I 
115TH CONGRESS 
2D SESSION 
H. R. 5624 
To facilitate the efforts of States to establish auto-enrollment systems to 
enroll certain individuals in health insurance coverage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 26, 2018 
Mr. BERA (for himself, Ms. KUSTER of New Hampshire, Mr. SCHRADER, Mr. 
SCHNEIDER, Miss RICE of New York, Mr. DELANEY, and Mr. PETERS) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on Ways and 
Means, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To facilitate the efforts of States to establish auto-enrollment 
systems to enroll certain individuals in 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. 
This Act may be cited as the ‘‘Pathway to Universal 
Coverage Act of 2018’’. 
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SEC. 2. ENCOURAGEMENT OF AUTO-ENROLLMENT FOR 
STATES. 
(a) STATE INNOVATIONS TO EXPAND COVERAGE.— 
(1) IN GENERAL.—Subject to paragraph (4), 
the Secretary of Health and Human Services shall 
award grants to eligible State agencies to enable 
such States to explore innovative solutions to pro-
mote greater enrollment in health insurance cov-
erage in the individual and small group markets, in-
cluding activities described in paragraph (3). 
(2) ELIGIBILITY.—For purposes of paragraph 
(1), eligible State agencies are Exchanges estab-
lished by a State under title I of the Patient Protec-
tion and Affordable Care Act and State agencies 
with primary responsibility over health and human 
services for the State involved. 
(3) USE
OF
FUNDS.—For purposes of para-
graph (1), the activities described in this subsection 
are the following: 
(A) State efforts to streamline health in-
surance enrollment procedures in order to re-
duce burdens on consumers and facilitate great-
er enrollment in health insurance coverage in 
the individual and small group markets, includ-
ing automatic enrollment and reenrollment of, 
or pre-populated applications for, individuals 
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without health insurance who are eligible for 
tax credits under section 36B of the Internal 
Revenue Code of 1986, with the ability to opt 
out of such enrollment. 
(B) State investment in technology to im-
prove data sharing and collection for the pur-
poses of facilitating greater enrollment in health 
insurance coverage in such markets. 
(C) Implementation of a State version of 
an individual mandate to be enrolled in health 
insurance coverage. 
(D) Feasibility studies to develop com-
prehensive and coherent State plan for increas-
ing enrollment in the individual and small 
group market. 
(4) FUNDING.—For purposes of carrying out 
this subsection, there is hereby appropriated, out of 
any funds in the Treasury not otherwise appro-
priated, $200,000,000 for each of the fiscal years 
2019 through 2021. Such amount shall remain 
available until expended. 
(b) AVAILABILITY OF SUBSIDY INFORMATION.—The 
information available under section 1411 of the Patient 
Protection and Affordable Care Act for determination of 
eligibility for and amount of credit against tax allowed 
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under section 36B shall be made available to State agen-
cies for determining eligibility for automatic enrollment 
described in subsection (f)(1). 
(c) RECONCILIATION OF ADVANCED PAYMENTS FOR 
AUTO-ENROLLED INDIVIDUALS.—Paragraph (2) of sec-
tion 36B(f) of the Internal Revenue Code of 1986 is 
amended by adding at the end the following new subpara-
graph: 
‘‘(C) EXCEPTION FOR AUTO-ENROLLED IN-
DIVIDUALS.—In the case of an individual who is 
enrolled through an auto-enrollment system (as 
defined in subsection (f) of the Pathway to Uni-
versal Coverage Act of 2018), subparagraph (A) 
shall not apply.’’. 
(d) FACILITATION OF STATE AUTO-ENROLLMENT.— 
(1) PROVISION
OF
ELIGIBILITY
INFORMA-
TION.—Section 1411 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18081) is amend-
ed— 
(A) in subsection (b)— 
(i) in the header, by striking ‘‘BY AP-
PLICANTS’’; and 
(ii) in paragraph (1), by inserting 
‘‘(or, in the case of an individual to be en-
rolled in such plan under an auto-enroll-
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ment system (as defined in subsection 
(f)(1) of the Pathway to Universal Cov-
erage Act of 2018), a State)’’ after ‘‘indi-
vidual market’’; and 
(B) in subsection (c)(1), by striking ‘‘pro-
vided by an applicant under’’ and inserting ‘‘de-
scribed in’’. 
(2) MEDICAID ENROLLMENT.—The requirement 
specified in section 435.907(f) of title 42, Code of 
Federal Regulations, shall not apply with respect an 
individual enrolled under a State plan under title 
XIX of the Social Security Act (or under a waiver 
of such plan) through an auto-enrollment system. 
(3) REPORTING OF TERMINATED COVERAGE.— 
(A) GROUP HEALTH PLANS AND HEALTH 
INSURANCE ISSUERS.—The first subpart II of 
part A of title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg–11 et seq.) is 
amended by adding at the end the following 
new section: 
‘‘SEC. 2729. REPORTING OF TERMINATED COVERAGE. 
‘‘For each month occurring in a plan year beginning 
on or after January 1, 2020, a group health plan and a 
health insurance issuer offering group or individual health 
insurance coverage shall notify the Secretary, in a time 
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and manner specified by the Secretary, of each individual 
whose enrollment under such coverage or such plan was 
terminated during such month.’’. 
(B) MEDICAID.—Section 1902 of the So-
cial Security Act (42 U.S.C. 1396a) is amended 
by adding at the end the following new sub-
section: 
‘‘(nn) REPORTING
ON DISENROLLMENT
OF MED-
ICAID ENROLLEES.—For each month beginning on or 
after January 1, 2020, a State shall submit to the Sec-
retary a report, at such time, in such manner, and con-
taining such information as the Secretary may require, on 
each individual who was disenrolled from the State plan 
(or a waiver of such plan) during such month.’’. 
(C) CHIP.—Section 2107(e)(1) of the So-
cial Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(i) by redesignating subparagraphs 
(L) through (S) as subparagraphs (M) 
through (T), respectively; and 
(ii) by inserting after subparagraph 
(K) the following new subparagraph: 
‘‘(L) Section 1902(nn) (relating to report-
ing on disenrollment of enrollees).’’. 
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(e) REPORT.—Not later than 6 months after the date 
of enactment of this Act, the Secretary of Health and 
Human Services, in coordination with the Commissioner 
of the Internal Revenue Service, shall submit to Congress 
a report with best practice recommendations on how a 
State may establish an auto-enrollment system (as defined 
in subsection (f)). Such report shall include the following: 
(1) Identification of any statutory barriers to 
establishing such a system, including data-sharing, 
administrative, and technological barriers. 
(2) How such a system would interact with en-
rollment periods for qualified health plans (as de-
fined in section 1301 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18021) and income 
eligibility determinations for premium assistance tax 
credits under section 36B of the Internal Revenue 
Code, the impact of such system on enrollment in 
health insurance coverage in a State establishing 
such system, and the effects of changing the enroll-
ment periods for such system to align with the filing 
of individual Federal tax returns. 
(3) An evaluation of prior outreach efforts tar-
geted to individuals without health insurance cov-
erage eligible for such tax credits. 
(f) DEFINITIONS.—For purposes of this Act: 
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(1) AUTO-ENROLLMENT
SYSTEM.—The term 
‘‘auto-enrollment system’’ means a system designed 
and operated by a State that provides for an eligible 
individual residing in such State to be automatically 
enrolled in a qualified health plan offered through 
an Exchange in the State, or, if eligible, in the State 
plan under title XIX of the Social Security Act (or 
under a waiver of such plan), provided that the sys-
tem exempts such individual from paying any pre-
mium imposed by the State under such plan (or 
waiver). Such automatic enrollment shall be void if 
within 60 days after first being notified of the auto-
matic enrollment the eligible individual declines such 
coverage. 
(2) ELIGIBLE INDIVIDUAL.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘‘eligible individual’’ means, 
with respect to a taxable year, an individual 
who is not eligible for minimum essential cov-
erage, other than minimum essential coverage 
described in subparagraph (A)(ii) or (C) of sec-
tion 5000A(f)(1) of the Internal Revenue Code 
of 1986, for such year. 
(B) LIMITATION.—An individual who is 
only eligible for minimum essential coverage de-
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