H.R.1304 – Self-Insurance Protection Act

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Week ending March 31, 2017

H.R.1304 – Self-Insurance Protection Act


This bill amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974…, and the Internal Revenue Code to exclude from the definition of “health insurance coverage” a stop-loss policy obtained by a self-insured health plan or a sponsor of a self-insured group health plan to reimburse the plan or sponsor for losses incurred in providing health benefits to plan participants in excess of a level set forth in the stop-loss policy. – crs

An employer who self-funds provides for employees’ medical costs by paying providers directly or reimbursing employees as claims arise, instead of paying a fixed premium to an insurance company.

The point at which the stop-loss carrier begins to pay claims is known as the “attachment point.” There are two types of stop-loss insurance: “specific” and “aggregate.” Specific stop-loss insurance protects against a high claim of a single employee, while aggregate stop-loss insurance institutes a maximum dollar amount of claims paid during a certain period of time.

(Dissenting view)

(Full text of H.R. 1304 at congress.gov)

Sponsor:  Rep. Roe, David P. [R-TN-1] (Introduced 03/02/2017)

Status: Passed House /



On Passage: H.R.1304

House Amendments:

Motion to recommit:

Text of the motion:


On Passage:

Procedural Actions:

Senate Amendments:


Cost to the taxpayers:  Data not available

Pay-as-you-go requirements:  Data not available

Regulatory and Other Impact: H.R. 1304 does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits as defined in  clause 9 of House Rule XXI.

Dynamic Scoring:   Data not available

Tax Complexity:  Not applicable to this bill.

Earmark Certification:  Data not available

Duplication of programs: No provision of H.R. 1304 establishes or reauthorizes a program of the Federal Government known to be duplicative of another Federal program.

Direct Rule-Making:  The committee estimates that enacting H.R. 1304 does not specifically direct the completion of any specific rule makings within the meaning of 5 U.S.C. 551.

Advisory Committee Statement: Data not available

Budget Authority: Data not available

Constitutional Authority:   Assumed.

More Bill Information:

Dissenting views


After seven years of disparaging the ACA, Republicans released a repeal and replacement plan that will leave millions of Americans worse off. Meanwhile, legislation considered in the Committee would not work to build on the progress of the ACA or improve and expand coverage. Committee Democrats continue to express concerns about the ambiguity of H.R. 1304, the Self-Insurance Protection Act and its impact on current and future state regulation of stop-loss insurance, particularly as Republicans seek to dismantle the entirety of the ACA.

Committee Democrats are committed to health care as a right, not a privilege for only the healthiest and wealthiest Americans.

Robert C. “Bobby” Scott, Ranking


Susan A. Davis.

Raul M. Grijalva.

Joe Courtney.

Marcia L. Fudge.

Jared Polis.

Gregorio Kilili Camacho Sablan.

Frederica S. Wilson.

Suzanne Bonamici.

Mark Takano.

Alma S. Adams.

Mark DeSaulnier.

Donald Norcross.

Lisa Blunt Rochester.

Raja Krishnamoorthi.

Carol Shea-Porter.

Adriano Espaillat.

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