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1 

59–006 

" ! HOUSE OF REPRESENTATIVES 

114TH CONGRESS

1st Session 

REPORT

2015

114–293 

RESTORING AMERICANS’ HEALTHCARE 

FREEDOM RECONCILIATION ACT OF 2015 

R E P O R T 

OF THE

COMMITTEE ON THE BUDGET 

HOUSE OF REPRESENTATIVES 

TO ACCOMPANY

H.R. 3762 

A BILL TO PROVIDE FOR RECONCILIATION PURSUANT TO SECTION 2002 OF THE CONCURRENT RESOLUTION ON THE BUDGET 

FOR FISCAL YEAR 2016 

together with 

ADDITIONAL AND MINORITY VIEWS 

OCTOBER 16, 2015.—Committed to the Committee of the Whole House 

on the State of the Union and ordered to be printed 


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COMMITTEE ON THE BUDGET 

TOM PRICE, M.D., Georgia,Chairman 

TODD ROKITA, Indiana,Vice Chairman 

SCOTT GARRETT, New Jersey 

MARIO DIAZ-BALART, Florida 

TOM COLE, Oklahoma 

TOM MCCLINTOCK, California 

DIANE BLACK, Tennessee 

ROB WOODALL, Georgia 

MARSHA BLACKBURN, Tennessee 

VICKY HARTZLER, Missouri 

TOM RICE, South Carolina 

MARLIN A. STUTZMAN, Indiana 

MARK SANFORD, South Carolina 

VERN BUCHANAN, Florida 

STEVE WOMACK, Arkansas 

DAVE BRAT, Virginia 

ROD BLUM, Iowa 

ALEXANDER X. MOONEY, West Virginia 

GLENN GROTHMAN, Wisconsin 

GARY J. PALMER, Alabama 

JOHN R. MOOLENAAR, Michigan 

BRUCE WESTERMAN, Arkansas 

CHRIS VAN HOLLEN, Maryland, 

Ranking Minority Member 

JOHN A. YARMUTH, Kentucky 

BILL PASCRELL, JR., New Jersey 

TIM RYAN, Ohio 

GWEN MOORE, Wisconsin 

KATHY CASTOR, Florida 

JIM MCDERMOTT, Washington 

BARBARA LEE, California 

MARK POCAN, Wisconsin 

MICHELLE LUJAN GRISHAM, New Mexico 

DEBBIE DINGELL, Michigan 

TED LIEU, California 

DONALD NORCROSS, New Jersey 

SETH MOULTON, Massachusetts 

PROFESSIONAL STAFF

RICHARD E. MAY,Staff Director 

THOMAS S. KAHN,Minority Staff Director 


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C O N T E N T S 

Page 

Introduction by the Committee on the Budget ...................................................... 3 

Reconciliation and the Budget Resolution ............................................................. 9 

Title I—Committee on Education and the Workforce .......................................... 14 

Title II—Committee on Energy and Commerce .................................................... 67 

Title III—Committee on Ways and Means ............................................................ 69 

Subtitle A—Revenue Provisions ...................................................................... 73 

Subtitle B—Repeal of the Independent Payment Advisory Board ............... 141 

Committee on the Budget: 

Votes of the Committee on the Budget ........................................................... 189 

Other House Report Requirements ................................................................. 193 

Views of Committee Members ......................................................................... 199 

H.R. 3762, Restoring Americans’ Healthcare Freedom Reconciliation Act of 

2015 ....................................................................................................................... 205


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114TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 114–293 

RESTORING AMERICANS’ HEALTHCARE FREEDOM 

RECONCILIATION ACT OF 2015 

PROVIDING FOR RECONCILIATION PURSUANT TO SECTION 2002 OF THE 

CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2016 

OCTOBER 16, 2015.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. TOM PRICE of Georgia, from the Committee on the Budget, 

submitted the following 

R E P O R T 

together with 

ADDITIONAL AND MINORITY VIEWS 

[To accompany H.R. 3762] 

The Committee on the Budget, to whom reconciliation recommendations were submitted pursuant to section 2002 of S. Con. 

Res. 11, the concurrent resolution on the budget for fiscal year 

2016, having considered the same, reports favorably thereon without amendment and recommends that the bill do pass. 


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1 Because the House and Senate could not agree on a single plan, they had to pass two bills, 

one modifying the other, to create the Affordable Care Act. The two measures were the Patient 

Protection and Affordable Care Act (H.R. 3590, Public Law 111–148) and the Health Care and 

Education Reconciliation Act of 2010 (H.R. 4872, Public Law 111–152). 

INTRODUCTION BY THE 

COMMITTEE ON THE BUDGET 

Clearing the Way for Real Health Care Reform 

The essential failing of Obamacare runs deeper than its distortions of health care delivery and financing, its clumsy rollout, or 

the President’s numerous unilateral changes in the lawafter its enactment. Beneath all these, the fundamental flaw of Obamacare is 

the conceit that Washington could somehow centrally manage a 

vast and complex medical sector serving nearly 320 million diverse 

individuals. That notion has proved a failure. It requires suffocating mandates and regulations. It stifles health care delivery, 

making it less responsive and more costly. Above all, it necessarily 

imposes government dictates on highly personal medical decisions, 

effectively placing a government agent in every examining room 

and alongside every hospital bed. 

That is why Obamacare must be dismantled. The aim is not only 

to reject this illegitimately conceived government expansion, which 

still—more than 5 years after its enactment—lacks the support of 

even a simple majority of the American public. It is not just to replace one national health program with another. The point is to 

discard the entire pretense of nationalized medicine, and recognize 

that health care works best when it promotes the most important 

and basic relationship in medicine—the one between the patient 

and the doctor. Everything else in the $3 trillion health care network—hospitals, nurses, technicians, medical device makers, pharmaceutical companies, researchers, health insurers, and many 

more—revolves around that fundamental partnership. 

Obamacare must be repealed to clear the way for genuine, compassionate, patient-centered health care reform. That is the broader aim of this legislation: the Restoring Americans’ Healthcare 

Freedom Reconciliation Act of 2015. 

Like so much of Washington’s health care policy, this massive 

program—formally called the Affordable Care Act1—was designed 

to satisfy the ivory tower aspirations of academics and protect the 

fortresses of government bureaucracies. Instead of responding to 

the medical needs of real people in the real world, it adds layers 

of rules and directives to further systematize health care as a government-run service. It seeks to control costs from the top down— 

which can only lead to rationing health services—rather than trustVerDate Sep 11 2014 08:07 Oct 17, 2015 Jkt 059006 PO 00000 Frm 00007 Fmt 6601 Sfmt 6601 E:\HR\OC\HR293.XXX HR293

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2See section 6205 of the Conference Report accompanying the Concurrent Resolution on the 

Budget for Fiscal Year 2016 (S. Con. Res. 11). 

ing prices to emerge naturally from the free choices of millions of 

individuals. 

True health care reform can only arise from a different way of 

thinking about it. There is no one strategy for making health care 

more effective and efficient; there is no unified approach, especially 

not by government. True reform can only emerge from the flexibility and innovation of all the participants, always seeking creative ways to advance better and less costly health care. As spelled 

out in the fiscal year 2016 budget resolution, which led to this legislation, policymakers should apply the guiding principles below to 

develop real health care reform.2

Affordability. Real reform should ensure that all Americans, no 

matter their age, income, or health status, can afford health coverage. The health care delivery structure should be improved, and 

individuals should not be priced out of the insurance market due 

to pre-existing conditions. Nationalized health care not only fails to 

accomplish these aims, but in fact undermines them. Individuals 

should be allowed to join together voluntarily to pool risk through 

mechanisms such as Individual Membership Associations and 

Small Employer Membership Associations. 

Accessibility. Instead of Washington dictating to Americans how 

they may or may not use their health insurance, reforms should 

make health coverage more portable. Individuals should be able to 

own their insurance and have it follow them in and out of jobs 

throughout their careers. Small business owners should be permitted to band together across State lines through their membership in bona fide trade or professional associations to purchase 

health coverage for their families and employees at a low cost. This 

will increase small businesses’ bargaining power, volume discounts, 

and administrative efficiencies while giving them freedom from 

State-mandated benefit packages. Also, insurers licensed to sell 

policies in one State should be permitted to offer them to residents 

in any other State; consumers should be permitted to shop for 

health insurance across State lines, as they are with other insurance products online, by mail, by telephone, or in consultation with 

an insurance agent. 

Quality. Incentives for providers to deliver high-quality, responsive, and coordinated care will promote better patient outcomes 

and drive down health care costs. Likewise, reforms should work 

to restore the patient-physician relationship by reducing administrative burdens and allowing physicians to do what they do best: 

care for patients. 

Choices. Genuine reform should free individuals and families to 

secure the health coverage that best meets their needs, rather than 

instituting one-size-fits-all directives from Federal bureaucracies 

such as the Internal Revenue Service, the Department of Health 

and Human Services, and the Independent Payment Advisory 

Board. 


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Innovation. Instead of stifling innovation in health care technologies, treatments, medications, and therapies with Federal mandates, taxes, and price controls, a reformed health care system 

should encourage research, development, and innovation. 

Responsiveness. Reform should vigorously apply the spirit of federalism, returning authority to States wherever possible, to make 

health care more responsive to patients and their needs. Instead of 

tying States’ hands with Federal requirements for their Medicaid 

programs, the Federal Government should return control of this 

program to the States. The current Medicaid Program only drives 

up Federal debt and threatens to bankrupt State budgets. States 

are better positioned to provide quality, affordable care to those eligible for the program and to track down and weed out waste, fraud, 

and abuse. Beneficiary choices in the State Children’s Health Insurance Program [SCHIP] and Medicaid should be improved. 

States should make available the purchase of private insurance as 

an option to their Medicaid and SCHIP populations (though they 

should not require enrollment). 

Legal Reforms. Policymakers should develop reforms that prevent lawsuit abuse and curb the practice of defensive medicine, 

which are significant drivers increasing health care costs. The burden of proof in medical malpractice cases should be based on compliance with best practice guidelines and States should be free to 

implement those policies to best suit their needs. 

The Role of the Committee on the Budget 

As required by the conference agreement accompanying the Concurrent Resolution on the Budget for Fiscal Year 2016 (S. Con. Res. 

11), this reconciliation legislation comprises provisions from three 

committees of the House of Representatives with jurisdiction related to the Affordable Care Act: the Committee on Education and 

the Workforce, the Committee on Energy and Commerce, and the 

Committee on Ways and Means. Each committee met its instruction to achieve at least $1 billion in deficit reduction over 10 years, 

submitting targeted provisions aimed at deconstructing the foundation of the Affordable Care Act. 

At this stage of the process, the role of the Committee on the 

Budget is to determine whether the bill complies with the deficit 

reduction targets in the budget resolution. It then binds together 

the submissions of the three committees into a single bill. The 

Committee on the Budget subsequently reports the combined bill 

to the House with the recommendation that it be passed by the entire House. The Congressional Budget Act of 1974 precludes the 

Committee on the Budget from making any substantive change in 

the bill during the course of its markup. If a change in the reported 

bill is necessary, section 310(d)(5) of the Act prescribes the following procedure: ‘‘The Committee on Rules of the House of Representatives may make in order amendments to achieve changes 

specified by reconciliation directives contained in a concurrent resolution on the budget if a committee or committees of the House fail 

to submit recommended changes to its Committee on the Budget 

pursuant to its instruction.’’ 


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During markup, the Committee on the Budget adopted a motion 

granting the Chairman, at his discretion, the authority to request 

the Committee on Rules to report a rule for consideration of this 

measure that would make in order an amendment to the bill. 

It is not unusual for amendments to budget reconciliation legislation to be made in order at the Rules Committee for reasons other 

than one or more committees failing to meet reconciliation instructions. Amendments often are needed to make technical and conforming changes in complex legislation. At other times, changes are 

needed to address any of the many House and Senate budget rules. 

On occasion, amendments are needed to resolve the inevitable 

interactions among multiple committees’ submissions or to address 

unresolved policy issues. 

The Committees’ Submissions 

The submissions from the three reporting committees detail and 

explain their specific provisions and outline how they fulfill their 

instructions and provide the required amount of deficit reduction 

over the next 10 years. A summary of the provisions is as follows: 

TITLE I: COMMITTEE ON EDUCATION AND THE WORKFORCE

Section 101: Repeal of Automatic Enrollment Requirement. Repeals Section 18A of the Fair Labor Standards Act (29 U.S.C. 

218a), as added by section 1511 of the Affordable Care Act. Section 

1511 requires employers with more than 200 employees to automatically enroll new full-time equivalents into a qualifying health 

plan if offered by that employer, and to automatically continue enrollment of current employees. 

Net Change in Deficit, 2016–2025: ¥$7.9 billion. 

TITLE II: COMMITTEE ON ENERGY AND COMMERCE

Section 201: Repeal Prevention and Public Health Fund. Repeals 

the Prevention and Public Health Fund [PPHF] and rescinds unobligated balances. The PPHF allows the Secretary of Health and 

Human Services to transfer amounts from the fund to Department 

of Health and Human Services accounts to increase funding for 

Public Health Service Act-authorized prevention, wellness, and 

public health activities, including prevention research and health 

screenings. 

Section 202: Federal Payment to States. Prohibits Medicaid reimbursement for 1 year for a defined entity, which includes its affiliates, subsidiaries, successors, and clinics. 

Section 203: Funding for Community Health Center Program. Increases funding to the Community Health Center Fund by $235 

million in each of fiscal years 2016 and 2017, as extended by the 

Medicare Access and CHIP Reauthorization Act (H.R. 2). 

Net Change in Deficit, 2016–2025: ¥$12.4 billion. 


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TITLE III: COMMITTEE ON WAYS AND MEANS

Subtitle A—Revenue Provisions 

Section 301: Repeal Individual Mandate Tax. Repeals the penalty 

on individuals who do not obtain qualified health insurance, effective after 1 December 2014. 

Section 302. Repeal of Employer Mandate. Repeals the penalty on 

employers who do not offer their employees qualified health insurance, effective after 1 December 2014. 

Section 303: Repeal Medical Device Tax. Repeals the 2.3-percent 

excise tax, effective 31 December 2012, on the sale of any taxable 

medical device by a manufacturer, producer, or importer of such 

device. 

Section 304: Repeal of the Excise Tax on Employee Health Insurance Premiums and Health Benefits and Related Reporting Requirements (i.e. the Cadillac Tax). Repeals the 40-percent excise tax on 

high-value health plans. 

Subtitle B—Repeal of the Independent Payment Advisory Board 

Section 311: Repeal Medicare Independent Payment Advisory 

Board [IPAB]. Repeals IPAB, which would have been required 

under certain circumstances to modify the Medicare Program to 

achieve specified savings in the Medicare Program. See also H.R. 

1190, which passed the House on 23 June 2015. 

Net Change in Deficit, 2016–2025: ¥$37.1 billion. 

Due to interactions between the provisions submitted by the 

House committees, an additional net change in the deficit of 

¥$19.4 billion for fiscal years 2016–2025 was determined by the 

Congressional Budget Office. The reconciliation bill’s total net 

change in the deficit for all reported provisions is ¥$78.9 billion 

for fiscal years 2016–2025. 


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3Section 310 of the Congressional Budget Act of 1974 (2 U.S.C. § 641). 

4 H. Rept. 114–096. 

5Sections 2001(a) and 2002(a) of S. Con. Res. 11 (114th Congress). 

RECONCILIATION AND THE 

BUDGET RESOLUTION 

Budget resolutions and reconciliation bills have a special relationship in the congressional budget process. The adoption of a 

budget resolution—formally designated a concurrent resolution on 

the budget—establishes the reconciliation process for a fiscal year 

in addition to providing rules that assist in guiding a reconciliation 

bill through the congressional legislative procedure. Conversely, a 

reconciliation bill may be essential to fulfilling the aims of a given 

budget resolution. 

The Reconciliation Process 

The term ‘‘reconciliation’’ refers to both a form of legislation and 

a specific legislative procedure. Only by adopting a concurrent resolution on the budget that includes reconciliation instructions can 

Congress initiate the reconciliation process,3 ideally culminating in 

the enactment of reconciliation legislation. Such a measure is 

termed a ‘‘reconciliation bill’’ because it is designed to amend existing law to reflect the assumptions underlying the budget resolution 

from which it has commenced; that is, it reconciles current law to 

the budget resolution framework. 

S. Con. Res. 11, the conference report accompanying the Concurrent Resolution on the Budget for Fiscal Year 2016,4 agreed to on 

May 5, 2015, included reconciliation instructions requiring three 

House committees and two Senate committees to amend laws in 

their jurisdictions such that each committee reduces the deficit by 

$1 billion over 10 years.5 Under the procedure, these legislative 

amendments were then to be submitted to the Committees on the 

Budget of the House and Senate by July 24, 2015. 

In the House, the Committee on the Budget accepted submissions from the three reconciled committees—the Committees on 

Education and the Workforce, Energy and Commerce, and Ways 

and Means—on October 2, 2015. The submissions included legislative text, short summaries, Congressional Budget Office estimates, 

and other material to assist the Committee on the Budget in preparing this explanatory report. 

The basic elements of a reconciliation bill are set forth in the 

Congressional Budget Act of 1974 [Budget Act]. Additional guidelines over content and procedures governing consideration may be 

included in budget resolutions. 


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6 Clause 10 of rule XXI of the Rules of the House of Representatives. 

7Section 3101(b)(2) of S. Con. Res. 11 (114th Congress). 

8Section 2002(b)(1)(A) of S. Con. Res. 11 (114th Congress). 

Reconciliation in the House of Representatives 

Reconciliation is defined as a privileged measure in the House 

and hence takes precedence over certain other matters that may be 

considered on the floor. When a bill is reported by the Committee 

on the Budget, comprising the submissions transmitted to it, under 

House Rules such a bill is ‘‘originated’’ rather than ‘‘introduced’’. 

Only certain measures become legislation in this fashion: resolutions providing for consideration of bills on the floor, appropriation 

bills, and budget resolutions are examples. Therefore, a reconciliation bill neither receives an ‘‘H.R.’’ number nor is considered a legislative matter until the Committee on the Budget votes to report 

the bill and formally files it with the Clerk of the House. 

Budget Resolution Adjustment and House Rules. Under normal 

circumstances, all points of order and other procedural budget-related requirements apply to House reconciliation bills. For the 

measure reported by the Committee on the Budget on October 9, 

2015, this is not the case. S. Con. Res. 11 specifically provided for 

the consideration of this bill and took into account its budgetary effects. Therefore, Budget Act points of order, the Cut-As-You-Go 

point of order,6 and the long-term direct spending point of order 

contained in the fiscal year 2016 budget resolution7 do not apply 

to this House reconciliation bill. 

The budget resolution also affirmed and clarified the authority of 

the Chairman of the Committee on the Budget to determine the 

cost estimates of legislative measures.8 In particular, if the Congressional Budget Office makes adjustments to its baseline subsequent to its official publication, the Chairman is authorized to 

make decisions as to how to treat those updates. The intent of the 

provision is to affirm the Chairman’s ability to take into account 

unforeseeable events that may occur and diverge from the assumptions underlying the budget resolution. This has important implications in how the budgetary effects of reconciliation bills are determined. 

Reconciliation and Health Care Legislation. An additional House 

component of the budget resolution entails providing guidance to 

the committees receiving reconciliation instructions. They are 

asked to ‘‘note the policies discussed in the fiscal year 2016 budget 

resolution that repeal the Affordable Care Act and the health care 

related provisions of the Health Care and Education Reconciliation 

Act of 2010’’. 

Reconciliation in the Senate 

The two committees in the Senate that received reconciliation instructions are the Committee on Finance and the Committee on 

Health, Education, Labor, and Pensions. These Senate committees 

generally have commensurate jurisdiction as those in the House, 

and each was required to reduce the deficit by $1 billion over the 

same 10-year period. 


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9Section 3204 of S. Con. Res. 11 (114th Congress). 

10Section 310(a)(3) of the Congressional Budget Act of 1974 authorizes a reconciliation measure to ‘‘specify the amounts by which the statutory limit on the public debt is to be changed 

and direct the committee having jurisdiction to recommend such change.’’ 11The statutory debt limit is set in 31 U.S.C. § 3101. 

Reconciliation and the Deficit Point of Order. The budget resolution amended Senate legislative procedures by repealing the point 

of order against a reconciliation bill increasing the deficit over 5 or 

10 fiscal years.9 This prohibition was originally adopted in the 

110th Congress and was intended to prevent such bills from reducing taxes. The reconciliation bill considered and reported by the 

Committee on the Budget of the House does not increase the deficit 

in either of the periods set forth in the Senate point of order repealed by the budget resolution. 

Debt Limit Prohibition. Under the Congressional Budget Act of 

1974, reconciliation bills are specifically allowed to include changes 

in the public debt limit.10 Section 2001(b)(1) of S. Con. Res. 11, 

though, overturns that authority and instead establishes a point of 

order against including a debt limit increase. The Senate may not 

consider a reconciliation bill, joint resolution, conference report, or 

an amendment, if it would increase the public debt limit in any 

year during the period of fiscal years 2016 through 2025.11

This point of order may be waived, but only if two-thirds of the 

Senate (67 Senators) votes to do so. This supermajority is atypical 

in that most budget-related points of order may be waived by a 

three-fifths vote (60 Senators). 

Conclusion 

The relationship between the concurrent resolution on the budget 

for a fiscal year, and a reconciliation bill that may result from the 

adoption of such a measure, is a significant element of the congressional budget process. Budget resolutions not only initiate the reconciliation procedure, but can set key parameters and guidelines by 

which a reconciliation bill ultimately navigates the sometimes complex legislative process of the U.S. Congress. Conversely, the provisions of a reconciliation bill may be necessary for achieving the 

budget resolution’s goals. Thus, this reconciliation measure represents an important step toward fulfilling the aims of S. Con. Res. 

11, the Concurrent Resolution on the Budget for Fiscal Year 2016. 


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[COMMITTEE PRINT] 

[Budget Reconciliation Legislative Recommendations Relating to Repeal of 

Automatic Enrollment Requirement] 

TITLE I—COMMITTEE ON EDUCATION 

AND THE WORKFORCE 

SEC.l01. REPEAL OF AUTOMATIC ENROLLMENT REQUIREMENT. 

The Fair Labor Standards Act of 1938 (29 U.S.C. 201 et seq.) is 

amended by repealing section 18A (as added by section 1511 of the 

Patient Protection and Affordable Care Act (P.L. 111–148)). 


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CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets and existing law in which no 

change is proposed is shown in roman): 

SECTION 18A OF THE FAIR LABOR STANDARDS ACT OF 

1938 

øSEC. 18A. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF LARGE EMPLOYERS. 

øIn accordance with regulations promulgated by the Secretary, 

an employer to which this Act applies that has more than 200 fulltime employees and that offers employees enrollment in 1 or more 

health benefits plans shall automatically enroll new full-time employees in one of the plans offered (subject to any waiting period 

authorized by law) and to continue the enrollment of current employees in a health benefits plan offered through the employer. Any 

automatic enrollment program shall include adequate notice and 

the opportunity for an employee to opt out of any coverage the individual or employee were automatically enrolled in. Nothing in this 

section shall be construed to supersede any State law which establishes, implements, or continues in effect any standard or requirement relating to employers in connection with payroll except to the 

extent that such standard or requirement prevents an employer 

from instituting the automatic enrollment program under this section.¿ 


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AMENDMENT IN THE NATURE OF A SUBSTITUTE TO THE COMMITTEE

RECOMMENDATIONS FOR THE COMMITTEE ON THE BUDGET

OFFERED BY MS. STEFANIK OF NEW YORK

Strike all after the instruction and insert the following: 

TITLE I—COMMITTEE ON EDUCATION 

AND THE WORKFORCE 

SEC.l01. REPEAL OF AUTOMATIC ENROLLMENT REQUIREMENT. 

The Fair Labor Standards Act (29 U.S.C. 201 et seq.) is amended 

by repealing section 18A (as added by section 1511 of the Patient 

Protection and Affordable Care Act (P.L. 111-148)). 


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57 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets and existing law in which no 

change is proposed is shown in roman): 

PATIENT PROTECTION AND AFFORDABLE CARE ACT 

* * * * * * * 

TITLE IV—PREVENTION OF CHRONIC 

DISEASE AND IMPROVING PUBLIC 

HEALTH 

Subtitle A—Modernizing Disease 

Prevention and Public Health Systems 

* * * * * * * 

øSEC. 4002. PREVENTION AND PUBLIC HEALTH FUND. 

ø(a)PURPOSE.—It is the purpose of this section to establish a Prevention and Public Health Fund (referred to in this section as the 

‘‘Fund’’), to be administered through the Department of Health and 

Human Services, Office of the Secretary, to provide for expanded 

and sustained national investment in prevention and public health 

programs to improve health and help restrain the rate of growth 

in private and public sector health care costs. 

ø(b)FUNDING.—There are hereby authorized to be appropriated, 

and appropriated, to the Fund, out of any monies in the Treasury 

not otherwise appropriated— 

ø(1) for fiscal year 2010, $500,000,000; 

ø(2) for each of fiscal years 2012 through 2017, 

$1,000,000,000; 

ø(3) for each of fiscal years 2018 and 2019, $1,250,000,000; 

ø(4) for each of fiscal years 2020 and 2021, $1,500,000,000; 

and 

ø(5) for fiscal year 2022, and each fiscal year thereafter, 

$2,000,000,000. 

ø(c)USE OF FUND.—The Secretary shall transfer amounts in the 

Fund to accounts within the Department of Health and Human 

Services to increase funding, over the fiscal year 2008 level, for programs authorized by the Public Health Service Act, for prevention, 

wellness, and public health activities including prevention research, health screenings, and initiatives, such as the Community 

Transformation grant program, the Education and Outreach Campaign Regarding Preventive Benefits, and immunization programs. 

ø(d)TRANSFER AUTHORITY.—The Committee on Appropriations of 

the Senate and the Committee on Appropriations of the House of 


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Representatives may provide for the transfer of funds in the Fund 

to eligible activities under this section, subject to subsection (c).¿ 

* * * * * * * 

MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT 

OF 2015 

* * * * * * * 

TITLE II—MEDICARE AND OTHER 

HEALTH EXTENDERS 

* * * * * * * 

Subtitle B—Other Health Extenders 

* * * * * * * 

SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH SERVICE CORPS, AND 

TEACHING HEALTH CENTERS. 

(a)FUNDING FOR COMMUNITY HEALTH CENTERS AND THE NATIONAL HEALTH SERVICE CORPS.— 

(1)COMMUNITY HEALTH CENTERS.—Section 10503(b)(1)(E) of 

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

254b-2(b)(1)(E)) is amendedby striking ‘‘$3,600,000,000’’ and inserting ‘‘$3,835,000,000’’ and by striking ‘‘for fiscal year 2015’’ 

and inserting ‘‘for each of fiscal years 2015 through 2017’’. 

(2)NATIONAL HEALTH SERVICE CORPS.—Section 10503(b)(2)(E) 

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

254b-2(b)(2)(E)) is amended by striking ‘‘for fiscal year 2015’’ 

and inserting ‘‘for each of fiscal years 2015 through 2017’’. 

(b)EXTENSION OF TEACHING HEALTH CENTERS PROGRAM.—Section 

340H(g) of the Public Health Service Act (42 U.S.C. 256h(g)) is 

amended by inserting ‘‘and $60,000,000 for each of fiscal years 

2016 and 2017’’ before the period at the end. 

(c)APPLICATION.—Amounts appropriated pursuant to this section 

for fiscal year 2016 and fiscal year 2017 are subject to the requirements contained in Public Law 113-235 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (42 U.S.C. 254b-256). 

* * * * * * * 


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RECOMMENDATIONS APPROVED BY THE COMMITTEE ON ENERGY AND

COMMERCE FOR TRANSMITTAL TO THE COMMITTEE ON BUDGET

PURSUANT TO SECTION 2002(A)(2) OF THE CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2016 (S. CON. RES. 11) 

TITLE II—COMMITTEE ON ENERGY AND 

COMMERCE 

SEC. 201. REPEAL OF THE PREVENTION AND PUBLIC HEALTH FUND. 

(a) IN GENERAL.—Section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u–11) is repealed. 

(b) RESCISSION OF UNOBLIGATED FUNDS.—Of the funds made 

available by such section 4002, the unobligated balance is rescinded. 

SEC. 202. FEDERAL PAYMENT TO STATES. 

(a) IN GENERAL.—Notwithstanding sections 504(a), 1902(a)(23), 

2002, 2005(a)(4), 2102(a)(7), or 2105(a)(1) of the Social Security Act 

(42 U.S.C. 704(a), 1396b(a)(23), 1397a, 1397d(a)(4), 1397bb(a)(2), 

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

date of enactment of this Act that is approved under section 1115 

or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n), for the 

one-year period beginning on the date of the enactment of this Act 

no Federal funds may be made available to a State for payments 

to a prohibited entity. 

(b) DEFINITION OF PROHIBITED ENTITY.—In this section, the term 

‘‘prohibited entity’’ means an entity, including its affiliates, subsidiaries, successors, and clinics— 

(1) that, as of the date of enactment of this Act— 

(A) is an organization described in section 501(c)(3) of 

the Internal Revenue Code of 1986 and exempt from tax 

under section 501(a) of such Code; 

(B) is an essential community provider described in section 156.235 of title 45, Code of Federal Regulations, that 

is primarily engaged in family planning services, reproductive health, and related medical care; and 

(C) provides for elective abortions; and 

(2) for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social 

Security Act in fiscal year 2014 made directly to the entity and 

to any affiliates, subsidiaries, successors, or clinics of the entity, or made to the entity and to any affiliates, subsidiaries, 

successors, or clinics of the entity as part of a nationwide 

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

SEC. 203. FUNDING FOR COMMUNITY HEALTH CENTER PROGRAM. 

Effective as if included in the enactment of the Medicare Access 

and CHIP Reauthorization Act of 2015 (Public Law 114–10, 129 

Stat. 87), paragraph (1) of section 221(a) of such Act is amended 

by inserting after ‘‘Section 10503(b)(1)(E) of the Patient Protection 

and Affordable Care Act (42 U.S.C. 254b-2(b)(1)(E)) is amended’’ 

the following: ‘‘by striking ‘$3,600,000,000’ and inserting 

‘$3,835,000,000’ and’’. 


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CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (new matter is printed in italics 

and existing law in which no change is proposed is shown in 

roman): 

INTERNAL REVENUE CODE OF 1986 

* * * * * * * 

Subtitle D—Miscellaneous Excise Taxes 

* * * * * * * 

CHAPTER 32—MANUFACTURERS EXCISE 

TAXES 

* * * * * * * 

øSUBCHAPTER E—MEDICAL DEVICES¿ 

* * * * * * * 

øSubchapter E—Medical Devices 

øSEC. 4191. MEDICAL DEVICES. 

ø(a) IN GENERAL.—There is hereby imposed on the sale of any 

taxable medical device by the manufacturer, producer, or importer 

a tax equal to 2.3 percent of the price for which so sold. 

ø(b) TAXABLE MEDICAL DEVICE.—For purposes of this section— 

ø(1) IN GENERAL.—The term ‘‘taxable medical device’’ means 

any device (as defined in section 201(h) of the Federal Food, 

Drug, and Cosmetic Act) intended for humans. 

ø(2) EXEMPTIONS.—Such term shall not include— 

ø(A) eyeglasses, 

ø(B) contact lenses, 

ø(C) hearing aids, and 

ø(D) any other medical device determined by the Secretary to be of a type which is generally purchased by the 

general public at retail for individual use.¿ 

* * * * * * * 

Subchapter G—Exemptions, Registration, Etc 

SEC. 4221. CERTAIN TAX-FREE SALES. 

(a) GENERAL RULE.—Under regulations prescribed by the Secretary, no tax shall be imposed under this chapter (other than 

under section 4121 or 4081) on the sale by the manufacturer (or 

under subchapter C of chapter 31 on the first retail sale) of an article— 


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(1) for use by the purchaser for further manufacture, or for 

resale by the purchaser to a second purchaser for use by such 

second purchaser in further manufacture, 

(2) for export, or for resale by the purchaser to a second purchaser for export, 

(3) for use by the purchaser as supplies for vessels or aircraft, 

(4) to a State or local government for the exclusive use of a 

State or local government, 

(5) to a nonprofit educational organization for its exclusive 

use, or 

(6) to a qualified blood collector organization (as defined in 

section 7701(a)(49)) for such organization’s exclusive use in the 

collection, storage, or transportation of blood, 

but only if such exportation or use is to occur before any other use. 

Paragraphs (4), (5), and (6) shall not apply to the tax imposed by 

section 4064. In the case of taxes imposed by section 4051, or 4071, 

paragraphs (4) and (5) shall not apply on and after October 1, 2016. 

In the case of the tax imposed by section 4131, paragraphs (3), (4), 

and (5) shall not apply and paragraph (2) shall apply only if the 

use of the exported vaccine meets such requirements as the Secretary may by regulations prescribe. In the case of taxes imposed 

by subchapter C or D, paragraph (6) shall not apply. øIn the case 

of the tax imposed by section 4191, paragraphs (3), (4), (5), and (6) 

shall not apply.¿ 

(b) PROOF OF RESALE FOR FURTHER MANUFACTURE; PROOF OF EX- PORT.—Where an article has been sold free of tax under subsection 

(a)— 

(1) for resale by the purchaser to a second purchaser for use 

by such second purchaser in further manufacture, or 

(2) for export, or for resale by the purchaser to a second purchaser for export, 

subsection (a) shall cease to apply in respect of such sale of such 

article unless, within the 6-month period which begins on the date 

of the sale by the manufacturer (or, if earlier, on the date of shipment by the manufacturer), the manufacturer receives proof that 

the article has been exported or resold for use in further manufacture. 

(c) MANUFACTURER RELIEVED FROM LIABILITY IN CERTAIN

CASES.—In the case of any article sold free of tax under this section 

(other than a sale to which subsection (b) applies), and in the case 

of any article sold free of tax under section 4053(6), if the manufacturer in good faith accepts a certification by the purchaser that the 

article will be used in accordance with the applicable provisions of 

law, no tax shall thereafter be imposed under this chapter in respect of such sale by such manufacturer. 

(d) DEFINITIONS.—For purposes of this section— 

(1) MANUFACTURER.—The term ‘‘manufacturer’’ includes a 

producer or importer of an article, and, in the case of taxes imposed by subchapter C of chapter 31, includes the retailer with 

respect to the first retail sale. 

(2) EXPORT.—The term ‘‘export’’ includes shipment to a possession of the United States; and the term ‘‘exported’’ includes 

shipped to a possession of the United States. 


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(3) SUPPLIES FOR VESSELS OR AIRCRAFT.—The term ‘‘supplies 

for vessels or aircraft’’ means fuel supplies, ships’ stores, sea 

stores, or legitimate equipment on vessels of war of the United 

States or of any foreign nation, vessels employed in the fisheries or in the whaling business, or vessels actually engaged in 

foreign trade or trade between the Atlantic and Pacific ports 

of the United States or between the United States and any of 

its possessions. For purposes of the preceding sentence, the 

term ‘‘vessels’’ includes civil aircraft employed in foreign trade 

or trade between the United States and any of its possessions, 

and the term ‘‘vessels of war of the United States or of any foreign nation’’ includes aircraft owned by the United States or by 

any foreign nation and constituting a part of the armed forces 

thereof. 

(4) STATE OR LOCAL GOVERNMENT.—The term ‘‘State or local 

government’’ means any State, any political subdivision thereof, or the District of Columbia. 

(5) NONPROFIT EDUCATIONAL ORGANIZATION.—The term ‘‘nonprofit educational organization’’ means an educational organization described in section 170(b)(1)(A)(ii) which is exempt 

from income tax under section 501(a). The term also includes 

a school operated as an activity of an organization described in 

section 501(c)(3) which is exempt from income tax under section 501(a), if such school normally maintains a regular faculty 

and curriculum and normally has a regularly enrolled body of 

pupils or students in attendance at the place where its educational activities are regularly carried on. 

(6) USE IN FURTHER MANUFACTURE.—An article shall be 

treated as sold for use in further manufacture if— 

(A) such article is sold for use by the purchaser as material in the manufacture or production of, or as a component part of, another article taxable under this chapter to 

be manufactured or produced by him; or 

(B) in the case of gasoline taxable under section 4081, 

such gasoline is sold for use by the purchaser, for nonfuel 

purposes, as a material in the manufacture or production 

of another article to be manufactured or produced by him. 

(7) QUALIFIED BUS.— (A) IN GENERAL.—The term ‘‘qualified bus’’ means— 

(i) an intercity or local bus, and 

(ii) a school bus. 

(B) INTERCITY OR LOCAL BUS.—The term ‘‘intercity or 

local bus’’ means any automobile bus which is used predominantly in furnishing (for compensation) passenger 

land transportation available to the general public if— 

(i) such transportation is scheduled and along regular routes, or 

(ii) the seating capacity of such bus is at least 20 

adults (not including the driver). 

(C) SCHOOL BUS.—The term ‘‘school bus’’ means any 

automobile bus substantially all the use of which is in 

transporting students and employees of schools. For purposes of the preceding sentence, the term ‘‘school’’ means 

an educational organization which normally maintains a 


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regular faculty and curriculum and normally has a regularly enrolled body of pupils or students in attendance at 

the place where its educational activities are carried on. 

(e) SPECIAL RULES.— 

(1) RECIPROCITY REQUIRED IN CASE OF CIVIL AIRCRAFT.—In 

the case of articles sold for use as supplies for aircraft, the 

privileges granted under subsection (a)(3) in respect of civil aircraft employed in foreign trade or trade between the United 

States and any of its possessions, in respect of aircraft registered in a foreign country, shall be allowed only if the Secretary of the Treasury has been advised by the Secretary of 

Commerce that he has found that such foreign country allows, 

or will allow, substantially reciprocal privileges in respect of 

aircraft registered in the United States. If the Secretary of the 

Treasury is advised by the Secretary of Commerce that he has 

found that a foreign country has discontinued or will discontinue the allowance of such privileges, the privileges granted under subsection (a)(3) shall not apply thereafter in respect 

of civil aircraft registered in that foreign country and employed 

in foreign trade or trade between the United States and any 

of its possessions. 

(2) TIRES.— 

(A) TAX-FREE SALES.—Under regulations prescribed by 

the Secretary, no tax shall be imposed under section 4071 

on the sale by the manufacturer of a tire if— 

(i) such tire is sold for use by the purchaser for sale 

on or in connection with the sale of another article 

manufactured or produced by such purchaser; and 

(ii) such other article is to be sold by such purchaser 

in a sale which either will satisfy the requirements of 

paragraph (2), (3), (4), or (5) of subsection (a) for a taxfree sale, or would satisfy such requirements but for 

the fact that such other article is not subject to tax 

under this chapter. 

(B) PROOF.—Where a tire has been sold free of tax under 

this paragraph, this paragraph shall cease to apply unless, 

within the 6-moth period which begins on the date of the 

sale by him (or, if earlier on the date of the shipment by 

him), the manufacturer of such tire receives proof that the 

other article referred to in clause (ii) of subparagraph (A) 

has been sold in a manner which satisfies the requirements of such clause (ii) (including in the case of a sale for 

export, proof of export of such other article). 

(C) SUBSECTION(A)(1) DOES NOT APPLY.—Paragraph (1) of 

subsection (a) shall not apply with respect to the tax imposed under section 4071 on the sale of a tire. 

(3) TIRES USED ON INTERCITY, LOCAL, AND SCHOOL BUSES.— 

Under regulations prescribed by the Secretary, the tax imposed 

by section 4071 shall not apply in the case of tires sold for use 

by the purchaser on or in connection with a qualified bus. 

* * * * * * * 


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CHAPTER 43—QUALIFIED PENSION, ETC., 

PLANS 

* * * * * * * 

øSec. 4980I. Excise tax on high cost employer-sponsored health coverage.¿ 

* * * * * * * 

SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING 

HEALTH COVERAGE. 

(a) LARGE EMPLOYERS NOT OFFERING HEALTH COVERAGE.—If— 

(1) any applicable large employer fails to offer to its full-time 

employees (and their dependents) the opportunity to enroll in 

minimum essential coverage under an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) for any month, 

and 

(2) at least one full-time employee of the applicable large employer has been certified to the employer under section 1411 of 

the Patient Protection and Affordable Care Act as having enrolled for such month in a qualified health plan with respect 

to which an applicable premium tax credit or cost-sharing reduction is allowed or paid with respect to the employee, 

then there is hereby imposed on the employer an assessable payment equal to the product of the applicable payment amount and 

the number of individuals employed by the employer as full-time 

employees during such month. 

(b) LARGE EMPLOYERS OFFERING COVERAGE WITH EMPLOYEES

WHO QUALIFY FOR PREMIUM TAX CREDITS OR COST-SHARING RE- DUCTIONS.— (1) IN GENERAL.—If— 

(A) an applicable large employer offers to its full-time 

employees (and their dependents) the opportunity to enroll 

in minimum essential coverage under an eligible employersponsored plan (as defined in section 5000A(f)(2)) for any 

month, and 

(B) 1 or more full-time employees of the applicable large 

employer has been certified to the employer under section 

1411 of the Patient Protection and Affordable Care Act as 

having enrolled for such month in a qualified health plan 

with respect to which an applicable premium tax credit or 

cost-sharing reduction is allowed or paid with respect to 

the employee, 

then there is hereby imposed on the employer an assessable 

payment equal to the product of the number of full-time employees of the applicable large employer described in subparagraph (B) for such month and an amount equal to 1⁄12 of 

$3,000. 

(2) OVERALL LIMITATION.—The aggregate amount of tax determined under paragraph (1) with respect to all employees of 

an applicable large employer for any month shall not exceed 

the product of the applicable payment amount and the number 

of individuals employed by the employer as full-time employees 

during such month. 

(c) DEFINITIONS AND SPECIAL RULES.—For purposes of this section— 


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(1) APPLICABLE PAYMENT AMOUNT.—The term ‘‘applicable 

payment amount’’ means, with respect to any month, 1⁄12 of 

$2,000. 

(2) APPLICABLE LARGE EMPLOYER.— (A) IN GENERAL.—The term ‘‘applicable large employer’’ 

means, with respect to a calendar year, an employer who 

employed an average of at least 50 full-time employees on 

business days during the preceding calendar year. 

(B) EXEMPTION FOR CERTAIN EMPLOYERS.— (i) IN GENERAL.—An employer shall not be considered to employ more than 50 full-time employees if— 

(I) the employer’s workforce exceeds 50 full-time 

employees for 120 days or fewer during the calendar year, and 

(II) the employees in excess of 50 employed during such 120-day period were seasonal workers. 

(ii) DEFINITION OF SEASONAL WORKERS.—The term 

‘‘seasonal worker’’ means a worker who performs labor 

or services on a seasonal basis as defined by the Secretary of Labor, including workers covered by section 

500.20(s)(1) of title 29, Code of Federal Regulations 

and retail workers employed exclusively during holiday seasons. 

(C) RULES FOR DETERMINING EMPLOYER SIZE.—For purposes of this paragraph— 

(i) APPLICATION OF AGGREGATION RULE FOR EMPLOY- ERS.—All persons treated as a single employer under 

subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 employer. 

(ii) EMPLOYERS NOT IN EXISTENCE IN PRECEDING

YEAR.—In the case of an employer which was not in 

existence throughout the preceding calendar year, the 

determination of whether such employer is an applicable large employer shall be based on the average number of employees that it is reasonably expected such 

employer will employ on business days in the current 

calendar year. 

(iii) PREDECESSORS.—Any reference in this subsection to an employer shall include a reference to any 

predecessor of such employer. 

(D) APPLICATION OF EMPLOYER SIZE TO ASSESSABLE PENALTIES.— 

(i) IN GENERAL.—The number of individuals employed by an applicable large employer as full-time 

employees during any month shall be reduced by 30 

solely for purposes of calculating— 

(I) the assessable payment under subsection (a), 

or 

(II) the overall limitation under subsection 

(b)(2). 

(ii) AGGREGATION.—In the case of persons treated as 

1 employer under subparagraph (C)(i), only 1 reduction under subclause (I) or (II) shall be allowed with 


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respect to such persons and such reduction shall be allocated among such persons ratably on the basis of the 

number of full-time employees employed by each such 

person. 

(E) FULL-TIME EQUIVALENTS TREATED AS FULL-TIME EM- PLOYEES.—Solely for purposes of determining whether an 

employer is an applicable large employer under this paragraph, an employer shall, in addition to the number of fulltime employees for any month otherwise determined, include for such month a number of full-time employees determined by dividing the aggregate number of hours of 

service of employees who are not full-time employees for 

the month by 120. 

(F) EXEMPTION FOR HEALTH COVERAGE UNDER TRICARE 

OR THE VETERANS ADMINISTRATION.—Solely for purposes of 

determining whether an employer is an applicable large 

employer under this paragraph for any month, an individual shall not be taken into account as an employee for 

such month if such individual has medical coverage for 

such month under— 

(i) chapter 55 of title 10, United States Code, including coverage under the TRICARE program, or 

(ii) under a health care program under chapter 17 or 

18 of title 38, United States Code, as determined by 

the Secretary of Veterans Affairs, in coordination with 

the Secretary of Health and Human Services and the 

Secretary. 

(3) APPLICABLE PREMIUM TAX CREDIT AND COST-SHARING REDUCTION.—The term ‘‘applicable premium tax credit and costsharing reduction’’ means— 

(A) any premium tax credit allowed under section 36B, 

(B) any cost-sharing reduction under section 1402 of the 

Patient Protection and Affordable Care Act, and 

(C) any advance payment of such credit or reduction 

under section 1412 of such Act. 

(4) FULL-TIME EMPLOYEE.— (A) IN GENERAL.—The term ‘‘full-time employee’’ means, 

with respect to any month, an employee who is employed 

on average at least 30 hours of service per week. 

(B) HOURS OF SERVICE.—The Secretary, in consultation 

with the Secretary of Labor, shall prescribe such regulations, rules, and guidance as may be necessary to determine the hours of service of an employee, including rules 

for the application of this paragraph to employees who are 

not compensated on an hourly basis. 

ø(5) INFLATION ADJUSTMENT.— 

ø(A) IN GENERAL.—In the case of any calendar year after 

2014, each of the dollar amounts in subsection (b) and 

paragraph (1) shall be increased by an amount equal to 

the product of— 

ø(i) such dollar amount, and 

ø(ii) the premium adjustment percentage (as defined 

in section 1302(c)(4) of the Patient Protection and Affordable Care Act) for the calendar year. 


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ø(B) ROUNDING.—If the amount of any increase under 

subparagraph (A) is not a multiple of $10, such increase 

shall be rounded to the next lowest multiple of $10.¿ 

(6) OTHER DEFINITIONS.—Any term used in this section 

which is also used in the Patient Protection and Affordable 

Care Act shall have the same meaning as when used in such 

Act. 

(7) TAX NONDEDUCTIBLE.—For denial of deduction for the tax 

imposed by this section, see section 275(a)(6). 

(d) ADMINISTRATION AND PROCEDURE.— 

(1) IN GENERAL.—Any assessable payment provided by this 

section shall be paid upon notice and demand by the Secretary, 

and shall be assessed and collected in the same manner as an 

assessable penalty under subchapter B of chapter 68. 

(2) TIME FOR PAYMENT.—The Secretary may provide for the 

payment of any assessable payment provided by this section on 

an annual, monthly, or other periodic basis as the Secretary 

may prescribe. 

(3) COORDINATION WITH CREDITS, ETC..—The Secretary shall 

prescribe rules, regulations, or guidance for the repayment of 

any assessable payment (including interest) if such payment is 

based on the allowance or payment of an applicable premium 

tax credit or cost-sharing reduction with respect to an employee, such allowance or payment is subsequently disallowed, 

and the assessable payment would not have been required to 

be made but for such allowance or payment. 

(e) TERMINATION.—This section shall not apply with respect to 

any month beginning after December 31, 2014. 

øSEC. 4980I. EXCISE TAX ON HIGH COST EMPLOYER-SPONSORED 

HEALTH COVERAGE. 

ø(a) IMPOSITION OF TAX.—If— 

ø(1) an employee is covered under any applicable employersponsored coverage of an employer at any time during a taxable period, and 

ø(2) there is any excess benefit with respect to the coverage, 

there is hereby imposed a tax equal to 40 percent of the excess 

benefit. 

ø(b) EXCESS BENEFIT.—For purposes of this section— 

ø(1) IN GENERAL.—The term ‘‘excess benefit’’ means, with respect to any applicable employer-sponsored coverage made 

available by an employer to an employee during any taxable 

period, the sum of the excess amounts determined under paragraph (2) for months during the taxable period. 

ø(2) MONTHLY EXCESS AMOUNT.—The excess amount determined under this paragraph for any month is the excess (if 

any) of— 

ø(A) the aggregate cost of the applicable employer- sponsored coverage of the employee for the month, over 

ø(B) an amount equal to 1⁄12 of the annual limitation 

under paragraph (3) for the calendar year in which the 

month occurs. 

ø(3) ANNUAL LIMITATION.—For purposes of this subsection— 


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ø(A) IN GENERAL.—The annual limitation under this 

paragraph for any calendar year is the dollar limit determined under subparagraph (C) for the calendar year. 

ø(B) APPLICABLE ANNUAL LIMITATION.— ø(i) IN GENERAL.—Except as provided in clause (ii), 

the annual limitation which applies for any month 

shall be determined on the basis of the type of coverage (as determined under subsection (f)(1)) provided 

to the employee by the employer as of the beginning 

of the month. 

ø(ii) MULTIEMPLOYER PLAN COVERAGE.—Any coverage provided under a multiemployer plan (as defined 

in section 414(f)) shall be treated as coverage other 

than self-only coverage. 

ø(C) APPLICABLE DOLLAR LIMIT.— 

ø(i) 2018.—In the case of 2018, the dollar limit 

under this subparagraph is— 

ø(I) in the case of an employee with self-only 

coverage, $10,200 multiplied by the health cost 

adjustment percentage (determined by only taking 

into account self-only coverage), and 

ø(II) in the case of an employee with coverage 

other than self-only coverage, $27,500 multiplied 

by the health cost adjustment percentage (determined by only taking into account coverage other 

than self-only coverage). 

ø(ii)HEALTH COST ADJUSTMENT PERCENTAGE.—For 

purposes of clause (i), the health cost adjustment percentage is equal to 100 percent plus the excess (if any) 

of— 

ø(I) the percentage by which the per employee 

cost for providing coverage under the Blue Cross/ 

Blue Shield standard benefit option under the 

Federal Employees Health Benefits Plan for plan 

year 2018 (determined by using the benefit package for such coverage in 2010) exceeds such cost 

for plan year 2010, over 

ø(II) 55 percent. 

ø(iii) AGE AND GENDER ADJUSTMENT.— ø(I) IN GENERAL.—The amount determined 

under subclause (I) or (II) of clause (i), whichever 

is applicable, for any taxable period shall be increased by the amount determined under subclause (II). 

ø(II) AMOUNT DETERMINED.—The amount determined under this subclause is an amount equal to 

the excess (if any) of— 

ø(aa) the premium cost of the Blue Cross/ 

Blue Shield standard benefit option under the 

Federal Employees Health Benefits Plan for 

the type of coverage provided such individual 

in such taxable period if priced for the age 

and gender characteristics of all employees of 

the individual’s employer, over 


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ø(bb) that premium cost for the provision of 

such coverage under such option in such taxable period if priced for the age and gender 

characteristics of the national workforce. 

ø(iv) EXCEPTION FOR CERTAIN INDIVIDUALS.—In the 

case of an individual who is a qualified retiree or who 

participates in a plan sponsored by an employer the 

majority of whose employees covered by the plan are 

engaged in a high-risk profession or employed to repair or install electrical or telecommunications lines— 

ø(I) the dollar amount in clause (i)(I) shall be increased by $1,650, and 

ø(II) the dollar amount in clause (i)(II) shall be 

increased by $3,450, 

ø(v) SUBSEQUENT YEARS.—In the case of any calendar year after 2018, each of the dollar amounts 

under clauses (i) (after the application of clause (ii)) 

and (iv) shall be increased to the amount equal to such 

amount as in effect for the calendar year preceding 

such year, increased by an amount equal to the product of— 

ø(I) such amount as so in effect, multiplied by 

ø(II) the cost-of-living adjustment determined 

under section 1(f)(3) for such year (determined by 

substituting the calendar year that is 2 years before such year for ‘‘1992’’ in subparagraph (B) 

thereof), increased by 1 percentage point in the 

case of determinations for calendar years beginning before 2020. 

If any amount determined under this clause is not a 

multiple of $50, such amount shall be rounded to the 

nearest multiple of $50. 

ø(c) LIABILITY TO PAY TAX.— ø(1) IN GENERAL.—Each coverage provider shall pay the tax 

imposed by subsection (a) on its applicable share of the excess 

benefit with respect to an employee for any taxable period. 

ø(2) COVERAGE PROVIDER.—For purposes of this subsection, 

the term ‘‘coverage provider’’ means each of the following: 

ø(A) HEALTH INSURANCE COVERAGE.—If the applicable 

employer-sponsored coverage consists of coverage under a 

group health plan which provides health insurance coverage, the health insurance issuer. 

ø(B) HSA AND MSA CONTRIBUTIONS.—If the applicable 

employer-sponsored coverage consists of coverage under an 

arrangement under which the employer makes contributions described in subsection (b) or (d) of section 106, the 

employer. 

ø(C) OTHER COVERAGE.—In the case of any other applicable employer-sponsored coverage, the person that administers the plan benefits. 

ø(3) APPLICABLE SHARE.—For purposes of this subsection, a 

coverage provider’s applicable share of an excess benefit for 

any taxable period is the amount which bears the same ratio 

to the amount of such excess benefit as— 


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ø(A) the cost of the applicable employer-sponsored coverage provided by the provider to the employee during 

such period, bears to 

ø(B) the aggregate cost of all applicable employer-sponsored coverage provided to the employee by all coverage 

providers during such period. 

ø(4) RESPONSIBILITY TO CALCULATE TAX AND APPLICABLE

SHARES.— 

ø(A) IN GENERAL.—Each employer shall— 

ø(i) calculate for each taxable period the amount of 

the excess benefit subject to the tax imposed by subsection (a) and the applicable share of such excess benefit for each coverage provider, and 

ø(ii) notify, at such time and in such manner as the 

Secretary may prescribe, the Secretary and each coverage provider of the amount so determined for the 

provider. 

ø(B) SPECIAL RULE FOR MULTIEMPLOYER PLANS.—In the 

case of applicable employer-sponsored coverage made 

available to employees through a multiemployer plan (as 

defined in section 414(f)), the plan sponsor shall make the 

calculations, and provide the notice, required under subparagraph (A). 

ø(d) APPLICABLE EMPLOYER-SPONSORED COVERAGE; COST.—For 

purposes of this section— 

ø(1) APPLICABLE EMPLOYER-SPONSORED COVERAGE.— ø(A) IN GENERAL.—The term ‘‘applicable employer-sponsored coverage’’ means, with respect to any employee, coverage under any group health plan made available to the 

employee by an employer which is excludable from the employee’s gross income under section 106, or would be so excludable if it were employer-provided coverage (within the 

meaning of such section 106). 

ø(B) EXCEPTIONS.—The term ‘‘applicable employer-sponsored coverage’’ shall not include— 

ø(i) any coverage (whether through insurance or otherwise) described in section 9832(c)(1) (other than subparagraph (G) thereof) or for long-term care, or 

ø(ii) any coverage under a separate policy, certificate, or contract of insurance which provides benefits 

substantially all of which are for treatment of the 

mouth (including any organ or structure within the 

mouth) or for treatment of the eye, or 

ø(iii) any coverage described in section 9832(c)(3) the 

payment for which is not excludable from gross income 

and for which a deduction under section 162(l) is not 

allowable. 

ø(C) COVERAGE INCLUDES EMPLOYEE PAID PORTION.— 

Coverage shall be treated as applicable employer-sponsored coverage without regard to whether the employer or 

employee pays for the coverage. 

ø(D) SELF-EMPLOYED INDIVIDUAL.—In the case of an individual who is an employee within the meaning of section 

401(c)(1), coverage under any group health plan providing 


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health insurance coverage shall be treated as applicable 

employer-sponsored coverage if a deduction is allowable 

under section 162(l) with respect to all or any portion of 

the cost of the coverage. 

ø(E) GOVERNMENTAL PLANS INCLUDED.—Applicable employer-sponsored coverage shall include coverage under 

any group health plan established and maintained primarily for its civilian employees by the Government of the 

United States, by the government of any State or political 

subdivision thereof, or by any agency or instrumentality of 

any such government. 

ø(2) DETERMINATION OF COST.— 

ø(A) IN GENERAL.—The cost of applicable employersponsored coverage shall be determined under rules similar to the rules of section 4980B(f)(4), except that in determining such cost, any portion of the cost of such coverage 

which is attributable to the tax imposed under this section 

shall not be taken into account and the amount of such 

cost shall be calculated separately for self-only coverage 

and other coverage. In the case of applicable employersponsored coverage which provides coverage to retired employees, the plan may elect to treat a retired employee who 

has not attained the age of 65 and a retired employee who 

has attained the age of 65 as similarly situated beneficiaries. 

ø(B) HEALTH FSAS.—In the case of applicable employersponsored coverage consisting of coverage under a flexible 

spending arrangement (as defined in section 106(c)(2)), the 

cost of the coverage shall be equal to the sum of— 

ø(i) the amount of employer contributions under any 

salary reduction election under the arrangement, plus 

ø(ii) the amount determined under subparagraph (A) 

with respect to any reimbursement under the arrangement in excess of the contributions described in clause 

(i). 

ø(C) ARCHER MSAS AND HSAS.—In the case of applicable employer-sponsored coverage consisting of coverage 

under an arrangement under which the employer makes 

contributions described in subsection (b) or (d) of section 

106, the cost of the coverage shall be equal to the amount 

of employer contributions under the arrangement. 

ø(D) ALLOCATION ON A MONTHLY BASIS.—If cost is determined on other than a monthly basis, the cost shall be allocated to months in a taxable period on such basis as the 

Secretary may prescribe. 

ø(3) EMPLOYEE.—The term ‘‘employee’’ includes any former 

employee, surviving spouse, or other primary insured individual. 

ø(e) PENALTY FOR FAILURE TO PROPERLY CALCULATE EXCESS

BENEFIT.— 

ø(1) IN GENERAL.—If, for any taxable period, the tax imposed 

by subsection (a) exceeds the tax determined under such subsection with respect to the total excess benefit calculated by 

the employer or plan sponsor under subsection (c)(4)— 


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ø(A) each coverage provider shall pay the tax on its applicable share (determined in the same manner as under 

subsection (c)(4)) of the excess, but no penalty shall be imposed on the provider with respect to such amount, and 

ø(B) the employer or plan sponsor shall, in addition to 

any tax imposed by subsection (a), pay a penalty in an 

amount equal to such excess, plus interest at the underpayment rate determined under section 6621 for the period 

beginning on the due date for the payment of tax imposed 

by subsection (a) to which the excess relates and ending on 

the date of payment of the penalty. 

ø(2) LIMITATIONS ON PENALTY.— 

ø(A) PENALTY NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE DILIGENCE.—No penalty 

shall be imposed by paragraph (1)(B) on any failure to 

properly calculate the excess benefit during any period for 

which it is established to the satisfaction of the Secretary 

that the employer or plan sponsor neither knew, nor exercising reasonable diligence would have known, that such 

failure existed. 

ø(B) PENALTY NOT TO APPLY TO FAILURES CORRECTED

WITHIN30 DAYS.—No penalty shall be imposed by paragraph (1)(B) on any such failure if— 

ø(i) such failure was due to reasonable cause and 

not to willful neglect, and 

ø(ii) such failure is corrected during the 30-day period beginning on the 1st date that the employer 

knew, or exercising reasonable diligence would have 

known, that such failure existed. 

ø(C) WAIVER BY SECRETARY.—In the case of any such 

failure which is due to reasonable cause and not to willful 

neglect, the Secretary may waive part or all of the penalty 

imposed by paragraph (1), to the extent that the payment 

of such penalty would be excessive or otherwise inequitable relative to the failure involved. 

ø(f) OTHER DEFINITIONS AND SPECIAL RULES.—For purposes of 

this section— 

ø(1) COVERAGE DETERMINATIONS.— ø(A) IN GENERAL.—Except as provided in subparagraph 

(B), an employee shall be treated as having self-only coverage with respect to any applicable employer-sponsored 

coverage of an employer. 

ø(B) MINIMUM ESSENTIAL COVERAGE.—An employee shall 

be treated as having coverage other than self-only coverage 

only if the employee is enrolled in coverage other than selfonly coverage in a group health plan which provides minimum essential coverage (as defined in section 5000A(f)) to 

the employee and at least one other beneficiary, and the 

benefits provided under such minimum essential coverage 

do not vary based on whether any individual covered 

under such coverage is the employee or another beneficiary. 

ø(2) QUALIFIED RETIREE.—The term ‘‘qualified retiree’’ means 

any individual who— 


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ø(A) is receiving coverage by reason of being a retiree, 

ø(B) has attained age 55, and 

ø(C) is not entitled to benefits or eligible for enrollment 

under the Medicare program under title XVIII of the Social Security Act. 

ø(3) EMPLOYEES ENGAGED IN HIGH-RISK PROFESSION.—The 

term ‘‘employees engaged in a high-risk profession’’ means law 

enforcement officers (as such term is defined in section 1204 of 

the Omnibus Crime Control and Safe Streets Act of 1968), employees in fire protection activities (as such term is defined in 

section 3(y) of the Fair Labor Standards Act of 1938), individuals who provide out- of-hospital emergency medical care (including emergency medical technicians, paramedics, and firstresponders), individuals whose primary work is longshore work 

(as defined in section 258(b) of the Immigration and Nationality Act (8 U.S.C. 1288(b)), determined without regard to 

paragraph (2) thereof), and individuals engaged in the construction, mining, agriculture (not including food processing), 

forestry, and fishing industries. Such term includes an employee who is retired from a high-risk profession described in 

the preceding sentence, if such employee satisfied the requirements of such sentence for a period of not less than 20 years 

during the employee’s employment. 

ø(4) GROUP HEALTH PLAN.—The term ‘‘group health plan’’ 

has the meaning given such term by section 5000(b)(1). 

ø(5) HEALTH INSURANCE COVERAGE; HEALTH INSURANCE

ISSUER.— 

ø(A) HEALTH INSURANCE COVERAGE.—The term ‘‘health 

insurance coverage’’ has the meaning given such term by 

section 9832(b)(1) (applied without regard to subparagraph 

(B) thereof, except as provided by the Secretary in regulations). 

ø(B) HEALTH INSURANCE ISSUER.—The term ‘‘health insurance issuer’’ has the meaning given such term by section 9832(b)(2). 

ø(6) PERSON THAT ADMINISTERS THE PLAN BENEFITS.—The 

term ‘‘person that administers the plan benefits’’ shall include 

the plan sponsor if the plan sponsor administers benefits under 

the plan. 

ø(7) PLAN SPONSOR.—The term ‘‘plan sponsor’’ has the meaning given such term in section 3(16)(B) of the Employee Retirement Income Security Act of 1974. 

ø(8) TAXABLE PERIOD.—The term ‘‘taxable period’’ means the 

calendar year or such shorter period as the Secretary may prescribe. The Secretary may have different taxable periods for 

employers of varying sizes. 

ø(9) AGGREGATION RULES.—All employers treated as a single 

employer under subsection (b), (c), (m), or (o) of section 414 

shall be treated as a single employer. 

ø(10) DENIAL OF DEDUCTION.—For denial of a deduction for 

the tax imposed by this section, see section 275(a)(6). 

ø(g) REGULATIONS.—The Secretary shall prescribe such regulations as may be necessary to carry out this section.¿ 

* * * * * * * 


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CHAPTER 48—MAINTENANCE OF MINIMUM 

ESSENTIAL COVERAGE 

SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE. 

(a) REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.—An applicable individual shall for each month beginning 

after 2013 ensure that the individual, and any dependent of the individual who is an applicable individual, is covered under minimum essential coverage for such month. 

(b) SHARED RESPONSIBILITY PAYMENT.— 

(1) IN GENERAL.—If a taxpayer who is an applicable individual, or an applicable individual for whom the taxpayer is 

liable under paragraph (3), fails to meet the requirement of 

subsection (a) for 1 or more months, then, except as provided 

in subsection (e), there is hereby imposed on the taxpayer a 

penalty with respect to such failures in the amount determined 

under subsection (c). 

(2) INCLUSION WITH RETURN.—Any penalty imposed by this 

section with respect to any month shall be included with a taxpayer’s return under chapter 1 for the taxable year which includes such month. 

(3) PAYMENT OF PENALTY.—If an individual with respect to 

whom a penalty is imposed by this section for any month— 

(A) is a dependent (as defined in section 152) of another 

taxpayer for the other taxpayer’s taxable year including 

such month, such other taxpayer shall be liable for such 

penalty, or 

(B) files a joint return for the taxable year including 

such month, such individual and the spouse of such individual shall be jointly liable for such penalty. 

(c) AMOUNT OF PENALTY.— 

(1) IN GENERAL.—The amount of the penalty imposed by this 

section on any taxpayer for any taxable year with respect to 

failures described in subsection (b)(1) shall be equal to the lesser of— 

(A) the sum of the monthly penalty amounts determined 

under paragraph (2) for months in the taxable year during 

which 1 or more such failures occurred, or 

(B) an amount equal to the national average premium 

for qualified health plans which have a bronze level of coverage, provide coverage for the applicable family size involved, and are offered through Exchanges for plan years 

beginning in the calendar year with or within which the 

taxable year ends. 

(2) MONTHLY PENALTY AMOUNTS.—For purposes of paragraph 

(1)(A), the monthly penalty amount with respect to any taxpayer for any month during which any failure described in subsection (b)(1) occurred is an amount equal to 1⁄12 of the greater 

of the following amounts: 

(A) FLAT DOLLAR AMOUNT.—An amount equal to the lesser of— 


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(i) the sum of the applicable dollar amounts for all 

individuals with respect to whom such failure occurred 

during such month, or 

(ii) 300 percent of the applicable dollar amount (determined without regard to paragraph (3)(C)) for the 

calendar year with or within which the taxable year 

ends. 

(B) PERCENTAGE OF INCOME.—An amount equal to the 

following percentage of the excess of the taxpayer’s household income for the taxable year over the amount of gross 

income specified in section 6012(a)(1) with respect to the 

taxpayer for the taxable year: 

(i) 1.0 percent for taxable years beginning in 2014. 

ø(ii) 2.0 percent for taxable years beginning in 2015. 

ø(iii) 2.5 percent for taxable years beginning after 

2015.¿ 

(3) APPLICABLE DOLLAR AMOUNT.—For purposes of paragraph 

(1)— 

(A) IN GENERAL.—Except as provided in subparagraphs 

(B) and (C), the applicable dollar amount is $695. 

(B) PHASE IN.—The applicable dollar amount is $95 for 

ø2014 and $325 for 2015.¿2014. 

(C) SPECIAL RULE FOR INDIVIDUALS UNDER AGE18.—If an 

applicable individual has not attained the age of 18 as of 

the beginning of a month, the applicable dollar amount 

with respect to such individual for the month shall be 

equal to one-half of the applicable dollar amount for the 

calendar year in which the month occurs. 

ø(D) INDEXING OF AMOUNT.—In the case of any calendar 

year beginning after 2016, the applicable dollar amount 

shall be equal to $695, increased by an amount equal to— 

ø(i) $695, multiplied by 

ø(ii) the cost-of-living adjustment determined under 

section 1(f)(3) for the calendar year, determined by 

substituting ‘‘calendar year 2015’’ for ‘‘calendar year 

1992’’ in subparagraph (B) thereof.¿ 

If the amount of any increase under clause (i) is not a multiple of $50, such increase shall be rounded to the next 

lowest multiple of $50. 

(4) TERMS RELATING TO INCOME AND FAMILIES.—For purposes 

of this section— 

(A) FAMILY SIZE.—The family size involved with respect 

to any taxpayer shall be equal to the number of individuals for whom the taxpayer is allowed a deduction under 

section 151 (relating to allowance of deduction for personal 

exemptions) for the taxable year. 

(B) HOUSEHOLD INCOME.—The term ‘‘household income’’ 

means, with respect to any taxpayer for any taxable year, 

an amount equal to the sum of— 

(i) the modified adjusted gross income of the taxpayer, plus 

(ii) the aggregate modified adjusted gross incomes of 

all other individuals who— 


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(I) were taken into account in determining the 

taxpayer’s family size under paragraph (1), and 

(II) were required to file a return of tax imposed 

by section 1 for the taxable year. 

(C) MODIFIED ADJUSTED GROSS INCOME.—The term 

‘‘modified adjusted gross income’’ means adjusted gross income increased by— 

(i) any amount excluded from gross income under 

section 911, and 

(ii) any amount of interest received or accrued by 

the taxpayer during the taxable year which is exempt 

from tax. 

(d) APPLICABLE INDIVIDUAL.—For purposes of this section— 

(1) IN GENERAL.—The term ‘‘applicable individual’’ means, 

with respect to any month, an individual other than an individual described in paragraph (2), (3), or (4). 

(2) RELIGIOUS EXEMPTIONS.— 

(A) RELIGIOUS CONSCIENCE EXEMPTION.—Such term shall 

not include any individual for any month if such individual 

has in effect an exemption under section 1311(d)(4)(H) of 

the Patient Protection and Affordable Care Act which certifies that such individual is— 

(i) a member of a recognized religious sect or division thereof which is described in section 1402(g)(1), 

and 

(ii) an adherent of established tenets or teachings of 

such sect or division as described in such section. 

(B)HEALTH CARE SHARING MINISTRY.— 

(i) IN GENERAL.—Such term shall not include any individual for any month if such individual is a member 

of a health care sharing ministry for the month. 

(ii) HEALTH CARE SHARING MINISTRY.—The term 

‘‘health care sharing ministry’’ means an organization— 

(I) which is described in section 501(c)(3) and is 

exempt from taxation under section 501(a), 

(II) members of which share a common set of 

ethical or religious beliefs and share medical expenses among members in accordance with those 

beliefs and without regard to the State in which 

a member resides or is employed, 

(III) members of which retain membership even 

after they develop a medical condition, 

(IV) which (or a predecessor of which) has been 

in existence at all times since December 31, 1999, 

and medical expenses of its members have been 

shared continuously and without interruption 

since at least December 31, 1999, and 

(V) which conducts an annual audit which is 

performed by an independent certified public accounting firm in accordance with generally accepted accounting principles and which is made available to the public upon request. 


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(3) INDIVIDUALS NOT LAWFULLY PRESENT.—Such term shall 

not include an individual for any month if for the month the 

individual is not a citizen or national of the United States or 

an alien lawfully present in the United States. 

(4) INCARCERATED INDIVIDUALS.—Such term shall not include 

an individual for any month if for the month the individual is 

incarcerated, other than incarceration pending the disposition 

of charges. 

(e) EXEMPTIONS.—No penalty shall be imposed under subsection 

(a) with respect to— 

(1) INDIVIDUALS WHO CANNOT AFFORD COVERAGE.— (A) IN GENERAL.—Any applicable individual for any 

month if the applicable individual’s required contribution 

(determined on an annual basis) for coverage for the 

month exceeds 8 percent of such individual’s household income for the taxable year described in section 1412(b)(1)(B) 

of the Patient Protection and Affordable Care Act. For purposes of applying this subparagraph, the taxpayer’s household income shall be increased by any exclusion from gross 

income for any portion of the required contribution made 

through a salary reduction arrangement. 

(B) REQUIRED CONTRIBUTION.—For purposes of this paragraph, the term ‘‘required contribution’’ means— 

(i) in the case of an individual eligible to purchase 

minimum essential coverage consisting of coverage 

through an eligible-employer-sponsored plan, the portion of the annual premium which would be paid by 

the individual (without regard to whether paid 

through salary reduction or otherwise) for self-only 

coverage, or 

(ii) in the case of an individual eligible only to purchase minimum essential coverage described in subsection (f)(1)(C), the annual premium for the lowest 

cost bronze plan available in the individual market 

through the Exchange in the State in the rating area 

in which the individual resides (without regard to 

whether the individual purchased a qualified health 

plan through the Exchange), reduced by the amount of 

the credit allowable under section 36B for the taxable 

year (determined as if the individual was covered by 

a qualified health plan offered through the Exchange 

for the entire taxable year). 

(C) SPECIAL RULES FOR INDIVIDUALS RELATED TO EMPLOYEES.—For purposes of subparagraph (B)(i), if an applicable individual is eligible for minimum essential coverage 

through an employer by reason of a relationship to an employee, the determination under subparagraph (A) shall be 

made by reference to required contribution of the employee. 

ø(D) INDEXING.—In the case of plan years beginning in 

any calendar year after 2014, subparagraph (A) shall be 

applied by substituting for ‘‘8 percent’’ the percentage the 

Secretary of Health and Human Services determines reflects the excess of the rate of premium growth between 


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the preceding calendar year and 2013 over the rate of income growth for such period.¿ 

(2) TAXPAYERS WITH INCOME BELOW FILING THRESHOLD.—Any 

applicable individual for any month during a calendar year if 

the individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and 

Affordable Care Act is the amount of gross income specified in 

section 6012(a)(1) with respect to the taxpayer. 

(3) MEMBERS OF INDIAN TRIBES.—Any applicable individual 

for any month during which the individual is a member of an 

Indian tribe (as defined in section 45A(c)(6)). 

(4) MONTHS DURING SHORT COVERAGE GAPS.— 

(A) IN GENERAL.—Any month the last day of which occurred during a period in which the applicable individual 

was not covered by minimum essential coverage for a continuous period of less than 3 months. 

(B) SPECIAL RULES.—For purposes of applying this paragraph— 

(i) the length of a continuous period shall be determined without regard to the calendar years in which 

months in such period occur, 

(ii) if a continuous period is greater than the period 

allowed under subparagraph (A), no exception shall be 

provided under this paragraph for any month in the 

period, and 

(iii) if there is more than 1 continuous period described in subparagraph (A) covering months in a calendar year, the exception provided by this paragraph 

shall only apply to months in the first of such periods. 

The Secretary shall prescribe rules for the collection of the 

penalty imposed by this section in cases where continuous 

periods include months in more than 1 taxable year. 

(5) HARDSHIPS.—Any applicable individual who for any 

month is determined by the Secretary of Health and Human 

Services under section 1311(d)(4)(H) to have suffered a hardship with respect to the capability to obtain coverage under a 

qualified health plan. 

(f) MINIMUM ESSENTIAL COVERAGE.—For purposes of this section— 

(1) IN GENERAL.—The term ‘‘minimum essential coverage’’ 

means any of the following: 

(A) GOVERNMENT SPONSORED PROGRAMS.—Coverage 

under— 

(i) the Medicare program under part A of title XVIII 

of the Social Security Act, 

(ii) the Medicaid program under title XIX of the Social Security Act, 

(iii) the CHIP program under title XXI of the Social 

Security Act, 

(iv) medical coverage under chapter 55 of title 10, 

United States Code, including coverage under the 

TRICARE program; 

(v) a health care program under chapter 17 or 18 of 

title 38, United States Code, as determined by the SecVerDate Sep 11 2014 08:07 Oct 17, 2015 Jkt 059006 PO 00000 Frm 00132 Fmt 6601 Sfmt 6601 E:\HR\OC\HR293.XXX HR293

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retary of Veterans Affairs, in coordination with the 

Secretary of Health and Human Services and the Secretary, 

(vi) a health plan under section 2504(e) of title 22, 

United States Code (relating to Peace Corps volunteers); or 

(vii) the Nonappropriated Fund Health Benefits Program of the Department of Defense, established under 

section 349 of the National Defense Authorization Act 

for Fiscal Year 1995 (Public Law 103-337; 10 U.S.C. 

1587 note). 

(B) EMPLOYER-SPONSORED PLAN.—Coverage under an eligible employer-sponsored plan. 

(C) PLANS IN THE INDIVIDUAL MARKET.—Coverage under 

a health plan offered in the individual market within a 

State. 

(D) GRANDFATHERED HEALTH PLAN.—Coverage under a 

grandfathered health plan. 

(E) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Secretary of Health and Human Services, in coordination with 

the Secretary, recognizes for purposes of this subsection. 

(2) ELIGIBLE EMPLOYER-SPONSORED PLAN.—The term ‘‘eligible 

employer-sponsored plan’’ means, with respect to any employee, a group health plan or group health insurance coverage 

offered by an employer to the employee which is— 

(A) a governmental plan (within the meaning of section 

2791(d)(8) of the Public Health Service Act), or 

(B) any other plan or coverage offered in the small or 

large group market within a State. 

Such term shall include a grandfathered health plan described 

in paragraph (1)(D) offered in a group market. 

(3) EXCEPTED BENEFITS NOT TREATED AS MINIMUM ESSENTIAL

COVERAGE.—The term ‘‘minimum essential coverage’’ shall not 

include health insurance coverage which consists of coverage of 

excepted benefits— 

(A) described in paragraph (1) of subsection (c) of section 

2791 of the Public Health Service Act; or 

(B) described in paragraph (2), (3), or (4) of such subsection if the benefits are provided under a separate policy, 

certificate, or contract of insurance. 

(4) INDIVIDUALS RESIDING OUTSIDE UNITED STATES OR RESIDENTS OF TERRITORIES.—Any applicable individual shall be 

treated as having minimum essential coverage for any 

month— 

(A) if such month occurs during any period described in 

subparagraph (A) or (B) of section 911(d)(1) which is applicable to the individual, or 

(B) if such individual is a bona fide resident of any possession of the United States (as determined under section 

937(a)) for such month. 

(5) INSURANCE-RELATED TERMS.—Any term used in this section which is also used in title I of the Patient Protection and 


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Affordable Care Act shall have the same meaning as when 

used in such title. 

(g) ADMINISTRATION AND PROCEDURE.— (1) IN GENERAL.—The penalty provided by this section shall 

be paid upon notice and demand by the Secretary, and except 

as provided in paragraph (2), shall be assessed and collected in 

the same manner as an assessable penalty under subchapter 

B of chapter 68. 

(2) SPECIAL RULES.—Notwithstanding any other provision of 

law— 

(A) WAIVER OF CRIMINAL PENALTIES.—In the case of any 

failure by a taxpayer to timely pay any penalty imposed by 

this section, such taxpayer shall not be subject to any 

criminal prosecution or penalty with respect to such failure. 

(B) LIMITATIONS ON LIENS AND LEVIES.—The Secretary 

shall not— 

(i) file notice of lien with respect to any property of 

a taxpayer by reason of any failure to pay the penalty 

imposed by this section, or 

(ii) levy on any such property with respect to such 

failure. 

(h) TERMINATION.—This section shall not apply with respect to 

any month beginning after December 31, 2014. 

* * * * * * * 

Subtitle F—Procedure and Administration 

* * * * * * * 

CHAPTER 61—INFORMATION AND RETURNS 

* * * * * * * 

Subchapter A—Returns and Records 

* * * * * * * 

PART III—INFORMATION RETURNS 

* * * * * * * 

Subpart C—Information Regarding Wages Paid Employees 

SEC. 6051. RECEIPTS FOR EMPLOYEES. 

(a) REQUIREMENT.—Every person required to deduct and withhold from an employee a tax under section 3101 or 3402, or who 

would have been required to deduct and withhold a tax under section 3402 (determined without regard to subsection (n)) if the employee had claimed no more than one withholding exemption, or 

every employer engaged in a trade or business who pays remuneration for services performed by an employee, including the cash 

value of such remuneration paid in any medium other than cash, 

shall furnish to each such employee in respect of the remuneration 


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paid by such person to such employee during the calendar year, on 

or before January 31 of the succeeding year, or, if his employment 

is terminated before the close of such calendar year, within 30 days 

after the date of receipt of a written request from the employee if 

such 30-day period ends before January 31, a written statement 

showing the following: 

(1) the name of such person, 

(2) the name of the employee (and his social security account 

number if wages as defined in section 3121(a) have been paid), 

(3) the total amount of wages as defined in section 3401(a), 

(4) the total amount deducted and withheld as tax under section 3402, 

(5) the total amount of wages as defined in section 3121(a), 

(6) the total amount deducted and withheld as tax under section 3101, 

(8) the total amount of elective deferrals (within the meaning 

of section 402(g)(3)) and compensation deferred under section 

457, including the amount of designated Roth contributions (as 

defined in section 402A), 

(9) the total amount incurred for dependent care assistance 

with respect to such employee under a dependent care assistance program described in section 129(d), 

(10) in the case of an employee who is a member of the 

Armed Forces of the United States, such employee’s earned income as determined for purposes of section 32 (relating to 

earned income credit), 

(11) the amount contributed to any Archer MSA (as defined 

in section 220(d)) of such employee or such employee’s spouse, 

(12) the amount contributed to any health savings account 

(as defined in section 223(d)) of such employee or such employee’s spouse,and 

(13) the total amount of deferrals for the year under a nonqualified deferred compensation plan (within the meaning of 

section 409A(d))ø, and¿. 

ø(14) the aggregate cost (determined under rules similar to 

the rules of section 4980B(f)(4)) of applicable employer-sponsored coverage (as defined in section 4980I(d)(1)), except that 

this paragraph shall not apply to— 

ø(A) coverage to which paragraphs (11) and (12) apply, 

or 

ø(B) the amount of any salary reduction contributions to 

a flexible spending arrangement (within the meaning of 

section 125).¿ 

In the case of compensation paid for service as a member of a uniformed service, the statement shall show, in lieu of the amount required to be shown by paragraph (5), the total amount of wages as 

defined in section 3121(a), computed in accordance with such section and section 3121(i)(2). In the case of compensation paid for 

service as a volunteer or volunteer leader within the meaning of 

the Peace Corps Act, the statement shall show, in lieu of the 

amount required to be shown by paragraph (5), the total amount 

of wages as defined in section 3121(a), computed in accordance 

with such section and section 3121(i)(3). In the case of tips received 

by an employee in the course of his employment, the amounts reVerDate Sep 11 2014 08:07 Oct 17, 2015 Jkt 059006 PO 00000 Frm 00135 Fmt 6601 Sfmt 6601 E:\HR\OC\HR293.XXX HR293

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quired to be shown by paragraphs (3) and (5) shall include only 

such tips as are included in statements furnished to the employer 

pursuant to section 6053(a). The amounts required to be shown by 

paragraph (5) shall not include wages which are exempted pursuant to sections 3101(c) and 3111(c) from the taxes imposed by sections 3101 and 3111. In the case of the amounts required to be 

shown by paragraph (13), the Secretary may (by regulation) establish a minimum amount of deferrals below which paragraph (13) 

does not apply. 

(b) SPECIAL RULE AS TO COMPENSATION OF MEMBERS OF ARMED

FORCES.—In the case of compensation paid for service as a member 

of the Armed Forces, the statement required by subsection (a) shall 

be furnished if any tax was withheld during the calendar year 

under section 3402, or if any of the compensation paid during such 

year is includible in gross income under chapter 1, or if during the 

calendar year any amount was required to be withheld as tax 

under section 3101. In lieu of the amount required to be shown by 

paragraph (3) of subsection (a), such statement shall show as 

wages paid during the calendar year the amount of such compensation paid during the calendar year which is not excluded from gross 

income under chapter 1 (whether or not such compensation constituted wages as defined in section 3401(a)). 

(c) ADDITIONAL REQUIREMENTS.—The statements required to be 

furnished pursuant to this section in respect of any remuneration 

shall be furnished at such other times, shall contain such other information, and shall be in such form as the Secretary may by regulations prescribe. The statements required under this section shall 

also show the proportion of the total amount withheld as tax under 

section 3101 which is for financing the cost of hospital insurance 

benefits under part A of title XVIII of the Social Security Act. 

(d) STATEMENTS TO CONSTITUTE INFORMATION RETURNS.—A duplicate of any statement made pursuant to this section and in accordance with regulations prescribed by the Secretary shall, when 

required by such regulations, be filed with the Secretary. 

(e) RAILROAD EMPLOYEES.— 

(1) ADDITIONAL REQUIREMENT.—Every person required to deduct and withhold tax under section 3201 from an employee 

shall include on or with the statement required to be furnished 

such employee under subsection (a) a notice concerning the 

provisions of this title with respect to the allowance of a credit 

or refund of the tax on wages imposed by section 3101(b) and 

the tax on compensation imposed by section 3201 or 3211 

which is treated as a tax on wages imposed by section 3101(b). 

(2) INFORMATION TO BE SUPPLIED TO EMPLOYEES.—Each person required to deduct and withhold tax under section 3201 

during any year from an employee who has also received wages 

during such year subject to the tax imposed by section 3101(b) 

shall, upon request of such employee, furnish to him a written 

statement showing— 

(A) the total amount of compensation with respect to 

which the tax imposed by section 3201 was deducted, 

(B) the total amount deducted as tax under section 3201, 

and 


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(C) the portion of the total amount deducted as tax 

under section 3201 which is for financing the cost of hospital insurance under part A of title XVIII of the Social Security Act. 

(f) STATEMENTS REQUIRED IN CASE OF SICK PAY PAID BY THIRD

PARTIES.— 

(1) STATEMENTS REQUIRED FROM PAYOR.— 

(A) IN GENERAL.—If, during any calendar year, any person makes a payment of third-party sick pay to an employee, such person shall, on or before January 15 of the 

succeeding year, furnish a written statement to the employer in respect of whom such payment was made showing— 

(i) the name and, if there is withholding under section 3402(o), the social security number of such employee, 

(ii) the total amount of the third-party sick pay paid 

to such employee during the calendar year, and 

(iii) the total amount (if any) deducted and withheld 

from such sick pay under section 3402. 

For purposes of the preceding sentence, the term ‘‘thirdparty sick pay’’ means any sick pay (as defined in section 

3402(o)(2)(C)) which does not constitute wages for purposes 

of chapter 24 (determined without regard to section 

3402(o)(1)). 

(B) SPECIAL RULES.— 

(i) STATEMENTS ARE IN LIEU OF OTHER REPORTING

REQUIREMENTS.—The reporting requirements of subparagraph (A) with respect to any payments shall, 

with respect to such payments, be in lieu of the requirements of subsection (a) and of section 6041. 

(ii) PENALTIES MADE APPLICABLE.—For purposes of 

sections 6674 and 7204, the statements required to be 

furnished by subparagraph (A) shall be treated as 

statements required under this section to be furnished 

to employees. 

(2) INFORMATION REQUIRED TO BE FURNISHED BY EMPLOYER.—Every employer who receives a statement under 

paragraph (1)(A) with respect to sick pay paid to any employee 

during any calendar year shall, on or before January 31 of the 

succeeding year, furnish a written statement to such employee 

showing— 

(A) the information shown on the statement furnished 

under paragraph (1)(A), and 

(B) if any portion of the sick pay is excludable from gross 

income under section 104(a)(3), the portion which is not so 

excludable and the portion which is so excludable. 

To the extent practicable, the information required under the 

preceding sentence shall be furnished on or with the statement 

(if any) required under subsection (a). 

* * * * * * * 


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CHAPTER 65—ABATEMENTS, CREDITS, AND 

REFUNDS 

* * * * * * * 

Subchapter B—Rules of Special Application 

* * * * * * * 

SEC. 6416. CERTAIN TAXES ON SALES AND SERVICES. 

(a) CONDITION TO ALLOWANCE.— (1) GENERAL RULE.—No credit or refund of any overpayment 

of tax imposed by chapter 31 (relating to retail excise taxes), 

or chapter 32 (manufacturers taxes), shall be allowed or made 

unless the person who paid the tax establishes, under regulations prescribed by the Secretary, that he— 

(A) has not included the tax in the price of the article 

with respect to which it was imposed and has not collected 

the amount of the tax from the person who purchased such 

article; 

(B) has repaid the amount of the tax to the ultimate purchaser of the article; 

(C) in the case of an overpayment under subsection 

(b)(2) of this section— 

(i) has repaid or agreed to repay the amount of the 

tax to the ultimate vendor of the article, or 

(ii) has obtained the written consent of such ultimate vendor to the allowance of the credit or the making of the refund; or 

(D) has filed with the Secretary the written consent of 

the person referred to in subparagraph (B) to the allowance of the credit or the making of the refund. 

(2) EXCEPTIONS.—This subsection shall not apply to— 

(A) the tax imposed by section 4041 (relating to tax on 

special fuels) on the use of any liquid, and 

(B) an overpayment of tax under paragraph (1), (3)(A), 

(4), (5), or (6) of subsection (b) of this section. 

(3) SPECIAL RULE.—For purposes of this subsection, in any 

case in which the Secretary determines that an article is not 

taxable, the term ‘‘ultimate purchaser’’ (when used in paragraph (1)(B) of this subsection) includes a wholesaler, jobber, 

distributor, or retailer who, on the 15th day after the date of 

such determination, holds such article for sale; but only if 

claim for credit or refund by reason of this paragraph is filed 

on or before the date for filing the return with respect to the 

taxes imposed under chapter 32 for the first period which begins more than 60 days after the date on such determination. 

(4) REGISTERED ULTIMATE VENDOR OR CREDIT CARD ISSUER TO

ADMINISTER CREDITS AND REFUNDS OF GASOLINE TAX.— 

(A) IN GENERAL.—For purposes of this subsection, except 

as provided in subparagraph (B), if an ultimate vendor 

purchases any gasoline on which tax imposed by section 

4081 has been paid and sells such gasoline to an ultimate 

purchaser described in subparagraph (C) or (D) of subVerDate Sep 11 2014 08:07 Oct 17, 2015 Jkt 059006 PO 00000 Frm 00138 Fmt 6601 Sfmt 6601 E:\HR\OC\HR293.XXX HR293

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section (b)(2) (and such gasoline is for a use described in 

such subparagraph), such ultimate vendor shall be treated 

as the person (and the only person) who paid such tax, but 

only if such ultimate vendor is registered under section 

4101. 

(B) CREDIT CARD ISSUER.—For purposes of this subsection, if the purchase of gasoline described in subparagraph (A) (determined without regard to the registration 

status of the ultimate vendor) is made by means of a credit 

card issued to the ultimate purchaser, paragraph (1) shall 

not apply and the person extending the credit to the ultimate purchaser shall be treated as the person (and the 

only person) who paid the tax, but only if such person— 

(i) is registered under section 4101, 

(ii) has established, under regulations prescribed by 

the Secretary, that such person— 

(I) has not collected the amount of the tax from 

the person who purchased such article, or 

(II) has obtained the written consent from the 

ultimate purchaser to the allowance of the credit 

or refund, and 

(iii) has so established that such person— 

(I) has repaid or agreed to repay the amount of 

the tax to the ultimate vendor, 

(II) has obtained the written consent of the ultimate vendor to the allowance of the credit or refund, or 

(III) has otherwise made arrangements which 

directly or indirectly provides the ultimate vendor 

with reimbursement of such tax. 

If clause (i), (ii), or (iii) is not met by such person extending the credit to the ultimate purchaser, then such person 

shall collect an amount equal to the tax from the ultimate 

purchaser and only such ultimate purchaser may claim 

such credit or payment. 

(C) TIMING OF CLAIMS.—The procedure and timing of any 

claim under subparagraph (A) or (B) shall be the same as 

for claims under section 6427(i)(4), except that the rules of 

section 6427(i)(3)(B) regarding electronic claims shall not 

apply unless the ultimate vendor or credit card issuer has 

certified to the Secretary for the most recent quarter of the 

taxable year that all ultimate purchasers of the vendor or 

credit card issuer are certified and entitled to a refund 

under subparagraph (C) or (D) of subsection (b)(2). 

(b) SPECIAL CASES IN WHICH TAX PAYMENTS CONSIDERED OVERPAYMENTS.—Under regulations prescribed by the Secretary, credit 

or refund (without interest) shall be allowed or made in respect of 

the overpayments determined under the following paragraphs: 

(1) PRICE READJUSTMENTS.— (A) IN GENERAL.—Except as provided in subparagraph 

(B) or (C), if the price of any article in respect of which a 

tax, based on such price, is imposed by chapter 31 or 32, 

is readjusted by reason of the return or repossession of the 

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count, rebate, or allowance, including a readjustment for 

local advertising (but only to the extent provided in section 

4216(e)(2) and (3)), the part of the tax proportionate to the 

part of the price repaid or credited to the purchaser shall 

be deemed to be an overpayment. 

(B) FURTHER MANUFACTURE.—Subparagraph (A) shall 

not apply in the case of an article in respect of which tax 

was computed under section 4223(b)(2); but if the price for 

which such article was sold is readjusted by reason of the 

return or repossession of the article, the part of the tax 

proportionate to the part of such price repaid or credited 

to the purchaser shall be deemed to be an overpayment. 

(C) ADJUSTMENT OF TIRE PRICE.—No credit or refund of 

any tax imposed by subsection (a) or (b) of section 4071 

shall be allowed or made by reason of an adjustment of a 

tire pursuant to a warranty or guarantee. 

(2) SPECIFIED USES AND RESALES.—The tax paid under chapter 32 (or under subsection (a) or (d) of section 4041 in respect 

of sales or under section 4051) in respect of any article shall 

be deemed to be an overpayment if such article was, by any 

person— 

(A) exported; 

(B) used or sold for use as supplies for vessels or aircraft; 

(C) sold to a State or local government for the exclusive 

use of a State or local government; 

(D) sold to a nonprofit educational organization for its 

exclusive use; 

(E) sold to a qualified blood collector organization (as defined in section 7701(a)(49)) for such organization’s exclusive use in the collection, storage, or transportation of 

blood; 

(F) in the case of any tire taxable under section 4071(a), 

sold to any person for use as described in section 

4221(e)(3); or 

(G) in the case of gasoline, used or sold for use in the 

production of special fuels referred to in section 4041. 

Subparagraphs (C), (D), and (E) shall not apply in the case of 

any tax paid under section 4064. In the case of the tax imposed 

by section 4131, subparagraphs (B), (C), (D), and (E) shall not 

apply and subparagraph (A) shall apply only if the use of the 

exported vaccine meets such requirements as the Secretary 

may by regulations prescribe. This paragraph shall not apply 

in the case of any tax imposed under section 4041(a)(1) or 4081 

on diesel fuel or kerosene and any tax paid under section 4121. 

Subparagraphs (C) and (D) shall not apply in the case of any 

tax imposed on gasoline under section 4081 if the requirements 

of subsection (a)(4) are not met. In the case of taxes imposed 

by subchapter C or D of chapter 32, subparagraph (E) shall not 

apply. øIn the case of the tax imposed by section 4191, subparagraphs (B), (C), (D), and (E) shall not apply.¿ 

(3) TAX-PAID ARTICLES USED FOR FURTHER MANUFACTURE, ETC..—If the tax imposed by chapter 32 has been paid with respect to the sale of any article (other than coal taxable under 


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section 4121) by the manufacturer, producer, or importer 

thereof and such article is sold to a subsequent manufacturer 

or producer before being used, such tax shall be deemed to be 

an overpayment by such subsequent manufacturer or producer 

if— 

(A) in the case of any article other than any fuel taxable 

under section 4081, such article is used by the subsequent 

manufacturer or producer as material in the manufacture 

or production of, or as a component part of— 

(i) another article taxable under chapter 32, or 

(ii) an automobile bus chassis or an automobile bus 

body, manufactured or produced by him; or 

(B) in the case of any fuel taxable under section 4081, 

such fuel is used by the subsequent manufacturer or producer, for nonfuel purposes, as a material in the manufacture or production of any other article manufactured or 

produced by him. 

(4) TIRES.—If— 

(A) the tax imposed by section 4071 has been paid with 

respect to the sale of any tire by the manufacturer, producer, or importer thereof, and 

(B) such tire is sold by any person on or in connection 

with, or with the sale of, any other article, such tax shall 

be deemed to be an overpayment by such person if such 

other article is— 

(i) an automobile bus chassis or an automobile bus 

body, 

(ii) by such person exported, sold to a State or local 

government for the exclusive use of a State or local 

government, sold to a nonprofit educational organization for its exclusive use, or used or sold for use as 

supplies for vessels or aircraft, or 

(iii) sold to a qualified blood collector organization 

for its exclusive use in connection with a vehicle the 

organization certifies will be primarily used in the collection, storage, or transportation of blood. 

(5) RETURN OF CERTAIN INSTALLMENT ACCOUNTS.—If— 

(A) tax was paid under section 4216(d)(1) in respect of 

any installment account, 

(B) such account is, under the agreement under which 

the account was sold, returned to the person who sold such 

account, and 

(C) the consideration is readjusted as provided in such 

agreement, 

the part of the tax paid under section 4216(d)(1) allocable to 

the part of the consideration repaid or credited to the purchaser of such account shall be deemed to be an overpayment. 

(6) TRUCK CHASSIS, BODIES, AND SEMITRAILERS USED FOR

FURTHER MANUFACTURE.—If— 

(A) the tax imposed by section 4051 has been paid with 

respect to the sale of any article, and 

(B) before any other use, such article is by any person 

used as a component part of another article taxable under 

section 4051 manufactured or produced by him, 


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such tax shall be deemed to be an overpayment by such person. For purposes of the preceding sentence, an article shall be 

treated as having been used as a component part of another 

article if, had it not been broken or rendered useless in the 

manufacture or production of such other article, it would have 

been so used. 

This subsection shall apply in respect of an article only if the 

exportation or use referred to in the applicable provision of this 

subsection occurs before any other use, or, in the case of a sale 

or resale, the use referred to in the applicable provision of this 

subsection is to occur before any other use. 

(c) REFUND TO EXPORTER OR SHIPPER.—Under regulations prescribed by the Secretary the amount of any tax imposed by chapter 

31, or chapter 32 erroneously or illegally collected in respect of any 

article exported to a foreign country or shipped to a possession of 

the United States may be refunded to the exporter or shipper 

thereof, if the person who paid such tax waives his claim to such 

amount. 

(d) CREDIT ON RETURNS.—Any person entitled to a refund of tax 

imposed by chapter 31 or 32, paid to the Secretary may, instead 

of filing a claim for refund, take credit therefor against taxes imposed by such chapter due on any subsequent return. The preceding sentence shall not apply to the tax imposed by section 4081 

in the case of refunds described in section 4081(e). 

(e) ACCOUNTING PROCEDURES FOR LIKE ARTICLES.—Under regulations prescribed by the Secretary, if any person uses or resells 

like articles, then for purposes of this section the manufacturer, 

producer, or importer of any such article may be identified, and the 

amount of tax paid under chapter 32 in respect of such article may 

be determined— 

(1) on a first-in-first-out basis, 

(2) on a last-in-first-out basis, or 

(3) in accordance with any other consistent method approved 

by the Secretary. 

(f) MEANING OF TERMS.—For purposes of this section, any term 

used in this section has the same meaning as when used in chapter 

31, 32, or 33, as the case may be. 

* * * * * * * 


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CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets and existing law in which no 

change is proposed is shown in roman): 

PATIENT PROTECTION AND AFFORDABLE CARE ACT 

* * * * * * * 

TITLE III—IMPROVING THE QUALITY 

AND EFFICIENCY OF HEALTH CARE 

* * * * * * * 

Subtitle E—Ensuring Medicare 

Sustainability 

* * * * * * * 

øSEC. 3403. INDEPENDENT MEDICARE ADVISORY BOARD. 

ø(a) BOARD.— 

ø(1) IN GENERAL.—Title XVIII of the Social Security Act (42 

U.S.C. 1395 et seq.), as amended by section 3022, is amended 

by adding at the end the following new section: 

ø‘‘INDEPENDENT MEDICARE ADVISORY BOARD

ø‘‘SEC.1899A. (a) ESTABLISHMENT.—There is established an independent board to be known as the ‘Independent Medicare Advisory 

Board’. 

ø‘‘(b) PURPOSE.—It is the purpose of this section to, in accordance 

with the following provisions of this section, reduce the per capita 

rate of growth in Medicare spending— 

ø‘‘(1) by requiring the Chief Actuary of the Centers for Medicare & Medicaid Services to determine in each year to which 

this section applies (in this section referred to as ‘a determination year’) the projected per capita growth rate under Medicare 

for the second year following the determination year (in this 

section referred to as ‘an implementation year’); 

ø‘‘(2) if the projection for the implementation year exceeds 

the target growth rate for that year, by requiring the Board to 

develop and submit during the first year following the determination year (in this section referred to as ‘a proposal year’) 

a proposal containing recommendations to reduce the Medicare 

per capita growth rate to the extent required by this section; 

and 

ø‘‘(3) by requiring the Secretary to implement such proposals 

unless Congress enacts legislation pursuant to this section. 

ø‘‘(c) BOARD PROPOSALS.— 

ø‘‘(1) DEVELOPMENT.— 


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ø‘‘(A) IN GENERAL.—The Board shall develop detailed 

and specific proposals related to the Medicare program in 

accordance with the succeeding provisions of this section. 

ø‘‘(B) ADVISORY REPORTS.—Beginning January 15, 2014, 

the Board may develop and submit to Congress advisory 

reports on matters related to the Medicare program, regardless of whether or not the Board submitted a proposal 

for such year. Such a report may, for years prior to 2020, 

include recommendations regarding improvements to payment systems for providers of services and suppliers who 

are not otherwise subject to the scope of the Board’s recommendations in a proposal under this section. Any advisory report submitted under this subparagraph shall not 

be subject to the rules for congressional consideration 

under subsection (d). In any year (beginning with 2014) 

that the Board is not required to submit a proposal under 

this section, the Board shall submit to Congress an advisory report on matters related to the Medicare program. 

ø‘‘(2) PROPOSALS.— 

ø‘‘(A) REQUIREMENTS.—Each proposal submitted under 

this section in a proposal year shall meet each of the following requirements: 

ø‘‘(i) If the Chief Actuary of the Centers for Medicare & Medicaid Services has made a determination 

under paragraph (7)(A) in the determination year, the 

proposal shall include recommendations so that the 

proposal as a whole (after taking into account recommendations under clause (v)) will result in a net reduction in total Medicare program spending in the implementation year that is at least equal to the applicable savings target established under paragraph (7)(B) 

for such implementation year. In determining whether 

a proposal meets the requirement of the preceding 

sentence, reductions in Medicare program spending 

during the 3-month period immediately preceding the 

implementation year shall be counted to the extent 

that such reductions are a result of the implementation of recommendations contained in the proposal for 

a change in the payment rate for an item or service 

that was effective during such period pursuant to subsection (e)(2)(A). 

ø‘‘(ii) The proposal shall not include any recommendation to ration health care, raise revenues or 

Medicare beneficiary premiums under section 1818, 

1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria. 

ø‘‘(iii) In the case of proposals submitted prior to December 31, 2018, the proposal shall not include any 

recommendation that would reduce payment rates for 

items and services furnished, prior to December 31, 

2019, by providers of services (as defined in section 

1861(u)) and suppliers (as defined in section 1861(d)) 


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scheduled, pursuant to the amendments made by section 3401 of the Patient Protection and Affordable 

Care Act, to receive a reduction to the inflationary 

payment updates of such providers of services and 

suppliers in excess of a reduction due to productivity 

in a year in which such recommendations would take 

effect. 

ø‘‘(iv) As appropriate, the proposal shall include recommendations to reduce Medicare payments under 

parts C and D, such as reductions in direct subsidy 

payments to Medicare Advantage and prescription 

drug plans specified under paragraph (1) and (2) of 

section 1860D–15(a) that are related to administrative 

expenses (including profits) for basic coverage, denying 

high bids or removing high bids for prescription drug 

coverage from the calculation of the national average 

monthly bid amount under section 1860D–13(a)(4), 

and reductions in payments to Medicare Advantage 

plans under clauses (i) and (ii) of section 1853(a)(1)(B) 

that are related to administrative expenses (including 

profits) and performance bonuses for Medicare Advantage plans under section 1853(n). Any such recommendation shall not affect the base beneficiary premium percentage specified under 1860D–13(a) or the 

full premium subsidy under section 1860D–14(a). 

ø‘‘(v) The proposal shall include recommendations 

with respect to administrative funding for the Secretary to carry out the recommendations contained in 

the proposal. 

ø‘‘(vi) The proposal shall only include recommendations related to the Medicare program. 

ø‘‘(vii) If the Chief Actuary of the Centers for Medicare & Medicaid Services has made a determination 

described in subsection (e)(3)(B)(i)(II) in the determination year, the proposal shall be designed to help 

reduce the growth rate described in paragraph (8) 

while maintaining or enhancing beneficiary access to 

quality care under this title. 

ø‘‘(B) ADDITIONAL CONSIDERATIONS.—In developing and 

submitting each proposal under this section in a proposal 

year, the Board shall, to the extent feasible— 

ø‘‘(i) give priority to recommendations that extend 

Medicare solvency; 

ø‘‘(ii) include recommendations that— 

ø‘‘(I) improve the health care delivery system 

and health outcomes, including by promoting integrated care, care coordination, prevention and 

wellness, and quality and efficiency improvement; 

and 

ø‘‘(II) protect and improve Medicare beneficiaries’ access to necessary and evidence-based 

items and services, including in rural and frontier 

areas; 


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ø‘‘(iii) include recommendations that target reductions in Medicare program spending to sources of excess cost growth; 

ø‘‘(iv) consider the effects on Medicare beneficiaries 

of changes in payments to providers of services (as defined in section 1861(u)) and suppliers (as defined in 

section 1861(d)); 

ø‘‘(v) consider the effects of the recommendations on 

providers of services and suppliers with actual or projected negative cost margins or payment updates; 

ø‘‘(vi) consider the unique needs of Medicare beneficiaries who are dually eligible for Medicare and the 

Medicaid program under title XIX; and 

ø‘‘(vii) take into account the data and findings contained in the annual reports under subsection (n) in 

order to develop proposals that can most effectively 

promote the delivery of efficient, high quality care to 

Medicare beneficiaries. 

ø‘‘(C) NO INCREASE IN TOTAL MEDICARE PROGRAM SPENDING.—Each proposal submitted under this section shall be 

designed in such a manner that implementation of the recommendations contained in the proposal would not be expected to result, over the 10-year period starting with the 

implementation year, in any increase in the total amount 

of net Medicare program spending relative to the total 

amount of net Medicare program spending that would 

have occurred absent such implementation. 

ø‘‘(D) CONSULTATION WITH MEDPAC.—The Board shall 

submit a draft copy of each proposal to be submitted under 

this section to the Medicare Payment Advisory Commission established under section 1805 for its review. The 

Board shall submit such draft copy by not later than September 1 of the determination year. 

ø‘‘(E) REVIEW AND COMMENT BY THE SECRETARY.—The 

Board shall submit a draft copy of each proposal to be submitted to Congress under this section to the Secretary for 

the Secretary’s review and comment. The Board shall submit such draft copy by not later than September 1 of the 

determination year. Not later than March 1 of the submission year, the Secretary shall submit a report to Congress 

on the results of such review, unless the Secretary submits 

a proposal under paragraph (5)(A) in that year. 

ø‘‘(F) CONSULTATIONS.—In carrying out its duties under 

this section, the Board shall engage in regular consultations with the Medicaid and CHIP Payment and Access 

Commission under section 1900. 

ø‘‘(3) SUBMISSION OF BOARD PROPOSAL TO CONGRESS AND THE

PRESIDENT.— 

ø‘‘(A) IN GENERAL.— 

ø‘‘(i) IN GENERAL.—Except as provided in clause (ii) 

and subsection (f)(3)(B), the Board shall submit a proposal under this section to Congress and the President 

on January 15 of each year (beginning with 2014). 


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ø‘‘(ii) EXCEPTION.—The Board shall not submit a 

proposal under clause (i) in a proposal year if the year 

is— 

ø‘‘(I) a year for which the Chief Actuary of the 

Centers for Medicare & Medicaid Services makes 

a determination in the determination year under 

paragraph (6)(A) that the growth rate described in 

clause (i) of such paragraph does not exceed the 

growth rate described in clause (ii) of such paragraph; or 

ø‘‘(II) a year in which the Chief Actuary of the 

Centers for Medicare & Medicaid Services makes 

a determination in the determination year that 

the projected percentage increase (if any) for the 

medical care expenditure category of the Consumer Price Index for All Urban Consumers 

(United States city average) for the implementation year is less than the projected percentage increase (if any) in the Consumer Price Index for All 

Urban Consumers (all items; United States city 

average) for such implementation year. 

ø‘‘(iii) START-UP PERIOD.—The Board may not submit 

a proposal under clause (i) prior to January 15, 2014. 

ø‘‘(B) REQUIRED INFORMATION.—Each proposal submitted 

by the Board under subparagraph (A)(i) shall include— 

ø‘‘(i) the recommendations described in paragraph 

(2)(A)(i); 

ø‘‘(ii) an explanation of each recommendation contained in the proposal and the reasons for including 

such recommendation; 

ø‘‘(iii) an actuarial opinion by the Chief Actuary of 

the Centers for Medicare & Medicaid Services certifying that the proposal meets the requirements of subparagraphs (A)(i) and (C) of paragraph (2); 

ø‘‘(iv) a legislative proposal that implements the recommendations; and 

ø‘‘(v) other information determined appropriate by 

the Board. 

ø‘‘(4) PRESIDENTIAL SUBMISSION TO CONGRESS.—Upon receiving a proposal from the Secretary under paragraph (5), the 

President shall within 2 days submit such proposal to Congress. 

ø‘‘(5) CONTINGENT SECRETARIAL DEVELOPMENT OF PROPOSAL.—If, with respect to a proposal year, the Board is required, but fails, to submit a proposal to Congress and the 

President by the deadline applicable under paragraph (3)(A)(i), 

the Secretary shall develop a detailed and specific proposal 

that satisfies the requirements of subparagraphs (A) and (C) 

(and, to the extent feasible, subparagraph (B)) of paragraph (2) 

and contains the information required paragraph (3)(B)). By 

not later than January 25 of the year, the Secretary shall 

transmit— 

ø‘‘(A) such proposal to the President; and 


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ø‘‘(B) a copy of such proposal to the Medicare Payment 

Advisory Commission for its review. 

ø‘‘(6) PER CAPITA GROWTH RATE PROJECTIONS BY CHIEF ACTUARY.— 

ø‘‘(A) IN GENERAL.—Subject to subsection (f)(3)(A), not 

later than April 30, 2013, and annually thereafter, the 

Chief Actuary of the Centers for Medicare & Medicaid 

Services shall determine in each such year whether— 

ø‘‘(i) the projected Medicare per capita growth rate 

for the implementation year (as determined under 

subparagraph (B)); exceeds 

ø‘‘(ii) the projected Medicare per capita target 

growth rate for the implementation year (as determined under subparagraph (C)). 

ø‘‘(B) MEDICARE PER CAPITA GROWTH RATE.— 

ø‘‘(i) IN GENERAL.—For purposes of this section, the 

Medicare per capita growth rate for an implementation year shall be calculated as the projected 5-year 

average (ending with such year) of the growth in 

Medicare program spending (calculated as the sum of 

per capita spending under each of parts A, B, and D). 

ø‘‘(ii) REQUIREMENT.—The projection under clause (i) 

shall— 

ø‘‘(I) to the extent that there is projected to be 

a negative update to the single conversion factor 

applicable to payments for physicians’ services 

under section 1848(d) furnished in the proposal 

year or the implementation year, assume that 

such update for such services is 0 percent rather 

than the negative percent that would otherwise 

apply; and 

ø‘‘(II) take into account any delivery system reforms or other payment changes that have been 

enacted or published in final rules but not yet implemented as of the making of such calculation. 

ø‘‘(C) MEDICARE PER CAPITA TARGET GROWTH RATE.—For 

purposes of this section, the Medicare per capita target 

growth rate for an implementation year shall be calculated 

as the projected 5-year average (ending with such year) 

percentage increase in— 

ø‘‘(i) with respect to a determination year that is 

prior to 2018, the average of the projected percentage 

increase (if any) in— 

ø‘‘(I) the Consumer Price Index for All Urban 

Consumers (all items; United States city average); 

and 

ø‘‘(II) the medical care expenditure category of 

the Consumer Price Index for All Urban Consumers (United States city average); and 

ø‘‘(ii) with respect to a determination year that is 

after 2017, the nominal gross domestic product per 

capita plus 1.0 percentage point. 

ø‘‘(7) SAVINGS REQUIREMENT.— 


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ø‘‘(A) IN GENERAL.—If, with respect to a determination 

year, the Chief Actuary of the Centers for Medicare & 

Medicaid Services makes a determination under paragraph 

(6)(A) that the growth rate described in clause (i) of such 

paragraph exceeds the growth rate described in clause (ii) 

of such paragraph, the Chief Actuary shall establish an applicable savings target for the implementation year. 

ø‘‘(B) APPLICABLE SAVINGS TARGET.—For purposes of this 

section, the applicable savings target for an implementation year shall be an amount equal to the product of— 

ø‘‘(i) the total amount of projected Medicare program 

spending for the proposal year; and 

ø‘‘(ii) the applicable percent for the implementation 

year. 

ø‘‘(C) APPLICABLE PERCENT.—For purposes of subparagraph (B), the applicable percent for an implementation 

year is the lesser of— 

ø‘‘(i) in the case of— 

ø‘‘(I) implementation year 2015, 0.5 percent; 

ø‘‘(II) implementation year 2016, 1.0 percent; 

ø‘‘(III) implementation year 2017, 1.25 percent; 

and 

ø‘‘(IV) implementation year 2018 or any subsequent implementation year, 1.5 percent; and 

ø‘‘(ii) the projected excess for the implementation 

year (expressed as a percent) determined under subparagraph (A). 

ø‘‘(8) PER CAPITA RATE OF GROWTH IN NATIONAL HEALTH EXPENDITURES.—In each determination year (beginning in 2018), 

the Chief Actuary of the Centers for Medicare & Medicaid 

Services shall project the per capita rate of growth in national 

health expenditures for the implementation year. Such rate of 

growth for an implementation year shall be calculated as the 

projected 5-year average (ending with such year) percentage increase in national health care expenditures. 

ø‘‘(d) CONGRESSIONAL CONSIDERATION.— 

ø‘‘(1) INTRODUCTION.— 

ø‘‘(A) IN GENERAL.—On the day on which a proposal is 

submitted by the Board or the President to the House of 

Representatives and the Senate under subsection 

(c)(3)(A)(i) or subsection (c)(4), the legislative proposal (described in subsection (c)(3)(B)(iv)) contained in the proposal shall be introduced (by request) in the Senate by the 

majority leader of the Senate or by Members of the Senate 

designated by the majority leader of the Senate and shall 

be introduced (by request) in the House by the majority 

leader of the House or by Members of the House designated by the majority leader of the House. 

ø‘‘(B) NOT IN SESSION.—If either House is not in session 

on the day on which such legislative proposal is submitted, 

the legislative proposal shall be introduced in that House, 

as provided in subparagraph (A), on the first day thereafter on which that House is in session. 


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ø‘‘(C) ANY MEMBER.—If the legislative proposal is not introduced in either House within 5 days on which that 

House is in session after the day on which the legislative 

proposal is submitted, then any Member of that House 

may introduce the legislative proposal. 

ø‘‘(D) REFERRAL.—The legislation introduced under this 

paragraph shall be referred by the Presiding Officers of 

the respective Houses to the Committee on Finance in the 

Senate and to the Committee on Energy and Commerce 

and the Committee on Ways and Means in the House of 

Representatives. 

ø‘‘(2) COMMITTEE CONSIDERATION OF PROPOSAL.— 

ø‘‘(A) REPORTING BILL.—Not later than April 1 of any 

proposal year in which a proposal is submitted by the 

Board or the President to Congress under this section, the 

Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and 

the Committee on Finance of the Senate may report the 

bill referred to the Committee under paragraph (1)(D) with 

committee amendments related to the Medicare program. 

ø‘‘(B) CALCULATIONS.—In determining whether a committee amendment meets the requirement of subparagraph 

(A), the reductions in Medicare program spending during 

the 3-month period immediately preceding the implementation year shall be counted to the extent that such reductions are a result of the implementation provisions in the 

committee amendment for a change in the payment rate 

for an item or service that was effective during such period 

pursuant to such amendment. 

ø‘‘(C) COMMITTEE JURISDICTION.—Notwithstanding rule 

XV of the Standing Rules of the Senate, a committee 

amendment described in subparagraph (A) may include 

matter not within the jurisdiction of the Committee on Finance if that matter is relevant to a proposal contained in 

the bill submitted under subsection (c)(3). 

ø‘‘(D) DISCHARGE.—If, with respect to the House involved, the committee has not reported the bill by the date 

required by subparagraph (A), the committee shall be discharged from further consideration of the proposal. 

ø‘‘(3) LIMITATION ON CHANGES TO THE BOARD RECOMMENDATIONS.— 

ø‘‘(A) IN GENERAL.—It shall not be in order in the Senate 

or the House of Representatives to consider any bill, resolution, or amendment, pursuant to this subsection or conference report thereon, that fails to satisfy the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2). 

ø‘‘(B) LIMITATION ON CHANGES TO THE BOARD REC- OMMENDATIONS IN OTHER LEGISLATION.—It shall not be in 

order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report 

(other than pursuant to this section) that would repeal or 

otherwise change the recommendations of the Board if 

that change would fail to satisfy the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2). 


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ø‘‘(C) LIMITATION ON CHANGES TO THIS SUBSECTION.—It 

shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, 

or conference report that would repeal or otherwise change 

this subsection. 

ø‘‘(D) WAIVER.—This paragraph may be waived or suspended in the Senate only by the affirmative vote of threefifths of the Members, duly chosen and sworn. 

ø‘‘(E) APPEALS.—An affirmative vote of three-fifths of the 

Members of the Senate, duly chosen and sworn, shall be 

required in the Senate to sustain an appeal of the ruling 

of the Chair on a point of order raised under this paragraph. 

ø‘‘(4) EXPEDITED PROCEDURE.— 

ø‘‘(A) CONSIDERATION.—A motion to proceed to the consideration of the bill in the Senate is not debatable. 

ø‘‘(B) AMENDMENT.— 

ø‘‘(i) TIME LIMITATION.—Debate in the Senate on any 

amendment to a bill under this section shall be limited 

to 1 hour, to be equally divided between, and controlled by, the mover and the manager of the bill, and 

debate on any amendment to an amendment, debatable motion, or appeal shall be limited to 30 minutes, 

to be equally divided between, and controlled by, the 

mover and the manager of the bill, except that in the 

event the manager of the bill is in favor of any such 

amendment, motion, or appeal, the time in opposition 

thereto shall be controlled by the minority leader or 

such leader’s designee. 

ø‘‘(ii) GERMANE.—No amendment that is not germane to the provisions of such bill shall be received. 

ø‘‘(iii) ADDITIONAL TIME.—The leaders, or either of 

them, may, from the time under their control on the 

passage of the bill, allot additional time to any Senator during the consideration of any amendment, debatable motion, or appeal. 

ø‘‘(iv) AMENDMENT NOT IN ORDER.—It shall not be in 

order to consider an amendment that would cause the 

bill to result in a net reduction in total Medicare program spending in the implementation year that is less 

than the applicable savings target established under 

subsection (c)(7)(B) for such implementation year. 

ø‘‘(v) WAIVER AND APPEALS.—This paragraph may be 

waived or suspended in the Senate only by the affirmative vote of three-fifths of the Members, duly chosen 

and sworn. An affirmative vote of three-fifths of the 

Members of the Senate, duly chosen and sworn, shall 

be required in the Senate to sustain an appeal of the 

ruling of the Chair on a point of order raised under 

this section. 

ø‘‘(C) CONSIDERATION BY THE OTHER HOUSE.— ø‘‘(i) IN GENERAL.—The expedited procedures provided in this subsection for the consideration of a bill 

introduced pursuant to paragraph (1) shall not apply 


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to such a bill that is received by one House from the 

other House if such a bill was not introduced in the 

receiving House. 

ø‘‘(ii) BEFORE PASSAGE.—If a bill that is introduced 

pursuant to paragraph (1) is received by one House 

from the other House, after introduction but before 

disposition of such a bill in the receiving House, then 

the following shall apply: 

ø‘‘(I) The receiving House shall consider the bill 

introduced in that House through all stages of 

consideration up to, but not including, passage. 

ø‘‘(II) The question on passage shall be put on 

the bill of the other House as amended by the language of the receiving House. 

ø‘‘(iii) AFTER PASSAGE.—If a bill introduced pursuant 

to paragraph (1) is received by one House from the 

other House, after such a bill is passed by the receiving House, then the vote on passage of the bill that 

originates in the receiving House shall be considered 

to be the vote on passage of the bill received from the 

other House as amended by the language of the receiving House. 

ø‘‘(iv) DISPOSITION.—Upon disposition of a bill introduced pursuant to paragraph (1) that is received by 

one House from the other House, it shall no longer be 

in order to consider the bill that originates in the receiving House. 

ø‘‘(v) LIMITATION.—Clauses (ii), (iii), and (iv) shall 

apply only to a bill received by one House from the 

other House if the bill— 

ø‘‘(I) is related only to the program under this 

title; and 

ø‘‘(II) satisfies the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2). 

ø‘‘(D) SENATE LIMITS ON DEBATE.— ø‘‘(i) IN GENERAL.—In the Senate, consideration of 

the bill and on all debatable motions and appeals in 

connection therewith shall not exceed a total of 30 

hours, which shall be divided equally between the majority and minority leaders or their designees. 

ø‘‘(ii) MOTION TO FURTHER LIMIT DEBATE.—A motion 

to further limit debate on the bill is in order and is not 

debatable. 

ø‘‘(iii) MOTION OR APPEAL.—Any debatable motion or 

appeal is debatable for not to exceed 1 hour, to be divided equally between those favoring and those opposing the motion or appeal. 

ø‘‘(iv) FINAL DISPOSITION.—After 30 hours of consideration, the Senate shall proceed, without any further 

debate on any question, to vote on the final disposition 

thereof to the exclusion of all amendments not then 

pending before the Senate at that time and to the exclusion of all motions, except a motion to table, or to 

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lish the presence of a quorum (and motions required 

to establish a quorum) immediately before the final 

vote begins. 

ø‘‘(E) CONSIDERATION IN CONFERENCE.— ø‘‘(i) IN GENERAL.—Consideration in the Senate and 

the House of Representatives on the conference report 

or any messages between Houses shall be limited to 

10 hours, equally divided and controlled by the majority and minority leaders of the Senate or their designees and the Speaker of the House of Representatives and the minority leader of the House of Representatives or their designees. 

ø‘‘(ii) TIME LIMITATION.—Debate in the Senate on 

any amendment under this subparagraph shall be limited to 1 hour, to be equally divided between, and controlled by, the mover and the manager of the bill, and 

debate on any amendment to an amendment, debatable motion, or appeal shall be limited to 30 minutes, 

to be equally divided between, and controlled by, the 

mover and the manager of the bill, except that in the 

event the manager of the bill is in favor of any such 

amendment, motion, or appeal, the time in opposition 

thereto shall be controlled by the minority leader or 

such leader’s designee. 

ø‘‘(iii) FINAL DISPOSITION.—After 10 hours of consideration, the Senate shall proceed, without any further 

debate on any question, to vote on the final disposition 

thereof to the exclusion of all motions not then pending before the Senate at that time or necessary to resolve the differences between the Houses and to the 

exclusion of all other motions, except a motion to 

table, or to reconsider and one quorum call on demand 

to establish the presence of a quorum (and motions required to establish a quorum) immediately before the 

final vote begins. 

ø‘‘(iv) LIMITATION.—Clauses (i) through (iii) shall 

only apply to a conference report, message or the 

amendments thereto if the conference report, message, 

or an amendment thereto— 

ø‘‘(I) is related only to the program under this 

title; and 

ø‘‘(II) satisfies the requirements of subparagraphs (A)(i) and (C) of subsection (c)(2). 

ø‘‘(F) VETO.—If the President vetoes the bill debate on a 

veto message in the Senate under this subsection shall be 

1 hour equally divided between the majority and minority 

leaders or their designees. 

ø‘‘(5) RULES OF THE SENATE AND HOUSE OF REPRESENTATIVES.—This subsection and subsection (f)(2) are enacted by 

Congress— 

ø‘‘(A) as an exercise of the rulemaking power of the Senate and the House of Representatives, respectively, and is 

deemed to be part of the rules of each House, respectively, 

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lowed in that House in the case of bill under this section, 

and it supersedes other rules only to the extent that it is 

inconsistent with such rules; and 

ø‘‘(B) with full recognition of the constitutional right of 

either House to change the rules (so far as they relate to 

the procedure of that House) at any time, in the same 

manner, and to the same extent as in the case of any other 

rule of that House. 

ø‘‘(e) IMPLEMENTATION OF PROPOSAL.— ø‘‘(1) IN GENERAL.—Notwithstanding any other provision of 

law, the Secretary shall, except as provided in paragraph (3), 

implement the recommendations contained in a proposal submitted by the Board or the President to Congress pursuant to 

this section on August 15 of the year in which the proposal is 

so submitted. 

ø‘‘(2) APPLICATION.— 

ø‘‘(A) IN GENERAL.—A recommendation described in 

paragraph (1) shall apply as follows: 

ø‘‘(i) In the case of a recommendation that is a 

change in the payment rate for an item or service 

under Medicare in which payment rates change on a 

fiscal year basis (or a cost reporting period basis that 

relates to a fiscal year), on a calendar year basis (or 

a cost reporting period basis that relates to a calendar 

year), or on a rate year basis (or a cost reporting period basis that relates to a rate year), such recommendation shall apply to items and services furnished on the first day of the first fiscal year, calendar 

year, or rate year (as the case may be) that begins 

after such August 15. 

ø‘‘(ii) In the case of a recommendation relating to 

payments to plans under parts C and D, such recommendation shall apply to plan years beginning on 

the first day of the first calendar year that begins 

after such August 15. 

ø‘‘(iii) In the case of any other recommendation, such 

recommendation shall be addressed in the regular regulatory process timeframe and shall apply as soon as 

practicable. 

ø‘‘(B) INTERIM FINAL RULEMAKING.—The Secretary may 

use interim final rulemaking to implement any recommendation described in paragraph (1). 

ø‘‘(3) EXCEPTIONS.— 

ø‘‘(A) IN GENERAL.—The Secretary shall not implement 

the recommendations contained in a proposal submitted in 

a proposal year by the Board or the President to Congress 

pursuant to this section if— 

ø‘‘(i) prior to August 15 of the proposal year, Federal 

legislation is enacted that includes the following provision: ‘This Act supercedes the recommendations of the 

Board contained in the proposal submitted, in the year 

which includes the date of enactment of this Act, to 

Congress under section 1899A of the Social Security 

Act.’; and 


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ø‘‘(ii) in the case of implementation year 2020 and 

subsequent implementation years, a joint resolution 

described in subsection (f)(1) is enacted not later than 

August 15, 2017. 

ø‘‘(B) LIMITED ADDITIONAL EXCEPTION.— ø‘‘(i) IN GENERAL.—Subject to clause (ii), the Secretary shall not implement the recommendations contained in a proposal submitted by the Board or the 

President to Congress pursuant to this section in a 

proposal year (beginning with proposal year 2019) if— 

ø‘‘(I) the Board was required to submit a proposal to Congress under this section in the year 

preceding the proposal year; and 

ø‘‘(II) the Chief Actuary of the Centers for Medicare & Medicaid Services makes a determination 

in the determination year that the growth rate described in subsection (c)(8) exceeds the growth 

rate described in subsection (c)(6)(A)(i). 

ø‘‘(ii) LIMITED ADDITIONAL EXCEPTION MAY NOT BE

APPLIED IN TWO CONSECUTIVE YEARS.—This subparagraph shall not apply if the recommendations contained in a proposal submitted by the Board or the 

President to Congress pursuant to this section in the 

year preceding the proposal year were not required to 

be implemented by reason of this subparagraph. 

ø‘‘(iii) NO AFFECT ON REQUIREMENT TO SUBMIT PRO- POSALS OR FOR CONGRESSIONAL CONSIDERATION OF

PROPOSALS.—Clause (i) and (ii) shall not affect— 

ø‘‘(I) the requirement of the Board or the President to submit a proposal to Congress in a proposal year in accordance with the provisions of 

this section; or 

ø‘‘(II) Congressional consideration of a legislative proposal (described in subsection (c)(3)(B)(iv)) 

contained such a proposal in accordance with subsection (d). 

ø‘‘(4) NO AFFECT ON AUTHORITY TO IMPLEMENT CERTAIN PRO- VISIONS.—Nothing in paragraph (3) shall be construed to affect 

the authority of the Secretary to implement any recommendation contained in a proposal or advisory report under this section to the extent that the Secretary otherwise has the authority to implement such recommendation administratively. 

ø‘‘(5) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the implementation by the Secretary under this subsection of the recommendations contained in a proposal. 

ø‘‘(f) JOINT RESOLUTION REQUIRED TO DISCONTINUE THE

BOARD.— 

ø‘‘(1) IN GENERAL.—For purposes of subsection (e)(3)(B), a 

joint resolution described in this paragraph means only a joint 

resolution— 

ø‘‘(A) that is introduced in 2017 by not later than February 1 of such year; 

ø‘‘(B) which does not have a preamble; 


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ø‘‘(C) the title of which is as follows: ‘Joint resolution approving the discontinuation of the process for consideration 

and automatic implementation of the annual proposal of 

the Independent Medicare Advisory Board under section 

1899A of the Social Security Act’; and 

ø‘‘(D) the matter after the resolving clause of which is as 

follows: ‘That Congress approves the discontinuation of the 

process for consideration and automatic implementation of 

the annual proposal of the Independent Medicare Advisory 

Board under section 1899A of the Social Security Act.’. 

ø‘‘(2) PROCEDURE.— 

ø‘‘(A) REFERRAL.—A joint resolution described in paragraph (1) shall be referred to the Committee on Ways and 

Means and the Committee on Energy and Commerce of the 

House of Representatives and the Committee on Finance 

of the Senate. 

ø‘‘(B) DISCHARGE.—In the Senate, if the committee to 

which is referred a joint resolution described in paragraph 

(1) has not reported such joint resolution (or an identical 

joint resolution) at the end of 20 days after the joint resolution described in paragraph (1) is introduced, such committee may be discharged from further consideration of 

such joint resolution upon a petition supported in writing 

by 30 Members of the Senate, and such joint resolution 

shall be placed on the calendar. 

ø‘‘(C) CONSIDERATION.— 

ø‘‘(i) IN GENERAL.—In the Senate, when the committee to which a joint resolution is referred has reported, or when a committee is discharged (under subparagraph (C)) from further consideration of a joint 

resolution described in paragraph (1), it is at any time 

thereafter in order (even though a previous motion to 

the same effect has been disagreed to) for a motion to 

proceed to the consideration of the joint resolution to 

be made, and all points of order against the joint resolution (and against consideration of the joint resolution) are waived, except for points of order under the 

Congressional Budget act of 1974 or under budget resolutions pursuant to that Act. The motion is not debatable. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. 

If a motion to proceed to the consideration of the joint 

resolution is agreed to, the joint resolution shall remain the unfinished business of the Senate until disposed of. 

ø‘‘(ii) DEBATE LIMITATION.—In the Senate, consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be 

limited to not more than 10 hours, which shall be divided equally between the majority leader and the minority leader, or their designees. A motion further to 

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ceed to the consideration of other business, or a motion to recommit the joint resolution is not in order. 

ø‘‘(iii) PASSAGE.—In the Senate, immediately following the conclusion of the debate on a joint resolution described in paragraph (1), and a single quorum 

call at the conclusion of the debate if requested in accordance with the rules of the Senate, the vote on passage of the joint resolution shall occur. 

ø‘‘(iv) APPEALS.—Appeals from the decisions of the 

Chair relating to the application of the rules of the 

Senate to the procedure relating to a joint resolution 

described in paragraph (1) shall be decided without 

debate. 

ø‘‘(D) OTHER HOUSE ACTS FIRST.—If, before the passage 

by 1 House of a joint resolution of that House described in 

paragraph (1), that House receives from the other House 

a joint resolution described in paragraph (1), then the following procedures shall apply: 

ø‘‘(i) The joint resolution of the other House shall 

not be referred to a committee. 

ø‘‘(ii) With respect to a joint resolution described in 

paragraph (1) of the House receiving the joint resolution— 

ø‘‘(I) the procedure in that House shall be the 

same as if no joint resolution had been received 

from the other House; but 

ø‘‘(II) the vote on final passage shall be on the 

joint resolution of the other House. 

ø‘‘(E) EXCLUDED DAYS.—For purposes of determining the 

period specified in subparagraph (B), there shall be excluded any days either House of Congress is adjourned for 

more than 3 days during a session of Congress. 

ø‘‘(F) MAJORITY REQUIRED FOR ADOPTION.—A joint resolution considered under this subsection shall require an affirmative vote of three-fifths of the Members, duly chosen 

and sworn, for adoption. 

ø‘‘(3) TERMINATION.—If a joint resolution described in paragraph (1) is enacted not later than August 15, 2017— 

ø‘‘(A) the Chief Actuary of the Medicare & Medicaid 

Services shall not— 

ø‘‘(i) make any determinations under subsection 

(c)(6) after May 1, 2017; or 

ø‘‘(ii) provide any opinion pursuant to subsection 

(c)(3)(B)(iii) after January 16, 2018; 

ø‘‘(B) the Board shall not submit any proposals, advisory 

reports, or advisory recommendations under this section or 

produce the public report under subsection (n) after January 16, 2018; and 

ø‘‘(C) the Board and the consumer advisory council 

under subsection (k) shall terminate on August 16, 2018. 

ø‘‘(g) BOARD MEMBERSHIP; TERMS OF OFFICE; CHAIRPERSON; RE- MOVAL.— 

ø‘‘(1) MEMBERSHIP.— 

ø‘‘(A) IN GENERAL.—The Board shall be composed of— 


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ø‘‘(i) 15 members appointed by the President, by and 

with the advice and consent of the Senate; and 

ø‘‘(ii) the Secretary, the Administrator of the Center 

for Medicare & Medicaid Services, and the Administrator of the Health Resources and Services Administration, all of whom shall serve ex officio as nonvoting 

members of the Board. 

ø‘‘(B) QUALIFICATIONS.— 

ø‘‘(i) IN GENERAL.—The appointed membership of 

the Board shall include individuals with national recognition for their expertise in health finance and economics, actuarial science, health facility management, 

health plans and integrated delivery systems, reimbursement of health facilities, allopathic and osteopathic physicians, and other providers of health services, and other related fields, who provide a mix of different professionals, broad geographic representation, 

and a balance between urban and rural representatives. 

ø‘‘(ii) INCLUSION.—The appointed membership of the 

Board shall include (but not be limited to) physicians 

and other health professionals, experts in the area of 

pharmaco-economics or prescription drug benefit programs, employers, third-party payers, individuals 

skilled in the conduct and interpretation of biomedical, 

health services, and health economics research and expertise in outcomes and effectiveness research and 

technology assessment. Such membership shall also 

include representatives of consumers and the elderly. 

ø‘‘(iii) MAJORITY NONPROVIDERS.—Individuals who 

are directly involved in the provision or management 

of the delivery of items and services covered under 

this title shall not constitute a majority of the appointed membership of the Board. 

ø‘‘(C) ETHICAL DISCLOSURE.—The President shall establish a system for public disclosure by appointed members 

of the Board of financial and other potential conflicts of interest relating to such members. Appointed members of 

the Board shall be treated as officers in the executive 

branch for purposes of applying title I of the Ethics in Government Act of 1978 (Public Law 95–521). 

ø‘‘(D) CONFLICTS OF INTEREST.—No individual may serve 

as an appointed member if that individual engages in any 

other business, vocation, or employment. 

ø‘‘(E) CONSULTATION WITH CONGRESS.—In selecting individuals for nominations for appointments to the Board, the 

President shall consult with— 

ø‘‘(i) the majority leader of the Senate concerning 

the appointment of 3 members; 

ø‘‘(ii) the Speaker of the House of Representatives 

concerning the appointment of 3 members; 

ø‘‘(iii) the minority leader of the Senate concerning 

the appointment of 3 members; and 


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ø‘‘(iv) the minority leader of the House of Representatives concerning the appointment of 3 members. 

ø‘‘(2) TERM OF OFFICE.—Each appointed member shall hold 

office for a term of 6 years except that— 

ø‘‘(A) a member may not serve more than 2 full consecutive terms (but may be reappointed to 2 full consecutive 

terms after being appointed to fill a vacancy on the Board); 

ø‘‘(B) a member appointed to fill a vacancy occurring 

prior to the expiration of the term for which that member’s 

predecessor was appointed shall be appointed for the remainder of such term; 

ø‘‘(C) a member may continue to serve after the expiration of the member’s term until a successor has taken office; and 

ø‘‘(D) of the members first appointed under this section, 

5 shall be appointed for a term of 1 year, 5 shall be appointed for a term of 3 years, and 5 shall be appointed for 

a term of 6 years, the term of each to be designated by the 

President at the time of nomination. 

ø‘‘(3) CHAIRPERSON.— 

ø‘‘(A) IN GENERAL.—The Chairperson shall be appointed 

by the President, by and with the advice and consent of 

the Senate, from among the members of the Board. 

ø‘‘(B) DUTIES.—The Chairperson shall be the principal 

executive officer of the Board, and shall exercise all of the 

executive and administrative functions of the Board, including functions of the Board with respect to— 

ø‘‘(i) the appointment and supervision of personnel 

employed by the Board; 

ø‘‘(ii) the distribution of business among personnel 

appointed and supervised by the Chairperson and 

among administrative units of the Board; and 

ø‘‘(iii) the use and expenditure of funds. 

ø‘‘(C) GOVERNANCE.—In carrying out any of the functions under subparagraph (B), the Chairperson shall be 

governed by the general policies established by the Board 

and by the decisions, findings, and determinations the 

Board shall by law be authorized to make. 

ø‘‘(D) REQUESTS FOR APPROPRIATIONS.—Requests or estimates for regular, supplemental, or deficiency appropriations on behalf of the Board may not be submitted by the 

Chairperson without the prior approval of a majority vote 

of the Board. 

ø‘‘(4) REMOVAL.—Any appointed member may be removed by 

the President for neglect of duty or malfeasance in office, but 

for no other cause. 

ø‘‘(h) VACANCIES; QUORUM; SEAL; VICE CHAIRPERSON; VOTING ON

REPORTS.— 

ø‘‘(1) VACANCIES.—No vacancy on the Board shall impair the 

right of the remaining members to exercise all the powers of 

the Board. 

ø‘‘(2) QUORUM.—A majority of the appointed members of the 

Board shall constitute a quorum for the transaction of business, but a lesser number of members may hold hearings. 


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ø‘‘(3) SEAL.—The Board shall have an official seal, of which 

judicial notice shall be taken. 

ø‘‘(4) VICE CHAIRPERSON.—The Board shall annually elect a 

Vice Chairperson to act in the absence or disability of the 

Chairperson or in case of a vacancy in the office of the Chairperson. 

ø‘‘(5) VOTING ON PROPOSALS.—Any proposal of the Board 

must be approved by the majority of appointed members 

present. 

ø‘‘(i) POWERS OF THE BOARD.— ø‘‘(1) HEARINGS.—The Board may hold such hearings, sit and 

act at such times and places, take such testimony, and receive 

such evidence as the Board considers advisable to carry out 

this section. 

ø‘‘(2) AUTHORITY TO INFORM RESEARCH PRIORITIES FOR DATA

COLLECTION.—The Board may advise the Secretary on priorities for health services research, particularly as such priorities 

pertain to necessary changes and issues regarding payment reforms under Medicare. 

ø‘‘(3) OBTAINING OFFICIAL DATA.—The Board may secure directly from any department or agency of the United States information necessary to enable it to carry out this section. Upon 

request of the Chairperson, the head of that department or 

agency shall furnish that information to the Board on an 

agreed upon schedule. 

ø‘‘(4) POSTAL SERVICES.—The Board may use the United 

States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government. 

ø‘‘(5) GIFTS.—The Board may accept, use, and dispose of gifts 

or donations of services or property. 

ø‘‘(6) OFFICES.—The Board shall maintain a principal office 

and such field offices as it determines necessary, and may meet 

and exercise any of its powers at any other place. 

ø‘‘(j) PERSONNEL MATTERS.— ø‘‘(1) COMPENSATION OF MEMBERS AND CHAIRPERSON.—Each 

appointed member, other than the Chairperson, shall be compensated at a rate equal to the annual rate of basic pay prescribed for level III of the Executive Schedule under section 

5315 of title 5, United States Code. The Chairperson shall be 

compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level II of the Executive 

Schedule under section 5315 of title 5, United States Code. 

ø‘‘(2) TRAVEL EXPENSES.—The appointed members shall be 

allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while 

away from their homes or regular places of business in the performance of services for the Board. 

ø‘‘(3) STAFF.— ø‘‘(A) IN GENERAL.—The Chairperson may, without regard to the civil service laws and regulations, appoint and 

terminate an executive director and such other additional 

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form its duties. The employment of an executive director 

shall be subject to confirmation by the Board. 

ø‘‘(B) COMPENSATION.—The Chairperson may fix the 

compensation of the executive director and other personnel 

without regard to chapter 51 and subchapter III of chapter 

53 of title 5, United States Code, relating to classification 

of positions and General Schedule pay rates, except that 

the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the 

Executive Schedule under section 5316 of such title. 

ø‘‘(4) DETAIL OF GOVERNMENT EMPLOYEES.—Any Federal 

Government employee may be detailed to the Board without 

reimbursement, and such detail shall be without interruption 

or loss of civil service status or privilege. 

ø‘‘(5) PROCUREMENT OF TEMPORARY AND INTERMITTENT SERVICES.—The Chairperson may procure temporary and intermittent services under section 3109(b) of title 5, United States 

Code, at rates for individuals which do not exceed the daily 

equivalent of the annual rate of basic pay prescribed for level 

V of the Executive Schedule under section 5316 of such title. 

ø‘‘(k) CONSUMER ADVISORY COUNCIL.— 

ø‘‘(1) IN GENERAL.—There is established a consumer advisory 

council to advise the Board on the impact of payment policies 

under this title on consumers. 

ø‘‘(2) MEMBERSHIP.— 

ø‘‘(A) NUMBER AND APPOINTMENT.—The consumer advisory council shall be composed of 10 consumer representatives appointed by the Comptroller General of the United 

States, 1 from among each of the 10 regions established by 

the Secretary as of the date of enactment of this section. 

ø‘‘(B) QUALIFICATIONS.—The membership of the council 

shall represent the interests of consumers and particular 

communities. 

ø‘‘(3) DUTIES.—The consumer advisory council shall, subject 

to the call of the Board, meet not less frequently than 2 times 

each year in the District of Columbia. 

ø‘‘(4) OPEN MEETINGS.—Meetings of the consumer advisory 

council shall be open to the public. 

ø‘‘(5) ELECTION OF OFFICERS.—Members of the consumer advisory council shall elect their own officers. 

ø‘‘(6) APPLICATION OF FACA.—The Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the consumer advisory 

council except that section 14 of such Act shall not apply. 

ø‘‘(l) DEFINITIONS.—In this section: 

ø‘‘(1) BOARD; CHAIRPERSON; MEMBER.—The terms ‘Board’, 

‘Chairperson’, and ‘Member’ mean the Independent Medicare 

Advisory Board established under subsection (a) and the 

Chairperson and any Member thereof, respectively. 

ø‘‘(2) MEDICARE.—The term ‘Medicare’ means the program 

established under this title, including parts A, B, C, and D. 

ø‘‘(3) MEDICARE BENEFICIARY.—The term ‘Medicare beneficiary’ means an individual who is entitled to, or enrolled for, 

benefits under part A or enrolled for benefits under part B. 


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ø‘‘(4) MEDICARE PROGRAM SPENDING.—The term ‘Medicare 

program spending’ means program spending under parts A, B, 

and D net of premiums. 

ø‘‘(m) FUNDING.— 

ø‘‘(1) IN GENERAL.—There are appropriated to the Board to 

carry out its duties and functions— 

ø‘‘(A) for fiscal year 2012, $15,000,000; and 

ø‘‘(B) for each subsequent fiscal year, the amount appropriated under this paragraph for the previous fiscal year 

increased by the annual percentage increase in the Consumer Price Index for All Urban Consumers (all items; 

United States city average) as of June of the previous fiscal year. 

ø‘‘(2) FROM TRUST FUNDS.—Sixty percent of amounts appropriated under paragraph (1) shall be derived by transfer from 

the Federal Hospital Insurance Trust Fund under section 1817 

and 40 percent of amounts appropriated under such paragraph 

shall be derived by transfer from the Federal Supplementary 

Medical Insurance Trust Fund under section 1841. 

ø‘‘(n) ANNUAL PUBLIC REPORT.— 

ø‘‘(1) IN GENERAL.—Not later than July 1, 2014, and annually thereafter, the Board shall produce a public report containing standardized information on system-wide health care 

costs, patient access to care, utilization, and quality-of-care 

that allows for comparison by region, types of services, types 

of providers, and both private payers and the program under 

this title. 

ø‘‘(2) REQUIREMENTS.—Each report produced pursuant to 

paragraph (1) shall include information with respect to the following areas: 

ø‘‘(A) The quality and costs of care for the population at 

the most local level determined practical by the Board 

(with quality and costs compared to national benchmarks 

and reflecting rates of change, taking into account quality 

measures described in section 1890(b)(7)(B)). 

ø‘‘(B) Beneficiary and consumer access to care, patient 

and caregiver experience of care, and the cost-sharing or 

out-of-pocket burden on patients. 

ø‘‘(C) Epidemiological shifts and demographic changes. 

ø‘‘(D) The proliferation, effectiveness, and utilization of 

health care technologies, including variation in provider 

practice patterns and costs. 

ø‘‘(E) Any other areas that the Board determines affect 

overall spending and quality of care in the private sector. 

ø‘‘(o) ADVISORY RECOMMENDATIONS FOR NON-FEDERAL HEALTH

CARE PROGRAMS.— 

ø‘‘(1) IN GENERAL.—Not later than January 15, 2015, and at 

least once every two years thereafter, the Board shall submit 

to Congress and the President recommendations to slow the 

growth in national health expenditures (excluding expenditures under this title and in other Federal health care programs) while preserving or enhancing quality of care, such as 

recommendations— 


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ø‘‘(A) that the Secretary or other Federal agencies can 

implement administratively; 

ø‘‘(B) that may require legislation to be enacted by Congress in order to be implemented; 

ø‘‘(C) that may require legislation to be enacted by State 

or local governments in order to be implemented; 

ø‘‘(D) that private sector entities can voluntarily implement; and 

ø‘‘(E) with respect to other areas determined appropriate 

by the Board. 

ø‘‘(2) COORDINATION.—In making recommendations under 

paragraph (1), the Board shall coordinate such recommendations with recommendations contained in proposals and advisory reports produced by the Board under subsection (c). 

ø‘‘(3) AVAILABLE TO PUBLIC.—The Board shall make recommendations submitted to Congress and the President under 

this subsection available to the public.’’. 

ø(2)LOBBYING COOLING-OFF PERIOD FOR MEMBERS OF THE

INDEPENDENT MEDICARE ADVISORY BOARD.—Section 207(c) of 

title 18, United States Code, is amended by inserting at the 

end the following: 

ø‘‘(3) MEMBERS OF THE INDEPENDENT MEDICARE ADVISORY

BOARD.— 

ø‘‘(A) IN GENERAL.—Paragraph (1) shall apply to a member of the Independent Medicare Advisory Board under 

section 1899A. 

ø‘‘(B) AGENCIES AND CONGRESS.—For purposes of paragraph (1), the agency in which the individual described in 

subparagraph (A) served shall be considered to be the 

Independent Medicare Advisory Board, the Department of 

Health and Human Services, and the relevant committees 

of jurisdiction of Congress, including the Committee on 

Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee 

on Finance of the Senate.’’. 

ø(b) GAO STUDY AND REPORT ON DETERMINATION AND IMPLE- MENTATION OF PAYMENT AND COVERAGE POLICIES UNDER THE

MEDICARE PROGRAM.— ø(1) INITIAL STUDY AND REPORT.— ø(A) STUDY.—The Comptroller General of the United 

States (in this section referred to as the ‘‘Comptroller General’’) shall conduct a study on changes to payment policies, methodologies, and rates and coverage policies and 

methodologies under the Medicare program under title 

XVIII of the Social Security Act as a result of the recommendations contained in the proposals made by the 

Independent Medicare Advisory Board under section 

1899A of such Act (as added by subsection (a)), including 

an analysis of the effect of such recommendations on— 

ø(i) Medicare beneficiary access to providers and 

items and services; 

ø(ii) the affordability of Medicare premiums and 

cost-sharing (including deductibles, coinsurance, and 

copayments); 


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ø(iii) the potential impact of changes on other government or private-sector purchasers and payers of 

care; and 

ø(iv) quality of patient care, including patient experience, outcomes, and other measures of care. 

ø(B) REPORT.—Not later than July 1, 2015, the Comptroller General shall submit to Congress a report containing the results of the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Comptroller General 

determines appropriate. 

ø(2) SUBSEQUENT STUDIES AND REPORTS.—The Comptroller 

General shall periodically conduct such additional studies and 

submit reports to Congress on changes to Medicare payments 

policies, methodologies, and rates and coverage policies and 

methodologies as the Comptroller General determines appropriate, in consultation with the Committee on Ways and Means 

and the Committee on Energy and Commerce of the House of 

Representatives and the Committee on Finance of the Senate. 

ø(c) CONFORMING AMENDMENTS.—Section 1805(b) of the Social 

Security Act (42 U.S.C. 1395b–6(b)) is amended— 

ø(1) by redesignating paragraphs (4) through (8) as paragraphs (5) through (9), respectively; and 

ø(2) by inserting after paragraph (3) the following: 

ø‘‘(4) REVIEW AND COMMENT ON THE INDEPENDENT MEDICARE

ADVISORY BOARD OR SECRETARIAL PROPOSAL.—If the Independent Medicare Advisory Board (as established under subsection (a) of section 1899A) or the Secretary submits a proposal to the Commission under such section in a year, the 

Commission shall review the proposal and, not later than 

March 1 of that year, submit to the Committee on Ways and 

Means and the Committee on Energy and Commerce of the 

House of Representatives and the Committee on Finance of the 

Senate written comments on such proposal. Such comments 

may include such recommendations as the Commission deems 

appropriate.’’.¿ 

* * * * * * * 

TITLE X—STRENGTHENING QUALITY, 

AFFORDABLE HEALTH CARE FOR ALL 

AMERICANS 

* * * * * * * 

Subtitle C—Provisions Relating to Title III 

* * * * * * * 

øSEC. 10320. EXPANSION OF THE SCOPE OF, AND ADDITIONAL IMPROVEMENTS TO, THE INDEPENDENT MEDICARE ADVISORY BOARD. 

ø(a) IN GENERAL.—Section 1899A of the Social Security Act, as 

added by section 3403, is amended— 


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ø(1) in subsection (c)— 

ø(A) in paragraph (1)(B), by adding at the end the following new sentence: ‘‘In any year (beginning with 2014) 

that the Board is not required to submit a proposal under 

this section, the Board shall submit to Congress an advisory report on matters related to the Medicare program.’’; 

ø(B) in paragraph (2)(A)— 

ø(i) in clause (iv), by inserting ‘‘or the full premium 

subsidy under section 1860D–14(a)’’ before the period 

at the end of the last sentence; and 

ø(ii) by adding at the end the following new clause: 

ø‘‘(vii) If the Chief Actuary of the Centers for Medicare & Medicaid Services has made a determination 

described in subsection (e)(3)(B)(i)(II) in the determination year, the proposal shall be designed to help 

reduce the growth rate described in paragraph (8) 

while maintaining or enhancing beneficiary access to 

quality care under this title.’’; 

ø(C) in paragraph (2)(B)— 

ø(i) in clause (v), by striking ‘‘and’’ at the end; 

ø(ii) in clause (vi), by striking the period at the end 

and inserting ‘‘; and’’; and 

ø(iii) by adding at the end the following new clause: 

ø‘‘(vii) take into account the data and findings contained in the annual reports under subsection (n) in 

order to develop proposals that can most effectively 

promote the delivery of efficient, high quality care to 

Medicare beneficiaries.’’; 

ø(D) in paragraph (3)— 

ø(i) in the heading, by striking ‘‘TRANSMISSION OF

BOARD PROPOSAL TO PRESIDENT’’ and inserting ‘‘SUBMISSION OF BOARD PROPOSAL TO CONGRESS AND THE

PRESIDENT’’; 

ø(ii) in subparagraph (A)(i), by striking ‘‘transmit a 

proposal under this section to the President’’ and insert ‘‘submit a proposal under this section to Congress 

and the President’’; and 

ø(iii) in subparagraph (A)(ii)— 

ø(I) in subclause (I), by inserting ‘‘or’’ at the 

end; 

ø(II) in subclause (II), by striking ‘‘; or’’ and inserting a period; and 

ø(III) by striking subclause (III); 

ø(E) in paragraph (4)— 

ø(i) by striking ‘‘the Board under paragraph (3)(A)(i) 

or’’; and 

ø(ii) by striking ‘‘immediately’’ and inserting ‘‘within 

2 days’’; 

ø(F) in paragraph (5)— 

ø(i) by striking ‘‘to but’’ and inserting ‘‘but’’; and 

ø(ii) by inserting ‘‘Congress and’’ after ‘‘submit a 

proposal to’’; and 


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ø(G) in paragraph (6)(B)(i), by striking ‘‘per unduplicated 

enrollee’’ and inserting ‘‘(calculated as the sum of per capita spending under each of parts A, B, and D)’’; 

ø(2) in subsection (d)— 

ø(A) in paragraph (1)(A)— 

ø(i) by inserting ‘‘the Board or’’ after ‘‘a proposal is 

submitted by’’; and 

ø(ii) by inserting ‘‘subsection (c)(3)(A)(i) or’’ after 

‘‘the Senate under’’; and 

ø(B) in paragraph (2)(A), by inserting ‘‘the Board or’’ 

after ‘‘a proposal is submitted by’’; 

ø(3) in subsection (e)— 

ø(A) in paragraph (1), by inserting ‘‘the Board or’’ after 

‘‘a proposal submitted by’’; and 

ø(B) in paragraph (3)— 

ø(i) By striking ‘‘EXCEPTION.—The Secretary shall 

not be required to implement the recommendations 

contained in a proposal submitted in a proposal year 

by’’ and inserting 

ø‘‘(A) IN GENERAL.—The Secretary shall not implement 

the recommendations contained in a proposal submitted in 

a proposal year by the Board or’’; 

ø(ii) by redesignating subparagraphs (A) and (B) as 

clauses (i) and (ii), respectively, and indenting appropriately; and 

ø(iii) by adding at the end the following new subparagraph: 

ø‘‘(B) LIMITED ADDITIONAL EXCEPTION.— 

ø‘‘(i) IN GENERAL.—Subject to clause (ii), the Secretary shall not implement the recommendations contained in a proposal submitted by the Board or the 

President to Congress pursuant to this section in a 

proposal year (beginning with proposal year 2019) if— 

ø‘‘(I) the Board was required to submit a proposal to Congress under this section in the year 

preceding the proposal year; and 

ø‘‘(II) the Chief Actuary of the Centers for Medicare & Medicaid Services makes a determination 

in the determination year that the growth rate described in subsection (c)(8) exceeds the growth 

rate described in subsection (c)(6)(A)(i). 

ø‘‘(ii)LIMITED ADDITIONAL EXCEPTION MAY NOT BE APPLIED IN TWO CONSECUTIVE YEARS.—This subparagraph shall not apply if the recommendations contained in a proposal submitted by the Board or the 

President to Congress pursuant to this section in the 

year preceding the proposal year were not required to 

be implemented by reason of this subparagraph. 

ø‘‘(iii)NO AFFECT ON REQUIREMENT TO SUBMIT PROPOSALS OR FOR CONGRESSIONAL CONSIDERATION OF

PROPOSALS.—Clause (i) and (ii) shall not affect— 

ø‘‘(I) the requirement of the Board or the President to submit a proposal to Congress in a proVerDate Sep 11 2014 08:07 Oct 17, 2015 Jkt 059006 PO 00000 Frm 00189 Fmt 6601 Sfmt 6601 E:\HR\OC\HR293.XXX HR293

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posal year in accordance with the provisions of 

this section; or 

ø‘‘(II) Congressional consideration of a legislative proposal (described in subsection (c)(3)(B)(iv)) 

contained such a proposal in accordance with subsection (d).’’; 

ø(4) in subsection (f)(3)(B)— 

ø(A) by striking ‘‘or advisory reports to Congress’’ and inserting ‘‘, advisory reports, or advisory recommendations’’; 

and 

ø(B) by inserting ‘‘or produce the public report under 

subsection (n)’’ after ‘‘this section’’; and 

ø(5) by adding at the end the following new subsections: 

ø‘‘(n) ANNUAL PUBLIC REPORT.— 

ø‘‘(1) IN GENERAL.—Not later than July 1, 2014, and annually thereafter, the Board shall produce a public report containing standardized information on system-wide health care 

costs, patient access to care, utilization, and quality-of-care 

that allows for comparison by region, types of services, types 

of providers, and both private payers and the program under 

this title. 

ø‘‘(2) REQUIREMENTS.—Each report produced pursuant to 

paragraph (1) shall include information with respect to the following areas: 

ø‘‘(A) The quality and costs of care for the population at 

the most local level determined practical by the Board 

(with quality and costs compared to national benchmarks 

and reflecting rates of change, taking into account quality 

measures described in section 1890(b)(7)(B)). 

ø‘‘(B) Beneficiary and consumer access to care, patient 

and caregiver experience of care, and the cost-sharing or 

out-of-pocket burden on patients. 

ø‘‘(C) Epidemiological shifts and demographic changes. 

ø‘‘(D) The proliferation, effectiveness, and utilization of 

health care technologies, including variation in provider 

practice patterns and costs. 

ø‘‘(E) Any other areas that the Board determines affect 

overall spending and quality of care in the private sector. 

ø‘‘(o) ADVISORY RECOMMENDATIONS FOR NON-FEDERAL HEALTH

CARE PROGRAMS.— 

ø‘‘(1) IN GENERAL.—Not later than January 15, 2015, and at 

least once every two years thereafter, the Board shall submit 

to Congress and the President recommendations to slow the 

growth in national health expenditures (excluding expenditures under this title and in other Federal health care programs) while preserving or enhancing quality of care, such as 

recommendations— 

ø‘‘(A) that the Secretary or other Federal agencies can 

implement administratively; 

ø‘‘(B) that may require legislation to be enacted by Congress in order to be implemented; 

ø‘‘(C) that may require legislation to be enacted by State 

or local governments in order to be implemented; 


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ø‘‘(D) that private sector entities can voluntarily implement; and 

ø‘‘(E) with respect to other areas determined appropriate 

by the Board. 

ø‘‘(2)COORDINATION.—In making recommendations under 

paragraph (1), the Board shall coordinate such recommendations with recommendations contained in proposals and advisory reports produced by the Board under subsection (c). 

ø‘‘(3) AVAILABLE TO PUBLIC.—The Board shall make recommendations submitted to Congress and the President under 

this subsection available to the public.’’. 

ø(b) NAME CHANGE.—Any reference in the provisions of, or 

amendments made by, section 3403 to the ‘‘Independent Medicare 

Advisory Board’’ shall be deemed to be a reference to the ‘‘Independent Payment Advisory Board’’. 

ø(c) RULE OF CONSTRUCTION.—Nothing in the amendments made 

by this section shall preclude the Independent Medicare Advisory 

Board, as established under section 1899A of the Social Security 

Act (as added by section 3403), from solely using data from public 

or private sources to carry out the amendments made by subsection 

(a)(4).¿ 

* * * * * * * 


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VOTES OF THE COMMITTEE ON THE BUDGET 

Clause 3(b) of House Rule XIII requires each committee report 

to accompany any bill or resolution of a public character to include 

the total number of votes cast for and against each roll call vote, 

on a motion to report and any amendments offered to the measure 

or matter, together with the names of those voting for and against. 

Listed below are the actions taken in the Committee on the 

Budget of the House of Representatives on the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015. 

On October 9, 2015, the Committee met in open session, a 

quorum being present. 

Mr. Rokita asked unanimous consent that the Chair be authorized, consistent with clause 4 of House Rule XVI, to declare a recess at any time during the Committee meeting. 

There was no objection to the unanimous consent request. 

The Committee adopted and ordered reported the Restoring 

Americans’ Healthcare Freedom Reconciliation Act of 2015. 

The Committee on the Budget took the following votes: 

Mr. Rokita made a motion that the Committee report the bill 

with the recommendation that the bill do pass. 

The motion was agreed to by a roll call vote of 21 ayes to 11 

noes. 

ROLLCALL VOTE NO. 1 

Name & State Aye No Answer 

Present Name & State Aye No Answer Present 

PRICE (GA) (Chairman) X VAN HOLLEN (MD) (Ranking) X 

ROKITA (IN) X YARMUTH (KY) X 

GARRETT (NJ) X PASCRELL (NJ) X 

DIAZ–BALART (FL) X RYAN (OH) X 

COLE (OK) X MOORE (WI) X 

McCLINTOCK (CA) X CASTOR (FL) X 

BLACK (TN) X McDERMOTT (WA) X 

WOODALL (GA) X LEE (CA) X 

BLACKBURN (TN) X POCAN (WI) X 

HARTZLER (MO) X LUJAN GRISHAM (NM) 

RICE (SC) X DINGELL (MI) 

STUTZMAN (IN) X LIEU (CA) 


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ROLLCALL VOTE NO. 1—Continued 

Name & State Aye No Answer 

Present Name & State Aye No Answer Present 

SANFORD (SC) NORCROSS (NJ) X 

BUCHANAN (FL) X MOULTON (MA) X 

WOMACK (AR) X 

BRAT (VA) X 

BLUM (IA) X 

MOONEY (WV) X 

GROTHMMAN (WI) X 

PALMER (AL) X 

MOOLENAAR (MI) X 

WESTERMAN (AR) X 

Mr. Rokita made a motion that, pursuant to clause 1 of rule 

XXII, the Chair be authorized to offer motions to go to conference 

and file any related conference report; the staff be authorized to 

make any necessary technical and conforming corrections prior to 

filing the bill, such as inserting the short title of the bill; and the 

motion to reconsider be laid on the table. 

The motion was agreed to without objection. 

MOTIONS ON THE RULE FOR CONSIDERATION OF THE RESTORING

AMERICANS’ HEALTHCARE FREEDOM RECONCILIATION ACT OF 2015

A Motion Offered by Mr. Van Hollen 

1. Representative Van Hollen moved that the Committee on the 

Budget direct its Chairman to request on behalf of the Committee 

that the rule for consideration of the reconciliation bill make in 

order an amendment that would (1) strike all of the underlying 

text, which is an irresponsible attack on women’s health care and 

the Affordable Care Act, and (2) replace it with the text of H.R. 

3708, which calls for bipartisan negotiations to raise the discretionary spending caps for fiscal year 2016 or, if those negotiations 

fail, raises the defense and non-defense discretionary caps by equal 

amounts to the President’s requested level to allow appropriations 

action to proceed and fund essential services at necessary levels. 

The motion was not agreed to by a roll call vote of 13 ayes to 

19 noes. 

ROLLCALL VOTE NO. 2 

Name & State Aye No Answer 

Present Name & State Aye No Answer Present 

PRICE (GA) (Chairman) X VAN HOLLEN (MD) (Ranking) X 

ROKITA (IN) X YARMUTH (KY) X 

GARRETT (NJ) X PASCRELL (NJ) X 


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ROLLCALL VOTE NO. 2—Continued 

Name & State Aye No Answer 

Present Name & State Aye No Answer Present 

DIAZ–BALART (FL) X RYAN (OH) X 

COLE (OK) X MOORE (WI) X 

McCLINTOCK (CA) X CASTOR (FL) X 

BLACK (TN) X McDERMOTT (WA) X 

WOODALL (GA) X LEE (CA) X 

BLACKBURN (TN) X POCAN (WI) X 

HARTZLER (MO) X LUJAN GRISHAM (NM) X 

RICE (SC) X DINGELL (MI) 

STUTZMAN (IN) X LIEU (CA) X 

SANFORD (SC) NORCROSS (NJ) X 

BUCHANAN (FL) X MOULTON (MA) X 

WOMACK (AR) X 

BRAT (VA) X 

BLUM (IA) X 

MOONEY (WV) X 

GROTHMMAN (WI) 

PALMER (AL) 

MOOLENAAR (MI) X 

WESTERMAN (AR) X 

Pursuant to a unanimous consent request made by Chairman 

Price, Representative Palmer requested that the record reflect he 

would have voted no on the roll call vote, but was unable to be 

present because he was voting at the Committee on Oversight and 

Government Reform when the vote in the Committee on the Budget was called. 

A Motion Offered by Mr. Rokita 

2. Representative Rokita moved that the Chairman of the Committee on the Budget be provided the discretion to request the 

Committee on Rules report a rule that would make in order an 

amendment to the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, as reported. 

The motion was agreed to by a roll call vote of 21 ayes to 13 

noes. 


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ROLLCALL VOTE NO. 3 

Name & State Aye No Answer 

Present Name & State Aye No Answer Present 

PRICE (GA) (Chairman) X VAN HOLLEN (MD) (Ranking) X 

ROKITA (IN) X YARMUTH (KY) X 

GARRETT (NJ) X PASCRELL (NJ) X 

DIAZ–BALART (FL) X RYAN (OH) X 

COLE (OK) X MOORE (WI) X 

McCLINTOCK (CA) X CASTOR (FL) X 

BLACK (TN) X McDERMOTT (WA) X 

WOODALL (GA) X LEE (CA) X 

BLACKBURN (TN) X POCAN (WI) X 

HARTZLER (MO) X LUJAN GRISHAM (NM) X 

RICE (SC) X DINGELL (MI) 

STUTZMAN (IN) X LIEU (CA) X 

SANFORD (SC) NORCROSS (NJ) X 

BUCHANAN (FL) X MOULTON (MA) X 

WOMACK (AR) X 

BRAT (VA) X 

BLUM (IA) X 

MOONEY (WV) X 

GROTHMMAN (WI) X 

PALMER (AL) X 

MOOLENAAR (MI) X 

WESTERMAN (AR) X 


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OTHER HOUSE REPORT REQUIREMENTS 

Committee Oversight Findings 

Clause 3(c)(1) of rule XIII of the Rules of the House of Representatives requires the report of a committee on a measure to contain 

oversight findings and recommendations required pursuant to 

clause (2)(b)(1) of rule X. The Committee on the Budget has examined its activities over the past session and has determined that 

there are no specific oversight findings on the text of the reported 

bill. 

Committee Cost Estimate 

For purposes of clauses 3(c)(2) and (3) of rule XIII of the Rules 

of the House of Representatives and section 308(a)(1) of the Congressional Budget Act of 1974 (relating to estimates of new budget 

authority, new spending autohrity, new credit authority, or increased or decreased revenues or tax expenditures), the committee 

report incorporates the cost estimate prepared by the Director of 

the Congressional Budget Office pursuant to sections 402 and 423 

of the Congressional Budget Act of 1974. 


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ESTIMATE OF THE BUDGETARY EFFECTS OF DRAFT LEGISLATION TO PROVIDE FOR RECONCILIATION 

[Pursuant to Title II of the Concurrent Resolution on the Budget for Fiscal Year 2016, as posted on the website of the House Committee on the Budget on October 8, 2015—without macroeconomic feedback] 

Billions of dollars, by fiscal year 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2016– 2020 2016– 2025 

CHANGES IN DIRECT SPENDING 

Title I—Committee on Education and the Workforce: Auto-Enrollment for Certain Large Employers: 

Estimated Budget Authority ........................................................................................... 0 0 .1 0 .2 0 .4 0 .5 0 .5 0 .5 0 .6 0 .6 0 .7 1 .3 4 .3 Estimated Outlays .......................................................................................................... 0 0 .1 0 .2 0 .4 0 .5 0 .5 0 .5 0 .6 0 .6 0 .7 1 .3 4 .3 

Title II—Committee on Energy and Commerce: Prevention and Public Health Fund: 

Estimated Budget Authority ........................................................................................... ¥1 .0 ¥1 .0 ¥1 .3 ¥1 .3 ¥1 .5 ¥1 .5 ¥2 .0 ¥2 .0 ¥2 .0 ¥2 .0 ¥6 .0 ¥15 .5 

Estimated Outlays .......................................................................................................... ¥0 .2 ¥0 .5 ¥0 .9 ¥1 .1 ¥1 .3 ¥1 .4 ¥1 .6 ¥1 .8 ¥1 .9 ¥2 .0 ¥4 .1 ¥12 .7 

Medicaid: 

Estimated Budget Authority ........................................................................................... ¥0 .2 * * * * * * * * 0 ¥0 .2 ¥0 .2 

Estimated Outlays .......................................................................................................... ¥0 .2 * * * * * * * * 0 ¥0 .2 ¥0 .2 

Community Health Center Program 

Estimated Budget Authority ........................................................................................... 0 .2 0 .2 0 0 0 0 0 0 0 0 0 .5 0 .5 Estimated Outlays .......................................................................................................... 0 .1 0 .2 0 .1 * 0 0 0 0 0 0 0 .5 0 .5 

Title III—Committee on Ways and Means: Repeal Individual and Employer Mandates: 

Estimated Budget Authority ........................................................................................... ¥8 .7 ¥17 .2 ¥21 .0 ¥24 .3 ¥26 .4 ¥28 .3 ¥30 .3 ¥31 .9 ¥33 .7 ¥35 .1 ¥97 .6 ¥256 .9 

Estimated Outlays .......................................................................................................... ¥8 .7 ¥17 .2 ¥21 .0 ¥24 .3 ¥26 .4 ¥28 .3 ¥30 .3 ¥31 .9 ¥33 .7 ¥35 .1 ¥97 .6 ¥256 .9 

Repeal Excise Tax on High-Premium Insurance Plans: 

Estimated Budget Authority ........................................................................................... 0 0 ¥0 .7 ¥0 .9 ¥1 .4 ¥1 .6 ¥2 .4 ¥3 .1 ¥3 .9 ¥4 .1 ¥3 .0 ¥18 .2 

Estimated Outlays .......................................................................................................... 0 0 ¥0 .7 ¥0 .9 ¥1 .4 ¥1 .6 ¥2 .4 ¥3 .1 ¥3 .9 ¥4 .1 ¥3 .0 ¥18 .2 

Repeal IPAB: 

Estimated Budget Authority ........................................................................................... 0 0 0 0 0 0 0 .6 1 .5 1 .9 3 .1 0 7 .1 Estimated Outlays .......................................................................................................... 0 0 0 0 0 0 0 .6 1 .5 1 .9 3 .1 0 7 .1 

Interaction Effects Across Titles: a

Estimated Budget Authority ........................................................................................... 0 * ¥0 .1 ¥0 .2 ¥0 .3 ¥0 .3 ¥0 .3 ¥0 .3 ¥0 .2 ¥0 .3 ¥0 .7 ¥2 .0 

Estimated Outlays .......................................................................................................... 0 * ¥0 .1 ¥0 .2 ¥0 .3 ¥0 .3 ¥0 .3 ¥0 .3 ¥0 .2 ¥0 .3 ¥0 .7 ¥2 .0 

Total Changes in Direct Spending: 

Estimated Budget Authority ......................................................................................... ¥9 .7 ¥17 .9 ¥22 .8 ¥26 .2 ¥29 .0 ¥31 .1 ¥33 .8 ¥35 .3 ¥37 .3 ¥37 .7 ¥105 .7 ¥281 .0 Estimated Outlays ......................................................................................................... ¥9 .1 ¥17 .5 ¥22 .4 ¥26 .1 ¥28 .8 ¥31 .0 ¥33 .4 ¥35 .0 ¥37 .2 ¥37 .7 ¥103 .8 ¥278 .2 

CHANGES IN REVENUES 

Title I—Committee on Education and the Workforce: Auto-Enrollment for Certain Large Employers ................................................................... 0 0 .2 0 .8 1 .4 0 .8 1 .1 1 .7 1 .9 2 .1 2 .2 3 .3 12 .2 


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Title III—Committee on Ways and Means: 

Repeal Individual and Employer Mandates ................................................................... ¥10 .1 ¥8 .0 ¥8 .0 ¥9 .8 ¥10 .5 ¥10 .9 ¥11 .9 ¥12 .9 ¥13 .5 ¥14 .1 ¥46 .4 ¥109 .8 

Repeal Medical Device Tax ............................................................................................ ¥1 .4 ¥2 .0 ¥2 .1 ¥2 .2 ¥2 .3 ¥2 .5 ¥2 .6 ¥2 .8 ¥2 .9 ¥3 .1 ¥10 .0 ¥23 .9 

Repeal Excise Tax on High-Premium Insurance Plans ................................................. 0 0 ¥2 .9 ¥8 .1 ¥9 .7 ¥11 .5 ¥14 .0 ¥17 .1 ¥20 .8 ¥25 .0 ¥20 .8 ¥109 .3 

Interaction Effects within Title III ...................................................................................... 0 0 * 2 .1 2 .0 1 .7 1 .7 1 .6 1 .6 1 .4 4 .1 12 .1 Interaction Effects Across Titles a ................................................................................... 0 0 .3 1 .0 1 .7 2 .3 2 .5 2 .5 2 .8 3 .1 3 .4 5 .2 19 .4 

Total Changes in Revenues .............................................................................................. ¥11 .5 ¥9 .4 ¥11 .2 ¥15 .0 ¥17 .5 ¥19 .7 ¥22 .6 ¥26 .5 ¥30 .5 ¥35 .2 ¥64 .6 ¥199 .3 

On-Budget ...................................................................................................................... ¥13 .0 ¥13 .7 ¥15 .8 ¥19 .7 ¥21 .8 ¥24 .1 ¥26 .8 ¥30 .2 ¥33 .8 ¥37 .7 ¥84 .1 ¥236 .6 Off-Budget b ................................................................................................................... 1 .5 4 .3 4 .6 4 .8 4 .4 4 .4 4 .2 3 .7 3 .3 2 .4 19 .7 37 .6 

NET INCREASE OR DECREASE (Ø) IN THE DEFICIT FROM CHANGES IN DIRECT SPENDING AND REVENUES c

Impact on Deficit .............................................................................................................. 2 .4 ¥8 .0 ¥11 .2 ¥11 .1 ¥11 .4 ¥11 .4 ¥10 .8 ¥8 .5 ¥6 .7 ¥2 .4 ¥39 .2 ¥78 .9 

On-Budget ...................................................................................................................... 3 .9 ¥3 .8 ¥6 .6 ¥6 .4 ¥7 .0 ¥6 .0 ¥6 .5 ¥4 .8 ¥3 .4 * ¥19 .5 ¥41 .3 

Off-Budget b ................................................................................................................... ¥1 .5 ¥4 .3 ¥4 .6 ¥4 .8 ¥4 .4 ¥4 .4 ¥4 .2 ¥3 .7 ¥3 .3 ¥2 .4 ¥19 .7 ¥37 .6 

Memorandum: Net Effect on Deficit: 

Title I .............................................................................................................................. 0 ¥0 .2 ¥0 .6 ¥0 .9 ¥0 .2 ¥0 .5 ¥1 .1 ¥1 .3 ¥1 .4 ¥1 .5 ¥2 .0 ¥7 .9 

Title II ............................................................................................................................. ¥0 .4 ¥0 .3 ¥0 .8 ¥1 .1 ¥1 .3 ¥1 .4 ¥1 .6 ¥1 .8 ¥1 .9 ¥2 .0 ¥3 .8 ¥12 .5 

Title III ............................................................................................................................ 2 .8 ¥7 .2 ¥8 .7 ¥7 .2 ¥7 .3 ¥6 .7 ¥5 .3 ¥2 .3 ¥0 .1 4 .7 ¥27 .5 ¥37 .1 

Interaction Effects Across Titles .................................................................................... 0 ¥0 .4 ¥1 .1 ¥1 .9 ¥2 .5 ¥2 .7 ¥2 .8 ¥3 .1 ¥3 .3 ¥3 .6 ¥5 .9 ¥21 .4 

Sources: Congressional Budget Office and the staff of the Joint Committee on Taxation Notes: Numbers may not add up to totals because of rounding; IPAB = Independent Payment Advisory Board; * = an increase or decrease between zero and $500 million; This legislation meets the threshold established in section 3112 of 

the Concurrent Resolution on the Budget for Fiscal Year 2016, which requires that the CBO estimate incorporate macroeconomic effects. CBO has not yet completed an analysis of those effects. An estimate including that analysis will be released at a later date 

a. Includes the additional effects of combining the repeal of the auto-enrollment requirement for large employers with the repeal of the individual and employer mandates b. All off-budget effects would come from changes in revenues. (The payroll taxes for Social Security are classified as off-budget.) c. CBO and JCT estimate that enacting the legislation would not increase net direct spending in either of the first two consecutive 10-year periods beginning in 2026; at some point the costs of repealing IPAB would exceed the savings 

from the other provisions, but the agencies cannot determine whether that would occur during the third or fourth 10-year period after 2026 or later. On a preliminary basis, the agencies estimate that enacting the legislation would increase on-budget deficits by at least $5 billion in one or more of the four consecutive 10-year periods beginning in 2026 


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Macroeconomic Estimates 

Clause 8 of rule XIII of the Rules of the House of Representatives 

requires that the estimates provided under section 402 of the Congressional Budget Act of 1974 for major legislation to include, to 

the extent practicable, the budgetary effects of changes in economic 

output, employment, capital stock, and other macroeconomic variables resulting from such legislation. It was not practicable for the 

Congressional Budget Office to produce the macroeconomic estimates prior to the deadline for filing this bill. It is anticipated that 

such estimate will be available prior to the consideration of this bill 

by the House, which will be made available on the Congressional 

Budget Office’s website. 

Performance Goals and Objectives 

Clause 3(c)(4) of rule XIII of the Rules of the House of Representatives requires the report of a committee on a measure to include 

a statement of general performance goals and objectives, including 

outcome-related goals and objectives, for which the measure authorizes funding. This bill is reported pursuant to section 2002 of 

S. Con. Res. 11, the Concurrent Resolution on the Budget for Fiscal 

Year 2016. The goals and objectives of this bill are to reduce the 

deficit by at least $3 billion over the 10-year period and clear the 

way for real health care reform that meets the principles set forth 

in the introduction of this report. 

Constitutional Authority Statement 

Clause 7(c)(1) of rule XII of the Rules of the House of Representatives requires each report of a committee on a public bill or public 

joint resolution contain a statement citing the specific powers 

granted to Congress in the Constitution to enact the law proposed 

by the bill or joint resolution. The Committee on the Budget finds 

the Constitutional authority for this legislation in Article I of the 

Constitution, Sections 5 and 8. 

Changes in Existing Law Made by the Bill, as Reported 

Clause 3(e) of rule XIII of the Rules of the House of Representatives requires each report of a committee on a bill or joint resolution contain the text of statutes that are proposed to be repealed 

and a comparative print of that part of the bill proposed to be 

amended whenever the bill repeals or amends any statute. The required matter is included in the report language for each title, or 

in the case of the Committee on Ways and Means each subtitle, of 

the legislative recommendations submitted by the appropriate authorizing committees and reported to the House by the Committee 

on the Budget. 

Federal Mandates Statement 

Section 423 of the Congressional Budget and Impoundment Control Act of 1974 requires a statement of whether the provisions of 

the reported bill include unfunded mandates. The Congressional 

Budget Office has determined that the bill contains no intergovernmental or private sector mandates within the narrow definition of 


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the Unfunded Mandates Reform Act of 1995. Any statements regarding unfunded mandates for the legislative recommendations 

submitted by each of the authorizing committees are included 

under the appropriate titles. 

Advisory on Earmarks 

In accordance with clause 9 of rule XXI of the Rules of the House 

of Representatives, the bill does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

clause 9(e), 9(f), or 9(g) of rule XXI of the Rules of the House of 

Representatives. 

Duplication of Federal Programs 

Section 3(g)(2) of H. Res. 5 requires reports for measures creating 

or reauthorizing programs of the Federal Government to include a 

statement indicating whether any such program is known to be duplicative of another such program. The reconciliation bill reported 

by the Committee on the Budget does not establish or authorize 

any new Federal programs. 

Disclosure of Directed Rulemakings 

Section 3(i) of H. Res. 5 requires committee reports on any bill 

or joint resolution to include a statement estimating the number directed makings required by the measure. This bill does not require 

any directed rulemakings. 


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VIEWS OF COMMITTEE MEMBERS 

Clause 2(c) of rule XIII of the Rules of the House of Representatives requires each report by a committee on a public matter to include any additional, minority, supplemental, or dissenting views 

submitted pursuant to clause 2(l) of rule XI by one or more members of the committee. In addition, this report includes views from 

members of committees submitting reconciliation recommendations 

pursuant to section 2002 of S. Con. Res. 11 under the appropriate 

titles or subtitles, as the case may be, of this report. The [minority 

and additional views] of members of the Committee on the Budget 

are as follows: 


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Be it enacted by the Senate and House of Representatives of the 

United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015’’. 

(b) TABLE OF CONTENTS.—The table of contents of this Act is as 

follows: 

Sec. 1. Short title; table of contents. 

TITLE I—COMMITTEE ON EDUCATION AND THE WORKFORCE 

Sec. 101. Repeal of automatic enrollment requirement. 

TITLE II—COMMITTEE ON ENERGY AND COMMERCE 

Sec. 201. Repeal of the Prevention and Public Health Fund. 

Sec. 202. Federal payment to States. 

Sec. 203. Funding for community health center program. 

TITLE III—COMMITTEE ON WAYS AND MEANS 

Subtitle A—Revenue Provisions 

Sec. 301. Repeal of individual mandate. 

Sec. 302. Repeal of employer mandate. 

Sec. 303. Repeal of medical device excise tax. 

Sec. 304. Repeal of the tax on employee health insurance premiums and health 

plan benefits and related reporting requirements. 

Subtitle B—Repeal of Independent Payment Advisory Board 

Sec. 311. Repeal of Independent Payment Advisory Board. 

TITLE I—COMMITTEE ON EDUCATION 

AND THE WORKFORCE 

SEC. 101. REPEAL OF AUTOMATIC ENROLLMENT REQUIREMENT. 

The Fair Labor Standards Act of 1938 (29 U.S.C. 201 et seq.) is 

amended by repealing section 18A (as added by section 1511 of the 

Patient Protection and Affordable Care Act (Public Law 111–148)). 

TITLE II—COMMITTEE ON ENERGY AND 

COMMERCE 

SEC. 201. REPEAL OF THE PREVENTION AND PUBLIC HEALTH FUND. 

(a) IN GENERAL.—Section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u–11) is repealed. 

(b) RESCISSION OF UNOBLIGATED FUNDS.—Of the funds made 

available by such section 4002, the unobligated balance is rescinded. 

SEC. 202. FEDERAL PAYMENT TO STATES. 

(a) IN GENERAL.—Notwithstanding sections 504(a), 1902(a)(23), 

2002, 2005(a)(4), 2102(a)(7), or 2105(a)(1) of the Social Security Act 

(42 U.S.C. 704(a), 1396b(a)(23), 1397a, 1397d(a)(4), 1397bb(a)(2), 

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

date of enactment of this Act that is approved under section 1115 

or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n), for the 

one-year period beginning on the date of the enactment of this Act 


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no Federal funds may be made available to a State for payments 

to a prohibited entity. 

(b) DEFINITION OF PROHIBITED ENTITY.—In this section, the term 

‘‘prohibited entity’’ means an entity, including its affiliates, subsidiaries, successors, and clinics— 

(1) that, as of the date of enactment of this Act— 

(A) is an organization described in section 501(c)(3) of 

the Internal Revenue Code of 1986 and exempt from tax 

under section 501(a) of such Code; 

(B) is an essential community provider described in section 156.235 of title 45, Code of Federal Regulations, that 

is primarily engaged in family planning services, reproductive health, and related medical care; and 

(C) provides for elective abortions; and 

(2) for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social 

Security Act in fiscal year 2014 made directly to the entity and 

to any affiliates, subsidiaries, successors, or clinics of the entity, or made to the entity and to any affiliates, subsidiaries, 

successors, or clinics of the entity as part of a nationwide 

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

SEC. 203. FUNDING FOR COMMUNITY HEALTH CENTER PROGRAM. 

Effective as if included in the enactment of the Medicare Access 

and CHIP Reauthorization Act of 2015 (Public Law 114–10, 129 

Stat. 87), paragraph (1) of section 221(a) of such Act is amended 

by inserting after ‘‘Section 10503(b)(1)(E) of the Patient Protection 

and Affordable Care Act (42 U.S.C. 254b-2(b)(1)(E)) is amended’’ 

the following: ‘‘by striking ‘$3,600,000,000’ and inserting 

‘$3,835,000,000’ and’’. 

TITLE III—COMMITTEE ON WAYS AND 

MEANS 

Subtitle A—Revenue Provisions 

SEC. 301. REPEAL OF INDIVIDUAL MANDATE. 

(a) IN GENERAL.—Section 5000A of the Internal Revenue Code of 

1986 is amended by adding at the end the following: 

‘‘(h) TERMINATION.—This section shall not apply with respect to 

any month beginning after December 31, 2014.’’. 

(b) CONFORMING AMENDMENTS.— 

(1) Section 5000A(c) of such Code is amended— 

(A) in paragraph (2)(B) by striking clauses (ii) and (iii), 

(B) in paragraph (3)(B) by striking ‘‘2014’’ and all that 

follows and inserting ‘‘2014.’’, and 

(C) in paragraph (3) by striking subparagraph (D). 

(2) Section 5000A(e)(1) of such Code is amended by striking 

subparagraph (D). 

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

apply to months beginning after December 31, 2014. 


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SEC. 302. REPEAL OF EMPLOYER MANDATE. 

(a) IN GENERAL.—Section 4980H of the Internal Revenue Code of 

1986 is amended by adding at the end the following: 

‘‘(e) TERMINATION.—This section shall not apply with respect to 

any month beginning after December 31, 2014.’’. 

(b) CONFORMING AMENDMENT.—Section 4980H(c) of such Code is 

amended by striking paragraph (5). 

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

apply to months beginning after December 31, 2014. 

SEC. 303. REPEAL OF MEDICAL DEVICE EXCISE TAX. 

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

1986 is amended by striking subchapter E. 

(b) CONFORMING AMENDMENTS.— 

(1) Subsection (a) of section 4221 of such Code is amended 

by striking the last sentence. 

(2) Paragraph (2) of section 6416(b) of such Code is amended 

by striking the last sentence. 

(c) CLERICAL AMENDMENT.—The table of subchapters for chapter 

32 of such Code is amended by striking the item relating to subchapter E. 

(d) EFFECTIVE DATE.—The amendments made by this section 

shall apply to sales in calendar quarters beginning after the date 

of the enactment of this Act. 

SEC. 304. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE 

PREMIUMS AND HEALTH PLAN BENEFITS AND RELATED 

REPORTING REQUIREMENTS. 

(a) EXCISE TAX.—Chapter 43 of the Internal Revenue Code of 

1986 is amended by striking section 4980I. 

(b) REPORTING REQUIREMENT.—Section 6051(a) of such Code is 

amended by inserting ‘‘and’’ at the end of paragraph (12), by striking ‘‘, and’’ at the end of paragraph (13) and inserting a period, and 

by striking paragraph (14). 

(c) CLERICAL AMENDMENT.—The table of sections for chapter 43 

of such Code is amended by striking the item relating to section 

4980I. 

(d) EFFECTIVE DATES.— 

(1) IN GENERAL.—Except as provided by paragraph (2), the 

amendments made by this section shall apply to taxable years 

beginning after December 31, 2017. 

(2) REPORTING REQUIREMENT.—The amendment made by 

subsection (b) shall apply to calendar years beginning after December 31, 2014. 

Subtitle B—Repeal of Independent 

Payment Advisory Board 

SEC. 311. REPEAL OF INDEPENDENT PAYMENT ADVISORY BOARD. 

Effective as of the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148), sections 3403 and 10320 

of such Act (including the amendments made by such sections) are 


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repealed, and any provision of law amended by such sections is 

hereby restored as if such sections had not been enacted into law. 

Æ 


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