II 113th CONGRESS 2d Session S. 2173 IN THE SENATE OF THE UNITED STATES March 27, 2014 Ms. Landrieu (for herself, Mr. Manchin , Mr. Warner , Ms. Heitkamp , and Mr. Begich ) 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 a permanent path for the direct enrollment of individuals in qualified health plans.

1. Short title This Act may be cited as the Consumers Having Options in Choosing Enrollment Act or the CHOICE Act . 2. Permanent Pathway for Direct Enrollment (a) Findings Congress finds the following: (1) Successful implementation of the Patient Protection and Affordable Care Act (referred to in this section as the ACA ) is critical to ensuring that more Americans are able to access health care coverage. (2) The ACA provided for the establishment of new State-based or, in the absence of State action, federally facilitated marketplaces to help connect consumers with health insurance options and coverage. (3) As part of the regulatory guidance related to the marketplaces, the Department of Health and Human Services provided consumers with an option to enroll in health insurance coverage directly, known as direct enrollment. (4) The Department of Health and Human Services also permits enrollment through an Exchange with the assistance of an agent or broker, including permitting consumers to select a product on the Internet website of an agent or broker. (5) Consumers should be permitted a permanent option to enroll directly with a qualified health plan issuer, or Internet website of an agent or broker, in a manner consistent with the marketplaces and as long as certain consumer protections are followed. (6) Consumers should continue to be informed that other health insurance products are available and offered. (7) Consumers should be notified of their eligibility determination for coverage through the Exchange Internet website for premium tax credits and cost sharing reductions. (8) Direct enrollment is not a new idea and has proven to work successfully in getting seniors coverage through the Medicare Advantage program and the Medicare Part D program. (9) Providing a permanent pathway for consumers to directly enroll with a qualified health plan issuer or the certified Internet website of an agent or broker gives such consumers another option to sign up for health insurance coverage and takes the United States one step closer to achieving the goals of the ACA. (b) Direct enrollment Section 1312 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18032 ) is amended by adding at the end the following: (g) Direct enrollment (1) In general Not later than 30 days after the date of enactment of this subsection, the Secretary shall issue guidelines and necessary operational specifications to provide for the establishment of a permanent pathway to enable individuals to enroll in qualified health plans through— (A) in the case of a State with a State-based Exchange, the Exchange, or if determined appropriate by the State, a health insurance issuer, a certified agent or broker, or a Centers for Medicare & Medicaid Services certified Internet web-based broker or entity; or (B) in the case of a State with no State Exchange, the Federal Exchange, a health insurance issuer, an agent or broker certified by the Federal Exchange, or a Centers for Medicare & Medicaid Services certified Internet web-based broker or entity. (2) Availability Guidelines and operational capabilities issued under paragraph (1) shall be available to consumers and applicable health insurance issuers and entities for any enrollment period required under section 1311(c)(6). .