HR 5348
110th CONGRESS
2d Session
H. R. 5348
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.
IN THE HOUSE OF REPRESENTATIVES
February 12, 2008
Mr. LANGEVIN (for himself and Mr. SHAYS) 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 concerned
A BILL
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.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS; TABLE OF CONTENTS.
(a) Short Title- This Act may be cited as the `American Health Benefits Program
Act of 2008'.
(b) Findings- Congress finds the following:
(1) UNINSURED AMERICANS AND LACK OF ACCESS TO CHOICES- (A) In 2006, 46.5
million Americans were uninsured, over 80 percent of whom were employed
(or dependents of individuals who were employed).
(B) Health care providers provided to uninsured Americans $41 billion in
care for which they were not compensated by the individuals or through insurance.
(C) Only 8 percent of employers providing health benefits are able to offer
their employees a choice between two or more health plans.
(2) DOUBLE-DIGIT GROWTH IN EMPLOYER COSTS- In 2003 the average per capita
cost for employers to provide health benefits coverage increased by almost
14 percent. This was the third consecutive year of double-digit increases
in such cost.
(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.
(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.
(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.
(D) In comparison, the overhead cost of coverage provided under FEHBP is
about 3 percent.
(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
(5) PERSONAL RESPONSIBILITY- A recent survey indicates that a clear majority
of Americans sees securing health insurance coverage as a personal responsibility
for themselves and others.
(6) SAVINGS FROM IMPLEMENTATION OF HEALTH INFORMATION TECHNOLOGY- Properly
implemented and widely adopted health information technology could significantly
improve the quality, safety and efficiency of healthcare delivery while
saving an estimated $77 billion per year
(c) Table of Contents- The table of contents of this Act is as follows:
Sec. 1. Short title; findings; table of contents.
Sec. 2. Establishment of American Health Benefits Program.
`TITLE XXII--AMERICAN HEALTH BENEFITS PROGRAM
`Sec. 2201. Establishment of program.
`Sec. 2202. Eligibility; requirement of coverage.
`Sec. 2203. Qualified health plans; benefits; premiums.
`Sec. 2204. Government contribution; American Health Benefits Program Trust
Fund.
`Sec. 2205. Premium and cost-sharing subsidies for lower income individuals.
`Sec. 2206. Administration.
`Sec. 2207. Definitions.
Sec. 3. Collection of premiums, subsidies, and employer funding.
Sec. 4. Amendments to the Medicaid program and SCHIP.
Sec. 5. Promotion of use of health information technologies.
Sec. 6. Non-preemption of existing collective bargaining agreements.
Sec. 7. Health Benefits Commission.
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:
`TITLE XXII--AMERICAN HEALTH BENEFITS PROGRAM
`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).
`SEC. 2202. ELIGIBILITY; REQUIREMENT OF COVERAGE.
`(1) IN GENERAL- Each AHBP-eligible individual is eligible to enroll in
a qualified health plan offered under this title.
`(2) AHBP-ELIGIBLE INDIVIDUAL DEFINED-
`(A) IN GENERAL- For purposes of this title, the term `AHBP-eligible individual'
means an individual residing in the United States who is--
`(i) a citizen or national of the United States;
`(ii) an alien lawfully admitted to the United States for permanent
residence;
`(iii) an alien admitted into the United States under section 207 of
the Immigration and Nationality Act (relating to refugees);
`(iv) an alien otherwise permanently residing in the United States under
color of law (as specified by the Commissioner); or
`(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 Commissioner determines, in consultation
with the Secretary of Homeland Security, to be appropriate.
`(B) EXCEPTIONS- Such term does not include the following individuals:
`(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.
`(ii) INCARCERATED INDIVIDUALS- An individual who is incarcerated (as
specified by the Commissioner).
`(b) Requirement of Coverage-
`(1) IN GENERAL- Except as provided in this subsection, each AHBP-eligible
individual shall be enrolled in a qualified health plan under this title.
`(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:
`(A) MEDICARE- Coverage under parts A and B (or under part C) of title
XVIII.
`(B) MEDICAID- Coverage under a State plan under title XIX.
`(C) TRICARE/CHAMPUS- Coverage under the TRICARE program under chapter
55, of title 10, United States Code.
`(D) INDIAN HEALTH SERVICES- Coverage under a medical care program of
the Indian Health Service or of a tribal organization.
`(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.
`(3) EXCEPTION FOR NONIMMIGRANTS- The requirement of paragraph (1) shall
not apply to an individual described in subsection (a)(2)(A)(v).
`(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--
`(A) the individual is conscientiously opposed to acceptance of medical
treatment of the type covered by qualified health plans; and
`(B) the individual's acceptance of medical treatment covered by such
a plan would be inconsistent with the individual's sincere religious beliefs.
`(c) Enrollment; Default Enrollment-
`(1) IN GENERAL- The Commissioner 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.
`(A) IN GENERAL- The Commissioner 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.
`(B) RULES- In carrying out subparagraph (A), the Commissioner 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.
`(3) CHANGES IN ENROLLMENT- The Commissioner 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.
`(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 Commissioner 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.
`(e) Changes in Plan Enrollment- The Commissioner 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 Commissioner shall provide for
termination of such enrollment for an individual at the time the individual
is no longer an AHBP-eligible individual.
`(f) Enrollment Guides- The Commissioner 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.
`SEC. 2203. QUALIFIED HEALTH PLANS; BENEFITS; PREMIUMS.
`(1) CONTRACTS- The Commissioner 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.
`(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--
`(A) is licensed as a health maintenance organization in that State or
is licensed to sell group health insurance coverage in that State;
`(B) meets such requirements, similar to requirements under FEHBP, as
the Commissioner may establish relating to solvency, organization, structure,
governance, access, and quality;
`(C) agrees to participate in the high-risk reinsurance pool described
in subsection (d); and
`(D) provides assurances satisfactory to the Commissioner 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.
`(3) CONTRACTING WITH LIMITED NUMBER OF PLANS IN A REGION WITHIN TYPES OF
PLANS-
`(A) IN GENERAL- The Commissioner shall contract with only a limited number
of qualified health plans of each type (as specified under subparagraph
(B)) in each AHBP region.
`(B) TYPES OF PLANS- For purposes of subparagraph (A), the Commissioner
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.
`(b) FEHBP Scope of Benefits-
`(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.
`(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).
`(3) OTHER CONSUMER PROTECTIONS- Qualified health plans also shall meet
consumer and patient protection requirements that the Commissioner establishes,
based on similar requirements previously imposed under FEHBP, including
protections of patients' rights previously effected pursuant to Executive
Memorandum.
`(c) Community-Rated Premiums-
`(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.
`(2) COLLECTION PROCESS- The Commissioner 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).
`(d) High-Risk Reinsurance Pool- The Commissioner shall establish an arrangement
among the entities offering qualified health plans under which such entities
contribute in an equitable manner (as determined by the Commissioner) into
a fund that provides payment to plans for a percentage (specified by the Commissioner
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 Commissioner.
`(e) Marketing Practices and Costs- The Commissioner shall monitor marketing
practices with respect to qualified health plans in order to assure--
`(1) the accuracy of the information disseminated regarding such plans;
and
`(2) that costs of marketing are reasonable and do not exceed a percentage
of total costs that is specified by the Commissioner and that takes into
account costs of market entry for new qualified health plans.
`SEC. 2204. GOVERNMENT CONTRIBUTION; AMERICAN HEALTH BENEFITS PROGRAM TRUST
FUND.
`(a) Government Contribution-
`(1) IN GENERAL- The Commissioner 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.
`(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 Commissioner 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 Commissioner).
`(1) IN GENERAL- The Commissioner shall provide for payment of qualified
health plans of the premiums for such plans, as adjusted under this subsection.
`(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 Commissioner to reflect the actuarial risk of the enrollees in the plan
compared to an average actuarial risk.
`(3) REDUCTION FOR ADMINISTRATIVE EXPENSES AND CONTINGENCY RESERVE- The
Commissioner 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:
`(A) CONTINGENCY RESERVE- A percentage (not to exceed 3 percent) to provide
for a contingency reserve described in section 2206(h)(1).
`(B) FEDERAL ADMINISTRATIVE COSTS- A percentage (not to exceed 5 percent)
to cover Federal administrative costs in implementing this title.
`(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').
`(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--
`(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;
`(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; and
`(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
36.
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.
`(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.
`SEC. 2205. PREMIUM AND COST-SHARING SUBSIDIES FOR LOWER INCOME INDIVIDUALS.
`(a) Premium Subsidies- The Commissioner, 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 36
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).
`(b) Cost-Sharing Subsidies-
`(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.
`(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.
`(3) SLIDING SCALE FOR OTHER INDIVIDUALS- In the case of cost-sharing subsidy-eligible
individuals not described in paragraph (1) or (2), the Commissioner, 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--
`(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;
and
`(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.
`(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).
`(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 Commissioner shall specify, has been made for such
subsidy.
`(6) PAYMENT OF SUBSIDIES TO PLANS- The Commissioner 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 Commissioner specifies and may
include--
`(A) a capitation payment, in an amount that reflects the per capita actuarial
value of such subsidies;
`(B) reimbursement for the reductions in cost-sharing made to carry out
this subsection; or
`(C) a combination of the methodologies under subparagraphs (A) and (B).
`(7) DEFINITIONS- For purposes of this subsection:
`(A) COST-SHARING SUBSIDY-ELIGIBLE INDIVIDUAL DEFINED- The term `cost-sharing
subsidy-eligible individual' means an AHBP-eligible individual--
`(i) who is enrolled, and required under section 2202(b) to be enrolled,
in a qualified health plan under this title;
`(ii) whose family income does not exceed twice the lowest income threshold
(as defined in subparagraph (B)); and
`(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 Commissioner,
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.
`(B) LOWEST INCOME THRESHOLD- The term `lowest income threshold' means--
`(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; or
`(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.
`(C) FAMILY INCOME- The term `family income' means, with respect to an
AHBP-eligible individual who is enrolled in a qualified health plan--
`(i) for individual-only coverage, the modified AGI of the individual;
or
`(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.
The Commissioner, 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 Commissioner).
`(D) MODIFIED AGI DEFINED- The term `modified AGI' means adjusted gross
income (as defined in section 62 of the Internal Revenue Code of 1986)--
`(i) determined without regard to sections 135, 911, 931, and 933 of
such Code; and
`(ii) increased by the amount of interest received or accrued during
the taxable year which is exempt from tax under such Code.
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.
`SEC. 2206. ADMINISTRATION.
`(a) Application of FEHBP Rules-
`(1) IN GENERAL- Except as otherwise provided in this title, the program
under this title shall be administered in the same manner as FEHBP.
`(2) SPECIFIC PROVISIONS- In carrying out this title, the Commissioner pursuant
to paragraph (1) shall provide for the following:
`(A) Approval and disapproval of plans as qualified health plans.
`(B) Negotiation of plan benefits (including cost-sharing) and plan premiums.
`(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').
`(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 Commissioner of Health Benefits.
`(2) ESTABLISHMENT OF AHBP REGIONS- For purposes of carrying out this title,
the Commissioner shall divide the United States into, and establish, AHBP
regions.
`(1) COMMISSIONER OF HEALTH BENEFITS-
`(A) IN GENERAL- There shall be in the Administration a Commissioner of
Health Benefits who shall be appointed by the President, by and with the
advice and consent of the Senate.
`(B) COMPENSATION- The Commissioner shall be compensated at the rate provided
for level I of the Executive Schedule.
`(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.
`(2) DEPUTY COMMISSIONER-
`(A) IN GENERAL- There shall be in the Administration a Deputy Commissioner
for Health Benefits, who shall be appointed by the President, by and with
the advice and consent of the Senate.
`(B) APPLICATION OF SSA PROVISIONS- The provisions of paragraphs (2) through
(4) of section 702(b) shall apply to the Deputy Commissioner 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).
`(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.
`(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 Commissioner
and the Administration in the same manner as they apply to the Commissioner
of Social Security and the Social Security Administration, respectively.
`(e) Authority and Rulemaking- The provisions of paragraphs (4) through (7)
of section 702(a) shall apply to the Administration and Commissioner in the
same manner as they apply to the Social Security Administration and the Commissioner
of Social Security.
`(f) Use of Regional and Field Offices- The Commissioner shall establish such
regional and field offices as may be appropriate for the convenient and efficient
administration of this title.
`(g) Coverage of Administration Costs- The Commissioner 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.
`(h) Contingency Reserves-
`(1) AHBP CONTINGENCY RESERVE- The Commissioner 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.
`(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.
`SEC. 2207. DEFINITIONS.
`For purposes of this title, except as otherwise provided:
`(1) The term `Administration' means the Health Benefits Administration
established under section 2206(b).
`(2) The term `AHBP-eligible individual' means an individual described in
section 2202(a)(2).
`(3) The term `AHBP region' means a region as specified by the Commissioner
under section 2206(c)(2).
`(4) The term `Commissioner' means the Commissioner of Health Benefits appointed
under section 2206(d)(1).
`(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.
`(6) The term `qualified employer-provided coverage' means health coverage
that is provided on the basis of employment and that the Commissioner 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.
`(7) The term `qualified health plan' means such a plan offered under this
title.'.
(b) Effective Date; Collective Bargaining Agreements-
(1) BENEFITS- Title XXII of the Social Security Act shall first apply to
benefits for items and services furnished on or after January 1, 2011.
(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.
SEC. 3. COLLECTION OF PREMIUMS, SUBSIDIES, AND EMPLOYER FUNDING.
(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:
`PART VIII--AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS
`Sec. 59B. American Health Benefits Program premiums.
`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.
`(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--
`(1) in the case of self-only coverage, the individual covered under such
coverage, and
`(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).
`(c) Joint and Several Liability- In the case of an individual and such individual's
spouse covered under family coverage--
`(1) each such individual shall be jointly and severally liable for the
amount imposed under subsection (a), and
`(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.
`(d) Coordination With Other Provisions-
`(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.
`(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--
`(A) the amount of any credit allowable under this chapter, or
`(B) the amount of the minimum tax imposed by section 55.
`(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.
`(4) SECTION 15 NOT TO APPLY- Section 15 shall not apply to the amount imposed
by this section.
`(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.
`(e) Regulations- The Secretary may prescribe such regulations as may be appropriate
to carry out the purposes of this section.'.
(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:
`(3) SPECIAL RULE FOR AMOUNTS IMPOSED BY SECTION 59B-
`(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.
`(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).'.
(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:
`Part VIII--American Health Benefits Program Premiums'.
(b) Credit for Subsidy and Prepayments of American Health Benefits Premiums-
(1) IN GENERAL- Subpart C of part IV of subchapter A of chapter 1 of the
Internal Revenue Code of 1986 is amended by redesignating section 36 as
section 37 and by inserting after section 35 the following new section:
`SEC. 36. 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--
`(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, and
`(2) in the case of any premium subsidy-eligible individual, the applicable
premium subsidy.
`(b) Applicable Premium Subsidy-
`(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 Commissioner of Health Benefits.
`(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--
`(A) the amount (if any) by which the taxpayer's family income for the
taxable year exceeds the lowest income threshold, bears to
`(B) the lowest income threshold.
`(c) Premium Subsidy-Eligible Individual- For purposes of this section, the
term `premium subsidy-eligible individual' means an individual--
`(1) who is enrolled, and required to be enrolled, in a qualified health
plan under title XXII of the Social Security Act,
`(2) whose family income does not exceed twice the lowest income threshold,
and
`(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 Commissioner 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)).
`(d) Lowest Income Threshold- For purposes of this section, the term `lowest
income threshold' means, with respect to coverage consisting of--
`(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, or
`(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.
`(e) Family Income- For purposes of this section--
`(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--
`(A) only such individual, the modified adjusted gross income of such
individual, or
`(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.
`(2) MODIFIED ADJUSTED GROSS INCOME- The term `modified adjusted gross income'
means adjusted gross income--
`(A) determined without regard to sections 135, 911, 931, and 933, and
`(B) increased by the amount of interest received or accrued during the
taxable year which is exempt from tax under this title.
`(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.
`(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.'.
(2) CONFORMING AMENDMENTS-
(A) Paragraph (2) of section 1324(b) of title 31, United States Code,
is amended by inserting `or 36' after `section 35'.
(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 striking the item
relating to section 36 and inserting the following new items:
`Sec. 36. Subsidy and prepayment of American Health Benefits premiums.
`Sec. 37. Overpayments of tax.'.
(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:
`CHAPTER 25--AMERICAN HEALTH BENEFITS PROGRAM
`Sec. 3451. Tax on employers.
`Sec. 3452. Refund of tax in case of qualified employer-provided coverage.
`Sec. 3453. Instrumentalities of the United States.
`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.
`(b) Applicable Percentage- For purposes of this section--
`(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:
`Applicable percentage (in percent)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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:
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Less than 10 4.00 5.00 6.00 8.75
10 through 25 4.25 5.25 6.75 9.50
26 through 49 4.50 5.50 7.25 10.00
50 through 199 4.75 5.75 8.00 10.00
200 through 499 5.00 6.00 8.75 10.00
500 or more 5.25 6.25 9.50 10.00
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
`(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.
`(3) AVERAGE EARNINGS PER EMPLOYEE- With respect to any employer for any
taxable year--
`(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.
`(B) AVERAGE EARNINGS- The term `average earnings' means the average taxable
income of the employer for the 3 taxable years preceding such taxable
year.
`(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.
`(5) INFLATION ADJUSTMENT- In the case of a taxable year beginning after
December 31, 2011, each of the dollar amounts in the table contained in
paragraphs (1) shall be increased by an amount equal to--
`(A) such dollar amount, multiplied by
`(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 2010' for `calendar year 1992' in subparagraph (B) thereof.
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.
`(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.
`(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).
`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).
`(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.
`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.'.
(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:
`(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.'.
(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:
`Chapter 25--American Health Benefits Program
`Chapter 26--General Provisions Relating to Employment Taxes'.
(d) Additional Tax on Hospital Revenues-
(1) IN GENERAL- Subchapter A of chapter 1 of the Internal Revenue Code of
1986 is amended by adding at the end the following new part:
`PART VIII--TAX ON HOSPITAL REVENUES
`Sec. 59B. Tax on hospital revenues.
`SEC. 59B. 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.
`(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--
`(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), over
`(2) so much of the deductions allowed under this chapter for such taxable
year as are properly allocable to such income.
`(c) Section 15 Not To Apply- Section 15 shall not apply to the tax imposed
by this section.'.
(2) CONFORMING AMENDMENTS-
(A) Section 26(b)(2) of the Internal Revenue Code of 1986 is amended by
striking `and' at the end of subparagraph (U), by striking the period
at the end of subparagraph (V) and inserting `, and', and by adding at
the end the following new subparagraph:
`(W) section 59B (relating to tax on hospital revenues).'.
(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:
`(5) section 59B (relating to tax on hospital revenues).'.
(C) Section 882(a)(1) of such Code is amended by inserting `59B,' after
`59A,'.
(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:
`(E) section 59B (relating to tax on hospital revenues).'.
(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:
`(iv) the tax imposed by section 59B, over'.
(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:
`(iv) the tax imposed by section 59B, plus'.
(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:
`Part VIII--Tax on Hospital Revenues'.
(e) Disclosure of Taxpayer Return Information To Carry Out Cost-Sharing Subsidies-
(1) IN GENERAL- Section 6103(l) of the Internal Revenue Code of 1986 is
amended by adding at the end the following new paragraph:
`(21) DISCLOSURE OF RETURN INFORMATION TO CARRY OUT AMERICAN HEALTH BENEFITS
PROGRAM-
`(A) IN GENERAL- The Secretary shall, upon written request from the Commissioner
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--
`(i) taxpayer identity information with respect to such taxpayer,
`(ii) the filing status of such taxpayer,
`(iii) the adjusted gross income of such taxpayer,
`(iv) the amounts excluded from such taxpayer's gross income under sections
135 and 911 to the extent such information is available,
`(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,
`(vi) the amounts excluded from such taxpayer's gross income by sections
931 and 933 to the extent such information is available, and
`(vii) the taxable year with respect to which the preceding information
relates.
`(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.'.
(2) CONFORMING AMENDMENTS-
(A) Paragraph (3) of section 6103(a) of such Code is amended by striking
`or (20)' and inserting `(20), or (21)'.
(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)'.
(C) Paragraph (2) of section 7213(a) of such Code is amended by striking
`or (20)' and inserting `(20), or (21)'.
(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:
`(10) DISCLOSURE OF INFORMATION TO ADMINISTER PREMIUM SUBSIDY UNDER SECTION
36- To the extent that Secretary determines that disclosure is necessary
to permit the effective administration of section 36, the Secretary may
disclose the modified adjusted gross income (as defined in section 36) of
any individual whose modified adjusted gross income is taken into account
in determining the amount of any credit under such section.'.
(1) IN GENERAL- Except as provided in paragraph (2), the amendments made
by this section shall take effect on January 1, 2011.
(2) SUBSECTIONS (a) AND (b)- The amendments made by subsections (a) and
(b) shall apply to months beginning after December 31, 2010, in taxable
years ending after such date.
(3) SUBSECTION (d)- The amendments made by subsection (d) shall apply to
taxable years beginning after December 31, 2010.
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:
`(dd)(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.
`(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).
`(3) The amount specified in this paragraph for a State for--
`(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; and
`(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.
`(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'.
(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:
`(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.'.
(c) Reduction in Medicaid DSH Payments- Section 1923(f) of such Act (42 U.S.C.
1396r-4(f)) is amended--
(1) by redesignating paragraph (7) as paragraph (8); and
(2) by inserting after paragraph (6) the following new paragraph:
`(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 2011 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 2010.'.
SEC. 5. PROMOTION OF USE OF HEALTH INFORMATION TECHNOLOGIES.
The Commissioner of Health Benefits (appointed under section 2206(d)(1) of
the Social Security Act, as added by section 2(a)), in consultation with the
Secretary of Health and Human Services, shall establish new guidelines that
promote the proper use and understanding of health information technologies.
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).
SEC. 7. HEALTH BENEFITS COMMISSION.
(a) Establishment- There is established an independent commission to be known
as the Health Benefits Commission (in this section referred to as the `Commission').
(b) Duties of the Commission-
(1) GENERAL DUTIES- The Commission shall examine and make recommendations
regarding the major issues and cost drivers affecting the delivery of healthcare
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').
(2) SPECIFIC ISSUES- The Commission shall specifically examine and make
recommendations regarding each of the following:
(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.
(B) The proper implementation and utilization of electronic medical records
and other health information technologies, including privacy and interoperability
issues.
(C) The effects of medical malpractice insurance and `defensive medicine'
on the delivery and cost of health care.
(D) The patterns and effects of overutilization on AHBP.
(E) Cost and implementation factors of retiree health coverage under AHBP.
(F) A comparison of prescription drug prices under AHBP with such prices
under other public health programs.
(G) The effects of insurance monopolies on healthcare costs and delivery.
(1) NUMBER AND APPOINTMENT- The Commission shall be composed of 9 members,
of whom--
(A) one shall be appointed by the President;
(B) one shall be appointed by the majority leader of the Senate;
(C) one shall be appointed by the minority leader of the Senate;
(D) one shall be appointed by the Speaker of the House of Representatives;
(E) one shall be appointed by the minority leader of the House of Representatives;
and
(F) four shall be appointed by the Comptroller General of the United States,
of whom one shall be designated by the Comptroller General as the Chair
and another as the Vice Chair of the Commission.
(2) TERMS OF APPOINTMENT- The term of any appointment under paragraph (1)
to the Commission shall be for 3 years.
(A) IN GENERAL- The terms of members of the Commission shall be for 3
years, except that the Comptroller General shall designate staggered terms
for the members first appointed.
(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.
(4) MEETINGS- The Commission shall meet at the call of its Chair or a majority
of its members.
(5) QUORUM- A quorum shall consist of 5 members of the Commission, except
that 3 members may conduct a hearing under subsection (e).
(6) 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.
(7) 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.
(8) CHAIR; VICE CHAIR- The Comptroller General shall designate a member
of the Commission appointed under paragraph (1)(F), 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 Comptroller
General may designate another member for the remainder of that member's
term.
(9) 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.
(10) CONTINUATION OF OPERATION- Section 14 of the Federal Advisory Committee
Act (5 U.S.C. App.) shall not apply to the Commission.
(d) Director and Staff; Experts and Consultants- Subject to such review as
the Comptroller General deems necessary to assure the efficient administration
of the Commission, the Commission may--
(1) employ and fix the compensation of an Executive Director (subject to
the approval of the Comptroller General) 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);
(2) seek such assistance and support as may be required in the performance
of its duties from appropriate Federal departments and agencies;
(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));
(4) make advance, progress, and other payments which relate to the work
of the Commission;
(5) provide transportation and subsistence for persons serving without compensation;
and
(6) prescribe such rules and regulations as it deems necessary with respect
to the internal organization and operation of the Commission.
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. For purposes of pay (other than pay of members
of the Commission) and employment benefits, rights, and privileges, all personnel
of the Commission shall be treated as if they were employees of the United
States Senate.
(e) Powers of Commission-
(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.
(2) STUDIES BY GAO- Upon the request of the Commission, the Comptroller
General of the United States shall conduct such studies or investigations
as the Commission determines to be necessary to carry out its duties.
(3) COST ESTIMATES BY CONGRESSIONAL BUDGET OFFICE-
(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.
(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).
(4) 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.
(5) TECHNICAL ASSISTANCE- Upon the request of the Commission, the head of
a Federal agency shall provide such technical assistance to the Commission
as the Commission determines to be necessary to carry out its duties.
(6) 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.
(7) 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.
(8) 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.
(9) 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.
(1) INITIAL FINDINGS- Not later than 6 months after the date of the enactment
of this Act, the Commission shall submit to the Commissioner of Health Benefits
and to appropriate committees of Congress a report which contains a statement
of the initial findings of the Commission.
(2) INITIAL REPORT- Not later than 18 months after the date of the enactment
of this Act, the Commission shall submit to such Commissioner and committees
an initial report which contains a detailed statement of its recommendations,
findings, and conclusions of the Commission.
(3) ANNUAL REPORT- Subsequently, the Commission shall annually submit to
such Commissioner and such committees a report containing such a statement.
(4) OTHER REPORTS- The Commission may issue such other reports at such times
as the Commission determines appropriate.
(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.
(g) Authorization of Appropriations- There are authorized to be appropriated
for each fiscal year beginning with fiscal year 2009 such sums as are necessary
to carry out this section.
END
