II 113th CONGRESS 2d Session S. 2174 IN THE SENATE OF THE UNITED STATES March 27, 2014 Mr. Warner (for himself, Mr. Manchin , Ms. Landrieu , Ms. Heitkamp , Mr. Begich , Mr. Franken , and Ms. Klobuchar ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Patient Protection and Affordable Care Act to provide greater flexibility in offering health insurance coverage across State lines.

1. Short title This Act may be cited as the Commonsense Competition and Access to Health Insurance Act . 2. Providing small business health insurance across State lines Section 1333(a)(1)(A) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18053(a)(1)(A) ) is amended by inserting and small group markets after individual markets . 3. Report and models Section 1333 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18053 ) is amended by adding at the end the following: (b) NAIC report and models (1) In general Not later than December 31, 2014, the Secretary shall request that the National Association of Insurance Commissioners submit to the Secretary a report concerning health plans provided for under this section. Such report shall include— (A) a description of the challenges that States would face by permitting issuers of qualified health plans to offer such plans in States other than those States where such plan was originally written or issued; (B) an assessment of how an out-of-State insurer would go about building an adequate provider network; (C) a description of how such challenges could be lessened without weakening the enforcement of laws and regulations described in subsection (a)(1)(B)(i) in any State that is included in a compact under this section; (D) a description of the commonalities that exist in State laws and opportunities to allow issuers of qualified health plans to offer such plans in States other than those States where such plan was originally written or issued; and (E) models to be used by States to establish and enter into interstate health care choice compacts under this section, which— (i) may include model legislation for use by States to enact laws to enter into such compacts; (ii) shall identify how States would continue to enforce, and not weaken, the laws and regulations described in subsection (a)(1)(B)(i) in any State that is included in such compact; and (iii) shall identify how such models would ensure that there is no violation of the conditions for Secretarial approval under subsection (a)(3). (2) Other organizations and entities In making the request under paragraph (1), the Secretary may also request that the National Association of Insurance Commissioners gather concepts for inclusion in the report under such paragraph from organizations and entities that have experience in offering qualified health plans in States in which such plans were not originally issued. (c) Report by Secretary Not later than December 31, 2014, the Secretary, in consultation with the National Association of Insurance Commissioners, shall submit to Congress a report that describes how the Secretary may utilize the flexibility provided by section 1311(f)(1) (relating to allowing a regional or interstate exchange) to allow health insurance issuers offering qualified health plans in an Exchange operated by the Federal Government to offer plans in a State other than the State in which such plan was originally written or issued. Such report shall describe how an Exchange operated by the Federal Government can be a conduit to forming interstate insurance State compacts. .