II 
Calendar No. 90 
116TH CONGRESS 
1ST SESSION 
H. R. 986 
IN THE SENATE OF THE UNITED STATES 
MAY 14, 2019 
Received; read the first time 
MAY 15, 2019 
Read the second time and placed on the calendar 
AN ACT 
To provide that certain guidance related to waivers for State 
innovation under the Patient Protection and Affordable 
Care Act shall have no force or effect. 
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 ‘‘Protecting Americans 
with Preexisting Conditions Act of 2019’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) On October 24, 2018, the administration 
published new guidance to carry out section 1332 of 
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the Patient Protection and Affordable Care Act (42 
U.S.C. 18052) entitled ‘‘State Relief and Empower-
ment Waivers’’ (83 Fed. Reg. 53575). 
(2) The new guidance encourages States to pro-
vide health insurance coverage through insurance 
plans that may discriminate against individuals with 
preexisting health conditions, including the one in 
four Americans living with a disability. 
(3) The implementation and enforcement of the 
new guidance weakens protections for the millions of 
Americans living with preexisting health conditions 
and jeopardizes Americans’ access to quality, afford-
able health insurance coverage. 
SEC. 3. PROVIDING THAT CERTAIN GUIDANCE RELATED TO 
WAIVERS FOR STATE INNOVATION UNDER 
THE PATIENT PROTECTION AND AFFORD-
ABLE CARE ACT SHALL HAVE NO FORCE OR 
EFFECT. 
Beginning April 1, 2019, the Secretary of Health and 
Human Services and the Secretary of the Treasury may 
not take any action to implement, enforce, or otherwise 
give effect to the guidance entitled ‘‘State Relief and Em-
powerment Waivers’’ (83 Fed. Reg. 53575 (October 24, 
2018)), including any such action that would result in in-
dividuals losing health insurance coverage that includes 
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the essential health benefits package (as defined in sub-
section (a) of section 1302 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(a)) without regard 
to any waiver of any provision of such package under a 
waiver under such section 1332), including the maternity 
and newborn care essential health benefit described in sub-
section (b)(1)(D) of such section, including any such ac-
tion that would result in a decrease in the number of such 
individuals enrolled in coverage that is at least as com-
prehensive as the coverage defined in section 1302(a) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18022(a)) compared to the number of such individ-
uals who would have been so enrolled in such coverage 
had such action not been taken, including any such action 
that would, with respect to individuals with substance use 
disorders, including opioid use disorders, reduce the avail-
ability or affordability of coverage that is at least as com-
prehensive as the coverage defined in section 1302(a) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18022(a)) compared to the availability or afford-
ability, respectively, of such coverage had such action not 
been taken, including any such action that would result, 
with respect to vulnerable populations (including low-in-
come individuals, elderly individuals, and individuals with 
serious health issues or who have a greater risk of devel-
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oping serious health issues), in a decrease in the avail-
ability of coverage that is at least as comprehensive as 
the coverage defined in section 1302(a) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 18022(a)) 
with coverage and cost sharing protections required under 
section 
1332(b)(1)(B) 
of 
such 
Act 
(42 
U.S.C. 
18052(b)(1)(B)), including any such action that would, 
with respect to individuals with preexisting conditions, re-
duce the affordability of coverage that is at least as com-
prehensive as the coverage defined in section 1302(a) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18022(a)) compared to the affordability of such 
coverage had such action not been taken, including any 
such action that would result in higher health insurance 
premiums for individuals enrolled in health insurance cov-
erage that is at least as comprehensive as the coverage 
defined in section 1302(b) of such Act (42 U.S.C. 
18022(b)), and the Secretaries may not promulgate any 
substantially similar guidance or rule. Nothing in the pre-
vious sentence shall be construed to affect the approval 
of waivers under section 1332 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18052) that establish 
reinsurance programs that are consistent with the require-
ments under subsection (b)(1) of such section (42 U.S.C. 
18052(b)(1)), lower health insurance premiums, and pro-
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tect health insurance coverage for people with preexisting 
conditions. 
SEC. 4. GAO REPORT ON AFFECT OF STATE INNOVATION 
WAIVERS ON COVERAGE OF INDIVIDUALS 
AND ON MENTAL HEALTH HEALTH CARE 
TREATMENT. 
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 on the number of indi-
viduals expected to lose access to health insurance cov-
erage (as defined in section 2791 of the Public Health 
Service Act (42 U.S.C. 300gg–91)) if section 2 were not 
enacted and waivers under section 1332 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18052) 
were approved under the guidance described in such sec-
tion 2. Such report shall include an analysis of the ex-
pected effect such waivers approved under such guidance 
would have on mental health care treatment. 
Passed the House of Representatives May 9, 2019. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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