,,ii  #aac? ,,congress  #b;d ,session   
,s4 #bchc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #bb1 #bjad ,mr4   
,alex&] introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to direct ! ,(fice 
( ! ,actu>y ( ! ,c5t]s = ,m$ic>e        
,m$icaid ,s]vices & ! ,comptroll] ,g5]al
 ( ! ,unit$ ,/ates to /udy ! impact ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act on small bus9esses4  #a4  ,%ort    
title  ,?is ,act may be cit$ z ! ,c]tify
 ,x ,act ( #bjad4  #b4  ,/udy on impact 
on small bus9ess jobs  7a7  ,/udy &     
report  7#a7  ,9 g5]al  ,n lat] ?an #a  
ye> aft] ! date ( enactm5t ( ?is ,act1 &
 ,decemb] #a = ea* ( ! #d consecutive   
ye>s !reaft]1 ! ,comptroll] ,g5]al ( !  
,unit$ ,/ates1 %all conduct a /udy on ! 
impact ( ! ,af=dable ,c>e ,act on small 
bus9esses1 includ+--  7,a7 ! impact (   
any increas$ heal? insurance co/s       
result+ f ! provisions ( su* ,act on    
economic indicators 7includ+ jobs lo/1  
h\rs work$ p] employee1 & any result+   

loss ( wages72 &  7,b7 ! impact (       
section #dihj;,h ( ! ,int]nal ,rev5ue   
,code ( #aihf 7relat+ to %>$            
responsibility = employ]s reg>d+ heal?  
cov]age7 on economic indicators1 includ+
 any jobs lo/4  7#b7  ,report  ,!       
,comptroll] ,g5]al ( ! ,unit$ ,/ates1   
us+ data f ! ,(fice ( ! ,actu>y1 ,c5t]s 
= ,m$ic>e  ,m$icaid ,s]vices1 "u section
 #c & economic indicators data f o!r    
,f$]al ag5cies1 %all submit to !        
appropriate committees ( ,congress a    
report on ! /udy conduct$ "u p>agraph   
7#a74  7b7  ,appropriate committees (   
congress  ,= purposes ( ?is section1 !  
t]m appropriate committees ( ,congress  
means ! ,committee on ,ways & ,means1 ! 
,committee on ,education & ! ,work=ce1 !
 ,committee on ,en]gy & ,comm]ce1 & !   
,small ,bus9ess ,committee ( ! ,h\se (  
,repres5tatives & ! ,committee on       
,f9ance1 ! ,committee on ,heal?1        
,education1 ,labor1 & ,p5sions1 & !     
,small ,bus9ess & ,entrepr5eur%ip       
,committee ( ! ,s5ate4  7c7 ,def9itions 

,= purposes ( ?is ,act3  7#a7  ,af=dable
 c>e act  ,! t]m ,af=dable ,c>e ,act    
means ! ,pati5t ,protection & ,af=dable 
,c>e ,act 7,public ,law #aaa-adh7 &     
title ,i & subtitle ,b ( title ,,ii ( ! 
,heal? ,c>e & ,education ,reconciliation
 ,act ( #bjaj 7,public ,law #aaa-aeb74  
7#b7 ,small bus9ess ,! t]m small bus9ess
 means an employ] ) #bej or few]        
employees4  #c4  ,/udy on impact on     
small bus9ess heal? insurance  7a7      
,/udy & report  7#a7  ,9 g5]al  ,n lat] 
?an #a ye> aft] ! date ( ! enactm5t (   
?is ,act1 & ,decemb] #a = ea* ( ! #d    
consecutive ye>s !reaft]1 ! ,(fice ( !  
,actu>y1 ,c5t]s = ,m$ic>e  ,m$icaid     
,s]vices1 %all conduct a /udy on !      
impact ( ! ,af=dable ,c>e ,act on small 
gr\p heal? insurance co/s1 includ+--    
7,a7 ! impact ( requirem5ts & b5efits   
pursuant to su* ,act on ! small gr\p    
heal? insurance m>ket1 includ+ community
 rat+ requirem5ts1 m9imum actu>ial value
 requirem5ts1 requirem5ts to provide =  
ess5tial heal? b5efits describ$ 9       

section #acjb7;b7 ( ! ,pati5t           
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjbb7;b771 requirem5ts      
relat$ to co/-%>+1 ! prohibition on     
annual & lifetime limits on b5efits "u  
section #bgaa ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;gg-#aa71      
prohibitions on co/-%>+ requirem5ts =   
prev5tive s]vices1 & ! ext5sion (       
dep5d5t cov]age "u section #bgad ( !    
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ad72 &  7,b7 ! impact
 ( new taxes & fees on ! small gr\p     
heal? insurance m>ket co/s1 includ+ !   
fee impos$ "u section #ijaj ( ! ,pati5t 
,protection & ,af=dable ,c>e ,act       
7relat+ to imposition ( annual fee on   
heal? insurance provid]s71 !            
transitional re9surance program         
contributions1 ! fees impos$ "u sub*apt]
 ,b ( *apt] #cd ( ! ,int]nal ,rev5ue    
,code ( #aihf 7relat+ to ! ,pati5t      
,c5t]$ ,outcome ,rese>* ,in/itute fees71
 & ,ex*ange assessm5ts or us] fees4     
7#b7  ,report  ,! ,(fice ( ! ,actu>y1   

,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1 9  
consultation ) ! ,comptroll] ,g5]al =   
purposes ( v]ify+ ! me?odology1         
assumptions1 validity1 & reasonabl5ess (
 ! data us$ by ! ,actu>y1 %all submit to
 ! appropriate committees ( ,congress a 
report on ! /udy conduct$ "u p>agraph   
7#a74  7b7  ,appropriate committees (   
congress  ,= purposes ( ?is section1 !  
t]m appropriate committees ( ,congress  
means ! ,committee on ,ways & ,means1 ! 
,committee on ,education & ! ,work=ce1 !
 ,committee on ,en]gy & ,comm]ce1 & !   
,small ,bus9ess ,committee ( ! ,h\se (  
,repres5tatives & ! ,committee on       
,f9ance1 ! ,committee on ,heal?1        
,education1 ,labor1 & ,p5sions1 & !     
,small ,bus9ess & ,entrepr5eur%ip       
,committee ( ! ,s5ate4  #d4  ,"o-ye>    
delay = employ] m&ate 9 case ( negative 
impact on small bus9ess  7a7  ,9 g5]al  
,if ! ,comptroll] ,g5]al ( ! ,unit$     
,/ates or ! ,(fice ( ! ,actu>y1 ,c5t]s =
 ,m$ic>e  ,m$icaid ,s]vices1 det]m9es 9 
any report submitt$ "u section #b or #c 

t ! ,af=dable ,c>e ,act has caus$ net   
employm5t loss among/ small bus9esses or
 caus$ small gr\p heal? insurance co/s  
to rise1 section #dihj;,h ( ! ,int]nal  
,rev5ue ,code ( #aihf %all n apply =    
mon?s beg9n+ dur+ ! #a-ye> p]iod beg9n+ 
on ! date ( ! submission ( su* report4  
7b7 ,failure ,to submit ,if !           
,comptroll] ,g5]al ( ! ,unit$ ,/ates or 
! ,(fice ( ! ,actu>y1 ,c5t]s = ,m$ic>e  
,m$icaid ,s]vices1 fails to submit a    
report 9 accordance ) ! timel9es        
specifi$ 9 ?is ,act1 section #dihj;,h ( 
! ,int]nal ,rev5ue ,code ( #aihf %all n 
apply ! foll[+ cal5d> ye>4