,i  #aaeth ,,congress  #b;d ,session    
,h4 ,r4 #fjig  ,,in ,,the ,,house ,,of  
,,representatives  ,june #ac1 #bjah,ms4 
,jayapal 7for herself1 ,ms4 ,schakowsky1
 and ,mr4 ,pocan7 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 #bjah4  7b7 ,purpose ,the
 purpose of this ,act is to establish a 
flexible framework under which ,states  
can provide comprehensive universal     
health coverage to all of their         
residents4  #b4 ,waiver for ,state      
universal health care  7a7 ,in general  
,title ,i of the ,patient ,protection   
and ,affordable ,care ,act 7,public ,law
 #aaa-adh7 is amended by striking       
section #accb 7#db ,u4,s4,c4 #ahjeb7 and
 inserting the following new section3   
#accb4 ,waiver for ,state universal     
health care  7a7 ,application  7#a7 ,in 
general ,a ,state may apply to the      
,secretary 7as defined in subsection    
7i77#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
 #bjai1 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  7ii7 a plan for how the ,state
 will achieve in #e years health        
coverage for at least #ie percent of the
 population of the ,state1 with five    
percent of the population of the ,state 
not spending more than #aj percent of   
their adjusted gross income on health2  
and  7iii7 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 enacted1 or will be enacting 
before the current ,state legislative   
session adjourns1 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 #bjai1 are as follows3     
7,a7 ,parts ,i1 ,,ii1 and ,,iii of this 
subtitle4  7,b7 ,section #adjb4  7,c7   
,sections #cf;,b and #dihj;,h 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      
,secretary1 after taking into account   
recommendations of the ,panel under     
subsection 7g71 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 #bjag1 the ,secretary     
shall promulgate regulations relating to
 waivers under this section that        
provide-- 7i7 a process for public      
notice and comment in accordance with   
the public notice and comment           
requirements applicable under           
regulations used for ,medicaid waivers  
pursuant to section #aaae of the ,social
 ,security ,act2  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 ,panel under     
subsection 7g7 to consider the          
applications for waivers so submitted   
and provide recommendations with respect
 to such applications2  7v7 a process   
for the submission to the ,secretary of 
periodic reports by the ,state          
concerning the implementation of the    
program under the waiver2  7vi7 a       

process for the periodic evaluation by  
the ,secretary with respect to waivers  
granted under this section2 and  7vii7 a
 process for providing technical        
assistance on-- 7,i7 how to develop an  
application to any ,state seeking to    
submit an application for a waiver      
relating to developing a program of     
providing health care for all residents 
for such ,state2 and  7,,ii7 how to     
improve such a program for purposes of a
 ,state seeking assistance pursuant to  
subsection 7e77#b74  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 ,each such report shall  
include1 with respect to any action by  
the ,secretary so taken1 with respect to
 an application1 that was not consistent
 with the recommendations of the ,panel 
under subsection 7g71 with respect to   
such application1 the reasons such      

action was taken4  7#e7 ,regional waiver
 request and plan ,nothing in this      
section shall be construed to prevent   
two or more ,states in a region from    
submitting a single application under   
this section for a waiver that          
establishes a plan that is applicable to
 all of the ,states included in such    
application4 ,in the case of such an    
application and plan1 the requirements  
of this section shall continue to be    
applicable with respect to each ,state  
included in such application4  7#f7     
,authorization of appropriations ,there 
is authorized to be appropriated such   
sums as may be necessary for providing  
funds to ,states with a waiver under    
this section for purposes of carrying   
out activities described in subsection  
7b77#a77;,e74  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 provide1 in accordance

 with subparagraph 7,b71 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 7as defined in  
subsection 7i77#d77 for which such      
residents would have been eligible1     
absent such waiver2  7,b7 will provide1 
in the case of such a waiver under      
subsection 7a77#a7 for the ,state to    
waive any of the requirements described 
in subsection 7a77#b77;,f71 health      
benefits coverage to ,state residents   
who would have otherwise received health
 benefits coverage in the form of       
medical assistance under the ,state     
,federal health program described in    
subsection 7i77#d77;,b7 7regardless of  
whether the ,state provides for such    
assistance through a ,state plan under  
title ,,xix of the ,social ,security    
,act or a waiver of such plan7 that     
includes at least the mandatory benefits
 under title ,,xix of the ,social       

,security ,act that are required of a   
,state without a waiver of a ,state plan
 under such title1 including at least   
benefits for early and periodic         
screening1 diagnostic1 and treatment2   
benefits for non-emergency              
transportation2 and retroactive         
coverage2  7,c7 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 7as defined in  
subsection 7i77#d77 for which such      
residents would have been eligible1     
absent such waiver2  7,d7 will provide  
coverage to all residents of the ,state1
 including 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,e7 will provide for public education  
activities to raise awareness of the    
availability of qualified health plans  
and the facilitation of enrollment in   
such coverage in a manner similar to an 
entity that serves as a navigator under 
a grant under section #acaa7;i72  7,f7  
will be publicly administered by an     
agency of the ,state2  7,g7 will not    
preclude the purchase of supplemental   
insurance2  7,h7 will provide systems   
for complaints1 appeals1 independent    
review1 and other procedures for        
accessing and maintaining benefits that 
are at least as accessible to ,state    
residents as those of the specified     
,federal health programs 7as defined in 
subsection 7i77#d77 for which such      
residents would have otherwise been     
eligible without application of such    
waiver under subsection 7a77#a72 and    
7,i7 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 shall1    
with respect to an application from a   
,state under this subsection and after  
taking into account recommendations of  
the ,panel under subsection 7g7 for such
 application1 make a determination under
 subsection 7a77#a7 not later than #ij  
days after the receipt of such          
recommendations4  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 ,required    
reports2 #e-,year review  7#a7 ,in      
general ,as a condition of receipt of a 
waiver under this section1 after each   

#e-year period of such waiver1 a ,state 
shall submit to the ,secretary a report 
that is carried out by an independent1  
non-partisan entity1 with respect to    
such #e-year period and after a process 
for public notice and comment at the    
,state level1 including public hearings1
 sufficient to ensure a meaningful level
 of public input1 on the following3     
7,a7 ,how waiver funds have been spent  
by the ,state4  7,b7 ,the number of     
residents of the ,state without health  
insurance and a description of how the  
,state plans to provide health insurance
 coverage within the subsequent #e years
 to residents of the ,state without     
health insurance4  7,c7 ,how            
affordability in the ,state for health  
care has changed over the period4  7,d7 
,whether the ,state has achieved health 
coverage for at least #ie percent of the
 population of the ,state4  7,e7 ,any   
additional information specified by the 
,secretary for purposes of determining  
the successes and challenges of the     

waiver4  7#b7 #e-year review ,in the    
case a ,state1 based on the report      
submitted under paragraph 7#a7 for a    
#e-year period-- 7,a7 has been          
determined by the ,secretary1 after     
taking into account recommendations of  
the ,panel under subsection 7g71 to have
 not achieved health coverage for at    
least #ie percent of the population of  
the ,state--  7i7 the ,state shall have 
access to technical assistance described
 in subsection 7a77#d77;,b77vii7 to     
improve the health insurance program of 
the ,state implemented through the      
waiver under this section2  7ii7 the    
,state shall have a grace period of #f  
months after such determination to      
achieve health coverage for at least #ie
 percent of such population2 and  7iii7 
if after such #f months1 the ,state has 
not achieved such health coverage1 the  
waiver under this section shall be      
terminated2 and  7,b7 has been          
determined by the ,secretary1 after     
taking into account recommendations of  

the ,panel under subsection 7g71 to have
 achieved health coverage for at least  
#ie percent of the population of the    
,state1 the ,state1 as a condition of   
continuing such waiver1 shall submit to 
the ,secretary a plan for achieving     
health coverage for the remainder of the
 population of the ,state4  7f7         
,assuring coordination  7#a7 ,in general
 ,not later than #ahj days after the    
enactment of the ,state-,based          
,universal ,health ,care ,act of #bjah1 
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    
,independent ,assessment ,panel for     
,comprehensive ,health ,care  7#a7      
,establishment ,there is established a  
committee to be known as the            
,independent ,assessment ,panel for     
,comprehensive ,health ,care 7in this   
section referred to as the ,panel74     
7#b7 ,consideration of submissions ,the 
,secretary shall forward a copy of each 

waiver application submitted under this 
section to the ,panel for consideration 
under this subsection4  7#c7 ,duties    
,the ,panel shall-- 7,a7 review any     
waiver application by a ,state forwarded
 under paragraph 7#b7 and any report    
submitted under paragraph 7#a7 of       
subsection 7e7 for purposes of the      
review under paragraph 7#b7 of such     
subsection2  7,b7 not later than #ij    
days after submission of such           
application 7or report7 by the ,state1  
provide to the ,state and to the        
,secretary the recommendations of the   
,panel regarding the approval or        
disapproval of such waiver application  
7or regarding the status of the waiver  
for continuation pursuant to subsection 
7e77#b77 and1 if applicable1 possible   
improvements to such application 7or for
 purposes of subsection 7e77#b772 and   
7,c7 submit to ,congress an annual      
report on waiver applications 7and      
waiver reports under subsection 7e77    
reviewed by the ,panel during the       

applicable year1 including the number of
 applications 7and reports7 received and
 the number of applications recommended 
for approval 7and of reports with       
respect to which recommendations for    
continuation were provided74  7#d7      
,membership  7,a7 ,number and           
appointment ,the ,panel shall consist of
 seven members appointed by the         
,secretary of ,health and ,human        
,services1 of whom--  7i7 one shall be  
appointed on the recommendation of the  
,speaker of the ,house of               
,representatives2  7ii7 one shall be    
appointed on the recommendation of the  
minority leader of the ,house of        
,representatives2  7iii7 one shall be   
appointed on the recommendation of the  
majority leader of the ,senate2  7iv7   
one shall be appointed on the           
recommendation of the minority leader of
 the ,senate2  7v7 one shall be         
appointed from the ,republican          
,governors ,association2  7vi7 one shall
 be appointed from the ,democratic      

,governors ,association2 and  7vii7 one 
shall be a representative from the      
consumer advocacy community4  7,b7 ,term
 of service  7i7 ,in general ,each      
member of the ,panel shall serve a      
three-year term4 ,a member may serve    
after the expiration of that member's   
term until a successor has been         
appointed pursuant to subparagraph 7,a74
  7ii7 ,vacancy ,any member appointed to
 fill a vacancy occurring before the    
expiration of the term for which the    
member's predecessor was appointed shall
 be appointed only for the remainder of 
that term4 ,a vacancy in the ,commission
 shall be filled in the manner in which 
the original appointment was made4  7,c7
 ,pay ,members of the ,panel shall serve
 without pay4  7,d7 ,chairperson2 ,vice 
,chairperson  7i7 ,chairperson ,the     
,secretary of ,health and ,human        
,services1 or a designee of the         
,secretary1 shall serve on the ,panel as
 the ,chairperson of the ,panel4  7ii7  
,vice ,chairperson ,the ,administrator  

of the ,federal ,emergency ,management  
,agency1 or a designee of the           
,administrator1 shall serve on the      
,panel as the ,vice ,chairperson of the 
,panel4  7#e7 ,staff1 experts1 and      
consultants ,the ,panel may-- 7,a7      
appoint such staff as the ,panel        
considers to be appropriate1 without    
regard to the provisions of title #e1   
,united ,states ,code1 governing        
appointments in the competitive service2
  7,b7 fix the pay of such staff1       
without regard to the provisions of     
chapter #ea and subchapter ,,iii of     
chapter #ec of such title relating to   
classification and ,general ,schedule   
pay rates2 and  7,c7 procure the        
services of experts and consultants in  
accordance with the provisions of       
section #caji7;b7 of such title4  7#f7  
,detail of ,federal personnel ,upon     
request of the ,panel1 the head of any  
,federal agency may detail1 on a        
reimbursable basis1 any of the personnel
 of the agency to the ,panel to assist  

it in carrying out the duties under     
paragraph 7#c74  7#g7 ,federal ,advisory
 ,committee ,act ,the ,federal ,advisory
 ,committee ,act 7#e ,u4,s4,c4 ,app47   
shall apply to the ,panel4  7#h7        
,authorization of appropriations ,there 
is authorized to be appropriated such   
sums as may be necessary to the ,panel  
for carrying out the duties of the panel
 for each of fiscal years #bjah through 
#bjbc4  7h7 ,guidance relating to       
,american ,indians and ,alaska ,natives 
7#a7 ,in general ,the ,secretary shall  
issue guidance with respect to applying 
the provisions of this section in a     
manner consistent with the following3   
7,a7 ,to further the goal that ,federal 
health services to maintain and improve 
the health of the ,indians are consonant
 with and required by the ,federal      
,government's historical and unique     
legal relationship with1 and resulting  
responsibility to1 the ,american ,indian
 people4  7,b7 ,no enrollment fee1      
premium1 or similar charge1 and no      

deduction1 copayment1 cost sharing1 or  
similar charge is to be imposed against 
an ,indian who is furnished an item or  
service through a waiver under this     
section4 ,all costs incurred in waiving 
such charges shall be borne by the      
,federal ,government in fulfillment of  
the trust responsibility4  7,c7 ,a      
,state may not require the enrollment of
 an individual who is an ,indian in     
health insurance offered through a      
waiver under this section4  7,d7 ,health
 insurance issuers offering coverage    
pursuant to a waiver under this section 
must make good faith efforts to contract
 with ,indian ,health ,care ,providers  
operating within the area served by the 
issuers4  7,e7 ,health insurance issuers
 offering coverage pursuant to a waiver 
under this section shall pay ,indian    
,health ,care ,providers1 whether such  
providers are participating or          
nonparticipating providers with respect 
to the coverage1 for covered services   
provided to those ,indian enrollees who 

are eligible to receive services from   
such providers at a rate equal to the   
rate negotiated between such entity and 
the provider involved or1 if such a rate
 has not been negotiated1 at a rate that
 is not less than the level and amount  
of payment which the entity would make  
for the services if the services were   
furnished by a participating provider   
which is not an ,indian ,health ,care   
,provider4  7,f7 ,health insurance      
issuers offering coverage pursuant to a 
waiver under this section will include a
 standard contract addendum when        
contracting with ,indian ,health ,care  
,providers4 ,the contract addendum will 
be developed in consultation with tribes
 and in conference with ,urban ,indian  
,health ,programs operating within the  
service area of the ,state4  7,g7 ,the  
treatment of ,indians under this        
legislation does not constitute         
invidious racial discrimination in      
violation of the ,due ,process ,clause  
of the ,fifth or ,fourteenth            

,amendments1 but is reasonable and      
rationally designed to further the      
health of ,indians4  7,h7 ,in the case  
of any ,state in which #a or more       
,indian ,health ,care ,programs         
furnishes health care services1 the     
,state will provide for a process under 
which the ,state seeks advice on a      
regular1 ongoing basis from designees of
 such ,indian ,health ,care ,programs   
and ,urban ,indian ,organizations on    
matters relating to the application of a
 waiver under this section that are     
likely to have a direct effect on such  
,indian ,health ,programs and that--    
7i7 shall include solicitation of advice
 prior to submission of any plan        
amendments1 waiver requests1 and        
proposals for demonstration projects    
likely to have a direct effect on       
,indians or ,indian ,health ,care       
,programs2 and  7ii7 may include        
appointment of an advisory committee and
 of a designee of such ,indian ,health  
,care ,programs to the medical care     

advisory committee advising the ,state  
on its waiver under this section4  7#b7 
,definitions ,for purposes of this      
subsection3 7,a7 ,the term ,indian has  
the meaning given such term in section  
#ddg4ej of title #db of the ,code of    
,federal ,regulations 7as in effect on  
,july #a1 #bjaj74  7,b7 ,the term       
,indian ,health ,care ,provider has the 
meaning given such term in section      
#dch4ad7;a7 of title #db of the ,code of
 ,federal ,regulations4  7i7            
,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-- 7,a7 who is--  7i7
 a citizen or national of the ,united   
,states2 or  7ii7 an alien lawfully     
residing in the ,state 7including an    
alien who is granted deferred action or 
who is otherwise authorized to remain in
 the ,united ,states72 and  7,b7 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 item in the
 table of contents in section #a7;b7 of 
the ,patient ,protection and ,affordable
 ,care ,act relating to section #accb is
 amended to read as follows3  ,sec4     
#accb4 ,waiver for ,state universal     
health care4  4  7c7 ,continuation of   
current law for current waivers and     
waiver applications  7#a7 ,in general   
,subject to paragraph 7#b71 in the case 
of a ,state that has applied to the     
,secretary of ,health and ,human        
,services for a waiver under section    
#accb of the ,patient ,protection and   
,affordable ,care ,act 7#db ,u4,s4,c4   
#ahjeb71 as in effect before the        
enactment of this ,act1 for plan year   
#bjah1 such section #accb shall continue

 to apply to such application and to any
 waiver under such application for      
subsequent plan years4  7#b7 ,transition
 to new waiver law ,nothing in paragraph
 7#a7 shall be construed as preventing a
 ,state described in such paragraph from
 withdrawing an application described in
 such paragraph 7or requesting the      
,secretary to terminate an approved     
waiver referred to in such paragraph7   
for plan year #bjai or a subsequent plan
 year and subsequently applying for a   
waiver under section #accb of the       
,patient ,protection and ,affordable    
,care ,act1 as amended by subsection    
7a71 for such a plan year4