I 
115TH CONGRESS 
2D SESSION 
H. R. 5155 
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 5, 2018 
Mr. PALLONE (for himself, Mr. SCOTT of Virginia, and Mr. NEAL) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Ways and Means, and 
Education and the Workforce, for a period to be subsequently determined 
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 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 
‘‘Undo Sabotage and Expand Affordability of Health In-
surance Act of 2018’’. 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
(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. Lower out-of-pocket costs for consumers. 
Sec. 103. Expand affordability for working families. 
TITLE II—UNDOING SABOTAGE 
Sec. 201. Protect comprehensive coverage for small businesses and workers. 
Sec. 202. Prevent junk plans and continue protections for consumers with pre-
existing conditions. 
Sec. 203. Ensure plans provide comprehensive benefits. 
Sec. 204. Undo Administration sabotage by requiring open enrollment outreach, 
education, and funding for navigators. 
Sec. 205. Improve marketplace stability to prevent sabotage from raising pre-
miums. 
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. Preserve State option to implement health care marketplaces. 
Sec. 304. Promote transparency and accountability in the Administration’s ex-
penditures of Exchange user fees. 
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 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
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% up to 133.0% ................
0.0% 
1.0%
133.0% up to 150.0% ........................
1.0% 
2.0%
150.0% up to 200.0% ........................
2.0% 
4.0%
200.0% up to 250.0% ........................
4.0% 
6.0%
250.0% up to 300.0% ........................
6.0% 
7.0%
300.0% up to 400.0% ........................
7.0% 
8.5%
400.0% 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’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2019. 
SEC. 102. LOWER OUT-OF-POCKET COSTS FOR CONSUMERS. 
(a) EXPANSION OF ELIGIBILITY.— 
(1) IN GENERAL.—Section 1402(c) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18071(c)) is amended— 
(A) by striking paragraphs (1) and (2) and 
inserting the following: 
‘‘(1) IN GENERAL.—The reduction in cost-shar-
ing under this subsection shall be achieved, with re-
spect to an issuer of a qualified health plan to which 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
this section applies, by reducing cost-sharing under 
the plan (and the applicable out-of pocket limit 
under section 1302(c)(1)) in a manner and amount 
sufficient to— 
‘‘(A) in the case of an eligible insured 
whose household income is not less than 100 
percent but not more than 250 percent of the 
poverty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 94 
percent of such costs; and 
‘‘(B) in the case of an eligible insured 
whose household income is more than 250 per-
cent but not more than 400 percent of the pov-
erty line for a family of the size involved, in-
crease the plan’s share of the total allowed 
costs of benefits provided under the plan to 87 
percent of such costs.’’; and 
(B) by redesignating paragraphs (3), (4), 
and (5) as paragraphs (2), (3), and (4), respec-
tively. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply with respect to plan 
years beginning after December 31, 2019. 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
(b) FUNDING COST SHARING REDUCTIONS.—Section 
1402 of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18071) is amended by adding at the end the 
following new subsection: 
‘‘(g) FUNDING.—Out of any funds in the Treasury 
not otherwise appropriated, there is hereby appropriated 
to the Secretary such sums as may be necessary for pay-
ments under this section.’’. 
SEC. 103. 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 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
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 
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)’’. 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
(3) Clause (iv) of section 36B(c)(2)(C) of such 
Code is amended by striking ‘‘9.5 percent under 
clause (i)(II)’’ and inserting ‘‘the 9.5 percent under 
clauses (i)(I) and (i)(II)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2019. 
TITLE II—UNDOING SABOTAGE 
SEC. 201. PROTECT COMPREHENSIVE COVERAGE FOR 
SMALL BUSINESSES AND WORKERS. 
Notwithstanding any other provision of law, the Sec-
retary of Labor may not take any action to implement, 
finalize, or enforce the proposed rule published on January 
5, 2018, on pages 614 through 636 of volume 83 of the 
Federal Register, or any substantially similar proposed 
rule. 
SEC. 202. PREVENT JUNK PLANS AND CONTINUE PROTEC-
TIONS FOR CONSUMERS WITH PREEXISTING 
CONDITIONS. 
(a) INCLUDING SHORT-TERM LIMITED DURATION 
INSURANCE AS INDIVIDUAL HEALTH INSURANCE COV-
ERAGE.—Section 2791(b)(5) of the Public Health Service 
Act (42 U.S.C. 300g–91(b)(5)) is amended by striking 
‘‘but does not include short-term limited duration insur-
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
ance’’ and inserting ‘‘, including short-term limited dura-
tion insurance’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning after December 31, 2018. 
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’’; 
(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, 
2019— 
‘‘(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; 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
‘‘(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 
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 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
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 
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 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
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-
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. UNDO ADMINISTRATION SABOTAGE BY REQUIR-
ING OPEN ENROLLMENT OUTREACH, EDU-
CATION, AND FUNDING FOR NAVIGATORS. 
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) NAVIGATOR
PROGRAM
AND
OUTREACH 
AND ENROLLMENT ACTIVITIES.— 
‘‘(A) NAVIGATOR PROGRAM.— 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
‘‘(i) IN GENERAL.—In the case of an 
Exchange established or operated by the 
Secretary pursuant to this subsection, the 
Secretary shall establish a program under 
which it awards grants to entities that 
would be described in paragraph (2) of sec-
tion 1311(i) to carry out the duties that 
would be described in paragraph (3) of 
such section if the references in such sec-
tion 1311(i) to ‘this subsection’ and ‘para-
graph (1)’ were each instead a reference to 
‘paragraph (3)(A) of section 1321(c)’. 
‘‘(ii) APPLICATION
OF
STATE
EX-
CHANGE
NAVIGATOR
PROVISIONS.—For 
purposes of carrying out this subpara-
graph, the provisions of paragraphs (2) 
through (5) of section 1311(i) shall apply 
to the Secretary with respect to an Ex-
change described in clause (i) and the pro-
gram under this subparagraph in the same 
manner as such provisions apply to a State 
with respect to an Exchange described in 
section 1311(i) and the program estab-
lished under such section. 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
‘‘(iii) FUNDING.—For purposes of 
carrying out this subparagraph, the Sec-
retary shall obligate $100,000,000 out of 
amounts collected through the user fees on 
participating health insurance issuers pur-
suant to section 156.50 of title 45, Code of 
Federal Regulations (or any successor reg-
ulations) for each of fiscal years 2019 
through 2021. Such amount shall remain 
available without fiscal year limitation 
until expended. 
‘‘(B) OUTREACH
AND
EDUCATIONAL
AC-
TIVITIES.— 
‘‘(i) IN GENERAL.—In the case of an 
Exchange established or operated by the 
Secretary pursuant to this subsection, the 
Secretary shall carry out outreach and 
educational activities for purposes of in-
forming potential enrollees in qualified 
health plans offered through the Exchange 
of the availability of coverage under such 
plans and financial assistance for coverage 
under such plans. 
‘‘(ii) FUNDING.—For purposes of car-
rying out this subparagraph, the Secretary 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
shall obligate $100,000,000 out of the 
amounts collected through the user fees on 
participating health insurance issuers pur-
suant to section 156.50 of title 45, Code of 
Federal Regulations (or any successor reg-
ulations) for each of fiscal years 2019 
through 2021. Such amount shall remain 
available without fiscal year limitation 
until expended.’’. 
SEC. 205. IMPROVE MARKETPLACE STABILITY TO PREVENT 
SABOTAGE FROM RAISING PREMIUMS. 
(a) FUND.— 
(1) IN GENERAL.—There is hereby established 
the National Reinsurance Program Fund to be ad-
ministered by the Secretary of Health and Human 
Services for purposes of carrying out a national rein-
surance program to make reinsurance payments, in 
accordance with this section. 
(2) APPROPRIATION.—There is hereby appro-
priated to the Fund established under paragraph 
(1), out of any funds in the Treasury not otherwise 
appropriated, such sums as are necessary for car-
rying out the purpose described in such paragraph. 
(b) PAYMENTS.— 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall use amounts available in the 
Fund to establish a national reinsurance program 
under which the Secretary makes reinsurance pay-
ments to health insurance issuers with respect to 
claims for individuals enrolled under qualifying rein-
surance plans offered by such issuers for plan year 
2019 or a subsequent plan year that exceed, subject 
to paragraph (2), $50,000 in an amount equal to 75 
percent of the amount of such claims, but not to ex-
ceed $1,000,000. 
(2) INDEXING.—For plan year 2020 or subse-
quent plan year, in lieu of each dollar amount speci-
fied in paragraph (1), each such dollar amount ap-
plied under this subsection for such plan year shall 
be the dollar amount applied under this subsection 
for the previous year, increased by the annual per-
centage increase in the Consumer Price Index for All 
Urban Consumers (all items; United States city av-
erage as of June of the previous fiscal year). 
(3) METHODS.—Payments under this sub-
section shall be based on such a method as the Sec-
retary determines. The Secretary may establish a 
payment method by which interim payments of 
amounts under this subsection are made during a 
VerDate Sep 11 2014 
22:54 Mar 12, 2018
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
plan year based on the Secretary’s best estimate of 
amounts that will be payable after obtaining all of 
necessary information. 
(c) QUALIFYING REINSURANCE PLAN.— 
(1) IN GENERAL.—For purposes of this section, 
the term ‘‘qualifying reinsurance plan’’ means, with 
respect to a health insurance issuer a qualified 
health plan (as defined in section 1301 of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18021)) offered by such issuer on the individual 
market. Such term does not include a grandfathered 
health plan (as defined in section 1251 of such Act 
(42 U.S.C. 18011)), transitional health plan, or a 
standard health plan offered in connection with a 
basic health program established under section 1331 
of such Act (42 U.S.C. 18051). 
(2) TRANSITIONAL
HEALTH
PLAN.—For pur-
poses of paragraph (1), the term ‘‘transitional health 
plan’’ means a plan continued under the letter 
issued by the Centers for Medicare & Medicaid Serv-
ices on November 14, 2013, to the State Insurance 
Commissioners outlining a transitional policy for 
coverage in the individual and small group markets 
to which section 1251 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18011) does not 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
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 Services on March 
5, 2014, February 29, 2016, and February 13, 
2017, or under any subsequent extensions thereof. 
(d) COORDINATION WITH RISK ADJUSTMENT.—The 
Secretary shall make adjustments to the risk adjustment 
program operated under section 1343 of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 18063), as 
appropriate, to account for the effects of this section on 
the actuarial risk of enrollees. 
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 
of the fiscal years 2019 through 2021. Such amount 
shall remain available until expended.’’. 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
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 
for tax credits under section 36B of the Internal 
Revenue Code of 1986, with the ability to opt out 
of such enrollment. 
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
(2) State investment in technology to improve 
data sharing and collection for the purposes of facili-
tating greater enrollment in health insurance cov-
erage in such markets. 
(3) Implementation of a State version of an in-
dividual mandate to be enrolled in health insurance 
coverage. 
(4) Feasibility studies to develop comprehensive 
and coherent State plan for increasing enrollment in 
the individual and small group market. 
(d) FUNDING.—For purposes of carrying out this 
section, there is hereby appropriated, out of any funds in 
the Treasury not otherwise appropriated, $200,000,000 
for each of the fiscal years 2019 through 2021. Such 
amount shall remain available until expended. 
SEC. 303. PRESERVE STATE OPTION TO IMPLEMENT 
HEALTH CARE MARKETPLACES. 
Section 1311(a)(4) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18031(a)(4)) is amended— 
(1) by striking subparagraph (B); 
(2) by striking ‘‘RENEWABILITY
OF
GRANT’’ 
and all that follows through ‘‘Subject to subsection 
(d)(4)’’ and inserting ‘‘RENEWABILITY OF GRANT.— 
Subject to subsection (d)(4)’’; 
VerDate Sep 11 2014 
22:54 Mar 12, 2018
Jkt 079200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS
(3) by redesignating clauses (i) and (ii) as sub-
paragraphs (A) and (B), respectively, with appro-
priate indentation; and 
(4) in subparagraph (A), as redesignated by 
paragraph (3), by redesignating subclauses (I) and 
(II) as clauses (i) and (ii), respectively, with appro-
priate indentation. 
SEC. 
304. 
PROMOTE 
TRANSPARENCY 
AND 
ACCOUNT-
ABILITY IN THE ADMINISTRATION’S EXPENDI-
TURES OF EXCHANGE USER FEES. 
For each of plan years 2018, 2019, and 2020, not 
later than the date that is 3 months after of the end of 
such fiscal year, the Secretary of Health and Human Serv-
ices shall submit to the appropriate committees of Con-
gress and make available to the public an annual report 
on the expenditure by the Department of Health and 
Human Services of user fees collected pursuant to section 
156.50 of title 45, Code of Federal Regulations (or any 
successor regulations). Each such report for a plan year 
shall include a detailed accounting of the amount of such 
user fees collected during such plan year and of the 
amount of such expenditures used during such plan year 
for the federally facilitated Exchange operated pursuant 
to section 1321(c) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18041(c)) on outreach and en-
VerDate Sep 11 2014 
02:43 Mar 09, 2018
Jkt 079200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H5155.IH
H5155
dlhill on DSK3GLQ082PROD with BILLS