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<\/p>\nWashington, DC…The House Republicans narrowly advanced the “American Healthcare Act” on to the Senate. Many of the Obamacare mandates have been stripped in this bill including individual and employer mandates. The full text of the bill in its’ current form is below.<\/p>\n
<\/p>\n
Union Calendar No. 30
\n115th CONGRESS
\n 1st Session
\n H. R. 1628<\/p>\n
[Report No. 115-52]<\/p>\n
To provide for reconciliation pursuant to title II of the concurrent
\n resolution on the budget for fiscal year 2017.<\/p>\n
_______________________________________________________________________<\/p>\n
IN THE HOUSE OF REPRESENTATIVES<\/p>\n
March 20, 2017<\/p>\n
Mrs. Black from the Committee on the Budget, reported the following
\n bill; which was committed to the Committee of the Whole House on the
\n State of the Union and ordered to be printed<\/p>\n
_______________________________________________________________________<\/p>\n
A BILL<\/p>\n
To provide for reconciliation pursuant to title II of the concurrent
\n resolution on the budget for fiscal year 2017.<\/p>\n
Be it enacted by the Senate and House of Representatives of the
\nUnited States of America in Congress assembled,<\/p>\n
SECTION 1. SHORT TITLE.<\/p>\n
This Act may be cited as the “American Health Care Act of 2017”.<\/p>\n
SEC. 2. TABLE OF CONTENTS.<\/p>\n
The table of contents of this Act is as follows:<\/p>\n
Sec. 1. Short title.
\nSec. 2. Table of contents.
\n TITLE I–ENERGY AND COMMERCE<\/p>\n
Subtitle A–Patient Access to Public Health Programs<\/p>\n
Sec. 101. The Prevention and Public Health Fund.
\nSec. 102. Community health center program.
\nSec. 103. Federal payments to States.
\n Subtitle B–Medicaid Program Enhancement<\/p>\n
Sec. 111. Repeal of Medicaid provisions.
\nSec. 112. Repeal of Medicaid expansion.
\nSec. 113. Elimination of DSH cuts.
\nSec. 114. Reducing State Medicaid costs.
\nSec. 115. Safety net funding for non-expansion States.
\nSec. 116. Providing incentives for increased frequency of eligibility
\n redeterminations.
\n Subtitle C–Per Capita Allotment for Medical Assistance<\/p>\n
Sec. 121. Per capita allotment for medical assistance.
\n Subtitle D–Patient Relief and Health Insurance Market Stability<\/p>\n
Sec. 131. Repeal of cost-sharing subsidy.
\nSec. 132. Patient and State Stability Fund.
\nSec. 133. Continuous health insurance coverage incentive.
\nSec. 134. Increasing coverage options.
\nSec. 135. Change in permissible age variation in health insurance
\n premium rates.
\n TITLE II–COMMITTEE ON WAYS AND MEANS<\/p>\n
Subtitle A–Repeal and Replace of Health-Related Tax Policy<\/p>\n
Sec. 201. Recapture excess advance payments of premium tax credits.
\nSec. 202. Additional modifications to premium tax credit.
\nSec. 203. Premium tax credit.
\nSec. 204. Small business tax credit.
\nSec. 205. Individual mandate.
\nSec. 206. Employer mandate.
\nSec. 207. Repeal of the tax on employee health insurance premiums and
\n health plan benefits.
\nSec. 208. Repeal of tax on over-the-counter medications.
\nSec. 209. Repeal of increase of tax on health savings accounts.
\nSec. 210. Repeal of limitations on contributions to flexible spending
\n accounts.
\nSec. 211. Repeal of medical device excise tax.
\nSec. 212. Repeal of elimination of deduction for expenses allocable to
\n medicare part D subsidy.
\nSec. 213. Repeal of increase in income threshold for determining
\n medical care deduction.
\nSec. 214. Repeal of Medicare tax increase.
\nSec. 215. Refundable tax credit for health insurance coverage.
\nSec. 216. Maximum contribution limit to health savings account
\n increased to amount of deductible and out-
\n of-pocket limitation.
\nSec. 217. Allow both spouses to make catch-up contributions to the same
\n health savings account.
\nSec. 218. Special rule for certain medical expenses incurred before
\n establishment of health savings account.
\n Subtitle B–Repeal of Certain Consumer Taxes<\/p>\n
Sec. 221. Repeal of tax on prescription medications.
\nSec. 222. Repeal of health insurance tax.
\n Subtitle C–Repeal of Tanning Tax<\/p>\n
Sec. 231. Repeal of tanning tax.
\n Subtitle D–Remuneration From Certain Insurers<\/p>\n
Sec. 241. Remuneration from certain insurers.
\n Subtitle E–Repeal of Net Investment Income Tax<\/p>\n
Sec. 251. Repeal of net investment income tax.<\/p>\n
TITLE I–ENERGY AND COMMERCE<\/p>\n
Subtitle A–Patient Access to Public Health Programs<\/p>\n
SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND.<\/p>\n
(a) In General.–Subsection (b) of section 4002 of the Patient
\nProtection and Affordable Care Act (42 U.S.C. 300u-11), as amended by
\nsection 5009 of the 21st Century Cures Act, is amended–
\n (1) in paragraph (2), by adding “and” at the end;
\n (2) in paragraph (3)–
\n (A) by striking “each of fiscal years 2018 and
\n 2019” and inserting “fiscal year 2018”; and
\n (B) by striking the semicolon at the end and
\n inserting a period; and
\n (3) by striking paragraphs (4) through (8).
\n (b) Rescission of Unobligated Funds.–Of the funds made available
\nby such section 4002, the unobligated balance at the end of fiscal year
\n2018 is rescinded.<\/p>\n
SEC. 102. COMMUNITY HEALTH CENTER PROGRAM.<\/p>\n
Effective as if included in the enactment of the Medicare Access
\nand CHIP Reauthorization Act of 2015 (Public Law 114-10, 129 Stat. 87),
\nparagraph (1) of section 221(a) of such Act is amended by inserting “,
\nand an additional $422,000,000 for fiscal year 2017” after “2017”.<\/p>\n
SEC. 103. FEDERAL PAYMENTS TO STATES.<\/p>\n
(a) In General.–Notwithstanding section 504(a), 1902(a)(23),
\n1903(a), 2002, 2005(a)(4), 2102(a)(7), or 2105(a)(1) of the Social
\nSecurity Act (42 U.S.C. 704(a), 1396a(a)(23), 1396b(a), 1397a,
\n1397d(a)(4), 1397bb(a)(7), 1397ee(a)(1)), or the terms of any Medicaid
\nwaiver in effect on the date of enactment of this Act that is approved
\nunder section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315,
\n1396n), for the 1-year period beginning on the date of the enactment of
\nthis Act, no Federal funds provided from a program referred to in this
\nsubsection that is considered direct spending for any year may be made
\navailable to a State for payments to a prohibited entity, whether made
\ndirectly to the prohibited entity or through a managed care
\norganization under contract with the State.
\n (b) Definitions.–In this section:
\n (1) Prohibited entity.–The term “prohibited entity”
\n means an entity, including its affiliates, subsidiaries,
\n successors, and clinics–
\n (A) that, as of the date of enactment of this Act–
\n (i) is an organization described in section
\n 501(c)(3) of the Internal Revenue Code of 1986
\n and exempt from tax under section 501(a) of
\n such Code;
\n (ii) is an essential community provider
\n described in section 156.235 of title 45, Code
\n of Federal Regulations (as in effect on the
\n date of enactment of this Act), that is
\n primarily engaged in family planning services,
\n reproductive health, and related medical care;
\n and
\n (iii) provides for abortions, other than an
\n abortion–
\n (I) if the pregnancy is the result
\n of an act of rape or incest; or
\n (II) in the case where a woman
\n suffers from a physical disorder,
\n physical injury, or physical illness
\n that would, as certified by a
\n physician, place the woman in danger of
\n death unless an abortion is performed,
\n including a life-endangering physical
\n condition caused by or arising from the
\n pregnancy itself; and
\n (B) for which the total amount of Federal and State
\n expenditures under the Medicaid program under title XIX
\n of the Social Security Act in fiscal year 2014 made
\n directly to the entity and to any affiliates,
\n subsidiaries, successors, or clinics of the entity, or
\n made to the entity and to any affiliates, subsidiaries,
\n successors, or clinics of the entity as part of a
\n nationwide health care provider network, exceeded
\n $350,000,000.
\n (2) Direct spending.–The term “direct spending” has the
\n meaning given that term under section 250(c) of the Balanced
\n Budget and Emergency Deficit Control Act of 1985 (2 U.S.C.
\n 900(c)).<\/p>\n
Subtitle B–Medicaid Program Enhancement<\/p>\n
SEC. 111. REPEAL OF MEDICAID PROVISIONS.<\/p>\n
The Social Security Act is amended–
\n (1) in section 1902 (42 U.S.C. 1396a)–
\n (A) in subsection (a)(47)(B), by inserting “and
\n provided that any such election shall cease to be
\n effective on January 1, 2020, and no such election
\n shall be made after that date” before the semicolon at
\n the end; and
\n (B) in subsection (l)(2)(C), by inserting “and
\n ending December 31, 2019,” after “January 1, 2014,”;
\n (2) in section 1915(k)(2) (42 U.S.C. 1396n(k)(2)), by
\n striking “during the period described in paragraph (1)” and
\n inserting “on or after the date referred to in paragraph (1)
\n and before January 1, 2020”; and
\n (3) in section 1920(e) (42 U.S.C. 1396r-1(e)), by striking
\n “under clause (i)(VIII), clause (i)(IX), or clause (ii)(XX) of
\n subsection (a)(10)(A)” and inserting “under clause (i)(VIII)
\n or clause (ii)(XX) of section 1902(a)(10)(A) before January 1,
\n 2020, section 1902(a)(10)(A)(i)(IX),”.<\/p>\n
SEC. 112. REPEAL OF MEDICAID EXPANSION.<\/p>\n
(a) In General.–Section 1902(a)(10)(A) of the Social Security Act
\n(42 U.S.C. 1396a(a)(10)(A)) is amended–
\n (1) in clause (i)(VIII), by inserting “at the option of a
\n State,” after “January 1, 2014,”; and
\n (2) in clause (ii)(XX), by inserting “and ending December
\n 31, 2019,” after “2014,”.
\n (b) Termination of EFMAP for New ACA Expansion Enrollees.–Section
\n1905 of the Social Security Act (42 U.S.C. 1396d) is amended–
\n (1) in subsection (y)(1), in the matter preceding
\n subparagraph (A), by striking “with respect to” and all that
\n follows through “shall be” and inserting “with respect to
\n amounts expended before January 1, 2020, by such State for
\n medical assistance for newly eligible individuals described in
\n subclause (VIII) of section 1902(a)(10)(A)(i) who are enrolled
\n under the State plan (or a waiver of the plan) before such date
\n and with respect to amounts expended after such date by such
\n State for medical assistance for individuals described in such
\n subclause who were enrolled under such plan (or waiver of such
\n plan) as of December 31, 2019, and who do not have a break in
\n eligibility for medical assistance under such State plan (or
\n waiver) for more than one month after such date, shall be”;
\n and
\n (2) in subsection (z)(2)–
\n (A) in subparagraph (A), by striking “medical
\n assistance for individuals” and all that follows
\n through “shall be” and inserting “amounts expended
\n before January 1, 2020, by such State for medical
\n assistance for individuals described in section
\n 1902(a)(10)(A)(i)(VIII) who are nonpregnant childless
\n adults with respect to whom the State may require
\n enrollment in benchmark coverage under section 1937 and
\n who are enrolled under the State plan (or a waiver of
\n the plan) before such date and with respect to amounts
\n expended after such date by such State for medical
\n assistance for individuals described in such section,
\n who are nonpregnant childless adults with respect to
\n whom the State may require enrollment in benchmark
\n coverage under section 1937, who were enrolled under
\n such plan (or waiver of such plan) as of December 31,
\n 2019, and who do not have a break in eligibility for
\n medical assistance under such State plan (or waiver)
\n for more than one month after such date, shall be”;
\n and
\n (B) in subparagraph (B)(ii)–
\n (i) in subclause (III), by adding “and”
\n at the end; and
\n (ii) by striking subclauses (IV), (V), and
\n (VI) and inserting the following new subclause:
\n “(IV) 2017 and each subsequent year is 80
\n percent.”.
\n (c) Sunset of Essential Health Benefits Requirement.–Section
\n1937(b)(5) of the Social Security Act (42 U.S.C. 1396u-7(b)(5)) is
\namended by adding at the end the following: “This paragraph shall not
\napply after December 31, 2019.”.<\/p>\n
SEC. 113. ELIMINATION OF DSH CUTS.<\/p>\n
Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f))
\nis amended–
\n (1) in paragraph (7)–
\n (A) in subparagraph (A)–
\n (i) in clause (i)–
\n (I) in the matter preceding
\n subclause (I), by striking “2025” and
\n inserting “2019”; and
\n (ii) in clause (ii)–
\n (I) in subclause (I), by adding
\n “and” at the end;
\n (II) in subclause (II), by striking
\n the semicolon at the end and inserting
\n a period; and
\n (III) by striking subclauses (III)
\n through (VIII); and
\n (B) by adding at the end the following new
\n subparagraph:
\n “(C) Exemption from exemption for non-expansion
\n states.–
\n “(i) In general.–In the case of a State
\n that is a non-expansion State for a fiscal
\n year, subparagraph (A)(i) shall not apply to
\n the DSH allotment for such State and fiscal
\n year.
\n “(ii) No change in reduction for expansion
\n states.–In the case of a State that is an
\n expansion State for a fiscal year, the DSH
\n allotment for such State and fiscal year shall
\n be determined as if clause (i) did not apply.
\n “(iii) Non-expansion and expansion state
\n defined.–
\n “(I) The term `expansion State’
\n means with respect to a fiscal year, a
\n State that, as of July 1 of the
\n preceding fiscal year, provides for
\n eligibility under clause (i)(VIII) or
\n (ii)(XX) of section 1902(a)(10)(A) for
\n medical assistance under this title (or
\n a waiver of the State plan approved
\n under section 1115).
\n “(II) The term `non-expansion
\n State’ means, with respect to a fiscal
\n year, a State that is not an expansion
\n State.”; and
\n (2) in paragraph (8), by striking “fiscal year 2025” and
\n inserting “fiscal year 2019”.<\/p>\n
SEC. 114. REDUCING STATE MEDICAID COSTS.<\/p>\n
(a) Letting States Disenroll High Dollar Lottery Winners.–
\n (1) In general.–Section 1902 of the Social Security Act
\n (42 U.S.C. 1396a) is amended–
\n (A) in subsection (a)(17), by striking “(e)(14),
\n (e)(14)” and inserting “(e)(14), (e)(15)”; and
\n (B) in subsection (e)–
\n (i) in paragraph (14) (relating to modified
\n adjusted gross income), by adding at the end
\n the following new subparagraph:
\n “(J) Treatment of certain lottery winnings and
\n income received as a lump sum.–
\n “(i) In general.–In the case of an
\n individual who is the recipient of qualified
\n lottery winnings (pursuant to lotteries
\n occurring on or after January 1, 2020) or
\n qualified lump sum income (received on or after
\n such date) and whose eligibility for medical
\n assistance is determined based on the
\n application of modified adjusted gross income
\n under subparagraph (A), a State shall, in
\n determining such eligibility, include such
\n winnings or income (as applicable) as income
\n received–
\n “(I) in the month in which such
\n winnings or income (as applicable) is
\n received if the amount of such winnings
\n or income is less than $80,000;
\n “(II) over a period of 2 months if
\n the amount of such winnings or income
\n (as applicable) is greater than or
\n equal to $80,000 but less than $90,000;
\n “(III) over a period of 3 months
\n if the amount of such winnings or
\n income (as applicable) is greater than
\n or equal to $90,000 but less than
\n $100,000; and
\n “(IV) over a period of 3 months
\n plus 1 additional month for each
\n increment of $10,000 of such winnings
\n or income (as applicable) received, not
\n to exceed a period of 120 months (for
\n winnings or income of $1,260,000 or
\n more), if the amount of such winnings
\n or income is greater than or equal to
\n $100,000.
\n “(ii) Counting in equal installments.–For
\n purposes of subclauses (II), (III), and (IV) of
\n clause (i), winnings or income to which such
\n subclause applies shall be counted in equal
\n monthly installments over the period of months
\n specified under such subclause.
\n “(iii) Hardship exemption.–An individual
\n whose income, by application of clause (i),
\n exceeds the applicable eligibility threshold
\n established by the State, may continue to be
\n eligible for medical assistance to the extent
\n that the State determines, under procedures
\n established by the State under the State plan
\n (or in the case of a waiver of the plan under
\n section 1115, incorporated in such waiver), or
\n as otherwise established by such State in
\n accordance with such standards as may be
\n specified by the Secretary, that the denial of
\n eligibility of the individual would cause an
\n undue medical or financial hardship as
\n determined on the basis of criteria established
\n by the Secretary.
\n “(iv) Notifications and assistance
\n required in case of loss of eligibility.–A
\n State shall, with respect to an individual who
\n loses eligibility for medical assistance under
\n the State plan (or a waiver of such plan) by
\n reason of clause (i), before the date on which
\n the individual loses such eligibility, inform
\n the individual of the date on which the
\n individual would no longer be considered
\n ineligible by reason of such clause to receive
\n medical assistance under the State plan or
\n under any waiver of such plan and the date on
\n which the individual would be eligible to
\n reapply to receive such medical assistance.
\n “(v) Qualified lottery winnings defined.–
\n In this subparagraph, the term `qualified
\n lottery winnings’ means winnings from a
\n sweepstakes, lottery, or pool described in
\n paragraph (3) of section 4402 of the Internal
\n Revenue Code of 1986 or a lottery operated by a
\n multistate or multijurisdictional lottery
\n association, including amounts awarded as a
\n lump sum payment.
\n “(vi) Qualified lump sum income defined.–
\n In this subparagraph, the term `qualified lump
\n sum income’ means income that is received as a
\n lump sum from one of the following sources:
\n “(I) Monetary winnings from
\n gambling (as defined by the Secretary
\n and including monetary winnings from
\n gambling activities described in
\n section 1955(b)(4) of title 18, United
\n States Code).
\n “(II) Income received as liquid
\n assets from the estate (as defined in
\n section 1917(b)(4)) of a deceased
\n individual.”; and
\n (ii) by striking “(14) Exclusion” and
\n inserting “(15) Exclusion”.
\n (2) Rules of construction.–
\n (A) Interception of lottery winnings allowed.–
\n Nothing in the amendment made by paragraph (1)(B)(i)
\n shall be construed as preventing a State from
\n intercepting the State lottery winnings awarded to an
\n individual in the State to recover amounts paid by the
\n State under the State Medicaid plan under title XIX of
\n the Social Security Act for medical assistance
\n furnished to the individual.
\n (B) Applicability limited to eligibility of
\n recipient of lottery winnings or lump sum income.–
\n Nothing in the amendment made by paragraph (1)(B)(i)
\n shall be construed, with respect to a determination of
\n household income for purposes of a determination of
\n eligibility for medical assistance under the State plan
\n under title XIX of the Social Security Act (42 U.S.C.
\n 1396 et seq.) (or a waiver of such plan) made by
\n applying modified adjusted gross income under
\n subparagraph (A) of section 1902(e)(14) of such Act (42
\n U.S.C. 1396a(e)(14)), as limiting the eligibility for
\n such medical assistance of any individual that is a
\n member of the household other than the individual (or
\n the individual’s spouse) who received qualified lottery
\n winnings or qualified lump-sum income (as defined in
\n subparagraph (J) of such section 1902(e)(14), as added
\n by paragraph (1)(B)(i) of this subsection).
\n (b) Repeal of Retroactive Eligibility.–
\n (1) In general.–
\n (A) State plan requirements.–Section 1902(a)(34)
\n of the Social Security Act (42 U.S.C. 1396a(a)(34)) is
\n amended by striking “in or after the third month
\n before the month in which he made application” and
\n inserting “in or after the month in which the
\n individual made application”.
\n (B) Definition of medical assistance.–Section
\n 1905(a) of the Social Security Act (42 U.S.C. 1396d(a))
\n is amended by striking “in or after the third month
\n before the month in which the recipient makes
\n application for assistance” and inserting “in or
\n after the month in which the recipient makes
\n application for assistance”.
\n (2) Effective date.–The amendments made by paragraph (1)
\n shall apply to medical assistance with respect to individuals
\n whose eligibility for such assistance is based on an
\n application for such assistance made (or deemed to be made) on
\n or after October 1, 2017.
\n (c) Ensuring States Are Not Forced to Pay for Individuals
\nIneligible for the Program.–
\n (1) In general.–Section 1137(f) of the Social Security Act
\n (42 U.S.C. 1320b-7(f)) is amended–
\n (A) by striking “Subsections (a)(1) and (d)” and
\n inserting “(1) Subsections (a)(1) and (d)”; and
\n (B) by adding at the end the following new
\n paragraph:
\n “(2)(A) Subparagraphs (A) and (B)(ii) of subsection (d)(4) shall
\nnot apply in the case of an initial determination made on or after the
\ndate that is 6 months after the date of the enactment of this paragraph
\nwith respect to the eligibility of an alien described in subparagraph
\n(B) for benefits under the program listed in subsection (b)(2).
\n “(B) An alien described in this subparagraph is an individual
\ndeclaring to be a citizen or national of the United States with respect
\nto whom a State, in accordance with section 1902(a)(46)(B), requires–
\n “(i) pursuant to 1902(ee), the submission of a social
\n security number; or
\n “(ii) pursuant to 1903(x), the presentation of
\n satisfactory documentary evidence of citizenship or
\n nationality.”.
\n (2) No payments for medical assistance provided before
\n presentation of evidence.–Section 1903(i)(22) of the Social
\n Security Act (42 U.S.C. 1396b(i)(22)) is amended–
\n (A) by striking “with respect to amounts
\n expended” and inserting “(A) with respect to amounts
\n expended”;
\n (B) by inserting “and” at the end; and
\n (C) by adding at the end the following new
\n subparagraph:
\n “(B) in the case of a State that elects to provide a
\n reasonable period to present satisfactory documentary evidence
\n of such citizenship or nationality pursuant to paragraph (2)(C)
\n of section 1902(ee) or paragraph (4) of subsection (x) of this
\n section, for amounts expended for medical assistance for such
\n an individual (other than an individual described in paragraph
\n (2) of such subsection (x)) during such period;”.
\n (3) Conforming amendments.–Section 1137(d)(4) of the
\n Social Security Act (42 U.S.C. 1320b-7(d)(4)) is amended–
\n (A) in subparagraph (A), in the matter preceding
\n clause (i), by inserting “subject to subsection
\n (f)(2),” before “the State”; and
\n (B) in subparagraph (B)(ii), by inserting “subject
\n to subsection (f)(2),” before “pending such
\n verification”.
\n (d) Updating Allowable Home Equity Limits in Medicaid.–
\n (1) In general.–Section 1917(f)(1) of the Social Security
\n Act (42 U.S.C. 1396p(f)(1)) is amended–
\n (A) in subparagraph (A), by striking
\n “subparagraphs (B) and (C)” and inserting
\n “subparagraph (B)”;
\n (B) by striking subparagraph (B);
\n (C) by redesignating subparagraph (C) as
\n subparagraph (B); and
\n (D) in subparagraph (B), as so redesignated, by
\n striking “dollar amounts specified in this paragraph”
\n and inserting “dollar amount specified in subparagraph
\n (A)”.
\n (2) Effective date.–
\n (A) In general.–The amendments made by paragraph
\n (1) shall apply with respect to eligibility
\n determinations made after the date that is 180 days
\n after the date of the enactment of this section.
\n (B) Exception for state legislation.–In the case
\n of a State plan under title XIX of the Social Security
\n Act that the Secretary of Health and Human Services
\n determines requires State legislation in order for the
\n respective plan to meet any requirement imposed by
\n amendments made by this subsection, the respective plan
\n shall not be regarded as failing to comply with the
\n requirements of such title solely on the basis of its
\n failure to meet such an additional requirement before
\n the first day of the first calendar quarter beginning
\n after the close of the first regular session of the
\n State legislature that begins after the date of the
\n enactment of this Act. For purposes of the previous
\n sentence, in the case of a State that has a 2-year
\n legislative session, each year of the session shall be
\n considered to be a separate regular session of the
\n State legislature.<\/p>\n
SEC. 115. SAFETY NET FUNDING FOR NON-EXPANSION STATES.<\/p>\n
Title XIX of the Social Security Act is amended by inserting after
\nsection 1923 (42 U.S.C. 1396r-4) the following new section:<\/p>\n
“adjustment in payment for services of safety net providers in non-
\n expansion states<\/p>\n
“Sec. 1923A. (a) In General.–Subject to the limitations of this
\nsection, for each year during the period beginning with 2018 and ending
\nwith 2021, each State that is one of the 50 States or the District of
\nColumbia and that, as of July 1 of the preceding year, did not provide
\nfor eligibility under clause (i)(VIII) or (ii)(XX) of section
\n1902(a)(10)(A) for medical assistance under this title (or a waiver of
\nthe State plan approved under section 1115) (each such State or
\nDistrict referred to in this section for the year as a `non-expansion
\nState’) may adjust the payment amounts otherwise provided under the
\nState plan under this title (or a waiver of such plan) to health care
\nproviders that provide health care services to individuals enrolled
\nunder this title (in this section referred to as `eligible providers’).
\n “(b) Increase in Applicable FMAP.–Notwithstanding section
\n1905(b), the Federal medical assistance percentage applicable with
\nrespect to expenditures attributable to a payment adjustment under
\nsubsection (a) for which payment is permitted under subsection (c)
\nshall be equal to–
\n “(1) 100 percent for calendar quarters in calendar years
\n 2018, 2019, 2020, and 2021; and
\n “(2) 95 percent for calendar quarters in calendar year
\n 2022.
\n “(c) Limitations; Disqualification of States.–
\n “(1) Annual allotment limitation.–Payment under section
\n 1903(a) shall not be made to a State with respect to any
\n payment adjustment made under this section for all calendar
\n quarters in a year in excess of the $2,000,000,000 multiplied
\n by the ratio of–
\n “(A) the population of the State with income below
\n 138 percent of the poverty line in 2015 (as determined
\n based the table entitled `Health Insurance Coverage
\n Status and Type by Ratio of Income to Poverty Level in
\n the Past 12 Months by Age’ for the universe of the
\n civilian noninstitutionalized population for whom
\n poverty status is determined based on the 2015 American
\n Community Survey 1-Year Estimates, as published by the
\n Bureau of the Census), to
\n “(B) the sum of the populations under subparagraph
\n (A) for all non-expansion States.
\n “(2) Limitation on payment adjustment amount for
\n individual providers.–The amount of a payment adjustment under
\n subsection (a) for an eligible provider may not exceed the
\n provider’s costs incurred in furnishing health care services
\n (as determined by the Secretary and net of payments under this
\n title, other than under this section, and by uninsured
\n patients) to individuals who either are eligible for medical
\n assistance under the State plan (or under a waiver of such
\n plan) or have no health insurance or health plan coverage for
\n such services.
\n “(d) Disqualification in Case of State Coverage Expansion.–If a
\nState is a non-expansion for a year and provides eligibility for
\nmedical assistance described in subsection (a) during the year, the
\nState shall no longer be treated as a non-expansion State under this
\nsection for any subsequent years.”.<\/p>\n
SEC. 116. PROVIDING INCENTIVES FOR INCREASED FREQUENCY OF ELIGIBILITY
\n REDETERMINATIONS.<\/p>\n
(a) In General.–Section 1902(e)(14) of the Social Security Act (42
\nU.S.C. 1396a(e)(14)) (relating to modified adjusted gross income), as
\namended by section 114(a)(1), is further amended by adding at the end
\nthe following:
\n “(K) Frequency of eligibility redeterminations.–
\n Beginning on October 1, 2017, and notwithstanding
\n subparagraph (H), in the case of an individual whose
\n eligibility for medical assistance under the State plan
\n under this title (or a waiver of such plan) is
\n determined based on the application of modified
\n adjusted gross income under subparagraph (A) and who is
\n so eligible on the basis of clause (i)(VIII) or clause
\n (ii)(XX) of subsection (a)(10)(A), a State shall
\n redetermine such individual’s eligibility for such
\n medical assistance no less frequently than once every 6
\n months.”.
\n (b) Civil Monetary Penalty.–Section 1128A(a) of the Social
\nSecurity Act (42 U.S.C. 1320a-7a(a)) is amended, in the matter
\nfollowing paragraph (10), by striking “(or, in cases under paragraph
\n(3)” and inserting the following: “(or, in cases under paragraph (1)
\nin which an individual was knowingly enrolled on or after October 1,
\n2017, pursuant to section 1902(a)(10)(A)(i)(VIII) for medical
\nassistance under the State plan under title XIX whose income does not
\nmeet the income threshold specified in such section or in which a claim
\nwas presented on or after October 1, 2017, as a claim for an item or
\nservice furnished to an individual described in such section but whose
\nenrollment under such State plan is not made on the basis of such
\nindividual’s meeting the income threshold specified in such section,
\n$20,000 for each such individual or claim; in cases under paragraph
\n(3)”.
\n (c) Increased Administrative Matching Percentage.–For each
\ncalendar quarter during the period beginning on October 1, 2017, and
\nending on December 31, 2019, the Federal matching percentage otherwise
\napplicable under section 1903(a) of the Social Security Act (42 U.S.C.
\n1396b(a)) with respect to State expenditures during such quarter that
\nare attributable to meeting the requirement of section 1902(e)(14)
\n(relating to determinations of eligibility using modified adjusted
\ngross income) of such Act shall be increased by 5 percentage points
\nwith respect to State expenditures attributable to activities carried
\nout by the State (and approved by the Secretary) to increase the
\nfrequency of eligibility redeterminations required by subparagraph (K)
\nof such section (relating to eligibility redeterminations made on a 6-
\nmonth basis) (as added by subsection (a)).<\/p>\n
Subtitle C–Per Capita Allotment for Medical Assistance<\/p>\n
SEC. 121. PER CAPITA ALLOTMENT FOR MEDICAL ASSISTANCE.<\/p>\n
Title XIX of the Social Security Act is amended–
\n (1) in section 1903 (42 U.S.C. 1396b)–
\n (A) in subsection (a), in the matter before
\n paragraph (1), by inserting “and section 1903A(a)”
\n after “except as otherwise provided in this section”;
\n and
\n (B) in subsection (d)(1), by striking “to which”
\n and inserting “to which, subject to section
\n 1903A(a),”; and
\n (2) by inserting after such section 1903 the following new
\n section:<\/p>\n
“SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR MEDICAL ASSISTANCE.<\/p>\n
“(a) Application of Per Capita Cap on Payments for Medical
\nAssistance Expenditures.–
\n “(1) In general.–If a State has excess aggregate medical
\n assistance expenditures (as defined in paragraph (2)) for a
\n fiscal year (beginning with fiscal year 2020), the amount of
\n payment to the State under section 1903(a)(1) for each quarter
\n in the following fiscal year shall be reduced by \\1\/4\\ of the
\n excess aggregate medical assistance payments (as defined in
\n paragraph (3)) for that previous fiscal year. In this section,
\n the term `State’ means only the 50 States and the District of
\n Columbia.
\n “(2) Excess aggregate medical assistance expenditures.–In
\n this subsection, the term `excess aggregate medical assistance
\n expenditures’ means, for a State for a fiscal year, the amount
\n (if any) by which–
\n “(A) the amount of the adjusted total medical
\n assistance expenditures (as defined in subsection
\n (b)(1)) for the State and fiscal year; exceeds
\n “(B) the amount of the target total medical
\n assistance expenditures (as defined in subsection (c))
\n for the State and fiscal year.
\n “(3) Excess aggregate medical assistance payments.–In
\n this subsection, the term `excess aggregate medical assistance
\n payments’ means, for a State for a fiscal year, the product
\n of–
\n “(A) the excess aggregate medical assistance
\n expenditures (as defined in paragraph (2)) for the
\n State for the fiscal year; and
\n “(B) the Federal average medical assistance
\n matching percentage (as defined in paragraph (4)) for
\n the State for the fiscal year.
\n “(4) Federal average medical assistance matching
\n percentage.–In this subsection, the term `Federal average
\n medical assistance matching percentage’ means, for a State for
\n a fiscal year, the ratio (expressed as a percentage) of–
\n “(A) the amount of the Federal payments that would
\n be made to the State under section 1903(a)(1) for
\n medical assistance expenditures for calendar quarters
\n in the fiscal year if paragraph (1) did not apply; to
\n “(B) the amount of the medical assistance
\n expenditures for the State and fiscal year.
\n “(b) Adjusted Total Medical Assistance Expenditures.–Subject to
\nsubsection (g), the following shall apply:
\n “(1) In general.–In this section, the term `adjusted
\n total medical assistance expenditures’ means, for a State–
\n “(A) for fiscal year 2016, the product of–
\n “(i) the amount of the medical assistance
\n expenditures (as defined in paragraph (2)) for
\n the State and fiscal year, reduced by the
\n amount of any excluded expenditures (as defined
\n in paragraph (3)) for the State and fiscal year
\n otherwise included in such medical assistance
\n expenditures; and
\n “(ii) the 1903A FY16 population percentage
\n (as defined in paragraph (4)) for the State; or
\n “(B) for fiscal year 2019 or a subsequent fiscal
\n year, the amount of the medical assistance expenditures
\n (as defined in paragraph (2)) for the State and fiscal
\n year that is attributable to 1903A enrollees, reduced
\n by the amount of any excluded expenditures (as defined
\n in paragraph (3)) for the State and fiscal year
\n otherwise included in such medical assistance
\n expenditures.
\n “(2) Medical assistance expenditures.–In this section,
\n the term `medical assistance expenditures’ means, for a State
\n and fiscal year, the medical assistance payments as reported by
\n medical service category on the Form CMS-64 quarterly expense
\n report (or successor to such a report form, and including
\n enrollment data and subsequent adjustments to any such report,
\n in this section referred to collectively as a `CMS-64 report’)
\n that directly result from providing medical assistance under
\n the State plan (including under a waiver of the plan) for which
\n payment is (or may otherwise be) made pursuant to section
\n 1903(a)(1).
\n “(3) Excluded expenditures.–In this section, the term
\n `excluded expenditures’ means, for a State and fiscal year,
\n expenditures under the State plan (or under a waiver of such
\n plan) that are attributable to any of the following:
\n “(A) DSH.–Payment adjustments made for
\n disproportionate share hospitals under section 1923.
\n “(B) Medicare cost-sharing.–Payments made for
\n medicare cost-sharing (as defined in section
\n 1905(p)(3)).
\n “(C) Safety net provider payment adjustments in
\n non-expansion states.–Payment adjustments under
\n subsection (a) of section 1923A for which payment is
\n permitted under subsection (c) of such section.
\n “(4) 1903A fy 16 population percentage.–In this
\n subsection, the term `1903A FY16 population percentage’ means,
\n for a State, the Secretary’s calculation of the percentage of
\n the actual medical assistance expenditures, as reported by the
\n State on the CMS-64 reports for calendar quarters in fiscal
\n year 2016, that are attributable to 1903A enrollees (as defined
\n in subsection (e)(1)).
\n “(c) Target Total Medical Assistance Expenditures.–
\n “(1) Calculation.–In this section, the term `target total
\n medical assistance expenditures’ means, for a State for a
\n fiscal year, the sum of the products, for each of the 1903A
\n enrollee categories (as defined in subsection (e)(2)), of–
\n “(A) the target per capita medical assistance
\n expenditures (as defined in paragraph (2)) for the
\n enrollee category, State, and fiscal year; and
\n “(B) the number of 1903A enrollees for such
\n enrollee category, State, and fiscal year, as
\n determined under subsection (e)(4).
\n “(2) Target per capita medical assistance expenditures.–
\n In this subsection, the term `target per capita medical
\n assistance expenditures’ means, for a 1903A enrollee category,
\n State, and a fiscal year, an amount equal to–
\n “(A) the provisional FY19 target per capita amount
\n for such enrollee category (as calculated under
\n subsection (d)(5)) for the State; increased by
\n “(B) the percentage increase in the medical care
\n component of the consumer price index for all urban
\n consumers (U.S. city average) from September of 2019 to
\n September of the fiscal year involved.
\n “(d) Calculation of FY19 Provisional Target Amount for Each 1903A
\nEnrollee Category.–Subject to subsection (g), the following shall
\napply:
\n “(1) Calculation of base amounts for fiscal year 2016.–
\n For each State the Secretary shall calculate (and provide
\n notice to the State not later than April 1, 2018, of) the
\n following:
\n “(A) The amount of the adjusted total medical
\n assistance expenditures (as defined in subsection
\n (b)(1)) for the State for fiscal year 2016.
\n “(B) The number of 1903A enrollees for the State
\n in fiscal year 2016 (as determined under subsection
\n (e)(4)).
\n “(C) The average per capita medical assistance
\n expenditures for the State for fiscal year 2016 equal
\n to–
\n “(i) the amount calculated under
\n subparagraph (A); divided by
\n “(ii) the number calculated under
\n subparagraph (B).
\n “(2) Fiscal year 2019 average per capita amount based on
\n inflating the fiscal year 2016 amount to fiscal year 2019 by
\n cpi-medical.–The Secretary shall calculate a fiscal year 2019
\n average per capita amount for each State equal to–
\n “(A) the average per capita medical assistance
\n expenditures for the State for fiscal year 2016
\n (calculated under paragraph (1)(C)); increased by
\n “(B) the percentage increase in the medical care
\n component of the consumer price index for all urban
\n consumers (U.S. city average) from September, 2016 to
\n September, 2019.
\n “(3) Aggregate and average expenditures per capita for
\n fiscal year 2019.–The Secretary shall calculate for each State
\n the following:
\n “(A) The amount of the adjusted total medical
\n assistance expenditures (as defined in subsection
\n (b)(1)) for the State for fiscal year 2019.
\n “(B) The number of 1903A enrollees for the State
\n in fiscal year 2019 (as determined under subsection
\n (e)(4)).
\n “(4) Per capita expenditures for fiscal year 2019 for each
\n 1903a enrollee category.–The Secretary shall calculate (and
\n provide notice to each State not later than January 1, 2020,
\n of) the following:
\n “(A)(i) For each 1903A enrollee category, the
\n amount of the adjusted total medical assistance
\n expenditures (as defined in subsection (b)(1)) for the
\n State for fiscal year 2019 for individuals in the
\n enrollee category, calculated by excluding from medical
\n assistance expenditures those expenditures attributable
\n to expenditures described in clause (iii) or non-DSH
\n supplemental expenditures (as defined in clause (ii)).
\n “(ii) In this paragraph, the term `non-DSH
\n supplemental expenditure’ means a payment to a provider
\n under the State plan (or under a waiver of the plan)
\n that–
\n “(I) is not made under section 1923;
\n “(II) is not made with respect to a
\n specific item or service for an individual;
\n “(III) is in addition to any payments made
\n to the provider under the plan (or waiver) for
\n any such item or service; and
\n “(IV) complies with the limits for
\n additional payments to providers under the plan
\n (or waiver) imposed pursuant to section
\n 1902(a)(30)(A), including the regulations
\n specifying upper payment limits under the State
\n plan in part 447 of title 42, Code of Federal
\n Regulations (or any successor regulations).
\n “(iii) An expenditure described in this clause is
\n an expenditure that meets the criteria specified in
\n subclauses (I), (II), and (III) of clause (ii) and is
\n authorized under section 1115 for the purposes of
\n funding a delivery system reform pool, uncompensated
\n care pool, a designated state health program, or any
\n other similar expenditure (as defined by the
\n Secretary).
\n “(B) For each 1903A enrollee category, the number
\n of 1903A enrollees for the State in fiscal year 2019 in
\n the enrollee category (as determined under subsection
\n (e)(4)).
\n “(C) For fiscal year 2016, the State’s non-DSH
\n supplemental payment percentage is equal to the ratio
\n (expressed as a percentage) of–
\n “(i) the total amount of non-DSH
\n supplemental expenditures (as defined in
\n subparagraph (A)(ii)) for the State for fiscal
\n year 2016; to
\n “(ii) the amount described in subsection
\n (b)(1)(A) for the State for fiscal year 2016.
\n “(D) For each 1903A enrollee category an average
\n medical assistance expenditures per capita for the
\n State for fiscal year 2019 for the enrollee category
\n equal to–
\n “(i) the amount calculated under
\n subparagraph (A) for the State, increased by
\n the non-DSH supplemental payment percentage for
\n the State (as calculated under subparagraph
\n (C)); divided by
\n “(ii) the number calculated under
\n subparagraph (B) for the State for the enrollee
\n category.
\n “(5) Provisional fy19 per capita target amount for each
\n 1903a enrollee category.–Subject to subsection (f)(2), the
\n Secretary shall calculate for each State a provisional FY19 per
\n capita target amount for each 1903A enrollee category equal to
\n the average medical assistance expenditures per capita for the
\n State for fiscal year 2019 (as calculated under paragraph
\n (4)(D)) for such enrollee category multiplied by the ratio of–
\n “(A) the product of–
\n “(i) the fiscal year 2019 average per
\n capita amount for the State, as calculated
\n under paragraph (2); and
\n “(ii) the number of 1903A enrollees for
\n the State in fiscal year 2019, as calculated
\n under paragraph (3)(B); to
\n “(B) the amount of the adjusted total medical
\n assistance expenditures for the State for fiscal year
\n 2019, as calculated under paragraph (3)(A).
\n “(e) 1903A Enrollee; 1903A Enrollee Category.–Subject to
\nsubsection (g), for purposes of this section, the following shall
\napply:
\n “(1) 1903A enrollee.–The term `1903A enrollee’ means,
\n with respect to a State and a month, any Medicaid enrollee (as
\n defined in paragraph (3)) for the month, other than such an
\n enrollee who for such month is in any of the following
\n categories of excluded individuals:
\n “(A) CHIP.–An individual who is provided, under
\n this title in the manner described in section
\n 2101(a)(2), child health assistance under title XXI.
\n “(B) IHS.–An individual who receives any medical
\n assistance under this title for services for which
\n payment is made under the third sentence of section
\n 1905(b).
\n “(C) Breast and cervical cancer services eligible
\n individual.–An individual who is entitled to medical
\n assistance under this title only pursuant to section
\n 1902(a)(10)(A)(ii)(XVIII).
\n “(D) Partial-benefit enrollees.–An individual
\n who–
\n “(i) is an alien who is entitled to
\n medical assistance under this title only
\n pursuant to section 1903(v)(2);
\n “(ii) is entitled to medical assistance
\n under this title only pursuant to subclause
\n (XII) or (XXI) of section 1902(a)(10)(A)(ii)
\n (or pursuant to a waiver that provides only
\n comparable benefits);
\n “(iii) is a dual eligible individual (as
\n defined in section 1915(h)(2)(B)) and is
\n entitled to medical assistance under this title
\n (or under a waiver) only for some or all of
\n medicare cost-sharing (as defined in section
\n 1905(p)(3)); or
\n “(iv) is entitled to medical assistance
\n under this title and for whom the State is
\n providing a payment or subsidy to an employer
\n for coverage of the individual under a group
\n health plan pursuant to section 1906 or section
\n 1906A (or pursuant to a waiver that provides
\n only comparable benefits).
\n “(2) 1903A enrollee category.–The term `1903A enrollee
\n category’ means each of the following:
\n “(A) Elderly.–A category of 1903A enrollees who
\n are 65 years of age or older.
\n “(B) Blind and disabled.–A category of 1903A
\n enrollees (not described in the previous subparagraph)
\n who are eligible for medical assistance under this
\n title on the basis of being blind or disabled.
\n “(C) Children.–A category of 1903A enrollees (not
\n described in a previous subparagraph) who are children
\n under 19 years of age.
\n “(D) Expansion enrollees.–A category of 1903A
\n enrollees (not described in a previous subparagraph)
\n for whom the amounts expended for medical assistance
\n are subject to an increase or change in the Federal
\n medical assistance percentage under subsection (y) or
\n (z)(2), respectively, of section 1905.
\n “(E) Other nonelderly, nondisabled, non-expansion
\n adults.–A category of 1903A enrollees who are not
\n described in any previous subparagraph.
\n “(3) Medicaid enrollee.–The term `Medicaid enrollee’
\n means, with respect to a State for a month, an individual who
\n is eligible for medical assistance for items or services under
\n this title and enrolled under the State plan (or a waiver of
\n such plan) under this title for the month.
\n “(4) Determination of number of 1903a enrollees.–The
\n number of 1903A enrollees for a State and fiscal year, and, if
\n applicable, for a 1903A enrollee category, is the average
\n monthly number of Medicaid enrollees for such State and fiscal
\n year (and, if applicable, in such category) that are reported
\n through the CMS-64 report under (and subject to audit under)
\n subsection (h).
\n “(f) Special Payment Rules.–
\n “(1) Application in case of research and demonstration
\n projects and other waivers.–In the case of a State with a
\n waiver of the State plan approved under section 1115, section
\n 1915, or another provision of this title, this section shall
\n apply to medical assistance expenditures and medical assistance
\n payments under the waiver, in the same manner as if such
\n expenditures and payments had been made under a State plan
\n under this title and the limitations on expenditures under this
\n section shall supersede any other payment limitations or
\n provisions (including limitations based on a per capita
\n limitation) otherwise applicable under such a waiver.
\n “(2) Treatment of states expanding coverage after fiscal
\n year 2016.–In the case of a State that did not provide for
\n medical assistance for the 1903A enrollee category described in
\n subsection (e)(2)(D) during fiscal year 2016 but which provides
\n for such assistance for such category in a subsequent year, the
\n provisional FY19 per capita target amount for such enrollee
\n category under subsection (d)(5) shall be equal to the
\n provisional FY19 per capita target amount for the 1903A
\n enrollee category described in subsection (e)(2)(E).
\n “(3) In case of state failure to report necessary data.–
\n If a State for any quarter in a fiscal year (beginning with
\n fiscal year 2019) fails to satisfactorily submit data on
\n expenditures and enrollees in accordance with subsection
\n (h)(1), for such fiscal year and any succeeding fiscal year for
\n which such data are not satisfactorily submitted–
\n “(A) the Secretary shall calculate and apply
\n subsections (a) through (e) with respect to the State
\n as if all 1903A enrollee categories for which such
\n expenditure and enrollee data were not satisfactorily
\n submitted were a single 1903A enrollee category; and
\n “(B) the growth factor otherwise applied under
\n subsection (c)(2)(B) shall be decreased by 1 percentage
\n point.
\n “(g) Recalculation of Certain Amounts for Data Errors.–The
\namounts and percentage calculated under paragraphs (1) and (4)(C) of
\nsubsection (d) for a State for fiscal year 2016, and the amounts of the
\nadjusted total medical assistance expenditures calculated under
\nsubsection (b) and the number of Medicaid enrollees and 1903A enrollees
\ndetermined under subsection (e)(4) for a State for fiscal year 2016,
\nfiscal year 2019, and any subsequent fiscal year, may be adjusted by
\nthe Secretary based upon an appeal (filed by the State in such a form,
\nmanner, and time, and containing such information relating to data
\nerrors that support such appeal, as the Secretary specifies) that the
\nSecretary determines to be valid, except that any adjustment by the
\nSecretary under this subsection for a State may not result in an
\nincrease of the target total medical assistance expenditures exceeding
\n2 percent.
\n “(h) Required Reporting and Auditing of CMS-64 Data; Transitional
\nIncrease in Federal Matching Percentage for Certain Administrative
\nExpenses.–
\n “(1) Reporting.–In addition to the data required on form
\n Group VIII on the CMS-64 report form as of January 1, 2017, in
\n each CMS-64 report required to be submitted (for each quarter
\n beginning on or after October 1, 2018), the State shall include
\n data on medical assistance expenditures within such categories
\n of services and categories of enrollees (including each 1903A
\n enrollee category and each category of excluded individuals
\n under subsection (e)(1)) and the numbers of enrollees within
\n each of such enrollee categories, as the Secretary determines
\n are necessary (including timely guidance published as soon as
\n possible after the date of the enactment of this section) in
\n order to implement this section and to enable States to comply
\n with the requirement of this paragraph on a timely basis.
\n “(2) Auditing.–The Secretary shall conduct for each State
\n an audit of the number of individuals and expenditures reported
\n through the CMS-64 report for fiscal year 2016, fiscal year
\n 2019, and each subsequent fiscal year, which audit may be
\n conducted on a representative sample (as determined by the
\n Secretary).
\n “(3) Temporary increase in federal matching percentage to
\n support improved data reporting systems for fiscal years 2018
\n and 2019.–For amounts expended during calendar quarters
\n beginning on or after October 1, 2017, and before October 1,
\n 2019–
\n “(A) the Federal matching percentage applied under
\n section 1903(a)(3)(A)(i) shall be increased by 10
\n percentage points to 100 percent;
\n “(B) the Federal matching percentage applied under
\n section 1903(a)(3)(B) shall be increased by 25
\n percentage points to 100 percent; and
\n “(C) the Federal matching percentage applied under
\n section 1903(a)(7) shall be increased by 10 percentage
\n points to 60 percent but only with respect to amounts
\n expended that are attributable to a State’s additional
\n administrative expenditures to implement the data
\n requirements of paragraph (1).”.<\/p>\n
Subtitle D–Patient Relief and Health Insurance Market Stability<\/p>\n
SEC. 131. REPEAL OF COST-SHARING SUBSIDY.<\/p>\n
(a) In General.–Section 1402 of the Patient Protection and
\nAffordable Care Act is repealed.
\n (b) Effective Date.–The repeal made by subsection (a) shall apply
\nto cost-sharing reductions (and payments to issuers for such
\nreductions) for plan years beginning after December 31, 2019.<\/p>\n
SEC. 132. PATIENT AND STATE STABILITY FUND.<\/p>\n
The Social Security Act (42 U.S.C. 301 et seq.) is amended by
\nadding at the end the following new title:<\/p>\n
“TITLE XXII–PATIENT AND STATE STABILITY FUND<\/p>\n
“SEC. 2201. ESTABLISHMENT OF PROGRAM.<\/p>\n
“There is hereby established the `Patient and State Stability
\nFund’ to be administered by the Secretary of Health and Human Services,
\nacting through the Administrator of the Centers for Medicare & Medicaid
\nServices (in this section referred to as the `Administrator’), to
\nprovide funding, in accordance with this title, to the 50 States and
\nthe District of Columbia (each referred to in this section as a
\n`State’) during the period, subject to section 2204(c), beginning on
\nJanuary 1, 2018, and ending on December 31, 2026, for the purposes
\ndescribed in section 2202.<\/p>\n
“SEC. 2202. USE OF FUNDS.<\/p>\n
“A State may use the funds allocated to the State under this title
\nfor any of the following purposes:
\n “(1) Helping, through the provision of financial
\n assistance, high-risk individuals who do not have access to
\n health insurance coverage offered through an employer enroll in
\n health insurance coverage in the individual market in the
\n State, as such market is defined by the State (whether through
\n the establishment of a new mechanism or maintenance of an
\n existing mechanism for such purpose).
\n “(2) Providing incentives to appropriate entities to enter
\n into arrangements with the State to help stabilize premiums for
\n health insurance coverage in the individual market, as such
\n markets are defined by the State.
\n “(3) Reducing the cost for providing health insurance
\n coverage in the individual market and small group market, as
\n such markets are defined by the State, to individuals who have,
\n or are projected to have, a high rate of utilization of health
\n services (as measured by cost).
\n “(4) Promoting participation in the individual market and
\n small group market in the State and increasing health insurance
\n options available through such market.
\n “(5) Promoting access to preventive services; dental care
\n services (whether preventive or medically necessary); vision
\n care services (whether preventive or medically necessary);
\n prevention, treatment, or recovery support services for
\n individuals with mental or substance use disorders; or any
\n combination of such services.
\n “(6) Providing payments, directly or indirectly, to health
\n care providers for the provision of such health care services
\n as are specified by the Administrator.
\n “(7) Providing assistance to reduce out-of-pocket costs,
\n such as copayments, coinsurance, premiums, and deductibles, of
\n individuals enrolled in health insurance coverage in the State.<\/p>\n
“SEC. 2203. STATE ELIGIBILITY AND APPROVAL; DEFAULT SAFEGUARD.<\/p>\n
“(a) Encouraging State Options for Allocations.–
\n “(1) In general.–To be eligible for an allocation of
\n funds under this title for a year during the period described
\n in section 2201 for use for one or more purposes described in
\n section 2202, a State shall submit to the Administrator an
\n application at such time (but, in the case of allocations for
\n 2018, not later than 45 days after the date of the enactment of
\n this title and, in the case of allocations for a subsequent
\n year, not later than March 31 of the previous year) and in such
\n form and manner as specified by the Administrator and
\n containing–
\n “(A) a description of how the funds will be used
\n for such purposes;
\n “(B) a certification that the State will make,
\n from non-Federal funds, expenditures for such purposes
\n in an amount that is not less than the State percentage
\n required for the year under section 2204(e)(1); and
\n “(C) such other information as the Administrator
\n may require.
\n “(2) Automatic approval.–An application so submitted is
\n approved unless the Administrator notifies the State submitting
\n the application, not later than 60 days after the date of the
\n submission of such application, that the application has been
\n denied for not being in compliance with any requirement of this
\n title and of the reason for such denial.
\n “(3) One-time application.–If an application of a State
\n is approved for a year, with respect to a purpose described in
\n section 2202, such application shall be treated as approved,
\n with respect to such purpose, for each subsequent year through
\n 2026.
\n “(4) Treatment as a state health care program.–Any
\n program receiving funds from an allocation for a State under
\n this title, including pursuant to subsection (b), shall be
\n considered to be a `State health care program’ for purposes of
\n sections 1128, 1128A, and 1128B.
\n “(b) Default Federal Safeguard.–
\n “(1) In general.–
\n “(A) 2018.–For allocations made under this title
\n for 2018, in the case of a State that does not submit
\n an application under subsection (a) by the 45-day
\n submission date applicable to such year under
\n subsection (a)(1) and in the case of a State that does
\n submit such an application by such date that is not
\n approved, subject to section 2204(e), the
\n Administrator, in consultation with the State insurance
\n commissioner, shall use the allocation that would
\n otherwise be provided to the State under this title for
\n such year, in accordance with paragraph (2), for such
\n State.
\n “(B) 2019 through 2026.–In the case of a State
\n that does not have in effect an approved application
\n under this section for 2019 or a subsequent year
\n beginning during the period described in section 2201,
\n subject to section 2204(e), the Administrator, in
\n consultation with the State insurance commissioner,
\n shall use the allocation that would otherwise be
\n provided to the State under this title for such year,
\n in accordance with paragraph (2), for such State.
\n “(2) Required use for market stabilization payments to
\n issuers.–Subject to section 2204(a), an allocation for a State
\n made pursuant to paragraph (1) for a year shall be used to
\n carry out the purpose described in section 2202(2) in such
\n State by providing payments to appropriate entities described
\n in such section with respect to claims that exceed $50,000 (or,
\n with respect to allocations made under this title for 2020 or a
\n subsequent year during the period specified in section 2201,
\n such dollar amount specified by the Administrator), but do not
\n exceed $350,000 (or, with respect to allocations made under
\n this title for 2020 or a subsequent year during such period,
\n such dollar amount specified by the Administrator), in an
\n amount equal to 75 percent (or, with respect to allocations
\n made under this title for 2020 or a subsequent year during such
\n period, such percentage specified by the Administrator) of the
\n amount of such claims.<\/p>\n
“SEC. 2204. ALLOCATIONS.<\/p>\n
“(a) Appropriation.–For the purpose of providing allocations for
\nStates (including pursuant to section 2203(b)) under this title there
\nis appropriated, out of any money in the Treasury not otherwise
\nappropriated–
\n “(1) for 2018, $15,000,000,000;
\n “(2) for 2019, $15,000,000,000;
\n “(3) for 2020, $10,000,000,000;
\n “(4) for 2021, $10,000,000,000;
\n “(5) for 2022, $10,000,000,000;
\n “(6) for 2023, $10,000,000,000;
\n “(7) for 2024, $10,000,000,000;
\n “(8) for 2025, $10,000,000,000; and
\n “(9) for 2026, $10,000,000,000.
\n “(b) Allocations.–
\n “(1) Payment.–
\n “(A) In general.–From amounts appropriated under
\n subsection (a) for a year, the Administrator shall,
\n with respect to a State and not later than the date
\n specified under subparagraph (B) for such year,
\n allocate, subject to subsection (e), for such State
\n (including pursuant to section 2203(b)) the amount
\n determined for such State and year under paragraph (2).
\n “(B) Specified date.–For purposes of subparagraph
\n (A), the date specified in this subparagraph is–
\n “(i) for 2018, the date that is 45 days
\n after the date of the enactment of this title;
\n and
\n “(ii) for 2019 and subsequent years,
\n January 1 of the respective year.
\n “(2) Allocation amount determinations.–
\n “(A) For 2018 and 2019.–
\n “(i) In general.–For purposes of
\n paragraph (1), the amount determined under this
\n paragraph for 2018 and 2019 for a State is an
\n amount equal to the sum of–
\n “(I) the relative incurred claims
\n amount described in clause (ii) for
\n such State and year; and
\n “(II) the relative uninsured and
\n issuer participation amount described
\n in clause (iv) for such State and year.
\n “(ii) Relative incurred claims amount.–
\n For purposes of clause (i), the relative
\n incurred claims amount described in this clause
\n for a State for 2018 and 2019 is the product
\n of–
\n “(I) 85 percent of the amount
\n appropriated under subsection (a) for
\n the year; and
\n “(II) the relative State incurred
\n claims proportion described in clause
\n (iii) for such State and year.
\n “(iii) Relative state incurred claims
\n proportion.–The relative State incurred claims
\n proportion described in this clause for a State
\n and year is the amount equal to the ratio of–
\n “(I) the adjusted incurred claims
\n by the State, as reported through the
\n medical loss ratio annual reporting
\n under section 2718 of the Public Health
\n Service Act for the third previous
\n year; to
\n “(II) the sum of such adjusted
\n incurred claims for all States, as so
\n reported, for such third previous year.
\n “(iv) Relative uninsured and issuer
\n participation amount.–For purposes of clause
\n (i), the relative uninsured and issuer
\n participation amount described in this clause
\n for a State for 2018 and 2019 is the product
\n of–
\n “(I) 15 percent of the amount
\n appropriated under subsection (a) for
\n the year; and
\n “(II) the relative State uninsured
\n and issuer participation proportion
\n described in clause (v) for such State
\n and year.
\n “(v) Relative state uninsured and issuer
\n participation proportion.–The relative State
\n uninsured and issuer participation proportion
\n described in this clause for a State and year
\n is–
\n “(I) in the case of a State not
\n described in clause (vi) for such year,
\n 0; and
\n “(II) in the case of a State
\n described in clause (vi) for such year,
\n the amount equal to the ratio of–
\n “(aa) the number of
\n individuals residing in such
\n State who for the third
\n preceding year were not
\n enrolled in a health plan or
\n otherwise did not have health
\n insurance coverage (including
\n through a Federal or State
\n health program) and whose
\n income is below 100 percent of
\n the poverty line applicable to
\n a family of the size involved;
\n to
\n “(bb) the sum of the
\n number of such individuals for
\n all States described in clause
\n (vi) for the third preceding
\n year.
\n “(vi) States described.–For purposes of
\n clause (v), a State is described in this
\n clause, with respect to 2018 and 2019, if the
\n State satisfies either of the following
\n criterion:
\n “(I) The number of individuals
\n residing in such State and described in
\n clause (v)(II)(aa) was higher in 2015
\n than 2013.
\n “(II) The State have fewer than
\n three health insurance issuers offering
\n qualified health plans through the
\n Exchange for 2017.
\n “(B) For 2020 through 2026.–For purposes of
\n paragraph (1), the amount determined under this
\n paragraph for a year (beginning with 2020) during the
\n period described in section 2201 for a State is an
\n amount determined in accordance with an allocation
\n methodology specified by the Administrator which–
\n “(i) takes into consideration the adjusted
\n incurred claims of such State, the number of
\n residents of such State who for the previous
\n year were not enrolled in a health plan or
\n otherwise did not have health insurance
\n coverage (including through a Federal or State
\n health program) and whose income is below 100
\n percent of the poverty line applicable to a
\n family of the size involved, and the number of
\n health insurance issuers participating in the
\n insurance market in such State for such year;
\n “(ii) is established after consultation
\n with health care consumers, health insurance
\n issuers, State insurance commissioners, and
\n other stakeholders and after taking into
\n consideration additional cost and risk factors
\n that may inhibit health care consumer and
\n health insurance issuer participation; and
\n “(iii) reflects the goals of improving the
\n health insurance risk pool, promoting a more
\n competitive health insurance market, and
\n increasing choice for health care consumers.
\n “(c) Annual Distribution of Previous Year’s Remaining Funds.– In
\ncarrying out subsection (b), the Administrator shall, with respect to a
\nyear (beginning with 2020 and ending with 2027), not later than March
\n31 of such year–
\n “(1) determine the amount of funds, if any, from the
\n amounts appropriated under subsection (a) for the previous year
\n but not allocated for such previous year; and
\n “(2) if the Administrator determines that any funds were
\n not so allocated for such previous year, allocate such
\n remaining funds, in accordance with the allocation methodology
\n specified pursuant to subsection (b)(2)(B)–
\n “(A) to States that have submitted an application
\n approved under section 2203(a) for such previous year
\n for any purpose for which such an application was
\n approved; and
\n “(B) for States for which allocations were made
\n pursuant to section 2203(b) for such previous year, to
\n be used by the Administrator for such States, to carry
\n out the purpose described in section 2202(2) in such
\n States by providing payments to appropriate entities
\n described in such section with respect to claims that
\n exceed $1,000,000;
\n with, respect to a year before 2027, any remaining funds being
\n made available for allocations to States for the subsequent
\n year.
\n “(d) Availability.–Amounts appropriated under subsection (a) for
\na year and allocated to States in accordance with this section shall
\nremain available for expenditure through December 31, 2027.
\n “(e) Conditions for and Limitations on Receipt of Funds.–The
\nSecretary may not make an allocation under this title for a State, with
\nrespect to a purpose described in section 2202–
\n “(1) in the case of an allocation that would be made to a
\n State pursuant to section 2203(a), if the State does not agree
\n that the State will make available non-Federal contributions
\n towards such purpose in an amount equal to–
\n “(A) for 2020, 7 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(B) for 2021, 14 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(C) for 2022, 21 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(D) for 2023, 28 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(E) for 2024, 35 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(F) for 2025, 42 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose; and
\n “(G) for 2026, 50 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(2) in the case of an allocation that would be made for a
\n State pursuant to section 2203(b), if the State does not agree
\n that the State will make available non-Federal contributions
\n towards such purpose in an amount equal to–
\n “(A) for 2020, 10 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(B) for 2021, 20 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose; and
\n “(C) for 2022, 30 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(D) for 2023, 40 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(E) for 2024, 50 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose;
\n “(F) for 2025, 50 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose; and
\n “(G) for 2026, 50 percent of the amount allocated
\n under this subsection to such State for such year and
\n purpose; or
\n “(3) if such an allocation for such purpose would not be
\n permitted under subsection (c)(7) of section 2105 if such
\n allocation were payment made under such section.”.<\/p>\n
SEC. 133. CONTINUOUS HEALTH INSURANCE COVERAGE INCENTIVE.<\/p>\n
Subpart I of part A of title XXVII of the Public Health Service Act
\nis amended–
\n (1) in section 2701(a)(1)(B), by striking “such rate” and
\n inserting “subject to section 2710A, such rate”;
\n (2) by redesignating the second section 2709 as section
\n 2710; and
\n (3) by adding at the end the following new section:<\/p>\n
“SEC. 2710A. ENCOURAGING CONTINUOUS HEALTH INSURANCE COVERAGE.<\/p>\n
“(a) Penalty Applied.–
\n “(1) In general.–Notwithstanding section 2701, subject to
\n the succeeding provisions of this section, a health insurance
\n issuer offering health insurance coverage in the individual or
\n small group market shall, in the case of an individual who is
\n an applicable policyholder of such coverage with respect to an
\n enforcement period applicable to enrollments for a plan year
\n beginning with plan year 2019 (or, in the case of enrollments
\n during a special enrollment period, beginning with plan year
\n 2018), increase the monthly premium rate otherwise applicable
\n to such individual for such coverage during each month of such
\n period, by an amount determined under paragraph (2).
\n “(2) Amount of penalty.–The amount determined under this
\n paragraph for an applicable policyholder enrolling in health
\n insurance coverage described in paragraph (1) for a plan year,
\n with respect to each month during the enforcement period
\n applicable to enrollments for such plan year, is the amount
\n that is equal to 30 percent of the monthly premium rate
\n otherwise applicable to such applicable policyholder for such
\n coverage during such month.
\n “(b) Definitions.–For purposes of this section:
\n “(1) Applicable policyholder.–The term `applicable
\n policyholder’ means, with respect to months of an enforcement
\n period and health insurance coverage, an individual who–
\n “(A) is a policyholder of such coverage for such
\n months;
\n “(B) cannot demonstrate (through presentation of
\n certifications described in section 2704(e) or in such
\n other manner as may be specified in regulations, such
\n as a return or statement made under section 6055(d) or
\n 36C of the Internal Revenue Code of 1986), during the
\n look-back period that is with respect to such
\n enforcement period, there was not a period of at least
\n 63 continuous days during which the individual did not
\n have creditable coverage (as defined in paragraph (1)
\n of section 2704(c) and credited in accordance with
\n paragraphs (2) and (3) of such section); and
\n “(C) in the case of an individual who had been
\n enrolled under dependent coverage under a group health
\n plan or health insurance coverage by reason of section
\n 2714 and such dependent coverage of such individual
\n ceased because of the age of such individual, is not
\n enrolling during the first open enrollment period
\n following the date on which such coverage so ceased.
\n “(2) Look-back period.–The term `look-back period’ means,
\n with respect to an enforcement period applicable to an
\n enrollment of an individual for a plan year beginning with plan
\n year 2019 (or, in the case of an enrollment of an individual
\n during a special enrollment period, beginning with plan year
\n 2018) in health insurance coverage described in subsection
\n (a)(1), the 12-month period ending on the date the individual
\n enrolls in such coverage for such plan year.
\n “(3) Enforcement period.–The term `enforcement period’
\n means–
\n “(A) with respect to enrollments during a special
\n enrollment period for plan year 2018, the period
\n beginning with the first month that is during such plan
\n year and that begins subsequent to such date of
\n enrollment, and ending with the last month of such plan
\n year; and
\n “(B) with respect to enrollments for plan year
\n 2019 or a subsequent plan year, the 12-month period
\n beginning on the first day of the respective plan
\n year.”.<\/p>\n
SEC. 134. INCREASING COVERAGE OPTIONS.<\/p>\n
Section 1302 of the Patient Protection and Affordable Care Act (42
\nU.S.C. 18022) is amended–
\n (1) in subsection (a)(3), by inserting “and with respect
\n to a plan year before plan year 2020” after “subsection
\n (e)”; and
\n (2) in subsection (d), by adding at the end the following:
\n “(5) Sunset.–The provisions of this subsection shall not
\n apply after December 31, 2019, and after such date any
\n reference to this subsection or level of coverage or plan
\n described in this subsection and any requirement under law
\n applying such a level of coverage or plan shall have no force
\n or effect (and such a requirement shall be applied as if this
\n section had been repealed).”.<\/p>\n
SEC. 135. CHANGE IN PERMISSIBLE AGE VARIATION IN HEALTH INSURANCE
\n PREMIUM RATES.<\/p>\n
Section 2701(a)(1)(A)(iii) of the Public Health Service Act (42
\nU.S.C. 300gg(a)(1)(A)(iii)), as inserted by section 1201(4) of the
\nPatient Protection and Affordable Care Act, is amended by inserting
\nafter “(consistent with section 2707(c))” the following: “or, for
\nplan years beginning on or after January 1, 2018, as the Secretary may
\nimplement through interim final regulation, 5 to 1 for adults
\n(consistent with section 2707(c)) or such other ratio for adults
\n(consistent with section 2707(c)) as the State involved may provide”.<\/p>\n
TITLE II–COMMITTEE ON WAYS AND MEANS<\/p>\n
Subtitle A–Repeal and Replace of Health-Related Tax Policy<\/p>\n
SEC. 201. RECAPTURE EXCESS ADVANCE PAYMENTS OF PREMIUM TAX CREDITS.<\/p>\n
Subparagraph (B) of section 36B(f)(2) of the Internal Revenue Code
\nof 1986 is amended by adding at the end the following new clause:
\n “(iii) Nonapplicability of limitation.–
\n This subparagraph shall not apply to taxable
\n years beginning after December 31, 2017, and
\n before January 1, 2020.”.<\/p>\n
SEC. 202. ADDITIONAL MODIFICATIONS TO PREMIUM TAX CREDIT.<\/p>\n
(a) Modification of Definition of Qualified Health Plan.–
\n (1) In general.–Section 36B(c)(3)(A) of the Internal
\n Revenue Code of 1986 is amended–
\n (A) by inserting “(determined without regard to
\n subparagraphs (A), (C)(ii), and (C)(iv) of paragraph
\n (1) thereof and without regard to whether the plan is
\n offered on an Exchange)” after “1301(a) of the
\n Patient Protection and Affordable Care Act”, and
\n (B) by striking “shall not include” and all that
\n follows and inserting “shall not include any health
\n plan that–
\n “(i) is a grandfathered health plan or a
\n grandmothered health plan, or
\n “(ii) includes coverage for abortions
\n (other than any abortion necessary to save the
\n life of the mother or any abortion with respect
\n to a pregnancy that is the result of an act of
\n rape or incest).”.
\n (2) Definition of grandmothered health plan.–Section
\n 36B(c)(3) of such Code is amended by adding at the end the
\n following new subparagraph:
\n “(C) Grandmothered health plan.–
\n “(i) In general.–The term `grandmothered
\n health plan’ means health insurance coverage
\n which is offered in the individual health
\n insurance market as of October 1, 2013, and is
\n permitted to be offered in such market after
\n January 1, 2014, as a result of CCIIO guidance.
\n “(ii) CCIIO guidance defined.–The term
\n `CCIIO guidance’ means the letter issued by the
\n Centers for Medicare & Medicaid Services on
\n November 14, 2013, to the State Insurance
\n Commissioners outlining a transitional policy
\n for non-grandfathered coverage in the
\n individual health insurance market, as
\n subsequently extended and modified (including
\n by a communication entitled `Insurance
\n Standards Bulletin Series–INFORMATION–
\n Extension of Transitional Policy through
\n Calendar Year 2017′ issued on February 29,
\n 2016, by the Director of the Center for
\n Consumer Information & Insurance Oversight of
\n such Centers).
\n “(iii) Individual health insurance
\n market.–The term `individual health insurance
\n market’ means the market for health insurance
\n coverage (as defined in section 9832(b))
\n offered to individuals other than in connection
\n with a group health plan (within the meaning of
\n section 5000(b)(1)).”.
\n (3) Conforming amendment related to abortion coverage.–
\n Section 36B(c)(3) of such Code, as amended by paragraph (2), is
\n amended by adding at the end the following new subparagraph:
\n “(D) Certain rules related to abortion.–
\n “(i) Option to purchase separate coverage
\n or plan.–Nothing in subparagraph (A) shall be
\n construed as prohibiting any individual from
\n purchasing separate coverage for abortions
\n described in such subparagraph, or a health
\n plan that includes such abortions, so long as
\n no credit is allowed under this section with
\n respect to the premiums for such coverage or
\n plan.
\n “(ii) Option to offer coverage or plan.–
\n Nothing in subparagraph (A) shall restrict any
\n health insurance issuer offering a health plan
\n from offering separate coverage for abortions
\n described in such subparagraph, or a plan that
\n includes such abortions, so long as premiums
\n for such separate coverage or plan are not paid
\n for with any amount attributable to the credit
\n allowed under this section (or the amount of
\n any advance payment of the credit under section
\n 1412 of the Patient Protection and Affordable
\n Care Act).
\n “(iii) Other treatments.–The treatment of
\n any infection, injury, disease, or disorder
\n that has been caused by or exacerbated by the
\n performance of an abortion shall not be treated
\n as an abortion for purposes of subparagraph
\n (A).”.
\n (4) Conforming amendments related to off-exchange
\n coverage.–
\n (A) Advance payment not applicable.–Section 1412
\n of the Patient Protection and Affordable Care Act is
\n amended by adding at the end the following new
\n subsection:
\n “(f) Exclusion of Off-Exchange Coverage.–Advance payments under
\nthis section, and advance determinations under section 1411, with
\nrespect to any credit allowed under section 36B shall not be made with
\nrespect to any health plan which is not enrolled in through an
\nExchange.”.
\n (B) Reporting.–Section 6055(b) of the Internal
\n Revenue Code of 1986 is amended by adding at the end
\n the following new paragraph:
\n “(3) Information relating to off-exchange premium credit
\n eligible coverage.–If minimum essential coverage provided to
\n an individual under subsection (a) consists of a qualified
\n health plan (as defined in section 36B(c)(3)) which is not
\n enrolled in through an Exchange established under title I of
\n the Patient Protection and Affordable Care Act, a return
\n described in this subsection shall include–
\n “(A) a statement that such plan is a qualified
\n health plan (as defined in section 36B(c)(3)),
\n “(B) the premiums paid with respect to such
\n coverage,
\n “(C) the months during which such coverage is
\n provided to the individual,
\n “(D) the adjusted monthly premium for the
\n applicable second lowest cost silver plan (as defined
\n in section 36B(b)(3)) for each such month with respect
\n to such individual, and
\n “(E) such other information as the Secretary may
\n prescribe.
\n This paragraph shall not apply with respect to coverage
\n provided for any month beginning after December 31, 2019.”.
\n (C) Other conforming amendments.–
\n (i) Section 36B(b)(2)(A) is amended by
\n striking “and which were enrolled” and all
\n that follows and inserting “, or”.
\n (ii) Section 36B(b)(3)(B)(i) is amended by
\n striking “the same Exchange” and all that
\n follows and inserting “the Exchange through
\n which such taxpayer is permitted to obtain
\n coverage, and”.
\n (b) Modification of Applicable Percentage.–Section 36B(b)(3)(A) of
\nsuch Code is amended to read as follows:
\n “(A) Applicable percentage.–
\n “(i) In general.–The applicable
\n percentage for any taxable year shall be the
\n percentage such that the applicable percentage
\n for any taxpayer whose household income is
\n within an income tier specified in the
\n following table shall increase, on a sliding
\n scale in a linear manner, from the initial
\n percentage to the final percentage specified in
\n such table for such income tier with respect to
\n a taxpayer of the age involved:<\/p>\n
————————————————————————————————————————————————————————————————
\n “In the case of Up to Age 29 Age 30-39 Age 40-49 Age 50-59 Over Age 59
\n household income —————————————————————————————————————————————————————————-
\n (expressed as a
\n percent of the
\n poverty line)
\n within the Initial % Final % Initial % Final % Initial % Final % Initial % Final % Initial % Final %
\n following income
\n tier:
\n————————————————————————————————————————————————————————————————
\nUp to 133% 2…………… 2…………… 2…………… 2………….. 2………….. 2………….. 2………….. 2………….. 2………….. 2
\n133%-150% 3…………… 4…………… 3…………… 4………….. 3………….. 4………….. 3………….. 4………….. 3………….. 4
\n150%-200% 4…………… 4.3…………. 4…………… 5.3………… 4………….. 6.3………… 4………….. 7.3………… 4………….. 8.3
\n200%-250% 4.3…………. 4.3…………. 5.3…………. 5.9………… 6.3………… 8.05……….. 7.3………… 9………….. 8.3………… 10
\n250%-300% 4.3…………. 4.3…………. 5.9…………. 5.9………… 8.05……….. 8.35……….. 9………….. 10.5……….. 10…………. 11.5
\n300%-400% 4.3…………. 4.3…………. 5.9…………. 5.9………… 8.35……….. 8.35……….. 10.5……….. 10.5……….. 11.5……….. 11.5
\n————————————————————————————————————————————————————————————————<\/p>\n
“(ii) Age determinations.–
\n “(I) In general.–For purposes of
\n clause (i), the age of the taxpayer
\n taken into account under clause (i)
\n with respect to any taxable year is the
\n age attained by such taxpayer before
\n the close of such taxable year.
\n “(II) Joint returns.–In the case
\n of a joint return, the age of the older
\n spouse shall be taken into account
\n under clause (i).
\n “(iii) Indexing.–In the case of any
\n taxable year beginning in calendar year 2019,
\n the initial and final percentages contained in
\n clause (i) shall be adjusted to reflect–
\n “(I) the excess (if any) of the
\n rate of premium growth for the period
\n beginning with calendar year 2013 and
\n ending with calendar year 2018, over
\n the rate of income growth for such
\n period, and
\n “(II) in addition to any
\n adjustment under subclause (I), the
\n excess (if any) of the rate of premium
\n growth for calendar year 2018, over the
\n rate of growth in the consumer price
\n index for calendar year 2018.
\n “(iv) Failsafe.–Clause (iii)(II) shall
\n apply only if the aggregate amount of premium
\n tax credits under this section and cost-sharing
\n reductions under section 1402 of the Patient
\n Protection and Affordable Care Act for calendar
\n year 2018 exceeds an amount equal to 0.504
\n percent of the gross domestic product for such
\n calendar year.”.
\n (b) Effective Date.–
\n (1) In general.–Except as otherwise provided in this
\n subsection, the amendments made by this section shall apply to
\n taxable years beginning after December 31, 2017.
\n (2) Advance payment not applicable to off-exchange
\n coverage.–The amendment made by subsection (a)(4)(A) shall
\n take effect on January 1, 2018.
\n (3) Reporting.–The amendment made by subsection (a)(4)(B)
\n shall apply to coverage provided for months beginning after
\n December 31, 2017.
\n (4) Modification of applicable percentage.–The amendment
\n made by subsection (b) shall apply to taxable years beginning
\n after December 31, 2018.<\/p>\n
SEC. 203. PREMIUM TAX CREDIT.<\/p>\n
(a) Repeal of Premium Tax Credit.–Section 36B of the Internal
\nRevenue Code of 1986 is amended by adding at the end the following new
\nsubsection:
\n “(h) Termination.–No credit shall be allowed under this section
\nwith respect to any coverage month which begins after December 31,
\n2019.”.
\n (b) Repeal of Advance Payment of, and Eligibility Determination
\nfor, Premium Tax Credit.–Section 1412 of the Patient Protection and
\nAffordable Care Act, as amended by the preceding provisions of this
\nsubtitle, is amended by adding at the end the following new subsection:
\n “(g) Termination With Respect to Premium Tax Credit.–Effective
\nJanuary 1, 2020, no provision of this section or section 1411 shall
\napply to the credit allowed under section 36B of the Internal Revenue
\nCode of 1986 (or to the advance payment of, or determination of
\neligibility for, such credit or payment).”.
\n (c) Effective Dates.–
\n (1) Premium tax credit.–The amendment made by subsection
\n (a) shall apply to months beginning after December 31, 2019, in
\n taxable years ending after such date.
\n (2) Eligibility determinations.–The amendment made by
\n subsection (b) shall take effect on January 1, 2020.<\/p>\n
SEC. 204. SMALL BUSINESS TAX CREDIT.<\/p>\n
(a) In General.–Section 45R of the Internal Revenue Code of 1986
\nis amended by adding at the end the following new subsection:
\n “(j) Shall Not Apply.–This section shall not apply with respect
\nto amounts paid or incurred in taxable years beginning after December
\n31, 2019.”.
\n (b) Disallowance of Small Employer Health Insurance Expense Credit
\nfor Plan Which Includes Coverage for Abortion.–Subsection (h) of
\nsection 45R of the Internal Revenue Code of 1986 is amended–
\n (1) by striking “Any term” and inserting the following:
\n “(1) In general.–Any term”; and
\n (2) by adding at the end the following new paragraph:
\n “(2) Exclusion of health plans including coverage for
\n abortion.–
\n “(A) In general.–The term `qualified health plan’
\n does not include any health plan that includes coverage
\n for abortions (other than any abortion necessary to
\n save the life of the mother or any abortion with
\n respect to a pregnancy that is the result of an act of
\n rape or incest) .
\n “(B) Certain rules related to abortion.–
\n “(i) Option to purchase separate coverage
\n or plan.–Nothing in subparagraph (A) shall be
\n construed as prohibiting any employer from
\n purchasing for its employees separate coverage
\n for abortions described in such subparagraph,
\n or a health plan that includes such abortions,
\n so long as no credit is allowed under this
\n section with respect to the employer
\n contributions for such coverage or plan.
\n “(ii) Option to offer coverage or plan.–
\n Nothing in subparagraph (A) shall restrict any
\n health insurance issuer offering a health plan
\n from offering separate coverage for abortions
\n described in such subparagraph, or a plan that
\n includes such abortions, so long as such
\n separate coverage or plan is not paid for with
\n any employer contribution eligible for the
\n credit allowed under this section.
\n “(iii) Other treatments.–The treatment of
\n any infection, injury, disease, or disorder
\n that has been caused by or exacerbated by the
\n performance of an abortion shall not be treated
\n as an abortion for purposes of subparagraph
\n (A).”.
\n (c) Effective Dates.–
\n (1) In general.–The amendment made by subsection (a) shall
\n apply to taxable years beginning after December 31, 2019.
\n (2) Disallowance of small employer health insurance expense
\n credit for plan which includes coverage for abortion.–The
\n amendments made by subsection (b) shall apply to taxable years
\n beginning after December 31, 2017.<\/p>\n
SEC. 205. INDIVIDUAL MANDATE.<\/p>\n
(a) In General.–Section 5000A(c) of the Internal Revenue Code of
\n1986 is amended–
\n (1) in paragraph (2)(B)(iii), by striking “2.5 percent”
\n and inserting “Zero percent”, and
\n (2) in paragraph (3)–
\n (A) by striking “$695” in subparagraph (A) and
\n inserting “$0”, and
\n (B) by striking subparagraph (D).
\n (b) Effective Date.–The amendments made by this section shall
\napply to months beginning after December 31, 2015.<\/p>\n
SEC. 206. EMPLOYER MANDATE.<\/p>\n
(a) In General.–
\n (1) Paragraph (1) of section 4980H(c) of the Internal
\n Revenue Code of 1986 is amended by inserting “($0 in the case
\n of months beginning after December 31, 2015)” after
\n “$2,000”.
\n (2) Paragraph (1) of section 4980H(b) of the Internal
\n Revenue Code of 1986 is amended by inserting “($0 in the case
\n of months beginning after December 31, 2015)” after
\n “$3,000”.
\n (b) Effective Date.–The amendments made by this section shall
\napply to months beginning after December 31, 2015.<\/p>\n
SEC. 207. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE PREMIUMS AND
\n HEALTH PLAN BENEFITS.<\/p>\n
Section 4980I of the Internal Revenue Code of 1986 is amended by
\nadding at the end the following new subsection:
\n “(h) Shall Not Apply.–No tax shall be imposed under this section
\nwith respect to any taxable period beginning after December 31, 2019,
\nand before January 1, 2025.”.<\/p>\n
SEC. 208. REPEAL OF TAX ON OVER-THE-COUNTER MEDICATIONS.<\/p>\n
(a) HSAs.–Subparagraph (A) of section 223(d)(2) of the Internal
\nRevenue Code of 1986 is amended by striking “Such term” and all that
\nfollows through the period.
\n (b) Archer MSAs.–Subparagraph (A) of section 220(d)(2) of the
\nInternal Revenue Code of 1986 is amended by striking “Such term” and
\nall that follows through the period.
\n (c) Health Flexible Spending Arrangements and Health Reimbursement
\nArrangements.–Section 106 of the Internal Revenue Code of 1986 is
\namended by striking subsection (f) and by redesignating subsection (g)
\nas subsection (f).
\n (d) Effective Dates.–
\n (1) Distributions from savings accounts.–The amendments
\n made by subsections (a) and (b) shall apply to amounts paid
\n with respect to taxable years beginning after December 31,
\n 2017.
\n (2) Reimbursements.–The amendment made by subsection (c)
\n shall apply to expenses incurred with respect to taxable years
\n beginning after December 31, 2017.<\/p>\n
SEC. 209. REPEAL OF INCREASE OF TAX ON HEALTH SAVINGS ACCOUNTS.<\/p>\n
(a) HSAs.–Section 223(f)(4)(A) of the Internal Revenue Code of
\n1986 is amended by striking “20 percent” and inserting “10
\npercent”.
\n (b) Archer MSAs.–Section 220(f)(4)(A) of the Internal Revenue Code
\nof 1986 is amended by striking “20 percent” and inserting “15
\npercent”.
\n (c) Effective Date.–The amendments made by this section shall
\napply to distributions made after December 31, 2017.<\/p>\n
SEC. 210. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO FLEXIBLE SPENDING
\n ACCOUNTS.<\/p>\n
(a) In General.–Section 125 of the Internal Revenue Code of 1986
\nis amended by striking subsection (i).
\n (b) Effective Date.–The amendment made by this section shall apply
\nto taxable years beginning after December 31, 2017.<\/p>\n
SEC. 211. REPEAL OF MEDICAL DEVICE EXCISE TAX.<\/p>\n
Section 4191 of the Internal Revenue Code of 1986 is amended by
\nadding at the end the following new subsection:
\n “(d) Applicability.–The tax imposed under subsection (a) shall
\nnot apply to sales after December 31, 2017.”.<\/p>\n
SEC. 212. REPEAL OF ELIMINATION OF DEDUCTION FOR EXPENSES ALLOCABLE TO
\n MEDICARE PART D SUBSIDY.<\/p>\n
(a) In General.–Section 139A of the Internal Revenue Code of 1986
\nis amended by adding at the end the following new sentence: “This
\nsection shall not be taken into account for purposes of determining
\nwhether any deduction is allowable with respect to any cost taken into
\naccount in determining such payment.”.
\n (b) Effective Date.–The amendment made by this section shall apply
\nto taxable years beginning after December 31, 2017.<\/p>\n
SEC. 213. REPEAL OF INCREASE IN INCOME THRESHOLD FOR DETERMINING
\n MEDICAL CARE DEDUCTION.<\/p>\n
(a) In General.–Subsection (a) of section 213 of the Internal
\nRevenue Code of 1986 is amended by striking “10 percent” and
\ninserting “7.5 percent”.
\n (b) Extension of Special Rule.–Subsection (f) of section 213 of
\nsuch Code is amended–
\n (1) by striking “2017” and inserting “2018”, and
\n (2) by striking “and 2016” and inserting “2016, and
\n 2017”.
\n (c) Effective Date.–
\n (1) In general.–The amendment made by subsection (a) shall
\n apply to taxable years beginning after December 31, 2017.
\n (2) Extension of special rule.–The amendments made by
\n subsection (b) shall apply to taxable years beginning after
\n December 31, 2016.<\/p>\n
SEC. 214. REPEAL OF MEDICARE TAX INCREASE.<\/p>\n
(a) In General.–Subsection (b) of section 3101 of the Internal
\nRevenue Code of 1986 is amended to read as follows:
\n “(b) Hospital Insurance.–In addition to the tax imposed by the
\npreceding subsection, there is hereby imposed on the income of every
\nindividual a tax equal to 1.45 percent of the wages (as defined in
\nsection 3121(a)) received by such individual with respect to employment
\n(as defined in section 3121(b)).”.
\n (b) SECA.–Subsection (b) of section 1401 of the Internal Revenue
\nCode of 1986 is amended to read as follows:
\n “(b) Hospital Insurance.–In addition to the tax imposed by the
\npreceding subsection, there shall be imposed for each taxable year, on
\nthe self-employment income of every individual, a tax equal to 2.9
\npercent of the amount of the self-employment income for such taxable
\nyear.”.
\n (c) Effective Date.–The amendments made by this section shall
\napply with respect to remuneration received after, and taxable years
\nbeginning after, December 31, 2017.<\/p>\n
SEC. 215. REFUNDABLE TAX CREDIT FOR HEALTH INSURANCE COVERAGE.<\/p>\n
(a) In General.–Subpart C of part IV of subchapter A of chapter 1
\nof the Internal Revenue Code of 1986 is amended by inserting after
\nsection 36B the following new section:<\/p>\n
“SEC. 36C. HEALTH INSURANCE COVERAGE.<\/p>\n
“(a) In General.–In the case of an individual, there shall be
\nallowed as a credit against the tax imposed by this subtitle for the
\ntaxable year the sum of the monthly credit amounts with respect to such
\ntaxpayer for calendar months during such taxable year.
\n “(b) Monthly Credit Amounts.–
\n “(1) In general.–The monthly credit amount with respect
\n to any taxpayer for any calendar month is the lesser of–
\n “(A) the sum of the monthly limitation amounts
\n determined under subsection (c) with respect to the
\n taxpayer and the taxpayer’s qualifying family members
\n for such month, or
\n “(B) the amount paid for eligible health insurance
\n for the taxpayer and the taxpayer’s qualifying family
\n members for such month.
\n “(2) Eligible coverage month requirement.–No amount shall
\n be taken into account under subparagraph (A) or (B) of
\n paragraph (1) with respect to any individual for any month
\n unless such month is an eligible coverage month with respect to
\n such individual.
\n “(c) Monthly Limitation Amounts.–
\n “(1) In general.–The monthly limitation amount with
\n respect to any individual for any eligible coverage month
\n during any taxable year is \\1\/12\\ of–
\n “(A) $2,000 in the case of an individual who has
\n not attained age 30 as of the beginning of such taxable
\n year,
\n “(B) $2,500 in the case of an individual who has
\n attained age 30 but who has not attained age 40 as of
\n such time,
\n “(C) $3,000 in the case of an individual who has
\n attained age 40 but who has not attained age 50 as of
\n such time,
\n “(D) $3,500 in the case of an individual who has
\n attained age 50 but who has not attained age 60 as of
\n such time, and
\n “(E) $4,000 in the case of an individual who has
\n attained age 60 as of such time.
\n “(2) Limitation based on modified adjusted gross income.–
\n “(A) In general.–The amount otherwise determined
\n under subsection (b)(1)(A) (without regard to this
\n subparagraph but after any other adjustment of such
\n amount under this section) for the taxable year shall
\n be reduced (but not below zero) by 10 percent of the
\n excess (if any) of–
\n “(i) the taxpayer’s modified adjusted
\n gross income for such taxable year, over
\n “(ii) $75,000 (twice such amount in the
\n case of a joint return).
\n “(B) Modified adjusted gross income.–For purposes
\n of this paragraph, the term `modified adjusted gross
\n income’ means adjusted gross income increased by–
\n “(i) any amount excluded from gross income
\n under section 911,
\n “(ii) any amount of interest received or
\n accrued by the taxpayer during the taxable year
\n which is exempt from tax, and
\n “(iii) an amount equal to the portion of
\n the taxpayer’s social security benefits (as
\n defined in section 86(d)) which is not included
\n in gross income under section 86 for the
\n taxable year.
\n “(3) Other limitations.–
\n “(A) Aggregate dollar limitation.–The sum of the
\n monthly limitation amounts taken into account under
\n this section with respect to any taxpayer for any
\n taxable year shall not exceed $14,000.
\n “(B) Maximum number of individuals taken into
\n account.–With respect to any taxpayer for any month,
\n monthly limitation amounts shall be taken into account
\n under this section only with respect to the 5 oldest
\n individuals with respect to whom monthly limitation
\n amounts could (without regard to this subparagraph)
\n otherwise be so taken into account.
\n “(d) Eligible Coverage Month.–For purposes of this section, the
\nterm `eligible coverage month’ means, with respect to any individual,
\nany month if, as of the first day of such month, the individual–
\n “(1) is covered by eligible health insurance,
\n “(2) is not eligible for other specified coverage,
\n “(3) is either–
\n “(A) a citizen or national of the United States,
\n or
\n “(B) a qualified alien (within the meaning of
\n section 431 of the Personal Responsibility and Work
\n Opportunity Reconciliation Act of 1996 (8 U.S.C.
\n 1641)), and
\n “(4) is not incarcerated, other than incarceration pending
\n the disposition of charges.
\n “(e) Qualifying Family Member.–For purposes of this section, the
\nterm `qualifying family member’ means–
\n “(1) in the case of a joint return, the taxpayer’s spouse,
\n “(2) any dependent of the taxpayer, and
\n “(3) with respect to any eligible coverage month, any
\n child (as defined in section 152(f)(1)) of the taxpayer who as
\n of the end of the taxable year has not attained age 27 if such
\n child is covered for such month under eligible health insurance
\n which also covers the taxpayer (in the case of a joint return,
\n either spouse).
\n “(f) Eligible Health Insurance.–For purposes of this section–
\n “(1) In general.–The term `eligible health insurance’
\n means any health insurance coverage (as defined in section
\n 9832(b)) if–
\n “(A) such coverage is either–
\n “(i) offered in the individual health
\n insurance market within a State, or
\n “(ii) is unsubsidized COBRA continuation
\n coverage,
\n “(B) such coverage is not a grandfathered health
\n plan (as defined in section 1251 of the Patient
\n Protection and Affordable Care Act) or a grandmothered
\n health plan,
\n “(C) substantially all of such coverage is not of
\n excepted benefits described in section 9832(c),
\n “(D) such coverage does not include coverage for
\n abortions (other than any abortion necessary to save
\n the life of the mother or any abortion with respect to
\n a pregnancy that is the result of an act of rape or
\n incest),
\n “(E) such coverage does not consist of short-term
\n limited duration insurance (as defined by the
\n Secretary), and
\n “(F) the State in which such insurance is offered
\n certifies that such coverage meets the requirements of
\n this paragraph.
\n “(2) Rules related to state certification.–
\n “(A) Certification made available to public.–A
\n certification shall not be taken into account under
\n paragraph (1)(E) unless such certification is made
\n available to the public and meets such other
\n requirements as the Secretary may provide.
\n “(B) Special rule for unsubsidized cobra
\n continuation coverage.–In the case of unsubsidized
\n COBRA continuation coverage–
\n “(i) paragraph (1)(E) shall be applied by
\n substituting `the plan administrator (as
\n defined in section 414(g)) of the health plan’
\n for `the State in which such insurance is
\n offered’, and
\n “(ii) the requirements of subparagraph (A)
\n shall be treated as satisfied if the
\n certification meets such requirements as the
\n Secretary may provide.
\n “(3) Grandmothered health plan.–
\n “(A) In general.–The term `grandmothered health
\n plan’ means health insurance coverage which is offered
\n in the individual health insurance market as of January
\n 1, 2013, and is permitted to be offered in such market
\n after January 1, 2014, as a result of CCIIO guidance.
\n “(B) CCIIO guidance defined.–The term `CCIIO
\n guidance’ means the letter issued by the Centers for
\n Medicare & Medicaid Services on November 14, 2013, to
\n the State Insurance Commissioners outlining a
\n transitional policy for non-grandfathered coverage in
\n the individual health insurance market, as subsequently
\n extended and modified (including by a communication
\n entitled `Insurance Standards Bulletin Series–
\n INFORMATION–Extension of Transitional Policy through
\n Calendar Year 2017′ issued on February 29, 2016, by the
\n Director of the Center for Consumer Information &
\n Insurance Oversight of such Centers).
\n “(4) Individual health insurance market.–The term
\n `individual health insurance market’ means the market for
\n health insurance coverage (as defined in section 9832(b))
\n offered to individuals other than in connection with a group
\n health plan (within the meaning of section 5000(b)(1)).
\n “(g) Other Specified Coverage.–For purposes of this section–
\n “(1) In general.–The term `other specified coverage’
\n means any of the following:
\n “(A) Coverage under a group health plan (within
\n the meaning of section 5000(b)(1)) other than–
\n “(i) coverage under a plan substantially
\n all of the coverage of which is of excepted
\n benefits described in section 9832(c), and
\n “(ii) COBRA continuation coverage.
\n “(B) Coverage under the Medicare program under
\n part A of title XVIII of the Social Security Act.
\n “(C) Coverage under the Medicaid program under
\n title XIX of the Social Security Act.
\n “(D) Coverage under the CHIP program under title
\n XXI of the Social Security Act.
\n “(E) Medical coverage under chapter 55 of title
\n 10, United States Code, including coverage under the
\n TRICARE program.
\n “(F) Coverage under a health care program under
\n chapter 17 or 18 of title 38, United States Code, as
\n determined by the Secretary of Veterans Affairs, in
\n coordination with the Secretary of Health and Human
\n Services and the Secretary of the Treasury.
\n “(G) Coverage under a health plan under section
\n 2504(e) of title 22, United States Code (relating to
\n Peace Corps volunteers).
\n “(H) Coverage under the Nonappropriated Fund
\n Health Benefits Program of the Department of Defense,
\n established under section 349 of the National Defense
\n Authorization Act for Fiscal Year 1995 (Public Law 103-
\n 337; 10 U.S.C. 1587 note).
\n “(2) Special rule with respect to veterans health
\n programs.–In the case of other specified coverage described in
\n paragraph (1)(F), an individual shall not be treated as
\n eligible for such coverage unless such individual is enrolled
\n in such coverage.
\n “(h) Unsubsidized COBRA Continuation Coverage.–For purposes of
\nthis section–
\n “(1) In general.–The term `unsubsidized COBRA
\n continuation coverage’ means COBRA continuation coverage no
\n portion of the premiums for which are subsidized by the
\n employer.
\n “(2) COBRA continuation coverage.–The term `COBRA
\n continuation coverage’ means continuation coverage provided
\n pursuant to part 6 of subtitle B of title I of the Employee
\n Retirement Income Security Act of 1974 (other than under
\n section 609), title XXII of the Public Health Service Act,
\n section 4980B of the Internal Revenue Code of 1986 (other than
\n subsection (f)(1) of such section insofar as it relates to
\n pediatric vaccines), or section 8905a of title 5, United States
\n Code, or under a State program that provides comparable
\n continuation coverage. Such term shall not include coverage
\n under a health flexible spending arrangement.
\n “(i) Special Rules.–
\n “(1) Married couples must file joint return.–If the
\n taxpayer is married (within the meaning of section 7703) at the
\n close of the taxable year, no credit shall be allowed under
\n this section to such taxpayer unless such taxpayer and the
\n taxpayer’s spouse file a joint return for such taxable year.
\n “(2) Denial of credit to dependents.–
\n “(A) In general.–No credit shall be allowed under
\n this section to any individual who is a dependent with
\n respect to another taxpayer for a taxable year
\n beginning in the calendar year in which such
\n individual’s taxable year begins.
\n “(B) Coordination with rule for older children.–
\n In the case of any individual who is a qualifying
\n family member described in subsection (e)(3) with
\n respect to another taxpayer for any month, in
\n determining the amount of any credit allowable to such
\n individual under this section for any taxable year of
\n such individual which includes such month, the monthly
\n limitation amount with respect to such individual for
\n such month shall be zero and no amount paid for
\n eligible health insurance with respect to such
\n individual for such month shall be taken into account.
\n “(3) Coordination with medical expense deduction.–Amounts
\n described in subsection (b)(1)(B) with respect to any month
\n shall not be taken into account in determining the deduction
\n allowed under section 213 except to the extent that such
\n amounts exceed the amount described in subsection (b)(1)(A)
\n with respect to such month.
\n “(4) Insurance which covers other individuals.–For
\n purposes of this section, rules similar to the rules of section
\n 213(d)(6) shall apply with respect to any contract for eligible
\n health insurance under which amounts are payable for coverage
\n of an individual other than the taxpayer and the taxpayer’s
\n qualifying family members.
\n “(5) Coordination with advance payments of credit.–With
\n respect to any taxable year–
\n “(A) the amount which would (but for this
\n subsection) be allowed as a credit to the taxpayer
\n under subsection (a) shall be reduced (but not below
\n zero) by the aggregate amount paid on behalf of such
\n taxpayer under section 7529 for months beginning in
\n such taxable year, and
\n “(B) the tax imposed by section 1 for such taxable
\n year shall be increased by the excess (if any) of–
\n “(i) the aggregate amount paid on behalf
\n of such taxpayer under section 7529 for months
\n beginning in such taxable year, over
\n “(ii) the amount which would (but for this
\n subsection) be allowed as a credit to the
\n taxpayer under subsection (a).
\n “(6) Special rules for qualified small employer health
\n reimbursement arrangements.–
\n “(A) In general.–If the taxpayer or any
\n qualifying family member of the taxpayer is provided a
\n qualified small employer health reimbursement
\n arrangement for any eligible coverage month, the sum
\n determined under subsection (b)(1)(A) with respect to
\n the taxpayer for such month shall be reduced (but not
\n below zero) by \\1\/12\\ of the permitted benefit (as
\n defined in section 9831(d)(3)(C)) under such
\n arrangement.
\n “(B) Qualified small employer health reimbursement
\n arrangement.–For purposes of this paragraph, the term
\n `qualified small employer health reimbursement
\n arrangement’ has the meaning given such term by section
\n 9831(d)(2).
\n “(C) Coverage for less than entire year.–In the
\n case of an employee who is provided a qualified small
\n employer health reimbursement arrangement for less than
\n an entire year, subparagraph (A) shall be applied by
\n substituting `the number of months during the year for
\n which such arrangement was provided’ for `12′.
\n “(7) Certain rules related to abortion.–
\n “(A) Option to purchase separate coverage or
\n plan.–Nothing in subsection (f)(1)(D) shall be
\n construed as prohibiting any individual from purchasing
\n separate coverage for abortions described in such
\n subparagraph, or a health plan that includes such
\n abortions, so long as no credit is allowed under this
\n section with respect to the premiums for such coverage
\n or plan.
\n “(B) Option to offer coverage or plan.–Nothing in
\n subsection (f)(1)(D) shall restrict any health
\n insurance issuer offering a health plan from offering
\n separate coverage for abortions described in such
\n clause, or a plan that includes such abortions, so long
\n as premiums for such separate coverage or plan are not
\n paid for with any amount attributable to the credit
\n allowed under this section.
\n “(C) Other treatments.–The treatment of any
\n infection, injury, disease, or disorder that has been
\n caused by or exacerbated by the performance of an
\n abortion shall not be treated as an abortion for
\n purposes of subsection (f)(1)(D).
\n “(8) Inflation adjustment.–
\n “(A) In general.–In the case of any taxable year
\n beginning in a calendar year after 2020, each dollar
\n amount in subsection (c)(1), the $75,000 amount in
\n subsection (c)(2)(A)(ii), and the dollar amount in
\n subsection (c)(3)(A), shall be increased by an amount
\n equal to–
\n “(i) such dollar amount, multiplied by
\n “(ii) the cost-of-living adjustment
\n determined under section 1(f)(3) for the
\n calendar year in which the taxable year begins,
\n determined–
\n “(I) by substituting `calendar
\n year 2019′ for `calendar year 1992′ in
\n subparagraph (B) thereof, and
\n “(II) by substituting for the CPI
\n referred to section 1(f)(3)(A) the
\n amount that such CPI would have been if
\n the annual percentage increase in CPI
\n with respect to each year after 2019
\n had been one percentage point greater.
\n “(B) Terms related to cpi.–
\n “(i) Annual percentage increase.–For
\n purposes of subparagraph (A)(ii)(II), the term
\n `annual percentage increase’ means the
\n percentage (if any) by which CPI for any year
\n exceeds CPI for the prior year.
\n “(ii) Other terms.–Terms used in this
\n paragraph which are also used in section
\n 1(f)(3) shall have the same meanings as when
\n used in such section.
\n “(C) Rounding.–Any increase determined under
\n subparagraph (A) shall be rounded to the nearest
\n multiple of $50.
\n “(9) Regulations.–The Secretary may prescribe such
\n regulations and other guidance as may be necessary or
\n appropriate to carry out this section, section 6050X, and
\n section 7529.”.
\n (b) Advance Payment of Credit; Excess Health Insurance Coverage
\nCredit Payable to Health Savings Account.–Chapter 77 of such Code is
\namended by adding at the end the following:<\/p>\n
“SEC. 7529. ADVANCE PAYMENT OF HEALTH INSURANCE COVERAGE CREDIT.<\/p>\n
“(a) General Rule.–Not later than January 1, 2020, the Secretary,
\nin consultation with the Secretary of Health and Human Services, the
\nSecretary of Homeland Security, and the Commissioner of Social
\nSecurity, shall establish a program (hereafter in this section referred
\nto as the `advance payment program’) for making payments to providers
\nof eligible health insurance on behalf of taxpayers eligible for the
\ncredit under section 36C.
\n “(b) Limitation.–The aggregate payments made under this section
\nwith respect to any taxpayer, determined as of any time during any
\ncalendar year, shall not exceed the monthly credit amounts determined
\nwith respect to such taxpayer under section 36C for months during such
\ncalendar year which have ended as of such time.
\n “(c) Administration.–
\n “(1) In general.–The advance payment program shall, to
\n the greatest extent practicable, use the methods and procedures
\n used to administer the programs created under sections 1411 and
\n 1412 of the Patient Protection and Affordable Care Act
\n (determined without regard to section 1412(f) of such Act) and
\n each entity that is authorized to take any actions under the
\n programs created under such sections (as so determined) shall,
\n at the request of the Secretary, take such actions to the
\n extent necessary to carry out this section.
\n “(2) Application to off-exchange coverage.–Except as
\n otherwise provided by the Secretary, for purposes of applying
\n this subsection in the case of eligible health insurance which
\n is not enrolled in through an Exchange established under title
\n I of the Patient Protection and Affordable Care Act, the
\n sections referred to in paragraph (1) shall be applied by
\n treating references in such sections to an Exchange as
\n references to the provider of such eligible health insurance
\n (or, as the Secretary determines appropriate, to the licensed
\n agent or broker with respect to such insurance), except that
\n the Secretary of Health and Human Services shall carry out the
\n responsibilities of the Exchange under section 1411(e)(4) of
\n the Patient Protection and Affordable Care Act (determined
\n without regard to section 1412(f) of such Act) in the case of
\n such insurance.
\n “(3) Documentation regarding other specified coverage.–
\n “(A) In general.–The advance payment program
\n shall provide that any individual applying to have
\n payments made on their behalf under such program shall,
\n if such individual (or any qualifying family member of
\n such individual taken into account in determining the
\n amount of the credit allowable under section 36C) is
\n employed, submit a written statement from each employer
\n of such individual or such qualifying family member
\n stating whether such individual or qualifying family
\n member (as the case may be) is eligible for other
\n specified coverage in connection with such employment.
\n “(B) Issuance of statements.–An employer shall,
\n at the request of any employee, provide the statement
\n under subparagraph (A) at such time, and in such form
\n and manner, as the Secretary may provide.
\n “(d) Definitions.–For purposes of this section, terms used in
\nthis section which are also used in section 36C shall have the same
\nmeaning as when used in section 36C.<\/p>\n
“SEC. 7530. EXCESS HEALTH INSURANCE COVERAGE CREDIT PAYABLE TO HEALTH
\n SAVINGS ACCOUNT.<\/p>\n
“(a) In General.–At the request of an eligible taxpayer, the
\nSecretary shall make a payment to the trustee of the designated health
\nsavings account with respect to such taxpayer in an amount equal to the
\nsum of the excesses (if any) described in subsection (c)(2) with
\nrespect to months in the taxable year.
\n “(b) Designated Health Savings Account.–The term `designated
\nhealth savings account’ means a health savings account of an individual
\ndescribed in subsection (c)(3) which is identified by the eligible
\ntaxpayer for purposes of this section.
\n “(c) Eligible Taxpayer.–The term `eligible taxpayer’ means, with
\nrespect to any taxable year, any taxpayer if–
\n “(1) such taxpayer is allowed a credit under section 36C
\n for such taxable year,
\n “(2) the amount described in subparagraph (A) of section
\n 36C(b)(1) exceeds the amount described in subparagraph (B) of
\n such section with respect to such taxpayer applied with respect
\n to any month during such taxable year, and
\n “(3) the taxpayer or one or more of the taxpayer’s
\n qualifying family members (as defined in section 36C(e)) were
\n eligible individuals (as defined in section 223(c)(1)) for one
\n or more months during such taxable year.
\n “(d) Contributions Treated as Rollovers, etc.–
\n “(1) In general.–Any amount paid the Secretary to a
\n health savings account under this section shall be treated for
\n purposes of this title in the same manner as a rollover
\n contribution described in section 223(f)(5).
\n “(2) Coordination with limitation on rollovers.–Any
\n amount described in paragraph (1) shall not be taken into
\n account in applying section 223(f)(5)(B) with respect to any
\n other amount and the limitation of section 223(f)(5)(B) shall
\n not apply with respect to the application of paragraph (1).
\n “(e) Form and Manner of Request.–The request referred to in
\nsubsection (a) shall be made at such time and in such form and manner
\nas the Secretary may provide. To the extent that the Secretary
\ndetermines feasible, such request may identify more than one designated
\nhealth savings account (and the amount to be paid to each such account)
\nprovided that the aggregate of such payments with respect to any
\ntaxpayer for any taxable year do not exceed the excess described in
\nsubsection (c)(2).
\n “(f) Taxpayers With Seriously Delinquent Tax Debt.–In the case of
\nan individual who has a seriously delinquent tax debt (as defined in
\nsection 7345(b)) which has not been fully satisfied–
\n “(1) if such individual is the eligible taxpayer (or, in
\n the case of a joint return, either spouse), the Secretary shall
\n not make any payment under this section with respect to such
\n taxpayer, and
\n “(2) if such individual is the account beneficiary (as
\n defined in section 223(d)(3)) of any health savings account,
\n the Secretary shall not make any payment under this section to
\n such health savings account.
\n “(g) Advance Payment.–To the extent that the Secretary determines
\nfeasible, payment under this section may be made in advance on a
\nmonthly basis under rules similar to the rules of sections 7529 and
\n36C(i)(5)(B).”.
\n (c) Information Reporting.–
\n (1) Reporting by health insurance providers.–Subpart B of
\n part III of subchapter A of chapter 61 of such Code is amended
\n by adding at the end the following new section:<\/p>\n
“SEC. 6050X. RETURNS BY HEALTH INSURANCE PROVIDERS RELATING TO HEALTH
\n INSURANCE COVERAGE CREDIT.<\/p>\n
“(a) Requirement of Reporting.–Every person who provides eligible
\nhealth insurance for any month of any calendar year with respect to any
\nindividual shall, at such time as the Secretary may prescribe, make the
\nreturn described in subsection (b) with respect to each such
\nindividual. With respect to any individual with respect to whom
\npayments under section 7529 are made by the Secretary, the reporting
\nunder subsection (b) shall be made on a monthly basis.
\n “(b) Form and Manner of Returns.–A return is described in this
\nsubsection if such return–
\n “(1) is in such form as the Secretary may prescribe, and
\n “(2) contains, with respect to each policy of eligible
\n health insurance–
\n “(A) the name, address, and TIN of each individual
\n covered under such policy,
\n “(B) the premiums paid with respect to such
\n policy,
\n “(C) the amount of advance payments made on behalf
\n of the individual under section 7529,
\n “(D) the months during which such health insurance
\n is provided to the individual,
\n “(E) whether such policy constitutes a high
\n deductible health plan (as defined in section
\n 223(c)(2)), and
\n “(F) such other information as the Secretary may
\n prescribe.
\n “(c) Statements to Be Furnished to Individuals With Respect to
\nWhom Information Is Required.–Every person required to make a return
\nunder subsection (a) shall furnish to each individual whose name is
\nrequired to be set forth in such return a written statement showing–
\n “(1) the name and address of the person required to make
\n such return and the phone number of the information contact for
\n such person, and
\n “(2) the information required to be shown on the return
\n with respect to such individual.
\nThe written statement required under the preceding sentence shall be
\nfurnished on or before January 31 of the year following the calendar
\nyear to which such statement relates.
\n “(d) Definitions.–For purposes of this section, terms used in
\nthis section which are also used in section 36C shall have the same
\nmeaning as when used in section 36C.”.
\n (2) Reporting by employers.–Section 6051(a) of such Code
\n is amended by striking “and” at the end of paragraph (14), by
\n striking the period at the end of paragraph (15) and inserting
\n “, and”, and by inserting after paragraph (15) the following
\n new paragraph:
\n “(16) each month with respect to which the employee is
\n eligible for other specified coverage (as defined in section
\n 36C(g)) in connection with employment with the employer.”.
\n (3) Assessable penalties.–
\n (A) Section 6724(d)(1)(B) of such Code is amended
\n by striking “or” at the end of clause (xxiv), by
\n inserting “or” at the end of clause (xxv), and by
\n inserting after clause (xxv) the following new clause:
\n “(xxvi) section 6050X (relating to returns
\n relating to health insurance coverage
\n credit),”.
\n (B) Section 6724(d)(2) of such Code is amended by
\n striking “or” at the end of subparagraph (HH), by
\n striking the period at the end of subparagraph (II) and
\n inserting a comma, and by adding after subparagraph
\n (II) the following new subparagraphs:
\n “(JJ) section 6050X (relating to returns relating
\n to health insurance coverage credit), or
\n “(KK) section 7529(c)(3) (relating to
\n documentation regarding other specified coverage).”.
\n (d) Disclosures.–Paragraph (21) of section 6103(l) of the Internal
\nRevenue Code of 1986 is amended–
\n (1) in subparagraph (A)–
\n (A) by striking “any premium tax credit under
\n section 36B or any cost-sharing reduction under section
\n 1402 of the Patient Protection and Affordable Care Act
\n or” and inserting “any credit under section 36C”,
\n (B) by striking “, a State’s children’s health
\n insurance program under title XXI of the Social
\n Security Act, or a basic health program under section
\n 1331 of Patient Protection and Affordable Care Act”
\n and inserting “or a State’s children’s health
\n insurance program under title XXI of the Social
\n Security Act”,
\n (C) by striking “(as defined in section 36B)” in
\n clause (iv) and inserting “(as defined in section
\n 36C(c)(2)(B))”, and
\n (D) by striking “or reduction” in clause (v),
\n (2) in subparagraph (B)–
\n (A) by striking “may disclose to an Exchange” and
\n inserting “may disclose–
\n “(i) to an Exchange”, and
\n (B) by striking the period at the end and inserting
\n “, and”, and
\n (C) by adding at the end the following new clause:
\n “(ii) in the case of any credit under
\n section 36C with respect to any health
\n insurance, the amount of such credit (or the
\n amount of any advance payment of such credit)
\n to the provider of such insurance (or, as the
\n Secretary determines appropriate, the licensed
\n agent or broker with respect to such
\n insurance).”, and
\n (3) in subparagraph (C)(i), by striking “amount of, any
\n credit or reduction” and inserting “amount of any credit”.
\n (e) Increased Penalty on Erroneous Claims of Credit.–Section
\n6676(a) of such Code is amended by inserting “(25 percent in the case
\nof a claim for refund or credit relating to the health insurance
\ncoverage credit under section 36C)” after “20 percent”.
\n (f) Conforming Amendments.–
\n (1) Section 35(g) of such Code is amended by adding at the
\n end the following new paragraph:
\n “(14) Coordination with health insurance coverage
\n credit.–
\n “(A) In general.–An eligible coverage month to
\n which the election under paragraph (11) applies shall
\n not be treated as an eligible coverage month (as
\n defined in section 36C(d)) for purposes of section 36C
\n with respect to the taxpayer or any of the taxpayer’s
\n qualifying family members (as defined in section
\n 36C(e)).
\n “(B) Coordination with advance payments of health
\n insurance coverage credit.–In the case of a taxpayer
\n who makes the election under paragraph (11) with
\n respect to any eligible coverage month in a taxable
\n year or on behalf of whom any advance payment is made
\n under section 7527 with respect to any month in such
\n taxable year–
\n “(i) the tax imposed by this chapter for
\n the taxable year shall be increased by the
\n excess, if any, of–
\n “(I) the sum of any advance
\n payments made on behalf of the taxpayer
\n under sections 7527 and 7529 for months
\n during such taxable year, over
\n “(II) the sum of the credits
\n allowed under this section (determined
\n without regard to paragraph (1)) and
\n section 36C (determined without regard
\n to subsection (i)(5)(A) thereof) for
\n such taxable year, and
\n “(ii) section 36C(i)(5)(B) shall not apply
\n with respect to such taxpayer for such taxable
\n year.”.
\n (2) Section 162(l) of such Code is amended by adding at the
\n end the following new paragraph:
\n “(6) Coordination with health insurance coverage credit.–
\n The deduction otherwise allowable to a taxpayer under paragraph
\n (1) for any taxable year shall be reduced (but not below zero)
\n by the sum of–
\n “(A) the amount of the credit allowable to such
\n taxpayer under section 36C (determined without regard
\n to subsection (i)(5)(A) thereof) for such taxable year,
\n plus
\n “(B) the aggregate payments made with respect to
\n the taxpayer under section 7530 for months during such
\n taxable year.”.
\n (3) Section 1324(b)(2) of title 31, United States Code is
\n amended–
\n (A) by inserting “36C,” after “36B,”, and
\n (B) by striking “or 6431” and inserting “6431,
\n or 7530”.
\n (4) The table of sections for subpart C of part IV of
\n subchapter A of chapter 1 of the Internal Revenue Code of 1986
\n is amended by inserting after the item relating to section 36B
\n the following new item:<\/p>\n
“Sec. 36C. Health insurance coverage.”.
\n (5) The table of sections for subpart B of part III of
\n subchapter A of chapter 61 of such Code is amended by adding at
\n the end the following new item:<\/p>\n
“Sec. 6050X. Returns by health insurance providers relating to health
\n insurance coverage credit.”.
\n (6) The table of sections for chapter 77 of such Code is
\n amended by adding at the end the following new items:<\/p>\n
“Sec. 7529. Advance payment of health insurance coverage credit.
\n“Sec. 7530. Excess health insurance coverage credit payable to health
\n savings account.”.
\n (g) Effective Date.–The amendments made by this section shall
\napply to months beginning after December 31, 2019, in taxable years
\nending after such date.<\/p>\n
SEC. 216. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAVINGS ACCOUNT
\n INCREASED TO AMOUNT OF DEDUCTIBLE AND OUT-OF-POCKET
\n LIMITATION.<\/p>\n
(a) Self-Only Coverage.–Section 223(b)(2)(A) of the Internal
\nRevenue Code of 1986 is amended by striking “$2,250” and inserting
\n“the amount in effect under subsection (c)(2)(A)(ii)(I)”.
\n (b) Family Coverage.–Section 223(b)(2)(B) of such Code is amended
\nby striking “$4,500” and inserting “the amount in effect under
\nsubsection (c)(2)(A)(ii)(II)”.
\n (c) Conforming Amendments.–Section 223(g)(1) of such Code is
\namended–
\n (1) by striking “subsections (b)(2) and” both places it
\n appears and inserting “subsection”, and
\n (2) in subparagraph (B), by striking “determined by” and
\n all that follows through “`calendar year 2003′.” and
\n inserting “determined by substituting `calendar year 2003′ for
\n `calendar year 1992′ in subparagraph (B) thereof .”.
\n (d) Effective Date.–The amendments made by this section shall
\napply to taxable years beginning after December 31, 2017.<\/p>\n
SEC. 217. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS TO THE SAME
\n HEALTH SAVINGS ACCOUNT.<\/p>\n
(a) In General.–Section 223(b)(5) of the Internal Revenue Code of
\n1986 is amended to read as follows:
\n “(5) Special rule for married individuals with family
\n coverage.–
\n “(A) In general.–In the case of individuals who
\n are married to each other, if both spouses are eligible
\n individuals and either spouse has family coverage under
\n a high deductible health plan as of the first day of
\n any month–
\n “(i) the limitation under paragraph (1)
\n shall be applied by not taking into account any
\n other high deductible health plan coverage of
\n either spouse (and if such spouses both have
\n family coverage under separate high deductible
\n health plans, only one such coverage shall be
\n taken into account),
\n “(ii) such limitation (after application
\n of clause (i)) shall be reduced by the
\n aggregate amount paid to Archer MSAs of such
\n spouses for the taxable year, and
\n “(iii) such limitation (after application
\n of clauses (i) and (ii)) shall be divided
\n equally between such spouses unless they agree
\n on a different division.
\n “(B) Treatment of additional contribution
\n amounts.–If both spouses referred to in subparagraph
\n (A) have attained age 55 before the close of the
\n taxable year, the limitation referred to in
\n subparagraph (A)(iii) which is subject to division
\n between the spouses shall include the additional
\n contribution amounts determined under paragraph (3) for
\n both spouses. In any other case, any additional
\n contribution amount determined under paragraph (3)
\n shall not be taken into account under subparagraph
\n (A)(iii) and shall not be subject to division between
\n the spouses.”.
\n (b) Effective Date.–The amendment made by this section shall apply
\nto taxable years beginning after December 31, 2017.<\/p>\n
SEC. 218. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED BEFORE
\n ESTABLISHMENT OF HEALTH SAVINGS ACCOUNT.<\/p>\n
(a) In General.–Section 223(d)(2) of the Internal Revenue Code of
\n1986 is amended by adding at the end the following new subparagraph:
\n “(D) Treatment of certain medical expenses
\n incurred before establishment of account.–If a health
\n savings account is established during the 60-day period
\n beginning on the date that coverage of the account
\n beneficiary under a high deductible health plan begins,
\n then, solely for purposes of determining whether an
\n amount paid is used for a qualified medical expense,
\n such account shall be treated as having been
\n established on the date that such coverage begins.”.
\n (b) Effective Date.–The amendment made by this section shall apply
\nwith respect to coverage beginning after December 31, 2017.<\/p>\n
Subtitle B–Repeal of Certain Consumer Taxes<\/p>\n
SEC. 221. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS.<\/p>\n
Section 9008 of the Patient Protection and Affordable Care Act is
\namended by adding at the end the following new subsection:
\n “(l) Termination.–No fee shall be imposed under subsection (a)(1)
\nwith respect to any calendar year beginning after December 31, 2017.”.<\/p>\n
SEC. 222. REPEAL OF HEALTH INSURANCE TAX.<\/p>\n
Section 9010 of the Patient Protection and Affordable Care Act is
\namended by adding at the end the following new subsection:
\n “(k) Termination.–No fee shall be imposed under subsection (a)(1)
\nwith respect to any calendar year beginning after December 31, 2017.”.<\/p>\n
Subtitle C–Repeal of Tanning Tax<\/p>\n
SEC. 231. REPEAL OF TANNING TAX.<\/p>\n
(a) In General.–The Internal Revenue Code of 1986 is amended by
\nstriking chapter 49.
\n (b) Effective Date.–The amendment made by this section shall apply
\nto services performed after December 31, 2017.<\/p>\n
Subtitle D–Remuneration From Certain Insurers<\/p>\n
SEC. 241. REMUNERATION FROM CERTAIN INSURERS.<\/p>\n
Paragraph (6) of section 162(m) of the Internal Revenue Code of
\n1986 is amended by adding at the end the following new subparagraph:
\n “(I) Termination.–This paragraph shall not apply
\n to taxable years beginning after December 31, 2017.”.<\/p>\n
Subtitle E–Repeal of Net Investment Income Tax<\/p>\n
SEC. 251. REPEAL OF NET INVESTMENT INCOME TAX.<\/p>\n
(a) In General.–Subtitle A of the Internal Revenue Code of 1986 is
\namended by striking chapter 2A.
\n (b) Effective Date.–The amendment made by this section shall apply
\nto taxable years beginning after December 31, 2017.
\n Union Calendar No. 30<\/p>\n
115th CONGRESS<\/p>\n
1st Session<\/p>\n
H. R. 1628<\/p>\n
[Report No. 115-52]<\/p>\n
_______________________________________________________________________<\/p>\n
A BILL<\/p>\n
To provide for reconciliation pursuant to title II of the concurrent
\n resolution on the budget for fiscal year 2017.<\/p>\n
_______________________________________________________________________<\/p>\n
March 20, 2017<\/p>\n
Committed to the Committee of the Whole House on the State of the Union
\n and ordered to be printed<\/p>\n","protected":false},"excerpt":{"rendered":"
Washington, DC…The House Republicans narrowly advanced the “American Healthcare Act” on to the Senate. Many of the Obamacare mandates have been stripped in this bill including individual and employer mandates. The full text of the bill in its’ current form is below. Union Calendar No. 30 115th CONGRESS 1st Session H. R. 1628 [Report No. […]<\/p>\n","protected":false},"author":1,"featured_media":38383,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_cbd_carousel_blocks":"[]","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[20,5,1],"tags":[],"class_list":["post-38382","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-featured","category-government","category-news","last_archivepost"],"jetpack_featured_media_url":"https:\/\/new.thepinetree.net\/wp-content\/uploads\/2017\/05\/Fullscreen-capture-542017-111920-AM.jpg","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/posts\/38382","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=38382"}],"version-history":[{"count":0,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/posts\/38382\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=\/wp\/v2\/media\/38383"}],"wp:attachment":[{"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=38382"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=38382"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/new.thepinetree.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=38382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}