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Fair Care Act of 2026
Introduced May 14, 2026 · Last action May 14, 2026 — Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, the Judiciary, Oversight and Government Reform, Rules, the Budget, Armed Services, and House Administration, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Summary
This legislation is called the Fair Care Act of 2026. It is being reviewed by a committee.
Full bill text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8840 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 8840
To address the high costs of health care services, prescription drugs,
and health insurance coverage in the United States, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 14, 2026
Mr. Westerman introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Education and Workforce, the Judiciary, Oversight and
Government Reform, Rules, the Budget, Armed Services, and House
Administration, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To address the high costs of health care services, prescription drugs,
and health insurance coverage in the United States, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Fair Care Act of
2026''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MODERNIZATION OF HEALTH SAVINGS ACCOUNTS
Subtitle A--Modernization of Health Savings Accounts and Contributions
Sec. 101. Modernization of health savings accounts.
Sec. 102. Unused premium tax credits may be deposited in health savings
accounts.
Sec. 103. Health Reimbursement Arrangements and Other Account-Based
Group Health Plans.
Sec. 104. Cost-sharing reduction payments as eligible contributions.
Subtitle B--Assistance to Health Savings Accounts
Sec. 111. One-time application of saver's credit to contributions to
health savings accounts.
Sec. 112. Grants for health savings account assistance and outreach.
Sec. 113. New corporations required to use health savings accounts.
Sec. 114. Federal employee health benefits and health savings accounts.
TITLE II--IMPROVING PRIVATE HEALTH INSURANCE
Subtitle A--Maintaining Protections for Patients With Preexisting
Conditions
Sec. 201. Guaranteed availability of coverage; prohibiting
discrimination.
Subtitle B--Expanding Coverage Options
Sec. 211. Definition of ``employer'' under ERISA with respect to group
health plans.
Sec. 212. Short-term limited duration insurance.
Subtitle C--Improving Commercial Health Insurance
Sec. 221. Invisible Guaranteed Coverage Pool Reinsurance Program; tax
on exchange plans.
Sec. 222. Employer health insurance mandate repeal.
Sec. 223. Refundable credits for coverage under a qualified health plan
for individuals offered employer-sponsored
insurance.
Sec. 224. Inclusion in income of certain costs of employer-provided
coverage under health plans.
Sec. 225. Change in permissible age variation in health insurance
premium rates.
Sec. 226. Premium assistance adjustment to reflect age.
Sec. 227. Premium assistance.
Sec. 228. Adding copper plans to Exchanges.
Sec. 229. Copper and bronze plans.
Sec. 230. Waivers for State innovation.
Sec. 231. Enrollment periods.
Sec. 232. State-operated Exchanges flexibility for open enrollment
periods.
Sec. 233. Promoting health plans that cover individuals in more than
one State.
TITLE III--COMPETITION, TRANSPARENCY AND ACCOUNTABILITY
Subtitle A--Provider and Insurer Competition
Sec. 301. Hospital consolidation.
Sec. 302. Authority of Federal Trade Commission over certain tax-exempt
organizations.
Sec. 303. Leveling the playing field between payers and providers.
Sec. 304. Banning anticompetitive terms in facility and insurance
contracts that limit access to higher
quality, lower cost care.
Sec. 305. Repealing eligibility of certain ACOs.
Sec. 306. Repeal of health care reform provisions limiting Medicare
exception to the prohibition on certain
physician referrals for hospitals.
Sec. 307. Alternative payment model for certain shoppable procedures.
Subtitle B--Price Transparency
Sec. 321. Price transparency requirements.
Sec. 322. Access of individuals to protected health information.
Sec. 323. Advisory group on reducing burden of hospital administrative
requirements.
Sec. 324. Data reporting to improve the transparency regarding how 340B
hospital covered entities provide care for
patients.
Sec. 325. Requiring 340B drug discount program reports by DSH hospital
covered entities on low-income utilization
rate of outpatient hospital services.
Sec. 326. Employer benefits reports.
Sec. 327. Government Accountability Office study on profit- and
revenue-sharing in health care.
Subtitle C--Prescription Drug Competition and Innovation
Sec. 341. Expedited development and priority review for generic complex
drug products.
Sec. 342. Preventing blocking of generic drugs.
Sec. 343. Ensuring timely access to generics.
Sec. 344. Preemption of State barriers to the substitution of
biosimilar products.
Sec. 345. Increasing pharmaceutical options to treat an unmet medical
need.
Sec. 346. Conditional approval of new human drugs for individuals with
rare, progressive, and serious diseases.
Sec. 347. Consolidating exclusivity periods for drugs treating rare
diseases and conditions.
Sec. 348. Exclusivity period for brand name biological products.
Sec. 349. Regulation of manufacturer-sponsored co-pay contributions.
Sec. 350. Antitrust exemption for private health insurance issuers to
negotiate wholesale acquisition prices of
prescription drugs purchased from drug
manufacturers.
Sec. 351. Biological product innovation.
Sec. 352. Biosimilar biological products.
Sec. 353. Prompt approval of drugs related to safety information.
Sec. 354. Congressional review of the Food and Drug Administration
rulemaking.
Sec. 355. Government Accountability Office study of rules.
Sec. 356. Provisional approval of new human drugs.
Subtitle D--Prescription Drug and Pharmacy Benefit Manager Transparency
Sec. 361. Patent disclosure requirements.
Sec. 362. Requirements with respect to prescription drug benefits.
Sec. 363. PBM transparency and elimination of DIR fees.
Sec. 364. Health plan oversight of pharmacy benefit manager services.
Sec. 365. Study by Comptroller General of the United States.
Subtitle E--Medicare and Medicaid Prescription Drug Reforms
Sec. 371. Market based part B pricing index.
Sec. 372. Innovation model testing of Medicare drug payments.
Subtitle F--Medical Malpractice Reform
Sec. 381. Definitions.
Sec. 382. Encouraging speedy resolution of claims.
Sec. 383. Compensating patient injury.
Sec. 384. Maximizing patient recovery.
Sec. 385. Authorization of payment of future damages to claimants in
health care lawsuits.
Sec. 386. Product liability for health care providers.
Sec. 387. Effect on other laws.
Sec. 388. Limitation on expert witness testimony.
Sec. 389. Expert witness qualifications.
Sec. 390. Communications following unanticipated outcome.
Sec. 391. Affidavit of merit.
Sec. 392. Notice of intent to commence lawsuit.
Sec. 393. Limitation on liability for volunteer health care
professionals.
Sec. 394. Rules of construction.
Sec. 395. Effective date.
TITLE IV--MEDICARE AND MEDICAID REFORMS
Subtitle A--Medicaid Reforms
Sec. 401. Medicaid payment reform.
Sec. 402. Income limitations for refundable credits for coverage under
a qualified health plan.
Sec. 403. Medicaid eligibility determinations.
Sec. 404. Lowering safe harbor threshold with respect to State taxes on
health care providers.
Sec. 405. Providing for State approval and implementation of specified
waivers under the Medicaid program.
Sec. 406. Deduction for qualified charity care.
Subtitle B--Medicare Reforms
Sec. 411. Off-campus provider-based department Medicare site neutral
payment.
Sec. 412. Eliminating FEHBP eligibility for annuitants.
Sec. 413. Elimination of Medicare eligibility for certain individuals.
Sec. 414. Medicare part D tax deduction.
Sec. 415. Repeal of net investment income tax.
Sec. 416. Medicare coverage of bad debt.
Subtitle C--Medicare Choice and Competition
Sec. 421. Competitive bidding and premiums under unified Medicare.
Sec. 422. New unified eligibility and enrollment rules.
Sec. 423. New benefit structure under unified Medicare.
Sec. 424. Late enrollment penalty not to apply for months of any health
coverage.
Sec. 425. Medigap reform.
Sec. 426. ACO revision.
Sec. 427. Primary care options.
Sec. 428. General provisions; effective date.
Subtitle D--Telehealth Improvements and Expansion
Sec. 431. Expansion of coverage of telehealth services.
Sec. 432. Expanding the use of telehealth through the waiver of certain
requirements.
Sec. 433. Expanding the use of telehealth for mental health services.
Sec. 434. Use of telehealth in emergency medical care.
Sec. 435. Improvements to the process for adding telehealth services.
Sec. 436. Rural health clinics and Federally qualified health centers.
Sec. 437. Native American health facilities.
Sec. 438. Waiver of telehealth restrictions during national
emergencies.
Sec. 439. Use of telehealth in recertification for hospice care.
Sec. 440. Clarification for fraud and abuse laws regarding technologies
provided to beneficiaries.
Sec. 441. Study and report on increasing access to telehealth services
in the home.
Sec. 442. Analysis of telehealth waivers in alternative payment models.
Sec. 443. Model to allow additional health professionals to furnish
telehealth services.
Sec. 444. Testing of models to examine the use of telehealth under the
Medicare program.
TITLE I--MODERNIZATION OF HEALTH SAVINGS ACCOUNTS
Subtitle A--Modernization of Health Savings Accounts and Contributions
SEC. 101. MODERNIZATION OF HEALTH SAVINGS ACCOUNTS.
(a) In General.--Section 223 of the Internal Revenue Code of 1986
is amended to read as follows:
``SEC. 223. HEALTH SAVINGS ACCOUNTS.
``(a) Deduction Allowed.--In the case of an individual who is an
eligible individual for any month during the taxable year, there shall
be allowed as a deduction for the taxable year an amount equal to the
aggregate amount paid in cash during such taxable year by or on behalf
of such individual to a health savings account of such individual.
``(b) Limitations.--
``(1) In general.--The amount allowable as a deduction
under subsection (a) with respect to any month is \1/12\ of the
dollar amount in effect under subsection (d)(2)(A) for the
taxable year which included such month.
``(2) Denial of deduction to dependents.--No deduction
shall be allowed under this section to any individual with
respect to whom a deduction under section 151 is allowable to
another taxpayer for a taxable year beginning in the calendar
year in which such individual's taxable year begins.
``(3) Increase in limit for individuals becoming eligible
individuals after the beginning of the year.--
``(A) In general.--For purposes of computing the
limitation under paragraph (1) for any taxable year, an
individual who is an eligible individual during the
last month of such taxable year shall be treated--
``(i) as having been an eligible individual
during each of the months in such taxable year,
and
``(ii) as having been enrolled, during each
of the months such individual is treated as an
eligible individual solely by reason of clause
(i), in the same qualified plan in which the
individual was enrolled for the last month of
such taxable year.
``(B) Failure to maintain qualified plan
coverage.--
``(i) In general.--If, at any time during
the testing period, the individual is not an
eligible individual, then--
``(I) gross income of the
individual for the taxable year in
which occurs the first month in the
testing period for which such
individual is not an eligible
individual is increased by the
aggregate amount of all contributions
to the health savings account of the
individual which could not have been
made but for subparagraph (A), and
``(II) the tax imposed by this
chapter for any taxable year on the
individual shall be increased by 10
percent of the amount of such increase.
``(ii) Exception for disability or death.--
Subclauses (I) and (II) of clause (i) shall not
apply if the individual ceased to be an
eligible individual by reason of the death of
the individual or the individual becoming
disabled (within the meaning of section
72(m)(7)).
``(iii) Testing period.--The term `testing
period' means the period beginning with the
last month of the taxable year referred to in
subparagraph (A) and ending on the last day of
the 12th month following such month.
``(c) Definitions and Special Rules.--For purposes of this
section--
``(1) Eligible individual.--The term `eligible individual'
means, with respect to any month, any individual if such
individual is covered under a qualified plan as of the 1st day
of such month.
``(2) Qualified plan.--
``(A) In general.--The term `qualified health plan'
means any health plan, including employer plans,
individual plans, short term plans, Medicare, Medicaid,
VA health care, TRICARE, Indian health service, health
care sharing ministries, and association health plans.
``(B) Exclusion of certain plans.--Such term does
not include a health plan if substantially all of its
coverage is--
``(i) coverage for any benefit provided by
permitted insurance, or
``(ii) coverage (whether through insurance
or otherwise) for accidents, disability, dental
care, vision care, or long-term care.
``(3) Permitted insurance.--The term `permitted insurance'
means--
``(A) insurance if substantially all of the
coverage provided under such insurance relates to--
``(i) liabilities incurred under workers'
compensation laws,
``(ii) tort liabilities,
``(iii) liabilities relating to ownership
or use of property, or
``(iv) such other similar liabilities as
the Secretary may specify by regulations,
``(B) insurance for a specified disease or illness,
and
``(C) insurance paying a fixed amount per day (or
other period) of hospitalization.
``(4) Family coverage.--The term `family coverage' means
any coverage other than self-only coverage.
``(d) Health Savings Account.--For purposes of this section--
``(1) In general.--The term `health savings account' means
a trust created or organized in the United States as a health
savings account exclusively for the purpose of paying the
qualified medical expenses of the account beneficiary, but only
if the written governing instrument creating the trust meets
the following requirements:
``(A) Except in the case of a rollover contribution
described in subsection (f)(5) or section 220(f)(5), no
contribution will be accepted--
``(i) unless it is in cash, or
``(ii) to the extent such contribution,
when added to previous contributions to the
trust for the calendar year, exceeds the
limitation amount specified in paragraph
(2)(A), or
``(iii) to the extent such contribution,
when added to the balance of the account,
exceeds the limitation amount specified in
paragraph (2)(B).
``(B) The trustee is a bank (as defined in section
408(n)), an insurance company (as defined in section
816), or another person who demonstrates to the
satisfaction of the Secretary that the manner in which
such person will administer the trust will be
consistent with the requirements of this section.
``(C) No part of the trust assets will be invested
in life insurance contracts.
``(D) The assets of the trust will not be
commingled with other property except in a common trust
fund or common investment fund.
``(E) The interest of an individual in the balance
in his account is nonforfeitable.
``(2) Limitations.--
``(A) Annual limitation.--
``(i) In general.--The limitation amount
specified in this subparagraph is--
``(I) $5,000 in the case of a
qualified health plan with an actuarial
value of less than 40 percent,
``(II) $4,300 in the case of a
qualified health plan with an actuarial
value that is 40 percent or more and
less than 75 percent, and
``(III) $3,600 in the case of a
qualified health plan with an actuarial
value that is 75 percent or more.
``(ii) Actuarial value of qualified health
plan.--For purposes of clause (i), the
actuarial value of a qualified health plan is
the percentage of the total average costs of
covered benefits under the health plan.
``(B) Account accumulation limitation.--The
limitation amount specified in this paragraph is
$50,000.
``(C) Indexing.--
``(i) In general.--In the case of any
taxable year beginning in a calendar year after
2026, each dollar amount contained in
subparagraphs (A)(i) and (B) shall be increased
by the medical care cost adjustment of such
amount for such calendar year.
``(ii) Medical care cost adjustment.--For
purposes of clause (i), the medical care cost
adjustment for any calendar year is the
percentage (if any) by which--
``(I) the medical care component of
the C-CPI-U (as defined in section
1(f)(6)) for August of the preceding
calendar year, exceeds
``(II) such component of the C-CPI-
U (as so defined) for August of 2025.
``(iii) Rounding.--
``(I) Annual limitation.--If any
increase in a dollar amount contained
in subparagraph (A)(i) determined under
clause (i) is not a multiple of $100,
such increase shall be rounded to the
nearest multiple of $100.
``(II) Account limitation.--If any
increase in the dollar amount contained
in subparagraph (B) determined under
clause (i) is not a multiple of $1,000,
such increase shall be rounded to the
nearest multiple of $1,000.
``(D) Coordination with other contributions.--The
limitation which would (but for this paragraph) apply
under subparagraphs (A) and (B) to an individual for
any taxable year shall be reduced (but not below zero)
by the sum of--
``(i) the aggregate amount contributed to
health savings accounts of such individual
which is excludable from the taxpayer's gross
income for such taxable year under section
106(d) (and such amount shall not be allowed as
a deduction under subsection (a)), and
``(ii) the aggregate amount contributed to
health savings accounts of such individual for
such taxable year under section 408(d)(9) (and
such amount shall not be allowed as a deduction
under subsection (a)).
``(3) Qualified medical expenses.--
``(A) In general.--The term `qualified medical
expenses' means, with respect to an account
beneficiary, amounts paid by such beneficiary for
medical care (as defined in section 213(d)) for such
individual, the spouse of such individual, and any
dependent (as defined in section 152, determined
without regard to subsections (b)(1), (b)(2), and
(d)(1)(B) thereof) of such individual, but only to the
extent such amounts are not compensated for by
insurance or otherwise. For purposes of this
subparagraph, amounts paid for menstrual care products
shall be treated as paid for medical care.
``(B) Health insurance may not be purchased from
account.--
``(i) In general.--Subparagraph (A) shall
not apply to any payment for insurance.
``(ii) Exceptions.--Clause (i) shall not
apply to any expense for coverage under--
``(I) a health plan during any
period of continuation coverage
required under any Federal law,
``(II) a qualified long-term care
insurance contract (as defined in
section 7702B(b)),
``(III) a health plan during a
period in which the individual is
receiving unemployment compensation
under any Federal or State law, or
``(IV) in the case of an account
beneficiary who has attained the age
specified in section 1811 of the Social
Security Act, any health insurance
other than a medicare supplemental
policy (as defined in section 1882 of
the Social Security Act).
``(iii) Exception for integrated health
plans.--Clause (i) shall not apply to any
expense for coverage under an integration
eligible health plan which is integrated with
the health savings account within the meaning
of section 106(d).
``(iv) Exception for direct primary care
service arrangements.--
``(I) In general.--A direct primary
care service arrangement shall not be
treated as insurance for purposes of
clause (i).
``(II) Direct primary care service
arrangement defined.--For purposes of
this clause, the term `direct primary
care service arrangement' means an
arrangement under which an individual
is provided medical care (as defined in
section 213(d)(1), determined without
regard to subparagraph (E) thereof)
consisting solely of primary care
services provided by primary care
practitioners (as defined in section
1833(x)(2)(A) of the Social Security
Act, determined without regard to
clause (ii) thereof), if the sole
compensation for such care is a fixed
periodic fee.
``(C) Menstrual care product.--For purposes of this
paragraph, the term `menstrual care product' means a
tampon, pad, liner, cup, sponge, or similar product
used by individuals with respect to menstruation or
other genital-tract secretions.
``(4) Account beneficiary.--The term `account beneficiary'
means the individual on whose behalf the health savings account
was established.
``(5) Certain rules to apply.--Rules similar to the
following rules shall apply for purposes of this section:
``(A) Section 219(d)(2) (relating to no deduction
for rollovers).
``(B) Section 219(f)(3) (relating to time when
contributions deemed made).
``(C) Except as provided in section 106(d), section
219(f)(5) (relating to employer payments).
``(D) Section 408(g) (relating to community
property laws).
``(E) Section 408(h) (relating to custodial
accounts).
``(e) Tax Treatment of Accounts.--
``(1) In general.--A health savings account is exempt from
taxation under this subtitle unless such account has ceased to
be a health savings account. Notwithstanding the preceding
sentence, any such account is subject to the taxes imposed by
section 511 (relating to imposition of tax on unrelated
business income of charitable, etc. organizations).
``(2) Account terminations.--Rules similar to the rules of
paragraphs (2) and (4) of section 408(e) shall apply to health
savings accounts, and any amount treated as distributed under
such rules shall be treated as not used to pay qualified
medical expenses.
``(f) Tax Treatment of Distributions.--
``(1) Amounts used for qualified medical expenses.--Any
amount paid or distributed out of a health savings account
which is used exclusively to pay qualified medical expenses of
any account beneficiary shall not be includible in gross
income.
``(2) Inclusion of amounts not used for qualified medical
expenses.--Any amount paid or distributed out of a health
savings account which is not used exclusively to pay the
qualified medical expenses of the account beneficiary shall be
included in the gross income of such beneficiary.
``(3) Excess contributions returned before due date of
return.--
``(A) In general.--If any excess contribution is
contributed for a taxable year to any health savings
account of an individual, paragraph (2) shall not apply
to distributions from the health savings accounts of
such individual (to the extent such distributions do
not exceed the aggregate excess contributions to all
such accounts of such individual for such year) if--
``(i) such distribution is received by the
individual on or before the last day prescribed
by law (including extensions of time) for
filing such individual's return for such
taxable year, and
``(ii) such distribution is accompanied by
the amount of net income attributable to such
excess contribution.
Any net income described in clause (ii) shall be
included in the gross income of the individual for the
taxable year in which it is received.
``(B) Excess contribution.--For purposes of
subparagraph (A), the term `excess contribution' means
any contribution (other than a rollover contribution
described in paragraph (5) or section 220(f)(5)) which
is neither excludable from gross income under section
106(d) nor deductible under this section.
``(4) Additional tax on distributions not used for
qualified medical expenses.--
``(A) In general.--The tax imposed by this chapter
on the account beneficiary for any taxable year in
which there is a payment or distribution from a health
savings account of such beneficiary which is includible
in gross income under paragraph (2) shall be increased
by 20 percent of the amount which is so includible.
``(B) Exception for disability or death.--
Subparagraph (A) shall not apply if the payment or
distribution is made after the account beneficiary
becomes disabled within the meaning of section 72(m)(7)
or dies.
``(C) Exception for distributions after medicare
eligibility.--Subparagraph (A) shall not apply to any
payment or distribution after the date on which the
account beneficiary attains the age specified in
section 1811 of the Social Security Act.
``(5) Rollover contribution.--An amount is described in
this paragraph as a rollover contribution if it meets the
requirements of subparagraphs (A) and (B).
``(A) In general.--Paragraph (2) shall not apply to
any amount paid or distributed from a health savings
account to the account beneficiary to the extent the
amount received is paid into a health savings account
for the benefit of such beneficiary not later than the
60th day after the day on which the beneficiary
receives the payment or distribution.
``(B) Limitation.--This paragraph shall not apply
to any amount described in subparagraph (A) received by
an individual from a health savings account if, at any
time during the 1-year period ending on the day of such
receipt, such individual received any other amount
described in subparagraph (A) from a health savings
account which was not includible in the individual's
gross income because of the application of this
paragraph.
``(C) Rollover from fsa, archer msa, and hra.--An
amount is described in this subparagraph for a calendar
year as a rollover contribution if the amount is the
remaining balance in a health flexible spending
account, Archer MSA, or health reimbursement
arrangement that is contributed to the health savings
account for a taxable year ending on or before one year
after the date of the enactment of this subparagraph.
``(6) Coordination with medical expense deduction.--For
purposes of determining the amount of the deduction under
section 213, any payment or distribution out of a health
savings account for qualified medical expenses shall not be
treated as an expense paid for medical care.
``(7) Transfer of account incident to divorce.--The
transfer of an individual's interest in a health savings
account to an individual's spouse or former spouse under a
divorce or separation instrument described in clause (i) of
section 121(d)(3)(C) shall not be considered a taxable transfer
made by such individual notwithstanding any other provision of
this subtitle, and such interest shall, after such transfer, be
treated as a health savings account with respect to which such
spouse is the account beneficiary.
``(8) Treatment after death of account beneficiary.--
``(A) Treatment if designated beneficiary is
spouse.--If the account beneficiary's surviving spouse
acquires such beneficiary's interest in a health
savings account by reason of being the designated
beneficiary of such account at the death of the account
beneficiary, such health savings account shall be
treated as if the spouse were the account beneficiary.
``(B) Other cases.--
``(i) In general.--If, by reason of the
death of the account beneficiary, any person
acquires the account beneficiary's interest in
a health savings account in a case to which
subparagraph (A) does not apply--
``(I) such account shall cease to
be a health savings account as of the
date of death, and
``(II) an amount equal to the fair
market value of the assets in such
account on such date shall be
includible if such person is not the
estate of such beneficiary, in such
person's gross income for the taxable
year which includes such date, or if
such person is the estate of such
beneficiary, in such beneficiary's
gross income for the last taxable year
of such beneficiary.
``(ii) Special rules.--
``(I) Reduction of inclusion for
predeath expenses.--The amount
includible in gross income under clause
(i) by any person (other than the
estate) shall be reduced by the amount
of qualified medical expenses which
were incurred by the decedent before
the date of the decedent's death and
paid by such person within 1 year after
such date.
``(II) Deduction for estate
taxes.--An appropriate deduction shall
be allowed under section 691(c) to any
person (other than the decedent or the
decedent's spouse) with respect to
amounts included in gross income under
clause (i) by such person.
``(g) Cost-of-Living Adjustment.--
``(1) In general.--In the case of any taxable year
beginning after December 31, 2026, each dollar amount in
paragraphs (2) and (3) of subsection (c) shall be increased by
an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year in which
such taxable year begins determined by substituting
`2025' for `2016' in subparagraph (A)(ii) thereof.
``(2) Rounding.--If any increase under paragraph (1) is not
a multiple of $50, such increase shall be rounded to the
nearest multiple of $50.
``(h) Reports.--The Secretary may require--
``(1) the trustee of a health savings account to make such
reports regarding such account to the Secretary and to the
account beneficiary with respect to contributions,
distributions, the return of excess contributions, and such
other matters as the Secretary determines appropriate, and
``(2) any person who provides an individual with a
qualified health plan to make such reports to the Secretary and
to the account beneficiary with respect to such plan as the
Secretary determines appropriate.''.
(b) Employer Contributions to Health Savings Accounts.--
(1) In general.--Section 106(d) is amended to read as
follows:
``(d) Contributions to Health Savings Accounts.--
``(1) In general.--In the case of an employee who is an
eligible individual, amounts contributed by such employee's
employer to any health savings account of such employee shall
be treated as employer-provided coverage for medical expenses
under an accident or health plan to the extent--
``(A) such amounts do not exceed twice the
limitation in effect under section 223(b)(2)
(determined without regard to this subsection) which is
applicable to such employee for such taxable year,
``(B) such amounts are contributed to an account
which is integrated with an integration eligible health
plan,
``(C) such employer does not offer such employee
coverage under any other accident or health plan,
``(D) such employer offers such amounts only to
members of a qualified class of employees and offers
such amounts to all members of any such qualified
class,
``(E) such employer offers employees an opportunity
to elect not to receive such amounts at least once per
year and upon termination from employment, and
``(F) such employee is not covered under any health
insurance offered by an employer of such employee's
spouse.
``(2) Integration eligible health plan.--For purposes of
this subsection, the term `integration eligible health plan'
means--
``(A) any bronze, silver, or gold plan offered
through an Exchange established under the Patient
Protection and Affordable Care Act,
``(B) entitlement to benefits under part A of title
XVIII of the Social Security Act and enrollment under
part B of such title, including enrollment under a
Medicare Advantage plan under part C of such title,
``(C) in the case of any individual who has not
attained age 30 or is determined by the Secretary
(after consultation with the Secretary of Health and
Human Services) to have a hardship, coverage under a
catastrophic plan, and
``(D) in the case of any student, coverage under a
health plan which is conditioned on maintaining status
as being such a student.
``(3) Integration of plans and accounts.--For purposes of
this subsection, an account shall be treated as integrated with
an integration eligible health plan (and such plan shall be
treated as integrated with such account) for any month if--
``(A) the employee is the account beneficiary of
such account and such employee is covered under an
integration eligible health plan for such month,
``(B) the employer verifies that the employee is so
covered by requiring the submission of documentation to
such employer, and
``(C) the employer makes contributions to such
account for such month which are not less than the
excess (if any) of--
``(i) the adjusted monthly premiums for the
applicable second lowest cost silver plan with
respect to the taxpayer, over
``(ii) \1/12\ of 9.5 percent of the
taxpayer's household income (within the meaning
of section 36B).
``(4) Qualified class.--For purposes of this subsection--
``(A) In general.--The term `qualified class' means
only the following: All employees; Full-time employees;
Part-time employees; Seasonal employees; Employees
covered under a collective bargaining agreement;
Employees in a waiting period; Foreign employees who
work abroad; Employees working in the same geographic
location (same insurance rating area, State, or multi-
State region); Salaried workers; Non-Salaried workers
(such as hourly workers); Temporary employees of
staffing firms.
``(B) Rules related to class size.--
``(i) Minimum class size.--A class shall
not be treated as a qualified class unless in
consisting of at least the following number of
employees:
``(I) In the case of an employer
with fewer than 100 employees, the
lesser of 10 employees or all employees
of the employer.
``(II) In the case of an employer
with at least 100 and not more than 200
employees, 10 percent of the number of
such employees (if not a whole number,
rounded down to the next lowest whole
number).
``(III) In the case of an employer
with more than 200 employees, 20
employees.
``(ii) Combination of classes.--Two or more
qualified classes described in subparagraph (A)
may be combined if each such class separately
would not satisfy the requirement of clause
(i).
``(C) Permitted variation within qualified
classes.--An employer shall not fail to meet the
requirements of paragraph (1)(D) solely because the
amounts offered to members of a qualified class vary on
the basis of--
``(i) number of dependents,
``(ii) age, if such variation based on age
does not exceed a ratio of 3:1, and
``(iii) chronic health condition, if such
variation based on chronic health condition
does not exceed a ratio of 1.2:1.
``(5) Coordination with aca provisions.--In the case of an
integration eligible health plan which is integrated with a
health savings account--
``(A) such plan shall be treated as an eligible
employer-sponsored plan described in section
5000A(f)(1)(B),
``(B) if an individual receives contributions to
such account which are excludible from the gross income
of such individual under this section during any
taxable year, no credit shall be allowed under section
36B with respect to such individual for such taxable
year, and
``(C) for purposes of section 36B(c)(2)(C)(i)(II),
the employee's required contribution with respect to
such plan shall be treated as being equal to the excess
(if any) of--
``(i) the adjusted monthly premiums for the
applicable second lowest cost silver plan with
respect to the taxpayer, over
``(ii) the contributions made the employer
to such health savings account which are
excludible from the gross income of the
employee under this section.
``(6) No constructive receipt.--No amount shall be included
in the gross income of any employee solely because the employee
may choose between the contributions referred to in paragraph
(1) and employer contributions to another health plan of the
employer.
``(7) Special rule for deduction of employer
contributions.--Any employer contribution to a health savings
account, if otherwise allowable as a deduction under this
chapter, shall be allowed only for the taxable year in which
paid.
``(8) Employer health savings account contributions
required to be shown on return.--Every individual required to
file a return under section 6012 for the taxable year shall
include on such return the aggregate amount contributed by
employers to the health savings accounts of such individual or
such individual's spouse for such taxable year.
``(9) Health savings account contributions not part of
cobra coverage.--Paragraph (1) shall not apply for purposes of
section 4980B.
``(10) Definitions.--Terms used in this subsection which
are also used in section 223 shall have the same respective
meanings as when used in such section.
``(11) Regulations.--The Secretaries of Treasury, Labor,
and Health and Human Services shall each issue such regulations
or other guidance as may be necessary or appropriate to carry
out the purposes of this subsection, including regulations or
other guidance to--
``(A) prevent employers from offering plans
integrated with health savings accounts selectively to
sicker workers, and
``(B) establish a safe harbor that helps employers
determine whether contributions to health savings
accounts with respect to which there is an integrated
health plan comply with affordability requirements
under the Patient Protection and Affordable Care Act
and the amendments made by such Act.
``(12) Cross reference.--For penalty on failure by employer
to make comparable contributions to the health savings accounts
of comparable employees, see section 4980G.''.
(2) Nonapplication of erisa.--Contributions by an employer
to a health savings account (as defined in section 223 of the
Internal Revenue Code of 1986), and an integration eligible
health plan which is integrated with such account (within the
meaning of such section), shall not be treated as a plan for
purposes of the Employee Retirement Income Security Act of 1974
if--
(A) receipt of such contributions by the employee
is voluntary,
(B) the employer does not select or endorse the
integration eligible health plan which is integrated
with such account,
(C) no premiums, other than premiums for the
integration eligible health plan which is integrated
with such account, are paid from the account,
(D) the employer receives no consideration (money
or other benefit) in connection with the employee
selecting or renewing a plan, and
(E) each participant is notified annually that such
contributions and such plan are not subject to the
requirements of such Act.
(c) Termination of Certain Other Health Care Related Tax
Benefits.--
(1) Exclusion limited to self-funded major medical plan of
employers.--Section 105(b) of such Code is amended by striking
``paid,'' and inserting ``paid under a self-funded major
medical plan of the employer''.
(2) Exclusion not applicable to health reimbursement
arrangements.--Section 105(h) of such Code is amended to read
as follows:
``(h) Exclusion Not Applicable to Health Reimbursement
Arrangements.--Subsection (b) shall not apply to health reimbursement
arrangements.''.
(3) Repeal of exclusions from income for archer msas and
fsas.--Section 106 of such Code is amended by striking
subsection (b), (e) and (g).
(4) Termination of deduction for contributions to archer
msas.--Section 220(a) of such Code is amended by adding at the
end the following: ``No amount shall be allowed as a deduction
under the preceding sentence for any taxable year beginning
after one year after the date of the enactment of this
sentence.''.
(d) Bankruptcy Protections.--Section 522 of title 11, United States
Code, is amended by adding at the end the following new subsection:
``(r) For purposes of this section, any health savings account (as
described in section 223 of the Internal Revenue Code of 1986) shall be
treated in the same manner as an individual retirement account
described in section 408 of such Code.''.
(e) Rollover of FSA, Archer MSA, HRA to Health Savings Account.--
Notwithstanding any other provision of law, if the remaining balance in
a health flexible spending arrangement, Archer MSA, or health
reimbursement arrangement is transferred to a health savings account
before the end of any taxable year ending on or before one year after
the date of the enactment of this Act, such transfer shall be treated
as a rollover to the health savings account under section 223(f)(5) of
the Internal Revenue Code of 1986 and the distribution from the health
flexible spending arrangement, Archer MSA, or health reimbursement
arrangement shall not be includible in gross income.
(f) Effective Dates.--
(1) In general.--The amendments made by subsections (a) and
(b) shall apply to taxable years beginning after the date of
the enactment of this Act.
(2) Termination of certain other health care related tax
benefits.--The amendments made by subsection (c) shall apply to
taxable years beginning after the date which is 1 year after
the date of the enactment of this Act.
(3) Bankruptcy protections.--The amendment made by
subsection (d) shall apply to cases commencing under title 11,
United States Code, after the date of the enactment of this
Act.
SEC. 102. UNUSED PREMIUM TAX CREDITS MAY BE DEPOSITED IN HEALTH SAVINGS
ACCOUNTS.
(a) In General.--Section 36B is amended by redesignating subsection
(h) as subsection (i) and by inserting after subsection (g) the
following new subsection:
``(h) Excess Credit May Be Deposited Into a Health Savings
Account.--
``(1) In general.--If the amount described in subparagraph
(B) of subsection (b)(2) exceeds the amount described in
subparagraph (A) of such subsection with respect to any
coverage month and an election under paragraph (2) is in effect
with respect to the applicable taxpayer, the Secretary shall
deposit such excess into a health savings account of such
taxpayer.
``(2) Election to deposit excess credit into a health
savings account.--A taxpayer may elect (at such time and in
such manner as the Secretary may provide) to have the Secretary
deposit the excess described in paragraph (1) into a health
savings account of the taxpayer. Any such election shall only
be treated as being in effect if the taxpayer provides the
Secretary with such information as the Secretary may require to
allow the Secretary to make such deposit.
``(3) Coordination with health savings account rules.--Any
amount deposited in a health savings account by the Secretary
under this subsection shall--
``(A) be includible in the gross income of the
applicable taxpayer, and
``(B) be taken into account as an amount paid to
such account for purposes of this section.
``(4) Treatment of deposits.--For purposes of section 1324
of title 31, United States Code, any deposit made under this
subsection shall be treated as a credit allowed under this
section.''.
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 103. HEALTH REIMBURSEMENT ARRANGEMENTS AND OTHER ACCOUNT-BASED
GROUP HEALTH PLANS.
The rule published by the Internal Revenue Service, the Employee
Benefits Security Administration, and the Health and Human Services
Department relating to ``Health Reimbursement Arrangements and Other
Account-Based Group Health Plans'' (June 20, 2019) shall have the force
and effect of law. Health Reimbursement Arrangements as described in
this rule are subject to all sections in this title.
SEC. 104. COST-SHARING REDUCTION PAYMENTS AS ELIGIBLE CONTRIBUTIONS.
(a) Alternative Waiver for State Innovation.--Section 1332 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18052) is amended
by adding at the end the following new subsection:
``(f) Alternative Waiver for State Innovation.--
``(1) In general.--Notwithstanding any preceding provision
of this section, a State may apply to the Secretary for the
waiver of any requirement of subsection (a)(2) with respect to
health insurance coverage within that State for plan years
beginning on or after January 1, 2026, if instead of complying
with section 1402 the State provides for the distribution of
funding received under paragraph (2) to health savings accounts
of qualifying individuals with respect to such State. Such
application shall be filed at such time and in such manner as
the Secretary may require, and shall include such information
as the Secretary may require (including a 10-year budget plan
for such plan that is budget neutral for the Federal
Government).
``(2) Pass-through funding.--With respect to a State waiver
under paragraph (1), under which, due to the structure of such
waiver, individuals in the State would not qualify for cost-
sharing reductions under section 1402 for which they would
otherwise be eligible, the Secretary shall provide for an
alternative means by which an amount is transferred to the
State equal to the aggregate amount of such reductions that
would have been paid on behalf of the participants in the
Exchanges established under this title--
``(A) had the State not received such waiver;
``(B) had references to `eligible insureds' under
section 1402 referred to `qualifying insureds (as
defined in section 1332(f))';
``(C) had, after application of clause (ii), in the
case of a qualifying insured enrolled in the bronze
level of coverage--
``(i) the percentages specified in
subclauses (I), (II), and (III) of section
1402(c)(1)(B) were references to 84 percent, 77
percent, and 63 percent, respectively; and
``(ii) the references in subparagraphs (A),
(B), and (C) of section 1402(c)(2) to 94
percent, 87 percent, and 73 percent,
respectively, were references to 84 percent, 77
percent, and 63 percent, respectively; and
``(D) had, after application of clause (ii), in the
case of a qualifying insured enrolled in the copper
level of coverage--
``(i) the percentages specified in
subclauses (I), (II), and (III) of section
1402(c)(1)(B) were references to 74 percent, 67
percent, and 53 percent, respectively; and
``(ii) the references in subparagraphs (A),
(B), and (C) of section 1402(c)(2) to 94
percent, 87 percent, and 73 percent,
respectively, were references to 74 percent, 67
percent, and 53 percent, respectively.
The amount transferred pursuant to the previous sentence shall
be determined annually by the Secretary, taking into
consideration the experience of other States with respect to
participation in an Exchange and reductions provided under such
provisions to residents of the other States, and shall be paid
to the State for purposes of implementing such waiver.
``(3) Waiver consideration and transparency.--The
provisions of paragraph (4) of subsection (a) shall apply to an
application for a waiver under paragraph (1) in the same manner
as such provisions apply with respect to an application for a
waiver under subsection (a)(1), except that, for purposes of
this paragraph, the provisions of subsection (a)(4)(B)(ii)
shall not apply.
``(4) Determinations; term of waiver.--The provisions of
subsections (d) and (e) shall apply with respect to a
determination with respect to an application under paragraph
(1), and with respect to the term of a waiver under such
paragraph, in the same manner as such provisions apply with
respect to a determination with respect to an application under
subsection (a)(1), and with respect to the term of a waiver
under such subsection.
``(5) Definitions.--For purposes of this subsection:
``(A) Health savings account.--The term `health
savings account' has the meaning given such term in
section 223 of the Internal Revenue Code of 1986.
``(B) Qualifying insured.--The term `qualifying
insured' means, with respect to a State and a year, an
individual--
``(i) who is enrolled in a health savings
account;
``(ii) who is enrolled for such year in a
silver, bronze, or copper level coverage
offered through an Exchange; and
``(iii) whose household income is not more
than 250 percent of the Federal poverty line
for a family of the size involved.''.
(b) Additional Amendments.--Section 1402 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18071) is amended by striking ``not
less than 100 percent but'' and ``exceeds 100 percent but'' and ``more
than 100 percent but'' each place such phrases appear.
(c) Conforming Amendments.--Section 1332 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18052), as amended by subsection
(a), is further amended in subsection (a)(4)--
(1) in subparagraph (A) by striking the period and
inserting ``, except in the case of a waiver described in
subsection (f).''; and
(2) in subparagraph (B)(ii) by inserting after ``an
application'' the following: ``(except in the case of a waiver
described in subsection (f))''.
(d) Appropriation for Cost-Sharing Payments.--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.--
``(1) Appropriations.--Out of any funds in the Treasury not
otherwise appropriated, there is appropriated such sums as may
be necessary to, subject to paragraph (2), provide health
benefits coverage through payment to issuers (under this
section or through advance payment by the Secretary of the
Treasury under section 1412(c)(3)) of the amounts computed
under this section for each of plan years 2026 through 2030.
``(2) Adjustments.--Notwithstanding any other provision of
law, payments and other actions for adjustments to obligations
incurred prior to December 31, 2026, may be made through
December 31, 2026.
``(3) Limitation.--Amounts appropriated under paragraph (1)
for each of plan years 2026 through 2030 are subject to the
requirements and limitations under sections 506 and 507 of
division H of Public Law 115-31 in the same manner and to the
same extent as if such amounts for each such year were
appropriated under such division.''.
Subtitle B--Assistance to Health Savings Accounts
SEC. 111. ONE-TIME APPLICATION OF SAVER'S CREDIT TO CONTRIBUTIONS TO
HEALTH SAVINGS ACCOUNTS.
(a) In General.--In the case of an applicable taxable year,
contributions to any health savings account of the taxpayer during such
taxable year shall be treated as a qualified retirement savings
contribution for purposes of section 25B of the Internal Revenue Code
of 1986.
(b) Applicable Taxable Year.--For purposes of this section, the
term ``applicable taxable year'' means any taxable year elected by the
taxpayer (at such time and in such manner as the Secretary of the
Treasury may provide) which begins during the 3-year period beginning 1
year after the date of the enactment of this Act. A taxpayer may not
elect not more than 1 applicable taxable year under this subsection.
SEC. 112. GRANTS FOR HEALTH SAVINGS ACCOUNT ASSISTANCE AND OUTREACH.
(a) In General.--The Administrator shall establish a grant program
to provide assistance to eligible entities to carry out the activities
described in subsection (c).
(b) Application.--An eligible entity shall submit an application to
the Administrator in such time and in such manner as the Administrator
may require, providing that such application requires a demonstration
of the existence of a relationship with, or the ability to establish a
relationship with, an employer, employee, self-employed individual, or
consumer eligible to enroll in a health savings account.
(c) Use of Funds.--An eligible entity receiving a grant under this
section shall use such funds to--
(1) distribute fair and impartial information to consumers
about health savings accounts, including the availability of
such accounts and how such accounts may be utilized;
(2) conduct activities to raise public awareness of health
savings accounts;
(3) facilitate enrollment in health savings accounts; and
(4) refer individuals enrolled in a health savings account
to the appropriate official, organization, or State agency for
the purpose of addressing a complaint, grievance, or other
question with respect to such health savings account.
(d) Amount.--The Administrator may distribute up to $5,000,000
annually to be divided among grant recipients under this section.
(e) Report.--Not later than one year after the date on which the
last of the grant periods awarded under this section ends, the
Administrator shall submit a report to the Congress on the
effectiveness of the grants provided under this section.
(f) Definitions.--In this section:
(1) Administrator.--The term ``Administrator'' means the
Administrator of the Centers for Medicare & Medicaid Services.
(2) Consumer.--The term ``consumer'' means an individual
enrolled in, or seeking to enroll in, a health savings account.
(3) Eligible entity.--The term ``eligible entity'' includes
the following:
(A) A State.
(B) Trade.
(C) Industry.
(D) Professional associations.
(E) Commercial fishing industry organizations.
(F) Ranching and farming organizations.
(G) Community and consumer-focused nonprofit
groups.
(H) Chambers of commerce.
(I) Unions.
(J) Small business development centers (as defined
in section 21 of the Small Business Act (15 U.S.C.
648)).
(K) Other entities capable of carrying out the
activities described under subsection (b).
(4) Health savings account.--The term ``health savings
account'' has the meaning given such term in section 223 of the
Internal Revenue Code of 1986.
(5) State.--The term ``State'' means each of the several
States, the District of Columbia, each territory and possession
of the United States, and each federally recognized Indian
Tribe.
SEC. 113. NEW CORPORATIONS REQUIRED TO USE HEALTH SAVINGS ACCOUNTS.
Notwithstanding any other provision of law, a corporation
incorporated after December 31, 2026, may not receive tax benefits for
offering employees health insurance. The previous sentence shall not
apply to health savings account contributions offered by such a
corporation.
SEC. 114. FEDERAL EMPLOYEE HEALTH BENEFITS AND HEALTH SAVINGS ACCOUNTS.
(a) In General.--Section 1312(d)(3)(D) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18032(d)(3)(D)) is amended--
(1) in the subparagraph heading, by striking ``Members of
congress'' and inserting ``President, vice president, members
of congress, and federal employees'';
(2) in clause (i), in the matter preceding subclause (I)--
(A) by striking ``Members of Congress and
congressional staff'' and inserting ``the President,
Vice President, Members of Congress, and Federal
employees''; and
(B) by striking ``a Member of Congress or
congressional staff'' and inserting ``the President,
the Vice President, a Member of Congress, or a Federal
employee''; and
(3) in clause (ii), by amending subclause (II) to read as
follows:
``(II) Federal employee.--The term
`Federal employee' means--
``(aa) an `employee', as
such term is defined in section
2105 of title 5, United States
Code; and
``(bb) includes an
individual to whom subsection
(c) or (f) of such section 2105
pertains (whether or not such
individual satisfies item
(aa)).''.
(b) Conversion to Health Savings Accounts.--Each plan offered under
chapter 89 of title 5, United States Code, shall be converted into a
health savings account deposit and funded at the level of the second-
least expensive silver plan available through the Exchange where the
applicable individual resides.
TITLE II--IMPROVING PRIVATE HEALTH INSURANCE
Subtitle A--Maintaining Protections for Patients With Preexisting
Conditions
SEC. 201. GUARANTEED AVAILABILITY OF COVERAGE; PROHIBITING
DISCRIMINATION.
(a) In General.--Subtitle C of title I of the Health Insurance
Portability and Accountability Act of 1996 (Public Law 104-191) is
amended by adding at the end the following:
``SEC. 196. GUARANTEED AVAILABILITY OF COVERAGE.
``(a) Guaranteed Issuance of Coverage in the Individual and Group
Market.--Subject to subsections (b) through (d), each health insurance
issuer that offers health insurance coverage in the individual or group
market in a State must accept every employer and individual in the
State that applies for such coverage.
``(b) Enrollment.--
``(1) Restriction.--A health insurance issuer described in
subsection (a) may restrict enrollment in coverage described in
such subsection to open or special enrollment periods.
``(2) Establishment.--A health insurance issuer described
in subsection (a) shall, in accordance with the regulations
promulgated under paragraph (3), establish special enrollment
periods for qualifying events (under section 603 of the
Employee Retirement Income Security Act of 1974).
``(3) Regulations.--The Secretary shall promulgate
regulations with respect to enrollment periods under paragraphs
(1) and (2).
``(c) Special Rules for Network Plans.--
``(1) In general.--In the case of a health insurance issuer
that offers health insurance coverage in the group and
individual market through a network plan, the issuer may--
``(A) limit the employers that may apply for such
coverage to those with eligible individuals who live,
work, or reside in the service area for such network
plan; and
``(B) within the service area of such plan, deny
such coverage to such employers and individuals if the
issuer has demonstrated, if required, to the applicable
State authority that--
``(i) it will not have the capacity to
deliver services adequately to enrollees of any
additional groups or any additional individuals
because of its obligations to existing group
contract holders and enrollees; and
``(ii) it is applying this paragraph
uniformly to all employers and individuals
without regard to the claims experience of
those individuals, employers and their
employees (and their dependents), or any health
status-related factor relating to such
individuals, employees, and dependents.
``(2) 180-day suspension upon denial of coverage.--An
issuer, upon denying health insurance coverage in any service
area in accordance with paragraph (1)(B), may not offer
coverage in the group or individual market within such service
area for a period of 180 days after the date such coverage is
denied.
``(d) Application of Financial Capacity Limits.--
``(1) In general.--A health insurance issuer may deny
health insurance coverage in the group or individual market if
the issuer has demonstrated, if required, to the applicable
State authority that--
``(A) it does not have the financial reserves
necessary to underwrite additional coverage; and
``(B) it is applying this paragraph uniformly to
all employers and individuals in the group or
individual market in the State consistent with
applicable State law and without regard to the claims
experience of those individuals, employers and their
employees (and their dependents) or any health status-
related factor relating to such individuals, employees,
and dependents.
``(2) 180-day suspension upon denial of coverage.--A health
insurance issuer upon denying health insurance coverage in
connection with group health plans in accordance with paragraph
(1) in a State may not offer coverage in connection with group
health plans in the group or individual market in the State for
a period of 180 days after the date such coverage is denied or
until the issuer has demonstrated to the applicable State
authority, if required under applicable State law, that the
issuer has sufficient financial reserves to underwrite
additional coverage, whichever is later. An applicable State
authority may provide for the application of this subsection on
a service-area-specific basis.
``(e) Definitions.--In this section and in sections 197 through
199A:
``(1) The term `Secretary' means the Secretary of Health
and Human Services.
``(2) The terms `genetic information', `genetic test',
`group health plan', `group market', `health insurance
coverage', `health insurance issuer', `group health insurance
coverage', `individual health insurance coverage', `individual
market', and `underwriting purpose' have the meanings given
such terms in section 2791 of the Public Health Service Act.
``SEC. 197. FAIR HEALTH INSURANCE PREMIUMS.
``(a) Prohibiting Discriminatory Premium Rates.--
``(1) In general.--With respect to the premium rate charged
by a health insurance issuer for health insurance coverage
offered in the individual or small group market--
``(A) such rate shall vary with respect to the
particular plan or coverage involved only by--
``(i) whether such plan or coverage covers
an individual or family;
``(ii) rating area, as established in
accordance with paragraph (2);
``(iii) age, except that such rate shall
not vary by more than 5 to 1 for adults; and
``(iv) tobacco use, except that such rate
shall not vary by more than 1.5 to 1; and
``(B) such rate shall not vary with respect to the
particular plan or coverage involved by any other
factor not described in subparagraph (A).
``(2) Rating area.--
``(A) In general.--Each State shall establish 1 or
more rating areas within that State for purposes of
applying the requirements of this title.
``(B) Secretarial review.--The Secretary shall
review the rating areas established by each State under
subparagraph (A) to ensure the adequacy of such areas
for purposes of carrying out the requirements of this
title. If the Secretary determines a State's rating
areas are not adequate, or that a State does not
establish such areas, the Secretary may establish
rating areas for that State.
``(3) Permissible age bands.--The Secretary, in
consultation with the National Association of Insurance
Commissioners, shall define the permissible age bands for
rating purposes under paragraph (1)(A)(iii).
``(4) Application of variations based on age or tobacco
use.--With respect to family coverage under a group health plan
or health insurance coverage, the rating variations permitted
under clauses (iii) and (iv) of paragraph (1)(A) shall be
applied based on the portion of the premium that is
attributable to each family member covered under the plan or
coverage.
``SEC. 198. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS
AND BENEFICIARIES BASED ON HEALTH STATUS.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not
establish rules for eligibility (including continued eligibility) of
any individual to enroll under the terms of the plan or coverage based
on any of the following health status-related factors in relation to
the individual or a dependent of the individual:
``(1) Health status.
``(2) Medical condition (including both physical and mental
illnesses).
``(3) Claims experience.
``(4) Receipt of health care.
``(5) Medical history.
``(6) Genetic information.
``(7) Evidence of insurability (including conditions
arising out of acts of domestic violence).
``(8) Disability.
``(9) Any other health status-related factor determined
appropriate by the Secretary.
``(b) In Premium Contributions.--
``(1) In general.--A group health plan, and a health
insurance issuer offering group or individual health insurance
coverage, may not require any individual (as a condition of
enrollment or continued enrollment under the plan) to pay a
premium or contribution which is greater than such premium or
contribution for a similarly situated individual enrolled in
the plan on the basis of any health status-related factor in
relation to the individual or to an individual enrolled under
the plan as a dependent of the individual.
``(2) Construction.--Nothing in paragraph (1) shall be
construed--
``(A) to restrict the amount that an employer or
individual may be charged for coverage under a group
health plan except as provided in paragraph (3) or
individual health coverage, as the case may be; or
``(B) to prevent a group health plan, and a health
insurance issuer offering group health insurance
coverage, from establishing premium discounts or
rebates or modifying otherwise applicable copayments or
deductibles in return for adherence to programs of
health promotion and disease prevention.
``(3) No group-based discrimination on basis of genetic
information.--
``(A) In general.--For purposes of this section, a
group health plan, and health insurance issuer offering
group health insurance coverage in connection with a
group health plan, may not adjust premium or
contribution amounts for the group covered under such
plan on the basis of genetic information.
``(B) Rule of construction.--Nothing in
subparagraph (A) or in paragraphs (1) and (2) of
subsection (d) shall be construed to limit the ability
of a health insurance issuer offering group or
individual health insurance coverage to increase the
premium for an employer based on the manifestation of a
disease or disorder of an individual who is enrolled in
the plan. In such case, the manifestation of a disease
or disorder in one individual cannot also be used as
genetic information about other group members and to
further increase the premium for the employer.
``(c) Genetic Testing.--
``(1) Limitation on requesting or requiring genetic
testing.--A group health plan, and a health insurance issuer
offering health insurance coverage in connection with a group
health plan, shall not request or require an individual or a
family member of such individual to undergo a genetic test.
``(2) Rule of construction.--Paragraph (1) shall not be
construed to limit the authority of a health care professional
who is providing health care services to an individual to
request that such individual undergo a genetic test.
``(3) Rule of construction regarding payment.--
``(A) In general.--Nothing in paragraph (1) shall
be construed to preclude a group health plan, or a
health insurance issuer offering health insurance
coverage in connection with a group health plan, from
obtaining and using the results of a genetic test in
making a determination regarding payment (as such term
is defined for the purposes of applying the regulations
promulgated by the Secretary under part C of title XI
of the Social Security Act and section 264 of this Act,
as may be revised from time to time) consistent with
subsection (a).
``(B) Limitation.--For purposes of subparagraph
(A), a group health plan, or a health insurance issuer
offering health insurance coverage in connection with a
group health plan, may request only the minimum amount
of information necessary to accomplish the intended
purpose.
``(4) Research exception.--Notwithstanding paragraph (1), a
group health plan, or a health insurance issuer offering health
insurance coverage in connection with a group health plan, may
request, but not require, that a participant or beneficiary
undergo a genetic test if each of the following conditions is
met:
``(A) The request is made pursuant to research that
complies with part 46 of title 45, Code of Federal
Regulations, or equivalent Federal regulations, and any
applicable State or local law or regulations for the
protection of human subjects in research.
``(B) The plan or issuer clearly indicates to each
participant or beneficiary, or in the case of a minor
child, to the legal guardian of such beneficiary, to
whom the request is made that--
``(i) compliance with the request is
voluntary; and
``(ii) noncompliance will have no effect on
enrollment status or premium or contribution
amounts.
``(C) No genetic information collected or acquired
under this paragraph shall be used for underwriting
purposes.
``(D) The plan or issuer notifies the Secretary in
writing that the plan or issuer is conducting
activities pursuant to the exception provided for under
this paragraph, including a description of the
activities conducted.
``(E) The plan or issuer complies with such other
conditions as the Secretary may by regulation require
for activities conducted under this paragraph.
``(d) Prohibition on Collection of Genetic Information.--
``(1) In general.--A group health plan, and a health
insurance issuer offering health insurance coverage in
connection with a group health plan, shall not request,
require, or purchase genetic information for underwriting
purposes.
``(2) Prohibition on collection of genetic information
prior to enrollment.--A group health plan, and a health
insurance issuer offering health insurance coverage in
connection with a group health plan, shall not request,
require, or purchase genetic information with respect to any
individual prior to such individual's enrollment under the plan
or coverage in connection with such enrollment.
``(3) Incidental collection.--If a group health plan, or a
health insurance issuer offering health insurance coverage in
connection with a group health plan, obtains genetic
information incidental to the requesting, requiring, or
purchasing of other information concerning any individual, such
request, requirement, or purchase shall not be considered a
violation of paragraph (2) if such request, requirement, or
purchase is not in violation of paragraph (1).
``(e) Genetic Information of a Fetus or Embryo.--Any reference in
this part to genetic information concerning an individual or family
member of an individual shall--
``(1) with respect to such an individual or family member
of an individual who is a pregnant woman, include genetic
information of any fetus carried by such pregnant woman; and
``(2) with respect to an individual or family member
utilizing an assisted reproductive technology, include genetic
information of any embryo legally held by the individual or
family member.
``(f) Programs of Health Promotion or Disease Prevention.--
``(1) General provisions.--
``(A) General rule.--For purposes of subsection
(b)(2)(B), a program of health promotion or disease
prevention (referred to in this subsection as a
`wellness program') shall be a program offered by an
employer that is designed to promote health or prevent
disease that meets the applicable requirements of this
subsection.
``(B) No conditions based on health status
factor.--If none of the conditions for obtaining a
premium discount or rebate or other reward for
participation in a wellness program is based on an
individual satisfying a standard that is related to a
health status factor, such wellness program shall not
violate this section if participation in the program is
made available to all similarly situated individuals
and the requirements of paragraph (2) are complied
with.
``(C) Conditions based on health status factor.--If
any of the conditions for obtaining a premium discount
or rebate or other reward for participation in a
wellness program is based on an individual satisfying a
standard that is related to a health status factor,
such wellness program shall not violate this section if
the requirements of paragraph (3) are complied with.
``(2) Wellness programs not subject to requirements.--If
none of the conditions for obtaining a premium discount or
rebate or other reward under a wellness program as described in
paragraph (1)(B) are based on an individual satisfying a
standard that is related to a health status factor (or if such
a wellness program does not provide such a reward), the
wellness program shall not violate this section if
participation in the program is made available to all similarly
situated individuals. The following programs shall not have to
comply with the requirements of paragraph (3) if participation
in the program is made available to all similarly situated
individuals:
``(A) A program that reimburses all or part of the
cost for memberships in a fitness center.
``(B) A diagnostic testing program that provides a
reward for participation and does not base any part of
the reward on outcomes.
``(C) A program that encourages preventive care
related to a health condition through the waiver of the
copayment or deductible requirement under a group
health plan for the costs of certain items or services
related to a health condition (such as prenatal care or
well-baby visits).
``(D) A program that reimburses individuals for the
costs of smoking cessation programs without regard to
whether the individual quits smoking.
``(E) A program that provides a reward to
individuals for attending a periodic health education
seminar.
``(3) Wellness programs subject to requirements.--If any of
the conditions for obtaining a premium discount, rebate, or
reward under a wellness program as described in paragraph
(1)(C) is based on an individual satisfying a standard that is
related to a health status factor, the wellness program shall
not violate this section if the following requirements are
complied with:
``(A) The reward for the wellness program, together
with the reward for other wellness programs with
respect to the plan that requires satisfaction of a
standard related to a health status factor, shall not
exceed 30 percent of the cost of employee-only coverage
under the plan. If, in addition to employees or
individuals, any class of dependents (such as spouses
or spouses and dependent children) may participate
fully in the wellness program, such reward shall not
exceed 30 percent of the cost of the coverage in which
an employee or individual and any dependents are
enrolled. For purposes of this paragraph, the cost of
coverage shall be determined based on the total amount
of employer and employee contributions for the benefit
package under which the employee is (or the employee
and any dependents are) receiving coverage. A reward
may be in the form of a discount or rebate of a premium
or contribution, a waiver of all or part of a cost-
sharing mechanism (such as deductibles, copayments, or
coinsurance), the absence of a surcharge, or the value
of a benefit that would otherwise not be provided under
the plan. The Secretaries of Labor, Health and Human
Services, and the Treasury may increase the reward
available under this subparagraph to up to 50 percent
of the cost of coverage if the Secretaries determine
that such an increase is appropriate.
``(B) The wellness program shall be reasonably
designed to promote health or prevent disease. A
program complies with the preceding sentence if the
program has a reasonable chance of improving the health
of, or preventing disease in, participating individuals
and it is not overly burdensome, is not a subterfuge
for discriminating based on a health status factor, and
is not highly suspect in the method chosen to promote
health or prevent disease.
``(C) The plan shall give individuals eligible for
the program the opportunity to qualify for the reward
under the program at least once each year.
``(D) The full reward under the wellness program
shall be made available to all similarly situated
individuals. For such purpose, among other things:
``(i) The reward is not available to all
similarly situated individuals for a period
unless the wellness program allows--
``(I) for a reasonable alternative
standard (or waiver of the otherwise
applicable standard) for obtaining the
reward for any individual for whom, for
that period, it is unreasonably
difficult due to a medical condition to
satisfy the otherwise applicable
standard; and
``(II) for a reasonable alternative
standard (or waiver of the otherwise
applicable standard) for obtaining the
reward for any individual for whom, for
that period, it is medically
inadvisable to attempt to satisfy the
otherwise applicable standard.
``(ii) If reasonable under the
circumstances, the plan or issuer may seek
verification, such as a statement from an
individual's physician, that a health status
factor makes it unreasonably difficult or
medically inadvisable for the individual to
satisfy or attempt to satisfy the otherwise
applicable standard.
``(E) The plan or issuer involved shall disclose in
all plan materials describing the terms of the wellness
program the availability of a reasonable alternative
standard (or the possibility of waiver of the otherwise
applicable standard) required under subparagraph (D).
If plan materials disclose that such a program is
available, without describing its terms, the disclosure
under this subparagraph shall not be required.
``SEC. 199. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER
DISCRIMINATION BASED ON HEALTH STATUS.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not
impose any preexisting condition exclusion with respect to such plan or
coverage.
``(b) Definitions.--For purposes of this section--
``(1) Preexisting condition exclusion.--
``(A) In general.--The term `preexisting condition
exclusion' means, with respect to coverage, a
limitation or exclusion of benefits relating to a
condition based on the fact that the condition was
present before the date of enrollment for such
coverage, whether or not any medical advice, diagnosis,
care, or treatment was recommended or received before
such date.
``(B) Treatment of genetic information.--Genetic
information shall not be treated as a condition
described in subsection (a)(1) in the absence of a
diagnosis of the condition related to such information.
``(2) Enrollment date.--The term `enrollment date' means,
with respect to an individual covered under a group health plan
or health insurance coverage, the date of enrollment of the
individual in the plan or coverage or, if earlier, the first
day of the waiting period for such enrollment.
``(3) Late enrollee.--The term `late enrollee' means, with
respect to coverage under a group health plan, a participant or
beneficiary who enrolls under the plan other than during--
``(A) the first period in which the individual is
eligible to enroll under the plan; or
``(B) a special enrollment period under subsection
(f).
``(4) Waiting period.--The term `waiting period' means,
with respect to a group health plan and an individual who is a
potential participant or beneficiary in the plan, the period
that must pass with respect to the individual before the
individual is eligible to be covered for benefits under the
terms of the plan.
``(c) Rules Relating to Crediting Previous Coverage.--
``(1) Creditable coverage defined.--For purposes of this
title, the term `creditable coverage' means, with respect to an
individual, coverage of the individual under any of the
following:
``(A) A group health plan.
``(B) Health insurance coverage.
``(C) Part A or part B of title XVIII of the Social
Security Act.
``(D) Title XIX of the Social Security Act, other
than coverage consisting solely of benefits under
section 1928.
``(E) Chapter 55 of title 10, United States Code.
``(F) A medical care program of the Indian Health
Service or of a tribal organization.
``(G) A State health benefits risk pool.
``(H) A health plan offered under chapter 89 of
title 5, United States Code.
``(I) A public health plan (as defined in
regulations).
``(J) A health benefit plan under section 5(e) of
the Peace Corps Act (22 U.S.C. 2504(e)).
Such term does not include coverage consisting solely of
coverage of excepted benefits (as defined in section 2791(c)).
``(2) Not counting periods before significant breaks in
coverage.--
``(A) In general.--A period of creditable coverage
shall not be counted, with respect to enrollment of an
individual under a group or individual health plan, if,
after such period and before the enrollment date, there
was a 63-day period during all of which the individual
was not covered under any creditable coverage.
``(B) Waiting period not treated as a break in
coverage.--For purposes of subparagraph (A) and
subsection (d)(4), any period that an individual is in
a waiting period for any coverage under a group or
individual health plan (or for group health insurance
coverage) or is in an affiliation period (as defined in
subsection (g)(2)) shall not be taken into account in
determining the continuous period under subparagraph
(A).
``(C) TAA-eligible individuals.--In the case of
plan years beginning before January 1, 2014--
``(i) TAA pre-certification period rule.--
In the case of a TAA-eligible individual, the
period beginning on the date the individual has
a TAA-related loss of coverage and ending on
the date that is 7 days after the date of the
issuance by the Secretary (or by any person or
entity designated by the Secretary) of a
qualified health insurance costs credit
eligibility certificate for such individual for
purposes of section 7527 of the Internal
Revenue Code of 1986 shall not be taken into
account in determining the continuous period
under subparagraph (A).
``(ii) Definitions.--The terms `TAA-
eligible individual' and `TAA-related loss of
coverage' have the meanings given such terms in
section 2205(b)(4).
``(3) Method of crediting coverage.--
``(A) Standard method.--Except as otherwise
provided under subparagraph (B), for purposes of
applying subsection (a)(3), a group health plan, and a
health insurance issuer offering group or individual
health insurance coverage, shall count a period of
creditable coverage without regard to the specific
benefits covered during the period.
``(B) Election of alternative method.--A group
health plan, or a health insurance issuer offering
group or individual health insurance, may elect to
apply subsection (a)(3) based on coverage of benefits
within each of several classes or categories of
benefits specified in regulations rather than as
provided under subparagraph (A). Such election shall be
made on a uniform basis for all participants and
beneficiaries. Under such election a group or
individual health plan or issuer shall count a period
of creditable coverage with respect to any class or
category of benefits if any level of benefits is
covered within such class or category.
``(C) Plan notice.--In the case of an election with
respect to a group health plan under subparagraph (B)
(whether or not health insurance coverage is provided
in connection with such plan), the plan shall--
``(i) prominently state in any disclosure
statements concerning the plan, and state to
each enrollee at the time of enrollment under
the plan, that the plan has made such election;
and
``(ii) include in such statements a
description of the effect of this election.
``(D) Issuer notice.--In the case of an election
under subparagraph (B) with respect to health insurance
coverage offered by an issuer in the individual or
group market, the issuer--
``(i) shall prominently state in any
disclosure statements concerning the coverage,
and to each employer at the time of the offer
or sale of the coverage, that the issuer has
made such election; and
``(ii) shall include in such statements a
description of the effect of such election.
``(4) Establishment of period.--Periods of creditable
coverage with respect to an individual shall be established
through presentation of certifications described in subsection
(e) or in such other manner as may be specified in regulations.
``(d) Exceptions.--
``(1) Exclusion not applicable to certain newborns.--
Subject to paragraph (4), a group health plan, and a health
insurance issuer offering group or individual health insurance
coverage, may not impose any preexisting condition exclusion in
the case of an individual who, as of the last day of the 30-day
period beginning with the date of birth, is covered under
creditable coverage.
``(2) Exclusion not applicable to certain adopted
children.--Subject to paragraph (4), a group health plan, and a
health insurance issuer offering group or individual health
insurance coverage, may not impose any preexisting condition
exclusion in the case of a child who is adopted or placed for
adoption before attaining 18 years of age and who, as of the
last day of the 30-day period beginning on the date of the
adoption or placement for adoption, is covered under creditable
coverage. The previous sentence shall not apply to coverage
before the date of such adoption or placement for adoption.
``(3) Exclusion not applicable to pregnancy.--A group
health plan, and health insurance issuer offering group or
individual health insurance coverage, may not impose any
preexisting condition exclusion relating to pregnancy as a
preexisting condition.
``(4) Loss if break in coverage.--Paragraphs (1) and (2)
shall no longer apply to an individual after the end of the
first 63-day period during all of which the individual was not
covered under any creditable coverage.
``(e) Certifications and Disclosure of Coverage.--
``(1) Requirement for certification of period of creditable
coverage.--
``(A) In general.--A group health plan, and a
health insurance issuer offering group or individual
health insurance coverage, shall provide the
certification described in subparagraph (B)--
``(i) at the time an individual ceases to
be covered under the plan or otherwise becomes
covered under a COBRA continuation provision;
``(ii) in the case of an individual
becoming covered under such a provision, at the
time the individual ceases to be covered under
such provision; and
``(iii) on the request on behalf of an
individual made not later than 24 months after
the date of cessation of the coverage described
in clause (i) or (ii), whichever is later.
The certification under clause (i) may be provided, to
the extent practicable, at a time consistent with
notices required under any applicable COBRA
continuation provision.
``(B) Certification.--The certification described
in this subparagraph is a written certification of--
``(i) the period of creditable coverage of
the individual under such plan and the coverage
(if any) under such COBRA continuation
provision; and
``(ii) the waiting period (if any) (and
affiliation period, if applicable) imposed with
respect to the individual for any coverage
under such plan.
``(C) Issuer compliance.--To the extent that
medical care under a group health plan consists of
group health insurance coverage, the plan is deemed to
have satisfied the certification requirement under this
paragraph if the health insurance issuer offering the
coverage provides for such certification in accordance
with this paragraph.
``(2) Disclosure of information on previous benefits.--In
the case of an election described in subsection (c)(3)(B) by a
group health plan or health insurance issuer, if the plan or
issuer enrolls an individual for coverage under the plan and
the individual provides a certification of coverage of the
individual under paragraph (1)--
``(A) upon request of such plan or issuer, the
entity which issued the certification provided by the
individual shall promptly disclose to such requesting
plan or issuer information on coverage of classes and
categories of health benefits available under such
entity's plan or coverage; and
``(B) such entity may charge the requesting plan or
issuer for the reasonable cost of disclosing such
information.
``(3) Regulations.--The Secretary shall establish rules to
prevent an entity's failure to provide information under
paragraph (1) or (2) with respect to previous coverage of an
individual from adversely affecting any subsequent coverage of
the individual under another group health plan or health
insurance coverage.
``(f) Special Enrollment Periods.--
``(1) Individuals losing other coverage.--A group health
plan, and a health insurance issuer offering group health
insurance coverage in connection with a group health plan,
shall permit an employee who is eligible, but not enrolled, for
coverage under the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not enrolled, for
coverage under such terms) to enroll for coverage under the
terms of the plan if each of the following conditions is met:
``(A) The employee or dependent was covered under a
group health plan or had health insurance coverage at
the time coverage was previously offered to the
employee or dependent.
``(B) The employee stated in writing at such time
that coverage under a group health plan or health
insurance coverage was the reason for declining
enrollment, but only if the plan sponsor or issuer (if
applicable) required such a statement at such time and
provided the employee with notice of such requirement
(and the consequences of such requirement) at such
time.
``(C) The employee's or dependent's coverage
described in subparagraph (A)--
``(i) was under a COBRA continuation
provision and the coverage under such provision
was exhausted; or
``(ii) was not under such a provision and
either the coverage was terminated as a result
of loss of eligibility for the coverage
(including as a result of legal separation,
divorce, death, termination of employment, or
reduction in the number of hours of employment)
or employer contributions toward such coverage
were terminated.
``(D) Under the terms of the plan, the employee
requests such enrollment not later than 30 days after
the date of exhaustion of coverage described in
subparagraph (C)(i) or termination of coverage or
employer contribution described in subparagraph
(C)(ii).
``(2) For dependent beneficiaries.--
``(A) In general.--If--
``(i) a group health plan makes coverage
available with respect to a dependent of an
individual;
``(ii) the individual is a participant
under the plan (or has met any waiting period
applicable to becoming a participant under the
plan and is eligible to be enrolled under the
plan but for a failure to enroll during a
previous enrollment period); and
``(iii) a person becomes such a dependent
of the individual through marriage, birth, or
adoption or placement for adoption,
the group health plan shall provide for a dependent
special enrollment period described in subparagraph (B)
during which the person (or, if not otherwise enrolled,
the individual) may be enrolled under the plan as a
dependent of the individual, and in the case of the
birth or adoption of a child, the spouse of the
individual may be enrolled as a dependent of the
individual if such spouse is otherwise eligible for
coverage.
``(B) Dependent special enrollment period.--A
dependent special enrollment period under this
subparagraph shall be a period of not less than 30 days
and shall begin on the later of--
``(i) the date dependent coverage is made
available; or
``(ii) the date of the marriage, birth, or
adoption or placement for adoption (as the case
may be) described in subparagraph (A)(iii).
``(C) No waiting period.--If an individual seeks to
enroll a dependent during the first 30 days of such a
dependent special enrollment period, the coverage of
the dependent shall become effective--
``(i) in the case of marriage, not later
than the first day of the first month beginning
after the date the completed request for
enrollment is received;
``(ii) in the case of a dependent's birth,
as of the date of such birth; or
``(iii) in the case of a dependent's
adoption or placement for adoption, the date of
such adoption or placement for adoption.
``(3) Special rules for application in case of medicaid and
chip.--
``(A) In general.--A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, shall
permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan (or a
dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such
terms) to enroll for coverage under the terms of the
plan if either of the following conditions is met:
``(i) Termination of medicaid or chip
coverage.--The employee or dependent is covered
under a Medicaid plan under title XIX of the
Social Security Act or under a State child
health plan under title XXI of such Act and
coverage of the employee or dependent under
such a plan is terminated as a result of loss
of eligibility for such coverage and the
employee requests coverage under the group
health plan (or health insurance coverage) not
later than 60 days after the date of
termination of such coverage.
``(ii) Eligibility for employment
assistance under medicaid or chip.--The
employee or dependent becomes eligible for
assistance, with respect to coverage under the
group health plan or health insurance coverage,
under such Medicaid plan or State child health
plan (including under any waiver or
demonstration project conducted under or in
relation to such a plan), if the employee
requests coverage under the group health plan
or health insurance coverage not later than 60
days after the date the employee or dependent
is determined to be eligible for such
assistance.
``(B) Coordination with medicaid and chip.--
``(i) Outreach to employees regarding
availability of medicaid and chip coverage.--
``(I) In general.--Each employer
that maintains a group health plan in a
State that provides medical assistance
under a State Medicaid plan under title
XIX of the Social Security Act, or
child health assistance under a State
child health plan under title XXI of
such Act, in the form of premium
assistance for the purchase of coverage
under a group health plan, shall
provide to each employee a written
notice informing the employee of
potential opportunities then currently
available in the State in which the
employee resides for premium assistance
under such plans for health coverage of
the employee or the employee's
dependents. For purposes of compliance
with this subclause, the employer may
use any State-specific model notice
developed in accordance with section
701(f)(3)(B)(i)(II) of the Employee
Retirement Income Security Act of 1974
(29 U.S.C. 1181(f)(3)(B)(i)(II)).
``(II) Option to provide concurrent
with provision of plan materials to
employee.--An employer may provide the
model notice applicable to the State in
which an employee resides concurrent
with the furnishing of materials
notifying the employee of health plan
eligibility, concurrent with materials
provided to the employee in connection
with an open season or election process
conducted under the plan, or concurrent
with the furnishing of the summary plan
description as provided in section
104(b) of the Employee Retirement
Income Security Act of 1974.
``(ii) Disclosure about group health plan
benefits to states for medicaid and chip
eligible individuals.--In the case of an
enrollee in a group health plan who is covered
under a Medicaid plan of a State under title
XIX of the Social Security Act or under a State
child health plan under title XXI of such Act,
the plan administrator of the group health plan
shall disclose to the State, upon request,
information about the benefits available under
the group health plan in sufficient
specificity, as determined under regulations of
the Secretary of Health and Human Services in
consultation with the Secretary that require
use of the model coverage coordination
disclosure form developed under section
311(b)(1)(C) of the Children's Health Insurance
Reauthorization Act of 2009, so as to permit
the State to make a determination (under
paragraph (2)(B), (3), or (10) of section
2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of
the State providing medical or child health
assistance through premium assistance for the
purchase of coverage under such group health
plan and in order for the State to provide
supplemental benefits required under paragraph
(10)(E) of such section or other authority.
``(g) Use of Affiliation Period by HMOs as Alternative to
Preexisting Condition Exclusion.--
``(1) In general.--A health maintenance organization which
offers health insurance coverage in connection with a group
health plan and which does not impose any preexisting condition
exclusion allowed under subsection (a) with respect to any
particular coverage option may impose an affiliation period for
such coverage option, but only if--
``(A) such period is applied uniformly without
regard to any health status-related factors; and
``(B) such period does not exceed 2 months (or 3
months in the case of a late enrollee).
``(2) Affiliation period.--
``(A) Defined.--For purposes of this title, the
term `affiliation period' means a period which, under
the terms of the health insurance coverage offered by
the health maintenance organization, must expire before
the health insurance coverage becomes effective. The
organization is not required to provide health care
services or benefits during such period and no premium
shall be charged to the participant or beneficiary for
any coverage during the period.
``(B) Beginning.--Such period shall begin on the
enrollment date.
``(C) Runs concurrently with waiting periods.--An
affiliation period under a plan shall run concurrently
with any waiting period under the plan.
``(3) Alternative methods.--A health maintenance
organization described in paragraph (1) may use alternative
methods, from those described in such paragraph, to address
adverse selection as approved by the State insurance
commissioner or official or officials designated by the State
to enforce the requirements of this part for the State involved
with respect to such issuer.
``SEC. 199A. EXTENSION OF DEPENDENT COVERAGE.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage that
provides dependent coverage of children shall continue to make such
coverage available for an adult child (who is not married) until the
child turns 26 years of age. Nothing in this section shall require a
health plan or a health insurance issuer described in the preceding
sentence to make coverage available for a child of a child receiving
dependent coverage.
``(b) Regulations.--The Secretary shall promulgate regulations to
define the dependents to which coverage shall be made available under
subsection (a).
``(c) Rule of Construction.--Nothing in this section shall be
construed to modify the definition of `dependent' as used in the
Internal Revenue Code of 1986 with respect to the tax treatment of the
cost of coverage.
``SEC. 199B. ANNUAL LIMITATION ON COST-SHARING.
``(a) In General.--
``(1) 2014.--The cost-sharing incurred under a group health
plan or group or individual health insurance coverage with
respect to self-only coverage or coverage other than self-only
coverage for a plan year beginning in 2014 shall not exceed the
dollar amounts in effect under section 223(c)(2)(A)(ii) of the
Internal Revenue Code of 1986 for self-only and family
coverage, respectively, for taxable years beginning in 2014.
``(2) 2015 and later.--In the case of any plan year
beginning in a calendar year after 2014, the limitation under
this paragraph shall--
``(A) in the case of self-only coverage, be equal
to the dollar amount under paragraph (1) for self-only
coverage for plan years beginning in 2014, increased by
an amount equal to the product of that amount and the
premium adjustment percentage under subsection (c) for
the calendar year; and
``(B) in the case of other coverage, twice the
amount in effect under subparagraph (A).
If the amount of any increase under subparagraph (A) is not a
multiple of $50, such increase shall be rounded to the next
lowest multiple of $50.
``(b) Cost-Sharing.--In this section:
``(1) In general.--The term `cost-sharing' includes--
``(A) deductibles, coinsurance, copayments, or
similar charges; and
``(B) any other expenditure required of an insured
individual which is a qualified medical expense (within
the meaning of section 223(d)(2) of the Internal
Revenue Code of 1986) with respect to essential health
benefits covered under the plan.
``(2) Exceptions.--Such term does not include premiums,
balance billing amounts for non-network providers, or spending
for non-covered services.
``(c) Premium Adjustment Percentage.--For purposes of subsection
(a)(2)(A), the premium adjustment percentage for any calendar year is
the percentage (if any) by which the average per capita premium for
health insurance coverage in the United States for the preceding
calendar year (as estimated by the Secretary no later than October 1 of
such preceding calendar year) exceeds such average per capita premium
for 2013 (as determined by the Secretary).
``SEC. 199C. ENFORCEMENT OF CERTAIN HEALTH INSURANCE REQUIREMENTS.
``(a) State Enforcement.--
``(1) State authority.--Each State may require that health
insurance issuers that issue, sell, renew, or offer health
insurance coverage in the State in the individual or group
market meet the requirements of this part with respect to such
issuers.
``(2) Failure to implement provisions.--In the case of a
determination by the Secretary that a State has failed to
substantially enforce a provision (or provisions) of sections
196 through 199A with respect to health insurance issuers in
the State, the Secretary shall enforce such provision (or
provisions) under subsection (b) insofar as they relate to the
issuance, sale, renewal, and offering of health insurance
coverage in connection with group health plans or individual
health insurance coverage in such State.
``(b) Secretarial Enforcement Authority.--
``(1) Limitation.--The provisions of this subsection shall
apply to enforcement of a provision (or provisions) described
in subsection (a)(2) only--
``(A) as provided under such subsection; and
``(B) with respect to individual health insurance
coverage or group health plans that are non-Federal
governmental plans.
``(2) Imposition of penalties.--In the cases described in
paragraph (1)--
``(A) In general.--Subject to the succeeding
provisions of this subsection, any non-Federal
governmental plan that is a group health plan and any
health insurance issuer that fails to meet a provision
of this part applicable to such plan or issuer is
subject to a civil money penalty under this subsection.
``(B) Liability for penalty.--In the case of a
failure by--
``(i) a health insurance issuer, the issuer
is liable for such penalty; or
``(ii) a group health plan that is a non-
Federal governmental plan which is--
``(I) sponsored by 2 or more
employers, the plan is liable for such
penalty; or
``(II) not so sponsored, the
employer is liable for such penalty.
``(C) Amount of penalty.--
``(i) In general.--The maximum amount of
penalty imposed under this paragraph is $100
for each day for each individual with respect
to which such a failure occurs.
``(ii) Considerations in imposition.--In
determining the amount of any penalty to be
assessed under this paragraph, the Secretary
shall take into account the previous record of
compliance of the entity being assessed with
the applicable provisions of this part and the
gravity of the violation.
``(iii) Limitations.--
``(I) Penalty not to apply where
failure not discovered exercising
reasonable diligence.--No civil money
penalty shall be imposed under this
paragraph on any failure during any
period for which it is established to
the satisfaction of the Secretary that
none of the entities against whom the
penalty would be imposed knew, or
exercising reasonable diligence would
have known, that such failure existed.
``(II) Penalty not to apply to
failures corrected within 30 days.--No
civil money penalty shall be imposed
under this paragraph on any failure if
such failure was due to reasonable
cause and not to willful neglect, and
such failure is corrected during the
30-day period beginning on the first
day any of the entities against whom
the penalty would be imposed knew, or
exercising reasonable diligence would
have known, that such failure existed.
``(D) Administrative review.--
``(i) Opportunity for hearing.--The entity
assessed shall be afforded an opportunity for
hearing by the Secretary upon request made
within 30 days after the date of the issuance
of a notice of assessment. In such hearing the
decision shall be made on the record pursuant
to section 554 of title 5, United States Code.
If no hearing is requested, the assessment
shall constitute a final and unappealable
order.
``(ii) Hearing procedure.--If a hearing is
requested, the initial agency decision shall be
made by an administrative law judge, and such
decision shall become the final order unless
the Secretary modifies or vacates the decision.
Notice of intent to modify or vacate the
decision of the administrative law judge shall
be issued to the parties within 30 days after
the date of the decision of the judge. A final
order which takes effect under this paragraph
shall be subject to review only as provided
under subparagraph (E).
``(E) Judicial review.--
``(i) Filing of action for review.--Any
entity against whom an order imposing a civil
money penalty has been entered after an agency
hearing under this paragraph may obtain review
by the United States district court for any
district in which such entity is located or the
United States District Court for the District
of Columbia by filing a notice of appeal in
such court within 30 days from the date of such
order, and simultaneously sending a copy of
such notice by registered mail to the
Secretary.
``(ii) Certification of administrative
record.--The Secretary shall promptly certify
and file in such court the record upon which
the penalty was imposed.
``(iii) Standard for review.--The findings
of the Secretary shall be set aside only if
found to be unsupported by substantial evidence
as provided by section 706(2)(E) of title 5,
United States Code.
``(iv) Appeal.--Any final decision, order,
or judgment of the district court concerning
such review shall be subject to appeal as
provided in chapter 83 of title 28 of such
Code.
``(F) Failure to pay assessment; maintenance of
action.--
``(i) Failure to pay assessment.--If any
entity fails to pay an assessment after it has
become a final and unappealable order, or after
the court has entered final judgment in favor
of the Secretary, the Secretary shall refer the
matter to the Attorney General who shall
recover the amount assessed by action in the
appropriate United States district court.
``(ii) Nonreviewability.--In such action
the validity and appropriateness of the final
order imposing the penalty shall not be subject
to review.
``(G) Payment of penalties.--Except as otherwise
provided, penalties collected under this paragraph
shall be paid to the Secretary (or other officer)
imposing the penalty and shall be available without
appropriation and until expended for the purpose of
enforcing the provisions with respect to which the
penalty was imposed.
``(3) Enforcement authority relating to genetic
discrimination.--
``(A) General rule.--In the cases described in
paragraph (1), notwithstanding the provisions of
paragraph (2)(C), the succeeding subparagraphs of this
paragraph shall apply with respect to an action under
this subsection by the Secretary with respect to any
failure of a health insurance issuer in connection with
a group health plan, to meet the requirements of
subsection (a)(1)(F), (b)(3), (c), or (d) of section
196 or section 197 or 196(b)(1) with respect to genetic
information in connection with the plan.
``(B) Amount.--
``(i) In general.--The amount of the
penalty imposed under this paragraph shall be
$100 for each day in the noncompliance period
with respect to each participant or beneficiary
to whom such failure relates.
``(ii) Noncompliance period.--For purposes
of this paragraph, the term `noncompliance
period' means, with respect to any failure, the
period--
``(I) beginning on the date such
failure first occurs; and
``(II) ending on the date the
failure is corrected.
``(C) Minimum penalties where failure discovered.--
Notwithstanding clauses (i) and (ii) of subparagraph
(D):
``(i) In general.--In the case of 1 or more
failures with respect to an individual--
``(I) which are not corrected
before the date on which the plan
receives a notice from the Secretary of
such violation; and
``(II) which occurred or continued
during the period involved;
the amount of penalty imposed by subparagraph
(A) by reason of such failures with respect to
such individual shall not be less than $2,500.
``(ii) Higher minimum penalty where
violations are more than de minimis.--To the
extent violations for which any person is
liable under this paragraph for any year are
more than de minimis, clause (i) shall be
applied by substituting `$15,000' for `$2,500'
with respect to such person.
``(D) Limitations.--
``(i) Penalty not to apply where failure
not discovered exercising reasonable
diligence.--No penalty shall be imposed by
subparagraph (A) on any failure during any
period for which it is established to the
satisfaction of the Secretary that the person
otherwise liable for such penalty did not know,
and exercising reasonable diligence would not
have known, that such failure existed.
``(ii) Penalty not to apply to failures
corrected within certain periods.--No penalty
shall be imposed by subparagraph (A) on any
failure if--
``(I) such failure was due to
reasonable cause and not to willful
neglect; and
``(II) such failure is corrected
during the 30-day period beginning on
the first date the person otherwise
liable for such penalty knew, or
exercising reasonable diligence would
have known, that such failure existed.
``(iii) Overall limitation for
unintentional failures.--In the case of
failures which are due to reasonable cause and
not to willful neglect, the penalty imposed by
subparagraph (A) for failures shall not exceed
the amount equal to the lesser of--
``(I) 10 percent of the aggregate
amount paid or incurred by the employer
(or predecessor employer) during the
preceding taxable year for group health
plans; or
``(II) $500,000.
``(E) Waiver by secretary.--In the case of a
failure which is due to reasonable cause and not to
willful neglect, the Secretary may waive part or all of
the penalty imposed by subparagraph (A) to the extent
that the payment of such penalty would be excessive
relative to the failure involved.
``(c) Definitions.--For purposes of this section:
``(1) Governmental plan.--The term `governmental plan' has
the meaning given such term under section 3(32) of the Employee
Retirement Income Security Act of 1974 and any Federal
governmental plan.
``(2) Federal governmental plan.--The term ``Federal
governmental plan'' means a governmental plan established or
maintained for its employees by the Government of the United
States or by any agency or instrumentality of such Government.
``(3) Non-federal governmental plan.--The term `non-Federal
governmental plan' means a governmental plan that is not a
Federal governmental plan.''.
(b) Conforming Amendment.--The table of contents under section 1(b)
of the Health Insurance Portability and Accountability Act of 1996
(Public Law 104-191) is amended by inserting after the item relating to
section 195 the following:
``Sec. 196. Guaranteed availability of coverage.
``Sec. 197. Fair health insurance premiums.
``Sec. 198. Prohibiting discrimination against individual participants
and beneficiaries based on health status.
``Sec. 199. Prohibition of preexisting condition exclusions or other
discrimination based on health status.
``Sec. 199A. Extension of dependent coverage.
``Sec. 199B. Annual limitation on cost-sharing.
``Sec. 199C. Enforcement of certain health insurance requirements.''.
(c) ERISA and IRC Enforcement.--
(1) ERISA.--Subpart B of part 7 of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.)
is amended by adding at the end the following new section:
``SEC. 716. OTHER MARKET REFORMS.
``Sections 196 and 197 of the Health Insurance Portability and
Accountability Act of 1996 shall apply to health insurance issuers
providing health insurance coverage in connection with group health
plans, and sections 198 through 199B of such Act shall apply to group
health plans and health insurance issuers providing health insurance
coverage in connection with group health plans, as if included in this
subpart, and to the extent that any provision of this part conflicts
with a provision of such section 196 or 197 with respect to health
insurance issuers providing health insurance coverage in connection
with group health plans or of such section 198, 199, 199A, or 199B with
respect to group health plans or health insurance issuers providing
health insurance coverage in connection with group health plans, the
provisions of such sections 196 through 199B shall apply.''.
(2) IRC.--Subchapter B of chapter 100 of subtitle K of
title 26 of the Internal Revenue Code of 1986 is amended by
adding at the end the following new section:
``SEC. 9816. OTHER MARKET REFORMS.
``Sections 196 and 197 of the Health Insurance Portability and
Accountability Act of 1996 shall apply to health insurance issuers
providing health insurance coverage in connection with group health
plans, and sections 198 through 199B of such Act shall apply to group
health plans and health insurance issuers providing health insurance
coverage in connection with group health plans, as if included in this
subchapter, and to the extent that any provision of this chapter
conflicts with a provision of such section 196 or 197 with respect to
health insurance issuers providing health insurance coverage in
connection with group health plans or of such section 198, 199, 199A,
or 199B with respect to group health plans or health insurance issuers
providing health insurance coverage in connection with group health
plans, the provisions of such sections 196 through 199B shall apply.''.
(d) Effective Date.--The amendments made by this section shall take
effect on the date on which the Supreme Court of the United States
issues a decision striking down the Patient Protection and Affordable
Care Act (Public Law 111-148) in its entirety.
Subtitle B--Expanding Coverage Options
SEC. 211. DEFINITION OF ``EMPLOYER'' UNDER ERISA WITH RESPECT TO GROUP
HEALTH PLANS.
(a) Definition of Employer.--Section 3(5) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1002(5)) is amended
by striking the period and inserting ``(which, with respect to a group
health plan, shall be determined in accordance with criteria that
includes the criteria under section 735).''.
(b) Group Health Plans.--Part 7 of subtitle B of title I of the
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 et
seq.) is amended by adding at the end the following:
``SEC. 735. DEFINITION OF `EMPLOYER' WITH RESPECT TO GROUP HEALTH
PLANS.
``(a) In General.--A group or association of employers that meets
the criteria under subsection (b) shall be considered an employer under
section 3(5) for purposes of sponsoring a group health plan.
``(b) Requirements.--The requirements under this subsection are
each of the following:
``(1) The primary purpose of the group or association may
be to offer and provide health coverage to its employer members
and their employees, if such group or association has at least
1 substantial business purpose, as described in subsection (c),
unrelated to offering and providing health coverage or other
employee benefits to its employer members and their employees.
``(2) Each employer member of the group or association
participating in the group health plan is a person acting
directly as an employer of at least 1 employee who is a
participant covered under the plan.
``(3) The group or association has--
``(A) a formal organizational structure with a
governing body; and
``(B) by-laws or other similar indications of
formality.
``(4) The functions and activities of the group or
association shall be controlled by the employer members of the
group or association, and the employer members of the group or
association that participate in the group health plan shall
control the plan. Control under this paragraph shall be in form
and substance.
``(5) The employer members shall have a commonality of
interest as described in subsection (d).
``(6)(A) The group or association shall not make health
coverage through the group health plan available other than
to--
``(i) an employee of a current employer member of
the group or association;
``(ii) a former employee of a current employer
member of the group or association who became eligible
for coverage under the group health plan when the
former employee was an employee of the employer; and
``(iii) a beneficiary of an individual described in
clause (i) or (ii), such as a spouse or dependent
child.
``(B) Notwithstanding subparagraph (A), the group or
association shall not make health coverage through the group
health plan available to any individual (or beneficiaries of
the individual) for any plan year following the plan year in
which the plan determines pursuant to reasonable monitoring
procedures described in subsection (f)(2)(C) that the
individual ceases to meet the conditions described in
subsection (f)(2) for being a working owner (unless the
individual again meets those conditions), except as may be
required by section 601.
``(7) The group or association, and any health coverage
offered by the group or association, shall comply with the
nondiscrimination provisions under subsection (e).
``(8) The group or association shall not be a health
insurance issuer, or owned or controlled by such a health
insurance issuer or by a subsidiary or affiliate of such a
health insurance issuer, other than to the extent such entities
participate in the group or association in their capacity as
employer members of the group or association.
``(c) Substantial Business Purpose.--
``(1) In general.--For purposes of subsection (b)(1), a
substantial business purpose shall exist if the group or
association would be a viable entity in the absence of
sponsoring an employee benefit plan.
``(2) Business purpose.--For purposes of subsection (b)(1)
and paragraph (1), a business purpose shall--
``(A) include promoting common business interests
of the members of the group or association or the
common economic interests in a given trade or employer
community; and
``(B) not be required to be a for-profit activity.
``(d) Commonality of Interest.--
``(1) In general.--Subject to paragraph (3), employer
members of the group or association shall be treated as having
a commonality of interest for purposes of subsection (b)(5)
if--
``(A) the employers are in the same trade,
industry, line of business, or profession; or
``(B) each employer has a principal place of
business in the same region that does not exceed the
boundaries of a single State or a metropolitan area
(even if the metropolitan area includes more than 1
State).
``(2) Same trade, industry, or line of business.--In the
case of a group or association that is sponsoring a group
health plan under this section and that is itself an employer
member of the group or association, the group or association
shall be deemed for purposes of paragraph (1)(A) to be in the
same trade, industry, line of business, or profession, as
applicable, as the other employer members of the group or
association.
``(3) Nondiscrimination.--The standards under paragraph (1)
shall not be implemented in a manner that is subterfuge for
discrimination as is prohibited under subsection (e).
``(e) Nondiscrimination.--
``(1) In general.--A group or association of employers
sponsoring a group health plan under this section, and any
health coverage sponsored by such group or association, shall
comply with each of the following:
``(A) The group or association shall not condition
employer membership in the group or association on any
health factor of any individual who is or may become
eligible to participate in the group health plan
sponsored by the group or association.
``(B) The group health plan sponsored by the group
or association shall comply with the rules under
section 2590.702(b) of title 29, Code of Federal
Regulations (as in effect on June 21, 2018), with
respect to nondiscrimination in rules for eligibility
for benefits, subject to subparagraph (D).
``(C) The group health plan sponsored by the group
or association shall comply with the rules under
section 2590.702(c) of title 29, Code of Federal
Regulations (as in effect on June 21, 2018), with
respect to nondiscrimination in premiums or
contributions required by any participant or
beneficiary for coverage under the plan, subject to
subparagraph (D).
``(D) In applying subparagraphs (B) and (C), the
group or association may not treat the employees of
different employer members of the group or association
as distinct groups of similarly situated individuals
based on a health factor of 1 or more individuals.
``(2) Definition of health factor.--For purposes of this
subsection, the term `health factor' has the meaning given such
term in section 2590.702(a) of title 29, Code of Federal
Regulations (as in effect on June 21, 2018).
``(f) Dual Treatment of Working Owners as Employers and
Employees.--
``(1) In general.--A person determined in accordance with
paragraph (2) to be a working owner of a trade or business may
qualify as both an employer and as an employee of the trade or
business for purposes of the requirements under subsection (b),
including the requirements under paragraphs (2) and (6) of such
subsection.
``(2) Working owner.--
``(A) Eligibility.--A person shall qualify as a
`working owner' if a responsible fiduciary of the group
health plan reasonably determines that the person--
``(i) does not have any common law
employees;
``(ii) has an ownership right of any nature
in a trade or business, whether incorporated or
unincorporated, including a partner and other
self-employed individual;
``(iii) is earning wages or self-employment
income from the trade or business for providing
personal services to the trade or business; and
``(iv) either--
``(I) works on average at least 20
hours per week, or at least 80 hours
per month, providing personal services
to the person's trade or business; or
``(II) has wages or self-employment
income from such trade or business that
at least equals the person's cost of
coverage for participation by the
person, and any covered beneficiaries,
in the group health plan sponsored by
the group or association in which the
person is participating.
``(B) Determination.--The determination under
subparagraph (A) shall be made when the person first
becomes eligible for coverage under the group health
plan.
``(C) Reasonable monitoring procedures.--A
responsible fiduciary of the group health plan shall,
through reasonable monitoring procedures, periodically
confirm the continued eligibility of a person to
qualify as a working owner under subparagraph (A) for
purposes of meeting the requirements under subsection
(b) for the group health plan sponsored under this
section.
``(g) Applicability.--
``(1) Fully insured.--This section shall apply beginning on
September 1, 2026, with respect to a group or association of
employers sponsoring a group health plan that is fully insured.
``(2) Plans expanding to include broader group.--This
section shall apply beginning on January 1, 2026, with respect
to a group or association of employers sponsoring a group
health plan that--
``(A) is not fully insured;
``(B) is in existence on June 21, 2025;
``(C) meets the requirements that applied with
respect to such plan before June 21, 2025; and
``(D) chooses to be a plan sponsored under this
section (and subject to the requirements under
subsections (b) through (f)).
``(3) Other association health plans.--This section shall
apply beginning on April 1, 2026, with respect to any other
group or association of employers sponsoring a group health
plan.
``(4) Other criteria in advisory opinions.--The criteria
under this section shall not invalidate any criteria provided
in an advisory opinion, in effect on or after the date of
enactment of the Fair Care Act of 2026, that the Secretary may
use to determine if a group or association of employers is an
employer under section 3(5) for purposes of sponsoring a group
health plan.
``(h) Determination of Employer or Joint Employer Status.--
``(1) In general.--Participating in or facilitating a group
health plan sponsored by a bona fide group or association of
employers pursuant to subsection (a) shall not be construed as
establishing an employer or joint employer relationship under
any Federal or State law.
``(2) Application of provision.--Paragraph (1) shall apply
to a group health plan sponsored or facilitated by a franchisor
and any franchisee, by multiple franchisors for the benefit of
the employees of such franchisors and their franchisees, by
multiple franchisees for the benefit of the employees of such
franchisees, by a franchisor whose franchisee or franchisees
participate or participates in the plan, or by a person or
entity that contracts with any individual as an independent
contractor for whom the plan benefits.
``(i) Rule of Construction.--Nothing in this section shall be
construed as repealing or otherwise limiting the application of this
Act (including section 712 relating to mental health parity) to group
health plans and employee welfare benefit plans.''.
SEC. 212. SHORT-TERM LIMITED DURATION INSURANCE.
(a) Definition.--Section 2791(b) of the Public Health Service Act
(42 U.S.C. 300gg-91(b)) is amended by adding at the end the following:
``(6) Short-term limited duration insurance.--The term
`short-term limited duration insurance' means health insurance
coverage provided pursuant to a contract with a health
insurance issuer that has an expiration date specified in the
contract (not taking into account any extensions that may be
elected by the policyholder with or without the issuer's
consent) that is less than 12 months after the original
effective date of the contract.''.
(b) Guaranteed Renewability.--Section 2703 of the Public Health
Service Act (42 U.S.C. 300gg-2) is amended--
(1) in subsection (a), by inserting ``or offers short-term
limited duration insurance'' after ``group market''; and
(2) by adding at the end the following:
``(f) Application to Short-Term Limited Duration Insurance.--
``(1) In general.--In applying this section in the case of
short-term limited duration insurance--
``(A) a reference to `health insurance coverage'
with respect to such coverage offered in the individual
market shall be deemed to include short-term limited
duration insurance; and
``(B) a reference to `health insurance issuer' with
respect to health insurance coverage offered in the
individual market shall be deemed to include an issuer
of short-term limited duration insurance.
``(2) Special rule for short-term limited duration
insurance.--In the case of short-term limited duration
insurance, at the time of application for enrollment in such
insurance coverage, an issuer of such insurance may offer
renewability of such coverage, and an individual may decline
renewability of such coverage in accordance with this section,
and the contract between such individual and the health
insurance issuer shall specify whether the individual opted for
renewability or no renewability.''.
(c) Applicability.--The amendments made by subsections (a) and (b)
shall apply with respect to contracts for short-term limited duration
insurance that take effect on or after January 1, 2026.
Subtitle C--Improving Commercial Health Insurance
SEC. 221. INVISIBLE GUARANTEED COVERAGE POOL REINSURANCE PROGRAM; TAX
ON EXCHANGE PLANS.
(a) Establishment.--Not later than 2 years after the date of
enactment of this Act, the Secretary of Health and Human Services shall
establish the Invisible Guaranteed Coverage Pool Reinsurance Program
(in this section referred to as the ``IGCPR program'').
(b) State Grants.--Under the IGCPR program, the Secretary shall,
from amounts appropriated under subsection (f) for a fiscal year, award
grants to States for such fiscal year, in amounts determined in
accordance with the allocation methodology specified under subsection
(d). Such grants shall be used for the purpose of establishing or
maintaining a qualifying Invisible Guaranteed Coverage Pool for the
State.
(c) Federal Default.--
(1) In general.--In the case of a State that does not, by a
date and in a manner specified by the Secretary, choose to be
awarded a grant under subsection (b) for a fiscal year to
operate a qualifying Invisible Guaranteed Coverage Pool for the
State, the Secretary shall, from amounts appropriated under
subsection (f) for such fiscal year, use the allocation
determined for the State under subsection (d) for participation
of such State in the Federal default qualifying Invisible
Guaranteed Coverage Pool described in paragraph (2).
(2) Federal default qualifying invisible guaranteed
coverage pool.--The Federal default qualifying high risk pool
is, with respect to each State that chooses not to be awarded a
grant under subsection (b) with respect to a fiscal year for
which funds are appropriated under subsection (f), an Invisible
Guaranteed Coverage Pool under which health insurance issuers
participating in the Exchange of such a State, with respect to
designated individuals who are enrolled in health insurance
coverage and are expected to experience higher than average
health costs as determined by the insurer, cede risk to the
pool, without affecting the premium paid by the designated
individuals or their terms of coverage. With respect to such
pool--
(A) high-risk individuals designated for cession to
the pool shall be designated by the ceding issuer;
(B) the premium amount the ceding issuer shall pay
to the reinsurance pool shall be 90 percent of the
premium paid to the issuer for the coverage;
(C) the ceding issuer shall retain the same risk
under the ceded policies as under any other policy of
the issuer with respect to the first $10,000 of
benefits for each ceded policy involved and will not
retain any risk under ceded policies after such first
$10,000 of benefits; and
(D) after a ceding issuer, with respect to a ceded
policy, no longer retains risk under such policy
pursuant to subparagraph (C), the negotiated rate under
such policy for items and services shall be payable at
the reimbursement rate under the Medicare program under
title XVIII of the Social Security Act for such items
and services, or in the case of items and services for
which payment is available under the policy but not the
Medicare program, at a rate determined by the
Secretary.
(d) Allocation Methodology.--Not later than six months after the
establishment of the IGCPR program, the Secretary shall specify an
allocation methodology for determining the amount of funds appropriated
under subsection (f) for a fiscal year to be allocated for each State
for purposes of subsections (b) and (c). Such methodology shall be
based on the number of residents of each State and the general health
status of such residents.
(e) Qualifying Invisible Guaranteed Coverage Pool.--For purposes of
this section, the term ``qualifying Invisible Guaranteed Coverage
Pool'' means, with respect to a State, a method of designation under
which health insurance issuers identify individuals who experience
higher than average health costs as determined by the State and are
enrolled in health insurance coverage offered in the individual market,
and cede the risk of spending more than $10,000 on health care services
for a single individual to the pool without affecting the premium paid
by the designated individuals or their terms of coverage. With respect
to such pool, the State, or an entity operating the pool on behalf of
the State, shall establish--
(1) the premium amount the ceding issuer shall pay to the
reinsurance pool;
(2) the applicable attachment points or coinsurance
percentages if the ceding issuer retains any portion of the
risk under ceded policies, except that the provisions of
subparagraphs (C) and (D) of subsection (c)(2) shall apply to
such high risk pool in the same manner as such clauses apply to
the Federal default high risk pool; and
(3) the mechanism by which high-risk individuals are
designated for cession to the pool, which may include a list of
designated high-cost health conditions.
(f) Appropriations.--There is appropriated to the Secretary of
Health and Human Services $200,000,000,000 to carry out this section
for the period of the first 10 years after the establishment of the
IGCPR program.
(g) Tax on Health Insurance Plans Sold on Exchanges.--
(1) In general.--Chapter 34 of the Internal Revenue Code of
1986 is amended by adding at the end the following new
subchapter:
``Subchapter C--Additional Tax on Health Insurance Plans Sold by
Insurers Offering Plans on Exchanges
``Sec. 4401. Additional tax on health insurance plans sold by insurers
offering plans on exchanges.
``SEC. 4401. ADDITIONAL TAX ON HEALTH INSURANCE PLANS SOLD BY INSURERS
OFFERING PLANS ON EXCHANGES.
``(a) Imposition of Tax.--There is imposed a tax of $4 for each
policy month of each health insurance policy sold by insurers offering
plans through an Exchange established under the Patient Protection and
Affordable Care Act.
``(b) Liability.--The tax imposed by subsection (a) shall be paid
by the plan sponsor.''.
(2) Conforming amendment.--The table of subchapters for
chapter 34 of the Internal Revenue Code of 1986 is amended by
adding at the end the following item:
``subchapter c--additional tax on health insurance plans sold by
insurers offering plans on exchanges''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to months beginning after the date of
enactment of this Act.
(h) Report.--The Secretary of Health and Human Services, in
collaboration with the Comptroller General of the United States, shall
submit to Congress, not later than 5 years after the date of enactment
of this Act, and again 5 years thereafter, a report on the status of
reinsurance pool funding, along with any recommendations with respect
to future allocations or funding methods for such pool.
SEC. 222. EMPLOYER HEALTH INSURANCE MANDATE REPEAL.
(a) In General.--Chapter 43 of the Internal Revenue Code of 1986 is
amended by striking section 4980H.
(b) Repeal of Related Reporting Requirements.--Subpart D of part
III of subchapter A of chapter 61 of such Code is amended by striking
section 6056.
(c) Conforming Amendments.--
(1) Section 6724(d)(1)(B) of such Code is amended by
inserting ``or'' at the end of clause (xxiii), by striking
``or'' at the end of clause (xxiv), and by striking clause
(xxv).
(2) Section 6724(d)(2) of such Code is amended by inserting
``or'' at the end of subparagraph (GG) and by striking
subparagraph (HH).
(3) The table of sections for chapter 43 of such Code is
amended by striking the item relating to section 4980H.
(4) The table of sections for subpart D of part III of
subchapter A of chapter 61 of such Code is amended by striking
the item relating to section 6056.
(5) Section 1513 of the Patient Protection and Affordable
Care Act is amended by striking subsection (c).
(d) Effective Date.--
(1) In general.--Except as otherwise provided in this
subsection, the amendments made by this section shall apply to
months and other periods beginning after December 31, 2026.
(2) Repeal of study and report.--The amendment made by
subsection (c)(5) shall take effect on the date of the
enactment of this Act.
SEC. 223. REFUNDABLE CREDITS FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN
FOR INDIVIDUALS OFFERED EMPLOYER-SPONSORED INSURANCE.
(a) In General.--Section 36B(c)(2) of the Internal Revenue Code of
1986 is amended--
(1) in subparagraph (B)(i), by inserting ``or section
5000A(f)(1)(B)'', and
(2) by striking subparagraph (C).
(b) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
SEC. 224. INCLUSION IN INCOME OF CERTAIN COSTS OF EMPLOYER-PROVIDED
COVERAGE UNDER HEALTH PLANS.
(a) In General.--Section 106 of the Internal Revenue Code of 1986
is amended by adding at the end the following new subsection:
``(h) Limitation.--
``(1) In general.--Subsection (a) shall not apply to the
extent that employer-provided coverage under health plans for
an employee for a taxable year exceeds--
``(A) $10,200 for self-only coverage, and
``(B) $27,500 for all other coverage.
``(2) In general.--In the case of any calendar year after
2026, the dollar amounts in paragraph (1) shall each be
increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for such calendar year,
determined--
``(i) by substituting `calendar year 2025'
for `calendar year 2018' in subparagraph
(A)(ii) thereof, and
``(ii) by substituting for the C-CPI-U
referred to in section 1(f)(3)(A) the amount
that such CPI would have been if the annual
percentage increase in CPI with respect to each
year after 2024 and before 2034 had been one
percentage point greater.
``(3) Terms related to cpi.--
``(A) Annual percentage increase.--For purposes of
subparagraph (B)(ii)(II), the term `annual percentage
increase' means the percentage (if any) by which C-CPI-
U for any year exceeds the C-CPI-U for the prior year.
``(B) Other terms.--Terms used in this paragraph
which are also used in section 1(f)(3) shall have the
same meanings as when used in such section.''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to taxable years beginning after December 31, 2026.
SEC. 225. CHANGE IN PERMISSIBLE AGE VARIATION IN HEALTH INSURANCE
PREMIUM RATES.
Section 2701(a)(1)(A)(iii) of the Public Health Service Act (42
U.S.C. 300gg(a)(1)(A)(iii)) is amended by inserting after ``(consistent
with section 2707(c))'' the following: ``or, for plan years beginning
on or after January 1, 2026, as the Secretary may implement through
interim final regulation, 5 to 1 for adults (consistent with section
2707(c))''.
SEC. 226. PREMIUM ASSISTANCE ADJUSTMENT TO REFLECT AGE.
(a) Modification of Applicable Percentage.--Section 36B(b)(3)(A) of
the Internal Revenue Code of 1986 is amended to read as follows:
``(A) Applicable percentage.--
``(i) In general.--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
percentage to the final percentage specified in
such table for such income tier with respect to
a taxpayer of the age involved:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
``In the case of Up to Age 29 Age 30-39 Age 40-49 Age 50-59 Over Age 59
household income ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(expressed as a
percent of the
poverty line)
within the Initial % Final % Initial % Final % Initial % Final % Initial % Final % Initial % Final %
following income
tier:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Up to 100% 0............... 0............... 0............... 0.............. 0.............. 0.............. 0.............. 0.............. 0.............. 0
100%-133% 2............... 2............... 2............... 2.............. 2.............. 2.............. 2.............. 2.............. 2.............. 2
133%-150% 3............... 4.3............. 3............... 4.3............ 3.............. 4.3............ 3.............. 4.3............ 3.............. 4.3
150%-200% 4.3............. 6.7............. 4.3............. 6.7............ 4.3............ 6.7............ 4.3............ 6.7............ 4.3............ 6.7
200%-250% 6.7............. 6.7............. 6.7............. 7.6............ 6.7............ 8.3............ 6.7............ 8.3............ 6.7............ 8.3
250%-300% 6.7............. 6.7............. 7.6............. 7.6............ 8.3............ 9.8............ 8.3............ 9.8............ 8.3............ 9.8
300%-400% 6.7............. 7............... 7.6............. 8.............. 9.8............ 10............. 9.8............ 10............. 9.8............ 10
400%-600% 7............... 9............... 8............... 10............. 10............. 15............. 10............. 15............. 10............. 15
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
``(ii) Age determinations.--
``(I) In general.--For purposes of
clause (i), the age of the taxpayer
taken into account under clause (i)
with respect to any taxable year is the
age attained by such taxpayer before
the close of such taxable year.
``(II) Joint returns.--In the case
of a joint return, the age of the older
spouse shall be taken into account
under clause (i).
``(iii) Indexing.--In the case of any
taxable year beginning after calendar year
2026, the initial and final percentages
contained in clause (i) shall be adjusted to
reflect--
``(I) the excess (if any) of the
rate of premium growth for the period
beginning with calendar year 2013 and
ending with calendar year 2025, over
the rate of income growth for such
period, and
``(II) in addition to any
adjustment under subclause (I), the
excess (if any) of the rate of premium
growth for calendar year 2025, over the
rate of growth in the consumer price
index for calendar year 2025.
``(iv) Failsafe.--Clause (iii)(II) shall
apply only if the aggregate amount of premium
tax credits under this section and cost-sharing
reductions under section 1402 of the Patient
Protection and Affordable Care Act for the
preceding calendar year exceeds an amount equal
to 0.504 percent of the gross domestic product
for such calendar year.''.
(b) Expansion of Eligibility.--Section 36B of the Internal Revenue
Code of 1986 is amended--
(1) in subsection (c)(1)(A), by striking ``400'' and
inserting ``600''; and
(2) in subsection (f)(2)(B)(i), by striking ``400'' each
place such reference appears and inserting ``600'' in each such
place.
(c) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2026.
SEC. 227. PREMIUM ASSISTANCE.
Notwithstanding any other provision of law, the Secretary of the
Treasury shall calculate the credit allowable under section 36B of the
Internal Revenue Code of 1986 based on the taxpayer's prior year tax
return and the Secretary of Health and Human Services shall provide for
open enrollment periods that end on April 15.
SEC. 228. ADDING COPPER PLANS TO EXCHANGES.
(a) In General.--Section 1302 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18022) is amended--
(1) in subsection (a)(3), by inserting ``copper,'' after
``either the'';
(2) in subsection (c), by adding at the end the following
new paragraph:
``(5) Special rule for copper plans.--A health plan in the
copper level of coverage (as described in subsection (d)(1)(E))
shall be deemed to meet the requirements of this subsection.'';
(3) in subsection (d)--
(A) in paragraph (1), by adding at the end the
following new subparagraph:
``(E) Copper level.--A plan in the copper level
shall provide a level of coverage that is designed to
provide benefits that are actuarially equivalent to 50
percent of the full actuarial value of the benefits
provided under the plan and will have out-of-pocket
limits that are 30 percent higher than bronze plans.'';
and
(B) in paragraph (4)--
(i) by inserting ``copper,'' after ``any
reference to a''; and
(ii) by inserting ``copper,'' after
``providing a''; and
(4) in subsection (e)(1), by inserting ``copper,'' after
``not providing a''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2026.
SEC. 229. COPPER AND BRONZE PLANS.
Notwithstanding any other provision of law, refundable credits for
coverage under a qualified health plan and cost-sharing reductions may
be used to purchase bronze and copper plans.
SEC. 230. WAIVERS FOR STATE INNOVATION.
(a) Streamlining the State Application Process.--Section 1332 of
the Patient Protection and Affordable Care Act (42 U.S.C. 18052) is
amended--
(1) in subsection (a)(1)(C), by striking ``the law'' and
inserting ``a law or has in effect a certification''; and
(2) in subsection (b)(2)--
(A) in the paragraph heading, by inserting ``or
certify'' after ``law'';
(B) in subparagraph (A)--
(i) by striking ``A law'' and inserting the
following:
``(i) Laws.--A law''; and
(ii) by adding at the end the following:
``(ii) Certifications.--A certification
described in this paragraph is a document,
signed by the Governor of the State, that
certifies that such Governor has the authority
under existing Federal and State law to take
action under this section, including
implementation of the State plan under
subsection (a)(1)(B).''; and
(C) in subparagraph (B)--
(i) in the subparagraph heading, by
striking ``of opt out''; and
(ii) by striking ``may repeal a law'' and
all that follows through the period at the end
and inserting the following: ``may terminate
the authority provided under the waiver with
respect to the State by--
``(i) repealing a law described in
subparagraph (A)(i); or
``(ii) terminating a certification
described in subparagraph (A)(ii), through a
certification for such termination signed by
the Governor of the State.''.
(b) Providing Expedited Approval of State Waivers.--Section 1332(d)
of the Patient Protection and Affordable Care Act (42 U.S.C. 18052(d))
is amended--
(1) in paragraph (1) by striking ``180'' and inserting
``90''; and
(2) by adding at the end the following:
``(3) Expedited determination.--
``(A) In general.--With respect to any application
under subsection (a)(1) submitted on or after the date
of this paragraph or any such application submitted
prior to such date of enactment and under review by the
Secretary on such date of enactment, the Secretary
shall make a determination on such application, using
the criteria for approval otherwise applicable under
this section, not later than 45 days after the receipt
of such application, and shall allow the public notice
and comment at the State and Federal levels described
under subsection (a)(4) to occur concurrently if such
State application--
``(i) is submitted in response to an urgent
situation, with respect to areas in the State
that the Secretary determines are at risk for
excessive premium increases or having no health
plans offered in the applicable health
insurance market for the current or following
plan year; or
``(ii) is for a waiver that is the same or
substantially similar to a waiver that the
Secretary already has approved for another
State.
``(B) Approval.--
``(i) Urgent situations.--
``(I) Provisional approval.--A
waiver approved under the expedited
determination process under
subparagraph (A)(i) shall be in effect
for a period of 3 years, unless the
State requests a shorter duration.
``(II) Full approval.--Subject to
the requirements for approval otherwise
applicable under this section, not
later than 1 year before the expiration
of a provisional waiver period
described in subclause (I) with respect
to an application described in
subparagraph (A)(i), the Secretary
shall make a determination on whether
to extend the approval of such waiver
for the full term of the waiver
requested by the State, for a total
approval period not to exceed 6 years.
The Secretary may request additional
information as the Secretary determines
appropriate to make such determination.
``(ii) Approval of same or similar
applications.--An approval of a waiver under
subparagraph (A)(ii) shall be subject to the
terms of subsection (e).
``(C) GAO study.--Not later than 5 years after the
date of enactment of this paragraph, the Comptroller
General of the United States shall conduct a review of
all waivers approved pursuant to an application under
subparagraph (A)(ii) to evaluate whether such waivers
met the requirements of subsection (b)(1) and whether
the applications should have qualified for such
expedited process.''.
(c) Providing Certainty for State-Based Reforms.--Section 1332(e)
of the Patient Protection and Affordable Care Act (42 U.S.C. 18052(e))
is amended by striking ``No waiver'' and all that follows through the
period at the end and inserting the following: ``A waiver under this
section--
``(1) shall be in effect for a period of 6 years unless the
State requests a shorter duration;
``(2) may be renewed, subject to the State meeting the
criteria for approval otherwise applicable under this section,
for unlimited additional 6-year periods upon application by the
State; and
``(3) may not be suspended or terminated, in whole or in
part, by the Secretary at any time before the date of
expiration of the waiver period (including any renewal period
under paragraph (2)), unless the Secretary determines that the
State materially failed to comply with the terms and conditions
of the waiver.''.
(d) Ensuring Patient Access to More Flexible Health Plans.--Section
1332(b)(1)(B) of the Patient Protection and Affordable Care Act (42
U.S.C. 18052(b)(1)(B)) is amended by striking ``at least as
affordable'' and inserting ``of comparable affordability, including for
low-income individuals, individuals with serious health needs, and
other vulnerable populations,''.
(e) Applicability.--The amendments made by this Act to section 1332
of the Patient Protection and Affordable Care Act (42 U.S.C. 18052)--
(1) with respect to applications for waivers under such
section 1332 submitted after the date of enactment of this Act
and applications for such waivers submitted prior to such date
of enactment and under review by the Secretary on the date of
enactment, shall take effect on the date of enactment of this
Act; and
(2) with respect to applications for waivers approved under
such section 1332 before the date of enactment of this Act,
shall not require reconsideration of whether such applications
meet the requirements of such section 1332, except that, at the
request of a State, the Secretary shall recalculate the amount
of funding provided under subsection (a)(3) of such section.
SEC. 231. ENROLLMENT PERIODS.
(a) Exchanges.--Paragraph (7) of section 1311(c) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(c)), as added by
section 106, is amended by adding at the end the following new
subparagraph:
``(B) Enrollments other than during initial, open,
and special enrollment periods.--Beginning with plan
year 2026, an Exchange may provide for enrollments
during periods in addition to open enrollment periods
described in subparagraph (A) or paragraph (6) and
special enrollment periods described in paragraph
(6).''.
(b) Health Plans.--Subpart I of part A of title XXVII of the Public
Health Service Act is amended by adding at the end the following new
section:
``SEC. 2710. ENROLLMENT OUTSIDE OF INITIAL, OPEN, AND SPECIAL
ENROLLMENT PERIOD.
``Beginning with plan year 2026, a group health plan and a health
insurance issuer offering group or individual health insurance coverage
may provide for enrollment in such plan or coverage during periods in
addition to initial, open, or special enrollment periods. In the case
that an individual enrolls in such plan or coverage during a period
pursuant to the previous sentence, the plan or issuer may charge the
individual a one-time enrollment fee.''.
SEC. 232. STATE-OPERATED EXCHANGES FLEXIBILITY FOR OPEN ENROLLMENT
PERIODS.
Section 1311(c) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031(c)) is amended--
(1) in paragraph (6), by striking ``The Secretary'' and
inserting ``Subject to paragraph (7), the Secretary''; and
(2) by adding at the end the following new paragraph:
``(7) Flexibility for enrollment periods.--
``(A) State-operated exchanges open enrollment
periods.--In the case of an Exchange operated by a
State, beginning with plan years of 1 year after the
date of enactment of this Act, the Exchange may provide
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Status
In Committee
- 1Introduced
- 2Committee
- 3Floor
- 4Passed
- 5Signed
Timeline reflects current normalized status only. Full action history is not yet stored in the API.
Sponsors
- Rep. Westerman, Bruce [R-AR-4]RHouseAR
Cosponsors
No cosponsors on record.
Votes
Voting records are not yet available for this bill.