,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #dfeb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #aa1 #bjai,mr4
 ,langev9 7= himself1 ,ms4 ,judy ,*u (  
,cali=nia1 & ,mr4 ,ruiz7 introduc$ !    
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committee on ,ways &     
,means1 = 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 e/abli% an ,individual     
,m>ket ,re9surance fund to provide fund+
 = ,/ate individual m>ket /abilization  
re9surance programs4  #a4 ,%ort title   
,?is ,act may be cit$ z ! ,individual   
,heal? ,insurance ,m>ketplace           
,improvem5t ,act4  #b4 ,individual      
,m>ket ,re9surance ,fund  7a7           
,e/abli%m5t ( ,fund  7#a7 ,9 g5]al ,!re 
is e/abli%$ ! ,individual ,m>ket        
,re9surance ,fund to be adm9i/]$ by !   
,secret>y to provide fund+ = an         
individual m>ket /abilization re9surance

 program 9 ea* ,/ate t complies ) !     
requirem5ts ( ?is section4  7#b7 ,fund+ 
,!re is appropriat$ to ! ,fund1 out (   
any moneys 9 ! ,treasury n o!rwise      
appropriat$1 su* sums z are necess>y to 
c>ry out ?is section 7o!r ?an subsection
 7c77 = ea* cal5d> ye> beg9n+ ) #bjbj4  
,am\nts appropriat$ to ! ,fund %all     
rema9 available )\t fiscal or cal5d> ye>
 limitation to c>ry out ?is section4    
7b7 ,individual ,m>ket ,re9surance      
,program  7#a7 ,use ( funds ,! ,secret>y
 %all use am\nts 9 ! ,fund to e/abli% a 
re9surance program "u :i* ! ,secret>y   
%all make re9surance paym5ts to heal?   
insurance issu]s ) respect to high-co/  
individuals enroll$ 9 qualifi$ heal?    
plans (f]$ by su* issu]s t are n        
gr&fa!r$ heal? plans or transitional    
heal? plans = any plan ye> beg9n+ ) !   
#bjbj plan ye>4 ,?is subsection         
con/itutes budget au?ority 9 advance (  
appropriations ,acts & repres5ts !      
obligation ( ! ,secret>y to provide     
paym5ts f ! ,fund 9 accordance ) ?is    

subsection4  7#b7 ,am\nt ( paym5t ,!    
paym5t made to a heal? insurance issu]  
"u subsection 7a7 ) respect to ea*      
high-co/ individual enroll$ 9 a qualifi$
 heal? plan issu$ by ! issu] t is n a   
gr&fa!r$ heal? plan or a transitional   
heal? plan %all equal #hj p]c5t ( !     
less] (--  7,a7 ! am\nt 7if any7 by :i* 
! individual's claims incurr$ dur+ !    
plan ye> exce$s-- 7i7 9 case ( ! #bjbj1 
#bjba1 or #bjbb plan ye>1 #ej1jjj2 &    
7ii7 9 ! case ( any o!r plan ye>1       
#ajj1jjj2 or  7,b7 = plan ye>s describ$ 
9--  7i7 subp>agraph 7,a77i71 #dej1jjj2 
&  7ii7 subp>agraph 7,a77ii71 #djj1jjj4 
7#c7 ,index+ ,9 ! case ( plan ye>s      
beg9n+ aft] #bjbj1 ! doll> am\nts t     
appe> 9 subp>agraphs 7,a7 & 7,b7 (      
p>agraph 7#b7 %all ea* be increas$ by an
 am\nt equal to--  7,a7 su* am\nt2      
multipli$ by  7,b7 ! premium adju/m5t   
p]c5tage specifi$ "u section            
#acjb7;c77#d7 ( ! ,af=dable ,c>e ,act1 b
 det]m9$ by sub/itut+ #bjbj = #bjac4    
7#d7 ,paym5t me?ods  7,a7 ,9 g5]al      

,paym5ts "u ?is subsection %all be bas$ 
on su* a me?od z ! ,secret>y det]m9es4  
,! ,secret>y may e/abli% a paym5t me?od 
by :i* int]im paym5ts ( am\nts "u ?is   
subsection are made dur+ a plan ye> bas$
 on ! ,secret>y's be/ e/imate ( am\nts t
 w be payable aft] obta9+ all ( !       
in=mation4  7,b7 ,requirem5t = provision
 ( in=mation  7i7 ,requirem5t ,paym5ts  
"u ?is subsection to a heal? insurance  
issu] are condition$ ^u ! furni%+ to !  
,secret>y1 9 a =m & mann] specifi$ by ! 
,secret>y1 ( su* in=mation z may be     
requir$ to c>ry out ?is subsection4     
7ii7 ,re/riction on use ( in=mation     
,in=mation disclos$ or obta9$ pursuant  
to clause 7i7 is subject to ! ,,hipaa   
privacy & security law1 z def9$ 9       
section #cjji7;a7 ( ! ,public ,heal?    
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;jj-#ai7;a774  7#e7 ,secret>y       
flexibility = budget neutral revisions  
to re9surance paym5t specifications ,if 
! ,secret>y det]m9es appropriate1 !     
,secret>y may sub/itute high] doll>     

am\nts = ! doll> am\nts specifi$ "u     
subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7
 7& adju/$ "u p>agraph 7#c71 if         
applicable7 if ! ,secret>y c]tifies t   
su* sub/itutions1 consid]$ toge!r1 nei!r
 increase nor decease ! total project$  
paym5ts "u ?is subsection4  7c7 ,outrea*
 & enrollm5t  7#a7 ,9 g5]al ,dur+ !     
p]iod t beg9s on ,janu>y #a1 #bjbj1 &   
ends on ,decemb] #ca1 #bjbb1 ! ,secret>y
 %all aw>d grants to eligible entities =
 ! foll[+ purposes3  7,a7 ,outrea* &    
enrollm5t ,to c>ry out outrea*1 public  
education activities1 & enrollm5t       
activities to raise aw>5ess ( !         
availability (1 & enc\rage enrollm5t 91 
qualifi$ heal? plans4  7,b7 ,assi/+     
individuals transition to qualifi$ heal?
 plans ,to provide assi/ance to         
individuals :o are enroll$ 9 heal?      
insurance cov]age t is n a qualifi$     
heal? plan enroll 9 a qualifi$ heal?    
plan4  7,c7 ,assi/+ enrollm5t 9 public  
heal? programs ,to facilitate !         
enrollm5t ( eligible individuals 9 !    

,m$ic>e program or 9 a ,/ate ,m$icaid   
program1 z appropriate4  7,d7 ,rais+    
aw>5ess ( premium assi/ance & co/-%>+   
r$uctions ,to di/ribute fair & imp>tial 
in=mation conc]n+ enrollm5t 9 qualifi$  
heal? plans & ! availability ( premium  
assi/ance tax cr$its "u section #cf;,b (
 ! ,int]nal ,rev5ue ,code ( #aihf &     
co/-%>+ r$uctions "u section #adjb ( !  
,pati5t ,protection & ,af=dable ,c>e    
,act1 & to assi/ eligible individuals 9 
apply+ = su* tax cr$its & co/-%>+       
r$uctions4  7#b7 ,eligible entities     
def9$  7,a7 ,9 g5]al ,9 ?is subsection1 
! t]m eligible entity means-- 7i7 a     
,/ate2 or  7ii7 a nonpr(it              
community-bas$ organization4  7,b7      
,enrollm5t ag5ts ,su* t]m includes a    
lic5s$ indep5d5t insurance ag5t or brok]
 t has an arrangem5t ) a ,/ate or       
nonpr(it community-bas$ organization to 
enroll eligible individuals 9 qualifi$  
heal? plans4  7,c7 ,exclusions ,su* t]m 
does n include an entity t-- 7i7 is a   
heal? insurance issu]2 or  7ii7 receives

 any consid]ation1 ei!r directly or     
indirectly1 f any heal? insurance issu] 
9 connection ) ! enrollm5t ( any        
qualifi$ individuals or employees ( a   
qualifi$ employ] 9 a qualifi$ heal?     
plan4  7#c7 ,priority ,9 aw>d+ grants "u
 ?is subsection1 ! ,secret>y %all give  
priority to aw>d+ grants to ,/ates or   
eligible entities 9 ,/ates t h          
geographic rat+ areas at risk ( hav+ no 
qualifi$ heal? plans 9 ! individual     
m>ket4  7#d7 ,fund+ ,out ( any moneys 9 
! ,treasury n o!rwise appropriat$1      
#ejj1jjj1jjj is appropriat$ to !        
,secret>y = ea* ( cal5d> ye>s #bjbj     
?r\gh #bjbb1 to c>ry out ?is subsection4
  7d7 ,reports to ,congress  7#a7       
,annual report ,! ,secret>y %all submit 
a report to ,congress1 n lat] ?an       
,janu>y #ba1 #bjba1 & ea* ye> !reaft]1 t
 conta9s ! foll[+ in=mation = ! mo/     
rec5tly end$ ye>3  7,a7 ,! numb] & types
 ( plans 9 ea* ,/ate's individual m>ket1
 specify+ ! numb] t are qualifi$ heal?  
plans1 gr&fa!r$ heal? plans1 or heal?   

insurance cov]age t is n a qualifi$     
heal? plan4  7,b7 ,! impact ( !         
re9surance paym5ts provid$ "u ?is       
section on ! availability ( cov]age1 co/
 ( cov]age1 & cov]age options 9 ea*     
,/ate4  7,c7 ,! am\nt ( premiums paid by
 individuals 9 ea* ,/ate by age1 family 
size1 geographic area 9 ! ,/ate's       
individual m>ket1 & category ( heal?    
plan 7z describ$ 9 subp>agraph 7,a774   
7,d7 ,! process us$ to aw>d funds =     
outrea* & enrollm5t activities aw>d$ to 
eligible entities "u subsection 7c71 !  
am\nt ( su* funds aw>d$1 & ! activities 
c>ri$ out ) su* funds4  7,e7 ,su* o!r   
in=mation z ! ,secret>y deems relevant4 
7#b7 ,evaluation report ,n lat] ?an     
,janu>y #ca1 #bjbd1 ! ,secret>y %all    
submit to ,congress a report t--  7,a7  
analyzes ! impact ( ! funds provid$ "u  
?is section on premiums & enrollm5t 9 ! 
individual m>ket 9 all ,/ates2 &  7,b7  
conta9s a ,/ate-by-,/ate comp>ison ( !  
design ( ! programs c>ri$ out by ,/ates 
) funds provid$ "u ?is section4  7e7    

,def9itions ,9 ?is section3 7#a7        
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ! ,dep>tm5t ( ,heal? &      
,human ,s]vices4  7#b7 ,fund ,! t]m     
,fund means ! ,individual ,m>ket        
,re9surance ,fund e/abli%$ "u subsection
 7a74  7#c7 ,gr&fa!r$ heal? plan ,! t]m 
gr&fa!r$ heal? plan has ! mean+ giv5 t  
t]m 9 section #abea7;e7 ( ! ,pati5t     
,protection & ,af=dable ,c>e ,act4  7#d7
 ,high-co/ individual ,! t]m high-co/   
individual means an individual enroll$ 9
 a qualifi$ heal? plan 7o!r ?an a       
gr&fa!r$ heal? plan or a transitional   
heal? plan7 :o incurs claims 9 excess ( 
#ej1jjj dur+ a plan ye>4  7#e7 ,/ate ,! 
t]m ,/ate means ea* ( ! #ej ,/ates & !  
,di/rict ( ,columbia4  7#f7             
,transitional heal? plan ,! t]m         
transitional heal? plan means a plan    
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 ( !    
,pati5t ,protection & ,af=dable ,c>e    
,act 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    
#bjag4