[Congressional Record Volume 163, Number 125 (Tuesday, July 25, 2017)]
[Senate]
[Pages S4196-S4224]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 262. Mrs. SHAHEEN (for herself and Mr. Sasse) submitted an 
amendment intended to be proposed by her to the bill S. 1519, to 
authorize appropriations for fiscal year 2018 for military activities 
of the Department of Defense, for military construction, and for 
defense activities of the Department of Energy, to prescribe military 
personnel strengths for such fiscal year, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the end of subtitle C of title XII, add the following:

     SEC. 1235. SYRIA STUDY GROUP.

       (a) Establishment.--There is hereby established a working 
     group to be known as the ``Syria Study Group'' (in this 
     section referred to as the ``Group'').
       (b) Purpose.--The purpose of the Group is to examine and 
     make recommendations with respect to the military and 
     diplomatic strategy of the United States with respect to the 
     conflict in Syria.
       (c) Composition.--
       (1) Membership.--The Group shall be composed of 8 members 
     appointed as follows:
       (A) One member appointed by the chair of the Committee on 
     Armed Services of the Senate.
       (B) One member appointed by the ranking minority member of 
     the Committee on Armed Services of the Senate.
       (C) One member appointed by the chair of the Committee on 
     Foreign Relations of the Senate.
       (D) One member appointed by the ranking minority member of 
     the Committee on Foreign Relations of the Senate.
       (E) One member appointed by the chair of the Committee on 
     Armed Services of the House of Representatives.
       (F) One member appointed by the ranking minority member of 
     the Committee on Armed Services of the House of 
     Representatives.
       (G) One member appointed by the chair of the Committee on 
     Foreign Affairs of the House of Representatives.
       (H) One member appointed by the ranking minority member of 
     the Committee on Foreign Affairs of the House of 
     Representatives.
       (2) Co-chairs.--
       (A) The chair of the Committee on Armed Services of the 
     Senate, the chair of the Committee on Armed Services of the 
     House of Representatives, the chair of the Committee on 
     Foreign Relations of the Senate, and the chair of the 
     Committee on Foreign Affairs of the House of Representatives 
     shall jointly designate one member of the Group to serve as 
     co-chair of the Group.
       (B) The ranking minority member of the Committee on Armed 
     Services of the Senate, the ranking minority member of the 
     Committee on Armed Services of the House of Representatives, 
     the ranking minority member of the Committee on Foreign 
     Relations of the Senate, and the ranking minority member of 
     the Committee on Foreign Affairs of the House of 
     Representatives shall jointly designate one member of the 
     Group to serve as co-chair of the Group.
       (3) Period of appointment; vacancies.--Members shall be 
     appointed for the life of the Group. Any vacancy in the Group 
     shall be filled in the same manner as the original 
     appointment.
       (d) Duties.--
       (1) Review.--The Group shall review the current situation 
     with respect to the United States military and diplomatic 
     strategy in Syria, including a review of current United 
     States objectives in Syria and the desired end state in 
     Syria.
       (2) Assessment and recommendations.--The Group shall--
       (A) conduct a comprehensive assessment of the current 
     situation in Syria, its impact on neighboring countries, 
     resulting regional and geopolitical threats to the United 
     States, and current military, diplomatic, and political 
     efforts to achieve a stable Syria; and
       (B) develop recommendations on a military and diplomatic 
     strategy for the United States with respect to the conflict 
     in Syria.
       (e) Cooperation From United States Government.--
       (1) In general.--The Group shall receive the full and 
     timely cooperation of the Secretary of Defense, the Secretary 
     of State, and the Director of National Intelligence in 
     providing the Group with analyses, briefings, and other 
     information necessary for the discharge of the duties of the 
     Group.
       (2) Liaison.--The Secretary of Defense, the Secretary of 
     State, and the Director of National Intelligence shall each 
     designate at least one officer or employee of their 
     respective organizations to serve as a liaison officer to the 
     Group.
       (f) Report.--
       (1) Final report.--Not later than September 30, 2018, the 
     Group shall submit to the President, the Secretary of 
     Defense, the Committee on Armed Services of the Senate, the 
     Committee on Armed Services of the House of Representatives, 
     the Committee on Foreign Relations of the Senate, and the 
     Committee on Foreign Affairs of the House of Representatives 
     a report on the findings, conclusions, and recommendations of 
     the Group under this section. The report shall do each of the 
     following:
       (A) Assess the current security, political, humanitarian, 
     and economic situation in Syria.
       (B) Assess the current participation and objectives of 
     various external actors in Syria.
       (C) Assess the consequences of continued conflict in Syria.
       (D) Provide recommendations for a diplomatic resolution of 
     the conflict in Syria, including options for a gradual 
     political transition to a post-Assad Syria and actions 
     necessary for reconciliation.
       (E) Provide a roadmap for a United States and coalition 
     strategy to reestablish security and governance in Syria, 
     including recommendations for the synchronization of 
     stabilization, development, counterterrorism, and 
     reconstruction efforts.
       (F) Address any other matters with respect to the conflict 
     in Syria that the Group considers appropriate.
       (2) Interim briefing.--Not later than June 30, 2018, the 
     Group shall provide to the Committees on Armed Services of 
     the Senate and the House of Representatives a briefing on the 
     status of its review and assessment under subsection (d), 
     together with a discussion of any interim recommendations 
     developed by the Group as of the date of the briefing.
       (3) Form of report.--The report submitted to Congress under 
     paragraph (1) shall be submitted in unclassified form, but 
     may include a classified annex.
       (g) Facilitation.--The United States Institute of Peace 
     shall take appropriate actions to facilitate the Group in the 
     discharge of its duties under this section.
       (h) Termination.--The Group shall terminate six months 
     after the date on which it submits the report required by 
     subsection (f)(1).
       (i) Funding.--Of the amounts authorized to be appropriated 
     for fiscal year 2018 for the Department of Defense by this 
     Act, $1,500,000 is available to fund the activities of the 
     Group.
                                 ______
                                 
  SA 263. Mrs. SHAHEEN submitted an amendment intended to be proposed 
by her to the bill S. 1519, to authorize appropriations for fiscal year 
2018 for military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle G of title X of division A, insert 
     the following:

     SEC. 1088. FOREIGN AGENTS REGISTRATION.

       (a) Short Title.--This section may be cited as the 
     ``Foreign Agents Registration Modernization and Enforcement 
     Act''.
       (b) Civil Investigative Demand Authority.--The Foreign 
     Agents Registration Act of 1938 (22 U.S.C. 611 et seq.) is 
     amended--
       (1) by redesignating sections 8, 9, 10, 11, 12, 13, and 14 
     as sections 9, 10, 11, 12, 13, 14, and 16, respectively; and

[[Page S4197]]

       (2) by inserting after section 7 (22 U.S.C. 617) the 
     following:


                 ``CIVIL INVESTIGATIVE DEMAND AUTHORITY

       ``Sec. 8. (a) Whenever the Attorney General has reason to 
     believe that any person or enterprise may be in possession, 
     custody, or control of any documentary material relevant to 
     an investigation under this Act, the Attorney General, before 
     initiating a civil or criminal proceeding with respect to the 
     production of such material, may serve a written demand upon 
     such person to produce such material for examination.
       ``(b) Each such demand under subsection (a) shall--
       ``(1) state the nature of the conduct constituting the 
     alleged violation which is under investigation and the 
     provision of law applicable to such violation;
       ``(2) describe the class or classes of documentary material 
     required to be produced under such demand with such 
     definiteness and certainty as to permit such material to be 
     fairly identified;
       ``(3) state that the demand is immediately returnable or 
     prescribe a return date which will provide a reasonable 
     period within which the material may be assembled and made 
     available for inspection and copying or reproduction; and
       ``(4) identify the custodian to whom such material shall be 
     made available.
       ``(c) A demand under subsection (a) may not--
       ``(1) contain any requirement that would be considered 
     unreasonable if contained in a subpoena duces tecum issued by 
     a court of the United States in aid of grand jury 
     investigation of such alleged violation; or
       ``(2) require the production of any documentary evidence 
     that would be privileged from disclosure if demanded by a 
     subpoena duces tecum issued by a court of the United States 
     in aid of a grand jury investigation of such alleged 
     violation.''.
       (c) Informational Materials.--
       (1) Definitions.--Section 1 of the Foreign Agents 
     Registration Act of 1938, as amended (22 U.S.C. 611) is 
     amended--
       (A) in subsection (c), by striking ``Expect as provided in 
     subsection (d) hereof,'' and inserting ``Except as provided 
     in subsection (d),''; and
       (B) by inserting after subsection (i) the following:
       ``(j) The term `informational materials' means any oral, 
     visual, graphic, written, or pictorial information or matter 
     of any kind, including matter published by means of 
     advertising, books, periodicals, newspapers, lectures, 
     broadcasts, motion pictures, or any means or instrumentality 
     of interstate or foreign commerce or otherwise.''.
       (2) Informational materials.--Section 4 of the such Act (22 
     U.S.C. 614) is amended--
       (A) in subsection (a)--
       (i) by inserting ``, including electronic mail and social 
     media,'' after ``United States mails''; and
       (ii) by striking ``, not later than forty-eight hours after 
     the beginning of the transmittal thereof, file with the 
     Attorney General two copies thereof'' and inserting ``file 
     such materials with the Attorney General in conjunction with, 
     and at the same intervals as, disclosures required under 
     section 2(b).''; and
       (B) in subsection (b)--
       (i) by striking ``It shall'' and inserting ``(1) Except as 
     provided in paragraph (2), it shall''; and
       (ii) by inserting at the end the following:
       ``(2) Foreign agents described in paragraph (1) may omit 
     disclosure required under that paragraph in individual 
     messages, posts, or transmissions on social media on behalf 
     of a foreign principal if the social media account or profile 
     from which the information is sent includes a conspicuous 
     statement that--
       ``(A) the account is operated by, and distributes 
     information on behalf of, the foreign agent; and
       ``(B) additional information about the account is on file 
     with the Department of Justice in Washington, District of 
     Columbia.
       ``(3) Informational materials disseminated by an agent of a 
     foreign principal as part of an activity that is exempt from 
     registration, or an activity which by itself would not 
     require registration, need not be filed under this 
     subsection.''.
       (d) Fees.--
       (1) Repeal.--The Department of Justice and Related Agencies 
     Appropriations Act, 1993 (title I of Public Law 102-395) is 
     amended, under the heading ``salaries and expenses, general 
     legal activities'', by striking ``In addition, 
     notwithstanding 31 U.S.C. 3302, for fiscal year 1993 and 
     thereafter, the Attorney General shall establish and collect 
     fees to recover necessary expenses of the Registration Unit 
     (to include salaries, supplies, equipment and training) 
     pursuant to the Foreign Agents Registration Act, and shall 
     credit such fees to this appropriation, to remain available 
     until expended.''.
       (2) Registration fee.--The Foreign Agents Registration Act 
     of 1938, as amended (22 U.S.C. 611 et seq.), as amended by 
     this Act, is further amended by adding after section 14, as 
     redesignated by subsection (b)(1), the following:


                                 ``FEES

       ``Sec. 15. The Attorney General shall--
       ``(1) establish and collect a registration fee, as part of 
     the initial filing requirement, to help defray the expenses 
     of the FARA Registration Unit; and
       ``(2) credit such fees to the amount appropriated to carry 
     out the activities of the National Security Division, which 
     shall remain available until expended.''.
       (e) Reports to Congress.--Section 12 of the Foreign Agents 
     Registration Act of 1938, as amended, as redesignated by 
     subsection (b)(1), is amended to read as follows:


                         ``REPORTS TO CONGRESS

       ``Sec. 12. The Assistant Attorney General for National 
     Security, through the FARA Registration Unit of the National 
     Security Division, shall submit a semiannual report to 
     Congress regarding the administration of this Act. Each 
     report under this section shall include, for the applicable 
     reporting period, the identification of--
       ``(1) registrations filed pursuant to this Act;
       ``(2) the nature, sources, and content of political 
     propaganda disseminated and distributed by agents of foreign 
     principal;
       ``(3) the number of investigations initiated based upon a 
     perceived violation of section 8; and
       ``(4) the number of such investigations that were referred 
     to the Attorney General for prosecution.''.
                                 ______
                                 
  SA 264. Mr. McCAIN submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       Beginning on page 41, strike lines 9 through 16 and insert 
     the following:
       (ii) in subparagraph (B)(ii)--

       (I) in subclause (IV), by striking the semicolon and 
     inserting ``; and'';
       (II) in subclause (V), by striking ``2018 is 90 percent; 
     and'' and inserting ``2018 and each subsequent year through 
     2023 is 90 percent.''; and
       (III) by striking subclause (VI).

                                 ______
                                 
  SA 265. Mr. McCAIN submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       Beginning on page 61, strike line 15 and all that follows 
     through page 62, line 13, and insert the following:
       ``(3) Applicable annual inflation factor.--In paragraph 
     (2), the term `applicable annual inflation factor' means, for 
     a fiscal year--
       ``(A) for each of the 1903A enrollee categories described 
     in subparagraphs (C), (D), and (E) of subsection (e)(2), the 
     percentage increase in the medical care component of the 
     consumer price index for all urban consumers (U.S. city 
     average) from September of the previous fiscal year to 
     September of the fiscal year involved, plus 1 percentage 
     point; and
       ``(B) for each of the 1903A enrollee categories described 
     in subparagraphs (A) and (B) of subsection (e)(2), the 
     percentage increase in the medical care component of the 
     consumer price index for all urban consumers (U.S. city 
     average) from September of the previous fiscal year to 
     September of the fiscal year involved, plus 2 percentage 
     points.
                                 ______
                                 
  SA 266. Mr. McCAIN submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 40, strike lines 1 through 19 and insert the 
     following:
       ``(E) 90 percent for calendar quarters in 2020;
       ``(F) 88 percent for calendar quarters in 2021;
       ``(G) 86 percent for calendar quarters in 2022;
       ``(H) 84 percent for calendar quarters in 2023;
       ``(I) 82 percent for calendar quarters in 2024;
       ``(J) 80 percent for calendar quarters in 2025;
       ``(K) 78 percent for calendar quarters in 2026;
       ``(L) 76 percent for calendar quarters in 2027;
       ``(M) 74 percent for calendar quarters in 2028; and
       ``(N) 72 percent for calendar quarters in 2029.''; and
       (iv) by adding after and below subparagraph (H) (as added 
     by clause (iii)), the following flush sentence:

     ``The Federal medical assistance percentage determined for a 
     State and year under subsection (b) shall apply to 
     expenditures for medical assistance to newly eligible 
     individuals (as so described) and expansion enrollees (as so 
     defined), in the case of a State that has elected to cover 
     newly eligible individuals before March 1, 2017, for calendar 
     quarters after 2029, and, in the case of any other State, for 
     calendar quarters (or portions of calendar quarters) after 
     February 28, 2017.''; and
                                 ______
                                 
  SA 267. Mr. McCONNELL proposed an amendment to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; as follows:


[[Page S4198]]


  

       Strike all after the first word and insert the following:

     1. SHORT TITLE.

       This Act may be cited as the ``Obamacare Repeal 
     Reconciliation Act of 2017''.

                                TITLE I

     SEC. 101. RECAPTURE EXCESS ADVANCE PAYMENTS OF PREMIUM TAX 
                   CREDITS.

       Subparagraph (B) of section 36B(f)(2) of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new clause:
       ``(iii) Nonapplicability of limitation.--This subparagraph 
     shall not apply to taxable years ending after December 31, 
     2017, and before January 1, 2020.''.

     SEC. 102. PREMIUM TAX CREDIT.

       (a) Premium Tax Credit.--
       (1) Repeal.--
       (A) In general.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     striking section 36B.
       (B) Effective date.--The amendment made by this paragraph 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Repeal of Eligibility Determinations.--
       (1) In general.--The following sections of the Patient 
     Protection and Affordable Care Act are repealed:
       (A) Section 1411 (other than subsection (i), the last 
     sentence of subsection (e)(4)(A)(ii), and such provisions of 
     such section solely to the extent related to the application 
     of the last sentence of subsection (e)(4)(A)(ii)).
       (B) Section 1412.
       (2) Effective date.--The repeals in paragraph (1) shall 
     take effect on January 1, 2020.
       (c) Protecting Americans by Repeal of Disclosure Authority 
     To Carry Out Eligibility Requirements for Certain Programs.--
       (1) In general.--Paragraph (21) of section 6103(l) of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new subparagraph:
       ``(D) Termination.--No disclosure may be made under this 
     paragraph after December 31, 2019.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect on January 1, 2020.

     SEC. 103. SMALL BUSINESS TAX CREDIT.

       (a) Sunset.--
       (1) In general.--Section 45R of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(j) Shall Not Apply.--This section shall not apply with 
     respect to amounts paid or incurred in taxable years 
     beginning after December 31, 2019.''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2019.

     SEC. 104. INDIVIDUAL MANDATE.

       (a) In General.--Section 5000A(c) of the Internal Revenue 
     Code of 1986 is amended--
       (1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' 
     and inserting ``Zero percent'', and
       (2) in paragraph (3)--
       (A) by striking ``$695'' in subparagraph (A) and inserting 
     ``$0'', and
       (B) by striking subparagraph (D).
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 105. EMPLOYER MANDATE.

       (a) In General.--
       (1) Paragraph (1) of section 4980H(c) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$2,000''.
       (2) Paragraph (1) of section 4980H(b) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$3,000''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 106. FEDERAL PAYMENTS TO STATES.

       (a) In General.--Notwithstanding section 504(a), 
     1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 
     2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 
     1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 1397bb(a)(7), 
     1397ee(a)(1)), or the terms of any Medicaid waiver in effect 
     on the date of enactment of this Act that is approved under 
     section 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n), for the 1-year period beginning on the date of 
     enactment of this Act, no Federal funds provided from a 
     program referred to in this subsection that is considered 
     direct spending for any year may be made available to a State 
     for payments to a prohibited entity, whether made directly to 
     the prohibited entity or through a managed care organization 
     under contract with the State.
       (b) Definitions.--In this section:
       (1) Prohibited entity.--The term ``prohibited entity'' 
     means an entity, including its affiliates, subsidiaries, 
     successors, and clinics--
       (A) that, as of the date of enactment of this Act--
       (i) is an organization described in section 501(c)(3) of 
     the Internal Revenue Code of 1986 and exempt from tax under 
     section 501(a) of such Code;
       (ii) is an essential community provider described in 
     section 156.235 of title 45, Code of Federal Regulations (as 
     in effect on the date of enactment of this Act), that is 
     primarily engaged in family planning services, reproductive 
     health, and related medical care; and
       (iii) provides for abortions, other than an abortion--

       (I) if the pregnancy is the result of an act of rape or 
     incest; or
       (II) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness that would, as 
     certified by a physician, place the woman in danger of death 
     unless an abortion is performed, including a life-endangering 
     physical condition caused by or arising from the pregnancy 
     itself; and

       (B) for which the total amount of Federal and State 
     expenditures under the Medicaid program under title XIX of 
     the Social Security Act in fiscal year 2014 made directly to 
     the entity and to any affiliates, subsidiaries, successors, 
     or clinics of the entity, or made to the entity and to any 
     affiliates, subsidiaries, successors, or clinics of the 
     entity as part of a nationwide health care provider network, 
     exceeded $1,000,000.
       (2) Direct spending.--The term ``direct spending'' has the 
     meaning given that term under section 250(c) of the Balanced 
     Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 
     900(c)).

     SEC. 107. MEDICAID.

       The Social Security Act (42 U.S.C. 301 et seq.) is 
     amended--
       (1) in section 1902--
       (A) in subsection (a)(10)(A), in each of clauses (i)(VIII) 
     and (ii)(XX), by inserting ``and ending December 31, 2019,'' 
     after ``January 1, 2014,''; and
       (B) in subsection (a)(47)(B), by inserting ``and provided 
     that any such election shall cease to be effective on January 
     1, 2020, and no such election shall be made after that date'' 
     before the semicolon at the end;
       (2) in section 1905--
       (A) in the first sentence of subsection (b), by inserting 
     ``(50 percent on or after January 1, 2020)'' after ``55 
     percent'';
       (B) in subsection (y)(1), by striking the semicolon at the 
     end of subparagraph (D) and all that follows through 
     ``thereafter''; and
       (C) in subsection (z)(2)--
       (i) in subparagraph (A), by inserting ``through 2019'' 
     after ``each year thereafter''; and
       (ii) in subparagraph (B)(ii)(VI), by striking ``and each 
     subsequent year'';
       (3) in section 1915(k)(2), by striking ``during the period 
     described in paragraph (1)'' and inserting ``on or after the 
     date referred to in paragraph (1) and before January 1, 
     2020'';
       (4) in section 1920(e), by adding at the end the following: 
     ``This subsection shall not apply after December 31, 2019.'';
       (5) in section 1937(b)(5), by adding at the end the 
     following: ``This paragraph shall not apply after December 
     31, 2019.''; and
       (6) in section 1943(a), by inserting ``and before January 
     1, 2020,'' after ``January 1, 2014,''.

     SEC. 108. REPEAL OF DSH ALLOTMENT REDUCTIONS.

       Section 1923(f) of the Social Security Act (42 U.S.C. 
     1396r-4(f)) is amended by striking paragraphs (7) and (8).

     SEC. 109. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE 
                   PREMIUMS AND HEALTH PLAN BENEFITS.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986 is amended by striking section 4980I.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     2019.
       (c) Subsequent Effective Date.--The amendment made by 
     subsection (a) shall not apply to taxable years beginning 
     after December 31, 2025, and chapter 43 of the Internal 
     Revenue Code of 1986 is amended to read as such chapter would 
     read if such subsection had never been enacted.

     SEC. 110. REPEAL OF TAX ON OVER-THE-COUNTER MEDICATIONS.

       (a) HSAs.--Subparagraph (A) of section 223(d)(2) of the 
     Internal Revenue Code of 1986 is amended by striking ``Such 
     term'' and all that follows through the period.
       (b) Archer MSAs.--Subparagraph (A) of section 220(d)(2) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``Such term'' and all that follows through the period.
       (c) Health Flexible Spending Arrangements and Health 
     Reimbursement Arrangements.--Section 106 of the Internal 
     Revenue Code of 1986 is amended by striking subsection (f).
       (d) Effective Dates.--
       (1) Distributions from savings accounts.--The amendments 
     made by subsections (a) and (b) shall apply to amounts paid 
     with respect to taxable years beginning after December 31, 
     2016.
       (2) Reimbursements.--The amendment made by subsection (c) 
     shall apply to expenses incurred with respect to taxable 
     years beginning after December 31, 2016.

     SEC. 111. REPEAL OF TAX ON HEALTH SAVINGS ACCOUNTS.

       (a) HSAs.--Section 223(f)(4)(A) of the Internal Revenue 
     Code of 1986 is amended by striking ``20 percent'' and 
     inserting ``10 percent''.
       (b) Archer MSAs.--Section 220(f)(4)(A) of the Internal 
     Revenue Code of 1986 is amended by striking ``20 percent'' 
     and inserting ``15 percent''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to distributions made after December 31, 2016.

     SEC. 112. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO FLEXIBLE 
                   SPENDING ACCOUNTS.

       (a) In General.--Section 125 of the Internal Revenue Code 
     of 1986 is amended by striking subsection (i).
       (b) Effective Date.--The amendment made by this section 
     shall apply to plan years beginning after December 31, 2017.

[[Page S4199]]

  


     SEC. 113. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS.

       Subsection (j) of section 9008 of the Patient Protection 
     and Affordable Care Act is amended to read as follows:
       ``(j) Repeal.--This section shall apply to calendar years 
     beginning after December 31, 2010, and ending before January 
     1, 2018.''.

     SEC. 114. REPEAL OF MEDICAL DEVICE EXCISE TAX.

       Section 4191 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new subsection:
       ``(d) Applicability.--The tax imposed under subsection (a) 
     shall not apply to sales after December 31, 2017.''.

     SEC. 115. REPEAL OF HEALTH INSURANCE TAX.

       Subsection (j) of section 9010 of the Patient Protection 
     and Affordable Care Act is amended by striking ``, and'' at 
     the end of paragraph (1) and all that follows through 
     ``2017''.

     SEC. 116. REPEAL OF ELIMINATION OF DEDUCTION FOR EXPENSES 
                   ALLOCABLE TO MEDICARE PART D SUBSIDY.

       (a) In General.--Section 139A of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     sentence: ``This section shall not be taken into account for 
     purposes of determining whether any deduction is allowable 
     with respect to any cost taken into account in determining 
     such payment.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 117. REPEAL OF CHRONIC CARE TAX.

       (a) In General.--Subsection (a) of section 213 of the 
     Internal Revenue Code of 1986 is amended by striking ``10 
     percent'' and inserting ``7.5 percent''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 118. REPEAL OF MEDICARE TAX INCREASE.

       (a) In General.--Subsection (b) of section 3101 of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(b) Hospital Insurance.--In addition to the tax imposed 
     by the preceding subsection, there is hereby imposed on the 
     income of every individual a tax equal to 1.45 percent of the 
     wages (as defined in section 3121(a)) received by such 
     individual with respect to employment (as defined in section 
     3121(b).''.
       (b) SECA.--Subsection (b) of section 1401 of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(b) Hospital Insurance.--In addition to the tax imposed 
     by the preceding subsection, there shall be imposed for each 
     taxable year, on the self-employment income of every 
     individual, a tax equal to 2.9 percent of the amount of the 
     self-employment income for such taxable year.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to remuneration received after, and 
     taxable years beginning after, December 31, 2017.

     SEC. 119. REPEAL OF TANNING TAX.

       (a) In General.--The Internal Revenue Code of 1986 is 
     amended by striking chapter 49.
       (b) Effective Date.--The amendment made by this section 
     shall apply to services performed after September 30, 2017.

     SEC. 120. REPEAL OF NET INVESTMENT TAX.

       (a) In General.--Subtitle A of the Internal Revenue Code of 
     1986 is amended by striking chapter 2A.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 121. REMUNERATION.

       Paragraph (6) of section 162(m) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(I) Termination.--This paragraph shall not apply to 
     taxable years beginning after December 31, 2016.''.

                                TITLE II

     SEC. 201. THE PREVENTION AND PUBLIC HEALTH FUND.

       Subsection (b) of section 4002 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 300u-11) is amended--
       (1) in paragraph (3), by striking ``each of fiscal years 
     2018 and 2019'' and inserting ``fiscal year 2018''; and
       (2) by striking paragraphs (4) through (8).

     SEC. 202. SUPPORT FOR STATE RESPONSE TO SUBSTANCE ABUSE 
                   PUBLIC HEALTH CRISIS AND URGENT MENTAL HEALTH 
                   NEEDS.

       (a) In General.--There are authorized to be appropriated, 
     and are appropriated, out of monies in the Treasury not 
     otherwise obligated, $750,000,000 for each of fiscal years 
     2018 and 2019, to the Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') to award 
     grants to States to address the substance abuse public health 
     crisis or to respond to urgent mental health needs within the 
     State. In awarding grants under this section, the Secretary 
     may give preference to States with an incidence or prevalence 
     of substance use disorders that is substantial relative to 
     other States or to States that identify mental health needs 
     within their communities that are urgent relative to such 
     needs of other States. Funds appropriated under this 
     subsection shall remain available until expended.
       (b) Use of Funds.--Grants awarded to a State under 
     subsection (a) shall be used for one or more of the following 
     public health-related activities:
       (1) Improving State prescription drug monitoring programs.
       (2) Implementing prevention activities, and evaluating such 
     activities to identify effective strategies to prevent 
     substance abuse.
       (3) Training for health care practitioners, such as best 
     practices for prescribing opioids, pain management, 
     recognizing potential cases of substance abuse, referral of 
     patients to treatment programs, and overdose prevention.
       (4) Supporting access to health care services provided by 
     Federally certified opioid treatment programs or other 
     appropriate health care providers to treat substance use 
     disorders or mental health needs.
       (5) Other public health-related activities, as the State 
     determines appropriate, related to addressing the substance 
     abuse public health crisis or responding to urgent mental 
     health needs within the State.

     SEC. 203. COMMUNITY HEALTH CENTER PROGRAM.

       Effective as if included in the enactment of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10, 129 Stat. 87), paragraph (1) of section 221(a) of such 
     Act is amended by inserting ``, and an additional 
     $422,000,000 for fiscal year 2017'' after ``2017''.

     SEC. 204. FUNDING FOR COST-SHARING PAYMENTS.

       There is appropriated to the Secretary of Health and Human 
     Services, out of any money in the Treasury not otherwise 
     appropriated, such sums as may be necessary for payments for 
     cost-sharing reductions authorized by the Patient Protection 
     and Affordable Care Act (including adjustments to any prior 
     obligations for such payments) for the period beginning on 
     the date of enactment of this Act and ending on December 31, 
     2019. Notwithstanding any other provision of this Act, 
     payments and other actions for adjustments to any obligations 
     incurred for plan years 2018 and 2019 may be made through 
     December 31, 2020.

     SEC. 205. REPEAL OF COST-SHARING SUBSIDY PROGRAM.

       (a) In General.--Section 1402 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18071) is repealed.
       (b) Effective Date.--The repeal made by subsection (a) 
     shall apply to cost-sharing reductions (and payments to 
     issuers for such reductions) for plan years beginning after 
     December 31, 2019.
                                 ______
                                 
  SA 268. Mr. WHITEHOUSE submitted an amendment intended to be proposed 
by him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. MEDICAL BANKRUPTCY FAIRNESS.

       (a) Definitions.--
       (1) In general.--Section 101 of title 11, United States 
     Code, is amended--
       (A) by inserting after paragraph (39A) the following:
       ``(39B) The term `medical debt' means any debt incurred 
     voluntarily or involuntarily--
       ``(A) as a result of the diagnosis, cure, mitigation, or 
     treatment of injury, deformity, or disease of an individual; 
     or
       ``(B) for services performed by a medical professional in 
     the prevention of disease or illness of an individual.
       ``(39C) The term `medically distressed debtor' means--
       ``(A) a debtor who, during the 3 years before the date of 
     the filing of the petition--
       ``(i) incurred or paid aggregate medical debts for the 
     debtor, a dependent of the debtor, or a nondependent parent, 
     grandparent, sibling, child, grandchild, or spouse of the 
     debtor that were not paid by any third-party payor and were 
     greater than the lesser of--

       ``(I) 10 percent of the debtor's adjusted gross income (as 
     such term is defined in section 62 of the Internal Revenue 
     Code of 1986); or
       ``(II) $10,000;

       ``(ii) did not receive domestic support obligations, or had 
     a spouse or dependent who did not receive domestic support 
     obligations, of at least $10,000 due to a medical issue of 
     the person obligated to pay that would cause the obligor to 
     meet the requirements under clause (i) or (iii), if the 
     obligor was a debtor in a case under this title; or
       ``(iii) experienced a change in employment status that 
     resulted in a reduction in wages, salaries, commissions, or 
     work hours or resulted in unemployment due to--

       ``(I) an injury, deformity, or disease of the debtor; or
       ``(II) care for an injured, deformed, or ill dependent or 
     nondependent parent, grandparent, sibling, child, grandchild, 
     or spouse of the debtor; or

       ``(B) a debtor who is the spouse of a debtor described in 
     subparagraph (A).''.
       (2) Conforming amendments.--Section 104 of title 11, United 
     States Code, is amended--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by inserting ``101(39C)(A),'' after ``101(19)(A),''; and
       (B) in subsection (b), by inserting ``101(39C)(A),'' after 
     ``101(19)(A),''.
       (b) Exemptions.--
       (1) Exempt property.--Section 522 of title 11, United 
     States Code, is amended by adding at the end the following:
       ``(r)(1) If a medically distressed debtor exempts property 
     listed in subsection (b)(2), the debtor may, in lieu of the 
     exemption provided under subsection (d)(1), elect to exempt

[[Page S4200]]

     the debtor's aggregate interest, not to exceed $250,000 in 
     value, in property described in paragraph (3) of this 
     subsection.
       ``(2) If a medically distressed debtor exempts property 
     listed in subsection (b)(3) and the exemption provided under 
     applicable law specifically for the kind of property 
     described in paragraph (3) is for less than $250,000 in 
     value, the debtor may elect to exempt the debtor's aggregate 
     interest, not to exceed $250,000 in value, in any such 
     property.
       ``(3) The property described in this paragraph is--
       ``(A) real property or personal property that the debtor or 
     a dependent of the debtor uses as a residence;
       ``(B) a cooperative that owns property that the debtor or a 
     dependent of the debtor uses as a residence; or
       ``(C) a burial plot for the debtor or a dependent of the 
     debtor.''.
       (2) Conforming amendments.--Section 104 of title 11, United 
     States Code, is amended--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by inserting ``522(r),'' after ``522(q),''; and
       (B) in subsection (b), by inserting ``522(r),'' after 
     ``522(q),''.
       (c) Waiver of Administrative Requirements.--
       (1) Case under chapter 7.--Section 707(b) of title 11, 
     United States Code, is amended by adding at the end the 
     following:
       ``(8) Paragraph (2) does not apply in any case in which the 
     debtor is a medically distressed debtor.''.
       (2) Case under chapter 13.--Section 1325(b)(1) of title 11, 
     United States Code, is amended--
       (A) in subparagraph (A), by striking ``or'' at the end;
       (B) in subparagraph (B), by striking the period at the end 
     and inserting ``; or''; and
       (C) by adding at the end the following:
       ``(C) the debtor is a medically distressed debtor.''.
       (d) Credit Counseling.--Section 109(h)(4) of title 11, 
     United States Code, is amended by inserting ``a medically 
     distressed debtor or'' after ``apply with respect to''.
       (e) Student Loan Undue Hardship.--Section 523(a)(8) of 
     title 11, United States Code, is amended by inserting ``the 
     debtor is a medically distressed debtor or'' before 
     ``excepting''.
       (f) Attestation by Debtor.--Section 521 of title 11, United 
     States Code, is amended by adding at the end the following:
       ``(k) If the debtor seeks relief as a medically distressed 
     debtor, the debtor shall file a statement of medical expenses 
     relevant to the determination of whether the debtor is a 
     medically distressed debtor, which statement shall declare 
     under penalty of perjury that such medical expenses were not 
     incurred for the purpose of bringing the debtor within the 
     meaning of the term medically distressed debtor.''.
       (g) Effective Date; Application of Amendments.--
       (1) Effective date.--Except as provided in paragraph (2), 
     this section and the amendments made by this section shall 
     take effect on the date of enactment of this Act.
       (2) Application of amendments.--The amendments made by this 
     section shall apply only with respect to cases commenced 
     under title 11, United States Code, on or after the date of 
     enactment of this Act.
                                 ______
                                 
  SA 269. Mr. REED (for himself, Mr. Rounds, Mr. Brown, Ms. Collins, 
Mr. Carper, Mr. Coons, Mr. Whitehouse, Mrs. Shaheen, Ms. Cortez Masto, 
and Ms. Hirono) submitted an amendment intended to be proposed by him 
to the bill H.R. 2810, to authorize appropriations for fiscal year 2018 
for military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the appropriate place in Subtitle B of title II, insert 
     the following:

     SEC. ___. REAUTHORIZATION OF DEPARTMENT OF DEFENSE 
                   ESTABLISHED PROGRAM TO STIMULATE COMPETITIVE 
                   RESEARCH.

       (a) Modification of Program Objectives.--Subsection (b) of 
     section 257 of the National Defense Authorization Act for 
     Fiscal Year 1995 (Public Law 103-337; 10 U.S.C. 2358 note) is 
     amended--
       (1) by redesignating paragraphs (1) and (2) as paragraphs 
     (2) and (3), respectively;
       (2) by inserting before paragraph (2), as redesignated by 
     paragraph (1), the following new paragraph (1):
       ``(1) To increase the number of university researchers in 
     eligible States capable of performing science and engineering 
     research responsive to the needs of the Department of 
     Defense.''; and
       (3) in paragraph (2), as redesignated by paragraph (1), by 
     inserting ``relevant to the mission of the Department of 
     Defense and'' after ``that is''.
       (b) Modification of Program Activities.--Subsection (c) of 
     such section is amended--
       (1) by redesignating paragraph (3) as paragraph (4); and
       (2) by inserting after paragraph (2) the following new 
     paragraph (3):
       ``(3) To provide assistance to science and engineering 
     researchers at institutions of higher education in eligible 
     States through collaboration between Department of Defense 
     laboratories and such researchers.''.
       (c) Modification of Eligibility Criteria for State 
     Participation.--Subsection (d) of such section is amended--
       (1) in paragraph (2)(B), by inserting ``in areas relevant 
     to the mission of the Department of Defense'' after 
     ``programs''; and
       (2) by adding at the end the following new paragraph:
       ``(3) The Under Secretary shall not remove a designation of 
     a State under paragraph (2) because the State exceeds the 
     funding levels specified under subparagraph (A) of such 
     paragraph unless the State has exceeded such funding levels 
     for at least two consecutive years.''.
       (d) Modification of Name.--
       (1) In general.--Such section is amended--
       (A) in subsections (a) and (e) by striking ``Experimental'' 
     each place it appears and inserting ``Established''; and
       (B) in the section heading, by striking ``experimental'' 
     and inserting ``established''.
       (2) Clerical amendment.--Such Act is amended, in the table 
     of contents in section 2(b), by striking the item relating to 
     section 257 and inserting the following new item:

``Sec. 257. Defense established program to stimulate competitive 
              research.''.
       (3) Conforming amendment.--Section 307 of the 1997 
     Emergency Supplemental Appropriations Act for Recovery from 
     Natural Disasters, and for Overseas Peacekeeping Efforts, 
     Including Those in Bosnia (Public Law 105-18) is amended by 
     striking ``Experimental'' and inserting ``Established''.
                                 ______
                                 
  SA 270. Mr. McCONNELL proposed an amendment to amendment SA 267 
proposed by Mr. McConnell to the bill H.R. 1628, to provide for 
reconciliation pursuant to title II of the concurrent resolution on the 
budget for fiscal year 2017; as follows:

       Strike all after line one and insert the following:
       This Act may be cited as the ``Better Care Reconciliation 
     Act of 2017''.

                                TITLE I

     SEC. 101. ELIMINATION OF LIMITATION ON RECAPTURE OF EXCESS 
                   ADVANCE PAYMENTS OF PREMIUM TAX CREDITS.

       Subparagraph (B) of section 36B(f)(2) of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new clause:
       ``(iii) Nonapplicability of limitation.--This subparagraph 
     shall not apply to taxable years ending after December 31, 
     2017.''.

     SEC. 102. RESTRICTIONS FOR THE PREMIUM TAX CREDIT.

       (a) Eligibility for Credit.--
       (1) In general.--Section 36B(c)(1) of the Internal Revenue 
     Code of 1986 is amended--
       (A) by striking ``equals or exceeds 100 percent but does 
     not exceed 400 percent'' in subparagraph (A) and inserting 
     ``does not exceed 350 percent'', and
       (B) by striking subparagraph (B) and redesignating 
     subparagraphs (C) and (D) as subparagraphs (B) and (C), 
     respectively.
       (2) Treatment of certain aliens.--
       (A) In general.--Paragraph (2) of section 36B(e) of the 
     Internal Revenue Code of 1986 is amended by striking ``an 
     alien lawfully present in the United States'' and inserting 
     ``a qualified alien (within the meaning of section 431 of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996)''.
       (B) Amendments to patient protection and affordable care 
     act.--
       (i) Section 1411(a)(1) of the Patient Protection and 
     Affordable Care Act is amended by striking ``or an alien 
     lawfully present in the United States'' and inserting ``or a 
     qualified alien (within the meaning of section 431 of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996)''.
       (ii) Section 1411(c)(2)(B) of such Act is amended by 
     striking ``an alien lawfully present in the United States'' 
     each place it appears in clauses (i)(I) and (ii)(II) and 
     inserting ``a qualified alien (within the meaning of section 
     431 of the Personal Responsibility and Work Opportunity 
     Reconciliation Act of 1996)''.
       (iii) Section 1412(d) of such Act is amended--

       (I) by striking ``not lawfully present in the United 
     States'' and inserting ``not citizens or nationals of the 
     United States or qualified aliens (within the meaning of 
     section 431 of the Personal Responsibility and Work 
     Opportunity Reconciliation Act of 1996)'', and
       (II) by striking ``Individuals Not Lawfully Present'' in 
     the heading and inserting ``Certain Aliens''.

       (b) Modification of Limitation on Premium Assistance 
     Amount.--
       (1) Use of benchmark plan.--
       (A) In general.--Section 36B(b) of the Internal Revenue 
     Code of 1986 is amended--
       (i) by striking ``applicable second lowest cost silver 
     plan'' each place it appears in paragraph (2)(B)(i) and 
     (3)(C) and inserting ``applicable median cost benchmark 
     plan'',
       (ii) by striking ``such silver plan'' in paragraph (3)(C) 
     and inserting ``such benchmark plan'', and
       (iii) in paragraph (3)(B)--

       (I) by redesignating clauses (i) and (ii) as clauses (iii) 
     and (iv), respectively, and by striking all that precedes 
     clause (iii) (as so redesignated) and inserting the 
     following:

       ``(B) Applicable median cost benchmark plan.--The 
     applicable median cost benchmark plan with respect to any 
     applicable taxpayer is the qualified health plan offered

[[Page S4201]]

     in the individual market in the rating area in which the 
     taxpayer resides which--
       ``(i) provides a level of coverage that is designed to 
     provide benefits that are actuarially equivalent to 58 
     percent of the full actuarial value of the benefits (as 
     determined under rules similar to the rules of paragraphs (2) 
     and (3) of section 1302(d) of the Patient Protection and 
     Affordable Care Act) provided under the plan,
       ``(ii) has a premium which is the median premium of all 
     qualified health plans described in clause (i) which are 
     offered in the individual market in such rating area (or, in 
     any case in which no such plan has such median premium, has a 
     premium nearest (but not in excess of) such median 
     premium),'', and

       (II) by striking ``clause (ii)(I)'' in the flush text at 
     the end and inserting ``clause (iv)(I)''.

       (B) Waiver of actuarial value standard for benchmark 
     plans.--Section 36B(b)(3)(B) of the Internal Revenue Code of 
     1986, as amended by subparagraph (A), is amended by adding at 
     the end the following new sentence: ``If, for any plan year 
     before 2027, the Secretary of the Treasury, in consultation 
     with the Secretary of Health and Human Services, determines 
     that there will be no plan offered in a rating area in the 
     individual market that meets the level of coverage described 
     in clause (i), the Secretary of the Treasury may increase the 
     58 percent amount in such clause.''.
       (2) Modification of applicable percentage.--Section 
     36B(b)(3)(A) of the Internal Revenue Code of 1986 is 
     amended--
       (A) in clause (i), by striking ``from the initial premium 
     percentage'' and all that follows and inserting ``from the 
     initial percentage to the final percentage specified in such 
     table for such income tier with respect to a taxpayer of the 
     age involved:


------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  ``In the case of              Up to Age 29                         Age 30-39                          Age 40-49                         Age 50-59                        Over Age 59
  household income  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  (expressed as a
   percent of the
   poverty line)
     within the          Initial %          Final %          Initial %         Final %         Initial %         Final %         Initial %         Final %         Initial %         Final %
  following income
       tier:
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Up to 100%           2...............  2...............  2...............  2..............  2..............  2..............  2..............  2..............  2..............  2
100%-133%            2...............  2.5.............  2...............  2.5............  2..............  2.5............  2..............  2.5............  2..............  2.5
133%-150%            2.5.............  4...............  2.5.............  4..............  2.5............  4..............  2.5............  4..............  2.5............  4
150%-200%            4...............  4.3.............  4...............  5.3............  4..............  6.3............  4..............  7.3............  4..............  8.3
200%-250%            4.3.............  4.3.............  5.3.............  5.9............  6.3............  8.05...........  7.3............  9..............  8.3............  10
250%-300%            4.3.............  4.3.............  5.9.............  5.9............  8.05...........  8.35...........  9..............  10.5...........  10.............  11.5
300%-350%            4.3.............  6.4.............  5.9.............  8.9............  8.35...........  12.5...........  10.5...........  15.8...........  11.5...........  16.2'',
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

       (B) by striking ``0.504'' in clause (ii)(III) and inserting 
     ``0.4'', and
       (C) by adding at the end the following new clause:
       ``(iii) Age determinations.--For purposes of clause (i), 
     the age of the taxpayer taken into account under clause (i) 
     with respect to any taxable year is the age attained before 
     the close of the taxable year by the oldest individual taken 
     into account on such taxpayer's return who is covered by a 
     qualified health plan taken into account under paragraph 
     (2)(A).''.
       (c) Elimination of Eligibility Exceptions for Employer-
     sponsored Coverage.--
       (1) In general.--Section 36B(c)(2) of the Internal Revenue 
     Code of 1986 is amended by striking subparagraph (C).
       (2) Amendments related to qualified small employer health 
     reimbursement arrangements.--Section 36B(c)(4) of such Code 
     is amended--
       (A) by striking ``which constitutes affordable coverage'' 
     in subparagraph (A), and
       (B) by striking subparagraphs (B), (C), (E), and (F) and 
     redesignating subparagraph (D) as subparagraph (B).
       (d) Modifications to Definition of Qualified Health Plan.--
       (1) In general.--Section 36B(c)(3)(A) of the Internal 
     Revenue Code of 1986 is amended by inserting at the end the 
     following new sentence: ``Such term shall not include a plan 
     that includes coverage for abortions (other than any abortion 
     necessary to save the life of the mother or any abortion with 
     respect to a pregnancy that is the result of an act of rape 
     or incest).''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2017.
       (e) Allowance of Credit for Catastrophic Plans.--Section 
     36B(c)(3)(A) of the Internal Revenue Code of 1986, as amended 
     by this Act, is amended by striking ``, except that such term 
     shall not include a qualified health plan that is a 
     catastrophic plan described in section 1302(e) of such Act''.
       (f) Increased Penalty on Erroneous Claims of Credit.--
     Section 6676(a) of the Internal Revenue Code of 1986 is 
     amended by inserting ``(25 percent in the case of a claim for 
     refund or credit relating to the health insurance coverage 
     credit under section 36B)'' after ``20 percent''.
       (g) Effective Date.--Except as otherwise provided in this 
     section, the amendments made by this section shall apply to 
     taxable years beginning after December 31, 2019.

     SEC. 103. MODIFICATIONS TO SMALL BUSINESS TAX CREDIT.

       (a) Sunset.--
       (1) In general.--Section 45R of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(j) Shall Not Apply.--This section shall not apply with 
     respect to amounts paid or incurred in taxable years 
     beginning after December 31, 2019.''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Disallowance of Small Employer Health Insurance Expense 
     Credit for Plan Which Does Not Include Protections for 
     Life.--
       (1) In general.--Subsection (h) of section 45R of the 
     Internal Revenue Code of 1986 is amended--
       (A) by striking ``Any term'' and inserting the following:
       ``(1) In general.--Any term'', and
       (B) by adding at the end the following new paragraph:
       ``(2) Exclusion of certain health plans.--The term 
     `qualified health plan' does not include any health plan that 
     includes coverage for abortions (other than any abortion 
     necessary to save the life of the mother or any abortion with 
     respect to a pregnancy that is the result of an act of rape 
     or incest).''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 104. INDIVIDUAL MANDATE.

       (a) In General.--Section 5000A(c) of the Internal Revenue 
     Code of 1986 is amended--
       (1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' 
     and inserting ``Zero percent'', and
       (2) in paragraph (3)--
       (A) by striking ``$695'' in subparagraph (A) and inserting 
     ``$0'', and
       (B) by striking subparagraph (D).
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 105. EMPLOYER MANDATE.

       (a) In General.--
       (1) Paragraph (1) of section 4980H(c) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$2,000''.
       (2) Paragraph (1) of section 4980H(b) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$3,000''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 106. STATE STABILITY AND INNOVATION PROGRAM.

       (a) In General.--Section 2105 of the Social Security Act 
     (42 U.S.C. 1397ee) is amended by adding at the end the 
     following new subsections:
       ``(h) Short-term Assistance to Address Coverage and Access 
     Disruption and Provide Support for States.--
       ``(1) Appropriation.--There are authorized to be 
     appropriated, and are appropriated, out of monies in the 
     Treasury not otherwise obligated, $15,000,000,000 for each of 
     calendar years 2018 and 2019, and $10,000,000,000 for each of 
     calendar years 2020 and 2021, to the Administrator of the 
     Centers for Medicare & Medicaid Services (in this subsection 
     and subsection (i) referred to as the `Administrator') to 
     fund arrangements with health insurance issuers to assist in 
     the purchase of health benefits coverage by addressing 
     coverage and access disruption and responding to urgent 
     health care needs within States. Funds appropriated under 
     this paragraph shall remain available until expended.
       ``(2) Participation requirements.--
       ``(A) Guidance.--Not later than 30 days after the date of 
     enactment of this subsection, the Administrator shall issue 
     guidance to health insurance issuers regarding how to submit 
     a notice of intent to participate in the program established 
     under this subsection.
       ``(B) Notice of intent to participate.--To be eligible for 
     funding under this subsection, a health insurance issuer 
     shall submit to the Administrator a notice of intent to 
     participate at such time (but, in the case of funding for 
     calendar year 2018, not later than 35 days after the date of 
     enactment of this subsection and, in the case of funding for 
     calendar year 2019, 2020, 2021, 2022, 2023, 2024, 2025, or 
     2026, not later than March 31 of the previous year) and in 
     such form and manner as specified by the Administrator and 
     containing--

[[Page S4202]]

       ``(i) a certification that the health insurance issuer will 
     use the funds in accordance with the requirements of 
     paragraph (5); and
       ``(ii) such information as the Administrator may require to 
     carry out this subsection.
       ``(3) Procedure for distribution of funds.--The 
     Administrator shall determine an appropriate procedure for 
     providing and distributing funds under this subsection that 
     includes reserving an amount equal to 1 percent of the 
     amounts appropriated under paragraph (1) for a calendar year 
     for providing and distributing funds to health insurance 
     issuers in States where the cost of insurance premiums are at 
     least 75 percent higher than the national average.
       ``(4) No match.--Neither the State percentage applicable to 
     payments to States under subsection (i)(5)(B) nor any other 
     matching requirement shall apply to funds provided to health 
     insurance issuers under this subsection.
       ``(5) Use of funds.--Funds provided to a health insurance 
     issuer under paragraph (1) or (6) shall be subject to the 
     requirements of paragraphs (1)(D) and (7) of subsection (i) 
     in the same manner as such requirements apply to States 
     receiving payments under subsection (i) and shall be used 
     only for the activities specified in paragraph (1)(A)(ii) of 
     subsection (i).
       ``(6) Additional support for stabilizing premiums and 
     promoting choice in plans offered in the individual market.--
       ``(A) Appropriation.--In addition to the amounts 
     appropriated under paragraph (1), there is appropriated, out 
     of any money in the Treasury not otherwise obligated, 
     $10,000,000,000 for each of calendar years 2020 through 2026, 
     for the purpose of funding arrangements with health insurance 
     issuers to support the offering of qualified health plans in 
     States in which such issuers also offer coverage in 
     accordance with section 212(a) of the Better Care 
     Reconciliation Act.
       ``(B) Use of funds.--
       ``(i) In general.--The Administrator shall use amounts 
     appropriated under subparagraph (A) to establish a Federal 
     fund for the purpose of providing health insurance coverage 
     by making payments to health insurance issuers that offer a 
     plan in accordance with section 212(a) of the Better Care 
     Reconciliation Act, to assist such health insurance issuers 
     in covering high risk individuals enrolled in qualified 
     health plans through an Exchange in rating areas in which 
     coverage is offered in accordance with section 212(a) of such 
     Act. The Administrator shall determine an appropriate 
     procedure for making such payments.
       ``(ii) Priority uses.--In making payments from the amounts 
     appropriated under subparagraph (A), the Administrator shall 
     prioritize payments--

       ``(I) based on the percentage of rating areas in the State 
     that meet the conditions in section212(b) of such Act; and
       ``(II) to health plans certified under section 212(b)(2) of 
     such Act in States for which paragraphs (1) through (6) of 
     section 212(c) of such Act are not applicable.

       ``(i) Long-Term State Stability and Innovation Program.--
       ``(1) Application and certification requirements.--To be 
     eligible for an allotment of funds under this subsection, a 
     State shall submit to the Administrator an application, not 
     later than March 31, 2018, in the case of allotments for 
     calendar year 2019, and not later than March 31 of the 
     previous year, in the case of allotments for any subsequent 
     calendar year) and in such form and manner as specified by 
     the Administrator, that contains the following:
       ``(A) A description of how the funds will be used to do 1 
     or more of the following:
       ``(i) To establish or maintain a program or mechanism to 
     help high-risk individuals in the purchase of health benefits 
     coverage, including by reducing premium costs for such 
     individuals, who have or are projected to have a high rate of 
     utilization of health services, as measured by cost, and who 
     do not have access to health insurance coverage offered 
     through an employer, enroll in health insurance coverage 
     under a plan offered in the individual market (within the 
     meaning of section 5000A(f)(1)(C) of the Internal Revenue 
     Code of 1986).
       ``(ii) To establish or maintain a program to enter into 
     arrangements with health insurance issuers to assist in the 
     purchase of health benefits coverage by stabilizing premiums 
     and promoting State health insurance market participation and 
     choice in plans offered in the individual market (within the 
     meaning of section 5000A(f)(1)(C) of the Internal Revenue 
     Code of 1986).
       ``(iii) To provide payments for health care providers for 
     the provision of health care services, as specified by the 
     Administrator.
       ``(iv) To provide health insurance coverage by funding 
     assistance to reduce out-of-pocket costs, such as copayments, 
     coinsurance, and deductibles, of individuals enrolled in 
     plans offered in the individual market (within the meaning of 
     section 5000A(f)(1)(C) of the Internal Revenue Code of 1986).
       ``(B) A certification that the State shall make, from non-
     Federal funds, expenditures for 1 or more of the activities 
     specified in subparagraph (A) in an amount that is not less 
     than the State percentage required for the year under 
     paragraph (5)(B)(ii).
       ``(C) A certification that the funds provided under this 
     subsection shall only be used for the activities specified in 
     subparagraph (A).
       ``(D) A certification that none of the funds provided under 
     this subsection shall be used by the State for an expenditure 
     that is attributable to an intergovernmental transfer, 
     certified public expenditure, or any other expenditure to 
     finance the non-Federal share of expenditures required under 
     any provision of law, including under the State plans 
     established under this title and title XIX or under a waiver 
     of such plans.
       ``(E) Such other information as necessary for the 
     Administrator to carry out this subsection.
       ``(2) Eligibility.--Only the 50 States and the District of 
     Columbia shall be eligible for an allotment and payments 
     under this subsection and all references in this subsection 
     to a State shall be treated as only referring to the 50 
     States and the District of Columbia.
       ``(3) One-time application.--If an application of a State 
     submitted under this subsection is approved by the 
     Administrator for a year, the application shall be deemed to 
     be approved by the Administrator for that year and each 
     subsequent year through December 31, 2026.
       ``(4) Long-term state stability and innovation 
     allotments.--
       ``(A) Appropriation; total allotment.--For the purpose of 
     providing allotments to States under this subsection, there 
     is appropriated, out of any money in the Treasury not 
     otherwise appropriated--
       ``(i) for calendar year 2019, $8,000,000,000;
       ``(ii) for calendar year 2020, $29,000,000,000;
       ``(iii) for calendar year 2021, $29,000,000,000;
       ``(iv) for calendar year 2022, $33,200,000,000;
       ``(v) for calendar year 2023, $33,200,000,000;
       ``(vi) for calendar year 2024, $33,200,000,000;
       ``(vii) for calendar year 2025, $33,200,000,000; and
       ``(viii) for calendar year 2026, $33,200,000,000.
       ``(B) Allotments.--
       ``(i) In general.--In the case of a State with an 
     application approved under this subsection with respect to a 
     year, the Administrator shall allot to the State, in 
     accordance with an allotment methodology specified by the 
     Administrator that ensures that the spending requirements in 
     paragraphs (6) are met for the year and that reserves an 
     amount that is at least 1 percent of the amount appropriated 
     under subparagraph (A) for a calendar year for allotments to 
     each State where the cost of insurance premiums are at least 
     75 percent higher than the national average, from amounts 
     appropriated for such year under subparagraph (A), such 
     amount as specified by the Administrator with respect to the 
     State and application and year.
       ``(ii) Annual redistribution of previous year's unused 
     funds.--

       ``(I) In general.-- In carrying out clause (i), with 
     respect to a year (beginning with 2021), the Administrator 
     shall, not later than March 31 of such year--

       ``(aa) determine the amount of funds, if any, remaining 
     unused under subparagraph (A) from the previous year; and
       ``(bb) if the Administrator determines that any funds so 
     remain from the previous year, redistribute such remaining 
     funds in accordance with an allotment methodology specified 
     by the Administrator to States that have submitted an 
     application approved under this subsection for the year.

       ``(II) Applicable state percentage.--The State percentage 
     specified for a year in paragraph (5)(B)(ii) shall apply to 
     funds redistributed under subclause (I) in that year.

       ``(C) Availability of allotted state funds.--
       ``(i) In general.--Amounts allotted to a State pursuant to 
     subparagraph (B)(i) for a year shall remain available for 
     expenditure by the State through the end of the second 
     succeeding year.
       ``(ii) Availability of amounts redistributed.--Amounts 
     redistributed to a State under subparagraph (B)(ii) in a year 
     shall be available for expenditure by the State through the 
     end of the second succeeding year.
       ``(5) Payments.--
       ``(A) Annual payment of allotments.--Subject to 
     subparagraph (B), the Administrator shall pay to each State 
     that has an application approved under this subsection for a 
     year, from the allotment determined under paragraph (4)(B) 
     for the State for the year, an amount equal to the Federal 
     percentage of the State's expenditures for the year.
       ``(B) State expenditures required beginning 2022.--For 
     purposes of subparagraph (A), the Federal percentage is equal 
     to 100 percent reduced by the State percentage for that year, 
     and the State percentage is equal to--
       ``(i) in the case of calendar year 2019, 0 percent;
       ``(ii) in the case of calendar year 2020, 0 percent;
       ``(iii) in the case of calendar year 2021, 0 percent;
       ``(iv) in the case of calendar year 2022, 7 percent;
       ``(v) in the case of calendar year 2023, 14 percent;
       ``(vi) in the case of calendar year 2024, 21 percent;
       ``(vii) in the case of calendar year 2025, 28 percent; and
       ``(viii) in the case of calendar year 2026, 35 percent.
       ``(C) Advance payment; retrospective adjustment.--
       ``(i) In general.--If the Administrator deems it 
     appropriate, the Administrator shall make payments under this 
     subsection for each year on the basis of advance estimates of 
     expenditures submitted by the

[[Page S4203]]

     State and such other investigation as the Administrator shall 
     find necessary, and shall reduce or increase the payments as 
     necessary to adjust for any overpayment or underpayment for 
     prior years.
       ``(ii) Misuse of funds.--If the Administrator determines 
     that a State is not using funds paid to the State under this 
     subsection in a manner consistent with the description 
     provided by the State in its application approved under 
     paragraph (1), the Administrator may withhold payments, 
     reduce payments, or recover previous payments to the State 
     under this subsection as the Administrator deems appropriate.
       ``(D) Flexibility in submittal of claims.--Nothing in this 
     subsection shall be construed as preventing a State from 
     claiming as expenditures in the year expenditures that were 
     incurred in a previous year.
       ``(6) Required uses.--
       ``(A) Premium stabilization and incentives for individual 
     market participation.--In determining allotments for States 
     under this subsection for each of calendar years 2019, 2020, 
     and 2021, the Administrator shall ensure that at least 
     $5,000,000,000 of the amounts appropriated for each such year 
     under paragraph (4)(A) are used by States for the purposes 
     described in paragraph (1)(A)(ii) and in accordance with 
     guidance issued by the Administrator not later than 30 days 
     after the date of enactment of this subsection that specifies 
     the parameters for the use of funds for such purposes.
       ``(B) Assistance with out-of-pocket costs.--In determining 
     allotments for States under this subsection for each of 
     calendar years 2020 through 2026, the Administrator shall 
     ensure that at least $15,000,000,000 of the amounts 
     appropriated for each of calendar years 2020 and 2021 under 
     paragraph (4)(A), and at least $14,000,000,000 of the amounts 
     appropriated for each of calendar years 2022 through 2026 
     under such paragraph, are used by States for the purposes 
     described in paragraph (1)(A)(iv) and in accordance with 
     guidance issued by the Administrator not later than September 
     1, 2019, that specifies the parameters for the use of funds 
     for such purposes.
       ``(7) Exemptions.--Paragraphs (2), (3), (5), (6), (8), 
     (10), and (11) of subsection (c) do not apply to payments 
     under this subsection.''.
       (b) Other Title XXI Amendments.--
       (1) Section 2101 of such Act (42 U.S.C. 1397aa) is 
     amended--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``The purpose'' and inserting ``Except with 
     respect to short-term assistance activities under section 
     2105(h) and the Long-Term State Stability and Innovation 
     Program established in section 2105(i), the purpose''; and
       (B) in subsection (b), in the matter preceding paragraph 
     (1), by inserting ``subsection (a) or (g) of'' before 
     ``section 2105''.
       (2) Section 2105(c)(1) of such Act (42 U.S.C. 1397ee(c)(1)) 
     is amended by striking ``and may not include'' and inserting 
     ``or to carry out short-term assistance activities under 
     subsection (h) or the Long-Term State Stability and 
     Innovation Program established in subsection (i) and, except 
     in the case of funds made available under subsection (h) or 
     (i), may not include''.
       (3) Section 2106(a)(1) of such Act (42 U.S.C. 1397ff(a)(1)) 
     is amended by inserting ``subsection (a) or (g) of'' before 
     ``section 2105''.

     SEC. 107. BETTER CARE RECONCILIATION IMPLEMENTATION FUND.

       (a) In General.--There is hereby established a Better Care 
     Reconciliation Implementation Fund (referred to in this 
     section as the ``Fund'') within the Department of Health and 
     Human Services to provide for Federal administrative expenses 
     in carrying out this Act.
       (b) Funding.--There is appropriated to the Fund, out of any 
     funds in the Treasury not otherwise appropriated, 
     $500,000,000.

     SEC. 108. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE 
                   PREMIUMS AND HEALTH PLAN BENEFITS.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986 is amended by striking section 4980I.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     2019.
       (c) Subsequent Effective Date.--The amendment made by 
     subsection (a) shall not apply to taxable years beginning 
     after December 31, 2025, and chapter 43 of the Internal 
     Revenue Code of 1986 is amended to read as such chapter would 
     read if such subsection had never been enacted.

     SEC. 109. REPEAL OF TAX ON OVER-THE-COUNTER MEDICATIONS.

       (a) HSAs.--Subparagraph (A) of section 223(d)(2) of the 
     Internal Revenue Code of 1986 is amended by striking ``Such 
     term'' and all that follows through the period.
       (b) Archer MSAs.--Subparagraph (A) of section 220(d)(2) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``Such term'' and all that follows through the period.
       (c) Health Flexible Spending Arrangements and Health 
     Reimbursement Arrangements.--Section 106 of the Internal 
     Revenue Code of 1986 is amended by striking subsection (f).
       (d) Effective Dates.--
       (1) Distributions from savings accounts.--The amendments 
     made by subsections (a) and (b) shall apply to amounts paid 
     with respect to taxable years beginning after December 31, 
     2016.
       (2) Reimbursements.--The amendment made by subsection (c) 
     shall apply to expenses incurred with respect to taxable 
     years beginning after December 31, 2016.

     SEC. 110. REPEAL OF TAX ON HEALTH SAVINGS ACCOUNTS.

       (a) HSAs.--Section 223(f)(4)(A) of the Internal Revenue 
     Code of 1986 is amended by striking ``20 percent'' and 
     inserting ``10 percent''.
       (b) Archer MSAs.--Section 220(f)(4)(A) of the Internal 
     Revenue Code of 1986 is amended by striking ``20 percent'' 
     and inserting ``15 percent''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to distributions made after December 31, 2016.

     SEC. 111. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO FLEXIBLE 
                   SPENDING ACCOUNTS.

       (a) In General.--Section 125 of the Internal Revenue Code 
     of 1986 is amended by striking subsection (i).
       (b) Effective Date.--The amendment made by this section 
     shall apply to plan years beginning after December 31, 2017.

     SEC. 112. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS.

       Subsection (j) of section 9008 of the Patient Protection 
     and Affordable Care Act is amended to read as follows:
       ``(j) Repeal.--This section shall apply to calendar years 
     beginning after December 31, 2010, and ending before January 
     1, 2018.''.

     SEC. 113. REPEAL OF MEDICAL DEVICE EXCISE TAX.

       Section 4191 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new subsection:
       ``(d) Applicability.--The tax imposed under subsection (a) 
     shall not apply to sales after December 31, 2017.''.

     SEC. 114. REPEAL OF HEALTH INSURANCE TAX.

       Subsection (j) of section 9010 of the Patient Protection 
     and Affordable Care Act is amended by striking ``, and'' at 
     the end of paragraph (1) and all that follows through 
     ``2017''.

     SEC. 115. REPEAL OF ELIMINATION OF DEDUCTION FOR EXPENSES 
                   ALLOCABLE TO MEDICARE PART D SUBSIDY.

       (a) In General.--Section 139A of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     sentence: ``This section shall not be taken into account for 
     purposes of determining whether any deduction is allowable 
     with respect to any cost taken into account in determining 
     such payment.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 116. REPEAL OF CHRONIC CARE TAX.

       (a) In General.--Subsection (a) of section 213 of the 
     Internal Revenue Code of 1986 is amended by striking ``10 
     percent'' and inserting ``7.5 percent''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 117. REPEAL OF TANNING TAX.

       (a) In General.--The Internal Revenue Code of 1986 is 
     amended by striking chapter 49.
       (b) Effective Date.--The amendment made by this section 
     shall apply to services performed after September 30, 2017.

     SEC. 118. PURCHASE OF INSURANCE FROM HEALTH SAVINGS ACCOUNT.

       (a) Purchase of High Deductible Health Plans.--
       (1) In general.--Paragraph (2) of section 223(d) of the 
     Internal Revenue Code of 1986, as amended by section 109(a), 
     is amended--
       (A) by striking ``and any dependent (as defined in section 
     152, determined without regard to subsections (b)(1), (b)(2), 
     and (d)(1)(B) thereof) of such individual'' in subparagraph 
     (A) and inserting ``any dependent (as defined in section 152, 
     determined without regard to subsections (b)(1), (b)(2), and 
     (d)(1)(B) thereof) of such individual, and any child (as 
     defined in section 152(f)(1)) of such individual who has not 
     attained the age of 27 before the end of such individual's 
     taxable year'',
       (B) by striking subparagraph (B) and inserting the 
     following:
       ``(B) Health insurance may not be purchased from account.--
     Except as provided in subparagraph (C), subparagraph (A) 
     shall not apply to any payment for insurance.'', and
       (C) by striking ``or'' at the end of subparagraph (C)(iii), 
     by striking the period at the end of subparagraph (C)(iv) and 
     inserting ``, or'', and by adding at the end the following:
       ``(v) a high deductible health plan but only to the extent 
     of the portion of such expense in excess of--

       ``(I) any amount allowable as a credit under section 36B 
     for the taxable year with respect to such coverage,
       ``(II) any amount allowable as a deduction under section 
     162(l) with respect to such coverage, or
       ``(III) any amount excludable from gross income with 
     respect to such coverage under section 106 (including by 
     reason of section 125) or 402(l).''.

       (2) Effective date.--The amendments made by this subsection 
     shall apply with respect to amounts paid for expenses 
     incurred for, and distributions made for, coverage under a 
     high deductible health plan beginning after December 31, 
     2017.
       (b) Consumer Freedom Plans.--
       (1) In general.--Section 223(d)(2)(C) of the Internal 
     Revenue Code of 1986, as amended by subsection (a) and 
     section 122, is amended--
       (A) by striking ``or'' at the end of clause (iv), by 
     striking the period at the end of clause (v), and by adding 
     at the end the following:

[[Page S4204]]

       ``(vi) any plan which--

       ``(I) is offered by a health insurance issuer which meets 
     the conditions described in section 212(b) of the Better Care 
     Reconciliation Act of 2017 for the plan year, and
       ``(II) would not be permitted to be offered in the market 
     but for such section.'', and

       (B) by inserting ``or (vi)'' after ``clause (v)'' in the 
     last sentence thereof.
       (2) Effective date.--The amendments made by this subsection 
     shall to taxable years beginning after December 31, 2019.

     SEC. 119. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAVINGS 
                   ACCOUNT INCREASED TO AMOUNT OF DEDUCTIBLE AND 
                   OUT-OF-POCKET LIMITATION.

       (a) Self-Only Coverage.--Section 223(b)(2)(A) of the 
     Internal Revenue Code of 1986 is amended by striking 
     ``$2,250'' and inserting ``the amount in effect under 
     subsection (c)(2)(A)(ii)(I)''.
       (b) Family Coverage.--Section 223(b)(2)(B) of such Code is 
     amended by striking ``$4,500'' and inserting ``the amount in 
     effect under subsection (c)(2)(A)(ii)(II)''.
       (c) Cost-of-living Adjustment.--Section 223(g)(1) of such 
     Code is amended--
       (1) by striking ``subsections (b)(2) and'' both places it 
     appears and inserting ``subsection'', and
       (2) in subparagraph (B), by striking ``determined by'' and 
     all that follows through `` `calendar year 2003'.'' and 
     inserting ``determined by substituting `calendar year 2003' 
     for `calendar year 1992' in subparagraph (B) thereof.''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 120. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS 
                   TO THE SAME HEALTH SAVINGS ACCOUNT.

       (a) In General.--Section 223(b)(5) of the Internal Revenue 
     Code of 1986 is amended to read as follows:
       ``(5) Special rule for married individuals with family 
     coverage.--
       ``(A) In general.--In the case of individuals who are 
     married to each other, if both spouses are eligible 
     individuals and either spouse has family coverage under a 
     high deductible health plan as of the first day of any 
     month--
       ``(i) the limitation under paragraph (1) shall be applied 
     by not taking into account any other high deductible health 
     plan coverage of either spouse (and if such spouses both have 
     family coverage under separate high deductible health plans, 
     only one such coverage shall be taken into account),
       ``(ii) such limitation (after application of clause (i)) 
     shall be reduced by the aggregate amount paid to Archer MSAs 
     of such spouses for the taxable year, and
       ``(iii) such limitation (after application of clauses (i) 
     and (ii)) shall be divided equally between such spouses 
     unless they agree on a different division.
       ``(B) Treatment of additional contribution amounts.--If 
     both spouses referred to in subparagraph (A) have attained 
     age 55 before the close of the taxable year, the limitation 
     referred to in subparagraph (A)(iii) which is subject to 
     division between the spouses shall include the additional 
     contribution amounts determined under paragraph (3) for both 
     spouses. In any other case, any additional contribution 
     amount determined under paragraph (3) shall not be taken into 
     account under subparagraph (A)(iii) and shall not be subject 
     to division between the spouses.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 121. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED 
                   BEFORE ESTABLISHMENT OF HEALTH SAVINGS ACCOUNT.

       (a) In General.--Section 223(d)(2) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(D) Treatment of certain medical expenses incurred before 
     establishment of account.--If a health savings account is 
     established during the 60-day period beginning on the date 
     that coverage of the account beneficiary under a high 
     deductible health plan begins, then, solely for purposes of 
     determining whether an amount paid is used for a qualified 
     medical expense, such account shall be treated as having been 
     established on the date that such coverage begins.''.
       (b) Effective Date.--The amendment made by this subsection 
     shall apply with respect to coverage under a high deductible 
     health plan beginning after December 31, 2017.

     SEC. 122. EXCLUSION FROM HSAS OF HIGH DEDUCTIBLE HEALTH PLANS 
                   WHICH DO NOT INCLUDE PROTECTIONS FOR LIFE.

       (a) In General.--Subparagraph (C) of section 223(d)(2) of 
     the Internal Revenue Code of 1986 is amended by adding at the 
     end the following flush sentence:
     ``A high deductible health plan shall not be treated as 
     described in clause (v) if such plan includes coverage for 
     abortions (other than any abortion necessary to save the life 
     of the mother or any abortion with respect to a pregnancy 
     that is the result of an act of rape or incest).''.
       (b) Effective Date.--The amendment made by this section 
     shall apply with respect to coverage under a high deductible 
     health plan beginning after December 31, 2017.

     SEC. 123. FEDERAL PAYMENTS TO STATES.

       (a) In General.--Notwithstanding section 504(a), 
     1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 
     2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 
     1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 1397bb(a)(7), 
     1397ee(a)(1)), or the terms of any Medicaid waiver in effect 
     on the date of enactment of this Act that is approved under 
     section 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n), for the 1-year period beginning on the date of 
     enactment of this Act, no Federal funds provided from a 
     program referred to in this subsection that is considered 
     direct spending for any year may be made available to a State 
     for payments to a prohibited entity, whether made directly to 
     the prohibited entity or through a managed care organization 
     under contract with the State.
       (b) Definitions.--In this section:
       (1) Prohibited entity.--The term ``prohibited entity'' 
     means an entity, including its affiliates, subsidiaries, 
     successors, and clinics--
       (A) that, as of the date of enactment of this Act--
       (i) is an organization described in section 501(c)(3) of 
     the Internal Revenue Code of 1986 and exempt from tax under 
     section 501(a) of such Code;
       (ii) is an essential community provider described in 
     section 156.235 of title 45, Code of Federal Regulations (as 
     in effect on the date of enactment of this Act), that is 
     primarily engaged in family planning services, reproductive 
     health, and related medical care; and
       (iii) provides for abortions, other than an abortion--

       (I) if the pregnancy is the result of an act of rape or 
     incest; or
       (II) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness that would, as 
     certified by a physician, place the woman in danger of death 
     unless an abortion is performed, including a life-endangering 
     physical condition caused by or arising from the pregnancy 
     itself; and

       (B) for which the total amount of Federal and State 
     expenditures under the Medicaid program under title XIX of 
     the Social Security Act in fiscal year 2014 made directly to 
     the entity and to any affiliates, subsidiaries, successors, 
     or clinics of the entity, or made to the entity and to any 
     affiliates, subsidiaries, successors, or clinics of the 
     entity as part of a nationwide health care provider network, 
     exceeded $350,000,000.
       (2) Direct spending.--The term ``direct spending'' has the 
     meaning given that term under section 250(c) of the Balanced 
     Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 
     900(c)).

     SEC. 124. MEDICAID PROVISIONS.

       The Social Security Act is amended--
       (1) in section 1902(a)(47)(B) (42 U.S.C. 1396a(a)(47)(B)), 
     by inserting ``and provided that any such election shall 
     cease to be effective on January 1, 2020, and no such 
     election shall be made after that date'' before the semicolon 
     at the end;
       (2) in section 1915(k)(2) (42 U.S.C. 1396n(k)(2)), by 
     striking ``during the period described in paragraph (1)'' and 
     inserting ``on or after the date referred to in paragraph (1) 
     and before January 1, 2020''; and
       (3) in section 1920(e) (42 U.S.C. 1396r-1(e)), by striking 
     ``under clause (i)(VIII), clause (i)(IX), or clause (ii)(XX) 
     of subsection (a)(10)(A)'' and inserting ``under clause 
     (i)(VIII) or clause (ii)(XX) of section 1902(a)(10)(A) before 
     January 1, 2020, section 1902(a)(10)(A)(i)(IX),''.

     SEC. 125. MEDICAID EXPANSION.

       (a) In General.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) is amended--
       (1) in section 1902 (42 U.S.C. 1396a)--
       (A) in subsection (a)(10)(A)--
       (i) in clause (i)(VIII), by inserting ``and ending December 
     31, 2019,'' after ``2014,''; and
       (ii) in clause (ii), in subclause (XX), by inserting ``and 
     ending December 31, 2017,'' after ``2014,'', and by adding at 
     the end the following new subclause:
       ``(XXIII) beginning January 1, 2020, who are expansion 
     enrollees (as defined in subsection (nn)(1));''; and
       (B) by adding at the end the following new subsection:
       ``(nn) Expansion Enrollees.--
       ``(1) In general.--In this title, the term `expansion 
     enrollee' means an individual--
       ``(A) who is under 65 years of age;
       ``(B) who is not pregnant;
       ``(C) who is not entitled to, or enrolled for, benefits 
     under part A of title XVIII, or enrolled for benefits under 
     part B of title XVIII;
       ``(D) who is not described in any of subclauses (I) through 
     (VII) of subsection (a)(10)(A)(i); and
       ``(E) whose income (as determined under subsection (e)(14)) 
     does not exceed 133 percent of the poverty line (as defined 
     in section 2110(c)(5)) applicable to a family of the size 
     involved.
       ``(2) Application of related provisions.--Any reference in 
     subsection (a)(10)(G), (k), or (gg) of this section or in 
     section 1903, 1905(a), 1920(e), or 1937(a)(1)(B) to 
     individuals described in subclause (VIII) of subsection 
     (a)(10)(A)(i) shall be deemed to include a reference to 
     expansion enrollees.''; and
       (2) in section 1905 (42 U.S.C. 1396d)--
       (A) in subsection (y)(1)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``, with respect to'' and all that follows through ``shall be 
     equal to'' and inserting ``and that has elected to cover 
     newly eligible individuals before March 1, 2017, with respect 
     to amounts expended by such State before January 1, 2020, for 
     medical assistance for newly eligible individuals

[[Page S4205]]

     described in subclause (VIII) of section 1902(a)(10)(A)(i), 
     and, with respect to amounts expended by such State after 
     December 31, 2019, and before January 1, 2024, for medical 
     assistance for expansion enrollees (as defined in section 
     1902(nn)(1)), shall be equal to the higher of the percentage 
     otherwise determined for the State and year under subsection 
     (b) (without regard to this subsection) and'';
       (ii) in subparagraph (D), by striking ``and'' after the 
     semicolon;
       (iii) by striking subparagraph (E) and inserting the 
     following new subparagraphs:
       ``(E) 90 percent for calendar quarters in 2020;
       ``(F) 85 percent for calendar quarters in 2021;
       ``(G) 80 percent for calendar quarters in 2022; and
       ``(H) 75 percent for calendar quarters in 2023.''; and
       (iv) by adding after and below subparagraph (H) (as added 
     by clause (iii)), the following flush sentence:
     ``The Federal medical assistance percentage determined for a 
     State and year under subsection (b) shall apply to 
     expenditures for medical assistance to newly eligible 
     individuals (as so described) and expansion enrollees (as so 
     defined), in the case of a State that has elected to cover 
     newly eligible individuals before March 1, 2017, for calendar 
     quarters after 2023, and, in the case of any other State, for 
     calendar quarters (or portions of calendar quarters) after 
     February 28, 2017.''; and
       (B) in subsection (z)(2)--
       (i) in subparagraph (A)--

       (I) by inserting ``through 2023'' after ``each year 
     thereafter''; and
       (II) by striking ``shall be equal to'' and inserting ``and, 
     for periods after December 31, 2019 and before January 1, 
     2024, who are expansion enrollees (as defined in section 
     1902(nn)(1)) shall be equal to the higher of the percentage 
     otherwise determined for the State and year under subsection 
     (b) (without regard to this subsection) and''; and

       (ii) in subparagraph (B)(ii)--

       (I) in subclause (III), by adding ``and'' at the end; and
       (II) by striking subclauses (IV), (V), and (VI) and 
     inserting the following new subclause:

       ``(IV) 2017 and each subsequent year through 2023 is 80 
     percent.''.
       (b) Sunset of Medicaid Essential Health Benefits 
     Requirement.--Section 1937(b)(5) of the Social Security Act 
     (42 U.S.C. 1396u-7(b)(5)) is amended by adding at the end the 
     following: ``This paragraph shall not apply after December 
     31, 2019.''.

     SEC. 126. RESTORING FAIRNESS IN DSH ALLOTMENTS.

       Section 1923(f)(7) of the Social Security Act (42 U.S.C. 
     1396r-4(f)(7)) is amended by adding at the end the following 
     new subparagraph:
       ``(C) Non-expansion states.--
       ``(i) In general.--In the case of a State that is a non-
     expansion State for a fiscal year--

       ``(I) subparagraph (A) shall not apply to the DSH allotment 
     for such State and fiscal year; and
       ``(II) the DSH allotment for the State for fiscal year 2020 
     (including for a non-expansion State that has a DSH allotment 
     determined under paragraph (6)) shall be increased by the 
     amount calculated according to clause (iii).

       ``(ii) No change in reduction for expansion states.--In the 
     case of a State that is an expansion State for a fiscal year, 
     the DSH allotment for such State and fiscal year shall be 
     determined as if clause (i) did not apply.
       ``(iii) Amount calculated.--For purposes of clause (i)(II), 
     the amount calculated according to this clause for a non-
     expansion State is the following:

       ``(I) For each State, the Secretary shall calculate a ratio 
     equal to the State's fiscal year 2016 DSH allotment divided 
     by the number of uninsured individuals in the State for such 
     fiscal year (determined on the basis of the most recent 
     information available from the Bureau of the Census).
       ``(II) The Secretary shall identify the States whose ratio 
     as so determined is below the national average of such ratio 
     for all States.
       ``(III) The amount calculated pursuant to this clause is an 
     amount that, if added to the State's fiscal year 2016 DSH 
     allotment, would increase the ratio calculated pursuant to 
     subclause (I) up to the national average for all States.

       ``(iv) Disregard of increase.--The DSH allotment for a non-
     expansion State for the second, third, and fourth quarters of 
     fiscal year 2024 and fiscal years thereafter shall be 
     determined as if there had been no increase in the State's 
     DSH allotment for fiscal year 2020 under clause (i)(II).
       ``(v) Non-expansion and expansion state defined.--In this 
     subparagraph:

       ``(I) The term `expansion State' means with respect to a 
     fiscal year, a State that, on or after January 1, 2021, 
     provides eligibility under subclause (XXIII) of section 
     1902(a)(10)(A)(ii) for medical assistance under this title 
     (or provides eligibility for individuals described in such 
     subclause under a waiver of the State plan approved under 
     section 1115).
       ``(II) The term `non-expansion State' means, with respect 
     to a fiscal year, a State that is not an expansion State, 
     except that--

       ``(aa) in the case of a State that provides eligibility 
     under clause (i)(VIII), (ii)(XX), or (ii)(XXIII) of section 
     1902(a)(10)(A) for medical assistance under this title (or 
     provides eligibility for individuals described in any of such 
     clauses under a waiver of the State plan approved under 
     section 1115) for any quarter occurring during the period 
     that begins on October 1, 2017, and ends on December 31, 2020 
     the State shall be treated as a non-expansion State for 
     purposes of clause (i) only for quarters beginning on or 
     after the first day of the first month for which the State no 
     longer provides such eligibility; and
       ``(bb) in the case of a State identified by the Secretary 
     under clause (iii)(II) that is a non-expansion State on 
     January 1, 2021, but which provided such eligibility on 
     January 1, 2020, the DSH allotment for such State for each of 
     fiscal years 2021 through 2023 and the first fiscal quarter 
     of 2024 shall be determined as if the State's DSH allotment 
     for fiscal year 2020 had been increased under clause 
     (i)(II).''.

     SEC. 127. REDUCING STATE MEDICAID COSTS.

       (a) In General.--
       (1) State plan requirements.--Section 1902(a)(34) of the 
     Social Security Act (42 U.S.C. 1396a(a)(34)) is amended by 
     striking ``in or after the third month'' and all that follows 
     through ``individual)'' and inserting ``in or after the month 
     in which the individual (or, in the case of a deceased 
     individual, another individual acting on the individual's 
     behalf) made application (or, in the case of an individual 
     who is 65 years of age or older or who is eligible for 
     medical assistance under the plan on the basis of being blind 
     or disabled, in or after the third month before such 
     month)''.
       (2) Definition of medical assistance.--Section 1905(a) of 
     the Social Security Act (42 U.S.C. 1396d(a)) is amended by 
     striking ``in or after the third month before the month in 
     which the recipient makes application for assistance'' and 
     inserting ``in or after the month in which the recipient 
     makes application for assistance, or, in the case of a 
     recipient who is 65 years of age or older or who is eligible 
     for medical assistance on the basis of being blind or 
     disabled at the time application is made, in or after the 
     third month before the month in which the recipient makes 
     application for assistance,''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to medical assistance with respect to individuals 
     whose eligibility for such assistance is based on an 
     application for such assistance made (or deemed to be made) 
     on or after October 1, 2017.

     SEC. 128. PROVIDING SAFETY NET FUNDING FOR NON-EXPANSION 
                   STATES.

       Title XIX of the Social Security Act is amended by 
     inserting after section 1923 (42 U.S.C. 1396r-4) the 
     following new section:


  ``adjustment in payment for services of safety net providers in non-
                            expansion states

       ``Sec. 1923A.  (a) In General.--Subject to the limitations 
     of this section, for each year during the period beginning 
     with fiscal year 2018 and ending with fiscal year 2022, each 
     State that is one of the 50 States or the District of 
     Columbia and that, as of July 1 of the preceding fiscal year, 
     did not provide for eligibility under clause (i)(VIII), 
     (ii)(XX), or (ii)(XXIII) of section 1902(a)(10)(A) for 
     medical assistance under this title (or a waiver of the State 
     plan approved under section 1115) (each such State or 
     District referred to in this section for the fiscal year as a 
     `non-expansion State') may adjust the payment amounts 
     otherwise provided under the State plan under this title (or 
     a waiver of such plan) to health care providers that provide 
     health care services to individuals enrolled under this title 
     (in this section referred to as `eligible providers') so long 
     as the payment adjustment to such an eligible provider does 
     not exceed the provider's costs in furnishing health care 
     services (as determined by the Secretary and net of payments 
     under this title, other than under this section, and by 
     uninsured patients) to individuals who either are eligible 
     for medical assistance under the State plan (or under a 
     waiver of such plan) or have no health insurance or health 
     plan coverage for such services.
       ``(b) Increase in Applicable FMAP.--Notwithstanding section 
     1905(b), the Federal medical assistance percentage applicable 
     with respect to expenditures attributable to a payment 
     adjustment under subsection (a) for which payment is 
     permitted under subsection (c) shall be equal to--
       ``(1) 100 percent for calendar quarters in fiscal years 
     2018, 2019, 2020, and 2021; and
       ``(2) 95 percent for calendar quarters in fiscal year 2022.
       ``(c) Annual Allotment Limitation.--Payment under section 
     1903(a) shall not be made to a State with respect to any 
     payment adjustment made under this section for all calendar 
     quarters in a fiscal year in excess of the product of 
     $2,000,000,000 multiplied by the ratio of--
       ``(1) the population of the State with income below 138 
     percent of the poverty line in 2015 (as determined based the 
     table entitled `Health Insurance Coverage Status and Type by 
     Ratio of Income to Poverty Level in the Past 12 Months by 
     Age' for the universe of the civilian noninstitutionalized 
     population for whom poverty status is determined based on the 
     2015 American Community Survey 1-Year Estimates, as published 
     by the Bureau of the Census), to
       ``(2) the sum of the populations under paragraph (1) for 
     all non-expansion States.
       ``(d) Disqualification in Case of State Coverage 
     Expansion.--If a State is a non-expansion for a fiscal year 
     and provides eligibility for medical assistance described in

[[Page S4206]]

     subsection (a) during the fiscal year, the State shall no 
     longer be treated as a non-expansion State under this section 
     for any subsequent fiscal years.''.

     SEC. 129. ELIGIBILITY REDETERMINATIONS.

       (a) In General.--Section 1902(e)(14) of the Social Security 
     Act (42 U.S.C. 1396a(e)(14)) (relating to modified adjusted 
     gross income) is amended by adding at the end the following:
       ``(J) Frequency of eligibility redeterminations.--Beginning 
     on October 1, 2017, and notwithstanding subparagraph (H), in 
     the case of an individual whose eligibility for medical 
     assistance under the State plan under this title (or a waiver 
     of such plan) is determined based on the application of 
     modified adjusted gross income under subparagraph (A) and who 
     is so eligible on the basis of clause (i)(VIII), (ii)(XX), or 
     (ii)(XXIII) of subsection (a)(10)(A), at the option of the 
     State, the State plan may provide that the individual's 
     eligibility shall be redetermined every 6 months (or such 
     shorter number of months as the State may elect).''.
       (b) Increased Administrative Matching Percentage.--For each 
     calendar quarter during the period beginning on October 1, 
     2017, and ending on December 31, 2019, the Federal matching 
     percentage otherwise applicable under section 1903(a) of the 
     Social Security Act (42 U.S.C. 1396b(a)) with respect to 
     State expenditures during such quarter that are attributable 
     to meeting the requirement of section 1902(e)(14) (relating 
     to determinations of eligibility using modified adjusted 
     gross income) of such Act shall be increased by 5 percentage 
     points with respect to State expenditures attributable to 
     activities carried out by the State (and approved by the 
     Secretary) to exercise the option described in subparagraph 
     (J) of such section (relating to eligibility redeterminations 
     made on a 6-month or shorter basis) (as added by subsection 
     (a)) to increase the frequency of eligibility 
     redeterminations.

     SEC. 130. OPTIONAL WORK REQUIREMENT FOR NONDISABLED, 
                   NONELDERLY, NONPREGNANT INDIVIDUALS.

       (a) In General.--Section 1902 of the Social Security Act 
     (42 U.S.C. 1396a), as previously amended, is further amended 
     by adding at the end the following new subsection:
       ``(oo) Optional Work Requirement for Nondisabled, 
     Nonelderly, Nonpregnant Individuals.--
       ``(1) In general.--Beginning October 1, 2017, subject to 
     paragraph (3), a State may elect to condition medical 
     assistance to a nondisabled, nonelderly, nonpregnant 
     individual under this title upon such an individual's 
     satisfaction of a work requirement (as defined in paragraph 
     (2)).
       ``(2) Work requirement defined.--In this section, the term 
     `work requirement' means, with respect to an individual, the 
     individual's participation in work activities (as defined in 
     section 407(d)) for such period of time as determined by the 
     State, and as directed and administered by the State.
       ``(3) Required exceptions.--States administering a work 
     requirement under this subsection may not apply such 
     requirement to--
       ``(A) a woman during pregnancy through the end of the month 
     in which the 60-day period (beginning on the last day of her 
     pregnancy) ends;
       ``(B) an individual who is under 19 years of age;
       ``(C) an individual who is the only parent or caretaker 
     relative in the family of a child who has not attained 6 
     years of age or who is the only parent or caretaker of a 
     child with disabilities; or
       ``(D) an individual who is married or a head of household 
     and has not attained 20 years of age and who--
       ``(i) maintains satisfactory attendance at secondary school 
     or the equivalent; or
       ``(ii) participates in education directly related to 
     employment.''.
       (b) Increase in Matching Rate for Implementation.--Section 
     1903 of the Social Security Act (42 U.S.C. 1396b) is amended 
     by adding at the end the following:
       ``(aa) The Federal matching percentage otherwise applicable 
     under subsection (a) with respect to State administrative 
     expenditures during a calendar quarter for which the State 
     receives payment under such subsection shall, in addition to 
     any other increase to such Federal matching percentage, be 
     increased for such calendar quarter by 5 percentage points 
     with respect to State expenditures attributable to activities 
     carried out by the State (and approved by the Secretary) to 
     implement subsection (oo) of section 1902.''.

     SEC. 131. PROVIDER TAXES.

       Section 1903(w)(4)(C) of the Social Security Act (42 U.S.C. 
     1396b(w)(4)(C)) is amended by adding at the end the following 
     new clause:
       ``(iii) For purposes of clause (i), a determination of the 
     existence of an indirect guarantee shall be made under 
     paragraph (3)(i) of section 433.68(f) of title 42, Code of 
     Federal Regulations, as in effect on June 1, 2017, except 
     that--

       ``(I) for fiscal year 2021, `5.8 percent' shall be 
     substituted for `6 percent' each place it appears;
       ``(II) for fiscal year 2022, `5.6 percent' shall be 
     substituted for `6 percent' each place it appears;
       ``(III) for fiscal year 2023, `5.4 percent' shall be 
     substituted for `6 percent' each place it appears;
       ``(IV) for fiscal year 2024, `5.2 percent' shall be 
     substituted for `6 percent' each place it appears; and
       ``(V) for fiscal year 2025 and each subsequent fiscal year, 
     `5 percent' shall be substituted for `6 percent' each place 
     it appears.''.

     SEC. 132. PER CAPITA ALLOTMENT FOR MEDICAL ASSISTANCE.

       (a) In General.--Title XIX of the Social Security Act is 
     amended--
       (1) in section 1903 (42 U.S.C. 1396b)--
       (A) in subsection (a), in the matter before paragraph (1), 
     by inserting ``and section 1903A(a)'' after ``except as 
     otherwise provided in this section''; and
       (B) in subsection (d)(1), by striking ``to which'' and 
     inserting ``to which, subject to section 1903A(a),''; and
       (2) by inserting after such section 1903 the following new 
     section:

     ``SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR MEDICAL 
                   ASSISTANCE.

       ``(a) Application of Per Capita Cap on Payments for Medical 
     Assistance Expenditures.--
       ``(1) In general.--If a State which is one of the 50 States 
     or the District of Columbia has excess aggregate medical 
     assistance expenditures (as defined in paragraph (2)) for a 
     fiscal year (beginning with fiscal year 2020), the amount of 
     payment to the State under section 1903(a)(1) for each 
     quarter in the following fiscal year shall be reduced by \1/
     4\ of the excess aggregate medical assistance payments (as 
     defined in paragraph (3)) for that previous fiscal year. In 
     this section, the term `State' means only the 50 States and 
     the District of Columbia.
       ``(2) Excess aggregate medical assistance expenditures.--In 
     this subsection, the term `excess aggregate medical 
     assistance expenditures' means, for a State for a fiscal 
     year, the amount (if any) by which--
       ``(A) the amount of the adjusted total medical assistance 
     expenditures (as defined in subsection (b)(1)) for the State 
     and fiscal year; exceeds
       ``(B) the amount of the target total medical assistance 
     expenditures (as defined in subsection (c)) for the State and 
     fiscal year.
       ``(3) Excess aggregate medical assistance payments.--In 
     this subsection, the term `excess aggregate medical 
     assistance payments' means, for a State for a fiscal year, 
     the product of--
       ``(A) the excess aggregate medical assistance expenditures 
     (as defined in paragraph (2)) for the State for the fiscal 
     year; and
       ``(B) the Federal average medical assistance matching 
     percentage (as defined in paragraph (4)) for the State for 
     the fiscal year.
       ``(4) Federal average medical assistance matching 
     percentage.--In this subsection, the term `Federal average 
     medical assistance matching percentage' means, for a State 
     for a fiscal year, the ratio (expressed as a percentage) of--
       ``(A) the amount of the Federal payments that would be made 
     to the State under section 1903(a)(1) for medical assistance 
     expenditures for calendar quarters in the fiscal year if 
     paragraph (1) did not apply; to
       ``(B) the amount of the medical assistance expenditures for 
     the State and fiscal year.
       ``(5) Per capita base period.--
       ``(A) In general.--In this section, the term `per capita 
     base period' means, with respect to a State, a period of 8 
     (or, in the case of a State selecting a period under 
     subparagraph (D), not less than 4) consecutive fiscal 
     quarters selected by the State.
       ``(B) Timeline.--Each State shall submit its selection of a 
     per capita base period to the Secretary not later than 
     January 1, 2018.
       ``(C) Parameters.--In selecting a per capita base period 
     under this paragraph, a State shall--
       ``(i) only select a period of 8 (or, in the case of a State 
     selecting a base period under subparagraph (D), not less than 
     4) consecutive fiscal quarters for which all the data 
     necessary to make determinations required under this section 
     is available, as determined by the Secretary; and
       ``(ii) shall not select any period of 8 (or, in the case of 
     a State selecting a base period under subparagraph (D), not 
     less than 4) consecutive fiscal quarters that begins with a 
     fiscal quarter earlier than the first quarter of fiscal year 
     2014 or ends with a fiscal quarter later than the third 
     fiscal quarter of 2017.
       ``(D) Base period for late-expanding states.--
       ``(i) In general.--In the case of a State that did not 
     provide for medical assistance for the 1903A enrollee 
     category described in subsection (e)(2)(D) as of the first 
     day of the fourth fiscal quarter of fiscal year 2015 but 
     which provided for such assistance for such category in a 
     subsequent fiscal quarter that is not later than the fourth 
     quarter of fiscal year 2016, the State may select a per 
     capita base period that is less than 8 consecutive fiscal 
     quarters, but in no case shall the period selected be less 
     than 4 consecutive fiscal quarters.
       ``(ii) Application of other requirements.--Except for the 
     requirement that a per capita base period be a period of 8 
     consecutive fiscal quarters, all other requirements of this 
     paragraph shall apply to a per capita base period selected 
     under this subparagraph.
       ``(iii) Application of base period adjustments.--The 
     adjustments to amounts for per capita base periods required 
     under subsections (b)(5) and (d)(4)(E) shall be applied to 
     amounts for per capita base periods selected under this 
     subparagraph by substituting `divided by the ratio that the 
     number of quarters in the base period bears to 4' for 
     `divided by 2'.
       ``(E) Adjustment by the secretary.--If the Secretary 
     determines that a State took

[[Page S4207]]

     actions after the date of enactment of this section 
     (including making retroactive adjustments to supplemental 
     payment data in a manner that affects a fiscal quarter in the 
     per capita base period) to diminish the quality of the data 
     from the per capita base period used to make determinations 
     under this section, the Secretary may adjust the data as the 
     Secretary deems appropriate.
       ``(b) Adjusted Total Medical Assistance Expenditures.--
     Subject to subsection (g), the following shall apply:
       ``(1) In general.--In this section, the term `adjusted 
     total medical assistance expenditures' means, for a State--
       ``(A) for the State's per capita base period (as defined in 
     subsection (a)(5)), the product of--
       ``(i) the amount of the medical assistance expenditures (as 
     defined in paragraph (2) and adjusted under paragraph (5)) 
     for the State and period, reduced by the amount of any 
     excluded expenditures (as defined in paragraph (3) and 
     adjusted under paragraph (5)) for the State and period 
     otherwise included in such medical assistance expenditures; 
     and
       ``(ii) the 1903A base period population percentage (as 
     defined in paragraph (4)) for the State; or
       ``(B) for fiscal year 2019 or a subsequent fiscal year, the 
     amount of the medical assistance expenditures (as defined in 
     paragraph (2)) for the State and fiscal year that is 
     attributable to 1903A enrollees, reduced by the amount of any 
     excluded expenditures (as defined in paragraph (3)) for the 
     State and fiscal year otherwise included in such medical 
     assistance expenditures and includes non-DSH supplemental 
     payments (as defined in subsection (d)(4)(A)(ii)) and 
     payments described in subsection (d)(4)(A)(iii) but shall not 
     be construed as including any expenditures attributable to 
     the program under section 1928 (relating to State pediatric 
     vaccine distribution programs). In applying subparagraph (B), 
     non-DSH supplemental payments (as defined in subsection 
     (d)(4)(A)(ii)) and payments described in subsection 
     (d)(4)(A)(iii) shall be treated as fully attributable to 
     1903A enrollees.
       ``(2) Medical assistance expenditures.--In this section, 
     the term `medical assistance expenditures' means, for a State 
     and fiscal year or per capita base period, the medical 
     assistance payments as reported by medical service category 
     on the Form CMS-64 quarterly expense report (or successor to 
     such a report form, and including enrollment data and 
     subsequent adjustments to any such report, in this section 
     referred to collectively as a `CMS-64 report') for quarters 
     in the year or base period for which payment is (or may 
     otherwise be) made pursuant to section 1903(a)(1), adjusted, 
     in the case of a per capita base period, under paragraph (5).
       ``(3) Excluded expenditures.--In this section, the term 
     `excluded expenditures' means, for a State and fiscal year or 
     per capita base period, expenditures under the State plan (or 
     under a waiver of such plan) that are attributable to any of 
     the following:
       ``(A) DSH.--Payment adjustments made for disproportionate 
     share hospitals under section 1923.
       ``(B) Medicare cost-sharing.--Payments made for medicare 
     cost-sharing (as defined in section 1905(p)(3)).
       ``(C) Safety net provider payment adjustments in non-
     expansion states.--Payment adjustments under subsection (a) 
     of section 1923A for which payment is permitted under 
     subsection (c) of such section.
       ``(D) Expenditures for public health emergencies.--Any 
     expenditures that are subject to a public health emergency 
     exclusion under paragraph (6).
       ``(4) 1903A base period population percentage.--In this 
     subsection, the term `1903A base period population 
     percentage' means, for a State, the Secretary's calculation 
     of the percentage of the actual medical assistance 
     expenditures, as reported by the State on the CMS-64 reports 
     for calendar quarters in the State's per capita base period, 
     that are attributable to 1903A enrollees (as defined in 
     subsection (e)(1)).
       ``(5) Adjustments for per capita base period.--In 
     calculating medical assistance expenditures under paragraph 
     (2) and excluded expenditures under paragraph (3) for a State 
     for the State's per capita base period, the total amount of 
     each type of expenditure for the State and base period shall 
     be divided by 2.
       ``(6) Authority to exclude state expenditures from caps 
     during public health emergency.--
       ``(A) In general.--During the period that begins on January 
     1, 2020, and ends on December 31, 2024, the Secretary may 
     exclude, from a State's medical assistance expenditures for a 
     fiscal year or portion of a fiscal year that occurs during 
     such period, an amount that shall not exceed the amount 
     determined under subparagraph (B) for the State and year or 
     portion of a year if--
       ``(i) a public health emergency declared by the Secretary 
     pursuant to section 319 of the Public Health Service Act 
     existed within the State during such year or portion of a 
     year; and
       ``(ii) the Secretary determines that such an exemption 
     would be appropriate.
       ``(B) Maximum amount of adjustment.--The amount excluded 
     for a State and fiscal year or portion of a fiscal year under 
     this paragraph shall not exceed the amount by which--
       ``(i) the amount of State expenditures for medical 
     assistance for 1903A enrollees in areas of the State which 
     are subject to a declaration described in subparagraph (A)(i) 
     for the fiscal year or portion of a fiscal year; exceeds
       ``(ii) the amount of such expenditures for such enrollees 
     in such areas during the most recent fiscal year or portion 
     of a fiscal year of equal length to the portion of a fiscal 
     year involved during which no such declaration was in effect.
       ``(C) Aggregate limitation on exclusions and additional 
     block grant payments.--The aggregate amount of expenditures 
     excluded under this paragraph and additional payments made 
     under section 1903B(c)(3)(E) for the period described in 
     subparagraph (A) shall not exceed $5,000,000,000.
       ``(D) Review.--If the Secretary exercises the authority 
     under this paragraph with respect to a State for a fiscal 
     year or portion of a fiscal year, the Secretary shall, not 
     later than 6 months after the declaration described in 
     subparagraph (A)(i) ceases to be in effect, conduct an audit 
     of the State's medical assistance expenditures for 1903A 
     enrollees during the year or portion of a year to ensure that 
     all of the expenditures so excluded were made for the purpose 
     of ensuring that the health care needs of 1903A enrollees in 
     areas affected by a public health emergency are met.
       ``(c)  Target Total Medical Assistance Expenditures.--
       ``(1) Calculation.--In this section, the term `target total 
     medical assistance expenditures' means, for a State for a 
     fiscal year and subject to paragraph (4), the sum of the 
     products, for each of the 1903A enrollee categories (as 
     defined in subsection (e)(2)), of--
       ``(A) the target per capita medical assistance expenditures 
     (as defined in paragraph (2)) for the enrollee category, 
     State, and fiscal year; and
       ``(B) the number of 1903A enrollees for such enrollee 
     category, State, and fiscal year, as determined under 
     subsection (e)(4).
       ``(2) Target per capita medical assistance expenditures.--
     In this subsection, the term `target per capita medical 
     assistance expenditures' means, for a 1903A enrollee category 
     and State--
       ``(A) for fiscal year 2020, an amount equal to--
       ``(i) the provisional FY19 target per capita amount for 
     such enrollee category (as calculated under subsection 
     (d)(5)) for the State; increased by
       ``(ii) the applicable annual inflation factor (as defined 
     in paragraph (3)) for fiscal year 2020; and
       ``(B) for each succeeding fiscal year, an amount equal to--
       ``(i) the target per capita medical assistance expenditures 
     (under subparagraph (A) or this subparagraph) for the 1903A 
     enrollee category and State for the preceding fiscal year; 
     increased by
       ``(ii) the applicable annual inflation factor for that 
     succeeding fiscal year.
       ``(3) Applicable annual inflation factor.--In paragraph 
     (2), the term `applicable annual inflation factor' means--
       ``(A) for fiscal years before 2025--
       ``(i) for each of the 1903A enrollee categories described 
     in subparagraphs (C), (D), and (E) of subsection (e)(2), the 
     percentage increase in the medical care component of the 
     consumer price index for all urban consumers (U.S. city 
     average) from September of the previous fiscal year to 
     September of the fiscal year involved; and
       ``(ii) for each of the 1903A enrollee categories described 
     in subparagraphs (A) and (B) of subsection (e)(2), the 
     percentage increase described in clause (i) plus 1 percentage 
     point; and
       ``(B) for fiscal years after 2024, for all 1903A enrollee 
     categories, the percentage increase in the consumer price 
     index for all urban consumers (U.S. city average) from 
     September of the previous fiscal year to September of the 
     fiscal year involved.
       ``(4) Decrease in target expenditures for required 
     expenditures by certain political subdivisions.--
       ``(A) In general.--In the case of a State that had a DSH 
     allotment under section 1923(f) for fiscal year 2016 that was 
     more than 6 times the national average of such allotments for 
     all the States for such fiscal year and that requires 
     political subdivisions within the State to contribute funds 
     towards medical assistance or other expenditures under the 
     State plan under this title (or under a waiver of such plan) 
     for a fiscal year (beginning with fiscal year 2020), the 
     target total medical assistance expenditures for such State 
     and fiscal year shall be decreased by the amount that 
     political subdivisions in the State are required to 
     contribute under the plan (or waiver) without reimbursement 
     from the State for such fiscal year, other than contributions 
     described in subparagraph (B).
       ``(B) Exceptions.--The contributions described in this 
     subparagraph are the following:
       ``(i) Contributions required by a State from a political 
     subdivision that, as of the first day of the calendar year in 
     which the fiscal year involved begins--

       ``(I) has a population of more than 5,000,000, as estimated 
     by the Bureau of the Census; and
       ``(II) imposes a local income tax upon its residents.

[[Page S4208]]

       ``(ii) Contributions required by a State from a political 
     subdivision for administrative expenses if the State required 
     such contributions from such subdivision without 
     reimbursement from the State as of January 1, 2017.
       ``(5) Adjustments to state expenditures targets to promote 
     program equity across states.--
       ``(A) In general.--Beginning with fiscal year 2020, the 
     target per capita medical assistance expenditures for a 1903A 
     enrollee category, State, and fiscal year, as determined 
     under paragraph (2), shall be adjusted (subject to 
     subparagraph (C)(i)) in accordance with this paragraph.
       ``(B) Adjustment based on level of per capita spending for 
     1903a enrollee categories.--Subject to subparagraph (C), with 
     respect to a State, fiscal year, and 1903A enrollee category, 
     if the State's per capita categorical medical assistance 
     expenditures (as defined in subparagraph (D)) for the State 
     and category in the preceding fiscal year--
       ``(i) exceed the mean per capita categorical medical 
     assistance expenditures for the category for all States for 
     such preceding year by not less than 25 percent, the State's 
     target per capita medical assistance expenditures for such 
     category for the fiscal year involved shall be reduced by a 
     percentage that shall be determined by the Secretary but 
     which shall not be less than 0.5 percent or greater than 3 
     percent; or
       ``(ii) are less than the mean per capita categorical 
     medical assistance expenditures for the category for all 
     States for such preceding year by not less than 25 percent, 
     the State's target per capita medical assistance expenditures 
     for such category for the fiscal year involved shall be 
     increased by a percentage that shall be determined by the 
     Secretary but which shall not be less than 0.5 percent or 
     greater than 3 percent.
       ``(C) Rules of application.--
       ``(i) Budget neutrality requirement.--In determining the 
     appropriate percentages by which to adjust States' target per 
     capita medical assistance expenditures for a category and 
     fiscal year under this paragraph, the Secretary shall make 
     such adjustments in a manner that does not result in a net 
     increase in Federal payments under this section for such 
     fiscal year, and if the Secretary cannot adjust such 
     expenditures in such a manner there shall be no adjustment 
     under this paragraph for such fiscal year.
       ``(ii) Assumption regarding state expenditures.--For 
     purposes of clause (i), in the case of a State that has its 
     target per capita medical assistance expenditures for a 1903A 
     enrollee category and fiscal year increased under this 
     paragraph, the Secretary shall assume that the categorical 
     medical assistance expenditures (as defined in subparagraph 
     (D)(ii)) for such State, category, and fiscal year will equal 
     such increased target medical assistance expenditures.
       ``(iii) Nonapplication to low-density states.--This 
     paragraph shall not apply to any State that has a population 
     density of less than 15 individuals per square mile, based on 
     the most recent data available from the Bureau of the Census.
       ``(iv) Disregard of adjustment.--Any adjustment under this 
     paragraph to target medical assistance expenditures for a 
     State, 1903A enrollee category, and fiscal year shall be 
     disregarded when determining the target medical assistance 
     expenditures for such State and category for a succeeding 
     year under paragraph (2).
       ``(v) Application for fiscal years 2020 and 2021.--In 
     fiscal years 2020 and 2021, the Secretary shall apply this 
     paragraph by deeming all categories of 1903A enrollees to be 
     a single category.
       ``(D) Per capita categorical medical assistance 
     expenditures.--
       ``(i) In general.--In this paragraph, the term `per capita 
     categorical medical assistance expenditures' means, with 
     respect to a State, 1903A enrollee category, and fiscal year, 
     an amount equal to--

       ``(I) the categorical medical expenditures (as defined in 
     clause (ii)) for the State, category, and year; divided by
       ``(II) the number of 1903A enrollees for the State, 
     category, and year.

       ``(ii) Categorical medical assistance expenditures.--The 
     term `categorical medical assistance expenditures' means, 
     with respect to a State, 1903A enrollee category, and fiscal 
     year, an amount equal to the total medical assistance 
     expenditures (as defined in paragraph (2)) for the State and 
     fiscal year that are attributable to 1903A enrollees in the 
     category, excluding any excluded expenditures (as defined in 
     paragraph (3)) for the State and fiscal year that are 
     attributable to 1903A enrollees in the category.
       ``(d) Calculation of FY19 Provisional Target Amount for 
     Each 1903A Enrollee Category.--Subject to subsection (g), the 
     following shall apply:
       ``(1) Calculation of base amounts for per capita base 
     period.--For each State the Secretary shall calculate (and 
     provide notice to the State not later than April 1, 2018, of) 
     the following:
       ``(A) The amount of the adjusted total medical assistance 
     expenditures (as defined in subsection (b)(1)) for the State 
     for the State's per capita base period.
       ``(B) The number of 1903A enrollees for the State in the 
     State's per capita base period (as determined under 
     subsection (e)(4)).
       ``(C) The average per capita medical assistance 
     expenditures for the State for the State's per capita base 
     period equal to--
       ``(i) the amount calculated under subparagraph (A); divided 
     by
       ``(ii) the number calculated under subparagraph (B).
       ``(2) Fiscal year 2019 average per capita amount based on 
     inflating the per capita base period amount to fiscal year 
     2019 by cpi-medical.--The Secretary shall calculate a fiscal 
     year 2019 average per capita amount for each State equal to--
       ``(A) the average per capita medical assistance 
     expenditures for the State for the State's per capita base 
     period (calculated under paragraph (1)(C)); increased by
       ``(B) the percentage increase in the medical care component 
     of the consumer price index for all urban consumers (U.S. 
     city average) from the last month of the State's per capita 
     base period to September of fiscal year 2019.
       ``(3) Aggregate and average expenditures per capita for 
     fiscal year 2019.--The Secretary shall calculate for each 
     State the following:
       ``(A) The amount of the adjusted total medical assistance 
     expenditures (as defined in subsection (b)(1)) for the State 
     for fiscal year 2019. 
       ``(B) The number of 1903A enrollees for the State in fiscal 
     year 2019 (as determined under subsection (e)(4)).
       ``(4) Per capita expenditures for fiscal year 2019 for each 
     1903a enrollee category.--The Secretary shall calculate (and 
     provide notice to each State not later than January 1, 2020, 
     of) the following:
       ``(A)(i) For each 1903A enrollee category, the amount of 
     the adjusted total medical assistance expenditures (as 
     defined in subsection (b)(1)) for the State for fiscal year 
     2019 for individuals in the enrollee category, calculated by 
     excluding from medical assistance expenditures those 
     expenditures attributable to expenditures described in clause 
     (iii) or non-DSH supplemental expenditures (as defined in 
     clause (ii)).
       ``(ii) In this paragraph, the term `non-DSH supplemental 
     expenditure' means a payment to a provider under the State 
     plan (or under a waiver of the plan) that--
       ``(I) is not made under section 1923;
       ``(II) is not made with respect to a specific item or 
     service for an individual;
       ``(III) is in addition to any payments made to the provider 
     under the plan (or waiver) for any such item or service; and
       ``(IV) complies with the limits for additional payments to 
     providers under the plan (or waiver) imposed pursuant to 
     section 1902(a)(30)(A), including the regulations specifying 
     upper payment limits under the State plan in part 447 of 
     title 42, Code of Federal Regulations (or any successor 
     regulations).
       ``(iii) An expenditure described in this clause is an 
     expenditure that meets the criteria specified in subclauses 
     (I), (II), and (III) of clause (ii) and is authorized under 
     section 1115 for the purposes of funding a delivery system 
     reform pool, uncompensated care pool, a designated State 
     health program, or any other similar expenditure (as defined 
     by the Secretary).
       ``(B) For each 1903A enrollee category, the number of 1903A 
     enrollees for the State in fiscal year 2019 in the enrollee 
     category (as determined under subsection (e)(4)).
       ``(C) For the State's per capita base period, the State's 
     non-DSH supplemental and pool payment percentage is equal to 
     the ratio (expressed as a percentage) of--
       ``(i) the total amount of non-DSH supplemental expenditures 
     (as defined in subparagraph (A)(ii) and adjusted under 
     subparagraph (E)) and payments described in subparagraph 
     (A)(iii) (and adjusted under subparagraph (E)) for the State 
     for the period; to
       ``(ii) the amount described in subsection (b)(1)(A) for the 
     State for the State's per capita base period.
       ``(D) For each 1903A enrollee category an average medical 
     assistance expenditures per capita for the State for fiscal 
     year 2019 for the enrollee category equal to--
       ``(i) the amount calculated under subparagraph (A) for the 
     State, increased by the non-DSH supplemental and pool payment 
     percentage for the State (as calculated under subparagraph 
     (C)); divided by
       ``(ii) the number calculated under subparagraph (B) for the 
     State for the enrollee category.
       ``(E) For purposes of subparagraph (C)(i), in calculating 
     the total amount of non-DSH supplemental expenditures and 
     payments described in subparagraph (A)(iii) for a State for 
     the per capita base period, the total amount of such 
     expenditures and the total amount of such payments for the 
     State and base period shall each be divided by 2.
       ``(5) Provisional fy19 per capita target amount for each 
     1903a enrollee category.--Subject to subsection (f)(2), the 
     Secretary shall calculate for each State a provisional FY19 
     per capita target amount for each 1903A enrollee category 
     equal to the average medical assistance expenditures per 
     capita for the State for fiscal year 2019 (as calculated 
     under paragraph (4)(D)) for such enrollee category multiplied 
     by the ratio of--
       ``(A) the product of--
       ``(i) the fiscal year 2019 average per capita amount for 
     the State, as calculated under paragraph (2); and
       ``(ii) the number of 1903A enrollees for the State in 
     fiscal year 2019, as calculated under paragraph (3)(B); to
       ``(B) the amount of the adjusted total medical assistance 
     expenditures for the State for fiscal year 2019, as 
     calculated under paragraph (3)(A).

[[Page S4209]]

       ``(e) 1903A Enrollee; 1903A Enrollee Category.--Subject to 
     subsection (g), for purposes of this section, the following 
     shall apply:
       ``(1) 1903A enrollee.--The term `1903A enrollee' means, 
     with respect to a State and a month and subject to subsection 
     (i)(1)(B), any Medicaid enrollee (as defined in paragraph 
     (3)) for the month, other than such an enrollee who for such 
     month is in any of the following categories of excluded 
     individuals:
       ``(A) CHIP.--An individual who is provided, under this 
     title in the manner described in section 2101(a)(2), child 
     health assistance under title XXI.
       ``(B) IHS.--An individual who receives any medical 
     assistance under this title for services for which payment is 
     made under the third sentence of section 1905(b).
       ``(C) Breast and cervical cancer services eligible 
     individual.--An individual who is eligible for medical 
     assistance under this title only on the basis of section 
     1902(a)(10)(A)(ii)(XVIII).
       ``(D) Partial-benefit enrollees.--An individual who--
       ``(i) is an alien who is eligible for medical assistance 
     under this title only on the basis of section 1903(v)(2);
       ``(ii) is eligible for medical assistance under this title 
     only on the basis of subclause (XII) or (XXI) of section 
     1902(a)(10)(A)(ii) (or on the basis of a waiver that provides 
     only comparable benefits);
       ``(iii) is a dual eligible individual (as defined in 
     section 1915(h)(2)(B)) and is eligible for medical assistance 
     under this title (or under a waiver) only for some or all of 
     medicare cost-sharing (as defined in section 1905(p)(3)); or
       ``(iv) is eligible for medical assistance under this title 
     and for whom the State is providing a payment or subsidy to 
     an employer for coverage of the individual under a group 
     health plan pursuant to section 1906 or section 1906A (or 
     pursuant to a waiver that provides only comparable benefits).
       ``(E) Blind and disabled children.--An individual who--
       ``(i) is a child under 19 years of age; and
       ``(ii) is eligible for medical assistance under this title 
     on the basis of being blind or disabled.
       ``(2) 1903A enrollee category.--The term `1903A enrollee 
     category' means each of the following:
       ``(A) Elderly.--A category of 1903A enrollees who are 65 
     years of age or older.
       ``(B) Blind and disabled.--A category of 1903A enrollees 
     (not described in the previous subparagraph) who--
       ``(i) are 19 years of age or older; and
       ``(ii) are eligible for medical assistance under this title 
     on the basis of being blind or disabled.
       ``(C) Children.--A category of 1903A enrollees (not 
     described in a previous subparagraph) who are children under 
     19 years of age.
       ``(D) Expansion enrollees.--A category of 1903A enrollees 
     (not described in a previous subparagraph) who are eligible 
     for medical assistance under this title only on the basis of 
     clause (i)(VIII), (ii)(XX), or (ii)(XXIII) of section 
     1902(a)(10)(A).
       ``(E) Other nonelderly, nondisabled, non-expansion 
     adults.--A category of 1903A enrollees who are not described 
     in any previous subparagraph.
       ``(3) Medicaid enrollee.--The term `Medicaid enrollee' 
     means, with respect to a State for a month, an individual who 
     is eligible for medical assistance for items or services 
     under this title and enrolled under the State plan (or a 
     waiver of such plan) under this title for the month.
       ``(4) Determination of number of 1903a enrollees.--The 
     number of 1903A enrollees for a State and fiscal year or the 
     State's per capita base period, and, if applicable, for a 
     1903A enrollee category, is the average monthly number of 
     Medicaid enrollees for such State and fiscal year or base 
     period (and, if applicable, in such category) that are 
     reported through the CMS-64 report under (and subject to 
     audit under) subsection (h).
       ``(f) Special Payment Rules.--
       ``(1) Application in case of research and demonstration 
     projects and other waivers.--In the case of a State with a 
     waiver of the State plan approved under section 1115, section 
     1915, or another provision of this title, this section shall 
     apply to medical assistance expenditures and medical 
     assistance payments under the waiver, in the same manner as 
     if such expenditures and payments had been made under a State 
     plan under this title and the limitations on expenditures 
     under this section shall supersede any other payment 
     limitations or provisions (including limitations based on a 
     per capita limitation) otherwise applicable under such a 
     waiver.
       ``(2) Treatment of states expanding coverage after july 1, 
     2016.--In the case of a State that did not provide for 
     medical assistance for the 1903A enrollee category described 
     in subsection (e)(2)(D) as of July 1, 2016, but which 
     subsequently provides for such assistance for such category, 
     the provisional FY19 per capita target amount for such 
     enrollee category under subsection (d)(5) shall be equal to 
     the provisional FY19 per capita target amount for the 1903A 
     enrollee category described in subsection (e)(2)(E).
       ``(3) In case of state failure to report necessary data.--
     If a State for any quarter in a fiscal year (beginning with 
     fiscal year 2019) fails to satisfactorily submit data on 
     expenditures and enrollees in accordance with subsection 
     (h)(1), for such fiscal year and any succeeding fiscal year 
     for which such data are not satisfactorily submitted--
       ``(A) the Secretary shall calculate and apply subsections 
     (a) through (e) with respect to the State as if all 1903A 
     enrollee categories for which such expenditure and enrollee 
     data were not satisfactorily submitted were a single 1903A 
     enrollee category; and
       ``(B) the growth factor otherwise applied under subsection 
     (c)(2)(B) shall be decreased by 1 percentage point.
       ``(g) Recalculation of Certain Amounts for Data Errors.--
     The amounts and percentage calculated under paragraphs (1) 
     and (4)(C) of subsection (d) for a State for the State's per 
     capita base period, and the amounts of the adjusted total 
     medical assistance expenditures calculated under subsection 
     (b) and the number of Medicaid enrollees and 1903A enrollees 
     determined under subsection (e)(4) for a State for the 
     State's per capita base period, fiscal year 2019, and any 
     subsequent fiscal year, may be adjusted by the Secretary 
     based upon an appeal (filed by the State in such a form, 
     manner, and time, and containing such information relating to 
     data errors that support such appeal, as the Secretary 
     specifies) that the Secretary determines to be valid, except 
     that any adjustment by the Secretary under this subsection 
     for a State may not result in an increase of the target total 
     medical assistance expenditures exceeding 2 percent.
       ``(h) Required Reporting and Auditing; Transitional 
     Increase in Federal Matching Percentage for Certain 
     Administrative Expenses.--
       ``(1) Reporting of cms-64 data.--
       ``(A) In general.--In addition to the data required on form 
     Group VIII on the CMS-64 report form as of January 1, 2017, 
     in each CMS-64 report required to be submitted (for each 
     quarter beginning on or after October 1, 2018), the State 
     shall include data on medical assistance expenditures within 
     such categories of services and categories of enrollees 
     (including each 1903A enrollee category and each category of 
     excluded individuals under subsection (e)(1)) and the numbers 
     of enrollees within each of such enrollee categories, as the 
     Secretary determines are necessary (including timely guidance 
     published as soon as possible after the date of the enactment 
     of this section) in order to implement this section and to 
     enable States to comply with the requirement of this 
     paragraph on a timely basis.
       ``(B) Reporting on qualified inpatient psychiatric hospital 
     services.--Not later than 60 days after the date of the 
     enactment of this section, the Secretary shall modify the 
     CMS-64 report form to require that States submit data with 
     respect to medical assistance expenditures for qualified 
     inpatient psychiatric hospital services (as defined in 
     section 1905(h)(3)).
       ``(C) Reporting on children with complex medical 
     conditions.--Not later than January 1, 2020, the Secretary 
     shall modify the CMS-64 report form to require that States 
     submit data with respect to individuals who--
       ``(i) are enrolled in a State plan under this title or 
     title XXI or under a waiver of such plan;
       ``(ii) are under 21 years of age; and
       ``(iii) have a chronic medical condition or serious injury 
     that--

       ``(I) affects two or more body systems;
       ``(II) affects cognitive or physical functioning (such as 
     reducing the ability to perform the activities of daily 
     living, including the ability to engage in movement or 
     mobility, eat, drink, communicate, or breathe independently); 
     and
       ``(III) either--

       ``(aa) requires intensive healthcare interventions (such as 
     multiple medications, therapies, or durable medical 
     equipment) and intensive care coordination to optimize health 
     and avoid hospitalizations or emergency department visits; or
       ``(bb) meets the criteria for medical complexity under 
     existing risk adjustment methodologies using a recognized, 
     publicly available pediatric grouping system (such as the 
     pediatric complex conditions classification system or the 
     Pediatric Medical Complexity Algorithm) selected by the 
     Secretary in close collaboration with the State agencies 
     responsible for administering State plans under this title 
     and a national panel of pediatric, pediatric specialty, and 
     pediatric subspecialty experts.
       ``(2) Auditing of cms-64 data.--The Secretary shall conduct 
     for each State an audit of the number of individuals and 
     expenditures reported through the CMS-64 report for the 
     State's per capita base period, fiscal year 2019, and each 
     subsequent fiscal year, which audit may be conducted on a 
     representative sample (as determined by the Secretary).
       ``(3) Auditing of state spending.--The Inspector General of 
     the Department of Health and Human Services shall conduct an 
     audit (which shall be conducted using random sampling, as 
     determined by the Inspector General) of each State's spending 
     under this section not less than once every 3 years.
       ``(4) Temporary increase in federal matching percentage to 
     support improved data reporting systems for fiscal years 2018 
     and 2019.--In the case of any State that selects as its per 
     capita base period the most recent 8 consecutive quarter 
     period for which the data necessary to make the 
     determinations required under this section is available, for 
     amounts expended during calendar quarters beginning on or 
     after October 1, 2017, and before October 1, 2019--
       ``(A) the Federal matching percentage applied under section 
     1903(a)(3)(A)(i) shall be

[[Page S4210]]

     increased by 10 percentage points to 100 percent;
       ``(B) the Federal matching percentage applied under section 
     1903(a)(3)(B) shall be increased by 25 percentage points to 
     100 percent; and
       ``(C) the Federal matching percentage applied under section 
     1903(a)(7) shall be increased by 10 percentage points to 60 
     percent but only with respect to amounts expended that are 
     attributable to a State's additional administrative 
     expenditures to implement the data requirements of paragraph 
     (1).
       ``(5) HHS report on adoption of t-msis data.--Not later 
     than January 1, 2025, the Secretary shall submit to Congress 
     a report making recommendations as to whether data from the 
     Transformed Medicaid Statistical Information System would be 
     preferable to CMS-64 report data for purposes of making the 
     determinations necessary under this section.''.
       (b) Ensuring Access to Home and Community Based Services.--
     Section 1915 of the Social Security Act (42 U.S.C. 1396n) is 
     amended by adding at the end the following new subsection:
       ``(l) Incentive Payments for Home and Community-based 
     Services.--
       ``(1) In general.--The Secretary shall establish a 
     demonstration project (referred to in this subsection as the 
     `demonstration project') under which eligible States may make 
     HCBS payment adjustments for the purpose of continuing to 
     provide and improving the quality of home and community-based 
     services provided under a waiver under subsection (c) or (d) 
     or a State plan amendment under subsection (i).
       ``(2) Selection of eligible states.--
       ``(A) Application.--A State seeking to participate in the 
     demonstration project shall submit to the Secretary, at such 
     time and in such manner as the Secretary shall require, an 
     application that includes--
       ``(i) an assurance that any HCBS payment adjustment made by 
     the State under this subsection will comply with the health 
     and welfare and financial accountability safeguards taken by 
     the State under subsection (c)(2)(A); and
       ``(ii) such other information and assurances as the 
     Secretary shall require.
       ``(B) Selection.--The Secretary shall select States to 
     participate in the demonstration project on a competitive 
     basis except that, in making selections under this paragraph, 
     the Secretary shall give priority to any State that is one of 
     the 15 States in the United States with the lowest population 
     density, as determined by the Secretary based on data from 
     the Bureau of the Census.
       ``(3) Term of demonstration project.--The demonstration 
     project shall be conducted for the 4-year period beginning on 
     January 1, 2020, and ending on December 31, 2023.
       ``(4) State allotments and increased fmap for payment 
     adjustments.--
       ``(A) In general.--
       ``(i) Annual allotment.--Subject to clause (ii), for each 
     year of the demonstration project, the Secretary shall allot 
     an amount to each State that is an eligible State for the 
     year.
       ``(ii) Limitation on federal spending.--The aggregate 
     amount that may be allotted to eligible States under clause 
     (i) for all years of the demonstration project shall not 
     exceed $8,000,000,000, and in no case may the aggregate 
     amount of payments made by the Secretary to eligible States 
     for payment adjustments under this subsection exceed such 
     amount.
       ``(B) Payments to eligible states and limitations on 
     payments.--
       ``(i) In general.--Subject to clauses (ii) and (iii), for 
     each year of the demonstration project, notwithstanding 
     section 1905(b), the Federal medical assistance percentage 
     applicable with respect to expenditures by an eligible State 
     that are attributable to HCBS payment adjustments shall be 
     equal to (and shall in no case exceed) 100 percent.
       ``(ii) Limitation on hcbs payment adjustments for 
     individual providers.--Payment under section 1903(a) shall 
     not be made to an eligible State for expenditures for a year 
     that are attributable to an HCBS payment adjustment that is 
     paid to a single provider and exceeds a percentage which 
     shall be established by the Secretary of the payment 
     otherwise made to the provider.
       ``(iii) Limitation of payment to amount of allotment.--
     Payment under section 1903(a) shall not be made to an 
     eligible State for expenditures for a year that are 
     attributable to an HCBS payment adjustment to the extent that 
     the aggregate amount of HCBS payment adjustments made by the 
     State in the year exceeds the amount allotted to the State 
     for the year under subparagraph (A)(i).
       ``(5) Reporting and evaluation.--
       ``(A) In general.--As a condition of receiving the 
     increased Federal medical assistance percentage described in 
     paragraph (4)(B)(i), each eligible State shall collect and 
     report information, as determined necessary by the Secretary, 
     for the purposes of providing Federal oversight and 
     evaluating the State's compliance with the health and welfare 
     and financial accountability safeguards taken by the State 
     under subsection (c)(2)(A).
       ``(B) Forms.--Expenditures by eligible States on HCBS 
     payment adjustments shall be separately reported on the CMS-
     64 Form and in T-MSIS.
       ``(6) Definitions.--In this subsection:
       ``(A) Eligible state.--The term `eligible State' means a 
     State that--
       ``(i) is one of the 50 States or the District of Columbia;
       ``(ii) has in effect--

       ``(I) a waiver under subsection (c) or (d); or
       ``(II) a State plan amendment under subsection (i);

       ``(iii) submits an application under paragraph (2)(A); and
       ``(iv) is selected by the Secretary to participate in the 
     demonstration project.
       ``(B) HCBS payment adjustment.--The term `HCBS payment 
     adjustment' means a payment adjustment made by an eligible 
     State to the amount of payment otherwise provided under a 
     waiver under subsection (c) or (d) or a State plan amendment 
     under subsection (i) for a home and community-based service 
     which is provided to a 1903A enrollee (as defined in section 
     1903A(e)(1)) who is in the enrollee category described in 
     subparagraph (A) or (B) of section 1903A(e)(2).''.

     SEC. 133. FLEXIBLE BLOCK GRANT OPTION FOR STATES.

       Title XIX of the Social Security Act, as amended by section 
     132, is further amended by inserting after section 1903A the 
     following new section:

     ``SEC. 1903B. MEDICAID FLEXIBILITY PROGRAM.

       ``(a) In General.--Beginning with fiscal year 2020, any 
     State (as defined in subsection (e)) that has an application 
     approved by the Secretary under subsection (b) may conduct a 
     Medicaid Flexibility Program to provide targeted health 
     assistance to program enrollees.
       ``(b) State Application.--
       ``(1) In general.--To be eligible to conduct a Medicaid 
     Flexibility Program, a State shall submit an application to 
     the Secretary that meets the requirements of this subsection.
       ``(2) Contents of application.--An application under this 
     subsection shall include the following:
       ``(A) A description of the proposed Medicaid Flexibility 
     Program and how the State will satisfy the requirements 
     described in subsection (d).
       ``(B) The proposed conditions for eligibility of program 
     enrollees.
       ``(C) The applicable program enrollee category (as defined 
     in subsection (e)(1)).
       ``(D) A description of the types, amount, duration, and 
     scope of services which will be offered as targeted health 
     assistance under the program, including a description of the 
     proposed package of services which will be provided to 
     program enrollees to whom the State would otherwise be 
     required to make medical assistance available under section 
     1902(a)(10)(A)(i).
       ``(E) A description of how the State will notify 
     individuals currently enrolled in the State plan for medical 
     assistance under this title of the transition to such 
     program.
       ``(F) Statements certifying that the State agrees to--
       ``(i) submit regular enrollment data with respect to the 
     program to the Centers for Medicare & Medicaid Services at 
     such time and in such manner as the Secretary may require;
       ``(ii) submit timely and accurate data to the Transformed 
     Medicaid Statistical Information System (T-MSIS);
       ``(iii) report annually to the Secretary on adult health 
     quality measures implemented under the program and 
     information on the quality of health care furnished to 
     program enrollees under the program as part of the annual 
     report required under section 1139B(d)(1);
       ``(iv) submit such additional data and information not 
     described in any of the preceding clauses of this 
     subparagraph but which the Secretary determines is necessary 
     for monitoring, evaluation, or program integrity purposes, 
     including--

       ``(I) survey data, such as the data from Consumer 
     Assessment of Healthcare Providers and Systems (CAHPS) 
     surveys;
       ``(II) birth certificate data; and
       ``(III) clinical patient data for quality measurements 
     which may not be present in a claim, such as laboratory data, 
     body mass index, and blood pressure; and

       ``(v) on an annual basis, conduct a report evaluating the 
     program and make such report available to the public.
       ``(G) An information technology systems plan demonstrating 
     that the State has the capability to support the 
     technological administration of the program and comply with 
     reporting requirements under this section.
       ``(H) A statement of the goals of the proposed program, 
     which shall include--
       ``(i) goals related to quality, access, rate of growth 
     targets, consumer satisfaction, and outcomes;
       ``(ii) a plan for monitoring and evaluating the program to 
     determine whether such goals are being met; and
       ``(iii) a proposed process for the State, in consultation 
     with the Centers for Medicare & Medicaid Services, to take 
     remedial action to make progress on unmet goals.
       ``(I) Such other information as the Secretary may require.
       ``(3) State notice and comment period.--
       ``(A) In general.--Before submitting an application under 
     this subsection, a State shall make the application publicly 
     available for a 30 day notice and comment period.
       ``(B) Notice and comment process.--During the notice and 
     comment period described in subparagraph (A), the State shall 
     provide opportunities for a meaningful level of public input, 
     which shall include public hearings on the proposed Medicaid 
     Flexibility Program.
       ``(4) Federal notice and comment period.--The Secretary 
     shall not approve of

[[Page S4211]]

     any application to conduct a Medicaid Flexibility Program 
     without making such application publicly available for a 30 
     day notice and comment period.
       ``(5) Timeline for submission.--
       ``(A) In general.--A State may submit an application under 
     this subsection to conduct a Medicaid Flexibility Program 
     that would begin in the next fiscal year at any time, subject 
     to subparagraph (B).
       ``(B) Deadlines.--Each year beginning with 2019, the 
     Secretary shall specify a deadline for submitting an 
     application under this subsection to conduct a Medicaid 
     Flexibility Program that would begin in the next fiscal year, 
     but such deadline shall not be earlier than 60 days after the 
     date that the Secretary publishes the amounts of State block 
     grants as required under subsection (c)(4).
       ``(c) Financing.--
       ``(1) In general.--For each fiscal year during which a 
     State is conducting a Medicaid Flexibility Program, the State 
     shall receive, instead of amounts otherwise payable to the 
     State under this title for medical assistance for program 
     enrollees, the amount specified in paragraph (3)(A).
       ``(2) Amount of block grant funds.--
       ``(A) In general.--The block grant amount under this 
     paragraph for a State and year shall be equal to the sum of 
     the amounts determined under subparagraph (B) for each 1903A 
     enrollee category within the applicable program enrollee 
     category for the State and year.
       ``(B) Enrollee category amounts.--
       ``(i) For initial year.--Subject to subparagraph (C), for 
     the first fiscal year in which a 1903A enrollee category is 
     included in the applicable program enrollee category for a 
     Medicaid Flexibility Program conducted by the State, the 
     amount determined under this subparagraph for the State, 
     year, and category shall be equal to the Federal average 
     medical assistance matching percentage (as defined in section 
     1903A(a)(4)) for the State and year multiplied by the product 
     of--

       ``(I) the target per capita medical assistance expenditures 
     (as defined in section 1903A(c)(2)) for the State, year, and 
     category; and
       ``(II) the number of 1903A enrollees in such category for 
     the State for the second fiscal year preceding such first 
     fiscal year, increased by the percentage increase in State 
     population from such second preceding fiscal year to such 
     first fiscal year, based on the best available estimates of 
     the Bureau of the Census.

       ``(ii) For any subsequent year.--For any fiscal year that 
     is not the first fiscal year in which a 1903A enrollee 
     category is included in the applicable program enrollee 
     category for a Medicaid Flexibility Program conducted by the 
     State, the block grant amount under this paragraph for the 
     State, year, and category shall be equal to the amount 
     determined for the State and category for the most recent 
     previous fiscal year in which the State conducted a Medicaid 
     Flexibility Program that included such category, except that 
     such amount shall be increased by the percentage increase in 
     the consumer price index for all urban consumers (U.S. city 
     average) from April of the second fiscal year preceding the 
     fiscal year involved to April of the fiscal year preceding 
     the fiscal year involved.
       ``(C) Cap on total population of 1903a enrollees for 
     purposes of block grant calculation.--
       ``(i) In general.--In calculating the amount of a block 
     grant for the first year in which a 1903A enrollee category 
     is included in the applicable program enrollee category for a 
     Medicaid Flexibility Program conducted by the State under 
     subparagraph (B)(i), the total number of 1903A enrollees in 
     such 1903A enrollee category for the State and year shall not 
     exceed the adjusted number of base period enrollees for the 
     State (as defined in clause (ii)).
       ``(ii) Adjusted number of base period enrollees.--The term 
     `adjusted number of base period enrollees' means, with 
     respect to a State and 1903A enrollee category, the number of 
     1903A enrollees in the enrollee category for the State for 
     the State's per capita base period (as determined under 
     section 1903A(e)(4)), increased by the percentage increase, 
     if any, in the total State population from the last April in 
     the State's per capita base period to April of the fiscal 
     year preceding the fiscal year involved (determined using the 
     best available data from the Bureau of the Census) plus 3 
     percentage points.
       ``(D) Availability of rollover funds.--
       ``(i) In general.--To the extent that the block grant 
     amount available to a State for a fiscal year under this 
     paragraph exceeds the amount of Federal payments made to the 
     State for such fiscal year under paragraph (3)(A), the 
     Secretary shall make such funds available to the State for 
     the succeeding fiscal year if the State--

       ``(I) satisfies the State maintenance of effort requirement 
     under paragraph (3)(B); and
       ``(II) is conducting a Medicaid Flexibility Program in such 
     succeeding fiscal year.

       ``(ii) Use of funds.--Funds made available to a State under 
     this subparagraph shall only be used for expenditures related 
     to the State plan under this title or to the State Medicaid 
     Flexibility Program.
       ``(3) Federal payment and state maintenance of effort.--
       ``(A) Federal payment.--Subject to subparagraphs (D) and 
     (E), the Secretary shall pay to each State conducting a 
     Medicaid Flexibility Program under this section for a fiscal 
     year, from its block grant amount under paragraph (2) for 
     such year, an amount for each quarter of such year equal to 
     the Federal average medical assistance percentage (as defined 
     in section 1903A(a)(4)) of the total amount expended under 
     the program during such quarter as targeted health 
     assistance, and the State is responsible for the balance of 
     the funds to carry out such program.
       ``(B) State maintenance of effort expenditures.--For each 
     year during which a State is conducting a Medicaid 
     Flexibility Program, the State shall make expenditures for 
     targeted health assistance under the program in an amount 
     equal to the product of--
       ``(i) the block grant amount determined for the State and 
     year under paragraph (2); and
       ``(ii) the enhanced FMAP described in the first sentence of 
     section 2105(b) for the State and year.
       ``(C) Reduction in block grant amount for states failing to 
     meet moe requirement.--
       ``(i) In general.--In the case of a State conducting a 
     Medicaid Flexibility Program that makes expenditures for 
     targeted health assistance under the program for a fiscal 
     year in an amount that is less than the required amount for 
     the fiscal year under subparagraph (B), the amount of the 
     block grant determined for the State under paragraph (2) for 
     the succeeding fiscal year shall be reduced by the amount by 
     which such expenditures are less than such required amount.
       ``(ii) Disregard of reduction.--For purposes of determining 
     the amount of a State block grant under paragraph (2), any 
     reduction made under this subparagraph to a State's block 
     grant amount in a previous fiscal year shall be disregarded.
       ``(iii) Application to states that terminate program.--In 
     the case of a State described in clause (i) that terminates 
     the State Medicaid Flexibility Program under subsection 
     (d)(2)(B) and such termination is effective with the end of 
     the fiscal year in which the State fails to make the required 
     amount of expenditures under subparagraph (B), the reduction 
     amount determined for the State and succeeding fiscal year 
     under clause (i) shall be treated as an overpayment under 
     this title.
       ``(D) Reduction for noncompliance.--If the Secretary 
     determines that a State conducting a Medicaid Flexibility 
     Program is not complying with the requirements of this 
     section, the Secretary may withhold payments, reduce 
     payments, or recover previous payments to the State under 
     this section as the Secretary deems appropriate.
       ``(E) Additional federal payments during public health 
     emergency.--
       ``(i) In general.--In the case of a State and fiscal year 
     or portion of a fiscal year for which the Secretary has 
     excluded expenditures under section 1903A(b)(6), if the State 
     has uncompensated targeted health assistance expenditures for 
     the year or portion of a year, the Secretary may make an 
     additional payment to such State equal to the Federal average 
     medical assistance percentage (as defined in section 
     1903A(a)(4)) for the year or portion of a year of the amount 
     of such uncompensated targeted health assistance 
     expenditures, except that the amount of such payment shall 
     not exceed the amount determined for the State and year or 
     portion of a year under clause (ii).
       ``(ii) Maximum amount of additional payment.--The amount 
     determined for a State and fiscal year or portion of a fiscal 
     year under this subparagraph shall not exceed the Federal 
     average medical assistance percentage (as defined in section 
     1903A(a)(4)) for such year or portion of a year of the amount 
     by which--

       ``(I) the amount of State expenditures for targeted health 
     assistance for program enrollees in areas of the State which 
     are subject to a declaration described in section 
     1903A(b)(6)(A)(i) for the year or portion of a year; exceeds
       ``(II) the amount of such expenditures for such enrollees 
     in such areas during the most recent fiscal year involved (or 
     portion of a fiscal year of equal length to the portion of a 
     fiscal year involved) during which no such declaration was in 
     effect.

       ``(iii) Uncompensated targeted health assistance.--In this 
     subparagraph, the term `uncompensated targeted health 
     assistance expenditures' means, with respect to a State and 
     fiscal year or portion of a fiscal year, an amount equal to 
     the amount (if any) by which--

       ``(I) the total amount expended by the State under the 
     program for targeted health assistance for the year or 
     portion of a year; exceeds
       ``(II) the amount equal to the amount of the block grant 
     (reduced, in the case of a portion of a year, to the same 
     proportion of the full block grant amount that the portion of 
     the year bears to the whole year) divided by the Federal 
     average medical assistance percentage for the year or portion 
     of a year.

       ``(iv) Review.--If the Secretary makes a payment to a State 
     for a fiscal year or portion of a fiscal year, the Secretary 
     shall, not later than 6 months after the declaration 
     described in section 1903A(b)(6)(A)(i) ceases to be in 
     effect, conduct an audit of the State's targeted health 
     assistance expenditures for program enrollees during the year 
     or portion of a year to ensure that all of the expenditures 
     for which the additional payment was made were made for the 
     purpose of ensuring that the health care needs of program 
     enrollees in areas affected by a public health emergency are 
     met.
       ``(4) Determination and publication of block grant 
     amount.--Beginning in 2019 and

[[Page S4212]]

     each year thereafter, the Secretary shall determine for each 
     State, regardless of whether the State is conducting a 
     Medicaid Flexibility Program or has submitted an application 
     to conduct such a program, the amount of the block grant for 
     the State under paragraph (2) which would apply for the 
     upcoming fiscal year if the State were to conduct such a 
     program in such fiscal year, and shall publish such 
     determinations not later than June 1 of each year.
       ``(d) Program Requirements.--
       ``(1) In general.--No payment shall be made under this 
     section to a State conducting a Medicaid Flexibility Program 
     unless such program meets the requirements of this 
     subsection.
       ``(2) Term of program.--
       ``(A) In general.--A State Medicaid Flexibility Program 
     approved under subsection (b)--
       ``(i) shall be conducted for not less than 1 program 
     period;
       ``(ii) at the option of the State, may be continued for 
     succeeding program periods without resubmitting an 
     application under subsection (b), provided that--

       ``(I) the State provides notice to the Secretary of its 
     decision to continue the program; and
       ``(II) no significant changes are made to the program; and

       ``(iii) shall be subject to termination only by the State, 
     which may terminate the program by making an election under 
     subparagraph (B).
       ``(B) Election to terminate program.--
       ``(i) In general.--Subject to clause (ii), a State 
     conducting a Medicaid Flexibility Program may elect to 
     terminate the program effective with the first day after the 
     end of the program period in which the State makes the 
     election.
       ``(ii) Transition plan requirement.--A State may not elect 
     to terminate a Medicaid Flexibility Program unless the State 
     has in place an appropriate transition plan approved by the 
     Secretary.
       ``(iii) Effect of termination.--If a State elects to 
     terminate a Medicaid Flexibility Program, the per capita cap 
     limitations under section 1903A shall apply effective with 
     the day described in clause (i), and such limitations shall 
     be applied as if the State had never conducted a Medicaid 
     Flexibility Program.
       ``(3) Provision of targeted health assistance.--
       ``(A) In general.--A State Medicaid Flexibility Program 
     shall provide targeted health assistance to program enrollees 
     and such assistance shall be instead of medical assistance 
     which would otherwise be provided to the enrollees under this 
     title.
       ``(B) Conditions for eligibility.--
       ``(i) In general.--A State conducting a Medicaid 
     Flexibility Program shall establish conditions for 
     eligibility of program enrollees, which shall be instead of 
     other conditions for eligibility under this title, except 
     that the program must provide for eligibility for program 
     enrollees to whom the State would otherwise be required to 
     make medical assistance available under section 
     1902(a)(10)(A)(i).
       ``(ii) MAGI.--Any determination of income necessary to 
     establish the eligibility of a program enrollee for purposes 
     of a State Medicaid Flexibility Program shall be made using 
     modified adjusted gross income in accordance with section 
     1902(e)(14).
       ``(4) Benefits and services.--
       ``(A) Required services.--In the case of program enrollees 
     to whom the State would otherwise be required to make medical 
     assistance available under section 1902(a)(10)(A)(i), a State 
     conducting a Medicaid Flexibility Program shall provide as 
     targeted health assistance the following types of services:
       ``(i) Inpatient and outpatient hospital services.
       ``(ii) Laboratory and X-ray services.
       ``(iii) Nursing facility services for individuals aged 21 
     and older.
       ``(iv) Physician services.
       ``(v) Home health care services (including home nursing 
     services, medical supplies, equipment, and appliances).
       ``(vi) Rural health clinic services (as defined in section 
     1905(l)(1)).
       ``(vii) Federally-qualified health center services (as 
     defined in section 1905(l)(2)).
       ``(viii) Family planning services and supplies.
       ``(ix) Nurse midwife services.
       ``(x) Certified pediatric and family nurse practitioner 
     services.
       ``(xi) Freestanding birth center services (as defined in 
     section 1905(l)(3)).
       ``(xii) Emergency medical transportation.
       ``(xiii) Non-cosmetic dental services.
       ``(xiv) Pregnancy-related services, including postpartum 
     services for the 12-week period beginning on the last day of 
     a pregnancy.
       ``(B) Optional benefits.--A State may, at its option, 
     provide services in addition to the services described in 
     subparagraph (A) as targeted health assistance under a 
     Medicaid Flexibility Program.
       ``(C) Benefit packages.--
       ``(i) In general.--The targeted health assistance provided 
     by a State to any group of program enrollees under a Medicaid 
     Flexibility Program shall have an aggregate actuarial value 
     that is equal to at least 95 percent of the aggregate 
     actuarial value of the benchmark coverage described in 
     subsection (b)(1) of section 1937 or benchmark-equivalent 
     coverage described in subsection (b)(2) of such section, as 
     such subsections were in effect prior to the enactment of the 
     Patient Protection and Affordable Care Act.
       ``(ii) Amount, duration, and scope of benefits.--Subject to 
     clause (i), the State shall determine the amount, duration, 
     and scope with respect to services provided as targeted 
     health assistance under a Medicaid Flexibility Program, 
     including with respect to services that are required to be 
     provided to certain program enrollees under subparagraph (A) 
     except as otherwise provided under such subparagraph.
       ``(iii) Mental health and substance use disorder coverage 
     and parity.--The targeted health assistance provided by a 
     State to program enrollees under a Medicaid Flexibility 
     Program shall include mental health services and substance 
     use disorder services and the financial requirements and 
     treatment limitations applicable to such services under the 
     program shall comply with the requirements of section 2726 of 
     the Public Health Service Act in the same manner as such 
     requirements apply to a group health plan.
       ``(iv) Prescription drugs.--If the targeted health 
     assistance provided by a State to program enrollees under a 
     Medicaid Flexibility Program includes assistance for covered 
     outpatient drugs, such drugs shall be subject to a rebate 
     agreement that complies with the requirements of section 
     1927, and any requirements applicable to medical assistance 
     for covered outpatient drugs under a State plan (including 
     the requirement that the State provide information to a 
     manufacturer) shall apply in the same manner to targeted 
     health assistance for covered outpatient drugs under a 
     Medicaid Flexibility Program.
       ``(D) Cost sharing.--A State conducting a Medicaid 
     Flexibility Program may impose premiums, deductibles, cost-
     sharing, or other similar charges, except that the total 
     annual aggregate amount of all such charges imposed with 
     respect to all program enrollees in a family shall not exceed 
     5 percent of the family's income for the year involved.
       ``(5) Administration of program.--Each State conducting a 
     Medicaid Flexibility Program shall do the following:
       ``(A) Single agency.--Designate a single State agency 
     responsible for administering the program.
       ``(B) Enrollment simplification and coordination with state 
     health insurance exchanges.--Provide for simplified 
     enrollment processes (such as online enrollment and 
     reenrollment and electronic verification) and coordination 
     with State health insurance exchanges.
       ``(C) Beneficiary protections.--Establish a fair process 
     (which the State shall describe in the application required 
     under subsection (b)) for individuals to appeal adverse 
     eligibility determinations with respect to the program.
       ``(6) Application of rest of title xix.--
       ``(A) In general.--To the extent that a provision of this 
     section is inconsistent with another provision of this title, 
     the provision of this section shall apply.
       ``(B) Application of section 1903a.--With respect to a 
     State that is conducting a Medicaid Flexibility Program, 
     section 1903A shall be applied as if program enrollees were 
     not 1903A enrollees for each program period during which the 
     State conducts the program.
       ``(C) Waivers and state plan amendments.--
       ``(i) In general.--In the case of a State conducting a 
     Medicaid Flexibility Program that has in effect a waiver or 
     State plan amendment, such waiver or amendment shall not 
     apply with respect to the program, targeted health assistance 
     provided under the program, or program enrollees.
       ``(ii) Replication of waiver or amendment.--In designing a 
     Medicaid Flexibility Program, a State may mirror provisions 
     of a waiver or State plan amendment described in clause (i) 
     in the program to the extent that such provisions are 
     otherwise consistent with the requirements of this section.
       ``(iii) Effect of termination.--In the case of a State 
     described in clause (i) that terminates its program under 
     subsection (d)(2)(B), any waiver or amendment which was 
     limited pursuant to subparagraph (A) shall cease to be so 
     limited effective with the effective date of such 
     termination.
       ``(D) Nonapplication of provisions.--With respect to the 
     design and implementation of Medicaid Flexibility Programs 
     conducted under this section, paragraphs (1), (10)(B), (17), 
     and (23) of section 1902(a), as well as any other provision 
     of this title (except for this section and as otherwise 
     provided by this section) that the Secretary deems 
     appropriate, shall not apply.
       ``(e) Definitions.--For purposes of this section:
       ``(1) Applicable program enrollee category.--The term 
     `applicable program enrollee category' means, with respect to 
     a State Medicaid Flexibility Program for a program period, 
     any of the following as specified by the State for the period 
     in its application under subsection (b):
       ``(A) 2 enrollee categories.--Both of the 1903A enrollee 
     categories described in subparagraphs (D) and (E) of section 
     1903A(e)(2).
       ``(B) Expansion enrollees.--The 1903A enrollee category 
     described in subparagraph (D) of section 1903A(e)(2).
       ``(C) Nonelderly, nondisabled, nonexpansion adults.--The 
     1903A enrollee category described in subparagraph (E) of 
     section 1903A(e)(2).
       ``(2) Medicaid flexibility program.--The term `Medicaid 
     Flexibility Program' means a

[[Page S4213]]

     State program for providing targeted health assistance to 
     program enrollees funded by a block grant under this section.
       ``(3) Program enrollee.--
       ``(A) In general.--The term `program enrollee' means, with 
     respect to a State that is conducting a Medicaid Flexibility 
     Program for a program period, an individual who is a 1903A 
     enrollee (as defined in section 1903A(e)(1)) who is in the 
     applicable program enrollee category specified by the State 
     for the period.
       ``(B) Rule of construction.--For purposes of section 
     1903A(e)(3), eligibility and enrollment of an individual 
     under a Medicaid Flexibility Program shall be deemed to be 
     eligibility and enrollment under a State plan (or waiver of 
     such plan) under this title.
       ``(4) Program period.--The term `program period' means, 
     with respect to a State Medicaid Flexibility Program, a 
     period of 5 consecutive fiscal years that begins with 
     either--
       ``(A) the first fiscal year in which the State conducts the 
     program; or
       ``(B) the next fiscal year in which the State conducts such 
     a program that begins after the end of a previous program 
     period.
       ``(5) State.--The term `State' means one of the 50 States 
     or the District of Columbia.
       ``(6) Targeted health assistance.--The term `targeted 
     health assistance' means assistance for health-care-related 
     items and medical services for program enrollees.''.

     SEC. 134. MEDICAID AND CHIP QUALITY PERFORMANCE BONUS 
                   PAYMENTS.

       Section 1903 of the Social Security Act (42 U.S.C. 1396b), 
     as amended by section 130, is further amended by adding at 
     the end the following new subsection:
       ``(bb) Quality Performance Bonus Payments.--
       ``(1) Increased federal share.--With respect to each of 
     fiscal years 2023 through 2026, in the case of one of the 50 
     States or the District of Columbia (each referred to in this 
     subsection as a `State') that--
       ``(A) equals or exceeds the qualifying amount (as 
     established by the Secretary) of lower than expected 
     aggregate medical assistance expenditures (as defined in 
     paragraph (4)) for that fiscal year; and
       ``(B) submits to the Secretary, in accordance with such 
     manner and format as specified by the Secretary and for the 
     performance period (as defined by the Secretary) for such 
     fiscal year--
       ``(i) information on the applicable quality measures 
     identified under paragraph (3) with respect to each category 
     of Medicaid eligible individuals under the State plan or a 
     waiver of such plan; and
       ``(ii) a plan for spending a portion of additional funds 
     resulting from application of this subsection on quality 
     improvement within the State plan under this title or under a 
     waiver of such plan,
     the Federal matching percentage otherwise applied under 
     subsection (a)(7) for such fiscal year shall be increased by 
     such percentage (as determined by the Secretary) so that the 
     aggregate amount of the resulting increase pursuant to this 
     subsection for the State and fiscal year does not exceed the 
     State allotment established under paragraph (2) for the State 
     and fiscal year.
       ``(2) Allotment determination.--The Secretary shall 
     establish a formula for computing State allotments under this 
     paragraph for each fiscal year described in paragraph (1) 
     such that--
       ``(A) such an allotment to a State is determined based on 
     the performance, including improvement, of such State under 
     this title and title XXI with respect to the quality measures 
     submitted under paragraph (3) by such State for the 
     performance period (as defined by the Secretary) for such 
     fiscal year; and
       ``(B) the total of the allotments under this paragraph for 
     all States for the period of the fiscal years described in 
     paragraph (1) is equal to $8,000,000,000.
       ``(3) Quality measures required for bonus payments.--For 
     purposes of this subsection, the Secretary shall, pursuant to 
     rulemaking and after consultation with State agencies 
     administering State plans under this title, identify and 
     publish (and update as necessary) peer-reviewed quality 
     measures (which shall include health care and long-term care 
     outcome measures and may include the quality measures that 
     are overseen or developed by the National Committee for 
     Quality Assurance or the Agency for Healthcare Research and 
     Quality or that are identified under section 1139A or 1139B) 
     that are quantifiable, objective measures that take into 
     account the clinically appropriate measures of quality for 
     different types of patient populations receiving benefits or 
     services under this title or title XXI.
       ``(4) Lower than expected aggregate medical assistance 
     expenditures.--In this subsection, the term `lower than 
     expected aggregate medical assistance expenditures' means, 
     with respect to a State the amount (if any) by which--
       ``(A) the amount of the adjusted total medical assistance 
     expenditures for the State and fiscal year determined in 
     section 1903A(b)(1) without regard to the 1903A enrollee 
     category described in section 1903A(e)(2)(E); is less than
       ``(B) the amount of the target total medical assistance 
     expenditures for the State and fiscal year determined in 
     section 1903A(c) without regard to the 1903A enrollee 
     category described in section 1903A(e)(2)(E).''.

     SEC. 135. GRANDFATHERING CERTAIN MEDICAID WAIVERS; 
                   PRIORITIZATION OF HCBS WAIVERS.

       (a) Managed Care Waivers.--
       (1) In general.--In the case of a State with a 
     grandfathered managed care waiver, the State may, at its 
     option through a State plan amendment, continue to implement 
     the managed care delivery system that is the subject of such 
     waiver in perpetuity under the State plan under title XIX of 
     the Social Security Act (or a waiver of such plan) without 
     submitting an application to the Secretary for a new waiver 
     to implement such managed care delivery system, so long as 
     the terms and conditions of the waiver involved (other than 
     such terms and conditions that relate to budget neutrality as 
     modified pursuant to section 1903A(f)(1) of the Social 
     Security Act) are not modified.
       (2) Modifications.--
       (A) In general.--If a State with a grandfathered managed 
     care waiver seeks to modify the terms or conditions of such a 
     waiver, the State shall submit to the Secretary an 
     application for approval of a new waiver under such modified 
     terms and conditions.
       (B) Approval of modification.--
       (i) In general.--An application described in subparagraph 
     (A) is deemed approved unless the Secretary, not later than 
     90 days after the date on which the application is submitted, 
     submits to the State--

       (I) a denial; or
       (II) a request for more information regarding the 
     application.

       (ii) Additional information.--If the Secretary requests 
     additional information, the Secretary has 30 days after a 
     State submission in response to the Secretary's request to 
     deny the application or request more information.
       (3) Grandfathered managed care waiver defined.--In this 
     subsection, the term ``grandfathered managed care waiver'' 
     means the provisions of a waiver or an experimental, pilot, 
     or demonstration project that relate to the authority of a 
     State to implement a managed care delivery system under the 
     State plan under title XIX of such Act (or under a waiver of 
     such plan under section 1115 of such Act) that--
       (A) is approved by the Secretary of Health and Human 
     Services under section 1915(b), 1932, or 1115(a)(1) of the 
     Social Security Act (42 U.S.C. 1396n(b), 1396u-2, 1315(a)(1)) 
     as of January 1, 2017; and
       (B) has been renewed by the Secretary not less than 1 time.
       (b) HCBS Waivers.--The Secretary of Health and Human 
     Services shall implement procedures encouraging States to 
     adopt or extend waivers related to the authority of a State 
     to make medical assistance available for home and community-
     based services under the State plan under title XIX of the 
     Social Security Act if the State determines that such waivers 
     would improve patient access to services.

     SEC. 136. COORDINATION WITH STATES.

       Title XIX of the Social Security Act is amended by 
     inserting after section 1904 (42 U.S.C. 1396d) the following:


                       ``coordination with states

       ``Sec. 1904A. No proposed rule (as defined in section 
     551(4) of title 5, United States Code) implementing or 
     interpreting any provision of this title shall be finalized 
     on or after January 1, 2018, unless the Secretary--
       ``(1) provides for a process under which the Secretary or 
     the Secretary's designee solicits advice from each State's 
     State agency responsible for administering the State plan 
     under this title (or a waiver of such plan) and State 
     Medicaid Director--
       ``(A) on a regular, ongoing basis on matters relating to 
     the application of this title that are likely to have a 
     direct effect on the operation or financing of State plans 
     under this title (or waivers of such plans); and
       ``(B) prior to submission of any final proposed rule, plan 
     amendment, waiver request, or proposal for a project that is 
     likely to have a direct effect on the operation or financing 
     of State plans under this title (or waivers of such plans);
       ``(2) accepts and considers written and oral comments from 
     a bipartisan, nonprofit, professional organization that 
     represents State Medicaid Directors, and from any State 
     agency administering the plan under this title, regarding 
     such proposed rule; and
       ``(3) incorporates in the preamble to the proposed rule a 
     summary of comments referred to in paragraph (2) and the 
     Secretary's response to such comments.''.

     SEC. 137. OPTIONAL ASSISTANCE FOR CERTAIN INPATIENT 
                   PSYCHIATRIC SERVICES.

       (a) State Option.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (1) in subsection (a)--
       (A) in paragraph (16)--
       (i) by striking ``and, (B)'' and inserting ``(B)''; and
       (ii) by inserting before the semicolon at the end the 
     following: ``, and (C) subject to subsection (h)(4), 
     qualified inpatient psychiatric hospital services (as defined 
     in subsection (h)(3)) for individuals who are over 21 years 
     of age and under 65 years of age''; and
       (B) in the subdivision (B) that follows paragraph (29), by 
     inserting ``(other than services described in subparagraph 
     (C) of paragraph (16) for individuals described in such 
     subparagraph)'' after ``patient in an institution for mental 
     diseases''; and
       (2) in subsection (h), by adding at the end the following 
     new paragraphs:
       ``(3) For purposes of subsection (a)(16)(C), the term 
     `qualified inpatient psychiatric

[[Page S4214]]

     hospital services' means, with respect to individuals 
     described in such subsection, services described in 
     subparagraph (B) of paragraph (1) that are not otherwise 
     covered under subsection (a)(16)(A) and are furnished--
       ``(A) in an institution (or distinct part thereof) which is 
     a psychiatric hospital (as defined in section 1861(f)); and
       ``(B) with respect to such an individual, for a period not 
     to exceed 30 consecutive days in any month and not to exceed 
     90 days in any calendar year.
       ``(4) As a condition for a State including qualified 
     inpatient psychiatric hospital services as medical assistance 
     under subsection (a)(16)(C), the State must (during the 
     period in which it furnishes medical assistance under this 
     title for services and individuals described in such 
     subsection)--
       ``(A) maintain at least the number of licensed beds at 
     psychiatric hospitals owned, operated, or contracted for by 
     the State that were being maintained as of the date of the 
     enactment of this paragraph or, if higher, as of the date the 
     State applies to the Secretary to include medical assistance 
     under such subsection; and
       ``(B) maintain on an annual basis a level of funding 
     expended by the State (and political subdivisions thereof) 
     other than under this title from non-Federal funds for 
     inpatient services in an institution described in paragraph 
     (3)(A), and for active psychiatric care and treatment 
     provided on an outpatient basis, that is not less than the 
     level of such funding for such services and care as of the 
     date of the enactment of this paragraph or, if higher, as of 
     the date the State applies to the Secretary to include 
     medical assistance under such subsection.''.
       (b) Special Matching Rate.--Section 1905(b) of the Social 
     Security Act (42 U.S.C. 1395d(b)) is amended by adding at the 
     end the following: ``Notwithstanding the previous provisions 
     of this subsection, the Federal medical assistance percentage 
     shall be 50 percent with respect to medical assistance for 
     services and individuals described in subsection 
     (a)(16)(C).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to qualified inpatient psychiatric hospital 
     services furnished on or after October 1, 2018.

     SEC. 138. ENHANCED FMAP FOR MEDICAL ASSISTANCE TO ELIGIBLE 
                   INDIANS.

       Section 1905(b) of the Social Security Act (42 U.S.C. 
     1396d(b)) is amended, in the third sentence, by inserting 
     ``and with respect to amounts expended by a State as medical 
     assistance for services provided by any other provider under 
     the State plan to an individual who is a member of an Indian 
     tribe who is eligible for assistance under the State plan'' 
     before the period.

     SEC. 139. MEDICAID OPTION TO PROVIDE CONSUMER-FOCUSED COST-
                   SHARING ASSISTANCE FOR LOW-INCOME INDIVIDUALS 
                   ENROLLING IN QUALIFIED HEALTH PLANS.

       Title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.), is amended by inserting after section 1906A the 
     following new section:


 ``consumer-focused cost-sharing assistance for low-income individuals 
                  enrolling in qualified health plans

       ``Sec. 1906B.  (a) In General.--A State may elect to 
     provide cost-sharing assistance (as defined in subsection 
     (c)) for an eligible low-income individual (as defined in 
     subsection (b)) who is enrolled in a qualified health plan 
     offered on an Exchange if the State meets the requirements of 
     this section and the offering of such assistance is cost-
     effective (as defined in subsection (d)).
       ``(b) Eligible Low-income Individual Defined.--For purposes 
     of this section, the term `eligible low-income individual' 
     means an individual--
       ``(1) whose income (as determined under section 
     1902(e)(14)) does not exceed 133 percent of the poverty line 
     (as defined in section 2110(c)(5)) applicable to a family of 
     the size involved;
       ``(2) who is eligible for premium assistance for the 
     purchase of a qualified health plan under section 36B of the 
     Internal Revenue Code of 1986 and is enrolled in such a plan;
       ``(3) who would be described in subparagraph (D) or (E) of 
     section 1903A(e)(2) if the individual were eligible for 
     medical assistance under the State plan; and
       ``(4) who satisfies such additional criteria for the 
     provision of cost-sharing assistance under this section as 
     the State may establish.
       ``(c) Cost-sharing Assistance Defined.--
       ``(1) In general.--For purposes of this section, the term 
     `cost-sharing assistance' includes amounts expended for all 
     or part of the costs of premiums, deductibles, coinsurance, 
     copayments, or similar charges, and all or part of any 
     amounts paid for medical care (within the meaning of section 
     213(d) of the Internal Revenue Code of 1986).
       ``(2) Option of additional benefits.--Such term may 
     include, at the option of a State, such additional benefits 
     as the State may specify.
       ``(d) Cost-effective Defined.--
       ``(1) In general.--For purposes of this section, with 
     respect to a State and year, cost-sharing assistance shall be 
     considered to be `cost-effective' with respect to a State if 
     the aggregate amount of Federal cost-sharing and premium 
     assistance (as defined in paragraph (2)) for the State and 
     year do not exceed the Federal cost-sharing assistance limit 
     (as defined in paragraph (3)) for the State and year.
       ``(2) Aggregate amount of federal cost-sharing and premium 
     assistance.--The term `aggregate amount of Federal cost-
     sharing and premium assistance' means, for a State and year, 
     the sum of--
       ``(A) the product of--
       ``(i) the Federal average medical assistance matching 
     percentage (as defined in section 1903A(a)(4)) for the State 
     and year; and
       ``(ii) the amount of cost-sharing assistance provided to 
     eligible low-income individuals by the State for the year; 
     and
       ``(B) the amount of Federal expenditures attributable to 
     advance payments for premium tax credits under section 
     1412(c)(2) of the Patient Protection and Affordable Care Act 
     made on behalf of eligible low-income individuals in the 
     State for the year.
       ``(3) Federal cost-sharing assistance limit.--The term 
     `Federal cost-sharing assistance limit' means, for a State 
     and year, the product of--
       ``(A) the Federal average medical assistance matching 
     percentage (as defined in section 1903A(a)(4)) for the State 
     and year; and
       ``(B) the sum of the products, for each of the 1903A 
     enrollee categories described in subparagraph (D) and (E) of 
     section 1903A(e)(2), of--
       ``(i) the target per capita medical assistance expenditures 
     for the State, year, and category; and
       ``(ii) the number of eligible low-income individuals in the 
     State for the year who, if they were eligible for medical 
     assistance, would be described in the category.
       ``(e) Other Provisions.--
       ``(1) Treatment as medical assistance.--Expenditures for 
     cost-sharing assistance provided by a State for a year in 
     accordance with this section shall be considered, for 
     purposes of section 1903, to be expenditures for medical 
     assistance, except that--
       ``(A) notwithstanding section 1905(b), the Federal medical 
     assistance percentage applicable to the total amount expended 
     for such assistance shall be equal to the Federal average 
     medical assistance matching percentage (as defined in section 
     1903A(a)(4)) for such State and year; and
       ``(B) in no case shall the amount of Federal payments made 
     to a State for a year with respect to amounts expended for 
     such assistance exceed the amount of the Federal cost-sharing 
     assistance limit for the State and year applicable under 
     subsection (d)(3).
       ``(2) Scaling of assistance.--A State may provide cost-
     sharing assistance under this section on a sliding scale 
     based on income and percentage of full actuarial value that 
     the State may determine.
       ``(3) Not considered minimum essential coverage.--Cost-
     sharing assistance provided under this section shall not be 
     considered to be minimum essential coverage (as defined in 
     section 5000A(f) of the Internal Revenue Code of 1986).
       ``(4) Nonapplication of other requirements.--Sections 
     1902(a)(1) (relating to statewideness), 1902(a)(10)(B) 
     (relating to comparability), 1916, and 1916A (relating to 
     cost-sharing for medical assistance), and any other provision 
     of this title which would be directly contrary to the 
     authority under this section shall not apply to the provision 
     of cost-sharing assistance under this section.''.

     SEC. 140. SMALL BUSINESS HEALTH PLANS.

       (a) Tax Treatment of Small Business Health Plans.--A small 
     business health plan (as defined in section 801(a) of the 
     Employee Retirement Income Security Act of 1974) shall be 
     treated--
       (1) as a group health plan (as defined in section 2791 of 
     the Public Health Service Act (42 U.S.C. 300gg-91)) for 
     purposes of applying title XXVII of the Public Health Service 
     Act (42 U.S.C. 300gg et seq.) and title XXII of such Act (42 
     U.S.C. 300bb-1);
       (2) as a group health plan (as defined in section 
     5000(b)(1) of the Internal Revenue Code of 1986) for purposes 
     of applying sections 4980B and 5000 and chapter 100 of the 
     Internal Revenue Code of 1986; and
       (3) as a group health plan (as defined in section 733(a)(1) 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1191b(a)(1))) for purposes of applying parts 6 and 7 
     of title I of the Employee Retirement Income Security Act of 
     1974 (29 U.S.C. 1161 et seq.).
       (b) Rules.--Subtitle B of title I of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1021 et 
     seq.) is amended by adding at the end the following new part:

      ``PART 8--RULES GOVERNING SMALL BUSINESS RISK SHARING POOLS

     ``SEC. 801. SMALL BUSINESS HEALTH PLANS.

       ``(a) In General.--For purposes of this part, the term 
     `small business health plan' means a fully insured group 
     health plan, offered by a health insurance issuer in the 
     large group market, whose sponsor is described in subsection 
     (b).
       ``(b) Sponsor.--The sponsor of a group health plan is 
     described in this subsection if such sponsor--
       ``(1) is a qualified sponsor and receives certification by 
     the Secretary;
       ``(2) is organized and maintained in good faith, with a 
     constitution or bylaws specifically stating its purpose and 
     providing for periodic meetings on at least an annual basis;
       ``(3) is established as a permanent entity;
       ``(4) is established for a purpose other than providing 
     health benefits to its members, such as an organization 
     established as a bona fide trade association, franchise, or 
     section 7705 organization; and
       ``(5) does not condition membership on the basis of a 
     minimum group size.

[[Page S4215]]

  


     ``SEC. 802. FILING FEE AND CERTIFICATION OF SMALL BUSINESS 
                   HEALTH PLANS.

       ``(a) Filing Fee.--A small business health plan shall pay 
     to the Secretary at the time of filing an application for 
     certification under subsection (b) a filing fee in the amount 
     of $5,000, which shall be available to the Secretary for the 
     sole purpose of administering the certification procedures 
     applicable with respect to small business health plans.
       ``(b) Certification.--
       ``(1) In general.--Not later than 6 months after the date 
     of enactment of this part, the Secretary shall prescribe by 
     interim final rule a procedure under which the Secretary--
       ``(A) will certify a qualified sponsor of a small business 
     health plan, upon receipt of an application that includes the 
     information described in paragraph (2);
       ``(B) may provide for continued certification of small 
     business health plans under this part;
       ``(C) shall provide for the revocation of a certification 
     if the applicable authority finds that the small business 
     health plan involved fails to comply with the requirements of 
     this part;
       ``(D) shall conduct oversight of certified plan sponsors, 
     including periodic review, and consistent with section 504, 
     applying the requirements of sections 518, 519, and 520; and
       ``(E) will consult with a State with respect to a small 
     business health plan domiciled in such State regarding the 
     Secretary's authority under this part and other enforcement 
     authority under sections 502 and 504.
       ``(2) Information to be included in application for 
     certification.--An application for certification under this 
     part meets the requirements of this section only if it 
     includes, in a manner and form which shall be prescribed by 
     the applicable authority by regulation, at least the 
     following information:
       ``(A) Identifying information.
       ``(B) States in which the plan intends to do business.
       ``(C) Bonding requirements.
       ``(D) Plan documents.
       ``(E) Agreements with service providers.
       ``(3) Requirements for certified plan sponsors.--Not later 
     than 6 months after the date of enactment of this part, the 
     Secretary shall prescribe by interim final rule requirements 
     for certified plan sponsors that include requirements 
     regarding--
       ``(A) structure and requirements for boards of trustees or 
     plan administrators;
       ``(B) notification of material changes; and
       ``(C) notification for voluntary termination.
       ``(c) Filing Notice of Certification With States.--A 
     certification granted under this part to a small business 
     health plan shall not be effective unless written notice of 
     such certification is filed by the plan sponsor with the 
     applicable State authority of each State in which the small 
     business health plan operates.
       ``(d) Expedited and Deemed Certification.--
       ``(1) In general.--If the Secretary fails to act on a 
     complete application for certification under this section 
     within 90 days of receipt of such complete application, the 
     applying small business health plan sponsor shall be deemed 
     certified until such time as the Secretary may deny for cause 
     the application for certification.
       ``(2) Penalty.--The Secretary may assess a penalty against 
     the board of trustees, plan administrator, and plan sponsor 
     (jointly and severally) of a small business health plan 
     sponsor that is deemed certified under paragraph (1) of up to 
     $500,000 in the event the Secretary determines that the 
     application for certification of such small business health 
     plan sponsor was willfully or with gross negligence 
     incomplete or inaccurate.

     ``SEC. 803. PARTICIPATION AND COVERAGE REQUIREMENTS.

       ``(a) Covered Employers and Individuals.--The requirements 
     of this subsection are met with respect to a small business 
     health plan if, under the terms of the plan--
       ``(1) each participating employer must be--
       ``(A) a member of the sponsor;
       ``(B) the sponsor; or
       ``(C) an affiliated member of the sponsor, except that, in 
     the case of a sponsor which is a professional association or 
     other individual-based association, if at least one of the 
     officers, directors, or employees of an employer, or at least 
     one of the individuals who are partners in an employer and 
     who actively participates in the business, is a member or 
     such an affiliated member of the sponsor, participating 
     employers may also include such employer; and
       ``(2) all individuals commencing coverage under the plan 
     after certification under this part must be--
       ``(A) active or retired owners (including self-employed 
     individuals with or without employees), officers, directors, 
     or employees of, or partners in, participating employers; or
       ``(B) the dependents of individuals described in 
     subparagraph (A).
       ``(b) Participating Employers.--In applying requirements 
     relating to coverage renewal, a participating employer shall 
     not be deemed to be a plan sponsor.
       ``(c) Prohibition of Discrimination Against Employers and 
     Employees Eligible to Participate.--The requirements of this 
     subsection are met with respect to a small business health 
     plan if--
       ``(1) under the terms of the plan, no participating 
     employer may provide health insurance coverage in the 
     individual market for any employee not covered under the 
     plan, if such exclusion of the employee from coverage under 
     the plan is based on a health status-related factor with 
     respect to the employee and such employee would, but for such 
     exclusion on such basis, be eligible for coverage under the 
     plan; and
       ``(2) information regarding all coverage options available 
     under the plan is made readily available to any employer 
     eligible to participate.

     ``SEC. 804. DEFINITIONS; RENEWAL.

       ``For purposes of this part:
       ``(1) Affiliated member.--The term `affiliated member' 
     means, in connection with a sponsor--
       ``(A) a person who is otherwise eligible to be a member of 
     the sponsor but who elects an affiliated status with the 
     sponsor, or
       ``(B) in the case of a sponsor with members which consist 
     of associations, a person who is a member or employee of any 
     such association and elects an affiliated status with the 
     sponsor.
       ``(2) Applicable state authority.--The term `applicable 
     State authority' means, with respect to a health insurance 
     issuer in a State, the State insurance commissioner or 
     official or officials designated by the State to enforce the 
     requirements of title XXVII of the Public Health Service Act 
     for the State involved with respect to such issuer.
       ``(3) Franchisor; franchisee.--The terms `franchisor' and 
     `franchisee' have the meanings given such terms for purposes 
     of sections 436.2(a) through 436.2(c) of title 16, Code of 
     Federal Regulations (including any such amendments to such 
     regulation after the date of enactment of this part) and, for 
     purposes of this part, franchisor or franchisee employers 
     participating in such a group health plan shall not be 
     treated as the employer, co-employer, or joint employer of 
     the employees of another participating franchisor or 
     franchisee employer for any purpose.
       ``(4) Health plan terms.--The terms `group health plan', 
     `health insurance coverage', and `health insurance issuer' 
     have the meanings given such terms in section 733.
       ``(5) Individual market.--
       ``(A) In general.--The term `individual market' means the 
     market for health insurance coverage offered to individuals 
     other than in connection with a group health plan.
       ``(B) Treatment of very small groups.--
       ``(i) In general.--Subject to clause (ii), such term 
     includes coverage offered in connection with a group health 
     plan that has fewer than 2 participants as current employees 
     or participants described in section 732(d)(3) on the first 
     day of the plan year.
       ``(ii) State exception.--Clause (i) shall not apply in the 
     case of health insurance coverage offered in a State if such 
     State regulates the coverage described in such clause in the 
     same manner and to the same extent as coverage in the small 
     group market (as defined in section 2791(e)(5) of the Public 
     Health Service Act) is regulated by such State.
       ``(6) Participating employer.--The term `participating 
     employer' means, in connection with a small business health 
     plan, any employer, if any individual who is an employee of 
     such employer, a partner in such employer, or a self-employed 
     individual who is such employer with or without employees (or 
     any dependent, as defined under the terms of the plan, of 
     such individual) is or was covered under such plan in 
     connection with the status of such individual as such an 
     employee, partner, or self-employed individual in relation to 
     the plan.
       ``(7) Section 7705 organization.--The term `section 7705 
     organization' means an organization providing services for a 
     customer pursuant to a contract meeting the conditions of 
     subparagraphs (A), (B), (C), (D), and (E) (but not (F)) of 
     section 7705(e)(2) of the Internal Revenue Code of 1986, 
     including an entity that is part of a section 7705 
     organization control group . For purposes of this part, any 
     reference to `member' shall include a customer of a section 
     7705 organization except with respect to references to a 
     `member' or `members' in paragraph (1).''.
       (c) Preemption Rules.--Section 514 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1144) is 
     amended by adding at the end the following:
       ``(f) The provisions of this title shall supersede any and 
     all State laws insofar as they may now or hereafter preclude 
     a health insurance issuer from offering health insurance 
     coverage in connection with a small business health plan 
     which is certified under part 8.''.
       (d) Plan Sponsor.--Section 3(16)(B) of such Act (29 U.S.C. 
     102(16)(B)) is amended by adding at the end the following new 
     sentence: ``Such term also includes a person serving as the 
     sponsor of a small business health plan under part 8.''.
       (e) Savings Clause.--Section 731(c) of such Act is amended 
     by inserting ``or part 8'' after ``this part''.
       (f) Effective Date.--The amendments made by this section 
     shall take effect 1 year after the date of the enactment of 
     this Act. The Secretary of Labor shall first issue all 
     regulations necessary to carry out the amendments made by 
     this section within 6 months after the date of the enactment 
     of this Act.

[[Page S4216]]

  


                                TITLE II

     SEC. 201. THE PREVENTION AND PUBLIC HEALTH FUND.

       Subsection (b) of section 4002 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 300u-11) is amended--
       (1) in paragraph (3), by striking ``each of fiscal years 
     2018 and 2019'' and inserting ``fiscal year 2018''; and
       (2) by striking paragraphs (4) through (8).

     SEC. 202. SUPPORT FOR STATE RESPONSE TO OPIOID AND SUBSTANCE 
                   ABUSE CRISIS.

       There is authorized to be appropriated, and is 
     appropriated, to the Secretary of Health and Human Services, 
     out of monies in the Treasury not otherwise obligated--
       (1) $4,972,000,000 for each of fiscal years 2018 through 
     2026, to provide grants to States to support substance use 
     disorder treatment and recovery support services for 
     individuals who have or may have mental or substance use 
     disorders, including counseling, medication assisted 
     treatment, and other substance abuse treatment and recovery 
     services as such Secretary determines appropriate; and
       (2) $50,400,000 for each of fiscal years 2018 through 2022, 
     for research on addiction and pain related to the substance 
     abuse crisis.
     Funds appropriated under this section shall remain available 
     until expended.

     SEC. 203. COMMUNITY HEALTH CENTER PROGRAM.

       Effective as if included in the enactment of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10, 129 Stat. 87), paragraph (1) of section 221(a) of such 
     Act is amended by inserting ``, and an additional 
     $422,000,000 for fiscal year 2017'' after ``2017''.

     SEC. 204. CHANGE IN PERMISSIBLE AGE VARIATION IN HEALTH 
                   INSURANCE PREMIUM RATES.

       Section 2701(a)(1)(A)(iii) of the Public Health Service Act 
     (42 U.S.C. 300gg(a)(1)(A)(iii)) is amended by inserting after 
     ``(consistent with section 2707(c))'' the following: ``or, 
     for plan years beginning on or after January 1, 2019, 5 to 1 
     for adults (consistent with section 2707(c)) or such other 
     ratio for adults (consistent with section 2707(c)) as the 
     State may determine''.

     SEC. 205. MEDICAL LOSS RATIO DETERMINED BY THE STATE.

       Section 2718(b) of the Public Health Service Act (42 U.S.C. 
     300gg-18(b)) is amended by adding at the end the following:
       ``(4) Sunset.--Paragraphs (1) through (3) and subsection 
     (d) shall not apply for plan years beginning on or after 
     January 1, 2019, and after such date any reference in law to 
     such paragraphs and subsection shall have no force or effect.
       ``(5) Medical loss ratio determined by the state.--For plan 
     years beginning on or after January 1, 2019, each State 
     shall--
       ``(A) set the ratio of the amount of premium revenue a 
     health insurance issuer offering group or individual health 
     insurance coverage may expend on non-claims costs to the 
     total amount of premium revenue; and
       ``(B) determine the amount of any annual rebate required to 
     be paid to enrollees under such coverage if the ratio of the 
     amount of premium revenue expended by the issuer on non-
     claims costs to the total amount of premium revenue exceeds 
     the ratio set by the State under subparagraph (A).''.

     SEC. 206. STABILIZING THE INDIVIDUAL INSURANCE MARKETS.

       (a) Enrollment Waiting Periods.--Section 2702(b)(1) of the 
     Public Health Services Act (42 U.S.C. 300gg-1(b)(1)) is 
     amended by inserting ``, and as described in paragraph (3)'' 
     before the period.
       (b) Creditable Coverage Requirement.--Section 2702(b)(2) of 
     the Public Health Services Act (42 U.S.C. 300gg-1(b)(2)) is 
     amended by striking ``paragraph (3)'' and inserting 
     ``paragraph (4)''.
       (c) Application of Waiting Periods.--Section 2702(b) of the 
     Public Health Services Act (42 U.S.C. 300gg-1(b)) is 
     amended--
       (1) in paragraph (3)--
       (A) by striking ``with respect to enrollment periods under 
     paragraphs (1) and (2)'', inserting ``in accordance with this 
     subsection''; and
       (B) by redesignating such paragraph as paragraph (4); and
       (2) by inserting after paragraph (2), the following:
       ``(3) Waiting periods.--
       ``(A) In general.--With respect to health insurance 
     coverage that is effective on or after January 1, 2019, a 
     health insurance issuer described in subsection (a) that 
     offers such coverage in the individual market shall impose a 
     6 month waiting period (as defined in the same manner as such 
     term is defined in section 2704(b)(4) for group health plans) 
     on any individual who enrolls in such coverage and who cannot 
     demonstrate--
       ``(i) in the case of an individual submitting an 
     application during an open enrollment period, 12 months of 
     continuous creditable coverage without experiencing a 
     significant break in such coverage as described in 
     subparagraphs (A) and (B) of section 2704(c)(2); or
       ``(ii) in the case of an individual submitting an 
     application during a special enrollment period--

       ``(I) 12 months of continuous creditable coverage as 
     described in clause (i); or
       ``(II) at least 1 day of creditable coverage during the 60-
     day period immediately preceding the date of submission of 
     such application.

       ``(B) Individuals enrolled in other coverage.--Such a 
     waiting period shall not apply to an individual who is 
     enrolled in health insurance coverage in the individual 
     market on the day before the effective date of the coverage 
     in which the individual is newly enrolling.
       ``(C) Waiting period described.--For purposes of 
     subparagraph (A)--
       ``(i) in the case of an individual that submits an 
     application during an open enrollment period or under a 
     special enrollment period for which the individual qualifies, 
     coverage under the plan begins on the first day of the first 
     month that begins 6 months after the date on which the 
     individual submits an application for health insurance 
     coverage; and
       ``(ii) in the case of an individual that submits an 
     application outside of an open enrollment period and does not 
     qualify for enrollment under a special enrollment period, 
     coverage under the plan begins on the later of--

       ``(I) the first day of the first month that begins 6 months 
     after the day on which the individual submits an application 
     for health insurance coverage; or
       ``(II) the first day of the next plan year.

       ``(D) Certificates of creditable coverage.--The Secretary 
     shall require health insurance issuers and health care 
     sharing ministries (as defined in section 5000A(d)(2)(B) of 
     the Internal Revenue Code of 1986) to provide certification 
     of periods of creditable coverage and waiting periods, in a 
     manner prescribed by the Secretary, for purposes of verifying 
     that the continuous coverage requirements of subparagraph (A) 
     are met.
       ``(E) Continuous creditable coverage defined.--For purposes 
     of this paragraph, the term `creditable coverage'--
       ``(i) has the meaning given such term in section 
     2704(c)(1); and
       ``(ii) includes membership in a health care sharing 
     ministry (as defined in section 5000A(d)(2)(B) of the 
     Internal Revenue Code of 1986).
       ``(F) Exceptions.--Notwithstanding subparagraph (A), a 
     health insurance issuer may not impose a waiting period with 
     respect to the following individuals:
       ``(i) A newborn who is enrolled in such coverage within 30 
     days of the date of birth.
       ``(ii) A child who is adopted or placed for adoption before 
     attaining 18 years of age and who is enrolled in such 
     coverage within 30 days of the date of the adoption.
       ``(iii) Other individuals, as the Secretary determines 
     appropriate.''.

     SEC. 207. WAIVERS FOR STATE INNOVATION.

       (a) In General.--Section 1332 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18052) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1)--
       (i) in subparagraph (B)--

       (I) by amending clause (i) to read as follows:

       ``(i) a description of how the State plan meeting the 
     requirements of a waiver under this section would, with 
     respect to health insurance coverage within the State--

       ``(I) take the place of the requirements described in 
     paragraph (2) that are waived; and
       ``(II) provide for alternative means of, and requirements 
     for, increasing access to comprehensive coverage, reducing 
     average premiums, providing consumers the freedom to purchase 
     the health insurance of their choice, and increasing 
     enrollment in private health insurance; and''; and
       (II) in clause (ii), by striking ``that is budget neutral 
     for the Federal Government'' and inserting ``, demonstrating 
     that the State plan does not increase the Federal deficit''; 
     and

       (ii) in subparagraph (C), by striking ``the law'' and 
     inserting ``a law or has in effect a certification'';
       (B) in paragraph (3)--
       (i) in the first sentence, by inserting ``or would qualify 
     for a reduction in'' after ``would not qualify for'';
       (ii) by adding after the second sentence the following: ``A 
     State may request that all of, or any portion of, such 
     aggregate amount of such credits or reductions be paid to the 
     State as described in the first sentence.'';
       (iii) in the paragraph heading, by striking ``Pass through 
     of funding'' and inserting ``Funding'';
       (iv) by striking ``With respect'' and inserting the 
     following:
       ``(A) Pass through of funding.--With respect''; and
       (v) by adding at the end the following:
       ``(B) Additional funding.--There is authorized to be 
     appropriated, and is appropriated, to the Secretary of Health 
     and Human Services, out of monies in the Treasury not 
     otherwise obligated, $2,000,000,000 for fiscal year 2017, to 
     remain available until the end of fiscal year 2019, to 
     provide grants to States for purposes of submitting an 
     application for a waiver granted under this section and 
     implementing the State plan under such waiver.
       ``(C) Authority to use long-term state innovation and 
     stability allotment.--If the State has an application for an 
     allotment under section 2105(i) of the Social Security Act 
     for the plan year, the State may use the funds available 
     under the State's allotment for the plan year to carry out 
     the State plan under this section, so long as such use is 
     consistent with the requirements of paragraphs (1) and (7) of 
     section 2105(i) of such Act (other than paragraph (1)(B) of 
     such section). Any funds used to carry out a State plan under 
     this subparagraph shall not be

[[Page S4217]]

     considered in determining whether the State plan increases 
     the Federal deficit.''; and
       (C) in paragraph (4), by adding at the end the following:
       ``(D) Expedited process.--The Secretary shall establish an 
     expedited application and approval process that may be used 
     if the Secretary determines that such expedited process is 
     necessary to respond to an urgent or emergency situation with 
     respect to health insurance coverage within a State.'';
       (2) in subsection (b)--
       (A) in paragraph (1)--
       (i) in the matter preceding subparagraph (A)--

       (I) by striking ``may'' and inserting ``shall''; and
       (II) by striking ``only if'' and inserting ``unless''; and

       (ii) by striking ``plan--'' and all that follows through 
     the period at the end of subparagraph (D) and inserting 
     ``application is missing a required element under subsection 
     (a)(1) or that the State plan will increase the Federal 
     deficit, not taking into account any amounts received through 
     a grant under subsection (a)(3)(B).'';
       (B) in paragraph (2)--
       (i) in the paragraph heading, by inserting ``or certify'' 
     after ``law'';
       (ii) in subparagraph (A), by inserting before the period 
     ``, and a certification described in this paragraph is a 
     document, signed by the Governor, and the State insurance 
     commissioner, of the State, that provides authority for State 
     actions under a waiver under this section, including the 
     implementation of the State plan under subsection 
     (a)(1)(B)''; and
       (iii) in subparagraph (B)--

       (I) in the subparagraph heading, by striking ``of opt 
     out''; and
       (II) by striking `` may repeal a law'' and all that follows 
     through the period at the end and inserting the following: 
     ``may terminate the authority provided under the waiver with 
     respect to the State by--

       ``(i) repealing a law described in subparagraph (A); or
       ``(ii) terminating a certification described in 
     subparagraph (A), through a certification for such 
     termination signed by the Governor, and the State insurance 
     commissioner, of the State.'';
       (3) in subsection (d)(2)(B), by striking ``and the reasons 
     therefore'' and inserting ``and the reasons therefore, and 
     provide the data on which such determination was made''; and
       (4) in subsection (e), by striking ``No waiver'' and all 
     that follows through the period at the end and inserting the 
     following: ``A waiver under this section--
       ``(1) shall be in effect for a period of 8 years unless the 
     State requests a shorter duration;
       ``(2) may be renewed for unlimited additional 8-year 
     periods upon application by the State; and
       ``(3) may not be cancelled by the Secretary before the 
     expiration of the 8-year period (including any renewal period 
     under paragraph (2)).''.
       (b) Applicability.--Section 1332 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18052) shall apply as 
     follows:
       (1) In the case of a State for which a waiver under such 
     section was granted prior to the date of enactment of this 
     Act, such section 1332, as in effect on the day before the 
     date of enactment of this Act shall apply to the waiver and 
     State plan.
       (2) In the case of a State that submitted an application 
     for a waiver under such section prior to the date of 
     enactment of this Act, and which application the Secretary of 
     Health and Human Services has not approved prior to such 
     date, the State may elect to have such section 1332, as in 
     effect on the day before the date of enactment of this Act, 
     or such section 1332, as amended by subsection (a), apply to 
     such application and State plan.
       (3) In the case of a State that submits an application for 
     a waiver under such section on or after the date of enactment 
     of this Act, such section 1332, as amended by subsection (a), 
     shall apply to such application and State plan.

     SEC. 208. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH 
                   INSURANCE IN THE INDIVIDUAL MARKET THE OPTION 
                   TO PURCHASE A LOWER PREMIUM CATASTROPHIC PLAN.

       (a) In General.--Section 1302(e) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18022(e)) is amended by 
     adding at the end the following:
       ``(4) Consumer freedom.--For plan years beginning on or 
     after January 1, 2019, paragraph (1)(A) shall not apply with 
     respect to any plan offered in the State.''.
       (b) Risk Pools.--Section 1312(c) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18032(c)) is amended--
       (1) in paragraph (1), by inserting ``and including, with 
     respect to plan years beginning on or after January 1, 2019, 
     enrollees in catastrophic plans described in section 
     1302(e)'' after ``Exchange''; and
       (2) in paragraph (2), by inserting ``and including, with 
     respect to plan years beginning on or after January 1, 2019, 
     enrollees in catastrophic plans described in section 
     1302(e)'' after ``Exchange''.

     SEC. 209. APPLICATION OF ENFORCEMENT PENALTIES.

       (a) In General.--Section 2723 of the Public Health Service 
     Act (42 U.S.C. 300gg-22) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by inserting ``and of section 1303 of 
     the Patient Protection and Affordable Care Act'' after ``this 
     part''; and
       (B) in paragraph (2), by inserting ``or in such section 
     1303'' after ``this part''; and
       (2) in subsection (b)--
       (A) in paragraphs (1) and (2)(A), by inserting ``or section 
     1303 of the Patient Protection and Affordable Care Act'' 
     after ``this part'' each place such term appears;
       (B) in paragraph (2)(C)(ii), by inserting ``and section 
     1303 of the Patient Protection and Affordable Care Act'' 
     after ``this part''.
       (b) Effect of Waiver.--A State waiver pursuant to section 
     1332 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052) shall not affect the authority of the Secretary 
     to impose penalties under section 2723 of the Public Health 
     Service Act (42 U.S.C. 300gg-22).

     SEC. 210. FUNDING FOR COST-SHARING PAYMENTS.

       There is appropriated to the Secretary of Health and Human 
     Services, out of any money in the Treasury not otherwise 
     appropriated, such sums as may be necessary for payments for 
     cost-sharing reductions authorized by the Patient Protection 
     and Affordable Care Act (including adjustments to any prior 
     obligations for such payments) for the period beginning on 
     the date of enactment of this Act and ending on December 31, 
     2019. Notwithstanding any other provision of this Act, 
     payments and other actions for adjustments to any obligations 
     incurred for plan years 2018 and 2019 may be made through 
     December 31, 2020.

     SEC. 211. REPEAL OF COST-SHARING SUBSIDY PROGRAM.

       (a) In General.--Section 1402 of the Patient Protection and 
     Affordable Care Act is repealed.
       (b) Effective Date.--The repeal made by subsection (a) 
     shall apply to cost-sharing reductions (and payments to 
     issuers for such reductions) for plan years beginning after 
     December 31, 2019.

     SEC. 212. CONDITIONS FOR RECEIVING ADDITIONAL SUPPORT FOR 
                   STABILIZING PREMIUMS AND PROMOTING CHOICE IN 
                   PLANS OFFERED IN THE INDIVIDUAL MARKET.

       (a) Federal Funding for Plans.--If, for any of plan years 
     2020 through 2026 for which funds are available under 
     subsection (h)(6) of section 2105 of the Social Security Act 
     (42 U.S.C. 1397ee), a health insurance issuer (as defined in 
     section 2791(b)(2) of the Public Health Service Act (42 
     U.S.C. 300gg-91(b)(2)) meets the conditions of subsection (b) 
     with respect to an entire rating area within a State (as 
     defined in section 2701(a)(2) of the Public Health Service 
     Act (42 U.S.C. Sec.  300gg(a)(2)), the provisions described 
     in subsection (c) shall be treated as not applying (directly 
     or through reference) for those plan years to health 
     insurance coverage offered off the Exchange by such issuer in 
     the individual market in the rating area in the State for 
     such plan year (other than with respect to health insurance 
     coverage certified under subsection (b)(2)), provided that 
     such coverage offered off the Exchange complies with the 
     applicable State health insurance requirements.
       (b) Conditions for Federal Funding for Plans.--The 
     conditions of this subsection for a health insurance issuer 
     for a plan year are that the health insurance issuer, on or 
     before May 3 of the calendar year preceding the plan year 
     involved--
       (1) certifies to the Secretary and the applicable State 
     insurance commissioner that such issuer will apply subsection 
     (a) with respect to health insurance coverage in a rating 
     area within a State for such plan year; and
       (2) certifies to the Secretary that such issuer will make 
     available through the Exchange in the rating area in the 
     State in such plan year at least one gold level and one 
     silver level qualified health plan (as described in section 
     1302(d)(1) of the Patient Protection and Affordable Care Act, 
     42 U.S.C. 18022(d)(1)) and one health plan that provides the 
     level of coverage described in section 36B(b)(3)(B)(i) of the 
     Internal Revenue Code of 1986.
       (c) Non-applicable Provisions Described.--The provisions 
     described in this subsection are the following:
       (1) Subsections (b), (c)(1)(B), and (d) of section 1302 of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18022).
       (2) Section 2701(a)(1) of the Public Health Service Act (42 
     U.S.C. 300gg(a)(1)).
       (3) Subsections (a) and (b)(2) of section 2702 of the 
     Public Health Service Act (42 U.S.C. Sec. Sec.  300gg-1).
       (4) Section 2704 of the Public Health Service Act (42 
     U.S.C. Sec. Sec.  300gg-3).
       (5) Subsections (a) through (j) of section 2705 of the 
     Public Health Service Act (42 U.S.C. Sec. Sec.  300gg-4).
       (6) Section 2707 of the Public Health Service Act (42 
     U.S.C. 300gg-6).
       (7) Section 2708 of the Public Health Service Act (42 
     U.S.C. 300gg-7).
       (8) Section 2713(a) of the Public Health Service Act (42 
     U.S.C. 300gg-13(a)).
       (9) Section 2718(b)(1) of the Public Health Service Act (42 
     U.S.C. Sec. Sec.  300gg-18(b)(1)).
       (d) Continuous Coverage.--For purposes of section 2702(b) 
     of the Public Health Service Act (42 U.S.C. 300gg-1), health 
     insurance coverage offered off the Exchange in accordance 
     with subsection (a) shall not be deemed creditable coverage, 
     as defined in section 2704(c) of the Public Health Service 
     Act (42 U.S.C. 300gg-3(c)).
       (e) Nonapplication of Risk Adjustment Program.--Section 
     1343 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18063) shall not apply to health insurance

[[Page S4218]]

     coverage offered off the Exchange in accordance with 
     subsection (a) or to the issuer of such coverage with respect 
     to that coverage.
       (f) Effect of Waiver.--A State that receives a waiver under 
     section 1332 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18052) shall not be permitted to use pass 
     through funding under subsection (a)(3)(C) of such section 
     either to provide assistance to individuals who enroll in 
     health insurance coverage offered in accordance with 
     subsection (a) or to make payments to issuers for any health 
     insurance coverage offered in accordance with subsection (a).
       (g) Funding for States.--
       (1) Appropriation.--There is appropriated to the Secretary 
     of Health and Human Services, out of any money in the 
     Treasury not otherwise appropriated, $2,000,000,000 for the 
     period beginning on January 1, 2020, and ending on December 
     31, 2026, for the purpose of providing allotments for States 
     in which a health insurance issuer offers coverage in 
     accordance with subsection (a). Amounts paid to any such 
     State from such an allotment shall be used to offset costs 
     attributable to the State's regulation and oversight of such 
     coverage. Funds appropriated under this paragraph shall 
     remain available until expended.
       (2) Procedure for distribution of funds.--The Secretary of 
     Health and Human Services shall determine an appropriate 
     procedure for providing and distributing funds under this 
     subsection.
       (h) Tax Credit Not Available.--Health insurance coverage 
     offered off the Exchange in accordance with subsection (a) 
     shall not be taken into account as a qualified health plan 
     for purposes of calculating the amount of the premium tax 
     credit under section 36B of the Internal Revenue Code of 
     1986.
                                 ______
                                 
  SA 271. Mr. ENZI submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; as follows:

       Strike all after the first line and insert the following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Obamacare Repeal 
     Reconciliation Act of 2017''.

                                TITLE I

     SEC. 101. RECAPTURE EXCESS ADVANCE PAYMENTS OF PREMIUM TAX 
                   CREDITS.

       Subparagraph (B) of section 36B(f)(2) of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new clause:
       ``(iii) Nonapplicability of limitation.--This subparagraph 
     shall not apply to taxable years ending after December 31, 
     2017, and before January 1, 2020.''.

     SEC. 102. PREMIUM TAX CREDIT.

       (a) Premium Tax Credit.--
       (1) Modification of definition of qualified health plan.--
       (A) In general.--Section 36B(c)(3)(A) of the Internal 
     Revenue Code of 1986 is amended by inserting before the 
     period at the end the following: ``or a plan that includes 
     coverage for abortions (other than any abortion necessary to 
     save the life of the mother or any abortion with respect to a 
     pregnancy that is the result of an act of rape or incest)''.
       (B) Effective date.--The amendment made by this paragraph 
     shall apply to taxable years beginning after December 31, 
     2017.
       (2) Repeal.--
       (A) In general.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     striking section 36B.
       (B) Effective date.--The amendment made by this paragraph 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Repeal of Eligibility Determinations.--
       (1) In general.--The following sections of the Patient 
     Protection and Affordable Care Act are repealed:
       (A) Section 1411 (other than subsection (i), the last 
     sentence of subsection (e)(4)(A)(ii), and such provisions of 
     such section solely to the extent related to the application 
     of the last sentence of subsection (e)(4)(A)(ii)).
       (B) Section 1412.
       (2) Effective date.--The repeals in paragraph (1) shall 
     take effect on January 1, 2020.
       (c) Protecting Americans by Repeal of Disclosure Authority 
     To Carry Out Eligibility Requirements for Certain Programs.--
       (1) In general.--Paragraph (21) of section 6103(l) of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new subparagraph:
       ``(D) Termination.--No disclosure may be made under this 
     paragraph after December 31, 2019.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect on January 1, 2020.

     SEC. 103. SMALL BUSINESS TAX CREDIT.

       (a) Sunset.--
       (1) In general.--Section 45R of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(j) Shall Not Apply.--This section shall not apply with 
     respect to amounts paid or incurred in taxable years 
     beginning after December 31, 2019.''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Disallowance of Small Employer Health Insurance Expense 
     Credit for Plan Which Includes Coverage for Abortion.--
       (1) In general.--Subsection (h) of section 45R of the 
     Internal Revenue Code of 1986 is amended--
       (A) by striking ``Any term'' and inserting the following:
       ``(1) In general.--Any term'', and
       (B) by adding at the end the following new paragraph:
       ``(2) Exclusion of health plans including coverage for 
     abortion.--The term `qualified health plan' does not include 
     any health plan that includes coverage for abortions (other 
     than any abortion necessary to save the life of the mother or 
     any abortion with respect to a pregnancy that is the result 
     of an act of rape or incest).''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 104. INDIVIDUAL MANDATE.

       (a) In General.--Section 5000A(c) of the Internal Revenue 
     Code of 1986 is amended--
       (1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' 
     and inserting ``Zero percent'', and
       (2) in paragraph (3)--
       (A) by striking ``$695'' in subparagraph (A) and inserting 
     ``$0'', and
       (B) by striking subparagraph (D).
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 105. EMPLOYER MANDATE.

       (a) In General.--
       (1) Paragraph (1) of section 4980H(c) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$2,000''.
       (2) Paragraph (1) of section 4980H(b) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$3,000''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 106. FEDERAL PAYMENTS TO STATES.

       (a) In General.--Notwithstanding section 504(a), 
     1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 
     2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 
     1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 1397bb(a)(7), 
     1397ee(a)(1)), or the terms of any Medicaid waiver in effect 
     on the date of enactment of this Act that is approved under 
     section 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n), for the 1-year period beginning on the date of 
     enactment of this Act, no Federal funds provided from a 
     program referred to in this subsection that is considered 
     direct spending for any year may be made available to a State 
     for payments to a prohibited entity, whether made directly to 
     the prohibited entity or through a managed care organization 
     under contract with the State.
       (b) Definitions.--In this section:
       (1) Prohibited entity.--The term ``prohibited entity'' 
     means an entity, including its affiliates, subsidiaries, 
     successors, and clinics--
       (A) that, as of the date of enactment of this Act--
       (i) is an organization described in section 501(c)(3) of 
     the Internal Revenue Code of 1986 and exempt from tax under 
     section 501(a) of such Code;
       (ii) is an essential community provider described in 
     section 156.235 of title 45, Code of Federal Regulations (as 
     in effect on the date of enactment of this Act), that is 
     primarily engaged in family planning services, reproductive 
     health, and related medical care; and
       (iii) provides for abortions, other than an abortion--

       (I) if the pregnancy is the result of an act of rape or 
     incest; or
       (II) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness that would, as 
     certified by a physician, place the woman in danger of death 
     unless an abortion is performed, including a life-endangering 
     physical condition caused by or arising from the pregnancy 
     itself; and

       (B) for which the total amount of Federal and State 
     expenditures under the Medicaid program under title XIX of 
     the Social Security Act in fiscal year 2014 made directly to 
     the entity and to any affiliates, subsidiaries, successors, 
     or clinics of the entity, or made to the entity and to any 
     affiliates, subsidiaries, successors, or clinics of the 
     entity as part of a nationwide health care provider network, 
     exceeded $1,000,000.
       (2) Direct spending.--The term ``direct spending'' has the 
     meaning given that term under section 250(c) of the Balanced 
     Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 
     900(c)).

     SEC. 107. MEDICAID.

       The Social Security Act (42 U.S.C. 301 et seq.) is 
     amended--
       (1) in section 1902--
       (A) in subsection (a)(10)(A), in each of clauses (i)(VIII) 
     and (ii)(XX), by inserting ``and ending December 31, 2019,'' 
     after ``January 1, 2014,''; and
       (B) in subsection (a)(47)(B), by inserting ``and provided 
     that any such election shall cease to be effective on January 
     1, 2020, and no such election shall be made after that date'' 
     before the semicolon at the end;
       (2) in section 1905--
       (A) in the first sentence of subsection (b), by inserting 
     ``(50 percent on or after January 1, 2020)'' after ``55 
     percent'';
       (B) in subsection (y)(1), by striking the semicolon at the 
     end of subparagraph (D) and all that follows through 
     ``thereafter''; and
       (C) in subsection (z)(2)--

[[Page S4219]]

       (i) in subparagraph (A), by inserting ``through 2019'' 
     after ``each year thereafter''; and
       (ii) in subparagraph (B)(ii)(VI), by striking ``and each 
     subsequent year'';
       (3) in section 1915(k)(2), by striking ``during the period 
     described in paragraph (1)'' and inserting ``on or after the 
     date referred to in paragraph (1) and before January 1, 
     2020'';
       (4) in section 1920(e), by adding at the end the following: 
     ``This subsection shall not apply after December 31, 2019.'';
       (5) in section 1937(b)(5), by adding at the end the 
     following: ``This paragraph shall not apply after December 
     31, 2019.''; and
       (6) in section 1943(a), by inserting ``and before January 
     1, 2020,'' after ``January 1, 2014,''.

     SEC. 108. REPEAL OF DSH ALLOTMENT REDUCTIONS.

       Section 1923(f) of the Social Security Act (42 U.S.C. 
     1396r-4(f)) is amended by striking paragraphs (7) and (8).

     SEC. 109. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE 
                   PREMIUMS AND HEALTH PLAN BENEFITS.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986 is amended by striking section 4980I.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     2019.
       (c) Subsequent Effective Date.--The amendment made by 
     subsection (a) shall not apply to taxable years beginning 
     after December 31, 2025, and chapter 43 of the Internal 
     Revenue Code of 1986 is amended to read as such chapter would 
     read if such subsection had never been enacted.

     SEC. 110. REPEAL OF TAX ON OVER-THE-COUNTER MEDICATIONS.

       (a) HSAs.--Subparagraph (A) of section 223(d)(2) of the 
     Internal Revenue Code of 1986 is amended by striking ``Such 
     term'' and all that follows through the period.
       (b) Archer MSAs.--Subparagraph (A) of section 220(d)(2) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``Such term'' and all that follows through the period.
       (c) Health Flexible Spending Arrangements and Health 
     Reimbursement Arrangements.--Section 106 of the Internal 
     Revenue Code of 1986 is amended by striking subsection (f).
       (d) Effective Dates.--
       (1) Distributions from savings accounts.--The amendments 
     made by subsections (a) and (b) shall apply to amounts paid 
     with respect to taxable years beginning after December 31, 
     2016.
       (2) Reimbursements.--The amendment made by subsection (c) 
     shall apply to expenses incurred with respect to taxable 
     years beginning after December 31, 2016.

     SEC. 111. REPEAL OF TAX ON HEALTH SAVINGS ACCOUNTS.

       (a) HSAs.--Section 223(f)(4)(A) of the Internal Revenue 
     Code of 1986 is amended by striking ``20 percent'' and 
     inserting ``10 percent''.
       (b) Archer MSAs.--Section 220(f)(4)(A) of the Internal 
     Revenue Code of 1986 is amended by striking ``20 percent'' 
     and inserting ``15 percent''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to distributions made after December 31, 2016.

     SEC. 112. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO FLEXIBLE 
                   SPENDING ACCOUNTS.

       (a) In General.--Section 125 of the Internal Revenue Code 
     of 1986 is amended by striking subsection (i).
       (b) Effective Date.--The amendment made by this section 
     shall apply to plan years beginning after December 31, 2017.

     SEC. 113. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS.

       Subsection (j) of section 9008 of the Patient Protection 
     and Affordable Care Act is amended to read as follows:
       ``(j) Repeal.--This section shall apply to calendar years 
     beginning after December 31, 2010, and ending before January 
     1, 2018.''.

     SEC. 114. REPEAL OF MEDICAL DEVICE EXCISE TAX.

       Section 4191 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new subsection:
       ``(d) Applicability.--The tax imposed under subsection (a) 
     shall not apply to sales after December 31, 2017.''.

     SEC. 115. REPEAL OF HEALTH INSURANCE TAX.

       Subsection (j) of section 9010 of the Patient Protection 
     and Affordable Care Act is amended by striking ``, and'' at 
     the end of paragraph (1) and all that follows through 
     ``2017''.

     SEC. 116. REPEAL OF ELIMINATION OF DEDUCTION FOR EXPENSES 
                   ALLOCABLE TO MEDICARE PART D SUBSIDY.

       (a) In General.--Section 139A of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     sentence: ``This section shall not be taken into account for 
     purposes of determining whether any deduction is allowable 
     with respect to any cost taken into account in determining 
     such payment.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 117. REPEAL OF CHRONIC CARE TAX.

       (a) In General.--Subsection (a) of section 213 of the 
     Internal Revenue Code of 1986 is amended by striking ``10 
     percent'' and inserting ``7.5 percent''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 118. REPEAL OF MEDICARE TAX INCREASE.

       (a) In General.--Subsection (b) of section 3101 of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(b) Hospital Insurance.--In addition to the tax imposed 
     by the preceding subsection, there is hereby imposed on the 
     income of every individual a tax equal to 1.45 percent of the 
     wages (as defined in section 3121(a)) received by such 
     individual with respect to employment (as defined in section 
     3121(b).''.
       (b) SECA.--Subsection (b) of section 1401 of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(b) Hospital Insurance.--In addition to the tax imposed 
     by the preceding subsection, there shall be imposed for each 
     taxable year, on the self-employment income of every 
     individual, a tax equal to 2.9 percent of the amount of the 
     self-employment income for such taxable year.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to remuneration received after, and 
     taxable years beginning after, December 31, 2017.

     SEC. 119. REPEAL OF TANNING TAX.

       (a) In General.--The Internal Revenue Code of 1986 is 
     amended by striking chapter 49.
       (b) Effective Date.--The amendment made by this section 
     shall apply to services performed after September 30, 2017.

     SEC. 120. REPEAL OF NET INVESTMENT TAX.

       (a) In General.--Subtitle A of the Internal Revenue Code of 
     1986 is amended by striking chapter 2A.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 121. REMUNERATION.

       Paragraph (6) of section 162(m) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(I) Termination.--This paragraph shall not apply to 
     taxable years beginning after December 31, 2016.''.

                                TITLE II

     SEC. 201. THE PREVENTION AND PUBLIC HEALTH FUND.

       Subsection (b) of section 4002 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 300u-11) is amended--
       (1) in paragraph (3), by striking ``each of fiscal years 
     2018 and 2019'' and inserting ``fiscal year 2018''; and
       (2) by striking paragraphs (4) through (8).

     SEC. 202. SUPPORT FOR STATE RESPONSE TO SUBSTANCE ABUSE 
                   PUBLIC HEALTH CRISIS AND URGENT MENTAL HEALTH 
                   NEEDS.

       (a) In General.--There are authorized to be appropriated, 
     and are appropriated, out of monies in the Treasury not 
     otherwise obligated, $750,000,000 for each of fiscal years 
     2018 and 2019, to the Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') to award 
     grants to States to address the substance abuse public health 
     crisis or to respond to urgent mental health needs within the 
     State. In awarding grants under this section, the Secretary 
     may give preference to States with an incidence or prevalence 
     of substance use disorders that is substantial relative to 
     other States or to States that identify mental health needs 
     within their communities that are urgent relative to such 
     needs of other States. Funds appropriated under this 
     subsection shall remain available until expended.
       (b) Use of Funds.--Grants awarded to a State under 
     subsection (a) shall be used for one or more of the following 
     public health-related activities:
       (1) Improving State prescription drug monitoring programs.
       (2) Implementing prevention activities, and evaluating such 
     activities to identify effective strategies to prevent 
     substance abuse.
       (3) Training for health care practitioners, such as best 
     practices for prescribing opioids, pain management, 
     recognizing potential cases of substance abuse, referral of 
     patients to treatment programs, and overdose prevention.
       (4) Supporting access to health care services provided by 
     Federally certified opioid treatment programs or other 
     appropriate health care providers to treat substance use 
     disorders or mental health needs.
       (5) Other public health-related activities, as the State 
     determines appropriate, related to addressing the substance 
     abuse public health crisis or responding to urgent mental 
     health needs within the State.

     SEC. 203. COMMUNITY HEALTH CENTER PROGRAM.

       Effective as if included in the enactment of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10, 129 Stat. 87), paragraph (1) of section 221(a) of such 
     Act is amended by inserting ``, and an additional 
     $422,000,000 for fiscal year 2017'' after ``2017''.

     SEC. 204. FUNDING FOR COST-SHARING PAYMENTS.

       There is appropriated to the Secretary of Health and Human 
     Services, out of any money in the Treasury not otherwise 
     appropriated, such sums as may be necessary for payments for 
     cost-sharing reductions authorized by the Patient Protection 
     and Affordable Care Act (including adjustments to any prior 
     obligations for such payments) for the period beginning on 
     the date of enactment of this Act and ending on December 31, 
     2019. Notwithstanding any other provision of this Act, 
     payments and other actions for adjustments to any obligations 
     incurred for

[[Page S4220]]

     plan years 2018 and 2019 may be made through December 31, 
     2020.

     SEC. 205. REPEAL OF COST-SHARING SUBSIDY PROGRAM.

       (a) In General.--Section 1402 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18071) is repealed.
       (b) Effective Date.--The repeal made by subsection (a) 
     shall apply to cost-sharing reductions (and payments to 
     issuers for such reductions) for plan years beginning after 
     December 31, 2019.
                                 ______
                                 
  SA 272. Mr. JOHNSON submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. HEALTH INSURANCE COVERAGE FOR MEMBERS OF CONGRESS 
                   AND CONGRESSIONAL STAFF.

       (a) Treatment of Congressional Staff.--
       (1) In general.--Section 1312(d)(3)(D) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18032(d)(3)(D)) 
     is amended--
       (A) in clause (i)--
       (i) in the matter preceding subclause (I)--

       (I) by striking ``and congressional staff''; and
       (II) by striking ``or congressional staff''; and

       (ii) in subclause (II), by inserting ``to individuals'' 
     before ``offered''; and
       (B) by adding at the end the following:
       ``(iii) No government contribution.--For a Member of 
     Congress enrolled in a health plan through an Exchange, there 
     shall be no Government contribution under section 8906 of 
     title 5, United States Code, or any other provision of 
     law.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall take effect with respect to plan years beginning on or 
     after January 1, 2018.
       (b) Regulations.--The Director of the Office of Personnel 
     Management shall update the regulations entitled, ``Federal 
     Employees Health Benefits Program: Members of Congress and 
     Congressional Staff'' (78 Fed. Reg. 60653), published on 
     October 2, 2013, in accordance with the amendments made by 
     subsection (a). The updated regulations shall provide that 
     the Office of Personnel Management shall not offer a Small 
     Business Health Options Program for Members of Congress;
                                 ______
                                 
  SA 273. Mr. JOHNSON submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       In lieu of the matter proposed to be inserted, insert the 
     following:

     SECTION 1. SUNSET OF THE PATIENT PROTECTION AND AFFORDABLE 
                   CARE ACT AND THE HEALTH CARE AND EDUCATION 
                   RECONCILIATION ACT OF 2010.

       (a) Patient Protection and Affordable Care Act.--Effective 
     with respect to plan years beginning on or after January 1, 
     2020, the Patient Protection and Affordable Care Act (Public 
     Law 111-148), including the amendments made by such Act, 
     shall have no force or effect.
       (b) Health Care and Education Reconciliation Act of 2010.--
     Effective with respect to plan years beginning on or after 
     January 1, 2020, the Health Care and Education Reconciliation 
     Act of 2010 (Public Law 111-152), including the amendments 
     made by such Act, shall have no force or effect.
                                 ______
                                 
  SA 274. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ____. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAVINGS 
                   ACCOUNT INCREASED TO AMOUNT OF DEDUCTIBLE AND 
                   OUT-OF-POCKET LIMITATION.

       (a) Self-Only Coverage.--Section 223(b)(2)(A) of the 
     Internal Revenue Code of 1986 is amended by striking 
     ``$2,250'' and inserting ``the amount in effect under 
     subsection (c)(2)(A)(ii)(I)''.
       (b) Family Coverage.--Section 223(b)(2)(B) of such Code is 
     amended by striking ``$4,500'' and inserting ``the amount in 
     effect under subsection (c)(2)(A)(ii)(II)''.
       (c) Cost-of-living Adjustment.--Section 223(g)(1) of such 
     Code is amended--
       (1) by striking ``subsections (b)(2) and'' both places it 
     appears and inserting ``subsection'', and
       (2) in subparagraph (B), by striking ``determined by'' and 
     all that follows through `` `calendar year 2003'.'' and 
     inserting ``determined by substituting `calendar year 2003' 
     for `calendar year 1992' in subparagraph (B) thereof.''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2017.
                                 ______
                                 
  SA 275. Mr. BARRASSO submitted an amendment intended to be proposed 
to amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH 
                   INSURANCE IN THE INDIVIDUAL MARKET THE OPTION 
                   TO PURCHASE A LOWER PREMIUM CATASTROPHIC PLAN.

       (a) In General.--Section 1302(e) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18022(e)) is amended by 
     adding at the end the following:
       ``(4) Consumer freedom.--For plan years beginning on or 
     after January 1, 2019, paragraph (1)(A) shall not apply with 
     respect to any plan offered in the State.''.
       (b) Risk Pools.--Section 1312(c) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18032(c)) is amended--
       (1) in paragraph (1), by inserting ``and including, with 
     respect to plan years beginning on or after January 1, 2019, 
     enrollees in catastrophic plans described in section 
     1302(e)'' after ``Exchange''; and
       (2) in paragraph (2), by inserting ``and including, with 
     respect to plan years beginning on or after January 1, 2019, 
     enrollees in catastrophic plans described in section 
     1302(e)'' after ``Exchange''.
                                 ______
                                 
  SA 276. Mr. KAINE (for himself, Mr. Carper, Mr. Coons, Mrs. Shaheen, 
Mr. Cardin, Ms. Hassan, Ms. Klobuchar, Ms. Stabenow, Mr. Warner, Ms. 
Heitkamp, and Mr. Nelson) submitted an amendment intended to be 
proposed by him to the bill H.R. 1628, to provide for reconciliation 
pursuant to title II of the concurrent resolution on the budget for 
fiscal year 2017; which was ordered to lie on the table; as follows:

       In lieu of the matter proposed to be inserted, insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Individual Health Insurance 
     Marketplace Improvement Act''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Before the passage of the Patient Protection and 
     Affordable Care Act (Public Law 114-148) in 2010, Americans 
     with pre-existing conditions faced unfair barriers to 
     accessing health insurance coverage and health care costs had 
     risen rapidly for decades.
       (2) Since 2010, the rate of uninsured Americans has 
     declined to a historic low, with more than 20,000,000 
     Americans gaining access to health insurance coverage.
       (3) Since 2010, America has experienced the slowest growth 
     in the price of health care in over five decades.
       (4) Thanks to the Patient Protection and Affordable Care 
     Act (Public Law 114-148), Americans can no longer be denied 
     insurance or charged more on the basis of their health 
     status, more Americans than ever have insurance, and the 
     health care they receive is continually improving.
       (5) Starting in 2016, independent, non-partisan 
     organizations, including the Congressional Budget Office, 
     have determined that the individual health insurance markets 
     have stabilized and improved.
       (6) The cost-sharing reduction payments in the Patient 
     Protection and Affordable Care Act provide stability in the 
     individual health insurance market, lower insurance premiums 
     by nearly 20 percent, and encourage competition among health 
     insurers. The payments reduce costs for approximately 
     6,000,000 people with incomes below 250 percent of the 
     poverty line by an average of about $1,100 per person and 
     should be increased to help more Americans.
       (7) Risk mitigation programs, such as the reinsurance 
     program for the Medicare Part D prescription drug benefit 
     program, have provided additional stability to the health 
     insurance markets, restrained premium growth, and lowered 
     taxpayer costs by helping health insurers predict and bear 
     risk associated with managing health care costs for a 
     population.
       (8) From 2014 to 2016, the temporary reinsurance program 
     established under the Affordable Care Act helped to stabilize 
     the new insurance marketplaces and reduced insurance premiums 
     in the individual health insurance market by as much as 10 
     percent.
       (9) Throughout his Presidential campaign, the President of 
     the United States repeatedly promised the American people 
     that his health care plan will result in reduced rates of 
     uninsured, lower costs, and higher quality care, stating on 
     January 14, 2017, that ``We're going to have insurance for 
     everybody. There was a philosophy in some circles that if you 
     can't pay for it, you don't get it. That's not going to 
     happen with us''; and on January 25, 2017, that ``I can 
     assure you, we are going to have a better plan, much better 
     health care, much better service treatment, a plan where you 
     can have access to the doctor that you want and the plan that 
     you want. We're

[[Page S4221]]

     gonna have a much better health care plan at much less 
     money''.
       (10) The goal of any health care legislation should be to 
     build on the Affordable Care Act to continue expanding 
     coverage and make health care more affordable for Americans. 
     Improving affordability and expanding coverage will also 
     broaden the individual market risk pool, contributing to 
     lower premiums and strengthening market stability.

     SEC. 3. SENSE OF THE SENATE.

       It is the sense of the Senate that, with the reinsurance 
     program under section 4 bringing additional stability to the 
     individual marketplace for the 2018 plan year, the Senate 
     should work in a bipartisan manner to find solutions to 
     improve the health care system.

     SEC. 4. INDIVIDUAL MARKET REINSURANCE FUND.

       (a) Establishment of Fund.--
       (1) In general.--There is established the ``Individual 
     Market Reinsurance Fund'' to be administered by the Secretary 
     to provide funding for an individual market stabilization 
     reinsurance program in each State that complies with the 
     requirements of this section.
       (2) Funding.--There is appropriated to the Fund, out of any 
     moneys in the Treasury not otherwise appropriated, such sums 
     as are necessary to carry out this section (other than 
     subsection (c)) for each calendar year beginning with 2018. 
     Amounts appropriated to the Fund shall remain available 
     without fiscal or calendar year limitation to carry out this 
     section.
       (b) Individual Market Reinsurance Program.--
       (1) Use of funds.--The Secretary shall use amounts in the 
     Fund to establish a reinsurance program under which the 
     Secretary shall make reinsurance payments to health insurance 
     issuers with respect to high-cost individuals enrolled in 
     qualified health plans offered by such issuers that are not 
     grandfathered health plans or transitional health plans for 
     any plan year beginning with the 2018 plan year. This 
     subsection constitutes budget authority in advance of 
     appropriations Acts and represents the obligation of the 
     Secretary to provide payments from the Fund in accordance 
     with this subsection.
       (2) Amount of payment.--The payment made to a health 
     insurance issuer under subsection (a) with respect to each 
     high-cost individual enrolled in a qualified health plan 
     issued by the issuer that is not a grandfathered health plan 
     or a transitional health plan shall equal 80 percent of the 
     lesser of--
       (A) the amount (if any) by which the individual's claims 
     incurred during the plan year exceeds--
       (i) in the case of the 2018, 2019, or 2020 plan year, 
     $50,000; and
       (ii) in the case of any other plan year, $100,000; or
       (B) for plan years described in--
       (i) subparagraph (A)(i), $450,000; and
       (ii) subparagraph (A)(ii), $400,000.
       (3) Indexing.--In the case of plan years beginning after 
     2018, the dollar amounts that appear in subparagraphs (A) and 
     (B) of paragraph (2) shall each be increased by an amount 
     equal to--
       (A) such amount; multiplied by
       (B) the premium adjustment percentage specified under 
     section 1302(c)(4) of the Affordable Care Act, but determined 
     by substituting ``2018'' for ``2013''.
       (4) Payment methods.--
       (A) In general.--Payments under this subsection shall be 
     based on such a method as the Secretary determines. The 
     Secretary may establish a payment method by which interim 
     payments of amounts under this subsection are made during a 
     plan year based on the Secretary's best estimate of amounts 
     that will be payable after obtaining all of the information.
       (B) Requirement for provision of information.--
       (i) Requirement.--Payments under this subsection to a 
     health insurance issuer are conditioned upon the furnishing 
     to the Secretary, in a form and manner specified by the 
     Secretary, of such information as may be required to carry 
     out this subsection.
       (ii) Restriction on use of information.--Information 
     disclosed or obtained pursuant to clause (i) is subject to 
     the HIPAA privacy and security law, as defined in section 
     3009(a) of the Public Health Service Act (42 U.S.C. 300jj-
     19(a)).
       (5) Secretary flexibility for budget neutral revisions to 
     reinsurance payment specifications.--If the Secretary 
     determines appropriate, the Secretary may substitute higher 
     dollar amounts for the dollar amounts specified under 
     subparagraphs (A) and (B) of paragraph (2) (and adjusted 
     under paragraph (3), if applicable) if the Secretary 
     certifies that such substitutions, considered together, 
     neither increase nor decease the total projected payments 
     under this subsection.
       (c) Outreach and Enrollment.--
       (1) In general.--During the period that begins on January 
     1, 2018, and ends on December 31, 2020, the Secretary shall 
     award grants to eligible entities for the following purposes:
       (A) Outreach and enrollment.--To carry out outreach, public 
     education activities, and enrollment activities to raise 
     awareness of the availability of, and encourage enrollment 
     in, qualified health plans.
       (B) Assisting individuals transition to qualified health 
     plans.--To provide assistance to individuals who are enrolled 
     in health insurance coverage that is not a qualified health 
     plan enroll in a qualified health plan.
       (C) Assisting enrollment in public health programs.--To 
     facilitate the enrollment of eligible individuals in the 
     Medicare program or in a State Medicaid program, as 
     appropriate.
       (D) Raising awareness of premium assistance and cost-
     sharing reductions.--To distribute fair and impartial 
     information concerning enrollment in qualified health plans 
     and the availability of premium assistance tax credits under 
     section 36B of the Internal Revenue Code of 1986 and cost-
     sharing reductions under section 1402 of the Patient 
     Protection and Affordable Care Act, and to assist eligible 
     individuals in applying for such tax credits and cost-sharing 
     reductions.
       (2) Eligible entities defined.--
       (A) In general.--In this subsection, the term ``eligible 
     entity'' means--
       (i) a State; or
       (ii) a nonprofit community-based organization.
       (B) Enrollment agents.--Such term includes a licensed 
     independent insurance agent or broker that has an arrangement 
     with a State or nonprofit community-based organization to 
     enroll eligible individuals in qualified health plans.
       (C) Exclusions.--Such term does not include an entity 
     that--
       (i) is a health insurance issuer; or
       (ii) receives any consideration, either directly or 
     indirectly, from any health insurance issuer in connection 
     with the enrollment of any qualified individuals or employees 
     of a qualified employer in a qualified health plan.
       (3) Priority.--In awarding grants under this subsection, 
     the Secretary shall give priority to awarding grants to 
     States or eligible entities in States that have geographic 
     rating areas at risk of having no qualified health plans in 
     the individual market.
       (4) Funding.--Out of any moneys in the Treasury not 
     otherwise appropriated, $500,000,000 is appropriated to the 
     Secretary for each of calendar years 2018 through 2020, to 
     carry out this subsection.
       (d) Reports to Congress.--
       (1) Annual report.--The Secretary shall submit a report to 
     Congress, not later than January 21, 2019, and each year 
     thereafter, that contains the following information for the 
     most recently ended year:
       (A) The number and types of plans in each State's 
     individual market, specifying the number that are qualified 
     health plans, grandfathered health plans, or health insurance 
     coverage that is not a qualified health plan.
       (B) The impact of the reinsurance payments provided under 
     this section on the availability of coverage, cost of 
     coverage, and coverage options in each State.
       (C) The amount of premiums paid by individuals in each 
     State by age, family size, geographic area in the State's 
     individual market, and category of health plan (as described 
     in subparagraph (A)).
       (D) The process used to award funds for outreach and 
     enrollment activities awarded to eligible entities under 
     subsection (c), the amount of such funds awarded, and the 
     activities carried out with such funds.
       (E) Such other information as the Secretary deems relevant.
       (2) Evaluation report.--Not later than January 31, 2022, 
     the Secretary shall submit to Congress a report that--
       (A) analyzes the impact of the funds provided under this 
     section on premiums and enrollment in the individual market 
     in all States; and
       (B) contains a State-by-State comparison of the design of 
     the programs carried out by States with funds provided under 
     this section.
       (e) Definitions.--In this section:
       (1) Secretary.--The term ``Secretary'' means the Secretary 
     of the Department of Health and Human Services.
       (2) Fund.--The term ``Fund'' means the Individual Market 
     Reinsurance Fund established under subsection (a).
       (3) Grandfathered health plan.--The term ``grandfathered 
     health plan'' has the meaning given that term in section 
     1251(e) of the Patient Protection and Affordable Care Act.
       (4) High-cost individual.--The term ``high-cost 
     individual'' means an individual enrolled in a qualified 
     health plan (other than a grandfathered health plan or a 
     transitional health plan) who incurs claims in excess of 
     $50,000 during a plan year.
       (5) State.--The term ``State'' means each of the 50 States 
     and the District of Columbia.
       (6) Transitional health plan.--The term ``transitional 
     health plan'' means a plan continued under the letter issued 
     by the Centers for Medicare & 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 of the Patient Protection 
     and Affordable Care Act 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 & Medicaid Services on 
     March 5, 2014, February 29, 2016, and February 13, 2017.
                                 ______
                                 
  SA 277. Mr. KAINE submitted an amendment intended to be proposed by 
him to the bill H.R. 2810, to authorize appropriations for fiscal year 
2018 for military activities of the Department

[[Page S4222]]

of Defense, for military construction, and for defense activities of 
the Department of Energy, to prescribe military personnel strengths for 
such fiscal year, and for other purposes; which was ordered to lie on 
the table; as follows:

       At the end of subtitle E of title XXVIII, add the 
     following:

     SEC. 2850. ESTABLISHMENT OF A VISITOR SERVICES FACILITY ON 
                   THE ARLINGTON RIDGE TRACT.

       (a) Arlington Ridge Tract Defined.--In this section, the 
     term ``Arlington Ridge tract'' means the parcel of Federal 
     land located in Arlington County, Virginia, known as the 
     ``Nevius Tract'' and transferred to the Department of the 
     Interior in 1953, that is bounded generally by--
       (1) Arlington Boulevard (United States Route 50) to the 
     north;
       (2) Jefferson Davis Highway (Virginia Route 110) to the 
     east;
       (3) Marshall Drive to the south; and
       (4) North Meade Street to the west.
       (b) Establishment of Visitor Services Facility.--
     Notwithstanding section 2863(g) of the Military Construction 
     Authorization Act for Fiscal Year 2002 (Public Law 107-107; 
     115 Stat. 1332), the Secretary of the Interior may construct 
     a structure for visitor services, including a public restroom 
     facility, on the Arlington Ridge tract in the area of the 
     United States Marine Corps War Memorial.
                                 ______
                                 
  SA 278. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the end of subtitle J of title VIII, add the following:

     SEC. 899D. INCLUSION OF SBIR AND STTR PROGRAMS IN TECHNICAL 
                   ASSISTANCE.

       Section 2418(c) of title 10, United States Code, is 
     amended--
       (1) by striking ``issued under'' and inserting the 
     following: ``issued--
       ``(1) under'';
       (2) by striking ``and on'' and inserting ``, and on'';
       (3) by striking ``requirements.'' and inserting 
     ``requirements; and''; and
       (4) by adding at the end the following new paragraph:
       ``(2) under section 9 of the Small Business Act (15 U.S.C. 
     638), and on compliance with those requirements.''.
                                 ______
                                 
  SA 279. Mr. PAUL submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF SECOND AMENDMENT RIGHTS.

       (a) Ensuring the Quality of Care.--Section 2717(c) of the 
     Public Health Service Act (42 U.S.C. 300gg-17(c)) is amended 
     by inserting ``, or the Better Care Reconciliation Act of 
     2017 or an amendment made by that Act,'' after ``the Patient 
     Protection and Affordable Care Act or an amendment made by 
     that Act'' each place that term appears.
       (b) Federal Health Databases; NICS.--No funds made 
     available to the Department of Health and Human Services or 
     any other agency under this Act may be used to examine a 
     Federal health database for the name of an individual to be 
     submitted to the National Instant Criminal Background Check 
     System (commonly known as ``NICS'') established under section 
     103 of the Brady Handgun Violence Prevention Act (18 U.S.C. 
     922 note).
                                 ______
                                 
  SA 280. Mr. PAUL submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Obamacare Repeal 
     Reconciliation Act of 2017''.

                                TITLE I

     SEC. 101. RECAPTURE EXCESS ADVANCE PAYMENTS OF PREMIUM TAX 
                   CREDITS.

       Subparagraph (B) of section 36B(f)(2) of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new clause:
       ``(iii) Nonapplicability of limitation.--This subparagraph 
     shall not apply to taxable years ending after December 31, 
     2017, and before January 1, 2020.''.

     SEC. 102. PREMIUM TAX CREDIT.

       (a) Premium Tax Credit.--
       (1) Modification of definition of qualified health plan.--
       (A) In general.--Section 36B(c)(3)(A) of the Internal 
     Revenue Code of 1986 is amended by inserting before the 
     period at the end the following: ``or a plan that includes 
     coverage for abortions (other than any abortion necessary to 
     save the life of the mother or any abortion with respect to a 
     pregnancy that is the result of an act of rape or incest)''.
       (B) Effective date.--The amendment made by this paragraph 
     shall apply to taxable years beginning after December 31, 
     2017.
       (2) Repeal.--
       (A) In general.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     striking section 36B.
       (B) Effective date.--The amendment made by this paragraph 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Repeal of Eligibility Determinations.--
       (1) In general.--The following sections of the Patient 
     Protection and Affordable Care Act are repealed:
       (A) Section 1411 (other than subsection (i), the last 
     sentence of subsection (e)(4)(A)(ii), and such provisions of 
     such section solely to the extent related to the application 
     of the last sentence of subsection (e)(4)(A)(ii)).
       (B) Section 1412.
       (2) Effective date.--The repeals in paragraph (1) shall 
     take effect on January 1, 2020.
       (c) Protecting Americans by Repeal of Disclosure Authority 
     To Carry Out Eligibility Requirements for Certain Programs.--
       (1) In general.--Paragraph (21) of section 6103(l) of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new subparagraph:
       ``(D) Termination.--No disclosure may be made under this 
     paragraph after December 31, 2019.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect on January 1, 2020.

     SEC. 103. SMALL BUSINESS TAX CREDIT.

       (a) Sunset.--
       (1) In general.--Section 45R of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(j) Shall Not Apply.--This section shall not apply with 
     respect to amounts paid or incurred in taxable years 
     beginning after December 31, 2019.''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Disallowance of Small Employer Health Insurance Expense 
     Credit for Plan Which Includes Coverage for Abortion.--
       (1) In general.--Subsection (h) of section 45R of the 
     Internal Revenue Code of 1986 is amended--
       (A) by striking ``Any term'' and inserting the following:
       ``(1) In general.--Any term'', and
       (B) by adding at the end the following new paragraph:
       ``(2) Exclusion of health plans including coverage for 
     abortion.--The term `qualified health plan' does not include 
     any health plan that includes coverage for abortions (other 
     than any abortion necessary to save the life of the mother or 
     any abortion with respect to a pregnancy that is the result 
     of an act of rape or incest).''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 104. INDIVIDUAL MANDATE.

       (a) In General.--Section 5000A(c) of the Internal Revenue 
     Code of 1986 is amended--
       (1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' 
     and inserting ``Zero percent'', and
       (2) in paragraph (3)--
       (A) by striking ``$695'' in subparagraph (A) and inserting 
     ``$0'', and
       (B) by striking subparagraph (D).
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 105. EMPLOYER MANDATE.

       (a) In General.--
       (1) Paragraph (1) of section 4980H(c) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$2,000''.
       (2) Paragraph (1) of section 4980H(b) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$3,000''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 106. FEDERAL PAYMENTS TO STATES.

       (a) In General.--Notwithstanding section 504(a), 
     1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 
     2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 
     1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 1397bb(a)(7), 
     1397ee(a)(1)), or the terms of any Medicaid waiver in effect 
     on the date of enactment of this Act that is approved under 
     section 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n), for the 1-year period beginning on the date of 
     enactment of this Act, no Federal funds provided from a 
     program referred to in this subsection that is considered 
     direct spending for any year may be made available to a State 
     for payments to a prohibited entity, whether made directly to 
     the prohibited entity or through a managed care organization 
     under contract with the State.
       (b) Definitions.--In this section:
       (1) Prohibited entity.--The term ``prohibited entity'' 
     means an entity, including its affiliates, subsidiaries, 
     successors, and clinics--
       (A) that, as of the date of enactment of this Act--
       (i) is an organization described in section 501(c)(3) of 
     the Internal Revenue Code of 1986 and exempt from tax under 
     section 501(a) of such Code;

[[Page S4223]]

       (ii) is an essential community provider described in 
     section 156.235 of title 45, Code of Federal Regulations (as 
     in effect on the date of enactment of this Act), that is 
     primarily engaged in family planning services, reproductive 
     health, and related medical care; and
       (iii) provides for abortions, other than an abortion--

       (I) if the pregnancy is the result of an act of rape or 
     incest; or
       (II) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness that would, as 
     certified by a physician, place the woman in danger of death 
     unless an abortion is performed, including a life-endangering 
     physical condition caused by or arising from the pregnancy 
     itself; and

       (B) for which the total amount of Federal and State 
     expenditures under the Medicaid program under title XIX of 
     the Social Security Act in fiscal year 2014 made directly to 
     the entity and to any affiliates, subsidiaries, successors, 
     or clinics of the entity, or made to the entity and to any 
     affiliates, subsidiaries, successors, or clinics of the 
     entity as part of a nationwide health care provider network, 
     exceeded $1,000,000.
       (2) Direct spending.--The term ``direct spending'' has the 
     meaning given that term under section 250(c) of the Balanced 
     Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 
     900(c)).

     SEC. 107. MEDICAID.

       The Social Security Act (42 U.S.C. 301 et seq.) is 
     amended--
       (1) in section 1902--
       (A) in subsection (a)(10)(A), in each of clauses (i)(VIII) 
     and (ii)(XX), by inserting ``and ending December 31, 2019,'' 
     after ``January 1, 2014,''; and
       (B) in subsection (a)(47)(B), by inserting ``and provided 
     that any such election shall cease to be effective on January 
     1, 2020, and no such election shall be made after that date'' 
     before the semicolon at the end;
       (2) in section 1905--
       (A) in the first sentence of subsection (b), by inserting 
     ``(50 percent on or after January 1, 2020)'' after ``55 
     percent'';
       (B) in subsection (y)(1), by striking the semicolon at the 
     end of subparagraph (D) and all that follows through 
     ``thereafter''; and
       (C) in subsection (z)(2)--
       (i) in subparagraph (A), by inserting ``through 2019'' 
     after ``each year thereafter''; and
       (ii) in subparagraph (B)(ii)(VI), by striking ``and each 
     subsequent year'';
       (3) in section 1915(k)(2), by striking ``during the period 
     described in paragraph (1)'' and inserting ``on or after the 
     date referred to in paragraph (1) and before January 1, 
     2020'';
       (4) in section 1920(e), by adding at the end the following: 
     ``This subsection shall not apply after December 31, 2019.'';
       (5) in section 1937(b)(5), by adding at the end the 
     following: ``This paragraph shall not apply after December 
     31, 2019.''; and
       (6) in section 1943(a), by inserting ``and before January 
     1, 2020,'' after ``January 1, 2014,''.

     SEC. 108. REPEAL OF DSH ALLOTMENT REDUCTIONS.

       Section 1923(f) of the Social Security Act (42 U.S.C. 
     1396r-4(f)) is amended by striking paragraphs (7) and (8).

     SEC. 109. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE 
                   PREMIUMS AND HEALTH PLAN BENEFITS.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986 is amended by striking section 4980I.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     2019.
       (c) Subsequent Effective Date.--The amendment made by 
     subsection (a) shall not apply to taxable years beginning 
     after December 31, 2025, and chapter 43 of the Internal 
     Revenue Code of 1986 is amended to read as such chapter would 
     read if such subsection had never been enacted.

     SEC. 110. REPEAL OF TAX ON OVER-THE-COUNTER MEDICATIONS.

       (a) HSAs.--Subparagraph (A) of section 223(d)(2) of the 
     Internal Revenue Code of 1986 is amended by striking ``Such 
     term'' and all that follows through the period.
       (b) Archer MSAs.--Subparagraph (A) of section 220(d)(2) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``Such term'' and all that follows through the period.
       (c) Health Flexible Spending Arrangements and Health 
     Reimbursement Arrangements.--Section 106 of the Internal 
     Revenue Code of 1986 is amended by striking subsection (f).
       (d) Effective Dates.--
       (1) Distributions from savings accounts.--The amendments 
     made by subsections (a) and (b) shall apply to amounts paid 
     with respect to taxable years beginning after December 31, 
     2016.
       (2) Reimbursements.--The amendment made by subsection (c) 
     shall apply to expenses incurred with respect to taxable 
     years beginning after December 31, 2016.

     SEC. 111. REPEAL OF TAX ON HEALTH SAVINGS ACCOUNTS.

       (a) HSAs.--Section 223(f)(4)(A) of the Internal Revenue 
     Code of 1986 is amended by striking ``20 percent'' and 
     inserting ``10 percent''.
       (b) Archer MSAs.--Section 220(f)(4)(A) of the Internal 
     Revenue Code of 1986 is amended by striking ``20 percent'' 
     and inserting ``15 percent''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to distributions made after December 31, 2016.

     SEC. 112. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO FLEXIBLE 
                   SPENDING ACCOUNTS.

       (a) In General.--Section 125 of the Internal Revenue Code 
     of 1986 is amended by striking subsection (i).
       (b) Effective Date.--The amendment made by this section 
     shall apply to plan years beginning after December 31, 2017.

     SEC. 113. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS.

       Subsection (j) of section 9008 of the Patient Protection 
     and Affordable Care Act is amended to read as follows:
       ``(j) Repeal.--This section shall apply to calendar years 
     beginning after December 31, 2010, and ending before January 
     1, 2018.''.

     SEC. 114. REPEAL OF MEDICAL DEVICE EXCISE TAX.

       Section 4191 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new subsection:
       ``(d) Applicability.--The tax imposed under subsection (a) 
     shall not apply to sales after December 31, 2017.''.

     SEC. 115. REPEAL OF HEALTH INSURANCE TAX.

       Subsection (j) of section 9010 of the Patient Protection 
     and Affordable Care Act is amended by striking ``, and'' at 
     the end of paragraph (1) and all that follows through 
     ``2017''.

     SEC. 116. REPEAL OF ELIMINATION OF DEDUCTION FOR EXPENSES 
                   ALLOCABLE TO MEDICARE PART D SUBSIDY.

       (a) In General.--Section 139A of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     sentence: ``This section shall not be taken into account for 
     purposes of determining whether any deduction is allowable 
     with respect to any cost taken into account in determining 
     such payment.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 117. REPEAL OF CHRONIC CARE TAX.

       (a) In General.--Subsection (a) of section 213 of the 
     Internal Revenue Code of 1986 is amended by striking ``10 
     percent'' and inserting ``7.5 percent''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 118. REPEAL OF MEDICARE TAX INCREASE.

       (a) In General.--Subsection (b) of section 3101 of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(b) Hospital Insurance.--In addition to the tax imposed 
     by the preceding subsection, there is hereby imposed on the 
     income of every individual a tax equal to 1.45 percent of the 
     wages (as defined in section 3121(a)) received by such 
     individual with respect to employment (as defined in section 
     3121(b).''.
       (b) SECA.--Subsection (b) of section 1401 of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(b) Hospital Insurance.--In addition to the tax imposed 
     by the preceding subsection, there shall be imposed for each 
     taxable year, on the self-employment income of every 
     individual, a tax equal to 2.9 percent of the amount of the 
     self-employment income for such taxable year.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to remuneration received after, and 
     taxable years beginning after, December 31, 2017.

     SEC. 119. REPEAL OF TANNING TAX.

       (a) In General.--The Internal Revenue Code of 1986 is 
     amended by striking chapter 49.
       (b) Effective Date.--The amendment made by this section 
     shall apply to services performed after September 30, 2017.

     SEC. 120. REPEAL OF NET INVESTMENT TAX.

       (a) In General.--Subtitle A of the Internal Revenue Code of 
     1986 is amended by striking chapter 2A.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 121. REMUNERATION.

       Paragraph (6) of section 162(m) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(I) Termination.--This paragraph shall not apply to 
     taxable years beginning after December 31, 2016.''.

                                TITLE II

     SEC. 201. THE PREVENTION AND PUBLIC HEALTH FUND.

       Subsection (b) of section 4002 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 300u-11) is amended--
       (1) in paragraph (3), by striking ``each of fiscal years 
     2018 and 2019'' and inserting ``fiscal year 2018''; and
       (2) by striking paragraphs (4) through (8).

     SEC. 202. SUPPORT FOR STATE RESPONSE TO SUBSTANCE ABUSE 
                   PUBLIC HEALTH CRISIS AND URGENT MENTAL HEALTH 
                   NEEDS.

       (a) In General.--There are authorized to be appropriated, 
     and are appropriated, out of monies in the Treasury not 
     otherwise obligated, $750,000,000 for each of fiscal years 
     2018 and 2019, to the Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') to award 
     grants to States to address the substance abuse public health 
     crisis or to respond to urgent mental health needs within the 
     State. In awarding grants under this section, the Secretary 
     may give preference to States with an incidence or prevalence 
     of substance use disorders that is substantial relative to 
     other States or to States that identify mental health needs 
     within their communities that are urgent relative to such 
     needs of other States. Funds

[[Page S4224]]

     appropriated under this subsection shall remain available 
     until expended.
       (b) Use of Funds.--Grants awarded to a State under 
     subsection (a) shall be used for one or more of the following 
     public health-related activities:
       (1) Improving State prescription drug monitoring programs.
       (2) Implementing prevention activities, and evaluating such 
     activities to identify effective strategies to prevent 
     substance abuse.
       (3) Training for health care practitioners, such as best 
     practices for prescribing opioids, pain management, 
     recognizing potential cases of substance abuse, referral of 
     patients to treatment programs, and overdose prevention.
       (4) Supporting access to health care services provided by 
     Federally certified opioid treatment programs or other 
     appropriate health care providers to treat substance use 
     disorders or mental health needs.
       (5) Other public health-related activities, as the State 
     determines appropriate, related to addressing the substance 
     abuse public health crisis or responding to urgent mental 
     health needs within the State.

     SEC. 203. COMMUNITY HEALTH CENTER PROGRAM.

       Effective as if included in the enactment of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10, 129 Stat. 87), paragraph (1) of section 221(a) of such 
     Act is amended by inserting ``, and an additional 
     $422,000,000 for fiscal year 2017'' after ``2017''.

     SEC. 204. FUNDING FOR COST-SHARING PAYMENTS.

       There is appropriated to the Secretary of Health and Human 
     Services, out of any money in the Treasury not otherwise 
     appropriated, such sums as may be necessary for payments for 
     cost-sharing reductions authorized by the Patient Protection 
     and Affordable Care Act (including adjustments to any prior 
     obligations for such payments) for the period beginning on 
     the date of enactment of this Act and ending on December 31, 
     2019. Notwithstanding any other provision of this Act, 
     payments and other actions for adjustments to any obligations 
     incurred for plan years 2018 and 2019 may be made through 
     December 31, 2020.

     SEC. 205. REPEAL OF COST-SHARING SUBSIDY PROGRAM.

       (a) In General.--Section 1402 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18071) is repealed.
       (b) Effective Date.--The repeal made by subsection (a) 
     shall apply to cost-sharing reductions (and payments to 
     issuers for such reductions) for plan years beginning after 
     December 31, 2019.

                          ____________________