I 

115TH CONGRESS 

2D SESSION H. R. 5624 

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 26, 2018 

Mr. BERA (for himself, Ms. KUSTER of New Hampshire, Mr. SCHRADER, Mr. 

SCHNEIDER, Miss RICE of New York, Mr. DELANEY, and Mr. PETERS) 

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 2018’’. 


dlhill on DSK3GLQ082PROD with BILLS
2 

•HR 5624 IH

1 SEC. 2. ENCOURAGEMENT OF AUTO-ENROLLMENT FOR 

2 STATES. 

3 (a) STATE INNOVATIONS TO EXPAND COVERAGE.— 

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

5 the Secretary of Health and Human Services shall 

6 award grants to eligible State agencies to enable 

7 such States to explore innovative solutions to pro8 mote greater enrollment in health insurance cov9 erage in the individual and small group markets, in10 cluding activities described in paragraph (3). 

11 (2) ELIGIBILITY.—For purposes of paragraph 

12 (1), eligible State agencies are Exchanges estab13 lished by a State under title I of the Patient Protec14 tion and Affordable Care Act and State agencies 

15 with primary responsibility over health and human 

16 services for the State involved. 

17 (3) USE OF FUNDS.—For purposes of para18 graph (1), the activities described in this subsection 

19 are the following: 

20 (A) State efforts to streamline health in21 surance enrollment procedures in order to re22 duce burdens on consumers and facilitate great23 er enrollment in health insurance coverage in 

24 the individual and small group markets, includ25 ing automatic enrollment and reenrollment of, 

26 or pre-populated applications for, individuals 


dlhill on DSK3GLQ082PROD with BILLS
3 

•HR 5624 IH

1 without health insurance who are eligible for 

2 tax credits under section 36B of the Internal 

3 Revenue Code of 1986, with the ability to opt 

4 out of such enrollment. 

5 (B) State investment in technology to im6 prove data sharing and collection for the pur7 poses of facilitating greater enrollment in health 

8 insurance coverage in such markets. 

9 (C) Implementation of a State version of 

10 an individual mandate to be enrolled in health 

11 insurance coverage. 

12 (D) Feasibility studies to develop com13 prehensive and coherent State plan for increas14 ing enrollment in the individual and small 

15 group market. 

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

17 this subsection, there is hereby appropriated, out of 

18 any funds in the Treasury not otherwise appro19 priated, $200,000,000 for each of the fiscal years 

20 2019 through 2021. Such amount shall remain 

21 available until expended. 

22 (b) AVAILABILITY OF SUBSIDY INFORMATION.—The 

23 information available under section 1411 of the Patient 

24 Protection and Affordable Care Act for determination of 

25 eligibility for and amount of credit against tax allowed 


dlhill on DSK3GLQ082PROD with BILLS
4 

•HR 5624 IH

1 under section 36B shall be made available to State agen2 cies for determining eligibility for automatic enrollment 

3 described in subsection (f)(1). 

4 (c) RECONCILIATION OF ADVANCED PAYMENTS FOR

5 AUTO-ENROLLED INDIVIDUALS.—Paragraph (2) of sec6 tion 36B(f) of the Internal Revenue Code of 1986 is 

7 amended by adding at the end the following new subpara8 graph: 

9 ‘‘(C) EXCEPTION FOR AUTO-ENROLLED IN10 DIVIDUALS.—In the case of an individual who is 

11 enrolled through an auto-enrollment system (as 

12 defined in subsection (f) of the Pathway to Uni13 versal Coverage Act of 2018), subparagraph (A) 

14 shall not apply.’’. 

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

16 (1) PROVISION OF ELIGIBILITY INFORMA17 TION.—Section 1411 of the Patient Protection and 

18 Affordable Care Act (42 U.S.C. 18081) is amend19 ed— 

20 (A) in subsection (b)— 

21 (i) in the header, by striking ‘‘BY AP22 PLICANTS’’; and 

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

24 ‘‘(or, in the case of an individual to be en25 rolled in such plan under an auto-enrollVerDate Sep 11 2014 02:58 May 02, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5624.IH H5624

dlhill on DSK3GLQ082PROD with BILLS
5 

•HR 5624 IH

1 ment system (as defined in subsection 

2 (f)(1) of the Pathway to Universal Cov3 erage Act of 2018), a State)’’ after ‘‘indi4 vidual market’’; and 

5 (B) in subsection (c)(1), by striking ‘‘pro6 vided by an applicant under’’ and inserting ‘‘de7 scribed in’’. 

8 (2) MEDICAID ENROLLMENT.—The requirement 

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

10 Federal Regulations, shall not apply with respect an 

11 individual enrolled under a State plan under title 

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

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

14 (3) REPORTING OF TERMINATED COVERAGE.— 

15 (A) GROUP HEALTH PLANS AND HEALTH

16 INSURANCE ISSUERS.—The first subpart II of 

17 part A of title XXVII of the Public Health 

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

19 amended by adding at the end the following 

20 new section: 

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

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

23 on or after January 1, 2020, a group health plan and a 

24 health insurance issuer offering group or individual health 

25 insurance coverage shall notify the Secretary, in a time 


dlhill on DSK3GLQ082PROD with BILLS
6 

•HR 5624 IH

1 and manner specified by the Secretary, of each individual 

2 whose enrollment under such coverage or such plan was 

3 terminated during such month.’’. 

4 (B) MEDICAID.—Section 1902 of the So5 cial Security Act (42 U.S.C. 1396a) is amended 

6 by adding at the end the following new sub7 section: 

8 ‘‘(nn) REPORTING ON DISENROLLMENT OF MED9 ICAID ENROLLEES.—For each month beginning on or 

10 after January 1, 2020, a State shall submit to the Sec11 retary a report, at such time, in such manner, and con12 taining such information as the Secretary may require, on 

13 each individual who was disenrolled from the State plan 

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

15 (C) CHIP.—Section 2107(e)(1) of the So16 cial Security Act (42 U.S.C. 1397gg(e)(1)) is 

17 amended— 

18 (i) by redesignating subparagraphs 

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

20 through (T), respectively; and 

21 (ii) by inserting after subparagraph 

22 (K) the following new subparagraph: 

23 ‘‘(L) Section 1902(nn) (relating to report24 ing on disenrollment of enrollees).’’. 


dlhill on DSK3GLQ082PROD with BILLS
7 

•HR 5624 IH

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

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

3 Human Services, in coordination with the Commissioner 

4 of the Internal Revenue Service, shall submit to Congress 

5 a report with best practice recommendations on how a 

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

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

8 (1) Identification of any statutory barriers to 

9 establishing such a system, including data-sharing, 

10 administrative, and technological barriers. 

11 (2) How such a system would interact with en12 rollment periods for qualified health plans (as de13 fined in section 1301 of the Patient Protection and 

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

15 eligibility determinations for premium assistance tax 

16 credits under section 36B of the Internal Revenue 

17 Code, the impact of such system on enrollment in 

18 health insurance coverage in a State establishing 

19 such system, and the effects of changing the enroll20 ment periods for such system to align with the filing 

21 of individual Federal tax returns. 

22 (3) An evaluation of prior outreach efforts tar23 geted to individuals without health insurance cov24 erage eligible for such tax credits. 

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


dlhill on DSK3GLQ082PROD with BILLS
8 

•HR 5624 IH

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

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

3 and operated by a State that provides for an eligible 

4 individual residing in such State to be automatically 

5 enrolled in a qualified health plan offered through 

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

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

8 under a waiver of such plan), provided that the sys9 tem exempts such individual from paying any pre10 mium imposed by the State under such plan (or 

11 waiver). Such automatic enrollment shall be void if 

12 within 60 days after first being notified of the auto13 matic enrollment the eligible individual declines such 

14 coverage. 

15 (2) ELIGIBLE INDIVIDUAL.— 

16 (A) IN GENERAL.—Subject to subpara17 graph (B), the term ‘‘eligible individual’’ means, 

18 with respect to a taxable year, an individual 

19 who is not eligible for minimum essential cov20 erage, other than minimum essential coverage 

21 described in subparagraph (A)(ii) or (C) of sec22 tion 5000A(f)(1) of the Internal Revenue Code 

23 of 1986, for such year. 

24 (B) LIMITATION.—An individual who is 

25 only eligible for minimum essential coverage deVerDate Sep 11 2014 02:58 May 02, 2018 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5624.IH H5624

dlhill on DSK3GLQ082PROD with BILLS
9 

•HR 5624 IH

1 scribed in section 5000A(f)(1)(C) of the Inter2 nal Revenue Code of 1986 may only be treated 

3 as an eligible individual for purposes of this sec4 tion if the amount that would be calculated 

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

6 such individual for a coverage month is not less 

7 than the monthly premium for the least expen8 sive plan offered on the Exchange for which 

9 such individual is eligible. This subclause shall 

10 be calculated on the basis of the individual’s 

11 household income for the most recent taxable 

12 year for which the Secretary determines infor13 mation is available. 

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

15 the several States, the District of Columbia, and 

16 each territory or possession of the United States. 

Æ 


dlhill on DSK3GLQ082PROD with BILLS