,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #ahhd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #bf1 #bjai,mr4   
,pallone 7= himself1 ,mr4 ,neal1 ,mr4   
,scott ( ,virg9ia1 ,mr4 ,hoy]1 ,ms4     
,s*ri]1 ,mr4 ,cisn]os1 ,ms4 ,de,gette1  
,ms4 ,ca/or ( ,florida1 ,mrs4 ,trahan1  
,mrs4 ,craig1 ,ms4 ,ku/] ( ,new         
,hamp%ire1 ,mr4 ,ruiz1 ,mr4 ,br5dan ,f4 
,boyle ( ,p5nsylvania1 ,mr4 ,allr$1     
,mrs4 ,bu/os1 ,mrs4 ,mc,bath1 ,mr4      
,lujn1 ,mr4 ,t$ ,lieu ( ,cali=nia1 ,mr4 
,pet]s1 ,ms4 ,wilson ( ,florida1 ,ms4   
,spanb]g]1 ,mr4 ,r\da1 ,ms4 ,und]wood1  
,mr4 ,delgado1 ,mrs4 ,lee ( ,nevada1    
,ms4 ,blunt ,ro*e/]1 ,mr4 ,doggett1 ,mr4
 ,gomez1 ,mrs4 ,d+ell1 ,ms4 ,%alala1    
,ms4 ,frankel1 ,ms4 ,e%oo1 ,mr4 ,sires1 
,mr4 ,soto1 ,ms4 ,jackson ,lee1 ,mr4    
,keat+1 ,ms4 ,/ev5s1 ,ms4 ,sewell (     
,alabama1 ,mr4 ,trone1 ,mr4 ,rose ( ,new
 ,york1 ,mrs4 ,kirkpatrick1 ,mr4 ,l>son 
( ,connecticut1 ,mr4 ,lewis1 ,ms4       
,jayapal1 ,ms4 ,g>cia ( ,texas1 ,mr4    
,c\rtney1 ,ms4 ,sn*ez1 ,mrs4 ,dem+s1    

,mrs4 ,murphy1 ,ms4 ,dean1 ,mr4 ,coh51  
,mr4 ,?ompson ( ,cali=nia1 ,mr4 ,ru%1   
,mr4 ,morelle1 ,ms4 ,hill ( ,cali=nia1  
,mr4 ,higg9s ( ,new ,york1 ,mrs4 ,davis 
( ,cali=nia1 ,ms4 ,br[nley ( ,cali=nia1 
,mr4 ,pascrell1 ,ms4 ,slotk91 ,mr4      
,engel1 ,mr4 ,kim1 ,mr4 ,blum5au]1 ,mrs4
 ,hayes1 ,mr4 ,cox ( ,cali=nia1 ,mr4    
,takano1 ,mr4 ,panetta1 ,mr4 ,kildee1   
,mr4 ,mal9[ski1 ,mr4 ,lev9 ( ,mi*igan1  
,mr4 ,gold51 ,mr4 ,van ,drew1 ,ms4      
,muc>sel-,p[ell1 ,mr4 ,grijalva1 ,mr4   
,espaillat1 ,ms4 ,s*ak[sky1 ,ms4 ,p+ree1
 ,ms4 ,norton1 & ,mr4 ,sablan7 introduc$
 ! foll[+ bill2 :i* 0 ref]r$ to !       
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committees on ,ways &    
,means1 & ,education & ,labor1 = a p]iod
 to be subsequ5tly det]m9$ by ! ,speak]1
 9 ea* case = consid]ation ( su*        
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d !
 ,pati5t ,protection & ,af=dable ,c>e   
,act to improve af=dability (1 undo     
sabotage ) respect to1 & increase access

 to heal? insurance cov]age1 & = o!r    
purposes4  #a4 ,%ort title2 table (     
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,protect+ ,pre-,exi/+       
,conditions & ,mak+ ,heal? ,c>e ,m      
,af=dable ,act ( #bjai4  7b7 ,table (   
cont5ts ,! table ( cont5ts ( ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title2 table
 ( cont5ts4 ,title ,i--,exp&+           
,af=dability ,sec4 #aja4 ,improve       
af=dability & r$uce premium co/s =      
consum]s4 ,sec4 #ajb4 ,exp& af=dability 
= work+ families4 ,title ,,ii--,undo+   
,sabotage ,sec4 #bja4 ,protect          
compreh5sive cov]age = small bus9esses &
 work]s4 ,sec4 #bjb4 ,%ort-t]m limit$   
duration insurance rule prohibition4    
,sec4 #bjc4 ,ensure plans provide       
compreh5sive b5efits4 ,sec4 #bjd4       
,provid+ = additional requirem5ts )     
respect to ! navigator program4 ,sec4   
#bje4 ,f$]al ,ex*ange outrea* &         
educational activities4 ,sec4 #bjf4     
,improve ,heal? ,insurance ,af=dability 
,fund4 ,sec4 #bjg4 ,provid+ t c]ta9     

guidance relat$ to waiv]s = ,/ate       
innovation "u ! ,pati5t ,protection &   
,af=dable ,c>e ,act %all h no =ce or    
effect4 ,title ,,iii--,/ate ,innovation 
& ,transp>5cy ,sec4 #cja4 ,fund ,/ate   
heal? insurance education programs =    
consum]s4 ,sec4 #cjb4 ,fund ,/ate       
innovations to exp& cov]age4 ,sec4 #cjc4
 ,pres]v+ ,/ate option to implem5t heal?
 c>e m>ketplaces4 ,sec4 #cjd4 ,promote  
transp>5cy & acc\ntability 9 !          
,adm9i/ration's exp5ditures ( ,ex*ange  
us] fees4  ,i ,exp&+ ,af=dability  #aja4
 ,improve af=dability & r$uce premium   
co/s = consum]s  7a7 ,9 g5]al ,section  
#cf;,b7b77#c77;,a7 ( ! ,int]nal ,rev5ue 
,code ( #aihf is am5d$ to read z foll[s3
  7,a7 ,applicable p]c5tage ,!          
applicable p]c5tage = any taxable ye>   
%all be ! p]c5tage su* t ! applicable   
p]c5tage = any taxpay] ^: h\sehold      
income is )9 an income ti] specifi$ 9 ! 
foll[+ table %all increase1 on a slid+  
scale 9 a l9e> mann]1 f ! initial       
premium p]c5tage to ! f9al premium      

p]c5tage specifi$ 9 su* table = su*     
income ti]3 ,9 ! case ( h\sehold income 
7express$ z a p]c5t ( pov]ty l9e7 )9 !  
foll[+ income ti]3,! initial            
premiump]c5tage is--,! f9al premium     
p]c5tage is--,ov] #ajj4j p]c5t up to    
#acc4j p]c5t#j4ja4jacc4j p]c5t up to    
#aej4j p]c5t#a4jb4jaej4j p]c5t up to    
#bjj4j p]c5t#b4jd4jbjj4j p]c5t up to    
#bej4j p]c5t#d4jf4jbej4j p]c5t up to    
#cjj4j p]c5t#f4jg4jcjj4j p]c5t up to    
#djj4j p]c5t#g4jh4edjj4j p]c5t &        
high]#h4eh4e  4  7b7 ,con=m+ am5dm5t    
,section #cf;,b7c77#a77;,a7 ( ! ,int]nal
 ,rev5ue ,code ( #aihf is am5d$ by /rik+
 b does n exce$ #djj p]c5t4  7c7        
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ,decemb] #ca1 #bjbj4  #ajb4 
,exp& af=dability = work+ families  7a7 
,9 g5]al ,clause 7i7 ( section          
#cf;,b7c77#b77;,c7 ( ! ,int]nal ,rev5ue 
,code ( #aihf is am5d$ to read z foll[s3
  7i7 ,cov]age mu/ be af=dable  7,i7    
,employees ,an employee %all n be treat$

 z eligible = m9imum ess5tial cov]age if
 su* cov]age consi/s ( an eligible      
employ]-sponsor$ plan 7z def9$ 9 section
 #ejjj;,a7f77#b77 & ! employee's requir$
 contribution 7)9 ! mean+ ( section     
#ejjj;,a7e77#a77;,b77 ) respect to !    
plan exce$s #i4e p]c5t ( ! employee's   
h\sehold income4  7,,ii7 ,family memb]s 
,an individual :o is eligible to enroll 
9 an eligible employ]-sponsor$ plan 7z  
def9$ 9 section #ejjj;,a7f77#b77 by     
reason ( a relation%ip ! individual be>s
 to ! employee %all n be treat$ z       
eligible = m9imum ess5tial cov]age by   
reason ( su* eligibility to enroll if ! 
employee's requir$ contribution 7)9 !   
mean+ ( section #ejjj;,a7e77#a77;,b71   
det]m9$ by sub/itut+ family = self-only7
 ) respect to ! plan exce$s #i4e p]c5t (
 ! employee's h\sehold income4  4  7b7  
,con=m+ am5dm5ts  7#a7 ,clause 7ii7 (   
section #cf;,b7c77#b77;,c7 ( ! ,int]nal 
,rev5ue ,code ( #aihf is am5d$ by /rik+ 
,except z provid$ 9 clause 7iii71 an    
employee & ins]t+ ,an individual4  7#b7 

,clause 7iii7 ( section                 
#cf;,b7c77#b77;,c7 ( su* ,code is am5d$ 
by /rik+ ! la/ s5t5ce ( clause 7i7 &    
ins]t+ clause 7i77,,ii74  7#c7 ,clause  
7iv7 ( section #cf;,b7c77#b77;,c7 ( su* 
,code is am5d$ by /rik+ ! #i4e p]c5t "u 
clause 7i77,,ii7 & ins]t+ ! #i4e p]c5t  
"u clauses 7i77,i7 & 7i77,,ii74  7c7    
,effective date ,! am5dm5ts made by ?is 
section %all apply to taxable ye>s      
beg9n+ aft] ,decemb] #ca1 #bjbj4  ,,ii  
,undo+ ,sabotage  #bja4 ,protect        
compreh5sive cov]age = small bus9esses &
 work]s ,! ,secret>y ( ,labor may n take
 any action to implem5t1 en=ce1 or      
o!rwise give effect to ! rule entitl$   
,def9ition ( ,employ] ,"u ,section #c7e7
 ( ,,erisa-,association ,heal? ,plans   
7#hc ,f$4 ,reg4 #bhiab 7,june #ba1      
#bjah771 & ! ,secret>y may n promulgate 
any sub/antially simil> rule4  #bjb4    
,%ort-t]m limit$ duration insurance rule
 prohibition ,! ,secret>y ( ,heal? &    
,human ,s]vices1 ! ,secret>y ( !        
,treasury1 & ! ,secret>y ( ,labor may n 

take any action to implem5t1 en=ce1 or  
o!rwise give effect to ! rule entitl$   
,%ort-,t]m1 ,limit$ ,duration ,insurance
 7#hc ,f$4 ,reg4 #chbab 7,augu/ #c1     
#bjah771 & ! ,secret>ies may n          
promulgate any sub/antially simil> rule4
  #bjc4 ,ensure plans provide           
compreh5sive b5efits  7a7 ,ess5tial     
heal? b5efits ,section #acjb7;b77#d7 ( !
 ,pati5t ,protection & ,af=dable ,c>e   
,act 7#db ,u4,s4,c4 #ahjbb7;b77#d77 is  
am5d$--  7#a7 9 subp>agraph 7,a71 by    
ins]t+ & s t b5efits are includ$ )9 ea* 
( su* categories be=e ! semicolon2  7#b7
 9 subp>agraph 7,g71 by /rik+ at ! end  
&2  7#c7 9 subp>agraph 7,h71 by /rik+ ! 
p]iod at ! end & ins]t+ 2 &2 &  7#d7 by 
add+ at ! end ! foll[+ new subp>agraph3 
7,i7 ensure t1 beg9n+ ,janu>y #a1       
#bjbj-- 7i7 9 ! case ( heal? b5efits t  
are e/abli%$ z ess5tial heal? b5efits1  
!re %all n be sub/itution ( su* b5efits 
across b5efit categories2  7ii7 a       
qualifi$ heal? plan %all n be treat$ z  
provid+ cov]age = ! ess5tial heal?      

b5efits unless "u su* plan--  7,i7      
cov]age ( prescription drugs provides = 
access to a wide v>iety ( classes (     
drugs )9 ! prescription drug =mul>y (   
su* plan2 &  7,,ii7 9 ! case t a drug t 
is m$ically necess>y = an enrollee "u   
su* plan is n includ$ )9 su* =mul>y1 su*
 individual has access to su* drug ?r\gh
 an exceptions process e/abli%$ by !    
plan2 &  7iii7 habilitative s]vices are 
cov]$ at p>ity ) rehabilitative s]vices4
  4  7b7 ,/&>d b5efit plans ,section    
#acjb7;d7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjbb7;d77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#e7 ,/&>d b5efit 
plans  7,a7 ,9 g5]al ,= purposes (      
provid+ individuals ) ! opportunity to  
make simpl] comp>isons ( heal? plans    
(f]$ by diff]5t heal? insurance issu]s &
 simplify ! selection process1 !        
,secret>y %all1 = ea* plan ye> beg9n+ ) 
plan ye> #bjbj1 ?r\gh rulemak+1 specify 
a /ructure describ$ 9 subp>agraph       
7,b77i7 = a /&>d b5efit plan = su* plan 

ye> = ea* ( ! bronze1 silv]1 & gold     
levels ( cov]age & = ea* actu>ial value 
v>iation ( a silv] plan result+ f !     
application ( section #adjb7;c74 ,a /&>d
 b5efit plan = a plan ye> = a level (   
cov]age or actu>ial value v>iation ( a  
silv] plan %all be model$ on ! mo/      
commonly pur*as$ plans 7det]m9$ by      
enrollm5ts 9 su* plans7 dur+ ! previ\s  
#b plan ye>s (f]$ 9 ! f$]ally facilitat$
 ,ex*ange op]at$ pursuant to section    
#acba7;c7 9 su* level or v>iation & %all
 include cov]age ( d$uctible-exempt     
s]vices consi/5t ) actual pur*as+       
patt]ns ( consum]s 9 ! previ\s two plan 
ye>s4  7,b7 ,/&>d b5efit plan ,=        
purposes ( ?is p>agraph1 ! t]m /&>d     
b5efit plan means a qualifi$ heal? plan 
to be (f]$ ?r\gh an ,ex*ange on !       
individual m>ket t has ei!r--  7i7 a    
/&>diz$ co/-%>+ /ructure specifi$ by !  
,secret>y pursuant to rulemak+2 or  7ii7
 a /&>diz$ co/-%>+ /ructure specifi$ by 
! ,secret>y pursuant to rulemak+ t is   
modifi$ by ! heal? insurance issu] ( su*

 plan only to ! ext5t necess>y to align 
) high d$uctible heal? plan requirem5ts 
"u section #bbc ( ! ,int]nal ,rev5ue    
,code ( #aihf or ! applicable annual    
limitation on co/ %>+ "u subsection 7c7 
& actu>ial value requirem5ts specifi$ by
 ! ,secret>y4  4  #bjd4 ,provid+ =      
additional requirem5ts ) respect to !   
navigator program  7a7 ,9 g5]al ,section
 #acaa7;i7 ( ! ,pati5t ,protection &    
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7;i77 is am5d$-- 7#a7 9 p>agraph  
7#b71 by add+ at ! end ! foll[+ new     
subp>agraph3  7,c7 ,selection (         
recipi5ts ,9 ! case ( an ,ex*ange       
e/abli%$ & op]at$ by ! ,secret>y )9 a   
,/ate pursuant to section #acba7;c71 9  
aw>d+ grants "u p>agraph 7#a71 !        
,ex*ange %all--  7i7 select entities to 
receive su* grants bas$ solely on an    
entity's demon/rat$ capacity to c>ry out
 ea* ( ! duties specifi$ 9 p>agraph     
7#c72  7ii7 n take into acc\nt :e!r or n
 ! entity has demon/rat$ h[ ! entity w  
provide in=mation to individuals relat+ 

to gr\p heal? plans (f]$ by a gr\p or   
association ( employ]s describ$ 9       
section #beaj4c-e7;b7 ( title #bi1 ,code
 ( ,f$]al ,regulations 7or any successor
 regulation71 or %ort-t]m limit$        
duration insurance 7z def9$ by !        
,secret>y = purposes ( section          
#bgia7;b77#e7 ( ! ,public ,heal? ,s]vice
 ,act72 &  7iii7 ensure t1 ea* ye>1 !   
,ex*ange aw>ds su* a grant to-- 7,i7 at 
lea/ "o entity describ$ 9 ?is p>agraph t
 is a community & consum]-focus$        
nonpr(it gr\p2 &  7,,ii7 at lea/ "o     
entity describ$ 9 subp>agraph 7,b71 :i* 
may include ano!r community &           
consum]-focus$ nonpr(it gr\p 9 addition 
to any su* gr\p aw>d$ a grant pursuant  
to subclause 7,i74  2  7#b7 9 p>agraph  
7#c7-- 7,a7 9 subp>agraph 7,c71 by      
ins]t+ aft] qualifi$ heal? plans !      
foll[+3 1 ,/ate ,m$icaid plans "u title 
,,xix ( ! ,social ,security ,act1 &     
,/ate ,*ildr5's ,heal? ,insurance       
,programs "u title ,,xxi ( su* ,act2 &  
7,b7 by add+ at ! end ! foll[+ flu% left

 s5t5ce3 ,! duties specifi$ 9 ! prec$+  
s5t5ce may be c>ri$ out by su* a        
navigator at any "t dur+ a ye>4 2  7#c7 
9 p>agraph 7#d77;,a7--  7,a7 9 ! matt]  
prec$+ clause 7i71 by /rik+ n2  7,b7 9  
clause 7i7--  7i7 by ins]t+ n be=e be2 &
  7ii7 by /rik+ 2 or & ins]t+ 22  7,c7 9
 clause 7ii7-- 7i7 by ins]t+ n be=e     
receive2 &  7ii7 by /rik+ ! p]iod &     
ins]t+ 22 &  7,d7 by add+ at ! end !    
foll[+ new clause3  7iii7 ma9ta9        
physical pres5ce 9 ! ,/ate ( ! ,ex*ange 
s z to all[ 9-p]son assi/ance to        
consum]s4  2 &  7#d7 9 p>agraph 7#f7--  
7,a7 by /rik+ ,fund+4--,grants "u &     
ins]t+  ,fund+4-- 7,a7 ,/ate ,ex*anges  
,grants "u  2 &  7,b7 by add+ at ! end !
 foll[+ new subp>agraph3  7,b7 ,f$]al   
,ex*anges ,= purposes ( c>ry+ out ?is   
subsection1 ) respect to an ,ex*ange    
e/abli%$ & op]at$ by ! ,secret>y )9 a   
,/ate pursuant to section #acba7;c71 !  
,secret>y %all obligate #ajj1jjj1jjj out
 ( am\nts collect$ ?r\gh ! us] fees on  
p>ticipat+ heal? insurance issu]s       

pursuant to section #aef4ej ( title #de1
 ,code ( ,f$]al ,regulations 7or any    
successor regulations7 = fiscal ye>     
#bjbj & ea* subsequ5t fiscal ye>4 ,su*  
am\nt = a fiscal ye> %all rema9         
available until exp5d$4  4  7b7         
,effective date ,! am5dm5ts made by     
subsection 7a7 %all apply ) respect to  
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbj4  #bje4 ,f$]al ,ex*ange outrea* & 
educational activities ,section         
#acba7;c7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjda7;c77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#c7 ,outrea* &   
educational activities  7,a7 ,9 g5]al ,9
 ! case ( an ,ex*ange e/abli%$ or op]at$
 by ! ,secret>y )9 a ,/ate pursuant to  
?is subsection1 ! ,secret>y %all c>ry   
out outrea* & educational activities =  
purposes ( in=m+ pot5tial enrollees 9   
qualifi$ heal? plans (f]$ ?r\gh !       
,ex*ange ( ! availability ( cov]age "u  
su* plans & f9ancial assi/ance = cov]age
 "u su* plans4 ,su* outrea* &           

educational activities %all be provid$ 9
 a mann] t is culturally & l+ui/ically  
appropriate to ! ne$s ( ! populations   
be+ s]v$ by ! ,ex*ange 7includ+         
h>d-to-rea* populations1 su* z racial & 
sexual m9orities1 limit$ ,engli%        
pr(ici5t populations1 & "y adults74     
7,b7 ,limitation on use ( funds ,no     
funds appropriat$ "u ?is p>agraph %all  
be us$ = exp5ditures = promot+ non-,,aca
 compliant heal? insurance cov]age4     
7,c7 ,non-aca compliant heal? insurance 
cov]age ,= purposes ( ?is subp>agraph   
7,b73 7i7 ,! t]m non-,,aca compliant    
heal? insurance cov]age means heal?     
insurance cov]age1 or a gr\p heal? plan1
 t is n a qualifi$ heal? plan4  7ii7    
,su* t]m includes ! foll[+3 7,i7 ,an    
association heal? plan4  7,,ii7         
,%ort-t]m limit$ duration insurance4    
7,d7 ,fund+ ,out ( any funds 9 !        
,treasury n o!rwise appropriat$1 !re are
 h]eby appropriat$ = fiscal ye> #bjbj & 
ea* subsequ5t fiscal ye>1 #ajj1jjj1jjj  
to c>ry out ?is p>agraph4 ,funds        

appropriat$ "u ?is subp>agraph %all     
rema9 available until exp5d$4  4  #bjf4 
,improve ,heal? ,insurance ,af=dability 
,fund ,subtitle ,d ( title ,i ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act is am5d$ 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 title1 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 or "u any    
subsequ5t ext5sions !re(4  #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 title &1
 9 ! case ( allocations = a subsequ5t   
ye>1 n lat] ?an ,m>* #ca ( ! 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  7b7 ,default ,f$]al 
safegu>d  7#a7 #bjbj ,= allocations made
 "u ?is "p = #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$1 ! ,adm9i/rator1 9         
consultation ) ! ,/ate insurance        
commission]1 %all use1 9 accordance )   
p>agraph 7#c71 ! allocation t w\ld      
o!rwise be provid$ to ! ,/ate "u ?is "p 
= su* ye> = su* ,/ate4  7#b7 #bjba &    
subsequ5t ye>s ,9 ! case ( a ,/ate t    

does n h 9 effect an approv$ application
 "u ?is section = #bjba or a subsequ5t  
ye>1 ! ,adm9i/rator1 9 consultation ) ! 
,/ate insurance commission]1 %all use1 9
 accordance ) p>agraph 7#c71 !          
allocation t w\ld o!rwise be provid$ to 
! ,/ate "u ?is "p = su* ye> = su* ,/ate4
  7#c7 ,specifi$ use ,an allocation = a 
,/ate made pursuant to p>agraph 7#a7 or 
7#b7 = a ye> %all be us$ to c>ry out !  
purpose describ$ 9 section #aceb7;a77#a7
 9 su* ,/ate by provid+ re9surance      
paym5ts to heal? insurance issu]s )     
respect to atta*m5t range claims 7z     
def9$ 9 section #aced7;b77#b71 us+ !    
doll> am\nts specifi$ 9 subp>agraph 7,b7
 ( su* section = su* ye>7 9 an am\nt    
equal to ! p]c5tage 7specifi$ = su* ye> 
by ! ,secret>y "u su* subp>agraph7 ( !  
am\nt ( su* claims4  #aced4 ,allocations
  7a7 ,appropriation ,= ! purpose (     
provid+ allocations = ,/ates "u ?is "p  
!re is appropriat$1 out ( any money 9 ! 
,treasury n o!rwise appropriat$         
#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 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 title2 &  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 is ! 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 all ,/ates us$ su* funds only = !    
purpose describ$ 9 p>agraph 7#a7 (      
section #aceb at ! doll> am\nts &       
p]c5tage specifi$ "u subp>agraph 7,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 subp>agraph 7,a7 = 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  7c7     
,annual di/ribution ( previ\s ye>'s     
rema9+ funds  7#a7 ,9 g5]al ,9 c>ry+ out
 subsection 7b71 ! ,secret>y %all1 )    
respect to a ye> 7beg9n+ ) #bjba71 n    
lat] ?an ,m>* #ca ( su* ye>--  7,a7     
det]m9e ! am\nt ( funds1 if any1 f !    
am\nts appropriat$ "u subsection 7a7 = !
 previ\s ye> b n allocat$ = su* previ\s 
ye>2 &  7,b7 if ! ,secret>y det]m9es t  
any funds 7 n s allocat$ = su* previ\s  
ye>1 allocate su* rema9+ funds to ,/ates
 = su* ye>1 9 accordance ) p>agraph     
7#b74  7#b7 ,allocation me?odology ,=   
purposes ( p>agraph 7#a71 ( ! total     
rema9+ funds to be allocat$ = a ye>     
pursuant to su* p>agraph1 ! ,secret>y   
%all allocate to ea* ,/ate an am\nt t   
be>s ! same ratio to su* total rema9+   
funds z ! am\nt allocat$ pursuant to    
subsection 7b7 to su* ,/ate = su* ye>   
be>s to ! total allocations made "u su* 

subsection = su* ye>4  4  #bjg4 ,provid+
 t c]ta9 guidance relat$ to waiv]s =    
,/ate innovation "u ! ,pati5t           
,protection & ,af=dable ,c>e ,act %all h
 no =ce or effect  ,beg9n+ ,april #a1   
#bjai1 ! ,secret>y ( ,heal? & ,human    
,s]vices & ! ,secret>y ( ! ,treasury may
 n take any action to implem5t1 en=ce1  
or o!rwise give effect to ! guidance    
entitl$ ,/ate ,relief & ,emp[]m5t       
,waiv]s 7#hc ,f$4 ,reg4 #ecege 7,octob] 
#bd1 #bjah771 & ! ,secret>ies may n     
promulgate any sub/antially simil>      
guidance or rule4  ,,iii ,/ate          
,innovation & ,transp>5cy  #cja4 ,fund  
,/ate heal? insurance education programs
 = consum]s ,section #bgic7;e7 ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ic7;e77 is am5d$ by  
add+ at ! end ! foll[+ new p>agraph3    
7#c7 ,appropriations ,= purposes ( c>ry+
 out ?is section1 !re is h]eby          
appropriat$ to ! ,secret>y1 out ( any   
funds 9 ! ,treasury n o!rwise           
appropriat$1 #ajj1jjj1jjj = ea* ( !     

fiscal ye>s #bjbj ?r\gh #bjbb4 ,su*     
am\nt %all rema9 available until exp5d$4
  4  #cjb4 ,fund ,/ate innovations to   
exp& cov]age  7a7 ,9 g5]al ,subject to  
subsection 7d71 ! ,secret>y ( ,heal? &  
,human ,s]vices %all aw>d grants to     
eligible ,/ate ag5cies to enable su*    
,/ates to explore innovative solutions  
to promote great] enrollm5t 9 heal?     
insurance cov]age 9 ! individual & small
 gr\p m>kets1 includ+ activities        
describ$ 9 subsection 7c74  7b7         
,eligibility ,= purposes ( subsection   
7a71 eligible ,/ate ag5cies are         
,ex*anges e/abli%$ by a ,/ate "u title  
,i ( ! ,pati5t ,protection & ,af=dable  
,c>e ,act & ,/ate ag5cies ) prim>y      
responsibility ov] heal? & human s]vices
 = ! ,/ate involv$4  7c7 ,use ( funds ,=
 purposes ( subsection 7a71 ! activities
 describ$ 9 ?is subsection are ! foll[+3
 7#a7 ,/ate ef=ts to /reaml9e heal?     
insurance enrollm5t proc$ures 9 ord] to 
r$uce burd5s on consum]s & facilitate   
great] enrollm5t 9 heal? insurance      

cov]age 9 ! individual & small gr\p     
m>kets1 includ+ automatic enrollm5t &   
re5rollm5t (1 or pre-populat$           
applications =1 individuals )\t heal?   
insurance :o are eligible = tax cr$its  
"u section #cf;,b ( ! ,int]nal ,rev5ue  
,code ( #aihf1 ) ! ability to opt out ( 
su* enrollm5t4  7#b7 ,/ate inve/m5t 9   
te*nology to improve data %>+ &         
collection = ! purposes ( facilitat+    
great] enrollm5t 9 heal? insurance      
cov]age 9 su* m>kets4  7#c7             
,implem5tation ( a ,/ate v]sion ( an    
individual m&ate to be enroll$ 9 heal?  
insurance cov]age4  7#d7 ,feasibility   
/udies to develop compreh5sive & coh]5t 
,/ate plan = increas+ enrollm5t 9 !     
individual & small gr\p m>ket4  7d7     
,fund+ ,= purposes ( c>ry+ out ?is      
section1 !re is h]eby appropriat$1 out (
 any funds 9 ! ,treasury n o!rwise      
appropriat$1 #bjj1jjj1jjj = ea* ( !     
fiscal ye>s #bjbj ?r\gh #bjbb4 ,su*     
am\nt %all rema9 available until exp5d$4
  #cjc4 ,pres]v+ ,/ate option to        

implem5t heal? c>e m>ketplaces  7a7 ,9  
g5]al ,section #acaa ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7 is am5d$-- 7#a7 9     
subsection 7a7--  7,a7 9 p>agraph       
7#d77;,b71 by /rik+ "u ?is subsection & 
ins]t+ "u ?is p>agraph or p>agraph 7#a72
 &  7,b7 by add+ at ! end ! foll[+ new  
p>agraph3  7#f7 ,additional plann+ &    
e/abli%m5t grants  7,a7 ,9 g5]al ,!re   
%all be appropriat$ to ! ,secret>y1 out 
( any moneys 9 ! ,treasury n o!rwise    
appropriat$1 #bjj1jjj1jjj to aw>d grants
 to eligible ,/ates = ! uses describ$ 9 
p>agraph 7#c74  7,b7 ,duration &        
r5ewability ,a grant aw>d$ "u           
subp>agraph 7,a7 %all be = a p]iod ( two
 ye>s & may n be r5ew$4  7,c7           
,limitation ,a grant may n be aw>d$ "u  
subp>agraph 7,a7 aft] ,decemb] #ca1     
#bjbb4  7,d7 ,eligible ,/ate def9$ ,=   
purposes ( ?is p>agraph1 ! t]m eligible 
,/ate means a ,/ate t1 z ( ! date ( !   
enactm5t ( ?is p>agraph1 is n op]at+ an 
,ex*ange4  2 &  7#b7 9 subsection       

7d77#e77;,a7-- 7,a7 by /rik+ ,9 e/abli%+
 an ,ex*ange "u ?is section & ins]t+ 7i7
 ,9 g5]al4--,9 e/abli%+ an ,ex*ange "u  
?is section 7o!r ?an 9 e/abli%+ an      
,ex*ange pursuant to subsection         
7a77#f772 &  7,b7 by add+ at ! end !    
foll[+3  7ii7 ,additional plann+ &      
e/abli%m5t grants ,9 e/abli%+ an        
,ex*ange pursuant to subsection 7a77#f71
 ! ,/ate %all ensure t su* ,ex*ange is  
self-su/a9+ beg9n+ on ,janu>y #a1 #bjbd1
 includ+ all[+ ! ,ex*ange to *>ge       
assessm5ts or us] fees to p>ticipat+    
heal? insurance issu]s1 or to o!rwise   
g5]ate fund+1 to support its op]ations4 
4  7b7 ,cl>ification reg>d+ failure ,to 
e/abli% ,ex*ange or implem5t requirem5ts
 ,section #acba7;c7 ( ! ,pati5t         
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjda7;c771 z am5d$ by       
section #bje1 is fur!r am5d$--  7#a7 9  
p>agraph 7#a71 by /rik+ ,if & ins]t+    
,subject to p>agraph 7#d71 if2 &  7#b7  
by add+ at ! end ! foll[+ new p>agraph3 
7#d7 ,cl>ification ,?is subsection %all 

n apply 9 ! case ( a ,/ate t elects to  
apply ! requirem5ts describ$ 9          
subsection 7a7 & satisfies ! requirem5t 
describ$ 9 subsection 7b7 on or aft]    
,janu>y #a1 #bjad4  4  #cjd4 ,promote   
transp>5cy & acc\ntability 9 !          
,adm9i/ration's exp5ditures ( ,ex*ange  
us] fees ,= ea* ( plan ye>s #bjah1      
#bjai1 & #bjbj1 n lat] ?an ! date t is  
#c mon?s aft] ! end ( su* plan ye>1 !   
,secret>y ( ,heal? & ,human ,s]vices    
%all submit to ! appropriate committees 
( ,congress & make available to ! public
 an annual report on ! exp5diture by !  
,dep>tm5t ( ,heal? & ,human ,s]vices (  
us] fees collect$ pursuant to section   
#aef4ej ( title #de1 ,code ( ,f$]al     
,regulations 7or any successor          
regulations74 ,ea* su* report = a plan  
ye> %all include a detail$ acc\nt+ ( !  
am\nt ( su* us] fees collect$ dur+ su*  
plan ye> & ( ! am\nt ( su* exp5ditures  
us$ dur+ su* plan ye> = ! f$]ally       
facilitat$ ,ex*ange op]at$ pursuant to  
section #acba7;c7 ( ! ,pati5t           

,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjda7;c77 on outrea* &      
enrollm5t activities1 navigators1       
ma9t5ance ( ,heal?c>e4gov1 & op]ation ( 
call c5t]s4