,,ii  #aac? ,,congress  #a/ ,session    
,s4 #aafd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #ac1 #bjac ,mr4  
,pryor 7= himself & ,mr4 ,coons7        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d ! ,pati5t  
,protection & ,af=dable ,c>e ,act to    
cl>ify provisions ) respect to *ur*     
plans4  #a4 ,%ort title ,?is ,act may be
 cit$ z ! ,*ur* ,heal? ,plan ,act (     
#bjac4  #b4 ,*ur* plans z qualifi$ heal?
 plans  7a7 ,9 g5]al ,section #acja7;a7 
( ! ,pati5t ,protection & ,af=dable ,c>e
 ,act 7#db ,u4,s4,c4 #ahjba7;a77 is     
am5d$--  7#a7 by r$esignat+ p>agraphs   
7#c7 & 7#d7 z p>agraphs 7#d7 & 7#e71    
respectively2 &  7#b7 by ins]t+ aft]    
p>agraph 7#b71 ! foll[+3  7#c7          
,inclusion ( qualifi$ *ur* plans  7,a7  
,9 g5]al ,any ref]5ce 9 ?is title to a  
qualifi$ heal? plan %all be deem$ to    
include a qualifi$ *ur* plan1 unless    
specifically provid$ = o!rwise4  7,b7   
,requirem5ts ( qualifi$ *ur* plans ,a   

qualifi$ *ur* plan is a *ur* plan1 z    
def9$ 9 section #dad7;e7 ( ! ,int]nal   
,rev5ue ,code ( #aihf1 t--  7i7 is a    
welf>e plan1 z def9$ 9 section #b7;c7 ( 
,public ,law #ajf-bdd1 & provides heal? 
c>e cov]age = ! employees ( t5 or m     
eligible common law employ]s1 & if a    
majority ( employees cov]$ by ! plan are
 employees ( *ur*es or qualifi$         
*ur*-controll$ organizations )9 ! mean+ 
( sections #caba7w77#c7 7,a7 & 7,b7 ( ! 
,int]nal ,rev5ue ,code ( #aihf1         
respectively2  7ii7 provides an ess5tial
 heal? b5efits package1 z def9$ 9       
section #acjb7;a72  7iii7 complies ) !  
requirem5ts "u sections #bgjc1 #bgjf1   
#bgjh1 #bgji1 #bgaa1 #bgab1 #bgac1      
#bgad1 #bgae1 #bgai1 & #bgai;,a ( !     
,public ,heal? ,s]vice ,act2  7iv7      
prohibits exclusions bas$ on preexi/+   
conditions or o!r heal? /atus1 &        
prohibits discrim9ation aga9/ individual
 p>ticipants & b5efici>ies bas$ on heal?
 /atus = ! purposes ( enrollm5t1 )9 !   
mean+ ( sections #bgjd & #bgje ( !      

,public ,heal? ,s]vice ,act1 except z   
provid$ "u subp>agraph 7,c77ii72 &  7v7 
limits1 on av]age1 ! ratio ( incurr$    
losses plus loss adju/m5t exp5ses to    
e>n$ premiums1 )9 ! mean+ ( section     
#bgah ( ! ,public ,heal? ,s]vice ,act1 z
 calculat$ across ! entire *ur* plan1   
except t1 = purposes ( ?is p>agraph1    
e>n$ premiums include paym5ts by1 or on 
behalf (1 employees ( a *ur*1 z def9$ 9 
#dad7;e77#c77;,b7 ( ! ,int]nal ,rev5ue  
,code ( #aihf4  7,c7 ,exclusion (       
qualifi$ *ur* plans f ,am]ican heal?    
b5efit ex*anges  7i7 ,9 g5]al ,a        
qualifi$ *ur* plan may n p>ticipate 9 an
 ,am]ican ,heal? ,b5efit ,ex*ange       
e/abli%$ by a ,/ate "u section #acaa7;b7
 or by ! ,secret>y ( ,heal? & ,human    
,s]vices 7ref]r$ to 9 ?is p>agraph z !  
,secret>y7 "u #acba7;c74 ,! ,secret>y   
%all n assess a *>ge or make a paym5t to
 a qualifi$ *ur* plan to reflect        
actu>ial risk pursuant to section #acdc1
 & a qualifi$ *ur* plan %all be exempt f
 any o!r subsidies1 paym5ts1 or         

requirem5ts "u ?is ,act t apply to      
qualifi$ heal? plans (f]$ on ,am]ican   
,heal? ,b5efit ,ex*anges1 except z      
provid$ by ?is p>agraph4  7ii7 ,premiums
 ,a qualifi$ *ur* plan may diff]5tiate  
premiums us+ me?ods & crit]ia consi/5t )
 ^? t ! ,secret>y uses to assess *>ges &
 paym5ts to o!r qualifi$ heal? plans    
bas$ on ! actu>ial risks ( enrollees (  
su* plans pursuant to section #acdc & ^?
 describ$ 9 section #dbb4cjh ( title    
#db1 ,code ( ,f$]al ,regulations4 ,a    
qualifi$ *ur* plan may develop          
additional me?ods & crit]ia to def9e &  
acc\nt = ! actu>ial risk associat$ ) !  
prohibition aga9/ qualifi$ *ur* plans   
enroll+ a l>g] numb] & m div]se pool (  
enrollees z long z su* additional me?ods
 & crit]ia are n inconsi/5t ) ! risk    
adju/]s describ$ 9 section #acdc & ^?   
describ$ 9 section #dbb4cjh ( title #db1
 ,code ( ,f$]al ,regulations4  7,d7     
,deem$ /atus ( qualifi$ *ur* plans ,a   
qualifi$ *ur* plan %all be deem$ to be--
  7i7 m9imum ess5tial cov]age "u an     

eligible employ]-sponsor$ plan1 z def9$ 
"u section #ejjj;,a7f77#b7 ( ! ,int]nal 
,rev5ue ,code ( #aihf2 &  7ii7 = !      
purposes ( subp>agraph 7,f71 equival5t  
to a heal? plan (f]$ ?r\gh an ,am]ican  
,heal? ,b5efit ,ex*ange1 )9 ! mean+ (   
section #acaa7;b74  7,e7 ,employ]s      
p>ticipat+ 9 qualifi$ *ur* plans  7i7   
,eligible small employ]s ,an employ]    
p>ticipat+ 9 a qualifi$ *ur* plan %all  
be deem$ an eligible small employ] "u   
section #de,r7d7 ( ! ,int]nal ,rev5ue   
,code ( #aihf1 if--  7,i7 ! employ] has 
n m ?an #be full-"t equival5t employees1
 z def9$ "u section #de,r7d77#b7 ( !    
,int]nal ,rev5ue ,code ( #aihf1 = !     
taxable ye>2 &  7,,ii7 ! av]age annual  
wages ( su* full-"t equival5t employees 
d exce$ an am\nt equal to twice ! doll> 
am\nt 9 effect "u section               
#de,r7d77#c77;,b7 ( ! ,int]nal ,rev5ue  
,code ( #aihf = ! taxable ye>1 & if no  
employee ( ! employ] :o is enroll$ 9 !  
qualifi$ *ur* plan receives premium tax 
cr$its or r$uctions 9 co/-%>+ "u        

subp>agraph 7,f74  7ii7 ,no exclusion f 
wages ,any employ] p>ticipat+ 9 a       
qualifi$ *ur* plan %all n exclude f     
wages & o!r comp5sation1 = any          
individual receiv+ premium tax cr$its "u
 section #adja1 any employ] contribution
 = m9imum ess5tial cov]age "u a qualifi$
 *ur* plan "u section #ajf ( ! ,int]nal 
,rev5ue ,code ( #aihf4  7iii7 ,employ]s 
p>ticipat+ 9 qualifi$ *ur* plans ,any   
employ] p>ticipat+ 9 a qualifi$ *ur*    
plan %all be deem$ to be a religi\s     
employ] z def9$ 9 section #adg4aca (    
title #de1 ,code ( ,f$]al ,regulations4 
7,f7 ,premium tax cr$its1 r$uctions 9   
co/-%>+1 & qualifi$ *ur* plans ,an      
individual receiv+ m9imum ess5tial      
cov]age "u a qualifi$ *ur* plan--  7i7  
%all be deem$ to satisfy ! individual   
responsibility requirem5ts "u section   
#ejjj;,a ( ! ,int]nal ,rev5ue ,code (   
#aihf2  7ii7 %all be deem$ to qualify z 
an applicable taxpay] eligible to       
receive premium tax cr$its "u section   
#adja1 if ! individual's h\sehold income

 = ! taxable ye> equals or exce$s #ajj  
p]c5t b does n exce$ #djj p]c5t ( an    
am\nt equal to ! pov]ty l9e = a family (
 ! size involv$2 &  7iii7 %all be deem$ 
to qualify z an eligible insur$ eligible
 to receive r$uctions 9 co/-%>+ "u      
section #adjb7;b71 if ! individual's    
h\sehold income exce$s #ajj p]c5t b does
 n exce$ #djj p]c5t ( ! pov]ty l9e = a  
family ( ! size involv$4  7,g7          
,regulations ,! ,secret>y & ! ,secret>y 
( ! ,treasury %all promulgate           
regulations--  7i7 "u subp>agraph 7,e7  
to ensure t an eligible small employ]   
(f]+ a qualifi$ *ur* plan receives !    
same tax cr$it z any o!r eligible small 
employ] "u section #de,r ( ! ,int]nal   
,rev5ue ,code ( #aihf2  7ii7 "u         
subp>agraph 7,f77ii7 to ensure t an     
applicable taxpay] receiv+ m9imum       
ess5tial cov]age "u a qualifi$ *ur* plan
 receives ! same premium tax cr$it z any
 o!r applicable taxpay] "u section      
#adja2  7iii7 "u subp>agraph 7,f77iii7  
to ensure t an eligible insur$ receiv+  

m9imum ess5tial cov]age "u a qualifi$   
*ur* plan receives ! same r$uction 9    
co/-%>+ z any o!r eligible insur$ "u    
section #adjb2 &  7iv7 provid+ *ur*     
plans suffici5t opportunity to make     
appropriate transitions 9 ord] to meet !
 def9ition ( qualifi$ *ur* plan "u      
subp>agraph 7,b74  4  7b7 ,effective    
date ,! am5dm5ts made by ?is ,act %all  
take effect z if enact$ z "p ( ! ,pati5t
 ,protection & ,af=dable ,c>e ,act      
7,public ,law #aaa-adh74