H.R. 7909

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7909 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 7909

To amend title XVIII of the Social Security Act to provide for an 
option for individuals who are ages 50 to 64 to buy into Medicare, to 
provide for health insurance market stabilization, and for other 
purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 12, 2026

Mr. Krishnamoorthi introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to provide for an 
option for individuals who are ages 50 to 64 to buy into Medicare, to 
provide for health insurance market stabilization, and for other 
purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Medicare Expansion and Lowering 
Costs Now Act''.

SEC. 2. FINDINGS.

Congress finds as follows:
(1) Medicare has coverage gaps and should provide more 
comprehensive coverage, including increasing coverage for the 
medical needs of beneficiaries relating to hearing, dental, and 
vision care.
(2) Special needs populations face financial challenges to 
secure coverage for Medicare's out-of-pocket costs and other 
hurdles.
(3) Medicare Buy-In is a step in the right direction as 
Congress considers additional needed legislation to address 
these and other coverage issues and beneficiary financial 
challenges in Medicare and Medicare Buy-In.

SEC. 3. MEDICARE BUY-IN OPTION.

(a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
1395c et seq.) is amended by adding at the end the following new 
section:

``medicare buy-in option

``Sec. 1899D. 
``(a) Option.--
``(1) In general.--Every individual who meets the 
requirements described in paragraph (2) shall be eligible to 
enroll under this section.
``(2) Eligibility.--An individual who meets the following 
requirements is eligible to enroll under this section:
``(A) Age.--The individual has attained 50 years of 
age, but has not attained 65 years of age.
``(B) Medicare eligibility (but for age).--The 
individual is not otherwise entitled to benefits under 
part A or eligible to enroll under part A or part B but 
would be eligible for benefits under part A or part B 
if the individual were 65 years of age.
``(3) Part a, b, and d benefits and protections.--An 
individual enrolled under this section is entitled to the same 
benefits (and shall receive the same protections) under this 
title as an individual who is entitled to benefits under part A 
and enrolled under parts B and D, including the ability to 
enroll in a Medicare Advantage plan that provides qualified 
prescription drug coverage (an MA-PD plan) and including access 
to the Medicare Beneficiary Ombudsman under section 1808(c).
``(b) Enrollment and Coverage Periods.--The Secretary shall 
establish enrollment and coverage periods for individuals who enroll 
under this section. Such periods shall be established in coordination 
with the enrollment and coverage periods for plans offered under an 
Exchange established under title I of the Patient Protection and 
Affordable Care Act. The Secretary shall establish such periods so that 
coverage under this section shall first begin on January 1 of the first 
year beginning at least one year after the date of the enactment of 
this section and shall include special enrollment periods, in 
accordance with section 155.420 of title 45 of the Code of Federal 
Regulations, that are applicable to qualified health plans offered 
through an Exchange.
``(c) Buy-In Premium.--
``(1) Amount of monthly premiums.--The Secretary shall 
(beginning for the first year that begins more than 1 year 
after the date of the enactment of this section), during 
September of the preceding year, determine a monthly premium 
for individuals enrolled under this section. Such monthly 
premium shall be equal to \1/12\ of the annual premium computed 
under paragraph (2)(B), which shall apply with respect to 
coverage provided under this section for any month in such 
year.
``(2) Annual premium.--
``(A) Combined national, per capita average for 
parts a, b, and d benefits.--The Secretary shall 
estimate the average, annual per capita amount for 
benefits and administrative expenses that will be 
payable under parts A, B, and D in the year for all 
individuals enrolled under this section.
``(B) Annual premium.--Subject to subparagraphs (C) 
and (D), the annual premium under this subsection for 
months in a year is equal to the average, annual per 
capita amount estimated under subparagraph (A) for the 
year.
``(C) Adjustments.--The Secretary shall adjust the 
annual premium under this subsection as necessary--
``(i) to ensure that expenditures under 
this title for any year are not increased by 
reason of this section; and
``(ii) by a geographic adjustment factor to 
address regional affordability concerns.
``(D) Authority to calculate amounts of monthly 
premiums separately for different ages.--In determining 
the annual premium amount under this paragraph for 
months in a year, the Secretary may make separate 
determinations of such amount for individuals by age, 
if the Secretary determines that making such separate 
determinations would increase enrollment under this 
section and reduce the risk of adverse selection.
``(3) Additional premium for certain part d plans.--Nothing 
in this section shall preclude an individual from choosing a 
prescription drug plan which requires the individual to pay an 
additional amount (because of the inclusion of supplemental 
prescription drug benefits or because the plan is a more 
expensive plan, pursuant to section 1860D-13(a)(1)). In such 
case, the monthly premium under paragraph (1) shall be 
increased with respect to such individual.
``(d) Payment of Premiums.--
``(1) Payment.--Premiums for enrollment under this section 
shall be paid to the Secretary at such times, and in such 
manner, as the Secretary determines appropriate.
``(2) Deposit.--Amounts collected by the Secretary under 
this section shall be deposited in the Medicare Buy-In Trust 
Fund established under subsection (e).
``(e) Medicare Buy-In Trust Fund.--
``(1) In general.--There is hereby created on the books of 
the Treasury of the United States a trust fund to be known as 
the `Medicare Buy-In Trust Fund' (in this subsection referred 
to as the `Trust Fund'). The Trust Fund shall consist of such 
gifts and bequests as may be made as provided in section 
201(i)(1) and such amounts as may be deposited in, or 
appropriated to, such fund as provided in this title.
``(2) Premiums.--Premiums collected under subsection (d) 
shall be transferred to the Trust Fund.
``(3) Incorporation of provisions.--Subsections (b) through 
(i) of section 1841 shall apply with respect to the Trust Fund 
and this title in the same manner as they apply with respect to 
the Federal Supplementary Medical Insurance Trust Fund and part 
B, respectively, except that in applying such section 1841, any 
reference in such section to `this part' shall be construed to 
be a reference to this section and any reference in section 
1841(h) to section 1840(d) and in section 1841(i) to sections 
1840(b)(1) and 1842(g) are deemed to be references to 
comparable authority exercised under this section.
``(f) Clarification.--Nothing in this section shall affect the 
benefits or eligibility under this title of individuals who would 
otherwise be entitled to or eligible for benefits under this title or 
title XIX, or both.
``(g) Eligibility for Financial Assistance.--
``(1) In general.--Individuals enrolled in coverage under 
this section shall, from amounts transferred under paragraph 
(2), receive financial assistance for such coverage that is 
substantially similar to the assistance the individual would 
have received if the individual were enrolled in a qualified 
health plan through an Exchange.
``(2) Transfer of funds to medicare buy-in trust fund.--
``(A) In general.--The Secretary shall transfer to 
the Medicare Buy-In Trust Fund under subsection (d) for 
each plan year the amount determined under paragraph 
(C) for such year.
``(B) Use of funds.--The amounts transferred to the 
Medicare Buy-In Trust Fund under subparagraph (A) shall 
only be used to reduce the premiums and cost-sharing 
for coverage under this section of individuals enrolled 
under such coverage who would be eligible for cost-
sharing reductions under section 1402 of the Patient 
Protection and Affordable Care Act and premium 
assistance under section 36B of the Internal Revenue 
Code of 1986 if such individual were enrolled in a 
qualified health plan.
``(C) Amount of transfer.--
``(i) In general.--The amount determined 
under this subparagraph for any plan year is 
the aggregate amount the Secretary determines 
is equal to 100 percent of the premium tax 
credits under section 36B of the Internal 
Revenue Code of 1986, and 100 percent of the 
cost-sharing reductions under section 1402 of 
the Patient Protection and Affordable Care Act, 
that would have been provided for the plan year 
to eligible individuals who meet specified 
income criteria and are enrolled for such plan 
year in coverage provided through enrollment 
under this section if such individuals were 
enrolled for such year in a qualified health 
plan through an Exchange.
``(ii) Specific requirements.--The 
Secretary shall make the determination under 
clause (i) on a per enrollee basis and shall 
take into account all relevant factors 
necessary to determine the value of the premium 
tax credits and cost-sharing reductions that 
would have been provided to eligible 
individuals described in section 1331 of the 
Patient Protection and Affordable Care Act, 
including the age and income of the enrollee, 
geographic differences in average spending for 
health care across rating areas, the health 
status of the enrollee for purposes of 
determining risk adjustment payments and 
reinsurance payments that would have been made 
if the enrollee had enrolled in a qualified 
health plan through an Exchange, and whether 
any reconciliation of the credit or cost-
sharing reductions would have occurred if the 
enrollee had been so enrolled. This 
determination shall take into consideration the 
experience of other States with respect to 
participation in an Exchange and such credits 
and reductions provided to residents of the 
other States, with a special focus on enrollees 
with income below 200 percent of poverty.
``(D) Certification.--
``(i) In general.--The Chief Actuary of the 
Centers for Medicare & Medicaid Services, in 
consultation with the Office of Tax Analysis of 
the Department of the Treasury, shall certify 
whether the methodology used to make 
determinations under subparagraph (C), and such 
determinations, meet the requirements of this 
paragraph. Such certifications shall be based 
on sufficient data from the Federal exchange 
and from comparable States about their 
experience with programs created by the Basic 
Health Plan.
``(ii) Corrections.--The Secretary shall 
adjust the payment to the Trust Fund for any 
plan year to reflect any error in the 
determinations under subparagraph (C) for any 
preceding plan year.
``(iii) Application.--Coverage provided 
through enrollment under this part and parts B 
and D pursuant to this section shall be treated 
as coverage under a qualified health plan in 
the silver level of coverage in the individual 
market offered through an Exchange and the 
Secretary shall be treated as the issuer of 
such plan.
``(h) Treatment in Relation to the Affordable Care Act.--
``(1) Treatment as minimum essential coverage.--For 
purposes of applying section 5000A of the Internal Revenue Code 
of 1986, the coverage provided through enrollment under this 
section constitutes minimum essential coverage under subsection 
(f)(1)(A)(i) of such section.
``(2) Use of exchanges.--Coverage provided through 
enrollment under this section shall be deemed to be coverage 
under a qualified health plan for purposes of section 
1311(d)(4)(C) of the Patient Protection and Affordable Care Act 
and shall be made available for enrollment, information 
comparison, and otherwise as such a plan through any internet 
website maintained by an Exchange established under title I of 
such Act (as described in such section).
``(3) Medicaid managed care.--States are prohibited from 
buying their Medicaid beneficiaries ages 50 to 64 into Medicare 
under this section, and individuals otherwise eligible for 
enrollment under a State plan under title XIX are prohibited 
from coverage under this title pursuant to enrollment under 
this section. The preceding sentence shall not apply to 
Medicaid beneficiaries whose Medicaid coverage or eligibility 
does not meet the definition of minimum essential coverage 
under a government-sponsored program under section 1.5000A-2 of 
title 26, Code of Federal Regulations (or any successor 
regulation).
``(4) Access to medigap.--Coverage provided through 
medicare supplemental policies certified under section 1882 
shall be made available to individuals eligible for enrollment 
pursuant to this section for enrollment, information, 
comparison, and otherwise as such a policy through any internet 
website described in paragraph (2).
``(i) Oversight.--There is established an advisory committee to be 
known as the `Medicare Buy-In Oversight Board' to monitor and oversee 
the implementation of this section, including the experience of the 
individuals enrolling under this section. The Medicare Buy-In Oversight 
Board shall make periodic recommendations for the continual improvement 
of the implementation of this section as well as the relationship of 
enrollment under this section to other health care programs.
``(j) Outreach and Enrollment.--
``(1) In general.--During the period that begins on January 
1, 2026, and ends on December 31, 2028, the Secretary shall 
award grants to eligible entities for the following purposes:
``(A) Outreach and enrollment.--To carry out 
outreach, public education activities, and enrollment 
activities to raise awareness of the availability of, 
and encourage, enrollment under this section.
``(B) Assisting individuals transition under this 
section.--To provide assistance to individuals to 
enroll under this section.
``(C) Raising awareness of premium assistance and 
cost-sharing reductions.--To distribute fair and 
impartial information concerning enrollment under this 
section and the availability of premium assistance tax 
credits under section 36B of the Internal Revenue Code 
of 1986 and cost-sharing reductions under section 1402 
of the Patient Protection and Affordable Care Act, and 
to assist eligible individuals in applying for such tax 
credits and cost-sharing reductions.
``(2) Eligible entities.--
``(A) In general.--In this subsection, the term 
`eligible entity' means--
``(i) a State; or
``(ii) a nonprofit community-based 
organization.
``(B) Enrollment agents.--Such term includes a 
licensed independent insurance agent or broker that has 
an arrangement with a State or nonprofit community-
based organization to enroll eligible individuals under 
this section.
``(C) Exclusions.--Such term does not include an 
entity that--
``(i) is a health insurance issuer; or
``(ii) receives any consideration, either 
directly or indirectly, from any health 
insurance issuer in connection with the 
enrollment of any individuals under this 
section.
``(3) Priority.--In awarding grants under this subsection, 
the Secretary shall give priority to awarding grants to States 
or eligible entities in States that have geographic rating 
areas at risk of having no qualified health plans in the 
individual market.
``(4) Funding.--Out of any moneys in the Treasury not 
otherwise appropriated, $500,000,000 is appropriated to the 
Secretary for each of calendar years 2026 through 2028, to 
carry out this subsection.
``(k) Implementation.--
``(1) Consultation.--In carrying out this section, the 
Secretary shall--
``(A) consult with other Federal agencies, 
including the Department of the Treasury, the 
Department of Labor, the Department of Veterans 
Affairs, the Department of Defense, and the Office of 
Personnel Management; and
``(B) incorporate significant public consultation 
and feedback, through public forums, notice and comment 
rulemaking, and any other appropriate mediums.
``(2) Report.--No later than one year after the date of the 
enactment of this section, the Secretary shall submit to 
Congress a report establishing the administrative parameters 
for the implementation of this section.
``(l) Feasibility Study.--The Secretary shall conduct a study on 
the feasibility of applying this section with respect to individuals 
residing in States that are not within the 50 States or the District of 
Columbia.''.
(b) Medigap.--Section 1882 of the Social Security Act is amended by 
adding at the end the following new subsection:
``(aa) Development of New Standards for Certain Medicare 
Supplemental Policies Relating to Buy-In Option.--The Secretary shall 
request the National Association of Insurance Commissioners to review 
and revise the standards for benefit packages described in subsection 
(p)(1), to otherwise update standards to include requirements for each 
medicare supplemental policy that offers such a policy in a State, with 
respect to each year, to accept every individual in the State who is 
eligible for enrollment pursuant to section 1899D and who applies for 
such coverage for such year if the individual applies for enrollment in 
such policy during the 30-day period following the date of enrollment 
pursuant to section 1899D and to accept every such individual during a 
period of transition from enrollment pursuant to such section to 
enrollment under this title pursuant to eligibility other than under 
such section. Such revisions shall be made consistent with the rules 
applicable under subsection (p)(1)(E) with the reference to the `1991 
NAIC Model Regulation' deemed a reference to the NAIC Model Regulation 
as published in the Federal Register on December 4, 1998, and as 
subsequently updated by the National Association of Insurance 
Commissioners to reflect previous changes in law and the reference to 
`date of enactment of this subsection' deemed a reference to the date 
of enactment of this subsection (aa).''.

SEC. 4. MEDICARE DIRECT SUPPLEMENTAL INSURANCE OPTION.

(a) In General.--Title XVIII of the Social Security Act is amended 
by inserting after section 1882 (42 U.S.C. 1395ss) the following new 
section:

``SEC. 1882A. MEDICARE DIRECT SUPPLEMENTAL INSURANCE OPTION.

``(a) In General.--The Secretary shall provide for the offering 
under this section of a voluntary program to supplement the benefits 
provided to individuals under parts A and B of this title.
``(b) Eligibility; Enrollment.--The Secretary shall provide 
procedures for the enrollment under the program under this section of 
individuals who are entitled to benefits under part A and enrolled 
under part B, but who are not enrolled in a Medicare Advantage plan (or 
in a plan under section 1876). Such procedures shall be consistent with 
the following:
``(1) There shall be an initial enrollment period during 
the last calendar quarter of 2027 that permits all individuals 
who are eligible to enroll at that time under this subsection 
to enroll and obtain benefits effective on January 1, 2028.
``(2) For individuals who are not eligible to enroll at 
such time but who subsequently become eligible, there shall be 
an individual enrollment period which is the 6-month period 
described in section 1882(s)(2)(A).
``(3) The Secretary shall permit eligible individuals to 
enroll at other times (and not less frequently than annually) 
in a uniform manner, but such enrollment shall be subject to a 
late enrollment penalty under subsection (d)(2)(B).
``(c) Benefits.--
``(1) In general.--The benefits provided under the program 
under this section shall consist of payment of the cost of 
deductibles, copayments, and other cost-sharing amounts 
(including amounts attributable to and permitted as balance 
billing) otherwise imposed or permitted under this title, 
subject to an annual deductible of $100.
``(2) Administration.--The Secretary shall coordinate 
payment of benefits under this part with those under parts A 
and B and may, for such purpose, enter into appropriate 
arrangements with qualified entities (which may include fiscal 
intermediaries and carriers).
``(3) No pre-existing condition limitations.--The benefits 
under this section shall not be subject to any pre-existing 
condition or similar underwriting limitation.
``(d) Premiums.--
``(1) Actuarial cost.--The Secretary shall, during 
September of each year beginning with 2027, determine a monthly 
actuarial rate for all enrollees under this section, which rate 
shall be applicable for months in the succeeding calendar year. 
Such actuarial rate shall be the amount the Secretary estimates 
to be necessary so that the aggregate amount for such calendar 
year with respect to those enrollees will equal the total 
amount which the Secretary estimates will be payable under this 
section for benefits accrued (including services performed and 
related administrative costs incurred) in such calendar year 
under the program under this section. In calculating the 
monthly actuarial rate, the Secretary shall make adjustments to 
take into account errors in estimations under this paragraph 
for previous years and shall include an appropriate amount for 
a contingency margin.
``(2) Premium.--
``(A) In general.--The monthly premium of each 
individual enrolled under this section for a month in a 
year shall be the monthly actuarial rate determined 
under paragraph (1) for months in such year. Such 
premium shall be community-rated and shall not vary 
among enrollees based upon the age, place of residence, 
or any other factors, except as provided under 
subparagraph (B).
``(B) Penalty for late enrollment.--In the case of 
an individual who does not enroll under this section in 
a period provided under paragraph (1) or (2) of 
subsection (b), the Secretary shall increase the 
monthly premium (in a manner similar to that applied 
under part B pursuant to section 1839(b)) of 10 percent 
for each full 12 months in which the individual could 
have been but was not so enrolled. In applying such an 
increase--
``(i) the aggregate percentage increase may 
not exceed 100 percent; and
``(ii) periods of time in which an 
individual is enrolled under an employee 
welfare benefit plan described in section 
1882(s)(3)(B)(i), under a Medicare Advantage 
plan, with an organization described in section 
1882(s)(3)(B)(iii), or under a PACE program 
under section 1894 shall not be taken into 
account.
``(3) Collection.--The Secretary shall provide for the 
collection of premiums for enrollees under this part in the 
same manner as premiums under part B are collected under 
section 1840, except that any reference in such section to the 
Federal Supplementary Medical Insurance Trust Fund shall be 
deemed a reference to an account (to be known as the `Direct 
Medicare Supplemental Insurance Account') to be established in 
the Treasury by the Secretary to carry out the program under 
this section. Amounts in such account may be invested and draw 
interest in the same manner as such Trust Fund under section 
1840(c).
``(4) Use of funds.--Premium amounts deposited into the 
account established under paragraph (3) shall be available 
without regard to appropriations to the Secretary to make 
payment for benefits and administrative costs incurred in 
carrying out this section.
``(e) Nonduplication of Coverage.--For purposes of applying section 
1882(d)(3)(A), coverage under this section shall be treated as coverage 
under a Medicare supplemental policy.''.
(b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and shall apply to 
benefits for months beginning with January 2027.

SEC. 5. NEGOTIATION OF LOWER COVERED PART D DRUG PRICES ON BEHALF OF 
MEDICARE BENEFICIARIES.

(a) Negotiation by Secretary.--Section 1860D-11 of the Social 
Security Act (42 U.S.C. 1395w-111) is amended by striking subsection 
(i) (relating to noninterference) and inserting the following:
``(i) Negotiation of Lower Drug Prices.--
``(1) In general.--Notwithstanding any other provision of 
law, the Secretary shall negotiate with pharmaceutical 
manufacturers the prices (including discounts, rebates, and 
other price concessions) that may be charged to PDP sponsors 
and MA organizations for covered part D drugs for part D 
eligible individuals who are enrolled under a prescription drug 
plan or under an MA-PD plan.
``(2) No change in rules for formularies.--
``(A) In general.--Nothing in paragraph (1) shall 
be construed to authorize the Secretary to establish or 
require a particular formulary.
``(B) Construction.--Subparagraph (A) shall not be 
construed as affecting the Secretary's authority to 
ensure appropriate and adequate access to covered part 
D drugs under prescription drug plans and under MA-PD 
plans, including compliance of such plans with 
formulary requirements under section 1860D-4(b)(3).
``(3) Construction.--Nothing in this subsection shall be 
construed as preventing the sponsor of a prescription drug 
plan, or an organization offering an MA-PD plan, from obtaining 
a discount or reduction of the price for a covered part D drug 
below the price negotiated under paragraph (1).
``(4) Semi-annual reports to congress.--Not later than June 
1, 2029, and every 6 months thereafter, the Secretary shall 
submit to the Committees on Ways and Means, Energy and 
Commerce, and Oversight and Reform of the House of 
Representatives and the Committee on Finance of the Senate a 
report on negotiations conducted by the Secretary to achieve 
lower prices for Medicare beneficiaries, and the prices and 
price discounts achieved by the Secretary as a result of such 
negotiations.''.
(b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and shall first 
apply to negotiations and prices for plan years beginning on January 1, 
2029.

SEC. 6. INDIVIDUAL MARKET REINSURANCE FUND.

(a) Establishment of Fund.--
(1) In general.--There is established the ``Individual 
Market Reinsurance Fund'' (in this section referred to as the 
``Fund'') to be administered by the Secretary to provide 
funding for an individual market stabilization reinsurance 
program in each State that complies with the requirements of 
this section.
(2) Funding.--Amounts made available to the Fund shall 
consist of the funds deposited into the Fund under paragraph 
(3) and shall be used to carry out this section (other than 
subsection (c)) for each calendar year beginning with 2029. 
Amounts made available to the Fund shall remain available 
without fiscal or calendar year limitation to carry out this 
section.
(3) Cost-sharing in costs of program.--
(A) In general.--A qualified health plan that 
participates in the reinsurance program established 
under subsection (b) shall pay the fee established 
under subparagraph (B).
(B) Authorization.--The Secretary is authorized to 
charge a fee to each qualified health plan that 
participates in the reinsurance program established 
under subsection (b). Any amounts collected pursuant to 
this paragraph shall be deposited into the Fund for 
purposes of payments under subsection (b).
(C) Requirements.--In establishing the fee under 
subparagraph (B)--
(i) the Secretary shall consult with 
interested parties; and
(ii) shall ensure that the amount of such 
fee is not excessive so as to unduly discourage 
qualified health plans from participating in 
the reinsurance program.
(b) Individual Market Reinsurance Program.--
(1) Use of funds.--The Secretary shall use amounts in the 
Fund to establish a reinsurance program under which the 
Secretary shall make reinsurance payments, subject to 
subsection (a)(3), to health insurance issuers with respect to 
high-cost individuals enrolled in qualified health plans 
offered by such issuers that are not grandfathered health plans 
or transitional health plans for any plan year beginning with 
the 2025 plan year. This subsection constitutes budget 
authority in advance of appropriations Acts and represents the 
obligation of the Secretary to provide payments from the Fund 
in accordance with this subsection.
(2) Amount of payment.--The payment made to a health 
insurance issuer under paragraph (1) with respect to each high-
cost individual enrolled in a qualified health plan issued by 
the issuer that is not a grandfathered health plan or a 
transitional health plan shall equal 80 percent of the lesser 
of--
(A) the amount (if any) by which the individual's 
claims incurred during the plan year exceeds--
(i) in the case of the 2026, 2027, or 2028 
plan year, $50,000; and
(ii) in the case of any other plan year, 
$100,000; or
(B) for plan years described in--
(i) subparagraph (A)(i), $450,000; and
(ii) subparagraph (A)(ii), $400,000.
(3) Indexing.--In the case of plan years beginning after 
2026, the dollar amounts that appear in subparagraphs (A) and 
(B) of paragraph (2) shall each be increased by an amount equal 
to--
(A) such amount; multiplied by
(B) the premium adjustment percentage specified 
under section 1302(c)(4) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(c)(4)), but 
determined by substituting ``2024'' for ``2013''.
(4) Payment methods.--
(A) In general.--Payments under this subsection 
shall be based on such a method as the Secretary 
determines. The Secretary may establish a payment 
method by which interim payments of amounts under this 
subsection are made during a plan year based on the 
Secretary's best estimate of amounts that will be 
payable after obtaining all of the information.
(B) Requirement for provision of information.--
(i) Requirement.--Payments under this 
subsection to a health insurance issuer are 
conditioned upon the furnishing to the 
Secretary, in a form and manner specified by 
the Secretary, of such information as may be 
required to carry out this subsection.
(ii) Restriction on use of information.--
Information disclosed or obtained pursuant to 
clause (i) is subject to the HIPAA privacy and 
security law, as defined in section 3009(a) of 
the Public Health Service Act (42 U.S.C. 300jj-
19(a)).
(5) Secretary flexibility for budget neutral revisions to 
reinsurance payment specifications.--If the Secretary 
determines appropriate, the Secretary may substitute higher 
dollar amounts for the dollar amounts specified under 
subparagraphs (A) and (B) of paragraph (2) (and adjusted under 
paragraph (3), if applicable) if the Secretary certifies that 
such substitutions, considered together, neither increase nor 
decease the total projected payments under this subsection.
(c) Reports to Congress.--
(1) Annual report.--The Secretary shall submit a report to 
Congress, not later than January 21, 2026, and each year 
thereafter, that contains the following information for the 
most recently ended year:
(A) The number and types of plans in each State's 
individual market, specifying the number that are 
qualified health plans, grandfathered health plans, or 
health insurance coverage that is not a qualified 
health plan.
(B) The impact of the reinsurance payments provided 
under this section on the availability of coverage, 
cost of coverage, and coverage options in each State.
(C) The amount of premiums paid by individuals in 
each State by age, family size, geographic area in the 
State's individual market, and category of health plan 
(as described in subparagraph (A)).
(D) The process used to award funds for outreach 
and enrollment activities awarded to eligible entities 
under subsection (c), the amount of such funds awarded, 
and the activities carried out with such funds.
(E) Such other information as the Secretary deems 
relevant.
(2) Evaluation report.--Not later than January 31, 2029, 
the Secretary shall submit to Congress a report that--
(A) analyzes the impact of the funds provided under 
this section on premiums and enrollment in the 
individual market in all States; and
(B) contains a State-by-State comparison of the 
design of the programs carried out by States with funds 
provided under this section.
(d) Definitions.--In this section:
(1) Secretary.--The term ``Secretary'' means the Secretary 
of the Department of Health and Human Services.
(2) Fund.--The term ``Fund'' means the Individual Market 
Reinsurance Fund established under subsection (a).
(3) Grandfathered health plan.--The term ``grandfathered 
health plan'' has the meaning given that term in section 
1251(e) of the Patient Protection and Affordable Care Act (42 
U.S.C. 18011(e)).
(4) High-cost individual.--The term ``high-cost 
individual'' means an individual enrolled in a qualified health 
plan (other than a grandfathered health plan or a transitional 
health plan) who incurs claims in excess of $50,000 during a 
plan year.
(5) State.--The term ``State'' means each of the 50 States 
and the District of Columbia.
(6) Transitional health plan.--The term ``transitional 
health plan'' means a plan continued under the letter issued by 
the Centers for Medicare & Medicaid Services on November 14, 
2013, to the State Insurance Commissioners outlining a 
transitional policy for coverage in the individual and small 
group markets to which section 1251 of the Patient Protection 
and Affordable Care Act does not apply, and under the extension 
of the transitional policy for such coverage set forth in the 
Insurance Standards Bulletin Series guidance issued by the 
Centers for Medicare & Medicaid Services on March 5, 2014, 
February 29, 2016, and February 13, 2017.

SEC. 7. REAUTHORIZATION OF RISK CORRIDORS.

Section 1342(a) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18062(a)) is amended by inserting ``and calendar years 2028 
through 2031'' after ``2016''.

SEC. 8. INTEGRATION OF INDIVIDUALS AGED 50 TO 64 INTO HEALTH 
DEMONSTRATIONS.

The Center for Medicare and Medicaid Innovation under section 1115A 
of the Social Security Act (42 U.S.C. 1315a) is authorized to include 
the individuals enrolled under title XVIII of the Social Security Act 
pursuant to section 1899D of such Act, as added by section 3, into 
existing and future demonstrations conducted by such Center.

SEC. 9. REPEAL OF RECONCILIATION HEALTH PROVISIONS.

Subtitle B of title VII of An Act to provide for reconciliation 
pursuant to title II of H. Con. Res. 14 (Public Law 119-21) is repealed 
and any law or regulation referred to in such subtitle shall be applied 
as if such subtitle and the amendments made by such subtitle had not 
been enacted.

SEC. 10. INCREASE IN ELIGIBILITY FOR PREMIUM TAX CREDIT.

(a) In General.--Section 36B(c)(1)(A) of the Internal Revenue Code 
of 1986 is amended by striking ``but does not exceed 400 percent''.
(b) Applicable Percentages.--
(1) In general.--Section 36B(b)(3)(A) of such Code is 
amended to read as follows:
``(A) Applicable percentage.--The applicable 
percentage for any taxable year shall be the percentage 
such that the applicable percentage for any taxpayer 
whose household income is within an income tier 
specified in the following table shall increase, on a 
sliding scale in a linear manner, from the initial 
premium percentage to the final premium percentage 
specified in such table for such income tier:

------------------------------------------------------------------------
The initial The final
``In the case of household income (expressed premium premium
as a percent of poverty line) within the percentage percentage
following income tier: is-- is--
------------------------------------------------------------------------
Up to 150 percent............................. 0 0
150 percent up to 200 percent................. 0 2.0
200 percent up to 250 percent................. 2.0 4.0
250 percent up to 300 percent................. 4.0 6.0
300 percent up to 400 percent................. 6.0 8.5
400 percent and higher........................ 8.5 8.5.''.
------------------------------------------------------------------------

(2) Conforming amendments relating to affordability of 
coverage.--
(A) Section 36B(c)(1) of such Code is amended by 
striking subparagraph (E).
(B) Section 36B(c)(2)(C) of such Code is amended by 
striking clause (iv).
(C) Section 36B(c)(4) of such Code is amended by 
striking subparagraph (F).
(c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2026.
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