116TH CONGRESS 

1ST SESSION H. R. 986 

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, 
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1 SECTION 1. SHORT TITLE. 

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

3 with Preexisting Conditions Act of 2019’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

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

7 published new guidance to carry out section 1332 of 

8 the Patient Protection and Affordable Care Act (42 

9 U.S.C. 18052) entitled ‘‘State Relief and Empower10 ment Waivers’’ (83 Fed. Reg. 53575). 

11 (2) The new guidance encourages States to pro12 vide health insurance coverage through insurance 

13 plans that may discriminate against individuals with 

14 preexisting health conditions, including the one in 

15 four Americans living with a disability. 

16 (3) The implementation and enforcement of the 

17 new guidance weakens protections for the millions of 

18 Americans living with preexisting health conditions 

19 and jeopardizes Americans’ access to quality, afford20 able health insurance coverage. 
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1 SEC. 3. PROVIDING THAT CERTAIN GUIDANCE RELATED TO 

2 WAIVERS FOR STATE INNOVATION UNDER 

3 THE PATIENT PROTECTION AND AFFORD4 ABLE CARE ACT SHALL HAVE NO FORCE OR 

5 EFFECT. 

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

7 Human Services and the Secretary of the Treasury may 

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

9 give effect to the guidance entitled ‘‘State Relief and Em10 powerment Waivers’’ (83 Fed. Reg. 53575 (October 24, 

11 2018)), including any such action that would result in in12 dividuals losing health insurance coverage that includes 

13 the essential health benefits package (as defined in sub14 section (a) of section 1302 of the Patient Protection and 

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

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

17 waiver under such section 1332), including the maternity 

18 and newborn care essential health benefit described in sub19 section (b)(1)(D) of such section, including any such ac20 tion that would result in a decrease in the number of such 

21 individuals enrolled in coverage that is at least as com22 prehensive as the coverage defined in section 1302(a) of 

23 the Patient Protection and Affordable Care Act (42 

24 U.S.C. 18022(a)) compared to the number of such individ25 uals who would have been so enrolled in such coverage 

26 had such action not been taken, including any such action 
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1 that would, with respect to individuals with substance use 

2 disorders, including opioid use disorders, reduce the avail3 ability or affordability of coverage that is at least as com4 prehensive as the coverage defined in section 1302(a) of 

5 the Patient Protection and Affordable Care Act (42 

6 U.S.C. 18022(a)) compared to the availability or afford7 ability, respectively, of such coverage had such action not 

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

9 with respect to vulnerable populations (including low-in10 come individuals, elderly individuals, and individuals with 

11 serious health issues or who have a greater risk of devel12 oping serious health issues), in a decrease in the avail13 ability of coverage that is at least as comprehensive as 

14 the coverage defined in section 1302(a) of the Patient Pro15 tection and Affordable Care Act (42 U.S.C. 18022(a)) 

16 with coverage and cost sharing protections required under 

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

18 18052(b)(1)(B)), including any such action that would, 

19 with respect to individuals with preexisting conditions, re20 duce the affordability of coverage that is at least as com21 prehensive as the coverage defined in section 1302(a) of 

22 the Patient Protection and Affordable Care Act (42 

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

24 coverage had such action not been taken, including any 

25 such action that would result in higher health insurance 
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1 premiums for individuals enrolled in health insurance cov2 erage that is at least as comprehensive as the coverage 

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

4 18022(b)), and the Secretaries may not promulgate any 

5 substantially similar guidance or rule. Nothing in the pre6 vious sentence shall be construed to affect the approval 

7 of waivers under section 1332 of the Patient Protection 

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

9 reinsurance programs that are consistent with the require10 ments under subsection (b)(1) of such section (42 U.S.C. 

11 18052(b)(1)), lower health insurance premiums, and pro12 tect health insurance coverage for people with preexisting 

13 conditions. 

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

15 WAIVERS ON COVERAGE OF INDIVIDUALS 

16 AND ON MENTAL HEALTH HEALTH CARE 

17 TREATMENT. 

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

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

20 shall submit to Congress a report on the number of indi21 viduals expected to lose access to health insurance cov22 erage (as defined in section 2791 of the Public Health 

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

24 enacted and waivers under section 1332 of the Patient 

25 Protection and Affordable Care Act (42 U.S.C. 18052) 
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1 were approved under the guidance described in such sec2 tion 2. Such report shall include an analysis of the ex3 pected effect such waivers approved under such guidance 

4 would have on mental health care treatment. 

Passed the House of Representatives May 9, 2019. 

Attest: 

Clerk. 

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