II 

113TH CONGRESS 

2D SESSION S. 2174 

To amend the Patient Protection and Affordable Care Act to provide greater 

flexibility in offering health insurance coverage across State lines. 

IN THE SENATE OF THE UNITED STATES 

MARCH 27, 2014 

Mr. WARNER (for himself, Mr. MANCHIN, Ms. LANDRIEU, Ms. HEITKAMP, 

Mr. BEGICH, Mr. FRANKEN, and Ms. KLOBUCHAR) introduced the following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To amend the Patient Protection and Affordable Care Act 

to provide greater flexibility in offering health insurance 

coverage across State lines. 

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 ‘‘Commonsense Com5 petition and Access to Health Insurance Act’’. 

6 SEC. 2. PROVIDING SMALL BUSINESS HEALTH INSURANCE 

7 ACROSS STATE LINES. 

8 Section 1333(a)(1)(A) of the Patient Protection and 

9 Affordable Care Act (42 U.S.C. 18053(a)(1)(A)) is 


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1 amended by inserting ‘‘and small group markets’’ after 

2 ‘‘individual markets’’. 

3 SEC. 3. REPORT AND MODELS. 

4 Section 1333 of the Patient Protection and Afford5 able Care Act (42 U.S.C. 18053) is amended by adding 

6 at the end the following: 

7 ‘‘(b) NAIC REPORT AND MODELS.— 

8 ‘‘(1) IN GENERAL.—Not later than December 

9 31, 2014, the Secretary shall request that the Na10 tional Association of Insurance Commissioners sub11 mit to the Secretary a report concerning health 

12 plans provided for under this section. Such report 

13 shall include— 

14 ‘‘(A) a description of the challenges that 

15 States would face by permitting issuers of 

16 qualified health plans to offer such plans in 

17 States other than those States where such plan 

18 was originally written or issued; 

19 ‘‘(B) an assessment of how an out-of-State 

20 insurer would go about building an adequate 

21 provider network; 

22 ‘‘(C) a description of how such challenges 

23 could be lessened without weakening the en24 forcement of laws and regulations described in 


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1 subsection (a)(1)(B)(i) in any State that is in2 cluded in a compact under this section; 

3 ‘‘(D) a description of the commonalities 

4 that exist in State laws and opportunities to 

5 allow issuers of qualified health plans to offer 

6 such plans in States other than those States 

7 where such plan was originally written or 

8 issued; and 

9 ‘‘(E) models to be used by States to estab10 lish and enter into interstate health care choice 

11 compacts under this section, which— 

12 ‘‘(i) may include model legislation for 

13 use by States to enact laws to enter into 

14 such compacts; 

15 ‘‘(ii) shall identify how States would 

16 continue to enforce, and not weaken, the 

17 laws and regulations described in sub18 section (a)(1)(B)(i) in any State that is in19 cluded in such compact; and 

20 ‘‘(iii) shall identify how such models 

21 would ensure that there is no violation of 

22 the conditions for Secretarial approval 

23 under subsection (a)(3). 

24 ‘‘(2) OTHER ORGANIZATIONS AND ENTITIES.— 

25 In making the request under paragraph (1), the SecVerDate Mar 15 2010 01:21 Mar 29, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2174.IS S2174

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1 retary may also request that the National Associa2 tion of Insurance Commissioners gather concepts for 

3 inclusion in the report under such paragraph from 

4 organizations and entities that have experience in of5 fering qualified health plans in States in which such 

6 plans were not originally issued. 

7 ‘‘(c) REPORT BY SECRETARY.—Not later than De8 cember 31, 2014, the Secretary, in consultation with the 

9 National Association of Insurance Commissioners, shall 

10 submit to Congress a report that describes how the Sec11 retary may utilize the flexibility provided by section 

12 1311(f)(1) (relating to allowing a regional or interstate 

13 exchange) to allow health insurance issuers offering quali14 fied health plans in an Exchange operated by the Federal 

15 Government to offer plans in a State other than the State 

16 in which such plan was originally written or issued. Such 

17 report shall describe how an Exchange operated by the 

18 Federal Government can be a conduit to forming inter19 state insurance State compacts.’’. 

Æ 


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