HR 2399 IHCommentsClose CommentsPermalink

To amend the Social Security Act and the Internal Revenue Code of 1986 to assure comprehensive, affordable health insurance coverage for all Americans through an American Health Benefits Program.CommentsClose CommentsPermalink

May 13, 2009CommentsClose CommentsPermalink

Mr. LANGEVIN introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink

To amend the Social Security Act and the Internal Revenue Code of 1986 to assure comprehensive, affordable health insurance coverage for all Americans through an American Health Benefits Program.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE; FINDINGS; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘American Health Benefits Program Act of 2009’.CommentsClose CommentsPermalink





(b) Findings- Congress finds the following:CommentsClose CommentsPermalink





(1) UNINSURED AMERICANS AND LACK OF ACCESS TO CHOICES- (A) In 2007, 45 million Americans were uninsured, over 80 percent of whom were employed (or dependents of individuals who were employed).CommentsClose CommentsPermalink





(B) Health care providers provided to uninsured Americans $41 billion in care for which they were not compensated by the individuals or through insurance.CommentsClose CommentsPermalink





(C) Only 15 percent of employers providing health benefits are able to offer their employees a choice between two or more health plans.CommentsClose CommentsPermalink





(2) COST GROWTH OF EMPLOYER COVERAGE- (A) Premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 1999.CommentsClose CommentsPermalink





(B) The employer cost of health benefits per eligible, enrolled worker is 18.3 percent of payroll.CommentsClose CommentsPermalink





(C) In 2007, 48 percent of all small businesses with three to 199 employees not offering health benefits list high premiums as the cause.CommentsClose CommentsPermalink





(3) ADMINISTRATIVE EFFICIENCY OF USING FEHBP MODEL FOR PROVIDING HEALTH INSURANCE COVERAGE- (A) The private insurance market presents increasing administrative challenges for employers in seeking out, contracting with, and administering health benefits.CommentsClose CommentsPermalink





(B) The Federal Employee Health Benefits Program (FEHBP) currently manages negotiations with health insurers over premiums and benefits on behalf of 8.6 million Federal employees and retirees and their dependents.CommentsClose CommentsPermalink





(C) Overhead costs for employers providing health benefits coverage can be over 30 percent for employers with fewer than 10 employees and about 12 percent for employers with more than 500 employees.CommentsClose CommentsPermalink





(D) In comparison, the overhead cost of coverage provided under FEHBP is about 3 percent.CommentsClose CommentsPermalink





(4) EXPANSION OF FEHBP MODEL TO COVER UNINSURED AND OTHER AMERICANS- Requiring participation in an FEHBP-style program would expand consumer choice, ensure portability and continuity of coverage, improve incentives for cost containment, and stabilize the burden on businesses.CommentsClose CommentsPermalink





(5) SAVINGS FROM IMPLEMENTATION OF HEALTH INFORMATION TECHNOLOGY- Properly implemented and widely adopted health information technology could significantly improve the quality, safety and efficiency of health care delivery while saving an estimated $77 billion per year.CommentsClose CommentsPermalink





(c) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; findings; table of contents.CommentsClose CommentsPermalink





Sec. 2. Establishment of American Health Benefits Program.CommentsClose CommentsPermalink

‘TITLE XXII--AMERICAN HEALTH BENEFITS PROGRAM

‘Sec. 2201. Establishment of program.CommentsClose CommentsPermalink

‘Sec. 2202. Eligibility; requirement of coverage.CommentsClose CommentsPermalink

‘Sec. 2203. Qualified health plans; benefits; premiums.CommentsClose CommentsPermalink

‘Sec. 2204. Government contribution; American Health Benefits Program Trust Fund.CommentsClose CommentsPermalink

‘Sec. 2205. Premium and cost-sharing subsidies for lower income individuals.CommentsClose CommentsPermalink

‘Sec. 2206. Administration.CommentsClose CommentsPermalink

‘Sec. 2207. Definitions.CommentsClose CommentsPermalink

Sec. 3. Collection of premiums, subsidies, and employer funding.CommentsClose CommentsPermalink





Sec. 4. Amendments to the Medicaid program and SCHIP.CommentsClose CommentsPermalink





Sec. 5. Consultation in implementation of health information technologies.CommentsClose CommentsPermalink





Sec. 6. Non-preemption of existing collective bargaining agreements.CommentsClose CommentsPermalink





Sec. 7. Health Benefits Commission.CommentsClose CommentsPermalink

SEC. 2. ESTABLISHMENT OF AMERICAN HEALTH BENEFITS PROGRAM.

(a) In General- The Social Security Act is amended by adding at the end the following new title:CommentsClose CommentsPermalink

‘TITLE XXII--AMERICAN HEALTH BENEFITS PROGRAMCommentsClose CommentsPermalink

‘SEC. 2201. ESTABLISHMENT OF PROGRAM.

‘There is established under this title a program (to be known as the ‘American Health Benefits Program’) to provide comprehensive health insurance coverage to all Americans who are not covered under certain Federal health insurance programs and who are not eligible for employer-provided insurance coverage. The coverage shall be provided in a manner similar to the manner in which coverage has been provided to Members of Congress and Federal Government employees and retirees and their dependents under the Federal Employees Health Benefits Program (FEHBP).CommentsClose CommentsPermalink

‘SEC. 2202. ELIGIBILITY; REQUIREMENT OF COVERAGE.

‘(a) Eligibility-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Each AHBP-eligible individual is eligible to enroll in a qualified health plan offered under this title.CommentsClose CommentsPermalink





‘(2) AHBP-ELIGIBLE INDIVIDUAL DEFINED-CommentsClose CommentsPermalink





‘(A) IN GENERAL- For purposes of this title, the term ‘AHBP-eligible individual’ means an individual residing in the United States who is--CommentsClose CommentsPermalink





‘(i) a citizen or national of the United States;CommentsClose CommentsPermalink





‘(ii) an alien lawfully admitted to the United States for permanent residence;CommentsClose CommentsPermalink





‘(iii) an alien admitted into the United States under section 207 of the Immigration and Nationality Act (relating to refugees);CommentsClose CommentsPermalink





‘(iv) an alien otherwise permanently residing in the United States under color of law (as specified by the Administrator); orCommentsClose CommentsPermalink





‘(v) an alien with the status of a nonimmigrant who is within a class of long-term nonimmigrants under section 101(a)(15) of the Immigration and Nationality Act that the Administrator determines, in consultation with the Secretary of Homeland Security, to be appropriate.CommentsClose CommentsPermalink





‘(B) EXCEPTIONS- Such term does not include the following individuals:CommentsClose CommentsPermalink





‘(i) INDIVIDUALS ELIGIBLE FOR QUALIFIED EMPLOYER-PROVIDED COVERAGE- An individual who is eligible for employer-provided coverage, as defined in section 2207(6), whether an employee, dependent, or otherwise.CommentsClose CommentsPermalink





‘(ii) INCARCERATED INDIVIDUALS- An individual who is incarcerated (as specified by the Administrator).CommentsClose CommentsPermalink





‘(b) Requirement of Coverage-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Except as provided in this subsection, each AHBP-eligible individual shall be enrolled in a qualified health plan under this title.CommentsClose CommentsPermalink





‘(2) EXCEPTION FOR INDIVIDUALS DEMONSTRATING PUBLIC HEALTH INSURANCE COVERAGE- The requirement of paragraph (1) shall not apply to an individual who demonstrates coverage under any of the following:CommentsClose CommentsPermalink





‘(A) MEDICARE- Coverage under parts A and B (or under part C) of title XVIII.CommentsClose CommentsPermalink





‘(B) MEDICAID- Coverage under a State plan under title XIX.CommentsClose CommentsPermalink





‘(C) TRICARE/CHAMPUS- Coverage under the TRICARE program under chapter 55, of title 10, United States Code.CommentsClose CommentsPermalink





‘(D) INDIAN HEALTH SERVICES- Coverage under a medical care program of the Indian Health Service or of a tribal organization.CommentsClose CommentsPermalink





‘(E) VETERANS HEALTH- Coverage under the veterans health care program under chapter 17 of title 38, United States Code, if the coverage for the individual involved is determined to be not less than the coverage provided under a qualified health plan, based on the individual’s priority for services as provided under section 1705(a) of such title.CommentsClose CommentsPermalink





‘(3) EXCEPTION FOR NONIMMIGRANTS- The requirement of paragraph (1) shall not apply to an individual described in subsection (a)(2)(A)(v).CommentsClose CommentsPermalink





‘(4) EXCEPTION BASED ON RELIGIOUS OBJECTION- The requirement of paragraph (1) shall not apply to an individual who executes a written statement (in a form and manner specified by the Secretary) that--CommentsClose CommentsPermalink





‘(A) the individual is conscientiously opposed to acceptance of medical treatment of the type covered by qualified health plans; andCommentsClose CommentsPermalink





‘(B) the individual’s acceptance of medical treatment covered by such a plan would be inconsistent with the individual’s sincere religious beliefs.CommentsClose CommentsPermalink





‘(c) Enrollment; Default Enrollment-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Administrator shall establish a process for AHBP-eligible individuals to enroll in qualified health plans. Such process shall be based on the enrollment process used under FEHBP and shall provide for the dissemination of information to AHBP-eligible individuals on qualified health plans being offered.CommentsClose CommentsPermalink





‘(2) DEFAULT ENROLLMENT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Administrator shall establish a procedure under which an AHBP-eligible individual who is required under subsection (b) to enroll, but is not enrolled, in a qualified health plan will be assigned to, and enrolled in, such a plan.CommentsClose CommentsPermalink





‘(B) RULES- In carrying out subparagraph (A), the Administrator shall assign AHBP-eligible individuals and families to the basic plan the premium of which is the lowest premium for the AHBP region or other area in which the individuals or families reside.CommentsClose CommentsPermalink





‘(3) CHANGES IN ENROLLMENT- The Administrator shall establish enrollment procedures that include an annual open season and permit changes in enrollment with qualified health plans at other times (such as by reason of changes in marital or dependent status). Such procedures shall be based on the enrollment procedures established under FEHBP.CommentsClose CommentsPermalink





‘(d) Treatment of Family Members- Enrollment under this title shall include both individual and family enrollment, in a manner similar to that provided under FEHBP. To the extent consistent with eligibility under subsection (a), the Administrator shall provide rules similar to the rules under FEHBP for the enrollment of family members who are AHBP-eligible individuals in the same plan, except that such rules shall permit a family consisting only of a married couple to elect to enroll each spouse in a different qualified health plan.CommentsClose CommentsPermalink





‘(e) Changes in Plan Enrollment- The Administrator shall provide for and permit changes in the qualified health plan in which an individual or family is enrolled under this section in a manner similar to the manner in which such changes are provided or permitted under FEHBP. The Administrator shall provide for termination of such enrollment for an individual at the time the individual is no longer an AHBP-eligible individual.CommentsClose CommentsPermalink





‘(f) Enrollment Guides- The Administrator shall provide for the broad dissemination of information on qualified health plans offered under this title. Such information shall be provided in a comparative manner, similar to that used under FEHBP, and shall include information, collected through surveys of enrollees, on measures of enrollee satisfaction with the different plans.CommentsClose CommentsPermalink

‘SEC. 2203. QUALIFIED HEALTH PLANS; BENEFITS; PREMIUMS.

‘(a) Offering of Plans-CommentsClose CommentsPermalink





‘(1) CONTRACTS- The Administrator shall enter into contracts with entities for the offering of qualified health plans in accordance with this title. Such contracts shall be entered into in a manner similar to the process by which the Director of the Office of Personnel Management is authorized to enter into contracts with health benefits plans under FEHBP.CommentsClose CommentsPermalink





‘(2) REQUIREMENTS FOR ENTITIES OFFERING PLANS- No such contract shall be entered into with an entity for the offering of a qualified health plan in a region unless the entity--CommentsClose CommentsPermalink





‘(A) is licensed as a health maintenance organization in that State or is licensed to sell group health insurance coverage in that State;CommentsClose CommentsPermalink





‘(B) meets such requirements, similar to requirements under FEHBP, as the Administrator may establish relating to solvency, organization, structure, governance, access, and quality;CommentsClose CommentsPermalink





‘(C) agrees to participate in the high-risk reinsurance pool described in subsection (d); andCommentsClose CommentsPermalink





‘(D) provides assurances satisfactory to the Administrator that at least 90 percent of the premium payments for the plan will be returned in the form of aggregate health care benefits or improvements, including health information technology.CommentsClose CommentsPermalink





‘(3) CONTRACTING WITH LIMITED NUMBER OF PLANS IN A REGION WITHIN TYPES OF PLANS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Administrator shall contract with only a limited number of qualified health plans of each type (as specified under subparagraph (B)) in each AHBP region.CommentsClose CommentsPermalink





‘(B) TYPES OF PLANS- For purposes of subparagraph (A), the Administrator shall classify the different types of qualified health plans, such as fee-for-service plans, health maintenance plans, preferred provider plans, and other types of plans.CommentsClose CommentsPermalink





‘(b) FEHBP Scope of Benefits-CommentsClose CommentsPermalink





‘(1) COMPREHENSIVE BENEFITS- Qualified health plans shall provide for the same scope and type of comprehensive benefits that have been provided under FEHBP, including the types of benefits described in section 8904 of title 5, United States Code and including benefits previously required by regulation or direction (such as preventive benefits, including childhood immunization and cancer screening, and mental health parity) under FEHBP.CommentsClose CommentsPermalink





‘(2) NO EXCLUSION FOR PRE-EXISTING CONDITIONS- Qualified health plans shall not impose pre-existing condition exclusions or otherwise discriminate against any enrollee based on the health status of such enrollee (including genetic information relating to such enrollee).CommentsClose CommentsPermalink





‘(3) OTHER CONSUMER PROTECTIONS- Qualified health plans also shall meet consumer and patient protection requirements that the Administrator establishes, based on similar requirements previously imposed under FEHBP, including protections of patients’ rights previously effected pursuant to Executive Memorandum.CommentsClose CommentsPermalink





‘(c) Community-Rated Premiums-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The premiums established for a qualified health plan under this title for individual or family coverage shall be community-rated and shall not vary based on age, gender, health status (including genetic information), or other factors.CommentsClose CommentsPermalink





‘(2) COLLECTION PROCESS- The Administrator shall establish a process for the timely and accurate collection of premiums owed by enrollees, taking into account any Government contribution under section 2204(a) and any premium subsidy referred to in section 2205(a). Such process shall include methods for payment through payroll withholding, as well as payment through automatic debiting of accounts with financial institutions, and shall be coordinated with the application of section 59B of the Internal Revenue Code of 1986. Such premiums shall be deposited into the American Health Benefits Program Trust Fund established under section 2204(c).CommentsClose CommentsPermalink





‘(d) High-Risk Reinsurance Pool- The Administrator shall establish an arrangement among the entities offering qualified health plans under which such entities contribute in an equitable manner (as determined by the Administrator) into a fund that provides payment to plans for a percentage (specified by the Administrator and not to exceed 90 percent) of the costs that they incur for enrollees beyond a predetermined threshold specified from time to time by the Administrator.CommentsClose CommentsPermalink





‘(e) Marketing Practices and Costs- The Administrator shall monitor marketing practices with respect to qualified health plans in order to assure--CommentsClose CommentsPermalink





‘(1) the accuracy of the information disseminated regarding such plans; andCommentsClose CommentsPermalink





‘(2) that costs of marketing are reasonable and do not exceed a percentage of total costs that is specified by the Administrator and that takes into account costs of market entry for new qualified health plans.CommentsClose CommentsPermalink

‘SEC. 2204. GOVERNMENT CONTRIBUTION; AMERICAN HEALTH BENEFITS PROGRAM TRUST FUND.

‘(a) Government Contribution-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Administrator shall provide each year for a contribution under this subsection towards the coverage provided under this title for those AHBP-eligible individuals who are required to be enrolled in a qualified health plan under section 2202(b). Except as provided in this subsection, the amount of such contribution shall be determined using the same methodology that is applied for purposes of determining the Government contribution under section 8906 of title 5, United States Code and shall not exceed 75 percent of the premium for the plan selected.CommentsClose CommentsPermalink





‘(2) USE OF REGIONAL WEIGHTED AVERAGE- Instead of computing the Government contribution using methodology under section 8906(b)(1) of title 5, United States Code, based on 72 percent of the weighted average premium for qualified health plans nationally, the Administrator shall compute such contribution based on 72 percent of the weighted average premium for qualified health plans in each region involved (as identified by the Administrator).CommentsClose CommentsPermalink





‘(b) Plan Payment-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Administrator shall provide for payment of qualified health plans of the premiums for such plans, as adjusted under this subsection.CommentsClose CommentsPermalink





‘(2) RISK ADJUSTED PAYMENT- The payment to a qualified health plan under this subsection shall be adjusted in a budget-neutral manner specified by the Administrator to reflect the actuarial risk of the enrollees in the plan compared to an average actuarial risk.CommentsClose CommentsPermalink





‘(3) REDUCTION FOR ADMINISTRATIVE EXPENSES AND CONTINGENCY RESERVE- The Administrator shall provide for a uniform percentage reduction in payment otherwise made to a qualified health plan under this subsection. Such percentage shall consist of the following:CommentsClose CommentsPermalink





‘(A) CONTINGENCY RESERVE- A percentage (not to exceed 3 percent) to provide for a contingency reserve described in section 2206(h)(1).CommentsClose CommentsPermalink





‘(B) FEDERAL ADMINISTRATIVE COSTS- A percentage (not to exceed 5 percent) to cover Federal administrative costs in implementing this title.CommentsClose CommentsPermalink





‘(c) Trust Fund-CommentsClose CommentsPermalink





‘(1) ESTABLISHMENT- There is hereby established a trust fund, to be known as the ‘American Health Benefits Program Trust Fund’ (in this subsection referred to as the ‘Trust Fund’).CommentsClose CommentsPermalink





‘(2) DEPOSITS- The Trust Fund shall consist of such gifts and bequests as may be provided in section 201(i)(1) and such amounts as may be deposited in, or appropriated to, such fund as provided in this title. There are hereby appropriated to the Trust Fund, out of any moneys in the Treasury not otherwise appropriated, amounts equivalent to 100 percent of--CommentsClose CommentsPermalink





‘(A) the taxes imposed by section 3451 of the Internal Revenue Code of 1986 with respect to wages reported to the Secretary of the Treasury or the Secretary’s delegate pursuant to subtitle F of such Code, as determined by the Secretary of the Treasury by applying the applicable rates of tax under such section to such wages, which wages shall be certified by the Commissioner of Social Security on the basis of records of wages established and maintained by such Commissioner in accordance with such reports;CommentsClose CommentsPermalink





‘(B) the taxes imposed by section 1401(c) of the Internal Revenue Code of 1986 with respect to self-employment income reported to the Secretary of the Treasury or the Secretary’s delegate pursuant to subtitle F of such Code, as determined by the Secretary of the Treasury by applying the applicable rates of tax under such section to such self-employment income, which self-employment income shall be certified by the Commissioner of Social Security on the basis of records of self-employment established and maintained by such Commissioner in accordance with such returns; andCommentsClose CommentsPermalink





‘(C) the excess of the amounts imposed under section 59B of the Internal Revenue Code of 1986 over the amounts of credits allowed under section 36B.CommentsClose CommentsPermalink





The amounts appropriated by the preceding sentence shall be transferred from time to time from the general fund in the Treasury to the Trust Fund, such amounts to be determined on the basis of estimates by the Secretary of the Treasury of the taxes, specified in the preceding sentence, paid to or deposited into the Treasury; and proper adjustments shall be made in amounts subsequently transferred to the extent prior estimates were in excess of or were less than the taxes specified in such sentence.CommentsClose CommentsPermalink





‘(3) APPLICATION OF TRUST FUND PROVISIONS- The provisions of subsections (b) through (f) of section 1817 shall apply to the Trust Fund in the same manner as they apply to the Federal Hospital Insurance Trust Fund, except that, for purposes of this paragraph, any reference in such subsections to a provision of the Internal Revenue Code of 1986 is deemed a reference to the corresponding provision of such Code referred to in paragraph (2) of this subsection.CommentsClose CommentsPermalink

‘SEC. 2205. PREMIUM AND COST-SHARING SUBSIDIES FOR LOWER INCOME INDIVIDUALS.

‘(a) Premium Subsidies- The Administrator, in consultation with the Secretary of the Treasury, shall assist individuals in estimating the amount of the premium subsidy which will be allowed to such individuals under section 36B of the Internal Revenue Code of 1986 with respect to any month, and shall take the estimated amount of such premium subsidy into account for purposes of collecting any premium under section 2203(c)(2).CommentsClose CommentsPermalink





‘(b) Cost-Sharing Subsidies-CommentsClose CommentsPermalink





‘(1) NO COST-SHARING FOR INDIVIDUALS WITH FAMILY INCOME BELOW LOWEST INCOME THRESHOLD- In the case of a cost-sharing subsidy-eligible individual whose family income is less than the lowest income threshold, there shall be a cost-sharing subsidy so the cost-sharing is reduced to zero.CommentsClose CommentsPermalink





‘(2) NO COST-SHARING FOR PREGNANT WOMEN AND CHILDREN- In the case of a cost-sharing subsidy-eligible individual who is under 18 years of age or who is a pregnant woman, there shall be a cost-sharing subsidy so the cost-sharing is reduced to zero.CommentsClose CommentsPermalink





‘(3) SLIDING SCALE FOR OTHER INDIVIDUALS- In the case of cost-sharing subsidy-eligible individuals not described in paragraph (1) or (2), the Administrator, in consultation with the Secretary of the Treasury, shall establish a schedule of cost-sharing subsidies consistent with this paragraph. Under such schedule the amount of a cost-sharing subsidy for such individuals shall be such that--CommentsClose CommentsPermalink





‘(A) the cost-sharing is nominal (as defined for purposes of section 1916(a)(3)) for individuals whose family income is at the lowest income threshold; andCommentsClose CommentsPermalink





‘(B) as the family income increases from such lowest income threshold to twice such threshold, the cost-sharing subsidy is reduced in a ratable matter to zero.CommentsClose CommentsPermalink





‘(4) APPLICATION OF A PREVIOUS YEAR’S FAMILY INCOME- In applying this subsection for cost-sharing subsidies for expenses incurred for services furnished in a year, family income shall be determined based on the modified AGI, as defined in paragraph (7)(D), for taxable years ending in or with the previous year (or, if information on such modified AGI for such taxable years is not available on a timely basis, for the most recent taxable years for which such information is so available).CommentsClose CommentsPermalink





‘(5) APPLICATION FOR SUBSIDIES- A cost-sharing subsidy shall not be available to a cost-sharing subsidy-eligible individual under this subsection unless an application, in a form and manner and containing such information and in such frequency as the Administrator shall specify, has been made for such subsidy.CommentsClose CommentsPermalink





‘(6) PAYMENT OF SUBSIDIES TO PLANS- The Administrator shall establish the form of additional payments to qualified health plans to compensate such plans for cost-sharing subsidies provided to enrollees under this subsection. Such payments may be in such form as the Administrator specifies and may include--CommentsClose CommentsPermalink





‘(A) a capitation payment, in an amount that reflects the per capita actuarial value of such subsidies;CommentsClose CommentsPermalink





‘(B) reimbursement for the reductions in cost-sharing made to carry out this subsection; orCommentsClose CommentsPermalink





‘(C) a combination of the methodologies under subparagraphs (A) and (B).CommentsClose CommentsPermalink





‘(7) DEFINITIONS- For purposes of this subsection:CommentsClose CommentsPermalink





‘(A) COST-SHARING SUBSIDY-ELIGIBLE INDIVIDUAL DEFINED- The term ‘cost-sharing subsidy-eligible individual’ means an AHBP-eligible individual--CommentsClose CommentsPermalink





‘(i) who is enrolled, and required under section 2202(b) to be enrolled, in a qualified health plan under this title;CommentsClose CommentsPermalink





‘(ii) whose family income does not exceed twice the lowest income threshold (as defined in subparagraph (B)); andCommentsClose CommentsPermalink





‘(iii) who does not have in effect (and any of whose family members does not have in effect), in a form and manner specified by the Administrator, in consultation with the Secretary of the Treasury, for any portion of the year involved an objection to the release of information under section 6103(l)(21) of the Internal Revenue Code of 1986.CommentsClose CommentsPermalink





‘(B) LOWEST INCOME THRESHOLD- The term ‘lowest income threshold’ means--CommentsClose CommentsPermalink





‘(i) in the case of coverage consisting of only an individual, 125 percent of the poverty line (as defined in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section) for a single individual; orCommentsClose CommentsPermalink





‘(ii) in the case of coverage consisting of a family of two or more individuals, 150 percent of the poverty line (as so defined) for a family of the size involved.CommentsClose CommentsPermalink





‘(C) FAMILY INCOME- The term ‘family income’ means, with respect to an AHBP-eligible individual who is enrolled in a qualified health plan--CommentsClose CommentsPermalink





‘(i) for individual-only coverage, the modified AGI of the individual; orCommentsClose CommentsPermalink





‘(ii) for coverage that includes other family members, the sum of the modified AGI of the individual and of each other individual covered under the plan as a family member of the individual.CommentsClose CommentsPermalink





The Administrator, in consultation with the Secretary of the Treasury, may provide for exclusion from family income under clause (ii) of family members (such as children) who have de minimis income (as specified by the Administrator).CommentsClose CommentsPermalink





‘(D) MODIFIED AGI DEFINED- The term ‘modified AGI’ means adjusted gross income (as defined in section 62 of the Internal Revenue Code of 1986)--CommentsClose CommentsPermalink





‘(i) determined without regard to sections 135, 911, 931, and 933 of such Code; andCommentsClose CommentsPermalink





‘(ii) increased by the amount of interest received or accrued during the taxable year which is exempt from tax under such Code.CommentsClose CommentsPermalink





In the case of an individual filing a joint return, any reference in this subsection to the modified adjusted gross income of such individual shall be 1/2 such return’s modified adjusted gross income.CommentsClose CommentsPermalink

‘SEC. 2206. ADMINISTRATION.

‘(a) Application of FEHBP Rules-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Except as otherwise provided in this title, the program under this title shall be administered in the same manner as FEHBP.CommentsClose CommentsPermalink





‘(2) SPECIFIC PROVISIONS- In carrying out this title, the Administrator pursuant to paragraph (1) shall provide for the following:CommentsClose CommentsPermalink





‘(A) Approval and disapproval of plans as qualified health plans.CommentsClose CommentsPermalink





‘(B) Negotiation of plan benefits (including cost-sharing) and plan premiums.CommentsClose CommentsPermalink





‘(b) Establishment of Health Benefits Administration- There is hereby established, as an independent agency in the executive branch of Government, a Health Benefits Administration (in this title referred to as the ‘Administration’).CommentsClose CommentsPermalink





‘(c) Duties-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Administration shall administer the program under this title and, with respect to application of any provision of FEHBP under this title, any reference in FEHBP to the Director of the Office of Management and Budget is deemed a reference to the Administrator of Health Benefits.CommentsClose CommentsPermalink





‘(2) ESTABLISHMENT OF AHBP REGIONS- For purposes of carrying out this title, the Administrator shall divide the United States into, and establish, AHBP regions.CommentsClose CommentsPermalink





‘(d) Officers-CommentsClose CommentsPermalink





‘(1) ADMINISTRATOR OF HEALTH BENEFITS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- There shall be in the Administration an Administrator of Health Benefits who shall be appointed by the President, by and with the advice and consent of the Senate.CommentsClose CommentsPermalink





‘(B) COMPENSATION- The Commissioner shall be compensated at the rate provided for level I of the Executive Schedule.CommentsClose CommentsPermalink





‘(C) TERM- The provisions of section 702(a)(3) shall apply to the Commissioner of Health Benefits in the same manner as they apply to the Commissioner of Social Security, except that any reference to January 19, 2001, shall be treated as a reference to the date that is January 19 of the seventh year that begins after the date of the enactment of this title.CommentsClose CommentsPermalink





‘(2) DEPUTY ADMINISTRATOR-CommentsClose CommentsPermalink





‘(A) IN GENERAL- There shall be in the Administration a Deputy Administrator for Health Benefits, who shall be appointed by the President, by and with the advice and consent of the Senate.CommentsClose CommentsPermalink





‘(B) APPLICATION OF SSA PROVISIONS- The provisions of paragraphs (2) through (4) of section 702(b) shall apply to the Deputy Administrator in the same manner as they apply to the Deputy Commissioner of Social Security, except that any reference to January 19, 2001, shall be treated as a reference to the date specified under paragraph (1)(C).CommentsClose CommentsPermalink





‘(3) OTHER OFFICERS- There shall be in the Administration a Chief Actuary, Chief Financial Officer, and Inspector General. The provisions of subsections (c) through (e) of section 702 shall apply with respect to such officers in the same manner as they apply with respect to comparable officers in the Social Security Administration.CommentsClose CommentsPermalink





‘(4) PERSONNEL; BUDGETARY MATTERS; SEAL OF OFFICE- The provisions of subsections (a)(1), (a)(2), (b), and (d) of section 704 shall apply to the Administrator and the Administration in the same manner as they apply to the Commissioner of Social Security and the Social Security Administration, respectively.CommentsClose CommentsPermalink





‘(e) Authority and Rulemaking- The provisions of paragraphs (4) through (7) of section 702(a) shall apply to the Administration and Administrator in the same manner as they apply to the Social Security Administration and the Commissioner of Social Security.CommentsClose CommentsPermalink





‘(f) Use of Regional and Field Offices- The Administrator shall establish such regional and field offices as may be appropriate for the convenient and efficient administration of this title.CommentsClose CommentsPermalink





‘(g) Coverage of Administration Costs- The Administrator shall provide for the collection of administrative costs of offering coverage under this title from entities offering qualified health plans in the same manner as FEHBP provides for coverage of its administrative costs.CommentsClose CommentsPermalink





‘(h) Contingency Reserves-CommentsClose CommentsPermalink





‘(1) AHBP CONTINGENCY RESERVE- The Administrator is authorized to establish and maintain a contingency reserve for purposes of carrying out this title and is authorized to impose under section 2204(b)(3)(A) a premium surcharge of up to three percent in order to provide financing for such reserve.CommentsClose CommentsPermalink





‘(2) PLAN RESERVES- A qualified health plan may establish contingency reserves, that are in addition to the reserve described in paragraph (1), in a manner similar to that permitted under FEHBP.CommentsClose CommentsPermalink

‘SEC. 2207. DEFINITIONS.

‘For purposes of this title, except as otherwise provided:CommentsClose CommentsPermalink





‘(1) The term ‘Administration’ means the Health Benefits Administration established under section 2206(b).CommentsClose CommentsPermalink





‘(2) The term ‘AHBP-eligible individual’ means an individual described in section 2202(a)(2).CommentsClose CommentsPermalink





‘(3) The term ‘AHBP region’ means a region as specified by the Administrator under section 2206(c)(2).CommentsClose CommentsPermalink





‘(4) The term ‘Administrator’ means the Administrator of Health Benefits appointed under section 2206(d)(1).CommentsClose CommentsPermalink





‘(5) The term ‘FEHBP’ means the program under chapter 89 of title 5, United States Code, as in effect before the date of the enactment of this title.CommentsClose CommentsPermalink





‘(6) The term ‘qualified employer-provided coverage’ means health coverage that is provided on the basis of employment and that the Administrator has certified as being equivalent to the coverage under qualified health plans. For purposes of the previous sentence, coverage provided on the basis of employment is not equivalent to coverage under a qualified health plan unless the employer’s share of the cost of such coverage is not less than the Government’s share of the cost of coverage under qualified health plans.CommentsClose CommentsPermalink





‘(7) The term ‘qualified health plan’ means such a plan offered under this title.’.CommentsClose CommentsPermalink





(b) Effective Date; Collective Bargaining Agreements-CommentsClose CommentsPermalink





(1) BENEFITS- Title XXII of the Social Security Act shall first apply to benefits for items and services furnished on or after January 1, 2012.CommentsClose CommentsPermalink





(2) EFFECT ON COLLECTIVE BARGAINING AGREEMENTS- Nothing in this Act shall be construed as preventing a collectively bargained agreement from providing coverage that is additional to, or supplementary of, benefits provided under the American Health Benefits Program.CommentsClose CommentsPermalink

SEC. 3. COLLECTION OF PREMIUMS, SUBSIDIES, AND EMPLOYER FUNDING.

(a) Premium Collection-CommentsClose CommentsPermalink





(1) IN GENERAL- Subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to determination of tax liability) is amended by adding at the end the following new part:CommentsClose CommentsPermalink

‘PART VIII--AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS

‘Sec. 59B. American Health Benefits Program premiums.CommentsClose CommentsPermalink

‘SEC. 59B. AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS.

‘(a) In General- In the case of a specified individual who is enrolled in a qualified health plan under title XXII of the Social Security Act (including by reason of a default enrollment under section 2202(c)(2)), there is hereby imposed (in addition to any other amount imposed by this subtitle) for the taxable year an amount equal to the aggregate premiums established under such title with respect to the coverage under such title which covers such individual for months beginning in such taxable year. The amount imposed under this subsection shall be reduced by the amount of any government contribution under section 2204(a) of such Act which relates to such coverage.CommentsClose CommentsPermalink





‘(b) Specified Individual- For purposes of this section, the term ‘specified individual’ means, with respect to coverage under title XXII of the Social Security Act for any month beginning in a taxable year--CommentsClose CommentsPermalink





‘(1) in the case of self-only coverage, the individual covered under such coverage, andCommentsClose CommentsPermalink





‘(2) in the case of family coverage, each individual covered under such coverage unless such individual is covered under such coverage by reason of being a member of the family (other than a spouse).CommentsClose CommentsPermalink





‘(c) Joint and Several Liability- In the case of an individual and such individual’s spouse covered under family coverage--CommentsClose CommentsPermalink





‘(1) each such individual shall be jointly and severally liable for the amount imposed under subsection (a), andCommentsClose CommentsPermalink





‘(2) the aggregate amount imposed under subsection (a) with respect to such coverage may not exceed the amount imposed with respect to either such individual.CommentsClose CommentsPermalink





‘(d) Coordination With Other Provisions-CommentsClose CommentsPermalink





‘(1) NOT TREATED AS MEDICAL EXPENSE- For purposes of section 213, the amount imposed by this section for any taxable year shall not be treated as an expense paid for medical care.CommentsClose CommentsPermalink





‘(2) NOT TREATED AS TAX FOR CERTAIN PURPOSES- The amount imposed by this section shall not be treated as a tax imposed by this chapter for purposes of determining--CommentsClose CommentsPermalink





‘(A) the amount of any credit allowable under this chapter, orCommentsClose CommentsPermalink





‘(B) the amount of the minimum tax imposed by section 55.CommentsClose CommentsPermalink





‘(3) TREATMENT UNDER SUBTITLE F- For purposes of subtitle F, the amount imposed by this section shall be treated as if it were a tax imposed by section 1.CommentsClose CommentsPermalink





‘(4) SECTION 15 NOT TO APPLY- Section 15 shall not apply to the amount imposed by this section.CommentsClose CommentsPermalink





‘(5) SECTION NOT TO AFFECT LIABILITY OF POSSESSIONS, ETC- This section shall not apply for purposes of determining liability to any possession of the United States. For purposes of section 932 and 7654, the amount imposed under this section shall not be treated as a tax imposed by this chapter.CommentsClose CommentsPermalink





‘(e) Regulations- The Secretary may prescribe such regulations as may be appropriate to carry out the purposes of this section.’.CommentsClose CommentsPermalink





(2) ADJUSTMENTS TO WITHHOLDING- Subsection (a) of section 3402 of such Code (relating to income tax collected at source) is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(3) SPECIAL RULE FOR AMOUNTS IMPOSED BY SECTION 59B-CommentsClose CommentsPermalink





‘(A) IN GENERAL- In determining the amount required to be deducted and withheld from wages paid to an individual during any month by such individual’s employer, the amount imposed by section 59B shall be taken into account.CommentsClose CommentsPermalink





‘(B) WAGES NOT REDUCED BY EXEMPTIONS- In determining the amount to be deducted and withheld by reason of subparagraph (A), the amount of wages shall not be reduced as provided in paragraph (2).’.CommentsClose CommentsPermalink





(3) CLERICAL AMENDMENT- The table of parts for subchapter A of chapter 1 of such Code is amended by adding at the end the following new item:CommentsClose CommentsPermalink

‘Part VIII--American Health Benefits Program Premiums’.

(b) Credit for Subsidy and Prepayments of American Health Benefits Premiums-CommentsClose CommentsPermalink





(1) IN GENERAL- Subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after section 36A the following new section:CommentsClose CommentsPermalink

‘SEC. 36B. SUBSIDY AND PREPAYMENT OF AMERICAN HEALTH BENEFITS PREMIUMS.

‘(a) In General- In the case of a specified individual (as defined in section 59B(b)), there shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to the sum of--CommentsClose CommentsPermalink





‘(1) the aggregate amount of premiums paid (other than any government contribution under section 2204(a) of the Social Security Act) with respect to the coverage of such individual under title XXII of the Social Security Act, andCommentsClose CommentsPermalink





‘(2) in the case of any premium subsidy-eligible individual, the applicable premium subsidy.CommentsClose CommentsPermalink





‘(b) Applicable Premium Subsidy-CommentsClose CommentsPermalink





‘(1) IN GENERAL- For purposes of this section, the term ‘applicable premium subsidy’ means, with respect to any premium subsidy-eligible individual, the lowest premium in effect for the calendar year in which the taxable year begins (for the type of coverage involved) for any basic plan in the AHBP region involved, as determined by the Administrator of Health Benefits.CommentsClose CommentsPermalink





‘(2) REDUCTION BASED ON FAMILY INCOME- The amount otherwise determined under paragraph (1) shall be reduced (but not below zero) by an amount which bears the same ratio to the amount so determined as--CommentsClose CommentsPermalink





‘(A) the amount (if any) by which the taxpayer’s family income for the taxable year exceeds the lowest income threshold, bears toCommentsClose CommentsPermalink





‘(B) the lowest income threshold.CommentsClose CommentsPermalink





‘(c) Premium Subsidy-Eligible Individual- For purposes of this section, the term ‘premium subsidy-eligible individual’ means an individual--CommentsClose CommentsPermalink





‘(1) who is enrolled, and required to be enrolled, in a qualified health plan under title XXII of the Social Security Act,CommentsClose CommentsPermalink





‘(2) whose family income does not exceed twice the lowest income threshold, andCommentsClose CommentsPermalink





‘(3) who does not have in effect (and, in the case of family coverage, each other individual covered under such coverage does not have in effect), in a form and manner specified by the Secretary of the Treasury in consultation with the Administrator of Health Benefits, for any portion of the taxable year of such individual an objection to the release of information under section 6103(k)(10).CommentsClose CommentsPermalink





‘(d) Lowest Income Threshold- For purposes of this section, the term ‘lowest income threshold’ means, with respect to coverage consisting of--CommentsClose CommentsPermalink





‘(1) only an individual, 125 percent of the poverty line (as defined in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section) for a single individual for the calendar year which includes the close of the taxable year, orCommentsClose CommentsPermalink





‘(2) a family of two or more individuals, 150 percent of the poverty line (as so defined) for a family of the size involved for the calendar year which includes the close of the taxable year.CommentsClose CommentsPermalink





‘(e) Family Income- For purposes of this section--CommentsClose CommentsPermalink





‘(1) IN GENERAL- The term ‘family income’ means, with respect to a specified individual (as defined in section 59B(b)) covered under coverage consisting of--CommentsClose CommentsPermalink





‘(A) only such individual, the modified adjusted gross income of such individual, orCommentsClose CommentsPermalink





‘(B) two or more individuals, the sum of the modified adjusted gross income of the specified individual and the modified adjusted gross income of each other individual covered under the plan for the taxable year that ends in or with the taxable year of the specified individual.CommentsClose CommentsPermalink





‘(2) MODIFIED ADJUSTED GROSS INCOME- The term ‘modified adjusted gross income’ means adjusted gross income--CommentsClose CommentsPermalink





‘(A) determined without regard to sections 135, 911, 931, and 933, andCommentsClose CommentsPermalink





‘(B) increased by the amount of interest received or accrued during the taxable year which is exempt from tax under this title.CommentsClose CommentsPermalink





‘(f) Denial of Credit to Dependents- No credit shall be allowed under this section to any individual with respect to whom a deduction under section 151 is allowable to another taxpayer for a taxable year beginning in the calendar year in which such individual’s taxable year begins.CommentsClose CommentsPermalink





‘(g) Regulations- The Secretary may prescribe such regulations as are necessary or appropriate to carry out this section, including regulations which provide for not taking into account individuals with de minimis income for purposes of determining family income for purposes of this section.’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(A) Paragraph (2) of section 1324(b) of title 31, United States Code, is amended by inserting ‘36B,’ after ‘36A,’.CommentsClose CommentsPermalink





(B) The table of section for subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after the item relating to section 36A the following new item:CommentsClose CommentsPermalink





‘Sec. 36B. Subsidy and prepayment of American Health Benefits premiums.’.CommentsClose CommentsPermalink





(c) Employer Funding-CommentsClose CommentsPermalink





(1) IN GENERAL- Subtitle C of the Internal Revenue Code of 1986 (relating to employment taxes) is amended by redesignating chapter 25 as chapter 26 and by inserting after chapter 24 the following new chapter:CommentsClose CommentsPermalink

‘CHAPTER 25--AMERICAN HEALTH BENEFITS PROGRAM

‘Sec. 3451. Tax on employers.CommentsClose CommentsPermalink





‘Sec. 3452. Refund of tax in case of qualified employer-provided coverage.CommentsClose CommentsPermalink





‘Sec. 3453. Instrumentalities of the United States.CommentsClose CommentsPermalink

‘SEC. 3451. TAX ON EMPLOYERS.

‘(a) Imposition of Tax- In addition to other taxes, there is hereby imposed on every employer an excise tax, with respect to having individuals in his employ, equal to the applicable percentage of the wages paid by him with respect to employment.CommentsClose CommentsPermalink





‘(b) Applicable Percentage- For purposes of this section--CommentsClose CommentsPermalink





‘(1) IN GENERAL- The term ‘applicable percentage’ means, with respect to wages paid during any taxable year of an employer of a specified firm size and average earnings per employee, the percentage determined in accordance with the following table:CommentsClose CommentsPermalink

‘Applicable percentage (in percent)CommentsClose CommentsPermalink

-------------------------------------------------------------------------------- CommentsClose CommentsPermalink

A firm size of: Average earnings per employee of $21,000 or less: Average earnings per employee of more than $21,000 and not in excess of $42,000: Average earnings per employee of more than $42,000 and not in excess of $83,000: Average earnings per employee of more than $83,000: CommentsClose CommentsPermalink

-------------------------------------------------------------------------------- CommentsClose CommentsPermalink

Less than 10                                                 4.00                                                                             5.00                                                                             6.00                                                8.75 CommentsClose CommentsPermalink

10 through 25                                                4.25                                                                             5.25                                                                             6.75                                                9.50 CommentsClose CommentsPermalink

26 through 49                                                4.50                                                                             5.50                                                                             7.25                                               10.00 CommentsClose CommentsPermalink

50 through 199                                               4.75                                                                             5.75                                                                             8.00                                               10.00 CommentsClose CommentsPermalink

200 through 499                                              5.00                                                                             6.00                                                                             8.75                                               10.00 CommentsClose CommentsPermalink

500 or more                                                  5.25                                                                             6.25                                                                             9.50                                              10.00. CommentsClose CommentsPermalink

-------------------------------------------------------------------------------- CommentsClose CommentsPermalink

‘(2) FIRM SIZE- The term ‘firm size’ means, with respect to any employer for any taxable year, the average number of employees employed by such person during the 3 taxable years preceding such taxable year.CommentsClose CommentsPermalink





‘(3) AVERAGE EARNINGS PER EMPLOYEE- With respect to any employer for any taxable year--CommentsClose CommentsPermalink





‘(A) IN GENERAL- The term ‘average earnings per employee’ means the average earnings of such employer for such taxable year divided by the firm size of such employer for such taxable year.CommentsClose CommentsPermalink





‘(B) AVERAGE EARNINGS- The term ‘average earnings’ means the average taxable income of the employer for the 3 taxable years preceding such taxable year.CommentsClose CommentsPermalink





‘(4) AGGREGATION RULE- All persons treated as a single employer under subsection (a) or (b) of section 52, or subsection (m) or (o) of section 414, shall be treated as one person.CommentsClose CommentsPermalink





‘(5) INFLATION ADJUSTMENT- In the case of a taxable year beginning after December 31, 2012, each of the dollar amounts in the table contained in paragraphs (1) shall be increased by an amount equal to--CommentsClose CommentsPermalink





‘(A) such dollar amount, multiplied byCommentsClose CommentsPermalink





‘(B) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins, determined by substituting ‘calendar year 2011’ for ‘calendar year 1992’ in subparagraph (B) thereof.CommentsClose CommentsPermalink





If any amount as increased under the preceding sentence is not a multiple of $100, such amount shall be rounded to the nearest multiple of $100.CommentsClose CommentsPermalink





‘(c) No Cover Over to Possessions- Notwithstanding any other provision of law, no amount collected under this chapter shall be covered over to any possession of the United States.CommentsClose CommentsPermalink





‘(d) Other Definitions- For purposes of this chapter, the terms ‘wages’, ‘employer’, and ‘employment’ have the same respective meanings as when used in chapter 21 and section 3121(a)(1) shall apply for purposes of this chapter in the same manner as such section applies for purposes of section 3101(a) and 3111(a).CommentsClose CommentsPermalink

‘SEC. 3452. REFUND OF TAX IN CASE OF QUALIFIED EMPLOYER-PROVIDED COVERAGE.

‘(a) In General- In the case of a person subject to tax under section 3451 or section 1401(c), there shall be allowed as a credit against the tax imposed by such section an amount equal to the tax imposed under such section with respect to the wages or self-employment income of individuals for periods during which the individual is covered by qualified employer-provided coverage (which is provided by such person).CommentsClose CommentsPermalink





‘(b) Qualified Employer-Provided Coverage- For purposes of subsection (a), the term ‘qualified employer-provided coverage’ has the meaning given that term in section 2207(6) of the Social Security Act.CommentsClose CommentsPermalink

‘SEC. 3453. INSTRUMENTALITIES OF THE UNITED STATES.

‘Notwithstanding any other provision of law (whether enacted before or after the enactment of this section) which grants to any instrumentality of the United States an exemption from taxation, such instrumentality shall not be exempt from the tax imposed by section 3451 unless such other provision of law grants a specific exemption, by reference to section 3451, from the tax imposed by such section.’.CommentsClose CommentsPermalink





(2) SELF-EMPLOYMENT- Section 1401 of such Code is amended by redesignating subsection (c) as subsection (d) and by inserting after subsection (b) the following new subsection:CommentsClose CommentsPermalink





‘(c) American Health Benefits Program- In addition to other taxes, there shall be imposed for each taxable year, on the self-employment income of every individual, a tax equal to the applicable percentage (as defined in section 3451(b)) of the amount of the self-employment income for such taxable year.’.CommentsClose CommentsPermalink





(3) CLERICAL AMENDMENT- The table of chapters for subtitle C of such Code is amended by striking the item relating to chapter 25 and inserting the following:CommentsClose CommentsPermalink

‘Chapter 25--American Health Benefits Program

‘Chapter 26--General Provisions Relating to Employment Taxes’.

(d) Additional Tax on Hospital Revenues-CommentsClose CommentsPermalink





(1) IN GENERAL- Subchapter A of chapter 1 of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new part:CommentsClose CommentsPermalink

‘PART IX--TAX ON HOSPITAL REVENUES

‘Sec. 59D. Tax on hospital revenues.CommentsClose CommentsPermalink

‘SEC. 59D. TAX ON HOSPITAL REVENUES.

‘(a) In General- In the case of a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to 2 percent of the hospital revenues of such corporation.CommentsClose CommentsPermalink





‘(b) Hospital Revenues- For purposes of this section, the term ‘hospital revenues’ means, with respect to any corporation for any taxable year, the excess (if any) of--CommentsClose CommentsPermalink





‘(1) so much of such corporation’s gross income for such taxable year as is derived from the operation of one or more hospitals (as defined in section 1861(e) of the Social Security Act), overCommentsClose CommentsPermalink





‘(2) so much of the deductions allowed under this chapter for such taxable year as are properly allocable to such income.CommentsClose CommentsPermalink





‘(c) Section 15 Not To Apply- Section 15 shall not apply to the tax imposed by this section.’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(A) Section 26(b)(2) of the Internal Revenue Code of 1986 is amended by striking ‘and’ at the end of subparagraph (W), by striking the period at the end of subparagraph (X) and inserting ‘, and’, and by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(Y) section 59D (relating to tax on hospital revenues).’.CommentsClose CommentsPermalink





(B) Section 30A(c) of such Code is amended by striking ‘or’ at the end of paragraph (3), by striking the period at the end of paragraph (4) and inserting ‘, or’, and by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(5) section 59D (relating to tax on hospital revenues).’.CommentsClose CommentsPermalink





(C) Section 882(a)(1) of such Code is amended by inserting ‘59D,’ after ‘59A,’.CommentsClose CommentsPermalink





(D) Section 936(a)(3) of such Code is amended by striking ‘or’ at the end of subparagraph (C), by striking the period at the end of subparagraph (D) and inserting ‘, or’, and by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(E) section 59D (relating to tax on hospital revenues).’.CommentsClose CommentsPermalink





(E) Section 6425(c)(1)(A) of such Code is amended by striking ‘plus’ at the end of clause (ii), by striking ‘over’ at the end of clause (iii) and inserting ‘plus’, and by adding at the end the following new clause:CommentsClose CommentsPermalink





‘(iv) the tax imposed by section 59D, over’.CommentsClose CommentsPermalink





(F) Section 6655(g)(1)(A) of such Code is amended by striking ‘plus’ at the end of clause (iii), by redesignating clause (iv) as clause (v), and by inserting after clause (iii) the following new clause:CommentsClose CommentsPermalink





‘(iv) the tax imposed by section 59D, plus’.CommentsClose CommentsPermalink





(G) The table of parts for subchapter A of chapter 1 of such Code is amended by adding at the end the following new item:CommentsClose CommentsPermalink

‘Part VIII--Tax on Hospital Revenues’.

(e) Disclosure of Taxpayer Return Information To Carry Out Cost-Sharing Subsidies-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 6103(l) of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(21) DISCLOSURE OF RETURN INFORMATION TO CARRY OUT AMERICAN HEALTH BENEFITS PROGRAM-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Secretary shall, upon written request from the Administrator of Health Benefits, disclose to officers, employees, and contractors of the Health Benefits Administration return information of a taxpayer who is, according to the records of the Secretary, a cost-sharing subsidy-eligible individual (as defined in section 2205(b)(7)(A) of the Social Security Act) or a family member of such an individual. Such return information shall be limited to--CommentsClose CommentsPermalink





‘(i) taxpayer identity information with respect to such taxpayer,CommentsClose CommentsPermalink





‘(ii) the filing status of such taxpayer,CommentsClose CommentsPermalink





‘(iii) the adjusted gross income of such taxpayer,CommentsClose CommentsPermalink





‘(iv) the amounts excluded from such taxpayer’s gross income under sections 135 and 911 to the extent such information is available,CommentsClose CommentsPermalink





‘(v) the interest received or accrued during the taxable year which is exempt from the tax imposed by chapter 1 to the extent such information is available,CommentsClose CommentsPermalink





‘(vi) the amounts excluded from such taxpayer’s gross income by sections 931 and 933 to the extent such information is available, andCommentsClose CommentsPermalink





‘(vii) the taxable year with respect to which the preceding information relates.CommentsClose CommentsPermalink





‘(B) RESTRICTION ON USE OF DISCLOSED INFORMATION- Return information disclosed under subparagraph (A) may be used by officers, employees, and contractors of the Health Benefits Administration only for the purposes of, and to the extent necessary in, establishing the appropriate amount of any cost-sharing subsidies under section 2205 of the Social Security Act.’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(A) Paragraph (3) of section 6103(a) of such Code is amended by striking ‘or (20)’ and inserting ‘(20), or (21)’.CommentsClose CommentsPermalink





(B) Paragraph (4) of section 6103(p) of such Code is amended by striking ‘(l)(16), (17), (19), or (20)’ each place it appears and inserting ‘(l)(16), (17), (19), (20), or (21)’.CommentsClose CommentsPermalink





(C) Paragraph (2) of section 7213(a) of such Code is amended by striking ‘or (20)’ and inserting ‘(20), or (21)’.CommentsClose CommentsPermalink





(f) Disclosure of Taxpayer Return Information To Carry Out Premium Subsidies- Section 6103(k) of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(10) DISCLOSURE OF INFORMATION TO ADMINISTER PREMIUM SUBSIDY UNDER SECTION 36B- To the extent that Secretary determines that disclosure is necessary to permit the effective administration of section 36B, the Secretary may disclose the modified adjusted gross income (as defined in section 36B) of any individual whose modified adjusted gross income is taken into account in determining the amount of any credit under such section.’.CommentsClose CommentsPermalink





(g) Effective Date-CommentsClose CommentsPermalink





(1) IN GENERAL- Except as provided in paragraph (2), the amendments made by this section shall take effect on January 1, 2012.CommentsClose CommentsPermalink





(2) SUBSECTIONS (a) AND (b)- The amendments made by subsections (a) and (b) shall apply to months beginning after December 31, 2011, in taxable years ending after such date.CommentsClose CommentsPermalink





(3) SUBSECTION (d)- The amendments made by subsection (d) shall apply to taxable years beginning after December 31, 2011.CommentsClose CommentsPermalink

SEC. 4. AMENDMENTS TO THE MEDICAID PROGRAM AND SCHIP.

(a) Maintenance of Effort in Medicaid Payments- Section 1902 of the Social Security Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(gg)(1) For each State fiscal year that begins on or after January 1 of the first calendar year in which coverage is provided under title XXII, each State shall submit a report to the Secretary on the amount of State expenditures for health services, as defined by the Secretary.CommentsClose CommentsPermalink





‘(2) Subject to paragraph (4), if the amount so reported for a State fiscal year is less than the amount specified in paragraph (3) for that State fiscal year, the State shall provide for payment to the Secretary of the amount of such difference. The provisions of subparagraphs (B) and (C) of section 1935(c)(1) shall apply to payment under the previous sentence in the same manner as they apply to payment under subparagraph (A) of such section, except that such payments shall be deposited into the American Health Benefits Program Trust Fund established under section 2204(c).CommentsClose CommentsPermalink





‘(3) The amount specified in this paragraph for a State for--CommentsClose CommentsPermalink





‘(A) the first State fiscal year described in paragraph (1), is the total amount of the State share of expenditures for health services (as defined in paragraph (1)) under all public health programs operated in the State that are funded in whole or in part with State expenditures, including expenditures under this title and title XXI, for the previous State fiscal year; andCommentsClose CommentsPermalink





‘(B) a subsequent State fiscal year, is the amount specified in this paragraph for the previous State fiscal year increased by the percentage change, if any, in the consumer price index for all urban consumers for the most recent completed Federal fiscal year.CommentsClose CommentsPermalink





‘(4) The Secretary may waive payment of all or a portion of the amount otherwise payable under paragraph (2) based on criteria specified by the Secretary’.CommentsClose CommentsPermalink





(b) Sunset of SCHIP Funding- Section 2105 of such Act (42 U.S.C. 1397ee) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(h) Sunset of Program Upon Initiation of American Health Benefits Program- No payment shall be made under this title to a State for items and services furnished after the effective date of the American Health Benefits Program under title XXII.’.CommentsClose CommentsPermalink





(c) Reduction in Medicaid DSH Payments- Section 1923(f) of such Act (42 U.S.C. 1396r-4(f)) is amended--CommentsClose CommentsPermalink





(1) by redesignating paragraph (7) as paragraph (8); andCommentsClose CommentsPermalink





(2) by inserting after paragraph (6) the following new paragraph:CommentsClose CommentsPermalink





‘(7) REDUCTION IN CONNECTION WITH AHBP- Notwithstanding the previous provisions in this paragraph, the Secretary shall provide for a phased-down reduction over a 5-fiscal-year-period beginning with fiscal year 2012 of the amount of the DSH allotment for each State so that, by the end of such period, such amount is equal to 10 percent of the amount of such allotment for such State for fiscal year 2011.’.CommentsClose CommentsPermalink

SEC. 5. CONSULTATION IN IMPLEMENTATION OF HEALTH INFORMATION TECHNOLOGIES.

The Administrator of Health Benefits (appointed under section 2206(d)(1) of the Social Security Act, as added by section 2(a)) shall consult with the Office of the National Coordinator for Health Information Technology and the Secretary of Health and Human Services in carrying out the implementation of health information technology in compliance with the amendments made by division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5) and regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996).CommentsClose CommentsPermalink

SEC. 6. NON-PREEMPTION OF EXISTING COLLECTIVE BARGAINING AGREEMENTS.

Nothing in this Act shall be construed as preempting any collective bargaining agreement that is in effect as of the date of the enactment of this Act, during the period in which such agreement is in effect (without regard to any extension of such agreement effected as such date of enactment).CommentsClose CommentsPermalink

SEC. 7. HEALTH BENEFITS COMMISSION.

(a) Establishment- There is established in the legislative branch an independent commission to be known as the Health Benefits Commission (in this section referred to as the ‘Commission’).CommentsClose CommentsPermalink





(b) Duties of the Commission-CommentsClose CommentsPermalink





(1) GENERAL DUTIES- The Commission shall examine and make recommendations regarding the major issues and cost drivers affecting the delivery of health care services as it pertains to the American Health Benefits Program under title XXII of the Social Security Act (in this section referred to as ‘AHBP’).CommentsClose CommentsPermalink





(2) SPECIFIC ISSUES- The Commission shall specifically examine and make recommendations regarding each of the following:CommentsClose CommentsPermalink





(A) A comparison of AHBP to other public health insurance programs (described in section 2202(b)(2) of the Social Security Act) and the feasibility and desirability of their integration into AHBP.CommentsClose CommentsPermalink





(B) The proper implementation and utilization of electronic medical records and other health information technologies, including privacy and interoperability issues.CommentsClose CommentsPermalink





(C) The effects of medical malpractice insurance and ‘defensive medicine’ on the delivery and cost of health care.CommentsClose CommentsPermalink





(D) The patterns and effects of overutilization on AHBP.CommentsClose CommentsPermalink





(E) Cost and implementation factors of retiree health coverage under AHBP.CommentsClose CommentsPermalink





(F) A comparison of prescription drug prices under AHBP with such prices under other public health programs.CommentsClose CommentsPermalink





(G) The effects of insurance monopolies on health care costs and delivery.CommentsClose CommentsPermalink





(c) Membership-CommentsClose CommentsPermalink





(1) NUMBER AND APPOINTMENT- The Commission shall be composed of 9 members, of whom--CommentsClose CommentsPermalink





(A) one shall be appointed by the President;CommentsClose CommentsPermalink





(B) two shall be appointed by the majority leader of the Senate;CommentsClose CommentsPermalink





(C) two shall be appointed by the minority leader of the Senate;CommentsClose CommentsPermalink





(D) two shall be appointed by the Speaker of the House of Representatives; andCommentsClose CommentsPermalink





(E) two shall be appointed by the minority leader of the House of Representatives.CommentsClose CommentsPermalink





Members shall first be appointed not later than 60 days after the date of the enactment of this Act.CommentsClose CommentsPermalink





(2) TERMS-CommentsClose CommentsPermalink





(A) IN GENERAL- The terms of members of the Commission shall be for 3 years, except that of the members first appointed--CommentsClose CommentsPermalink





(i) the initial term shall be for 2 years in the case of one of the members appointed under paragraph (1)(C), as specified by the minority leader of the Senate, one of the members appointed under paragraph (1)(D), as specified by the Speaker of the House of Representatives, and one of the members appointed under paragraph (1)(E), as specified by the minority leader of the House of Representatives; andCommentsClose CommentsPermalink





(ii) the initial term shall be for 1 year in the case of one of the members appointed under paragraph (1)(B), as specified by the majority leader of the Senate, one of the members appointed under paragraph (1)(C), as specified by the minority leader of the Senate and one of the members appointed under paragraph (1)(D), as specified by the minority leader of the House of Representatives.CommentsClose CommentsPermalink





(B) VACANCIES- Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member’s term until a successor has taken office. A vacancy in the Commission shall be filled in the manner in which the original appointment was made.CommentsClose CommentsPermalink





(3) MEETINGS- The Commission shall meet at the call of its Chair or a majority of its members.CommentsClose CommentsPermalink





(4) QUORUM- A quorum shall consist of 5 members of the Commission, except that 3 members may conduct a hearing under subsection (e).CommentsClose CommentsPermalink





(5) VACANCIES- A vacancy on the Commission shall be filled in the same manner in which the original appointment was made not later than 30 days after the Commission is given notice of the vacancy and shall not affect the power of the remaining members to execute the duties of the Commission.CommentsClose CommentsPermalink





(6) COMPENSATION- While serving on the business of the Commission (including traveltime), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code; and while so serving away from home and the member’s regular place of business, a member may be allowed travel expenses, as authorized by the Chairman of the Commission.CommentsClose CommentsPermalink





(7) CHAIR; VICE CHAIR- The Speaker of the House of Representatives shall designate a member of the Commission at the time of appointment of the member as Chair and a member as Vice Chair for that term of appointment, except that in the case of vacancy of the Chair or Vice Chair, the Speaker may designate another member for the remainder of that member’s term.CommentsClose CommentsPermalink





(8) EXPENSES- Each member of the Commission shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code.CommentsClose CommentsPermalink





(d) Director and Staff; Experts and Consultants- The Commission may--CommentsClose CommentsPermalink





(1) employ and fix the compensation of an Executive Director and such other personnel (not to exceed 11) as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service), except that the rate of pay for the Executive Director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title;CommentsClose CommentsPermalink





(2) seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies;CommentsClose CommentsPermalink





(3) enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Commission (without regard to section 3709 of the Revised Statutes (41 U.S.C. 5));CommentsClose CommentsPermalink





(4) make advance, progress, and other payments which relate to the work of the Commission;CommentsClose CommentsPermalink





(5) provide transportation and subsistence for persons serving without compensation;CommentsClose CommentsPermalink





(6) procure supplies, services, and property by contract in accordance with applicable laws and regulations and to the extent or in such amounts as are provided in appropriations Acts;CommentsClose CommentsPermalink





(7) enter into contracts with departments, agencies, and instrumentalities of the Federal Government, State agencies, and private firms, institutions, and agencies, for the conduct of research or surveys, the preparation of reports, and other activities necessary for the discharge of the duties of the Commission, to the extent or in such amounts as are provided in appropriations Acts;CommentsClose CommentsPermalink





(8) notwithstanding section 1342 of title 31, United States Code, accept and utilize the services of volunteers serving without compensation and reimburse such volunteers for local travel and office supplies, and for other travel expenses, including per diem in lieu of substance, as authorized by section 5703 of title 5, of such Code; andCommentsClose CommentsPermalink





(9) prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the Commission.CommentsClose CommentsPermalink





Physicians serving as personnel of the Commission may be provided a physician comparability allowance by the Commission in the same manner as Government physicians may be provided such an allowance by an agency under section 5948 of title 5, United States Code, and for such purpose subsection (i) of such section shall apply to the Commission in the same manner as it applies to the Tennessee Valley Authority. A person providing volunteer services to the Commission under paragraph (8) shall be considered an employee of the Federal Government in the performance of those services for the purposes of chapter 81 of title 5, United States Code (relating to compensation for work-related injuries), chapter 11 of title 18, of such Code (relating to conflicts of interests), and chapter 171 of title 28, of such Code (relating to tort claims).CommentsClose CommentsPermalink





(e) Powers of Commission-CommentsClose CommentsPermalink





(1) HEARINGS AND OTHER ACTIVITIES- For the purpose of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties.CommentsClose CommentsPermalink





(2) COST ESTIMATES BY CONGRESSIONAL BUDGET OFFICE-CommentsClose CommentsPermalink





(A) The Director of the Congressional Budget Office shall provide to the Commission, upon the request of the Commission, such cost estimates as the Commission determines to be necessary to carry out its duties.CommentsClose CommentsPermalink





(B) The Commission shall reimburse the Director of the Congressional Budget Office for expenses relating to the employment in the office of the Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under subparagraph (A).CommentsClose CommentsPermalink





(3) DETAIL OF FEDERAL EMPLOYEES- Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employee.CommentsClose CommentsPermalink





(4) TECHNICAL ASSISTANCE- Upon the request of the Commission, the head of a Federal agency shall provide on a reimbursable basis such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties.CommentsClose CommentsPermalink





(5) USE OF MAILS- The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code.CommentsClose CommentsPermalink





(6) OBTAINING INFORMATION- The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under section 552 of title 5, United States Code. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the Commission.CommentsClose CommentsPermalink





(7) ADMINISTRATIVE SUPPORT SERVICES- Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request.CommentsClose CommentsPermalink





(8) PRINTING- For purposes of costs relating to printing and binding, including the cost of personnel detailed from the Government Printing Office, the Commission shall be deemed to be a committee of the Congress.CommentsClose CommentsPermalink





(f) Reports-CommentsClose CommentsPermalink





(1) INITIAL FINDINGS- Not later than 6 months after the date of the enactment of this Act, the Commission shall submit to the Administrator of Health Benefits and to appropriate committees of Congress a report which contains a statement of the initial findings of the Commission.CommentsClose CommentsPermalink





(2) INITIAL REPORT- Not later than 18 months after the date of the enactment of this Act, the Commission shall submit to such Administrator and committees an initial report which contains a detailed statement of its recommendations, findings, and conclusions of the Commission.CommentsClose CommentsPermalink





(3) ANNUAL REPORT- Subsequently, the Commission shall annually submit to such Administrator and such committees a report containing such a statement.CommentsClose CommentsPermalink





(4) OTHER REPORTS- The Commission may issue such other reports at such times as the Commission determines appropriate.CommentsClose CommentsPermalink





(5) SUPERMAJORITY REQUIREMENT- The Commission shall not include in any report submitted under this subsection a recommendation, finding, or conclusion unless it has received the approval of at least 6 members of the Commission.CommentsClose CommentsPermalink





(6) INCLUSION OF MINORITY VIEWS- Reports under this subsection shall include as separate viewpoints, the views of a minority of members of the Commission.CommentsClose CommentsPermalink





(g) Authorization of Appropriations- There are authorized to be appropriated for each fiscal year beginning with fiscal year 2010 such sums as are necessary to carry out this section.CommentsClose CommentsPermalink