I 
115TH CONGRESS 
1ST SESSION H. R. 4695 
To amend the Patient Protection and Affordable Care Act to provide for 
stabilization in the individual health insurance market, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 20, 2017 
Mr. SCHRADER (for himself, Mr. REED, Mr. GOTTHEIMER, Mr. LANCE, Mr. 
BERA, Mr. TROTT, Mrs. MURPHY of Florida, Mr. THOMPSON of Pennsyl-
vania, Mr. O’HALLERAN, Mr. COSTELLO of Pennsylvania, Mr. SUOZZI, 
Mr. DENT, Mr. PANETTA, Mr. CURBELO of Florida, Ms. SINEMA, Mr. 
FITZPATRICK, Mr. SOTO, Mr. KATKO, Mr. LIPINSKI, Mr. FASO, Ms. 
ESTY of Connecticut, Mr. COSTA, Mr. NOLAN, Mr. SCHNEIDER, Mr. 
PETERS, and Mr. WELCH) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Patient Protection and Affordable Care Act 
to provide for stabilization in the individual health insur-
ance market, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Bipartisan Market Sta-
bilization and Innovation Act of 2017’’. 
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SEC. 2. FUNDING FOR PPACA EXCHANGE PLANS COST- 
SHARING REDUCTIONS. 
Section 1402 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18071) is amended by adding 
at the end the following new subsection: 
‘‘(g) FUNDING.— 
‘‘(1) IN GENERAL.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated such sums as may be necessary for payments 
under this section, including through advance pay-
ment under section 1412(c)(3). Funds appropriated 
under this paragraph shall remain available for obli-
gation until expended. 
‘‘(2) REPORTS.—The Secretary shall for 2017 
and each subsequent year submit to the Committee 
on Energy and Commerce, the Committee on Ways 
and Means, and the Committee on Appropriations of 
the House of Representatives and the Committee on 
Finance, the Committee on Health, Education, 
Labor, and Pensions, and the Committee on Appro-
priations of the Senate an annual report on— 
‘‘(A) the amount of payments made under 
this section with respect to such year; 
‘‘(B) the effects of such payments on the 
costs of health insurance in the individual mar-
ket; and 
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‘‘(C) the projected costs of health insur-
ance in the individual market over the subse-
quent year.’’. 
SEC. 3. PATIENT AND STATE STABILITY FUND. 
The Social Security Act (42 U.S.C. 301 et seq.) is 
amended by adding at the end the following new title: 
‘‘TITLE XXII—PATIENT AND 
STATE STABILITY FUND 
‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM. 
‘‘There is hereby established the ‘Patient and State 
Stability Fund’ to be administered by the Secretary of 
Health and Human Services, acting through the Adminis-
trator of the Centers for Medicare & Medicaid Services 
(in this section referred to as the ‘Administrator’), to pro-
vide funding, in accordance with this title, to the 50 States 
and the District of Columbia (each referred to in this sec-
tion as a ‘State’) during the period, subject to section 
2204(c), beginning on January 1, 2019, and ending on 
December 31, 2028, for the purposes described in section 
2202. 
‘‘SEC. 2202. USE OF FUNDS. 
‘‘A State may use the funds allocated to the State 
under this title for any of the following purposes: 
‘‘(1) Helping, through the provision of financial 
assistance, high-risk individuals who do not have ac-
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cess to health insurance coverage offered through an 
employer enroll in health insurance coverage. 
‘‘(2) Providing incentives to appropriate entities 
to enter into arrangements with the State to help 
stabilize premiums for health insurance coverage in 
the individual market, as such markets are defined 
by the State. 
‘‘(3) Reducing the cost for providing health in-
surance coverage in the individual market and small 
group market to individuals who have, or are pro-
jected to have, a high rate of utilization of health 
services (as measured by cost) and to individuals 
who have high costs of health insurance coverage 
due to the low density population of the State in 
which they reside. 
‘‘(4) Promoting participation in the individual 
market and small group market in the State and in-
creasing health insurance options available through 
such market. 
‘‘(5) Providing assistance to reduce out-of-pock-
et costs, such as copayments, coinsurance, pre-
miums, and deductibles, of individuals enrolled in 
health insurance coverage in the State. 
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‘‘SEC. 2203. STATE ELIGIBILITY AND APPROVAL; DEFAULT 
SAFEGUARD. 
‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA-
TIONS.— 
‘‘(1) IN GENERAL.—To be eligible for an alloca-
tion of funds under this title for a year during the 
period described in section 2201 for use for one or 
more purposes described in section 2202, a State 
shall submit to the Administrator an application at 
such time (not later than March 31 of the previous 
year) and in such form and manner as specified by 
the Administrator and containing— 
‘‘(A) a description of how the funds will be 
used for such purposes; 
‘‘(B) a certification that the State will 
make, from non-Federal funds, expenditures for 
such purposes in an amount that is not less 
than the State percentage required for the year 
under section 2204(e)(1); and 
‘‘(C) such other information as the Admin-
istrator may require. 
‘‘(2) 
ADMINISTRATOR
DETERMINATION 
TIMELINE.— 
‘‘(A) IN
GENERAL.—The Administrator 
shall make a determination as to the approval 
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or disapproval of an application not later than 
90 days after the receipt of such application. 
‘‘(B) EXPEDITED
DETERMINATION.—The 
Administrator shall make a determination as to 
the approval or disapproval of an application 
not later than 45 days after the receipt of such 
application if such application— 
‘‘(i) is submitted in response to an ur-
gent situation, with respect to areas in the 
State that the Administrator determines 
are at risk for excessive premium increases 
or having no health plans offered in the 
applicable health insurance market for the 
current or following plan year; or 
‘‘(ii) resembles an application that is 
the same or substantially similar to an ap-
plication that the Administrator has al-
ready approved for another State. 
‘‘(3) PERIOD OF APPROVAL.—If an application 
of a State is approved for a year, with respect to a 
purpose described in section 2202, such application 
shall also be treated as approved, with respect to 
such purpose, for each of the subsequent 4 years, 
but in no case shall an application be approved for 
a year after 2028. 
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‘‘(4) TREATMENT AS A STATE HEALTH CARE 
PROGRAM.—Any program receiving funds from an 
allocation for a State under this title, including pur-
suant to subsection (b), shall be considered to be a 
‘State health care program’ for purposes of sections 
1128, 1128A, and 1128B. 
‘‘(b) DEFAULT FEDERAL SAFEGUARD.— 
‘‘(1) IN GENERAL.—In the case of a State that 
does not have in effect an approved application 
under this section for 2019 or a subsequent year be-
ginning during the period described in section 2201, 
subject to section 2204(e), the Administrator, in 
consultation with the State insurance commissioner, 
shall use the allocation that would otherwise be pro-
vided to the State under this title for such year, in 
accordance with paragraph (2), for such State. 
‘‘(2) REQUIRED USE FOR MARKET STABILIZA-
TION
PAYMENTS
TO
ISSUERS.—Subject to section 
2204(a), an allocation for a State made pursuant to 
paragraph (1) for a year shall be used to carry out 
the purpose described in section 2202(2) in such 
State by providing payments to appropriate entities 
described in such section with respect to claims that 
exceed $50,000 (or, with respect to allocations made 
under this title for 2020 or a subsequent year dur-
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ing the period specified in section 2201, such dollar 
amount specified by the Administrator), but do not 
exceed $350,000 (or, with respect to allocations 
made under this title for 2020 or a subsequent year 
during such period, such dollar amount specified by 
the Administrator), in an amount equal to 75 per-
cent (or, with respect to allocations made under this 
title for 2020 or a subsequent year during such pe-
riod, such percentage specified by the Administrator) 
of the amount of such claims. 
‘‘SEC. 2204. ALLOCATIONS. 
‘‘(a) APPROPRIATION.—For the purpose of providing 
allocations for States (including pursuant to section 
2203(b)) under this title there is appropriated, out of any 
money in the Treasury not otherwise appropriated, 
$11,500,000,000 for each of 2019 through 2028. 
‘‘(b) ALLOCATIONS.— 
‘‘(1) PAYMENT.—From amounts appropriated 
under subsection (a) for a year, the Administrator 
shall, with respect to a State and not later than 
January 1 of such year, allocate, subject to sub-
section (e), for such State (including pursuant to 
section 2203(b)) the amount determined for such 
State and year under paragraph (2). 
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‘‘(2) 
ALLOCATION
AMOUNT
DETERMINA-
TIONS.— 
‘‘(A) FOR 2019 THROUGH 2021.— 
‘‘(i) IN
GENERAL.—For purposes of 
paragraph (1), the amount determined 
under this paragraph for each of 2019 
through 2021 for a State is an amount 
equal to the sum of— 
‘‘(I) the relative incurred claims 
amount described in clause (ii) for 
such State and year; and 
‘‘(II) the relative uninsured and 
issuer participation amount described 
in clause (iv) for such State and year. 
‘‘(ii) RELATIVE
INCURRED
CLAIMS 
AMOUNT.—For purposes of clause (i), the 
relative incurred claims amount described 
in this clause for a State for 2019, 2020, 
and 2021 is the product of— 
‘‘(I) 90 percent of the amount 
appropriated under subsection (a) for 
the year; and 
‘‘(II) the relative State incurred 
claims proportion described in clause 
(iii) for such State and year. 
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‘‘(iii) RELATIVE
STATE
INCURRED 
CLAIMS PROPORTION.—The relative State 
incurred claims proportion described in 
this clause for a State and year is the 
amount equal to the ratio of— 
‘‘(I) the adjusted incurred claims 
by the State, as reported through the 
medical loss ratio annual reporting 
under section 2718 of the Public 
Health Service Act for the third pre-
vious year; to 
‘‘(II) the sum of such adjusted 
incurred claims for all States, as so 
reported, for such third previous year. 
‘‘(iv) 
RELATIVE
UNINSURED
AND 
ISSUER
PARTICIPATION
AMOUNT.—For 
purposes of clause (i), the relative unin-
sured and issuer participation amount de-
scribed in this clause for a State for 2019, 
2020, and 2021 is the product of— 
‘‘(I) 10 percent of the amount 
appropriated under subsection (a) for 
the year; and 
‘‘(II) the relative State uninsured 
and issuer participation proportion de-
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scribed in clause (v) for such State 
and year. 
‘‘(v) RELATIVE
STATE
UNINSURED 
AND
ISSUER
PARTICIPATION
PROPOR-
TION.—The relative State uninsured and 
issuer participation proportion described in 
this clause for a State and year is— 
‘‘(I) in the case of a State not 
described in clause (vi) for such year, 
0; and 
‘‘(II) in the case of a State de-
scribed in clause (vi) for such year, 
the amount equal to the ratio of— 
‘‘(aa) the number of individ-
uals residing in such State who 
for the third preceding year were 
not enrolled in a health plan or 
otherwise did not have health in-
surance 
coverage 
(including 
through a Federal or State 
health program) and whose in-
come is below 100 percent of the 
poverty line applicable to a family 
of the size involved; to 
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