Rep. Jill N. Tokuda

Maddy summaryHR 1692, the Health Care Affordability Act of 2023, adjusts how health insurance subsidies are calculated for people buying coverage through the marketplace. It replaces the previous subsidy formula with a sliding scale based on income, where households earning up to 150% of the poverty line pay 0% of premiums, and those at 400% or more pay 8.5%. The change applies to all income tiers between these points, with percentages increasing incrementally (e.g., 2% for 150-200% income). This directly affects individuals purchasing health insurance through the marketplace who qualify for subsidies under the Affordable Care Act. The bill amends Section 36B of the Internal Revenue Code and takes effect for tax years beginning after December 31, 2022.

Maddy summaryThe E-BIKE Act establishes a 30% tax credit for individuals purchasing qualified electric bicycles, with a maximum credit of $1,500 per bicycle (30% of the $5,000 cost limit). To qualify, bicycles must meet specific safety standards including speed limits (20 mph for classes 1-2, 28 mph for class 3), pedal assistance requirements, and safety certifications like UL 2849. The credit phases out for higher-income taxpayers, beginning at $150,000 modified adjusted gross income for single filers, $225,000 for heads of household, and $300,000 for joint filers. The bill also includes a provision allowing retailers to claim the credit directly when selling qualifying bicycles, reducing the upfront cost for consumers.

Maddy summaryHR 1666 extends deadlines for ambulance service reimbursement rules under Medicare. It amends Section 1834(l) of the Social Security Act by changing dates from 2025 to 2028 in two specific provisions: paragraph (12)(A) and paragraph (13)(A). This delay gives ambulance providers additional time to adjust to existing Medicare payment rules. The bill directly affects Medicare-certified ambulance services and the patients relying on ground ambulance care covered by Medicare.

Maddy summaryThis bill increases Medicare reimbursement for clinical social workers from 75% to 85% of the payment rate for psychologists under Part B. It also removes an exclusion that previously prevented skilled nursing facilities from billing Medicare for social worker services provided to residents. The bill expands covered services to include specific mental health assessments and interventions identified by HCPCS codes (like 96156, 96158-96161, etc.) for Medicare beneficiaries. These changes take effect for services provided on or after January 1, 2024, directly affecting Medicare patients and clinical social workers.

Maddy summaryThe Prevent Interruptions in Physical Therapy Act of 2023 amends Medicare rules to allow physical therapists to use temporary replacement providers (locum tenens) for outpatient physical therapy services, aligning with existing provisions for physicians. This directly affects Medicare beneficiaries receiving physical therapy and physical therapy practices needing temporary staffing solutions during provider shortages. The bill updates the Social Security Act to extend the current physician locum tenens rule to physical therapists, ensuring continuity of care without requiring separate approval for temporary coverage. It applies to services furnished after the bill's enactment date.

Maddy summaryThis bill requires private health insurance plans and Medicaid to cover selected insulin products for individuals under 26 years old without deductibles and with cost-sharing capped at $35 per 30-day supply or 25% of the negotiated price (whichever is lower). It defines "selected insulin products" as at least one of each type (e.g., rapid-acting, long-acting) and form (e.g., vial, pump) of insulin that plans select. The cost-sharing for these products counts toward the plan’s annual out-of-pocket maximum, and the requirement applies to all private plans and Medicaid starting January 1, 2024. Plans are not required to cover insulin from out-of-network providers at the same cost-sharing level.

Maddy summaryHR 1610 would modernize Medicare coverage for chiropractic care by removing the current restriction that limited beneficiaries to one chiropractic service per visit. It expands coverage to include all services provided by licensed chiropractors within their state-authorized scope, aligning Medicare with VA, military, and private insurance practices. The bill requires chiropractors to complete a Secretary-approved educational webinar to cover non-spinal services, while still allowing payment for spinal manipulation treatments without this requirement. This directly affects Medicare beneficiaries seeking chiropractic care and chiropractors seeking Medicare reimbursement for their services.

Maddy summaryHR 1571, the Compact Impact Fairness Act of 2023, removes barriers to federal benefits for citizens of the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and Palau who legally reside in the U.S. under the Compacts of Free Association. The bill amends the 1996 welfare law to add an exception, making these citizens eligible for most federal benefit programs (like Medicaid and food assistance) that previously excluded them due to their immigration status. It eliminates a 5-year waiting period for benefits and removes specific references to Medicaid, applying the change broadly across all federal programs. This directly affects over 30,000 citizens of these nations living in the U.S. under the compacts, who currently face restrictions on accessing critical support. The bill aims to align federal benefit eligibility with the unique status granted by the Compacts of Free Association.

Maddy summaryThe Critical Access Hospital Relief Act of 2023 removes a Medicare requirement that hospitals needed a physician's certification within 96 hours for inpatient services. This change directly affects critical access hospitals (CAHs), which are typically small, rural facilities serving remote communities. The bill amends Section 1814(a) of the Social Security Act to delete the 96-hour certification rule, effective January 1, 2024. This reduces administrative burden for CAHs by eliminating a specific documentation step for patient admissions. The policy change streamlines Medicare billing processes without altering payment rates or other core hospital services.

Maddy summaryThe Affordable Insulin Now Act (HR 1488) requires health insurance plans and issuers to cover specific insulin products with cost-sharing capped at $35 per 30-day supply or 25% of the negotiated price, whichever is lower, starting in 2024. It directly affects people with diabetes who rely on insulin by limiting out-of-pocket costs for covered products. The bill mandates coverage of all insulin types (rapid-acting, long-acting, etc.) and dosage forms (vials, pumps, etc.) as selected by the plan. This applies to both group and individual health insurance plans under the Public Health Service Act, Internal Revenue Code, and ERISA, with cost-sharing counting toward annual deductibles.