State Flexibility and Patient Choice Act of 2019 This bill revises the procedures for states to waive certain federal health insurance requirements and implement state-administered health insurance programs. Specifically, the bill revises the affordability requirement to allow states to provide coverage of comparable affordability to what is available through the federal health insurance exchange. Further, the reviewing agencies may consider the budgetary impact of a state waiver program on other federal programs (e.g., Medicaid) when determining whether the waiver application would increase the federal deficit. Additionally, the bill applies the budget-neutrality requirement over the term of the waiver period. States may certify that a governor has the authority to apply for a waiver under current state law, as an alternative to referencing a specific state statute. The bill also provides expedited review and approval of state applications that are substantially similar to a waiver program that already has been approved.