,,ib ,union ,cal5d> ,no4 #ccd #aaf?     
,,congress  #b;d ,session  ,h4 ,r4 #adbe
 ,report ,no4 #aaf-dad ,,9 ,,! ,,h\se   
,,( ,,repres5tatives  ,febru>y #bh1     
#bjai,ms4 ,craig 7= h]self & ,mr4       
,pet]s7 introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce  ,m>* #i1 #bjbj;,additional    
sponsors3 ,ms4 ,und]wood1 ,mr4 ,s*rad]1 
,ms4 ,ku/] ( ,new ,hamp%ire1 ,mr4       
,lip9ski1 ,mr4 ,c>bajal1 ,mr4 ,heck1    
,ms4 ,br[nley ( ,cali=nia1 ,ms4         
,s*ak[sky1 ,mr4 ,himes1 ,ms4 ,blunt     
,ro*e/]1 ,mr4 ,cisn]os1 ,ms4 ,s*ri]1    
,mrs4 ,lee ( ,nevada1 ,mr4 ,lujn1 ,mr4  
,allr$1 ,mr4 ,r\da1 ,ms4 ,hill (        
,cali=nia1 ,mrs4 ,bu/os1 ,mr4 ,trone1   
,mr4 ,b]a1 ,mr4 ,rose ( ,new ,york1 ,ms4
 ,f9k5au]1 ,mr4 ,l>s5 ( ,wa%+ton1 ,mr4  
,co/a1 ,mrs4 ,d+ell1 ,mr4 ,ruiz1 ,mr4   
,ru%1 ,mr4 ,s*iff1 ,mr4 ,pallone1 ,ms4  
,e%oo1 ,mr4 ,k5n$y1 ,ms4 ,matsui1 ,ms4  
,spanb]g]1 ,mr4 ,phillips1 ,mr4 ,van    
,drew1 ,mr4 ,case1 ,ms4 ,cl>ke ( ,new   
,york1 ,mr4 ,br9disi1 ,mr4 ,neguse1 ,ms4

 ,mc,collum1 ,mr4 ,mc,adams1 ,ms4       
,moore1 ,mr4 ,kilm]1 ,ms4 ,/ev5s1 ,ms4  
,muc>sel-,p[ell1 ,mr4 ,tonko1 ,ms4      
,kelly ( ,ill9ois1 ,ms4 ,b>ragn1 ,mr4   
,crd5as1 ,mr4 ,wel*1 ,mr4 ,rask91 ,ms4  
,l(gr51 ,ms4 ,davids ( ,kansas1 ,mrs4   
,luria1 ,mr4 ,=t5b]ry1 ,mrs4            
,kirkpatrick1 ,miss ,rice ( ,new ,york1 
,ms4 ,wexton1 ,ms4 ,spei]1 & ,mr4       
,connolly  ,m>* #i1 #bjbj,report$ ) an  
am5dm5t2 committ$ to ! ,committee ( !   
,:ole ,h\se on ! ,/ate ( ! ,union &     
ord]$ to be printed,strike out all aft] 
! enact+ clause & ins]t ! "p pr9t$ 9    
italic,for text ( introduc$ bill1 see   
copy ( bill z introduc$ on ,febru>y #bh1
 #bjai  ,a ,,bill  ,to am5d ! ,pati5t   
,protection & ,af=dable ,c>e ,act to    
provide = a ,improve ,heal? ,insurance  
,af=dability ,fund to provide = c]ta9   
re9surance paym5ts to l[] premiums 9 !  
individual heal? insurance m>ket4  #a4  
,%ort title ,?is ,act may be cit$ z !   
,/ate ,heal? ,c>e ,premium ,r$uction    
,act4  #b4 ,improve ,heal? ,insurance   

,af=dability ,fund ,subtitle ,d ( title 
,i ( ! ,pati5t ,protection & ,af=dable  
,c>e ,act is am5d$ by ins]t+ aft] "p #e 
7#db ,u4,s4,c4 #ahjfa et seq47 ! foll[+ 
new "p3  #f ,improve ,heal? ,insurance  
,af=dability ,fund  #acea4 ,e/abli%m5t (
 program ,!re is h]eby e/abli%$ !       
,improve ,heal? ,insurance ,af=dability 
,fund to be adm9i/]$ by ! ,secret>y (   
,heal? & ,human ,s]vices1 act+ ?r\gh !  
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices 79 ?is section ref]r$ 
to z ! ,adm9i/rator71 to provide fund+1 
9 accordance ) ?is "p1 to ! #ej ,/ates &
 ! ,di/rict ( ,columbia 7ea* ref]r$ to 9
 ?is section z a ,/ate7 beg9n+ on       
,janu>y #a1 #bjbj1 = ! purposes describ$
 9 section #aceb4  #aceb4 ,use ( funds  
7a7 ,9 g5]al ,a ,/ate %all use ! funds  
allocat$ to ! ,/ate "u ?is "p = "o ( !  
foll[+ purposes3 7#a7 ,to provide       
re9surance paym5ts to heal? insurance   
issu]s ) respect to individuals enroll$ 
"u individual heal? insurance cov]age   
7o!r ?an ?r\gh a plan describ$ 9        

subsection 7b77 (f]$ by su* issu]s4     
7#b7 ,to provide assi/ance 7o!r ?an     
?r\gh paym5ts describ$ 9 p>agraph 7#a77 
to r$uce out-(-pocket co/s1 su* z       
copaym5ts1 co9surance1 premiums1 &      
d$uctibles1 ( individuals enroll$ "u    
qualifi$ heal? plans (f]$ on !          
individual m>ket ?r\gh an ,ex*ange4  7b7
 ,exclusion ( c]ta9 gr&fa!r$ &          
transitional plans ,= purposes (        
subsection 7a71 a plan describ$ 9 ?is   
subsection is ! foll[+3 7#a7 ,a gr&fa!r$
 heal? plan 7z def9$ 9 section #abea74  
7#b7 ,a plan 7commonly ref]r$ to z a    
transitional plan7 cont9u$ "u ! lett]   
issu$ by ! ,c5t]s = ,m$ic>e  ,m$icaid   
,s]vices on ,novemb] #ad1 #bjac1 to !   
,/ate ,insurance ,commission]s outl9+ a 
transitional policy = cov]age 9 !       
individual & small gr\p m>kets to :i*   
section #abea does n apply1 & "u !      
ext5sion ( ! transitional policy = su*  
cov]age set =? 9 ! ,insurance ,/&>ds    
,bullet9 ,s]ies guidance issu$ by !     
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices on  

,m>* #e1 #bjad1 ,febru>y #bi1 #bjaf1    
,febru>y #ac1 #bjag1 ,april #i1 #bjah1 &
 ,m>* #be1 #bjai1 or "u any subsequ5t   
ext5sions !re(4  7#c7 ,/ud5t heal?      
insurance cov]age 7z def9$ 9 section    
#adg4ade ( title #de1 ,code ( ,f$]al    
,regulations74  #acec4 ,/ate eligibility
 & approval2 ,default safegu>d  7a7     
,enc\rag+ ,/ate options = allocations   
7#a7 ,9 g5]al ,to be eligible = an      
allocation ( funds "u ?is "p = a ye>    
7beg9n+ ) #bjbj71 a ,/ate %all submit to
 ! ,adm9i/rator an application at su* "t
 7b1 9 ! case ( allocations = #bjbj1 n  
lat] ?an #ij days aft] ! date ( !       
enactm5t ( ?is "p &1 9 ! case (         
allocations = a subsequ5t ye>1 n lat]   
?an ,m>* #a ( ! previ\s ye>7 & 9 su* =m 
& mann] z specifi$ by ! ,adm9i/rator    
conta9+-- 7,a7 a description ( h[ !     
funds w be us$2 &  7,b7 su* o!r         
in=mation z ! ,adm9i/rator may require4 
7#b7 ,automatic approval ,an application
 s submitt$ is approv$ unless !         
,adm9i/rator notifies ! ,/ate submitt+ !

 application1 n lat] ?an #fj days aft] !
 date ( ! submission ( su* application1 
t ! application has be5 d5i$ = n be+ 9  
compliance ) any requirem5t ( ?is "p & (
 ! reason = su* d5ial4  7#c7 #e-ye>     
application approval ,if an application 
( a ,/ate is approv$ = a purpose        
describ$ 9 section #aceb = a ye>1 su*   
application %all be treat$ z approv$ =  
su* purpose = ea* ( ! subsequ5t #d ye>s4
  7#d7 ,revocation ( approval ,!        
approval ( an application ( a ,/ate1 )  
respect to a purpose describ$ 9 section 
#aceb1 may be revok$ if ! ,/ate fails to
 use funds provid$ to ! ,/ate "u ?is    
section = su* purpose or o!rwise fails  
to comply ) ! requirem5ts ( ?is section4
  7b7 ,default ,f$]al safegu>d  7#a7    
#bjbj ,= #bjbj1 9 ! case ( a ,/ate t    
does n submit an application "u         
subsection 7a7 by ! #ij-;day submission 
date applicable to su* ye> "u subsection
 7a77#a7 & 9 ! case ( a ,/ate t does    
submit su* an application by su* date t 
is n approv$1 ! ,adm9i/rator1 9         

consultation ) ! ,/ate insurance        
commission]1 %all1 f ! am\nt calculat$  
"u p>agraph 7#d7 = su* ye>1 c>ry out !  
purpose describ$ 9 p>agraph 7#c7 9 su*  
,/ate = su* ye>4  7#b7 #bjba & subsequ5t
 ye>s ,= #bjba or a subsequ5t ye>1 9 !  
case ( a ,/ate t does n h 9 effect an   
approv$ application "u ?is section = su*
 ye>1 ! ,adm9i/rator1 9 consultation ) !
 ,/ate insurance commission]1 %all1 f ! 
am\nt calculat$ "u p>agraph 7#d7 = su*  
ye>1 c>ry out ! purpose describ$ 9      
p>agraph 7#c7 9 su* ,/ate = su* ye>4    
7#c7 ,specifi$ use ,! am\nt describ$ 9  
p>agraph 7#d71 ) respect to #bjbj or a  
subsequ5t ye>1 %all be us$ to c>ry out !
 purpose describ$ 9 section             
#aceb7;a77#a7 9 ea* ,/ate describ$ 9    
p>agraph 7#a7 or 7#b7 = su* ye>1 z      
applicable1 by provid+ re9surance       
paym5ts to heal? insurance issu]s )     
respect to atta*m5t range claims 7z     
def9$ 9 section #aced7;b77#b771 us+ !   
doll> am\nts specifi$ 9 subp>agraph 7,b7
 ( su* section = su* ye>7 9 an am\nt    

equal to1 subject to p>agraph 7#e71 !   
p]c5tage 7specifi$ = su* ye> by !       
,secret>y "u su* subp>agraph7 ( ! am\nt 
( su* claims4  7#d7 ,am\nt describ$ ,!  
am\nt describ$ 9 ?is p>agraph1 ) respect
 to #bjbj or a subsequ5t ye>1 is ! am\nt
 equal to ! total sum ( am\nts t !      
,secret>y w\ld o!rwise e/imate "u       
section #aced7;b77#b77;,a77i7 = su* ye> 
= ea* ,/ate describ$ 9 p>agraph 7#a7 or 
7#b7 = su* ye>1 z applicable1 if ea* su*
 ,/ate 7 n s describ$ = su* ye>4  7#e7  
,adju/m5t ,= purposes ( ?is subsection1 
! ,secret>y may apply a p]c5tage "u     
p>agraph 7#c7 ) respect to a ye> t is   
less ?an ! p]c5tage o!rwise specifi$ 9  
section #aced7;b77#b77;,b7 = su* ye>1 if
 ! co/ ( pay+ ! total eligible atta*m5t 
range claims = ,/ates describ$ 9 ?is    
subsection = su* ye> at su* p]c5tage    
o!rwise specifi$ w\ld exce$ ! am\nt     
calculat$ "u p>agraph 7#d7 = su* ye>4   
#aced4 ,allocations  7a7 ,appropriation 
,= ! purpose ( provid+ allocations =    
,/ates "u subsection 7b7 & paym5ts "u   

section #acec7;b7 !re is appropriat$1   
out ( any money 9 ! ,treasury n o!rwise 
appropriat$1 #aj1jjj1jjj1jjj = #bjbj &  
ea* subsequ5t ye>4  7b7 ,allocations    
7#a7 ,paym5t  7,a7 ,9 g5]al ,f am\nts   
appropriat$ "u subsection 7a7 = a ye>1 !
 ,secret>y %all1 ) respect to a ,/ate n 
describ$ 9 section #acec7;b7 = su* ye> &
 n lat] ?an ! date specifi$ "u          
subp>agraph 7,b7 = su* ye>1 allocate =  
su* ,/ate ! am\nt det]m9$ = su* ,/ate & 
ye> "u p>agraph 7#b74  7,b7 ,specifi$   
date ,= purposes ( subp>agraph 7,a71 !  
date specifi$ 9 ?is subp>agraph is-- 7i7
 = #bjbj1 ! date t is #de days aft] !   
date ( ! enactm5t ( ?is "p2 &  7ii7 =   
#bjba or a subsequ5t ye>1 ,janu>y #a ( !
 respective ye>4  7,c7 ,notifications ( 
allocation am\nts ,= #bjba & ea*        
subsequ5t ye>1 ! ,secret>y %all notify  
ea* ,/ate ( ! am\nt det]m9$ = su* ,/ate 
"u p>agraph 7#b7 = su* ye> by n lat] ?an
 ,janu>y #a ( ! previ\s ye>4  7#b7      
,allocation am\nt det]m9ations  7,a7 ,9 
g5]al ,= purposes ( p>agraph 7#a71 !    

am\nt det]m9$ "u ?is p>agraph = a ye> = 
a ,/ate describ$ 9 p>agraph 7#a77;,a7 = 
su* ye> is ! am\nt equal to-- 7i7 !     
am\nt t ! ,secret>y e/imates w\ld be    
exp5d$ "u ?is "p = su* ye> on atta*m5t  
range claims ( individuals resid+ 9 su* 
,/ate if su* ,/ate us$ su* funds only = 
! purpose describ$ 9 p>agraph 7#a7 (    
section #aceb7;a7 at ! doll> am\nts &   
p]c5tage specifi$ "u subp>agraph 7,b7 = 
su* ye>2 m9us  7ii7 ! am\nt1 if any1 by 
:i* ! ,secret>y det]m9es-- 7,i7 !       
e/imat$ am\nt ( premium tax cr$its "u   
section #cf;,b ( ! ,int]nal ,rev5ue     
,code ( #aihf t w\ld be attributable to 
individuals resid+ 9 su* ,/ate = su* ye>
 )\t application ( ?is "p2 exce$s       
7,,ii7 ! e/imat$ am\nt ( premium tax    
cr$its "u section #cf;,b ( ! ,int]nal   
,rev5ue ,code ( #aihf t w\ld be         
attributable to individuals resid+ 9 su*
 ,/ate = su* ye> if su* ,/ate 7 a ,/ate 
describ$ 9 section #acec7;b7 = su* ye>4 
,= purposes ( ! previ\s s5t5ce & section
 #acec7;b77#c71 ! t]m atta*m5t range    

claims means1 ) respect to an           
individual1 ! claims = su* individual t 
exce$ a doll> am\nt specifi$ by !       
,secret>y = a ye>1 b d n exce$ a ceil+  
doll> am\nt specifi$ by ! ,secret>y =   
su* ye>1 "u subp>agraph 7,b74  7,b7     
,specifications ,= purposes (           
subp>agraph 7,a7 & section              
#acec7;b77#c71 ! ,secret>y %all det]m9e 
! doll> am\nts & ! p]c5tage to be       
specifi$ "u ?is subp>agraph = a ye> 9 a 
mann] to ensure t ! total am\nt (       
exp5ditures "u ?is "p = su* ye> is      
e/imat$ to equal ! total am\nt          
appropriat$ = su* ye> "u subsection 7a7 
if su* exp5ditures 7 us$ solely = !     
purpose describ$ 9 p>agraph 7#a7 (      
section #aceb7;a7 = atta*m5t range      
claims at ! doll> am\nts & p]c5tage s   
specifi$ = su* ye>4  7#c7 ,availability 
,funds allocat$ to a ,/ate "u ?is       
subsection = a ye> %all rema9 available 
?r\gh ! end ( ! subsequ5t ye>4  4  ,m>* 
#i1 #bjbj,report$ ) an am5dm5t2 committ$
 to ! ,committee ( ! ,:ole ,h\se on !   

,/ate ( ! ,union & ord]$ to be pr9t$