To provide for premium assistance for low-income individuals.

SA 389. Mr. STRANGE submitted an amendment intended to be proposed by
him to the bill H.R. 1628, to provide for reconciliation pursuant to
title II of the concurrent resolution on the budget for fiscal year
2017; which was ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. 1__. PREMIUM ASSISTANCE FOR LOW INCOME INDIVIDUALS.

(a) In General.--Subsection (h) of section 2105 of the
Social Security Act (42 U.S.C. 1397ee), as added by this Act,
is amended to read as follows:
``(h) Short-term Assistance to Address Coverage and Access
Disruption and Provide Support for States and Direct Premium
Assistance.--
``(1) Appropriation.--There are authorized to be
appropriated, and are appropriated, out of monies in the
Treasury not otherwise obligated--
``(A) $15,000,000,000 for each of calendar years 2018 and
2019, and $10,000,000,000 for each of calendar years 2020 and
2021, to remain available until expended, to the
Administrator of the Centers for Medicare & Medicaid Services
(in this subsection and subsection (i) referred to as the
`Administrator') to fund arrangements with health insurance
issuers to assist in the purchase of health benefits coverage
by addressing coverage and access disruption and responding
to urgent health care needs within States; and
``(B) such sums as are necessary for calendar year 2019 and
each calendar year thereafter to the Secretary of the
Treasury for the purpose of making payments to the
Administrator to allow the Administrator to make the premium
assistance payments described in paragraph (2).
``(2) Premium assistance payments.--For calendar year 2019
and each calendar year thereafter, with respect to each
individual enrolled in a qualified health plan (as defined in
section 1301(a) of the Patient Protection and Affordable Care
Act) for whom an advance payment has been determined under
section 1412 of such Act (as reported by the Secretary under
subsection (c)(4)(B) of such section), the Administrator
shall pay to the issuer of such plan the amount described in
subsection (c)(4)(D) of such section.
``(3) Participation requirements.--
``(A) Guidance.--Not later than 30 days after the date of
enactment of this subsection, the Administrator shall issue
guidance to health insurance issuers regarding how to submit
a notice of intent to participate in the program established
under this subsection.
``(B) Notice of intent to participate.--To be eligible for
funding under this subsection, a health insurance issuer
shall submit to the Administrator a notice of intent to
participate at such time (but, in the case of funding for
calendar year 2018, not later than 35 days after the date of
enactment of this subsection and, in the case of funding for
any subsequent calendar year, not later than March 31 of the
previous year) and in such form and manner as specified by
the Administrator and containing--
``(i) a certification that the health insurance issuer will
use the funds in accordance with the requirements of
paragraph (6); and
``(ii) such information as the Administrator may require to
carry out this subsection.
``(4) Procedure for distribution of funds.--The
Administrator shall determine an appropriate procedure for
providing and distributing funds under this subsection that
includes reserving an amount equal to 1 percent of the amount
appropriated under paragraph (1)(A) for a calendar year for
providing and distributing funds to health insurance issuers
in States where the cost of insurance premiums are at least
75 percent higher than the national average.
``(5) No match.--Neither the State percentage applicable to
payments to States under subsection (i)(5)(B) nor any other
matching requirement shall apply to funds provided to health
insurance issuers under this subsection.
``(6) Use of funds.--Funds provided to a health insurance
issuer under paragraphs (1) and (2) shall be subject to the
requirements of paragraphs (1)(D) and (7) of subsection (i)
in the same manner as such requirements apply to States
receiving payments under subsection (i) and shall be used
only for the activities specified in paragraph (1)(A)(ii) of
subsection (i) or, in the case of funds provided under
paragraph (2), for reducing the amount of the premiums
charged to individuals as required under section
1412(c)(4)(E) of the Patient Protection and Affordable Care
Act.
``(7) Misuse of funds.--If the Administrator determines
that a health insurance issuer is not using funds provided
under this subsection in a manner consistent with the
requirements applicable to such funds, the Administrator may
withhold payments, reduce payments, or recover previous
payments to such health insurance issuer under this
subsection as the Administrator deems appropriate.''.
(b) Pass-through of Funding.--Subsection (i) of section
2105 of the Social Security Act (42 U.S.C. 1397ee), as added
by this Act, is amended by adding at the end the following
new paragraph:
``(8) Pass-through of funding.--Beginning in calendar year
2019, notwithstanding the other requirements of funds
provided to States under this subsection, except for the
requirements of paragraphs (1)(D) and (7), with respect to a
State waiver under section 1332 of the Patient Protection and
Affordable Care Act under which, due to the structure of the
State plan, individuals would not qualify for advance
payments under section 1412 of such Act (or under which the
amount of such payments would be reduced), the Secretary
shall provide for an alternative means by which the aggregate
amount of such payments which would have been paid on behalf
of participants in the Exchange established under such Act
for or by the State if the State had not received such a
waiver, shall be paid to the State for the purpose of
assisting in the purchase of health benefits coverage by
implementing the State plan under the waiver. Such amount
shall be determined annually by the Secretary, taking into
consideration the experience of other States with respect to
participation in an Exchange and payments provided under such
section to residents of the other States. A State may request
that all of, or any portion of, the amount determined under
this paragraph for the State for a year be paid to the State
as described in subsection (h)(2).''.
(c) Conforming Amendments.--
(1) Section 2101(a) of the Social Security Act (42 U.S.C.
1397aa(a)), as previously amended by this Act, is amended in
the matter preceding paragraph (1), by striking ``short-term
assistance''.
(2) Section 2105(c)(1) of the Social Security Act (42
U.S.C. 1397ee(c)(1)), as previously amended by this Act, is
amended by striking ``short-term assistance''.
(3) Section 1332(a) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18052(a)), as previously
amended by this Act, is amended--
(A) in paragraph (2), by adding at the end the following
new subparagraph:
``(E) Section 2105(h)(1)(B) of the Social Security Act.'';
and
(B) in paragraph (3), by striking subparagraph (A) and
redesignating subparagraphs (B) and (C) as subparagraphs (A)
and (B), respectively.
(d) Phasedown of Tax Credits.--
(1) In general.--Subsection (b) of section 36B of the
Internal Revenue Code of 1986, as amended by section 102, is
further amended

[[Page S4333]]

by adding at the end the following new paragraph:
``(4) Phasedown of premium assistance credit amount in
years after 2018.--In the case of any taxable year beginning
after 2018, the premium assistance credit amount is 1/10 of
the amount determined under paragraph (1) (without regard to
this paragraph).''.
(2) Coordination with direct premium assistance.--
(A) In general.--Subsection (c) of section 1412 of the
Patient Protection and Affordable Care Act is amended by
adding at the end the following new paragraph:
``(4) Coordination with direct premium assistance.--In the
case of calendar, taxable, and plan years beginning after
December 31, 2018--
``(A) solely for purposes of this section, the premium tax
credit under section 36B of the Internal Revenue Code of 1986
shall be determined without regard to subsection (b)(4)
thereof;
``(B) in addition to the persons described in paragraph
(1), the Secretary shall notify the Administrator of the
Centers for Medicare and Medicaid Services of the advance
determination under this section;
``(C) notwithstanding subparagraph (A), only \1/10\ of the
advance payment determined under this section (but for this
paragraph) shall be paid to the issuer of a qualified health
plan as provided in paragraph (2);
``(D) the remaining \9/10\ of the advance payment so
determined shall be paid to the Administrator of the Centers
for Medicare and Medicaid Services for the purposes described
in section 2105(h)(2) of the Social Security Act; and
``(E) an issuer of a qualified health plan receiving a
payment from the Administrator of the Centers for Medicare
and Medicaid Services under section 2105(h)(2) of the Social
Security Act shall treat such payment for purposes of
paragraph (2)(B) in the same manner as an advance payment
under paragraph (2).''.
(B) Recapture of excess payments and information
reporting.--Subsection (f) of section 36B of the Internal
Revenue Code of 1986 is amended--
(i) by striking ``advance payments to a taxpayer under
section 1412 of the Patient Protection and Affordable Care
Act for a taxable year exceed'' in paragraph (2)(A) and
inserting ``aggregate sum of any advance payments to a
taxpayer under section 1412 of the Patient Protection and
Affordable Care Act and any premium assistance paid to a
health insurance issuer with respect to such taxpayer under
section 2105(h)(2) of the Social Security Act for a taxable
year exceeds'',
(ii) by inserting ``or subsection (b)(4)'' after
``paragraph (1)'' in paragraph (2)(A),
(iii) by striking ``or cost-sharing reductions under
section 1402 of such Act'' in paragraph (3)(B) and inserting
``, premium assistance under section 2105(h)(2) of the Social
Security Act, or cost-sharing reductions under section 1402
of the Patient Protection and Affordable Care Act'',
(iv) by striking ``such Act'' in paragraph (3)(C) and
inserting ``the Patient Protection and Affordable Care Act,
and any premium assistance under section 2105(h)(2) of the
Social Security Act'', and
(v) by striking ``excess advance payments'' in paragraph
(3)(F) and inserting ``an excess aggregate amount of advance
payments and premium assistance payments for purposes of
paragraph (2)''.
(C) Regulations.--Subsection (g) of section 36B of such
Code is amended by inserting ``and payments for premium
assistance'' after ``the credit'' both places it appears.
(3) Effective date.--The amendments made by this subsection
shall apply to years beginning after December 31, 2018.
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