,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #igjh  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #ai1 #bjbd  
,ms4 ,sewell 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 ensure af=dable 
heal? insurance cov]age = l[-income     
individuals 9 ,/ates t h n exp&$        
,m$icaid4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,bridge to ,m$icaid ,act ( 
#bjbd4  #b4 ,ensur+ af=dability (       
cov]age = c]ta9 l[-income populations   
7a7 ,r$uc+ co/ %>+ "u qualifi$ heal?    
plans ,section #adjb ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjga7 is am5d$--  7#a7 9    
subsection 7b7-- 7,a7 9 p>agraph 7#b71  
by ins]t+ 7or1 ) respect to plan ye>s   
#bjbf1 #bjbg1 & #bjbh1 ^: h\sehold      
income does n exce$ #djj p]c5t ( !      

pov]ty l9e = a family ( ! size involv$7 
be=e ! p]iod2 &  7,b7 9 ! matt] foll[+  
p>agraph 7#b71 by add+ at ! end ! foll[+
 new s5t5ce3 ,9 ! case ( an individual  
:o is det]m9$ at any po9t to h a        
h\sehold income = #bjbe t does n exce$  
#ach p]c5t ( ! pov]ty l9e = a family ( !
 size involv$1 su* individual %all1 =   
ea* mon? dur+ su* ye>1 be treat$ z hav+ 
a h\sehold income equal to #ajj p]c5t = 
purposes ( apply+ ?is section42 &  7#b7 
9 subsection 7c7--  7,a7 9 p>agraph     
7#a77;,a71 9 ! matt] prec$+ clause 7i71 
by ins]t+ 1 ) respect to eligible       
insur$s 7o!r ?an1 ) respect to plan ye>s
 #bjbf1 #bjbg1 & #bjbh1 specifi$        
enrollees 7z def9$ 9 p>agraph           
7#f77;,c7771 aft] fir/ be a*iev$2  7,b7 
9 p>agraph 7#b71 9 ! matt] prec$+       
subp>agraph 7,a71 by ins]t+ ) respect to
 eligible insur$s 7o!r ?an1 ) respect to
 plan ye>s #bjbf1 #bjbg1 & #bjbh1       
specifi$ enrollees7 aft] "u ! plan2     
7,c7 9 p>agraph 7#c7-- 7i7 9 subp>agraph
 7,a71 by /rik+ ?is subsection & ins]t+ 

p>agraph 7#a7 or 7#b72 &  7ii7 9        
subp>agraph 7,b71 by /rik+ ?is section &
 ins]t+ p>agraphs 7#a7 & 7#b72 &  7,d7  
by add+ at ! end ! foll[+ new p>agraph3 
7#f7 ,special rule = specifi$ enrollees 
7,a7 ,9 g5]al ,! ,secret>y %all e/abli% 
proc$ures "u :i* ! issu] ( a qualifi$   
heal? plan to :i* ?is section applies   
%all r$uce co/-%>+ "u ! plan ) respect  
to mon?s occurr+ dur+ plan ye>s #bjbf1  
#bjbg1 & #bjbh = enrollees :o are       
specifi$ enrollees 7z def9$ 9           
subp>agraph 7,c77 9 a mann] suffici5t to
 increase ! plan's %>e ( ! total all[$  
co/s ( b5efits provid$ "u ! plan to #ii 
p]c5t ( su* co/s4  7,b7 ,me?ods = r$uc+ 
co/ %>+  7i7 ,9 g5]al ,an issu] ( a     
qualifi$ heal? plan mak+ r$uctions "u   
?is p>agraph %all notify ! ,secret>y (  
su* r$uctions & ! ,secret>y %all1 out ( 
funds made available "u clause 7ii71    
make p]iodic & timely paym5ts to ! issu]
 equal to #ab p]c5t ( ! total all[$ co/s
 ( b5efits provid$ "u ea* su* plan to   
specifi$ enrollees dur+ plan ye>s #bjbf1

 #bjbg1 & #bjbh4  7ii7 ,appropriation ,9
 addition to am\nts o!rwise available1  
!re are appropriat$1 out ( any money 9 !
 ,treasury n o!rwise appropriat$1 su*   
sums z may be necess>y to ! ,secret>y to
 make paym5ts "u clause 7i74  7,c7      
,specifi$ enrollee def9$ ,= purposes (  
?is section1 ! t]m specifi$ enrollee    
means1 ) respect to a plan ye>1 an      
eligible insur$ :o is det]m9$ at any    
po9t to h a h\sehold income = su* plan  
ye> t does n exce$ #ach p]c5t ( ! pov]ty
 l9e = a family ( ! size involv$4 ,su*  
insur$ %all be deem$ to be a specifi$   
enrollee = ea* mon? 9 su* plan ye>4  4  
7b7 ,op5 enrollm5ts applicable to c]ta9 
l[]-income populations ,section         
#acaa7;c7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7;c77 is am5d$-- 7#a7 9 p>agraph  
7#f7--  7,a7 9 subp>agraph 7,c71 by     
/rik+ at ! end &2  7,b7 9 subp>agraph   
7,d71 by /rik+ ! p]iod at ! end & ins]t+
 2 &2 &  7,c7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,e7 ) respect to a   

qualifi$ heal? plan ) respect to :i*    
section #adjb applies1 = mon?s occurr+  
dur+ ! p]iod beg9n+ on ,janu>y #a1      
#bjbf1 & end+ on ,decemb] #ca1 #bjbh1   
enrollm5t p]iods describ$ 9 subp>agraph 
7,a7 ( p>agraph 7#h7 = individuals      
describ$ 9 subp>agraph 7,b7 ( su*       
p>agraph4  2 &  7#b7 by add+ at ! end ! 
foll[+ new p>agraph3  7#h7 ,special     
enrollm5t p]iod = c]ta9 l[-income       
populations  7,a7 ,9 g5]al ,! enrollm5t 
p]iod describ$ 9 ?is p>agraph is1 9 !   
case ( an individual describ$ 9         
subp>agraph 7,b71 ! cont9u\s p]iod      
beg9n+ on ! fir/ day t su* individual is
 s describ$4  7,b7 ,individual describ$ 
,= purposes ( subp>agraph 7,a71 an      
individual describ$ 9 ?is subp>agraph is
 an individual-- 7i7 ) a h\sehold income
 t does n exce$ #ach p]c5t ( ! pov]ty   
l9e = a family ( ! size involv$2 &  7ii7
 :o is n eligible = m9imum ess5tial     
cov]age 7z def9$ 9 section #ejjj;,a7f7 (
 ! ,int]nal ,rev5ue ,code ( #aihf71 o!r 
?an = cov]age describ$ 9 any (          

subp>agraphs 7,b7 ?r\gh 7,e7 ( p>agraph 
7#a7 ( su* section4  4  7c7 ,additional 
b5efits = c]ta9 l[-,income individuals =
 plan ye>s #bjbf & #bjbg ,section       
#acja7;a7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjba7;a77 is am5d$--  7#a7 9 p>agraph 
7#a7-- 7,a7 9 subp>agraph 7,b71 by /rik+
 & at ! end2  7,b7 9 subp>agraph        
7,c77iv71 by /rik+ ! p]iod & ins]t+ 2 &2
 &  7,c7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,d7 provides1 ) respect  
to a plan (f]$ 9 ! silv] level ( cov]age
 to :i* section #adjb applies dur+ plan 
ye> #bjbf & #bjbg1 = b5efits describ$ 9 
p>agraph 7#e7 9 ! case ( an individual  
:o has a h\sehold income t does n exce$ 
#ach p]c5t ( ! pov]ty l9e = a family ( !
 size involv$1 & :o is eligible to      
receive co/-%>+ r$uctions "u section    
#adjb4  2 &  7#b7 by add+ at ! end !    
foll[+ new p>agraph3  7#e7 ,additional  
b5efits = c]ta9 l[-income individuals = 
plan ye> #bjbf & #bjbg  7,a7 ,9 g5]al   
7i7 ,b5efits ,= purposes ( p>agraph     

7#a77;,d71 ! b5efits describ$ 9 ?is     
p>agraph to be provid$ by a qualifi$    
heal? plan are b5efits consi/+ (-- 7,i7 
non-em]g5cy m$ical transportation       
s]vices 7z describ$ 9 section           
#aijb7;a77#d7 ( ! ,social ,security     
,act7 = :i* ,f$]al paym5ts w\ld h be5   
available "u title ,,xix ( ! ,social    
,security ,act _h su* s]vices be5       
furni%$ to an individual enroll$ "u a   
,/ate plan 7or waiv] ( su* plan7 "u su* 
title2 &  7,,ii7 s]vices describ$ 9     
subsection 7a77#d77;,c7 ( section #aije 
( su* ,act = :i* ,f$]al paym5ts w\ld h  
be5 s available2  :i* are n o!rwise     
provid$ "u su* plan z "p ( ! ess5tial   
heal? b5efits package describ$ 9 section
 #acjb7;a74  7ii7 ,condition on         
provision ( b5efits ,b5efits describ$ 9 
?is p>agraph %all be provid$--  7,i7 )\t
 any re/riction on ! *oice ( a qualifi$ 
provid] f :om an individual may receive 
su* b5efits2 &  7,,ii7 )\t any          
imposition ( co/ %>+4  7,b7 ,paym5ts =  
additional b5efits  7i7 ,9 g5]al ,an    

issu] ( a qualifi$ heal? plan mak+      
paym5ts = s]vices describ$ 9 subp>agraph
 7,a7 furni%$ to individuals describ$ 9 
p>agraph 7#a77;,d7 dur+ plan ye> #bjbf  
or #bjbg %all notify ! ,secret>y ( su*  
paym5ts & ! ,secret>y %all1 out ( funds 
made available "u clause 7ii71 make     
p]iodic & timely paym5ts to ! issu]     
equal to paym5ts = su* s]vices s        
furni%$4  7ii7 ,appropriation ,9        
addition to am\nts o!rwise available1   
!re is appropriat$1 out ( any money 9 ! 
,treasury n o!rwise appropriat$1 su*    
sums z may be necess>y to ! ,secret>y to
 make paym5ts "u clause 7i74  4  7d7    
,education & outrea* activities  7#a7 ,9
 g5]al ,section #acba7;c7 ( ! ,pati5t   
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjda7;c77 is am5d$ 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+ individuals describ$ 9 section    
#aijb7;a77#aj77;,a77i77,,viii7 ( !      
,social ,security ,act :o reside 9      
,/ates t h n exp5d$ am\nts "u a ,/ate   
plan 7or waiv] ( su* plan7 "u title     
,,xix ( su* ,act = all su* individuals  
ab\t qualifi$ heal? plans (f]$ ?r\gh !  
,ex*ange1 includ+ by in=m+ su*          
individuals ( ! 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 individuals resid+
 9 areas :]e ! unemploym5t rates exce$s 
! national av]age unemploym5t rate1     
individuals 9 rural areas1 vet]ans1 & "y
 adults74  7,b7 ,limitation on use (    
funds ,funds appropriat$ "u ?is p>agraph
 %all n be us$ to promote any heal?     

insurance cov]age o!r ?an qualifi$ heal?
 plans4  7,c7 ,fund+ ,9 addition to     
am\nts o!rwise available1 !re is        
appropriat$1 out ( any money 9 !        
,treasury n o!rwise appropriat$1 to     
rema9 available until exp5d$1           
#aje1jjj1jjj = fiscal ye> #bjbf to c>ry 
out ?is p>agraph1 ( :i*--  7i7          
#ae1jjj1jjj %all be us$ to c>ry out ?is 
p>agraph 9 fiscal ye> #bjbf2 &  7ii7    
#cj1jjj1jjj %all be us$ to c>ry out ?is 
p>agraph = ea* ( fiscal ye>s #bjbg ?r\gh
 #bjbh4  4  7#b7 ,navigator program     
,section #acaa7;i7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;i77 is am5d$-- 7,a7 9 
p>agraph 7#a7--  7i7 by /rik+ ,an       
,ex*ange & ins]t+ ! foll[+3  7,a7 ,9    
g5]al ,an ,ex*ange  2 &  7ii7 by add+ at
 ! end ! foll[+3  7,b7 ,grants =        
eligible entities ) respect to c]ta9    
,/ates ,! ,secret>y %all e/abli% a      
program to aw>d grants to entities      
describ$ 9 p>agraph 7#b7 to c>ry out !  
duties describ$ 9 p>agraph 7#c7 9 "o or 

m ,/ates t d n provide "u ! ,/ate plan  
"u title ,,xix ( ! ,social ,security    
,act 7or a waiv] ( su* plan7 b5*m>k     
cov]age describ$ 9 section #aicg7;b77#a7
 ( su* ,act or b5*m>k equival5t cov]age 
describ$ 9 section #aicg7;b77#b7 ( su*  
,act to all individuals describ$ 9      
section #aijb7;a77#aj77;,a77i77,,viii7 (
 su* ,act4  2 &  7,b7 9 p>agraph 7#f7-- 
7i7 by /rik+ ,grants "u & ins]t+ !      
foll[+3  7,a7 ,/ate ,ex*anges ,grants "u
  2 &  7ii7 by add+ at ! end ! foll[+   
new subp>agraph3  7,b7 ,f$]al ,ex*anges2
 grants to eligible entities ) respect  
to c]ta9 ,/ates ,= purposes ( c>ry+ out 
?is subsection1 ) respect to an ,ex*ange
 e/abli%$ & op]at$ by ! ,secret>y )9 a  
,/ate pursuant to section #acba7;c7 & ) 
respect to grants "u p>agraph 7#a77;,b71
 ! ,secret>y %all obligate n less ?an   
#aj1jjj1jjj 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> #bjbf1 & n less ?an #bj1jjj1jjj =   
ea* ( fiscal ye>s #bjbg & #bjbh4 ,su*   
am\nt s obligat$ = a fiscal ye> %all    
rema9 available until exp5d$4  4  7e7   
,fund+ ,9 addition to am\nts o!rwise    
available1 !re is appropriat$ to !      
,secret>y ( ,heal? & ,human ,s]vices =  
fiscal ye> #bjbf1 out ( any money 9 !   
,treasury n o!rwise appropriat$1        
#fe1jjj1jjj1 to rema9 available until   
exp5d$1 = purposes ( c>ry+ out !        
provisions (1 & ! am5dm5ts made by1 ?is 
section4  #c4 ,tempor>y expansion (     
heal? insurance premium tax cr$its =    
c]ta9 l[-income populations  7a7 ,9     
g5]al ,section #cf;,b ( ! ,int]nal      
,rev5ue ,code ( #aihf is am5d$ by       
r$esignat+ subsection 7h7 z subsection  
7i7 & by ins]t+ aft] subsection 7g7 !   
foll[+ new subsection3  7h7 ,c]ta9      
tempor>y rules beg9n+ 9 #bjbf ,) respect
 to any taxable ye> beg9n+ aft] ,decemb]
 #ca1 #bjbe1 & be=e ,janu>y #a1 #bjbi-- 
7#a7 ,eligibility = cr$it n limit$ bas$ 
on income ,subsection 7c77#a77;,a7 %all 

be appli$ )\t reg>d to equals or exce$s 
#ajj p]c5t b4  7#b7 ,cr$it all[$ to     
c]ta9 l[-income employees (f]$          
employ]-provid$ cov]age ,9 ! case ( an  
individual ^: h\sehold income does n    
exce$ #ach p]c5t ( ! pov]ty l9e = a     
family ( ! size involv$1 clause 7i7 (   
subsection 7c77#b77;,c7 %all be appli$  
7includ+ 9 ! case ( any individual      
describ$ 9 ! la/ s5t5ce ( su* clause7   
)\t reg>d to subclause 7,,ii7 !re(4     
7#c7 ,cr$it all[$ to c]ta9 l[-income    
employees (f]$ qualifi$ small employ]   
heal? reimbursem5t arrangem5ts ,a       
qualifi$ small employ] heal?            
reimbursem5t arrangem5t %all n be treat$
 z con/itut+ af=dable cov]age = an      
employee 7or any sp\se or dep5d5t ( su* 
employee7 = any mon?s ( a taxable ye> if
 ! employee's h\sehold income = su*     
taxable ye> does n exce$ #ach p]c5t ( ! 
pov]ty l9e = a family ( ! size involv$4 
7#d7 ,limitations on recapture  7,a7 ,9 
g5]al ,9 ! case ( a taxpay] ^: h\sehold 
income is less ?an #bjj p]c5t ( ! pov]ty

 l9e = ! size ( ! family involv$ = !    
taxable ye>1 ! am\nt ( ! increase "u    
subsection 7f77#b77;,a7 %all 9 no ev5t  
exce$ #cjj 7"o-half ( su* am\nt 9 ! case
 ( a taxpay] ^: tax is det]m9$ "u       
section #a7;c7 = ! taxable ye>74  7,b7  
,limitation on increase = c]ta9         
non-fil]s ,9 ! case ( any taxpay] :o    
w\ld n be requir$ to file a return ( tax
 = ! taxable ye> b = any requirem5t to  
reconcile advance cr$it paym5ts "u      
subsection 7f71 if an ,ex*ange e/abli%$ 
"u title ,i ( ! ,pati5t ,protection &   
,af=dable ,c>e ,act has det]m9$ t-- 7i7 
su* taxpay] is eligible = advance       
paym5ts "u section #adab ( su* ,act =   
any portion ( su* taxable ye>1 &  7ii7  
su* taxpay]'s h\sehold income = su*     
taxable ye> is project$ n to exce$ #ach 
p]c5t ( ! pov]ty l9e = a family ( ! size
 involv$1  subsection 7f77#b77;,a7 %all 
n apply to su* taxpay] = su* taxable ye>
 & su* taxpay] %all n be requir$ to file
 su* return ( tax4  7,c7 ,in=mation     
provid$ by ,ex*ange ,! in=mation requir$

 to be provid$ by an ,ex*ange to !      
,secret>y & to ! taxpay] "u subsection  
7f77#c7 %all include su* in=mation z is 
necess>y to det]m9e :e!r su* ,ex*ange   
has made ! det]m9ations describ$ 9      
clauses 7i7 & 7ii7 ( subp>agraph 7,b7 ) 
respect to su* taxpay]4  4  7b7 ,employ]
 %>$ responsibility provision n         
applicable ) respect to c]ta9 l[-,income
 taxpay]s receiv+ premium assi/ance     
,section #dihj;,h7c77#c7 ( ! ,int]nal   
,rev5ue ,code ( #aihf is am5d$ to read z
 foll[s3  7#c7 ,applicable premium tax  
cr$it & co/-%>+ r$uction  7,a7 ,9 g5]al 
,! t]m applicable premium tax cr$it &   
co/-%>+ r$uction means--  7i7 any       
premium tax cr$it all[$ "u section      
#cf;,b1  7ii7 any co/-%>+ r$uction "u   
section #adjb ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act1 &  7iii7 any       
advance paym5t ( su* cr$it or r$uction  
"u section #adab ( su* ,act4  7,b7      
,exception ) respect to c]ta9 l[-income 
taxpay]s ,su* t]m %all n include any    
premium tax cr$it1 co/-%>+ r$uction1 or 

advance paym5t o!rwise describ$ 9       
subp>agraph 7,a7 if su* cr$it1 r$uction1
 or paym5t is all[$ or paid = a taxable 
ye> ( an employee 7beg9n+ aft] ,decemb] 
#ca1 #bjbe1 & be=e ,janu>y #a1 #bjbi7 ) 
respect to :i*--  7i7 an ,ex*ange       
e/abli%$ "u title ,i ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act has   
det]m9$ t su* employee's h\sehold income
 = su* taxable ye> is project$ to n     
exce$ #ach p]c5t ( ! pov]ty l9e = a     
family ( ! size involv$1 or  7ii7 su*   
employee's h\sehold income = su* taxable
 ye> does n exce$ #ach p]c5t ( ! pov]ty 
l9e = a family ( ! size involv$4  4  7c7
 ,effective date ,! am5dm5ts made by ?is
 section %all apply to taxable ye>s     
beg9n+ aft] ,decemb] #ca1 #bjbe4  #d4   
,fur!r increase 9 ,,fmap = ,m$ical      
,assi/ance = ,newly ,eligible ,m&atory  
,individuals ,section #aije7y77#a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7y77#a77 is am5d$--  7#a7 9      
subp>agraph 7,d71 by /rik+ at ! end &2  
7#b7 9 subp>agraph 7,e71 by /rik+ #bjbj 

& ea* ye> !reaft]4 & ins]t+ #bjbj1      
#bjba1 #bjbb1 #bjbc1 #bjbd1 & #bjbe22 & 
7#c7 by add+ at ! end ! foll[+ new      
subp>agraphs3  7,f7 #ic p]c5t = cal5d>  
qu>t]s 9 #bjbf1 #bjbg1 & #bjbh2 &  7,g7 
#ij p]c5t = cal5d> qu>t]s 9 #bjbi & ea* 
ye> !reaft]4  4