,i  #aadth ,,congress  #ast ,session    
,h4 ,r4 #cbda  ,,in ,,the ,,house ,,of  
,,representatives  ,july #bh1 #bjae ,mr4
 ,mc,dermott introduced the following   
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committees on ,ways
 and ,means1 ,oversight and ,government 
,reform1 ,armed ,services1 and          
,education and the ,workforce1 for a    
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
amend title ,i of the ,patient          
,protection and ,affordable ,care ,act  
to authorize the establishment of1 and  
provide support for1 ,state-based       
universal health care systems that      
provide comprehensive health benefits to
 ,state residents1 and for other        
purposes4  #a4 ,short title2 purpose    
7a7 ,short title ,this ,act may be cited
 as the ,state-,based ,universal ,health

 ,care ,act of #bjae4  7b7 ,purpose ,the
 purpose of this ,act is to establish a 
flexible framework under which each     
,state can provide comprehensive        
universal health coverage to all of its 
residents4  #b4 ,waiver for ,state      
universal health care  7a7 ,in general  
,subtitle ,d of title ,i of the ,patient
 ,protection and ,affordable ,care ,act 
7,public ,law #aaa-adh7 is amended by   
inserting after section #accb 7#db      
,u4,s4,c4 #ahjeb7 the following new     
section3  #accb;,a4 ,waiver for ,state  
universal health care  7a7 ,application 
7#a7 ,in general ,a ,state may apply to 
the ,secretary 7as defined in subsection
 7g77#c77 for the waiver of so much of  
the requirements described in paragraph 
7#b7 with respect to health benefits    
coverage within that ,state for plan    
years beginning on or after ,january #a1
 #bjaf1 as is necessary to implement a  
comprehensive ,state universal health   
care plan in the ,state under this      
section4 ,such application shall--  7,a7

 be filed at such time and in such      
manner as the ,secretary may require2   
7,b7 contain such information as the    
,secretary may require1 including--  7i7
 a comprehensive description of the     
,state legislation and program to       
implement a plan meeting the            
requirements for a waiver under this    
section2 and  7ii7 a #aj-;fiscal-year   
budget plan for such plan that is budget
 neutral for the ,federal ,government2  
and  7,c7 provide an assurance that the 
,state has enacted the law described in 
subsection 7b77#b74  7#b7 ,requirements 
,the requirements described in this     
paragraph with respect to health        
benefits coverage within the ,state for 
plan years beginning on or after        
,january #a1 #bjaf1 are as follows3     
7,a7 ,parts ,i1 ,,ii1 and ,,iii of      
subtitle ,d4  7,b7 ,section #adjb4  7,c7
 ,sections #cf;,b1 #dihj;,h1 and        
#ejjj;,a of the ,internal ,revenue ,code
 of #aihf4  7,d7 ,title ,,xi of the     
,social ,security ,act4  7,e7 ,title    

,,xviii of the ,social ,security ,act4  
7,f7 ,title ,,xix of the ,social        
,security ,act4  7,g7 ,title ,,xxi of   
the ,social ,security ,act4  7,h7       
,chapter #hi of title #e of the ,united 
,states ,code4  7,i7 ,chapter #ee of    
title #aj1 ,united ,states ,code1       
including coverage under the ,,tricare  
program4  7,j7 ,section #ead of the     
,employee ,retirement ,income ,security 
,act of #aigd4  7#c7 ,pass through of   
funding ,with respect to a ,state waiver
 under paragraph 7#a71 under which the  
,state assumes responsibility for health
 coverage under a specified ,federal    
health program1 including under each of 
the ,federal health care or subsidy     
programs specified in subparagraphs     
7,b71 7,c71 7,e71 7,f71 7,g71 and 7,h7  
of paragraph 7#b71 the ,secretary shall 
not spend ,federal health funds that    
would otherwise have been spent for such
 program and shall provide for an       
alternative means by which the aggregate
 amount of such funds shall be paid to  

the ,state for purposes of implementing 
the ,state plan under the waiver4 ,such 
amount shall be determined annually by  
the ,secretary1 taking into account the 
amount that would otherwise have been   
spent under such ,federal health program
 with respect to residents of such      
,state1 if such waiver did not apply4   
,such amount shall include funds equal  
to the amount of premium tax credits1   
cost-sharing reductions1 or             
small-business credits under sections   
#cf;,b and #de,r of the ,internal       
,revenue ,code of #aihf or under section
 #adjb that would have been available to
 individuals and businesses in the      
,state if such waiver did not apply4    
7#d7 ,waiver consideration and          
transparency  7,a7 ,in general ,an      
application for a waiver under this     
section shall be considered by the      
,secretary in accordance with the       
regulations described in subparagraph   
7,b74  7,b7 ,regulations ,not later than
 #ahj days after the date of enactment  

of the ,state-,based ,universal ,health 
,care ,act of #bjae1 the ,secretary     
shall promulgate regulations relating to
 waivers under this section that        
provide-- 7i7 a process for public      
notice and comment at the ,state level1 
including public hearings1 sufficient to
 ensure a meaningful level of public    
input2  7ii7 a process for the          
submission of an application that       
ensures the disclosure of-- 7,i7 the    
provisions of law that the ,state       
involved seeks to waive2 and  7,,ii7 the
 specific plans of the ,state to ensure 
that the waiver will be in compliance   
with subsection 7b72  7iii7 a process   
for providing public notice and comment 
after the application is received by the
 ,secretary1 that is sufficient to      
ensure a meaningful level of public     
input and that does not impose          
requirements that are in addition to1 or
 duplicative of1 requirements imposed   
under the ,administrative ,procedure    
,act1 or requirements that are          

unreasonable or unnecessarily burdensome
 with respect to ,state compliance2     
7iv7 a process for the submission to the
 ,secretary of periodic reports by the  
,state concerning the implementation of 
the program under the waiver2 and  7v7 a
 process for the periodic evaluation by 
the ,secretary with respect to waivers  
granted under this section4  7,c7       
,report ,the ,secretary shall annually  
report to ,congress concerning actions  
taken by the ,secretary with respect to 
applications for waivers1 and programs  
conducted through waivers granted1 under
 this section4  7b7 ,granting of waivers
  7#a7 ,in general ,the ,secretary may  
grant a request for a waiver under      
subsection 7a77#a7 only if the          
,secretary determines that the ,state   
plan--  7,a7 will provide health        
benefits coverage to ,state residents   
that is at least as comprehensive as the
 health benefits coverage that such     
residents would have received under the 
specified ,federal health program for   

which such residents would have been    
eligible1 absent such waiver2  7,b7 will
 provide coverage and cost sharing      
protections against excessive           
out-of-pocket spending to ,state        
residents that are at least as          
affordable as the coverage and cost     
sharing protections under the specified 
,federal health program for which such  
residents would have been eligible1     
absent such waiver2  7,c7 will provide  
coverage to substantially all residents 
of the ,state1 including substantially  
all those otherwise covered under the   
,federal health care or subsidy programs
 specified in subparagraphs 7,b71 7,c71 
7,e71 7,f71 7,g71 and 7,h7 of subsection
 7a77#b71 except individuals who are    
eligible for benefits through the       
,indian ,health ,service or for benefits
 and services under title #ch1 ,united  
,states ,code2  7,d7 will be publicly   
administered by an agency of the ,state2
 and  7,e7 will not increase the        
,federal deficit4  ,subparagraph 7,d7   

shall not be construed as limiting a    
,state from contracting with one or more
 private entities to administer the     
plan4  7#b7 ,requirement to enact a law 
7,a7 ,in general ,a law described in    
this paragraph is a ,state law that     
provides for ,state actions under a     
waiver under this section1 including the
 implementation of the ,state plan under
 subsection 7a77#a77;,b74  7,b7         
,termination of opt out ,a ,state may   
repeal a law described in subparagraph  
7,a7 and terminate the authority        
provided under the waiver with respect  
to the ,state4  7c7 ,scope of waiver    
7#a7 ,in general ,the ,secretary shall  
determine the scope of a waiver of a    
requirement described in subsection     
7a77#b7 granted to a ,state under       
subsection 7a77#a74  7#b7 ,limitation   
,under this section1 the ,secretary may 
not waive any ,federal law or           
requirement that is not listed in       
subsection 7a77#b74  7d7 ,determinations
 by ,secretary  7#a7 ,time for          

determination ,the ,secretary shall make
 a determination under subsection       
7a77#a7 not later than #ahj days after  
the receipt of an application from a    
,state under such subsection4  7#b7     
,effect of ,determination  7,a7         
,granting of waivers ,if the ,secretary 
determines to grant a waiver under      
subsection 7a77#a71 the ,secretary shall
 notify the ,state involved of such     
determination and the terms and         
effectiveness of such waiver4  7,b7     
,denial of waiver ,if the ,secretary    
determines a waiver should not be       
granted under subsection 7a77#a71 the   
,secretary shall notify the ,state      
involved and the appropriate committees 
of ,congress of such determination and  
the reasons therefor4  7e7 ,term of     
waiver ,no waiver under this section may
 extend over a period of longer than #e 
years unless the ,state requests        
continuation of such waiver1 and such   
request shall be deemed granted unless  
the ,secretary1 within #ij days after   

the date of its submission to the       
,secretary1 either denies such request  
in writing or informs the ,state in     
writing with respect to any additional  
information which is needed in order to 
make a final determination with respect 
to the request4  7f7 ,assuring          
coordination  7#a7 ,in general ,not     
later than #ahj days after the enactment
 of the ,state-,based ,universal ,health
 ,care ,act of #bjae1 the ,secretary of 
,health and ,human ,services1 the       
,secretary of the ,treasury1 the        
,director of the ,office of ,personnel  
,management1 the ,secretary of ,defense1
 and the ,secretary of ,labor shall1    
through the execution of an interagency 
memorandum of understanding among such  
,secretaries and the ,director--  7,a7  
develop a process for coordinating and  
consolidating the ,state waiver         
processes applicable under the          
provisions of this section1 and the     
existing waiver processes applicable    
under--  7i7 titles ,,xi1 ,,xviii1      

,,xix1 and ,,xxi of the ,social         
,security ,act2 and  7ii7 any other     
,federal law relating to the provision  
of health care items or services2 and   
7,b7 ensure that-- 7i7 regulations      
7including regulations required under   
subsection 7a77#d77;,b771 rulings1 and  
interpretations issued by such          
,secretaries and the ,director relating 
to the same matter over which two or    
more such ,secretaries or ,director have
 responsibility under this section are  
administered so as to have the same     
effect at all times2 and  7ii7          
coordination of policies relating to the
 granting1 implementation1 and          
continuation of waivers through such    
,secretaries and ,director in order to  
have a coordinated strategy that avoids 
duplication of effort by the ,states or 
,secretaries and ,director and ensures  
clarity about waiver application status 
and approval4  7#b7 ,single application 
,the process under paragraph 7#a77;,a7  
shall permit a ,state to submit a single

 application for a waiver under all of  
the provisions of this section and the  
provisions of law listed under clauses  
7i7 and 7ii7 of such paragraph4  7#c7   
,submission of conforming amendments    
,the ,secretary of ,health and ,human   
,services1 in coordination with the     
other ,secretaries 7including the       
,director of the ,office of ,personnel  
,management71 shall submit to ,congress 
such recommendations for such technical 
and conforming amendments to law as may 
be appropriate to assist in the         
implementation of this section4  7g7    
,definitions ,in this section3 7#a7     
,health benefits coverage ,the term     
health benefits coverage--  7,a7 means--
 7i7 health insurance coverage1 as such 
term is defined in section #bgia7;b7 of 
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #cjj;gg-#ia7;b772 and  7ii7   
coverage under a group health plan1 as  
such term is defined in section         
#bgia7;a7 of the ,public ,health        
,service ,act 7#db ,u4,s4,c4            

#cjj;gg-#ia7;a772 and  7,b7 includes any
 medical coverage or health benefits    
provided under any specified ,federal   
health program described in             
subparagraphs 7,a7 through 7,e7 of      
paragraph 7#d74  7#b7 ,resident ,with   
respect to a ,state1 the term resident  
means an individual who is a citizen or 
national of the ,united ,states or an   
alien lawfully residing in the ,state1  
and whose primary residence 7as defined 
by the ,state7 is located in the ,state4
  7#c7 ,secretary ,the term ,secretary  
means-- 7,a7 the ,secretary of ,health  
and ,human ,services with respect to    
waivers relating to the provisions      
described in subparagraphs 7,a71 7,b71  
and 7,d7 through 7,g7 of paragraph 7#b7 
of subsection 7a72  7,b7 the ,secretary 
of the ,treasury with respect to waivers
 relating to the provisions described in
 subparagraph 7,c7 of such paragraph2   
7,c7 the ,director of the ,office of    
,personnel ,management with respect to  
waivers relating to the provisions      

described in subparagraph 7,h7 of such  
paragraph2  7,d7 the ,secretary of      
,defense with respect to waivers        
relating to the provisions described in 
subparagraph 7,i7 of such paragraph2 and
  7,e7 the ,secretary of ,labor with    
respect to waivers relating to the      
provisions described in subparagraph    
7,j7 of such paragraph4  7#d7 ,specified
 ,federal health program ,the term      
specified ,federal health program means 
all of the following programs3 7,a7 ,the
 ,medicare program under title ,,xviii  
of the ,social ,security ,act4  7,b7    
,the ,medicaid program under title ,,xix
 of the ,social ,security ,act4  7,c7   
,the ,children's ,health ,insurance     
,program under title ,,xxi of the       
,social ,security ,act4  7,d7 ,the      
,federal ,employees ,health ,benefits   
,plan under chapter #hi of title #e of  
the ,united ,states ,code4  7,e7        
,medical coverage under chapter #ee of  
title #aj1 ,united ,states ,code1       
including coverage under the ,,tricare  

program4  7,f7 ,an ,exchange established
 under this subtitle4  7,g7 ,subsidies  
under section #adjb4  7,h7 ,tax credits 
under sections #cf;,b and #de,r of the  
,internal ,revenue ,code of #aihf4  4   
7b7 ,clerical amendment ,the table of   
contents in section #a7;b7 of such ,act 
is amended by inserting after the item  
relating to section #accb the following 
new item3  ,sec4 #accb;,a4 ,waiver for  
,state universal health care4  4