CCAGW Annual Ratings

Health Insurance Pricing and Expansions – Passage


Passage of the bill, as amended, that would include a number of provisions to expand enrollment in and reduce consumer costs for state- and federally-operated Affordable Care Act health insurance marketplaces; incentivize Medicaid expansion by states; and authorize maximum price negotiations for prescription drugs under Medicare. Title I of the bill would expand eligibility for federal tax subsidies toward insurance premiums and increase the percentage of premiums such subsidies would cover. It would provide $10 billion annually beginning in fiscal 2022 to help states lower costs of ACA plans, including to provide reinsurance payments to health insurance issuers and subsidies to individuals. It would provide $200 million for grants to states to establish and operate state-based ACA health insurance marketplaces; $100 million annually for Health and Human Services Department consumer outreach related to ACA marketplace plans; $100 million annually for the HHS "navigator" program, which helps individuals enroll in qualified plans; and $200 million annually through fiscal 2024 for grants to states to encourage plan enrollment. It would also prohibit implementation of August 2018 regulations related to health insurance plans that are not required to meet ACA patient protection requirements, including short-term, limited-duration plans. Title II of the bill would provide for full federal reimbursement of state Medicaid expansion costs for new enrollees for three years, then gradually decrease the federal medical assistance cost-share to 90% for those enrollees. It would authorize HHS to reduce the federal cost-share percentage for states that do not expand their Medicaid programs by 0.5% quarterly beginning in fiscal 2023, and by 10% beginning July 2027. It would permanently authorize funding for the Children's Health Insurance Program. It would require Medicaid and CHIP programs to provide at least 12 continuous months of coverage for qualifying individuals and provide one year of coverage for women after the end of a pregnancy. It would allow states to expand eligibility for Medicaid and CHIP programs to include children whose family income exceeds certain amounts, and it would make citizens of the Freely Associated States residing in the U.S. eligible for Medicaid. Title III of the bill would establish a fair price negotiation program under which the Health and Human Services Department would enter into agreements with drug manufacturers to negotiate a "maximum fair price" for insulin and up to 250 other Medicare-eligible, brand-name drugs that do not have generic competition and account for high levels of spending. It would require the department to negotiate the maximum price of at least 25 drugs for 2023 and at least 50 drugs in each subsequent year, with maximum prices not exceeding 120% of a drug's average international price or 85% of the average manufacturer price for that year. It would subject manufacturers who do not reach a negotiated agreement for a drug to excise taxes based on gross sales of that drug. It would require manufacturers to offer negotiated prices to private health insurers. It would authorize a total of $3 billion through fiscal 2023 for implementation of the price negotiation program. As amended, the bill would authorize $2 billion for National Institutes of Health cancer research and make Deferred Action for Childhood Arrivals program recipients eligible to enroll in ACA marketplace health plans.

Vote Number: 
House Vote 124
Bill Number: 
HR 1425
CCAGW Position: 
Vote Results: 
Passed 234-179: R 2-177; D 232-1; I 0-0; O 0-1.