Vote Smart's Synopsis:

Vote to pass a bill that amends the Affordable Care Act by making changes including, but not limited to, the following areas: premiums, taxes and tax credits for individuals and providers, Medicaid eligibility requirements, individual and small market health insurance requirements, cost-sharing, funding for various facilities and organizations, health savings accounts and flexible spending arrangements, the "individual mandate", and the "employer mandate".

Highlights:

• Authorizes a state to submit an application for a waiver to the Secretary of Health and Human Services which would allow such state to (Sec. 136):

• Apply a variation ratio greater than 3:1 to premiums that vary by age;

• Apply essential benefits specified by the state in place of those required under 42 United States Code, Section 18022(b)(1); or

• Apply to increase an individual’s monthly premium rate using such individual’s health status as a factor, if such state’s program provides funding to help stabilize premiums or enroll high-risk individuals in health insurance coverage (Sec. 132), or such state participates in the 63-day enforcement period for premium increases (Sec. 133).

• Repeals the “individual mandate,” which  penalizes those not covered by a health plan that provides at least minimum essential coverage, effective retroactively for months beginning after December 31, 2015 (Sec. 205).

• Repeals the “employer mandate,” which penalizes large employers who do not offer minimum essential coverage to full-time employees and their dependents, effective retroactively for months beginning after December 31, 2015 (Sec. 206).

• Authorizes a refundable, advanceable tax credit for individuals who are not eligible for another source of coverage and whose coverage (Sec. 215):

• Is either offered in the individual health insurance market or is unsubsidized COBRA continuation coverage;

• Is not a grandfathered or grandmothered health plan;

• Is not substantially composed of excepted benefits providing limited coverage, such as dental, vision, or long-term care;

• Does not cover abortions, unless such abortion is provided in order to save the life of the patient or the pregnancy is the result of rape or incest;

• Does not consist of short-term limited duration insurance; and

• Is offered in a state which certifies that such coverage meets the above requirements.Is offered in a state which certifies that such coverage meets the above requirements.

• Defines a grandmothered health plan as health insurance coverage offered in the individual market as of October 1, 2013 and which is permitted to be offered in such market after January 1, 2014 (Sec. 215).

• Prohibits, for a 1-year period, direct spending to states for payments, either directly or through managed care, to any tax-exempt corporation or organization which primarily provides family planning services, reproductive health and related medical care and which provides abortions (Sec. 103).

• Repeals the excise tax on medical devices, effective after December 31, 2017 (Sec. 211).

• Requires an insurance issuer offering coverage in the individual or small group market to increase the monthly premium rate by 30 percent for individuals with a break in coverage of 63 or more days in the previous year (Sec. 133).

• Requires a taxpayer with a household income of less than 400 percent of the poverty line to be liable for the full amount of any advance payments on a premium tax credit which exceeds the amount permitted, effective until January 1, 2020 (Sec. 201). 

• Reduces the threshold for the minimum family income that a state uses to determine the Medicaid eligibility of children between ages 6 and 19 from 133 percent to 100 percent of the poverty line (Sec. 111).

• Requires a state to redetermine an individual’s eligibility for Medicaid coverage based on income every 6 months, effective October 1, 2017 (Sec. 116).

• Increases the civil penalty to $20,000 for an individual who is ineligible for Medicaid coverage but who files a Medicaid claim and fails to report and return a resulting overpayment (Sec. 116).

• Prohibits a hospital from determining or attempting to determine whether an individual is eligible for medical assistance under a state plan or waiver of a state plan after January 1, 2020 (Sec. 111).

• Increases to 5 percent the federal matching funds for state expenditures which increase the frequency of eligibility redeterminations, effective October 1, 2017 and ending December 31, 2019 (Sec. 116).

• Reduces federal matching funds for state Medicaid programs which exceed their targeted spending caps (Sec. 121).

• Repeals cost-sharing reductions for an individual who is enrolled in a qualified, individual health plan at the silver level of coverage and whose household income exceeds 100 percent, but does not exceed 400 percent, of the poverty line (Sec. 131).

• Establishes the Patient and State Stability Fund to provide funds to states through December 31, 2026, which the states may use for various purposes, including, but not limited to (Sec. 132):

• The provision of financial assistance to high-risk individuals without employer health insurance coverage, so that they may enroll in individual market coverage;

• The stabilization of health insurance premiums;

• The reduction of provision costs for individual and small market coverage; and

• The reduction of out-of-pocket costs, such as copayments, coinsurance, premiums, and deductibles.

• Authorizes the Secretary of Health and Human Services to increase the ratio by which premiums may vary by age from a 3 to 1 ratio to a 5 to 1 ratio for plan years beginning on or after January 1, 2018 (Sec. 135).

• Authorizes a state to provide an alternative ratio by which premiums may vary by age for plan years beginning on or after January 1, 2018 (Sec. 135). 

• Prohibits the use of the small employer tax credit for a health plan that covers abortions, unless such an abortion is necessary to preserve the life of the pregnant woman, or such pregnancy is the result of rape or incest (Sec. 204).

• Prohibits the imposition of an excise tax on high-cost employer-sponsored health coverage, effective until January 1, 2025 (Sec. 207).

• Authorizes an individual to use the following to purchase over-the-counter drugs not prescribed by a physician, effective after December 31, 2017 (Sec. 208):

• Health savings accounts; and

• Archer MSAs.

• Authorizes reimbursements from the following for the purchase of over-the-counter drugs not prescribed by a physician, effective after December 31, 2017 (Sec. 208):

• Health flexible spending arrangements; and

• Health reimbursement arrangements.

• Authorizes tax deductions for expenses not compensated by insurance for the medical care of an individual  if such expenses exceed 7.5 percent of the individual’s adjusted gross income, effective after December 31, 2017 (Sec. 213).

• Extends the special rule authorizing tax deductions for expenses exceeding 7.5 percent of an individual’s adjusted gross income for individuals aged 65 or older through January 1, 2018, and makes such extension retroactive for taxable years beginning after December 31, 2016 (Sec. 213).

• Increases the maximum contribution limits on health spending accounts to match the sum of the annual deductible and out-of-pocket expense permitted under a high deductible health plan (Sec. 216).

Full Bill Text

Full Bill Text