HR-6703 : Still Just a Bill

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The "Lower Health Care Premiums for All Americans Act" (H.R. 6703) aims to expand health care options for workers and reduce overall health care premiums through several key provisions:

• Improving Health Care Options for Workers:
  • Association Health Plans (AHPs): This Act amends the Employee Retirement Income Security Act of 1974 (ERISA) to allow more flexibility for groups or associations of employers to offer group health plans. Key requirements for these AHPs include:
    • They must be formed and maintained for purposes other than solely providing health insurance coverage and must have existed for at least two years prior to offering a plan.
    • They must provide coverage to at least 51 employees and make it available to all employees of member employers and their dependents.
    • They cannot discriminate based on health status-related factors for eligibility or premiums and cannot deny coverage based on pre-existing conditions.
    • Premium rates can be based on an actuarially sound, modified community rating methodology that pools all plan participant claims, with potential adjustments for individual employer risk profiles where not prohibited by state law.
    • Self-employed individuals are eligible to participate as both employer members and employees.
  • Stop-Loss Insurance: The bill clarifies that medical stop-loss insurance obtained by self-insured group health plans or their sponsors is not defined as "health insurance coverage" under ERISA. It also preempts state laws that would prevent plans from insuring against the risk of excess health claims.
  • Custom Health Option and Individual Care Expense Arrangements (CHOICE Arrangements): The bill amends the Internal Revenue Code to recognize these health reimbursement arrangements (HRAs). These employer-provided, employer-funded arrangements allow payments or reimbursements for medical care, provided the individual is covered by individual health insurance or Medicare. Key features, effective for plan years beginning after December 31, 2025, include:
    • Nondiscrimination requirements, stipulating that these arrangements must be offered on the same terms to all employees within a specified class (with allowed variations for dependents and age).
    • Requirements for substantiating enrollment in qualifying health coverage and for medical care reimbursement requests.
    • Mandatory written notice to eligible employees regarding their rights and obligations.
    • The total amount of permitted benefits for enrolled individuals under a CHOICE arrangement will be reported on the employee's W-2 form.
    • Employees participating in a CHOICE arrangement are permitted to purchase Exchange insurance through a cafeteria plan.
• Lowering Health Care Premiums for Everyone:
  • Oversight of Pharmacy Benefit Management (PBM) Services: This Act establishes new reporting and disclosure requirements for entities providing PBM services to group health plans, effective for plan years beginning 30 months after the date of enactment. These requirements mandate that PBMs:
    • Provide detailed reports to group health plans at least every six months (or quarterly upon request) on drug costs, spending, rebates, and other remuneration, including drug-specific and therapeutic class-specific information.
    • Ensure contracts with other applicable entities (such as drug manufacturers or wholesalers) do not hinder the disclosure of necessary information.
    • Adhere to strict privacy standards, ensuring reports contain only summary health information and are consistent with HIPAA regulations.
    • Make summary documents and specific claims-level cost information available to participants or beneficiaries upon request.
    • Face civil monetary penalties for non-compliance or for knowingly providing false information.
  • Funding Cost-Sharing Reduction Payments: The bill appropriates necessary funds for cost-sharing reduction payments under the Patient Protection and Affordable Care Act (ACA) for plan years beginning on or after January 1, 2027. However, these funds are specifically prohibited from being used for qualified health plans that cover abortion, except in cases of rape, incest, or to save the life of the mother.

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An error occured and we cannot provide a prediction at this time. Either Congress API has not provided a text file or subject list for this bill, or the bill text is too large to make a prediction.