datamatters24/research-document-archive huggingface dataset:
103 
(2) by adding at the end the following new 
paragraph: 
‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 
COVERAGE FOR ABORTION.— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
health plan’ does not include any health plan 
that includes coverage for abortions (other than 
any abortion necessary to save the life of the 
mother or any abortion with respect to a preg-
nancy that is the result of an act of rape or in-
cest). 
‘‘(B) CERTAIN RULES RELATED TO ABOR-
TION.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any employer from purchasing for its em-
ployees separate coverage for abortions de-
scribed in such subparagraph, or a health 
plan that includes such abortions, so long 
as no credit is allowed under this section 
with respect to the employer contributions 
for such coverage or plan. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall
104 
restrict any health insurance issuer offer-
ing a health plan from offering separate 
coverage for abortions described in such 
subparagraph, or a plan that includes such 
abortions, so long as such separate cov-
erage or plan is not paid for with any em-
ployer contribution eligible for the credit 
allowed under this section. 
‘‘(iii) 
OTHER
TREATMENTS.—The 
treatment of any infection, injury, disease, 
or disorder that has been caused by or ex-
acerbated by the performance of an abor-
tion shall not be treated as an abortion for 
purposes of subparagraph (A).’’. 
(c) EFFECTIVE DATES.— 
(1) IN
GENERAL.—The amendment made by 
subsection (a) shall apply to taxable years beginning 
after December 31, 2019. 
(2) DISALLOWANCE
OF
SMALL
EMPLOYER 
HEALTH
INSURANCE
EXPENSE
CREDIT
FOR
PLAN 
WHICH INCLUDES COVERAGE FOR ABORTION.—The 
amendments made by subsection (b) shall apply to 
taxable years beginning after December 31, 2017.
110 
amount of the self-employment income for such taxable 
year.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to remuneration re-
ceived after, and taxable years beginning after, December 
31, 2022. 
SEC. 214. REFUNDABLE TAX CREDIT FOR HEALTH INSUR-
ANCE COVERAGE. 
(a) IN GENERAL.—Section 36B of the Internal Rev-
enue Code of 1986 is amended to read as follows: 
‘‘SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE UNDER A 
QUALIFIED HEALTH PLAN. 
‘‘(a) ALLOWANCE OF PREMIUM TAX CREDIT.—In the 
case of an individual, there shall be allowed as a credit 
against the tax imposed by this subtitle for the taxable 
year the sum of the monthly credit amounts with respect 
to such taxpayer for calendar months during such taxable 
year which are eligible coverage months appropriately 
taken into account under subsection (b)(2) with respect 
to the taxpayer or any qualifying family member of the 
taxpayer. 
‘‘(b) MONTHLY CREDIT AMOUNTS.— 
‘‘(1) IN GENERAL.—The monthly credit amount 
with respect to any taxpayer for any calendar month 
is the lesser of—
117 
‘‘(iv) has not met the requirements of 
clauses (i), (ii), and (iii) for each of the 3 
preceding taxable years. 
‘‘(2) DENIAL OF CREDIT TO DEPENDENTS.— 
‘‘(A) IN GENERAL.—No credit shall be al-
lowed under this section to any individual who 
is a dependent with respect to another taxpayer 
for a taxable year beginning in the calendar 
year in which such individual’s taxable year be-
gins. 
‘‘(B) COORDINATION
WITH
RULE
FOR 
OLDER CHILDREN.—In the case of any indi-
vidual who is a qualifying family member de-
scribed in subsection (e)(3) with respect to an-
other taxpayer for any month, in determining 
the amount of any credit allowable to such indi-
vidual under this section for any taxable year of 
such individual which includes such month, the 
monthly limitation amount with respect to such 
individual for such month shall be zero and no 
amount paid for any qualified health plan with 
respect to such individual for such month shall 
be taken into account. 
‘‘(3) COORDINATION WITH MEDICAL EXPENSE 
DEDUCTION.—Amounts 
described 
in 
subsection
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Sec. 217. Special rule for certain medical expenses incurred before establish-
ment of health savings account. 
Subtitle B—Repeal of Certain Consumer Taxes 
Sec. 221. Repeal of tax on prescription medications. 
Sec. 222. Repeal of health insurance tax. 
Subtitle C—Repeal of Tanning Tax 
Sec. 231. Repeal of tanning tax. 
Subtitle D—Remuneration From Certain Insurers 
Sec. 241. Remuneration from certain insurers. 
Subtitle E—Repeal of Net Investment Income Tax 
Sec. 251. Repeal of net investment income tax. 
TITLE I—ENERGY AND 
COMMERCE 
Subtitle A—Patient Access to 
Public Health Programs 
SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND. 
(a) IN GENERAL.—Subsection (b) of section 4002 of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 300u–11), as amended by section 5009 of the 21st 
Century Cures Act, is amended— 
(1) in paragraph (2), by adding ‘‘and’’ at the 
end; 
(2) in paragraph (3)— 
(A) by striking ‘‘each of fiscal years 2018 
and 2019’’ and inserting ‘‘fiscal year 2018’’; 
and 
(B) by striking the semicolon at the end 
and inserting a period; and 
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(2) in section 1905 (42 U.S.C. 1396d)— 
(A) in subsection (y)(1), in the matter pre-
ceding subparagraph (A)— 
(i) by inserting ‘‘and that has elected 
to cover newly eligible individuals before 
March 1, 2017’’ after ‘‘that is one of the 
50 States or the District of Columbia’’; 
and 
(ii) by inserting after ‘‘subclause 
(VIII) of section 1902(a)(10)(A)(i)’’ the 
following: ‘‘who, for periods after Decem-
ber 31, 2019, are grandfathered expansion 
enrollees 
(as 
defined 
in 
section 
1902(nn)(2))’’; and 
(B) in subsection (z)(2)— 
(i) in subparagraph (A), by inserting 
after ‘‘section 1937’’ the following: ‘‘and, 
for periods after December 31, 2019, who 
are grandfathered expansion enrollees (as 
defined in section 1902(nn)(2))’’; and 
(ii) in subparagraph (B)(ii)— 
(I) in subclause (III), by adding 
‘‘and’’ at the end; and 
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(II) by striking subclauses (IV), 
(V), and (VI) and inserting the fol-
lowing new subclause: 
‘‘(IV) 2017 and each subsequent year is 80 
percent.’’. 
(b) SUNSET OF ESSENTIAL HEALTH BENEFITS RE-
QUIREMENT.—Section 1937(b)(5) of the Social Security 
Act (42 U.S.C. 1396u–7(b)(5)) is amended by adding at 
the end the following: ‘‘This paragraph shall not apply 
after December 31, 2019.’’. 
SEC. 113. ELIMINATION OF DSH CUTS. 
Section 1923(f) of the Social Security Act (42 U.S.C. 
1396r–4(f)) is amended— 
(1) in paragraph (7)— 
(A) in subparagraph (A)— 
(i) in clause (i)— 
(I) in the matter preceding sub-
clause (I), by striking ‘‘2025’’ and in-
serting ‘‘2019’’; and 
(ii) in clause (ii)— 
(I) in subclause (I), by adding 
‘‘and’’ at the end; 
(II) in subclause (II), by striking 
the semicolon at the end and inserting 
a period; and 
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(III) by striking subclauses (III) 
through (VIII); and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(C) EXEMPTION FROM REDUCTION FOR 
NON-EXPANSION STATES.— 
‘‘(i) IN GENERAL.—In the case of a 
State that is a non-expansion State for a 
fiscal year, subparagraph (A)(i) shall not 
apply to the DSH allotment for such State 
and fiscal year. 
‘‘(ii) NO CHANGE IN REDUCTION FOR 
EXPANSION
STATES.—In the case of a 
State that is an expansion State for a fis-
cal year, the DSH allotment for such State 
and fiscal year shall be determined as if 
clause (i) did not apply. 
‘‘(iii) NON-EXPANSION
AND
EXPAN-
SION STATE DEFINED.— 
‘‘(I) The term ‘expansion State’ 
means with respect to a fiscal year, a 
State that, as of July 1 of the pre-
ceding fiscal year, provides for eligi-
bility 
under 
clause 
(i)(VIII) 
or 
(ii)(XX) of section 1902(a)(10)(A) for 
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medical assistance under this title (or 
a waiver of the State plan approved 
under section 1115). 
‘‘(II) The term ‘non-expansion 
State’ means, with respect to a fiscal 
year, a State that is not an expansion 
State.’’; and 
(2) in paragraph (8), by striking ‘‘fiscal year 
2025’’ and inserting ‘‘fiscal year 2019’’. 
SEC. 114. REDUCING STATE MEDICAID COSTS. 
(a) LETTING STATES DISENROLL HIGH DOLLAR 
LOTTERY WINNERS.— 
(1) IN GENERAL.—Section 1902 of the Social 
Security Act (42 U.S.C. 1396a) is amended— 
(A) in subsection (a)(17), by striking 
‘‘(e)(14), (e)(14)’’ and inserting ‘‘(e)(14), 
(e)(15)’’; and 
(B) in subsection (e)— 
(i) in paragraph (14) (relating to 
modified adjusted gross income), by adding 
at the end the following new subparagraph: 
‘‘(J) TREATMENT
OF
CERTAIN
LOTTERY 
WINNINGS AND INCOME RECEIVED AS A LUMP 
SUM.— 
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‘‘(i) IN GENERAL.—In the case of an 
individual who is the recipient of qualified 
lottery winnings (pursuant to lotteries oc-
curring on or after January 1, 2020) or 
qualified lump sum income (received on or 
after such date) and whose eligibility for 
medical assistance is determined based on 
the application of modified adjusted gross 
income under subparagraph (A), a State 
shall, in determining such eligibility, in-
clude such winnings or income (as applica-
ble) as income received— 
‘‘(I) in the month in which such 
winnings or income (as applicable) is 
received if the amount of such 
winnings or income is less than 
$80,000; 
‘‘(II) over a period of 2 months 
if the amount of such winnings or in-
come (as applicable) is greater than or 
equal to $80,000 but less than 
$90,000; 
‘‘(III) over a period of 3 months 
if the amount of such winnings or in-
come (as applicable) is greater than or 
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equal to $90,000 but less than 
$100,000; and 
‘‘(IV) over a period of 3 months 
plus 1 additional month for each in-
crement of $10,000 of such winnings 
or income (as applicable) received, not 
to exceed a period of 120 months (for 
winnings or income of $1,260,000 or 
more), if the amount of such winnings 
or income is greater than or equal to 
$100,000. 
‘‘(ii) COUNTING IN EQUAL INSTALL-
MENTS.—For purposes of subclauses (II), 
(III), and (IV) of clause (i), winnings or 
income to which such subclause applies 
shall be counted in equal monthly install-
ments over the period of months specified 
under such subclause. 
‘‘(iii) HARDSHIP EXEMPTION.—An in-
dividual whose income, by application of 
clause (i), exceeds the applicable eligibility 
threshold established by the State, may 
continue to be eligible for medical assist-
ance to the extent that the State deter-
mines, under procedures established by the 
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State under the State plan (or in the case 
of a waiver of the plan under section 1115, 
incorporated in such waiver), or as other-
wise established by such State in accord-
ance with such standards as may be speci-
fied by the Secretary, that the denial of eli-
gibility of the individual would cause an 
undue medical or financial hardship as de-
termined on the basis of criteria estab-
lished by the Secretary. 
‘‘(iv) NOTIFICATIONS
AND
ASSIST-
ANCE REQUIRED IN CASE OF LOSS OF ELI-
GIBILITY.—A State shall, with respect to 
an individual who loses eligibility for med-
ical assistance under the State plan (or a 
waiver of such plan) by reason of clause 
(i), before the date on which the individual 
loses such eligibility, inform the individual 
of the date on which the individual would 
no longer be considered ineligible by reason 
of such clause to receive medical assistance 
under the State plan or under any waiver 
of such plan and the date on which the in-
dividual would be eligible to reapply to re-
ceive such medical assistance. 
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‘‘(v) QUALIFIED LOTTERY WINNINGS 
DEFINED.—In this subparagraph, the term 
‘qualified lottery winnings’ means winnings 
from a sweepstakes, lottery, or pool de-
scribed in paragraph (3) of section 4402 of 
the Internal Revenue Code of 1986 or a 
lottery operated by a multistate or multi-
jurisdictional lottery association, including 
amounts awarded as a lump sum payment. 
‘‘(vi) QUALIFIED LUMP SUM INCOME 
DEFINED.—In this subparagraph, the term 
‘qualified lump sum income’ means income 
that is received as a lump sum from one 
of the following sources: 
‘‘(I) Monetary winnings from 
gambling (as defined by the Secretary 
and including monetary winnings from 
gambling activities described in sec-
tion 1955(b)(4) of title 18, United 
States Code). 
‘‘(II) Income received as liquid 
assets from the estate (as defined in 
section 1917(b)(4)) of a deceased in-
dividual.’’; and 
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(ii) by striking ‘‘(14) EXCLUSION’’ 
and inserting ‘‘(15) EXCLUSION’’. 
(2) RULES OF CONSTRUCTION.— 
(A) INTERCEPTION OF LOTTERY WINNINGS 
ALLOWED.—Nothing in the amendment made 
by paragraph (1)(B)(i) shall be construed as 
preventing a State from intercepting the State 
lottery winnings awarded to an individual in the 
State to recover amounts paid by the State 
under the State Medicaid plan under title XIX 
of the Social Security Act for medical assistance 
furnished to the individual. 
(B) APPLICABILITY
LIMITED
TO
ELIGI-
BILITY OF RECIPIENT OF LOTTERY WINNINGS 
OR LUMP SUM INCOME.—Nothing in the amend-
ment made by paragraph (1)(B)(i) shall be con-
strued, with respect to a determination of 
household income for purposes of a determina-
tion of eligibility for medical assistance under 
the State plan under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) (or a waiver 
of such plan) made by applying modified ad-
justed gross income under subparagraph (A) of 
section 1902(e)(14) of such Act (42 U.S.C. 
1396a(e)(14)), as limiting the eligibility for 
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such medical assistance of any individual that is 
a member of the household other than the indi-
vidual (or the individual’s spouse) who received 
qualified lottery winnings or qualified lump-sum 
income (as defined in subparagraph (J) of such 
section 1902(e)(14), as added by paragraph 
(1)(B)(i) of this subsection). 
(b) REPEAL OF RETROACTIVE ELIGIBILITY.— 
(1) IN GENERAL.— 
(A) STATE PLAN REQUIREMENTS.—Section 
1902(a)(34) of the Social Security Act (42 
U.S.C. 1396a(a)(34)) is amended by striking 
‘‘in or after the third month before the month 
in which he made application’’ and inserting ‘‘in 
or after the month in which the individual made 
application’’. 
(B) DEFINITION
OF
MEDICAL
ASSIST-
ANCE.—Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)) is amended by strik-
ing ‘‘in or after the third month before the 
month in which the recipient makes application 
for assistance’’ and inserting ‘‘in or after the 
month in which the recipient makes application 
for assistance’’. 
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(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to medical assistance 
with respect to individuals whose eligibility for such 
assistance is based on an application for such assist-
ance made (or deemed to be made) on or after Octo-
ber 1, 2017. 
(c) UPDATING ALLOWABLE HOME EQUITY LIMITS IN 
MEDICAID.— 
(1) IN
GENERAL.—Section 1917(f)(1) of the 
Social Security Act (42 U.S.C. 1396p(f)(1)) is 
amended— 
(A) in subparagraph (A), by striking ‘‘sub-
paragraphs (B) and (C)’’ and inserting ‘‘sub-
paragraph (B)’’; 
(B) by striking subparagraph (B); 
(C) by redesignating subparagraph (C) as 
subparagraph (B); and 
(D) in subparagraph (B), as so redesig-
nated, by striking ‘‘dollar amounts specified in 
this paragraph’’ and inserting ‘‘dollar amount 
specified in subparagraph (A)’’. 
(2) EFFECTIVE DATE.— 
(A) IN GENERAL.—The amendments made 
by paragraph (1) shall apply with respect to eli-
gibility determinations made after the date that 
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is 180 days after the date of the enactment of 
this section. 
(B) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State plan under title 
XIX of the Social Security Act that the Sec-
retary of Health and Human Services deter-
mines requires State legislation in order for the 
respective plan to meet any requirement im-
posed by amendments made by this subsection, 
the respective plan shall not be regarded as fail-
ing to comply with the requirements of such 
title solely on the basis of its failure to meet 
such an additional requirement before the first 
day of the first calendar quarter beginning after 
the close of the first regular session of the 
State legislature that begins after the date of 
the enactment of this Act. For purposes of the 
previous sentence, in the case of a State that 
has a 2-year legislative session, each year of the 
session shall be considered to be a separate reg-
ular session of the State legislature. 
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SEC. 115. SAFETY NET FUNDING FOR NON-EXPANSION 
STATES. 
Title XIX of the Social Security Act is amended by 
inserting after section 1923 (42 U.S.C. 1396r–4) the fol-
lowing new section: 
‘‘ADJUSTMENT IN PAYMENT FOR SERVICES OF SAFETY 
NET PROVIDERS IN NON-EXPANSION STATES 
‘‘SEC. 1923A. (a) IN GENERAL.—Subject to the limi-
tations of this section, for each year during the period be-
ginning with fiscal year 2018 and ending with fiscal year 
2022, each State that is one of the 50 States or the Dis-
trict of Columbia and that, as of July 1 of the preceding 
fiscal year, did not provide for eligibility under clause 
(i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) for medical 
assistance under this title (or a waiver of the State plan 
approved under section 1115) (each such State or District 
referred to in this section for the fiscal year as a ‘non- 
expansion State’) may adjust the payment amounts other-
wise provided under the State plan under this title (or a 
waiver of such plan) to health care providers that provide 
health care services to individuals enrolled under this title 
(in this section referred to as ‘eligible providers’) so long 
as the payment adjustment to such an eligible provider 
does not exceed the provider’s costs in furnishing health 
care services (as determined by the Secretary and net of 
payments under this title, other than under this section, 
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and by uninsured patients) to individuals who either are 
eligible for medical assistance under the State plan (or 
under a waiver of such plan) or have no health insurance 
or health plan coverage for such services. 
‘‘(b) INCREASE IN APPLICABLE FMAP.—Notwith-
standing section 1905(b), the Federal medical assistance 
percentage applicable with respect to expenditures attrib-
utable to a payment adjustment under subsection (a) for 
which payment is permitted under subsection (c) shall be 
equal to— 
‘‘(1) 100 percent for calendar quarters in fiscal 
years 2018, 2019, 2020, and 2021; and 
‘‘(2) 95 percent for calendar quarters in fiscal 
year 2022. 
‘‘(c) ANNUAL ALLOTMENT LIMITATION.—Payment 
under section 1903(a) shall not be made to a State with 
respect to any payment adjustment made under this sec-
tion for all calendar quarters in a fiscal year in excess 
of the $2,000,000,000 multiplied by the ratio of— 
‘‘(1) the population of the State with income 
below 138 percent of the poverty line in 2015 (as de-
termined based the table entitled ‘Health Insurance 
Coverage Status and Type by Ratio of Income to 
Poverty Level in the Past 12 Months by Age’ for the 
universe of the civilian noninstitutionalized popu-
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lation for whom poverty status is determined based 
on the 2015 American Community Survey 1–Year 
Estimates, as published by the Bureau of the Cen-
sus), to 
‘‘(2) the sum of the populations under para-
graph (1) for all non-expansion States. 
‘‘(d) DISQUALIFICATION IN CASE OF STATE COV-
ERAGE EXPANSION.—If a State is a non-expansion for a 
fiscal year and provides eligibility for medical assistance 
described in subsection (a) during the fiscal year, the 
State shall no longer be treated as a non-expansion State 
under this section for any subsequent fiscal years.’’. 
SEC. 116. PROVIDING INCENTIVES FOR INCREASED FRE-
QUENCY 
OF 
ELIGIBILITY 
REDETERMINA-
TIONS. 
(a) IN GENERAL.—Section 1902(e)(14) of the Social 
Security Act (42 U.S.C. 1396a(e)(14)) (relating to modi-
fied adjusted gross income), as amended by section 
114(a)(1), is further amended by adding at the end the 
following: 
‘‘(K) FREQUENCY OF ELIGIBILITY REDE-
TERMINATIONS.—Beginning 
on 
October 
1, 
2017, and notwithstanding subparagraph (H), 
in the case of an individual whose eligibility for 
medical assistance under the State plan under 
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this title (or a waiver of such plan) is deter-
mined based on the application of modified ad-
justed gross income under subparagraph (A) 
and who is so eligible on the basis of clause 
(i)(VIII) or clause (ii)(XX) of subsection 
(a)(10)(A), a State shall redetermine such indi-
vidual’s eligibility for such medical assistance 
no less frequently than once every 6 months.’’. 
(b) INCREASED ADMINISTRATIVE MATCHING PER-
CENTAGE.—For each calendar quarter during the period 
beginning on October 1, 2017, and ending on December 
31, 2019, the Federal matching percentage otherwise ap-
plicable under section 1903(a) of the Social Security Act 
(42 U.S.C. 1396b(a)) with respect to State expenditures 
during such quarter that are attributable to meeting the 
requirement of section 1902(e)(14) (relating to determina-
tions of eligibility using modified adjusted gross income) 
of such Act shall be increased by 5 percentage points with 
respect to State expenditures attributable to activities car-
ried out by the State (and approved by the Secretary) to 
increase the frequency of eligibility redeterminations re-
quired by subparagraph (K) of such section (relating to 
eligibility redeterminations made on a 6-month basis) (as 
added by subsection (a)). 
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