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