HB 25-1297 — Health Insurance Affordability Enterprise Update

First Regular Session Seventy-fifth General Assembly STATE OF COLORADO INTRODUCEDPREAMENDED This Unofficial Version Includes Committee Amendments Not Yet Adopted on Second Reading LLS NO.

25-0887.01 Brita Darling x2241 HOUSE BILL 25-1297 HOUSE SPONSORSHIP Brown and Gilchrist, SENATE SPONSORSHIP Jodeh, House Committees Senate Committees Health & Human Services Finance A BILL FOR AN ACT C ONCERNING UPDATES TO THE HEALTH INSURANCE AFFORDABILITY ENTERPRISE TO PROVIDE CONTINUING COVERAGE FOR HEALTH INSURANCE NEEDS IN THE STATE .

In Colorado RevisedStatutes,10-16-1205,amend (1)(a)(I) introductoryintroductoryrtion portion,and (1)(b)(II),(2)(d)(I) introductoryportion;and add (1)(a.5), (1)(b)(VI), (1)(b)(VII), (2)(d)(IV),), and (2)(d)(I)(6) introductoryas portion;follows:

and add (1)(a.5), (1)(b)(VI), (1)(b)(VII), (2)(d)(IV), and (2)(e) as follows:

Health insurance affordability fee - special assessment on hospitals - allocation ofofevenues revenues.- report on revenue and expenditures.

(1) (a) (I) Starting in the 2021 calendar year, the enterprise shall assess and collect from carriers, by July 15 each year, a -2- HB25-12971297 carriers,byJuly15eachyear,ahealthinsuranceaffordabilityXCEPThealth insurance affordabilityXCEPT AS PROVIDED IN SUBSECTIO(1)(a.5OFSUBSECTION (1)(a.5)F THIS SECTIO,SECTION, the fee amount is based on the following percentages of premiums collected by the following carriers in the immediatelyimmediatelyprecedingcalendaryearonhealthbenefitplansissuedinthe preceding calendar year on health benefit plans issued in the state:

(a.5) (I) STARTINGSTING IN THETHE2026CALENDAR 2026 CALENDAR YEAR ,,IFTHE THEFEDERAL COMMISSIONERGOVERNMENT MAYDISCONTINUES INCREASEOR DECREASES THE HEALTHENHANCED INSURANCEFEDERAL AFFORDABILITY"PATIENTP FEEBYUPTOONEPERCENTAGEPOINTABOVETHEPERCENTAGESSPECIFIEDROTECTIONAND INA SUBSECTION(1)(a)(IOFFFORDABLEC THISAREA SECTI.NCT"SUBSIDIESCREATED (II)BYTHEFEDERAL IETERMININGWHETHERTOINCREASETHEPERCENTAGEOF"A PREMIUMSMERICANR COLLECTEDESCUE BYPLANA THECTOF CARRIERS2021",PUB.L.117-2, PURSUANTAND TOEXTENDED SUBSECTIONBY (1)(a)(IOFTHE THISFEDERAL SECTION,THE"NFLATION COMMISSIONERREDUCTION SHALLA CONSIDERCT THEOF2022", FOLLOWINGPUB OBJECTIVES:.L.

(A)117-169, M136 AINTAININGTAT. THE ENTERPRISE PROGRAMS TO ACHIEVE A STATEWIDE AVERAGE TWENTY PERCENT PREMIUM REDUCTION IN THE REINSURANCEPROGRAM ,PROVIDINGSUBSIDIESFORINDIVIDUALSWITHAN INCOMEOFUPTOTWOHUNDREDFIFTYPERCENTOFTHEFEDERALPOVERTY LINE WHO PURCHASE INSURANCE ON THE EXCHANGE , AND PROVIDING COVERAGE FOR QUALIFIED INDIVIDUALS AT THE2025 CALENDAR YEAR ENROLLMENT LEVEL ;

(B)1818 C(2022),OR OVERINGMONEY THEIS COSTSOTHERWISE OFINSUFFICIEN,THE ENSURINGENTERPRISE COMPLIANCEMAY ININCREASE THE INDIVIDUALMARKETWITHTHEFEDERALHEALTH HINSURANCE YDEAMENDMENTORASIMILARAFFORDABILITY AMENDMENTFEE ;ANDBY (C)UP SUPPORTINGTO ADDITIONALONE AFFORDABILITYPERCENTAGE EFFORTSPOINT TOABOVE MAINTAINTHE ORPERCENTAGESSPECIFIEDINSUBSECTION INCREASE(1)(a)(IOFTHISSECTIONTOTHE COVERAGEEXTENT INNECESSARY THETO INDIVIDUAL: MARKE.

(III)(A) TECOMMISSIONERSHALLNOTIFYCARRIERSOFTHEHEALTHM INSURANCEAINTAIN FEETHE AMOUNTENTERPRISE FORPROGRAMS TO ACHIEVE A STATEWIDE AVERAGE TWENTY PERCENT PREMIUM REDUCTION IN THE CALENDARREINSURANCE YEARPROGRAM NOT, LATERPROVIDE THANSUBSIDIES -3-FOR HB25-1297INDIVIDUALS AWHO UGUSTPURCHASE 31OFINSURANCE ON THE YEAREXCHANGE BEFOREAT THE CALENDAR2026SUBSIDY YEARLEVELS RECOMMENDED BY THE BOARD IN 2025,AND PROVIDE COVERAGE FOR WHICHQUALIFIED INDIVIDUALS AT THE FEE2025 AMOUNTCALENDAR ISYEAR ASSESSE.ENROLLMENT LEVEL;

(B) C OVER THE COSTS OF ENSURING COMPLIANCE IN THE INDIVIDUALMARKETWITHTHEFEDERAL H YDEAMENDMENTORASIMILAR AMENDMENT ;AND (C) C OVER THE COSTS OF ENSURING THATC OLORADANS HAVE ACCESS TO LEGALLY PROTECTED HEALTH-CARE ACTIVITYAS DEFINED IN -3- 1297 SECTION 12-30-121 (1)(d).

(II) HE COMMISSIONER SHALL NOTIFY CARRIERS OF THE HEALTH INSURANCE FEE AMOUNT FOR THE CALENDAR YEAR NOT LATER THAN A UGUST 31, 2025,FOR THE2026 ASSESSMENT AND ,FOR SUBSEQUENT YEARS ,NOT LATER THANJUNE 1 OF THE YEAR BEFORE THE CALENDAR YEAR FOR WHICH THE FEE AMOUNT IS ASSESSE.

(II)(VI) ToT provideO paymentsCOVER toTHE carriersCOSTS toOF increaseENSURING theCOMPLIANCE affordabilityIN ofTHE healthINDIVIDUALMARKETWITHTHEFEDERAL insuranceH onYDEAMENDMENTORASIMILAR theAMENDMENT individual;AND market(VII) forTO ColoradansCOVER whoTHE receiveCOSTS theOF premiumENSURING taxC credPURCHASEOLORADANS INSURANCEHAVE ONACCESSTOLEGALLYPROTECTEDHEALTH THECAREACTIVITIES,ASDEFINEDIN EXCHANGESECTION ;12-30-121 (1)(d).

(VI)(2) T(d) O(I) COVERThe THEenterprise COSTSshall OFallocate ENSURINGthe COMPLIANCErevenues INcollected THEin INDIVIDUALMARKETWITHTHEFEDERAL2023 Hand YDEAMENDMENTORASIMILAReach AMENDMENTyear ;ANDthereafterROUGH (VII)2026, TOand SUPPORTany ADDITIONALother AFFORDABILITYmoney EFFORTSdeposited TOin MAINTAINthe ORfund INCREASEin COVERAGE2023 INand THEeach INDIVIDUALyear MARKE.tTHROUGHe2026, in the following amounts and order of priority:

(2) (d) (I) The enterprise shall allocate the revenues collected in 2023 and each year thereafterROUGH 2026, and any other money deposited in the fund in 2023 and each year thereafter026, in the following amounts and order of priority:

(e) THE ENTERPRISE SHALL ALLOCATE THE REVENUES ASSESSED FOR THE 2026 CALENDAR YEAR AND FOR EACH CALENDAR YEAR THEREAFTER ,AND ANY OTHER MONEY DEPOSITED IN THE FUND IN2026 -4- 1297 AND EACH YEAR THEREAFTER ,IN THE FOLLOWING WAY:

(I) UP TO FORTY PERCENT FOR SUBSIDIES FOR STSUBSIDIZED INDIVIDUAL HEALTH COVERAGE PLANS PURCHASED BY QUALIFIED -4- HB25-1297 INDIVIDUALS;

(II) UPU TO FORTY PERCENT TO THE REINSURANCE PROGRAM CASH FUND ;

(III) UPU TO TEN PERCENT TO REDUCE THE COSTS OF INDIVIDUAL HEALTHPLANSFORINDIVIDUALSWHOPURCHASEANINDIVIDUALHEALTHHEALTHPLANSFORINDIVIDUALSWHORECEIVEPREMIUMTAXCREDITSON BENEFIT PLAN ON THE EXCHANGE ;

(IV) UPU P TO THREE AND ONE -HALF PERCENT FOR ACTUAL ADMINISTRATIVE COSTS AS SET FORTH IN SUBSECTION(1)(b)(IVOFSUBSECTI(1)(b)(IVOF THIS SECTIONSECTION;AND ;AND (V) UPU P TO SIX AND ONE HALF PERCENT ,AND, AND ANY MONEY REMAINING AFTER THE ALLOCATIONS ARE MADE IN THIS SUBSECTION (2)(e)THAT(2)(e),HAT THE COMMISSIONER MAY DESIGNATE FORFOR: :

(A) AANY NY ALLOCATION SPECIFIED IN THIS SUBSECTIO(2)(e)ORSUBSECTI(2)(e)OR (B) N EW AND EMERGING HEALTH INSURANCE AFFORDABILITY INITIATIVE, INCLUDING THE PURPOSES SPECIFIED IN SUBSECTIONS (1)(b)(VI)AND(1)(b)(VIAND (1)(b)(VIIOF THIS SECTION AND HEALTH INSURANCE AFFORDABILITY CASH FUND RESERVESRESERVES. .

SECTION3.(6) BEGINNING JANUARY 15, 2026, AND NOT LATER THAN JANUARY 15 EACHYEARTHEREAFTER ,THECOMMISSIONERSHALLREPORT ANNUALLY TO THE BOARD AND TO THE HOUSE OF REPRESENTATIVES HEALTHANDHUMANSERVICESCOMMITTEEANDTHESENATEHEALTHAND HUMANSERVICESCOMMITTEE ORTHEIRSUCCESSORCOMMITTEES ,ANDTO THE JOINT BUDGET COMMITTEE CONCERNING THE REVENUE AND EXPENDITURES OF THE ENTERPRIS,BY ENTERPRISE PROGRAM.

-5- 1297 SECTION3.

and (g) Thefederalshareofthemedicalassistancepaymentsreceived pursuant to section 25.5-4-503 (2);AND;

(h) G IFT,GRANTS ,OR DONATIONS RECEIVED FROM PRIVATE OR -5- HB25-1297 PUBLICSOURCESFORTHEOPERATION RESERVES,RESERVES,ANDSUSTAINABILITYOF ,ANDSUSTAINABILITYOF THE ENTERPRISE.ENTERPRISE .

In Colorado Revised Statutes, 10-16-1207, add (4)(e)(4)(e)and (4.5) as follows:

(e) SEEK ,ACCEPT,,ACCEPT AND,AND EXPEND GIFTS,GRANTSGIFTS ,GRANTS ,OR DONATIONS FROM PRIVATE OR PUBLIC SOURCES FOR THE OPERATION,RESERVES AND,AND SUSTAINABILITY OF THE ENTERPRISE.

HE ENTERPRISE SHALL CONSIDER THEFEASIBILITYOFALLOCATINGGIFTS ,GRANTS,ORDONATIONSRECEIVED,GRANTS ORDONATIONSRECEIVED FROM SPECIFIC LOCALITIES OR DIRECTED TO SPECIFIC LOCALITIES TO BE USED ONLY IN THOSE LOCALITIES.

(4.5) ATLEASTANNUALLY ,THEBOARDSHALLSEEKFORMALINPUT FROM INDIVIDUALS DIRECTLY IMPACTED BY PROGRAMS FUNDED BY THE ENTERPRISE IN ORDER TO UNDERSTAND THE IMPACT OF THE PROGRAMS -6- 1297 AND OPPORTUNITIES FOR IMPROVEMENT OF THE PROGRAMS.

-6--7- HB25-12971297