I 
116TH CONGRESS 
1ST SESSION H. R. 1884 
To amend the Patient Protection and Affordable Care Act to improve afford-
ability 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. UNDER-
WOOD, 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 Cali-
fornia, 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. NOR-
TON, and Mr. SABLAN) introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittees on Ways and Means, and Education and Labor, for a period to 
be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
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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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Protecting Pre-Existing Conditions and Making Health 
Care More Affordable Act of 2019’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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 innova-
tion 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 ex-
penditures of Exchange user fees. 
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TITLE I—EXPANDING 
AFFORDABILITY 
SEC. 101. IMPROVE AFFORDABILITY AND REDUCE PRE-
MIUM COSTS FOR CONSUMERS. 
(a) IN GENERAL.—Section 36B(b)(3)(A) of the In-
ternal Revenue Code of 1986 is amended to read as fol-
lows: 
‘‘(A) APPLICABLE PERCENTAGE.—The ap-
plicable percentage for any taxable year shall be 
the percentage such that the applicable percent-
age for any taxpayer whose household income is 
within an income tier specified in the following 
table shall increase, on a sliding scale in a lin-
ear manner, from the initial premium percent-
age to the final premium percentage specified in 
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’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
36B(c)(1)(A) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘but does not exceed 400 percent’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2020. 
SEC. 102. EXPAND AFFORDABILITY FOR WORKING FAMI-
LIES. 
(a) IN GENERAL.—Clause (i) of section 36B(c)(2)(C) 
of the Internal Revenue Code of 1986 is amended to read 
as follows: 
‘‘(i) COVERAGE
MUST
BE
AFFORD-
ABLE.— 
‘‘(I) EMPLOYEES.—An employee 
shall not be treated as eligible for 
minimum essential coverage if such 
coverage consists of an eligible em-
ployer-sponsored plan (as defined in 
section 5000A(f)(2)) and the employ-
ee’s required contribution (within the 
meaning of section 5000A(e)(1)(B)) 
with respect to the plan exceeds 9.5 
percent of the employee’s household 
income. 
‘‘(II) FAMILY MEMBERS.—An in-
dividual who is eligible to enroll in an 
eligible employer-sponsored plan (as 
defined in section 5000A(f)(2)) by 
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reason of a relationship the individual 
bears to the employee shall not be 
treated as eligible for minimum essen-
tial coverage by reason of such eligi-
bility to enroll if the employee’s re-
quired contribution (within the mean-
ing of section 5000A(e)(1)(B), deter-
mined by substituting ‘family’ for 
‘self-only’) with respect to the plan ex-
ceeds 9.5 percent of the employee’s 
household income.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Clause (ii) of section 36B(c)(2)(C) of the 
Internal Revenue Code of 1986 is amended by strik-
ing ‘‘Except as provided in clause (iii), an employee’’ 
and inserting ‘‘An individual’’. 
(2) Clause (iii) of section 36B(c)(2)(C) of such 
Code is amended by striking ‘‘the last sentence of 
clause (i)’’ and inserting ‘‘clause (i)(II)’’. 
(3) Clause (iv) of section 36B(c)(2)(C) of such 
Code is amended by striking ‘‘the 9.5 percent under 
clause (i)(II)’’ and inserting ‘‘the 9.5 percent under 
clauses (i)(I) and (i)(II)’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2020. 
TITLE II—UNDOING SABOTAGE 
SEC. 201. PROTECT COMPREHENSIVE COVERAGE FOR 
SMALL BUSINESSES AND WORKERS. 
The Secretary of Labor may not take any action to 
implement, enforce, or otherwise give effect to the rule en-
titled ‘‘Definition of ‘Employer’ Under Section 3(5) of 
ERISA–Association Health Plans’’ (83 Fed. Reg. 28912 
(June 21, 2018)), and the Secretary may not promulgate 
any substantially similar rule. 
SEC. 202. SHORT-TERM LIMITED DURATION INSURANCE 
RULE PROHIBITION. 
The Secretary of Health and Human Services, the 
Secretary of the Treasury, and the Secretary of Labor 
may not take any action to implement, enforce, or other-
wise give effect to the rule entitled ‘‘Short-Term, Limited 
Duration Insurance’’ (83 Fed. Reg. 38212 (August 3, 
2018)), and the Secretaries may not promulgate any sub-
stantially similar rule. 
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SEC. 203. ENSURE PLANS PROVIDE COMPREHENSIVE BENE-
FITS. 
(a) 
ESSENTIAL
HEALTH
BENEFITS.—Section 
1302(b)(4) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18022(b)(4)) is amended— 
(1) in subparagraph (A), by inserting ‘‘and so 
that benefits are included within each of such cat-
egories’’ before the semicolon; 
(2) in subparagraph (G), by striking at the end 
‘‘and’’; 
(3) in subparagraph (H), by striking the period 
at the end and inserting ‘‘; and’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(I) ensure that, beginning January 1, 
2020— 
‘‘(i) in the case of health benefits that 
are established as essential health benefits, 
there shall not be substitution of such ben-
efits across benefit categories; 
‘‘(ii) a qualified health plan shall not 
be treated as providing coverage for the es-
sential health benefits unless under such 
plan— 
‘‘(I) 
coverage 
of 
prescription 
drugs provides for access to a wide 
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variety of classes of drugs within the 
prescription drug formulary of such 
plan; and 
‘‘(II) in the case that a drug that 
is medically necessary for an enrollee 
under such plan is not included within 
such formulary, such individual has 
access to such drug through an excep-
tions process established by the plan; 
and 
‘‘(iii) habilitative services are covered 
at parity with rehabilitative services.’’. 
(b) STANDARD BENEFIT PLANS.—Section 1302(d) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18022(d)) is amended by adding at the end the 
following new paragraph: 
‘‘(5) STANDARD BENEFIT PLANS.— 
‘‘(A) IN GENERAL.—For purposes of pro-
viding individuals with the opportunity to make 
simpler comparisons of health plans offered by 
different health insurance issuers and simplify 
the selection process, the Secretary shall, for 
each plan year beginning with plan year 2020, 
through rulemaking, specify a structure de-
scribed in subparagraph (B)(i) for a standard 
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benefit plan for such plan year for each of the 
bronze, silver, and gold levels of coverage and 
for each actuarial value variation of a silver 
plan resulting from the application of section 
1402(c). A standard benefit plan for a plan 
year for a level of coverage or actuarial value 
variation of a silver plan shall be modeled on 
the most commonly purchased plans (deter-
mined by enrollments in such plans) during the 
previous 2 plan years offered in the federally fa-
cilitated Exchange operated pursuant to section 
1321(c) in such level or variation and shall in-
clude coverage of deductible-exempt services 
consistent with actual purchasing patterns of 
consumers in the previous two plan years. 
‘‘(B) STANDARD
BENEFIT
PLAN.—For 
purposes of this paragraph, the term ‘standard 
benefit plan’ means a qualified health plan to 
be offered through an Exchange on the indi-
vidual market that has either— 
‘‘(i) a standardized cost-sharing struc-
ture specified by the Secretary pursuant to 
rulemaking; or 
‘‘(ii) 
a 
standardized 
cost-sharing 
structure specified by the Secretary pursu-
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ant to rulemaking that is modified by the 
health insurance issuer of such plan only 
to the extent necessary to align with high 
deductible health plan requirements under 
section 223 of the Internal Revenue Code 
of 1986 or the applicable annual limitation 
on cost sharing under subsection (c) and 
actuarial value requirements specified by 
the Secretary.’’. 
SEC. 204. PROVIDING FOR ADDITIONAL REQUIREMENTS 
WITH RESPECT TO THE NAVIGATOR PRO-
GRAM. 
(a) IN GENERAL.—Section 1311(i) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031(i)) 
is amended— 
(1) in paragraph (2), by adding at the end the 
following new subparagraph: 
‘‘(C) SELECTION OF RECIPIENTS.—In the 
case of an Exchange established and operated 
by the Secretary within a State pursuant to sec-
tion 1321(c), in awarding grants under para-
graph (1), the Exchange shall— 
‘‘(i) select entities to receive such 
grants based solely on an entity’s dem-
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onstrated capacity to carry out each of the 
duties specified in paragraph (3); 
‘‘(ii) not take into account whether or 
not the entity has demonstrated how the 
entity will provide information to individ-
uals relating to group health plans offered 
by a group or association of employers de-
scribed in section 2510.3–5(b) of title 29, 
Code of Federal Regulations (or any suc-
cessor regulation), or short-term limited 
duration insurance (as defined by the Sec-
retary for purposes of section 2791(b)(5) 
of the Public Health Service Act); and 
‘‘(iii) ensure that, each year, the Ex-
change awards such a grant to— 
‘‘(I) at least one entity described 
in this paragraph that is a community 
and 
consumer-focused 
nonprofit 
group; and 
‘‘(II) at least one entity described 
in subparagraph (B), which may in-
clude another community and con-
sumer-focused nonprofit group in ad-
dition to any such group awarded a 
grant pursuant to subclause (I).’’; 
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(2) in paragraph (3)— 
(A) in subparagraph (C), by inserting after 
‘‘qualified health plans’’ the following: ‘‘, State 
Medicaid plans under title XIX of the Social 
Security Act, and State Children’s Health In-
surance Programs under title XXI of such 
Act’’; and 
(B) by adding at the end the following 
flush left sentence: 
‘‘The duties specified in the preceding sentence may 
be carried out by such a navigator at any time dur-
ing a year.’’; 
(3) in paragraph (4)(A)— 
(A) in the matter preceding clause (i), by 
striking ‘‘not’’; 
(B) in clause (i)— 
(i) by inserting ‘‘not’’ before ‘‘be’’; 
and 
(ii) by striking ‘‘; or’’ and inserting 
‘‘;’’; 
(C) in clause (ii)— 
(i) by inserting ‘‘not’’ before ‘‘re-
ceive’’; and 
(ii) by striking the period and insert-
ing ‘‘;’’; and 
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(D) by adding at the end the following new 
clause: 
‘‘(iii) maintain physical presence in 
the State of the Exchange so as to allow 
in-person assistance to consumers.’’; and 
(4) in paragraph (6)— 
(A) 
by 
striking 
‘‘FUNDING.—Grants 
under’’ and inserting ‘‘FUNDING.— 
‘‘(A) STATE EXCHANGES.—Grants under’’; 
and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(B) FEDERAL
EXCHANGES.—For pur-
poses of carrying out this subsection, with re-
spect to an Exchange established and operated 
by the Secretary within a State pursuant to sec-
tion 1321(c), the Secretary shall obligate 
$100,000,000 out of amounts collected through 
the user fees on participating health insurance 
issuers pursuant to section 156.50 of title 45, 
Code of Federal Regulations (or any successor 
regulations) for fiscal year 2020 and each sub-
sequent fiscal year. Such amount for a fiscal 
year shall remain available until expended.’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to plan years begin-
ning on or after January 1, 2020. 
SEC. 205. FEDERAL EXCHANGE OUTREACH AND EDU-
CATIONAL ACTIVITIES. 
Section 1321(c) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18041(c)) is amended by adding 
at the end the following new paragraph: 
‘‘(3) OUTREACH
AND
EDUCATIONAL
ACTIVI-
TIES.— 
‘‘(A) IN GENERAL.—In the case of an Ex-
change established or operated by the Secretary 
within a State pursuant to this subsection, the 
Secretary shall carry out outreach and edu-
cational activities for purposes of informing po-
tential enrollees in qualified health plans offered 
through the Exchange of the availability of cov-
erage under such plans and financial assistance 
for coverage under such plans. Such outreach 
and educational activities shall be provided in a 
manner that is culturally and linguistically ap-
propriate to the needs of the populations being 
served by the Exchange (including hard-to- 
reach populations, such as racial and sexual mi-
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norities, limited English proficient populations, 
and young adults). 
‘‘(B) LIMITATION ON USE OF FUNDS.—No 
funds appropriated under this paragraph shall 
be used for expenditures for promoting non- 
ACA compliant health insurance coverage. 
‘‘(C) NON-ACA COMPLIANT HEALTH INSUR-
ANCE COVERAGE.—For purposes of this sub-
paragraph (B): 
‘‘(i) The term ‘non-ACA compliant 
health insurance coverage’ means health 
insurance coverage, or a group health plan, 
that is not a qualified health plan. 
‘‘(ii) Such term includes the following: 
‘‘(I) An association health plan. 
‘‘(II) Short-term limited duration 
insurance. 
‘‘(D) FUNDING.—Out of any funds in the 
Treasury not otherwise appropriated, there are 
hereby appropriated for fiscal year 2020 and 
each subsequent fiscal year, $100,000,000 to 
carry out this paragraph. Funds appropriated 
under this subparagraph shall remain available 
until expended.’’. 
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SEC. 206. IMPROVE HEALTH INSURANCE AFFORDABILITY 
FUND. 
Subtitle D of title I of the Patient Protection and 
Affordable Care Act is amended by inserting after part 
5 (42 U.S.C. 18061 et seq.) the following new part: 
‘‘PART 6—IMPROVE HEALTH INSURANCE 
AFFORDABILITY FUND 
‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM. 
‘‘There is hereby established the ‘Improve Health In-
surance Affordability Fund’ to be administered by the Sec-
retary of Health and Human Services, acting through the 
Administrator of the Centers for Medicare & Medicaid 
Services (in this section referred to as the ‘Adminis-
trator’), to provide funding, in accordance with this title, 
to the 50 States and the District of Columbia (each re-
ferred to in this section as a ‘State’) beginning on January 
1, 2020, for the purposes described in section 1352. 
‘‘SEC. 1352. USE OF FUNDS. 
‘‘(a) IN GENERAL.—A State shall use the funds allo-
cated to the State under this part for one of the following 
purposes: 
‘‘(1) To provide reinsurance payments to health 
insurance issuers with respect to individuals enrolled 
under individual health insurance coverage (other 
than through a plan described in subsection (b)) of-
fered by such issuers. 
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‘‘(2) To provide assistance (other than through 
payments described in paragraph (1)) to reduce out- 
of-pocket costs, such as copayments, coinsurance, 
premiums, and deductibles, of individuals enrolled 
under qualified health plans offered on the indi-
vidual market through an Exchange. 
‘‘(b) EXCLUSION OF CERTAIN GRANDFATHERED AND 
TRANSITIONAL PLANS.—For purposes of subsection (a), 
a plan described in this subsection is the following: 
‘‘(1) A grandfathered health plan (as defined in 
section 1251). 
‘‘(2) A plan (commonly referred to as a ‘transi-
tional plan’) continued under the letter issued by the 
Centers for Medicare & Medicaid Services on No-
vember 14, 2013, to the State Insurance Commis-
sioners outlining a transitional policy for coverage in 
the individual and small group markets to which sec-
tion 1251 does not apply, and under the extension 
of the transitional policy for such coverage set forth 
in the Insurance Standards Bulletin Series guidance 
issued by the Centers for Medicare & Medicaid Serv-
ices on March 5, 2014, February 29, 2016, Feb-
ruary 13, 2017, and April 9, 2018, or under any 
subsequent extensions thereof. 
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‘‘SEC. 1353. 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 part for a year (beginning 
with 2020), a State shall submit to the Adminis-
trator an application at such time (but, in the case 
of allocations for 2020, not later than 90 days after 
the date of the enactment of this title and, in the 
case of allocations for a subsequent year, not later 
than March 31 of the previous year) and in such 
form and manner as specified by the Administrator 
containing— 
‘‘(A) a description of how the funds will be 
used; and 
‘‘(B) such other information as the Admin-
istrator may require. 
‘‘(2) AUTOMATIC APPROVAL.—An application so 
submitted is approved unless the Administrator noti-
fies the State submitting the application, not later 
than 60 days after the date of the submission of 
such application, that the application has been de-
nied for not being in compliance with any require-
ment of this part and of the reason for such denial. 
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