119-hr1776

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1776 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 1776

To amend the Patient Protection and Affordable Care Act to establish a 
 reinsurance program, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 March 3, 2025

 Mr. Palmer introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
 Ways and Means, and Education and Workforce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
 of such provisions as fall within the jurisdiction of the committee 
 concerned

_______________________________________________________________________

 A BILL

To amend the Patient Protection and Affordable Care Act to establish a 
 reinsurance program, and for other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``New Health Options Act of 2025''.

SEC. 2. CREATION OF A REINSURANCE PROGRAM FOR A NEW HEALTH INSURANCE 
 RISK POOL.

    (a) In General.--Part V of subtitle B of title I of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18061 et seq.) is amended 
by adding at the end the following new section:

``

SEC. 1344. REINSURANCE PROGRAM FOR CERTAIN OFF-EXCHANGE PLANS.

 ``

    (a) In General.--There is established a Reinsurance Program, to 
be administered by the Secretary of Health and Human Services, to 
provide payments to health insurance issuers with respect to claims for 
eligible individuals for the purpose of lowering premiums for such 
individuals.
 ``

    (b) Funding.--
 ``

    (1) Appropriation.--For the purpose of providing funding 
 for the Reinsurance Program, for each year during the period 
 beginning on January 1, 2026, and ending on December 31, 2030, 
 there is appropriated out of any monies in the Treasury not 
 otherwise obligated an amount equal to the product of $50 and 
 the aggregate number of member months for all eligible 
 individuals enrolled in a covered plan during such year.
 ``

    (2) Limitation on appropriation.--In no year shall the 
 appropriation for the Reinsurance Program authorized in 
 paragraph

    (1) exceed $6,000,000,000.
 ``

    (3) Use of unexpended funds.--Appropriated amounts 
 remaining unexpended at the end of any year may be used to make 
 payments under the Reinsurance Program in any future year.
 ``

    (4) Limitation on use of funds.--No funds received under 
 the Reinsurance Program may be used to pay for services 
 described in 

section 1303

    (b)

    (1)
        (B)
            (i) (as in effect on the date 
 of the enactment of this section).
 ``
            (c) Operation of Program.--
 ``

    (1) In general.--The Secretary shall establish parameters 
 for the operation of the Reinsurance Program consistent with 
 this section.
 ``

    (2) Deadline for initial operation.--Not later than 120 
 days after the date of the enactment, the Secretary shall 
 establish sufficient parameters to specify how the Program will 
 operate for 2026.
 ``

    (3) === Definitions. ===
-In this section:
 ``
        (A) Covered plan.--The term `covered plan' means 
 individual health insurance coverage (as such term is 
 defined in 

section 2791 of the Public Health Service 
 Act)--
 ``
            (i) with respect to which the issuer of 
 such coverage has made the election described 
 in 

section 1312
            (c) (1)
        (A) ; and
 ``
            (ii) that does not provide coverage for 
 services described in 

section 1303

    (b)

    (1)
        (B)
            (i) (as in effect on the date of the enactment of 
 this section).
 ``
        (B) Eligible individual.--The term `eligible 
 individual' means an individual enrolled in a covered 
 plan.
 ``
            (d) Attachment Dollar Amount and Payment Proportion.--
 ``

    (1) In general.--The Secretary shall annually establish 
 an attachment point, payment proportion, and reinsurance cap 
 with respect to claims for eligible individuals for payments 
 under the Reinsurance Program, consistent with the following:
 ``
        (A) The attachment point for the period beginning 
 January 1, 2026, and ending December 31, 2026, shall be 
 $110,000.
 ``
        (B) The payment proportion for the period 
 beginning January 1, 2026, and ending December 31, 
 2026, shall be 90 percent.
 ``
            (C) The reinsurance cap for the period beginning 
 January 1, 2026 and ending December 31, 2026, shall be 
 $300,000.
 ``

    (2) Adjustment authority.--The Secretary may adjust any 
 amounts described in paragraph

    (1) as necessary to ensure the 
 Reinsurance Program does not make payment for a year in excess 
 of the amount available for such year under subsection

    (b) .''.

    (b) Election To Opt Out of Single Risk Pool.--

    (1) In general.--

Section 1312
            (c) (1) of the Patient 
 Protection and Affordable Care Act (42 U.S.C. 18032
            (c) (1) ) is 
 amended--
        (A) by striking ``A health insurance issuer'' and 
 inserting the following:
 ``
        (A) In general.--A health insurance issuer'';
        (B) in subparagraph
        (A) , as inserted by paragraph

    (1) , by inserting ``and other than any health plan with 
 respect to which such issuer has elected for this 
 subparagraph not to apply'' after ``grandfathered 
 health plans''; and
            (C) by adding at the end the following new 
 subparagraph:
 ``
        (B) Treatment of plans opting out of single risk 
 pool.--A health insurance issuer shall consider all 
 enrollees in all health plans offered by such issuer in 
 the individual market with respect to which such issuer 
 has made the election described in subparagraph
        (A) to 
 be members of a single risk pool.''.

    (2) Prohibiting single risk pool opt out for qualified 
 health plans.--

Section 1301

    (a)

    (1)
            (C) of the Patient Protection 
 and Affordable Care Act (42 U.S.C. 18021

    (a)

    (1) ) is amended--
        (A) in clause
            (iii) , by striking ``and'' at the 
 end;
        (B) in clause
            (iv) , by striking the period and 
 inserting ``; and''; and
            (C) by adding at the end the following new clause:
 ``
            (v) has not made the election described 
 in 

section 1312
            (c) (1)
        (A) with respect to such 
 plan.''.

    (3) Effective date.--The amendments made by this subsection 
 shall apply with respect to plan years beginning on or after 
 January 1, 2026.
            (c) Removing Age Premium Variation Limitation for Certain Plans.--

    (1) In general.--
        (A) Removal of limitation for certain plans.--
 

Section 2701

    (a)

    (1)
        (A)
            (iii) of the Public Health Service 
 Act (42 U.S.C 300gg

    (a)

    (1)
        (A)
            (iii) ) is amended by 
 inserting ``or, in the case of such coverage with 
 respect to which the issuer of such coverage has made 
 the election described in 

section 1312
            (c) (1)
        (A) of the 
 Patient Protection and Affordable Care Act, by more 
 than an actuarially justified amount for adults'' 
 before ``; and''.
        (B) Effective date.--The amendment made by 
 subparagraph
        (A) shall apply with respect to plan years 
 beginning on or after January 1, 2026.

    (2) Maintaining age premium variation limitation for 
 qualified health plans.--

Section 1301

    (a)

    (1) of the Patient 
 Protection and Affordable Care Act (42 U.S.C. 18021

    (a)

    (1) ), as 
 amended by subsection

    (b) , is further amended--
        (A) in subparagraph
        (B) , by striking ``and'' at the 
 end;
        (B) in subparagraph
            (C) 
            (v) , by striking the period 
 and inserting ``; and''; and
            (C) by adding at the end the following new 
 subparagraph:
 ``
            (D) with respect to the premium rate charged by 
 such plan, if such plan varies such rate by age, does 
 not vary such rate by more than 3 to 1 for adults 
 (consistent with 

section 2707
            (c) of the Public Health 
 Service Act).''.
            (d) Treatment of Opt Out Plans in Relation to Individual Health 
Coverage Reimbursement Arrangements.--The Secretaries of Health and 
Human Services, Labor, and the Treasury shall not fail to treat any 
individual health insurance coverage (as defined in 

section 2791 of the 
Public Health Service Act (42 U.S.C. 300gg-91)) as eligible for 
integration with an individual health care reimbursement arrangement on 
the basis that the health insurance issuer (as so defined) of such 
coverage has made the election described in 

section 1312
            (c) (1)
        (A) of 
the Patient Protection and Affordable Care Act (as inserted by 
subsection

    (b) ).

SEC. 3. PROMOTION OF HIGH-VALUE CARE.

    (a) In General.--Subpart II of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at 
the end the following new section:

``

SEC. 2730. APPLICATION OF CERTAIN OUT-OF-NETWORK COSTS TO DEDUCTIBLES 
 AND OUT-OF-POCKET MAXIMUMS.

 ``

    (a) In General.--A group health plan, and a health insurance 
issuer offering group or individual health insurance coverage, shall, 
in the case that an individual enrolled under such plan or coverage is 
furnished items or services by a health care provider or health care 
facility that does not have in effect a contractual relationship with 
such plan or issuer for the furnishing of such items or services and 
such individual incurs any out-of-pockets costs with respect to such 
items and services, at the option of such individual, apply such costs 
to any deductible or out-of-pocket maximum applicable to items and 
services furnished by health care providers or health care facilities 
with contracts in effect with such plan or issuer for the furnishing of 
such items or services, but only if the following requirements are met:
 ``

    (1) The item or service furnished by such provider or 
 facility without a contract in effect with such plan or issuer 
 is an item or service for which benefits are available under 
 such plan or coverage.
 ``

    (2) The amount charged by such provider or facility for 
 such item or service is equal to or less than--
 ``
        (A) the lowest amount recognized by the plan or 
 coverage as payment for such item or service out of all 
 health care providers and health care facilities with a 
 contract in effect with such plan or issuer to furnish 
 such item or service in the same rating area (as 
 defined for purposes of 

section 2701) in which the item 
 or service described in paragraph

    (1) was furnished; or
 ``
        (B) the 25th percentile of charges for such item 
 or service furnished in the same State in which the 
 item or service described in paragraph

    (1) was 
 furnished.
 ``

    (b) Disclosure of Information.--A group health plan, and a health 
insurance issuer offering group or individual health insurance 
coverage, shall, with respect to each item or service for which 
benefits are available under such plan or coverage, make available the 
lowest amount described in subsection

    (a)

    (2)
        (A) and the 25th percentile 
described in subsection

    (a)

    (2)
        (B) to all individuals enrolled under 
such plan or coverage.''.

    (b) Effective Date.--The amendment made by subsection

    (a) shall 
apply to plan years beginning on or after January 1, 2026.

SEC. 4. DISCLOSURE OF LOWER PRICES.

 Part E of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-131) is amended by adding at the end the following new section:

``

SEC. 2799B-10. DISCLOSURE OF LOWER PRICES.

 ``

    (a) In General.--Beginning January 1, 2026, each health care 
provider and health care facility shall disclose to patients and 
prospective patients enrolled in a group health plan, group or 
individual health insurance coverage, or a Federal health care program 
(as defined in 

section 1128B but including the program established 
under chapter 89 of title 5, United States Code) being furnished or 
seeking to be furnished an item or service by such provider or facility 
for which benefits are available under such plan, coverage, or program, 
as applicable, whether the amount of cost sharing (including 
deductibles, copayments, and coinsurance) that would be incurred by 
such individual for such item or service under such plan, coverage, or 
program, as applicable, exceeds the charge that would apply for such 
item or service for an individual without benefits under any such plan, 
coverage, or program for such item or service.
 ``

    (b) Additional Enforcement.--In addition to any other penalty 
applicable with respect to a violation of subsection

    (a) , an individual 
who is harmed by a violation of this section by a health care provider 
or health care facility may bring an action against such provider or 
facility in an appropriate district court of the United States for--
 ``

    (1) appropriate injunctive relief; and
 ``

    (2) damages in an amount that is equal to the amount 
 provided for such harm in a civil action under the law of the 
 State in which the provider or facility is located.''.
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