I 

114TH CONGRESS 

2D SESSION H. R. 4362 

To amend the Social Security Act to replace the Medicaid program and 

the Children’s Health Insurance program with a block grant to the 

States, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 11, 2016 

Mr. ROKITA (for himself, Mr. BISHOP of Utah, Mrs. BLACK, Mrs. BLACKBURN, Mr. BRIDENSTINE, Mr. COLE, Mr. CRAMER, Mr. CULBERSON, Mr. 

DUNCAN of South Carolina, Mr. FRANKS of Arizona, Mr. GARRETT, Mr. 

HARPER, Mr. HUIZENGA of Michigan, Mr. JORDAN, Mr. MEADOWS, Mr. 

MESSER, Mr. MOOLENAAR, Mr. MULVANEY, Mr. PITTENGER, Mr. 

RIBBLE, Mr. SCHWEIKERT, Mr. STEWART, Mr. STUTZMAN, Mr. TIPTON, 

Mr. WALBERG, Mr. WESTMORELAND, and Mr. ALLEN) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education 

and the Workforce, the Judiciary, Natural Resources, House Administration, Rules, and Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Social Security Act to replace the Medicaid 

program and the Children’s Health Insurance program 

with a block grant to the States, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘State Health Flexibility Act of 2016’’. 

4 (b) TABLE OF CONTENTS.—The table of contents of 

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Health grants to the States for health care services to indigent individuals. 

‘‘TITLE XXII—BLOCK GRANTS TO STATES FOR HEALTH CARE 

SERVICES TO INDIGENT INDIVIDUALS 

‘‘Sec. 2201. Purpose. 

‘‘Sec. 2202. Grants to States. 

‘‘Sec. 2203. Administrative and fiscal accountability. 

‘‘Sec. 2204. Nondiscrimination provisions. 

‘‘Sec. 2205. Emergency assistance. 

‘‘Sec. 2206. Definitions.’’. 

Sec. 3. Repeal of PPACA, HCERA, and the Federal requirements of Medicaid 

and CHIP. 

Sec. 4. Severability. 

Sec. 5. Effective date. 

6 SEC. 2. HEALTH GRANTS TO THE STATES FOR HEALTH 

7 CARE SERVICES TO INDIGENT INDIVIDUALS. 

8 (a) HEALTH CARE BLOCK GRANT TO STATES.—The 

9 Social Security Act is amended by adding at the end the 

10 following new title: 

11 ‘‘TITLE XXII—BLOCK GRANTS TO 

12 STATES FOR HEALTH CARE 

13 SERVICES TO INDIGENT INDI14 VIDUALS 

15 ‘‘SEC. 2201. PURPOSE. 

16 ‘‘The purpose of this title is to provide Federal finan17 cial assistance to the States, in the form of a single grant, 

18 to allow the States maximum flexibility in providing, and 


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1 financing the provision of, health-care-related items and 

2 services to indigent individuals. 

3 ‘‘SEC. 2202. GRANTS TO STATES. 

4 ‘‘(a) IN GENERAL.—Subject to the requirements of 

5 this title, each State is entitled to receive from the Sec6 retary of the Treasury a grant for each quarter of each 

7 of fiscal years 2017 through 2025, in an amount that is 

8 equal to 25 percent of the total amount received by a State 

9 under title XIX and title XXI for fiscal year 2013. 

10 ‘‘(b) APPROPRIATION.—Out of any money in the 

11 Treasury of the United States not otherwise appropriated, 

12 there are appropriated for each of fiscal years 2017 

13 through 2026 such sums as are necessary for grants under 

14 this section. 

15 ‘‘(c) REQUIREMENTS RELATING TO INTERGOVERN16 MENTAL FINANCING.—The Secretary of the Treasury 

17 shall make the transfer of funds under grants under sub18 section (a) directly to each State in accordance with the 

19 requirements of section 6503 of title 31, United States 

20 Code. 

21 ‘‘(d) EXPENDITURE OF FUNDS.— 

22 ‘‘(1) IN GENERAL.—Except as provided in para23 graph (2), amounts received by a State under this 

24 title for any fiscal year shall be expended by the 


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1 State in such fiscal year or in the succeeding fiscal 

2 year. 

3 ‘‘(2) USE OF RAINY DAY FUND PERMITTED.— 

4 Of the amounts received by a State under this title, 

5 the State may set aside, in a separate account, such 

6 amounts as the State deems necessary to provide, 

7 without fiscal limitation, health-care-related items 

8 and services for indigent individuals during— 

9 ‘‘(A) periods of unexpectedly high rates of 

10 unemployment; or 

11 ‘‘(B) periods related to circumstances that 

12 are not described in subparagraph (A) and that 

13 cause unexpected increases in the need for such 

14 items and services for such individuals. 

15 ‘‘(3) FUNDS REMAINING AFTER FISCAL YEAR

16 2026.—If, after fiscal year 2026, a State has funds 

17 in the account under paragraph (2), the State may 

18 only expend such funds if such funds are used in a 

19 manner that is permitted under subsection (e), as 

20 such subsection is in effect on September 30, 2026. 

21 ‘‘(e) USE OF FUNDS.—A State may only use the 

22 amounts received under subsection (a) as follows: 

23 ‘‘(1) GENERAL PURPOSE.—For the purpose 

24 under section 2201, including the provision of 

25 health-care-related items and services as required 


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1 under section 2205. Nothing in this title shall be 

2 construed as limiting the flexibility of a State to de3 termine which providers of such items and services 

4 qualify to receive payment from a grant made to the 

5 State under this title. 

6 ‘‘(2) FUNDING FOR RISK ADJUSTMENT MECHA7 NISMS.—To fund qualified high risk pools, reinsur8 ance pools, or other risk-adjustment mechanisms 

9 used for the purpose of subsidizing the purchase of 

10 private health insurance for the high-risk population. 

11 ‘‘(3) AUTHORITY TO USE PORTION OF FEDERAL

12 ASSISTANCE FOR OTHER WELFARE-RELATED PRO13 GRAMS.— 

14 ‘‘(A) IN GENERAL.—Subject to the limit 

15 under subparagraph (B), to carry out a State 

16 program pursuant to any or all of the following 

17 provisions of law: 

18 ‘‘(i) Part A of title IV of this Act. 

19 ‘‘(ii) Section 1616 of this Act. 

20 ‘‘(iii) The Food and Nutrition Act of 

21 2008. 

22 ‘‘(B) LIMITATION.—A State may not use 

23 more than 30 percent of the amount received 

24 under subsection (a) for a fiscal year to carry 


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1 out a State program, or programs, under sub2 paragraph (A). 

3 ‘‘(C) REQUIREMENTS ON FUNDS.—Any 

4 amounts that are used under subparagraph 

5 (A)— 

6 ‘‘(i) shall not be subject to any of the 

7 requirements of subsection (d), subsection 

8 (f), section 2204, or section 2205; and 

9 ‘‘(ii) shall be subject to— 

10 ‘‘(I) the audit requirements 

11 under section 2203; and 

12 ‘‘(II) any requirements that 

13 apply to Federal funds provided di14 rectly for such State program. 

15 ‘‘(f) MAINTENANCE OF CURRENT LAW RESTRIC16 TIONS ON USE OF FEDERAL FUNDS.— 

17 ‘‘(1) IN GENERAL.— 

18 ‘‘(A) NO FUNDING FOR ABORTIONS.— 

19 None of the funds appropriated in this title 

20 shall be expended for any abortion. 

21 ‘‘(B) NO FUNDS FOR COVERAGE OF ABOR22 TION.—None of the funds appropriated in this 

23 title shall be expended for health benefits cov24 erage that includes coverage of abortion. 


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1 ‘‘(C) HEALTH BENEFITS COVERAGE DE2 FINED.—For purposes of this subsection, the 

3 term ‘health benefits coverage’ means the pack4 age of services covered by a managed care pro5 vider or organization pursuant to a contract or 

6 other arrangement. 

7 ‘‘(2) EXCEPTIONS.—The limitations established 

8 in paragraph (1) shall not apply to an abortion— 

9 ‘‘(A) if the pregnancy is the result of an 

10 act of rape or incest; or 

11 ‘‘(B) in the case where a woman suffers 

12 from a physical disorder, physical injury, or 

13 physical illness that would, as certified by a 

14 physician, place the woman in danger of death 

15 unless an abortion is performed, including a 

16 life-endangering physical condition caused by or 

17 arising from the pregnancy itself. 

18 ‘‘(3) STATE FUNDS USED IN CONJUNCTION

19 WITH FEDERAL FUNDS.—The limitations established 

20 in paragraph (1) shall apply to any State funds used 

21 in conjunction with Federal funds appropriated 

22 under this title to provide, or finance the provision 

23 of, health-care-related items and services to indigent 

24 individuals pursuant to section 2201 or subsections 

25 (d)(2), (e)(1), or (e)(2) of this section. 


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1 ‘‘(4) OPTION TO PURCHASE SEPARATE COV2 ERAGE OR PLAN.—Nothing in this subsection shall 

3 be construed as prohibiting a State from purchasing 

4 separate coverage for abortions for which funding is 

5 prohibited under this subsection, or a health plan 

6 that includes such abortions, so long as such cov7 erage or plan is paid for entirely using funds not 

8 provided by this title. 

9 ‘‘(5) OPTION TO OFFER COVERAGE OR PLAN.— 

10 Nothing in this subsection shall restrict any health 

11 insurance issuer from offering separate coverage for 

12 abortions for which funding is prohibited under this 

13 subsection, or a health plan that includes such abor14 tions, so long as— 

15 ‘‘(A) premiums for such separate coverage 

16 or plan are paid entirely with funds not pro17 vided by this title; and 

18 ‘‘(B) administrative costs and all services 

19 offered through such separate coverage or plan 

20 are paid for using only premiums collected for 

21 such coverage or plan. 

22 ‘‘(6) CONSCIENCE PROTECTIONS.— 

23 ‘‘(A) None of the funds appropriated in 

24 this Act may be made available to a Federal 

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1 ernment, if such agency, program, or govern2 ment subjects any institutional or individual 

3 health care entity to discrimination on the basis 

4 that the health care entity does not provide, pay 

5 for, provide coverage of, or refer for abortions. 

6 ‘‘(B) In this paragraph, the term ‘health 

7 care entity’ includes an individual physician or 

8 other health care professional, a hospital, a pro9 vider-sponsored organization, a health mainte10 nance organization, a health insurance plan, or 

11 any other kind of health care facility, organiza12 tion, or plan. 

13 ‘‘(g) NO FUNDING FOR ILLEGAL ALIENS.—Except as 

14 provided under this section and section 2205, no funds 

15 appropriated in this title may be used to provide health16 care-related items and services to an alien who is not law17 fully admitted for permanent residence or otherwise per18 manently residing in the United States under color of law. 

19 ‘‘(h) NONENTITLEMENT.—Nothing in this title shall 

20 be construed as providing an individual with an entitle21 ment to health-care-related items and services under this 

22 title. 

23 ‘‘SEC. 2203. ADMINISTRATIVE AND FISCAL ACCOUNT24 ABILITY. 

25 ‘‘(a) AUDITS.— 


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1 ‘‘(1) CONTRACT WITH APPROVED AUDITING EN2 TITY.—Not later than October 1, 2017, and annu3 ally thereafter, a State shall contract with an ap4 proved auditing entity (as defined under paragraph 

5 (3)(B)) for purposes of conducting an audit under 

6 paragraph (2) (with respect to the fiscal year ending 

7 September 30 of such year). 

8 ‘‘(2) AUDIT REQUIREMENT.—Under a contract 

9 under paragraph (1), an approved auditing entity 

10 shall conduct an audit of the expenditures or trans11 fers made by a State from amounts received under 

12 a grant under this title, or from State funds de13 scribed in section 2202(f)(3), with respect to the fis14 cal year which such audit covers, to determine the 

15 extent to which such expenditures and transfers 

16 were expended in accordance with this title. 

17 ‘‘(3) ENTITY CONDUCTING AUDIT.— 

18 ‘‘(A) IN GENERAL.—With respect to a 

19 State, the audit under paragraph (2) shall be 

20 conducted by an approved auditing entity in ac21 cordance with generally accepted auditing prin22 ciples. 

23 ‘‘(B) APPROVED AUDITING ENTITY.—For 

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1 diting entity’ means, with respect to a State, an 

2 entity that is— 

3 ‘‘(i) approved by the Secretary of the 

4 Treasury; 

5 ‘‘(ii) approved by the chief executive 

6 officer of the State; and 

7 ‘‘(iii) independent of any Federal, 

8 State, or local agency. 

9 ‘‘(4) SUBMISSION OF AUDIT.—Not later than 

10 December 31, 2017, and annually thereafter, a State 

11 shall submit the results of the audit under para12 graph (2) (with respect to the fiscal year ending on 

13 September 30 of such year) to the State legislature 

14 and to the Secretary of the Treasury. 

15 ‘‘(5) ADDITIONAL ACCOUNTING REQUIRE16 MENTS.—The provisions of chapter 75 of title 31, 

17 United States Code, shall apply to the audit require18 ments of this section. 

19 ‘‘(b) REIMBURSEMENT AND PENALTY.— 

20 ‘‘(1) IN GENERAL.—If, through an audit con21 ducted under subsection (a), an approved auditing 

22 entity finds that any amounts paid to a State under 

23 a grant under this title were not expended in accord24 ance with this title— 


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1 ‘‘(A) the State shall pay to the Treasury of 

2 the United States any such amount, plus 10 

3 percent of such amount as a penalty; or 

4 ‘‘(B) the Secretary of the Treasury shall 

5 offset such amount plus the 10 percent penalty 

6 against any other amount in any other fiscal 

7 year that the State may be entitled to receive 

8 under a grant under this title. 

9 ‘‘(2) MISUSE OF STATE FUNDS.—If, through an 

10 audit conducted under subsection (a), an approved 

11 auditing entity finds that a State violated the re12 quirements of section 2202(f)(3), the State shall pay 

13 to the Treasury of the United States 100 percent of 

14 the amount of State funds that were used in viola15 tion of section 2202(f)(3) as a penalty. Insofar as a 

16 State fails to pay any such penalty, the Secretary of 

17 the Treasury shall offset the amount not so paid 

18 against the amount of any grant otherwise payable 

19 to the State under this title. 

20 ‘‘(c) ANNUAL REPORTING REQUIREMENTS.— 

21 ‘‘(1) IN GENERAL.—Not later than January 31, 

22 2018, and annually thereafter, each State shall sub23 mit to the Secretary of the Treasury and the State 

24 legislature a report on the activities carried out by 

25 the State during the most recently completed fiscal 


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1 year with funds received by the State under a grant 

2 under this title for such fiscal year. 

3 ‘‘(2) CONTENT.—A report under paragraph (1) 

4 shall, with respect to a fiscal year— 

5 ‘‘(A) contain the results of the audit con6 ducted by an approved auditing entity for a 

7 State for such fiscal year, in accordance with 

8 the requirements of subsection (a) of this sec9 tion; 

10 ‘‘(B) specify the amount of the grant made 

11 to the State under this title that is used to 

12 carry out a program under section 2202(e)(3); 

13 and 

14 ‘‘(C) be in such form and contain such 

15 other information as the State determines is 

16 necessary to provide— 

17 ‘‘(i) an accurate description of the ac18 tivities conducted by the State for the pur19 pose described under section 2201 and any 

20 other use of funds permitted under sub21 sections (d) and (e) of section 2202; and 

22 ‘‘(ii) a complete record of the pur23 poses for which amounts were expended in 

24 accordance with this title. 


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1 ‘‘(3) CONFORMITY WITH ACCOUNTING PRIN2 CIPALS.—Any financial information in the report 

3 under paragraph (1) shall be prepared and reported 

4 in accordance with generally accepted accounting 

5 principles, including the provisions of chapter 75 of 

6 title 31, United States Code. 

7 ‘‘(4) PUBLIC AVAILABILITY.—A State shall 

8 make copies of the reports required under this sec9 tion available on a public Web site and shall make 

10 copies available in other formats upon request. 

11 ‘‘(d) FAILURE TO COMPLY WITH REQUIREMENTS.— 

12 The Secretary of the Treasury shall not make any pay13 ment to a State under a grant authorized by section 

14 2202(a)— 

15 ‘‘(1) if an audit for a State is not submitted as 

16 required under subsection (a), during the period be17 tween the date such audit is due and the date on 

18 which such audit is submitted; 

19 ‘‘(2) if a State fails to submit a report as re20 quired under subsection (c), during the period be21 tween the date such report is due and the date on 

22 which such report is submitted; or 

23 ‘‘(3) if a State violates a requirement of section 

24 2202(f), during the period beginning on the date the 

25 Secretary becomes aware of such violation and the 


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1 date on which such violation is corrected by the 

2 State. 

3 ‘‘(e) ADMINISTRATIVE SUPERVISION AND OVER4 SIGHT.— 

5 ‘‘(1) LIMITED ROLE FOR SECRETARY OF THE

6 TREASURY AND THE ATTORNEY GENERAL.— 

7 ‘‘(A) TREASURY.—The authority of the 

8 Secretary of the Treasury under this title is 

9 limited to— 

10 ‘‘(i) promulgating regulations, issuing 

11 rules, or publishing guidance documents to 

12 the extent necessary for purposes of imple13 menting subsection (a)(3)(B), subsection 

14 (b), and subsection (d); 

15 ‘‘(ii) making quarterly payments to 

16 the States under grants under this title in 

17 accordance with section 2202(a); 

18 ‘‘(iii) approving entities under sub19 section (a)(3)(B) for purposes of the audits 

20 required under subsection (a); 

21 ‘‘(iv) withholding payment to a State 

22 of a grant under subsection (d) or offset23 ting a payment of such a grant to a State 

24 under subsection (b); and 


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1 ‘‘(v) exercising the authority relating 

2 to nondiscrimination that is specified in 

3 section 2204(b). 

4 ‘‘(B) ATTORNEY GENERAL.—The authority 

5 of the Attorney General to supervise the 

6 amounts received by a State under this title is 

7 limited to the authority under section 2204(c). 

8 ‘‘(2) FEDERAL SUPERVISION.— 

9 ‘‘(A) IN GENERAL.—Except as provided 

10 under paragraph (1), an administrative officer, 

11 employee, department, or agency of the United 

12 States (including the Secretary of Health and 

13 Human Services) may not— 

14 ‘‘(i) supervise— 

15 ‘‘(I) the amounts received by the 

16 States under this title; or 

17 ‘‘(II) the use of such amounts by 

18 the States; or 

19 ‘‘(ii) promulgate regulations or issue 

20 rules in accordance with this title. 

21 ‘‘(B) LIMITATION ON SECRETARY OF

22 HEALTH AND HUMAN SERVICES.—The Sec23 retary of Health and Human Services shall 

24 have no authority over any provision of this 

25 title. 


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1 ‘‘(f) RESERVATION OF STATE POWERS.—Nothing in 

2 this section shall be construed to limit the power of a 

3 State, including the power of a State to pursue civil and 

4 criminal penalties under State law against any individual 

5 or entity that misuses, or engages in fraud or abuse re6 lated to, the funds provided to a State under this title. 

7 ‘‘SEC. 2204. NONDISCRIMINATION PROVISIONS. 

8 ‘‘(a) NO DISCRIMINATION AGAINST INDIVIDUALS.— 

9 No individual shall be excluded from participation in, de10 nied the benefits of, or subjected to discrimination under, 

11 any program or activity funded in whole or in part with 

12 amounts paid to a State under this title on the basis of 

13 such individual’s— 

14 ‘‘(1) disability under section 504 of the Reha15 bilitation Act of 1973 (29 U.S.C. 794); 

16 ‘‘(2) sex under title IX of the Education 

17 Amendments of 1972 (20 U.S.C. 1681 et seq.); or 

18 ‘‘(3) race, color, or national origin under title 

19 VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d 

20 et seq.). 

21 ‘‘(b) COMPLIANCE.— 

22 ‘‘(1) If the Secretary of the Treasury deter23 mines that a State or an entity that has received 

24 funds from amounts paid to a State under a grant 

25 under this title has failed to comply with a provision 


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1 of law referred to in subsection (a), the Secretary of 

2 the Treasury shall notify the chief executive officer 

3 of the State of such failure to comply and shall re4 quest that such chief executive officer secure such 

5 compliance. 

6 ‘‘(2) If, not later than 60 days after receiving 

7 notification under paragraph (1), the chief executive 

8 officer of a State fails or refuses to secure compli9 ance with the provision of law referred to in such 

10 notification, the Secretary of the Treasury may— 

11 ‘‘(A) refer the matter to the Attorney Gen12 eral with a recommendation that an appropriate 

13 civil action be instituted; or 

14 ‘‘(B) exercise the powers and functions 

15 provided under section 505 of the Rehabilita16 tion Act of 1973 (29 U.S.C. 794a), title IX of 

17 the Education Amendments of 1972 (20 U.S.C. 

18 1681 et seq.), or title VI of the Civil Rights Act 

19 of 1964 (42 U.S.C. 2000d et seq.) (as applica20 ble). 

21 ‘‘(c) CIVIL ACTIONS.—If a matter is referred to the 

22 Attorney General under subsection (b)(2)(A), or the At23 torney General has reason to believe that a State or entity 

24 has failed to comply with a provision of law referred to 

25 in subsection (a), the Attorney General may bring a civil 


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1 action in an appropriate district court of the United States 

2 for such relief as may be appropriate, including injunctive 

3 relief. 

4 ‘‘SEC. 2205. EMERGENCY ASSISTANCE. 

5 ‘‘(a) IN GENERAL.—A State that receives a grant 

6 under this title for a fiscal year shall provide payment for 

7 health-care-related items and services provided to a cit8 izen, legal resident, or an alien who is not lawfully admit9 ted for permanent residence or otherwise permanently re10 siding in the United States under color of law, consistent 

11 with the requirements of section 1867, if— 

12 ‘‘(1) such health-care-related items and services 

13 are— 

14 ‘‘(A) necessary for the treatment of an 

15 emergency medical condition; and 

16 ‘‘(B) health-care-related items and services 

17 that such State would provide payment for 

18 under this title, if provided to an indigent indi19 vidual; 

20 ‘‘(2) the individual meets all necessary eligi21 bility requirements for health-care-related items and 

22 services under the State program funded under this 

23 title, except for any requirement related to immigra24 tion status; and 


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1 ‘‘(3) such items and services are not related to 

2 an organ transplant procedure. 

3 ‘‘(b) EMERGENCY MEDICAL CONDITION.—For pur4 poses of this section, the term ‘emergency medical condi5 tion’ means a medical condition (including emergency 

6 labor and delivery) manifesting itself by acute symptoms 

7 of sufficient severity (including severe pain) such that the 

8 absence of immediate medical attention could reasonably 

9 be expected to result in— 

10 ‘‘(1) placing the patient’s health in serious jeop11 ardy; 

12 ‘‘(2) serious impairment to bodily functions; or 

13 ‘‘(3) serious dysfunction of any bodily organ or 

14 part. 

15 ‘‘SEC. 2206. DEFINITIONS. 

16 ‘‘For purposes of this title: 

17 ‘‘(1) HEALTH-CARE-RELATED ITEMS AND SERV18 ICES.—The term ‘health-care-related items and serv19 ices’ shall be defined by a State with respect to use 

20 of such term for purposes of the application of this 

21 title to the State. 

22 ‘‘(2) HIGH-RISK POPULATION.—The term ‘high23 risk population’ means individuals who are described 

24 in one of the following subparagraphs: 


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1 ‘‘(A) Individuals who, by reason of the ex2 istence or history of a medical condition, are 

3 able to acquire health coverage only at rates 

4 which are at least 150 percent of the standard 

5 risk rates for such coverage. 

6 ‘‘(B) Individuals who are provided health 

7 coverage by a qualified high risk pool. 

8 ‘‘(3) INDIGENT INDIVIDUAL.—The term ‘indi9 gent individual’ shall be defined by a State with re10 spect to use of such term for purposes of the appli11 cation of this title to the State. 

12 ‘‘(4) QUALIFIED HIGH RISK POOL.—The term 

13 ‘qualified high risk pool’ has the meaning given such 

14 term in section 2745(g)(1)(A) of the Public Health 

15 Service Act. 

16 ‘‘(5) RISK-ADJUSTMENT MECHANISM DE17 FINED.—For purposes of this section, the term 

18 ‘risk-adjustment mechanism’ means any risk-spread19 ing mechanism to subsidize the purchase of private 

20 health insurance for the high-risk population, includ21 ing a qualified high risk pool.’’. 

22 (b) REPORT ON REDUCTION OF FEDERAL ADMINIS23 TRATIVE EXPENDITURES.—Beginning not later than Oc24 tober 31, 2017, and annually thereafter until October 31, 

25 2026, the Secretary of Health and Human Services, in 


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1 consultation with the Secretary of the Treasury, shall sub2 mit a report to the Committee on Energy and Commerce 

3 in the House of Representatives and the Finance Com4 mittee in the Senate containing a description of the total 

5 reduction in Federal expenditures required to administer 

6 and provide oversight for the programs to provide health7 care-related items and services to indigent individuals 

8 under this Act, compared to the expenditures required to 

9 administer and provide oversight for the programs under 

10 titles XIX and XXI of the Social Security Act, as in effect 

11 on September 30, 2012. 

12 (c) STATE DEFINED.—Section 1101(a)(1) of the So13 cial Security Act (42 U.S.C. 1301(a)(1)) is amended— 

14 (1) in the first sentence, by striking ‘‘and XXI’’ 

15 and inserting ‘‘XXI, and XXII’’; and 

16 (2) in the fourth sentence, by striking ‘‘and 

17 XXI’’ and inserting ‘‘, XXI, and XXII’’. 

18 SEC. 3. REPEAL OF PPACA, HCERA, AND THE FEDERAL RE19 QUIREMENTS OF MEDICAID AND CHIP. 

20 (a) PPACA.—The Patient Protection and Affordable 

21 Care Act (Public Law 111–148) is repealed, and the provi22 sions of law amended or repealed by such Act are restored 

23 or revived as if such Act had not been enacted. 

24 (b) HCERA.—Title I and subtitle B of title II of the 

25 Health Care and Education Reconciliation Act of 2010 


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1 (Public Law 111–152) are repealed, and the provisions of 

2 law amended or repealed by such title or subtitle, respec3 tively, are restored or revived as if such title and subtitle 

4 had not been enacted. 

5 (c) MEDICAID AND CHIP.—Titles XIX and XXI of 

6 the Social Security Act are repealed. 

7 SEC. 4. SEVERABILITY. 

8 If any provision of this Act, or the application of such 

9 provision to any person or circumstance, is found to be 

10 unconstitutional, the remainder of this Act, or the applica11 tion of that provision to other persons or circumstances, 

12 shall not be affected. 

13 SEC. 5. EFFECTIVE DATE. 

14 This Act and the amendments and repeals made by 

15 this Act shall take effect with respect to items and services 

16 furnished on or after October 1, 2016. 

Æ 


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