Amended by section 10104 of the Manager’s Amendment. Permits qualified individuals, excluding incarcerated individuals and including only U.S. citizens or nationals or aliens who are lawfully present, to enroll in any available Qualified Health Plan (QHP) for which they are eligible.
Specifies that qualified employers – generally defined as a small employer that elects to make all full-time employees of such employer eligible for one or more QHPs – may provide support for employees’ QHP coverage by selecting a metallic coverage level; employees of such employers would have a choice of QHPs in that coverage tier. Beginning in 2017, allows States to permit issuers in the large group market in the State to offer QHPs through an Exchange and correspondingly allows large employers to be considered qualifying employers under this section.
Requires issuers to consider all enrollees in all health plans (other than grandfathered health plans) offered by such issuer in the individual and small group markets, respectively – both inside and outside of Exchanges – to be members of a single risk pool for each market and allows a State to require a merger of these markets if determined appropriate.
Generally provides for the continued operation of the outside-of-Exchange market and includes provisions regarding the voluntary nature of Exchanges, such as individuals’ ability to enroll in any QHP except in the case of a catastrophic plan created under ACA section 1302. Requires that Members of Congress and congressional staff receive only health plans created by the ACA or offered through Exchanges.