S.Amdt. 476

SA 476. Mr. SULLIVAN (for himself, Mr. Hoeven, Ms. Murkowski, and Mr.
Rounds) submitted an amendment intended to be proposed to amendment SA
267 proposed by Mr. McConnell 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:

On page 18, strike lines 7 through 26 and insert the
following:

SEC. 204. FUNDING FOR COST-SHARING PAYMENTS.

There is appropriated to the Secretary of Health and Human
Services, out of any money in the Treasury not otherwise
appropriated, such sums as may be necessary for payments for
cost-sharing reductions authorized by the Patient Protection
and Affordable Care Act (including adjustments to any prior
obligations for such payments) for the period beginning on
the date of enactment of this Act and (except for payments
authorized by section 1402 of such Act, as amended by section
209) ending on December 31, 2019. Notwithstanding any other
provision of this Act, payments and other actions for
adjustments to any obligations incurred for plan years 2018
and 2019 may be made through December 31, 2020.

SEC. 205. REPEAL OF COST-SHARING SUBSIDY PROGRAM.

(a) In General.--The Patient Protection and Affordable Care
Act is amended by striking section 1402.
(b) Preservation of Cost-sharing for Indians.--The Patient
Protection and Affordable Care Act, as amended by subsection
(a), is amended by inserting after section 1401 the
following:

``SEC. 1402. REDUCED COST-SHARING FOR CERTAIN INDIVIDUALS.

``(a) In General.--In the case of an eligible insured
enrolled in a qualified health plan in the individual market
through an Exchange--
``(1) the Secretary shall notify the issuer of the plan of
such eligibility; and
``(2) the issuer shall reduce the cost-sharing under the
plan at the level and in the manner specified in subsection
(c).
``(b) Eligible Insured.--For purposes of this section, the
term `eligible insured' means an Indian (as defined in
section 4(d) of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450b(d))) whose household income is
not more than 300 percent of the poverty line for a family of
the size involved.
``(c) Reduction of Cost-sharing.--
``(1) In general.--The issuer of the plan described in
subsection (a) in which an eligible insured is enrolled shall
eliminate any cost-sharing under the plan.
``(2) Items or services furnished through indian health
providers.--If an Indian (as so defined) enrolled in a
qualified health plan is furnished an item or service
directly by the Indian Health Service, an Indian Tribe,
Tribal Organization, or Urban Indian Organization or through
referral under contract health services--
``(A) no cost-sharing under the plan shall be imposed under
the plan for such item or service; and
``(B) the issuer of the plan shall not reduce the payment
to any such entity for such item or service by the amount of
any cost-sharing that would be due from the Indian but for
subparagraph (A).
``(d) Payment.--The Secretary shall pay to the issuer of a
qualified health plan the amount necessary to reflect the
increase in actuarial value of the plan required by reason of
this section.
``(e) Definitions and Special Rules.--In this section:
``(1) In general.--Any term used in this section which is
also used in section 36B of the Internal Revenue Code of 1986
shall have the meaning given such term by such section.
``(2) Limitations on reduction.--No cost-sharing reduction
shall be allowed under this section with respect to coverage
for any month unless the month is a coverage month with
respect to which a credit is allowed to the insured (or an
applicable taxpayer on behalf of the insured) under section
36B of such Code.
``(3) Data used for eligibility.--Any determination under
this section shall be made on the basis of the taxable year
for which the advance determination is made under section
1412 and not the taxable year for which the credit under
section 36B of such Code is allowed.''.
(c) Effective Date.--The amendments made by this section
shall apply to cost-sharing reductions (and payments to
issuers for such reductions) for plan years beginning after
December 31, 2019.
______