‘‘(3) SPECIFIED
USE.—An allocation for a 
State made pursuant to paragraph (1) or (2) for a 
year shall be used to carry out the purpose described 
in section 1352(a)(1) in such State by providing re-
insurance payments to health insurance issuers with 
respect to attachment range claims (as defined in 
section 1354(b)(2), using the dollar amounts speci-
fied in subparagraph (B) of such section for such 
year) in an amount equal to the percentage (speci-
fied for such year by the Secretary under such sub-
paragraph) of the amount of such claims. 
‘‘SEC. 1354. ALLOCATIONS. 
‘‘(a) APPROPRIATION.—For the purpose of providing 
allocations for States under this part there is appro-
priated, out of any money in the Treasury not otherwise 
appropriated $10,000,000,000 for 2020 and each subse-
quent year. 
‘‘(b) ALLOCATIONS.— 
‘‘(1) PAYMENT.— 
‘‘(A) IN GENERAL.—From amounts appro-
priated under subsection (a) for a year, the 
Secretary shall, with respect to a State and not 
later than the date specified under subpara-
graph (B) for such year, allocate for such State 
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the amount determined for such State and year 
under paragraph (2). 
‘‘(B) SPECIFIED DATE.—For purposes of 
subparagraph (A), the date specified in this 
subparagraph is— 
‘‘(i) for 2020, the date that is 45 days 
after the date of the enactment of this 
title; and 
‘‘(ii) for 2021 or a subsequent year, 
January 1 of the respective year. 
‘‘(C) 
NOTIFICATIONS
OF
ALLOCATION 
AMOUNTS.—For 2021 and each subsequent 
year, the Secretary shall notify each State of 
the amount determined for such State under 
paragraph (2) for such year by not later than 
January 1 of the previous year. 
‘‘(2) 
ALLOCATION
AMOUNT
DETERMINA-
TIONS.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), the amount determined under this 
paragraph for a year for a State is the amount 
that the Secretary estimates would be expended 
under this part for such year on attachment 
range claims of individuals residing in such 
State if all States used such funds only for the 
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purpose described in paragraph (1) of section 
1352 at the dollar amounts and percentage 
specified under subparagraph (B) for such year. 
For purposes of the previous sentence and sec-
tion 1353(b)(3), the term ‘attachment range 
claims’ means, with respect to an individual, the 
claims for such individual that exceed a dollar 
amount specified by the Secretary for a year, 
but do not exceed a ceiling dollar amount speci-
fied by the Secretary for such year, under sub-
paragraph (B). 
‘‘(B) SPECIFICATIONS.—For purposes of 
subparagraph (A) and section 1353(b)(3), the 
Secretary shall determine the dollar amounts 
and the percentage to be specified under sub-
paragraph (A) for a year in a manner to ensure 
that the total amount of expenditures under 
this part for such year is estimated to equal the 
total amount appropriated for such year under 
subsection (a) if such expenditures were used 
solely for the purpose described in paragraph 
(1) of section 1352(a) for attachment range 
claims at the dollar amounts and percentage so 
specified for such year. 
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‘‘(3) AVAILABILITY.—Funds allocated to a 
State under this subsection for a year shall remain 
available through the end of the subsequent year. 
‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS YEAR’S 
REMAINING FUNDS.— 
‘‘(1) IN GENERAL.—In carrying out subsection 
(b), the Secretary shall, with respect to a year (be-
ginning with 2021), not later than March 31 of such 
year— 
‘‘(A) determine the amount of funds, if 
any, from the amounts appropriated under sub-
section (a) for the previous year but not allo-
cated for such previous year; and 
‘‘(B) if the Secretary determines that any 
funds were not so allocated for such previous 
year, allocate such remaining funds to States 
for such year, in accordance with paragraph 
(2). 
‘‘(2) ALLOCATION
METHODOLOGY.—For pur-
poses of paragraph (1), of the total remaining funds 
to be allocated for a year pursuant to such para-
graph, the Secretary shall allocate to each State an 
amount that bears the same ratio to such total re-
maining funds as the amount allocated pursuant to 
subsection (b) to such State for such year bears to 
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the total allocations made under such subsection for 
such year.’’. 
SEC. 207. PROVIDING THAT CERTAIN GUIDANCE RELATED 
TO WAIVERS FOR STATE INNOVATION UNDER 
THE PATIENT PROTECTION AND AFFORD-
ABLE CARE ACT SHALL HAVE NO FORCE OR 
EFFECT. 
Beginning April 1, 2019, the Secretary of Health and 
Human Services and the Secretary of the Treasury may 
not take any action to implement, enforce, or otherwise 
give effect to the guidance entitled ‘‘State Relief and Em-
powerment Waivers’’ (83 Fed. Reg. 53575 (October 24, 
2018)), and the Secretaries may not promulgate any sub-
stantially similar guidance or rule. 
TITLE III—STATE INNOVATION 
AND TRANSPARENCY 
SEC. 301. FUND STATE HEALTH INSURANCE EDUCATION 
PROGRAMS FOR CONSUMERS. 
Section 2793(e) of the Public Health Service Act (42 
U.S.C. 300gg–93(e)) is amended by adding at the end the 
following new paragraph: 
‘‘(3) APPROPRIATIONS.—For purposes of car-
rying out this section, there is hereby appropriated 
to the Secretary, out of any funds in the Treasury 
not otherwise appropriated, $100,000,000 for each 
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of the fiscal years 2020 through 2022. Such amount 
shall remain available until expended.’’. 
SEC. 302. FUND STATE INNOVATIONS TO EXPAND COV-
ERAGE. 
(a) IN GENERAL.—Subject to subsection (d), the Sec-
retary of Health and Human Services shall award grants 
to eligible State agencies to enable such States to explore 
innovative solutions to promote greater enrollment in 
health insurance coverage in the individual and small 
group markets, including activities described in subsection 
(c). 
(b) ELIGIBILITY.—For purposes of subsection (a), el-
igible State agencies are Exchanges established by a State 
under title I of the Patient Protection and Affordable Care 
Act and State agencies with primary responsibility over 
health and human services for the State involved. 
(c) USE OF FUNDS.—For purposes of subsection (a), 
the activities described in this subsection are the following: 
(1) State efforts to streamline health insurance 
enrollment procedures in order to reduce burdens on 
consumers and facilitate greater enrollment in health 
insurance coverage in the individual and small group 
markets, including automatic enrollment and re-
enrollment of, or pre-populated applications for, in-
dividuals without health insurance who are eligible 
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