Title II — S. 1213 (Introduced in Senate)

Sec. 201 Enhancement of premium assistance credit

(a)

Use of gold level plan for benchmark—

(1)

In general— Clause (i) of section 36B(b)(2)(B) of the Internal Revenue Code of 1986 is amended by striking “applicable second lowest cost silver plan” and inserting “applicable second lowest cost gold plan”.

(2)

Conforming amendment related to affordability— Section 36B(c)(4)(C)(i)(I) of such Code is amended by striking “second lowest cost silver plan” and inserting “second lowest cost gold plan”.

(3)

Other conforming amendments— Subparagraphs (B) and (C) of section 36B(b)(3) of such Code are each amended by striking “silver plan” each place it appears in the text and the heading and inserting “gold plan”.

(b)

Expansion of eligibility for refundable credits for coverage under qualified health plans—

(1)

In general— Section 36B(c)(1)(A) of the Internal Revenue Code of 1986 is amended by striking “but does not exceed 400 percent”.

(2)

Conforming amendments relating to recapture of excess advanced payments— Clause (i) of section 36B(f)(2)(B) of such Code is amended—

(A)

by striking “In the case of” and all that follows through “the amount of” and inserting “The amount of”, and

(B)

by striking “but less than 400%” in the table therein.

(c)

Determination of applicable percentage—

(1)

In general— Subparagraph (A) of section 36B(b)(3) of the Internal Revenue Code of 1986 is amended to read as follows:

“(A) Applicable percentage—The applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:”

(2)

Conforming amendments— Subsections (c)(2)(C)(iv) and (c)(4)(F) of section 36B of the Internal Revenue Code of 1986 are each amended by inserting “(as in effect before the date of the enactment of the Consumer Health Insurance Protection Act of 2019)” after “subsection (b)(3)(A)(ii)”.

(d)

Reconciliation of premium assistance credit and advance credit for single-Parent households—

(1)

In general— Clause (i) of section 36B(f)(2)(B) of the Internal Revenue Code of 1986 is amended by striking “section 1(c)” and inserting “subsection (b) or (c) of section 1”.

(2)

Effective date— The amendment made by this subsection shall apply to taxable years beginning after December 31, 2019.

(e)

Determination of premium assistance credit for disabled workers—

(1)

In general— Section 36B(d)(2) of the Internal Revenue Code of 1986 is amended by inserting at the end the following new subparagraph:

“(C) Exclusion of certain amounts received as lump-sum payment—For purposes of subparagraph (B), such amount shall not include any portion of a lump-sum payment of disability insurance benefits under section 223 of the Social Security Act (42 U.S.C. 423) which is—

“(i) received during the taxable year, and

“(ii) attributable to prior taxable years.”

(2)

Effective date— The amendment made by this subsection shall apply to taxable years beginning after December 31, 2019.

(f)

Effective date— The amendments made by this section shall apply to taxable years beginning after December 31, 2020.

Sec. 202 Enhancements for reduced cost-sharing

(a)

Modification of amount—

(1)

In general— Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended—

(A)

in subsection (b)(1), by striking “silver” and inserting “gold”;

(B)

by amending subsection (c)(1)(B) to read as follows:

“(B) Coordination with actuarial limits—The Secretary shall ensure the reduction under this paragraph shall not result in the plan’s share of the total allowed costs of benefits provided under the plan becoming less than—

“(i) 95 percent in the case of an eligible insured described in paragraph (2)(A);

“(ii) 90 percent in the case of an eligible insured described in paragraph (2)(B); and

“(iii) 85 percent in the case of an eligible insured described in paragraph (2)(C).”

(C)

by amending subsection (c)(2) to read as follows:

“(2) Additional reduction—The Secretary shall establish procedures under which the issuer of a qualified health plan to which this section applies shall further reduce cost-sharing under the plan in a manner sufficient to—

“(A) in the case of an eligible insured whose household income is not less than 100 percent but not more than 200 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 95 percent of such costs;

“(B) in the case of an eligible insured whose household income is more than 200 percent but not more than 300 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 90 percent of such costs; and

“(C) in the case of an eligible insured whose household income is more than 300 percent but not more than 400 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed costs of benefits provided under the plan to 85 percent of such costs.”

(2)

Effective date— The amendments made by this subsection shall apply to plan years beginning after December 31, 2020.

(b)

Funding— Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended by adding at the end the following new subsection:

“(g) Funding—Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary such sums as may be necessary for payments under this section.”

Sec. 203 Cap on prescription drug cost-sharing

(a)

Qualified health plans— Section 1302(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(c)) is amended—

(1)

in paragraph (3)(A)(i), by inserting “, including cost-sharing with respect to prescription drugs covered by the plan” after “charges”; and

(2)

by adding at the end the following:

“(5) Prescription drug cost-sharing

“(A) 2021—For plan years beginning in 2021, the cost-sharing incurred under a health plan with respect to prescription drugs covered by the plan shall not exceed $250 per month for each enrolled individual, or $500 for each family.

“(B) 2022 and later

“(i) In general—In the case of any plan year beginning in a calendar year after 2021, the limitation under this paragraph shall be equal to the applicable dollar amount under subparagraph (A) for plan years beginning in 2021, increased by an amount equal to the product of that amount and the medical care component of the consumer price index for all urban consumers (as published by the Bureau of Labor Statistics) for that year.

“(ii) Adjustment to amount—If the amount of any increase under clause (i) is not a multiple of $5, such increase shall be rounded to the next lowest multiple of $5.”

(b)

Group health plans— Section 2707(b) of the Public Health Service Act (42 U.S.C. 300gg–6(b)) is amended—

(1)

by striking “annual”; and

(2)

by striking “paragraph (1) of section 1302(c)” and inserting “paragraphs (1) and (5) of section 1302(c) of the Patient Protection and Affordable Care Act”.

(c)

Effective date— The amendments made by subsections (a) and (b) shall take effect with respect to plans beginning after December 31, 2020.

Sec. 204 Standardized options in the bronze, silver, and gold levels of coverage

(a)

In general— Section 1301(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)) is amended—

(1)

in paragraph (1)(C)—

(A)

in clause (iii), by striking “; and” and inserting “;”;

(B)

by redesignating clause (iv) as clause (v); and

(C)

by inserting after clause (iii) the following:

“(iv)

“(I) agrees to offer the applicable standardized option under paragraph (5) for each level of coverage offered by the issuer that is the bronze, silver, or gold level of coverage; and

“(II) with respect to offering coverage that is the bronze, silver, or gold level of coverage through an Exchange that is operated by the Secretary, agrees to offer only the applicable standardized option under paragraph (5) and not any other plan for such levels of coverage; and”

(2)

by adding at the end the following:

“(5) Standardized options

“(A) Definition of standardized option—In this section, the term standardized option means a qualified health plan—

“(i) with a standardized cost-sharing structure established by the applicable State, or the Secretary, in accordance with this paragraph; and

“(ii) that is offered through an Exchange.

“(B) Establishment

“(i) State—Each State may establish a standardized option for the bronze, silver, and gold levels of coverage.

“(ii) Secretary—The Secretary shall establish a standardized option in a State for any level of coverage described in clause (i) for which the State has not established a standardized option.

“(iii) Updates—The Secretary shall annually update any standardized option established by the Secretary under clause (ii).

“(C) Deductible-exempt services

“(i) In general—Except as provided in clause (ii), each standardized option established by the Secretary under subparagraph (B)(ii) shall provide coverage for and waive the application of a deductible for—

“(I) all primary care visits and specialist visits;

“(II) all mental health and substance use disorder outpatient services;

“(III) all drugs approved under section 505(j) of the Federal Food, Drug, and Cosmetic Act and biological products licensed under section 351(k) of the Public Health Service Act; and

“(IV) all urgent care services.

“(ii) Bronze and silver levels of coverage—The Secretary may alter the services that shall be covered as deductible-exempt services under clause (i) for standardized options in the bronze and silver levels of coverage.

“(D) Display—Each Exchange operated by a State shall preferentially display the standardized options offered in such State on the website of the Exchange.”

(b)

Effective date— The amendments made by this section shall apply to plans beginning after December 31, 2020.

Sec. 205 Deductible-exempt services for group health plans and group health insurance coverage

(a)

In general— Section 2713 of the Public Health Service Act (42 U.S.C. 300gg–13) is amended by adding at the end the following:

“(d) Deductible-Exempt services for group health plans and group health insurance coverage

“(1) In general—Subject to paragraph (2), a group health plan and a health insurance issuer offering group health insurance coverage shall, in addition to the requirement under subsection (a), at a minimum provide coverage for and waive the application of a deductible for—

“(A) all primary care visits and specialist visits;

“(B) all mental health and substance use disorder outpatient services;

“(C) all drugs approved under section 505(j) of the Federal Food, Drug, and Cosmetic Act and biological products licensed under section 351(k) of the Public Health Service Act; and

“(D) all urgent care services.

“(2) Regulations—The Secretary may issue regulations to—

“(A) assist group health plans and health insurance issuers offering group health insurance coverage in complying with paragraph (1); and

“(B) alter the services that shall be covered as deductible-exempt services under paragraph (1) for group health plans and group health insurance coverage with levels of coverage that are designed to provide benefits that are actuarially equivalent to 60 or 70 percent of the full actuarial value of the benefits provided under the plan or coverage.”

(b)

Effective date— The amendments made by this section shall apply to plans beginning after December 31, 2020.

Sec. 206 Clarification regarding determination of affordability of employer-sponsored minimum essential coverage

(a)

Special rule for employer-Sponsored minimum essential coverage— Clause (i) of section 36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended to read as follows:

“(i) Coverage must be affordable

“(I) In general—Except as provided in clause (iii), an individual shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) and the required contribution with respect to the plan exceeds 8.5 percent of the applicable taxpayer's household income.

“(II) Required contribution with respect to employee—In the case of the employee eligible to enroll in the plan, the required contribution for purposes of subclause (I) is the employee's required contribution (within the meaning of section 5000A(e)(1)(B)(i)) with respect to the plan.

“(III) Required contribution with respect to family members—In the case of an individual who is eligible to enroll in the plan by reason of a relationship the individual bears to the employee, the required contribution for purposes of subclause (I) is the employee's required contribution (within the meaning of section 5000A(e)(1)(B)(i), determined by substituting “family” for “self-only”) with respect to the plan.”

(b)

Conforming amendments—

(1)

Clause (ii) of section 36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended by adding at the end the following: “This clause shall also apply to an individual who is eligible to enroll in the plan by reason of a relationship the individual bears to the employee.”.

(2)

Clause (iii) of section 36B(c)(2)(C) of such Code is amended by striking “the last sentence of clause (i)” and inserting “clause (i)(III)”.

(3)

Clause (iv) of section 36B(c)(2)(C) of such Code is amended by striking “clause (i)(II)” and inserting “clause (i)(I)”.

(c)

Effective date— The amendments made by this section shall apply to taxable years beginning after December 31, 2020.

Title II — Making health insurance coverage affordable

II Making health insurance coverage affordable