,,ii  #aacth ,,congress  #b;d ,session  
,s4 #bagd  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,march #bg1    
#bjad ,mr4 ,warner 7for himself1 ,mr4   
,manchin1 ,ms4 ,landrieu1 ,ms4          
,heitkamp1 ,mr4 ,begich1 ,mr4 ,franken1 
and ,ms4 ,klobuchar7 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 greater flexibility in       
offering health insurance coverage      
across ,state lines4  #a4 ,short title  
,this ,act may be cited as the          
,commonsense ,competition and ,access to
 ,health ,insurance ,act4  #b4          
,providing small business health        
insurance across ,state lines ,section  
#accc7;a77#a77;,a7 of the ,patient      
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjec7;a77#a77;,a77 is  
amended by inserting and small group    
markets after individual markets4  #c4  

,report and models ,section #accc of the
 ,patient ,protection and ,affordable   
,care ,act 7#db ,u4,s4,c4 #ahjec7 is    
amended by adding at the end the        
following3  7b7 ,,naic report and models
  7#a7 ,in general ,not later than      
,december #ca1 #bjad1 the ,secretary    
shall request that the ,national        
,association of ,insurance              
,commissioners submit to the ,secretary 
a report concerning health plans        
provided for under this section4 ,such  
report shall include-- 7,a7 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 issued2  7,b7 an assessment  
of how an out-of-,state insurer would go
 about building an adequate provider    
network2  7,c7 a description of how such
 challenges could be lessened without   
weakening the enforcement of laws and   
regulations described in subsection     

7a77#a77;,b77i7 in any ,state that is   
included in a compact under this        
section2  7,d7 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 issued2 and  7,e7 models to  
be used by ,states to establish and     
enter into interstate health care choice
 compacts under this section1 which--   
7i7 may include model legislation for   
use by ,states to enact laws to enter   
into such compacts2  7ii7 shall identify
 how ,states would continue to enforce1 
and not weaken1 the laws and regulations
 described in subsection 7a77#a77;,b77i7
 in any ,state that is included in such 
compact2 and  7iii7 shall identify how  
such models would ensure that there is  
no violation of the conditions for      
,secretarial approval under subsection  
7a77#c74  7#b7 ,other organizations and 
entities ,in making the request under   

paragraph 7#a71 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 issued4  7c7 ,report by      
,secretary ,not later than ,december    
#ca1 #bjad1 the ,secretary1 in          
consultation with the ,national         
,association of ,insurance              
,commissioners1 shall submit to         
,congress a report that describes how   
the ,secretary may utilize the          
flexibility provided by section         
#acaa7;f77#a7 7relating to allowing a   
regional or interstate exchange7 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 issued4 ,such report shall  

describe how an ,exchange operated by   
the ,federal ,government can be a       
conduit to forming interstate insurance 
,state compacts4  4