```

[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 508 Introduced in House (IH)]

103d CONGRESS
  2d Session
H. RES. 508

 Making in order, in the consideration by the House of Representatives 
of H.R. 3600 (the ``Health Security Act''), an amendment-in-the-nature-
  of-a-substitute consisting of the text of H.R. 3080 and including a 
  title providing for assistance for the purpose of health insurance.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             August 4, 1994

Mr. McMillan submitted the following resolution; which was referred to 
                         the Committee on Rules

_______________________________________________________________________

                               RESOLUTION

 
 Making in order, in the consideration by the House of Representatives 
of H.R. 3600 (the ``Health Security Act''), an amendment-in-the-nature-
  of-a-substitute consisting of the text of H.R. 3080 and including a 
  title providing for assistance for the purpose of health insurance.

    Resolved,

SECTION 1. CONSIDERATION OF CERTAIN AMENDMENTS TO H.R. 3600.

    (a) In General.--In the consideration of the bill (H.R. 3600), to 
ensure individual and family security through health care coverage for 
all Americans in a manner that contains the rate of growth in health 
care costs and promotes responsible insurance practices, to promote 
choice in health care, and to ensure and protect the health care of all 
Americans, in the Committee of the Whole--
            (1) an amendment-in-the-nature-of-a-substitute consisting 
        of the text of H.R. 3080, as introduced in the 103d Congress 
        and the amendments described in subsection (b), if offered by 
        Mr. Michel of Illinois, (or his designee), shall be made in 
        order,
            (2) any points of order against such amendment are hereby 
        waived, and
            (3) the amendment shall not be subject to amendment or to a 
        demand for a division of the question in the House or in the 
        Committee of the Whole.
    (b) Amendments Described.--The amendments described in this 
subsection are specified in the following paragraphs:
            (1) Limitations on underwriting.--Strike part 2 of subtitle 
        A of title I and insert the following:

                 ``PART 2--RESTRICTIONS ON UNDERWRITING

``SEC. 1011. LIMITATIONS ON UNDERWRITING.

    ``(a) Guaranteed Issue.--Subject to permissible plan restrictions 
based on capacity, as specified under rules established by the 
Secretary, each group health plan or health insurance plan that 
provides standard coverage described in section 1102(c) must accept for 
enrollment every individual who resides in the area covered by the plan 
and who seeks such enrollment, without regard to health status or the 
need for health services.
    ``(b) Guaranteed Renewability.--Each group health plan and health 
insurance plan that provides such coverage may not deny renewal of a 
policy other than on the basis of--
            ``(1) fraud or material misrepresentation, or
            ``(2) nonpayment of premiums.
    ``(c) Elimination of Pre-Existing Condition Exclusions.--A group 
health plan or health insurance plan that provides such coverage may 
not restrict, limit, or exclude coverage of items or services included 
in the standard coverage because of health status, the need for health 
services, or existing (or pre-existing) medical conditions.''
            (2) Standard benefit package.--Insert after section 1102 
        the following new sections:

``SEC. 1102A. STANDARD BENEFIT PACKAGE.

    ``(a) In General.--Subject to the cost-sharing described in section 
1102B or section 1102C applicable to the items and services involved, 
notwithstanding section 1102(c), the standard coverage described in 
such section shall include benefits for--
            ``(1) the acute care items and services described in 
        subsection (b), and
            ``(2) the long-term care services described in subsection 
        (c)(1) for an individual determined to be eligible for such 
        services under subsection (c)(2) provided pursuant to a plan of 
        care.
    ``(b) Acute Care.--
            ``(1) In general.--Subject to paragraph (2), the acute care 
        items and services described in this subsection include the 
        following (as specified in regulations of the Secretary):
                    ``(A) Inpatient care.--
                            ``(i) Inpatient hospital care (other than 
                        mental health and substance abuse treatment 
                        services).
                            ``(ii) Inpatient surgical and medical care 
                        (other than mental health and substance abuse 
                        treatment services), including dental services 
                        required due to injury requiring surgery.
                    ``(B) Outpatient care.--
                            ``(i) Outpatient hospital care (other than 
                        mental health and substance abuse treatment 
                        services).
                            ``(ii) Outpatient surgical and medical care 
                        (other than mental health and substance abuse 
                        treatment services), including dental services 
                        required due to injury requiring surgery.
                    ``(C) Outpatient prescription drug benefits.--
                Outpatient prescription drugs, including biologicals 
                and insulin.
                    ``(D) Dental care.--Periodic teeth cleaning and 
                preventive dental care.
            ``(2) Limitations on mental health and substance abuse 
        treatment benefits.--
                    ``(A) Annual limit for substance abuse treatment 
                services.--Subject to subparagraph (B), a health plan 
                providing standard coverage is not required to provide 
                for payment for more than $3,000 in any year for any 
                individual for substance abuse treatment services.
                    ``(B) Lifetime limit.--Such a health plan is not 
                required to provide for payment for either mental 
                health or substance abuse treatment services for an 
                individual once the plan (or another such plan) has 
                provided for payment of $50,000 for such services for 
                the individual in the individual's lifetime.
                    ``(C) Indexing.--The dollar amounts specified in 
                subparagraphs (A) and (B) of this paragraph shall be 
                increased for each year after 1994 by the same 
                percentage as the percentage increase in the consumer 
                price index for all urban consumers (U.S. city average) 
                between September of the previous year and September 
                1993. Any such increase that is not a multiple of $10 
                or $100, respectively, shall be rounded to the nearest 
                multiple of $10 or $100.
    ``(c) Long-Term Care Services.--
            ``(1) Services.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                long-term care services described in this paragraph 
                include the following (as specified in regulations of 
                the Secretary):
                            ``(i) Nursing facility services.--
                                    ``(I) In general.--Nursing facility 
                                services.
                                    ``(II) Bed reservation.--Payment 
                                for reservation of a bed in a nursing 
                                facility during a period of temporary 
                                hospitalization (not to exceed 21 days 
                                of continuous hospitalization).
                            ``(ii) Home care services.--Home care 
                        services, including--
                                    ``(I) home health services provided 
                                by a registered nursing or licensed 
                                practical nurse,
                                    ``(II) professional services of a 
                                licensed physical, occupational, 
                                respiratory, or speech therapist,
                                    ``(III) adult day care,
                                    ``(IV) home health aide and 
                                personal care attendant services,
                                    ``(V) homemaker services, and
                                    ``(VI) chore services.
                    ``(B) Benefit period and limitation.--Benefits for 
                long-term care services are limited to--
                            ``(i) a consecutive period of 2 years 
                        (beginning on the first date benefits are first 
                        covered),
                            ``(ii) $150 per day, and
                            ``(iii) $60,000 for an individual in a 
                        lifetime.
                Subsection (b)(2)(C) shall apply to the dollar amounts 
                under clauses (ii) and (iii) of this subparagraph in 
                the same manner as it applies to the dollar amounts 
                under subparagraphs (A) and (B) of subsection (b)(2), 
                except that for this purpose any reference to $10 is 
                deemed a reference to $1.
            ``(2) Eligibility.--An individual is eligible for long-term 
        care services described in paragraph (1) only if a physician 
        certifies that the individual--
                    ``(A) cannot perform at least 2 of 5 of the 
                following activities of daily living without on-hand 
                help from some else when performing the activity: 
                dressing, eating, continence, toileting, and 
                transferring from a chair or bed; or
                    ``(B) is dependent upon another person because of 
                cognitive impairment.

``SEC. 1102B. COST-SHARING FOR LONG-TERM CARE SERVICES.

    ``(a) Required Deductible.--No benefits are payable under standard 
coverage with respect to long-term care services for an individual 
until the individual has satisfied a deductible under subsection (b). 
Once such deductible has been satisfied, benefits are covered for long-
term care services until there has elapsed 180 consecutive days on 
which no covered long-term care benefits are provided. Not more than 
$150 per day may be counted toward the deductible and only expenses 
incurred in a consecutive period of 90 days may be counted toward the 
deductible. The dollar amount under the previous sentence is subject to 
annual increases in the same manner as the dollar amount under section 
1102A(c)(1)(B)(ii) is subject to annual increases under section 
1102A(c)(1)(B).
    ``(b) Deductible.--The amount of the long-term care deductible 
shall be based on the income of the family of which the individual is a 
member (expressed as a percentage of the applicable poverty line) as 
follows:
            ``(1) $450, if family income is less than 100 percent of 
        the applicable poverty line.
            ``(2) $1,250, if family income is at least 100 percent, but 
        less than 200 percent, of the applicable poverty line.
            ``(3) $4,500, if family income is at least 200 percent, but 
        less than 300 percent, of the applicable poverty line.
            ``(4) $6,750, if family income is at least 300 percent of 
        the applicable poverty line.
    ``(c) Indexing.--The dollar amounts specified in subsection (b) 
shall be increased for each year after 1994 by the same percentage as 
the percentage increase in the consumer price index for all urban 
consumers (U.S. city average) between September of the previous year 
and September 1993. Any such increase that is not a multiple of $10 
shall be rounded to the nearest multiple of $10.

``SEC. 1102C. INCOME RELATED COST SHARING FOR ACUTE CARE SERVICES.

    ``(a) Deductible.--Subject to subsections (d) and (e)--
            ``(1) Individual deductible.--The individual deductible 
        under a health plan that provides standard coverage for an 
        individual shall be based on the income of the family of which 
        the individual is a member (expressed as a percentage of the 
        applicable poverty line) in accordance with the following table 
        (subject to subsection (e)):

                         ``INDIVIDUAL DEDUCTIBLE                        
   ``[Based on Family Income (Expressed as a Percent of Poverty Line)]  
------------------------------------------------------------------------
 ``Income (Expressed as a Percent of Applicable                         
                 Poverty Line):                    Individual Deductible
------------------------------------------------------------------------
Less than 100% of Applicable Poverty Line         $100                  
------------------------------------------------------------------------
At least 100%, but less than 120%, of Applicable  $140                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 120%, but less than 140%, of Applicable  $180                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 140%, but less than 160%, of Applicable  $220                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 160%, but less than 180%, of Applicable  $260                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 180%, but less than 200%, of Applicable  $300                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 200%, but less than 220%, of Applicable  $340                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 220%, but less than 240%, of Applicable  $380                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 240%, but less than 260%, of Applicable  $420                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 260%, but less than 280%, of Applicable  $460                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 280%, but less than 300%, of Applicable  $500                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 300%, but less than 320%, of Applicable  $540                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 320%, but less than 340%, of Applicable  $580                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 340%, but less than 360%, of Applicable  $620                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 360%, but less than 380%, of Applicable  $660                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 380%, but less than 400%, of Applicable  $700                  
 Poverty Line                                                           
------------------------------------------------------------------------
At least 400% of Applicable Poverty Line          $740                  
------------------------------------------------------------------------

            ``(2) Maximum of 2 deductibles for a family.--The 
        deductible shall be considered to have been met with respect to 
        a family when the family has incurred expenses, that are 
        countable with respect to covered items and services, equal to 
        twice the individual deductible described in paragraph (1).
    ``(b) Copayments and Coinsurance.--Subject to subsections (d) and 
(e)--
            ``(1) Small copayments for families with income below the 
        poverty line.--In the case of an individual with family income 
        that is less than the applicable poverty line, a health plan 
        that provides standard coverage shall only impose cost-sharing 
        for acute care benefits in the form of a copayment of $5 for 
        each item or service provided (as identified in accordance with 
        rules established by the Secretary).
            ``(2) Coinsurance for other families.--In the case of any 
        other individual, such a plan shall impose cost-sharing for 
        acute care benefits in the form of coinsurance, based on the 
        income of the family of which the individual is a member 
        (expressed as a percentage of the applicable poverty line) in 
        accordance with the percentage specified in the following 
        table:

                        ``COINSURANCE PERCENTAGE                        
 ``[Based on Family Income (Expressed as a Percent of Applicable Poverty
                                 Line)]                                 
------------------------------------------------------------------------
 ``Income (Expressed as a Percent of Applicable                         
                 Poverty Line):                         Coinsurance     
------------------------------------------------------------------------
At least 100%, but less than 200%, of Applicable  10 percent            
 Poverty Line                                                           
------------------------------------------------------------------------
At least 200%, but less than 300%, of Applicable  15 percent            
 Poverty Line                                                           
------------------------------------------------------------------------
At least 300%, but less than 400%, of Applicable  20 percent            
 Poverty Line                                                           
------------------------------------------------------------------------
At least 400% of Applicable Poverty Line          25 percent            
------------------------------------------------------------------------

    ``(c) Catastrophic Limit on Out-of-Pocket Expenses.--The 
catastrophic limit on out-of-pocket expenses under a health plan that 
provides standard coverage for an individual shall be based on the 
income of the family of which the individual is a member (expressed as 
a percentage of the applicable poverty line) in accordance with the 
following table (subject to subsection (e)):

             ``CATASTROPHIC LIMIT ON OUT-OF-POCKET EXPENSES             
 ``[Based on Family Income (Expressed as a Percent of Applicable Poverty
                                 Line)]                                 
------------------------------------------------------------------------
 ``Income (Expressed as a Percent of Applicable    Catastrophic Limit on
                 Poverty Line):                   Out-of-Pocket Expenses
------------------------------------------------------------------------
Less than 100% of Applicable Poverty Line         $2,000                
------------------------------------------------------------------------
At least 100%, but less than 120%, of Applicable  $2,400                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 120%, but less than 140%, of Applicable  $2,800                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 140%, but less than 160%, of Applicable  $3,200                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 160%, but less than 180%, of Applicable  $3,600                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 180%, but less than 200%, of Applicable  $4,000                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 200%, but less than 220%, of Applicable  $4,400                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 220%, but less than 240%, of Applicable  $4,800                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 240%, but less than 260%, of Applicable  $5,200                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 260%, but less than 280%, of Applicable  $5,600                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 280%, but less than 300%, of Applicable  $6,000                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 300%, but less than 320%, of Applicable  $6,400                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 320%, but less than 340%, of Applicable  $6,800                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 340%, but less than 360%, of Applicable  $7,200                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 360%, but less than 380%, of Applicable  $7,600                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 380%, but less than 400%, of Applicable  $8,000                
 Poverty Line                                                           
------------------------------------------------------------------------
At least 400% of Applicable Poverty Line          $8,400                
------------------------------------------------------------------------

    ``(d) Special Rules.--Under a plan providing standard coverage:
            ``(1) No copayments or coinsurance for inpatient hospital 
        services.--There shall be no copayments or coinsurance imposed 
        for inpatient hospital services.
            ``(2) No cost-sharing for maternity services.--There shall 
        be no cost-sharing imposed for maternity services.
            ``(3) No cost-sharing for hospital and physician emergency 
        care for treatment of injuries within 72 hours of onset of 
        injury.--There shall be no cost-sharing imposed for hospital 
        and physician emergency care for treatment of injuries within 
        72 hours of onset of injury.
            ``(4) No deductible for dental care.--The deductible under 
        subsection (a) shall not apply to coverage of dental services 
        described in section 1102A(b)(1)(D) (relating to periodic 
        dental cleaning and dental preventive care).
            ``(5) Mental health services.--In the case of mental health 
        and substance abuse treatment services (whether inpatient or 
        outpatient):
                    ``(A) Separate per person annual deductible.--There 
                shall be a separate calendar year deductible of $250 
                per individual, without regard to the income of the 
                family of which the individual is a member.
                    ``(B) Higher coinsurance.--A plan providing 
                standard coverage may impose coinsurance of 40 percent, 
                without regard to the income of the family of which the 
                individual is a member.
    ``(e) Indexing Values.--The dollar amounts specified in subsections 
(a), (c), and (d)(5)(A) shall be increased for each year after 1994 by 
the same percentage as the percentage increase in the consumer price 
index for all urban consumers (U.S. city average) between September of 
the previous year and September 1993. Any such increase that is not a 
multiple of $10, $100, or $10, respectively, shall be rounded to the 
nearest multiple of $10, $100, or $10.''
            (3) Premiums.--Strike sections 1104 and 1005 and insert the 
        following:

``SEC. 1104. ESTABLISHMENT OF PREMIUMS.

    ``(a) In General.--Each group health plan or health insurance plan 
that provides coverage of standard benefits described in section 
1102(c) shall establish premiums on a per capita basis that vary within 
a premium rating area (as defined by the Secretary) only based on age 
of the individual and income classification (within the same classes of 
age and income used for the reference per person annual premium amount 
under section 1703(a)) and may vary among such classes only in the same 
ratios as the reference amounts under such section vary among such 
classes.
    ``(b) Family Rate as Sum of Individual Rates.--The premium imposed 
by such a plan with respect to members of a family shall be the sum of 
the per capita rates established under subsection (a) with respect to 
all the members of the family.''
            (4) Income-related tax deductions.--Amend subtitle D of 
        title I to read as follows:

                      ``Subtitle B--Tax Provisions

``SEC. 1301. ELIMINATION OF EXCLUSION FROM INCOME FOR EMPLOYER-PROVIDED 
              HEALTH CARE.

    ``(a) In General.--The text of section 106 of the Internal Revenue 
Code of 1986 (relating to contributions by employer to accident and 
health plans) is amended to read as follows:
    ```(a) In General.--Gross income of an employee does not include 
employer-provided coverage under an accident or health plan.
    ```(b) Termination.--Gross income of an employee shall include 
employer-provided coverage under an accident or health plan if such 
coverage is provided after December 31, 1995.'
    ``(b) Employment Tax Treatment.--
            ``(1) Social security tax.--
                    ``(A) Subsection (a) of section 3121 of such Code 
                is amended by inserting after paragraph (21) the 
                following new sentence:
`Nothing in paragraph (2) shall exclude from the term ``wages'' any 
amount which is required to be included in gross income under section 
106(b).'
                    ``(B) Subsection (a) of section 209 of the Social 
                Security Act is amended by inserting after paragraph 
                (21) the following new sentence:
`Nothing in paragraph (2) shall exclude from the term ``wages'' any 
amount which is required to be included in gross income under section 
106(b) of the Internal Revenue Code of 1986.'
            ``(2) Railroad retirement tax.--Paragraph (1) of section 
        3231(e) of such Code is amended by adding at the end thereof 
        the following new sentence: `Nothing in clause (i) of the 
        second sentence of this paragraph shall exclude from the term 
        ``compensation'' any amount which is required to be included in 
        gross income under section 106(b).'
            ``(3) Unemployment tax.--Subsection (b) of section 3306 of 
        such Code is amended by inserting after paragraph (16) the 
        following new sentence:
`Nothing in paragraph (2) shall exclude from the term ``wages'' any 
amount which is required to be included in gross income under section 
106(b).'
            ``(4) Wage withholding.--Subsection (a) of section 3401 of 
        such Code is amended by adding at the end thereof the following 
        new sentence:
`Nothing in the preceding provisions of this subsection shall exclude 
from the term ``wages'' any amount which is required to be included in 
gross income under section 106(b).'
    ``(c) Effective Date.--
            ``(1) Income tax.--The amendment made by subsection (a) 
        shall apply to taxable years ending after December 31, 1995.
            ``(2) Employment tax.--The amendments made by subsection 
        (b) shall apply to remuneration paid after December 31, 1995.

``SEC. 1302. LIMITATION ON EMPLOYER DEDUCTION FOR HEALTH CARE PROVIDED 
              TO EMPLOYEES.

    ``(a) In General.--Section 162 of the Internal Revenue Code of 1986 
(relating to trade or business expenses) is amended by redesignating 
subsection (o) as subsection (p) and by inserting after subsection (n) 
the following new subsection:
    ```(o) Denial of Deduction for Certain Health Care Coverage 
Provided to Employee.--No deduction shall be allowed under this chapter 
to an employer for coverage provided to an employee (or the spouse or 
any dependent of an employee) under an accident or health plan unless 
such plan provides standard coverage in accordance with the applicable 
provisions of the Affordable Health Care Now Act of 1993.'
    ``(b) Effective Date.--The amendment made by this section shall 
apply to coverage for periods after December 31, 1995, in taxable years 
ending after such date.

``SEC. 1303. NON-ITEMIZED DEDUCTION FOR PREMIUMS FOR QUALIFIED HEALTH 
              PLANS AND FOR CONTRIBUTIONS TO MEDICAL SAVINGS ACCOUNTS 
              BY TAXPAYERS COVERED UNDER CATASTROPHIC COVERAGE HEALTH 
              PLANS.

    ``(a) In General.--Part VII of subchapter B of chapter 1 of the 
Internal Revenue Code of 1986 (relating to additional itemized 
deductions for individuals), as amended by section 2202, is amended by 
redesignating section 221 as section 222 and by inserting after section 
220 the following new section:

```SEC. 221. CERTAIN PAYMENTS FOR HEALTH COVERAGE.

    ```(a) In General.--In the case of an individual, there shall be 
allowed as a deduction for the taxable year an amount equal to the 
qualified health expenses paid by the taxpayer during the taxable year.
    ```(b) Qualified Health Expenses.--For purposes of this section:
            ```(1) In general.--The term ``qualified health expenses'' 
        means expenses for coverage of the taxpayer and the spouse and 
        dependents (as defined in section 152) of the taxpayer under a 
        qualified health plan.
            ```(2) Taxpayers covered under catastrophic coverage health 
        plan.--In the case of a taxpayer who is covered (and whose 
        spouse and dependents are covered) under a qualified health 
        plan which is a catastrophic coverage health plan, the term 
        ``qualified health expenses'' includes amounts contributed by 
        or on behalf of such taxpayer to a medical savings account (as 
        defined in section 220(d)(1)(A)) for the benefit of such 
        taxpayer.
    ```(c) Limitation.--The amount allowed as a deduction under 
subsection (a) for the taxable year shall not exceed the excess (if 
any) of--
            ```(1) the maximum voucher amount that would have been 
        provided to the taxpayer under subtitle A of title I of the 
        Affordable Health Care Now Act of 1993 for the calendar year 
        ending with or within such taxable year if the taxpayer's 
        family income were zero for such calendar year, over
            ```(2) the voucher amount provided to the taxpayer under 
        such subtitle A for such calendar year.
    ```(d) Definitions.--For purposes of this section--
            ```(1) the term ``qualified health plan'' means a MedAccess 
        plan or other health plan that provides standard coverage 
        consistent with the applicable requirements of the Affordable 
        Health Care Now Act of 1993; and
            ```(2) the term ``catastrophic coverage health plan'' has 
        the meaning given such term in section 220(c)(2).'
    ``(b) Clerical Amendment.--The table of sections for part VII is 
amended by striking the last item and inserting the following new 
items:

                              ```Sec. 221. Certain payments for health 
                                        coverage.
                              ```Sec. 222. Cross reference.'
    ``(c) Effective Date.--The amendments made by this section shall 
apply to coverage for periods after December 31, 1995, in taxable years 
ending after such date.''
            (5) Individual mandate and income-related vouchers.--Strike 
        subtitles G and H of title I and insert the following:

                    ``Subtitle G--Individual Mandate

``SEC. 1601. REQUIREMENT.

    ``(a) In General.--Each individual who is lawfully in the United 
States shall obtain health insurance coverage under a health plan that 
is a MedAccess plan or a plan that benefits equivalent to the benefits 
provided in a MedAccess plan.
    ``(b) Exceptions.--An individual who is a member of the Uniformed 
Services of the United States on active duty or is entitled to benefits 
under the CHAMPUS program or title 38, United States Code, is deemed to 
have satisfied the requirement of subsection (a).
    ``(c) Enforcement.--Each individual who fails to meet the 
requirement of subsection (a) shall be enrolled, in a manner specified 
by the Secretary, in a plan described in such subsection and is liable 
for the premiums otherwise payable during the period in which the 
individual failed to be enrolled, plus a penalty or interest as 
specified by the Secretary. Amounts so owed may be collected by the 
Secretary through garnishment, withholding of tax refunds owed, or 
other appropriate means.

                 ``Subtitle H--Income-Related Vouchers

``SEC. 1701. ELIGIBILITY.

    ``(a) Eligibility.--
            ``(1) In general.--Each qualified family (as defined in 
        subsection (b)) is entitled to be provided financial assistance 
        toward the cost of the premium for a health plan that provides 
        standard coverage either--
                    ``(A) in the form of a voucher under paragraph (2) 
                in the amount specified in section 1702(a), or
                    ``(B) in the form of a non-itemized deduction 
                against taxes otherwise payable, in accordance with 
                section 221 of the Internal Revenue Code of 1986.
            ``(2) Use of voucher.--
                    ``(A) In general.--Subject to subparagraph (B), a 
                voucher provided to a family under this subtitle shall 
                be remitted by any individual in such family to the 
                health plan, the exempted multiple employer health plan 
                (as defined in section 701 of the Employee Retirement 
                Income Security Act of 1974), or, in the case of an 
                employment-related health plan, to the employee's 
                employer, as the case may be, for payment by the 
                Secretary. The health plan, multiple employer health 
                plan, or employer shall make proper adjustments in 
                billing statements to reflect such family's remaining 
                premium obligations (if any).
                    ``(B) Election of tax credit.--A family may elect, 
                in a manner specified by the Secretary in consultation 
                with the Secretary of the Treasury, to be provided the 
                voucher in the form of a credit against income taxes 
                payable by members of the family.
    ``(b) Qualified Family.--For purposes of this subtitle, except as 
provided in subsection (c), the term `qualified family' means an 
individual and dependents (as defined in section 1023).
    ``(c) Special Treatment of Medicare Beneficiaries.--
            ``(1) Individuals currently 60 years of age or older.--In 
        the case of individuals who are 60 years of age or older on the 
        date of the enactment of this Act, the individual shall only be 
        considered to be a member of a qualified family if the 
        individual elects to be eligible for benefits under this 
        subtitle instead of any entitlement to benefits under the 
        medicare program under title XVIII of the Social Security Act. 
        Such election shall be made at such time and in such manner as 
        the Secretary specifies. Once such an election is made with 
        respect to an individual it is irrevocable.
            ``(2) Other individuals.--In the case of eligible 
        individuals not described in paragraph (1), the individuals are 
        entitled to benefits under this title instead of entitlement to 
        benefits under the medicare program under title XVIII of the 
        Social Security Act.
            ``(3) Medicare payments.--In the case of an individual who, 
        under paragraph (1) or (2), is entitled to benefits under this 
        title instead of entitlement to benefits under the medicare 
        program, the Secretary shall provide for payment on behalf of 
        the individual for premiums under health plans that provide 
        benefits for the individual in an amount equal to the amount 
        that would be payable under section 1876 of the Social Security 
        Act if the individual had been enrolled under a risk-sharing 
        contract with an eligible organization under such section (but 
        substituting 100 percent for 95 percent in subsection (a)(2)(C) 
        of such section).
    ``(d) Special Treatment of Medicaid Beneficiaries.--
            ``(1) State options for acute care.--Each State that has a 
        medicaid plan approved under title XIX of the Social Security 
        Act shall elect one of the following options in relation to 
        such plan with respect to medical assistance with respect to 
        acute care services:
                    ``(A) Contribution option.--The State may pay an 
                amount equivalent to the product of--
                            ``(i) 1 minus the Federal medical 
                        assistance percentage for the State (as defined 
                        in section 1905(b) of the Social Security Act), 
                        and
                            ``(ii) the Federal subsidies provided under 
                        this subtitle for individuals residing in the 
                        State who have family incomes below the 
                        applicable poverty line for a family of the 
                        size involved.
                    ``(B) Capitation option.--The State may assume 
                responsibility for providing (through capitated plans 
                or otherwise) benefits under standard coverage 
                (described in section 1102A) for all individuals 
                described in subparagraph (A) and the State is entitled 
                to receive from the Federal Government an amount equal 
                to the Federal subsidies that otherwise would have been 
                provided under this subtitle for such individuals 
                reduced by the amount the State would have been 
                required to pay under subparagraph (A) if the option 
                under such subparagraph had been elected.
            ``(2) Transitional long-term care services.--
                    ``(A) Elimination of current medicaid coverage for 
                transitional services.--An individual who first becomes 
                entitled to and receives transitional long-term care 
                services under a State medicaid plan on or after the 
                effective date of this subtitle shall not be entitled 
                to medical assistance with respect to such services 
                under the plan, but shall receive benefits with respect 
                to such services under the standard benefit package or 
                under the State option described in paragraph (1)(B).
                    ``(B) Grandfathering of long-term care medicaid 
                recipients.--An individual who is entitled to and is 
                receiving, as of the effective date of this subtitle, 
                transitional long-term care services under a State 
                medicaid plan shall continue to be entitled to medical 
                assistance with respect to such services and States may 
                not change the benefits made available under such plans 
                with respect to such individuals.
                    ``(C) Transitional long-term care services.--In 
                this subsection, the term `transitional long-term care 
                services' means, with respect to an individual, long-
                term care services furnished to the individual during 
                the 2-year period beginning on the date such services 
                are first furnished to the individual.
            ``(3) Extended long-term care services.--With respect to 
        coverage of long-term care services other than transitional 
        long-term care services under a State medicaid plan, on and 
        after the effective date of this subtitle the Federal medical 
        assistance percentage shall be equal to 100 percent.
    ``(e) Additional Special Rules.--
            ``(1) Active duty military not eligible.--An individual who 
        is a member of the Uniformed Services of the United States on 
        active duty is not eligible for benefits under this section.
            ``(2) Election by individuals eligible for champus and 
        veterans benefits.--An individual who is receiving benefits 
        under the CHAMPUS program or under title 38, United States 
        Code, as of the effective date of this subtitle shall only be 
        eligible for benefits under this section if the individual 
        elects, on a 1-time basis, to waive the rights to benefits 
        under such program or title and instead receive benefits 
        described in subsection (a).

``SEC. 1702. AMOUNT OF VOUCHER.

    ``(a) In General.--The amount of a voucher specified in this 
subsection for a qualified family for a year is the sum of the voucher 
amounts for each member of the family in the year. The voucher amount 
for each member of a family in the year is the lesser of--
            ``(1) the annual premium paid by or on behalf of the family 
        member for such year for coverage under a health plan that 
        provides standard coverage in which the member is enrolled, or
            ``(2) the voucher percentage (specified in subsection (b)) 
        of the sum, for all months in the year, of \1/12\ of the 
        reference per person annual premium amount (specified under 
        section 1703) for that member for that year.
Paragraph (2) shall be applied to a member based on the age, income 
class, family status, and geographic location of the member as of the 
first day of the month.
    ``(b) Voucher Percentage.--
            ``(1) In general.--Subject to paragraph (2), for a 
        qualified family, the voucher percentage is the percentage 
        specified in the following table, based on the income 
        (expressed as a percent of the applicable poverty line for a 
        family of the size involved) of the family of which the 
        individual is a member:

                          ``VOUCHER PERCENTAGE                          
 ``[Based on Family Income (Expressed as a Percent of Applicable Poverty
                                 Line)]                                 
------------------------------------------------------------------------
 ``Income (Expressed as a Percent of Applicable                         
                 Poverty Line):                     Voucher Percentage  
------------------------------------------------------------------------
Less than 100% of Applicable Poverty Line         100%                  
------------------------------------------------------------------------
At least 100%, but less than 110%, of Applicable  90%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 110%, but less than 120%, of Applicable  80%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 120%, but less than 130%, of Applicable  70%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 130%, but less than 140%, of Applicable  60%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 140%, but less than 160%, of Applicable  60%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 160%, but less than 160%, of Applicable  60%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 160%, but less than 170%, of Applicable  55%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 170%, but less than 220%, of Applicable  50%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 220%, but less than 240%, of Applicable  40%                   
 Poverty Line                                                           
------------------------------------------------------------------------
At least 240% of Applicable Poverty Line          0%                    
------------------------------------------------------------------------

            ``(2) Treatment of elderly individuals.--In the case of an 
        individual who is 65 years of age or older as of the first day 
        of a month and whose family income (expressed as a percent of 
        applicable poverty line) is at least 240 percent of the 
        applicable poverty line, the voucher percentage is 20 percent.
    ``(c) Definitions and Determination of Income.--For purposes of 
this subtitle:
            ``(1) Applicable poverty line.--The term `applicable 
        poverty line' means the income official poverty line (as 
        defined by the Office of Management and Budget, and revised 
        annually in accordance with section 673(2) of the Omnibus 
        Budget Reconciliation Act of 1981) applicable to a family of 
        the size involved. Such poverty line shall be revised as of 
        October 1 of each year for the next succeeding year.
            ``(2) Determinations of income.--
                    ``(A) In general.--Subject to paragraph (3), the 
                term `income' means adjusted gross income (as defined 
                in section 62(a) of the Internal Revenue Code of 
                1986)--
                            ``(i) determined without regard to sections 
                        135, 162(l), 911, 931, and 933 of such Code; 
                        and
                            ``(ii) increased by--
                                    ``(I) the amount of interest 
                                received or accrued which is exempt 
                                from tax, plus
                                    ``(II) the amount of social 
                                security benefits (described in section 
                                86(d) of such Code) which is not 
                                includible in gross income under 
                                section 86 of such Code.
                    ``(B) Family income.--The term `family income' 
                means, with respect to a family, the sum of the income 
                for all members of the family, not including the income 
                of a dependent child with respect to which no return is 
                required under the Internal Revenue Code of 1986.
                    ``(C) Family size.--The family size to be applied 
                under this section, with respect to family income, is 
                the number of individuals included in the family for 
                purposes of coverage under a health plan that provides 
                standard coverage.
            ``(3) Special rule where loss of earned income during a 
        year.--
                    ``(A) In general.--In the case of a family 
                described in subparagraph (B), the family may elect to 
                have the voucher amount under this subtitle computed 
                based only on other, nonearned income (and attributable 
                amounts described in subparagraph (C)).
                    ``(B) Family described.--A family described in this 
                subparagraph is a family--
                            ``(i) that has a significant loss of wages 
                        or earned income (as defined by the Secretary) 
                        during a year, and
                            ``(ii) has net assets (as determined in 
                        accordance with rules specified by the 
                        Secretary) of less than $500,000.
                    ``(C) Attributable amounts.--In applying 
                subparagraph (A), any nonexempt assets of a family 
                shall be deemed to provide income at a rate of not less 
                than the interest rate applicable to long-term 
                obligations of the United States (as determined by the 
                Secretary of the Treasury).

``SEC. 1703. REFERENCE PER PERSON ANNUAL PREMIUM AMOUNT.

    ``(a) In General.--Subject to the succeeding provisions of this 
section, for purposes of this subtitle, the reference per person annual 
premium amount for an individual is the following amount for standard 
coverage, based on the age of the individual and the income (expressed 
as a percent of the applicable poverty line for a family of the size 
involved) of the family of which the individual is a member in 
accordance with the following table:

                       ``REFERENCE PER PERSON ANNUAL PREMIUM AMOUNT FOR STANDARD COVERAGE                       
  ``[Based on Family Income (Expressed as a Percent of Applicable Poverty Line) and Based on Age of Individual] 
----------------------------------------------------------------------------------------------------------------
  ``Income Expressed as a                                                                                       
   Percent of Applicable        Under 18           18-34            35-49            50-64           Over 64    
      Poverty Line):                                                                                            
----------------------------------------------------------------------------------------------------------------
Less than 100% of           $1,568            $2,613           $3,714           $5,057           $13,233        
 Applicable Poverty Line                                                                                        
----------------------------------------------------------------------------------------------------------------
At least 100%, but less     $776              $1,293           $1,839           $2,503           $8,537         
 than 200%, of Applicable                                                                                       
 Poverty Line                                                                                                   
----------------------------------------------------------------------------------------------------------------
At least 200% of            $644              $1,074           $1,526           $2,078           $7,086         
 Applicable Poverty Line                                                                                        
----------------------------------------------------------------------------------------------------------------

    ``(b) Update.--The reference per person annual premium amounts 
specified in subsection (a) shall be updated annually by the Secretary, 
based on estimates of changes in the actuarial value for the different 
classes based on income and age of the standard benefit package between 
1993 and the year involved.
    ``(c) Geographic Adaptation.--
            ``(1) In general.--The reference per person annual premium 
        amounts specified in subsection (a) and updated under 
        subsection (b) shall be adjusted by the Secretary for each 
        geographic area so they reflect variations in costs of the 
        standard benefit package in different areas.
            ``(2) Methodology.--The Secretary shall make such 
        adjustment using methodology (and areas) similar to the 
        methodology and areas used for establishing the average annual 
        per capita cost for payments to eligible organizations under 
        section 1876 of the Social Security Act.
    ``(d) Application on Monthly Basis.--The reference per person 
annual premium amounts under this section shall be computed for a 
family on a monthly basis, to take into account the age, income class, 
and family status as of the first day of the month involved.

``SEC. 1704. APPLICATION FOR VOUCHER.

    ``(a) Time of Filing.--
            ``(1) November 1 of previous year.--Not later than November 
        1 of each year (beginning with 1995), each family desiring to 
        obtain a voucher under this subtitle shall submit to the 
        Secretary (in such form and manner as the Secretary may 
        require, in consultation with the Secretary of the Treasury) an 
        estimate of the individual's family income anticipated for the 
        taxable year ending with or within the following calendar year, 
        to be used to determine initially whether the individual is 
        eligible for a voucher under this subtitle, and the amount of 
        such a voucher, for such following calendar year.
            ``(2) Special rule for first year of coverage.--For the 
        first year in which an individual is eligible for such a 
        voucher, the individual shall submit to the Secretary (at such 
        time and in such form and manner as the Secretary may require, 
        in consultation with the Secretary of the Treasury) an estimate 
        of the individual's family income anticipated for the taxable 
        year ending with December 31 of such year, to be used to 
        determine initially whether the individual is eligible for a 
        voucher under this subtitle, and the amount of such a voucher, 
        for such following calendar year.
            ``(3) Subsequent applications.--Under rules established by 
        the Secretary, applications for a voucher may also be filed at 
        other times during a year.
    ``(b) Form.--
            ``(1) Use of simple form.--The Secretary shall use an 
        application which shall be as simple in form as possible and 
        understandable to the average individual. The application may 
        require attachment of such documentation as deemed necessary by 
        the Secretary in order to ensure eligibility for assistance. 
        The Secretary shall use, as deemed practicable by the 
        Secretary, any existing forms employed for Federal income tax 
        filings as an application for assistance.
            ``(2) Availability of forms.--The Secretary shall make 
        application forms available through health care providers and 
        plans, public assistance offices, public libraries, and at 
        other locations (including post offices) accessible to a broad 
        cross-section of families.
            ``(3) Submission of application form.--An application form 
        under this section may be submitted in such manner as the 
        Secretary shall provide.
    ``(c) Permitting Submission of Revised Application.--During a year, 
a family may submit a revised application to reflect changes in the 
estimated income of the family, including changes in employment status 
of family members, during the year. The voucher amount shall be revised 
to reflect such a revised application.
    ``(d) Enrollment at Point of Application.--To the extent 
practicable, the Secretary shall provide for the option of enrollment 
in a health plan that provides standard coverage as part of the 
application and approval process for assistance under this subtitle. In 
providing for such an option, the Secretary may require the State of 
residence to provide such information and assistance regarding such 
plans as may be necessary.

``SEC. 1705. DETERMINATION OF ELIGIBILITY AND AMOUNT OF VOUCHER.

    ``(a) In General.--Upon receiving an application for a voucher 
under section 1804, the Secretary shall provide in a prompt manner for 
notice of the determination of eligibility for, and amount of, a 
voucher under this subtitle.
    ``(b) Election With Respect to Income Determination.--As elected by 
a family at the time of submission of an application for a voucher 
under section 1804, the family income shall be determined either--
            ``(1) by multiplying by a factor of 4 the income for the 3-
        month period immediately preceding the month in which the 
        application is made, or
            ``(2) based upon estimated income for the entire year in 
        which the application is submitted.
    ``(c) Disclosure of Certain Tax Information by Secretary of 
Treasury.--
            ``(1) In general.--Subsection (l) of section 6103 of the 
        Internal Revenue Code of 1986 (relating to confidentiality and 
        disclosure of returns and return information) is amended by 
        adding at the end thereof the following new paragraph:
            ```(14) Disclosure of return information.--
                    ```(A) In general.--The Secretary shall, upon 
                written request from the Secretary of Health and Human 
                Services, disclose to the officers and employees of the 
                Department of Health and Human Services return 
                information necessary to determine the family income 
                (as defined in section 1702(c)(2)(B) of the Affordable 
                Health Care Now Act of 1993) of any individual to be 
                used to determine whether the individual is eligible 
                for a voucher under subtitle I of title I of such Act, 
                and the amount of such a voucher.
                    ```(B) Restriction on use of disclosed 
                information.--Any officer or employee of the Department 
                of Health and Human Services receiving return 
                information under subparagraph (A) shall use such 
                information only for purposes of, and to the extent 
                necessary in, establishing the family income (as so 
                defined) for such purpose.'
            ``(2) Conforming amendments.--Paragraphs (3)(A) and (4) of 
        section 6103(p) of such Code are each amended by striking `or 
        (13)' each place it appears and inserting `(13), or (14)'.
            ``(3) Effective date.--The amendments made by paragraphs 
        (1) and (2) shall apply with respect to information for taxable 
        years beginning after the date of the enactment of this Act.

``SEC. 1706. RECONCILIATION.

    ``(a) Notice of Voucher Amounts Provided.--In the case of a 
qualified family that has received a voucher under this subtitle for 
any month in a year, the Secretary shall, not later than January 31 of 
the following year, notify such family of the total amount of the 
vouchers that such family received during the year.
    ``(b) Filing of Notice.--
            ``(1) In general.--A family that receives a notice under 
        subsection (a) shall attach such notice to the tax return filed 
        by such family for the year involved. The Secretary of the 
        Treasury shall establish a procedure to enable a family that is 
        not required to file a tax return for the year involved to file 
        the notice received under subsection (a).
            ``(2) Instructions for filing notice.--The Secretary shall 
        provide instructions for filing the notice described in 
        paragraph (1) (in such form as the Secretary prescribes) no 
        later than January 31 of the year following the year involved.
    ``(c) Reconciliation of Assistance Based on Actual Income.--
            ``(1) In general.--Based on and using the information 
        contained in the notice filed under subsection (b) with respect 
        to a family, the Secretary of the Treasury shall compute the 
        amount of the voucher that should have been provided under this 
        subtitle with respect to the family in the year involved.
            ``(2) Overpayment of voucher.--If the amount of the voucher 
        provided was greater than the amount computed under paragraph 
        (1), the excess amount shall be treated as an underpayment of a 
        tax imposed by chapter 1 of the Internal Revenue Code of 1986 
        and paid by the Secretary of the Treasury to the family 
        involved.
            ``(3) Underpayment of voucher.--If the amount computed 
        under paragraph (1) is greater than the amount of the voucher 
        provided, the amount of the difference shall be treated as an 
        overpayment of tax imposed by such chapter, or in the event 
        such family is entitled to a refund of such a tax, subject to 
        the provisions of section 6402(d) of such Code.
    ``(d) Failure To File.--In the case of any family that is required 
to file a notice under subsection (b) for a year and that fails to file 
such a notice by the deadline specified by the Secretary, the entire 
amount of the voucher provided in such year shall be considered the 
excess amount under subsection (c)(2). The Secretary shall waive the 
application of this subsection if the family establishes, to the 
satisfaction of the Secretary, good cause for the failure to file the 
notice on a timely basis.

``SEC. 1707. PENALTIES FOR FALSE INFORMATION.

    ``Any individual who knowingly makes a material misrepresentation 
of information in an application for a voucher under this subtitle, 
shall be liable to the Federal Government for excess payments made 
based on such misrepresentation and interest on such excess payments at 
a rate specified by the Secretary, and, in addition, shall be liable to 
the Federal Government for $1,000 or, if greater, 3 times the excess 
payments made based on such misrepresentation.

``SEC. 1708. ADMINISTRATION.

    ``(a) In General.--Except as provided in this section, this 
subtitle shall be administered by the Secretary of Health and Human 
Services.
    ``(b) Administration by a State.--Upon application of a State, the 
Secretary may provide for the administration of this subtitle in a 
State through an appropriate State agency.''
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