,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #dgj  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #ac1 #bjai,ms4
 ,/ab5[ 7= h]self1 ,mr4 ,br[n1 ,ms4     
,baldw91 ,mr4 ,blum5?al1 ,mr4 ,book]1   
,mr4 ,c>d91 ,ms4 ,duckwor?1 ,mr4 ,durb91
 ,ms4 ,h>ris1 ,ms4 ,klobu*>1 ,mr4       
,leahy1 ,mr4 ,m>key1 ,mr4 ,m]kley1 ,mr4 
,pet]s1 ,mr4 ,re$1 ,mrs4 ,%ahe51 ,ms4   
,smi?1 ,mr4 ,:iteh\se1 ,mrs4 ,gillibr&1 
& ,mr4 ,he9ri*7 introduc$ ! foll[+ bill2
 :i* 0 read twice & ref]r$ to !         
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xviii ( ! ,social ,security
 ,act to provide = an option = any      
citiz5 or p]man5t resid5t ( ! ,unit$    
,/ates age #ej to #fd to buy into       
,m$ic>e4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,m$ic>e at #ej ,act4  #b4   
,m$ic>e buy-9 option = individuals #ej  
to #fd ye>s ( age  7a7 ,9 g5]al ,title  
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #acie;c et seq47 is am5d$ by  
add+ at ! end ! foll[+ new section3     
#ahii;,c4 ,m$ic>e buy-9 option =        

individuals #ej to #fd ye>s ( age  7a7  
,option  7#a7 ,9 g5]al ,e individual :o 
meets ! requirem5ts describ$ 9 p>agraph 
7#c7 %all be eligible to enroll "u ?is  
section4  7#b7 ,"p ,a1 ,b1 & ,d b5efits 
& protections ,an individual enroll$ "u 
?is section is entitl$ to ! same b5efits
 7& %all receive ! same protections7 "u 
?is title z an individual :o is entitl$ 
to b5efits "u "p ,a & enroll$ "u p>ts ,b
 & ,d1 includ+ ! ability to enroll 9 a  
,m$ic>e ,advantage plan t provides      
qualifi$ prescription drug cov]age 7an  
,,ma-,,pd plan7 & includ+ access to !   
,m$ic>e ,b5efici>y ,ombudsman "u section
 #ahjh7;c74  7#c7 ,requirem5ts =        
eligibility ,! requirem5ts describ$ 9   
?is p>agraph are ! foll[+3 7,a7 ,age ,! 
individual has atta9$ #ej ye>s ( age1 b 
has n atta9$ #fe ye>s ( age4  7,b7      
,m$ic>e eligibility 7b = age7 ,!        
individual is n o!rwise entitl$ to      
b5efits "u "p ,a or eligible to enroll  
"u "p ,a or "p ,b b w\ld be eligible =  
b5efits "u "p ,a or "p ,b if !          

individual 7 #fe ye>s ( age4  7b7       
,enrollm5t & cov]age p]iods  7#a7 ,9    
g5]al ,! ,secret>y %all e/abli%         
enrollm5t & cov]age p]iods = individuals
 :o enroll "u ?is section4  7#b7        
,coord9ation ,su* p]iods %all be        
e/abli%$ 9 coord9ation ) ! enrollm5t &  
cov]age p]iods = plans (f]$ "u an       
,ex*ange e/abli%$ "u title ,i ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act & plans "u p>ts ,c & ,d4 ,if !     
,secret>y det]m9es appropriate1 !       
,secret>y may exp& su* enrollm5t p]iods 
beyond ! enrollm5t p]iods "u su* an     
,ex*ange or "u p>ts ,c & ,d4  7#c7      
,beg9n+ ( cov]age & special enrollm5t   
p]iods ,! ,secret>y %all e/abli% su*    
p]iods s t cov]age "u ?is section %all  
fir/ beg9 on ,janu>y #a ( ! fir/ ye>    
beg9n+ at lea/ "o ye> aft] ! date ( !   
enactm5t ( ?is section & %all include   
special enrollm5t p]iods1 9 accordance )
 section #aee4dbj ( title #de ( ! ,code 
( ,f$]al ,regulations1 t are applicable 
to qualifi$ heal? plans (f]$ ?r\gh an   

,ex*ange4  7c7 ,premium  7#a7 ,am\nt (  
mon?ly premiums ,! ,secret>y %all       
7beg9n+ = ! fir/ ye> t beg9s m ?an #a   
ye> aft] ! date ( ! enactm5t ( ?is      
section71 dur+ ,septemb] ( ! prec$+ ye>1
 det]m9e a mon?ly premium = all         
individuals enroll$ "u ?is section4 ,su*
 mon?ly premium %all be equal to #a_/ab 
( ! annual premium comput$ "u p>agraph  
7#b77;,b71 :i* %all apply ) respect to  
cov]age provid$ "u ?is section = any    
mon? 9 ! succe$+ ye>4  7#b7 ,annual     
premium  7,a7 ,comb9$ p] capita av]age =
 all ,m$ic>e b5efits ,! ,secret>y %all  
e/imate ! av]age1 annual p] capita am\nt
 = b5efits & adm9i/rative exp5ses t w be
 payable "u p>ts ,a1 ,b1 & ,d 7includ+1 
z applicable1 "u "p ,c7 9 ! ye> = all   
individuals enroll$ "u ?is section4     
7,b7 ,annual premium ,! annual premium  
"u ?is subsection = mon?s 9 a ye> is    
equal to ! av]age1 annual p] capita     
am\nt e/imat$ "u subp>agraph 7,a7 = !   
ye>4  7#c7 ,increas$ premium = c]ta9 "p 
,c & ,d plans ,no?+ 9 ?is section %all  

preclude an individual f *oos+ a ,m$ic>e
 ,advantage plan or a prescription drug 
plan t requires ! individual to pay an  
additional am\nt 7because ( supplem5tal 
b5efits or because x is a m exp5sive    
plan74 ,9 su* case ! individual w\ld be 
responsible = ! increas$ mon?ly premium4
  7d7 ,paym5t ( premiums  7#a7 ,9 g5]al 
,premiums = enrollm5t "u ?is section    
%all be paid to ! ,secret>y at su*      
times1 & 9 su* mann]1 z ! ,secret>y     
det]m9es appropriate4  7#b7 ,deposit    
into ,m$ic>e ,buy-,9 tru/ ,fund ,am\nts 
collect$ by ! ,secret>y "u ?is section  
%all be deposit$ 9 ! ,m$ic>e ,buy-,9    
,tru/ ,fund e/abli%$ "u p>agraph 7#c74  
7#c7 ,m$ic>e ,buy-,9 ,tru/ ,fund  7,a7  
,9 g5]al ,!re is h]eby creat$ on ! books
 ( ! ,treasury ( ! ,unit$ ,/ates a tru/ 
fund to be kn[n z ! ,m$ic>e ,buy-,9     
,tru/ ,fund 79 ?is p>agraph ref]r$ to z 
! ,tru/ ,fund74 ,! ,tru/ ,fund %all     
consi/ ( su* gifts & beque/s z may be   
made z provid$ 9 section #bja7;i77#a7 & 
su* am\nts z may be deposit$ 91 or      

appropriat$ to1 su* fund z provid$ 9 ?is
 title4  7,b7 ,incorporation (          
,provisions ,subsections 7b7 ?r\gh 7i7 (
 section #ahda %all apply ) respect to !
 ,tru/ ,fund & ?is title 9 ! same mann] 
z !y apply ) respect to ! ,f$]al        
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund & "p ,b1 respectively1 except t 9 
apply+ su* section #ahda1 any ref]5ce 9 
su* section to ?is "p %all be con/ru$ to
 be a ref]5ce to ?is section & any      
ref]5ce 9 section #ahda7;h7 to section  
#ahdj7;d7 & 9 section #ahda7;i7 to      
sections #ahdj7;b77#a7 & #ahdb7;g7 are  
deem$ to be ref]5ces to comp>able       
au?ority ex]cis$ "u ?is section4  7e7 ,n
 eligible = ,m$ic>e co/-,%>+ assi/ance  
,an individual enroll$ "u ?is section   
%all n be treat$ z enroll$ "u any "p (  
?is title = purposes ( obta9+ m$ical    
assi/ance = ,m$ic>e co/-%>+ or o!rwise  
"u title ,,xix4  7f7 ,eligibility =     
f9ancial assi/ance  7#a7 ,9 g5]al       
,individuals enroll$ 9 cov]age "u ?is   
section %all1 f am\nts transf]r$ "u     

p>agraph 7#b71 receive f9ancial         
assi/ance = su* cov]age t is            
sub/antially simil> to ! assi/ance !    
individual w\ld h receiv$ if !          
individual 7 enroll$ 9 a qualifi$ heal? 
plan ?r\gh an ,ex*ange4  7#b7 ,transf] (
 funds to m$ic>e buy-9 tru/ fund  7,a7  
,9 g5]al ,! ,secret>y %all transf] to ! 
,m$ic>e ,buy-,9 ,tru/ ,fund "u          
subsection 7d77#c7 = ea* plan ye> !     
am\nt det]m9$ "u p>agraph 7,c7 = su*    
ye>4  7,b7 ,use ( funds ,! am\nts       
transf]r$ to ! ,m$ic>e ,buy-,9 ,tru/    
,fund "u subp>agraph 7,a7 %all only be  
us$ to r$uce ! premiums & co/-%>+ =     
cov]age "u ?is section ( individuals    
enroll$ "u su* cov]age :o w\ld be       
eligible = co/-%>+ r$uctions "u section 
#adjb ( ! ,pati5t ,protection &         
,af=dable ,c>e ,act & premium assi/ance 
"u section #cf;,b ( ! ,int]nal ,rev5ue  
,code ( #aihf if su* individual 7       
enroll$ 9 a qualifi$ heal? plan4  7,c7  
,am\nt ( transf]  7i7 ,9 g5]al ,! am\nt 
det]m9$ "u ?is subp>agraph = any plan   

ye> is ! aggregate am\nt ! ,secret>y    
det]m9es is equal to #ajj p]c5t ( !     
premium tax cr$its "u section #cf;,b ( !
 ,int]nal ,rev5ue ,code ( #aihf1 & #ajj 
p]c5t ( ! co/-%>+ r$uctions "u section  
#adjb ( ! ,pati5t ,protection &         
,af=dable ,c>e ,act1 t w\ld h be5       
provid$ = ! plan ye> to eligible        
individuals :o meet specifi$ income     
crit]ia & are enroll$ = su* plan ye> 9  
cov]age provid$ ?r\gh enrollm5t "u ?is  
section if su* individuals 7 enroll$ =  
su* ye> 9 a qualifi$ heal? plan ?r\gh an
 ,ex*ange4  7ii7 ,specific requirem5ts  
,! ,secret>y %all make ! det]m9ation "u 
clause 7i7 on a p] enrollee basis & %all
 take into acc\nt all relevant factors  
necess>y to det]m9e ! value ( ! premium 
tax cr$its & co/-%>+ r$uctions t w\ld h 
be5 provid$ to eligible individuals     
describ$ 9 section #acca ( ! ,pati5t    
,protection & ,af=dable ,c>e ,act1      
includ+ ! age & income ( ! enrollee1    
geographic diff]5ces 9 av]age sp5d+ =   
heal? c>e across rat+ areas1 ! heal?    

/atus ( ! enrollee = purposes ( det]m9+ 
risk adju/m5t paym5ts & re9surance      
paym5ts t w\ld h be5 made if ! enrollee 
_h enroll$ 9 a qualifi$ heal? plan ?r\gh
 an ,ex*ange1 & :e!r any reconciliation 
( ! cr$it or co/-%>+ r$uctions w\ld h   
occurr$ if ! enrollee _h be5 s enroll$4 
,?is det]m9ation %all take into         
consid]ation ! exp]i5ce ( o!r ,/ates )  
respect to p>ticipation 9 an ,ex*ange & 
su* cr$its & r$uctions provid$ to       
resid5ts ( ! o!r ,/ates1 ) a special    
focus on enrollees ) income bel[ #bjj   
p]c5t ( pov]ty4  7,d7 ,c]tification  7i7
 ,9 g5]al ,! ,*ief ,actu>y ( ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices1 9           
consultation ) ! ,(fice ( ,tax ,analysis
 ( ! ,dep>tm5t ( ! ,treasury1 %all      
c]tify :e!r ! me?odology us$ to make    
det]m9ations "u subp>agraph 7,c71 & su* 
det]m9ations1 meet ! requirem5ts ( ?is  
p>agraph4  7ii7 ,corrections ,!         
,secret>y %all adju/ ! paym5t to ! ,tru/
 ,fund = any plan ye> to reflect any    
error 9 ! det]m9ations "u subp>agraph   

7,c7 = any prec$+ plan ye>4  7iii7      
,application ,cov]age provid$ ?r\gh     
enrollm5t "u ?is "p & p>ts ,b & ,d      
pursuant to ?is section %all be treat$ z
 cov]age "u a qualifi$ heal? plan 9 !   
silv] level ( cov]age 9 ! individual    
m>ket (f]$ ?r\gh an ,ex*ange & !        
,secret>y %all be treat$ z ! issu] ( su*
 plan4  7g7 ,treatm5t 9 relation to !   
,af=dable ,c>e ,act  7#a7 ,satisfaction 
( individual m&ate ,= purposes ( apply+ 
section #ejjj;,a ( ! ,int]nal ,rev5ue   
,code ( #aihf1 ! cov]age provid$ "u ?is 
section con/itutes m9imum ess5tial      
cov]age "u subsection 7f77#a77;,a77i7 ( 
su* section #ejjj;,a4  7#b7 ,eligibility
 = premium assi/ance ,cov]age provid$ "u
 ?is section--  7,a7 %all be treat$ z   
cov]age "u a qualifi$ heal? plan 9 !    
individual m>ket enroll$ 9 ?r\gh !      
,ex*ange :]e ! individual resides = all 
purposes ( section #cf;,b ( ! ,int]nal  
,rev5ue ,code ( #aihf o!r ?an subsection
 7c77#b77;,b7 !re(2 &  7,b7 %all n be   
treat$ z eligibility = o!r m9imum       

ess5tial cov]age = purposes ( subsection
 7c77#b77;,b7 ( su* section #cf;,b4  ,! 
,secret>y %all det]m9e ! applicable     
second l[e/ co/ silv] plan :i* %all     
apply to cov]age "u ?is section =       
purposes ( det]m9+ ! premium assi/ance  
am\nt "u section #cf;,b7b77#b7 ( su*    
,code4 ,not)/&+ ! prec$+ s5t5ces1 9     
det]m9+ ! applicable second l[e/ co/    
silv] plan ) respect to any taxpay] "u  
section #cf;,b7b77#c77;,b7 ( su* ,code1 
cov]age provid$ "u ?is section %all n be
 tak5 into acc\nt z a silv] plan ( !    
individual m>ket4  7#c7 ,eligibility =  
co/-%>+ r$uctions ,= purposes ( apply+  
section #adjb ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjga7--  7,a7 cov]age provid$ "u ?is  
section %all be treat$ z cov]age "u a   
qualifi$ heal? plan 9 ! silv] level (   
cov]age 9 ! individual m>ket (f]$ ?r\gh 
an ,ex*ange2 &  7,b7 ! ,secret>y %all be
 treat$ z ! issu] ( su* plan4  7#d7     
,m$icaid manag$ c>e ,/ates are prohibit$
 f buy+ _! ,m$icaid b5efici>ies ages #ej

 to #fd into ,m$ic>e "u ?is section1 &  
individuals o!rwise eligible = enrollm5t
 "u a ,/ate plan "u title ,,xix are     
prohibit$ f cov]age "u ?is title        
pursuant to enrollm5t "u ?is section4 ,!
 prec$+ s5t5ce %all n apply to ,m$icaid 
b5efici>ies ^: ,m$icaid cov]age or      
eligibility does n meet ! def9ition (   
m9imum ess5tial cov]age "u a            
gov]nm5t-sponsor$ program "u section    
#a4ejjj;,a-#b ( title #bf1 ,code (      
,f$]al ,regulations 7or any successor   
regulation74  7h7 ,gu>ante$ issue (     
,m$igap policies ^u fir/ enrollm5t & ea*
 subsequ5t enrollm5t ,9 ! case ( an     
individual :o enrolls "u ?is section    
7includ+ an individual :o 0 previ\sly   
enroll$ "u ?is section71 p>agraphs      
7#b77;,a71 7#b77;,d71 7#c77;,b77ii71 &  
7#c77;,b77vi7 ( section #ahhb7s7--  7#a7
 %all be appli$ by sub/itut+ #ej = #fe2 
7#b7 if ! individual 0 enroll$ "u ?is   
section & subsequ5tly dis5rolls1 %all   
apply ea* "t ! individual subsequ5tly   
re5rolls "u ?is section z if !          

individual _h atta9$ #ej ye>s ( age on !
 date ( su* re5rollm5t 7& z if !        
individual _h nev] previ\sly enroll$ 9 a
 ,m$ic>e supplem5tal policy72 &  7#c7   
%all be appli$ z if ?is section _h n be5
 enact$ 7& z if ! individual _h nev]    
previ\sly enroll$ 9 a ,m$ic>e           
supplem5tal policy7 :5 ! individual     
atta9s #fe ye>s ( age4  7i7 ,ov]sight   
,!re is e/abli%$ an advisory committee  
to be kn[n z ! ,m$ic>e ,buy ,9 ,ov]sight
 ,bo>d to monitor & ov]see !            
implem5tation ( ?is section1 includ+ !  
exp]i5ce ( ! individuals enroll+ "u ?is 
section4 ,! ,m$ic>e ,buy ,9 ,ov]sight   
,bo>d %all make p]iodic recomm5dations =
 ! cont9ual improvem5t ( ! implem5tation
 ( ?is section z well z ! relation%ip ( 
enrollm5t "u ?is section to o!r heal?   
c>e programs4  7j7 ,outrea* & enrollm5t 
7#a7 ,9 g5]al ,dur+ ! p]iod t beg9s on  
,janu>y #a1 #bjai1 & ends on ,decemb]   
#ca1 #bjba1 ! ,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\rage1 enrollm5t "u ?is section4     
7,b7 ,assi/+ individuals' transition "u 
?is section ,to provide assi/ance to    
individuals to enroll "u ?is section4   
7,c7 ,rais+ aw>5ess ( premium assi/ance 
& co/-%>+ r$uctions ,to di/ribute fair &
 imp>tial in=mation conc]n+ enrollm5t "u
 ?is section & ! availability ( premium 
assi/ance tax cr$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$uctions4  7#b7 ,eligible entities     
7,a7 ,9 g5]al ,9 ?is subsection1 ! t]m  
eligible entity means-- 7i7 a ,/ate2 or 
7ii7 a nonpr(it community-bas$          
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 "u ?is section4    
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        
individuals "u ?is section4  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+ ,= purposes ( c>ry+ 
out ?is subsection1 !re is appropriat$  
to ! ,secret>y1 out ( any moneys 9 !    
,treasury n o!rwise appropriat$1        
#ejj1jjj1jjj = cal5d> ye> #bjai & = ea* 
subsequ5t cal5d> ye>4  7k7 ,no effect on
 b5efits = individuals o!rwise eligible 
or on ,tru/ funds ,! ,secret>y %all     
implem5t ! provisions ( ?is section 9   
su* a mann] to ensure t su* provisions--

  7#a7 h no effect on ! b5efits "u ?is  
title = individuals :o are entitl$ to1  
or enroll$ =1 su* b5efits o!r ?an ?r\gh 
?is section2 &  7#b7 h no negative      
impact on ! ,f$]al ,hospital ,insurance 
,tru/ ,fund or ! ,f$]al ,supplem5t>y    
,m$ical ,insurance ,tru/ ,fund 7includ+ 
! ,m$ic>e ,prescription ,drug ,acc\nt )9
 su* ,tru/ ,fund74  7l7 ,consultation ,9
 promulgat+ regulations to implem5t ?is 
section1 ! ,secret>y %all consult )     
int]e/$ p>ties1 includ+ gr\ps repres5t+ 
b5efici>ies1 heal? c>e provid]s1        
employ]s1 & insurance companies4  4  #c4
 ,au?ority to negotiate fair prices =   
,m$ic>e prescription drugs  7a7 ,9 g5]al
 ,section #ahfj;,d-#aa ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#aaa7 is am5d$ by /rik+          
subsection 7i74  7b7 ,effective date ,! 
am5dm5t made by ?is section %all take   
effect on ! date ( ! enactm5t ( ?is     
,act4