[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1057 Introduced in Senate (IS)]
103d CONGRESS
1st Session
S. 1057
To provide for the establishment of a nationwide, universal access
health coverage program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 27 (legislative day, April 19), 1993
Mr. Jeffords introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide for the establishment of a nationwide, universal access
health coverage program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``MediCORE Health Act of 1993''.
SEC. 2. TABLE OF CONTENTS.
The table of contents is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
Sec. 4. Definitions.
(1) Board.
(2) CORE services.
(3) Secretary.
(4) State.
(5) State plan.
(6) State program.
TITLE I--ELIGIBILITY AND ENROLLMENT
Sec. 101. Eligibility.
(a) In general.
(b) Lawful resident alien defined.
(c) Overseas residents and travelers.
(1) Overseas residents.
(2) Travelers.
(d) Non-resident aliens and illegal immigrants.
(e) Primary residence.
Sec. 102. Enrollment in State programs.
(a) Enrollment process.
(1) Automatic enrollment.
(2) Enrollment process for other individuals.
(3) Default enrollment.
(b) MediCORE cards.
TITLE II--ADMINISTRATION BY FEDERAL MEDICORE BOARD
Sec. 201. Establishment and composition.
(a) Establishment.
(b) Composition.
(1) Appointment.
(2) Terms.
(3) Vacancies.
(4) Chairperson.
(5) Compensation.
(c) Staff.
(1) Authority.
(2) Applicability of civil service provisions.
Sec. 202. Duties of MediCORE Board.
(a) General administration.
(b) CORE services.
(c) Federal MediCORE guidelines.
(d) Approval and oversight of State programs.
(e) Model MediCORE Administration Manual.
(1) In general.
(2) Contents.
(3) Time for provision of manuals.
(f) National data bank system.
(1) Establishment.
(2) Functions.
(g) Studies.
(1) In general.
(2) Immigrants and early retirees.
(3) Veterans affairs.
(4) Malpractice reform.
(5) Coordination of programs.
(h) Annual report.
Sec. 203. Organization.
(a) In general.
(b) Subcommittees.
(c) Advisory panels.
TITLE III--CORE SERVICES
Sec. 301. CORE services.
(a) Review.
(b) Scope and content of CORE services.
(c) Specific components.
(1) Medically necessary services.
(2) Medicare services.
(3) Supplemental benefits.
(4) Preventive health care services.
(5) Long-term health, custodial or personal
assistance.
(6) Catastrophic care.
(d) Adjustment or expansion of CORE services.
Sec. 302. Special supplemental food program.
(a) In general.
(b) Appropriation.
TITLE IV--FEDERAL MEDICORE GUIDELINES
Sec. 401. Federal MediCORE guidelines.
(a) Procedure.
(1) Submission to States.
(2) Adjustment of guidelines.
(b) Requirements.
(1) Universality.
(2) Portability.
(3) Single administrator.
(4) Choice and managed competition.
(5) Rural and underserved areas.
(6) Private health insurance.
(7) Cost sharing.
(8) Mental health.
(9) Primary care.
TITLE V--APPROVAL AND OVERSIGHT OF STATE PROGRAMS
Sec. 501. Approval and oversight of State programs.
(a) In general.
(b) Submission of programs.
(1) In general.
(2) Regional programs.
(c) Review and approval of programs.
(d) Annual review.
(e) Failure of approval.
(1) Resubmission.
(2) Sanctions.
(f) Payments, premiums, copayments, deductibles,
etc.
(1) Reimbursements.
(2) Mandatory assignment.
(g) Administration by State.
(1) In general.
(2) Administration by contract.
TITLE VI--MEDICORE BUDGET
Sec. 601. MediCORE budget.
(a) Budgetary requirement.
(b) National average per capita costs.
(1) In general.
(2) Adjustments for risk groups.
(3) State adjustments to national average per
capita costs.
(c) State total expenditures.
(d) Federal contributions.
(1) In general.
(2) State share.
(3) State protection.
(e) Subsequent calculations.
Sec. 602. Health care revenue share payments to States.
(a) In general.
(b) Use of funds.
Sec. 603. MediCORE trust fund.
(a) Trust fund established.
(1) In general.
(2) Transfer of amounts equivalent to certain
taxes.
(3) Transfer of funds.
(4) Appropriation of additional sums.
(5) Incorporation of trust fund provisions.
(b) Expenditures.
(1) To States.
(2) Administrative expenses.
(c) Trust fund off-budget.
Sec. 604. Health care revenue sharing provisions.
(a) Payroll taxes.
(1) Tax on employees.
(2) Tax on employers.
(3) Tax on self-employment income.
(4) Elimination of limit on employer-portion of
wages or self-employment income subject to
MediCORE tax.
(5) Additional Federal, State, and local
employees subject to MediCORE taxes.
(6) Effective date.
(b) Individual tax on certain adjusted gross
income.
(1) In general.
(2) Conforming amendment.
(3) Effective date.
(d) Treatment of health care deductions,
exclusions, and credits.
(1) Limitation on exclusion of compensation for
injuries or sickness.
(2) Termination of exclusion for amounts
received under accident and health plans.
(3) Termination of exclusion for contributions
by employer to accident and health plans.
(4) Limitation on cafeteria plans.
(5) Prohibition on use of MediCORE expenses as
business expense deduction for employer.
(6) Deduction for medical expenses limited to
uncompensated expenses and employee MediCORE
tax.
(7) Termination of pension payment of medical
benefits.
(8) Termination of child health insurance
credit.
(9) Effective date.
TITLE VII--PREPARATION AND SUBMISSION OF MEDICORE BUDGET TO CONGRESS
Sec. 701. Preparation and submission.
Sec. 702. Publication and comment.
Sec. 703. Submission to Congress.
(a) In general.
(b) Income requirements.
Sec. 704. Action by Congress.
TITLE VIII--EFFECTIVE DATE; REPEALS; TRANSITION; RELATION TO ERISA
Sec. 801. Effective date.
Sec. 802. Repeals.
(a) In general.
(b) Repeal of CHAMPUS provisions.
(1) Amendments to chapter 55 of title 10.
(2) Table of sections.
(3) Conforming amendments.
(c) Health care financing administration.
(d) Effective date.
Sec. 803. Authorization of appropriations and transition.
(a) Authorization of appropriations.
(b) Regulations.
Sec. 804. Relation to ERISA.
Sec. 805. Relation to other laws.
(a) In general.
(b) Definition.
SEC. 3. FINDINGS.
Congress finds the following:
(1) The rate of growth in health care costs in the United
States in both the public and private sectors is excessive and
destructive, and more specifically--
(A)(i) between 1980 and 1992, health care spending
in the United States increased from 9 percent of the
Gross Domestic Product to 14 percent and in 1993 it is
expected to rise to 15 percent, a higher percentage of
Gross Domestic Product than that of any other
industrialized nation; and
(ii) by the year 2000 health care spending in the
United States will exceed 18 percent of the Gross
Domestic Product if left at current spending levels;
(B) expenditures for health care in the United
States will total approximately $885,000,000,000 in
1993, a rise of 13 percent since 1992, while Gross
Domestic Product rose at only a 4.6-percent rate over
the same period;
(C)(i) health care costs for an average family in
the United States grew by 147 percent while average
family income rose by 88 percent during the 1980s;
(ii) average family cost for health care was $1,742
in 1980 and has grown to $4,887 in 1992; and
(iii) 50 percent of all personal bankruptcies are
caused by unmanageable health care costs;
(D) the average cost of private employer health
plans rose approximately 119 percent between 1984 and
1991, badly eroding company profits and international
competitiveness;
(E)(i) the cost of Medicare grew from
$34,000,000,000 in 1980 to $104,000,000,000 in fiscal
year 1990; and
(ii) 27 percent of Medicare costs are paid for from
general funds from the Treasury and not from
specifically dedicated taxes;
(F)(i) the cost of Medicaid is expected to increase
38 percent between 1991 and 1993 and Medicaid has grown
from 10.2 percent of State health budgets in 1987 to
approximately 46 percent in 1992;
(ii) all Federal expenditures for Medicaid are
financed from general funds from the Treasury; and
(iii) by the year 2000 under current spending
levels, State Medicaid will have grown to 56 percent of
State health care budgets;
(G) the cost of medical care in general in the
United States continues to rise at approximately three
times the rate of the Consumer Price Index;
(H) these disproportionate rises in health care
costs are inflicting undue burdens on the United States
economy, business and citizens in recessionary and
deficit ridden times;
(I) the Congressional Budget Office estimates that
unless costs are stabilized, medical care cost
increases in Federal programs above increases in
Federal revenues, will by themselves increase the
Federal debt by over $1,500,000,000,000 by the middle
of the next decade, and will result in an increase in
annual Federal medical care costs over baseline by
$190,000,000,000 at the end of a decade; and
(J) unless Federal health care cost increases are
halted it will take Draconian measures to bring the
Federal deficit under control.
(2) Structural defects in the organization of the health
care system in the United States are leading to excessive
costs, to unequal and limited access, and to fragmentation,
complexity, and confusion in the delivery of health care
because--
(A) an anachronism in tax policy carried forward
from World War II has led to great inequities in health
care between those employed in firms paying for health
care of employees, and those working for companies
without such coverage and all others paying for health
care coverage;
(B) the employer-based system, due to inherent
limitations, has been ineffective in providing
affordable health care to large segments of the
population including the poor and elderly;
(C) the costs of ``uncompensated care'' are shifted
in concealed and indirect ways to providers, employers
and the insured, and ultimately to governments and
taxpayers;
(D) the widespread coverage gaps caused by the
employer-based health care system have been
inadequately compensated for by public programs, in
terms of the number of people covered, the scope of
services provided, and the efficiency of providing
services;
(E) private and public insurance alike have adopted
reimbursement policies which encourage providers to
maximize income with unnecessary services and consumers
to overutilize;
(F)(i) attempts to reduce costs of overburdened and
under funded public programs have caused increasing
cost shifting back to employers, further diminishing
the ability of employers to provide adequate health
insurance and to be competitive internationally;
(ii) for these reasons and others retiree health
benefits are being curtailed dramatically; and
(iii) such shifts are also limiting the
availability and affordability of adequate coverage to
others;
(G) piecemeal attempts to control cost escalation
in both the private and public sectors, including the
use of managed care and other alternative delivery
systems, by themselves are not succeeding in
significantly controlling cost or cost shifting;
(H) cost escalation has left gaps is coverage,
especially with respect to preventive, primary and
long-term care, and protection against catastrophic
costs;
(I)(i) increasing costs and cost shifts have
resulted in insurers reducing cost by reducing risks
with the result that more and more individuals are left
uncovered;
(ii) this has substantially reduced the
effectiveness of private health insurance as a adequate
answer to health care problems because--
(I) insurance companies use defensive
practices such as pre-existing conditions
exclusions and ``cherry-picking'' which reduce
access rather than promote cost efficient
competition on the basis of price and product
design;
(II) short-term ``experience ratings'' are
depriving Americans of consistent protection
against catastrophic health care occurrences;
and
(III) employer-group organized health care
has spawned excessive numbers of commercial
insurers causing undue advertising costs,
administrative expense and confusion, and
redtape for employers, providers and consumers;
(J) tax induced employer-based health care has
diminished the market role of both employers and
employees in making prudent and thrifty choices for
efficient and cost conscious health care coverage; and
(K) the administrative difficulties, payment
inequities, regional differences in cost of services,
and the cost containment problems of Medicare exemplify
the difficulties of a federally run program.
(3) Other factors, as well, demonstrate the need for
comprehensive reform in the nations health care systems. These
include:
(A) Current health care spending with proper cost
sharing and resource allocation is sufficient to cover
presently uncovered benefits, such as preventative
health, long-term health care, pharmaceutical costs,
and catastrophic protection.
(B) The reduction of present administrative
inefficiencies, defensive medical costs, and increased
use of outcome research will accommodate improved
coverage and care.
(C) State run programs, with single or
administrative agencies, but federally structured and
coordinated will result in a less costly, more
efficient and diversified system.
(D) Present tax inequities can only be corrected at
the Federal level, and only Federal funds can provide
sufficient funding for comprehensive change.
(E) A coordinated global cost containment structure
can only be provided by the Federal Government.
(F) States are best placed to create efficient
competition among health care providers for
administrative and service cost reductions.
SEC. 4. DEFINITIONS.
As used in this Act:
(1) Board.--The term ``Board'' means the Federal MediCORE
Board established under section 201.
(2) CORE services.--The term ``CORE SERVICES'' means those
health care services specified in section 301.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(4) State.--
(A) In general.--The term ``State'' includes the
District of Columbia, the Commonwealth of Puerto Rico,
the United States Virgin Islands, Guam, American Samoa,
and the Commonwealth of the Northern Mariana Islands.
(B) Region.--A reference to a State under this Act
shall be considered to include a region implementing a
regional program under the authority of this Act.
(5) State plan.--The term ``State plan'' means a health
delivery plan approved under a State program.
(6) State program.--
(A) In general.--The term ``State program'' means a
State health care program approved under section 501.
(B) Regional program.--A reference to a State
program under this Act shall be considered to include a
regional program implemented under the authority of
this Act.
TITLE I--ELIGIBILITY AND ENROLLMENT
SEC. 101. ELIGIBILITY.
(a) In General.--Except as otherwise provided in this section, each
individual who is a legal resident of the United States, including
lawful resident aliens, is eligible for CORE SERVICES under the State
program in the State in which the individual maintains a primary
residence.
(b) Lawful Resident Alien Defined.--For purposes of this section,
the term ``lawful resident alien'' means an alien lawfully admitted for
permanent residence or for educational purposes and any other alien
lawfully residing permanently in the United States under color of law,
including an alien with lawful temporary resident status under section
210, 210A, or 245A of the Immigration and Nationality Act (8 U.S.C.
1160, 1161, or 1255a).
(c) Overseas Residents and Travelers.--
(1) Overseas residents.--As used in subsection (a), the
term ``legal resident of the United States'' does not include a
United States citizen or lawful resident alien who has
established a primary residence outside of the United States.
(2) Travelers.--An individual described in subsection (a)
who is traveling at the time at which CORE SERVICES are
provided to such individual shall be covered under the State
program in the State in which the individual maintains a
primary residence.
(d) Non-Resident Aliens and Illegal Immigrants.--The Board shall
develop and implement special procedures with respect to the
eligibility of non-resident aliens and illegal immigrants for CORE
SERVICES under a State program. In developing such procedures, the
Board shall ensure that those States with the highest incidence of
illegal immigrants receive some type of additional payment under this
Act for the provision of CORE SERVICES to such aliens and immigrants.
(e) Primary Residence.--As used in this title, the term ``primary
residence'' means that State in which the individual resides for the
greatest period of time (not necessarily a consecutive period of time)
during the calendar year. With respect to individuals who are
unemancipated students, the primary residence of such individuals shall
be the primary residence of their parents or legal guardians. With
respect to a homeless individual, the State of primary residence shall
be the State in which such individual applies for CORE benefits.
SEC. 102. ENROLLMENT IN STATE PROGRAMS.
(a) Enrollment Process.--
(1) Automatic enrollment.--Each State program shall provide
for the automatic enrollment of an individual described in
section 101 who is born after the effective date described in
section 801, on the date on which such individual is born.
(2) Enrollment process for other individuals.--With respect
to individuals described in section 101 who are not
automatically enrolled under paragraph (1), each State program
shall develop and utilize an understandable and readily
available process for the enrollment of such individuals in the
State program.
(3) Default enrollment.--In the case of an individual
described in section 101 who otherwise is not enrolled in a
State program, such individual shall be covered by the State
program in the State in which such individual maintains a
primary residence. The State shall provide a process for
enrollment of the individual at the time and place in which the
individual first is provided (after the effective date
described in section 801) CORE SERVICES under a State program.
(b) MediCORE Cards.--Upon enrollment in a State program, an
individual shall be issued a MediCORE card that shall--
(1) indicate the State program in which the individual is
enrolled;
(2) contain a brief description of any cost-sharing,
benefit or delivery features of the program in which such
individual is enrolled;
(3) where feasible, and if privacy interests can be
maintained, contain the health record of the individual; and
(4) indicate any other information determined appropriate
by the Board.
TITLE II--ADMINISTRATION BY FEDERAL MEDICORE BOARD
SEC. 201. ESTABLISHMENT AND COMPOSITION.
(a) Establishment.--There is established within the Department of
Health and Human Services a Federal MediCORE Board.
(b) Composition.--
(1) Appointment.--The Board shall be composed of nine
members to be appointed by the President not later than 60 days
after the date of enactment of this Act, by and with the advice
and consent of the Senate, from among individuals who will, as
a whole, represent the interests of the following--
(A) Federal and State governments;
(B) employers;
(C) employees and labor unions;
(D) health care providers;
(E) consumers;
(F) academic and industry experts in health care
delivery; and
(G) cost containment and quality improvement
experts.
(2) Terms.--Individuals appointed to the Board under
paragraph (1) shall serve for a term of 5 years, except that
the terms of individuals initially appointed shall be as
follows--
(A) three of such individuals shall be appointed
for a term of 2 years;
(B) three of such individuals shall be appointed
for a term of 3 years; and
(C) three of such individuals shall be appointed
for a term of 4 years.
(3) Vacancies.--The President shall fill any vacancy in the
membership of the Board in the same manner as the original
appointment and such members shall serve for the remainder of
the term for which the predecessor of the member was appointed.
The vacancy shall not affect the power of the remaining members
to execute the duties of the Board.
(4) Chairperson.--
(A) Initial chairperson.--The initial chairperson
of the Board shall be selected by the President and
serve for a term of 3 years.
(B) Subsequent chairpersons.--Except as provided in
subparagraph (A), the members of the Board shall select
a chairperson of the Board from among such members and
such chairperson shall serve for a term of 3 years.
(5) Compensation.--Members of the Board shall be
compensated at a level comparable to level II of the Executive
Schedule, in accordance with section 5313 of title 5, United
States Code. Amounts for such compensation shall be derived
from the MediCORE Trust Fund.
(c) Staff.--
(1) Authority.--The Board shall employ such staff as the
Board may determine necessary and such staff shall be
compensated in accordance with paragraph (2).
(2) Applicability of civil service provisions.--The staff
of the Board may be appointed without regard to the provisions
of title 5, United States Code, governing appointments in the
competitive service and be compensated without regard to the
provisions of chapter 51, and subchapter III of chapter 53 of
title 5 relating to classification and General Schedule pay
rates, except that no individual may receive pay more than the
rate of basic pay payable for level IV of the Executive
Schedule. Amounts for such compensation shall be derived from
the MediCORE Trust Fund.
SEC. 202. DUTIES OF MEDICORE BOARD.
(a) General Administration.--The Board shall be responsible for the
overall administration of this Act and for the oversight of State
compliance with this Act, as well as the development of CORE SERVICES
and of specific guidelines to permit States to carry out this Act.
(b) CORE SERVICES.--The Board shall, in accordance with title III,
determine a basic, comprehensive package of health care services
(referred to in this Act as ``CORE SERVICES'') that shall be provided
under this Act.
(c) Federal MediCORE Guidelines.--The Board shall, in accordance
with title IV, develop and implement Federal guidelines for the
equitable and efficient delivery of CORE SERVICES through State
programs operating under this Act.
(d) Approval and Oversight of State Programs.--Not later than 16
months after the date of enactment of this Act, the Board shall, in
accordance with title V, develop and administer procedures for the
approval of State programs under this Act and for the monitoring of
State compliance with the requirements of this Act. Such procedures
shall be published in the Federal Register and made available to
States.
(e) Model MediCORE Administration Manual.--
(1) In general.--The Board shall develop, publish and make
available to each State a Model MediCORE Administration Manual.
(2) Contents.--The Manual developed under paragraph (1)
shall contain--
(A) recommendations, models, policies and
procedures, in sufficient detail, concerning all
aspects of the administration required for a State
program covering CORE SERVICES so as to avoid any
unnecessary duplication of development effort by
States;
(B) sample requests for proposals and model
selection criteria for a claims administrator, managed
care vendors, health care provider networks and
regional or areawide providers of highly specialized or
tertiary health services;
(C) model fee schedules with respect to all
professional and ancillary health services (such
schedules shall allow for regional cost differences);
(D) model payment systems with respect to
hospitals, skilled nursing facilities and other health
care facilities, developed in a manner that would
encourage the efficient bundling of services;
(E) outcome review procedures that may be
implemented by the States through the establishment of
a State outcome review panel;
(F) ethical consideration policies that may be
implemented by the States through the establishment of
a State Medical Ethics Panel; and
(G) any other information determined appropriate by
the Board.
(3) Time for provision of manuals.--With respect to the
Manual developed under paragraph (1)--
(A) an initial draft of such Manual shall be
provided to the States for comment not later than 12
months after the date of enactment of this Act; and
(B) the final draft of such Manual shall be
provided to the States not later than 14 months after
the date of enactment of this Act.
(f) National Data Bank Data System.--
(1) Establishment.--Not later than 12 months after the date
of enactment of this Act, the Board, in consultation with the
National Institutes of Health and the Health Care Financing
Administration, shall establish and administer the operation of
a National Data Bank System.
(2) Functions.--The National Data Bank System shall--
(A) function as the nationwide repository for
health care data and information collected under this
Act;
(B) collect information, with respect to State
programs, concerning--
(i) comprehensive individual medical
records, available health insurance and
delivery plans and health services under such
plans, and administrative data including
claims, billing and electronic billing
information; and
(ii) outcomes analyses that detail the
effectiveness, efficiency, viability and
ethical considerations involved in medical
treatments, technology and practice; and
(C) assist in conducting and supervising the
studies required under subsection (g).
(g) Studies.--
(1) In general.--
(A) General report.--Not later than 18 months after
the date of enactment of this Act, the Board, acting
through the National Data Bank System, if appropriate,
shall prepare and submit to the Secretary and the
appropriate committees of Congress, a report concerning
the studies conducted under this paragraph.
(B) National service and home health care.--The
Board, acting through the National Data Bank System, if
appropriate, either directly or in consultation and
cooperation with the Commission on National and
Community Service, shall conduct studies or
demonstration projects concerning--
(i) the feasibility and desirability of
instituting a national service program under
which individuals under the age of 25 who are
not serving in the armed forces would
coordinate with other home health service
providers to provide assistance to disabled or
older individuals in their homes; and
(ii) the feasibility and desirability of
providing financial assistance to families that
care for and provide financial assistance to
disabled or older individuals in their homes,
evaluated both as a cost savings measure and as
an avenue to improve the quality of care and
quality of life of such individuals.
(C) Other studies.--The Board, acting through the
National Data Bank System, if appropriate, shall
conduct, either directly or through grant or contract,
studies to determine the feasibility and desirability
of--
(i) authorizing certain States to implement
statewide demonstration health delivery
programs, consistent with the MediCORE program,
prior to the full implementation of this Act as
models for the MediCORE program;
(ii) implementing a program to provide for
reduced deductibles or other cost-sharing
mechanisms with respect to CORE SERVICES for
individuals or families certified as being free
of substance use or as abiding by a specified
physical fitness program; and
(iii) including health information on a
MediCORE card pursuant to section 102(b)(3),
particularly as it relates to the privacy
interests of individuals.
(2) Immigrants and early retirees.--Not later than 14
months after the date of enactment of this Act, the Board,
acting through the National Data Bank System, if appropriate,
shall conduct a study, and prepare and submit to the Secretary
and the appropriate committees of Congress a report,
concerning--
(A) the provision of CORE SERVICES to illegal
immigrants and, if appropriate, the implementation of a
system to compensate those States with the highest
incidence of resident illegal immigrants for such
services; and
(B) the implementation of procedures for the
appropriate recapture of the costs of coverage of CORE
SERVICES provided to employees retired on the date
described in section 801, and those who retire after
such date, and further procedures, to be developed with
the Secretary of the Treasury, for the equitable
treatment of those retirees who have contractual
agreements with their former employers for the
provision of such health care to ensure that the
employees are treated fairly with respect to taxation
on their retirement income under this Act.
(3) Veterans affairs.--
(A) Study.--The Board shall, either directly or
through grant or contract, conduct a study of the role
of the Department of Veterans Affairs, and its
independent medical care system for veterans under
title 38, United States Code, as it relates to the
MediCORE program under this Act.
(B) Conduct.--In conducting the study under
subparagraph (A), the Board shall--
(i) recognize and maintain the independent
responsibility of the Department of Veterans
Affairs for the special health care needs and
rights of veterans, its unique and long-
standing contributions to the health of the
United States through medical and mental health
care, medical research and health professional
education, and its function as the primary
back-up to military medicine in time of war;
(ii) identify opportunities for entering
into health care, research and education
sharing arrangements with the Department of
Veterans Affairs to optimize the use of medical
and mental health resources in the United
States;
(iii) consider the manner in which the cost
containment features of the MediCORE program
under this Act and of the Department of
Veterans Affairs may be coordinated and
integrated in the interest of containing
national health care costs; and
(iv) review the findings of the Department
of Veterans Affairs Commission on the Future
Structure of Veterans Health Care, the
Paralyzed Veterans of America, study entitled
``The VA: Responsibility in Tomorrow's National
Health Care System,'' and such other
publications as it considers appropriate.
(C) Study.--Not later than 36 months after the date
of enactment of this Act, the Board shall prepare and
submit to the Secretary and the appropriate committees
of Congress a report, concerning the results of the
study conducted under this paragraph.
(4) Malpractice reform.--
(A) Study and model legislation.--The Board shall
conduct a study of Federal and State medical
malpractice laws and proposals for the reform of such
laws. Not later than 24 months after the date of
enactment of this Act, the Board shall develop a model
malpractice alternative dispute/claims dispute
resolution reform law or laws for the guidance of the
States. In developing such model law or laws, the Board
shall consider--
(i) alternative dispute resolution systems
and coordination with State claims dispute
resolution systems;
(ii) State tort reforms;
(iii) payments of future damages;
(iv) caps on noneconomic damages;
(v) caps on punitive damages and payment of
punitive damages to States for use in
monitoring, disciplining and educating of
health care providers;
(vi) collateral source rules;
(vii) restrictions on attorney fees,
including contingency fees, and costs;
(viii) statutes of limitations;
(ix) patient protection and disciplinary
reforms and coordination with professional
self-regulation;
(x) joint and several liability;
(xi) community and migrant health care
centers and risk retention groups;
(xii) practice guidelines and quality
assurance;
(xiii) products liability protections for
medical products; and
(xiv) others matters determined
appropriate.
(B) Grants.--The Board shall award grants to
selected States from amounts available under the
MediCORE Trust Fund for the development or
implementation of State malpractice alternative
dispute/claims dispute resolution systems under
regulations to be adopted by the Board. The Board shall
monitor and evaluate the effectiveness of State systems
and prepare reports concerning such systems to be
included in the annual report required under subsection
(h).
(C) Implementation.--Not later than 2 years after
the development of the model law or laws under
subparagraph (A), a State shall enact and implement a
malpractice alternative dispute/claims dispute
resolution system that the Board determined is in
substantial conformity with the requirements and
guidelines of the Board as developed under
subparagraphs (A) and (B).
(D) Enforcement.--If the Board determines that a
State has not complied with the requirements of
subparagraph (C), the Board may not grant the approval
required in title V.
(5) Coordination of programs.--
(A) In general.--The Board shall conduct a study of
any agencies of the Department of Health and Human
Services, including the Health Care Financing
Administration and the Agency for Health Care Policy
and Research, and any other department and agency of
the Federal Government, to calculate the various
programs and activities of such department and
agencies, and to recommend how best to coordinate any
of such programs and activities with the MediCORE Board
and the MediCORE program under this Act. Such study
shall determine which activities and programs should be
retained, repealed or reorganized, and which should be
consigned to State responsibility. Within such study,
the Board shall review any ongoing studies being
conducted by such departments and agencies, and in
particular the debit/credit card study of the Health
Care Finance Administration, to determine the
feasibility and desirability of such within the
MediCORE program.
(B) Report.--Not later than 14 months after the
date of enactment of this Act, the Board shall prepare
and submit to the Secretary and the appropriate
committees of Congress a report concerning the results
of the study completed under this subparagraph (A).
(6) Ethical guidelines.--
(A) In general.--The Board shall conduct a study
concerning the feasibility and desirability of
establishing ethical guidelines on medical and
biomedical issues (such as cutting edge lifesaving
techniques and biotechnology procedures) that are
consistent with the MediCORE program. Such study shall
focus on whether the guidelines can be established
prior to the full implementation of this Act and be
utilized as an ethical model for the MediCORE program.
In conducting such study, the Board shall conduct a
review of existing medical ethical studies completed or
currently being done within the United States and
foreign nations (such as France).
(B) Report.--Not later than 18 months after the
date of enactment of this Act, the Board shall prepare
and submit to the Secretary and the appropriate
committees of Congress a report concerning the results
of the study completed under this subparagraph (A).
(7) Primary care.--
(A) In general.--The Board shall conduct a study
concerning the feasibility and desirability of
establishing, consistent with the MediCORE program and
prior to the full implementation of this Act--
(i) recruitment guidelines to encourage or
provide incentives for medical students to
enter into primary care services; and
(ii) guidelines to attract the physician
manpower necessary to insure Americans have
access to continued health care and preliminary
health care, which may include guidelines for--
(I) expanding the National Health
Service Corps;
(II) providing increased funding
for innovative training schedules;
(III) developing recruitment
policies to increase the number of
minority primary care physicians; and
(IV) the development of flexible
loan and loan repayment policies.
In conducting such study the Board shall review primary
care physician shortages in inner-city and rural areas.
(B) Report.--Not later than 18 months after the
date of enactment of this Act, the Board shall prepare
and submit to the Secretary and the appropriate
committees of Congress a report concerning the results
of the study completed under this subparagraph (A).
(h) Annual Report.--The Board shall annually prepare and submit to
the appropriate committees of Congress a report entitled ``The State of
the Nation's Health Care Services'' which shall concern the
effectiveness of the MediCORE program and the improvement in health
care quality and cost effectiveness of CORE SERVICES provided under
such program.
SEC. 203. ORGANIZATION.
(a) In General.--The Board may organize itself into such
subcommittees as the Board determines are appropriate for the efficient
and effective administration of the requirements of this Act.
(b) Subcommittees.--In addition to any subcommittees established
under subsection (a), the Board shall establish--
(1) a MediCORE Fund Administration Subcommittee that shall
be responsible for the day to day administration of this Act
and the development of policies and guidelines for such
administration, including revenue, payment and reimbursement
policies, with special emphasis being placed on the
administration of the MediCORE Trust Fund; and
(2) a MediCORE Health Policy Subcommittee that shall be
responsible for--
(A) the development of health policy
recommendations;
(B) performance outcomes analyses that are based on
medical appropriateness determinations and the issuance
of guidelines concerning such determinations, with
special consideration placed on the ethical
implications of the implementation of this Act;
(C) the development of CORE SERVICES
interpretations and access and quality guidelines; and
(D) any other aspects determined appropriate by the
Board.
(c) Advisory Panels.--The Board may establish such advisory panels
as the Board determines appropriate to assist the Board in its duties,
projects or studies.
TITLE III--CORE SERVICES
SEC. 301. CORE SERVICES.
(a) Review.--The Board shall conduct a detailed review of the
health services and benefits provided or assisted under--
(1) Federal health programs (including programs under
titles XVIII and XIX of the Social Security Act);
(2) health insurance plans available to Federal and State
employees;
(3) other private health insurance plans in general (such
as Blue Cross/Blue Shield); and
(4) such other programs or plans determined appropriate by
the Board;
that are operating or provided on the date of enactment of this Act.
(b) Scope and Content of CORE SERVICES.--The Board shall define the
content and scope of the CORE SERVICES to be as comprehensive as
practicable taking into consideration the monetary constraints of the
MediCORE Trust Fund. In making such definition, the Board shall
consider the estimated costs of the CORE SERVICES and coordinate the
content and scope of such SERVICES to the extent necessary to reconcile
such costs, as outlined in the MediCORE Budget, with the amount of
funds expected to be available with respect to the year involved from
the MediCORE Trust Fund. The MediCORE Budget Report shall contain a
detailed description of the CORE SERVICES as required by title VII.
(c) Specific Components.--In defining the CORE SERVICES to be
provided under this Act under subsection (b), the Board shall include,
subject to such limitations, schedules, formularies, appropriateness
criteria and cost sharing requirements as the Board shall determine
appropriate, the following components:
(1) Medically necessary services.--The CORE SERVICES shall
include those services determined by the Board as being
medically necessary, including prescription drugs, mental
health and substance abuse and rehabilitative services.
(2) Medicare services.--The CORE SERVICES shall include
those services that otherwise would have been provided to
individuals under title XVIII of the Social Security Act prior
to the effective date of the amendments made by section 702 as
reconfigured by the Board in consideration of the MediCORE
budget.
(3) Preventive health care services.--
(A) Specifications.--The CORE SERVICES shall
include minimum preventive health care services
determined appropriate under specifications developed
by the Board taking into consideration the cost-
effectiveness of such services in significantly
reducing preventable illnesses and the administrative
efficiency of providing such services within the scope
of appropriate State programs.
(B) Transition.--Prior to the publication of the
specifications referred to in subparagraph (A), the
preventive health care services that shall be covered
under a State program shall include:
(i) Health screening and immunization
services.--Those screening and immunization
services recommended in the document entitled
``Guide to Clinical Preventive Services''
published by the Preventive Services Task Force
for asyptomatic low-risk pregnant women,
infants and all other age groups. Screening
services shall include the medical history,
physical exam and laboratory or diagnostic
procedures described in the Guide, and dental
screening for individuals under the age of 18.
(ii) Education and counseling services.--
Those education services provided as part of a
public education program administered by the
State that are designed to educate individuals,
including school-aged children, concerning
taking personal responsibility for their
health. Such services shall include the health
aspects of those counseling topics recommended
in the Guide referred to in clause (i) such as
nutrition, exercise, sexual behavior, tobacco
use, substance abuse, injury prevention and the
value of periodic preventive health and dental
care.
(C) State election.--Services required under this
paragraph shall be delivered under a State program in a
manner determined appropriate by the Board. In addition
to the services required under subparagraph (B), a
State may elect to provide enhanced preventive services
for high-risk individuals until such time as such
services are mandated under the guidelines developed
under subparagraph (A). Individual counseling
concerning preventive health care behavior and
intervention should be made available as part of a
State education or public health program or otherwise
incorporated into the delivery of other CORE SERVICES
under the State program.
(4) Long-term health, custodial or personal assistance.--
The Board shall establish specifications and eligibility
criteria with respect to long-term health, custodial or
personal assistance services that may be provided under this
Act. Benefits such as home health, skilled and unskilled care,
respite care and adult day care shall be evaluated by the Board
as options to prevent institutionalization and to reduce stress
on families. Guidance will be provided to States with respect
to supplemental insurance and sliding scale supplemental
payments for nursing home care or other additional long-term
care benefits that may not be covered initially under the
MediCORE program.
(5) Catastrophic care.--The Board shall impose a limitation
concerning the amount of expenses for catastrophic care that an
individual shall be liable for with respect to CORE SERVICES
provided under the MediCORE program.
(d) Exclusion of Services.--The Board may not include as part of
CORE SERVICES the hospital care, medical services and domiciliary care
provided to veterans for service-connected disabilities pursuant to
chapter 17 of title 38, United States Code.
(e) Adjustment or Expansion of CORE SERVICES.--The Board shall
annually review the type and level of CORE SERVICES that are required
to be provided under this Act and adjust such SERVICES if the Board
determines that a more efficient or effective use of available
resources is desirable. In undertaking such review and making any
adjustments, the Board shall make available to the States a description
of such adjustments and provide such States with an appropriate period
in which to comment on such adjustments.
SEC. 302. SPECIAL SUPPLEMENTAL FOOD PROGRAM.
(a) In General.--Section 17(c)(1) of the Child Nutrition Act of
1966 (42 U.S.C. 1786(c)(1)) is amended--
(1) in the first sentence, by striking ``may'' and
inserting ``shall''; and
(2) by inserting after the first sentence the following new
sentence: ``Subject to the other provisions of this section, an
eligible individual shall be entitled to receive the full
amount of benefits authorized under this section, except for
those benefits that would otherwise be covered under the
MediCORE Health Act of 1993.''.
(b) Appropriation.--Section 17(g)(1) of such Act is amended by
striking the first sentence and inserting the following new sentences:
``For purposes of providing benefits (except for those benefits that
would otherwise be covered under the MediCORE Health Act of 1993) to
all eligible individuals in the program and otherwise carrying out this
section, there are authorized to be appropriated, and there are
appropriated, to carry out this section such sums as may be necessary
for fiscal year 1992 and each succeeding fiscal year. The Secretary
shall make available the sums described in the previous sentence to
carry out this section.''.
TITLE IV--FEDERAL MEDICORE GUIDELINES
SEC. 401. FEDERAL MEDICORE GUIDELINES.
(a) Procedure.--
(1) Submission to states.--Not later than 14 months after
the date of enactment of this Act, the Board shall publish in
the Federal Register a description of the preliminary Federal
MediCORE guidelines to be implemented by the Board under
section 202(c). Subsequent to such publication, the Board shall
solicit comments from the States concerning the preliminary
guidelines. Not later than 19 months after the date of
enactment of this Act, the Board shall publish in the Federal
Register the final initial Federal guidelines to be implemented
by the Board under section 202(c).
(2) Adjustment of guidelines.--The Board shall periodically
review the Federal MediCORE guidelines developed under this
section and adjust such guidelines as the Board determines
appropriate. In undertaking such review and making any
adjustments, the Board shall make available to the States a
description of such adjustments and provide the States with an
appropriate period in which to comment on such adjustments.
(b) Requirements.--Federal guidelines shall be developed and
implemented by the Board under section 202(c) for the delivery of CORE
SERVICES to ensure that:
(1) Universality.--CORE SERVICES are universally accessible
and delivered in a nondiscriminatory manner.
(2) Portability.--CORE SERVICES, with respect to those
services and benefits provided by the State of primary
residence (as such term is defined in section 101(d)), will be
portable across State lines, except that preventive health care
services and other specific services may be limited to the
State of primary residence.
(3) Single administrator.--With respect to each State with
a program approved under section 501, a single agency is
designated as being responsible for the administration of the
State program, including ensuring that services and payments to
providers are equitably and efficiently delivered under such
programs.
(4) Choice and managed competition.--
(A) Choice of delivery plans.--A State is
encouraged to include two or more CORE SERVICES
delivery plans within the State program to permit
market forces to operate within such State with respect
to health care delivery through managed competition
between such plans.
(B) Consideration by state.--A State should
consider the inclusion of at least one CORE SERVICES
delivery plan that would permit a significant freedom
of choice by consumers with respect to health care
providers (including physicians) for which additional
fees may be assessed by the State. Other plans may
include managed care programs (such as health
maintenance organizations or community health centers)
and health care provider contracts that share
responsibility for cost and outcome management with
health care providers or provider networks.
(C) Provision of information.--A State annually
shall provide information to residents of the State
concerning the CORE SERVICES delivery plans available
within that State. Such information shall be in such
form and contain information of such a nature so as to
permit State residents to seek the highest health care
value within the State for the lowest prices.
(5) Rural and underserved areas.--Rural and underserved
areas, and the disability community, are provided with fair
access to CORE SERVICES on equitable terms.
(6) Private health insurance.--Private insurance covering
health care services that are not otherwise covered under this
Act may be sold in a State.
(7) Cost sharing.--A State program may require or permit
the assessment of premiums, copayments, coinsurance, or annual
deductibles with respect to expenses incurred in the provision
of CORE SERVICES under a program to the extent and in a manner
consistent with specific guidelines to be developed by the
Board. In no event shall cost sharing be permitted with respect
to preventive health care CORE SERVICES. Total cost sharing may
not exceed 15 percent of the cost of CORE SERVICES as
determined in the MediCORE Budget pursuant to section 601. The
cost sharing permitted by this paragraph may be income
sensitive and should decrease as the cost of the care
increases.
(8) Mental health.--A State program shall ensure that CORE
SERVICES include benefits covering medically and
psychologically necessary treatments for mental health services
that are equitable and comparable to benefits offered for any
other illness.
(9) Primary care.--A State program shall ensure that
primary care benefits and services are emphasized and focused
within the State program in accordance with the results of the
study conducted under section 202(g)(7). In complying with this
paragraph, a State shall be encouraged and guided by the Board
in order to develop programs to attract, educate and train more
primary care physicians, and other primary care providers, and
to give the support necessary to retain them in primary care.
TITLE V--APPROVAL AND OVERSIGHT OF STATE PROGRAMS
SEC. 501. APPROVAL AND OVERSIGHT OF STATE PROGRAMS
(a) In General.--The Board shall administer this Act, with respect
to the approval of, and oversight over, State programs, in accordance
with this section.
(b) Submission of Programs.--
(1) In general.--Not later than 19 months after the date of
enactment of this Act, each State shall prepare and submit to
the Board the State program in the State.
(2) Regional programs.--Any State may join with neighboring
States to prepare and submit to the Board a regional program to
operate in all States so joined in lieu of a State program.
(c) Review and Approval of Programs.--Not later than 20 months
after the date of enactment of this Act, the Board shall review the
programs submitted under subsection (b) and determine whether such
programs meet the requirements and guidelines of the Board for
approval. The Board shall not approve such a program unless it
determines that the program provides, consistent with the provisions of
this Act, for the following:
(1) The equitable and efficient delivery of CORE SERVICES
within the State or for the delivery of a defined set of health
care services determined by the Board to be substantially
equivalent to the CORE SERVICES, except that no diminution
shall be permitted with respect to the MediCORE guidelines
concerning preventive health care services included in the CORE
SERVICES. A State may provide additional services and benefits
to supplement CORE SERVICES but the cost of any such additional
services or benefits shall be borne solely by such State and a
State may use demonstrated savings from its MediCORE program to
supplement its CORE SERVICES on terms to be approved by the
Board.
(2) Adequate financing of CORE SERVICES under the program,
including the annual submission of the State program budget to
the Board.
(3) A system by which the State program shall provide all
enrolled individuals within the State with standardized
information about CORE SERVICES under the State program.
(4) Effective cost containment measures and payment
methodologies consistent with the guidelines developed by the
Board.
(5) Adequate administration, including the designation of a
single agency responsible for administration of the program
consistent with the guidelines developed by the Board.
Administrative costs of a State may not exceed 5 percent of the
cost of CORE SERVICES co-determined in the MediCORE Budget
pursuant to section 601.
(6) Adequate quality assurance mechanisms.
(7) Organization of a State procedure to determine capital
needs and recommend allocation of capital to localities and
institutions consistent with the guidelines developed by the
Board.
(8) An organized grievance procedure available to consumers
through which complaints about the organization and
administration of the State program and delivery of CORE
SERVICES covered by the State program may be filed, heard, and
resolved.
(9) A process for developing the State's annual health
budget, fee schedules, cost containment measures, payment
practices, quality assurance mechanisms, grievance procedures,
outcomes review procedures, ethical analyses procedures, and
other relevant aspects of the State program, which process
shall include regular and adequate opportunities in diverse
geographical settings for the citizens of the State to have
their opinions solicited and heard, consistent with the
guidelines developed by the Board.
(10) An agreement, if sufficient capacity exists, with
veterans hospitals to reimburse the hospitals for care, not
required under Federal law, provided to veterans and their
dependents (any such agreement shall not be for charges in
excess of these charged other providers under the State
program).
(11) A process under which self-insured groups may seek
State certification if such groups are made up of at least
1,000 participants and if such groups are provided with health
care benefits, including quality of care, that is at least
equal to that otherwise required under the State program. The
State may require such groups to meet other requirements,
including data collection or surcharge requirements. Self-
insured groups certified by the State shall be reimbursed by
the State in an amount that equals the actual costs incurred in
self-insuring, or 6 percent of the amount the State receives
under section 602 for the fiscal year involved, whichever is
less.
(12) Any other matter determined appropriate by the Board.
In assessing the cost containment measures and payment methodologies of
a State for purposes of paragraph (4), the Board shall consider whether
the State program includes different CORE SERVICES delivery plans as
described in section 401(4)(A) that permit enrollees to be presented
with a choice of delivery plans and allow for health care efficiencies
and effectiveness to result from the competition of such plans.
(d) Annual Review.--Beginning the second year after a State program
under this Act is in operation, and annually thereafter, the Board
shall review such State program and determine whether such program
continues to meet the requirements of this Act. At least 3 months prior
to the conduct of each such review, the Board shall publish a
description of the criteria to be used by the Board in determining
whether a State program complies with the requirements of this Act.
(e) Failure of Approval.--
(1) Resubmission.--If the Board determines that the initial
State program submitted under subsection (b) does not meet the
requirements for approval under subsection (c), the Board shall
provide notice to the State of such failure and the State
shall, not later than 21 months after the date of enactment of
this Act, resubmit such program with the modifications required
by the Board.
(2) Sanctions.--
(A) Resubmission.--If the Board determines that a
State program resubmitted under paragraph (1) does not
meet the requirements for approval under subsection
(c), the Board shall provide notice to the State of
such failure and may place the State program in
receivership under the jurisdiction of the Board or
impose the other sanctions described in subparagraph
(C).
(B) Other failures.--If under a review conducted
under subsection (d) the Board determines that a State
program previously approved under subsection (c) no
longer meets the requirements of such section, the
Board shall provide notice to the State of such failure
and that unless corrective action is taken within a
period of 90 days the sanctions described in
subparagraph (C) may be applied, effective 30 days
after the end of such 90-day period.
(C) Sanctions.--The sanctions described in
subparagraph (B) are--
(i) censure;
(ii) reductions in the future amounts
otherwise payable by the Federal Government
under this Act to the State, but in no event
shall such amount be reduced by more than 5
percent; and
(iii) placing the State program in
receivership under the jurisdiction of the
Board.
For purposes of clause (ii), no reduction shall
result in the contraction of primary or essential CORE
SERVICES as determined appropriate by the Board.
(3) Receivership.--In the event that a State program is
placed in receivership under paragraph (2)(C)(iii), the Board
shall ensure that such program is administered using managed
competition networks determined appropriate by the Board in all
areas in the State except those areas determined to lack
sufficient health care providers.
(f) Payments, Premiums, Copayments, Deductibles, Etc.
(1) Payments.--A State program shall provide for the
payment of CORE service providers according to procedures
established under the State program consistent with the
guidelines developed by the Board.
(2) Mandatory assignment.--Each provider of services or
other practitioner, institution or facility that receives
reimbursement related to CORE SERVICES provided under this Act
shall be considered to have agreed to accept the reimbursement
amount recognized under the State program for the CORE SERVICES
covered under such program as payment in full for such services
and may not impose any charges for such services other than
those permitted with respect to such services under the
procedures established by the State consistent with the
guidelines developed by the Board.
(g) Administration by State.--
(1) In general.--On the January 1 referred to in section
801, and subject to the approval of a State program under
subsection (c), the State shall begin the administration,
management, and supervision of its program under this Act.
(2) Administration by contract.--A State may contract with
a third party or parties (including private health insurance
carriers, claims administrations, and managed care
organizations) or with the MediCORE Fund Administration for the
administration, management, and supervision of its program, but
in no event shall more than one entity be responsible for such
duties with respect to CORE SERVICES provided under the State
program. The Board may waive the single entity claims
processing requirement of the preceding sentence if the Board
determines such action appropriate.
TITLE VI--MEDICORE BUDGET
SEC. 601. MEDICORE BUDGET.
(a) Budgetary Requirement.--The Board shall prepare an annual
MediCORE Budget containing estimates of--
(1) the total expenditures the Board expects to be made
during the calendar year for which the budget is being prepared
by States and the Federal Government for CORE SERVICES under
this Act (including administrative costs); and
(2) the total amount that the Board expects to be available
in the MediCORE Trust Fund for the calendar year for which the
budget is being prepared.
(b) National Average Per Capita Costs.--
(1) In general.--The Board shall compute the national
average per capita cost for each category of the CORE SERVICES
described in section 301(b) using data from the national health
accounts of the Office of National Cost Estimates of the Office
of the Actuary of the Health Care Financing Administration, and
other available data. On the effective date of the repeals
under section 702, the National Data Bank System established
under section 202(f) shall compile and maintain the data
previously collected by the Office of National Cost Estimates
of the Office of the Actuary of the Health Care Financing
Administration.
(2) Adjustments for risk groups.--
(A) In general.--The Board shall develop an
adjustment factor to the national average per capita
costs computed under paragraph (1) for each risk group
(as designated under subparagraph (B)) to reflect the
national average per capita costs for that risk group.
(B) Risk groups.--The Board shall designate a
series of risk groups, determined by age, sex, and
other factors that represent distinct patterns of
health care services and long-term care services
utilization and costs.
(3) State adjustments to national average per capita
costs.--The Board shall develop for each State a factor to
adjust the national average per capita costs for each risk
group to reflect the differing circumstances with respect to
each such State, including--
(A) the number of illegal immigrants in such State;
(B) the number of homeless individuals in such
State;
(C) the overall poverty level of the State;
(D) the percentage of the State that is determined
to be rural and the percentage determined to be urban;
(E) the overall health status of the State; and
(F) other factors determined appropriate by the
Board.
(c) State Total Expenditures.--The Board shall compute for each
State total projected expenditures for each of the CORE SERVICES
described in subsection (a) by multiplying the national average per
capita costs of each risk group designated in subsection (b)(2)(B) by
the State adjustment factors described in subsection (b)(3) by the
number of persons in the State estimated by the Bureau of the Census to
be resident members of each risk group.
(d) Federal Contributions.--
(1) In general.--The Board shall determine the appropriate
Federal health care revenue contribution for each State. The
Federal health care revenue contribution shall be determined by
subtracting the State share from 100 percent of the total State
expenditures for such State for the calendar year involved (as
described under subsection (c)).
(2) State share.--The State share referred to in paragraph
(1) shall not be less than an amount that equals--
(A) the revenue generated under section 3101(c) of
the Internal Revenue Code of 1986 with respect to a
State; and
(B) the State's share of spending under title XVIII
of the Social Security Act in 1995, as adjusted for
each subsequent fiscal year based on the increase in
the Gross Domestic Product for such year and
demographic changes determined relevant by the Board.
(3) State protection.--In determining the amount of the
State share under paragraph (2), the Board shall consider the
ability of the State to provide for the continued operation of
the State program at a level sufficient to provide individuals
within such State with the CORE SERVICES under such program.
(e) Subsequent Calculations.--For each subsequent calendar year
during which a program is in effect in a State, the Board shall make
recomputations under subsections (a), (b), (c), and (d) for the State
at least 7 months before the beginning of such calendar year.
SEC. 602. HEALTH CARE REVENUE SHARE PAYMENTS TO STATES.
(a) In General.--Each State with an approved State program is
entitled to receive, from amounts in the Trust Fund, an amount equal to
the annual Federal share determined under section 601(d) with respect
to each such State.
(b) Use of Funds.--Amounts provided to a State under subsection (a)
and the State share, as defined in section 601(d)(2) shall be used to
carry out the State program in such State.
SEC. 603. MEDICORE TRUST FUND.
(a) Trust Fund Established.--
(1) In general.--There is hereby created on the books of
the Treasury of the United States a trust fund to be known as
the ``MediCORE Trust Fund''. The Trust Fund shall consist of
such gifts and bequests as may be made and such amounts as may
be deposited in, or appropriated to, such Trust Fund as
provided in this Act.
(2) Transfer of amounts equivalent to certain taxes.--
(A) In general.--There are hereby appropriated to
the Trust Fund amounts equivalent to 100 percent of the
taxes imposed under sections 59B, 1401(b), 1401(c),
3101(b), 3101(c), 3111(b), and 3111(c) of the Internal
Revenue Code of 1986.
(B) Additional revenues.--There are appropriated to
the Trust Fund amounts equivalent to the additional
revenues received in the Treasury as the result of the
amendments made by section 604(d) of this Act.
(C) Transfers based on estimates.--The amounts
appropriated by subparagraphs (A) and (B) shall be
transferred from time to time (not less frequently than
monthly) 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 such subparagraphs, 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 subparagraphs.
(3) Transfer of funds.--All amounts, not otherwise
obligated, that remain in the Federal Hospital Insurance Trust
Fund and the Federal Supplemental Medical Insurance Trust Fund
on the first day of the year described in section 801 shall be
transferred to the Trust Fund.
(4) Appropriation of additional sums.--There is hereby
appropriated to the Trust Fund--
(A) on January 1 of the year described in section
801 of MediCORE Health Act of 1992, an amount equal to
the amounts appropriated with respect to titles XVIII
and XIX of the Social Security Act, section 1079 of
title 10, United States Code (CHAMPUS), and chapter 89
of title 5, United States Code, for the fiscal year
ending before such year,
(B) on January 1 of each succeeding year, an amount
equal to the amount determined under this paragraph for
the preceding year increased by the percentage increase
(if any) in Gross Domestic Product.
(5) Incorporation of trust fund provisions.--The provisions
of subsections (b) through (e) of section 1841 of the Social
Security Act (42 U.S.C. 1395t), as in effect on the day before
the date of the enactment of this Act, shall apply to the Trust
Fund in the same manner as such provisions apply to the Federal
Supplemental Medical Insurance Trust Fund, except that any
reference to the Secretary of Health and Human Services or the
Administrator of the Health Care Financing Administration shall
be deemed a reference to the Board.
(b) Expenditures.--
(1) Reservation.--The Board shall reserve 2 percent of
amounts contained in the Trust Fund each fiscal year to provide
supplemental payments to States determined by the Board to be
in need of such supplemental payments. Such payments may be
made by the Board where the Board determines that the amount of
payment to which a State is entitled under section 602 is
inadequate as a result of an unforeseen health emergency or
other increase in health care demand in such State.
(2) To states.--Payments in each calendar year to each
State from the Trust Fund as determined under section 602 are
hereby authorized and appropriated.
(3) Administrative expenses.--There are hereby authorized
and appropriated such sums as are necessary for the
administrative expenses of the Board for each year, not to
exceed 1 percent of the total payments made to the States for
such year as determined under section 602.
(c) Trust Fund Off-Budget.--The receipts and disbursements of the
Trust Fund and the taxes described in subsection (a)(2) shall not be
included in the totals of the budget of the United States Government as
submitted by the President or of the congressional budget and shall be
exempt from any general budget limitation imposed by statute on
expenditures and net lending (budget outlays) of the United States
Government.
SEC. 604. HEALTH CARE REVENUE SHARING PROVISIONS.
(a) Payroll Taxes.--
(1) Tax on employees.--Section 3101 of the Internal Revenue
Code of 1986 (relating to rate of tax on employees) is amended
by redesignating subsections (c) and (d) as subsections (d) and
(e) and by inserting after subsection (b) the following new
subsection:
``(c) MediCORE.--In addition to the taxes imposed by the preceding
subsections, there is hereby imposed on the income of every individual
a tax equal to 2 percent of the wages (as defined in section 3121(a))
received by such individual on or after January 1 of the year described
in section 801 of MediCORE Health Act of 1992, with respect to
employment (as defined in section 3121(b)).''.
(2) Tax on employers.--Section 3111 of such Code (relating
to rate of tax on employers) is amended by redesignating
subsection (c) as subsection (d) and by inserting after
subsection (b) the following new subsection:
``(c) MediCORE.--In addition to the taxes imposed by the preceding
subsections, there is hereby imposed on every employer an excise tax,
with respect to having individuals in such employer's employ, equal to
4 percent of the wages (as defined in section 3121(a)) paid by such
employer during each calendar year beginning on or after January 1 of
the year described in section 801 of MediCORE Health Act of 1992, with
respect to employment (as defined in section 3121(b)).''.
(3) Tax on self-employment income.--Section 1401 of such
Code (relating to rate of tax on self-employment income for
hospital insurance) is amended by redesignating subsection (c)
as subsection (d) and by inserting after subsection (b) the
following new subsection:
``(c) MediCORE.--In addition to the taxes imposed by the preceding
subsections, there shall be imposed for each taxable year beginning on
or after January 1 of the year described in section 801 of MediCORE
Health Act of 1992, on the self-employment income of every individual,
a tax equal to the sum of--
``(1) 2 percent, plus
``(2) 4 percent
of the amount of the self-employment income for such taxable year.''.
(4) Elimination of limit on employer portion of wages or
self-employment income subject to medicore tax.--
(A) Wages.--Subsection (x) of section 3121 of the
Internal Revenue Code of 1986 (relating to applicable
contribution base) is amended by adding at the end
thereof the following new paragraph:
``(3) Medicore.--
``(A) Employee portion.--For purposes of the taxes
imposed by section 3101(c), the applicable contribution
base is--
``(i) $100,000 for the calendar year
beginning on January 1 of the year described in
section 801 of MediCORE Health Act of 1992, and
``(ii) for any calendar year after the
calendar year described in clause (i), the
applicable contribution base for the preceding
year adjusted in the same manner as is used in
adjusting the contribution and benefit base
under section 230(b) of the Social Security
Act.
``(B) Employer portion.--For purposes of the taxes
imposed by section 3111(c), the applicable contribution
base for any calendar year is equal to the remuneration
for employment paid to an individual for such calendar
year.''.
(B) Self-employment income.--Subsection (k) of
section 1402 of such Code (relating to applicable
contribution base) is amended by adding at the end
thereof the following new paragraph:
``(3) Medicore.--
``(A) Employee portion.--For purposes of the taxes
imposed by section 1402(c)(1), the applicable
contribution base is--
``(i) $100,000 for calendar year beginning
on January 1 of the year described in section
801 of MediCORE Health Act of 1992, and
``(ii) for any calendar year after the
calendar year described in clause (i), the
applicable contribution base for the preceding
year adjusted in the same manner as is used in
adjusting the contribution and benefit base
under section 230(b) of the Social Security
Act.
``(B) Employer portion.--For purposes of the tax
imposed by section 1401(c)(2), the applicable
contribution base for any calendar year is equal to the
individual's net earnings from self-employment for such
calendar year.''.
(C) Conforming amendment.--Subsection (c) of
section 6413 of such Code is amended by adding at the
end thereof the following new paragraph:
``(4) Separate application for medicore taxes.--In applying
this subsection with respect to--
``(A) the tax imposed by section 3101(c) (or any
amount equivalent to such tax), and
``(B) so much of the tax imposed by section 3201 as
is determined at a rate not greater than the rate in
effect under section 3101(c),
the applicable contribution base determined under section
3121(x)(3)(A) for any calendar year shall be substituted for
`contribution and benefit base (as determined under section 230
of the Social Security Act)' each place it appears.''.
(5) Additional federal, state, and local employees subject
to medicore taxes.--Section 3121(u) (relating to application of
hospital insurance tax to Federal, State, and local employment)
is amended--
(A) by striking ``sections 3101(b) and 3111(b)'' in
paragraph (1) and inserting ``sections 3101(b),
3101(c), 3111(b), and 3111(c)'',
(B) by striking ``Except as provided in
subparagraphs (B) and (C)'' in paragraph (2)(A) and
inserting ``Except as provided in subparagraph (B)'' ,
and
(C) by striking subparagraphs (C) and (D) of
paragraph (2).
(6) Effective date.--The amendments made by this subsection
shall apply with respect to remuneration paid on or after
January 1 of the year described in section 801 of MediCORE
Health Act of 1992, and with respect to earnings from self-
employment attributable to taxable years beginning on or after
such date.
(b) Individual Tax on Certain Adjusted Gross Income.--
(1) In general.--Subchapter A of chapter 1 of the Internal
Revenue Code of 1986 (relating to normal taxes and surtaxes) is
amended by adding at the end thereof the following new part:
``PART VIII--MEDICORE REVENUE SHARING TAXES
``Sec. 59B. Individual MediCORE tax.
``SEC. 59B. INDIVIDUAL MEDICORE TAX.
``(a) In General.--In the case of an individual, there is hereby
imposed (in addition to any other tax imposed by this subtitle) a tax
equal to the excess (if any) of--
``(1) the tax determined under subsection (b), over
``(2) the sum of--
``(A) the tax imposed under section 3111(c) or
1402(c)(2) for such taxable year with respect to the
wages or self-employment income (as the case may be) of
such individual which does not exceed the applicable
contribution base under section 3121(x)(3)(A) or
1402(k)(3)(A) (as the case may be), plus
``(B) the retiree health care amount available to
the individual for such taxable year.
``(b) Tax on Adjusted Gross Income.--The tax imposed under this
subsection is as follows:
``(1) Married individuals filing joint returns and
surviving spouses.--There is hereby imposed on the adjusted
gross income of--
``(A) every married individual (as defined in
section 7703) who makes a single return jointly with
such individual's spouse under section 6013, and
``(B) every surviving spouse (as defined in section
2(a)),
a tax determined in accordance with the following table:
``If adjusted gross income is: The tax is:
Not over $10,000...............
$0.
Over $10,000 but not over
$11,000.
$0, plus 1% of the excess over
$10,000.
Over $11,000 but not over
$12,000.
$10, plus 2% of the excess over
$11,000.
Over $12,000 but not over
$13,000.
$30, plus 3% of the excess over
$12,000.
Over $13,000 but not over
$14,000.
$60, plus 4% of the excess over
$13,000.
Over $14,000 but not over
$15,000.
$100, plus 5% of the excess
over $14,000.
Over $15,000 but not over
$162,500.
$150, plus 6% of the excess
over $15,000.
``(2) Unmarried individuals (other than surviving
spouses).--There is hereby imposed on the adjusted gross income
of every individual (other than a surviving spouse as defined
in section 2(a)) who is not a married individual (as defined in
section 7703) a tax determined in accordance with the following
table:
``If adjusted gross income is: The tax is:
Not over $7,000................
$0.
Over $7,000 but not over $8,000
$0, plus 1% of the excess over
$7,000.
Over $8,000 but not over $9,000
$10, plus 2% of the excess over
$8,000.
Over $9,000 but not over
$10,000.
$30, plus 3% of the excess over
$9,000.
Over $10,000 but not over
$11,000.
$60, plus 4% of the excess over
$10,000.
Over $11,000 but not over
$12,000.
$100, plus 5% of the excess
over $11,000.
Over $12,000 but not over
$109,500.
$150, plus 6% of the excess
over $12,000.
``(3) Married individuals filing separate returns.--There
is hereby imposed on the adjusted gross income of every married
individual (as defined in section 7703) who does not make a
single return jointly with such individual's spouse under
section 6013, a tax determined in accordance with the following
table:
``If adjusted gross income is: The tax is:
Not over $5,000................
$0.
Over $5,000 but not over $5,500
$0, plus 1% of the excess over
$5,000.
Over $5,500 but not over $6,000
$5, plus 2% of the excess over
$5,500.
Over $6,000 but not over $6,500
$15, plus 3% of the excess over
$6,000.
Over $6,500 but not over $7,000
$30, plus 4% of the excess over
$6,500.
Over $7,000 but not over $7,500
$50, plus 5% of the excess over
$7,000.
Over $7,500 but not over
$81,250.
$75, plus 6% of the excess over
$7,500.
``(c) Retiree Health Care Amounts.--For purposes of subsection
(a)(2)(B), and to the extent provided by regulation, an individual's
retiree health care amount is equal to the amount deposited in the
MediCORE Trust Fund by the individual's employer with respect to such
individual under an agreement with the Secretary.''.
(2) Conforming amendment.--The table of parts of subchapter
A of chapter 1 of such Code is amended by adding at the end
thereof the following new item:
``Part VIII. MediCORE taxes.''.
(3) Effective date.--The amendments made by this subsection
shall apply to taxable years beginning on or after January 1 of
the year described in section 801 of MediCORE Health Act of
1992.
(c) Treatment of Health Care Deductions, Exclusions, and Credits.--
(1) Limitation on exclusion of compensation for injuries or
sickness.--Subsection (a) of section 104 of the Internal
Revenue Code of 1986 (relating to compensation for injuries or
sickness) is amended--
(A) by striking paragraph (3) and inserting the
following new paragraph:
``(3) amounts received through MediCORE for personal
injuries or sickness;'', and
(B) by striking the second sentence thereof.
(2) Termination of exclusion for amounts received under
accident and health plans.--
(A) In general.--Section 105 of such Code (relating
to amounts received under accident and health plans) is
amended--
(i) by striking ``income'' and all that
follows in subsection (a) and inserting
``income.'',
(ii) by striking subsections (b), (e), (f),
(g), and (h), and
(iii) by redesignating subsections (c) and
(i) as subsections (b) and (c), respectively.
(B) Conforming amendment.--Paragraph (6) of section
7871(a)(6) of such Code is amended by striking
subparagraph (A) and by redesignating subparagraphs
(B), (C), and (D) as subparagraphs (A), (B), and (C),
respectively.
(3) Termination of exclusion for contributions by employer
to accident and health plans.--
(A) In general.--Section 106 of such Code (relating
to contributions by employer to accident and health
plans) is repealed.
(B) Conforming amendments.--
(i) Subsection (c) of section 104 of such
Code is amended to read as follows:
``(c) Cross Reference.--
``For exclusion of part of disability
retirement pay from the application of subsection (a)(4) of this
section, see section 1403 of title 10, United States Code (relating to
career compensation laws).''.
(ii) Sections 414(n)(3)(C), 414(t)(2), and
6039D(d)(1) of such Code are each amended by
striking ``106,''.
(4) Limitation on cafeteria plans.--Subsection (g) of
section 125 of such Code (relating to cafeteria plans) is
amended by striking paragraph (2) and by redesignating
paragraphs (3) and (4) as paragraphs (2) and (3), respectively.
(5) Prohibition on use of medicore expenses as business
expense deduction for employer.--Subsection (l) of section 162
of such Code (relating to trade or business expenses) is
amended to read as follows:
``(l) Employer MediCORE Expenses.--No amount paid or incurred with
respect to MediCORE may be allowed as a deduction under this
section.''.
(6) Deduction for medical expenses limited to uncompensated
expenses and employee medicore tax.--
(A) In general.--Subsection (a) of section 213 of
such Code (relating to medical, dental, etc., expenses)
is amended to read as follows:
``(a) Allowance of Deduction.--There shall be allowed as a
deduction the expenses paid during the taxable year, not compensated
for by insurance or otherwise for--
``(1) medical care of the taxpayer, the taxpayer's spouse,
or a dependent of the taxpayer (as defined in section 152), to
the extent that such expenses exceed 7.5 percent of adjusted
gross income, and
``(2) the tax imposed under section 3101(c) or
1402(c)(1).''.
(B) Conforming amendments.--Subsection (d) of
section 213 of such Code (relating to definitions) is
amended--
(i) by inserting ``or'' at the end of
paragraph (1)(A),
(ii) by striking ``, or'' at the end of
paragraph (1)(B) and inserting a period,
(iii) by striking paragraph (1)(C),
(iv) by striking paragraphs (6) and (7) and
by redesignating paragraphs (8) and (9) as
paragraphs (6) and (7), respectively.
(7) Termination of pension payment of medical benefits.--
Subsection (h) of section 401 of such Code (relating to
qualified pension, profit-sharing, and stock bonus plans) is
repealed.
(8) Termination of child health insurance credit.--Clause
(i) of section 32(b)(2)(A) of such Code (relating to health
insurance credit) is amended by inserting ``(0 percent for
taxable years beginning on or after January 1 of the year
described in section 801 of MediCORE Health Act of 1992)''
after ``6 percent''.
(9) Effective date.--The amendments made by this subsection
shall apply with respect to taxable years beginning on or after
January 1 of the year described in section 801 of MediCORE
Health Act of 1992.
TITLE VII--PREPARATION AND SUBMISSION OF MEDICORE BUDGET TO CONGRESS
SEC. 701. PREPARATION AND SUBMISSION.
The Board shall annually prepare and submit to Congress a MediCORE
Budget Report. Such Report shall include a description of--
(1) the content and scope of the CORE SERVICES as required
under title III;
(2) the MediCORE Budget prepared under section 601(a) (1)
and (2);
(3) the national average per capita cost for each category
of the CORE SERVICES as required under section 601(b);
(4) the adjustments for risk groups as required under
section 601(b)(2) (A) and (B);
(5) the State adjustment factor as computed under section
601(b)(3);
(6) the total projected expenditures for each State for
each of the CORE SERVICES as computed under section 601(c); and
(7) the recommended Federal contributions and State share
for each State, including the state protection required under
section 601(d).
SEC. 702. PUBLICATION AND COMMENT.
In preparing the MediCORE Budget Report under section 701, the
Board shall--
(1) not later than 9 months prior to the first January 1
referred to in section 801, and each January 1 thereafter,
publish in the Federal Register the preliminary findings and
recommendations of the Board with respect to the Report;
(2) not later than 2 months after the publication required
under paragraph (1) is made, solicit from each State comments
concerning the published preliminary findings and
recommendations; and
(3) consider the comments received under paragraph (2) in
developing the final MediCORE Budget Report to be submitted to
Congress pursuant to section 703.
SEC. 703. SUBMISSION TO CONGRESS.
(a) In General.--Not later than 4 months prior to the effective
date of the Act referred to in section 801, and prior to January 1 of
each succeeding calendar year, the Board shall submit the final
MediCORE Budget Report to Congress.
(b) Income Requirements.--With respect to a calendar year for which
the Board determines in the MediCORE Budget Report that the Federal
income and administrative expenses required under this Act exceed the
amounts expected to be available from the MediCORE Trust Fund for such
calendar year, the Board shall recommend in the MediCORE Budget Report
one of the following:
(1) That a reduction be made in the CORE SERVICES covered
under section 301 to the extent necessary to meet the
limitation of such Budget, with a description of the details as
to the manner in which such a reduction will be accomplished
(which may include the establishment of restrictions on the
availability of services so as to achieve the greatest possible
social benefit). The Report shall also contain guidelines for
the States as to the methodology of and the cost containment
measures for the States to accomplish the reduction.
(2) That an increase be made in the revenues generated for
deposit into the MediCORE Trust Fund.
(3) That a combination of the measures described in
paragraphs (1) and (2) be implemented.
SEC. 704. ACTION BY CONGRESS.
If Congress fails to act with respect to any increase in funds
recommended under section 703(b)(2) and (3) within 2 months of the date
of the submission of the MediCORE Budget, the Board shall proceed to
reduce the CORE SERVICES covered under section 301 as required by the
recommendation referred to in section 703(b)(1).
TITLE VIII--EFFECTIVE DATE; REPEALS; TRANSITION; RELATION TO ERISA
SEC. 801. EFFECTIVE DATE.
The program established under this Act shall become effective in
each State on January 1 of the first calendar year beginning after the
date that is 24 months after the date of enactment of this Act.
SEC. 802. REPEALS.
(a) In General.--Titles XVIII and XIX of the Social Security Act
and chapter 89 of title 5, United States Code, are repealed.
(b) Repeal of CHAMPUS Provisions.--
(1) Amendments to chapter 55 of title 10.--Sections 1079
through 1083, 1086, and 1097 through 1100 of title 10, United
States Code, are repealed.
(2) Table of sections.--The table of sections at the
beginning of chapter 55 of title 10, United States Code, is
amended by striking out the items relating to the sections
referred to in paragraph (1).
(3) Conforming amendments.--Chapter 55 of title 10, United
States Code, is amended as follows:
(A) Definition.--Section 1072 is amended by
striking out paragraph (4).
(B) Reimbursement of the department of veterans
affairs.--Section 1104(b) is amended--
(i) in the subsection heading, by striking
out ``from CHAMPUS funds''; and
(ii) by striking out ``from funds'' and all
that follows and inserting in lieu thereof
``for medical care provided by the Department
of Veterans Affairs pursuant to such
agreement.''.
(c) Health Care Financing Administration.--Upon the effective date
of the repeals described in subsection (a), the duties and activities
of the Health Care Financing Administration shall be transferred to and
assumed by the Board.
(d) Effective Date.--The repeals and amendments made by this
section shall take effect on the first day of the year described in
section 801.
SEC. 803. AUTHORIZATION OF APPROPRIATIONS AND TRANSITION.
(a) Authorization of Appropriations.--There are authorized to be
appropriated for each of the fiscal years beginning after the effective
date referred to in section 801, such sums as may be necessary to
provide for financial assistance to States in the planning and
development of State programs.
(b) Regulations.--The Board shall issue such regulations as are
necessary to provide for a transition to the MediCORE health care
program established under this Act from the programs repealed under
section 802.
SEC. 804. RELATION TO ERISA.
The provisions of the Employee Retirement Income Security Act are
superseded to the extent inconsistent with the requirements of this
Act.
SEC. 805. RELATION TO OTHER LAWS.
(a) In General.--Notwithstanding any provision of the antitrust
laws, it shall not be considered a violation of the antitrust laws for
a State to develop or implement a State program under this Act.
(b) Definition.--For purposes of subsection (a), the term
``antitrust laws'' means--
(1) the Act entitled ``An Act to protect trade and commerce
against unlawful restraints and monopolies'', approved July 2,
1890, commonly known as the Sherman Act (26 Stat. 209; chapter
647; 15 U.S.C. 1 et seq.);
(2) the Federal Trade Commission Act, approved September
26, 1914 (38 Stat. 717; chapter 311; 15 U.S.C. 41 et seq.);
(3) the Act entitled ``An Act to supplement existing laws
against unlawful restraints and monopolies'', and for other
purposes, approved October 15, 1914, commonly known as the
Clayton Act (38 Stat. 730; chapter 323; 15 U.S.C. 12 et seq.;
18 U.S.C. 402, 660, 3285, 3691; 29 U.S.C. 52, 53); and
(4) any State antitrust laws that would prohibit the State
from carrying out a State program under this Act.
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