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HR 1425 - Patient Protection and Affordable Care Enhancement Act - National Key Vote

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Title: Patient Protection and Affordable Care Enhancement Act

Vote Smart's Synopsis:

Vote to pass a bill that establishes the Improve Health Insurance Affordability Fund which will be used to issue reinsurance payments to health insurers and to reduce out-of-pocket costs for qualified health plans offered in the individual health insurance market.

Highlights:

 

  • Expands premium assistance for consumers by repealing the 400 percent threshold and specifies that no taxpayer is required to pay more than 8.5 percent of their household income on the most popular tier of marketplace health plans (Sec. 101).

  • Amends the Patient Protection and Affordable Care Act (ACA) by establishing the Improve Health Insurance Affordability Fund (Sec. 106).

  • Specifies that the Fund will be administered by the Secretary of Health and Human Services (HHS) to provide funding to states and the District of Columbia beginning January 1, 2022 (Sec. 106).

  • Requires a state to use allocated funds for the following purposes (Sec. 106):

    • To provide reinsurance payments to health insurers for individuals enrolled under individual health insurance coverage; and

    • To provide assistance to reduce out-of-pocket costs, such as copayments, coinsurance, premiums, and deductibles, of individuals enrolled under qualified health plans offered on the individual market through an exchange.

  • Specifies that reinsurance payments using such funds may not be applied to the following (Sec. 106):

    • A grandfathered health plan; 

    • A plan continued by the Centers for Medicare & Medicaid Services (CMS); or

    • Student health insurance coverage.

  • Appropriates $10 billion for state funding for 2022 and each subsequent year (Sec. 106).

  • Appropriates $200 million to award grants to eligible states for preserving the state option to implement health care marketplaces (Sec. 105).

  • Requires the HHS Secretary to award grants to eligible state agencies to enable states to explore innovative solutions to promote greater enrollment in health insurance coverage in the individual market and small group markets (Sec. 114).

  • Appropriates $200 million for fiscal years 2022 through 2024 in order to perform the following activities (Sec. 114):

    • State efforts to streamline health insurance enrollment procedures in order to reduce burdens on consumers and facilitate greater enrollment in health insurance coverage in the individual and small group markets, including automatic enrollment and re-enrollment of individuals without health insurance who are eligible for tax credits, with the ability to opt out of such enrollment; 

    • State investment in technology to improve data sharing and collection for the purposes of facilitating greater enrollment in health insurance coverage in such markets; 

    • Implementation of a state version of an individual mandate to be enrolled in health insurance coverage; and

    • Feasibility studies to develop a comprehensive and coherent state plan for increasing enrollment in the individual and small group market. 

  • Requires a state to submit an application containing the following information to the CMS Administrator in order to receive their allocation of funds (Sec. 106):

    • A description of how the funds will be used; and

    • Such other information as the CMS Administrator may require.

  • Prohibits an employee from being treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan and the employee’s required contribution to the plan exceeds 9.5 percent of the employee’s household income (Sec. 103).

  • Authorizes a family member to enroll in an employer-sponsored plan by reason of a relationship to the employee and cannot be treated eligible for minimum essential coverage by reason of such eligibility to enroll if the employee’s required contribution to the plan exceeds 9.5 percent of the employee’s household income (Sec. 103).

  • Requires 12-month continuous eligibility for coverage of Medicaid and Children’s Health Insurance Program (CHIP) (Sec. 202). 

  • Requires the HHS Secretary to establish a Fair Price Negotiation Program to lower prices for certain high-priced single-source drugs (Sec. 301).

  • Establishes the Fair Price Negotiation Implementation Fund and appropriates $3 billion to the Fund (Sec. 303).

Title: Patient Protection and Affordable Care Enhancement Act

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