) with respect to any month shall not be 1

taken into account in determining the deduction al-2

lowed under section 213 except to the extent that 3

such amounts exceed the amount described in sub-4

section (b)(1)(A) with respect to such month. 5

‘‘(4) C

OORDINATION WITH ADVANCE PAYMENTS

OF CREDIT

.—With respect to any taxable year— 7

‘‘(A) the amount which would (but for this 8

subsection) be allowed as a credit to the tax-9

payer under subsection (a) shall be reduced 10

(but not below zero) by the aggregate amount 11

paid on behalf of such taxpayer under section 12

1412 of the Patient Protection and Affordable 13

Care Act for months beginning in such taxable 14

year, and 15

‘‘(B) the tax imposed by section 1 for such 16

taxable year shall be increased by the excess (if 17

any) of— 18

‘‘(i) the aggregate amount paid on be-19

half of such taxpayer under such section 20

1412 for months beginning in such taxable 21

year, over 22

‘‘(ii) the amount which would (but for 23

this subsection) be allowed as a credit to 24

the taxpayer under subsection (a). 25

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‘‘(5) S

PECIAL RULES FOR QUALIFIED SMALL

EMPLOYER HEALTH REIMBURSEMENT ARRANGE

-2

MENTS

.— 3

‘‘(A) I

N GENERAL

.—If the taxpayer or any 4

qualifying family member of the taxpayer is 5

provided a qualified small employer health reim-6

bursement arrangement for an eligible coverage 7

month, the sum determined under subsection 8

(b)(1)(A) with respect to the taxpayer shall be 9

reduced (but not below zero) by

⁄

of the per-10

mitted benefit (as defined in section 11

9831(d)(3)(C)) under such arrangement for 12

each such month such arrangement is provided 13

to such taxpayer. 14

‘‘(B) Q

UALIFIED SMALL EMPLOYER

HEALTH REIMBURSEMENT ARRANGEMENT

.— 16

For purposes of this paragraph, the term 17

‘qualified small employer health reimbursement 18

arrangement’ has the meaning given such term 19

by section 9831(d)(2). 20

‘‘(C) C

OVERAGE FOR LESS THAN ENTIRE

YEAR

.—In the case of an employee who is pro-22

vided a qualified small employer health reim-23

bursement arrangement for less than an entire 24

year, subparagraph (A) shall be applied by sub-25

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stituting ‘the number of months during the year 1

for which such arrangement was provided’ for 2

‘12’. 3

‘‘(6) C

ERTAIN RULES RELATED TO NON

-4

QUALIFIED HEALTH PLANS

.—The rules of section 5

36B(c)(3)(D), as in effect for taxable years begin-6

ning before January 1, 2020, shall apply with re-7

spect to subsection (f)(5). 8

‘‘(7) I

NFLATION ADJUSTMENT

.— 9

‘‘(A) I

N GENERAL

.—In the case of any 10

taxable year beginning in a calendar year after 11

2020, each dollar amount in subsection (c)(1), 12

the $75,000 amount in subsection (c)(2)(B), 13

and the dollar amount in subsection (c)(3)(A), 14

shall be increased by an amount equal to— 15

‘‘(i) such dollar amount, multiplied by 16

‘‘(ii) the cost-of-living adjustment de-17

termined under section 1(f)(3) for the cal-18

endar year in which the taxable year be-19

gins, determined— 20

‘‘(I) by substituting ‘calendar 21

year 2019’ for ‘calendar year 1992’ in 22

subparagraph (B) thereof, and 23

‘‘(II) by substituting for the CPI 24

referred to section 1(f)(3)(A) the 25

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•HR 1628 EH

amount that such CPI would have 1

been if the annual percentage increase 2

in CPI with respect to each year after 3

2019 had been one percentage point 4

greater. 5

‘‘(B) T

ERMS RELATED TO CPI

.— 6

‘‘(i) A

NNUAL PERCENTAGE IN

-7

CREASE

.—For purposes of subparagraph 8

(A)(ii)(II), the term ‘annual percentage in-9

crease’ means the percentage (if any) by 10

which CPI for any year exceeds CPI for 11

the prior year. 12

‘‘(ii) O

THER TERMS

.—Terms used in 13

this paragraph which are also used in sec-14

tion 1(f)(3) shall have the same meanings 15

as when used in such section. 16

‘‘(C) R

OUNDING

.—Any increase deter-17

mined under subparagraph (A) shall be rounded 18

to the nearest multiple of $50. 19

‘‘(8) R

ULES RELATED TO STATE CERTIFI

-20

CATION OF QUALIFIED HEALTH PLANS

.—A certifi-21

cation shall not be taken into account under sub-22

section (d)(1) unless such certification is made avail-23

able to the public and meets such other require-24

ments as the Secretary may provide. 25

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‘‘(9) R

EGULATIONS

.—The Secretary may pre-1

scribe such regulations and other guidance as may 2

be necessary or appropriate to carry out this section 3

and section 1412 of the Patient Protection and Af-4

fordable Care Act.’’. 5

(b) A

DVANCE

AYMENT OF

REDIT

.—Section 6

1412(f) of the Patient Protection and Affordable Care 7

Act, as added by section 202, is amended to read as fol-8

lows: 9

‘‘(f) A

PPLICATION TO

ERTAIN

LANS

.—The Sec-10

retary and the Secretary of the Treasury shall prescribe 11

such regulations as each respective Secretary may deem 12

necessary in order to establish and operate the advance 13

payment program established under this section for indi-14

viduals covered under qualified health plans (whether en-15

rolled in through an Exchange or otherwise) in such a 16

manner that protects taxpayer information (including 17

names, taxpayer identification numbers, and other con-18

fidential information), provides robust verification of all 19

information necessary to establish eligibility of taxpayer 20

for advance payments under this section, ensures proper 21

and timely payments to appropriate health providers, and 22

protects program integrity to the maximum extent fea-23

sible.’’. 24

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NCREASED

ENALTY ON

RRONEOUS

LAIMS OF

REDIT

.—Section 6676(a) of the Internal Revenue Code 2

of 1986 is amended by inserting ‘‘(25 percent in the case 3

of a claim for refund or credit relating to the health insur-4

ance coverage credit under section 36B)’’. 5

(d) R

EPORTING BY

MPLOYERS

.—Section 6051(a) of 6

such Code is amended by striking ‘‘and’’ at the end of 7

paragraph (14), by striking the period at the end of para-8

graph (15) and inserting ‘‘, and’’, and by inserting after 9

paragraph (15) the following new paragraph: 10

‘‘(16) each month with respect to which the em-11

ployee is eligible for coverage described in section 12

36B(d)(2) in connection with employment with the 13

employer.’’. 14

(e) C

OORDINATION

ITH

THER

ENEFITS

.— 15

(1) C

REDIT FOR HEALTH INSURANCE COSTS OF

ELIGIBLE INDIVIDUALS

.—Section 35(g) of such 17

Code is amended by adding at the end the following 18

new paragraph: 19

‘‘(14) C

OORDINATION WITH HEALTH INSUR

-20

ANCE COVERAGE CREDIT

.— 21

‘‘(A) I

N GENERAL

.—An eligible coverage 22

month to which the election under paragraph 23

(11) applies shall not be treated as an eligible 24

coverage month (as defined in section 36B(d)) 25

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•HR 1628 EH

for purposes of section 36B with respect to the 1

taxpayer or any of the taxpayer’s qualifying 2

family members (as defined in section 36B(e)). 3

‘‘(B) C

OORDINATION WITH ADVANCE PAY

-4

MENTS OF HEALTH INSURANCE COVERAGE

CREDIT

.—In the case of a taxpayer who makes 6

the election under paragraph (11) with respect 7

to any eligible coverage month in a taxable year 8

or on behalf of whom any advance payment is 9

made under section 7527 with respect to any 10

month in such taxable year— 11

‘‘(i) the tax imposed by this chapter 12

for the taxable year shall be increased by 13

the excess, if any, of— 14

‘‘(I) the sum of any advance pay-15

ments made on behalf of the taxpayer 16

under section 7527 and section 1412 17

of the Patient Protection and Afford-18

able Care Act, over 19

‘‘(II) the sum of the credits al-20

lowed under this section (determined 21

without regard to paragraph (1)) and 22

section 36B (determined without re-23

gard to subsection (g)(4)(A) thereof) 24

for such taxable year, and 25

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•HR 1628 EH

‘‘(ii) section 36B(g)(4)(B) shall not 1

apply with respect to such taxpayer for 2

such taxable year.’’. 3

(2) T

RADE OR BUSINESS DEDUCTION

.—Section 4

162(l) of such Code is amended by adding at the 5

end the following new paragraph: 6

‘‘(6) C

OORDINATION WITH HEALTH INSURANCE

COVERAGE CREDIT

.—The deduction otherwise allow-8

able to a taxpayer under paragraph (1) for any tax-9

able year shall be reduced (but not below zero) by 10

the amount of the credit allowable to such taxpayer 11

under section 36B (determined without regard to 12

subsection (g)(4)(A) thereof) for such taxable year.’’. 13

(f) E

FFECTIVE

ATE

.—The amendments made by 14

this section shall apply to months beginning after Decem-15

ber 31, 2019, in taxable years ending after such date. 16

SEC. 215. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAV-17

INGS ACCOUNT INCREASED TO AMOUNT OF 18

DEDUCTIBLE AND OUT-OF-POCKET LIMITA-19

TION. 20

(a) S

ELF

-O

NLY

OVERAGE

.—Section 223(b)(2)(A) 21

of the Internal Revenue Code of 1986 is amended by strik-22

ing ‘‘$2,250’’ and inserting ‘‘the amount in effect under 23

subsection (c)(2)(A)(ii)(I)’’. 24

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•HR 1628 EH

(b) F

AMILY

OVERAGE

.—Section 223(b)(2)(B) of 1

such Code is amended by striking ‘‘$4,500’’ and inserting 2

‘‘the amount in effect under subsection (c)(2)(A)(ii)(II)’’. 3

ONFORMING

MENDMENTS

.—Section 223(g)(1) 4

of such Code is amended— 5

(1) by striking ‘‘subsections (b)(2) and’’ both 6

places it appears and inserting ‘‘subsection’’, and 7

(2) in subparagraph (B), by striking ‘‘deter-8

mined by’’ and all that follows through ‘‘ ‘calendar 9

year 2003’.’’ and inserting ‘‘determined by sub-10

stituting ‘calendar year 2003’ for ‘calendar year 11

1992’ in subparagraph (B) thereof.’’. 12

(d) E

FFECTIVE

ATE

.—The amendments made by 13

this section shall apply to taxable years beginning after 14

December 31, 2017. 15

SEC. 216. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CON-16

TRIBUTIONS TO THE SAME HEALTH SAVINGS 17

ACCOUNT. 18

(a) I

ENERAL

.—Section 223(b)(5) of the Internal 19

Revenue Code of 1986 is amended to read as follows: 20

‘‘(5) S

PECIAL RULE FOR MARRIED INDIVIDUALS

WITH FAMILY COVERAGE

.— 22

‘‘(A) I

N GENERAL

.—In the case of individ-23

uals who are married to each other, if both 24

spouses are eligible individuals and either 25

127

•HR 1628 EH

spouse has family coverage under a high de-1

ductible health plan as of the first day of any 2

month— 3

‘‘(i) the limitation under paragraph 4

(1) shall be applied by not taking into ac-5

count any other high deductible health 6

plan coverage of either spouse (and if such 7

spouses both have family coverage under 8

separate high deductible health plans, only 9

one such coverage shall be taken into ac-10

count), 11

‘‘(ii) such limitation (after application 12

of clause (i)) shall be reduced by the ag-13

gregate amount paid to Archer MSAs of 14

such spouses for the taxable year, and 15

‘‘(iii) such limitation (after application 16

of clauses (i) and (ii)) shall be divided 17

equally between such spouses unless they 18

agree on a different division. 19

‘‘(B) T

REATMENT OF ADDITIONAL CON

-20

TRIBUTION AMOUNTS

.—If both spouses referred 21

to in subparagraph (A) have attained age 55 22

before the close of the taxable year, the limita-23

tion referred to in subparagraph (A)(iii) which 24

is subject to division between the spouses shall 25

128

•HR 1628 EH

include the additional contribution amounts de-1

termined under paragraph (3) for both spouses. 2

In any other case, any additional contribution 3

amount determined under paragraph (3) shall 4

not be taken into account under subparagraph 5

(A)(iii) and shall not be subject to division be-6

tween the spouses.’’. 7

(b) E

FFECTIVE

ATE

.—The amendment made by 8

this section shall apply to taxable years beginning after 9

December 31, 2017. 10

SEC. 217. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES 11

INCURRED BEFORE ESTABLISHMENT OF 12

HEALTH SAVINGS ACCOUNT. 13

(a) I

ENERAL

.—Section 223(d)(2) of the Internal 14

Revenue Code of 1986 is amended by adding at the end 15

the following new subparagraph: 16

‘‘(D) T

REATMENT OF CERTAIN MEDICAL

EXPENSES INCURRED BEFORE ESTABLISHMENT

OF ACCOUNT

.—If a health savings account is 19

established during the 60-day period beginning 20

on the date that coverage of the account bene-21

ficiary under a high deductible health plan be-22

gins, then, solely for purposes of determining 23

whether an amount paid is used for a qualified 24

medical expense, such account shall be treated 25

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•HR 1628 EH

as having been established on the date that 1

such coverage begins.’’. 2

(b) E

FFECTIVE

ATE

.—The amendment made by 3

this section shall apply with respect to coverage beginning 4

after December 31, 2017. 5

Subtitle B—Repeal of Certain 6

Consumer Taxes 7

SEC. 221. REPEAL OF TAX ON PRESCRIPTION MEDICA-8

TIONS. 9

Subsection (j) of section 9008 of the Patient Protec-10

tion and Affordable Care Act is amended to read as fol-11

lows: 12

‘‘(j) R

EPEAL

.—This section shall apply to calendar 13

years beginning after December 31, 2010, and ending be-14

fore January 1, 2017.’’. 15

SEC. 222. REPEAL OF HEALTH INSURANCE TAX. 16

Subsection (j) of section 9010 of the Patient Protec-17

tion and Affordable Care Act is amended to read as fol-18

lows: 19

‘‘(j) R

EPEAL

.—This section shall apply to calendar 20

years beginning after December 31, 2013, and ending be-21

fore January 1, 2017.’’. 22

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•HR 1628 EH

Subtitle C—Repeal of Tanning Tax 1

SEC. 231. REPEAL OF TANNING TAX. 2

(a) I

ENERAL

.—The Internal Revenue Code of 3

1986 is amended by striking chapter 49. 4

(b) E

FFECTIVE

ATE

.—The amendment made by 5

this section shall apply to services performed after June 6

30, 2017. 7

Subtitle D—Remuneration From 8

Certain Insurers 9

SEC. 241. REMUNERATION FROM CERTAIN INSURERS. 10

Paragraph (6) of section 162(m) of the Internal Rev-11

enue Code of 1986 is amended by adding at the end the 12

following new subparagraph: 13

‘‘(I) T

ERMINATION

.—This paragraph shall 14

not apply to taxable years beginning after De-15

cember 31, 2016.’’. 16

Subtitle E—Repeal of Net 17

Investment Income Tax 18

SEC. 251. REPEAL OF NET INVESTMENT INCOME TAX. 19

(a) I

ENERAL

.—Subtitle A of the Internal Rev-20

enue Code of 1986 is amended by striking chapter 2A. 21

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•HR 1628 EH

(b) E

FFECTIVE

ATE

.—The amendment made by 1

this section shall apply to taxable years beginning after 2

December 31, 2016. 3

Passed the House of Representatives May 4, 2017.

Attest:

Clerk.

115

CONGRESS

ESSION

H. R. 1628

AN ACT

To provide for reconciliation pursuant to title II of

the concurrent resolution on the budget for fiscal

year 2017.