1. Short title This Act may be cited as the State Flexibility and Patient Choice Act of 2019 . 2. Streamlining the State innovation waiver process 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)(ii), by inserting over both the term of the proposed waiver and the 10-year budget plan after Government ; and (ii) in subparagraph (C), by striking the law described in subsection (b)(2) and inserting a law or has in effect a certification described in subsection (b)(3) ; and (B) in paragraph (3)— (i) in the first sentence— (I) by inserting or would qualify for a lesser amount of after would not qualify for ; (II) by inserting , or the State would not qualify for or would qualify for a lesser payment under section 1331, after subtitle E ; (III) by inserting , or on behalf of participants in a basic health program established under section 1331 had such participants been enrolled in an Exchange, after this title ; and (IV) by inserting or for implementing a basic health program established under section 1331 before the period; and (ii) in the second sentence, by inserting before the period the following: , and with respect to participation in the basic health program and funds provided to such other States under section 1331 ; (2) in subsection (b)— (A) in paragraph (1)— (i) in subparagraph (B), by striking at least as affordable and inserting of comparable affordability ; and (ii) in subparagraph (D), by inserting over the term of the waiver and over the 10-year budget plan with respect to such waiver before the period at the end; (B) by redesignating paragraph (2) as paragraph (3)