Creation of a reinsurance program for a new health insurance risk pool

(a) In general Part V of subtitle B of title I of the Patient Protection and Affordable Care Act (42 U.S.C. 18061 et seq.) is amended by adding at the end the following new section: 1344. Reinsurance program for certain off-exchange plans (a) In general There is established a Reinsurance Program, to be administered by the Secretary of Health and Human Services, to provide payments to health insurance issuers with respect to claims for eligible individuals for the purpose of lowering premiums for such individuals. (b) Funding (1) Appropriation For the purpose of providing funding for the Reinsurance Program, for each year during the period beginning on January 1, 2026, and ending on December 31, 2030, there is appropriated out of any monies in the Treasury not otherwise obligated an amount equal to the product of $50 and the aggregate number of member months for all eligible individuals enrolled in a covered plan during such year. (2) Limitation on appropriation In no year shall the appropriation for the Reinsurance Program authorized in paragraph (1) exceed $6,000,000,000. (3) Use of unexpended funds Appropriated amounts remaining unexpended at the end of any year may be used to make payments under the Reinsurance Program in any future year. (4) Limitation on use of funds No funds received under the Reinsurance Program may be used to pay for services described in section 1303(b)(1)(B)(i) (as in effect on the date of the enactment of this section). (c) Operation of program (1) In general The Secretary shall establish parameters for the operation of the Reinsurance Program consistent with this section. (2) Deadline for initial operation Not later than 120 days after the date of the enactment, the Secretary shall establish sufficient parameters to specify how the Program will operate for 2026. (3) Definitions In this section: (A) Covered plan The term covered plan means individual health insurance coverage (as such term is defined in section 2791 of the Public Health Service Act)— (i) with respect to which the issuer of such coverage has made the election described in section 1312(c)(1)(A); and (ii) that does not provide coverage for services described in section 1303(b)(1)(B)(i) (as in effect on the date of the enactment of this section). (B) Eligible individual The term eligible individual means an individual enrolled in a covered plan. (d) Attachment dollar amount and payment proportion (1) In general The Secretary shall annually establish an attachment point, payment proportion, and reinsurance cap with respect to claims for eligible individuals for payments under the Reinsurance Program, consistent with the following: (A) The attachment point for the period beginning January 1, 2026, and ending December 31, 2026, shall be $110,000. (B) The payment proportion for the period beginning January 1, 2026, and ending December 31, 2026, shall be 90 percent. (C) The reinsurance cap for the period beginning January 1, 2026 and ending December 31, 2026, shall be $300,000. (2) Adjustment authority The Secretary may adjust any amounts described in paragraph (1) as necessary to ensure the Reinsurance Program does not make payment for a year in excess of the amount available for such year under subsection (b).. (b) Election To opt out of single risk pool (1) In general Section 1312(c)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(c)(1)) is amended— (A) by striking A health insurance issuer and inserting the following: (A) In general A health insurance issuer; (B) in subparagraph (A), as inserted by paragraph (1), by inserting and other than any health plan with respect to which such issuer has elected for this subparagraph not to apply after grandfathered health plans; and (C) by adding at the end the following new subparagraph: (B) Treatment of plans opting out of single risk pool A health insurance issuer shall consider all enrollees in all health plans offered by such issuer in the individual market with respect to which such issuer has made the election described in subparagraph (A) to be members of a single risk pool.. (2) Prohibiting single risk pool opt out for qualified health plans Section 1301(a)(1)(C) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)) is amended— (A) in clause (iii), by striking and at the end; (B) in clause (iv), by striking the period and inserting; and; and (C) by adding at the end the following new clause: (v) has not made the election described in section 1312(c)(1)(A) with respect to such plan.. (3) Effective date The amendments made by this subsection shall apply with respect to plan years beginning on or after January 1, 2026. (c) Removing age premium variation limitation for certain plans (1) In general (A) Removal of limitation for certain plans Section 2701(a)(1)(A)(iii) of the Public Health Service Act (42 U.S.C 300gg(a)(1)(A)(iii)) is amended by inserting or, in the case of such coverage with respect to which the issuer of such coverage has made the election described in section 1312(c)(1)(A) of the Patient Protection and Affordable Care Act, by more than an actuarially justified amount for adults before; and. (B) Effective date The amendment made by subparagraph (A) shall apply with respect to plan years beginning on or after January 1, 2026. (2) Maintaining age premium variation limitation for qualified health plans Section 1301(a)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)(1)), as amended by subsection (b), is further amended— (A) in subparagraph (B), by striking and at the end; (B) in subparagraph (C)(v), by striking the period and inserting; and; and (C) by adding at the end the following new subparagraph: (D) with respect to the premium rate charged by such plan, if such plan varies such rate by age, does not vary such rate by more than 3 to 1 for adults (consistent with section 2707(c) of the Public Health Service Act).. (d) Treatment of opt out plans in relation to individual health coverage reimbursement arrangements The Secretaries of Health and Human Services, Labor, and the Treasury shall not fail to treat any individual health insurance coverage (as defined in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91)) as eligible for integration with an individual health care reimbursement arrangement on the basis that the health insurance issuer (as so defined) of such coverage has made the election described in section 1312(c)(1)(A) of the Patient Protection and Affordable Care Act (as inserted by subsection (b)).