II 

Calendar No. 90 

116TH CONGRESS 

1ST SESSION H. R. 986 

IN THE SENATE OF THE UNITED STATES 

MAY 14, 2019 

Received; read the first time 

MAY 15, 2019 

Read the second time and placed on the calendar 

AN ACT 

To provide that certain guidance related to waivers for State 

innovation under the Patient Protection and Affordable 

Care Act shall have no force or effect. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protecting Americans 

5 with Preexisting Conditions Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) On October 24, 2018, the administration 

9 published new guidance to carry out section 1332 of 


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1 the Patient Protection and Affordable Care Act (42 

2 U.S.C. 18052) entitled ‘‘State Relief and Empower3 ment Waivers’’ (83 Fed. Reg. 53575). 

4 (2) The new guidance encourages States to pro5 vide health insurance coverage through insurance 

6 plans that may discriminate against individuals with 

7 preexisting health conditions, including the one in 

8 four Americans living with a disability. 

9 (3) The implementation and enforcement of the 

10 new guidance weakens protections for the millions of 

11 Americans living with preexisting health conditions 

12 and jeopardizes Americans’ access to quality, afford13 able health insurance coverage. 

14 SEC. 3. PROVIDING THAT CERTAIN GUIDANCE RELATED TO 

15 WAIVERS FOR STATE INNOVATION UNDER 

16 THE PATIENT PROTECTION AND AFFORD17 ABLE CARE ACT SHALL HAVE NO FORCE OR 

18 EFFECT. 

19 Beginning April 1, 2019, the Secretary of Health and 

20 Human Services and the Secretary of the Treasury may 

21 not take any action to implement, enforce, or otherwise 

22 give effect to the guidance entitled ‘‘State Relief and Em23 powerment Waivers’’ (83 Fed. Reg. 53575 (October 24, 

24 2018)), including any such action that would result in in25 dividuals losing health insurance coverage that includes 


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1 the essential health benefits package (as defined in sub2 section (a) of section 1302 of the Patient Protection and 

3 Affordable Care Act (42 U.S.C. 18022(a)) without regard 

4 to any waiver of any provision of such package under a 

5 waiver under such section 1332), including the maternity 

6 and newborn care essential health benefit described in sub7 section (b)(1)(D) of such section, including any such ac8 tion that would result in a decrease in the number of such 

9 individuals enrolled in coverage that is at least as com10 prehensive as the coverage defined in section 1302(a) of 

11 the Patient Protection and Affordable Care Act (42 

12 U.S.C. 18022(a)) compared to the number of such individ13 uals who would have been so enrolled in such coverage 

14 had such action not been taken, including any such action 

15 that would, with respect to individuals with substance use 

16 disorders, including opioid use disorders, reduce the avail17 ability or affordability of coverage that is at least as com18 prehensive as the coverage defined in section 1302(a) of 

19 the Patient Protection and Affordable Care Act (42 

20 U.S.C. 18022(a)) compared to the availability or afford21 ability, respectively, of such coverage had such action not 

22 been taken, including any such action that would result, 

23 with respect to vulnerable populations (including low-in24 come individuals, elderly individuals, and individuals with 

25 serious health issues or who have a greater risk of develVerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H986.PCS H986

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1 oping serious health issues), in a decrease in the avail2 ability of coverage that is at least as comprehensive as 

3 the coverage defined in section 1302(a) of the Patient Pro4 tection and Affordable Care Act (42 U.S.C. 18022(a)) 

5 with coverage and cost sharing protections required under 

6 section 1332(b)(1)(B) of such Act (42 U.S.C. 

7 18052(b)(1)(B)), including any such action that would, 

8 with respect to individuals with preexisting conditions, re9 duce the affordability of coverage that is at least as com10 prehensive as the coverage defined in section 1302(a) of 

11 the Patient Protection and Affordable Care Act (42 

12 U.S.C. 18022(a)) compared to the affordability of such 

13 coverage had such action not been taken, including any 

14 such action that would result in higher health insurance 

15 premiums for individuals enrolled in health insurance cov16 erage that is at least as comprehensive as the coverage 

17 defined in section 1302(b) of such Act (42 U.S.C. 

18 18022(b)), and the Secretaries may not promulgate any 

19 substantially similar guidance or rule. Nothing in the pre20 vious sentence shall be construed to affect the approval 

21 of waivers under section 1332 of the Patient Protection 

22 and Affordable Care Act (42 U.S.C. 18052) that establish 

23 reinsurance programs that are consistent with the require24 ments under subsection (b)(1) of such section (42 U.S.C. 

25 18052(b)(1)), lower health insurance premiums, and proVerDate Sep 11 2014 02:47 May 16, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H986.PCS H986

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1 tect health insurance coverage for people with preexisting 

2 conditions. 

3 SEC. 4. GAO REPORT ON AFFECT OF STATE INNOVATION 

4 WAIVERS ON COVERAGE OF INDIVIDUALS 

5 AND ON MENTAL HEALTH HEALTH CARE 

6 TREATMENT. 

7 Not later than 1 year after the date of the enactment 

8 of this Act, the Comptroller General of the United States 

9 shall submit to Congress a report on the number of indi10 viduals expected to lose access to health insurance cov11 erage (as defined in section 2791 of the Public Health 

12 Service Act (42 U.S.C. 300gg–91)) if section 2 were not 

13 enacted and waivers under section 1332 of the Patient 

14 Protection and Affordable Care Act (42 U.S.C. 18052) 

15 were approved under the guidance described in such sec16 tion 2. Such report shall include an analysis of the ex17 pected effect such waivers approved under such guidance 

18 would have on mental health care treatment. 

Passed the House of Representatives May 9, 2019. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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Calendar No. 90 

116TH CONGRESS 

1ST SESSION H. R. 986 

AN ACT 

To provide that certain guidance related to waivers 

effect. and Affordable Care Act shall have no force or for State innovation under the Patient Protection 

MAY 15, 2019 

Read the second time and placed on the calendar 


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