I 
118TH CONGRESS 
2D SESSION 
H. R. 9708 
To ensure affordable health insurance coverage for low-income individuals 
in States that have not expanded Medicaid. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 19, 2024 
Ms. SEWELL introduced the following bill; which was referred to the Com-
mittee on Energy 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 jurisdiction of the committee concerned 
A BILL 
To ensure affordable health insurance coverage for low-in-
come individuals in States that have not expanded Med-
icaid. 
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 ‘‘Bridge to Medicaid 
Act of 2024’’. 
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SEC. 2. ENSURING AFFORDABILITY OF COVERAGE FOR 
CERTAIN LOW-INCOME POPULATIONS. 
(a) REDUCING COST SHARING UNDER QUALIFIED 
HEALTH PLANS.—Section 1402 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18071) is amended— 
(1) in subsection (b)— 
(A) in paragraph (2), by inserting ‘‘(or, 
with respect to plan years 2026, 2027, and 
2028, whose household income does not exceed 
400 percent of the poverty line for a family of 
the size involved)’’ before the period; and 
(B) in the matter following paragraph (2), 
by adding at the end the following new sen-
tence: ‘‘In the case of an individual who is de-
termined at any point to have a household in-
come for 2025 that does not exceed 138 percent 
of the poverty line for a family of the size in-
volved, such individual shall, for each month 
during such year, be treated as having a house-
hold income equal to 100 percent for purposes 
of applying this section.’’; and 
(2) in subsection (c)— 
(A) in paragraph (1)(A), in the matter 
preceding clause (i), by inserting ‘‘, with respect 
to eligible insureds (other than, with respect to 
plan years 2026, 2027, and 2028, specified en-
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rollees (as defined in paragraph (6)(C))),’’ after 
‘‘first be achieved’’; 
(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by inserting ‘‘with re-
spect to eligible insureds (other than, with re-
spect to plan years 2026, 2027, and 2028, spec-
ified enrollees)’’ after ‘‘under the plan’’; 
(C) in paragraph (3)— 
(i) in subparagraph (A), by striking 
‘‘this subsection’’ and inserting ‘‘paragraph 
(1) or (2)’’; and 
(ii) in subparagraph (B), by striking 
‘‘this section’’ and inserting ‘‘paragraphs 
(1) and (2)’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL RULE FOR SPECIFIED ENROLL-
EES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish procedures under which the issuer of 
a qualified health plan to which this section ap-
plies shall reduce cost-sharing under the plan 
with respect to months occurring during plan 
years 2026, 2027, and 2028 for enrollees who 
are specified enrollees (as defined in subpara-
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graph (C)) in a manner sufficient to increase 
the plan’s share of the total allowed costs of 
benefits provided under the plan to 99 percent 
of such costs. 
‘‘(B) METHODS
FOR
REDUCING
COST 
SHARING.— 
‘‘(i) IN
GENERAL.—An issuer of a 
qualified health plan making reductions 
under this paragraph shall notify the Sec-
retary of such reductions and the Sec-
retary shall, out of funds made available 
under clause (ii), make periodic and timely 
payments to the issuer equal to 12 percent 
of the total allowed costs of benefits pro-
vided under each such plan to specified en-
rollees during plan years 2026, 2027, and 
2028. 
‘‘(ii) APPROPRIATION.—In addition to 
amounts otherwise available, there are ap-
propriated, out of any money in the Treas-
ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i). 
‘‘(C) SPECIFIED
ENROLLEE
DEFINED.— 
For purposes of this section, the term ‘specified 
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enrollee’ means, with respect to a plan year, an 
eligible insured who is determined at any point 
to have a household income for such plan year 
that does not exceed 138 percent of the poverty 
line for a family of the size involved. Such in-
sured shall be deemed to be a specified enrollee 
for each month in such plan year.’’. 
(b) OPEN ENROLLMENTS APPLICABLE TO CERTAIN 
LOWER-INCOME POPULATIONS.—Section 1311(c) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18031(c)) is amended— 
(1) in paragraph (6)— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) with respect to a qualified health plan 
with respect to which section 1402 applies, for 
months occurring during the period beginning 
on January 1, 2026, and ending on December 
31, 2028, enrollment periods described in sub-
paragraph (A) of paragraph (8) for individuals 
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described in subparagraph (B) of such para-
graph.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
TAIN LOW-INCOME POPULATIONS.— 
‘‘(A) IN GENERAL.—The enrollment period 
described in this paragraph is, in the case of an 
individual described in subparagraph (B), the 
continuous period beginning on the first day 
that such individual is so described. 
‘‘(B) INDIVIDUAL
DESCRIBED.—For pur-
poses of subparagraph (A), an individual de-
scribed in this subparagraph is an individual— 
‘‘(i) with a household income that 
does not exceed 138 percent of the poverty 
line for a family of the size involved; and 
‘‘(ii) who is not eligible for minimum 
essential coverage (as defined in section 
5000A(f) of the Internal Revenue Code of 
1986), other than for coverage described in 
any of subparagraphs (B) through (E) of 
paragraph (1) of such section.’’. 
(c) ADDITIONAL BENEFITS FOR CERTAIN LOW-IN-
COME INDIVIDUALS FOR PLAN YEARS 2026 AND 2027.— 
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Section 1301(a) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18021(a)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (C)(iv), by striking 
the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) provides, with respect to a plan of-
fered in the silver level of coverage to which sec-
tion 1402 applies during plan year 2026 and 
2027, for benefits described in paragraph (5) in 
the case of an individual who has a household 
income that does not exceed 138 percent of the 
poverty line for a family of the size involved, 
and who is eligible to receive cost-sharing re-
ductions under section 1402.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) ADDITIONAL
BENEFITS
FOR
CERTAIN 
LOW-INCOME INDIVIDUALS FOR PLAN YEAR 2026 AND 
2027.— 
‘‘(A) IN GENERAL.— 
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ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i).’’. 
(d) EDUCATION AND OUTREACH ACTIVITIES.— 
(1) IN GENERAL.—Section 1321(c) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18041(c)) is amended by adding at the end the fol-
lowing 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 in-
dividuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of the Social Security 
Act who reside in States that have not ex-
pended amounts under a State plan (or waiver 
of such plan) under title XIX of such Act for 
all such individuals about qualified health plans 
offered through the Exchange, including by in-
forming such individuals of the availability of 
coverage under such plans and financial assist-
ance for coverage under such plans. Such out-
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reach and educational activities shall be pro-
vided in a manner that is culturally and linguis-
tically appropriate to the needs of the popu-
lations being served by the Exchange (including 
hard-to-reach populations, such as racial and 
sexual minorities, limited English proficient 
populations, individuals residing in areas where 
the unemployment rates exceeds the national 
average unemployment rate, individuals in rural 
areas, veterans, and young adults). 
‘‘(B) LIMITATION
ON
USE
OF
FUNDS.— 
Funds appropriated under this paragraph shall 
not be used to promote any health insurance 
coverage other than qualified health plans. 
‘‘(C) FUNDING.—In addition to amounts 
otherwise available, there is appropriated, out of 
any money in the Treasury not otherwise ap-
propriated, to remain available until expended, 
$105,000,000 for fiscal year 2026 to carry out 
this paragraph, of which— 
‘‘(i) $15,000,000 shall be used to 
carry out this paragraph in fiscal year 
2026; and 
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‘‘(ii) $30,000,000 shall be used to 
carry out this paragraph for each of fiscal 
years 2027 through 2028.’’. 
(2) NAVIGATOR PROGRAM.—Section 1311(i) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18031(i)) is amended— 
(A) in paragraph (1)— 
(i) by striking ‘‘An Exchange’’ and in-
serting the following: 
‘‘(A) IN GENERAL.—An Exchange’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(B) GRANTS
FOR
ELIGIBLE
ENTITIES 
WITH RESPECT TO CERTAIN STATES.—The Sec-
retary shall establish a program to award 
grants to entities described in paragraph (2) to 
carry out the duties described in paragraph (3) 
in one or more States that do not provide under 
the State plan under title XIX of the Social Se-
curity Act (or a waiver of such plan) bench-
mark coverage described in section 1937(b)(1) 
of such Act or benchmark equivalent coverage 
described in section 1937(b)(2) of such Act to 
all 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of such Act.’’; and 
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(B) in paragraph (6)— 
(i) by striking ‘‘Grants under’’ and in-
serting the following: 
‘‘(A) STATE EXCHANGES.—Grants under’’; 
and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) FEDERAL
EXCHANGES; GRANTS
TO 
ELIGIBLE ENTITIES WITH RESPECT TO CERTAIN 
STATES.—For purposes of carrying out this 
subsection, with respect to an Exchange estab-
lished and operated by the Secretary within a 
State pursuant to section 1321(c) and with re-
spect to grants under paragraph (1)(B), the 
Secretary 
shall 
obligate 
not 
less 
than 
$10,000,000 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 2026, and not less 
than $20,000,000 for each of fiscal years 2027 
and 2028. Such amount so obligated for a fiscal 
year shall remain available until expended.’’. 
(e) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Secretary of Health 
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and Human Services for fiscal year 2026, out of any 
money in the Treasury not otherwise appropriated, 
$65,000,000, to remain available until expended, for pur-
poses of carrying out the provisions of, and the amend-
ments made by, this section. 
SEC. 3. TEMPORARY EXPANSION OF HEALTH INSURANCE 
PREMIUM TAX CREDITS FOR CERTAIN LOW- 
INCOME POPULATIONS. 
(a) IN GENERAL.—Section 36B of the Internal Rev-
enue Code of 1986 is amended by redesignating subsection 
(h) as subsection (i) and by inserting after subsection (g) 
the following new subsection: 
‘‘(h) CERTAIN TEMPORARY RULES BEGINNING IN 
2026.—With respect to any taxable year beginning after 
December 31, 2025, and before January 1, 2029— 
‘‘(1) ELIGIBILITY
FOR
CREDIT
NOT
LIMITED 
BASED ON INCOME.—Subsection (c)(1)(A) shall be 
applied without regard to ‘equals or exceeds 100 
percent but’. 
‘‘(2) CREDIT ALLOWED TO CERTAIN LOW-IN-
COME
EMPLOYEES
OFFERED
EMPLOYER-PROVIDED 
COVERAGE.—In the case of an individual whose 
household income does not exceed 138 percent of the 
poverty line for a family of the size involved, clause 
(i) of subsection (c)(2)(C) shall be applied (including 
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