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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1278 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1278

    To establish the Consumers Choice Health Plan, a public health 
   insurance plan that provides an affordable and accountable health 
                    insurance option for consumers.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             June 17, 2009

 Mr. Rockefeller (for himself and Mr. Brown) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
    To establish the Consumers Choice Health Plan, a public health 
   insurance plan that provides an affordable and accountable health 
                    insurance option for consumers.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Consumers Health Care Act of 2009''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Americans need health care coverage that is always 
        affordable.
            (2) Americans need health care coverage that is always 
        adequate.
            (3) Americans need health care coverage that is always 
        accountable.
            (4) A public health insurance plan option that can compete 
        with private insurance plans is the only way to guarantee that 
        all consumers have affordable, adequate, and accountable 
        options available in the insurance marketplace.

SEC. 3. OFFICE OF HEALTH PLAN MANAGEMENT.

    (a) Establishment.--Not later than July 1, 2010, there shall be 
established within the Department of Health and Human Services an 
Office of Health Plan Management (referred to in this Act as the 
``Office''). The Office shall be headed by a Director (referred to in 
this Act as the ``Director'') who shall be appointed by the President, 
by and with the advice and consent of the Senate.
    (b) Compensation.--The Director shall be paid at the annual rate of 
pay for a position at level II of the Executive Schedule under section 
5313 of title 5, United States Code.
    (c) Limitation.--Neither the Director nor the Office shall 
participate in the administration of the National Health Insurance 
Exchange (as defined in section 7) or the promulgation or 
administration of any regulation regarding the health insurance 
industry.
    (d) Personnel and Operations Authority.--The Director shall have 
the same general authorities with respect to personnel and operations 
of the Office as the heads of other agencies and departments of the 
Federal Government have with respect to such agencies and departments.

SEC. 4. CONSUMER CHOICE HEALTH PLAN.

    (a) In General.--The Office shall establish and administer the 
Consumer Choice Health Plan (referred to in this Act as the ``Plan'') 
to provide for health insurance coverage that is made available to all 
eligible individuals (as described in subsection (d)(1)) in the United 
States and its territories.
    (b) Regulatory Compliance.--The Plan shall comply with--
            (1) all regulations and requirements that are applicable 
        with respect to other health insurance plans that are offered 
        through the National Health Insurance Exchange; and
            (2) any additional regulations and requirements, as 
        determined by the Director.
    (c) Benefits.--
            (1) In general.--The Plan shall offer health insurance 
        coverage at different benefit levels, provided that such 
        benefits are commensurate with the required benefit levels to 
        be provided by a health insurance plan under the National 
        Health Insurance Exchange.
            (2) Minimum benefits for children.--
                    (A) In general.--The minimum benefit level 
                available under the Plan for children shall include at 
                least the services described in the most recently 
                published version of the ``Maternal and Child Health 
                Plan Benefit Model'' developed by the National Business 
                Group on Health.
                    (B) Amendment of benefit level.--The Secretary of 
                Health and Human Services, acting through the Director 
                of the Agency for Healthcare Research and Quality, may 
                amend the benefits described in subparagraph (A) based 
                on the most recent peer-reviewed and evidence-based 
                data.
    (d) Eligibility and Enrollment.--
            (1) Eligibility.--An individual who is eligible to purchase 
        coverage from a health insurance plan through the National 
        Health Insurance Exchange shall be eligible to enroll in the 
        Plan.
            (2) Enrollment process.--An individual may enroll in the 
        Plan only in such manner and form as may be prescribed by 
        applicable regulations, and only during an enrollment period as 
        prescribed by the Director.
            (3) Employer enrollment.--An employer shall be eligible to 
        purchase health insurance coverage for their employees and the 
        employees' dependents to the extent provided for all health 
        benefits plans under the National Health Insurance Exchange.
            (4) Satisfaction of individual mandate requirement.--An 
        individual's enrollment with the Plan shall be treated as 
        satisfying any requirement under Federal law for such 
        individual to demonstrate enrollment in health insurance or 
        benefits coverage.
    (e) Providers.--
            (1) Network requirement.--
                    (A) Medicare.--A participating provider who is 
                voluntarily providing health care services under the 
                Medicare program established under title XVIII of the 
                Social Security Act (42 U.S.C. 1395 et seq.) shall be 
                required to provide services to any individual enrolled 
                in the Plan.
                    (B) Medicaid and chip.--A provider of health care 
                services under the Medicaid program established under 
                title XIX of the Social Security Act (42 U.S.C. 1396 et 
                seq.), or the CHIP program established under title XXI 
                of such Act (42 U.S.C. 1397aa et seq.), shall be 
                required to provide services to any individual enrolled 
                in the Plan.
            (2) Exception.--Paragraph (1) shall not be construed as 
        requiring a provider to accept new patients due to bona fide 
        capacity limitations of the provider.
            (3) Opt-out provision.--
                    (A) Medicare.--A participating provider as 
                described under paragraph (1)(A) shall be required to 
                provide services to any individual enrolled in the Plan 
                for the 3-year period following the establishment of 
                the Plan. Upon the expiration of the 3-year period, a 
                participating provider in the Plan may elect to become 
                a non-participating provider without affecting their 
                status as a participating provider under the Medicare 
                program.
                    (B) Medicaid and chip.--A provider as described 
                under paragraph (1)(B) shall be required to provide 
                services to any individual enrolled in the Plan for the 
                3-year period following the establishment of the Plan. 
                Upon the expiration of the 3-year period, a provider in 
                the Plan may elect to cease provision of services under 
                the Plan without affecting their status as a provider 
                under the Medicaid program or the CHIP program.
            (4) Payment rates.--
                    (A) Initial payment rates.--
                            (i) In general.--During the 2-year period 
                        following the establishment of the Plan, 
                        providers shall be reimbursed at such payment 
                        rates as are applicable under the Medicare 
                        program.
                            (ii) Adjustment.--The Director may 
                        reimburse providers at rates lower or higher 
                        than applicable under the Medicare program if 
                        the Director determines that the adjusted rates 
                        are appropriate and ensure that enrollees in 
                        the Plan are provided with adequate access to 
                        health care services.
                    (B) Subsequent payment rates.--Subject to 
                subparagraph (C), upon the expiration of the 2-year 
                period following the establishment of the Plan, the 
                Director shall develop payment rates for reimbursement 
                of providers in order to maintain an adequate provider 
                network necessary to assure that enrollees in the Plan 
                have adequate access to health care. In determining 
                such payment rates, the Director shall consider--
                            (i) competitive provider payment rates in 
                        both the public and private sectors;
                            (ii) best practices among providers;
                            (iii) integrated models of care delivery 
                        (including medical home and chronic care 
                        coordination models);
                            (iv) geographic variation in health care 
                        costs;
                            (v) evidence-based practices;
                            (vi) quality improvement;
                            (vii) use of health information technology; 
                        and
                            (viii) any additional measures, as 
                        determined by the Director.
                    (C) Payment rate consultation.--The Director shall 
                determine payment rates under subparagraph (B) in 
                consultation with providers participating under the 
                Plan, the Director of the Office of Personnel 
                Management, the Medicare Payment Advisory Commission, 
                and the Medicaid and CHIP Payment and Access 
                Commission.
            (5) Adoption of medicare reforms.--The Plan may adopt 
        Medicare system delivery reforms that provide patients with a 
        coordinated system of care and make changes to the provider 
        payment structure.
    (f) Subsidies.--The Plan shall be eligible to accept subsidies, 
including subsidies for the enrollment of individuals under the Plan, 
in the same manner and to the same extent as other health insurance 
plans offered through the National Health Insurance Exchange.
    (g) Financing.--
            (1) Transitional funding.--
                    (A) In general.--In order to provide for adequate 
                funding of the Plan in advance of receipt of payments 
                as described in paragraph (2), beginning July 1, 2010, 
                there are transferred to the Plan from the general fund 
                of the Treasury such amounts as may be necessary for 
                operation of the Plan until the end of the 3-year 
                period following the establishment of the Plan.
                    (B) Return of funds.--Upon the expiration of the 3-
                year period following the establishment of the Plan, 
                the Director shall enter into a repayment schedule with 
                the Secretary of the Treasury to provide for repayment 
                of funds provided under subparagraph (A). Any 
                expenditures made by the Plan pursuant to a repayment 
                schedule established under this subparagraph shall not 
                constitute administrative expenses as described in 
                paragraph (2)(B).
            (2) Self-financing.--
                    (A) In general.--The Plan shall be financially 
                self-sustaining insofar as funds used for operation of 
                the Plan (including benefits, administration, and 
                marketing) shall be derived from--
                            (i) insurance premium payments and 
                        subsidies for individuals enrolled in the Plan; 
                        and
                            (ii) payments made to the Plan by employers 
                        that do not offer health insurance coverage to 
                        their employees.
                    (B) Limitation on administrative expenses.--Not 
                more than 5 percent of the amounts provided under 
                subparagraph (A) may be used for the annual 
                administrative costs of the Plan.
            (3) Contingency reserve.--
                    (A) In general.--The Director shall establish and 
                fund a contingency reserve for the Plan in a form 
                similar to the contingency reserve provided for health 
                benefits plans under the Federal Employees Health 
                Benefits Program under chapter 89 of title 5, United 
                States Code.
                    (B) Revenue.--Any revenue generated through the 
                contingency reserve established in subparagraph (A) 
                shall be transferred to the Plan for the purpose of 
                reducing enrollee premiums, reducing enrollee cost-
                sharing, increasing enrollee benefits, or any 
                combination thereof.
            (4) GAO financial audit and report.--Beginning not later 
        than October 1, 2011, the Comptroller General shall conduct an 
        annual audit of the financial statements and records of the 
        Plan, in accordance with generally accepted government auditing 
        standards, and submit an annual report on such audit to the 
        Congress.
            (5) Supermajority requirement for supplemental funding.--
        Upon certification by the Comptroller General that the 
        financial audit described in paragraph (4) indicates that the 
        Plan is insolvent, supplemental funding may be appropriated for 
        the Plan if such measure receives not less than a three-fifths 
        vote of approval of the total number of Members of the House of 
        Representatives and the Senate.
    (h) Transparency.--
            (1) In general.--Beginning with the first year of operation 
        of the Plan through the National Health Insurance Exchange, the 
        Director shall provide standards and undertake activities for 
        promoting transparency in costs, benefits, and other factors 
        for health insurance coverage provided under the Plan.
            (2) Standard definitions of insurance and medical terms.--
                    (A) In general.--The Director shall provide for the 
                development of standards for the definitions of terms 
                used in health insurance coverage under the Plan, 
                including insurance-related terms (including the 
                insurance-related terms described in subparagraph (B)) 
                and medical terms (including the medical terms 
                described in subparagraph (C)).
                    (B) Insurance-related terms.--The insurance-related 
                terms described in this subparagraph are premium, 
                deductible, co-insurance, co-payment, out-of-pocket 
                limit, preferred provider, non-preferred provider, out-
                of-network co-payments, UCR (usual, customary and 
                reasonable) fees, excluded services, grievance and 
                appeals, and such other terms as the Director 
                determines are important to define so that consumers 
                may compare health insurance coverage and understand 
                the terms of their coverage.
                    (C) Medical terms.--The medical terms described in 
                this subparagraph are hospitalization, hospital 
                outpatient care, emergency room care, physician 
                services, prescription drug coverage, durable medical 
                equipment, home health care, skilled nursing care, 
                rehabilitation services, hospice services, emergency 
                medical transportation, and such other terms as the 
                Director determines are important to define so that 
                consumers may compare the medical benefits offered by 
                health insurance plans and understand the extent of 
                those medical benefits (or exceptions to those 
                benefits).
            (3) Disclosure.--
                    (A) In general.--In carrying out this subsection, 
                the Director shall disclose to Plan enrollees, 
                potential enrollees, in-network health care providers, 
                and others (through a publically available Internet 
                website and other appropriate means) relevant 
                information regarding each policy of health insurance 
                coverage marketed or in force (in such standardized 
                manner as determined by the Director), including--
                            (i) full policy contract language; and
                            (ii) a summary of the information described 
                        in paragraph (4).
                    (B) Personalized statement.--The Director shall 
                disclose to enrollees (in such standardized manner as 
                determined by the Director) an annual personalized 
                statement that summarizes use of health care services 
                and payment of claims with respect to an enrollee (and 
                covered dependents) under health insurance coverage 
                provided through the Plan in the preceding year.
            (4) Required information.--The information described in 
        this paragraph includes, but is not limited to, the following:
                    (A) Data on the price of each new policy of health 
                insurance coverage and renewal rating practices.
                    (B) Claims payment policies and practices, 
                including how many and how quickly claims were paid.
                    (C) Provider fee schedules and usual, customary, 
                and reasonable fees (for both in-network and out-of-
                network providers).
                    (D) Provider participation and provider 
                directories.
                    (E) Loss ratios, including detailed information 
                about amount and type of non-claims expenses.
                    (F) Covered benefits, cost-sharing, and amount of 
                payment provided toward each type of service identified 
                as a covered benefit, including preventive care 
                services recommended by the United States Preventive 
                Services Task Force.
                    (G) Civil or criminal actions successfully 
                concluded against the Plan by any governmental entity.
                    (H) Benefit exclusions and limits.
            (5) Development of patient claims scenarios.--
                    (A) In general.--In order to improve the ability of 
                individuals and employers to compare the coverage and 
                relative value provided under the Plan, the Director 
                shall develop and make publically available a series of 
                patient claims scenarios under which benefits 
                (including out-of-pocket costs) under the Plan are 
                simulated for certain common or expensive conditions or 
                courses of treatment (including maternity care, breast 
                cancer, heart disease, diabetes management, and well-
                child visits).
                    (B) Consultation.--The Director shall develop the 
                patient claims scenarios described in subparagraph 
                (A)--
                            (i) in consultation with the Secretary of 
                        Health and Human Services, the National 
                        Institutes of Health, the Centers for Disease 
                        Control and Prevention, the Agency for 
                        Healthcare Research and Quality, health 
                        professional societies, patient advocates, and 
                        other entities as deemed necessary by the 
                        Director; and
                            (ii) based upon recognized clinical 
                        practice guidelines.
            (6) Manner of disclosure.--The Director shall disclose the 
        information under this subsection--
                    (A) with all marketing materials;
                    (B) on the website for the Plan; and
                    (C) at other times upon request.

SEC. 5. ESTABLISHMENT OF AMERICA'S HEALTH INSURANCE TRUST.

    (a) Establishment.--As of the date of enactment of this Act, there 
is authorized to be established a non-profit corporation that shall be 
known as the ``America's Health Insurance Trust'' (referred to in this 
Act as the ``Trust''), which is neither an agency nor establishment of 
the United States Government.
    (b) Location; Service of Process.--The Trust shall maintain its 
principal office within the District of Columbia and have a designated 
agent in the District of Columbia to receive service of process for the 
Trust. Notice to or service on the agent shall be deemed as notice to 
or service on the corporation.
    (c) Application of Provisions.--The Trust shall be subject to the 
provisions of this section and, to the extent consistent with this 
section, to the District of Columbia Nonprofit Corporation Act.
    (d) Tax Exempt Status.--The Trust shall be treated as a nonprofit 
organization described under section 170(c)(2)(B) and section 501(c)(3) 
of the Internal Revenue Code of 1986 that is exempt from taxation under 
section 501(a) of the Internal Revenue Code of 1986.
    (e) Board of Directors.--
            (1) In general.--The Board of Directors of the Trust 
        (referred to in this Act as the ``Board'') shall consist of 19 
        voting members appointed by the Comptroller General.
            (2) Terms.--
                    (A) In general.--Subject to subparagraph (C), each 
                member of the Board shall serve for a term of 6 years.
                    (B) Limitation.--No individual shall be appointed 
                to the Board for more than 2 consecutive terms.
                    (C) Initial members.--The initial members of the 
                Board shall be appointed by the Comptroller General not 
                later than October 1, 2010, and shall serve terms as 
                follows:
                            (i) 8 members shall be appointed for a term 
                        of 5 years.
                            (ii) 8 members shall be appointed for a 
                        term of 3 years.
                            (iii) 3 members shall be appointed for a 
                        term of 1 year.
                    (D) Expiration of term.--Any member of the Board 
                whose term has expired may serve until such member's 
                successor has taken office, or until the end of the 
                calendar year in which such member's term has expired, 
                whichever is earlier.
                    (E) Vacancies.--
                            (i) In general.--Any member appointed to 
                        fill a vacancy prior to the expiration of the 
                        term for which such member's predecessor was 
                        appointed shall be appointed for the remainder 
                        of such term.
                            (ii) Vacancies not to affect power of 
                        board.--A vacancy on the Board shall not affect 
                        its powers, but shall be filled in the same 
                        manner as the original appointment was made.
            (3) Chairperson and vice-chairperson.--
                    (A) In general.--The Comptroller General shall 
                designate a Chairperson and Vice-Chairperson of the 
                Board from among the members of the Board.
                    (B) Term.--The members designated as Chairperson 
                and Vice-Chairperson shall serve for a period of 3 
                years.
            (4) Conflicts of interest.--An individual may not serve on 
        the Board if such individual (or an immediate family member of 
        such individual) is employed by or has a financial interest 
        in--
                    (A) an organization that provides a health 
                insurance plan;
                    (B) a pharmaceutical manufacturer; or
                    (C) any subsidiary entities of an organization 
                described in subparagraphs (A) or (B).
            (5) Composition of the board.--
                    (A) Political parties.--Not more than 10 members of 
                the Board may be affiliated with the same political 
                party.
                    (B) Diversity.--In appointing members under this 
                paragraph, the Comptroller General shall ensure that 
                such members provide appropriately diverse 
                representation with respect to race, ethnicity, age, 
                gender, and geography.
                    (C) Consumer representation.--10 members of the 
                Board shall be independent and non-conflicted 
                individuals representing the interests of health care 
                consumers. Each member selected under this subparagraph 
                shall represent 1 of the 10 Department of Health and 
                Human Services regions in the United States.
                    (D) Remaining representation.--
                            (i) In general.--9 members of the Board 
                        shall be selected based on relevant experience, 
                        including expertise in--
                                    (I) community affairs;
                                    (II) Federal, State, and local 
                                government;
                                    (III) health professions and 
                                administration;
                                    (IV) business, finance, and 
                                accounting;
                                    (V) legal affairs;
                                    (VI) insurance;
                                    (VII) trade unions;
                                    (VIII) social services; and
                                    (IX) any additional areas as 
                                determined by the Comptroller General.
                            (ii) Income from health care industry.--Not 
                        more than 4 of the members selected under this 
                        subparagraph shall earn more than 10 percent of 
                        their income from the health care industry.
            (6) Meetings and hearings.--The Board shall meet and hold 
        hearings at the call of the Chairperson or a majority of its 
        members. Meetings of the Board on matters not related to 
        personnel shall be open to the public and advertised through 
        public notice at least 7 days prior to the meeting.
            (7) Quorum.--A majority of the members of the Board shall 
        constitute a quorum for purposes of conducting the duties of 
        the Trust, but a lesser number of members may meet and hold 
        hearings.
            (8) Executive director and staff; performance of duties.--
        The Board may--
                    (A) employ and fix the compensation of an Executive 
                Director and such other personnel as may be necessary 
                to carry out the duties of the Trust;
                    (B) seek such assistance and support as may be 
                required in the performance of the duties of the Trust 
                from appropriate departments and agencies of the 
                Federal Government;
                    (C) enter into contracts or other arrangements and 
                make such payments as may be necessary for performance 
                of the duties of the Trust;
                    (D) provide travel, subsistence, and per diem 
                compensation for individuals performing the duties of 
                the Trust, including members of the Advisory Council 
                (as described in subsection (f)); and
                    (E) prescribe such rules, regulations, and bylaws 
                as the Board determines necessary with respect to the 
                internal organization and operation of the Trust.
            (9) Lobbying cooling-off period for members of the board.--
        Section 207(c) of title 18, United States Code, is amended by 
        inserting at the end the following:
            ``(3) Members of the board of directors of the america's 
        health insurance trust.--Paragraph (1) shall apply to a member 
        of the Board of Directors of the America's Health Insurance 
        Trust who was appointed to the Board as of the day before the 
        date of enactment of the Consumers Health Care Act of 2009.''.
    (f) Advisory Council.--
            (1) Establishment.--The Board shall establish an advisory 
        council that shall be comprised of the insurance commissioners 
        of each State (including the District of Columbia) to advise 
        the Board on the development and impact of measures to improve 
        the transparency and accountability of health insurance plans 
        provided through the National Health Insurance Exchange.
            (2) Meetings.--The advisory council shall meet not less 
        than twice a year and at the request of the Board.
    (g) Financial Oversight.--
            (1) Contract for audits.--The Trust shall provide for 
        financial audits of the Trust on an annual basis by a private 
        entity with expertise in conducting financial audits.
            (2) Review and report on audits.--The Comptroller General 
        shall--
                    (A) review and evaluate the results of the audits 
                conducted pursuant to paragraph (1); and
                    (B) submit a report to Congress containing the 
                results and review of such audits, including an 
                analysis of the adequacy and use of the funding for the 
                Trust and its activities.
    (h) Rules on Gifts and Outside Contributions.--
            (1) Gifts.--The Trust (including the Board and any staff 
        acting on behalf of the Trust) shall not accept gifts, 
        bequeaths, or donations of services or property.
            (2) Prohibition on outside funding or contributions.--The 
        Trust shall not--
                    (A) establish a corporation other than as provided 
                under this section; or
                    (B) accept any funds or contributions other than as 
                provided under this section.
    (i) America's Health Insurance Trust Fund.--
            (1) In general.--There is established in the Treasury a 
        trust fund to be known as the ``America's Health Insurance 
        Trust Fund'' (referred to in this section as the ``Trust 
        Fund''), consisting of such amounts as may be credited to the 
        Trust Fund as provided under this subsection.
            (2) Transfer.--The Secretary of the Treasury shall transfer 
        to the Trust Fund out of the general fund of the Treasury 
        amounts determined by the Secretary to be equivalent to the 
        amounts received into such general fund that are attributable 
        to the fees collected under sections 4375 and 4376 of the 
        Internal Revenue Code of 1986 (relating to fees on health 
        insurance policies and self-insured health plans).
            (3) Financing for fund from fees on insured and self-
        insured health plans.--
                    (A) General rule.--Chapter 34 of the Internal 
                Revenue Code of 1986 is amended by adding at the end 
                the following new subchapter:

         ``Subchapter B--Insured and Self-Insured Health Plans

``Sec. 4375. Health insurance.
``Sec. 4376. Self-insured health plans.
``Sec. 4377. Definitions and special rules.

``SEC. 4375. HEALTH INSURANCE.

    ``(a) Imposition of Fee.--In the case of any specified health 
insurance policy issued after October 1, 2009, there is hereby imposed 
a fee equal to--
            ``(1) for policies issued during fiscal years 2010 through 
        2013, 50 cents multiplied by the average number of lives 
        covered under the policy; and
            ``(2) for policies issued after September 30, 2013, $1 
        multiplied by the average number of lives covered under the 
        policy.
    ``(b) Liability for Fee.--The fee imposed by subsection (a) shall 
be paid by the issuer of the policy.
    ``(c) Specified Health Insurance Policy.--For purposes of this 
section:
            ``(1) In general.--Except as otherwise provided in this 
        section, the term `specified health insurance policy' means any 
        accident or health insurance policy (including a policy under a 
        group health plan) issued with respect to individuals residing 
        in the United States.
            ``(2) Exemption for certain policies.--The term `specified 
        health insurance policy' does not include any insurance if 
        substantially all of its coverage is of excepted benefits 
        described in section 9832(c).
            ``(3) Treatment of prepaid health coverage arrangements.--
                    ``(A) In general.--In the case of any arrangement 
                described in subparagraph (B)--
                            ``(i) such arrangement shall be treated as 
                        a specified health insurance policy, and
                            ``(ii) the person referred to in such 
                        subparagraph shall be treated as the issuer.
                    ``(B) Description of arrangements.--An arrangement 
                is described in this subparagraph if under such 
                arrangement fixed payments or premiums are received as 
                consideration for any person's agreement to provide or 
                arrange for the provision of accident or health 
                coverage to residents of the United States, regardless 
                of how such coverage is provided or arranged to be 
                provided.
    ``(d) Adjustments for Increases in Health Care Spending.--In the 
case of any policy issued in any fiscal year beginning after September 
30, 2014, the dollar amount in effect under subsection (a) for such 
policy shall be equal to the sum of such dollar amount for policies 
issued in the previous fiscal year (determined after the application of 
this subsection), plus an amount equal to the product of--
            ``(1) such dollar amount for policies issued in the 
        previous fiscal year, multiplied by
            ``(2) the percentage increase in the projected per capita 
        amount of National Health Expenditures from the calendar year 
        in which the previous fiscal year ends to the calendar year in 
        which the fiscal year involved ends, as most recently published 
        by the Secretary of Health and Human Services before the 
        beginning of the fiscal year.
    ``(e) Termination.--This section shall not apply to policy years 
ending after September 30, 2019.

``SEC. 4376. SELF-INSURED HEALTH PLANS.

    ``(a) Imposition of Fee.--In the case of any applicable self-
insured health plan issued after October 1, 2009, there is hereby 
imposed a fee equal to--
            ``(1) for plans issued during fiscal years 2010 through 
        2013, 50 cents multiplied by the average number of lives 
        covered under the plan; and
            ``(2) for plans issued after September 30, 2013, $1 
        multiplied by the average number of lives covered under the 
        plans.
    ``(b) Liability for Fee.--
            ``(1) In general.--The fee imposed by subsection (a) shall 
        be paid by the plan sponsor.
            ``(2) Plan sponsor.--For purposes of paragraph (1) the term 
        `plan sponsor' means--
                    ``(A) the employer in the case of a plan 
                established or maintained by a single employer,
                    ``(B) the employee organization in the case of a 
                plan established or maintained by an employee 
                organization,
                    ``(C) in the case of--
                            ``(i) a plan established or maintained by 2 
                        or more employers or jointly by 1 or more 
                        employers and 1 or more employee organizations,
                            ``(ii) a multiple employer welfare 
                        arrangement, or
                            ``(iii) a voluntary employees' beneficiary 
                        association described in section 501(c)(9),
                the association, committee, joint board of trustees, or 
                other similar group of representatives of the parties 
                who establish or maintain the plan, or
                    ``(D) the cooperative or association described in 
                subsection (c)(2)(F) in the case of a plan established 
                or maintained by such a cooperative or association.
    ``(c) Applicable Self-Insured Health Plan.--For purposes of this 
section, the term `applicable self-insured health plan' means any plan 
for providing accident or health coverage if--
            ``(1) any portion of such coverage is provided other than 
        through an insurance policy, and
            ``(2) such plan is established or maintained--
                    ``(A) by one or more employers for the benefit of 
                their employees or former employees,
                    ``(B) by one or more employee organizations for the 
                benefit of their members or former members,
                    ``(C) jointly by 1 or more employers and 1 or more 
                employee organizations for the benefit of employees or 
                former employees,
                    ``(D) by a voluntary employees' beneficiary 
                association described in section 501(c)(9),
                    ``(E) by any organization described in section 
                501(c)(6), or
                    ``(F) in the case of a plan not described in the 
                preceding subparagraphs, by a multiple employer welfare 
                arrangement (as defined in section 3(40) of Employee 
                Retirement Income Security Act of 1974), a rural 
                electric cooperative (as defined in section 
                3(40)(B)(iv) of such Act), or a rural telephone 
                cooperative association (as defined in section 
                3(40)(B)(v) of such Act).
    ``(d) Adjustments for Increases in Health Care Spending.--In the 
case of any plan issued in any fiscal year beginning after September 
30, 2014, the dollar amount in effect under subsection (a) for such 
plan shall be equal to the sum of such dollar amount for plans issued 
in the previous fiscal year (determined after the application of this 
subsection), plus an amount equal to the product of--
            ``(1) such dollar amount for plans issued in the previous 
        fiscal year, multiplied by
            ``(2) the percentage increase in the projected per capita 
        amount of National Health Expenditures from the calendar year 
        in which the previous fiscal year ends to the calendar year in 
        which the fiscal year involved ends, as most recently published 
        by the Secretary of Health and Human Services before the 
        beginning of the fiscal year.
    ``(e) Termination.--This section shall not apply to plans issued 
after September 30, 2019.

``SEC. 4377. DEFINITIONS AND SPECIAL RULES.

    ``(a) Definitions.--For purposes of this subchapter--
            ``(1) Accident and health coverage.--The term `accident and 
        health coverage' means any coverage which, if provided by an 
        insurance policy, would cause such policy to be a specified 
        health insurance policy (as defined in section 4375(c)).
            ``(2) Insurance policy.--The term `insurance policy' means 
        any policy or other instrument whereby a contract of insurance 
        is issued, renewed, or extended.
            ``(3) United states.--The term `United States' includes any 
        possession of the United States.
    ``(b) Treatment of Governmental Entities.--
            ``(1) In general.--For purposes of this subchapter--
                    ``(A) the term `person' includes any governmental 
                entity, and
                    ``(B) notwithstanding any other law or rule of law, 
                governmental entities shall not be exempt from the fees 
                imposed by this subchapter except as provided in 
                paragraph (2).
            ``(2) Treatment of exempt governmental programs.--In the 
        case of an exempt governmental program, no fee shall be imposed 
        under section 4375 or section 4376 on any covered policy or 
        plan under such program.
            ``(3) Exempt governmental program defined.--For purposes of 
        this subchapter, the term `exempt governmental program' means--
                    ``(A) any insurance program established under title 
                XVIII of the Social Security Act,
                    ``(B) the medical assistance program established by 
                title XIX or XXI of the Social Security Act,
                    ``(C) the Federal Employees Health Benefits Program 
                under chapter 89 of title 5, United States Code,
                    ``(D) the Consumer Choice Health Plan established 
                under the Consumers Health Care Act of 2009,
                    ``(E) any program established by Federal law for 
                providing medical care (other than through insurance 
                policies) to individuals (or the spouses and dependents 
                thereof) by reason of such individuals being--
                            ``(i) members of the Armed Forces of the 
                        United States, or
                            ``(ii) veterans, and
                    ``(F) any program established by Federal law for 
                providing medical care (other than through insurance 
                policies) to members of Indian tribes (as defined in 
                section 4(d) of the Indian Health Care Improvement 
                Act).
    ``(c) Treatment as Tax.--For purposes of subtitle F, the fees 
imposed by this subchapter shall be treated as if they were taxes.
    ``(d) No Cover Over to Possessions.--Notwithstanding any other 
provision of law, no amount collected under this subchapter shall be 
covered over to any possession of the United States.''.
                    (B) Clerical amendments.--
                            (i) Chapter 34 of such Code is amended by 
                        striking the chapter heading and inserting the 
                        following:

           ``CHAPTER 34--TAXES ON CERTAIN INSURANCE POLICIES

          ``subchapter a. policies issued by foreign insurers

         ``subchapter b. insured and self-insured health plans

         ``Subchapter A--Policies Issued By Foreign Insurers''.

                            (ii) The table of chapters for subtitle D 
                        of such Code is amended by striking the item 
                        relating to chapter 34 and inserting the 
                        following new item:

          ``Chapter 34--Taxes on Certain Insurance Policies''.

SEC. 6. DUTIES OF AMERICA'S HEALTH INSURANCE TRUST.

    (a) Insurance Plan Rankings and Website.--
            (1) Web-based materials.--The Trust shall establish and 
        maintain a website that provides informational materials 
        regarding the health insurance plans provided through the 
        National Health Insurance Exchange, including appropriate links 
        for all available State insurance commissioner websites.
            (2) Plan rankings.--The Trust shall develop and publish 
        annual rankings of the health insurance plans provided through 
        the National Health Insurance Exchange, based on the assignment 
        of a letter grade between ``grade A'' (highest) and ``grade F'' 
        (lowest). The Trust shall provide for a comparative evaluation 
        of each plan based upon--
                    (A) administrative expenditures;
                    (B) affordability of coverage;
                    (C) adequacy of coverage;
                    (D) timeliness and adequacy of consumer claims 
                processing;
                    (E) available consumer complaint systems;
                    (F) grievance and appeals processes;
                    (G) transparency;
                    (H) consumer satisfaction; and
                    (I) any additional measures as determined by the 
                Board.
            (3) Information available on website by zip code.--The 
        annual rankings of the health insurance plans (as described in 
        paragraph (2)) shall be available on the website for the Trust 
        (as described in paragraph (1)), and the website for the 
        National Health Insurance Exchange, in a manner that is 
        searchable and sortable by zip code.
            (4) Consumer feedback.--
                    (A) Consumer complaints.--The Trust shall develop 
                written and web-based methods for individuals to 
                provide recommendations and complaints regarding the 
                health insurance plans provided through the National 
                Health Insurance Exchange.
                    (B) Consumer surveys.--The Trust shall obtain 
                meaningful consumer input, including consumer surveys, 
                that measure the extent to which an individual receives 
                the services and supports described in the individual's 
                health insurance plan and the individual's satisfaction 
                with such services and supports.
    (b) Data Sharing.--
            (1) In general.--An organization that provides a health 
        insurance plan through the National Health Insurance Exchange 
        shall provide the Trust with all information and data that is 
        necessary for improving transparency, monitoring, and oversight 
        of such plans.
            (2) Annual disclosure.--Beginning with the first full year 
        of operation of the National Health Insurance Exchange, an 
        organization that provides a health insurance plan through the 
        National Health Insurance Exchange shall annually provide the 
        Trust with appropriate information regarding the following:
                    (A) Name of the plan.
                    (B) Levels of available plan benefits.
                    (C) Description of plan benefits.
                    (D) Number of enrollees under the plan.
                    (E) Demographic profile of enrollees under the 
                plan.
                    (F) Number of claims paid to enrollees.
                    (G) Number of enrollees that terminated their 
                coverage under the plan.
                    (H) Total operating cost for the plan (including 
                administrative costs).
                    (I) Patterns of utilization of the plan's services.
                    (J) Availability, accessibility, and acceptability 
                of the plan's services.
                    (K) Such information as the Trust may require 
                demonstrating that the organization has a fiscally 
                sound operation.
                    (L) Any additional information as determined by the 
                Trust.
            (3) Form and manner of information.--Information to be 
        provided to the Trust under paragraphs (1) and (2) shall be 
        provided--
                    (A) in such form and manner as specified by the 
                Trust; and
                    (B) within 30 days of the date of receipt of the 
                request for such information, or within such extended 
                period as the Trust deems appropriate.
            (4) Information from the department of health and human 
        services.--
                    (A) In general.--Any information regarding the 
                health insurance plans that are offered through the 
                National Health Insurance Exchange that has been 
                provided to the Secretary of Health and Human Services 
                shall also be made available (as deemed appropriate by 
                the Secretary) to the Trust for the purpose of 
                improving transparency, monitoring, and oversight of 
                such plans. Such information may include, but is not 
                limited to, the following:
                            (i) Underwriting guidelines to ensure 
                        compliance with applicable Federal health 
                        insurance requirements.
                            (ii) Rating practices to ensure compliance 
                        with applicable Federal health insurance 
                        requirements.
                            (iii) Enrollment and disenrollment data, 
                        including information the Secretary may need to 
                        detect patterns of discrimination against 
                        individuals based on health status or other 
                        characteristics, to ensure compliance with 
                        applicable Federal health insurance 
                        requirements (including non-discrimination in 
                        group coverage, guaranteed issue, and 
                        guaranteed renewability requirements applicable 
                        in all markets).
                            (iv) Post-claims underwriting and 
                        rescission practices to ensure compliance with 
                        applicable Federal health insurance 
                        requirements relating to guaranteed 
                        renewability.
                            (v) Marketing materials and agent 
                        guidelines to ensure compliance with applicable 
                        Federal health insurance requirements.
                            (vi) Data on the imposition of pre-existing 
                        condition exclusion periods and claims 
                        subjected to such exclusion periods.
                            (vii) Information on issuance of 
                        certificates of creditable coverage.
                            (viii) Information on cost-sharing and 
                        payments with respect to any out-of-network 
                        coverage.
                            (ix) The application to issuers of 
                        penalties for violation of applicable Federal 
                        health insurance requirements (including 
                        failure to produce requested information).
                            (x) Such other information as the Trust may 
                        determine to be necessary to verify compliance 
                        with the requirements of this Act.
                    (B) Required disclosure.--The Secretary of Health 
                and Human Services shall provide the Trust with all 
                consumer claims data or information that has been 
                provided to the Secretary by any health insurance plan 
                that is offered through the National Health Insurance 
                Exchange.
                    (C) Period for providing information.--Information 
                to be provided to the Trust under this paragraph shall 
                be provided by the Secretary within 30 days of the date 
                of receipt of the request for such information, or 
                within such extended period as the Secretary and the 
                Trust mutually deem appropriate.
            (5) Non-disclosure of health insurance data.--The Trust 
        shall prevent disclosure of any data or information provided 
        under this paragraph that the Trust determines is proprietary 
        or qualifies as a trade secret subject to withholding from 
        public dissemination. Any data or information provided under 
        this paragraph shall not be subject to disclosure under section 
        552 of title 5, United States Code (commonly referred to as the 
        Freedom of Information Act).

SEC. 7. DEFINITION OF NATIONAL HEALTH INSURANCE EXCHANGE.

    In this Act, the term ``National Health Insurance Exchange'' means 
a mechanism established or recognized under Federal law for 
coordinating the offering of health insurance coverage to individuals 
in the United States through the establishment of standards for 
benefits, cost-sharing, and premiums for such health insurance 
coverage.
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