Title: State-Based Universal Health Care Act of 2018
Policy area: Health

Summary:
State-Based Universal Health Care Act of 2018
This bill repeals and replaces existing Section 1332 waiver provisions under the Patient Protection and Affordable Care Act (also known as State Innovation Waivers) with waiver provisions that allow states to establish comprehensive universal health care plans, in accordance with specified requirements.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6097 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 6097

 To amend title I of the Patient Protection and Affordable Care Act to 
 authorize the establishment of, and provide support for, State-based 
    universal health care systems that provide comprehensive health 
          benefits to State residents, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 13, 2018

Ms. Jayapal (for herself, Ms. Schakowsky, and Mr. Pocan) introduced the 
   following bill; which was referred to the Committee on Energy and 
    Commerce, and in addition to the Committees on Ways and Means, 
Oversight and Government Reform, Armed Services, 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 title I of the Patient Protection and Affordable Care Act to 
 authorize the establishment of, and provide support for, State-based 
    universal health care systems that provide comprehensive health 
          benefits to State residents, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``State-Based 
Universal Health Care Act of 2018''.
    (b) Purpose.--The purpose of this Act is to establish a flexible 
framework under which States can provide comprehensive universal health 
coverage to all of their residents.

SEC. 2. WAIVER FOR STATE UNIVERSAL HEALTH CARE.

    (a) In General.--Title I of the Patient Protection and Affordable 
Care Act (Public Law 111-148) is amended by striking section 1332 (42 
U.S.C. 18052) and inserting the following new section:

``SEC. 1332. WAIVER FOR STATE UNIVERSAL HEALTH CARE.

    ``(a) Application.--
            ``(1) In general.--A State may apply to the Secretary (as 
        defined in subsection (i)(3)) for the waiver of so much of the 
        requirements described in paragraph (2) with respect to health 
        benefits coverage within that State for plan years beginning on 
        or after January 1, 2019, as is necessary to implement a 
        comprehensive State universal health care plan in the State 
        under this section. Such application shall--
                    ``(A) be filed at such time and in such manner as 
                the Secretary may require;
                    ``(B) contain such information as the Secretary may 
                require, including--
                            ``(i) a comprehensive description of the 
                        State legislation and program to implement a 
                        plan meeting the requirements for a waiver 
                        under this section;
                            ``(ii) a plan for how the State will 
                        achieve in 5 years health coverage for at least 
                        95 percent of the population of the State, with 
                        five percent of the population of the State not 
                        spending more than 10 percent of their adjusted 
                        gross income on health; and
                            ``(iii) a 10-fiscal-year budget plan for 
                        such plan that is budget neutral for the 
                        Federal Government; and
                    ``(C) provide an assurance that the State has 
                enacted, or will be enacting before the current State 
                legislative session adjourns, the law described in 
                subsection (b)(2).
            ``(2) Requirements.--The requirements described in this 
        paragraph with respect to health benefits coverage within the 
        State for plan years beginning on or after January 1, 2019, are 
        as follows:
                    ``(A) Parts I, II, and III of this subtitle.
                    ``(B) Section 1402.
                    ``(C) Sections 36B and 4980H of the Internal 
                Revenue Code of 1986.
                    ``(D) Title XI of the Social Security Act.
                    ``(E) Title XVIII of the Social Security Act.
                    ``(F) Title XIX of the Social Security Act.
                    ``(G) Title XXI of the Social Security Act.
                    ``(H) Chapter 89 of title 5 of the United States 
                Code.
                    ``(I) Chapter 55 of title 10, United States Code, 
                including coverage under the TRICARE program.
                    ``(J) Section 514 of the Employee Retirement Income 
                Security Act of 1974.
            ``(3) Pass through of funding.--With respect to a State 
        waiver under paragraph (1), under which the State assumes 
        responsibility for health coverage under a specified Federal 
        health program, including under each of the Federal health care 
        or subsidy programs specified in subparagraphs (B), (C), (E), 
        (F), (G), and (H) of paragraph (2), the Secretary shall not 
        spend Federal health funds that would otherwise have been spent 
        for such program and shall provide for an alternative means by 
        which the aggregate amount of such funds shall be paid to the 
        State for purposes of implementing the State plan under the 
        waiver. Such amount shall be determined annually by the 
        Secretary, taking into account the amount that would otherwise 
        have been spent under such Federal health program with respect 
        to residents of such State, if such waiver did not apply. Such 
        amount shall include funds equal to the amount of premium tax 
        credits, cost-sharing reductions, or small-business credits 
        under sections 36B and 45R of the Internal Revenue Code of 1986 
        or under section 1402 that would have been available to 
        individuals and businesses in the State if such waiver did not 
        apply.
            ``(4) Waiver consideration and transparency.--
                    ``(A) In general.--An application for a waiver 
                under this section shall be considered by the 
                Secretary, after taking into account recommendations of 
                the Panel under subsection (g), in accordance with the 
                regulations described in subparagraph (B).
                    ``(B) Regulations.--Not later than 180 days after 
                the date of enactment of the State-Based Universal 
                Health Care Act of 2017, the Secretary shall promulgate 
                regulations relating to waivers under this section that 
                provide--
                            ``(i) a process for public notice and 
                        comment in accordance with the public notice 
                        and comment requirements applicable under 
                        regulations used for Medicaid waivers pursuant 
                        to section 1115 of the Social Security Act;
                            ``(ii) a process for the submission of an 
                        application that ensures the disclosure of--
                                    ``(I) the provisions of law that 
                                the State involved seeks to waive; and
                                    ``(II) the specific plans of the 
                                State to ensure that the waiver will be 
                                in compliance with subsection (b);
                            ``(iii) a process for providing public 
                        notice and comment after the application is 
                        received by the Secretary, that is sufficient 
                        to ensure a meaningful level of public input 
                        and that does not impose requirements that are 
                        in addition to, or duplicative of, requirements 
                        imposed under the Administrative Procedure Act, 
                        or requirements that are unreasonable or 
                        unnecessarily burdensome with respect to State 
                        compliance;
                            ``(iv) a process for the Panel under 
                        subsection (g) to consider the applications for 
                        waivers so submitted and provide 
                        recommendations with respect to such 
                        applications;
                            ``(v) a process for the submission to the 
                        Secretary of periodic reports by the State 
                        concerning the implementation of the program 
                        under the waiver;
                            ``(vi) a process for the periodic 
                        evaluation by the Secretary with respect to 
                        waivers granted under this section; and
                            ``(vii) a process for providing technical 
                        assistance on--
                                    ``(I) how to develop an application 
                                to any State seeking to submit an 
                                application for a waiver relating to 
                                developing a program of providing 
                                health care for all residents for such 
                                State; and
                                    ``(II) how to improve such a 
                                program for purposes of a State seeking 
                                assistance pursuant to subsection 
                                (e)(2).
                    ``(C) Report.--The Secretary shall annually report 
                to Congress concerning actions taken by the Secretary 
                with respect to applications for waivers, and programs 
                conducted through waivers granted, under this section. 
                Each such report shall include, with respect to any 
                action by the Secretary so taken, with respect to an 
                application, that was not consistent with the 
                recommendations of the Panel under subsection (g), with 
                respect to such application, the reasons such action 
                was taken.
            ``(5) Regional waiver request and plan.--Nothing in this 
        section shall be construed to prevent two or more States in a 
        region from submitting a single application under this section 
        for a waiver that establishes a plan that is applicable to all 
        of the States included in such application. In the case of such 
        an application and plan, the requirements of this section shall 
        continue to be applicable with respect to each State included 
        in such application.
            ``(6) Authorization of appropriations.--There is authorized 
        to be appropriated such sums as may be necessary for providing 
        funds to States with a waiver under this section for purposes 
        of carrying out activities described in subsection (b)(1)(E).
    ``(b) Granting of Waivers.--
            ``(1) In general.--The Secretary may grant a request for a 
        waiver under subsection (a)(1) only if the Secretary determines 
        that the State plan--
                    ``(A) will provide, in accordance with subparagraph 
                (B), health benefits coverage to State residents that 
                is at least as comprehensive as the health benefits 
                coverage that such residents would have received under 
                the specified Federal health program (as defined in 
                subsection (i)(4)) for which such residents would have 
                been eligible, absent such waiver;
                    ``(B) will provide, in the case of such a waiver 
                under subsection (a)(1) for the State to waive any of 
                the requirements described in subsection (a)(2)(F), 
                health benefits coverage to State residents who would 
                have otherwise received health benefits coverage in the 
                form of medical assistance under the State Federal 
                health program described in subsection (i)(4)(B) 
                (regardless of whether the State provides for such 
                assistance through a State plan under title XIX of the 
                Social Security Act or a waiver of such plan) that 
                includes at least the mandatory benefits under title 
                XIX of the Social Security Act that are required of a 
                State without a waiver of a State plan under such 
                title, including at least benefits for early and 
                periodic screening, diagnostic, and treatment; benefits 
                for non-emergency transportation; and retroactive 
                coverage;
                    ``(C) will provide coverage and cost sharing 
                protections against excessive out-of-pocket spending to 
                State residents that are at least as affordable as the 
                coverage and cost sharing protections under the 
                specified Federal health program (as defined in 
                subsection (i)(4)) for which such residents would have 
                been eligible, absent such waiver;
                    ``(D) will provide coverage to all residents of the 
                State, including all those otherwise covered under the 
                Federal health care or subsidy programs specified in 
                subparagraphs (B), (C), (E), (F), (G), and (H) of 
                subsection (a)(2), except individuals who are eligible 
                for benefits through the Indian Health Service or for 
                benefits and services under title 38, United States 
                Code;
                    ``(E) will provide for public education activities 
                to raise awareness of the availability of qualified 
                health plans and the facilitation of enrollment in such 
                coverage in a manner similar to an entity that serves 
                as a navigator under a grant under section 1311(i);
                    ``(F) will be publicly administered by an agency of 
                the State;
                    ``(G) will not preclude the purchase of 
                supplemental insurance;
                    ``(H) will provide systems for complaints, appeals, 
                independent review, and other procedures for accessing 
                and maintaining benefits that are at least as 
                accessible to State residents as those of the specified 
                Federal health programs (as defined in subsection 
                (i)(4)) for which such residents would have otherwise 
                been eligible without application of such waiver under 
                subsection (a)(1); and
                    ``(I) will not increase the Federal deficit.
        Subparagraph (D) shall not be construed as limiting a State 
        from contracting with one or more private entities to 
        administer the plan.
            ``(2) Requirement to enact a law.--
                    ``(A) In general.--A law described in this 
                paragraph is a State law that provides for State 
                actions under a waiver under this section, including 
                the implementation of the State plan under subsection 
                (a)(1)(B).
                    ``(B) Termination of opt out.--A State may repeal a 
                law described in subparagraph (A) and terminate the 
                authority provided under the waiver with respect to the 
                State.
    ``(c) Scope of Waiver.--
            ``(1) In general.--The Secretary shall determine the scope 
        of a waiver of a requirement described in subsection (a)(2) 
        granted to a State under subsection (a)(1).
            ``(2) Limitation.--Under this section, the Secretary may 
        not waive any Federal law or requirement that is not listed in 
        subsection (a)(2).
    ``(d) Determinations by Secretary.--
            ``(1) Time for determination.--The Secretary shall, with 
        respect to an application from a State under this subsection 
        and after taking into account recommendations of the Panel 
        under subsection (g) for such application, make a determination 
        under subsection (a)(1) not later than 90 days after the 
        receipt of such recommendations.
            ``(2) Effect of determination.--
                    ``(A) Granting of waivers.--If the Secretary 
                determines to grant a waiver under subsection (a)(1), 
                the Secretary shall notify the State involved of such 
                determination and the terms and effectiveness of such 
                waiver.
                    ``(B) Denial of waiver.--If the Secretary 
                determines a waiver should not be granted under 
                subsection (a)(1), the Secretary shall notify the State 
                involved and the appropriate committees of Congress of 
                such determination and the reasons therefor.
    ``(e) Required Reports; 5-Year Review.--
            ``(1) In general.--As a condition of receipt of a waiver 
        under this section, after each 5-year period of such waiver, a 
        State shall submit to the Secretary a report that is carried 
        out by an independent, non-partisan entity, with respect to 
        such 5-year period and after a process for public notice and 
        comment at the State level, including public hearings, 
        sufficient to ensure a meaningful level of public input, on the 
        following:
                    ``(A) How waiver funds have been spent by the 
                State.
                    ``(B) The number of residents of the State without 
                health insurance and a description of how the State 
                plans to provide health insurance coverage within the 
                subsequent 5 years to residents of the State without 
                health insurance.
                    ``(C) How affordability in the State for health 
                care has changed over the period.
                    ``(D) Whether the State has achieved health 
                coverage for at least 95 percent of the population of 
                the State.
                    ``(E) Any additional information specified by the 
                Secretary for purposes of determining the successes and 
                challenges of the waiver.
            ``(2) 5-year review.--In the case a State, based on the 
        report submitted under paragraph (1) for a 5-year period--
                    ``(A) has been determined by the Secretary, after 
                taking into account recommendations of the Panel under 
                subsection (g), to have not achieved health coverage 
                for at least 95 percent of the population of the 
                State--
                            ``(i) the State shall have access to 
                        technical assistance described in subsection 
                        (a)(4)(B)(vii) to improve the health insurance 
                        program of the State implemented through the 
                        waiver under this section;
                            ``(ii) the State shall have a grace period 
                        of 6 months after such determination to achieve 
                        health coverage for at least 95 percent of such 
                        population; and
                            ``(iii) if after such 6 months, the State 
                        has not achieved such health coverage, the 
                        waiver under this section shall be terminated; 
                        and
                    ``(B) has been determined by the Secretary, after 
                taking into account recommendations of the Panel under 
                subsection (g), to have achieved health coverage for at 
                least 95 percent of the population of the State, the 
                State, as a condition of continuing such waiver, shall 
                submit to the Secretary a plan for achieving health 
                coverage for the remainder of the population of the 
                State.
    ``(f) Assuring Coordination.--
            ``(1) In general.--Not later than 180 days after the 
        enactment of the State-Based Universal Health Care Act of 2018, 
        the Secretary of Health and Human Services, the Secretary of 
        the Treasury, the Director of the Office of Personnel 
        Management, the Secretary of Defense, and the Secretary of 
        Labor shall, through the execution of an interagency memorandum 
        of understanding among such Secretaries and the Director--
                    ``(A) develop a process for coordinating and 
                consolidating the State waiver processes applicable 
                under the provisions of this section, and the existing 
                waiver processes applicable under--
                            ``(i) titles XI, XVIII, XIX, and XXI of the 
                        Social Security Act; and
                            ``(ii) any other Federal law relating to 
                        the provision of health care items or services; 
                        and
                    ``(B) ensure that--
                            ``(i) regulations (including regulations 
                        required under subsection (a)(4)(B)), rulings, 
                        and interpretations issued by such Secretaries 
                        and the Director relating to the same matter 
                        over which two or more such Secretaries or 
                        Director have responsibility under this section 
                        are administered so as to have the same effect 
                        at all times; and
                            ``(ii) coordination of policies relating to 
                        the granting, implementation, and continuation 
                        of waivers through such Secretaries and 
                        Director in order to have a coordinated 
                        strategy that avoids duplication of effort by 
                        the States or Secretaries and Director and 
                        ensures clarity about waiver application status 
                        and approval.
            ``(2) Single application.--The process under paragraph 
        (1)(A) shall permit a State to submit a single application for 
        a waiver under all of the provisions of this section and the 
        provisions of law listed under clauses (i) and (ii) of such 
        paragraph.
            ``(3) Submission of conforming amendments.--The Secretary 
        of Health and Human Services, in coordination with the other 
        Secretaries (including the Director of the Office of Personnel 
        Management), shall submit to Congress such recommendations for 
        such technical and conforming amendments to law as may be 
        appropriate to assist in the implementation of this section.
    ``(g) Independent Assessment Panel for Comprehensive Health Care.--
            ``(1) Establishment.--There is established a committee to 
        be known as the `Independent Assessment Panel for Comprehensive 
        Health Care' (in this section referred to as the `Panel').
            ``(2) Consideration of submissions.--The Secretary shall 
        forward a copy of each waiver application submitted under this 
        section to the Panel for consideration under this subsection.
            ``(3) Duties.--The Panel shall--
                    ``(A) review any waiver application by a State 
                forwarded under paragraph (2) and any report submitted 
                under paragraph (1) of subsection (e) for purposes of 
                the review under paragraph (2) of such subsection;
                    ``(B) not later than 90 days after submission of 
                such application (or report) by the State, provide to 
                the State and to the Secretary the recommendations of 
                the Panel regarding the approval or disapproval of such 
                waiver application (or regarding the status of the 
                waiver for continuation pursuant to subsection (e)(2)) 
                and, if applicable, possible improvements to such 
                application (or for purposes of subsection (e)(2)); and
                    ``(C) submit to Congress an annual report on waiver 
                applications (and waiver reports under subsection (e)) 
                reviewed by the Panel during the applicable year, 
                including the number of applications (and reports) 
                received and the number of applications recommended for 
                approval (and of reports with respect to which 
                recommendations for continuation were provided).
            ``(4) Membership.--
                    ``(A) Number and appointment.--The Panel shall 
                consist of seven members appointed by the Secretary of 
                Health and Human Services, of whom--
                            ``(i) one shall be appointed on the 
                        recommendation of the Speaker of the House of 
                        Representatives;
                            ``(ii) one shall be appointed on the 
                        recommendation of the minority leader of the 
                        House of Representatives;
                            ``(iii) one shall be appointed on the 
                        recommendation of the majority leader of the 
                        Senate;
                            ``(iv) one shall be appointed on the 
                        recommendation of the minority leader of the 
                        Senate;
                            ``(v) one shall be appointed from the 
                        Republican Governors Association;
                            ``(vi) one shall be appointed from the 
                        Democratic Governors Association; and
                            ``(vii) one shall be a representative from 
                        the consumer advocacy community.
                    ``(B) Term of service.--
                            ``(i) In general.--Each member of the Panel 
                        shall serve a three-year term. A member may 
                        serve after the expiration of that member's 
                        term until a successor has been appointed 
                        pursuant to subparagraph (A).
                            ``(ii) Vacancy.--Any member appointed to 
                        fill a vacancy occurring before the expiration 
                        of the term for which the member's predecessor 
                        was appointed shall be appointed only for the 
                        remainder of that term. A vacancy in the 
                        Commission shall be filled in the manner in 
                        which the original appointment was made.
                    ``(C) Pay.--Members of the Panel shall serve 
                without pay.
                    ``(D) Chairperson; vice chairperson.--
                            ``(i) Chairperson.--The Secretary of Health 
                        and Human Services, or a designee of the 
                        Secretary, shall serve on the Panel as the 
                        Chairperson of the Panel.
                            ``(ii) Vice chairperson.--The Administrator 
                        of the Federal Emergency Management Agency, or 
                        a designee of the Administrator, shall serve on 
                        the Panel as the Vice Chairperson of the Panel.
            ``(5) Staff, experts, and consultants.--The Panel may--
                    ``(A) appoint such staff as the Panel considers to 
                be appropriate, without regard to the provisions of 
                title 5, United States Code, governing appointments in 
                the competitive service;
                    ``(B) fix the pay of such staff, without regard to 
                the provisions of chapter 51 and subchapter III of 
                chapter 53 of such title relating to classification and 
                General Schedule pay rates; and
                    ``(C) procure the services of experts and 
                consultants in accordance with the provisions of 
                section 3109(b) of such title.
            ``(6) Detail of federal personnel.--Upon request of the 
        Panel, the head of any Federal agency may detail, on a 
        reimbursable basis, any of the personnel of the agency to the 
        Panel to assist it in carrying out the duties under paragraph 
        (3).
            ``(7) Federal advisory committee act.--The Federal Advisory 
        Committee Act (5 U.S.C. App.) shall apply to the Panel.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated such sums as may be necessary to the Panel 
        for carrying out the duties of the panel for each of fiscal 
        years 2018 through 2023.
    ``(h) Guidance Relating to American Indians and Alaska Natives.--
            ``(1) In general.--The Secretary shall issue guidance with 
        respect to applying the provisions of this section in a manner 
        consistent with the following:
                    ``(A) To further the goal that Federal health 
                services to maintain and improve the health of the 
                Indians are consonant with and required by the Federal 
                Government's historical and unique legal relationship 
                with, and resulting responsibility to, the American 
                Indian people.
                    ``(B) No enrollment fee, premium, or similar 
                charge, and no deduction, copayment, cost sharing, or 
                similar charge is to be imposed against an Indian who 
                is furnished an item or service through a waiver under 
                this section. All costs incurred in waiving such 
                charges shall be borne by the Federal Government in 
                fulfillment of the trust responsibility.
                    ``(C) A State may not require the enrollment of an 
                individual who is an Indian in health insurance offered 
                through a waiver under this section.
                    ``(D) Health insurance issuers offering coverage 
                pursuant to a waiver under this section must make good 
                faith efforts to contract with Indian Health Care 
                Providers operating within the area served by the 
                issuers.
                    ``(E) Health insurance issuers offering coverage 
                pursuant to a waiver under this section shall pay 
                Indian Health Care Providers, whether such providers 
                are participating or nonparticipating providers with 
                respect to the coverage, for covered services provided 
                to those Indian enrollees who are eligible to receive 
                services from such providers at a rate equal to the 
                rate negotiated between such entity and the provider 
                involved or, if such a rate has not been negotiated, at 
                a rate that is not less than the level and amount of 
                payment which the entity would make for the services if 
                the services were furnished by a participating provider 
                which is not an Indian Health Care Provider.
                    ``(F) Health insurance issuers offering coverage 
                pursuant to a waiver under this section will include a 
                standard contract addendum when contracting with Indian 
                Health Care Providers. The contract addendum will be 
                developed in consultation with tribes and in conference 
                with Urban Indian Health Programs operating within the 
                service area of the State.
                    ``(G) The treatment of Indians under this 
                legislation does not constitute invidious racial 
                discrimination in violation of the Due Process Clause 
                of the Fifth or Fourteenth Amendments, but is 
                reasonable and rationally designed to further the 
                health of Indians.
                    ``(H) In the case of any State in which 1 or more 
                Indian Health Care Programs furnishes health care 
                services, the State will provide for a process under 
                which the State seeks advice on a regular, ongoing 
                basis from designees of such Indian Health Care 
                Programs and Urban Indian Organizations on matters 
                relating to the application of a waiver under this 
                section that are likely to have a direct effect on such 
                Indian Health Programs and that--
                            ``(i) shall include solicitation of advice 
                        prior to submission of any plan amendments, 
                        waiver requests, and proposals for 
                        demonstration projects likely to have a direct 
                        effect on Indians or Indian Health Care 
                        Programs; and
                            ``(ii) may include appointment of an 
                        advisory committee and of a designee of such 
                        Indian Health Care Programs to the medical care 
                        advisory committee advising the State on its 
                        waiver under this section.
            ``(2) Definitions.--For purposes of this subsection:
                    ``(A) The term `Indian' has the meaning given such 
                term in section 447.50 of title 42 of the Code of 
                Federal Regulations (as in effect on July 1, 2010).
                    ``(B) The term `Indian Health Care Provider' has 
                the meaning given such term in section 438.14(a) of 
                title 42 of the Code of Federal Regulations.
    ``(i) Definitions.--In this section:
            ``(1) Health benefits coverage.--The term `health benefits 
        coverage'--
                    ``(A) means--
                            ``(i) health insurance coverage, as such 
                        term is defined in section 2791(b) of the 
                        Public Health Service Act (42 U.S.C. 300gg-
                        91(b)); and
                            ``(ii) coverage under a group health plan, 
                        as such term is defined in section 2791(a) of 
                        the Public Health Service Act (42 U.S.C. 300gg-
                        91(a)); and
                    ``(B) includes any medical coverage or health 
                benefits provided under any specified Federal health 
                program described in subparagraphs (A) through (E) of 
                paragraph (4).
            ``(2) Resident.--With respect to a State, the term 
        `resident' means an individual--
                    ``(A) who is--
                            ``(i) a citizen or national of the United 
                        States; or
                            ``(ii) an alien lawfully residing in the 
                        State (including an alien who is granted 
                        deferred action or who is otherwise authorized 
                        to remain in the United States); and
                    ``(B) whose primary residence (as defined by the 
                State) is located in the State.
            ``(3) Secretary.--The term `Secretary' means--
                    ``(A) the Secretary of Health and Human Services 
                with respect to waivers relating to the provisions 
                described in subparagraphs (A), (B), and (D) through 
                (G) of paragraph (2) of subsection (a);
                    ``(B) the Secretary of the Treasury with respect to 
                waivers relating to the provisions described in 
                subparagraph (C) of such paragraph;
                    ``(C) the Director of the Office of Personnel 
                Management with respect to waivers relating to the 
                provisions described in subparagraph (H) of such 
                paragraph;
                    ``(D) the Secretary of Defense with respect to 
                waivers relating to the provisions described in 
                subparagraph (I) of such paragraph; and
                    ``(E) the Secretary of Labor with respect to 
                waivers relating to the provisions described in 
                subparagraph (J) of such paragraph.
            ``(4) Specified federal health program.--The term 
        `specified Federal health program' means all of the following 
        programs:
                    ``(A) The Medicare program under title XVIII of the 
                Social Security Act.
                    ``(B) The Medicaid program under title XIX of the 
                Social Security Act.
                    ``(C) The Children's Health Insurance Program under 
                title XXI of the Social Security Act.
                    ``(D) The Federal Employees Health Benefits Plan 
                under chapter 89 of title 5 of the United States Code.
                    ``(E) Medical coverage under chapter 55 of title 
                10, United States Code, including coverage under the 
                TRICARE program.
                    ``(F) An Exchange established under this subtitle.
                    ``(G) Subsidies under section 1402.
                    ``(H) Tax credits under sections 36B and 45R of the 
                Internal Revenue Code of 1986.''.
    (b) Clerical Amendment.--The item in the table of contents in 
section 1(b) of the Patient Protection and Affordable Care Act relating 
to section 1332 is amended to read as follows:

``Sec. 1332. Waiver for State universal health care.''.
    (c) Continuation of Current Law for Current Waivers and Waiver 
Applications.--
            (1) In general.--Subject to paragraph (2), in the case of a 
        State that has applied to the Secretary of Health and Human 
        Services for a waiver under section 1332 of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18052), as in 
        effect before the enactment of this Act, for plan year 2018, 
        such section 1332 shall continue to apply to such application 
        and to any waiver under such application for subsequent plan 
        years.
            (2) Transition to new waiver law.--Nothing in paragraph (1) 
        shall be construed as preventing a State described in such 
        paragraph from withdrawing an application described in such 
        paragraph (or requesting the Secretary to terminate an approved 
        waiver referred to in such paragraph) for plan year 2019 or a 
        subsequent plan year and subsequently applying for a waiver 
        under section 1332 of the Patient Protection and Affordable 
        Care Act, as amended by subsection (a), for such a plan year.
                                 <all>