In the Senate of the United States, 

December 3, 2015. 

Resolved, That the bill from the House of Representatives (H.R. 3762) entitled ‘‘An Act to provide for reconciliation pursuant to section 2002 of the concurrent resolution 

on the budget for fiscal year 2016.’’, do pass with the following 

AMENDMENT: 

Strike all after the enacting clause and insert the 

following: 

1 TITLE I—HEALTH, EDUCATION, 

2 LABOR, AND PENSIONS 

3 SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND. 

4 (a) IN GENERAL.—Subsection (b) of section 4002 of 

5 the Patient Protection and Affordable Care Act (42 U.S.C. 

6 300u–11) is amended— 

7 (1) in paragraph (2), by striking ‘‘2017’’ and in8 serting ‘‘2015’’; and 

9 (2) by striking paragraphs (3) through (5). 
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1 (b) RESCISSION OF UNOBLIGATED FUNDS.—Of the 

2 funds made available by such section 4002, the unobligated 

3 balance is rescinded. 

4 SEC. 102. COMMUNITY HEALTH CENTER PROGRAM. 

5 Effective as if included in the enactment of the Medi6 care Access and CHIP Reauthorization Act of 2015 (Public 

7 Law 114–10, 129 Stat. 87), paragraph (1) of section 221(a) 

8 of such Act is amended by inserting after ‘‘Section 

9 10503(b)(1)(E) of the Patient Protection and Affordable 

10 Care Act (42 U.S.C. 254b–2(b)(1)(E)) is amended’’ the fol11 lowing: ‘‘by striking ‘$3,600,000,000’ and inserting 

12 ‘$3,835,000,000’ and’’. 

13 SEC. 103. TERRITORIES. 

14 Section 1323(c) of the Patient Protection and Afford15 able Care Act (42 U.S.C. 18043(c)) is amended by adding 

16 at the end the following: 

17 ‘‘(3) NO FORCE AND EFFECT.—Effective January 

18 1, 2018, this subsection shall have no force or effect.’’. 

19 SEC. 104. REINSURANCE, RISK CORRIDOR, AND RISK AD20 JUSTMENT PROGRAMS. 

21 (a) TRANSITIONAL REINSURANCE PROGRAM FOR INDI22 VIDUAL MARKET.—Section 1341 of the Patient Protection 

23 and Affordable Care Act (42 U.S.C. 18061) is amended by 

24 adding at the end the following: 
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1 ‘‘(e) NO FORCE AND EFFECT.—Effective January 1, 

2 2016, the Secretary shall not collect fees and shall not make 

3 payments under this section.’’. 

4 SEC. 105. SUPPORT FOR STATE RESPONSE TO SUBSTANCE 

5 ABUSE PUBLIC HEALTH CRISIS AND URGENT 

6 MENTAL HEALTH NEEDS. 

7 (a) IN GENERAL.—There are authorized to be appro8 priated, and are appropriated, out of monies in the Treas9 ury not otherwise obligated, $750,000,000 for each of fiscal 

10 years 2016 and 2017, to the Secretary of Health and 

11 Human Services (referred to in this section as the ‘‘Sec12 retary’’) to award grants to States to address the substance 

13 abuse public health crisis or to respond to urgent mental 

14 health needs within the State. In awarding grants under 

15 this section, the Secretary may give preference to States 

16 with an incidence or prevalence of substance use disorders 

17 that is substantial relative to other States or to States that 

18 identify mental health needs within their communities that 

19 are urgent relative to such needs of other States. Funds ap20 propriated under this subsection shall remain available 

21 until expended. 

22 (b) USE OF FUNDS.—Grants awarded to a State under 

23 subsection (a) shall be used for one or more of the following 

24 public health-related activities: 
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1 (1) Improving State prescription drug moni2 toring programs. 

3 (2) Implementing prevention activities, and eval4 uating such activities to identify effective strategies to 

5 prevent substance abuse. 

6 (3) Training for health care practitioners, such 

7 as best practices for prescribing opioids, pain man8 agement, recognizing potential cases of substance 

9 abuse, referral of patients to treatment programs, and 

10 overdose prevention. 

11 (4) Supporting access to health care services pro12 vided by federally certified opioid treatment programs 

13 or other appropriate health care providers to treat 

14 substance use disorders or mental health needs. 

15 (5) Other public health-related activities, as the 

16 State determines appropriate, related to addressing 

17 the substance abuse public health crisis or responding 

18 to urgent mental health needs within the State. 

19 TITLE II—FINANCE 

20 SEC. 201. RECAPTURE EXCESS ADVANCE PAYMENTS OF 

21 PREMIUM TAX CREDITS. 

22 Subparagraph (B) of section 36B(f)(2) of the Internal 

23 Revenue Code of 1986 is amended by adding at the end 

24 the following new clause: 
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1 ‘‘(iii) NONAPPLICABILITY OF LIMITA2 TION.—This subparagraph shall not apply 

3 to taxable years ending after December 31, 

4 2015, and before January 1, 2018.’’. 

5 SEC. 202. PREMIUM TAX CREDIT AND COST-SHARING SUB6 SIDIES. 

7 (a) REPEAL OF PREMIUM TAX CREDIT.—Subpart C 

8 of part IV of subchapter A of chapter 1 of the Internal Rev9 enue Code of 1986 is amended by striking section 36B. 

10 (b) REPEAL OF COST-SHARING SUBSIDY.—Section 

11 1402 of the Patient Protection and Affordable Care Act is 

12 repealed. 

13 (c) REPEAL OF ELIGIBILITY DETERMINATIONS.—The 

14 following sections of the Patient Protection and Affordable 

15 Care Act are repealed: 

16 (1) Section 1411 (other than subsection (i), the 

17 last sentence of subsection (e)(4)(A)(ii), and such pro18 visions of such section solely to the extent related to 

19 the application of the last sentence of subsection 

20 (e)(4)(A)(ii)). 

21 (2) Section 1412. 

22 (d) PROTECTING AMERICANS BY REPEAL OF DISCLO23 SURE AUTHORITY TO CARRY OUT ELIGIBILITY REQUIRE24 MENTS FOR CERTAIN PROGRAMS.— 
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1 (1) IN GENERAL.—Paragraph (21) of section 

2 6103(l) of the Internal Revenue Code of 1986 is 

3 amended by adding at the end the following new sub4 paragraph: 

5 ‘‘(D) TERMINATION.—No disclosure may be 

6 made under this paragraph after December 31, 

7 2017.’’. 

8 (e) EFFECTIVE DATES.— 

9 (1) PREMIUM TAX CREDIT.—The amendment 

10 made by subsection (a) shall apply to taxable years 

11 beginning after December 31, 2017. 

12 (2) COST SHARING-SUBSIDIES AND ELIGIBILITY

13 DETERMINATIONS.—The repeals in subsection (b) and 

14 (c) shall take effect on December 31, 2017. 

15 (3) PROTECTING AMERICANS BY RESCINDING

16 DISCLOSURE AUTHORITY.—The amendments made by 

17 subsection (d) shall take effect on December 31, 2017. 

18 SEC. 203. SMALL BUSINESS TAX CREDIT. 

19 (a) IN GENERAL.—Section 45R of the Internal Rev20 enue Code of 1986 is amended by adding at the end the 

21 following new subsection: 

22 ‘‘(j) SHALL NOT APPLY.—This section shall not apply 

23 with respect to amounts paid or incurred in taxable years 

24 beginning after December 31, 2017.’’. 
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1 (b) EFFECTIVE DATE.—The amendment made by this 

2 section shall apply to amounts paid or incurred in taxable 

3 years beginning after December 31, 2017. 

4 SEC. 204. INDIVIDUAL MANDATE. 

5 (a) IN GENERAL.—Section 5000A(c) of the Internal 

6 Revenue Code of 1986 is amended— 

7 (1) in paragraph (2)(B) by striking clauses (ii) 

8 and (iii) and inserting the following: 

9 ‘‘(ii) Zero percent for taxable years be10 ginning after 2014.’’, and 

11 (2) in paragraph (3)— 

12 (A) by striking ‘‘$695’’ in subparagraph 

13 (A) and inserting ‘‘$0’’, 

14 (B) by striking ‘‘and $325 for 2015’’ in sub15 paragraph (B), and 

16 (C) by striking subparagraph (D). 

17 (b) EFFECTIVE DATE.—The amendments made by this 

18 section shall apply to months beginning after December 31, 

19 2014. 

20 SEC. 205. EMPLOYER MANDATE. 

21 (a) IN GENERAL.— 

22 (1) Paragraph (1) of section 4980H(c) of the In23 ternal Revenue Code of 1986 is amended by inserting 

24 ‘‘($0 in the case of months beginning after December 

25 31, 2014)’’ after ‘‘$2,000’’. 
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1 (2) Paragraph (1) of section 4980H(b) of the In2 ternal Revenue Code of 1986 is amended by inserting 

3 ‘‘($0 in the case of months beginning after December 

4 31, 2014)’’ after ‘‘$3,000’’. 

5 (b) EFFECTIVE DATE.—The amendments made by this 

6 section shall apply to months beginning after December 31, 

7 2014. 

8 SEC. 206. FEDERAL PAYMENTS TO STATES. 

9 (a) IN GENERAL.—Notwithstanding section 504(a), 

10 1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 

11 2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 

12 1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 1397bb(a)(7), 

13 1397ee(a)(1)), or the terms of any Medicaid waiver in effect 

14 on the date of enactment of this Act that is approved under 

15 section 1115 or 1915 of the Social Security Act (42 U.S.C. 

16 1315, 1396n), for the 1-year period beginning on the date 

17 of enactment of this Act, no Federal funds provided from 

18 a program referred to in this subsection that is considered 

19 direct spending for any year may be made available to a 

20 State for payments to a prohibited entity, whether made 

21 directly to the prohibited entity or through a managed care 

22 organization under contract with the State. 

23 (b) DEFINITIONS.—In this section: 
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1 (1) PROHIBITED ENTITY.—The term ‘‘prohibited 

2 entity’’ means an entity, including its affiliates, sub3 sidiaries, successors, and clinics— 

4 (A) that, as of the date of enactment of this 

5 Act— 

6 (i) is an organization described in sec7 tion 501(c)(3) of the Internal Revenue Code 

8 of 1986 and exempt from tax under section 

9 501(a) of such Code; 

10 (ii) is an essential community provider 

11 described in section 156.235 of title 45, 

12 Code of Federal Regulations (as in effect on 

13 the date of enactment of this Act), that is 

14 primarily engaged in family planning serv15 ices, reproductive health, and related med16 ical care; and 

17 (iii) provides for abortions, other than 

18 an abortion— 

19 (I) if the pregnancy is the result 

20 of an act of rape or incest; or 

21 (II) in the case where a woman 

22 suffers from a physical disorder, phys23 ical injury, or physical illness that 

24 would, as certified by a physician, 

25 place the woman in danger of death 
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1 unless an abortion is performed, in2 cluding a life-endangering physical 

3 condition caused by or arising from 

4 the pregnancy itself; and 

5 (B) for which the total amount of Federal 

6 and State expenditures under the Medicaid pro7 gram under title XIX of the Social Security Act 

8 in fiscal year 2014 made directly to the entity 

9 and to any affiliates, subsidiaries, successors, or 

10 clinics of the entity, or made to the entity and 

11 to any affiliates, subsidiaries, successors, or clin12 ics of the entity as part of a nationwide health 

13 care provider network, exceeded $350,000,000. 

14 (2) DIRECT SPENDING.—The term ‘‘direct spend15 ing’’ has the meaning given that term under section 

16 250(c) of the Balanced Budget and Emergency Deficit 

17 Control Act of 1985 (2 U.S.C. 900(c)). 

18 SEC. 207. MEDICAID. 

19 The Social Security Act (42 U.S.C. 301 et seq.) is 

20 amended— 

21 (1) in section 1108(g)(5), by striking ‘‘2019’’ 

22 and inserting ‘‘2017’’; 

23 (2) in section 1902— 

24 (A) in subsection (a)(10)(A), in each of 

25 clauses (i)(VIII) and (ii)(XX), by inserting ‘‘and 
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1 ending December 31, 2017,’’ after ‘‘January 1, 

2 2014,’’; 

3 (B) in subsection (a)(47)(B), by inserting 

4 ‘‘and provided that any such election shall cease 

5 to be effective on January 1, 2018, and no such 

6 election shall be made after that date’’ before the 

7 semicolon at the end; and 

8 (C) in subsection (l)(2)(C), by inserting 

9 ‘‘and ending December 31, 2017,’’ after ‘‘Janu10 ary 1, 2014,’’; 

11 (3) in each of sections 1902(gg)(2) and 

12 2105(d)(3)(A), by striking ‘‘September 30, 2019’’ and 

13 inserting ‘‘September 30, 2017’’; 

14 (4) in section 1905— 

15 (A) in the first sentence of subsection (b), by 

16 inserting ‘‘(50 percent on or after January 1, 

17 2018)’’ after ‘‘55 percent’’; 

18 (B) in subsection (y)(1), by striking the 

19 semicolon at the end of subparagraph (B) and 

20 all that follows through ‘‘thereafter’’; and 

21 (C) in subsection (z)(2)— 

22 (i) in subparagraph (A), by striking 

23 ‘‘each year thereafter’’ and inserting 

24 ‘‘through 2017’’; and 
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1 (ii) in subparagraph (B)(ii), by strik2 ing the semicolon at the end of subclause 

3 (IV) and all that follows through ‘‘100 per4 cent’’; 

5 (5) in section 1915(k)(2), by striking ‘‘during the 

6 period described in paragraph (1)’’ and inserting ‘‘on 

7 or after the date referred to in paragraph (1) and be8 fore January 1, 2018’’; 

9 (6) in section 1920(e), by adding at the end the 

10 following: ‘‘This subsection shall not apply after De11 cember 31, 2017.’’; 

12 (7) in section 1937(b)(5), by adding at the end 

13 the following: ‘‘This paragraph shall not apply after 

14 December 31, 2017.’’; and 

15 (8) in section 1943(a), by inserting ‘‘and before 

16 January 1, 2018,’’ after ‘‘January 1, 2014,’’. 

17 SEC. 208. REPEAL OF DSH ALLOTMENT REDUCTIONS. 

18 Section 1923(f) of the Social Security Act (42 U.S.C. 

19 1396r–4(f)) is amended by striking paragraphs (7) and (8). 

20 SEC. 209. REPEAL OF THE TAX ON EMPLOYEE HEALTH IN21 SURANCE PREMIUMS AND HEALTH PLAN BEN22 EFITS. 

23 (a) IN GENERAL.—Chapter 43 of the Internal Revenue 

24 Code of 1986 is amended by striking section 4980I. 
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1 (b) EFFECTIVE DATE.—The amendment made by sub2 section (a) shall apply to taxable years beginning after De3 cember 31, 2017. 

4 SEC. 210. REPEAL OF TAX ON OVER-THE-COUNTER MEDICA5 TIONS. 

6 (a) HSAS.—Subparagraph (A) of section 223(d)(2) of 

7 the Internal Revenue Code of 1986 is amended by striking 

8 ‘‘Such term’’ and all that follows through the period. 

9 (b) ARCHER MSAS.—Subparagraph (A) of section 

10 220(d)(2) of the Internal Revenue Code of 1986 is amended 

11 by striking ‘‘Such term’’ and all that follows through the 

12 period. 

13 (c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS

14 AND HEALTH REIMBURSEMENT ARRANGEMENTS.—Section 

15 106 of the Internal Revenue Code of 1986 is amended by 

16 striking subsection (f). 

17 (d) EFFECTIVE DATES.— 

18 (1) DISTRIBUTIONS FROM SAVINGS ACCOUNTS.— 

19 The amendments made by subsections (a) and (b) 

20 shall apply to amounts paid with respect to taxable 

21 years beginning after December 31, 2015. 

22 (2) REIMBURSEMENTS.—The amendment made 

23 by subsection (c) shall apply to expenses incurred 

24 with respect to taxable years beginning after Decem25 ber 31, 2015. 
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1 SEC. 211. REPEAL OF TAX ON HEALTH SAVINGS ACCOUNTS. 

2 (a) HSAS.—Section 223(f)(4)(A) of the Internal Rev3 enue Code of 1986 is amended by striking ‘‘20 percent’’ and 

4 inserting ‘‘10 percent’’. 

5 (b) ARCHER MSAS.—Section 220(f)(4)(A) of the Inter6 nal Revenue Code of 1986 is amended by striking ‘‘20 per7 cent’’ and inserting ‘‘15 percent’’. 

8 (c) EFFECTIVE DATE.—The amendments made by this 

9 section shall apply to distributions made after December 31, 

10 2015. 

11 SEC. 212. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO 

12 FLEXIBLE SPENDING ACCOUNTS. 

13 (a) IN GENERAL.—Section 125 of the Internal Revenue 

14 Code of 1986 is amended by striking subsection (i). 

15 (b) EFFECTIVE DATE.—The amendment made by this 

16 section shall apply to taxable years beginning after Decem17 ber 31, 2015. 

18 SEC. 213. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS. 

19 Subsection (j) of section 9008 of the Patient Protection 

20 and Affordable Care Act is amended to read as follows: 

21 ‘‘(j) REPEAL.—This section shall apply to calendar 

22 years beginning after December 31, 2010, and ending before 

23 January 1, 2016.’’. 

24 SEC. 214. REPEAL OF MEDICAL DEVICE EXCISE TAX. 

25 (a) IN GENERAL.—Chapter 32 of the Internal Revenue 

26 Code of 1986 is amended by striking subchapter E. 
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1 (b) EFFECTIVE DATE.—The amendment made by this 

2 section shall apply to sales in calendar quarters beginning 

3 after December 31, 2015. 

4 SEC. 215. REPEAL OF HEALTH INSURANCE TAX. 

5 Subsection (j) of section 9010 of the Patient Protection 

6 and Affordable Care Act is amended to read as follows: 

7 ‘‘(j) REPEAL.—This section shall apply to calendar 

8 years beginning after December 31, 2013, and ending before 

9 January 1, 2016.’’. 

10 SEC. 216. REPEAL OF ELIMINATION OF DEDUCTION FOR EX11 PENSES ALLOCABLE TO MEDICARE PART D 

12 SUBSIDY. 

13 (a) IN GENERAL.—Section 139A of the Internal Rev14 enue Code of 1986 is amended by adding at the end the 

15 following new sentence: ‘‘This section shall not be taken into 

16 account for purposes of determining whether any deduction 

17 is allowable with respect to any cost taken into account in 

18 determining such payment.’’. 

19 (b) EFFECTIVE DATE.—The amendment made by this 

20 section shall apply to taxable years beginning after Decem21 ber 31, 2015. 

22 SEC. 217. REPEAL OF CHRONIC CARE TAX. 

23 (a) IN GENERAL.—Subsection (a) of section 213 of the 

24 Internal Revenue Code of 1986 is amended by striking ‘‘10 

25 percent’’ and inserting ‘‘7.5 percent’’. 
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1 (b) EFFECTIVE DATE.—The amendment made by this 

2 section shall apply to taxable years beginning after Decem3 ber 31, 2015. 

4 SEC. 218. REPEAL OF MEDICARE TAX INCREASE. 

5 (a) IN GENERAL.—Subsection (b) of section 3101 of 

6 the Internal Revenue Code of 1986 is amended to read as 

7 follows: 

8 ‘‘(b) HOSPITAL INSURANCE.—In addition to the tax 

9 imposed by the preceding subsection, there is hereby im10 posed on the income of every individual a tax equal to 1.45 

11 percent of the wages (as defined in section 3121(a)) received 

12 by such individual with respect to employment (as defined 

13 in section 3121(b).’’. 

14 (b) SECA.—Subsection (b) of section 1401 of the Inter15 nal Revenue Code of 1986 is amended to read as follows: 

16 ‘‘(b) HOSPITAL INSURANCE.—In addition to the tax 

17 imposed by the preceding subsection, there shall be imposed 

18 for each taxable year, on the self-employment income of 

19 every individual, a tax equal to 2.9 percent of the amount 

20 of the self-employment income for such taxable year.’’. 

21 (c) EFFECTIVE DATE.—The amendments made by this 

22 section shall apply with respect to remuneration received 

23 after, and taxable years beginning after, December 31, 2015. 
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1 SEC. 219. REPEAL OF TANNING TAX. 

2 (a) IN GENERAL.—The Internal Revenue Code of 1986 

3 is amended by striking chapter 49. 

4 (b) EFFECTIVE DATE.—The amendment made by this 

5 section shall apply to services performed on or after Decem6 ber 31, 2015. 

7 SEC. 220. REPEAL OF NET INVESTMENT TAX. 

8 (a) IN GENERAL.—Subtitle A of the Internal Revenue 

9 Code of 1986 is amended by striking chapter 2A. 

10 (b) EFFECTIVE DATE.—The amendment made by this 

11 section shall apply to taxable years beginning after Decem12 ber 31, 2015. 

13 SEC. 221. REMUNERATION. 

14 Paragraph (6) of section 162(m) of the Internal Rev15 enue Code of 1986 is amended by adding at the end the 

16 following new subparagraph: 

17 ‘‘(I) TERMINATION.—This paragraph shall 

18 not apply to taxable years beginning after De19 cember 31, 2015.’’. 

20 SEC. 222. ECONOMIC SUBSTANCE DOCTRINE. 

21 (a) IN GENERAL.—Subsection (o) of section 7701 of 

22 the Internal Revenue Code of 1986 is repealed. 

23 (b) PENALTY FOR UNDERPAYMENTS.—Paragraph (6) 

24 of section 6662(b) of the Internal Revenue Code of 1986 is 

25 repealed. 
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1 (c) INCREASED PENALTY FOR NONDISCLOSED TRANS2 ACTIONS.—Subsection (i) of section 6662 of the Internal 

3 Revenue Code of 1986 is repealed. 

4 (d) REASONABLE CAUSE EXCEPTION FOR UNDERPAY5 MENTS.—Paragraph (2) of section 6664(c) of the Internal 

6 Revenue Code of 1986 is repealed. 

7 (e) REASONABLE CAUSE EXCEPTION FOR NONDIS8 CLOSED TRANSACTIONS.—Paragraph (2) of section 6664(d) 

9 of the Internal Revenue Code of 1986 is repealed. 

10 (f) ERRONEOUS CLAIM FOR REFUND OR CREDIT.— 

11 Subsection (c) of section 6676 of the Internal Revenue Code 

12 of 1986 is repealed. 

13 (g) EFFECTIVE DATE.—The repeals made by this sec14 tion shall apply to transactions entered into, and to under15 payments, understatements, or refunds and credits attrib16 utable to transactions entered into, after December 31, 2015. 

17 SEC. 223. BUDGETARY SAVINGS FOR EXTENDING MEDICARE 

18 SOLVENCY. 

19 As a result of policies contained in this Act, the Sec20 retary of the Treasury shall transfer to the Federal Hospital 

21 Insurance Trust Fund under section 1817 of the Social Se22 curity Act (42 U.S.C. 1395i) $379,300,000,000 (which rep23 resents the full amount of on-budget savings during the pe-
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1 riod of fiscal years 2016 through 2025) for extending Medi2 care solvency, to remain available until expended. 

Attest: 

Secretary. 
114TH CONGRESS 

1ST SESSION H.R. 3762 

AMENDMENT