(F) directly from issuers or web brokers; 
and 
(G) other means. 
(b) OPEN ENROLLMENT AFTER ACTION REPORT.— 
For plan year 2020 and each subsequent year, the Sec-
retary, in coordination with the Secretary of the Treasury 
and the Secretary of Labor, shall publish an after action 
report not later than 3 months after the completion of the 
annual open enrollment period regarding the performance 
of the Federal Exchange for the applicable plan year. 
Each such report shall include a summary, including in-
formation on a State-by-State basis where available, of— 
(1) the open enrollment data reported under 
subsection (a) for the entirety of the enrollment pe-
riod; and 
(2) activities related to patient navigators de-
scribed in section 1311(i) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18031(i)), in-
cluding— 
(A) the performance objectives established 
by the Secretary for such patient navigators; 
(B) the number of consumers enrolled by 
such a patient navigator; 
(C) an assessment of how such patient 
navigators have met established performance
metrics, including a detailed list of all patient 
navigators, funding received by patient naviga-
tors, and whether established performance ob-
jectives of patient navigators were met; and 
(D) with respect to the performance objec-
tives described in subparagraph (A)— 
(i) whether such objectives assess the 
full scope of patient navigator responsibil-
ities, including general education, plan se-
lection, and determination of eligibility for 
tax credits, cost-sharing reductions, or 
other coverage; 
(ii) how the Secretary worked with pa-
tient navigators to establish such objec-
tives; and 
(iii) how the Secretary adjusted such 
objectives for case complexity and other 
contextual factors. 
(c) REPORT ON ADVERTISING AND CONSUMER OUT-
REACH.—Not later than 3 months after the completion of 
the annual open enrollment period for the 2020 plan year, 
the Secretary shall issue a report on advertising and out-
reach to consumers for the open enrollment period for the 
2020 plan year. Such report shall include a description 
of—
(1) the division of spending on individual adver-
tising platforms, including television and radio ad-
vertisements and digital media, to raise consumer 
awareness of open enrollment; 
(2) the division of spending on individual out-
reach platforms, including email and text messages, 
to raise consumer awareness of open enrollment; and 
(3) whether the Secretary conducted targeted 
outreach to specific demographic groups and geo-
graphic areas. 
SEC. 208. GAO REPORT. 
Not later than 1 year after the date of the enactment 
of this Act, the Comptroller General of the United States 
shall submit to Congress a study that analyzes the costs 
and benefits of the establishment of State-administered 
health insurance plans to be offered in the insurance mar-
ket of such States that choose to administer and offer such 
a plan. 
SEC. 209. REPORT ON THE EFFECTS OF WEBSITE MAINTE-
NANCE DURING OPEN ENROLLMENT. 
Not later than 1 year after the date of the enactment 
of this Act, the Comptroller General of the United States 
shall submit to Congress a report examining whether the 
Department of Health and Human Services has been con-
ducting maintenance on the website commonly referred to
as ‘‘Healthcare.gov’’ during annual open enrollment peri-
ods (as described in section 1311(c)(6)(B) of the Patient 
Protection 
and 
Affordable 
Care 
Act 
(42 
U.S.C. 
18031(c)(6)(B)) in such a manner so as to minimize any 
disruption to the use of such website resulting from such 
maintenance. 
TITLE III—BUDGETARY EFFECTS 
SEC. 301. DETERMINATION OF BUDGETARY EFFECTS. 
The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go Act of 2010, 
shall be determined by reference to the latest statement 
titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 
Act, submitted for printing in the Congressional Record 
by the Chairman of the House Budget Committee, pro-
vided that such statement has been submitted prior to the 
vote on passage. 
Passed the House of Representatives May 16, 2019. 
Attest: 
Clerk.
116TH CONGRESS 
1ST SESSION 
H. R. 987 
AN ACT 
To amend the Patient Protection and Affordable 
Care Act to provide for Federal Exchange out-
reach and educational activities.