MARKETPLACE CERTAINTY ACT; Congressional Record Vol. 163, No. 112
(Senate - June 29, 2017)

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[Page S3854]
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                       MARKETPLACE CERTAINTY ACT

  Mrs. SHAHEEN. Mr. President, I am expressing sentiments for myself 
and on behalf of Senators Wyden and Murray, as a fair reading of the 
Affordable Care Act, ACA, makes clear, S. 1462, the Marketplace 
Certainty Act, is not necessary to provide a permanent appropriation 
for the payment of cost-sharing reductions under the ACA. The ACA 
already prescribes that such payments are to be made from such a 
permanent appropriation pursuant to 31 U.S.C. 1324. This is because an 
essential component of the ACA's system for ensuring the availability 
of affordable health insurance coverage is its two-part package of 
subsidies: tax credits and cost-sharing reductions. Whereas the premium 
tax credits make it more affordable for an individual to purchase 
health insurance, the cost-sharing reductions make healthcare more 
affordable by reducing the often daunting costs, such as copayments and 
deductibles, that even those with health insurance must pay to obtain 
healthcare, ACA, sections 1401, 1402, 26 U.S.C. 36B, 42 U.S.C. 18071. 
The ACA directs the Secretary of the Treasury to ``establish'' a 
single, integrated ``program'' to ``make advance payment'' of both 
subsidies to insurance companies, who are accordingly mandated to 
reduce individuals' premium payments to insurers, and their cost-
sharing obligations to healthcare providers. To assure insurers and 
covered individuals that these equally essential funds will both be 
available, the act provides that requisite payments are to be jointly 
made from a permanent appropriation, 31 U.S.C. 1324, rather than be 
subject to the year-to-year whims of the annual appropriations process.
  Despite the fact that the current permanent appropriation in section 
1324 plainly covers these cost-sharing reduction payments, pending 
litigation brought by the House Republican leadership--which is 
currently being held in abeyance in the D.C. Circuit Court of Appeals--
and the current administration's mixed signals as to whether it will 
continue to make these payments required by law, could generate 
instability in individual insurance markets. S. 1462 removes all basis 
for any further questions about what is already clear from a fair 
reading of the ACA as a whole: both subsidies are to be funded from the 
same permanent appropriation. In addition, the amendment includes 
provisions that will strengthen the existing subsidy provisions, and, 
in light of developments since the ACA was enacted in 2010, make 
insurance more affordable for beneficiaries and help stabilize State-
level individual insurance markets.