Paid to the state under this subsection in a manner consistent with the description provided by the state in its application approved under paragraph 1 , the administrator may withhold payments, reduce payments, or recover previous payments to the state under this subsection as the administrator deems appropriate. d flexibility in submittal of claims. Nothing in this subsection shall be construed as preventing a state from claiming as expenditures in the year expenditures that were incurred in a previous year. 6 required uses. a premium stabilization and incentives for individual market participation. In determining allotments for states under this subsection for each of calendar years 2019, 2020, and 2021, the administrator shall ensure that at least 5,000,000,000 of the amounts appropriated for each such year under paragraph 4 a are used by states for the purposes described in paragraph 1 a ii and in accordance with guidance issued by the administrator not later than 30 days after the date of enactment of this subsection that specifies the parameters for the use of funds for such purposes. b assistance with outofpocket costs. In determining allotments for states under this subsection for each of calendar years 2020 through 2026, the administrator shall ensure that at least 15,000,000,000 of the amounts appropriated for each of calendar years 2020 and 2021 under paragraph 4 a , and at least 14,000,000,000 of the amounts appropriated for each of calendar years 2022 through 2026 under such paragraph, are used by states for the purposes described in paragraph 1 a iv and in accordance with guidance issued by the administrator not later than september 1, 2019, that specifies the parameters for the use of funds for such purposes. 7 exemptions. Paragraphs 2 , 3 , 5 , 6 , 8 , 10 , and 11 of subsection c do not apply to payments under this subsection. b other title xxi amendments. 1 section 2101 of such act 42 u. S. C. 1397aa is amended a in subsection a , in the matter preceding paragraph 1 , by striking the purpose and inserting except with respect to shortterm assistance activities under section 2105 h and the longterm state stability and Innovation Program established in section 2105 i , the purpose; and b in subsection b , in the matter preceding paragraph 1 , by inserting subsection a or g of before section 2105. 2 section 2105 c 1 of such act 42 u. S. C. 1397ee c 1 is amended by striking and may not include and inserting or to carry out shortterm assistance activities under subsection h or the longterm state stability and Innovation Program established in subsection i and, except in the case of funds made available under subsection h or i , may not include. 3 section 2106 a 1 of such act 42 u. S. C. 1397ff a 1 is amended by inserting subsection a or g of before section 2105. Section 107, better Care Reconciliation Implementation Fund. a in general. There is hereby established a better Care Reconciliation Implementation Fund referred to in this section as the fund within the department of health and Human Services to provide for federal Administrative Expenses in carrying out this act. b funding. There is appropriated to the fund, out of any funds in the treasury not otherwise appropriated, 500,000,000. Section 108, repeal of the tax on Employee Health insurance premiums and health plan benefits. a in general. Chapter 43 of the Internal Revenue code of 1986 is amended by striking section 4980i. b Effective Date. The amendment made by subsection a shall apply to taxable years beginning after december 31, 2019. c subsequent Effective Date. The amendment made by subsection a shall not apply to taxable years beginning after december 31, 2025, and chapter 43 of the Internal Revenue code of 1986 is amended to read as such chapter would read if such subsection had never been enacted. Section 109, repeal of tax on overthecounter medications. a hsas. Subparagraph a of section 223 d 2 of the Internal Revenue code of 1986 is amended by striking such term and all that follows through the period. b archer msas. Subparagraph a of section 220 d 2 of the Internal Revenue code of 1986 is amended by striking such term and all that follows through the period. c Health Flexible spending arrangements and Health Reimbursement arrangements. Section 106 of the Internal Revenue code of 1986 is amended by striking subsection f . d Effective Dates. 1 distributions from savings accounts. The amendments made by subsections a and b shall apply to amounts paid with respect to taxable years beginning after december 31, 2016. 2 reimbursements. The amendment made by subsection c shall apply to expenses incurred with respect to taxable years beginning after december 31, 2016. Section 110, repeal of tax on Health Savings accounts. a hsas. Section 223 f 4 a of the Internal Revenue code of 1986 is amended by striking 20 percent and inserting 10 percent. b archer msas. Section 220 f 4 a of the Internal Revenue code of 1986 is amended by striking 20 percent and inserting 15 percent. c Effective Date. The amendments made by this section shall apply to distributions made after december 31, 2016. Section 111, repeal of limitations on contributions to flexible spending accounts. a in general. Section 125 of the Internal Revenue code of 1986 is amended by striking subsection i . b Effective Date. The amendment made by this section shall apply to plan years beginning after december 31, 2017. Section 112, repeal of tax on prescription medications. Subsection j of section 9008 of the Patient Protection and Affordable Care act is amended to read as follows j repeal. This section shall apply to calendar years beginning after december 31, 2010, and ending before january 1, 2018. Section 113, repeal of medical device excise tax. Section 4191 of the Internal Revenue code of 1986 is amended by adding at the end the following new subsection d applicability. The tax imposed under subsection a shall not apply to sales after december 31, 2017. Section 114, repeal of Health Insurance tax. Subsection j of section 9010 of the Patient Protection and Affordable Care act is amended by striking , and at the end of paragraph 1 and all that follows through 2017. Section 115, repeal of elimination of deduction for expenses allocable to Medicare Part d subsidy. a in general. Section 139a of the Internal Revenue code of 1986 is amended by adding at the end the following new sentence this section shall not be taken into account for purposes of determining whether any deduction is allowable with respect to any cost taken into account in determining such payment. b Effective Date. The amendment made by this section shall apply to taxable years beginning after december 31, 2016. Section 116 repeal of chronic care tax. a in general. Subsection a of section 213 of the Internal Revenue code of 1986 is amended by striking 10 percent and inserting 7. 5 percent. b Effective Date. The amendment made by this section shall apply to taxable years beginning after december 31, 2016. Section 117, repeal of tanning tax. a in general. The Internal Revenue code of 1986 is amended by striking chapter 49. b Effective Date. The amendment made by this section shall apply to Services Performed after september 30, 2017. Section 118, purchase of insurance from Health Savings account. a purchase of High Deductible Health plans. 1 in general. Paragraph 2 of section 223 d of the Internal Revenue code of 1986, as amended by section 109 a , is amended a by striking and any dependent as defined in section 152, determined without regard to subsections b 1 , b 2 , and d 1 b thereof of such individual in subparagraph a and inserting any dependent as defined in section 152, determined without regard to subsections b 1 , b 2 , and d 1 b thereof of such individual, and any child as defined in section 152 f 1 of such individual who has not attained the age of 27 before the end of such individuals taxable year b by striking subparagraph b and inserting the following b Health Insurance may not be purchased from account. Except as provided in subparagraph c , subparagraph a shall not apply to any payment for insurance. , and c by striking or at the end of subparagraph c iii , by striking the period at the end of subparagraph c iv and inserting , or, and by adding at the end the following v a High Deductible Health plan but only to the extent of the portion of such expense in excess of i any amount allowable as a credit under section 36b for the taxable year with respect to such coverage ii any amount allowable as a deduction under section 162 l with respect to such coverage, or iii any amount excludable from gross income with respect to such coverage under section 106 including by reason of section 125 or 402 l . 2 Effective Date. The amendments made by this subsection shall apply with respect to amounts paid for expenses incurred for, and distributions made for, coverage under a High Deductible Health plan beginning after december 31, 2017. b Consumer Freedom plans. 1 in general. Section 223 d 2 c of the Internal Revenue code of 1986, as amended by subsection a and section 122, is amended a by striking or at the end of clause iv , by striking the period at the end of clause v , and by adding at the end the following vi any plan which i is offered by a Health Insurance issuer which meets the conditions described in section 212 b of the Better Care Reconciliation Act of 2017 for the plan year, and ii would not be permitted to be offered in the market but for such section. , and b by inserting or vi after clause v in the last sentence thereof. 2 Effective Date. The amendments made by this subsection shall to taxable years beginning after december 31, 2019. Section 119, maximum contribution limit to Health Savings account increased to amount of deductible and outofpocket limitation. a selfonly coverage. Section 223 b 2 a of the Internal Revenue code of 1986 is amended by striking 2,250 and inserting the amount in effect under subsection c 2 a ii i . b family coverage. Section 223 b 2 b of such code is amended by striking 4,500 and inserting the amount in effect under subsection c 2 a ii ii . c costofliving adjustment. Section 223 g 1 of such code is amended 1 by striking subsections b 2 and both places it appears and inserting subsection, and 2 in subparagraph b , by striking determined by and all that follows through calendar year 2003. And inserting determined by substituting calendar year 2003 for calendar year 1992 in subparagraph b thereof. d Effective Date. The amendments made by this section shall apply to taxable years beginning after december 31, 2017. Section 120, allow both spouses to make catchup contributions to the same Health Savings account. a in general. Section 223 b 5 of the Internal Revenue code of 1986 is amended to read as follows 5 special rule for married individuals with family coverage. a in general. In the case of individuals who are married to each other, if both spouses are eligible individuals and either spouse has family coverage under a High Deductible Health plan as of the first day of any month i the limitation under paragraph 1 shall be applied by not taking into account any other High Deductible Health plan coverage of either spouse and if such spouses both have family coverage under separate High Deductible Health plans, only one such coverage shall be taken into account ii such limitation after application of clause i shall be reduced by the aggregate amount paid to archer msas of such spouses for the taxable year, and iii such limitation after application of clauses i and ii shall be divided equally between such spouses unless they agree on a different division. b treatment of additional contribution amounts. If both spouses referred to in subparagraph a have attained age 55 before the close of the taxable year, the limitation referred to in subparagraph a iii which is subject to division between the spouses shall include the additional contribution amounts determined under paragraph 3 for both spouses. In any other case, any additional contribution amount determined under paragraph 3 shall not be taken into account under subparagraph a iii and shall not be subject to division between the spouses. b Effective Date. The amendment made by this section shall apply to taxable years beginning after december 31, 2017. Section 121, special rule for certain medical expenses incurred before establishment of a in general. Section 223 d 2 of the Internal Revenue code of 1986 is amended by adding at the end the following new subparagraph d treatment of certain medical expenses incurred before establishment of account. If a Health Savings account is established during the 60day period beginning on the date that coverage of the account beneficiary under a High Deductible Health plan begins, then, solely for purposes of determining whether an amount paid is used for a qualified medical expense, such account shall be treated as having been established on the date that such coverage begins. b Effective Date. The amendment made by this subsection shall apply with respect to coverage under a High Deductible Health plan beginning after december 31, 2017. Sec. 122. Exclusion from hsas of High Deductible Health plans which do not include protections for life. a in general. Subparagraph c of section 223 d 2 of the Internal Revenue code of 1986 is amended by adding at the end the following flush sentence a High Deductible Health plan shall not be treated as described in clause v if such plan includes coverage for abortions other than any abortion necessary to save the life of the mother or any abortion with respect to a pregnancy that is the result of an act of rape or incest . b Effective Date. The amendment made by this section shall apply with respect to coverage under a High Deductible Health plan beginning after december 31, 2017. Sec. 123. Federal payments to states. a in general. Notwithstanding section 504 a , 1902 a 23 , 1903 a , 2002, 2005 a 4 , 2102 a 7 , or 2105 a 1 of the Social Security act 42 u. S. C. 704 a , 1396a a 23 , 1396b a , 1397a, 1397d a 4 , 1397bb a 7 , 1397ee a 1 , or the terms of any medicaid waiver in effect on the date of enactment of this act that is approved under section 1115 or 1915 of the Social Security act 42 u. S. C. 1315, 1396n , for the 1year period beginning on the date of enactment of this act, no federal funds provided from a program referred to in this subsection that is considered direct spending for any year may be made available to a state for payments to a prohibited entity, whether made directly to the prohibited entity or through a managed Care Organization under contract with the state. b definitions. In this section 1 prohibited entity. The term prohibited entity means an entity, including its affiliates, subsidiaries, successors, and clinics a that, as of the date of enactment of this act i is an organization described in section 501 c 3 of the Internal Revenue code of 1986 and exempt from tax under section 501 a of such code; ii is an essential Community Provider described in section 156. 235 of title 45, code of federal regulations as in effect on the date of enactment of this act , that is primarily engaged in Family Planning services, reproductive health, and related medical care; and iii provides for abortions, other than an abortion i if the pregnancy is the result of an act of rape or incest; or ii in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman