I 

116TH CONGRESS 

1ST SESSION H. R. 2061 

To facilitate the efforts of States to establish auto-enrollment systems to 

enroll certain individuals in health insurance coverage, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 3, 2019 

Mr. BERA (for himself, Mr. CARBAJAL, Miss RICE of New York, Mr. 

CISNEROS, Ms. WILD, and Mr. SCHRADER) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, 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 facilitate the efforts of States to establish auto-enrollment 

systems to enroll certain individuals in 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. 

4 This Act may be cited as the ‘‘Pathway to Universal 

5 Coverage Act of 2019’’. 

6 SEC. 2. ENCOURAGEMENT OF AUTO-ENROLLMENT FOR 

7 STATES. 

8 (a) STATE INNOVATIONS TO EXPAND COVERAGE.— 


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1 (1) IN GENERAL.—Subject to paragraph (4), 

2 the Secretary of Health and Human Services shall 

3 award grants to eligible State agencies to enable 

4 such States to explore innovative solutions to pro5 mote greater enrollment in health insurance cov6 erage in the individual and small group markets, in7 cluding activities described in paragraph (3). 

8 (2) ELIGIBILITY.—For purposes of paragraph 

9 (1), eligible State agencies are Exchanges estab10 lished by a State under title I of the Patient Protec11 tion and Affordable Care Act and State agencies 

12 with primary responsibility over health and human 

13 services for the State involved. 

14 (3) USE OF FUNDS.—For purposes of para15 graph (1), the activities described in this subsection 

16 are the following: 

17 (A) State efforts to streamline health in18 surance enrollment procedures in order to re19 duce burdens on consumers and facilitate great20 er enrollment in health insurance coverage in 

21 the individual and small group markets, includ22 ing automatic enrollment and reenrollment of, 

23 or pre-populated applications for, individuals 

24 without health insurance who are eligible for 

25 tax credits under section 36B of the Internal 


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1 Revenue Code of 1986, with the ability to opt 

2 out of such enrollment. 

3 (B) State investment in technology to im4 prove data sharing and collection for the pur5 poses of facilitating greater enrollment in health 

6 insurance coverage in such markets. 

7 (C) Implementation of a State version of 

8 an individual mandate to be enrolled in health 

9 insurance coverage. 

10 (D) Feasibility studies to develop com11 prehensive and coherent State plan for increas12 ing enrollment in the individual and small 

13 group market. 

14 (4) FUNDING.—For purposes of carrying out 

15 this subsection, there is hereby appropriated, out of 

16 any funds in the Treasury not otherwise appro17 priated, $200,000,000 for each of the fiscal years 

18 2020 through 2022. Such amount shall remain 

19 available until expended. 

20 (b) AVAILABILITY OF SUBSIDY INFORMATION.—The 

21 information available under section 1411 of the Patient 

22 Protection and Affordable Care Act for determination of 

23 eligibility for and amount of credit against tax allowed 

24 under section 36B shall be made available to State agenVerDate Sep 11 2014 23:50 Apr 16, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2061.IH H2061

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1 cies for determining eligibility for automatic enrollment 

2 described in subsection (f)(1). 

3 (c) RECONCILIATION OF ADVANCED PAYMENTS FOR

4 AUTO-ENROLLED INDIVIDUALS.—Paragraph (2) of sec5 tion 36B(f) of the Internal Revenue Code of 1986 is 

6 amended by adding at the end the following new subpara7 graph: 

8 ‘‘(C) EXCEPTION FOR AUTO-ENROLLED IN9 DIVIDUALS.—In the case of an individual who is 

10 enrolled through an auto-enrollment system (as 

11 defined in subsection (f) of the Pathway to Uni12 versal Coverage Act of 2019), subparagraph (A) 

13 shall not apply.’’. 

14 (d) FACILITATION OF STATE AUTO-ENROLLMENT.— 

15 (1) PROVISION OF ELIGIBILITY INFORMA16 TION.—Section 1411 of the Patient Protection and 

17 Affordable Care Act (42 U.S.C. 18081) is amend18 ed— 

19 (A) in subsection (b)— 

20 (i) in the header, by striking ‘‘BY AP21 PLICANTS’’; and 

22 (ii) in paragraph (1), by inserting 

23 ‘‘(or, in the case of an individual to be en24 rolled in such plan under an auto-enroll25 ment system (as defined in subsection 


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1 (f)(1) of the Pathway to Universal Cov2 erage Act of 2018), a State)’’ after ‘‘indi3 vidual market’’; and 

4 (B) in subsection (c)(1), by striking ‘‘pro5 vided by an applicant under’’ and inserting ‘‘de6 scribed in’’. 

7 (2) MEDICAID ENROLLMENT.—The requirement 

8 specified in section 435.907(f) of title 42, Code of 

9 Federal Regulations, shall not apply with respect to 

10 an individual enrolled under a State plan under title 

11 XIX of the Social Security Act (or under a waiver 

12 of such plan) through an auto-enrollment system. 

13 (3) REPORTING OF TERMINATED COVERAGE.— 

14 (A) GROUP HEALTH PLANS AND HEALTH

15 INSURANCE ISSUERS.—The first subpart II of 

16 part A of title XXVII of the Public Health 

17 Service Act (42 U.S.C. 300gg–11 et seq.) is 

18 amended by adding at the end the following 

19 new section: 

20 ‘‘SEC. 2729. REPORTING OF TERMINATED COVERAGE. 

21 ‘‘For each month occurring in a plan year beginning 

22 on or after January 1, 2021, a group health plan and a 

23 health insurance issuer offering group or individual health 

24 insurance coverage shall notify the Secretary, in a time 

25 and manner specified by the Secretary, of each individual 


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1 whose enrollment under such coverage or such plan was 

2 terminated during such month.’’. 

3 (B) MEDICAID.—Section 1902 of the So4 cial Security Act (42 U.S.C. 1396a) is amended 

5 by adding at the end the following new sub6 section: 

7 ‘‘(nn) REPORTING ON DISENROLLMENT OF MED8 ICAID ENROLLEES.—For each month beginning on or 

9 after January 1, 2021, a State shall submit to the Sec10 retary a report, at such time, in such manner, and con11 taining such information as the Secretary may require, on 

12 each individual who was disenrolled from the State plan 

13 (or a waiver of such plan) during such month.’’. 

14 (C) CHIP.—Section 2107(e)(1) of the So15 cial Security Act (42 U.S.C. 1397gg(e)(1)) is 

16 amended— 

17 (i) by redesignating subparagraphs 

18 (L) through (S) as subparagraphs (M) 

19 through (T), respectively; and 

20 (ii) by inserting after subparagraph 

21 (K) the following new subparagraph: 

22 ‘‘(L) Section 1902(nn) (relating to report23 ing on disenrollment of enrollees).’’. 

24 (e) REPORT.—Not later than 6 months after the date 

25 of enactment of this Act, the Secretary of Health and 


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1 Human Services, in coordination with the Commissioner 

2 of the Internal Revenue Service, shall submit to Congress 

3 a report with best practice recommendations on how a 

4 State may establish an auto-enrollment system (as defined 

5 in subsection (f)). Such report shall include the following: 

6 (1) Identification of any statutory barriers to 

7 establishing such a system, including data-sharing, 

8 administrative, and technological barriers. 

9 (2) How such a system would interact with en10 rollment periods for qualified health plans (as de11 fined in section 1301 of the Patient Protection and 

12 Affordable Care Act (42 U.S.C. 18021)) and income 

13 eligibility determinations for premium assistance tax 

14 credits under section 36B of the Internal Revenue 

15 Code, the impact of such system on enrollment in 

16 health insurance coverage in a State establishing 

17 such system, and the effects of changing the enroll18 ment periods for such system to align with the filing 

19 of individual Federal tax returns. 

20 (3) An evaluation of prior outreach efforts tar21 geted to individuals without health insurance cov22 erage eligible for such tax credits. 

23 (f) DEFINITIONS.—For purposes of this Act: 

24 (1) AUTO-ENROLLMENT SYSTEM.—The term 

25 ‘‘auto-enrollment system’’ means a system designed 


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1 and operated by a State that provides for an eligible 

2 individual residing in such State to be automatically 

3 enrolled in a qualified health plan offered through 

4 an Exchange in the State, or, if eligible, in the State 

5 plan under title XIX of the Social Security Act (or 

6 under a waiver of such plan), provided that the sys7 tem exempts such individual from paying any pre8 mium imposed by the State under such plan (or 

9 waiver). Such automatic enrollment shall be void if 

10 within 60 days after first being notified of the auto11 matic enrollment the eligible individual declines such 

12 coverage. 

13 (2) ELIGIBLE INDIVIDUAL.— 

14 (A) IN GENERAL.—Subject to subpara15 graph (B), the term ‘‘eligible individual’’ means, 

16 with respect to a taxable year, an individual 

17 who is not eligible for minimum essential cov18 erage, other than minimum essential coverage 

19 described in subparagraph (A)(ii) or (C) of sec20 tion 5000A(f)(1) of the Internal Revenue Code 

21 of 1986, for such year. 

22 (B) LIMITATION.—An individual who is 

23 only eligible for minimum essential coverage de24 scribed in section 5000A(f)(1)(C) of the Inter25 nal Revenue Code of 1986 may only be treated 


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1 as an eligible individual for purposes of this sec2 tion if the amount that would be calculated 

3 under section 36B(b)(2)(B) of such Code for 

4 such individual for a coverage month is not less 

5 than the monthly premium for the least expen6 sive plan offered on the Exchange for which 

7 such individual is eligible. This subclause shall 

8 be calculated on the basis of the individual’s 

9 household income for the most recent taxable 

10 year for which the Secretary determines infor11 mation is available. 

12 (3) STATE.—The term ‘‘State’’ means each of 

13 the several States, the District of Columbia, and 

14 each territory or possession of the United States. 

Æ 


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