I 

116TH CONGRESS 

1ST SESSION H. R. 1884 

To amend the Patient Protection and Affordable Care Act to improve affordability of, undo sabotage with respect to, and increase access to health 

insurance coverage, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 26, 2019 

Mr. PALLONE (for himself, Mr. NEAL, Mr. SCOTT of Virginia, Mr. HOYER, 

Ms. SCHRIER, Mr. CISNEROS, Ms. DEGETTE, Ms. CASTOR of Florida, 

Mrs. TRAHAN, Mrs. CRAIG, Ms. KUSTER of New Hampshire, Mr. RUIZ, 

Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. ALLRED, Mrs. BUSTOS, 

Mrs. MCBATH, Mr. LUJA ́N, Mr. TED LIEU of California, Mr. PETERS, 

Ms. WILSON of Florida, Ms. SPANBERGER, Mr. ROUDA, Ms. UNDERWOOD, Mr. DELGADO, Mrs. LEE of Nevada, Ms. BLUNT ROCHESTER, 

Mr. DOGGETT, Mr. GOMEZ, Mrs. DINGELL, Ms. SHALALA, Ms. 

FRANKEL, Ms. ESHOO, Mr. SIRES, Mr. SOTO, Ms. JACKSON LEE, Mr. 

KEATING, Ms. STEVENS, Ms. SEWELL of Alabama, Mr. TRONE, Mr. 

ROSE of New York, Mrs. KIRKPATRICK, Mr. LARSON of Connecticut, Mr. 

LEWIS, Ms. JAYAPAL, Ms. GARCIA of Texas, Mr. COURTNEY, Ms. 

SA ́NCHEZ, Mrs. DEMINGS, Mrs. MURPHY, Ms. DEAN, Mr. COHEN, Mr. 

THOMPSON of California, Mr. RUSH, Mr. MORELLE, Ms. HILL of California, Mr. HIGGINS of New York, Mrs. DAVIS of California, Ms. 

BROWNLEY of California, Mr. PASCRELL, Ms. SLOTKIN, Mr. ENGEL, Mr. 

KIM, Mr. BLUMENAUER, Mrs. HAYES, Mr. COX of California, Mr. 

TAKANO, Mr. PANETTA, Mr. KILDEE, Mr. MALINOWSKI, Mr. LEVIN of 

Michigan, Mr. GOLDEN, Mr. VAN DREW, Ms. MUCARSEL-POWELL, Mr. 

GRIJALVA, Mr. ESPAILLAT, Ms. SCHAKOWSKY, Ms. PINGREE, Ms. NORTON, and Mr. SABLAN) introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, 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 


pbinns on DSK79D2C42PROD with BILLS
2 

•HR 1884 IH

A BILL 

To amend the Patient Protection and Affordable Care Act 

to improve affordability of, undo sabotage with respect 

to, and increase access to health insurance coverage, 

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, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Protecting Pre-Existing Conditions and Making Health 

6 Care More Affordable Act of 2019’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—EXPANDING AFFORDABILITY 

Sec. 101. Improve affordability and reduce premium costs for consumers. 

Sec. 102. Expand affordability for working families. 

TITLE II—UNDOING SABOTAGE 

Sec. 201. Protect comprehensive coverage for small businesses and workers. 

Sec. 202. Short-term limited duration insurance rule prohibition. 

Sec. 203. Ensure plans provide comprehensive benefits. 

Sec. 204. Providing for additional requirements with respect to the navigator 

program. 

Sec. 205. Federal Exchange outreach and educational activities. 

Sec. 206. Improve Health Insurance Affordability Fund. 

Sec. 207. Providing that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act 

shall have no force or effect. 

TITLE III—STATE INNOVATION AND TRANSPARENCY 

Sec. 301. Fund State health insurance education programs for consumers. 

Sec. 302. Fund State innovations to expand coverage. 

Sec. 303. Preserving State option to implement health care marketplaces. 

Sec. 304. Promote transparency and accountability in the Administration’s expenditures of Exchange user fees. 


pbinns on DSK79D2C42PROD with BILLS
3 

•HR 1884 IH

1 TITLE I—EXPANDING 

2 AFFORDABILITY 

3 SEC. 101. IMPROVE AFFORDABILITY AND REDUCE PRE4 MIUM COSTS FOR CONSUMERS. 

5 (a) IN GENERAL.—Section 36B(b)(3)(A) of the In6 ternal Revenue Code of 1986 is amended to read as fol7 lows: 

8 ‘‘(A) APPLICABLE PERCENTAGE.—The ap9 plicable percentage for any taxable year shall be 

10 the percentage such that the applicable percent11 age for any taxpayer whose household income is 

12 within an income tier specified in the following 

13 table shall increase, on a sliding scale in a lin14 ear manner, from the initial premium percent15 age to the final premium percentage specified in 

16 such table for such income tier: 

‘‘In the case of household 

income (expressed as 

a percent of poverty line) 

within the following income tier: 

The initial 

premium 

percentage is— 

The final 

premium 

percentage is— 

Over 100.0 percent up to 133.0 percent .... 0.0 1.0

133.0 percent up to 150.0 percent ............. 1.0 2.0

150.0 percent up to 200.0 percent ............. 2.0 4.0

200.0 percent up to 250.0 percent ............. 4.0 6.0

250.0 percent up to 300.0 percent ............. 6.0 7.0

300.0 percent up to 400.0 percent ............. 7.0 8.5

400.0 percent and higher ........................... 8.5 8.5’’. 

17 (b) CONFORMING AMENDMENT.—Section 

18 36B(c)(1)(A) of the Internal Revenue Code of 1986 is 

19 amended by striking ‘‘but does not exceed 400 percent’’. 


pbinns on DSK79D2C42PROD with BILLS
4 

•HR 1884 IH

1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to taxable years beginning after 

3 December 31, 2020. 

4 SEC. 102. EXPAND AFFORDABILITY FOR WORKING FAMI5 LIES. 

6 (a) IN GENERAL.—Clause (i) of section 36B(c)(2)(C) 

7 of the Internal Revenue Code of 1986 is amended to read 

8 as follows: 

9 ‘‘(i) COVERAGE MUST BE AFFORD10 ABLE.— 

11 ‘‘(I) EMPLOYEES.—An employee 

12 shall not be treated as eligible for 

13 minimum essential coverage if such 

14 coverage consists of an eligible em15 ployer-sponsored plan (as defined in 

16 section 5000A(f)(2)) and the employ17 ee’s required contribution (within the 

18 meaning of section 5000A(e)(1)(B)) 

19 with respect to the plan exceeds 9.5 

20 percent of the employee’s household 

21 income. 

22 ‘‘(II) FAMILY MEMBERS.—An in23 dividual who is eligible to enroll in an 

24 eligible employer-sponsored plan (as 

25 defined in section 5000A(f)(2)) by 


pbinns on DSK79D2C42PROD with BILLS
5 

•HR 1884 IH

1 reason of a relationship the individual 

2 bears to the employee shall not be 

3 treated as eligible for minimum essen4 tial coverage by reason of such eligi5 bility to enroll if the employee’s re6 quired contribution (within the mean7 ing of section 5000A(e)(1)(B), deter8 mined by substituting ‘family’ for 

9 ‘self-only’) with respect to the plan ex10 ceeds 9.5 percent of the employee’s 

11 household income.’’. 

12 (b) CONFORMING AMENDMENTS.— 

13 (1) Clause (ii) of section 36B(c)(2)(C) of the 

14 Internal Revenue Code of 1986 is amended by strik15 ing ‘‘Except as provided in clause (iii), an employee’’ 

16 and inserting ‘‘An individual’’. 

17 (2) Clause (iii) of section 36B(c)(2)(C) of such 

18 Code is amended by striking ‘‘the last sentence of 

19 clause (i)’’ and inserting ‘‘clause (i)(II)’’. 

20 (3) Clause (iv) of section 36B(c)(2)(C) of such 

21 Code is amended by striking ‘‘the 9.5 percent under 

22 clause (i)(II)’’ and inserting ‘‘the 9.5 percent under 

23 clauses (i)(I) and (i)(II)’’. 


pbinns on DSK79D2C42PROD with BILLS
6 

•HR 1884 IH

1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to taxable years beginning after 

3 December 31, 2020. 

4 TITLE II—UNDOING SABOTAGE 

5 SEC. 201. PROTECT COMPREHENSIVE COVERAGE FOR 

6 SMALL BUSINESSES AND WORKERS. 

7 The Secretary of Labor may not take any action to 

8 implement, enforce, or otherwise give effect to the rule en9 titled ‘‘Definition of ‘Employer’ Under Section 3(5) of 

10 ERISA–Association Health Plans’’ (83 Fed. Reg. 28912 

11 (June 21, 2018)), and the Secretary may not promulgate 

12 any substantially similar rule. 

13 SEC. 202. SHORT-TERM LIMITED DURATION INSURANCE 

14 RULE PROHIBITION. 

15 The Secretary of Health and Human Services, the 

16 Secretary of the Treasury, and the Secretary of Labor 

17 may not take any action to implement, enforce, or other18 wise give effect to the rule entitled ‘‘Short-Term, Limited 

19 Duration Insurance’’ (83 Fed. Reg. 38212 (August 3, 

20 2018)), and the Secretaries may not promulgate any sub21 stantially similar rule. 


pbinns on DSK79D2C42PROD with BILLS
7 

•HR 1884 IH

1 SEC. 203. ENSURE PLANS PROVIDE COMPREHENSIVE BENE2 FITS. 

3 (a) ESSENTIAL HEALTH BENEFITS.—Section 

4 1302(b)(4) of the Patient Protection and Affordable Care 

5 Act (42 U.S.C. 18022(b)(4)) is amended— 

6 (1) in subparagraph (A), by inserting ‘‘and so 

7 that benefits are included within each of such cat8 egories’’ before the semicolon; 

9 (2) in subparagraph (G), by striking at the end 

10 ‘‘and’’; 

11 (3) in subparagraph (H), by striking the period 

12 at the end and inserting ‘‘; and’’; and 

13 (4) by adding at the end the following new sub14 paragraph: 

15 ‘‘(I) ensure that, beginning January 1, 

16 2020— 

17 ‘‘(i) in the case of health benefits that 

18 are established as essential health benefits, 

19 there shall not be substitution of such ben20 efits across benefit categories; 

21 ‘‘(ii) a qualified health plan shall not 

22 be treated as providing coverage for the es23 sential health benefits unless under such 

24 plan— 

25 ‘‘(I) coverage of prescription 

26 drugs provides for access to a wide 


pbinns on DSK79D2C42PROD with BILLS
8 

•HR 1884 IH

1 variety of classes of drugs within the 

2 prescription drug formulary of such 

3 plan; and 

4 ‘‘(II) in the case that a drug that 

5 is medically necessary for an enrollee 

6 under such plan is not included within 

7 such formulary, such individual has 

8 access to such drug through an excep9 tions process established by the plan; 

10 and 

11 ‘‘(iii) habilitative services are covered 

12 at parity with rehabilitative services.’’. 

13 (b) STANDARD BENEFIT PLANS.—Section 1302(d) of 

14 the Patient Protection and Affordable Care Act (42 

15 U.S.C. 18022(d)) is amended by adding at the end the 

16 following new paragraph: 

17 ‘‘(5) STANDARD BENEFIT PLANS.— 

18 ‘‘(A) IN GENERAL.—For purposes of pro19 viding individuals with the opportunity to make 

20 simpler comparisons of health plans offered by 

21 different health insurance issuers and simplify 

22 the selection process, the Secretary shall, for 

23 each plan year beginning with plan year 2020, 

24 through rulemaking, specify a structure de25 scribed in subparagraph (B)(i) for a standard 


pbinns on DSK79D2C42PROD with BILLS
9 

•HR 1884 IH

1 benefit plan for such plan year for each of the 

2 bronze, silver, and gold levels of coverage and 

3 for each actuarial value variation of a silver 

4 plan resulting from the application of section 

5 1402(c). A standard benefit plan for a plan 

6 year for a level of coverage or actuarial value 

7 variation of a silver plan shall be modeled on 

8 the most commonly purchased plans (deter9 mined by enrollments in such plans) during the 

10 previous 2 plan years offered in the federally fa11 cilitated Exchange operated pursuant to section 

12 1321(c) in such level or variation and shall in13 clude coverage of deductible-exempt services 

14 consistent with actual purchasing patterns of 

15 consumers in the previous two plan years. 

16 ‘‘(B) STANDARD BENEFIT PLAN.—For 

17 purposes of this paragraph, the term ‘standard 

18 benefit plan’ means a qualified health plan to 

19 be offered through an Exchange on the indi20 vidual market that has either— 

21 ‘‘(i) a standardized cost-sharing struc22 ture specified by the Secretary pursuant to 

23 rulemaking; or 

24 ‘‘(ii) a standardized cost-sharing 

25 structure specified by the Secretary pursuVerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884

pbinns on DSK79D2C42PROD with BILLS
10 

•HR 1884 IH

1 ant to rulemaking that is modified by the 

2 health insurance issuer of such plan only 

3 to the extent necessary to align with high 

4 deductible health plan requirements under 

5 section 223 of the Internal Revenue Code 

6 of 1986 or the applicable annual limitation 

7 on cost sharing under subsection (c) and 

8 actuarial value requirements specified by 

9 the Secretary.’’. 

10 SEC. 204. PROVIDING FOR ADDITIONAL REQUIREMENTS 

11 WITH RESPECT TO THE NAVIGATOR PRO12 GRAM. 

13 (a) IN GENERAL.—Section 1311(i) of the Patient 

14 Protection and Affordable Care Act (42 U.S.C. 18031(i)) 

15 is amended— 

16 (1) in paragraph (2), by adding at the end the 

17 following new subparagraph: 

18 ‘‘(C) SELECTION OF RECIPIENTS.—In the 

19 case of an Exchange established and operated 

20 by the Secretary within a State pursuant to sec21 tion 1321(c), in awarding grants under para22 graph (1), the Exchange shall— 

23 ‘‘(i) select entities to receive such 

24 grants based solely on an entity’s demVerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884

pbinns on DSK79D2C42PROD with BILLS
11 

•HR 1884 IH

1 onstrated capacity to carry out each of the 

2 duties specified in paragraph (3); 

3 ‘‘(ii) not take into account whether or 

4 not the entity has demonstrated how the 

5 entity will provide information to individ6 uals relating to group health plans offered 

7 by a group or association of employers de8 scribed in section 2510.3–5(b) of title 29, 

9 Code of Federal Regulations (or any suc10 cessor regulation), or short-term limited 

11 duration insurance (as defined by the Sec12 retary for purposes of section 2791(b)(5) 

13 of the Public Health Service Act); and 

14 ‘‘(iii) ensure that, each year, the Ex15 change awards such a grant to— 

16 ‘‘(I) at least one entity described 

17 in this paragraph that is a community 

18 and consumer-focused nonprofit 

19 group; and 

20 ‘‘(II) at least one entity described 

21 in subparagraph (B), which may in22 clude another community and con23 sumer-focused nonprofit group in ad24 dition to any such group awarded a 

25 grant pursuant to subclause (I).’’; 


pbinns on DSK79D2C42PROD with BILLS
12 

•HR 1884 IH

1 (2) in paragraph (3)— 

2 (A) in subparagraph (C), by inserting after 

3 ‘‘qualified health plans’’ the following: ‘‘, State 

4 Medicaid plans under title XIX of the Social 

5 Security Act, and State Children’s Health In6 surance Programs under title XXI of such 

7 Act’’; and 

8 (B) by adding at the end the following 

9 flush left sentence: 

10 ‘‘The duties specified in the preceding sentence may 

11 be carried out by such a navigator at any time dur12 ing a year.’’; 

13 (3) in paragraph (4)(A)— 

14 (A) in the matter preceding clause (i), by 

15 striking ‘‘not’’; 

16 (B) in clause (i)— 

17 (i) by inserting ‘‘not’’ before ‘‘be’’; 

18 and 

19 (ii) by striking ‘‘; or’’ and inserting 

20 ‘‘;’’; 

21 (C) in clause (ii)— 

22 (i) by inserting ‘‘not’’ before ‘‘re23 ceive’’; and 

24 (ii) by striking the period and insert25 ing ‘‘;’’; and 


pbinns on DSK79D2C42PROD with BILLS
13 

•HR 1884 IH

1 (D) by adding at the end the following new 

2 clause: 

3 ‘‘(iii) maintain physical presence in 

4 the State of the Exchange so as to allow 

5 in-person assistance to consumers.’’; and 

6 (4) in paragraph (6)— 

7 (A) by striking ‘‘FUNDING.—Grants 

8 under’’ and inserting ‘‘FUNDING.— 

9 ‘‘(A) STATE EXCHANGES.—Grants under’’; 

10 and 

11 (B) by adding at the end the following new 

12 subparagraph: 

13 ‘‘(B) FEDERAL EXCHANGES.—For pur14 poses of carrying out this subsection, with re15 spect to an Exchange established and operated 

16 by the Secretary within a State pursuant to sec17 tion 1321(c), the Secretary shall obligate 

18 $100,000,000 out of amounts collected through 

19 the user fees on participating health insurance 

20 issuers pursuant to section 156.50 of title 45, 

21 Code of Federal Regulations (or any successor 

22 regulations) for fiscal year 2020 and each sub23 sequent fiscal year. Such amount for a fiscal 

24 year shall remain available until expended.’’. 


pbinns on DSK79D2C42PROD with BILLS
14 

•HR 1884 IH

1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply with respect to plan years begin3 ning on or after January 1, 2020. 

4 SEC. 205. FEDERAL EXCHANGE OUTREACH AND EDU5 CATIONAL ACTIVITIES. 

6 Section 1321(c) of the Patient Protection and Afford7 able Care Act (42 U.S.C. 18041(c)) is amended by adding 

8 at the end the following new paragraph: 

9 ‘‘(3) OUTREACH AND EDUCATIONAL ACTIVI10 TIES.— 

11 ‘‘(A) IN GENERAL.—In the case of an Ex12 change established or operated by the Secretary 

13 within a State pursuant to this subsection, the 

14 Secretary shall carry out outreach and edu15 cational activities for purposes of informing po16 tential enrollees in qualified health plans offered 

17 through the Exchange of the availability of cov18 erage under such plans and financial assistance 

19 for coverage under such plans. Such outreach 

20 and educational activities shall be provided in a 

21 manner that is culturally and linguistically ap22 propriate to the needs of the populations being 

23 served by the Exchange (including hard-to24 reach populations, such as racial and sexual miVerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884

pbinns on DSK79D2C42PROD with BILLS
15 

•HR 1884 IH

1 norities, limited English proficient populations, 

2 and young adults). 

3 ‘‘(B) LIMITATION ON USE OF FUNDS.—No 

4 funds appropriated under this paragraph shall 

5 be used for expenditures for promoting non6 ACA compliant health insurance coverage. 

7 ‘‘(C) NON-ACA COMPLIANT HEALTH INSUR8 ANCE COVERAGE.—For purposes of this sub9 paragraph (B): 

10 ‘‘(i) The term ‘non-ACA compliant 

11 health insurance coverage’ means health 

12 insurance coverage, or a group health plan, 

13 that is not a qualified health plan. 

14 ‘‘(ii) Such term includes the following: 

15 ‘‘(I) An association health plan. 

16 ‘‘(II) Short-term limited duration 

17 insurance. 

18 ‘‘(D) FUNDING.—Out of any funds in the 

19 Treasury not otherwise appropriated, there are 

20 hereby appropriated for fiscal year 2020 and 

21 each subsequent fiscal year, $100,000,000 to 

22 carry out this paragraph. Funds appropriated 

23 under this subparagraph shall remain available 

24 until expended.’’. 


pbinns on DSK79D2C42PROD with BILLS
16 

•HR 1884 IH

1 SEC. 206. IMPROVE HEALTH INSURANCE AFFORDABILITY 

2 FUND. 

3 Subtitle D of title I of the Patient Protection and 

4 Affordable Care Act is amended by inserting after part 

5 5 (42 U.S.C. 18061 et seq.) the following new part: 

6 ‘‘PART 6—IMPROVE HEALTH INSURANCE 

7 AFFORDABILITY FUND 

8 ‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM. 

9 ‘‘There is hereby established the ‘Improve Health In10 surance Affordability Fund’ to be administered by the Sec11 retary of Health and Human Services, acting through the 

12 Administrator of the Centers for Medicare & Medicaid 

13 Services (in this section referred to as the ‘Adminis14 trator’), to provide funding, in accordance with this title, 

15 to the 50 States and the District of Columbia (each re16 ferred to in this section as a ‘State’) beginning on January 

17 1, 2020, for the purposes described in section 1352. 

18 ‘‘SEC. 1352. USE OF FUNDS. 

19 ‘‘(a) IN GENERAL.—A State shall use the funds allo20 cated to the State under this part for one of the following 

21 purposes: 

22 ‘‘(1) To provide reinsurance payments to health 

23 insurance issuers with respect to individuals enrolled 

24 under individual health insurance coverage (other 

25 than through a plan described in subsection (b)) of26 fered by such issuers. 


pbinns on DSK79D2C42PROD with BILLS
17 

•HR 1884 IH

1 ‘‘(2) To provide assistance (other than through 

2 payments described in paragraph (1)) to reduce out3 of-pocket costs, such as copayments, coinsurance, 

4 premiums, and deductibles, of individuals enrolled 

5 under qualified health plans offered on the indi6 vidual market through an Exchange. 

7 ‘‘(b) EXCLUSION OF CERTAIN GRANDFATHERED AND

8 TRANSITIONAL PLANS.—For purposes of subsection (a), 

9 a plan described in this subsection is the following: 

10 ‘‘(1) A grandfathered health plan (as defined in 

11 section 1251). 

12 ‘‘(2) A plan (commonly referred to as a ‘transi13 tional plan’) continued under the letter issued by the 

14 Centers for Medicare & Medicaid Services on No15 vember 14, 2013, to the State Insurance Commis16 sioners outlining a transitional policy for coverage in 

17 the individual and small group markets to which sec18 tion 1251 does not apply, and under the extension 

19 of the transitional policy for such coverage set forth 

20 in the Insurance Standards Bulletin Series guidance 

21 issued by the Centers for Medicare & Medicaid Serv22 ices on March 5, 2014, February 29, 2016, Feb23 ruary 13, 2017, and April 9, 2018, or under any 

24 subsequent extensions thereof. 


pbinns on DSK79D2C42PROD with BILLS
18 

•HR 1884 IH

1 ‘‘SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT 

2 SAFEGUARD. 

3 ‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA4 TIONS.— 

5 ‘‘(1) IN GENERAL.—To be eligible for an alloca6 tion of funds under this part for a year (beginning 

7 with 2020), a State shall submit to the Adminis8 trator an application at such time (but, in the case 

9 of allocations for 2020, not later than 90 days after 

10 the date of the enactment of this title and, in the 

11 case of allocations for a subsequent year, not later 

12 than March 31 of the previous year) and in such 

13 form and manner as specified by the Administrator 

14 containing— 

15 ‘‘(A) a description of how the funds will be 

16 used; and 

17 ‘‘(B) such other information as the Admin18 istrator may require. 

19 ‘‘(2) AUTOMATIC APPROVAL.—An application so 

20 submitted is approved unless the Administrator noti21 fies the State submitting the application, not later 

22 than 60 days after the date of the submission of 

23 such application, that the application has been de24 nied for not being in compliance with any require25 ment of this part and of the reason for such denial. 


pbinns on DSK79D2C42PROD with BILLS
19 

•HR 1884 IH

1 ‘‘(3) 5-YEAR APPLICATION APPROVAL.—If an 

2 application of a State is approved for a purpose de3 scribed in section 1352 for a year, such application 

4 shall be treated as approved for such purpose for 

5 each of the subsequent 4 years. 

6 ‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 

7 ‘‘(1) 2020.—For allocations made under this 

8 part for 2020, in the case of a State that does not 

9 submit an application under subsection (a) by the 

10 90-day submission date applicable to such year 

11 under subsection (a)(1) and in the case of a State 

12 that does submit such an application by such date 

13 that is not approved, the Administrator, in consulta14 tion with the State insurance commissioner, shall 

15 use, in accordance with paragraph (3), the allocation 

16 that would otherwise be provided to the State under 

17 this part for such year for such State. 

18 ‘‘(2) 2021 AND SUBSEQUENT YEARS.—In the 

19 case of a State that does not have in effect an ap20 proved application under this section for 2021 or a 

21 subsequent year, the Administrator, in consultation 

22 with the State insurance commissioner, shall use, in 

23 accordance with paragraph (3), the allocation that 

24 would otherwise be provided to the State under this 

25 part for such year for such State. 


pbinns on DSK79D2C42PROD with BILLS
20 

•HR 1884 IH

1 ‘‘(3) SPECIFIED USE.—An allocation for a 

2 State made pursuant to paragraph (1) or (2) for a 

3 year shall be used to carry out the purpose described 

4 in section 1352(a)(1) in such State by providing re5 insurance payments to health insurance issuers with 

6 respect to attachment range claims (as defined in 

7 section 1354(b)(2), using the dollar amounts speci8 fied in subparagraph (B) of such section for such 

9 year) in an amount equal to the percentage (speci10 fied for such year by the Secretary under such sub11 paragraph) of the amount of such claims. 

12 ‘‘SEC. 1354. ALLOCATIONS. 

13 ‘‘(a) APPROPRIATION.—For the purpose of providing 

14 allocations for States under this part there is appro15 priated, out of any money in the Treasury not otherwise 

16 appropriated $10,000,000,000 for 2020 and each subse17 quent year. 

18 ‘‘(b) ALLOCATIONS.— 

19 ‘‘(1) PAYMENT.— 

20 ‘‘(A) IN GENERAL.—From amounts appro21 priated under subsection (a) for a year, the 

22 Secretary shall, with respect to a State and not 

23 later than the date specified under subpara24 graph (B) for such year, allocate for such State 


pbinns on DSK79D2C42PROD with BILLS
21 

•HR 1884 IH

1 the amount determined for such State and year 

2 under paragraph (2). 

3 ‘‘(B) SPECIFIED DATE.—For purposes of 

4 subparagraph (A), the date specified in this 

5 subparagraph is— 

6 ‘‘(i) for 2020, the date that is 45 days 

7 after the date of the enactment of this 

8 title; and 

9 ‘‘(ii) for 2021 or a subsequent year, 

10 January 1 of the respective year. 

11 ‘‘(C) NOTIFICATIONS OF ALLOCATION

12 AMOUNTS.—For 2021 and each subsequent 

13 year, the Secretary shall notify each State of 

14 the amount determined for such State under 

15 paragraph (2) for such year by not later than 

16 January 1 of the previous year. 

17 ‘‘(2) ALLOCATION AMOUNT DETERMINA18 TIONS.— 

19 ‘‘(A) IN GENERAL.—For purposes of para20 graph (1), the amount determined under this 

21 paragraph for a year for a State is the amount 

22 that the Secretary estimates would be expended 

23 under this part for such year on attachment 

24 range claims of individuals residing in such 

25 State if all States used such funds only for the 


pbinns on DSK79D2C42PROD with BILLS
22 

•HR 1884 IH

1 purpose described in paragraph (1) of section 

2 1352 at the dollar amounts and percentage 

3 specified under subparagraph (B) for such year. 

4 For purposes of the previous sentence and sec5 tion 1353(b)(3), the term ‘attachment range 

6 claims’ means, with respect to an individual, the 

7 claims for such individual that exceed a dollar 

8 amount specified by the Secretary for a year, 

9 but do not exceed a ceiling dollar amount speci10 fied by the Secretary for such year, under sub11 paragraph (B). 

12 ‘‘(B) SPECIFICATIONS.—For purposes of 

13 subparagraph (A) and section 1353(b)(3), the 

14 Secretary shall determine the dollar amounts 

15 and the percentage to be specified under sub16 paragraph (A) for a year in a manner to ensure 

17 that the total amount of expenditures under 

18 this part for such year is estimated to equal the 

19 total amount appropriated for such year under 

20 subsection (a) if such expenditures were used 

21 solely for the purpose described in paragraph 

22 (1) of section 1352(a) for attachment range 

23 claims at the dollar amounts and percentage so 

24 specified for such year. 


pbinns on DSK79D2C42PROD with BILLS
23 

•HR 1884 IH

1 ‘‘(3) AVAILABILITY.—Funds allocated to a 

2 State under this subsection for a year shall remain 

3 available through the end of the subsequent year. 

4 ‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS YEAR’S

5 REMAINING FUNDS.— 

6 ‘‘(1) IN GENERAL.—In carrying out subsection 

7 (b), the Secretary shall, with respect to a year (be8 ginning with 2021), not later than March 31 of such 

9 year— 

10 ‘‘(A) determine the amount of funds, if 

11 any, from the amounts appropriated under sub12 section (a) for the previous year but not allo13 cated for such previous year; and 

14 ‘‘(B) if the Secretary determines that any 

15 funds were not so allocated for such previous 

16 year, allocate such remaining funds to States 

17 for such year, in accordance with paragraph 

18 (2). 

19 ‘‘(2) ALLOCATION METHODOLOGY.—For pur20 poses of paragraph (1), of the total remaining funds 

21 to be allocated for a year pursuant to such para22 graph, the Secretary shall allocate to each State an 

23 amount that bears the same ratio to such total re24 maining funds as the amount allocated pursuant to 

25 subsection (b) to such State for such year bears to 


pbinns on DSK79D2C42PROD with BILLS
24 

•HR 1884 IH

1 the total allocations made under such subsection for 

2 such year.’’. 

3 SEC. 207. PROVIDING THAT CERTAIN GUIDANCE RELATED 

4 TO WAIVERS FOR STATE INNOVATION UNDER 

5 THE PATIENT PROTECTION AND AFFORD6 ABLE CARE ACT SHALL HAVE NO FORCE OR 

7 EFFECT. 

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

9 Human Services and the Secretary of the Treasury may 

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

11 give effect to the guidance entitled ‘‘State Relief and Em12 powerment Waivers’’ (83 Fed. Reg. 53575 (October 24, 

13 2018)), and the Secretaries may not promulgate any sub14 stantially similar guidance or rule. 

15 TITLE III—STATE INNOVATION 

16 AND TRANSPARENCY 

17 SEC. 301. FUND STATE HEALTH INSURANCE EDUCATION 

18 PROGRAMS FOR CONSUMERS. 

19 Section 2793(e) of the Public Health Service Act (42 

20 U.S.C. 300gg–93(e)) is amended by adding at the end the 

21 following new paragraph: 

22 ‘‘(3) APPROPRIATIONS.—For purposes of car23 rying out this section, there is hereby appropriated 

24 to the Secretary, out of any funds in the Treasury 

25 not otherwise appropriated, $100,000,000 for each 


pbinns on DSK79D2C42PROD with BILLS
25 

•HR 1884 IH

1 of the fiscal years 2020 through 2022. Such amount 

2 shall remain available until expended.’’. 

3 SEC. 302. FUND STATE INNOVATIONS TO EXPAND COV4 ERAGE. 

5 (a) IN GENERAL.—Subject to subsection (d), the Sec6 retary of Health and Human Services shall award grants 

7 to eligible State agencies to enable such States to explore 

8 innovative solutions to promote greater enrollment in 

9 health insurance coverage in the individual and small 

10 group markets, including activities described in subsection 

11 (c). 

12 (b) ELIGIBILITY.—For purposes of subsection (a), el13 igible State agencies are Exchanges established by a State 

14 under title I of the Patient Protection and Affordable Care 

15 Act and State agencies with primary responsibility over 

16 health and human services for the State involved. 

17 (c) USE OF FUNDS.—For purposes of subsection (a), 

18 the activities described in this subsection are the following: 

19 (1) State efforts to streamline health insurance 

20 enrollment procedures in order to reduce burdens on 

21 consumers and facilitate greater enrollment in health 

22 insurance coverage in the individual and small group 

23 markets, including automatic enrollment and re24 enrollment of, or pre-populated applications for, in25 dividuals without health insurance who are eligible 


pbinns on DSK79D2C42PROD with BILLS
26 

•HR 1884 IH

1 for tax credits under section 36B of the Internal 

2 Revenue Code of 1986, with the ability to opt out 

3 of such enrollment. 

4 (2) State investment in technology to improve 

5 data sharing and collection for the purposes of facili6 tating greater enrollment in health insurance cov7 erage in such markets. 

8 (3) Implementation of a State version of an in9 dividual mandate to be enrolled in health insurance 

10 coverage. 

11 (4) Feasibility studies to develop comprehensive 

12 and coherent State plan for increasing enrollment in 

13 the individual and small group market. 

14 (d) FUNDING.—For purposes of carrying out this 

15 section, there is hereby appropriated, out of any funds in 

16 the Treasury not otherwise appropriated, $200,000,000 

17 for each of the fiscal years 2020 through 2022. Such 

18 amount shall remain available until expended. 

19 SEC. 303. PRESERVING STATE OPTION TO IMPLEMENT 

20 HEALTH CARE MARKETPLACES. 

21 (a) IN GENERAL.—Section 1311 of the Patient Pro22 tection and Affordable Care Act (42 U.S.C. 18031) is 

23 amended— 

24 (1) in subsection (a)— 


pbinns on DSK79D2C42PROD with BILLS
27 

•HR 1884 IH

1 (A) in paragraph (4)(B), by striking 

2 ‘‘under this subsection’’ and inserting ‘‘under 

3 this paragraph or paragraph (1)’’; and 

4 (B) by adding at the end the following new 

5 paragraph: 

6 ‘‘(6) ADDITIONAL PLANNING AND ESTABLISH7 MENT GRANTS.— 

8 ‘‘(A) IN GENERAL.—There shall be appro9 priated to the Secretary, out of any moneys in 

10 the Treasury not otherwise appropriated, 

11 $200,000,000 to award grants to eligible States 

12 for the uses described in paragraph (3). 

13 ‘‘(B) DURATION AND RENEWABILITY.—A 

14 grant awarded under subparagraph (A) shall be 

15 for a period of two years and may not be re16 newed. 

17 ‘‘(C) LIMITATION.—A grant may not be 

18 awarded under subparagraph (A) after Decem19 ber 31, 2022. 

20 ‘‘(D) ELIGIBLE STATE DEFINED.—For 

21 purposes of this paragraph, the term ‘eligible 

22 State’ means a State that, as of the date of the 

23 enactment of this paragraph, is not operating 

24 an Exchange.’’; and 

25 (2) in subsection (d)(5)(A)— 


pbinns on DSK79D2C42PROD with BILLS
28 

•HR 1884 IH

1 (A) by striking ‘‘In establishing an Ex2 change under this section’’ and inserting ‘‘(i) IN

3 GENERAL.—In establishing an Exchange under 

4 this section (other than in establishing an Ex5 change pursuant to subsection (a)(6))’’; and 

6 (B) by adding at the end the following: 

7 ‘‘(ii) ADDITIONAL PLANNING AND ES8 TABLISHMENT GRANTS.—In establishing 

9 an Exchange pursuant to subsection 

10 (a)(6), the State shall ensure that such 

11 Exchange is self-sustaining beginning on 

12 January 1, 2024, including allowing the 

13 Exchange to charge assessments or user 

14 fees to participating health insurance 

15 issuers, or to otherwise generate funding, 

16 to support its operations.’’. 

17 (b) CLARIFICATION REGARDING FAILURE TO ESTAB18 LISH EXCHANGE OR IMPLEMENT REQUIREMENTS.—Sec19 tion 1321(c) of the Patient Protection and Affordable 

20 Care Act (42 U.S.C. 18041(c)), as amended by section 

21 205, is further amended— 

22 (1) in paragraph (1), by striking ‘‘If’’ and in23 serting ‘‘Subject to paragraph (4), if’’; and 

24 (2) by adding at the end the following new 

25 paragraph: 


pbinns on DSK79D2C42PROD with BILLS
29 

•HR 1884 IH

1 ‘‘(4) CLARIFICATION.—This subsection shall 

2 not apply in the case of a State that elects to apply 

3 the requirements described in subsection (a) and 

4 satisfies the requirement described in subsection (b) 

5 on or after January 1, 2014.’’. 

6 SEC. 304. PROMOTE TRANSPARENCY AND ACCOUNT7 ABILITY IN THE ADMINISTRATION’S EXPENDI8 TURES OF EXCHANGE USER FEES. 

9 For each of plan years 2018, 2019, and 2020, not 

10 later than the date that is 3 months after the end of such 

11 plan year, the Secretary of Health and Human Services 

12 shall submit to the appropriate committees of Congress 

13 and make available to the public an annual report on the 

14 expenditure by the Department of Health and Human 

15 Services of user fees collected pursuant to section 156.50 

16 of title 45, Code of Federal Regulations (or any successor 

17 regulations). Each such report for a plan year shall in18 clude a detailed accounting of the amount of such user 

19 fees collected during such plan year and of the amount 

20 of such expenditures used during such plan year for the 

21 federally facilitated Exchange operated pursuant to sec22 tion 1321(c) of the Patient Protection and Affordable 

23 Care Act (42 U.S.C. 18041(c)) on outreach and enrollVerDate Sep 11 2014 21:14 Apr 10, 2019 Jkt 089200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H1884.IH H1884

pbinns on DSK79D2C42PROD with BILLS
30 

•HR 1884 IH

1 ment activities, navigators, maintenance of 

2 Healthcare.gov, and operation of call centers. 

Æ 


pbinns on DSK79D2C42PROD with BILLS