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Title II — Health Insurance Market Stabilization

H.R. 987 · 116th Congress · May 20, 2019 · Lineage

II Health Insurance Market Stabilization

Sec. 201 Preserving State option to implement health care marketplaces

(a)
In general— Section 1311 of the Patient Protection and Affordable Care Act (42 U.S.C. 18031) is amended—
(1)
in subsection (a)—
(A)
in paragraph (4)(B), by striking “under this subsection” and inserting “under this paragraph or paragraph (1)”; and
(B)
by adding at the end the following new paragraph:

“(6) Additional planning and establishment grants

“(A) In general—There shall be appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $200 million to award grants to eligible States for the uses described in paragraph (3).

“(B) Duration and renewability—A grant awarded under subparagraph (A) shall be for a period of 2 years and may not be renewed.

“(C) Limitation—A grant may not be awarded under subparagraph (A) after December 31, 2023.

“(D) Eligible State defined—For purposes of this paragraph, the term eligible State means a State that, as of the date of the enactment of this paragraph, is not operating an Exchange (other than an Exchange described in section 155.200(f) of title 45, Code of Federal Regulations).”

(2)
in subsection (d)(5)(A)—
(A)
by striking “operations.—In establishing an Exchange under this section” and inserting

“(i) In general—In establishing an Exchange under this section (other than in establishing an Exchange pursuant to a grant awarded under subsection (a)(6))”

(B)
by adding at the end the following:

“(ii) Additional planning and establishment grants—In establishing an Exchange pursuant to a grant awarded under subsection (a)(6), the State shall ensure that such Exchange is self-sustaining beginning on January 1, 2025, including allowing the Exchange to charge assessments or user fees to participating health insurance issuers, or to otherwise generate funding, to support its operations.”

(b)
Clarification regarding failure to establish Exchange or implement requirements— Section 1321(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)) is amended—
(1)
in paragraph (1), by striking “If” and inserting “Subject to paragraph (3), if”; and
(2)
by adding at the end the following new paragraph:

“(3) Clarification—This subsection shall not apply in the case of a State that elects to apply the requirements described in subsection (a) and satisfies the requirement described in subsection (b) on or after January 1, 2014.”

Sec. 202 Providing for additional requirements with respect to the navigator program

(a)
In general— Section 1311(i) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(i)) is amended—
(1)
in paragraph (2), by adding at the end the following new subparagraph:

“(C) Selection of recipients—In the case of an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), in awarding grants under paragraph (1), the Exchange shall—

“(i) select entities to receive such grants based on an entity’s demonstrated capacity to carry out each of the duties specified in paragraph (3);

“(ii) not take into account whether or not the entity has demonstrated how the entity will provide information to individuals relating to group health plans offered by a group or association of employers described in section 2510.3–5(b) of title 29, Code of Federal Regulations (or any successor regulation), or short-term limited duration insurance (as defined by the Secretary for purposes of section 2791(b)(5) of the Public Health Service Act); and

“(iii) ensure that, each year, the Exchange awards such a grant to—

“(I) at least one entity described in this paragraph that is a community and consumer-focused nonprofit group; and

“(II) at least one entity described in subparagraph (B), which may include another community and consumer-focused nonprofit group in addition to any such group awarded a grant pursuant to subclause (I).”

(2)
in paragraph (3)—
(A)
by amending subparagraph (C) to read as follows:

“(C) facilitate enrollment, including with respect to individuals with limited English proficiency and individuals with chronic illnesses, in qualified health plans, State medicaid plans under title XIX of the Social Security Act, and State child health plans under title XXI of such Act;”

(B)
in subparagraph (D), by striking “and” at the end;
(C)
in subparagraph (E), by striking the period at the end and inserting a semicolon;
(D)
by inserting after subparagraph (E) the following:

“(F) conduct public education activities in plain language to raise awareness of the requirements of and the protections provided under—

“(i) the essential health benefits package (as defined in section 1302(a)); and

“(ii) section 2726 of the Public Health Service Act (relating to parity in mental health and substance use disorder benefits); and”

(E)
by inserting after subparagraph (F) (as added by subparagraph (D)) the following new subparagraph:

“(G) provide referrals to community-based organizations that address social needs related to health outcomes.”

(F)
by adding at the end the following flush left sentence:
(3)
in paragraph (4)(A)—
(A)
in the matter preceding clause (i), by striking “not”;
(B)
in clause (i)—
(i)
by inserting “not” before “be”; and
(ii)
by striking “; or” and inserting a semicolon;
(C)
in clause (ii)—
(i)
by inserting “not” before “receive”; and
(ii)
by striking the period and inserting a semicolon; and
(D)
by adding at the end the following new clauses:

“(iii) maintain physical presence in the State of the Exchange so as to allow in-person assistance to consumers;

“(iv) receive training on how to assist individuals with enrolling for medical assistance under State plans under the Medicaid program under title XIX of the Social Security Act or for child health assistance under State child health plans under title XXI of such Act; and

“(v) receive opioid specific education and training that ensures the navigator can best educate individuals on qualified health plans offered through an Exchange, specifically coverage under such plans for opioid health care treatment.”

(4)
in paragraph (6)—
(A)
by striking “Funding.—Grants under” and inserting

“(A) State Exchanges—Subject to subparagraph (C), grants under”

(B)
by adding at the end the following new subparagraphs:

“(B) Federal Exchanges—For purposes of carrying out this subsection, with respect to an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), the Secretary shall obligate $100 million out of amounts collected through the user fees on participating health insurance issuers pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations) for fiscal year 2020 and each subsequent fiscal year. Such amount for a fiscal year shall remain available until expended.

“(C) State Exchanges—For the purposes of carrying out this subsection, with respect to an Exchange operated by a State pursuant to this section, there is authorized to be appropriated $25 million for fiscal year 2020 and each subsequent fiscal year. Each State receiving a grant pursuant to this subparagraph shall receive a grant in an amount that is not less than $1 million.”

(b)
Study on effects of funding cuts— Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall study the effects of funding cuts made for plan year 2019 with respect to the navigator program (as described in section 1311(i) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(i))) and other education and outreach activities carried out with respect to Exchanges established by the Secretary of Health and Human Services pursuant to section 1321(c) of such Act. Such study shall describe the following:
(1)
How such funding cuts negatively impacted the ability of entities under such program to conduct outreach activities and fulfill duties required under such section 1311(i).
(2)
The overall effect on—
(A)
the number of individuals enrolled in health insurance coverage offered in the individual market for plan year 2019; and
(B)
the costs of health insurance coverage offered in the individual market.
(c)
Promote transparency and accountability in the administration’s expenditures of exchange user fees— For plan year 2020 and each subsequent plan year, not later than the date that is 3 months after the end of such plan year, the Secretary of Health and Human Services shall submit to the appropriate committees of Congress and make available to the public an annual report on the expenditures by the Department of Health and Human Services of user fees collected pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations). Each such report for a plan year shall include a detailed accounting of the amount of such user fees collected during such plan year and of the amount of such expenditures used during such plan year for the federally facilitated Exchange operated pursuant to section 1321(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)) on outreach and enrollment activities, navigators, maintenance of Healthcare.gov, and operation of call centers.
(d)
Effective date— The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2020.

Sec. 203 Federal Exchange outreach and educational activities and annual enrollment targets

(a)
In general— Section 1321(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)), as amended by section 201(b)(2), is further amended by adding at the end the following new paragraphs:

“(4) Outreach and educational activities

“(A) In general—In the case of an Exchange established or operated by the Secretary within a State pursuant to this subsection, the Secretary shall carry out outreach and educational activities for purposes of informing individuals about qualified health plans offered through the Exchange, including by informing such individuals of the availability of coverage under such plans and financial assistance for coverage under such plans. Such outreach and educational activities shall be provided in a manner that is culturally and linguistically appropriate to the needs of the populations being served by the Exchange (including hard-to-reach populations, such as racial and sexual minorities, limited English proficient populations, individuals residing in areas where the unemployment rates exceeds the national average unemployment rate, individuals in rural areas, veterans, and young adults) and shall be provided to populations residing in high health disparity areas (as defined in subparagraph (E)) served by the Exchange, in addition to other populations served by the Exchange.

“(B) Limitation on use of funds—No funds appropriated under this paragraph shall be used for expenditures for promoting non-ACA compliant health insurance coverage.

“(C) Non-aca compliant health insurance coverage—For purposes of subparagraph (B):

“(i) The term non-ACA compliant health insurance coverage means health insurance coverage, or a group health plan, that is not a qualified health plan.

“(ii) Such term includes the following:

“(I) An association health plan.

“(II) Short-term limited duration insurance.

“(D) Funding—Out of any funds in the Treasury not otherwise appropriated, there are hereby appropriated for fiscal year 2020 and each subsequent fiscal year, $100 million to carry out this paragraph. Funds appropriated under this subparagraph shall remain available until expended.

“(E) High health disparity area defined—For purposes of subparagraph (A), the term “high health disparity area” means a contiguous geographic area that—

“(i) is located in one census tract or ZIP code;

“(ii) has measurable and documented racial, ethnic, or geographic health disparities;

“(iii) has a low-income population, as demonstrated by—

“(I) average income below 138 percent of the Federal poverty line; or

“(II) a rate of participation in the special supplemental nutrition program under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786) that is higher than the national average rate of participation in such program;

“(iv) has poor health outcomes, as demonstrated by—

“(I) lower life expectancy than the national average; or

“(II) a higher percentage of instances of low birth weight than the national average; and

“(v) is part of a Metropolitan Statistical Area identified by the Office of Management and Budget.

“(5) Annual enrollment targets—For plan year 2020 and each subsequent plan year, in the case of an Exchange established or operated by the Secretary within a State pursuant to this subsection, the Secretary shall establish annual enrollment targets for such Exchange for such year.”

(b)
Study and report— Not later than 30 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall release to Congress all aggregated documents relating to studies and data sets that were created on or after January 1, 2014, and related to marketing and outreach with respect to qualified health plans offered through Exchanges under title I of the Patient Protection and Affordable Care Act.

Sec. 204 Short-term limited duration insurance rule prohibition

(a)
Findings— Congress finds the following:
(1)
On August 3, 2018, the Administration issued a final rule entitled “Short-Term, Limited-Duration Insurance” (83 Fed. Reg. 38212).
(2)
The final rule dramatically expands the sale and marketing of insurance that—
(A)
may discriminate against individuals living with preexisting health conditions, including children with complex medical needs and disabilities and their families;
(B)
lacks important financial protections provided by the Patient Protection and Affordable Care Act (Public Law 111–148), including the prohibition of annual and lifetime coverage limits and annual out-of-pocket limits, that may increase the cost of treatment and cause financial hardship to those requiring medical care, including children with complex medical needs and disabilities and their families; and
(C)
excludes coverage of essential health benefits including hospitalization, prescription drugs, and other lifesaving care.
(3)
The implementation and enforcement of the final rule weakens critical protections for up to 130 million Americans living with preexisting health conditions and may place a large financial burden on those who enroll in short-term limited-duration insurance, which jeopardizes Americans’ access to quality, affordable health insurance.
(b)
Prohibition— The Secretary of Health and Human Services, the Secretary of the Treasury, and the Secretary of Labor may not take any action to implement, enforce, or otherwise give effect to the rule entitled “Short-Term, Limited Duration Insurance” (83 Fed. Reg. 38212 (August 3, 2018)), and the Secretaries may not promulgate any substantially similar rule.

Sec. 205 Protection of health insurance coverage in certain Exchanges

In the case of an Exchange that the Secretary of Health and Human Services operates pursuant to section 1321(c)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)(1)), the Secretary may not implement any process that would terminate the health insurance coverage of an enrollee solely because such enrollee did not actively enroll during the most recent open enrollment period.

Sec. 206 Sense of Congress relating to the practice of silver loading

It is the sense of Congress that the Secretary of Health and Human Services should not take any action to prohibit or otherwise restrict the practice commonly known as “silver loading” (as described in the rule entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020” published on April 25, 2019 (84 Fed. Reg. 17533)).

Sec. 207 Consumer outreach, education, and assistance

(a)
Open enrollment reports— For plan year 2020 and each subsequent year, the Secretary of Health and Human Services (referred to in this section as the “Secretary”), in coordination with the Secretary of the Treasury and the Secretary of Labor, shall issue biweekly public reports during the annual open enrollment period on the performance of the Federal Exchange. Each such report shall include a summary, including information on a State-by-State basis where available, of—
(1)
the number of unique website visits;
(2)
the number of individuals who create an account;
(3)
the number of calls to the call center;
(4)
the average wait time for callers contacting the call center;
(5)
the number of individuals who enroll in a qualified health plan; and
(6)
the percentage of individuals who enroll in a qualified health plan through each of—
(A)
the website;
(B)
the call center;
(C)
navigators;
(D)
agents and brokers;
(E)
the enrollment assistant program;
(F)
directly from issuers or web brokers; and
(G)
other means.
(b)
Open Enrollment After Action Report— For plan year 2020 and each subsequent year, the Secretary, in coordination with the Secretary of the Treasury and the Secretary of Labor, shall publish an after action report not later than 3 months after the completion of the annual open enrollment period regarding the performance of the Federal Exchange for the applicable plan year. Each such report shall include a summary, including information on a State-by-State basis where available, of—
(1)
the open enrollment data reported under subsection (a) for the entirety of the enrollment period; and
(2)
activities related to patient navigators described in section 1311(i) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(i)), including—
(A)
the performance objectives established by the Secretary for such patient navigators;
(B)
the number of consumers enrolled by such a patient navigator;
(C)
an assessment of how such patient navigators have met established performance metrics, including a detailed list of all patient navigators, funding received by patient navigators, and whether established performance objectives of patient navigators were met; and
(D)
with respect to the performance objectives described in subparagraph (A)—
(i)
whether such objectives assess the full scope of patient navigator responsibilities, including general education, plan selection, and determination of eligibility for tax credits, cost-sharing reductions, or other coverage;
(ii)
how the Secretary worked with patient navigators to establish such objectives; and
(iii)
how the Secretary adjusted such objectives for case complexity and other contextual factors.
(c)
Report on advertising and consumer outreach— Not later than 3 months after the completion of the annual open enrollment period for the 2020 plan year, the Secretary shall issue a report on advertising and outreach to consumers for the open enrollment period for the 2020 plan year. Such report shall include a description of—
(1)
the division of spending on individual advertising platforms, including television and radio advertisements and digital media, to raise consumer awareness of open enrollment;
(2)
the division of spending on individual outreach platforms, including email and text messages, to raise consumer awareness of open enrollment; and
(3)
whether the Secretary conducted targeted outreach to specific demographic groups and geographic areas.

Sec. 208 GAO report

Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a study that analyzes the costs and benefits of the establishment of State-administered health insurance plans to be offered in the insurance market of such States that choose to administer and offer such a plan.

Sec. 209 Report on the effects of website maintenance during open enrollment

Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report examining whether the Department of Health and Human Services has been conducting maintenance on the website commonly referred to as “Healthcare.gov” during annual open enrollment periods (as described in section 1311(c)(6)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)(B)) in such a manner so as to minimize any disruption to the use of such website resulting from such maintenance.