[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5348 Introduced in House (IH)]
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.
``(a) Eligibility.--
``(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.
``(2) Default enrollment.--
``(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.
``(a) Offering of Plans.--
``(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).
``(b) Plan Payment.--
``(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.
``(c) Trust Fund.--
``(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').
``(c) Duties.--
``(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.
``(d) Officers.--
``(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.
(a) Premium Collection.--
(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.''.
(c) Employer Funding.--
(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)
----------------------------------------------------------------------------------------------------------------
Average Average
earnings earnings
Average per per Average
earnings employee of employee of earnings
A firm size of: per more than more than per
employee of $21,000 and $42,000 and employee of
$21,000 or not in not in more than
less: excess of excess of $83,000:
$42,000: $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.''.
(g) Effective Date.--
(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.
(c) Membership.--
(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.
(3) Terms.--
(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.
(f) Reports.--
(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.
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