[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9708 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 9708
To ensure affordable health insurance coverage for low-income
individuals in States that have not expanded Medicaid.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 19, 2024
Ms. Sewell 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 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 ensure affordable health insurance coverage for low-income
individuals in States that have not expanded Medicaid.
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 ``Bridge to Medicaid Act of 2024''.
SEC. 2. ENSURING AFFORDABILITY OF COVERAGE FOR CERTAIN LOW-INCOME
POPULATIONS.
(a) Reducing Cost Sharing Under Qualified Health Plans.--Section
1402 of the Patient Protection and Affordable Care Act (42 U.S.C.
18071) is amended--
(1) in subsection (b)--
(A) in paragraph (2), by inserting ``(or, with
respect to plan years 2026, 2027, and 2028, whose
household income does not exceed 400 percent of the
poverty line for a family of the size involved)''
before the period; and
(B) in the matter following paragraph (2), by
adding at the end the following new sentence: ``In the
case of an individual who is determined at any point to
have a household income for 2025 that does not exceed
138 percent of the poverty line for a family of the
size involved, such individual shall, for each month
during such year, be treated as having a household
income equal to 100 percent for purposes of applying
this section.''; and
(2) in subsection (c)--
(A) in paragraph (1)(A), in the matter preceding
clause (i), by inserting ``, with respect to eligible
insureds (other than, with respect to plan years 2026,
2027, and 2028, specified enrollees (as defined in
paragraph (6)(C))),'' after ``first be achieved'';
(B) in paragraph (2), in the matter preceding
subparagraph (A), by inserting ``with respect to
eligible insureds (other than, with respect to plan
years 2026, 2027, and 2028, specified enrollees)''
after ``under the plan'';
(C) in paragraph (3)--
(i) in subparagraph (A), by striking ``this
subsection'' and inserting ``paragraph (1) or
(2)''; and
(ii) in subparagraph (B), by striking
``this section'' and inserting ``paragraphs (1)
and (2)''; and
(D) by adding at the end the following new
paragraph:
``(6) Special rule for specified enrollees.--
``(A) In general.--The Secretary shall establish
procedures under which the issuer of a qualified health
plan to which this section applies shall reduce cost-
sharing under the plan with respect to months occurring
during plan years 2026, 2027, and 2028 for enrollees
who are specified enrollees (as defined in subparagraph
(C)) in a manner sufficient to increase the plan's
share of the total allowed costs of benefits provided
under the plan to 99 percent of such costs.
``(B) Methods for reducing cost sharing.--
``(i) In general.--An issuer of a qualified
health plan making reductions under this
paragraph shall notify the Secretary of such
reductions and the Secretary shall, out of
funds made available under clause (ii), make
periodic and timely payments to the issuer
equal to 12 percent of the total allowed costs
of benefits provided under each such plan to
specified enrollees during plan years 2026,
2027, and 2028.
``(ii) Appropriation.--In addition to
amounts otherwise available, there are
appropriated, out of any money in the Treasury
not otherwise appropriated, such sums as may be
necessary to the Secretary to make payments
under clause (i).
``(C) Specified enrollee defined.--For purposes of
this section, the term `specified enrollee' means, with
respect to a plan year, an eligible insured who is
determined at any point to have a household income for
such plan year that does not exceed 138 percent of the
poverty line for a family of the size involved. Such
insured shall be deemed to be a specified enrollee for
each month in such plan year.''.
(b) Open Enrollments Applicable to Certain Lower-income
Populations.--Section 1311(c) of the Patient Protection and Affordable
Care Act (42 U.S.C. 18031(c)) is amended--
(1) in paragraph (6)--
(A) in subparagraph (C), by striking at the end
``and'';
(B) in subparagraph (D), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(E) with respect to a qualified health plan with
respect to which section 1402 applies, for months
occurring during the period beginning on January 1,
2026, and ending on December 31, 2028, enrollment
periods described in subparagraph (A) of paragraph (8)
for individuals described in subparagraph (B) of such
paragraph.''; and
(2) by adding at the end the following new paragraph:
``(8) Special enrollment period for certain low-income
populations.--
``(A) In general.--The enrollment period described
in this paragraph is, in the case of an individual
described in subparagraph (B), the continuous period
beginning on the first day that such individual is so
described.
``(B) Individual described.--For purposes of
subparagraph (A), an individual described in this
subparagraph is an individual--
``(i) with a household income that does not
exceed 138 percent of the poverty line for a
family of the size involved; and
``(ii) who is not eligible for minimum
essential coverage (as defined in section
5000A(f) of the Internal Revenue Code of 1986),
other than for coverage described in any of
subparagraphs (B) through (E) of paragraph (1)
of such section.''.
(c) Additional Benefits for Certain Low-Income Individuals for Plan
Years 2026 and 2027.--Section 1301(a) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18021(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (B), by striking ``and'' at the
end;
(B) in subparagraph (C)(iv), by striking the period
and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(D) provides, with respect to a plan offered in
the silver level of coverage to which section 1402
applies during plan year 2026 and 2027, for benefits
described in paragraph (5) in the case of an individual
who has a household income that does not exceed 138
percent of the poverty line for a family of the size
involved, and who is eligible to receive cost-sharing
reductions under section 1402.''; and
(2) by adding at the end the following new paragraph:
``(5) Additional benefits for certain low-income
individuals for plan year 2026 and 2027.--
``(A) In general.--
``(i) Benefits.--For purposes of paragraph
(1)(D), the benefits described in this
paragraph to be provided by a qualified health
plan are benefits consisting of--
``(I) non-emergency medical
transportation services (as described
in section 1902(a)(4) of the Social
Security Act) for which Federal
payments would have been available
under title XIX of the Social Security
Act had such services been furnished to
an individual enrolled under a State
plan (or waiver of such plan) under
such title; and
``(II) services described in
subsection (a)(4)(C) of section 1905 of
such Act for which Federal payments
would have been so available;
which are not otherwise provided under such
plan as part of the essential health benefits
package described in section 1302(a).
``(ii) Condition on provision of
benefits.--Benefits described in this paragraph
shall be provided--
``(I) without any restriction on
the choice of a qualified provider from
whom an individual may receive such
benefits; and
``(II) without any imposition of
cost sharing.
``(B) Payments for additional benefits.--
``(i) In general.--An issuer of a qualified
health plan making payments for services
described in subparagraph (A) furnished to
individuals described in paragraph (1)(D)
during plan year 2026 or 2027 shall notify the
Secretary of such payments and the Secretary
shall, out of funds made available under clause
(ii), make periodic and timely payments to the
issuer equal to payments for such services so
furnished.
``(ii) Appropriation.--In addition to
amounts otherwise available, there is
appropriated, out of any money in the Treasury
not otherwise appropriated, such sums as may be
necessary to the Secretary to make payments
under clause (i).''.
(d) Education and Outreach Activities.--
(1) In general.--Section 1321(c) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18041(c)) is amended by
adding at the end the following new paragraph:
``(3) Outreach and educational activities.--
``(A) In general.--In the case of an Exchange
established or operated by the Secretary within a State
pursuant to this subsection, the Secretary shall carry
out outreach and educational activities for purposes of
informing individuals described in section
1902(a)(10)(A)(i)(VIII) of the Social Security Act who
reside in States that have not expended amounts under a
State plan (or waiver of such plan) under title XIX of
such Act for all such individuals about qualified
health plans offered through the Exchange, including by
informing such individuals of the availability of
coverage under such plans and financial assistance for
coverage under such plans. Such outreach and
educational activities shall be provided in a manner
that is culturally and linguistically appropriate to
the needs of the populations being served by the
Exchange (including hard-to-reach populations, such as
racial and sexual minorities, limited English
proficient populations, individuals residing in areas
where the unemployment rates exceeds the national
average unemployment rate, individuals in rural areas,
veterans, and young adults).
``(B) Limitation on use of funds.--Funds
appropriated under this paragraph shall not be used to
promote any health insurance coverage other than
qualified health plans.
``(C) Funding.--In addition to amounts otherwise
available, there is appropriated, out of any money in
the Treasury not otherwise appropriated, to remain
available until expended, $105,000,000 for fiscal year
2026 to carry out this paragraph, of which--
``(i) $15,000,000 shall be used to carry
out this paragraph in fiscal year 2026; and
``(ii) $30,000,000 shall be used to carry
out this paragraph for each of fiscal years
2027 through 2028.''.
(2) Navigator program.--Section 1311(i) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(i)) is
amended--
(A) in paragraph (1)--
(i) by striking ``An Exchange'' and
inserting the following:
``(A) In general.--An Exchange''; and
(ii) by adding at the end the following:
``(B) Grants for eligible entities with respect to
certain states.--The Secretary shall establish a
program to award grants to entities described in
paragraph (2) to carry out the duties described in
paragraph (3) in one or more States that do not provide
under the State plan under title XIX of the Social
Security Act (or a waiver of such plan) benchmark
coverage described in section 1937(b)(1) of such Act or
benchmark equivalent coverage described in section
1937(b)(2) of such Act to all individuals described in
section 1902(a)(10)(A)(i)(VIII) of such Act.''; and
(B) in paragraph (6)--
(i) by striking ``Grants under'' and
inserting the following:
``(A) State exchanges.--Grants under''; and
(ii) by adding at the end the following new
subparagraph:
``(B) Federal exchanges; grants to eligible
entities with respect to certain states.--For purposes
of carrying out this subsection, with respect to an
Exchange established and operated by the Secretary
within a State pursuant to section 1321(c) and with
respect to grants under paragraph (1)(B), the Secretary
shall obligate not less than $10,000,000 out of amounts
collected through the user fees on participating health
insurance issuers pursuant to section 156.50 of title
45, Code of Federal Regulations (or any successor
regulations) for fiscal year 2026, and not less than
$20,000,000 for each of fiscal years 2027 and 2028.
Such amount so obligated for a fiscal year shall remain
available until expended.''.
(e) Funding.--In addition to amounts otherwise available, there is
appropriated to the Secretary of Health and Human Services for fiscal
year 2026, out of any money in the Treasury not otherwise appropriated,
$65,000,000, to remain available until expended, for purposes of
carrying out the provisions of, and the amendments made by, this
section.
SEC. 3. TEMPORARY EXPANSION OF HEALTH INSURANCE PREMIUM TAX CREDITS FOR
CERTAIN LOW-INCOME POPULATIONS.
(a) In General.--Section 36B of the Internal Revenue Code of 1986
is amended by redesignating subsection (h) as subsection (i) and by
inserting after subsection (g) the following new subsection:
``(h) Certain Temporary Rules Beginning in 2026.--With respect to
any taxable year beginning after December 31, 2025, and before January
1, 2029--
``(1) Eligibility for credit not limited based on income.--
Subsection (c)(1)(A) shall be applied without regard to `equals
or exceeds 100 percent but'.
``(2) Credit allowed to certain low-income employees
offered employer-provided coverage.--In the case of an
individual whose household income does not exceed 138 percent
of the poverty line for a family of the size involved, clause
(i) of subsection (c)(2)(C) shall be applied (including in the
case of any individual described in the last sentence of such
clause) without regard to subclause (II) thereof.
``(3) Credit allowed to certain low-income employees
offered qualified small employer health reimbursement
arrangements.--A qualified small employer health reimbursement
arrangement shall not be treated as constituting affordable
coverage for an employee (or any spouse or dependent of such
employee) for any months of a taxable year if the employee's
household income for such taxable year does not exceed 138
percent of the poverty line for a family of the size involved.
``(4) Limitations on recapture.--
``(A) In general.--In the case of a tax