69–008 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 115–109 

PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 2192) TO AMEND THE 

PUBLIC HEALTH SERVICE ACT TO ELIMINATE THE NON-APPLICATION 

OF CERTAIN STATE WAIVER PROVISIONS TO MEMBERS OF CONGRESS 

AND CONGRESSIONAL STAFF, AND PROVIDING FOR FURTHER CONSIDERATION OF THE BILL (H.R. 1628) TO PROVIDE FOR RECONCILIATION 

PURSUANT TO TITLE II OF THE CONCURRENT RESOLUTION ON THE 

BUDGET FOR FISCAL YEAR 2017 

MAY 3, 2017.—Referred to the House Calendar and ordered to be printed 

Mr. COLLINS of Georgia, from the Committee on Rules, 

submitted the following 

R E P O R T 

[To accompany H. Res. 308] 

The Committee on Rules, having had under consideration House 

Resolution 308, by record vote of 8 to 3, report the same to the 

House with the recommendation that the resolution be adopted. 

SUMMARY OF PROVISIONS OF THE RESOLUTION

The resolution provides for consideration of H.R. 2192, to amend 

the Public Health Service Act to eliminate the non-application of 

certain State waiver provisions to Members of Congress and congressional staff, under a closed rule. The resolution provides one 

hour of debate equally divided and controlled by the chair and 

ranking minority member of the Committee on Energy and Commerce. The resolution waives all points of order against consideration of the bill. The resolution provides that the bill shall be considered as read. The resolution waives all points of order against 

provisions in the bill. The resolution provides one motion to recommit. 

Section 2 of the resolution provides for further consideration of 

H.R. 1628, the American Health Care Act of 2017. The resolution 

provides that the further amendments printed in this report shall 

be considered as adopted. 

EXPLANATION OF WAIVERS

Although the resolution waives all points of order against consideration of H.R. 2192, the Committee is not aware of any points of 

order. The waiver is prophylactic in nature. 


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Although the resolution waives all points of order against provisions in H.R. 2192, the Committee is not aware of any points of 

order. The waiver is prophylactic in nature. 

COMMITTEE VOTES

The results of each record vote on an amendment or motion to 

report, together with the names of those voting for and against, are 

printed below: 

Rules Committee record vote No. 54 

Motion by Mr. Hastings to make in order and provide the appropriate waivers for every amendment submitted to H.R. 1628 to the 

Rules Committee and provide 10 minutes of debate on each amendment. Defeated: 3–8 

Majority Members Vote Minority Members Vote 

Mr. Cole ............................................................ Nay Ms. Slaughter .................................................. ...................

Mr. Woodall ...................................................... Nay Mr. McGovern ................................................... Yea 

Mr. Burgess ...................................................... Nay Mr. Hastings of Florida ................................... Yea 

Mr. Collins ........................................................ Nay Mr. Polis ........................................................... Yea 

Mr. Byrne .......................................................... Nay 

Mr. Newhouse ................................................... ...................

Mr. Buck ........................................................... Nay 

Ms. Cheney ....................................................... Nay 

Mr. Sessions, Chairman ................................... Nay 

Rules Committee record vote No. 55 

Motion by Mr. Cole to report the rule. Adopted: 8–3 

Majority Members Vote Minority Members Vote 

Mr. Cole ............................................................ Yea Ms. Slaughter .................................................. ...................

Mr. Woodall ...................................................... Yea Mr. McGovern ................................................... Nay 

Mr. Burgess ...................................................... Yea Mr. Hastings of Florida ................................... Nay 

Mr. Collins ........................................................ Yea Mr. Polis ........................................................... Nay 

Mr. Byrne .......................................................... Yea 

Mr. Newhouse ................................................... ...................

Mr. Buck ........................................................... Yea 

Ms. Cheney ....................................................... Yea 

Mr. Sessions, Chairman ................................... Yea 

SUMMARY OF THE FURTHER AMENDMENTS TO H.R. 1628 CONSIDERED

AS ADOPTED

1. Palmer (AL), Schweikert (AZ): Creates a $15 billion risk sharing program to help states lower premiums for health coverage offered in the individual market. 

2. MacArthur (NJ): Allows states to waive essential health benefits, age rating, and community rating. Health insurers would not 

be allowed to deny coverage, discriminate based on gender or limit 

access based on preexisting conditions. States must explain how 

the waiver will reduce average premiums for patients, increase enrollment for residents, stabilize the state’s health insurance market, stabilize premiums for individuals living with preexisting conditions, or increase patients’ health care plan options. 

3. Upton (MI), Long (MO), Young, David (IA), Valadao (CA), 

Knight (CA), Denham (CA), McMorris Rodgers (WA), McSally (AZ): 

Increases the Patient and State Stability Fund by $8 billion from 

2018 to 2023 to States with an approved community rating waiver, 


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as established by the MacArthur Amendment, for providing assistance to reduce premiums or other out-of-pocket costs to individuals 

who may be subject to an increase in their monthly premium rates 

as a result of the States waiver. The amendment also resolves two 

minor technical drafting amendments, including the correction of 

an inaccurate cross-reference and to ensure proper labeling of subsections. 

TEXT OF FURTHER AMENDMENTS TO H.R. 1628 CONSIDERED AS

ADOPTED

In the section 2204(c)(2)(B) proposed to be added to the Social Security Act by section 132, strike ‘‘to carry out the purpose described 

in section 2202(2) in such States by providing payments to appropriate entities described in such section with respect to claims that 

exceed $1,000,000’’ and insert ‘‘to carry out the Federal Invisible 

Risk Sharing Program in such States under section 2205’’. 

In title XXII of the Social Security Act, as added by section 132, 

add at the end the following: 

‘‘SEC. 2205. FEDERAL INVISIBLE RISK SHARING PROGRAM. 

‘‘(a) IN GENERAL.—There is established within the Patient and 

State Stability Fund a Federal Invisible Risk Sharing Program (in 

this section referred to as the ‘Program’), to be administered by the 

Secretary of Health and Human Services, acting through the Administrator of the Centers for Medicare & Medicaid Services (in 

this section referred to as the ‘Administrator’), to provide payments 

to health insurance issuers with respect to claims for eligible individuals for the purpose of lowering premiums for health insurance 

coverage offered in the individual market. 

‘‘(b) FUNDING.— 

‘‘(1) APPROPRIATION.—For the purpose of providing funding 

for the Program there is appropriated, out of any money in the 

Treasury not otherwise appropriated, $15,000,000,000 for the 

period beginning on January 1, 2018, and ending on December 

31, 2026. 

‘‘(2) USE OF UNALLOCATED FUNDS.—Funds provided under 

section 2204(c)(2)(B) to carry out this section are in addition to 

the amount appropriated under paragraph (1). 

‘‘(c) OPERATION OF PROGRAM.— 

‘‘(1) IN GENERAL.—The Administrator shall establish, after 

consultation with health care consumers, health insurance 

issuers, State insurance commissioners, and other stakeholders 

and after taking into consideration high cost health conditions 

and other health trends that generate high cost, parameters 

for the operation of the Program consistent with this section 

and consistent with the same limitation on payment with respect to health insurance coverage that applies to payment 

with respect health benefits coverage under section 2105(c)(7). 

‘‘(2) DEADLINE FOR INITIAL OPERATION.—Not later than 60 

days after the date of the enactment of this title, the Administrator shall establish sufficient parameters to specify how the 

Program will operate for plan year 2018. 

‘‘(3) STATE OPERATION OF PROGRAM.—The Administrator 

shall establish a process for a State to operate the Program in 

such State beginning with plan year 2020. 


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‘‘(d) DETAILS OF PROGRAM.—The parameters for the Program 

shall include the following: 

‘‘(1) ELIGIBLE INDIVIDUALS.—A definition for eligible individuals. 

‘‘(2) HEALTH STATUS STATEMENTS.—The development and use 

of health status statements with respect to such individuals. 

‘‘(3) STANDARDS FOR QUALIFICATION.— ‘‘(A) AUTOMATIC QUALIFICATION.—The identification of 

health conditions that automatically qualify individuals as 

eligible individuals at the time of application for health insurance coverage. 

‘‘(B) VOLUNTARY QUALIFICATION.—A process under which 

health insurance issuers may voluntarily qualify individuals, who do not automatically qualify under subparagraph (A), as eligible individuals at the time of application 

for such coverage. 

‘‘(4) PERCENTAGE OF INSURANCE PREMIUMS TO BE APPLIED.— The percentage of the premiums paid, to health insurance 

issuers for health insurance coverage by eligible individuals, 

that shall be collected and deposited to the credit (and available for the use) of the Program. 

‘‘(5) ATTACHMENT DOLLAR AMOUNT AND PAYMENT PROPOR- TION.—The dollar amount of claims for eligible individuals 

after which the Program will provide payments to health insurance issuers and the proportion of such claims above such 

dollar amount that the Program will pay.’’. 

Strike section 136 and insert the following: 

SEC. 136. PERMITTING STATES TO WAIVE CERTAIN ACA REQUIREMENTS TO ENCOURAGE FAIR HEALTH INSURANCE PREMIUMS. 

(a) IN GENERAL.—Section 2701 of the Public Health Service Act 

(42 U.S.C. 300gg) is amended by adding at the end the following 

new subsection: 

‘‘(b) PERMISSIBLE STATE WAIVER TO ENCOURAGE FAIR HEALTH IN- SURANCE PREMIUMS.— ‘‘(1) IN GENERAL.—A State may submit an application to the 

Secretary for one or more of the following purposes: 

‘‘(A) In the case of plan years beginning on or after January 1, 2018, to apply, subject to paragraph (5), under subsection (a)(1)(A)(iii), instead of the ratio specified in such 

subsection, a higher ratio specified by the State (consistent 

with section 2707(c)). 

‘‘(B) In the case of plan years beginning on or after January 1, 2020, for health insurance coverage offered in the 

individual or small group market in such State, to apply, 

subject to paragraph (5), instead of the essential health 

benefits specified under subsection (b) of section 1302 of 

the Patient Protection and Affordable Care Act, essential 

health benefits as specified by the State. 

‘‘(C) In the case of a State that has in place a program 

that carries out the purpose described in paragraph (1) or 

(2) of section 2202(a) of the Social Security Act or participates in the program established under section 2205 of 

such Act, for health insurance offered in the individual 


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market in such State, with respect to an individual who is 

an applicable policyholder of such coverage with respect to 

an enforcement period (as defined in section 2710A(b)) applicable to enrollments for a plan year beginning with plan 

year 2019 (or, in the case of enrollments during a special 

enrollment period, beginning with plan year 2018), to— 

‘‘(i) subject to paragraph (5), not apply any increase 

to the monthly premium rate that would otherwise 

apply under section 2710A to such individual for such 

coverage; and 

‘‘(ii) instead, subject to paragraph (5)— 

‘‘(I) apply subsection (a)(1) as if health status 

were included as a factor described in subparagraph (A) of such subsection; and 

‘‘(II) not apply section 2705(b). 

‘‘(2) DEFAULT APPROVAL.—An application submitted under 

paragraph (1) is approved unless the Secretary notifies the 

State submitting the application, not later than 60 days after 

the date of the submission of such application, that the application has been denied for not being in compliance with any requirement of paragraph (3) and of the reason for such denial. 

‘‘(3) REQUIREMENTS.—The requirements of this paragraph, 

with respect to an application submitted under paragraph (1), 

are the following: 

‘‘(A) The application is submitted at such time, and in 

such manner, as the Secretary may require. 

‘‘(B) The application specifies how the approval of such 

application will provide for one or more of the following: 

‘‘(i) Reducing average premiums for health insurance coverage in the State. 

‘‘(ii) Increasing enrollment in health insurance coverage in the State. 

‘‘(iii) Stabilizing the market for health insurance 

coverage in the State. 

‘‘(iv) Stabilizing premiums for individuals with preexisting conditions. 

‘‘(v) Increasing the choice of health plans in the 

State. 

‘‘(C) The application specifies the period for which the 

waiver is to be effective, consistent with paragraph (4). 

‘‘(D) In the case of an application for purposes of paragraph (1)(A), the application specifies the higher ratio to be 

applied pursuant to such paragraph. 

‘‘(E) In the case of an application for purposes of paragraph (1)(B), the application specifies the essential health 

benefits to be applied pursuant to such paragraph. 

‘‘(F) In the case of an application for purposes of paragraph (1)(C), the application demonstrates that the State 

has in place a program that carries out the purpose described in paragraph (1) or (2) of section 2202(a) of the Social Security Act or participates in the program established 

under section 2205 of such Act. 

‘‘(4) TERM OF WAIVER.— 

‘‘(A) IN GENERAL.—No waiver for a State under this subsection may extend over a period of longer than 10 years 


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unless the State requests continuation of such waiver, and 

such request shall be deemed granted unless the Secretary, within 90 days after the date of its submission to 

the Secretary, either denies such request in writing or informs the State in writing with respect to any additional 

information which is needed in order to make a final determination with respect to the request. 

‘‘(B) SPECIAL RULE.—A waiver applied for by a State 

under paragraph (1)(C) may only be effective for a period 

during which the State— 

‘‘(i) has in place a program that carries out the purpose described in paragraph (1) or (2) of section 

2202(a) of the Social Security Act; or 

‘‘(ii) participates in the program established under 

section 2205 of such Act. 

‘‘(5) NON-APPLICATION RULES.— 

‘‘(A) SPECIFIED NON-APPLICATION PROVISIONS.—In no 

case may a waiver for purposes of paragraph (1) apply 

with respect to any of the following provisions: 

‘‘(i) Section 1301 of the Patient Protection and Affordable Care Act, to the extent that such section applies to qualified health plans offered through the COOP program under section 1322 of such Act or multiState plans under section 1334 of such Act. 

‘‘(ii) Sections 1312(d)(3)(D), 1331, 1332, 1333, and 

1334 of such Act. 

‘‘(B) HOLD HARMLESS.—Any standard or requirement 

adopted by a State pursuant to the terms of a waiver approved under this subsection shall be deemed to comply 

with section 1252 of the Patient Protection and Affordable 

Care Act and subsection (a) of section 1324 of such Act, insofar as such standard or requirement relates to a Federal 

or State law described in subsection (b)(2) of such section 

(relating to rating).’’. 

(b) APPLICATION TO ESSENTIAL HEALTH BENEFITS.—Section 

1302(a)(1) of the Patient Protection and Affordable Care Act (42 

U.S.C. 18022(a)(1)) is amended by inserting ‘‘(or, in the case of 

health insurance coverage offered in the individual or small group 

market in a State for which there is an applicable waiver in effect 

under section 2701(b) of the Public Health Service Act for a plan 

year, the essential health benefits applicable under such waiver)’’ 

after ‘‘subsection (b)’’. 

SEC. 137. CONSTRUCTIONS. 

(a) NO GENDER RATING.—Nothing in this Act shall be construed 

as permitting health insurance issuers to discriminate in rates for 

health insurance coverage by gender. 

(b) NO LIMITING ACCESS TO COVERAGE FOR INDIVIDUALS WITH

PREEXISTING CONDITIONS.—Nothing in this Act shall be construed 

as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions. 

In the section 2710A(a)(1) proposed to be added to the Public 

Health Service Act by section 133, strike ‘‘Notwithstanding section 

2701, subject’’ and insert ‘‘Subject’’. 


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In the amendment proposed to be inserted into section 

2701(a)(1)(A)(iii) of the Public Health Service Act by section 135, 

insert after ‘‘or such other ratio for adults (consistent with section 

2707(c)) as the State involved may provide’’ the following: ‘‘(or, in 

the case of a State with a waiver under subsection (b) in effect for 

such a plan year, the ratio applied for such plan year in accordance 

with such waiver)’’. 

In the section 2202(a) proposed to be added to the Social Security 

Act by section 132, strike ‘‘Subject to subsection (b)’’ and insert 

‘‘Subject to subsections (b) and (c)’’. 

Add at the end of the section 2202 proposed to be added to the 

Social Security Act by section 132, the following: 

‘‘(c) REQUIRED USE OF ADDITIONAL INCREASE TO CERTAIN WAIVER

STATES TO PROVIDE FINANCIAL HARDSHIP ASSISTANCE.—A State 

shall use the additional allocation provided to the State from the 

funds appropriated under the last sentence of section 2204(a) only 

in accordance with such last sentence. 

Insert at the end of the section 2204(a) proposed to be added to 

the Social Security Act by section 132, the following: 

‘‘The amount otherwise appropriated under this subsection shall be 

increased by $8,000,000,000 for the period beginning with 2018 and 

ending with 2023, to be allocated to States with a waiver in effect 

under section 2701(b) of the Public Health Service Act with respect 

to the purpose described in paragraph (1)(C) of such section, in accordance with an allocation methodology specified by the Secretary 

that takes into account the relative allocation of other amounts appropriated under this subsection among such States, and to be used 

by (and made available under subsection (d), for any year during 

such period that such waiver is in effect, to) such States for the 

purpose of providing assistance to reduce premiums or other outof-pocket costs of individuals who are subject to an increase in the 

monthly premium rate for health insurance coverage as a result of 

such waiver. 

In the section 2202(b) proposed to be added to the Social Security 

Act by section 132, strike ‘‘section 2204(b)’’ and insert ‘‘section 

2204(a)’’. 

In section 214(b), strike ‘‘Section 1412 of the Patient Protection 

and Affordable Care Act is amended by adding at the end the following new subsection:’’ and insert ‘‘Section 1412(f) of the Patient 

Protection and Affordable Care Act, as added by section 202, is 

amended to read as follows:’’ 

Æ 


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