,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #ejaj  ,,in ,,the ,,house ,,of  
,,representatives  ,november #h1        
#bjai,mr4 ,khanna 7for himself1 ,ms4    
,jayapal1 ,mr4 ,blumenauer1 ,ms4        
,bonamici1 ,mr4 ,de,fazio1 ,mr4 ,garca  
of ,illinois1 ,mr4 ,grijalva1 ,ms4 ,lee 
of ,california1 ,ms4 ,ocasio-,cortez1   
,ms4 ,omar1 ,mr4 ,pocan1 ,ms4 ,pressley1
 ,mr4 ,raskin1 ,ms4 ,schakowsky1 ,mr4   
,smith of ,washington1 and ,mrs4 ,watson
 ,coleman7 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 ,reform1    
,armed ,services1 and ,education and    
,labor1 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 #bjai4  7b7 ,purpose ,the
 purpose of this ,act is to establish a 
flexible framework under which ,states  
can provide comprehensive universal     
health coverage to their residents4  #b4
 ,waiver for ,state universal health    
care  7a7 ,in general ,subtitle ,d of   
title ,i of the ,patient ,protection and
 ,affordable ,care ,act 7#db ,u4,s4,c4  
#ahjba et seq47 is amended by inserting 
after section #accd the following new   
section3  #acce4 ,waiver for ,state     
universal health care  7a7 ,application 
7#a7 ,in general ,subject to paragraph  
7#f71 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 the ,state for plan     
years beginning on or after ,january #a1
 #bjbj1 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 legislation1 or other ,state     
legal authority as applicable1 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    
residents of the ,state2 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 legal  
authority to implement such plan or has 

enacted 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
 #bjbj1 are as follows3  7,a7 ,sections 
#acja through #acbd4  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 #e1 ,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 ,passthrough of    
funding ,with respect to a ,state waiver
 under paragraph 7#a71 under which the  

,state assumes responsibility for health
 coverage under one or more of the      
specified ,federal health programs1     
including under each of the ,federal    
health care or subsidy programs         
specified in subparagraphs 7,a71 7,b71  
7,c71 7,e71 7,f71 7,g71 7,h71 and 7,i7  
of paragraph 7#b71 the ,secretary shall 
not spend ,federal health or related    
administrative funds that would         
otherwise have been spent for such a    
program1 as applicable1 for the time    
periods covered under the waiver and    
shall provide for an alternative means  
by which the aggregate amount of such   
funds 7determined by the ,secretary in  
coordination with the ,state71 including
 caseload growth1 adjusted for inflation
 in health care costs within the ,state1
 shall be paid to the ,state for        
purposes of implementing the ,state plan
 under the waiver4 ,any savings in      
health care spending1 including         
administrative savings1 shall be        
available to the ,state for reinvestment

 in health care services under the      
,state plan4 ,such amount shall be      
determined annually by the ,secretary1  
taking into account the amount that     
would otherwise have been spent under   
each such ,federal health program1      
including for administrative activities 
and caseload growth1 with respect to    
residents of such ,state1 for those time
 periods covered under the waiver1      
adjusted for inflation in health care   
costs1 if such waiver did not apply4    
,such amount shall include funds equal  
to the aggregate amount of premium tax  
credits1 cost-sharing reductions1 or    
small-business credits1 to the extent   
applicable to an approved waiver1 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 for those time periods   
covered under the waiver1 including     
caseload growth1 adjusted for inflation 
in health care costs1 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 the        
enactment of the ,state-,based          
,universal ,health ,care ,act of #bjai1 
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
 ,secretary 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 chapter #e of
 title #e1 ,united ,states ,code        
7commonly referred to as the            
,administrative ,procedure ,act71 or    
requirements that are unreasonable or   
unnecessarily burdensome with respect to
 ,state compliance2  7iv7 a process for 
the submission to the ,secretary of     
periodic reports by the ,state          
concerning the implementation of the    
program under the waiver2  7v7 a process
 for the periodic evaluation by the     
,secretary with respect to waivers      
granted under this section2 and  7vi7 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 waivers under this     
section and programs conducted pursuant 
to such waivers that are approved4  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 ,coordination with   
#accb waivers ,a ,state may not apply   
for a waiver under this section with    
respect to a plan year if such ,state   
has in effect1 with respect to such plan
 year1 a waiver under section #accb4    
7#g7 ,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 shall grant a request for a  
waiver under subsection 7a77#a7 if the  
,secretary determines that the ,state   
plan--  7,a7 will provide1 in accordance
 with subparagraph 7,b71 health benefits
 coverage to applicable ,state residents
 that is at least as comprehensive as   
the health benefits coverage that such  
residents would have received under one 
or more of the specified ,federal health

 programs 7as defined in subsection     
7i77#d771 as applicable1 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 as          
applicable1 health benefits coverage to 
applicable ,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 ,medicaid plan under   
title ,,xix of the ,social ,security    
,act or a waiver of such ,state         
,medicaid 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 ,medicaid plan under such     
title1 including benefits for early and 

periodic screening1 diagnostic1 and     
treatment1 benefits for non-emergency   
transportation1 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 those otherwise   
covered under one or more 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 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 or multiple agencies of the      
,state1 or an independent public entity 
within the government of the ,state2    
7,g7 will not preclude the purchase of  
insurance that offers coverage for      
benefits that are not offered under the 
,state plan2 and  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      
applicable ,state residents as those of 
one or more 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#a74        

,subparagraph 7,d7 shall not be         
construed as limiting a ,state from     
contracting with one or more private    
entities to administer the ,state plan4 
7#b7 ,requirement to enact a law  7,a7  
,in general ,a law described in this    
paragraph is a ,state law 7including an 
executive order by a ,state governor7   
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 section 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
 residents of the ,state4  7,e7         
,measurable changes in quality and      

access4  7,f7 ,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
 ,secretary to have not achieved health 
coverage for at least #ie percent of the
 residents 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 #ab months after 
such determination to achieve health    
coverage for at least #ie percent of    
residents of the ,state2 and  7iii7 if  
after such #ab months1 the ,state has   
not achieved such health coverage1 the  
waiver under this section may be        
terminated at the discretion of the     

,secretary2 and  7,b7 has been          
determined by the ,secretary to have    
achieved health coverage for at least   
#ie percent of residents 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       
residents of the ,state4  7f7 ,assuring 
coordination  7#a7 ,in general ,not     
later than #ahj days after the date of  
the enactment of the ,state-,based      
,universal ,health ,care ,act of #bjai1 
the ,secretary of ,health and ,human    
,services1 the ,secretary of the        
,treasury1 the ,secretary of ,defense1  
the ,secretary of ,labor1 and the       
,director of the ,office of ,personnel  
,management1 shall1 through the         
execution of an interagency memorandum  
of understanding among such ,secretaries
 and ,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 ,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 listed in paragraph  
7#a7 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
 #aa 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 on the              
recommendation of the ,republican       
,governors ,association2  7vi7 one shall

 be appointed on the recommendation of  
the ,democratic ,governors ,association2
  7vii7 one shall be a representative   
from the patient advocacy community2    
7viii7 two shall be representatives of a
 labor organization representing health 
care professionals who provide direct   
patient care1 including at least one    
labor organization that primarily       
represents registered nurses2  7ix7 one 
shall be a representative of primary    
care physicians2 and  7x7 one shall be a
 representative of health care          
professionals practicing in rural or    
underserved areas4  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 #bjbj through 
#bjbe4  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 ,indians are consonant    
with and required by the ,federal       
,government's historical and unique     
legal relationship with1 and resulting  
responsibility to1 ,indians4  7,b7 ,no  
enrollment fee1 premium1 or similar     
charge1 and no deduction1 copayment1    
cost sharing1 or similar charge1 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 section 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 #db1   
,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 #db1 ,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-7b772 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-7a772 and  7,b7 includes any    
medical coverage or health benefits     
provided under one or more of the       
specified ,federal health program       
described in subparagraphs 7,a7 through 
7,e7 of paragraph 7#d71 as applicable to
 a waiver under subsection 7a77#a74     
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 

one or more of the following programs1  
as applicable to a waiver under         
subsection 7a77#a73 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 #e1 ,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 table of   
contents in section #a7;b7 of the       
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #ahjja note7  

is amended by inserting after the item  
relating to section #accd the following 
new item3  #acce4 ,waiver for ,state    
universal health care4  4