I 

112TH CONGRESS 

2D SESSION H. R. 4160 

To amend the Social Security Act to replace the Medicaid program and 

the Children’s Health Insurance program with a block grant to the 

States, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 7, 2012 

Mr. ROKITA (for himself, Mr. HUELSKAMP, Mr. BROUN of Georgia, and Mr. 

JORDAN) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means, Education and the Workforce, the Judiciary, Natural 

Resources, House Administration, Rules, and Appropriations, 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 to replace the Medicaid 

program and the Children’s Health Insurance program 

with a block grant to the States, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘State Health Flexibility Act of 2012’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Health grants to the States for health care services to indigent individuals. 

‘‘TITLE XXII—BLOCK GRANTS TO STATES FOR HEALTH CARE 

SERVICES TO INDIGENT INDIVIDUALS 

‘‘Sec. 2201. Purpose. 

‘‘Sec. 2202. Grants to States. 

‘‘Sec. 2203. Administrative and fiscal accountability. 

‘‘Sec. 2204. Nondiscrimination provisions. 

‘‘Sec. 2205. Emergency assistance. 

‘‘Sec. 2206. Definitions. 

Sec. 3. Repeal of PPACA, HCERA, and the Federal requirements of Medicaid 

and CHIP. 

Sec. 4. Severability. 

Sec. 5. Effective date. 

3 SEC. 2. HEALTH GRANTS TO THE STATES FOR HEALTH 

4 CARE SERVICES TO INDIGENT INDIVIDUALS. 

5 (a) HEALTH CARE BLOCK GRANT TO STATES.—The 

6 Social Security Act is amended by adding at the end the 

7 following new title: 

8 ‘‘TITLE XXII—BLOCK GRANTS TO 

9 STATES FOR HEALTH CARE 

10 SERVICES TO INDIGENT INDI11 VIDUALS 

12 ‘‘SEC. 2201. PURPOSE. 

13 ‘‘The purpose of this title is to provide Federal finan14 cial assistance to the States, in the form of a single grant, 

15 to allow the States maximum flexibility in providing, and 

16 financing the provision of, health-care-related items and 

17 services to indigent individuals. 


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1 ‘‘SEC. 2202. GRANTS TO STATES. 

2 ‘‘(a) IN GENERAL.—Subject to the requirements of 

3 this title, each State is entitled to receive from the Sec4 retary of the Treasury a grant for each quarter of fiscal 

5 years 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020, 

6 2021, and 2022, in an amount that is equal to 25 percent 

7 of the total amount received by a State under title XIX 

8 and title XXI for fiscal year 2012. 

9 ‘‘(b) APPROPRIATION.—Out of any money in the 

10 Treasury of the United States not otherwise appropriated, 

11 there are appropriated for fiscal years 2013, 2014, 2015, 

12 2016, 2017, 2018, 2019, 2020, 2021 and 2022 such sums 

13 as are necessary for grants under this section. 

14 ‘‘(c) REQUIREMENTS RELATING TO INTERGOVERN15 MENTAL FINANCING.—The Secretary of the Treasury 

16 shall make the transfer of funds under grants under sub17 section (a) directly to each State in accordance with the 

18 requirements of section 6503 of title 31, United States 

19 Code. 

20 ‘‘(d) EXPENDITURE OF FUNDS.— 

21 ‘‘(1) IN GENERAL.—Except as provided in para22 graph (2), amounts received by a State under this 

23 title for any fiscal year shall be expended by the 

24 State in such fiscal year or in the succeeding fiscal 

25 year. 


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1 ‘‘(2) USE OF RAINY DAY FUND PERMITTED.— 

2 Of the amounts received by a State under this title, 

3 the State may set aside, in a separate account, such 

4 amounts as the State deems necessary to provide, 

5 without fiscal limitation, health-care-related items 

6 and services for indigent individuals during— 

7 ‘‘(A) periods of unexpectedly high rates of 

8 unemployment; or 

9 ‘‘(B) periods related to circumstances that 

10 are not described in subparagraph (A) and that 

11 cause unexpected increases in the need for such 

12 items and services for such individuals. 

13 ‘‘(3) FUNDS REMAINING AFTER FISCAL YEAR

14 2022.—If, after 2022, a State has funds in the ac15 count under paragraph (2), the State may only ex16 pend such funds if such funds are used in a manner 

17 that is permitted under subsection (e), as such sub18 section is in effect on September 30, 2022. 

19 ‘‘(e) USE OF FUNDS.—A State may only use the 

20 amounts received under subsection (a) as follows: 

21 ‘‘(1) GENERAL PURPOSE.—For the purpose 

22 under section 2201, including the provision of 

23 health-care-related items and services as required 

24 under section 2205. Nothing in this title shall be 

25 construed as limiting the flexibility of a State to deVerDate Mar 15 2010 03:15 Mar 08, 2012 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4160.IH H4160

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1 termine which providers of such items and services 

2 qualify to receive payment from a grant made to the 

3 State under this title. 

4 ‘‘(2) FUNDING FOR RISK ADJUSTMENT MECHA5 NISMS.—To fund qualified high risk pools, reinsur6 ance pools, or other risk-adjustment mechanisms 

7 used for the purpose of subsidizing the purchase of 

8 private health insurance for the high-risk population. 

9 ‘‘(3) AUTHORITY TO USE PORTION OF FEDERAL

10 ASSISTANCE FOR OTHER WELFARE-RELATED PRO11 GRAMS.— 

12 ‘‘(A) IN GENERAL.—Subject to the limit 

13 under subparagraph (B), to carry out a State 

14 program pursuant to any or all of the following 

15 provisions of law: 

16 ‘‘(i) Part A of title IV of this Act. 

17 ‘‘(ii) Section 1616 of this Act. 

18 ‘‘(iii) The Food and Nutrition Act of 

19 2008. 

20 ‘‘(B) LIMITATION.—A State may not use 

21 more than 30 percent of the amount received 

22 under subsection (a) for a fiscal year to carry 

23 out a State program, or programs, under sub24 paragraph (A). 


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1 ‘‘(C) REQUIREMENTS ON FUNDS.—Any 

2 amounts that are used under subparagraph 

3 (A)— 

4 ‘‘(i) shall not be subject to any of the 

5 requirements of subsection (d), subsection 

6 (f), section 2204, or section 2205; and 

7 ‘‘(ii) shall be subject to— 

8 ‘‘(I) the audit requirements 

9 under section 2203; and 

10 ‘‘(II) any requirements that 

11 apply to Federal funds provided di12 rectly for such State program. 

13 ‘‘(f) MAINTENANCE OF CURRENT LAW RESTRIC14 TIONS ON USE OF FEDERAL FUNDS.— 

15 ‘‘(1) IN GENERAL.— 

16 ‘‘(A) NO FUNDING FOR ABORTIONS.— 

17 None of the funds appropriated in this title 

18 shall be expended for any abortion. 

19 ‘‘(B) NO FUNDS FOR COVERAGE OF ABOR20 TION.—None of the funds appropriated in this 

21 title shall be expended for health benefits cov22 erage that includes coverage of abortion. 

23 ‘‘(C) HEALTH BENEFITS COVERAGE DE24 FINED.—For purposes of this subsection, the 

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1 age of services covered by a managed care pro2 vider or organization pursuant to a contract or 

3 other arrangement. 

4 ‘‘(2) EXCEPTIONS.—The limitations established 

5 in paragraph (1) shall not apply to an abortion— 

6 ‘‘(A) if the pregnancy is the result of an 

7 act of rape or incest; or 

8 ‘‘(B) in the case where a woman suffers 

9 from a physical disorder, physical injury, or 

10 physical illness that would, as certified by a 

11 physician, place the woman in danger of death 

12 unless an abortion is performed, including a 

13 life-endangering physical condition caused by or 

14 arising from the pregnancy itself. 

15 ‘‘(3) STATE FUNDS USED IN CONJUNCTION

16 WITH FEDERAL FUNDS.—The limitations established 

17 in paragraph (1) shall apply to any State funds used 

18 in conjunction with Federal funds appropriated 

19 under this title to provide, or finance the provision 

20 of, health-care-related items and services to indigent 

21 individuals pursuant to section 2201 or subsections 

22 (d)(2), (e)(1), or (e)(2) of section 2202. 

23 ‘‘(4) OPTION TO PURCHASE SEPARATE COV24 ERAGE OR PLAN.—Nothing in this subsection shall 

25 be construed as prohibiting a State from purchasing 


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1 separate coverage for abortions for which funding is 

2 prohibited under this subsection, or a health plan 

3 that includes such abortions, so long as such cov4 erage or plan is paid for entirely using funds not 

5 provided by this title. 

6 ‘‘(5) OPTION TO OFFER COVERAGE OR PLAN.— 

7 Nothing in this subsection shall restrict any health 

8 insurance issuer from offering separate coverage for 

9 abortions for which funding is prohibited under this 

10 subsection, or a health plan that includes such abor11 tions, so long as— 

12 ‘‘(A) premiums for such separate coverage 

13 or plan are paid entirely with funds not pro14 vided by this title; and 

15 ‘‘(B) administrative costs and all services 

16 offered through such separate coverage or plan 

17 are paid for using only premiums collected for 

18 such coverage or plan. 

19 ‘‘(6) CONSCIENCE PROTECTIONS.— 

20 ‘‘(A) None of the funds appropriated in 

21 this Act may be made available to a Federal 

22 agency or program, or to a State or local gov23 ernment, if such agency, program, or govern24 ment subjects any institutional or individual 

25 health care entity to discrimination on the basis 


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1 that the health care entity does not provide, pay 

2 for, provide coverage of, or refer for abortions. 

3 ‘‘(B) In this paragraph, the term ‘health 

4 care entity’ includes an individual physician or 

5 other health care professional, a hospital, a pro6 vider-sponsored organization, a health mainte7 nance organization, a health insurance plan, or 

8 any other kind of health care facility, organiza9 tion, or plan. 

10 ‘‘(g) NO FUNDING FOR ILLEGAL ALIENS.—Except as 

11 provided under this section and section 2205, no funds 

12 appropriated in this title may be used to provide health13 care-related items and services to an alien who is not law14 fully admitted for permanent residence or otherwise per15 manently residing in the United States under color of law. 

16 ‘‘(h) NONENTITLEMENT.—Nothing in this title shall 

17 be construed as providing an individual with an entitle18 ment to health-care-related items and services under this 

19 title. 

20 ‘‘SEC. 2203. ADMINISTRATIVE AND FISCAL ACCOUNT21 ABILITY. 

22 ‘‘(a) AUDITS.— 

23 ‘‘(1) CONTRACT WITH APPROVED AUDITING EN24 TITY.—Not later than October 1, 2013, and annu25 ally thereafter, a State shall contract with an apVerDate Mar 15 2010 03:15 Mar 08, 2012 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4160.IH H4160

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1 proved auditing entity (as defined under paragraph 

2 (3)(B)) for purposes of conducting an audit under 

3 paragraph (2) (with respect to the fiscal year ending 

4 September 30 of such year). 

5 ‘‘(2) AUDIT REQUIREMENT.—Under a contract 

6 under paragraph (1), an approved auditing entity 

7 shall conduct an audit of the expenditures or trans8 fers made by a State from amounts received under 

9 a grant under this title, or from State funds de10 scribed in section 2202(f)(3), with respect to the fis11 cal year which such audit covers, to determine the 

12 extent to which such expenditures and transfers 

13 were expended in accordance with this title. 

14 ‘‘(3) ENTITY CONDUCTING AUDIT.— 

15 ‘‘(A) IN GENERAL.—With respect to a 

16 State, the audit under paragraph (2) shall be 

17 conducted by an approved auditing entity in ac18 cordance with generally accepted auditing prin19 ciples. 

20 ‘‘(B) APPROVED AUDITING ENTITY.—For 

21 purposes of this section, the term ‘approved au22 diting entity’ means, with respect to a State, an 

23 entity that is— 

24 ‘‘(i) approved by the Secretary of the 

25 Treasury; 


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1 ‘‘(ii) approved by the chief executive 

2 officer of the State; and 

3 ‘‘(iii) independent of any Federal, 

4 State, or local agency. 

5 ‘‘(4) SUBMISSION OF AUDIT.—Not later than 

6 December 31, 2013, and annually thereafter, a State 

7 shall submit the results of the audit under para8 graph (2) (with respect to the fiscal year ending on 

9 September 30 of such year) to the State legislature 

10 and to the Secretary of the Treasury. 

11 ‘‘(5) ADDITIONAL ACCOUNTING REQUIRE12 MENTS.—The provisions of chapter 75 of title 31, 

13 United States Code, shall apply to the audit require14 ments of this section. 

15 ‘‘(b) REIMBURSEMENT AND PENALTY.— 

16 ‘‘(1) IN GENERAL.—If, through an audit con17 ducted under subsection (a), an approved auditing 

18 entity finds that any amounts paid to a State under 

19 a grant under this title were not expended in accord20 ance with this title— 

21 ‘‘(A) the State shall pay to the Treasury of 

22 the United States any such amount, plus 10 

23 percent of such amount as a penalty; or 

24 ‘‘(B) the Secretary of the Treasury shall 

25 offset such amount plus the 10 percent penalty 


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1 against any other amount in any other fiscal 

2 year that the State may be entitled to receive 

3 under a grant under this title. 

4 ‘‘(2) MISUSE OF STATE FUNDS.—If, through an 

5 audit conducted under subsection (a), an approved 

6 auditing entity finds that a State violated the re7 quirements of section 2202(f)(3), the State shall pay 

8 to the Treasury of the United States 100 percent of 

9 the amount of State funds that were used in viola10 tion of section 2202(f)(3) as a penalty. Insofar as a 

11 State fails to pay any such penalty, the Secretary of 

12 the Treasury shall offset the amount not so paid 

13 against the amount of any grant otherwise payable 

14 to the State under this title. 

15 ‘‘(c) ANNUAL REPORTING REQUIREMENTS.— 

16 ‘‘(1) IN GENERAL.—Not later than January 31, 

17 2014, and annually thereafter, each State shall sub18 mit to the Secretary of the Treasury and the State 

19 legislature a report on the activities carried out by 

20 the State during the most recently completed fiscal 

21 year with funds received by the State under a grant 

22 under this title for such fiscal year. 

23 ‘‘(2) CONTENT.—A report under paragraph (1) 

24 shall, with respect to a fiscal year— 


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1 ‘‘(A) contain the results of the audit con2 ducted by an approved auditing entity for a 

3 State for such fiscal year, in accordance with 

4 the requirements of subsection (a) of this sec5 tion; 

6 ‘‘(B) specify the amount of the grant made 

7 to the State under this title that is used to 

8 carry out a program under section 2202(e)(3); 

9 and 

10 ‘‘(C) be in such form and contain such 

11 other information as the State determines is 

12 necessary to provide— 

13 ‘‘(i) an accurate description of the ac14 tivities conducted by the State for the pur15 pose described under section 2201 and any 

16 other use of funds permitted under sub17 sections (d) and (e) of section 2202; and 

18 ‘‘(ii) a complete record of the pur19 poses for which amounts were expended in 

20 accordance with this title. 

21 ‘‘(3) CONFORMITY WITH ACCOUNTING PRIN22 CIPALS.—Any financial information in the report 

23 under paragraph (1) shall be prepared and reported 

24 in accordance with generally accepted accounting 


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1 principles, including the provisions of chapter 75 of 

2 title 31, United States Code. 

3 ‘‘(4) PUBLIC AVAILABILITY.—A State shall 

4 make copies of the reports required under this sec5 tion available on a public Web site and shall make 

6 copies available in other formats upon request. 

7 ‘‘(d) FAILURE TO COMPLY WITH REQUIREMENTS.— 

8 The Secretary of the Treasury shall not make any pay9 ment to a State under a grant authorized by section 

10 2202(a)— 

11 ‘‘(1) if an audit for a State is not submitted as 

12 required under subsection (a), during the period be13 tween the date such audit is due and the date on 

14 which such audit is submitted; 

15 ‘‘(2) if a State fails to submit a report as re16 quired under subsection (c), during the period be17 tween the date such report is due and the date on 

18 which such report is submitted; or 

19 ‘‘(3) if a State violates a requirement of section 

20 2202(f), during the period beginning on the date the 

21 Secretary becomes aware of such violation and the 

22 date on which such violation is corrected by the 

23 State. 

24 ‘‘(e) ADMINISTRATIVE SUPERVISION AND OVER25 SIGHT.— 


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1 ‘‘(1) LIMITED ROLE FOR SECRETARY OF TREAS2 URY AND THE ATTORNEY GENERAL.— 

3 ‘‘(A) TREASURY.—The authority of the 

4 Secretary of the Treasury under this title is 

5 limited to— 

6 ‘‘(i) promulgating regulations, issuing 

7 rules, or publishing guidance documents to 

8 the extent necessary for purposes of imple9 menting subsection (a)(3)(B), subsection 

10 (b), and subsection (d); 

11 ‘‘(ii) making quarterly payments to 

12 the States under grants under this title in 

13 accordance with section 2202(a); 

14 ‘‘(iii) approving entities under sub15 section (a)(3)(B) for purposes of the audits 

16 required under subsection (a); 

17 ‘‘(iv) withholding payment to a State 

18 of a grant under subsection (d) or offset19 ting a payment of such a grant to a State 

20 under subsection (b); and 

21 ‘‘(v) exercising the authority relating 

22 to nondiscrimination that is specified in 

23 section 2204(b). 

24 ‘‘(B) ATTORNEY GENERAL.—The authority 

25 of the Attorney General to supervise the 


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1 amounts received by a State under this title is 

2 limited to the authority under section 2204(c). 

3 ‘‘(2) FEDERAL SUPERVISION.— 

4 ‘‘(A) IN GENERAL.—Except as provided 

5 under paragraph (1), an administrative officer, 

6 employee, department, or agency of the United 

7 States (including the Secretary of Health and 

8 Human Services) may not— 

9 ‘‘(i) supervise— 

10 ‘‘(I) the amounts received by the 

11 States under this title; or 

12 ‘‘(II) the use of such amounts by 

13 the States; or 

14 ‘‘(ii) promulgate regulations or issue 

15 rules in accordance with this title. 

16 ‘‘(B) LIMITATION ON SECRETARY OF

17 HEALTH AND HUMAN SERVICES.—The Sec18 retary of Health and Human Services shall 

19 have no authority over any provision of this 

20 title. 

21 ‘‘(f) RESERVATION OF STATE POWERS.—Nothing in 

22 this section shall be construed to limit the power of a 

23 State, including the power of a State to pursue civil and 

24 criminal penalties under State law against any individual 


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1 or entity that misuses, or engages in fraud or abuse re2 lated to, the funds provided to a State under this title. 

3 ‘‘SEC. 2204. NONDISCRIMINATION PROVISIONS. 

4 ‘‘(a) NO DISCRIMINATION AGAINST INDIVIDUALS.— 

5 No individual shall be excluded from participation in, de6 nied the benefits of, or subjected to discrimination under, 

7 any program or activity funded in whole or in part with 

8 amounts paid to a State under this title on the basis of 

9 such individual’s— 

10 ‘‘(1) disability under section 504 of the Reha11 bilitation Act of 1973 (29 U.S.C. 794); 

12 ‘‘(2) sex under title IX of the Education 

13 Amendments of 1972 (20 U.S.C. 1681 et seq.); or 

14 ‘‘(3) race, color, or national origin under title 

15 VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d 

16 et seq.). 

17 ‘‘(b) COMPLIANCE.— 

18 ‘‘(1) If the Secretary of the Treasury deter19 mines that a State or an entity that has received 

20 funds from amounts paid to a State under a grant 

21 under this title has failed to comply with a provision 

22 of law referred to in subsection (a), the Secretary of 

23 the Treasury shall notify the chief executive officer 

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1 quest that such chief executive officer secure such 

2 compliance. 

3 ‘‘(2) If, not later than 60 days after receiving 

4 notification under paragraph (1), the chief executive 

5 officer of a State fails or refuses to secure compli6 ance with the provision of law referred to in such 

7 notification, the Secretary of the Treasury may— 

8 ‘‘(A) refer the matter to the Attorney Gen9 eral with a recommendation that an appropriate 

10 civil action be instituted; or 

11 ‘‘(B) exercise the powers and functions 

12 provided under section 505 of the Rehabilita13 tion Act of 1973 (29 U.S.C. 794a), title IX of 

14 the Education Amendments of 1972 (20 U.S.C. 

15 1681 et seq.), or title VI of the Civil Rights Act 

16 of 1964 (42 U.S.C. 2000d et seq.) (as applica17 ble). 

18 ‘‘(c) CIVIL ACTIONS.—If a matter is referred to the 

19 Attorney General under subsection (b)(2)(A), or the At20 torney General has reason to believe that a State or entity 

21 has failed to comply with a provision of law referred to 

22 in subsection (a), the Attorney General may bring a civil 

23 action in an appropriate district court of the United States 

24 for such relief as may be appropriate, including injunctive 

25 relief. 


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1 ‘‘SEC. 2205. EMERGENCY ASSISTANCE. 

2 ‘‘(a) IN GENERAL.—A State that receives a grant 

3 under this title for a fiscal year shall provide payment for 

4 health-care-related items and services provided to a cit5 izen, legal resident, or an alien who is not lawfully admit6 ted for permanent residence or otherwise permanently re7 siding in the United States under color of law, consistent 

8 with the requirements of section 1867, if— 

9 ‘‘(1) such health-care-related items and services 

10 are— 

11 ‘‘(A) necessary for the treatment of an 

12 emergency medical condition; and 

13 ‘‘(B) health-care-related items and services 

14 that such State would provide payment for 

15 under this title, if provided to an indigent indi16 vidual; 

17 ‘‘(2) the individual meets all necessary eligi18 bility requirements for health-care-related items and 

19 services under the State program funded under this 

20 title, except for any requirement related to immigra21 tion status; and 

22 ‘‘(3) such items and services are not related to 

23 an organ transplant procedure. 

24 ‘‘(b) EMERGENCY MEDICAL CONDITION.—For pur25 poses of this section, the term ‘emergency medical condi26 tion’ means a medical condition (including emergency 


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1 labor and delivery) manifesting itself by acute symptoms 

2 of sufficient severity (including severe pain) such that the 

3 absence of immediate medical attention could reasonably 

4 be expected to result in— 

5 ‘‘(1) placing the patient’s health in serious jeop6 ardy; 

7 ‘‘(2) serious impairment to bodily functions; or 

8 ‘‘(3) serious dysfunction of any bodily organ or 

9 part. 

10 ‘‘SEC. 2206. DEFINITIONS. 

11 ‘‘For purposes of this title: 

12 ‘‘(1) HEALTH-CARE-RELATED ITEMS AND SERV13 ICES.—The term ‘health-care-related items and serv14 ices’ shall be defined by a State with respect to use 

15 of such term for purposes of the application of this 

16 title to the State. 

17 ‘‘(2) HIGH-RISK POPULATION.—The term ‘high18 risk population’ means individuals who are described 

19 in one of the following subparagraphs: 

20 ‘‘(A) Individuals who, by reason of the ex21 istence or history of a medical condition, are 

22 able to acquire health coverage only at rates 

23 which are at least 150 percent of the standard 

24 risk rates for such coverage. 


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1 ‘‘(B) Individuals who are provided health 

2 coverage by a qualified high risk pool. 

3 ‘‘(3) INDIGENT INDIVIDUAL.—The term ‘indi4 gent individual’ shall be defined by a State with re5 spect to use of such term for purposes of the appli6 cation of this title to the State. 

7 ‘‘(4) QUALIFIED HIGH RISK POOL.—The term 

8 ‘qualified high risk pool’ has the meaning given such 

9 term in section 2745(g)(1)(A) of the Public Health 

10 Service Act. 

11 ‘‘(5) RISK-ADJUSTMENT MECHANISM DE12 FINED.—For purposes of this section, the term 

13 ‘risk-adjustment mechanism’ means any risk-spread14 ing mechanism to subsidize the purchase of private 

15 health insurance for the high-risk population, includ16 ing a qualified high risk pool.’’. 

17 (b) REPORT ON REDUCTION OF FEDERAL ADMINIS18 TRATIVE EXPENDITURES.—Beginning not later than Oc19 tober 31, 2013, and annually thereafter until October 31, 

20 2022, the Secretary of Health and Human Services, in 

21 consultation with the Secretary of the Treasury, shall sub22 mit a report to the Committee on Energy and Commerce 

23 in the House of Representatives and the Finance Com24 mittee in the Senate containing a description of the total 

25 reduction in Federal expenditures required to administer 


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1 and provide oversight for the programs to provide health2 care-related items and services to indigent individuals 

3 under this Act, compared to the expenditures required to 

4 administer and provide oversight for the programs under 

5 titles XIX and XXI of the Social Security Act, as in effect 

6 on September 30, 2012. 

7 (c) STATE DEFINED.—Section 1101(a)(1) of the So8 cial Security Act (42 U.S.C. 1301(a)(1)) is amended— 

9 (1) in the first sentence, by striking ‘‘and XXI’’ 

10 and inserting ‘‘XXI, and XXII’’; and 

11 (2) in the fourth sentence, by striking ‘‘and 

12 XXI’’ and inserting ‘‘, XXI, and XXII’’. 

13 SEC. 3. REPEAL OF PPACA, HCERA, AND THE FEDERAL RE14 QUIREMENTS OF MEDICAID AND CHIP. 

15 (a) PPACA.—The Patient Protection and Affordable 

16 Care Act (Public Law 111–148) is repealed, and the provi17 sions of law amended or repealed by such Act are restored 

18 or revived as if such Act had not been enacted. 

19 (b) HCERA.—Title I and subtitle B of title II of the 

20 Health Care and Education Reconciliation Act of 2010 

21 (Public Law 111–152) are repealed, and the provisions of 

22 law amended or repealed by such title or subtitle, respec23 tively, are restored or revived as if such title and subtitle 

24 had not been enacted. 


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1 (c) MEDICAID AND CHIP.—Titles XIX and XXI of 

2 the Social Security Act are repealed. 

3 SEC. 4. SEVERABILITY. 

4 If any provision of this Act, or the application of such 

5 provision to any person or circumstance, is found to be 

6 unconstitutional, the remainder of this Act, or the applica7 tion of that provision to other persons or circumstances, 

8 shall not be affected. 

9 SEC. 5. EFFECTIVE DATE. 

10 This Act and the amendments made by this Act shall 

11 take effect with respect to items and services furnished 

12 on or after October 1, 2012. 

Æ 


jbell on DSK7SPTVN1PROD with BILLS