datamatters24/research-document-archive huggingface dataset:
‘‘(2) AUDITING.—The Secretary shall conduct 
for each State an audit of the number of individuals 
and expenditures reported through the CMS–64 re-
port for fiscal year 2016, fiscal year 2019, and each 
subsequent fiscal year, which audit may be con-
ducted on a representative sample (as determined by 
the Secretary). 
‘‘(3) 
TEMPORARY
INCREASE
IN
FEDERAL 
MATCHING
PERCENTAGE
TO
SUPPORT
IMPROVED 
DATA REPORTING SYSTEMS FOR FISCAL YEARS 2018 
AND 2019.—For amounts expended during calendar 
quarters beginning on or after October 1, 2017, and 
before October 1, 2019— 
‘‘(A) the Federal matching percentage ap-
plied under section 1903(a)(3)(A)(i) shall be in-
creased by 10 percentage points to 100 percent; 
‘‘(B) the Federal matching percentage ap-
plied under section 1903(a)(3)(B) shall be in-
creased by 25 percentage points to 100 percent; 
and 
‘‘(C) the Federal matching percentage ap-
plied under section 1903(a)(7) shall be in-
creased by 10 percentage points to 60 percent 
but only with respect to amounts expended that 
are attributable to a State’s additional adminis-
trative expenditures to implement the data re-
quirements of paragraph (1). 
‘‘(i) 
FLEXIBLE
BLOCK
GRANT
OPTION
FOR 
STATES.— 
‘‘(1) IN GENERAL.—In the case of a State that 
elects the option of applying this subsection for a 
10-fiscal-year period (beginning no earlier than fiscal 
year 2020 and, at the State option, for any suc-
ceeding 10-fiscal-year period) and that has a plan 
approved by the Secretary under paragraph (2) to 
carry out the option for such period— 
‘‘(A) the State shall receive, instead of 
amounts otherwise payable to the State under 
this title for medical assistance for block grant 
individuals within the applicable block grant 
category (as defined in paragraph (6)) for the 
State during the period in which the election is 
in effect, the amount specified in paragraph 
(4); 
‘‘(B) the previous provisions of this section 
shall be applied as if— 
‘‘(i) block grant individuals within the 
applicable block grant category for the 
State and period were not section 1903A 
enrollees for each 10-fiscal year period for
which the State elects to apply this sub-
section; and 
‘‘(ii) if such option is not extended at 
the end of a 10-fiscal-year-period, the per 
capita limitations under such previous pro-
visions shall again apply after such period 
and such limitations shall be applied as if 
the election under this subsection had 
never taken place; 
‘‘(C) the payment under this subsection 
may only be used consistent with the State plan 
under paragraph (2) for block grant health care 
assistance (as defined in paragraph (7)); and 
‘‘(D) with respect to block grant individ-
uals within the applicable block grant category 
for the State for which block grant health care 
assistance is made available under this sub-
section, such assistance shall be instead of med-
ical assistance otherwise provided to the indi-
vidual under this title. 
‘‘(2) STATE PLAN FOR ADMINISTERING BLOCK 
GRANT OPTION.— 
‘‘(A) IN GENERAL.—No payment shall be 
made under this subsection to a State pursuant 
to an election for a 10-fiscal-year period under
specified by the State for such period in its plan 
under paragraph (2)(A)(i): 
‘‘(A) 2 ENROLLEE CATEGORIES.—Both of 
the following 1903A enrollee categories: 
‘‘(i) CHILDREN.—The 1903A enrollee 
category specified in subparagraph (C) of 
subsection (e)(2). 
‘‘(ii) 
OTHER
NONELDERLY, 
NON-
DISABLED, NON-EXPANSION ADULTS.—The 
1903A enrollee category specified in sub-
paragraph (E) of such subsection. 
‘‘(B) OTHER NONELDERLY, NONDISABLED, 
NON-EXPANSION ADULTS.—Only the 1903A en-
rollee category specified in subparagraph (E) of 
subsection (e)(2). 
‘‘(7) BLOCK
GRANT
HEALTH
CARE
ASSIST-
ANCE.—In this subsection, the term ‘block grant 
health care assistance’ means assistance for health- 
care-related items and medical services for block 
grant individuals within the applicable block grant 
category for the State and 10-fiscal-year period in-
volved who are low-income individuals (as defined by 
the State). 
‘‘(8) AUDITING.—As a condition of receiving 
funds under this subsection, a State shall contract
with an independent entity to conduct audits of its 
expenditures made with respect to activities funded 
under this subsection for each fiscal year for which 
the State elects to apply this subsection to ensure 
that such funds are used consistent with this sub-
section and shall make such audits available to the 
Secretary upon the request of the Secretary.’’. 
Subtitle D—Patient Relief and 
Health Insurance Market Stability 
SEC. 131. REPEAL OF COST-SHARING SUBSIDY. 
(a) IN GENERAL.—Section 1402 of the Patient Pro-
tection and Affordable Care Act is repealed. 
(b) EFFECTIVE DATE.—The repeal made by sub-
section (a) shall apply to cost-sharing reductions (and pay-
ments to issuers for such reductions) for plan years begin-
ning after December 31, 2019. 
SEC. 132. 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, 2018, and ending on 
December 31, 2026, for the purposes described in section 
2202. 
‘‘SEC. 2202. USE OF FUNDS. 
‘‘(a) IN GENERAL.—Subject to subsections (b) and 
(c), 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-
cess to health insurance coverage offered through an 
employer enroll in health insurance coverage in the 
individual market in the State, as such market is de-
fined by the State (whether through the establish-
ment of a new mechanism or maintenance of an ex-
isting mechanism for such purpose). 
‘‘(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, as such markets are defined by the 
State, to individuals who have, or are projected 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) Promoting access to preventive services; 
dental care services (whether preventive or medically 
necessary); vision care services (whether preventive 
or medically necessary); or any combination of such 
services. 
‘‘(6) Maternity coverage and newborn care. 
‘‘(7) Prevention, treatment, or recovery support 
services for individuals with mental or substance use 
disorders, focused on either or both of the following: 
‘‘(A) Direct inpatient or outpatient clinical 
care for treatment of addiction and mental ill-
ness.
‘‘(B) Early identification and intervention 
for children and young adults with serious men-
tal illness. 
‘‘(8) Providing payments, directly or indirectly, 
to health care providers for the provision of such 
health care services as are specified by the Adminis-
trator. 
‘‘(9) 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. 
‘‘(b) REQUIRED
USE
OF
INCREASE
IN
ALLOT-
MENT.—A State shall use the additional allocation pro-
vided to the State from the funds appropriated under the 
second sentence of section 2204(a) for each year only for 
the purposes described in paragraphs (6) and (7) of sub-
section (a). 
‘‘(c) REQUIRED USE OF ADDITIONAL INCREASE TO 
CERTAIN
WAIVER
STATES
TO
PROVIDE
FINANCIAL 
HARDSHIP ASSISTANCE.—A State shall use the additional 
allocation provided to the State from the funds appro-
priated under the last sentence of section 2204(a) only 
in accordance with such last sentence.
‘‘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 (but, in the case of allocations for 2018, 
not later than 45 days after the date of the enact-
ment 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 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) 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 title and of the reason for such denial. 
‘‘(3) ONE-TIME APPLICATION.—If an applica-
tion of a State is approved for a year, with respect 
to a purpose described in section 2202, such applica-
tion shall be treated as approved, with respect to 
such purpose, for each subsequent year through 
2026. 
‘‘(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.— 
‘‘(A) 2018.—For allocations made under 
this title for 2018, in the case of a State that 
does not submit an application under subsection 
(a) by the 45-day submission date applicable to 
such year under subsection (a)(1) and in the 
case of a State that does submit such an appli-
cation by such date that is not approved, sub-
ject to section 2204(e), the Administrator, in 
consultation with the State insurance commis-
sioner, shall use the allocation that would other-
wise be provided to the State under this title 
for such year, in accordance with paragraph 
(2), for such State. 
‘‘(B) 2019 THROUGH 2026.—In the case of 
a State that does not have in effect an approved 
application under this section for 2019 or a 
subsequent year beginning 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 provided to 
the State under this title for such year, in ac-
cordance 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
‘‘(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 
‘‘(bb) the sum of the num-
ber of such individuals for all 
States described in clause (vi) for 
the third preceding year. 
‘‘(vi) STATES DESCRIBED.—For pur-
poses of clause (v), a State is described in 
this clause, with respect to 2018 and 2019, 
if the State satisfies either of the following 
criterion: 
‘‘(I) The ratio described in sub-
clause (II) of clause (v) that would be
‘‘(B) for 2021, 20 percent of the amount 
allocated under this subsection to such State 
for such year and purpose; and 
‘‘(C) for 2022, 30 percent of the amount 
allocated under this subsection to such State 
for such year and purpose; 
‘‘(D) for 2023, 40 percent of the amount 
allocated under this subsection to such State 
for such year and purpose; 
‘‘(E) for 2024, 50 percent of the amount 
allocated under this subsection to such State 
for such year and purpose; 
‘‘(F) for 2025, 50 percent of the amount 
allocated under this subsection to such State 
for such year and purpose; and 
‘‘(G) for 2026, 50 percent of the amount 
allocated under this subsection to such State 
for such year and purpose; or 
‘‘(3) if such an allocation for such purpose 
would not be permitted under subsection (c)(7) of 
section 2105 if such allocation were payment made 
under such section. 
‘‘SEC. 2205. FEDERAL INVISIBLE RISK SHARING PROGRAM. 
‘‘(a) IN GENERAL.—There is established within the 
Patient and State Stability Fund a Federal Invisible Risk
Sharing Program (in this section referred to as the ‘Pro-
gram’), to be administered by the Secretary of Health and 
Human Services, acting through the Administrator of the 
Centers for Medicare & Medicaid Services (in this section 
referred to as the ‘Administrator’), to provide payments 
to health insurance issuers with respect to claims for eligi-
ble individuals for the purpose of lowering premiums for 
health insurance coverage offered in the individual market. 
‘‘(b) FUNDING.— 
‘‘(1) APPROPRIATION.—For the purpose of pro-
viding funding for the Program there is appro-
priated, out of any money in the Treasury not other-
wise appropriated, $15,000,000,000 for the period 
beginning on January 1, 2018, and ending on De-
cember 31, 2026. 
‘‘(2) USE
OF
UNALLOCATED
FUNDS.—Funds 
provided under section 2204(c)(2)(B) to carry out 
this section are in addition to the amount appro-
priated under paragraph (1). 
‘‘(c) OPERATION OF PROGRAM.— 
‘‘(1) IN GENERAL.—The Administrator shall es-
tablish, after consultation with health care con-
sumers, health insurance issuers, State insurance 
commissioners, and other stakeholders and after tak-
ing into consideration high cost health conditions
and other health trends that generate high cost, pa-
rameters for the operation of the Program consistent 
with this section and consistent with the same limi-
tation on payment with respect to health insurance 
coverage that applies to payment with respect health 
benefits coverage under section 2105(c)(7). 
‘‘(2) DEADLINE FOR INITIAL OPERATION.—Not 
later than 60 days after the date of the enactment 
of this title, the Administrator shall establish suffi-
cient parameters to specify how the Program will op-
erate for plan year 2018. 
‘‘(3) STATE
OPERATION
OF
PROGRAM.—The 
Administrator shall establish a process for a State to 
operate the Program in such State beginning with 
plan year 2020. 
‘‘(d) DETAILS OF PROGRAM.—The parameters for 
the Program shall include the following: 
‘‘(1) ELIGIBLE INDIVIDUALS.—A definition for 
eligible individuals. 
‘‘(2) HEALTH STATUS STATEMENTS.—The de-
velopment and use of health status statements with 
respect to such individuals. 
‘‘(3) STANDARDS FOR QUALIFICATION.— 
‘‘(A) AUTOMATIC
QUALIFICATION.—The 
identification of health conditions that auto-
matically qualify individuals as eligible individ-
uals at the time of application for health insur-
ance coverage. 
‘‘(B) 
VOLUNTARY
QUALIFICATION.—A 
process under which health insurance issuers 
may voluntarily qualify individuals, who do not 
automatically qualify under subparagraph (A), 
as eligible individuals at the time of application 
for such coverage. 
‘‘(4) PERCENTAGE
OF
INSURANCE
PREMIUMS 
TO BE APPLIED.—The percentage of the premiums 
paid, to health insurance issuers for health insur-
ance coverage by eligible individuals, that shall be 
collected and deposited to the credit (and available 
for the use) of the Program. 
‘‘(5) ATTACHMENT DOLLAR AMOUNT AND PAY-
MENT PROPORTION.—The dollar amount of claims 
for eligible individuals after which the Program will 
provide payments to health insurance issuers and 
the proportion of such claims above such dollar 
amount that the Program will pay.’’. 
SEC. 133. CONTINUOUS HEALTH INSURANCE COVERAGE IN-
CENTIVE. 
Subpart I of part A of title XXVII of the Public 
Health Service Act is amended—
(1) in section 2701(a)(1)(B), by striking ‘‘such 
rate’’ and inserting ‘‘subject to section 2710A, such 
rate’’; 
(2) by redesignating the second section 2709 as 
section 2710; and 
(3) by adding at the end the following new sec-
tion: 
‘‘SEC. 2710A. ENCOURAGING CONTINUOUS HEALTH INSUR-
ANCE COVERAGE. 
‘‘(a) PENALTY APPLIED.— 
‘‘(1) IN GENERAL.—Subject to the succeeding 
provisions of this section, a health insurance issuer 
offering health insurance coverage in the individual 
market shall, in the case of an individual who is an 
applicable policyholder of such coverage with respect 
to an enforcement period applicable to enrollments 
for a plan year beginning with plan year 2019 (or, 
in the case of enrollments during a special enroll-
ment period, beginning with plan year 2018), in-
crease the monthly premium rate otherwise applica-
ble to such individual for such coverage during each 
month of such period, by an amount determined 
under paragraph (2). 
‘‘(2) AMOUNT OF PENALTY.—The amount de-
termined under this paragraph for an applicable pol-
icyholder enrolling in health insurance coverage de-
scribed in paragraph (1) for a plan year, with re-
spect to each month during the enforcement period 
applicable to enrollments for such plan year, is the 
amount that is equal to 30 percent of the monthly 
premium rate otherwise applicable to such applicable 
policyholder for such coverage during such month. 
‘‘(b) DEFINITIONS.—For purposes of this section: 
‘‘(1) APPLICABLE
POLICYHOLDER.—The term 
‘applicable policyholder’ means, with respect to 
months of an enforcement period and health insur-
ance coverage, an individual who— 
‘‘(A) is a policyholder of such coverage for 
such months; 
‘‘(B) cannot demonstrate that (through 
presentation of certifications described in sec-
tion 2704(e) or in such other manner as may 
be specified in regulations, such as a return or 
statement made under section 6055(d) or 36B 
of the Internal Revenue Code of 1986), during 
the look-back period that is with respect to such 
enforcement period, there was not a period of 
at least 63 continuous days during which the 
individual did not have creditable coverage (as 
defined in paragraph (1) of section 2704(c) and
TITLE II—COMMITTEE ON WAYS 
AND MEANS 
Subtitle A—Repeal and Replace of 
Health-Related Tax Policy 
SEC. 201. RECAPTURE EXCESS ADVANCE PAYMENTS OF 
PREMIUM TAX CREDITS. 
Subparagraph (B) of section 36B(f)(2) of the Inter-
nal Revenue Code of 1986 is amended by adding at the 
end the following new clause: 
‘‘(iii) NONAPPLICABILITY OF LIMITA-
TION.—This subparagraph shall not apply 
to taxable years beginning after December 
31, 2017, and before January 1, 2020.’’. 
SEC. 202. ADDITIONAL MODIFICATIONS TO PREMIUM TAX 
CREDIT. 
(a) MODIFICATION OF DEFINITION OF QUALIFIED 
HEALTH PLAN.— 
(1) IN GENERAL.—Section 36B(c)(3)(A) of the 
Internal Revenue Code of 1986 is amended— 
(A) by inserting ‘‘(determined without re-
gard to subparagraphs (A), (C)(ii), and (C)(iv) 
of paragraph (1) thereof and without regard to 
whether the plan is offered on an Exchange)’’ 
after ‘‘1301(a) of the Patient Protection and 
Affordable Care Act’’, and
(B) by striking ‘‘shall not include’’ and all 
that follows and inserting ‘‘shall not include any 
health plan that— 
‘‘(i) is a grandfathered health plan or 
a grandmothered health plan, or 
‘‘(ii) includes coverage for abortions 
(other than any abortion necessary to save 
the life of the mother or any abortion with 
respect to a pregnancy that is the result of 
an act of rape or incest).’’. 
(2) DEFINITION OF GRANDMOTHERED HEALTH 
PLAN.—Section 36B(c)(3) of such Code is amended 
by adding at the end the following new subpara-
graph: 
‘‘(C) GRANDMOTHERED HEALTH PLAN.— 
‘‘(i) 
IN
GENERAL.—The 
term 
‘grandmothered health plan’ means health 
insurance coverage which is offered in the 
individual health insurance market as of 
October 1, 2013, and is permitted to be of-
fered in such market after January 1, 
2014, as a result of CCIIO guidance. 
‘‘(ii) CCIIO GUIDANCE
DEFINED.— 
The term ‘CCIIO guidance’ means the let-
ter issued by the Centers for Medicare &
Medicaid Services on November 14, 2013, 
to the State Insurance Commissioners out-
lining a transitional policy for non-grand-
fathered coverage in the individual health 
insurance market, as subsequently ex-
tended and modified (including by a com-
munication entitled ‘Insurance Standards 
Bulletin 
Series—INFORMATION—Ex-
tension of Transitional Policy through Cal-
endar Year 2017’ issued on February 29, 
2016, by the Director of the Center for 
Consumer Information & Insurance Over-
sight of such Centers). 
‘‘(iii) INDIVIDUAL
HEALTH
INSUR-
ANCE
MARKET.—The 
term 
‘individual 
health insurance market’ means the mar-
ket for health insurance coverage (as de-
fined in section 9832(b)) offered to individ-
uals other than in connection with a group 
health plan (within the meaning of section 
5000(b)(1)).’’. 
(3) CONFORMING
AMENDMENT
RELATED
TO 
ABORTION
COVERAGE.—Section 36B(c)(3) of such 
Code, as amended by paragraph (2), is amended by 
adding at the end the following new subparagraph:
101 
over the rate of income growth for 
such period, and 
‘‘(II) in addition to any adjust-
ment under subclause (I), the excess 
(if any) of the rate of premium 
growth for calendar year 2018, over 
the rate of growth in the consumer 
price index for calendar year 2018. 
‘‘(iv) FAILSAFE.—Clause (iii)(II) shall 
apply only if the aggregate amount of pre-
mium tax credits under this section and 
cost-sharing reductions under section 1402 
of the Patient Protection and Affordable 
Care Act for calendar year 2018 exceeds 
an amount equal to 0.504 percent of the 
gross domestic product for such calendar 
year.’’. 
(c) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided in this subsection, the amendments made by 
this section shall apply to taxable years beginning 
after December 31, 2017. 
(2) ADVANCE PAYMENT NOT APPLICABLE TO 
OFF-EXCHANGE COVERAGE.—The amendment made
102 
by subsection (a)(4)(A) shall take effect on January 
1, 2018. 
(3) REPORTING.—The amendment made by 
subsection (a)(4)(B) shall apply to coverage provided 
for months beginning after December 31, 2017. 
(4) MODIFICATION OF APPLICABLE PERCENT-
AGE.—The amendment made by subsection (b) shall 
apply to taxable years beginning after December 31, 
2018. 
SEC. 203. SMALL BUSINESS TAX CREDIT. 
(a) IN GENERAL.—Section 45R of the Internal Rev-
enue Code of 1986 is amended by adding at the end the 
following new subsection: 
‘‘(j) SHALL NOT APPLY.—This section shall not 
apply with respect to amounts paid or incurred in taxable 
years beginning after December 31, 2019.’’. 
(b) DISALLOWANCE OF SMALL EMPLOYER HEALTH 
INSURANCE EXPENSE CREDIT
FOR PLAN WHICH IN-
CLUDES COVERAGE FOR ABORTION.—Subsection (h) of 
section 45R of the Internal Revenue Code of 1986 is 
amended— 
(1) by striking ‘‘Any term’’ and inserting the 
following: 
‘‘(1) IN GENERAL.—Any term’’; and