,,ii  #aacth ,,congress  #b;d ,session  
,s4 #bagc  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,march #bg1    
#bjad ,ms4 ,landrieu 7for herself1 ,mr4 
,manchin1 ,mr4 ,warner1 ,ms4 ,heitkamp1 
and ,mr4 ,begich7 introduced the        
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 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 plans4  #a4 ,short     
title  ,this ,act may be cited as the   
,consumers ,having ,options in ,choosing
 ,enrollment ,act or the ,,choice ,act4 
#b4 ,permanent ,pathway for ,direct     
,enrollment  7a7 ,findings ,congress    
finds the following3 7#a7 ,successful   
implementation of the ,patient          
,protection and ,affordable ,care ,act  
7referred to in this section as the     
,,aca7 is critical to ensuring that more
 ,americans are able to access health   

care coverage4  7#b7 ,the ,,aca provided
 for the establishment of new           
,state-based or1 in the absence of      
,state action1 federally facilitated    
marketplaces to help connect consumers  
with health insurance options and       
coverage4  7#c7 ,as part of the         
regulatory guidance related to the      
marketplaces1 the ,department of ,health
 and ,human ,services provided consumers
 with an option to enroll in health     
insurance coverage directly1 known as   
direct enrollment4  7#d7 ,the           
,department of ,health and ,human       
,services also permits enrollment       
through an ,exchange with the assistance
 of an agent or broker1 including       
permitting consumers to select a product
 on the ,internet website of an agent or
 broker4  7#e7 ,consumers should be     
permitted a permanent option to enroll  
directly with a qualified health plan   
issuer1 or ,internet website of an agent
 or broker1 in a manner consistent with 
the marketplaces and as long as certain 

consumer protections are followed4  7#f7
 ,consumers should continue to be       
informed that other health insurance    
products are available and offered4     
7#g7 ,consumers should be notified of   
their eligibility determination for     
coverage through the ,exchange ,internet
 website for premium tax credits and    
cost sharing reductions4  7#h7 ,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 program4  7#i7 ,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 ,,aca4  7b7  
,direct enrollment ,section #acab of the
 ,patient ,protection and ,affordable   
,care ,act 7#db ,u4,s4,c4 #ahjcb7 is    

amended by adding at the end the        
following3  7g7 ,direct enrollment  7#a7
 ,in general ,not later than #cj days   
after the date of enactment of this     
subsection1 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-- 7,a7 in
 the case of a ,state with a            
,state-based ,exchange1 the ,exchange1  
or if determined appropriate by the     
,state1 a health insurance issuer1 a    
certified agent or broker1 or a ,centers
 for ,medicare  ,medicaid ,services     
certified ,internet web-based broker or 
entity2 or  7,b7 in the case of a ,state
 with no ,state ,exchange1 the ,federal 
,exchange1 a health insurance issuer1 an
 agent or broker certified by the       
,federal ,exchange1 or a ,centers for   
,medicare  ,medicaid ,services certified
 ,internet web-based broker or entity4  
7#b7 ,availability ,guidelines and      

operational capabilities issued under   
paragraph 7#a7 shall be available to    
consumers and applicable health         
insurance issuers and entities for any  
enrollment period required under section
 #acaa7;c77#f74  4