State Public Option Act

I 116TH CONGRESS 1ST SESSION H. R. 1277 To establish a State public option through Medicaid to provide Americans with the choice of a high-quality, low-cost health insurance plan. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 14, 2019 Mr. LUJA´N (for himself, Mr. BLUMENAUER, Mr. CARSON of Indiana, Mr. CICILLINE, Ms. CLARK of Massachusetts, Ms. CLARKE of New York, Mr. COHEN, Mr. DESAULNIER, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. ENGEL, Ms. FUDGE, Mr. GALLEGO, Mr. GARAMENDI, Ms. HILL of Cali- fornia, Ms. JAYAPAL, Mr. KHANNA, Mr. KRISHNAMOORTHI, Ms. MATSUI, Ms. MCCOLLUM, Mrs. NAPOLITANO, Mr. NEGUSE, Ms. NORTON, Ms. OMAR, Mr. PERLMUTTER, Mr. POCAN, Mr. ROUDA, Ms. ROYBAL- ALLARD, Mr. SCHIFF, Ms. SCHRIER, Mr. TAKANO, Ms. TITUS, Mr. TONKO, Mrs. WATSON COLEMAN, Mr. WELCH, Ms. VELA´ZQUEZ, Ms. MOORE, Mr. COX of California, Ms. WILD, Ms. KUSTER of New Hamp- shire, Ms. SCHAKOWSKY, and Mr. CLAY) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subse- quently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To establish a State public option through Medicaid to pro- vide Americans with the choice of a high-quality, low- cost health insurance plan. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 2 •HR 1277 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘State Public Option 2 Act’’. 3 SEC. 2. MEDICAID BUY-IN OPTION. 4 (a) IN GENERAL.—Section 1902 of the Social Secu- 5 rity Act (42 U.S.C. 1396a) is amended— 6 (1) in subsection (a)(10)— 7 (A) in subparagraph (A)(ii)— 8 (i) in subclause (XXI), by striking ‘‘; 9 or’’ and inserting a semicolon; 10 (ii) in subclause (XXII), by adding 11 ‘‘or’’ at the end; and 12 (iii) by adding at the end the fol- 13 lowing new subclause: 14 ‘‘(XXIII) beginning January 1, 15 2020, who are residents of the State 16 and are not concurrently enrolled in 17 another health insurance coverage 18 plan, subject, in the case of individ- 19 uals described in subsection (qq) and 20 notwithstanding section 1916 (except 21 for subsection (k) of such section), to 22 payment of premiums or other cost- 23 sharing charges;’’; and 24 (B) in the matter following subparagraph 25 (G), in clause (XV), by inserting ‘‘or subsection 26 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 3 •HR 1277 IH (qq)’’ after ‘‘described in subparagraph 1 (A)(i)(VIII)’’; and 2 (2) by adding at the end the following new sub- 3 section: 4 ‘‘(qq) PREVIOUSLY UNDESCRIBED INDIVIDUALS.— 5 Individuals described in this subsection are individuals 6 who are— 7 ‘‘(1) described in subclause (XXIII) of sub- 8 section (a)(10)(A)(ii); and 9 ‘‘(2) are not described in any other subclause of 10 such subsection or any other provision in this Act 11 which provides for eligibility for medical assist- 12 ance.’’. 13 (b) PROVISION OF AT LEAST MINIMUM COVERAGE.— 14 (1) IN GENERAL.—Section 1902(k)(1) of the 15 Social Security Act (42 U.S.C. 1396a(k)(1)) is 16 amended by inserting ‘‘or an individual described in 17 subsection (qq)’’ after ‘‘an individual described in 18 subclause (VIII) of subsection (a)(10)(A)(i)’’ each 19 place it appears. 20 (2) CONFORMING AMENDMENT.—Section 21 1903(i)(26) of the Social Security Act (42 U.S.C. 22 1396b(i)(26)) is amended by striking ‘‘individuals 23 described in subclause (VIII) of subsection 24 (a)(10)(A)(i)’’ and inserting ‘‘individuals described 25 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 4 •HR 1277 IH in subsection (a)(10)(A)(i)(VIII) or (qq) of section 1 1902’’. 2 (c) FEDERAL FINANCIAL PARTICIPATION IN BUY-IN 3 PROGRAM.— 4 (1) ENHANCED MATCH FOR ADMINISTRATIVE 5 EXPENSES.—Section 1903(a) of the Social Security 6 Act (42 U.S.C. 1396b(a)) is amended— 7 (A) by redesignating paragraph (7) as 8 paragraph (8); and 9 (B) by inserting after paragraph (6) the 10 following new paragraph: 11 ‘‘(7) an amount equal to 90 percent of the 12 sums expended during such quarter which are at- 13 tributable to reasonable administrative expenses re- 14 lated to the administration of a Medicaid buy-in pro- 15 gram for individuals described in section 16 1902(a)(10)(A)(ii)(XXIII); plus’’. 17 (2) TREATMENT OF PREMIUM AND COST-SHAR- 18 ING REVENUES FROM MEDICAID BUY-IN PROGRAM.— 19 (A) IN GENERAL.—For purposes of section 20 1903(a)(1) of the Social Security Act (42 21 U.S.C. 1396b(a)(1)), for any fiscal quarter dur- 22 ing which a State collects premiums, cost-shar- 23 ing, or similar charges under subsection (k) of 24 section 1916 of such Act (42 U.S.C. 1396o) (as 25 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 5 •HR 1277 IH added by this Act), including any advance pay- 1 ments of premium tax credits under section 2 1412 of the Patient Protection and Affordable 3 Care Act or payments for cost-sharing reduc- 4 tions under section 1402 of such Act that are 5 received by the State, the total amount ex- 6 pended during such quarter as medical assist- 7 ance for individuals who buy into Medicaid cov- 8 erage under subclause (XXIII) of section 9 1902(a)(10)(A)(ii) of the Social Security Act 10 (as added by this Act) shall be reduced by the 11 amount of such premiums or charges. 12 (B) TREATMENT OF EXCESS PREMIUMS.— 13 Each State that collects premiums or similar 14 charges under subsection (k) of section 1916 of 15 the Social Security Act (42 U.S.C. 1396o) (as 16 added by this Act) in a fiscal year shall pay to 17 the Secretary of Health and Human Services, 18 at such time and in such form and manner as 19 the Secretary shall specify, an amount equal to 20 50 percent of the amount, if any, by which— 21 (i) the total amount of such premiums 22 and charges collected by the State for such 23 year; exceeds 24 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 6 •HR 1277 IH (ii) the total amount expended by the 1 State during such year as medical assist- 2 ance for individuals who buy into Medicaid 3 coverage under subclause (XXIII) of sec- 4 tion 1902(a)(10)(A)(ii) of such Act (as 5 added by this Act). 6 (d) COST-SHARING REQUIREMENT.—Section 1916 of 7 the Social Security Act (42 U.S.C. 1396o) is amended by 8 adding at the end the following new subsection: 9 ‘‘(k) PREMIUMS AND COST-SHARING FOR INDIVID- 10 UALS PARTICIPATING IN MEDICAID BUY-IN PROGRAM.— 11 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 12 with respect to individuals who are eligible for med- 13 ical assistance under subsection 14 (a)(10)(A)(ii)(XXIII) of section 1902 and are de- 15 scribed in subsection (qq) of such section, a State 16 may— 17 ‘‘(A) impose premiums, deductibles, cost- 18 sharing, or other similar charges that are actu- 19 arially fair; and 20 ‘‘(B) vary the premium rate imposed on an 21 individual based only on the factors described in 22 section 2701(a)(1)(A) of the Public Health 23 Service Act and subject to the same limitations 24 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 7 •HR 1277 IH on the weight which may be given to such fac- 1 tors under such section. 2 ‘‘(2) LIMITATIONS.— 3 ‘‘(A) PREMIUMS.—The total amount of 4 premiums imposed for a year under this sub- 5 section with respect to all individuals described 6 in paragraph (1) in a family shall not exceed an 7 amount equal to 9.5 percent of the family’s 8 household income (as defined in section 9 36B(d)(2) of the Internal Revenue Code of 10 1986) for the year involved. 11 ‘‘(B) OTHER COST-SHARING.— 12 ‘‘(i) IN GENERAL.—The cost-sharing 13 limitations described in section 1302(c) of 14 the Patient Protection and Affordable Care 15 Act shall apply to cost-sharing (as defined 16 in such section) for medical assistance pro- 17 vided under section 18 1902(a)(10)(A)(ii)(XXIII) in the same 19 manner as such limitations apply to cost- 20 sharing under qualified health plans under 21 title I of such Act. 22 ‘‘(ii) AVAILABILITY OF COST-SHARING 23 REDUCTIONS.—Individuals provided med- 24 ical assistance under section 25 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 8 •HR 1277 IH 1902(a)(10)(A)(ii)(XXIII) and subject to 1 cost-sharing under this subsection are eli- 2 gible for cost-sharing reductions under sec- 3 tion 1402 of the Patient Protection and 4 Affordable Care Act (subject to the income 5 eligibility threshold in subsection (b)(2) of 6 such section), and in applying such sec- 7 tion— 8 ‘‘(I) enrollment in a State plan 9 under section 10 1902(a)(10)(A)(ii)(XXIII) shall be 11 treated as coverage under a qualified 12 health plan in the silver level of cov- 13 erage in the individual market offered 14 through an Exchange established for 15 or by the State under title I of the 16 Patient Protection and Affordable 17 Care Act; and 18 ‘‘(II) the State agency admin- 19 istering such plan shall be treated as 20 the issuer of such plan. 21 ‘‘(3) PREMIUMS AND COST-SHARING FOR CER- 22 TAIN OTHER INDIVIDUALS.—If an individual is eligi- 23 ble for medical assistance under subsection 24 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 9 •HR 1277 IH (a)(10)(A)(ii)(XXIII) of section 1902 and is not de- 1 scribed in subsection (qq) of such section, a State— 2 ‘‘(A) shall not impose premiums and cost- 3 sharing on the individual under this subsection; 4 and 5 ‘‘(B) may impose premiums and cost-shar- 6 ing on the individual to the extent allowed by 7 another provision of this Act (other than sec- 8 tion 1902(a)(10)(A)(ii)(XXIII)) which provides 9 for eligibility for medical assistance, but only if 10 the individual is described in such other provi- 11 sion. 12 ‘‘(4) APPLICATION OF PREMIUM ASSISTANCE 13 TAX CREDITS.—An individual who is required to pay 14 premiums under this subsection for a year for med- 15 ical assistance shall be eligible for a premium assist- 16 ance credit under section 36B of the Internal Rev- 17 enue Code to the same extent that such individual 18 would be eligible for a premium assistance credit 19 under such section if such individual had paid the 20 same amount in premiums for coverage under a 21 qualified health plan for such year.’’. 22 (e) MANAGED CARE.—Section 1932(a)(1)(A)(i) of 23 the Social Security Act (42 U.S.C. 1396u–2(a)(1)(A)(i)) 24 is amended by inserting ‘‘, including an individual who is 25 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 10 •HR 1277 IH eligible for such assistance after buying into such coverage 1 under section 1902(a)(10)(A)(ii)(XXIII),’’ after ‘‘the 2 State plan under this title’’. 3 (f) OFFERING BUY-IN PROGRAM ON STATE EX- 4 CHANGE; ENROLLMENT PERIODS.— 5 (1) IN GENERAL.—A State that has elected to 6 allow individuals to buy into Medicaid coverage 7 under section 1902(a)(10)(A)(ii)(XXIII) of the So- 8 cial Security Act (as added by this Act) shall allow 9 individuals to enroll in such coverage through the 10 Federal, federally facilitated, or State Exchange es- 11 tablished pursuant to title I of the Patient Protec- 12 tion and Affordable Care Act. 13 (2) ENROLLMENT PERIODS.—A State may limit 14 the enrollment of individuals into Medicaid coverage 15 under section 1902(a)(10)(A)(ii)(XXIII) of the So- 16 cial Security Act (as added by this Act) to the en- 17 rollment periods provided for under section 18 1311(c)(6) of the Patient Protection and Affordable 19 Care Act. 20 (g) APPLICATION OF ADVANCED PREMIUM TAX 21 CREDITS TO MEDICAID BUY-IN PLANS.— 22 (1) IN GENERAL.—Section 36B of the Internal 23 Revenue Code of 1986 is amended— 24 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 11 •HR 1277 IH (A) in subsection (b)(3)(B), by adding at 1 the end the following new sentence: 2 ‘‘If an applicable taxpayer resides in a rating 3 area in which no silver plan is offered on the 4 individual market but the taxpayer buys into 5 Medicaid coverage under section 6 1902(a)(10)(A)(ii)(XXIII) of the Social Secu- 7 rity Act, such Medicaid coverage shall be 8 deemed to be the applicable second lowest cost 9 silver plan with respect to such taxpayer.’’; and 10 (B) by adding at the end the following new 11 subsection: 12 ‘‘(h) APPLICATION TO INDIVIDUALS PURCHASING 13 MEDICAID COVERAGE.—In the case of any individual who 14 buys into Medicaid coverage under section 15 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act, this 16 section shall be applied with the following modifications: 17 ‘‘(1) The amount determined under subsection 18 (b)(2)(A) shall be increased by the amount of the 19 monthly premiums paid for such coverage. 20 ‘‘(2) Subsection (c)(2)(A)(i) shall be applied by 21 treating coverage under the Medicaid program under 22 title XIX of the Social Security Act in the same 23 manner as a qualified health plan that was enrolled 24 in through an Exchange. 25 VerDate Sep 11 2014 02:15 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1277.IH H1277 kjohnson on DSK79L0C42 with BILLS 12 •HR 1277 IH ‘‘(3) In applying subsection (c)(2)(B)— 1 ‘‘(A) an individual shall not be considered 2 to be eligible for minimum essential coverage 3 described in section 5000A(f)(1)(A)(ii) by rea- 4 son of eligibility for medical assistance under a 5 State Medicaid program under section 6 1902(a)(10)(A)(ii)(XXIII); and 7 ‘‘(B) an individual who is not covered by 8 minimum essential coverage described in section 9 5000A(f)(1)(B) shall not be considered to be el- 10 igible for such coverage.’’. 11 (2) ADVANCED PAYMENT OF CREDIT.— 12 (A) IN GENERAL.—The Secretary of 13 Health and Human Services, in consultation 14 with the Secretary of the Treasury, shall estab- 15 lish a program under which— 16 (i) upon request of a State agency ad- 17 ministering a State Medicaid program 18 under title XI [Text truncated for display. 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