,,ib ,union ,calendar ,no4 #ccd #aafth  
,,congress  #b;d ,session  ,h4 ,r4 #adbe
 ,report ,no4 #aaf-dad ,,in ,,the       
,,house ,,of ,,representatives          
,february #bh1 #bjai,ms4 ,craig 7for    
herself and ,mr4 ,peters7 introduced the
 following bill2 which was referred to  
the ,committee on ,energy and ,commerce 
,march #i1 #bjbj;,additional sponsors3  
,ms4 ,underwood1 ,mr4 ,schrader1 ,ms4   
,kuster of ,new ,hampshire1 ,mr4        
,lipinski1 ,mr4 ,carbajal1 ,mr4 ,heck1  
,ms4 ,brownley of ,california1 ,ms4     
,schakowsky1 ,mr4 ,himes1 ,ms4 ,blunt   
,rochester1 ,mr4 ,cisneros1 ,ms4        
,schrier1 ,mrs4 ,lee of ,nevada1 ,mr4   
,lujn1 ,mr4 ,allred1 ,mr4 ,rouda1 ,ms4  
,hill of ,california1 ,mrs4 ,bustos1    
,mr4 ,trone1 ,mr4 ,bera1 ,mr4 ,rose of  
,new ,york1 ,ms4 ,finkenauer1 ,mr4      
,larsen of ,washington1 ,mr4 ,costa1    
,mrs4 ,dingell1 ,mr4 ,ruiz1 ,mr4 ,rush1 
,mr4 ,schiff1 ,mr4 ,pallone1 ,ms4       
,eshoo1 ,mr4 ,kennedy1 ,ms4 ,matsui1    
,ms4 ,spanberger1 ,mr4 ,phillips1 ,mr4  

,van ,drew1 ,mr4 ,case1 ,ms4 ,clarke of 
,new ,york1 ,mr4 ,brindisi1 ,mr4        
,neguse1 ,ms4 ,mc,collum1 ,mr4          
,mc,adams1 ,ms4 ,moore1 ,mr4 ,kilmer1   
,ms4 ,stevens1 ,ms4 ,mucarsel-,powell1  
,mr4 ,tonko1 ,ms4 ,kelly of ,illinois1  
,ms4 ,barragn1 ,mr4 ,crdenas1 ,mr4      
,welch1 ,mr4 ,raskin1 ,ms4 ,lofgren1    
,ms4 ,davids of ,kansas1 ,mrs4 ,luria1  
,mr4 ,fortenberry1 ,mrs4 ,kirkpatrick1  
,miss ,rice of ,new ,york1 ,ms4 ,wexton1
 ,ms4 ,speier1 and ,mr4 ,connolly       
,march #i1 #bjbj,reported with an       
amendment2 committed to the ,committee  
of the ,whole ,house on the ,state of   
the ,union and ordered to be            
printed,strike out all after the        
enacting clause and insert the part     
printed in italic,for text of introduced
 bill1 see copy of bill as introduced on
 ,february #bh1 #bjai  ,a ,,bill  ,to   
amend the ,patient ,protection and      
,affordable ,care ,act to provide for a 
,improve ,health ,insurance             
,affordability ,fund to provide for     

certain reinsurance payments to lower   
premiums in the individual health       
insurance market4  #a4 ,short title     
,this ,act may be cited as the ,state   
,health ,care ,premium ,reduction ,act4 
#b4 ,improve ,health ,insurance         
,affordability ,fund ,subtitle ,d of    
title ,i of the ,patient ,protection and
 ,affordable ,care ,act is amended by   
inserting after part #e 7#db ,u4,s4,c4  
#ahjfa et seq47 the following new part3 
#f ,improve ,health ,insurance          
,affordability ,fund  #acea4            
,establishment of program ,there is     
hereby established the ,improve ,health 
,insurance ,affordability ,fund to be   
administered by the ,secretary of       
,health and ,human ,services1 acting    
through the ,administrator of the       
,centers for ,medicare  ,medicaid       
,services 7in this section referred to  
as the ,administrator71 to provide      
funding1 in accordance with this part1  
to the #ej ,states and the ,district of 
,columbia 7each referred to in this     

section as a ,state7 beginning on       
,january #a1 #bjbj1 for the purposes    
described in section #aceb4  #aceb4 ,use
 of funds  7a7 ,in general ,a ,state    
shall use the funds allocated to the    
,state under this part for one of the   
following purposes3 7#a7 ,to provide    
reinsurance payments to health insurance
 issuers with respect to individuals    
enrolled under individual health        
insurance coverage 7other than through a
 plan described in subsection 7b77      
offered by such issuers4  7#b7 ,to      
provide assistance 7other than through  
payments described in paragraph 7#a77 to
 reduce out-of-pocket costs1 such as    
copayments1 coinsurance1 premiums1 and  
deductibles1 of individuals enrolled    
under qualified health plans offered on 
the individual market through an        
,exchange4  7b7 ,exclusion of certain   
grandfathered and transitional plans    
,for purposes of subsection 7a71 a plan 
described in this subsection is the     
following3 7#a7 ,a grandfathered health 

plan 7as defined in section #abea74     
7#b7 ,a plan 7commonly referred to as a 
transitional plan7 continued under the  
letter issued by the ,centers for       
,medicare  ,medicaid ,services on       
,november #ad1 #bjac1 to the ,state     
,insurance ,commissioners outlining a   
transitional policy for coverage in the 
individual and small group markets to   
which section #abea does not apply1 and 
under the extension of the transitional 
policy for such coverage set forth in   
the ,insurance ,standards ,bulletin     
,series guidance issued by the ,centers 
for ,medicare  ,medicaid ,services on   
,march #e1 #bjad1 ,february #bi1 #bjaf1 
,february #ac1 #bjag1 ,april #i1 #bjah1 
and ,march #be1 #bjai1 or under any     
subsequent extensions thereof4  7#c7    
,student health insurance coverage 7as  
defined in section #adg4ade of title    
#de1 ,code of ,federal ,regulations74   
#acec4 ,state eligibility and approval2 
,default safeguard  7a7 ,encouraging    
,state options for allocations  7#a7 ,in

 general ,to be eligible for an         
allocation of funds under this part for 
a year 7beginning with #bjbj71 a ,state 
shall submit to the ,administrator an   
application at such time 7but1 in the   
case of allocations for #bjbj1 not later
 than #ij days after the date of the    
enactment of this part and1 in the case 
of allocations for a subsequent year1   
not later than ,march #a of the previous
 year7 and in such form and manner as   
specified by the ,administrator         
containing-- 7,a7 a description of how  
the funds will be used2 and  7,b7 such  
other information as the ,administrator 
may require4  7#b7 ,automatic approval  
,an application so submitted is approved
 unless the ,administrator notifies the 
,state submitting the application1 not  
later than #fj days after the date of   
the submission of such application1 that
 the application has been denied for not
 being in compliance with any           
requirement of this part and of the     
reason for such denial4  7#c7 #e-year   

application approval ,if an application 
of a ,state is approved for a purpose   
described in section #aceb for a year1  
such application shall be treated as    
approved for such purpose for each of   
the subsequent #d years4  7#d7          
,revocation of approval ,the approval of
 an application of a ,state1 with       
respect to a purpose described in       
section #aceb1 may be revoked if the    
,state fails to use funds provided to   
the ,state under this section for such  
purpose or otherwise fails to comply    
with the requirements of this section4  
7b7 ,default ,federal safeguard  7#a7   
#bjbj ,for #bjbj1 in the case of a      
,state that does not submit an          
application under subsection 7a7 by the 
#ij-;day submission date applicable to  
such year under subsection 7a77#a7 and  
in the case of a ,state that does submit
 such an application by such date that  
is not approved1 the ,administrator1 in 
consultation with the ,state insurance  
commissioner1 shall1 from the amount    

calculated under paragraph 7#d7 for such
 year1 carry out the purpose described  
in paragraph 7#c7 in such ,state for    
such year4  7#b7 #bjba and subsequent   
years ,for #bjba or a subsequent year1  
in the case of a ,state that does not   
have in effect an approved application  
under this section for such year1 the   
,administrator1 in consultation with the
 ,state insurance commissioner1 shall1  
from the amount calculated under        
paragraph 7#d7 for such year1 carry out 
the purpose described in paragraph 7#c7 
in such ,state for such year4  7#c7     
,specified use ,the amount described in 
paragraph 7#d71 with respect to #bjbj or
 a subsequent year1 shall be used to    
carry out the purpose described in      
section #aceb7;a77#a7 in each ,state    
described in paragraph 7#a7 or 7#b7 for 
such year1 as applicable1 by providing  
reinsurance payments to health insurance
 issuers with respect to attachment     
range claims 7as defined in section     
#aced7;b77#b771 using the dollar amounts

 specified in subparagraph 7,b7 of such 
section for such year7 in an amount     
equal to1 subject to paragraph 7#e71 the
 percentage 7specified for such year by 
the ,secretary under such subparagraph7 
of the amount of such claims4  7#d7     
,amount described ,the amount described 
in this paragraph1 with respect to #bjbj
 or a subsequent year1 is the amount    
equal to the total sum of amounts that  
the ,secretary would otherwise estimate 
under section #aced7;b77#b77;,a77i7 for 
such year for each ,state described in  
paragraph 7#a7 or 7#b7 for such year1 as
 applicable1 if each such ,state were   
not so described for such year4  7#e7   
,adjustment ,for purposes of this       
subsection1 the ,secretary may apply a  
percentage under paragraph 7#c7 with    
respect to a year that is less than the 
percentage otherwise specified in       
section #aced7;b77#b77;,b7 for such     
year1 if the cost of paying the total   
eligible attachment range claims for    
,states described in this subsection for

 such year at such percentage otherwise 
specified would exceed the amount       
calculated under paragraph 7#d7 for such
 year4  #aced4 ,allocations  7a7        
,appropriation ,for the purpose of      
providing allocations for ,states under 
subsection 7b7 and payments under       
section #acec7;b7 there is appropriated1
 out of any money in the ,treasury not  
otherwise appropriated1 #aj1jjj1jjj1jjj 
for #bjbj and each subsequent year4  7b7
 ,allocations  7#a7 ,payment  7,a7 ,in  
general ,from amounts appropriated under
 subsection 7a7 for a year1 the         
,secretary shall1 with respect to a     
,state not described in section         
#acec7;b7 for such year and not later   
than the date specified under           
subparagraph 7,b7 for such year1        
allocate for such ,state the amount     
determined for such ,state and year     
under paragraph 7#b74  7,b7 ,specified  
date ,for purposes of subparagraph 7,a71
 the date specified in this subparagraph
 is-- 7i7 for #bjbj1 the date that is   

#de days after the date of the enactment
 of this part2 and  7ii7 for #bjba or a 
subsequent year1 ,january #a of the     
respective year4  7,c7 ,notifications of
 allocation amounts ,for #bjba and each 
subsequent year1 the ,secretary shall   
notify each ,state of the amount        
determined for such ,state under        
paragraph 7#b7 for such year by not     
later than ,january #a of the previous  
year4  7#b7 ,allocation amount          
determinations  7,a7 ,in general ,for   
purposes of paragraph 7#a71 the amount  
determined under this paragraph for a   
year for a ,state described in paragraph
 7#a77;,a7 for such year is the amount  
equal to-- 7i7 the amount that the      
,secretary estimates would be expended  
under this part for such year on        
attachment range claims of individuals  
residing in such ,state if such ,state  
used such funds only for the purpose    
described in paragraph 7#a7 of section  
#aceb7;a7 at the dollar amounts and     
percentage specified under subparagraph 

7,b7 for such year2 minus  7ii7 the     
amount1 if any1 by which the ,secretary 
determines-- 7,i7 the estimated amount  
of premium tax credits under section    
#cf;,b of the ,internal ,revenue ,code  
of #aihf that would be attributable to  
individuals residing in such ,state for 
such year without application of this   
part2 exceeds  7,,ii7 the estimated     
amount of premium tax credits under     
section #cf;,b of the ,internal ,revenue
 ,code of #aihf that would be           
attributable to individuals residing in 
such ,state for such year if such ,state
 were a ,state described in section     
#acec7;b7 for such year4  ,for purposes 
of the previous sentence and section    
#acec7;b77#c71 the term attachment range
 claims means1 with respect to an       
individual1 the claims for such         
individual that exceed a dollar amount  
specified by the ,secretary for a year1 
but do not exceed a ceiling dollar      
amount specified by the ,secretary for  
such year1 under subparagraph 7,b74     

7,b7 ,specifications ,for purposes of   
subparagraph 7,a7 and section           
#acec7;b77#c71 the ,secretary shall     
determine the dollar amounts and the    
percentage to be specified under this   
subparagraph for a year in a manner to  
ensure that the total amount of         
expenditures under this part for such   
year is estimated to equal the total    
amount appropriated for such year under 
subsection 7a7 if such expenditures were
 used solely for the purpose described  
in paragraph 7#a7 of section #aceb7;a7  
for attachment range claims at the      
dollar amounts and percentage so        
specified for such year4  7#c7          
,availability ,funds allocated to a     
,state under this subsection for a year 
shall remain available through the end  
of the subsequent year4  4  ,march #i1  
#bjbj,reported with an amendment2       
committed to the ,committee of the      
,whole ,house on the ,state of the      
,union and ordered to be printed