,,ii  #aai? ,,congress  #a/ ,session    
,s4 #ccfh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #d1 #bjbe,ms4 
,blunt ,ro*e/] 7= h]self1 ,mr4 ,wyd51   
,mr4 ,book]1 ,mr4 ,m]kley1 & ,ms4 ,smi?7
 introduc$ ! foll[+ bill2 :i* 0 read    
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to improve pati5t  
protections & af=dability "u ! ,pati5t  
,protection & ,af=dable ,c>e ,act1 & =  
o!r purposes4  #a4 ,%ort title2 table ( 
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,re/or+ ,pati5t ,protections
 & ,af=dability ,act ( #bjbe4  7b7      
,table ( cont5ts ,! table ( cont5ts =   
?is ,act is z foll[s3 ,sec4 #a4 ,%ort   
title2 table ( cont5ts4,,title          
,i--,consum] protections,sec4 #aja4     
,ext5sion ( tempor>y enhanc$ premium    
cr$its4,sec4 #ajb4 ,ext5d+ annual op5   
enrollm5t p]iod = plan ye> #bjbf4,sec4  
#ajc4 ,re/or+ navigator program4,sec4   
#ajd4 ,repeal ( disall[ance ( premium   
tax cr$it 9 case ( c]ta9 cov]age enroll$
 9 dur+ special enrollm5t p]iod4,,title 

,,ii--,heal? plan accountability,sec4   
#bja4 ,m9imum notice requirem5ts = plan 
ye> #bjbe enrollees4,sec4 #bjb4 ,m9imum 
notice requirem5ts = plan ye> #bjbf     
enrollees4,sec4 #bjc4 ,heal? insurance  
issu] report+ requirem5ts4,sec4 #bjd4   
,en=cem5t4,,title ,,iii--,elim9at+ r$   
tape,sec4 #cja4 ,apply+ comm]cial m>ket 
policy to re5rollm5t process4,sec4 #cjb4
 ,protection aga9/ bureaucratic cov]age 
d5ials4,sec4 #cjc4 ,automatic enrollm5t 
f bronze to silv] level qualifi$ heal?  
plans (f]$ on ,ex*anges4,,title         
,,iv--,m>ket stabilization,sec4 #dja4   
,re/or+ m>ketplace flexibility4,sec4    
#djb4 ,no heal? plan g\g+4,sec4 #djc4   
,protect+ cont9uity ( cov]age4,sec4     
#djd4 ,protect+ enrollees f surprise    
premium bills4,sec4 #dje4 ,no ,,aca &   
employ] cov]age premium spikes4  ,i     
,consum] protections  #aja4 ,ext5sion ( 
tempor>y enhanc$ premium cr$its  7a7 ,9 
g5]al ,clause 7iii7 ( section           
#cf;,b7b77#c77;,a7 ( ! ,int]nal ,rev5ue 
,code ( #aihf is am5d$-- 7#a7 by /rik+  

,janu>y #a1 #bjbf & ins]t+ ,janu>y #a1  
#bjbi1 &  7#b7 by /rik+ #bjbe 9 ! head+ 
& ins]t+ #bjbh4  7b7 ,taxpay]s ^:       
h\sehold income exce$s #djj p]c5t ( !   
pov]ty l9e ,section #cf;,b7c77#a77;,e7 (
 ! ,int]nal ,rev5ue ,code ( #aihf is    
am5d$-- 7#a7 by /rik+ ,janu>y #a1 #bjbf 
& ins]t+ ,janu>y #a1 #bjbi1 &  7#b7 by  
/rik+ #bjbe 9 ! head+ & ins]t+ #bjbh4   
7c7 ,effective date ,! am5dm5ts made by 
?is section %all apply to taxable ye>s  
beg9n+ aft] ,decemb] #ca1 #bjbe4  #ajb4 
,ext5d+ annual op5 enrollm5t p]iod =    
plan ye> #bjbf ,) respect to plan ye>   
#bjbf1 ! annual op5 enrollm5t p]iod     
requir$ to be provid$ by ,ex*anges "u   
section #acaa7;c77#f7 ( ! ,pati5t       
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;c77#f77 %all ext5d    
?r\gh ,may #a1 #bjbf4  #ajc4 ,re/or+    
navigator program  7a7 ,fund+ ,section  
#acaa7;i77#f7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7;i77#f77 is am5d$--  7#a7 by     
/rik+ ,grants "u & ins]t+ ! foll[+3     

7,a7  ,/ate ,ex*anges  ,9 ! case ( an   
,ex*ange e/abli%$ & op]at$ by a ,/ate   
pursuant to subsection 7b71 grants "u  2
 &  7#b7 by add+ at ! end ! foll[+3     
7,b7 ,f$]al ,ex*anges ,= purposes (     
c>ry+ out ?is subsection ) respect to an
 ,ex*ange e/abli%$ & op]at$ by !        
,secret>y pursuant to section #acba7;c71
 ! ,secret>y %all obligate #ajj1jjj1jjj 
out ( am\nts collect$ ?r\gh ! us] fees  
on p>ticipat+ heal? insurance issu]s    
pursuant to section #aef4ej ( title #de1
 ,code ( ,f$]al ,regulations 7or any    
successor regulations7 = fiscal ye>     
#bjbf4 ,su* am\nt s obligat$ = a fiscal 
ye> %all rema9 available until exp5d$4  
4  7b7 ,/&>ds ,section                  
#acaa7;i77#d77;,a7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;i77#d77;,a77 is       
am5d$-- 7#a7 9 clause 7i71 by /rik+ or  
at ! end2  7#b7 9 clause 7ii71 by /rik+ 
! p]iod & ins]t+ a semicolon2 &  7#c7 by
 add+ at ! end ! foll[+3  7iii7 *>ge any
 fees to applicants or enrollees2 or    

7iv7 reque/ any =m ( remun]ation f or on
 behalf ( any applicant or enrollee4  4 
#ajd4 ,repeal ( disall[ance ( premium   
tax cr$it 9 case ( c]ta9 cov]age enroll$
 9 dur+ special enrollm5t p]iod  7a7 ,9 
g5]al ,section #cf;,b7c77#c77;,a7 ( !   
,int]nal ,rev5ue ,code ( #aihf1 z am5d$ 
by ,public ,law #aai-ba1 is am5d$ by    
/rik+ clause 7iii74  7b7 ,effective date
 ,! am5dm5t made by ?is section %all    
apply ) respect to plan ye>s beg9n+ aft]
 ,decemb] #ca1 #bjbe4  ,,ii ,heal? plan 
acc\ntability  #bja4 ,m9imum notice     
requirem5ts = plan ye> #bjbe enrollees  
,! ,secret>y ( ,heal? & ,human ,s]vices 
%all require ea* heal? insurance issu] t
 (f]$ a qualifi$ heal? plan ?r\gh a     
,f$]al or ,/ate ,ex*ange = plan ye>     
#bjbe to notify1 n lat] ?an #ae days    
aft] ! date ( enactm5t ( ?is ,act1 all  
individuals enroll$ 9 su* plan = any    
mon? dur+ plan ye> #bjbe (-- 7#a7 *anges
 to eligibility = premium assi/ance     
cr$its1 & to ! premium assi/ance cr$it  
am\nts1 "u section #cf;,b ( ! ,int]nal  

,rev5ue ,code ( #aihf t fir/ take effect
 ) respect to plan ye> #bjbf2  7#b7 !   
ext5d$ op5 enrollm5t p]iod = plan ye>   
#bjbf pursuant to section #aja2 &  7#c7 
any additional in=mation relat+ to su*  
eligibility & enrollm5t1 z ! ,secret>y  
det]m9es appropriate1 includ+ ! website 
& phone numb] = ! applicable ,f$]al or  
,/ate ,ex*ange4  #bjb4 ,m9imum notice   
requirem5ts = plan ye> #bjbf enrollees  
7a7 ,9 g5]al ,! ,secret>y ( ,heal? &    
,human ,s]vices %all require ea* heal?  
insurance issu] t (f]s a qualifi$ heal? 
plan ?r\gh a ,f$]al or ,/ate ,ex*ange = 
plan ye> #bjbf to notify all individuals
 enroll$ 9 su* plan = plan ye> #bjbf (--
 7#a7 *anges to eligibility = premium   
assi/ance cr$its1 & to ! premium        
assi/ance cr$it am\nts1 "u section      
#cf;,b ( ! ,int]nal ,rev5ue ,code (     
#aihf t fir/ take effect ) respect to   
plan ye> #bjbf2  7#b7 ! ext5d$ op5      
enrollm5t p]iod = plan ye> #bjbf        
pursuant to section #aja2 &  7#c7 any   
additional in=mation relat+ to su*      

eligibility & enrollm5t1 z ! ,secret>y  
det]m9es appropriate1 includ+ ! website 
& phone numb] = ! applicable ,f$]al or  
,/ate ,ex*ange4  7b7 ,tim+ ,!           
notification by a heal? insurance issu] 
"u subsection 7a7 %all be made-- 7#a7 n 
lat] ?an #ae days aft] ! date ( enactm5t
 ( ?is ,act1 ) respect to individuals   
enroll$ 9 su* plan z ( ! date ( enactm5t
 ( ?is ,act2 &  7#b7 n lat] ?an #ae days
 aft] an individual's enrollm5t1 )      
respect to individuals enroll+1 aft] su*
 date ( enactm5t1 9 ! plan dur+ ! op5   
enrollm5t p]iod = plan ye> #bjbf4  #bjc4
 ,heal? insurance issu] report+         
requirem5ts  7a7 ,report f issu] ,n lat]
 ?an #ij days aft] ! date ( enactm5t (  
?is ,act1 ea* heal? insurance issu] t is
 subject to ! report+ requirem5ts "u    
sections #bja & #bjb %all submit to !   
,secret>y ( ,heal? & ,human ,s]vices a  
report atte/+ to compliance ) !         
requirem5ts "u sections #bja & #bjb4    
7b7 ,consolidat$ report to ,congress ,n 
lat] ?an #abj days aft] ! date (        

enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all submit to 
! ,committee on ,f9ance & ! ,committee  
on ,heal?1 ,education1 ,labor1 &        
,p5sions ( ! ,s5ate & ! ,committee on   
,ways & ,means1 ! ,committee on ,en]gy &
 ,comm]ce1 & ! ,committee on ,education 
& ,work=ce ( ! ,h\se ( ,repres5tatives a
 report t consolidates ! reports        
submitt$ by issu]s "u subsection 7a74   
#bjd4 ,en=cem5t  7a7 ,9 g5]al ,consi/5t 
) ! process set =? 9 subsections 7d7 &  
7e7 ( section #aef4hje ( title #de1     
,code ( ,f$]al ,regulations 7or         
successor regulations71 ! ,secret>y (   
,heal? & ,human ,s]vices may impose a   
civil monet>y p5alty ^u any heal?       
insurance issu] :o fails to comply ) !  
notification requirem5ts "u section #bja
 or #bjb or ! report+ requirem5ts "u    
section #bjc4  7b7 ,p5alty am\nts  7#a7 
,violations reg>d+ notice to enrollees  
,9 ! case ( a violation ( section #bja  
or #bjb1 su* p5alty %all be 9 ! am\nt   
equal to #a1jjj = ea* individual enroll$

 9 a plan = plan ye> #bjbe or #bjbf :o  
did n receive a notice z requir$ "u     
section #bja or #bjb1 z applicable1 =   
ea* day betwe5 ! date on :i* su* notice 
0 due & ! date on :i* ! notice is       
provid$4  7#b7 ,report+ violations ,9 ! 
case ( a violation ( section #bjc1 su*  
p5alty %all be 9 ! am\nt ( #a1jjj p] day
 = ea* individual enroll$ 9 heal?       
insurance cov]age ) respect to :i* !    
report is requir$1 = ea* day betwe5 !   
date on :i* ! report "u section #cjb 0  
due & ! date on :i* ! report is         
submitt$4  ,,iii ,elim9at+ r$ tape      
#cja4 ,apply+ comm]cial m>ket policy to 
re5rollm5t process  7a7 ,9 g5]al        
,section #cf;,b7c77#e77;,a7 ( ! ,int]nal
 ,rev5ue ,code ( #aihf1 z add$ by       
,public ,law #aai-ba1 is am5d$ by /rik+ 
1 us+ applicable enrollm5t in=mation t  
%all be provid$ or v]ifi$ by !          
applicant14  7b7 ,effective date ,!     
am5dm5t made by ?is section %all apply  
to taxable ye>s beg9n+ aft] ,decemb]    
#ca1 #bjbg4  #cjb4 ,protection aga9/    

bureaucratic cov]age d5ials  7a7 ,9     
g5]al ,section #acaa7;c77#f7 ( ! ,pati5t
 ,protection & ,af=dable ,c>e ,act 7#db 
,u4,s4,c4 #ahjca7;c77#f77 is am5d$--    
7#a7 9 subp>agraph 7,c71 by /rik+ 2 & & 
ins]t+ a semicolon2 &  7#b7 by add+ at !
 end ! foll[+3  7,e7 special enrollm5t  
p]iods = any individual d5i$ ! advance  
paym5t = :i* ! individual applies = "o  
or m mon?s p5d+ ! v]ification prescrib$ 
by section #cf;,b7c77#e77;,a7 ( !       
,int]nal ,rev5ue ,code ( #aihf1 to p]mit
 enrollm5t ( any su* individual foll[+  
su* v]ification2 &  4  7b7 ,effective   
date ,! am5dm5t made by ?is section %all
 apply ) respect to plan ye>s beg9n+ on 
or aft] ,janu>y #a1 #bjbh4  #cjc4       
,automatic enrollm5t f bronze to silv]  
level qualifi$ heal? plans (f]$ on      
,ex*anges ,! ,secret>y ( ,heal? & ,human
 ,s]vices %all revise section           
#aee4cce7;j7 ( title #de1 ,code ( ,f$]al
 ,regulations 7or any successor         
regulation7 to ensure t1 ) respect to   
re5rollm5ts = plan ye>s beg9n+ on or    

aft] ,janu>y #a1 #bjbf1 a ,f$]al or     
,/ate ,ex*ange e/abli%$ "u subtitle ,d (
 title ,i ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjba et seq47 may re5roll an          
individual :o 0 enroll$ 9 a bronze level
 qualifi$ heal? plan 9 a silv] level    
qualifi$ heal? plan 7z su* t]ms are     
def9$ 9 section #acja7;a7 & describ$ 9  
#acjb7;d7 ( su* ,act 7#db ,u4,s4,c4     
#ahjba7;a72 #ahjbb7;d7774  ,,iv ,m>ket  
/abilization  #dja4 ,re/or+ m>ketplace  
flexibility  7a7 ,9 g5]al ,section      
#acaa7;c77#f7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7;c77#f771 z am5d$ by section     
#cjb7;a71 is fur!r am5d$ by add+ at !   
end ! foll[+3  7,f7 a special enrollm5t 
p]iod once p] mon? = any individual :o  
is eligible = ! advance paym5t ( premium
 tax cr$its "u section #adab & ^:       
h\sehold income is n expect$ to exce$   
#aej p]c5t ( ! pov]ty l9e = a family ( !
 size involv$4  4  7b7 ,effective date  
,! am5dm5t made by subsection 7a7 %all  

apply ) respect to plan ye>s beg9n+ on  
or aft] ,janu>y #a1 #bjbf4  #djb4 ,no   
heal? plan g\g+ ,! ,secret>y ( ,heal? & 
,human ,s]vices %all-- 7#a7 revise      
section #aef4adj7;c7 ( title #de1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation71 to provide t1 = plan ye>s  
beg9n+ on or aft] ,janu>y #a1 #bjbf1 !  
all[able v>iation 9 ! actu>ial value ( a
 heal? plan applicable "u su* section   
%all be ! all[able v>iation = su* plan  
applicable "u su* section = plan ye>    
#bjbe2 &  7#b7 revise section #aef4djj (
 title #de1 ,code ( ,f$]al ,regulations 
7or a successor regulation71 to provide 
t1 = plan ye>s beg9n+ on or aft] ,janu>y
 #a1 #bjbf1 ! t]m de m9imis v>iation = a
 silv] plan v>iation means a m9us #j    
p]c5tage po9t & plus #b p]c5tage po9t   
all[able actu>ial value v>iation4  #djc4
 ,protect+ cont9uity ( cov]age  7a7 ,9  
g5]al ,! ,secret>y ( ,heal? & ,human    
,s]vices %all revise section            
#aee4cje7;f77#d7 ( title #de1 ,code (   
,f$]al ,regulations 7or a successor     

regulation7 to provide t an ,ex*ange may
 det]m9e an enrollee ineligible = an    
advance premium tax cr$it "u section    
#cf;,b ( ! ,int]nal ,rev5ue ,code (     
#aihf z describ$ 9 su* section          
#aee4cje7;f77#d7 only aft] a taxpay] 7or
 a taxpay]'s sp\se1 if m>ri$7 has fail$ 
to file a ,f$]al income tax return &    
reconcile _! pa/ advance premium tax    
cr$it = #b consecutive ye>s = :i* tax   
data w be utiliz$ = v]ification (       
h\sehold income & family size4  7b7     
,effective date ,! requirem5t describ$ 9
 subsection 7a7 %all apply ) respect to 
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbf4  #djd4 ,protect+ enrollees f     
surprise premium bills  7a7 ,9 g5]al    
,section #cf;,b7f77#b7 ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z am5d$ by       
,public ,law #aai-ba1 is am5d$-- 7#a7 by
 /rik+ ,if ! advanc$ paym5ts & ins]t+ ! 
foll[+3  7,a7  ,9 g5]al  ,if ! advanc$  
paym5ts  1 &  7#b7 by add+ at ! end !   
foll[+ new subp>agraph3  7,b7           
,limitation on increase  7i7 ,9 g5]al ,9

 ! case ( a taxpay] ^: h\sehold income  
is less ?an #djj p]c5t ( ! pov]ty l9e = 
! size ( ! family involv$ = ! taxable   
ye>1 ! am\nt ( ! increase "u subp>agraph
 7,a7 %all 9 no ev5t exce$ ! applicable 
doll> am\nt det]m9$ 9 accordance ) !    
foll[+ table 7"o-half ( su* am\nt 9 !   
case ( a taxpay] ^: tax is det]m9$ "u   
section #a7;c7 = ! taxable ye>73 ,if !  
h\sehold income 7express$ z a p]c5tage (
 ! pov]ty l9e7 is3,! applicable doll>   
am\nt is3,less ?an #bjjfjj;,at lea/ #bjj
 b less ?an #cjja1ejj;,at lea/ #cjj b   
less ?an #djjb1ejj4  7ii7 ,index+ (     
am\nt ,9 ! case ( any cal5d> ye> beg9n+ 
aft] #bjad1 ea* ( ! doll> am\nts 9 !    
table conta9$ "u clause 7i7 %all be     
increas$ by an am\nt equal to-- 7,i7 su*
 doll> am\nt1 multipli$ by  7,,ii7 !    
co/-(-liv+ adju/m5t det]m9$ "u section  
#a7;f77#c7 = ! cal5d> ye>1 det]m9$ by   
sub/itut+ cal5d> ye> #bjac = cal5d> ye> 
#bjaf 9 subp>agraph 7,a77ii7 !re(4  ,if 
! am\nt ( any increase "u clause 7i7 is 
n a multiple ( #ej1 su* increase %all be

 r\nd$ to ! next l[e/ multiple ( #ej4  4
  7b7 ,con=m+ am5dm5t ,section          
#ce7;g77#ab77;,b77ii7 ( su* ,code is    
am5d$ by /rik+ ! am\nt det]m9$ "u clause
 7i7 %all be sub/itut$ = ! am\nt det]m9$
 "u section #cf;,b7f77#b7 & ins]t+ !n   
section #cf;,b7f77#b77;,b7 %all be      
appli$ by sub/itut+ ! am\nt det]m9$ "u  
clause 7i7 = ! am\nt det]m9$ "u section 
#cf7;f77#b77;,a74  7c7 ,effective date  
,! am5dm5t made by ?is section %all     
apply to taxable ye>s beg9n+ aft]       
,decemb] #ca1 #bjbe4  #dje4 ,no ,,aca & 
employ] cov]age premium spikes ,section 
#acjb7;c77#d7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjbb7;c77#d77 is am5d$ by add+ at !   
end ! foll[+3 ,= cal5d> ye> #bjbf & ea* 
subsequ5t cal5d> ye>1 ! l[] b\nd ( !    
all[able premium adju/m5t p]c5tage =    
purposes ( p>agraph 7#a77;,b77i7 is !   
l[] b\nd ( ! premium adju/m5t p]c5tage t
 appli$ "u ?is p>agraph = plan ye> #bjbb
 us+ ,national ,heal? ,exp5diture       
,acc\nts projections ( av]age p]        

enrollee employ]-sponsor$ insurance     
premiums44