S.Amdt. 649

SA 649. Mr. ALEXANDER (for himself, Mr. Barrasso, Mr. Grassley, and
Mr. Sasse) submitted an amendment intended to be proposed by him to the
bill H.R. 1628, to provide for reconciliation pursuant to title II of
the concurrent resolution on the budget for fiscal year 2017; which was
ordered to lie on the table; as follows:

At the appropriate place, insert the following:

SEC. ___. WAIVERS FOR STATE INNOVATION.

(a) In General.--Section 1332 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18052) is amended--
(1) in subsection (a)--
(A) in paragraph (1)--
(i) in subparagraph (B)--

(I) by amending clause (i) to read as follows:

``(i) a description of how the State plan meeting the
requirements of a waiver under this section would, with
respect to health insurance coverage within the State--

``(I) take the place of the requirements described in
paragraph (2) that are waived; and
``(II) provide for alternative means of, and requirements
for, increasing access to comprehensive coverage, reducing
average premiums, providing consumers the freedom to purchase
the health insurance of their choice, and increasing
enrollment in private health insurance; and''; and
(II) in clause (ii), by striking ``that is budget neutral
for the Federal Government'' and inserting ``, demonstrating
that the State plan does not increase the Federal deficit'';
and

(ii) in subparagraph (C), by striking ``the law'' and
inserting ``a law or has in effect a certification''; and
(B) in paragraph (3)--
(i) in the first sentence, by inserting ``or would qualify
for a reduction in'' after ``would not qualify for'';
(ii) by adding after the second sentence the following: ``A
State may request that all of, or any portion of, such
aggregate amount of such credits or reductions be paid to the
State as described in the first sentence.'';
(iii) in the paragraph heading, by striking ``Pass through
of funding'' and inserting ``Funding'';
(iv) by striking ``With respect'' and inserting the
following:
``(A) Pass through of funding.--With respect''; and
(v) by adding at the end the following:
``(B) Additional funding.--There is authorized to be
appropriated, and is appropriated, to the Secretary of Health
and Human Services, out of monies in the Treasury not
otherwise obligated, $2,000,000,000 for fiscal year 2017, to
remain available until the end of fiscal year 2019, to
provide grants to States for purposes of submitting an
application for a waiver granted under this section and
implementing the State plan under such waiver.
``(C) Authority to use long-term state innovation and
stability allotment.--If the State has an application for an
allotment under section 2105(i) of the Social Security Act
for the plan year, the State may use the funds available
under the State's allotment for the plan year to carry out
the State plan under this section, so long as such use is
consistent with the requirements of paragraphs (1) and (7) of
section 2105(i) of such Act (other than paragraph (1)(B) of
such section). Any funds used to carry out a State plan under
this subparagraph shall not be considered in determining
whether the State plan increases the Federal deficit.'';
(2) in subsection (b)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph (A)--

(I) by striking ``may'' and inserting ``shall''; and
(II) by striking ``only if'' and inserting ``unless''; and

(ii) by striking ``plan--'' and all that follows through
the period at the end of subparagraph (D) and inserting
``application is missing a required element under subsection
(a)(1) or that the State plan will increase the Federal
deficit, not taking into account any amounts received through
a grant under subsection (a)(3)(B).'';
(B) in paragraph (2)--
(i) in the paragraph heading, by inserting ``or certify''
after ``law'';
(ii) in subparagraph (A), by inserting before the period
``, and a certification described in this paragraph is a
document, signed by the Governor, and the State insurance
commissioner, of the State, that provides authority for State
actions under a waiver under this section, including the
implementation of the State plan under subsection
(a)(1)(B)''; and
(iii) in subparagraph (B)--

(I) in the subparagraph heading, by striking ``of opt
out''; and
(II) by striking `` may repeal a law'' and all that follows
through the period at the end and inserting the following:
``may terminate the authority provided under the waiver with
respect to the State by--

``(i) repealing a law described in subparagraph (A); or
``(ii) terminating a certification described in
subparagraph (A), through a certification for such
termination signed by the Governor, and the State insurance
commissioner, of the State.'';
(3) in subsection (d)--
(A) in paragraph (2)(B), by striking ``and the reasons
therefore'' and inserting ``and the reasons therefore, and
provide the data on which such determination was made''; and
(B) by adding at the end the following:
``(3) Expedited determination.--The Secretary shall
establish an expedited determination process in which a State
may request that a determination on an application under
subsection (a)(1) be made not later than 45 days after the
receipt of such application. A State may request an expedited
determination by the Secretary under such process if the
State determines the time for determination under paragraph
(1) would prevent a State from responding in a timely manner
to an urgent situation with respect to ensuring access to
private health insurance coverage within such State or a
portion of such State for the current or following plan
year.''; and
(4) in subsection (e), by striking ``No waiver'' and all
that follows through the period at the end and inserting the
following: ``A waiver under this section--
``(1) shall be in effect for a period of 8 years unless the
State requests a shorter duration;
``(2) may be renewed for unlimited additional 8-year
periods upon application by the State; and
``(3) may not be cancelled by the Secretary before the
expiration of the 8-year period (including any renewal period
under paragraph (2)).''.
(b) Applicability.--Section 1332 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18052) shall apply as
follows:
(1) In the case of a State for which a waiver under such
section was granted prior to the date of enactment of this
Act, such section 1332, as in effect on the day before the
date of enactment of this Act shall apply to the waiver and
State plan.
(2) In the case of a State that submitted an application
for a waiver under such section prior to the date of
enactment of this Act, and which application the Secretary of
Health and Human Services has not approved prior to such
date, the State may elect to have such section 1332, as in
effect on the day before the date of enactment of this Act,
or such section 1332, as amended by subsection (a), apply to
such application and State plan.
(3) In the case of a State that submits an application for
a waiver under such section on or after the date of enactment
of this Act, such section 1332, as amended by subsection (a),
shall apply to such application and State plan.
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