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<dc:title>116 HR 1884 IH: Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019</dc:title>
<dc:publisher>U.S. House of Representatives</dc:publisher>
<dc:date>2019-03-26</dc:date>
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<dc:language>EN</dc:language>
<dc:rights>Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.</dc:rights>
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<distribution-code display="yes">I</distribution-code><congress display="yes">116th CONGRESS</congress><session display="yes">1st Session</session><legis-num display="yes">H. R. 1884</legis-num><current-chamber>IN THE HOUSE OF REPRESENTATIVES</current-chamber><action display="yes"><action-date date="20190326">March 26, 2019</action-date><action-desc><sponsor name-id="P000034">Mr. Pallone</sponsor> (for himself, <cosponsor name-id="N000015">Mr. Neal</cosponsor>, <cosponsor name-id="S000185">Mr. Scott of Virginia</cosponsor>, <cosponsor name-id="H000874">Mr. Hoyer</cosponsor>, <cosponsor name-id="S001216">Ms. Schrier</cosponsor>, <cosponsor name-id="C001123">Mr. Cisneros</cosponsor>, <cosponsor name-id="D000197">Ms. DeGette</cosponsor>, <cosponsor name-id="C001066">Ms. Castor of Florida</cosponsor>, <cosponsor name-id="T000482">Mrs. Trahan</cosponsor>, <cosponsor name-id="C001119">Mrs. Craig</cosponsor>, <cosponsor name-id="K000382">Ms. Kuster of New Hampshire</cosponsor>, <cosponsor name-id="R000599">Mr. Ruiz</cosponsor>, <cosponsor name-id="B001296">Mr. Brendan F. Boyle of Pennsylvania</cosponsor>, <cosponsor name-id="A000376">Mr. Allred</cosponsor>, <cosponsor name-id="B001286">Mrs. Bustos</cosponsor>, <cosponsor name-id="M001208">Mrs. McBath</cosponsor>, <cosponsor name-id="L000570">Mr. Luján</cosponsor>, <cosponsor name-id="L000582">Mr. Ted Lieu of California</cosponsor>, <cosponsor name-id="P000608">Mr. Peters</cosponsor>, <cosponsor name-id="W000808">Ms. Wilson of Florida</cosponsor>, <cosponsor name-id="S001209">Ms. Spanberger</cosponsor>, <cosponsor name-id="R000616">Mr. Rouda</cosponsor>, <cosponsor name-id="U000040">Ms. Underwood</cosponsor>, <cosponsor name-id="D000630">Mr. Delgado</cosponsor>, <cosponsor name-id="L000590">Mrs. Lee of Nevada</cosponsor>, <cosponsor name-id="B001303">Ms. Blunt Rochester</cosponsor>, <cosponsor name-id="D000399">Mr. Doggett</cosponsor>, <cosponsor name-id="G000585">Mr. Gomez</cosponsor>, <cosponsor name-id="D000624">Mrs. Dingell</cosponsor>, <cosponsor name-id="S001206">Ms. Shalala</cosponsor>, <cosponsor name-id="F000462">Ms. Frankel</cosponsor>, <cosponsor name-id="E000215">Ms. Eshoo</cosponsor>, <cosponsor name-id="S001165">Mr. Sires</cosponsor>, <cosponsor name-id="S001200">Mr. Soto</cosponsor>, <cosponsor name-id="J000032">Ms. Jackson Lee</cosponsor>, <cosponsor name-id="K000375">Mr. Keating</cosponsor>, <cosponsor name-id="S001215">Ms. Stevens</cosponsor>, <cosponsor name-id="S001185">Ms. Sewell of Alabama</cosponsor>, <cosponsor name-id="T000483">Mr. Trone</cosponsor>, <cosponsor name-id="R000613">Mr. Rose of New York</cosponsor>, <cosponsor name-id="K000368">Mrs. Kirkpatrick</cosponsor>, <cosponsor name-id="L000557">Mr. Larson of Connecticut</cosponsor>, <cosponsor name-id="L000287">Mr. Lewis</cosponsor>, <cosponsor name-id="J000298">Ms. Jayapal</cosponsor>, <cosponsor name-id="G000587">Ms. Garcia of Texas</cosponsor>, <cosponsor name-id="C001069">Mr. Courtney</cosponsor>, <cosponsor name-id="S001156">Ms. Sánchez</cosponsor>, <cosponsor name-id="D000627">Mrs. Demings</cosponsor>, <cosponsor name-id="M001202">Mrs. Murphy</cosponsor>, <cosponsor name-id="D000631">Ms. Dean</cosponsor>, <cosponsor name-id="C001068">Mr. Cohen</cosponsor>, <cosponsor name-id="T000460">Mr. Thompson of California</cosponsor>, <cosponsor name-id="R000515">Mr. Rush</cosponsor>, <cosponsor name-id="M001206">Mr. Morelle</cosponsor>, <cosponsor name-id="H001087">Ms. Hill of California</cosponsor>, <cosponsor name-id="H001038">Mr. Higgins of New York</cosponsor>, <cosponsor name-id="D000598">Mrs. Davis of California</cosponsor>, <cosponsor name-id="B001285">Ms. Brownley of California</cosponsor>, <cosponsor name-id="P000096">Mr. Pascrell</cosponsor>, <cosponsor name-id="S001208">Ms. Slotkin</cosponsor>, <cosponsor name-id="E000179">Mr. Engel</cosponsor>, <cosponsor name-id="K000394">Mr. Kim</cosponsor>, <cosponsor name-id="B000574">Mr. Blumenauer</cosponsor>, <cosponsor name-id="H001081">Mrs. Hayes</cosponsor>, <cosponsor name-id="C001124">Mr. Cox of California</cosponsor>, <cosponsor name-id="T000472">Mr. Takano</cosponsor>, <cosponsor name-id="P000613">Mr. Panetta</cosponsor>, <cosponsor name-id="K000380">Mr. Kildee</cosponsor>, <cosponsor name-id="M001203">Mr. Malinowski</cosponsor>, <cosponsor name-id="L000592">Mr. Levin of Michigan</cosponsor>, <cosponsor name-id="G000592">Mr. Golden</cosponsor>, <cosponsor name-id="V000133">Mr. Van Drew</cosponsor>, <cosponsor name-id="M001207">Ms. Mucarsel-Powell</cosponsor>, <cosponsor name-id="G000551">Mr. Grijalva</cosponsor>, <cosponsor name-id="E000297">Mr. Espaillat</cosponsor>, <cosponsor name-id="S001145">Ms. Schakowsky</cosponsor>, <cosponsor name-id="P000597">Ms. Pingree</cosponsor>, <cosponsor name-id="N000147">Ms. Norton</cosponsor>, and <cosponsor name-id="S001177">Mr. Sablan</cosponsor>) introduced the following bill; which was referred to the <committee-name committee-id="HIF00">Committee on Energy and Commerce</committee-name>, and in addition to the Committees on <committee-name committee-id="HWM00">Ways and Means</committee-name>, and <committee-name committee-id="HED00">Education and Labor</committee-name>, for a period to be subsequently determined by the Speaker, in each case for consideration of such
			 provisions as fall within the jurisdiction of the committee concerned</action-desc></action><legis-type>A BILL</legis-type><official-title display="yes">To amend the Patient Protection and Affordable Care Act to improve affordability of, undo sabotage
			 with respect to, and increase access to health insurance coverage, and for
			 other purposes.</official-title></form>
	<legis-body id="HCE9B6597F2774C229E6613D4AC40B631" style="OLC">
		<section id="H506A17BDC76448D8897901A8AF09D383" section-type="section-one"><enum>1.</enum><header>Short title; table of contents</header>
 <subsection id="HD2E7AB83CE0D435182EA3C0A876D99A7"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This Act may be cited as the <quote><short-title>Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019</short-title></quote>.</text> </subsection><subsection id="H67DB4A1AC9D44BB3BA33496436E2A121"><enum>(b)</enum><header>Table of contents</header><text>The table of contents of this Act is as follows:</text>
				<toc container-level="legis-body-container" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
					<toc-entry idref="H506A17BDC76448D8897901A8AF09D383" level="section">Sec. 1. Short title; table of contents.</toc-entry>
					<toc-entry idref="H7FC609D3283346D69995B222EE3F1BB2" level="title">Title I—Expanding Affordability</toc-entry>
					<toc-entry idref="H3469019B13AA447CB8F3708401B1EB05" level="section">Sec. 101. Improve affordability and reduce premium costs for consumers.</toc-entry>
					<toc-entry idref="H7AE51A14DEB64F3B829E42AF7C052F8B" level="section">Sec. 102. Expand affordability for working families.</toc-entry>
					<toc-entry idref="H17C52DC25E2D4B26A7AF7687D6BDF517" level="title">Title II—Undoing Sabotage</toc-entry>
					<toc-entry idref="HA3D894BEAB00454D90E7EE644BFAEF49" level="section">Sec. 201. Protect comprehensive coverage for small businesses and workers.</toc-entry>
					<toc-entry idref="HB003C9C622F142F8897144B88557B4A6" level="section">Sec. 202. Short-term limited duration insurance rule prohibition.</toc-entry>
					<toc-entry idref="HEE9C3E4CC6C445A2AB2B9216FE862D43" level="section">Sec. 203. Ensure plans provide comprehensive benefits.</toc-entry>
					<toc-entry idref="HA27640D953834AEBB056E1DB4ADFB1F6" level="section">Sec. 204. Providing for additional requirements with respect to the navigator program.</toc-entry>
					<toc-entry idref="HFE7B6D2C3A7149CD92CD39A43E5D3E3C" level="section">Sec. 205. Federal Exchange outreach and educational activities.</toc-entry>
					<toc-entry idref="HA1D2420101874DFAAB9BA9D7CC7A6BD8" level="section">Sec. 206. Improve Health Insurance Affordability Fund.</toc-entry>
					<toc-entry idref="HDE7710A9F6AC4088BC91DEF703E54775" level="section">Sec. 207. Providing that certain guidance related to waivers for State innovation under the Patient
			 Protection and Affordable Care Act shall have no force or effect.</toc-entry>
					<toc-entry idref="H05AFB7F062CE46E28AE90778A3910201" level="title">Title III—State Innovation and Transparency</toc-entry>
					<toc-entry idref="HF715BB3F815643098486D267A04157C1" level="section">Sec. 301. Fund State health insurance education programs for consumers.</toc-entry>
					<toc-entry idref="H42EFD665E5C04BECB6CA9E4E26043FED" level="section">Sec. 302. Fund State innovations to expand coverage.</toc-entry>
					<toc-entry idref="H265F0819472F4CFF89F6600ABD91C232" level="section">Sec. 303. Preserving State option to implement health care marketplaces.</toc-entry>
					<toc-entry idref="H96100C9540604CF89445408A1860ADA3" level="section">Sec. 304. Promote transparency and accountability in the Administration’s expenditures of Exchange
			 user fees.</toc-entry>
				</toc>
			</subsection></section><title id="H7FC609D3283346D69995B222EE3F1BB2"><enum>I</enum><header>Expanding Affordability</header>
			<section id="H3469019B13AA447CB8F3708401B1EB05"><enum>101.</enum><header>Improve affordability and reduce premium costs for consumers</header>
 <subsection id="H2E7BE1B6E9D54BEBA8C3036230A7EC37"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/26/36B">Section 36B(b)(3)(A)</external-xref> of the Internal Revenue Code of 1986 is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H188073787BB14656A62D6BCE1CAF833F" style="OLC"> <subparagraph id="H4A6D918FBD3B4DFB8CDFDC720CE1395E"><enum>(A)</enum><header>Applicable percentage</header><text display-inline="yes-display-inline">The applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier:</text>
							<table align-to-level="section" blank-lines-before="1" colsep="1" frame="topbot" line-rules="hor-ver" rowsep="0" rule-weights="4.4.4.0.0.0" table-template-name="Generic: 1 text, 1 num, 1 text" table-type=""><tgroup cols="3" grid-typeface="1.1" rowsep="0" thead-tbody-ldg-size="10.10.10"><colspec coldef="txt" colname="column1" colwidth="290.25pt" min-data-value="120" rowsep="0"></colspec><colspec coldef="fig" colname="column2" colwidth="116.25pt" min-data-value="13"></colspec><colspec coldef="fig" colname="column3" colsep="0" colwidth="118.25pt" min-data-value="13" rowsep="0"></colspec><thead><row><entry align="center" colname="column1" morerows="0" namest="column1" rowsep="1">In the case of household<linebreak></linebreak> income (expressed as<linebreak></linebreak> a percent of poverty line)<linebreak></linebreak> within the following income tier:</entry><entry align="center" colname="column2" morerows="0" namest="column2" rowsep="1">The initial<linebreak></linebreak> premium<linebreak></linebreak>percentage is—</entry><entry align="center" colname="column3" morerows="0" namest="column3" rowsep="1">The final<linebreak></linebreak> premium<linebreak></linebreak> percentage is—</entry></row></thead><tbody><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">Over 100.0 percent up to 133.0 percent</entry><entry align="right" colname="column2" leader-modify="force-ldr" rowsep="0">0.0</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">1.0</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">133.0 percent up to 150.0 percent</entry><entry align="right" colname="column2" leader-modify="force-ldr" rowsep="0">1.0</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">2.0</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">150.0 percent up to 200.0 percent</entry><entry align="right" colname="column2" leader-modify="force-ldr" rowsep="0">2.0</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">4.0</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">200.0 percent up to 250.0 percent</entry><entry align="right" colname="column2" leader-modify="force-ldr" rowsep="0">4.0</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">6.0</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">250.0 percent up to 300.0 percent</entry><entry align="right" colname="column2" leader-modify="force-ldr" rowsep="0">6.0</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">7.0</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">300.0 percent up to 400.0 percent</entry><entry align="right" colname="column2" leader-modify="force-ldr" rowsep="0">7.0</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">8.5</entry></row><row><entry align="left" colname="column1" leader-modify="force-ldr" rowsep="0" stub-definition="txt-ldr" stub-hierarchy="1">400.0 percent and higher</entry><entry align="right" colname="column2" leader-modify="force-ldr" rowsep="0">8.5</entry><entry align="right" colname="column3" leader-modify="clr-ldr" rowsep="0">8.5</entry></row></tbody></tgroup></table></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
 </subsection><subsection id="HE3464766A857479BA211138234BBD5AF"><enum>(b)</enum><header>Conforming amendment</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/26/36B">Section 36B(c)(1)(A)</external-xref> of the Internal Revenue Code of 1986 is amended by striking <quote>but does not exceed 400 percent</quote>.</text> </subsection><subsection id="HEDF29F848EE94444B8418E029A5E5380"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall apply to taxable years beginning after December 31, 2020.</text>
				</subsection></section><section commented="no" display-inline="no-display-inline" id="H7AE51A14DEB64F3B829E42AF7C052F8B" section-type="subsequent-section"><enum>102.</enum><header>Expand affordability for working families</header>
 <subsection commented="no" id="H423A9990D77E4132A4DA27BD5191FFED"><enum>(a)</enum><header>In general</header><text>Clause (i) of <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(c)(2)(C)</external-xref> of the Internal Revenue Code of 1986 is amended to read as follows:</text>
					<quoted-block act-name="" id="HBC6107809B4246D9A487EC2A9E1DAC51" style="OLC">
						<clause commented="no" id="HAA5D4853A0F04B33ABD8B6339F615BDA"><enum>(i)</enum><header>Coverage must be affordable</header>
 <subclause commented="no" id="HD63C599EEA604C19A59D3F4EC3DB2100"><enum>(I)</enum><header>Employees</header><text display-inline="yes-display-inline">An employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) and the employee’s required contribution (within the meaning of section 5000A(e)(1)(B)) with respect to the plan exceeds 9.5 percent of the employee’s household income.</text>
 </subclause><subclause commented="no" id="HE5A4A23F9F0C4C498025F12B87D486CF"><enum>(II)</enum><header>Family members</header><text display-inline="yes-display-inline">An individual who is eligible to enroll in an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) by reason of a relationship the individual bears to the employee shall not be treated as eligible for minimum essential coverage by reason of such eligibility to enroll if the employee’s required contribution (within the meaning of section 5000A(e)(1)(B), determined by substituting <quote>family</quote> for <quote>self-only</quote>) with respect to the plan exceeds 9.5 percent of the employee’s household income.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection commented="no" id="H40EB5B579859454FA8DC487DA95A28C5"><enum>(b)</enum><header>Conforming amendments</header>
 <paragraph commented="no" id="H41ABE6905B2B49D2A3F57C726784D006"><enum>(1)</enum><text>Clause (ii) of <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B(c)(2)(C)</external-xref> of the Internal Revenue Code of 1986 is amended by striking <quote>Except as provided in clause (iii), an employee</quote> and inserting <quote>An individual</quote>.</text> </paragraph><paragraph commented="no" id="HFD7D16E2F17A430B92256851E91BD35D"><enum>(2)</enum><text>Clause (iii) of section 36B(c)(2)(C) of such Code is amended by striking <quote>the last sentence of clause (i)</quote> and inserting <quote>clause (i)(II)</quote>.</text>
 </paragraph><paragraph commented="no" id="HD8CC292D0A1D4569A0EC9E35C1EF30F4"><enum>(3)</enum><text>Clause (iv) of section 36B(c)(2)(C) of such Code is amended by striking <quote>the 9.5 percent under clause (i)(II)</quote> and inserting <quote>the 9.5 percent under clauses (i)(I) and (i)(II)</quote>.</text> </paragraph></subsection><subsection commented="no" id="H7ADCC852DCBB47EBA3D491F99FAFB93B"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall apply to taxable years beginning after December 31, 2020.</text>
				</subsection></section></title><title id="H17C52DC25E2D4B26A7AF7687D6BDF517"><enum>II</enum><header>Undoing Sabotage</header>
 <section commented="no" id="HA3D894BEAB00454D90E7EE644BFAEF49"><enum>201.</enum><header>Protect comprehensive coverage for small businesses and workers</header><text display-inline="no-display-inline">The Secretary of Labor may not take any action to implement, enforce, or otherwise give effect to the rule entitled <quote>Definition of <quote>Employer</quote> Under Section 3(5) of ERISA–Association Health Plans</quote> (83 Fed. Reg. 28912 (June 21, 2018)), and the Secretary may not promulgate any substantially similar rule.</text>
 </section><section id="HB003C9C622F142F8897144B88557B4A6"><enum>202.</enum><header>Short-term limited duration insurance rule prohibition</header><text display-inline="no-display-inline">The Secretary of Health and Human Services, the Secretary of the Treasury, and the Secretary of Labor may not take any action to implement, enforce, or otherwise give effect to the rule entitled <quote>Short-Term, Limited Duration Insurance</quote> (83 Fed. Reg. 38212 (August 3, 2018)), and the Secretaries may not promulgate any substantially similar rule.</text>
			</section><section commented="no" id="HEE9C3E4CC6C445A2AB2B9216FE862D43"><enum>203.</enum><header>Ensure plans provide comprehensive benefits</header>
 <subsection commented="no" id="HC4AB5BBEA4914658A361ABA8F8DD79F8"><enum>(a)</enum><header>Essential health benefits</header><text display-inline="yes-display-inline">Section 1302(b)(4) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18022">42 U.S.C. 18022(b)(4)</external-xref>) is amended—</text>
 <paragraph commented="no" id="HCBBDAE534D824159BC78985D02AF3E6F"><enum>(1)</enum><text>in subparagraph (A), by inserting <quote>and so that benefits are included within each of such categories</quote> before the semicolon;</text> </paragraph><paragraph commented="no" id="HA71BC79596374FCF87BAFC0E02BA0559"><enum>(2)</enum><text>in subparagraph (G), by striking at the end <quote>and</quote>;</text>
 </paragraph><paragraph commented="no" id="HD18F0535B1F14D26B8FEE9ED1A4F207C"><enum>(3)</enum><text>in subparagraph (H), by striking the period at the end and inserting <quote>; and</quote>; and</text> </paragraph><paragraph commented="no" id="HED55ABB5416840D89F144E5822A57AE8"><enum>(4)</enum><text>by adding at the end the following new subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="H31FCA69878CB4F6CA6985B824E6350B1" style="OLC">
 <subparagraph commented="no" id="H028EBA00074548CBA56B33537E0EB98B"><enum>(I)</enum><text display-inline="yes-display-inline">ensure that, beginning January 1, 2020—</text> <clause commented="no" id="HFEC7EDE62EDC4E65A1EBE73152F39039"><enum>(i)</enum><text>in the case of health benefits that are established as essential health benefits, there shall not be substitution of such benefits across benefit categories;</text>
 </clause><clause commented="no" id="HA61C828F220B4DE3ABE3FF6B064CB738"><enum>(ii)</enum><text>a qualified health plan shall not be treated as providing coverage for the essential health benefits unless under such plan—</text>
 <subclause commented="no" id="H1BD020B05DAF4576B2701DF4A58B4745"><enum>(I)</enum><text>coverage of prescription drugs provides for access to a wide variety of classes of drugs within the prescription drug formulary of such plan; and</text>
 </subclause><subclause commented="no" id="H5F3DA9ABEA684957B187D589F0046F2E"><enum>(II)</enum><text>in the case that a drug that is medically necessary for an enrollee under such plan is not included within such formulary, such individual has access to such drug through an exceptions process established by the plan; and</text>
 </subclause></clause><clause commented="no" id="H92650B4573A649499CDFE91CDB7920A3"><enum>(iii)</enum><text>habilitative services are covered at parity with rehabilitative services.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection><subsection commented="no" id="H7AFD46592A5344848D0A2D5FC4111D22"><enum>(b)</enum><header>Standard benefit plans</header><text display-inline="yes-display-inline">Section 1302(d) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18022">42 U.S.C. 18022(d)</external-xref>) is amended by adding at the end the following new paragraph:</text>
					<quoted-block display-inline="no-display-inline" id="H7E31EDA96C22439FBC3C9CBED697EA75" style="OLC">
						<paragraph commented="no" id="H4A72F9D4BE504EC781003B21DEC768FA"><enum>(5)</enum><header>Standard benefit plans</header>
 <subparagraph commented="no" id="H891B1D1C7EEE4E10995DEF1E13E8C085"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of providing individuals with the opportunity to make simpler comparisons of health plans offered by different health insurance issuers and simplify the selection process, the Secretary shall, for each plan year beginning with plan year 2020, through rulemaking, specify a structure described in subparagraph (B)(i) for a standard benefit plan for such plan year for each of the bronze, silver, and gold levels of coverage and for each actuarial value variation of a silver plan resulting from the application of section 1402(c). A standard benefit plan for a plan year for a level of coverage or actuarial value variation of a silver plan shall be modeled on the most commonly purchased plans (determined by enrollments in such plans) during the previous 2 plan years offered in the federally facilitated Exchange operated pursuant to section 1321(c) in such level or variation and shall include coverage of deductible-exempt services consistent with actual purchasing patterns of consumers in the previous two plan years.</text>
 </subparagraph><subparagraph commented="no" id="HC5A727D210A547EBAC9FE271384902CF"><enum>(B)</enum><header>Standard benefit plan</header><text display-inline="yes-display-inline">For purposes of this paragraph, the term <term>standard benefit plan</term> means a qualified health plan to be offered through an Exchange on the individual market that has either—</text>
 <clause commented="no" id="H9A5D184E65004A4DB1336E6672C4EF88"><enum>(i)</enum><text>a standardized cost-sharing structure specified by the Secretary pursuant to rulemaking; or</text> </clause><clause commented="no" id="H3833CF7732834A91A8AE8A37AC98BFD8"><enum>(ii)</enum><text>a standardized cost-sharing structure specified by the Secretary pursuant to rulemaking that is modified by the health insurance issuer of such plan only to the extent necessary to align with high deductible health plan requirements under <external-xref legal-doc="usc" parsable-cite="usc/26/223">section 223</external-xref> of the Internal Revenue Code of 1986 or the applicable annual limitation on cost sharing under subsection (c) and actuarial value requirements specified by the Secretary.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection></section><section id="HA27640D953834AEBB056E1DB4ADFB1F6"><enum>204.</enum><header>Providing for additional requirements with respect to the navigator program</header>
 <subsection id="H6295220638B243DDB23EA31B3AFDABE2"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1311(i) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031(i)</external-xref>) is amended—</text> <paragraph id="H24D4F2FBB35B4880A3E4C180FCA6E6FA"><enum>(1)</enum><text>in paragraph (2), by adding at the end the following new subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="H1CE560B8435447D9BB4C33C46CDB0153" style="OLC">
 <subparagraph id="H8278C171BE4E4B0096DDDA2F06BFEAEF"><enum>(C)</enum><header>Selection of recipients</header><text display-inline="yes-display-inline">In the case of an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), in awarding grants under paragraph (1), the Exchange shall—</text>
 <clause commented="no" id="H76FBC5A764E84398BB17BEA13D08E168"><enum>(i)</enum><text display-inline="yes-display-inline">select entities to receive such grants based solely on an entity’s demonstrated capacity to carry out each of the duties specified in paragraph (3);</text>
 </clause><clause id="H44B4ED9AE0B84952A7F09A14FF040E90"><enum>(ii)</enum><text>not take into account whether or not the entity has demonstrated how the entity will provide information to individuals relating to group health plans offered by a group or association of employers described in section 2510.3–5(b) of title 29, Code of Federal Regulations (or any successor regulation), or short-term limited duration insurance (as defined by the Secretary for purposes of section 2791(b)(5) of the Public Health Service Act); and</text>
 </clause><clause id="H26CAC1D2BC76413D919C6A363D276203"><enum>(iii)</enum><text>ensure that, each year, the Exchange awards such a grant to—</text> <subclause id="H517E51CE05F74A62B7F651A765DAFAA0"><enum>(I)</enum><text>at least one entity described in this paragraph that is a community and consumer-focused nonprofit group; and</text>
 </subclause><subclause id="H4063E020A75C4BE3976ECE6CBAD111BB"><enum>(II)</enum><text>at least one entity described in subparagraph (B), which may include another community and consumer-focused nonprofit group in addition to any such group awarded a grant pursuant to subclause (I).</text></subclause></clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
 </paragraph><paragraph id="H7329050A583B4FBE9F6B9180633558A8"><enum>(2)</enum><text>in paragraph (3)—</text> <subparagraph id="H18397B8A12CF47F6B95A78E472CD1167"><enum>(A)</enum><text>in subparagraph (C), by inserting after <quote>qualified health plans</quote> the following: <quote>, State Medicaid plans under title XIX of the Social Security Act, and State Children’s Health Insurance Programs under title XXI of such Act</quote>; and</text>
 </subparagraph><subparagraph id="HE8494348C1794AD8A0A454E757B53830"><enum>(B)</enum><text>by adding at the end the following flush left sentence:</text> <quoted-block display-inline="no-display-inline" id="HFCF9DE6D82E048B08EDCC3992FD7402B" style="OLC"> <quoted-block-continuation-text quoted-block-continuation-text-level="paragraph">The duties specified in the preceding sentence may be carried out by such a navigator at any time during a year.</quoted-block-continuation-text><after-quoted-block>; </after-quoted-block></quoted-block> </subparagraph></paragraph><paragraph id="H339AAD57D1304D0B8A8E4966064F217F"><enum>(3)</enum><text display-inline="yes-display-inline">in paragraph (4)(A)—</text>
 <subparagraph id="H6B7DCCA721344AD09F5E5348EB312E22"><enum>(A)</enum><text>in the matter preceding clause (i), by striking <quote>not</quote>;</text> </subparagraph><subparagraph id="HDC882442635740978C9B7BABC7D40E5E"><enum>(B)</enum><text>in clause (i)—</text>
 <clause id="H709C081D80674B599C48CAD7D1CB8C5B"><enum>(i)</enum><text>by inserting <quote>not</quote> before <quote>be</quote>; and</text> </clause><clause id="HB8A391D37AAC4E6F82F308E193EDEFDB"><enum>(ii)</enum><text>by striking <quote>; or</quote> and inserting <quote>;</quote>;</text>
 </clause></subparagraph><subparagraph id="H1C3535C78D5C437F91151B89B8C2BB83"><enum>(C)</enum><text>in clause (ii)—</text> <clause id="H85976E3CA4A64C3994E064E5F3403E6D"><enum>(i)</enum><text>by inserting <quote>not</quote> before <quote>receive</quote>; and</text>
 </clause><clause id="HA8B307F94D5443D38EFA706C9794A9B5"><enum>(ii)</enum><text>by striking the period and inserting <quote>;</quote>; and</text> </clause></subparagraph><subparagraph id="H9F8D2324BC1741BFA5F70A70678E9304"><enum>(D)</enum><text>by adding at the end the following new clause:</text>
							<quoted-block display-inline="no-display-inline" id="HE4E56005F22749D4B2C4197D16856AD5" style="OLC">
 <clause id="HD51523F5DD484FCCBBF4EAB710103DC5"><enum>(iii)</enum><text display-inline="yes-display-inline">maintain physical presence in the State of the Exchange so as to allow in-person assistance to consumers.</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block>
 </subparagraph></paragraph><paragraph id="H97258E9EC35C4042BEB92C88B602AAB9"><enum>(4)</enum><text>in paragraph (6)—</text> <subparagraph id="H042293BC23454030B8C243CB4CE755C6"><enum>(A)</enum><text>by striking <quote><header-in-text level="paragraph" style="OLC">Funding.—</header-in-text>Grants under</quote> and inserting</text>
							<quoted-block display-inline="yes-display-inline" id="H050040B10F7E476BB2B23E046203772F" style="OLC">
 <text><header-in-text level="paragraph" style="OLC">Funding.—</header-in-text></text><subparagraph id="H22B3F2EB4B6F4C489019C5385FDAC809"><enum>(A)</enum><header>State Exchanges</header><text display-inline="yes-display-inline">Grants under</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block> </subparagraph><subparagraph id="HB4EA4D7E3104454FABD96DA3480F1D4F"><enum>(B)</enum><text>by adding at the end the following new subparagraph:</text>
							<quoted-block display-inline="no-display-inline" id="H8FC19E6620AD4EC3BA0879170F14BA36" style="OLC">
 <subparagraph id="HC6C6D1ECEE2A47AF999AC21263B25BA1"><enum>(B)</enum><header>Federal Exchanges</header><text display-inline="yes-display-inline">For purposes of carrying out this subsection, with respect to an Exchange established and operated by the Secretary within a State pursuant to section 1321(c), the Secretary shall obligate $100,000,000 out of amounts collected through the user fees on participating health insurance issuers pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations) for fiscal year 2020 and each subsequent fiscal year. Such amount for a fiscal year shall remain available until expended.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
 </subparagraph></paragraph></subsection><subsection id="HC6C0635ADAB34640BACF07842DAEFFE9"><enum>(b)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2020.</text>
 </subsection></section><section id="HFE7B6D2C3A7149CD92CD39A43E5D3E3C"><enum>205.</enum><header>Federal Exchange outreach and educational activities</header><text display-inline="no-display-inline">Section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>) is amended by adding at the end the following new paragraph:</text>
				<quoted-block display-inline="no-display-inline" id="HEB7933F8A34C46C1B1FB24898049D8A2" style="OLC">
					<paragraph id="H67BF8D8C963B4FB6A4A0DD90E5C9199D"><enum>(3)</enum><header>Outreach and educational activities</header>
 <subparagraph id="H181E14B1E2A5448BAC6F6A6ADBC6B067"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">In the case of an Exchange established or operated by the Secretary within a State pursuant to this subsection, the Secretary shall carry out outreach and educational activities for purposes of informing potential enrollees in qualified health plans offered through the Exchange of the availability of coverage under such plans and financial assistance for coverage under such plans. Such outreach and educational activities shall be provided in a manner that is culturally and linguistically appropriate to the needs of the populations being served by the Exchange (including hard-to-reach populations, such as racial and sexual minorities, limited English proficient populations, and young adults).</text>
 </subparagraph><subparagraph id="HBFB230C2DC704370A6376FF626D3D8E3"><enum>(B)</enum><header>Limitation on use of funds</header><text display-inline="yes-display-inline">No funds appropriated under this paragraph shall be used for expenditures for promoting non-ACA compliant health insurance coverage.</text>
 </subparagraph><subparagraph id="HB2B8514FDFF04E4DA1DE2CBCE60AD08E"><enum>(C)</enum><header>Non-aca compliant health insurance coverage</header><text>For purposes of this subparagraph (B):</text> <clause id="HBBEB83D5915A41E4B0C2EBDC412961A2"><enum>(i)</enum><text>The term <term>non-ACA compliant health insurance coverage</term> means health insurance coverage, or a group health plan, that is not a qualified health plan.</text>
 </clause><clause id="HBBA0F6E2A92C4BD0B65F225D2FB52DE2"><enum>(ii)</enum><text>Such term includes the following:</text> <subclause id="H1F2A5F5A248541F2A15C26F22A9989C7"><enum>(I)</enum><text>An association health plan.</text>
 </subclause><subclause id="HB452959873214B30B119CA9DBC24C466"><enum>(II)</enum><text>Short-term limited duration insurance.</text> </subclause></clause></subparagraph><subparagraph id="H0B12B2334027489DB476E280F2044951"><enum>(D)</enum><header>Funding</header><text display-inline="yes-display-inline">Out of any funds in the Treasury not otherwise appropriated, there are hereby appropriated for fiscal year 2020 and each subsequent fiscal year, $100,000,000 to carry out this paragraph. Funds appropriated under this subparagraph shall remain available until expended.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
 </section><section id="HA1D2420101874DFAAB9BA9D7CC7A6BD8" section-type="subsequent-section"><enum>206.</enum><header>Improve Health Insurance Affordability Fund</header><text display-inline="no-display-inline">Subtitle D of title I of the Patient Protection and Affordable Care Act is amended by inserting after part 5 (<external-xref legal-doc="usc" parsable-cite="usc/42/18061">42 U.S.C. 18061</external-xref> et seq.) the following new part:</text>
				<quoted-block display-inline="no-display-inline" id="H13535F6AB4404CA9BFC8DA5451F956ED" style="OLC">
					<part id="HE06F5C46C0934EBF9EC2F23DA10AD3C2"><enum>6</enum><header>Improve Health Insurance Affordability Fund</header>
 <section commented="no" id="H16E8EB2CB35045EE85E7B366FC404C82"><enum>1351.</enum><header>Establishment of program</header><text display-inline="no-display-inline">There is hereby established the <quote>Improve Health Insurance Affordability Fund</quote> to be administered by the Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare &amp; Medicaid Services (in this section referred to as the <quote>Administrator</quote>), to provide funding, in accordance with this title, to the 50 States and the District of Columbia (each referred to in this section as a <quote>State</quote>) beginning on January 1, 2020, for the purposes described in section 1352.</text>
						</section><section commented="no" id="H52D769F6B3D34897B719AED62EE53803"><enum>1352.</enum><header>Use of funds</header>
 <subsection id="H7571FF0515EC443AB173403034056083"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">A State shall use the funds allocated to the State under this part for one of the following purposes:</text>
 <paragraph id="HDCCCB2E78171498AABA938A03C4C5C04"><enum>(1)</enum><text>To provide reinsurance payments to health insurance issuers with respect to individuals enrolled under individual health insurance coverage (other than through a plan described in subsection (b)) offered by such issuers.</text>
 </paragraph><paragraph id="HE564050F6CCD4128B537A9D1C6EC34D7"><enum>(2)</enum><text display-inline="yes-display-inline">To provide assistance (other than through payments described in paragraph (1)) to reduce out-of-pocket costs, such as copayments, coinsurance, premiums, and deductibles, of individuals enrolled under qualified health plans offered on the individual market through an Exchange.</text>
 </paragraph></subsection><subsection id="H210389D14C244D19893464F065BE86E2"><enum>(b)</enum><header>Exclusion of certain grandfathered and transitional plans</header><text display-inline="yes-display-inline">For purposes of subsection (a), a plan described in this subsection is the following:</text> <paragraph id="H2A16F4C244C94541868BDA5AAB4B2CC5"><enum>(1)</enum><text>A grandfathered health plan (as defined in section 1251).</text>
 </paragraph><paragraph id="H89CE56CCC42C40F2BD0CC76D95AE6B74"><enum>(2)</enum><text display-inline="yes-display-inline">A plan (commonly referred to as a <quote>transitional plan</quote>) continued under the letter issued by the Centers for Medicare &amp; Medicaid Services on November 14, 2013, to the State Insurance Commissioners outlining a transitional policy for coverage in the individual and small group markets to which section 1251 does not apply, and under the extension of the transitional policy for such coverage set forth in the Insurance Standards Bulletin Series guidance issued by the Centers for Medicare &amp; Medicaid Services on March 5, 2014, February 29, 2016, February 13, 2017, and April 9, 2018, or under any subsequent extensions thereof.</text>
								</paragraph></subsection></section><section id="H964503492B11482BA067DCE874708E7F"><enum>1353.</enum><header>State eligibility and approval; Default safeguard</header>
							<subsection id="H416F6B0DB19942DABED8DFF4021ED250"><enum>(a)</enum><header>Encouraging State options for allocations</header>
 <paragraph id="HFB69214E5FB34DA9A982FFA4DC056584"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">To be eligible for an allocation of funds under this part for a year (beginning with 2020), a State shall submit to the Administrator an application at such time (but, in the case of allocations for 2020, not later than 90 days after the date of the enactment of this title and, in the case of allocations for a subsequent year, not later than March 31 of the previous year) and in such form and manner as specified by the Administrator containing—</text>
 <subparagraph id="HCE70F2C3FE884358A50E39174C6801D1"><enum>(A)</enum><text>a description of how the funds will be used; and</text> </subparagraph><subparagraph id="H5CB6B77D8CA344D9A76C66346B96BA5B"><enum>(B)</enum><text>such other information as the Administrator may require.</text>
 </subparagraph></paragraph><paragraph id="H148695AD5669439588931E4F16E6885C"><enum>(2)</enum><header>Automatic approval</header><text>An application so submitted is approved unless the Administrator notifies the State submitting the application, not later than 60 days after the date of the submission of such application, that the application has been denied for not being in compliance with any requirement of this part and of the reason for such denial.</text>
 </paragraph><paragraph id="H2E6B726D152547EFACC72D0E092A6AF1"><enum>(3)</enum><header><enum-in-header>5</enum-in-header>-year application approval</header><text>If an application of a State is approved for a purpose described in section 1352 for a year, such application shall be treated as approved for such purpose for each of the subsequent 4 years.</text>
								</paragraph></subsection><subsection id="H0386BA0B79FF4E4BB150C2FEBBA88983"><enum>(b)</enum><header>Default Federal safeguard</header>
 <paragraph id="H5613B423FA1B48AF85F3119411AC1AC0"><enum>(1)</enum><header><enum-in-header>2020</enum-in-header></header><text>For allocations made under this part for 2020, in the case of a State that does not submit an application under subsection (a) by the 90-day submission date applicable to such year under subsection (a)(1) and in the case of a State that does submit such an application by such date that is not approved, the Administrator, in consultation with the State insurance commissioner, shall use, in accordance with paragraph (3), the allocation that would otherwise be provided to the State under this part for such year for such State.</text>
 </paragraph><paragraph id="H2254E84B26214998970D14C86ACA5B69"><enum>(2)</enum><header><enum-in-header>2021</enum-in-header> and subsequent years</header><text display-inline="yes-display-inline">In the case of a State that does not have in effect an approved application under this section for 2021 or a subsequent year, the Administrator, in consultation with the State insurance commissioner, shall use, in accordance with paragraph (3), the allocation that would otherwise be provided to the State under this part for such year for such State.</text>
 </paragraph><paragraph id="H457D0020E43748E08A54D9B33515F11A"><enum>(3)</enum><header>Specified use</header><text display-inline="yes-display-inline">An allocation for a State made pursuant to paragraph (1) or (2) for a year shall be used to carry out the purpose described in section 1352(a)(1) in such State by providing reinsurance payments to health insurance issuers with respect to attachment range claims (as defined in section 1354(b)(2), using the dollar amounts specified in subparagraph (B) of such section for such year) in an amount equal to the percentage (specified for such year by the Secretary under such subparagraph) of the amount of such claims.</text>
								</paragraph></subsection></section><section id="H504F90F25FA541A09D06AC95CBC0C967"><enum>1354.</enum><header>Allocations</header>
 <subsection id="H406D25E1F515457AA54DDEEBB8B995B8"><enum>(a)</enum><header>Appropriation</header><text display-inline="yes-display-inline">For the purpose of providing allocations for States under this part there is appropriated, out of any money in the Treasury not otherwise appropriated $10,000,000,000 for 2020 and each subsequent year.</text>
							</subsection><subsection commented="no" id="H5C4591B2A9CA4BB38080883E3D3DB699"><enum>(b)</enum><header>Allocations</header>
								<paragraph commented="no" id="HA8FB5E573B544EC5BF6662608AE75431"><enum>(1)</enum><header>Payment</header>
 <subparagraph commented="no" id="H93BFED31A2BD4649B7E241B1E6C64679"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">From amounts appropriated under subsection (a) for a year, the Secretary shall, with respect to a State and not later than the date specified under subparagraph (B) for such year, allocate for such State the amount determined for such State and year under paragraph (2).</text>
 </subparagraph><subparagraph commented="no" id="H966E41310FE04C17835B905E1779FE44"><enum>(B)</enum><header>Specified date</header><text display-inline="yes-display-inline">For purposes of subparagraph (A), the date specified in this subparagraph is—</text> <clause commented="no" id="HF774F2BFB7AD4AAFB50BC32DB7813048"><enum>(i)</enum><text display-inline="yes-display-inline">for 2020, the date that is 45 days after the date of the enactment of this title; and</text>
 </clause><clause commented="no" id="HA1E0CD5EB1434D409E40F5896D252BD3"><enum>(ii)</enum><text>for 2021 or a subsequent year, January 1 of the respective year.</text> </clause></subparagraph><subparagraph id="HDEAAA6512CA64DDE81A485CE634BA653"><enum>(C)</enum><header>Notifications of allocation amounts</header><text>For 2021 and each subsequent year, the Secretary shall notify each State of the amount determined for such State under paragraph (2) for such year by not later than January 1 of the previous year.</text>
									</subparagraph></paragraph><paragraph commented="no" id="HFD7DC6A3CABB4DF9A4B678ECDF882830"><enum>(2)</enum><header>Allocation amount determinations</header>
 <subparagraph id="H17ECAD7608C348CEA6293CD39053542B"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of paragraph (1), the amount determined under this paragraph for a year for a State is the amount that the Secretary estimates would be expended under this part for such year on attachment range claims of individuals residing in such State if all States used such funds only for the purpose described in paragraph (1) of section 1352 at the dollar amounts and percentage specified under subparagraph (B) for such year. For purposes of the previous sentence and section 1353(b)(3), the term <term>attachment range claims</term> means, with respect to an individual, the claims for such individual that exceed a dollar amount specified by the Secretary for a year, but do not exceed a ceiling dollar amount specified by the Secretary for such year, under subparagraph (B).</text>
 </subparagraph><subparagraph id="HB473C3E240814C8FA41ECDA76B8BA6CC"><enum>(B)</enum><header>Specifications</header><text>For purposes of subparagraph (A) and section 1353(b)(3), the Secretary shall determine the dollar amounts and the percentage to be specified under subparagraph (A) for a year in a manner to ensure that the total amount of expenditures under this part for such year is estimated to equal the total amount appropriated for such year under subsection (a) if such expenditures were used solely for the purpose described in paragraph (1) of section 1352(a) for attachment range claims at the dollar amounts and percentage so specified for such year.</text>
 </subparagraph></paragraph><paragraph id="H9E5097D3AFF540F195B739C435B067C2"><enum>(3)</enum><header>Availability</header><text>Funds allocated to a State under this subsection for a year shall remain available through the end of the subsequent year.</text>
								</paragraph></subsection><subsection commented="no" id="H6E8374FFE2934E14A319D9BF8BFBFE34"><enum>(c)</enum><header>Annual distribution of previous year’s remaining funds</header>
 <paragraph id="HAC0519564B97456AB63FDB188136C2F0"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">In carrying out subsection (b), the Secretary shall, with respect to a year (beginning with 2021), not later than March 31 of such year—</text>
 <subparagraph commented="no" id="HCF3D2F89A2164F91A9E723F58B22FB8E"><enum>(A)</enum><text display-inline="yes-display-inline">determine the amount of funds, if any, from the amounts appropriated under subsection (a) for the previous year but not allocated for such previous year; and</text>
 </subparagraph><subparagraph commented="no" id="H3CB4933FFA0D4843BAF2EDDA1E50A164"><enum>(B)</enum><text>if the Secretary determines that any funds were not so allocated for such previous year, allocate such remaining funds to States for such year, in accordance with paragraph (2).</text>
 </subparagraph></paragraph><paragraph id="H63F8528FDDA2479C93E7A614F20C402D"><enum>(2)</enum><header>Allocation methodology</header><text>For purposes of paragraph (1), of the total remaining funds to be allocated for a year pursuant to such paragraph, the Secretary shall allocate to each State an amount that bears the same ratio to such total remaining funds as the amount allocated pursuant to subsection (b) to such State for such year bears to the total allocations made under such subsection for such year.</text></paragraph></subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="HDE7710A9F6AC4088BC91DEF703E54775"><enum>207.</enum><header>Providing that certain guidance related to waivers for State innovation under the Patient
			 Protection and Affordable Care Act shall have no force or effect</header>
 <text display-inline="no-display-inline">Beginning April 1, 2019, the Secretary of Health and Human Services and the Secretary of the Treasury may not take any action to implement, enforce, or otherwise give effect to the guidance entitled <quote>State Relief and Empowerment Waivers</quote> (83 Fed. Reg. 53575 (October 24, 2018)), and the Secretaries may not promulgate any substantially similar guidance or rule.</text>
			</section></title><title id="H05AFB7F062CE46E28AE90778A3910201"><enum>III</enum><header>State Innovation and Transparency</header>
 <section id="HF715BB3F815643098486D267A04157C1"><enum>301.</enum><header>Fund State health insurance education programs for consumers</header><text display-inline="no-display-inline">Section 2793(e) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300gg-93">42 U.S.C. 300gg–93(e)</external-xref>) is amended by adding at the end the following new paragraph:</text>
				<quoted-block display-inline="no-display-inline" id="H43A9B3148DAE43269E60CFAE8F812412" style="OLC">
 <paragraph id="H16B4E605BA7F46A8B21E9F41B39181DC"><enum>(3)</enum><header>Appropriations</header><text display-inline="yes-display-inline">For purposes of carrying out this section, there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $100,000,000 for each of the fiscal years 2020 through 2022. Such amount shall remain available until expended.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="H42EFD665E5C04BECB6CA9E4E26043FED"><enum>302.</enum><header>Fund State innovations to expand coverage</header>
 <subsection id="H2BFCE991FB7A4966B00C89D7A30F5B93"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to subsection (d), the Secretary of Health and Human Services shall award grants to eligible State agencies to enable such States to explore innovative solutions to promote greater enrollment in health insurance coverage in the individual and small group markets, including activities described in subsection (c).</text>
 </subsection><subsection id="HFE866EF59CBD44D7AD98E57F4F4145B7"><enum>(b)</enum><header>Eligibility</header><text>For purposes of subsection (a), eligible State agencies are Exchanges established by a State under title I of the Patient Protection and Affordable Care Act and State agencies with primary responsibility over health and human services for the State involved.</text>
 </subsection><subsection commented="no" id="HE362CFF3ADD0488D8F1BD78E61376387"><enum>(c)</enum><header>Use of funds</header><text>For purposes of subsection (a), the activities described in this subsection are the following:</text> <paragraph commented="no" id="H9184EFF2426A4873867056F199916621"><enum>(1)</enum><text display-inline="yes-display-inline">State efforts to streamline health insurance enrollment procedures in order to reduce burdens on consumers and facilitate greater enrollment in health insurance coverage in the individual and small group markets, including automatic enrollment and reenrollment of, or pre-populated applications for, individuals without health insurance who are eligible for tax credits under <external-xref legal-doc="usc" parsable-cite="usc/26/36B">section 36B</external-xref> of the Internal Revenue Code of 1986, with the ability to opt out of such enrollment.</text>
 </paragraph><paragraph commented="no" id="H0517929B669A4F2091A03A8471E3B63C"><enum>(2)</enum><text>State investment in technology to improve data sharing and collection for the purposes of facilitating greater enrollment in health insurance coverage in such markets.</text>
 </paragraph><paragraph commented="no" id="H5BD5EB55460145049B87D41F3FB2DC3B"><enum>(3)</enum><text display-inline="yes-display-inline">Implementation of a State version of an individual mandate to be enrolled in health insurance coverage.</text>
 </paragraph><paragraph commented="no" id="H3488E35095784FFF91B4329E9D923770"><enum>(4)</enum><text>Feasibility studies to develop comprehensive and coherent State plan for increasing enrollment in the individual and small group market.</text>
 </paragraph></subsection><subsection id="H0F61EC06CDFC46A6B234AE827466D8C6"><enum>(d)</enum><header>Funding</header><text display-inline="yes-display-inline">For purposes of carrying out this section, there is hereby appropriated, out of any funds in the Treasury not otherwise appropriated, $200,000,000 for each of the fiscal years 2020 through 2022. Such amount shall remain available until expended.</text>
				</subsection></section><section id="H265F0819472F4CFF89F6600ABD91C232"><enum>303.</enum><header>Preserving State option to implement health care marketplaces</header>
 <subsection id="H075082F4802C4BEEB1A46F835BC37C1B"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1311 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18031">42 U.S.C. 18031</external-xref>) is amended—</text> <paragraph id="H02879153B1DD461299BC69E938C9CE7C"><enum>(1)</enum><text>in subsection (a)—</text>
 <subparagraph id="H22D16C2325874E2087C7A2F35E561A56"><enum>(A)</enum><text>in paragraph (4)(B), by striking <quote>under this subsection</quote> and inserting <quote>under this paragraph or paragraph (1)</quote>; and</text> </subparagraph><subparagraph id="H442D158AA72E47DA8CA0A090E8035459"><enum>(B)</enum><text>by adding at the end the following new paragraph:</text>
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								<paragraph id="HFA45011E09C64B5AAC1F2DCDD39C2B0B"><enum>(6)</enum><header>Additional planning and establishment grants</header>
 <subparagraph id="H0E6B333B0CAE458BB123DDF93A40F408"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">There shall be appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $200,000,000 to award grants to eligible States for the uses described in paragraph (3).</text>
 </subparagraph><subparagraph id="HF5514D0DCF944182833840D74BB30797"><enum>(B)</enum><header>Duration and renewability</header><text>A grant awarded under subparagraph (A) shall be for a period of two years and may not be renewed.</text> </subparagraph><subparagraph id="HF2CE0ADFED55473FBCE235C360A1DFB7"><enum>(C)</enum><header>Limitation</header><text>A grant may not be awarded under subparagraph (A) after December 31, 2022.</text>
 </subparagraph><subparagraph commented="no" id="HBC99DE244225461AB870E1FD3E7DDF89"><enum>(D)</enum><header>Eligible State defined</header><text>For purposes of this paragraph, the term <term>eligible State</term> means a State that, as of the date of the enactment of this paragraph, is not operating an Exchange.</text></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block>
 </subparagraph></paragraph><paragraph id="H5DCF128F8E874231BCB1C914D14981B2"><enum>(2)</enum><text>in subsection (d)(5)(A)—</text> <subparagraph id="HFFB02872FC2A4A588804C11463EBA6AB"><enum>(A)</enum><text>by striking <quote>In establishing an Exchange under this section</quote> and inserting <quote>(i) <header-in-text level="clause" style="OLC">In general.—</header-in-text>In establishing an Exchange under this section (other than in establishing an Exchange pursuant to subsection (a)(6))</quote>; and</text>
 </subparagraph><subparagraph id="HEDB8E22AC9684C5593B73BAADEFC880E"><enum>(B)</enum><text>by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HC851643710CC42F58874732D62ECFDAB" style="OLC"> <clause id="HA6D687F35C14487C89A657C8EC3269E3"><enum>(ii)</enum><header>Additional planning and establishment grants</header><text display-inline="yes-display-inline">In establishing an Exchange pursuant to subsection (a)(6), the State shall ensure that such Exchange is self-sustaining beginning on January 1, 2024, including allowing the Exchange to charge assessments or user fees to participating health insurance issuers, or to otherwise generate funding, to support its operations.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block>
 </subparagraph></paragraph></subsection><subsection commented="no" id="H9183DE74170A45F5975E3424B5955F59"><enum>(b)</enum><header>Clarification regarding failure To establish Exchange or implement requirements</header><text display-inline="yes-display-inline">Section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>), as amended by section 205, is further amended—</text>
 <paragraph commented="no" id="H9FF2ACB26D3B4A3F83E50D3041DF62A8"><enum>(1)</enum><text>in paragraph (1), by striking <quote>If</quote> and inserting <quote>Subject to paragraph (4), if</quote>; and</text> </paragraph><paragraph commented="no" id="HBCAA317E3CD44500861ECCF39851C9A1"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text>
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 <paragraph commented="no" id="H3D4B58F3F1A64D178C4A52853088C1D5"><enum>(4)</enum><header>Clarification</header><text display-inline="yes-display-inline">This subsection shall not apply in the case of a State that elects to apply the requirements described in subsection (a) and satisfies the requirement described in subsection (b) on or after January 1, 2014.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
 </paragraph></subsection></section><section id="H96100C9540604CF89445408A1860ADA3"><enum>304.</enum><header>Promote transparency and accountability in the Administration’s expenditures of Exchange user fees</header><text display-inline="no-display-inline">For each of plan years 2018, 2019, and 2020, not later than the date that is 3 months after the end of such plan year, the Secretary of Health and Human Services shall submit to the appropriate committees of Congress and make available to the public an annual report on the expenditure by the Department of Health and Human Services of user fees collected pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations). Each such report for a plan year shall include a detailed accounting of the amount of such user fees collected during such plan year and of the amount of such expenditures used during such plan year for the federally facilitated Exchange operated pursuant to section 1321(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18041">42 U.S.C. 18041(c)</external-xref>) on outreach and enrollment activities, navigators, maintenance of Healthcare.gov, and operation of call centers.</text>
			</section></title></legis-body></bill>


