This bill would aim to strengthen the protections for people with pre-existing conditions, reverse Trump administration actions related to health insurance plan regulations, increase premium assistance tax credits, and provide more funding for enrollment outreach under the Affordable Care Act (aka Obamacare). The bill’s authors have broken it into three sections — “Expanding Affordability”, “Undoing Sabotage”, and “State Innovation & Transparency” — which are described in greater detail below.
This section of the bill would expand eligibility for premium assistance tax credits beyond the current threshold of 400% of the federal poverty line ($49,960 for individuals or $103,000 for a family of four), and would increase the size of the tax credits for all income brackets.
It’d also expand access to premium assistance tax credits for people who have an offer of coverage through their employer by allowing them to obtain subsidized coverage through an exchange if family coverage (rather than self-only coverage) is more affordable than the employer plan.
This section would block Trump administration executive actions regarding health insurance regulations by:
Preventing small businesses and individuals from obtaining coverage through association health plans (AHPs).
Reversing the expansion of short-term, limited-duration health plans for consumers, and not allowing tax credit subsidies to be used for such plans.
Requiring health insurance plans to cover all essential health benefits (EHBs) without allowing the substitution of benefits across benefit categories or limited prescription drug coverage.
Not allowing states to get waivers for certain aspects of Obamacare by demonstrating that a comparable number of residents will have access to comprehensive coverage if part of the law is waived.
It would also restore funding for several Obamacare initiatives that were reduced by the Trump administration, including:
Funding the navigators program, through which community-based organizations provide people seeking coverage information about coverage options on the federal insurance marketplace, with $100 million per year.
Funding marketing and outreach for the federal marketplace with $100 million per year.
Additionally, this part of the bill would establish a state-based reinsurance program that’d give states a choice of setting up their own reinsurance programs or using funds to provide premium subsidies or cost-sharing support to consumers. It’d also provide a federal default reinsurance program for states that decline to set up their own reinsurance programs.
“State Innovation & Transparency”
This section of the bill would fund state health insurance education programs for consumers, including $100 million in Consumer Assistance Program grants for states to support educational activities about health insurance (like filing complaints, assisting with enrollment, or getting premium tax credits).
From 2020 to 2022, $200 million in funding per year would be provided for states to conduct feasibility studies, pilot programs, technology upgrades, or other efforts to promote enrollment in health insurance plans in the individual and small group markets (including implementing a state version of the individual mandate to buy health insurance).
States that haven’t set up a health insurance marketplace of their own would be permitted to establish such a marketplace and receive federal funding for planning and implementation. Under current law states were cut off from getting federal funds to set up a marketplace after January 1, 2015.
Additionally, the Dept. of Health and Human Services (HHS) would required to provide Congress with an annual report detailing its spending on outreach and enrollment, navigators, maintenance of Healthcare.gov, and operation of the Healthcare.gov call centers.