,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #aggf  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #c1 #bjbe,mr4    
,palm] introduc$ ! foll[+ bill2 :i* 0   
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committees 
on ,ways & ,means1 & ,education &       
,work=ce1 = 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 e/abli% a      
re9surance program1 & = o!r purposes4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,new ,heal? ,options ,act ( #bjbe4    
#b4 ,creation ( a re9surance program = a
 new heal? insurance risk pool  7a7 ,9  
g5]al ,"p ,v ( subtitle ,b ( title ,i ( 
! ,pati5t ,protection & ,af=dable ,c>e  
,act 7#db ,u4,s4,c4 #ahjfa et seq47 is  
am5d$ by add+ at ! end ! foll[+ new     
section3  #acdd4 ,re9surance program =  
c]ta9 (f-,ex*ange plans  7a7 ,9 g5]al   
,!re is e/abli%$ a ,re9surance ,program1

 to be adm9i/]$ by ! ,secret>y ( ,heal? 
& ,human ,s]vices1 to provide paym5ts to
 heal? insurance issu]s ) respect to    
claims = eligible individuals = !       
purpose ( l[]+ premiums = su*           
individuals4  7b7 ,fund+  7#a7          
,appropriation ,= ! purpose ( provid+   
fund+ = ! ,re9surance ,program1 = ea*   
ye> dur+ ! p]iod beg9n+ on ,janu>y #a1  
#bjbf1 & end+ on ,decemb] #ca1 #bjcj1   
!re is appropriat$ out ( any monies 9 ! 
,treasury n o!rwise obligat$ an am\nt   
equal to ! product ( #ej & ! aggregate  
numb] ( memb] mon?s = all eligible      
individuals enroll$ 9 a cov]$ plan dur+ 
su* ye>4  7#b7 ,limitation on           
appropriation ,9 no ye> %all !          
appropriation = ! ,re9surance ,program  
au?oriz$ 9 p>agraph 7#a7 exce$          
#f1jjj1jjj1jjj4  7#c7 ,use ( unexp5d$   
funds ,appropriat$ am\nts rema9+        
unexp5d$ at ! end ( any ye> may be us$  
to make paym5ts "u ! ,re9surance        
,program 9 any future ye>4  7#d7        
,limitation on use ( funds ,no funds    

receiv$ "u ! ,re9surance ,program may be
 us$ to pay = s]vices describ$ 9 section
 #acjc7;b77#a77;,b77i7 7z 9 effect on ! 
date ( ! enactm5t ( ?is section74  7c7  
,op]ation ( program  7#a7 ,9 g5]al ,!   
,secret>y %all e/abli% p>amet]s = !     
op]ation ( ! ,re9surance ,program       
consi/5t ) ?is section4  7#b7 ,deadl9e =
 initial op]ation ,n lat] ?an #abj days 
aft] ! date ( ! enactm5t1 ! ,secret>y   
%all e/abli% suffici5t p>amet]s to      
specify h[ ! ,program w op]ate = #bjbf4 
7#c7 ,def9itions ,9 ?is section3 7,a7   
,cov]$ plan ,! t]m cov]$ plan means     
individual heal? insurance cov]age 7z   
su* t]m is def9$ 9 section #bgia ( !    
,public ,heal? ,s]vice ,act7-- 7i7 )    
respect to :i* ! issu] ( su* cov]age has
 made ! election describ$ 9 section     
#acab7;c77#a77;,a72 &  7ii7 t does n    
provide cov]age = s]vices describ$ 9    
section #acjc7;b77#a77;,b77i7 7z 9      
effect on ! date ( ! enactm5t ( ?is     
section74  7,b7 ,eligible individual ,! 
t]m eligible individual means an        

individual enroll$ 9 a cov]$ plan4  7d7 
,atta*m5t doll> am\nt & paym5t          
proportion  7#a7 ,9 g5]al ,! ,secret>y  
%all annually e/abli% an atta*m5t po9t1 
paym5t proportion1 & re9surance cap )   
respect to claims = eligible individuals
 = paym5ts "u ! ,re9surance ,program1   
consi/5t ) ! foll[+3 7,a7 ,! atta*m5t   
po9t = ! p]iod beg9n+ ,janu>y #a1 #bjbf1
 & end+ ,decemb] #ca1 #bjbf1 %all be    
#aaj1jjj4  7,b7 ,! paym5t proportion = !
 p]iod beg9n+ ,janu>y #a1 #bjbf1 & end+ 
,decemb] #ca1 #bjbf1 %all be #ij p]c5t4 
7,c7 ,! re9surance cap = ! p]iod beg9n+ 
,janu>y #a1 #bjbf & end+ ,decemb] #ca1  
#bjbf1 %all be #cjj1jjj4  7#b7 ,adju/m5t
 au?ority ,! ,secret>y may adju/ any    
am\nts describ$ 9 p>agraph 7#a7 z       
necess>y to ensure ! ,re9surance        
,program does n make paym5t = a ye> 9   
excess ( ! am\nt available = su* ye> "u 
subsection 7b74  4  7b7 ,election ,to   
opt out ( s+le risk pool  7#a7 ,9 g5]al 
,section #acab7;c77#a7 ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  

,u4,s4,c4 #ahjcb7;c77#a77 is am5d$--    
7,a7 by /rik+ ,a heal? insurance issu] &
 ins]t+ ! foll[+3  7,a7 ,9 g5]al ,a     
heal? insurance issu]  2  7,b7 9        
subp>agraph 7,a71 z ins]t$ by p>agraph  
7#a71 by ins]t+ & o!r ?an any heal? plan
 ) respect to :i* su* issu] has elect$ =
 ?is subp>agraph n to apply aft]        
gr&fa!r$ heal? plans2 &  7,c7 by add+ at
 ! end ! foll[+ new subp>agraph3  7,b7  
,treatm5t ( plans opt+ out ( s+le risk  
pool ,a heal? insurance issu] %all      
consid] all enrollees 9 all heal? plans 
(f]$ by su* issu] 9 ! individual m>ket )
 respect to :i* su* issu] has made !    
election describ$ 9 subp>agraph 7,a7 to 
be memb]s ( a s+le risk pool4  4  7#b7  
,prohibit+ s+le risk pool opt out =     
qualifi$ heal? plans ,section           
#acja7;a77#a77;,c7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjba7;a77#a77 is am5d$--    
7,a7 9 clause 7iii71 by /rik+ & at !    
end2  7,b7 9 clause 7iv71 by /rik+ !    
p]iod & ins]t+ 2 &2 &  7,c7 by add+ at !

 end ! foll[+ new clause3  7v7 has n    
made ! election describ$ 9 section      
#acab7;c77#a77;,a7 ) respect to su*     
plan4  4  7#c7 ,effective date ,!       
am5dm5ts made by ?is subsection %all    
apply ) respect to plan ye>s beg9n+ on  
or aft] ,janu>y #a1 #bjbf4  7c7 ,remov+ 
age premium v>iation limitation = c]ta9 
plans  7#a7 ,9 g5]al  7,a7 ,removal (   
limitation = c]ta9 plans ,section       
#bgja7;a77#a77;,a77iii7 ( ! ,public     
,heal? ,s]vice ,act 7#db ,u4,s4,c       
#cjj;gg7a77#a77;,a77iii77 is am5d$ by   
ins]t+ or1 9 ! case ( su* cov]age )     
respect to :i* ! issu] ( su* cov]age has
 made ! election describ$ 9 section     
#acab7;c77#a77;,a7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act1 by m 
?an an actu>ially ju/ifi$ am\nt = adults
 be=e 2 &4  7,b7 ,effective date ,!     
am5dm5t made by subp>agraph 7,a7 %all   
apply ) respect to plan ye>s beg9n+ on  
or aft] ,janu>y #a1 #bjbf4  7#b7        
,ma9ta9+ age premium v>iation limitation
 = qualifi$ heal? plans ,section        

#acja7;a77#a7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjba7;a77#a771 z am5d$ by subsection  
7b71 is fur!r am5d$-- 7,a7 9 subp>agraph
 7,b71 by /rik+ & at ! end2  7,b7 9     
subp>agraph 7,c77v71 by /rik+ ! p]iod & 
ins]t+ 2 &2 &  7,c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,d7 ) respect 
to ! premium rate *>g$ by su* plan1 if  
su* plan v>ies su* rate by age1 does n  
v>y su* rate by m ?an #c to #a = adults 
7consi/5t ) section #bgjg7;c7 ( !       
,public ,heal? ,s]vice ,act74  4  7d7   
,treatm5t ( opt out plans 9 relation to 
individual heal? cov]age reimbursem5t   
arrangem5ts ,! ,secret>ies ( ,heal? &   
,human ,s]vices1 ,labor1 & ! ,treasury  
%all n fail to treat any individual     
heal? insurance cov]age 7z def9$ 9      
section #bgia ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;gg-#ia77 z    
eligible = integration ) an individual  
heal? c>e reimbursem5t arrangem5t on !  
basis t ! heal? insurance issu] 7z s    
def9$7 ( su* cov]age has made ! election

 describ$ 9 section #acab7;c77#a77;,a7 (
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act 7z ins]t$ by subsection 7b774  #c4 
,promotion ( high-value c>e  7a7 ,9     
g5]al ,subp>t ,,ii ( "p ,a ( title      
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is  
am5d$ by add+ at ! end ! foll[+ new     
section3  #bgcj4 ,application ( c]ta9   
out-(-network co/s to d$uctibles &      
out-(-pocket maximums  7a7 ,9 g5]al ,a  
gr\p heal? plan1 & a heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 %all1 9 ! case t an  
individual enroll$ "u su* plan or       
cov]age is furni%$ items or s]vices by a
 heal? c>e provid] or heal? c>e facility
 t does n h 9 effect a contractual      
relation%ip ) su* plan or issu] = !     
furni%+ ( su* items or s]vices & su*    
individual incurs any out-(-pockets co/s
 ) respect to su* items & s]vices1 at ! 
option ( su* individual1 apply su* co/s 
to any d$uctible or out-(-pocket maximum
 applicable to items & s]vices furni%$  

by heal? c>e provid]s or heal? c>e      
facilities ) contracts 9 effect ) su*   
plan or issu] = ! furni%+ ( su* items or
 s]vices1 b only if ! foll[+ requirem5ts
 are met3 7#a7 ,! item or s]vice furni%$
 by su* provid] or facility )\t a       
contract 9 effect ) su* plan or issu] is
 an item or s]vice = :i* b5efits are    
available "u su* plan or cov]age4  7#b7 
,! am\nt *>g$ by su* provid] or facility
 = su* item or s]vice is equal to or    
less ?an-- 7,a7 ! l[e/ am\nt recogniz$  
by ! plan or cov]age z paym5t = su* item
 or s]vice out ( all heal? c>e provid]s 
& heal? c>e facilities ) a contract 9   
effect ) su* plan or issu] to furni% su*
 item or s]vice 9 ! same rat+ area 7z   
def9$ = purposes ( section #bgja7 9 :i* 
! item or s]vice describ$ 9 p>agraph    
7#a7 0 furni%$2 or  7,b7 ! #be? p]c5tile
 ( *>ges = su* item or s]vice furni%$ 9 
! same ,/ate 9 :i* ! item or s]vice     
describ$ 9 p>agraph 7#a7 0 furni%$4  7b7
 ,disclosure ( in=mation ,a gr\p heal?  
plan1 & a heal? insurance issu] (f]+    

gr\p or individual heal? insurance      
cov]age1 %all1 ) respect to ea* item or 
s]vice = :i* b5efits are available "u   
su* plan or cov]age1 make available !   
l[e/ am\nt describ$ 9 subsection        
7a77#b77;,a7 & ! #be? p]c5tile describ$ 
9 subsection 7a77#b77;,b7 to all        
individuals enroll$ "u su* plan or      
cov]age4  4  7b7 ,effective date ,!     
am5dm5t made by subsection 7a7 %all     
apply to plan ye>s beg9n+ on or aft]    
,janu>y #a1 #bjbf4  #d4 ,disclosure (   
l[] prices ,"p ,e ( title ,,xxvii ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#aca7 is am5d$ by add+
 at ! end ! foll[+ new section3         
#bgii;,b-#aj4 ,disclosure ( l[] prices  
7a7 ,9 g5]al ,beg9n+ ,janu>y #a1 #bjbf1 
ea* heal? c>e provid] & heal? c>e       
facility %all disclose to pati5ts &     
prospective pati5ts enroll$ 9 a gr\p    
heal? plan1 gr\p or individual heal?    
insurance cov]age1 or a ,f$]al heal? c>e
 program 7z def9$ 9 section #aabh;,b b  
includ+ ! program e/abli%$ "u *apt] #hi 

( title #e1 ,unit$ ,/ates ,code7 be+    
furni%$ or seek+ to be furni%$ an item  
or s]vice by su* provid] or facility =  
:i* b5efits are available "u su* plan1  
cov]age1 or program1 z applicable1 :e!r 
! am\nt ( co/ %>+ 7includ+ d$uctibles1  
copaym5ts1 & co9surance7 t w\ld be      
incurr$ by su* individual = su* item or 
s]vice "u su* plan1 cov]age1 or program1
 z applicable1 exce$s ! *>ge t w\ld     
apply = su* item or s]vice = an         
individual )\t b5efits "u any su* plan1 
cov]age1 or program = su* item or       
s]vice4  7b7 ,additional en=cem5t ,9    
addition to any o!r p5alty applicable ) 
respect to a violation ( subsection 7a71
 an individual :o is h>m$ by a violation
 ( ?is section by a heal? c>e provid] or
 heal? c>e facility may br+ an action   
aga9/ su* provid] or facility 9 an      
appropriate di/rict c\rt ( ! ,unit$     
,/ates =-- 7#a7 appropriate injunctive  
relief2 &  7#b7 damages 9 an am\nt t is 
equal to ! am\nt provid$ = su* h>m 9 a  
civil action "u ! law ( ! ,/ate 9 :i* ! 

provid] or facility is locat$4  4