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house Bill H.R. 1304

Should Congress Clarify That Stop-Loss Insurance Isn’t Considered Health Insurance?

Argument in favor

Companies that self insure need access to stop loss insurance, which would become unaffordable if it were regulated as if it were health insurance and consequently employees would have fewer options to get their healthcare paid for.

Tafinzer's Opinion
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04/04/2017
Vote yea to protect insured citizens from having to pay back to the insurance companies. This is a positive move.
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Deborah's Opinion
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04/06/2017
This is a bill which could help businesses cover some of the medical expenses for their employees. It is not insurance and should be made clear that it is not. However, anything which will help people get medical care is a small step in the right direction. Basically, however, I believe that every resident of the United States should be entitled to basic healthcare, if for no other reason than to produce a healthy, productive work force. Even if you don't care about individual people, you should care about our society as a whole and recognize how we all benefit by keeping society healthy.
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04/05/2017
This is the free market trying to find solutions to problems that the government has created. To pull these under the umbrella of health insurance and its web of entangling regulations would be to stymie the process of experimentation and innovation that could provide new solutions. Best to let innovators in the market work.
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Argument opposed

This bill could create unintended consequences related to the ability of states to regulate stop-loss insurance and doesn’t do enough to address those concerns despite the bipartisan changes made to the bill’s text.

Lesia's Opinion
···
04/05/2017
Single payer healthcare is the only acceptable solution. The long and ridiculous attempts to undermine the ACA rather than improve the facets of it that aren't working, smacks of republican insecurities and need to "prove" themselves even as the American people suffer for their selfish childishness. At least pretend that you actually care about us.
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Yvette's Opinion
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04/05/2017
It's nice to see how you're trying to destroy America and hurt its citizens. Why can we not have universal insurance like so many other countries have? Why do we have to be in a capitalist society that only cares for the rich and cares nothing for the rest of us. Elections are coming up. Get ready to say goodbye to your job!
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Hilary's Opinion
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04/05/2017
For the love of cheese please stop picking apart the what we've got and start working on making it better
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What is House Bill H.R. 1304?

This bill would clarify that stop-loss insurance policies obtained by a group health plan that self-insures the health risks of plan participants are excluded from the definition of health insurance in relevant federal laws. Stop-loss insurance is commonly purchased by businesses that choose to self-insure and pay for their employees’ medical expenses rather than buying a group health insurance plan. It pays for an employee or family member’s medical bills after the purchaser of the stop-loss insurance has already paid out a predetermined amount of the beneficiary’s medical bills. This protects buyers of stop-loss coverage from having to cover catastrophic claims.

Impact

Employees that work for businesses that self-insure and those companies; state regulators; and federal regulators.

Cost of House Bill H.R. 1304

A CBO cost estimate is unavailable.

More Information

In-Depth: Sponsoring Rep. Phil Roe (R-TN) also introduced this bill during the 114th Congress, saying at the time that it would help businesses that self-insure continue to provide for their healthcare expenses of their workers:

“I am proud to introduce this commonsense bill that will protect employers that provide health insurance to employees through a self-insured group health plan. Stop-loss insurance is an essential tool for these employers, as it helps manage financial risk while providing employers more flexibility in designing the right plan for their workers. This legislation will simply prevent federal regulators from redefining and regulating this safeguard as traditional health insurance, which it was never intended to be.”

Democrats on the House Education & Workforce Committee mentioned in the bill’s committee report that while they “continue to be concerned about the lack of clarity of the legislation and the possible unintended consequences, Committee Democrats have worked with the Majority to ensure that report language addresses some of these concerns.”

The committee passed this bill on a voice vote, and has the support of seven Republican cosponsors in the House.

This legislation was introduced during the 114th Congress to counteract an anticipated move by the Obama administration to redefine stop-loss insurance as health insurance and thus subject it to the Affordable Care Act (commonly known as Obamacare).


Media:

Summary by Eric Revell

(Photo Credit: 401(K) 2012 via Flickr / Creative Commons)

AKA

Self-Insurance Protection Act

Official Title

To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to exclude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans.

bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
      senate Committees
      Committee on Health, Education, Labor, and Pensions
  • The house Passed April 5th, 2017
    Roll Call Vote 400 Yea / 16 Nay
      house Committees
      Committee on Education and Labor
      Committee on Energy and Commerce
      Health
      Committee on Ways and Means
    IntroducedMarch 2nd, 2017

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    Vote yea to protect insured citizens from having to pay back to the insurance companies. This is a positive move.
    Like (57)
    Follow
    Share
    Single payer healthcare is the only acceptable solution. The long and ridiculous attempts to undermine the ACA rather than improve the facets of it that aren't working, smacks of republican insecurities and need to "prove" themselves even as the American people suffer for their selfish childishness. At least pretend that you actually care about us.
    Like (118)
    Follow
    Share
    It's nice to see how you're trying to destroy America and hurt its citizens. Why can we not have universal insurance like so many other countries have? Why do we have to be in a capitalist society that only cares for the rich and cares nothing for the rest of us. Elections are coming up. Get ready to say goodbye to your job!
    Like (55)
    Follow
    Share
    For the love of cheese please stop picking apart the what we've got and start working on making it better
    Like (43)
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    This will undermine the ACA. We need single payer, we need coverage for EVERY TENNESSEAN & EVERY AMERICAN , Sir!
    Like (28)
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    We need to get small businesses out of the business of providing health insurance, not find ways to keep them in it. Health insurance should not be dependent on one's ability to work, so it should not be linked to employment. Small businesses do not need to be trying to figure out how to cover their employees (getting scammed in the process).
    Like (20)
    Follow
    Share
    This is a bill which could help businesses cover some of the medical expenses for their employees. It is not insurance and should be made clear that it is not. However, anything which will help people get medical care is a small step in the right direction. Basically, however, I believe that every resident of the United States should be entitled to basic healthcare, if for no other reason than to produce a healthy, productive work force. Even if you don't care about individual people, you should care about our society as a whole and recognize how we all benefit by keeping society healthy.
    Like (18)
    Follow
    Share
    This is the free market trying to find solutions to problems that the government has created. To pull these under the umbrella of health insurance and its web of entangling regulations would be to stymie the process of experimentation and innovation that could provide new solutions. Best to let innovators in the market work.
    Like (16)
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    Stop undermining the ACA. Improve what we have with Single Payer.
    Like (13)
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    Piecemeal solutions to the cost and coverage of healthcare are unacceptable. Get with the program and provide for the needs of We the People with single-payer healthcare!
    Like (12)
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    This bill eliminates a predatory practice in Stop-Loss clauses for health insurance policies that would make plan holders pay money back to the insurance company if the money goes over the pre-determined stop-loss. This is a win for health insurance holders.
    Like (8)
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    Certainly a step in the right direction but lots to still be done to end and replace the Obama train wreck
    Like (6)
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    If they can afford to insure themselves than they shouldn't have to pay insurance companies back
    Like (6)
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    This is undermining ACA thus harming the average American. Concede that your duty is to the majority so ACA must be supported and fixed.
    Like (6)
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    This seems to be an attempt to erode the Affordable Care Act. And then what: blame the ACA when it all falls apart? Furthermore, single-payer is the way to go.
    Like (5)
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    It is never a good sign when you start to exclude language from definitions. That means you are excluding healthcare coverages.
    Like (5)
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    Self insurance protection act is no federal regulations. The last administration let's face it BHO was a globalist with one intent. The reason in controlling health care insurance under ERISA and PHSA the code forces the employer to decide offering self insured benefits and giving a more expensive fully insured healthcare plan. This bill 1304 insures federal government cannot stop loss insurance,it is protecting access to flexible and affordable care coverage. Since the federal government is out the states will regulate, does this mean purchase across state line like car insurance, I'm thinking it does.
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    Stop-loss insurance is commonly purchased by businesses that choose to self-insure and pay for their employees’ medical expenses rather than buying a group health insurance plan..... The ACA has nothing to with this Bill since the ACA is applied to the Individual insurance marketplace and not to the employer group insurance marketplace.
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    Self-insurance is the best kind of insurance.
    Like (5)
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    The fact that ur trying to gut the ACA is evidence to me that your intent is revengeful and not in best interests to American people. Stop acting like little babies and man up.
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