II 

112TH CONGRESS 

2D SESSION S. 3473 

To replace automatic spending cuts with targeted reforms, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 1, 2012 

Mr. INHOFE introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To replace automatic spending cuts with targeted reforms, 

and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Sequestration Prevention Act of 2012’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—FULLY REPEAL THE SEQUESTRATION PROVISION OF 

ROUND 2 OF THE BUDGET CONTROL ACT 

Sec. 101. Repeal. 

TITLE II—REPEAL OF HEALTH CARE LAW 


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Sec. 201. Short title. 

Sec. 202. Repeal of the job-killing health care law and health care-related provisions in the Health Care and Education Reconciliation Act of 

2010. 

Sec. 203. Budgetary effects of this Act. 

TITLE III—NUTRITION ASSISTANCE BLOCK GRANT PROGRAM 

Sec. 301. Nutrition assistance block grant program. 

Sec. 302. Funding. 

Sec. 303. Repeals. 

Sec. 304. Baseline. 

TITLE IV—BLOCK GRANT THE MEDICAID PROGRAM 

Sec. 401. Medical assistance block grant program. 

Sec. 402. Funding. 

Sec. 403. Termination of mandatory funding. 

Sec. 404. Miscellaneous. 

Sec. 405. Baseline. 

Sec. 406. Definitions. 

TITLE V—REDUCTION OF FEDERAL WORKFORCE 

Sec. 501. Reduction in the number of Federal employees. 

TITLE VI—PROHIBITION ON CLIMATE CHANGE AND GLOBAL 

WARMING FUNDING 

Sec. 601. No funding for climate change or global warming. 

TITLE VII—PROTECTING ACCESS TO HEALTH CARE 

Sec. 700. Short title. 

Subtitle A—HEALTH Act 

Sec. 701. Short title. 

Sec. 702. Purpose. 

Sec. 703. Encouraging speedy resolution of claims. 

Sec. 704. Compensating patient injury. 

Sec. 705. Maximizing patient recovery. 

Sec. 706. Punitive damages. 

Sec. 707. Authorization of payment of future damages to claimants in health 

care lawsuits. 

Sec. 708. Definitions. 

Sec. 709. Effect on other laws. 

Sec. 710. State flexibility and protection of States’ rights. 

Sec. 711. Applicability; effective date. 

Subtitle B—Health Care Safety Net Enhancement 

Sec. 721. Short title. 

Sec. 722. Protection for emergency and related services furnished pursuant to 

EMTALA. 

Sec. 723. Constitutional authority. 

Subtitle C—Restoring the Application of Antitrust Laws to Health Sector 

Insurers 


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Sec. 731. Short title. 

Sec. 732. Application of the antitrust laws to the business of health insurance. 

Subtitle D—Protections for Good Samaritan Health Professionals 

Sec. 741. Short title. 

Sec. 742. Limitation on liability for volunteer health care professionals. 

TITLE VIII—BUDGET CONTROL ACT SPENDING CAP 

ADJUSTMENTS 

Sec. 801. Budget Control Act spending cap adjustments. 

1 TITLE I—FULLY REPEAL THE SE2 QUESTRATION PROVISION OF 

3 ROUND 2 OF THE BUDGET 

4 CONTROL ACT 

5 SEC. 101. REPEAL. 

6 Section 251A of the Balanced Budget and Emer7 gency Deficit Control Act of 1985 is repealed. 

8 TITLE II—REPEAL OF HEALTH 

9 CARE LAW 

10 SEC. 201. SHORT TITLE. 

11 This title may be cited as the ‘‘Repealing the Job12 Killing Health Care Law Act’’. 

13 SEC. 202. REPEAL OF THE JOB-KILLING HEALTH CARE LAW 

14 AND HEALTH CARE-RELATED PROVISIONS IN 

15 THE HEALTH CARE AND EDUCATION REC16 ONCILIATION ACT OF 2010. 

17 (a) JOB-KILLING HEALTH CARE LAW.—Effective as 

18 of the enactment of Public Law 111–148, such Act is re19 pealed, and the provisions of law amended or repealed by 


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1 such Act are restored or revived as if such Act had not 

2 been enacted. 

3 (b) HEALTH CARE-RELATED PROVISIONS IN THE

4 HEALTH CARE AND EDUCATION RECONCILIATION ACT OF

5 2010.—Effective as of the enactment of the Health Care 

6 and Education Reconciliation Act of 2010 (Public Law 

7 111–152), title I and subtitle B of title II of such Act 

8 are repealed, and the provisions of law amended or re9 pealed by such title or subtitle, respectively, are restored 

10 or revived as if such title and subtitle had not been en11 acted. 

12 SEC. 203. BUDGETARY EFFECTS OF THIS ACT. 

13 The budgetary effects of this title, for the purpose 

14 of complying with the Statutory Pay-As-You-Go Act of 

15 2010, shall be determined by reference to the latest state16 ment titled ‘‘Budgetary Effects of PAYGO Legislation’’ 

17 for this title, submitted for printing in the Congressional 

18 Record by the Chairman of the Committee on the Budget 

19 of the House of Representatives, as long as such statement 

20 has been submitted prior to the vote on passage of this 

21 Act. 


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1 TITLE III—NUTRITION ASSIST2 ANCE BLOCK GRANT PRO3 GRAM 

4 SEC. 301. NUTRITION ASSISTANCE BLOCK GRANT PRO5 GRAM. 

6 (a) IN GENERAL.—For each of fiscal years 2014 

7 through 2022, the Secretary shall establish a nutrition as8 sistance block grant program under which the Secretary 

9 shall make annual grants to each participating State that 

10 establishes a nutrition assistance program in the State 

11 and submits to the Secretary annual reports under sub12 section (d). 

13 (b) REQUIREMENTS.—As a requirement of receiving 

14 grants under this section, the Governor of each partici15 pating State shall certify that the State nutrition assist16 ance program includes— 

17 (1) work requirements; 

18 (2) mandatory drug testing; and 

19 (3) limitations on the eligible uses of benefits 

20 that are at least as restrictive as the limitations in 

21 place for the supplemental nutrition assistance pro22 gram established under the Food and Nutrition Act 

23 of 2008 (7 U.S.C. 2011 et seq.) as of May 31, 2012. 


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1 (c) AMOUNT OF GRANT.—For each fiscal year, the 

2 Secretary shall make a grant to each participating State 

3 in an amount equal to the product of— 

4 (1) the amount made available under section 

5 302 for the applicable fiscal year; and 

6 (2) the proportion that— 

7 (A) the number of legal residents in the 

8 State whose income does not exceed 100 per9 cent of the poverty line (as defined in section 

10 673(2) of the Community Services Block Grant 

11 Act (42 U.S.C. 9902(2), including any revision 

12 required by such section)) applicable to a family 

13 of the size involved; bears to 

14 (B) the number of such individuals in all 

15 participating States for the applicable fiscal 

16 year, based on data for the most recent fiscal 

17 year for which data is available. 

18 (d) ANNUAL REPORT REQUIREMENTS.— 

19 (1) IN GENERAL.—Not later than January 1 of 

20 each year, each State that receives a grant under 

21 this section shall submit to the Secretary a report 

22 that shall include, for the year covered by the re23 port— 

24 (A) a description of the structure and de25 sign of the nutrition assistance program of the 


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1 State, including the manner in which residents 

2 of the State qualify for the program; 

3 (B) the cost the State incurs to administer 

4 the program; 

5 (C) whether the State has established a 

6 rainy day fund for the nutrition assistance pro7 gram of the State; and 

8 (D) general statistics about participation 

9 in the nutrition assistance program. 

10 (2) AUDIT.—Each year, the Comptroller Gen11 eral of the United States shall— 

12 (A) conduct an audit on the effectiveness 

13 of the nutritional assistance block grant pro14 gram and the manner in which each partici15 pating State is implementing the program; and 

16 (B) not later than June 30, submit to the 

17 appropriate committees of Congress a report 

18 describing— 

19 (i) the results of the audit; and 

20 (ii) the manner in which the State will 

21 carry out the supplemental nutrition as22 sistance program in the State, including 

23 eligibility and fraud prevention require24 ments. 

25 (e) USE OF FUNDS.— 


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1 (1) IN GENERAL.—A State that receives a 

2 grant under this section may use the grant in any 

3 manner determined to be appropriate by the State to 

4 provide nutrition assistance to the legal residents of 

5 the State. 

6 (2) AVAILABILITY OF FUNDS.—Grant funds 

7 made available to a State under this section shall— 

8 (A) remain available to the State for a pe9 riod of 5 years; and 

10 (B) after that period, shall— 

11 (i) revert to the Federal Government 

12 to be deposited in the Treasury and used 

13 for Federal budget deficit reduction; or 

14 (ii) if there is no Federal budget def15 icit, be used to reduce the Federal debt in 

16 such manner as the Secretary of the 

17 Treasury considers appropriate. 

18 SEC. 302. FUNDING. 

19 There is authorized to be appropriated to carry out 

20 this title— 

21 (1) for fiscal year 2014, $44,400,000,000; 

22 (2) for fiscal year 2015, $45,500,000,000; 

23 (3) for fiscal year 2016, $46,600,000,000; 

24 (4) for fiscal year 2017, $47,800,000,000; 

25 (5) for fiscal year 2018, $49,000,000,000; 


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1 (6) for fiscal year 2019, $50,200,000,000; 

2 (7) for fiscal year 2020, $51,500,000,000; 

3 (8) for fiscal year 2021, $52,800,000,000; and 

4 (9) for fiscal year 2022, $54,100,000,000. 

5 SEC. 303. REPEALS. 

6 (a) IN GENERAL.—Effective September 30, 2013, the 

7 Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) 

8 is repealed. 

9 (b) REPEAL OF MANDATORY FUNDING.— 

10 (1) IN GENERAL.—Notwithstanding any other 

11 provision of law, effective September 30, 2013, the 

12 supplemental nutrition assistance program estab13 lished under the Food and Nutrition Act of 2008 (7 

14 U.S.C. 2011 et seq.) (as in effect prior to that date) 

15 shall cease to be a program funded through direct 

16 spending (as defined in section 250(c) of the Bal17 anced Budget and Emergency Deficit Control Act of 

18 1985 (2 U.S.C. 900(c)) prior to the amendment 

19 made by paragraph (2)). 

20 (2) DIRECT SPENDING.—Effective September 

21 30, 2013, section 250(c)(8) of the Balanced Budget 

22 and Emergency Deficit Control Act of 1985 (2 

23 U.S.C. 900(c)(8)) is amended— 

24 (A) in subparagraph (A), by adding ‘‘and’’ 

25 at the end; 


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1 (B) in subparagraph (B), by striking ‘‘; 

2 and’’ at the end and inserting a period; and 

3 (C) by striking subparagraph (C). 

4 (3) ENTITLEMENT AUTHORITY.—Effective Sep5 tember 30, 2013, section 3(9) of the Congressional 

6 Budget and Impoundment Control Act of 1974 (2 

7 U.S.C. 622(9)) is amended— 

8 (A) by striking ‘‘means—’’ and all that fol9 lows through ‘‘the authority to make’’ and in10 serting ‘‘means the authority to make’’; 

11 (B) by striking ‘‘; and’’ and inserting a pe12 riod; and 

13 (C) by striking subparagraph (B). 

14 (4) OTHER DIRECT SPENDING.—Effective Sep15 tember 30, 2013, section 1026(5) of the Congres16 sional Budget and Impoundment Control Act of 

17 1974 (2 U.S.C. 691e(5)) is amended— 

18 (A) in subparagraph (A), by adding ‘‘and’’ 

19 at the end; 

20 (B) in subparagraph (B), by striking ‘‘; 

21 and’’ at the end and inserting a period; and 

22 (C) by striking subparagraph (C). 

23 (c) RELATIONSHIP TO OTHER LAW.—Any reference 

24 in this title, an amendment made by this title, or any other 

25 law to the supplemental nutrition assistance program shall 


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1 be considered to be a reference to the nutrition assistance 

2 block grant program under this title. 

3 SEC. 304. BASELINE. 

4 Notwithstanding section 257 of the Balanced Budget 

5 and Emergency Deficit Control Act of 1985 (2 U.S.C. 

6 907), the baseline shall assume that, on and after Sep7 tember 30, 2013, no benefits shall be provided under the 

8 supplemental nutrition assistance program established 

9 under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 

10 et seq.) (as in effect prior to that date). 

11 TITLE IV—BLOCK GRANT THE 

12 MEDICAID PROGRAM 

13 SEC. 401. MEDICAL ASSISTANCE BLOCK GRANT PROGRAM. 

14 (a) IN GENERAL.—For each of fiscal years 2014 

15 through 2022, the Secretary shall establish a Medicaid 

16 block grant program under which the Secretary shall make 

17 annual grants to each participating State that establishes 

18 a medical assistance program for individuals in the State 

19 and submits to the Secretary annual reports under sub20 section (d). 

21 (b) AMOUNT OF GRANT.—For each fiscal year, the 

22 Secretary shall make a grant to each participating State 

23 in an amount equal to the product of— 

24 (1) the amount made available under section 

25 402 for the applicable fiscal year; and 


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1 (2) the proportion that— 

2 (A) the number of legal residents in the 

3 State whose income does not exceed 185 per4 cent of the poverty line (as defined in section 

5 673(2) of the Community Services Block Grant 

6 Act (42 U.S.C. 9902(2), including any revision 

7 required by such section)) applicable to a family 

8 of the size involved; bears to 

9 (B) the number of such individuals in all 

10 participating States for the applicable fiscal 

11 year, based on data for the most recent fiscal 

12 year for which data is available. 

13 (c) USE OF FUNDS.— 

14 (1) IN GENERAL.—A State that receives a 

15 grant under this section may use the grant in any 

16 manner determined to be appropriate by the State to 

17 provide medical assistance to legal residents of the 

18 State. 

19 (2) AVAILABILITY OF FUNDS.—Grant funds 

20 made available to a State under this section shall— 

21 (A) remain available to the State for a pe22 riod of 5 years; and 

23 (B) after that period, shall— 


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1 (i) revert to the Federal Government 

2 to be deposited in the Treasury and used 

3 for Federal budget deficit reduction; or 

4 (ii) if there is no Federal budget def5 icit, be used to reduce the Federal debt in 

6 such manner as the Secretary of the 

7 Treasury considers appropriate. 

8 (d) ANNUAL REPORT REQUIREMENTS.— 

9 (1) IN GENERAL.—Not later than January 1 of 

10 each year, each State that receives a grant under 

11 this section shall submit to the Secretary a report 

12 that shall include, for the year covered by the re13 port— 

14 (A) a description of the structure and de15 sign of the Medicaid program of the State, in16 cluding the manner in which residents of the 

17 State qualify for the program; 

18 (B) the cost the State incurs to administer 

19 the program; 

20 (C) whether the State has established a 

21 rainy day fund for the Medicaid program of the 

22 State; and 

23 (D) general statistics about participation 

24 in Medicaid program. 


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1 (2) AUDIT.—Each year, the Comptroller Gen2 eral of the United States shall— 

3 (A) conduct an audit on the effectiveness 

4 of the Medicaid block grant program and the 

5 manner in which each participating State is im6 plementing the program; and 

7 (B) not later than June 30, submit to the 

8 appropriate committees of Congress a report 

9 describing— 

10 (i) the results of the audit; and 

11 (ii) the manner in which the State will 

12 carry out the Medicaid program in the 

13 State, including eligibility and fraud pre14 vention requirements. 

15 SEC. 402. FUNDING. 

16 There is authorized to be appropriated to carry out 

17 this title— 

18 (1) for fiscal year 2014, $304,000,000,000; 

19 (2) for fiscal year 2015, $311,000,000,000; 

20 (3) for fiscal year 2016, $317,000,000,000; 

21 (4) for fiscal year 2017, $334,000,000,000; 

22 (5) for fiscal year 2018, $345,000,000,000; 

23 (6) for fiscal year 2019, $355,000,000,000; 

24 (7) for fiscal year 2020, $370,000,000,000; 

25 (8) for fiscal year 2021, $382,000,000,000; and 


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1 (9) for fiscal year 2022, $402,000,000,000. 

2 SEC. 403. TERMINATION OF MANDATORY FUNDING. 

3 (a) IN GENERAL.—Effective October 1, 2013, title 

4 XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 

5 and subsections (f) and (g) of section 1108 of the Social 

6 Security Act (42 U.S.C. 1308) are repealed. 

7 (b) ELIMINATION OF MANDATORY FUNDING.—Not8 withstanding any other provision of law, effective October 

9 1, 2013, the Medicaid program established under title 

10 XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 

11 shall cease to be a program funded through direct spend12 ing (as defined in section 250(c) of the Balanced Budget 

13 and Emergency Deficit Control Act of 1985 (2 U.S.C. 

14 900(c)). 

15 SEC. 404. MISCELLANEOUS. 

16 (a) RELATIONSHIP TO OTHER LAW.—Any reference 

17 in this Act, an amendment made by this Act, or any other 

18 Act to the Medicaid program or to title XIX of the Social 

19 Security Act shall be considered to be a reference to the 

20 Medicaid block grant program established under this title. 

21 (b) NONENTITLEMENT.—Nothing in this title shall 

22 be construed as providing— 

23 (1) an individual with an entitlement to medical 

24 assistance provided under a grant made under this 

25 title; or 


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1 (2) as an obligation of the Federal Government 

2 to provide payments to States to carry out this title 

3 other than to the extent funds are made available 

4 for that purpose through an appropriations Act. 

5 (c) WAIVERS.— 

6 (1) IN GENERAL.—In the case of a State con7 ducting an experimental, pilot, or demonstration 

8 project under section 1115 of the Social Security 

9 Act (42 U.S.C. 1315) or other authority relating to 

10 the Medicaid program under title XIX of the Social 

11 Security Act that is in effect on the date of enact12 ment of this Act, the waiver shall terminate on Sep13 tember 30, 2013, unless the State submits a request, 

14 not later than July 1, 2013, to the Secretary to con15 tinue the project. The Secretary may approve the re16 quest of a State to continue with such a project only 

17 if the total amount of Federal funds paid to the 

18 State to conduct the project will not exceed the 

19 amount of Federal funds that would be paid to the 

20 State under this title if the project were not contin21 ued. 

22 (2) NO WAIVER AUTHORITY.—The Secretary 

23 may not waive any provision of this title under sec24 tion 1115 of the Social Security Act (42 U.S.C. 

25 1315). 


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1 (d) HOLD HARMLESS PROVISIONS.— 

2 (1) CHIP.—The State children’s health insur3 ance program established under title XXI of the So4 cial Security Act (42 U.S.C. 1397aa et seq.) shall 

5 continue to be operated in accordance with the pro6 visions of that title. 

7 (2) CHILD SUPPORT AND FOSTER CARE PAY8 MENTS.—The Federal medical assistance percent9 age, as defined in section 1905(b) of the Social Se10 curity Act (42 U.S.C. 1396d(b)), (as in effect on 

11 September 30, 2013) shall continue to apply to pay12 ments to States under parts D and E of title IV of 

13 the Social Security Act (42 U.S.C. 651 et seq.; 670 

14 et seq.). Notwithstanding the repeal of title XIX of 

15 the Social Security Act under section 403(a), the 

16 Secretary shall annually determine and promulgate 

17 the Federal medical assistance percentage for each 

18 State in accordance with the provisions of section 

19 1101(a)(8)(B) of the Social Security Act (42 U.S.C. 

20 1301(a)(8)(B)). 

21 (3) VACCINES FOR CHILDREN PROGRAM.—The 

22 program for the distribution of pediatric vaccines es23 tablished under section 1928 of the Social Security 

24 Act (42 U.S.C. 1396s) shall continue to be operated 


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1 in accordance with the provisions of that section (as 

2 in effect on September 30, 2013). 

3 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

4 provide technical assistance and guidance to States to co5 ordinate the transition to the Medicaid block grant pro6 gram established under this title. 

7 SEC. 405. BASELINE. 

8 Notwithstanding section 257 of the Balanced Budget 

9 and Emergency Deficit Control Act of 1985 (2 U.S.C. 

10 907), the baseline shall assume that after September 30, 

11 2013, no payments shall be provided under section 1903 

12 of title XIX of the Social Security Act (42 U.S.C. 1396b). 

13 SEC. 406. DEFINITIONS. 

14 In this title: 

15 (1) MEDICAL ASSISTANCE.—The term ‘‘medical 

16 assistance’’ means payment for part or all of the 

17 cost of providing, or arranging for the provision of 

18 (including through the purchase of health insurance 

19 coverage), health benefits. 

20 (2) SECRETARY.—The term ‘‘Secretary’’ means 

21 the Secretary of Health and Human Services. 

22 (3) STATE.—The term ‘‘State’’ means each of 

23 the 50 States, the District of Columbia, Puerto Rico, 

24 the United States Virgin Islands, Guam, the North25 ern Mariana Islands, and American Samoa. 


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1 TITLE V—REDUCTION OF 

2 FEDERAL WORKFORCE 

3 SEC. 501. REDUCTION IN THE NUMBER OF FEDERAL EM4 PLOYEES. 

5 (a) DEFINITION.—In this section, the term ‘‘agency’’ 

6 has the meaning given the term ‘‘Executive agency’’ under 

7 section 105 of title 5, United States Code. 

8 (b) DETERMINATION OF NUMBER OF EMPLOYEES.— 

9 Not later than 60 days after the date of enactment of this 

10 Act, the Director of the Office of Management and Budget 

11 shall determine the number of full-time employees em12 ployed in each agency. The head of each agency shall co13 operate with the Director of the Office of Management 

14 and Budget in making the determinations. 

15 (c) REPLACEMENT HIRE RATE.— 

16 (1) IN GENERAL.—During the period described 

17 under paragraph (2), the head of each agency may 

18 hire no more than 2 employees in that agency for 

19 every 3 employees who leave employment in that 

20 agency. 

21 (2) PERIOD OF REPLACEMENT HIRE RATE.— 

22 Paragraph (1) shall apply to each agency during the 

23 period beginning 60 days after the date of enact24 ment of this Act through the date on which the Di25 rector of the Office of Management and Budget 


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1 makes a determination that the number of full-time 

2 employees employed in that agency is 10 percent less 

3 than the number of full-time employees employed in 

4 that agency determined under subsection (a). 

5 (d) WAIVERS.—This section may be waived upon a 

6 determination by the President that— 

7 (1) the existence of a state of war or other na8 tional security concern so requires; or 

9 (2) the existence of an extraordinary emergency 

10 threatening life, health, public safety, property, or 

11 the environment so requires. 

12 TITLE VI—PROHIBITION ON CLI13 MATE CHANGE AND GLOBAL 

14 WARMING FUNDING 

15 SEC. 601. NO FUNDING FOR CLIMATE CHANGE OR GLOBAL 

16 WARMING. 

17 On and after the date of enactment of this Act, no 

18 Federal funds may be expended for any activity relating 

19 to climate change or global warming. 

20 TITLE VII—PROTECTING ACCESS 

21 TO HEALTH CARE 

22 SEC. 700. SHORT TITLE. 

23 This title may be cited as the ‘‘Protecting Access to 

24 Health Care Act’’. 


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1 Subtitle A—HEALTH Act 

2 SEC. 701. SHORT TITLE. 

3 This subtitle may be cited as the ‘‘Help Efficient, Ac4 cessible, Low-cost, Timely Healthcare (HEALTH) Act of 

5 2012’’. 

6 SEC. 702. PURPOSE. 

7 It is the purpose of this subtitle to implement reason8 able, comprehensive, and effective health care liability re9 forms designed to— 

10 (1) improve the availability of health care serv11 ices in cases in which health care liability actions 

12 have been shown to be a factor in the decreased 

13 availability of services; 

14 (2) reduce the incidence of ‘‘defensive medi15 cine’’ and lower the cost of health care liability in16 surance, all of which contribute to the escalation of 

17 health care costs; 

18 (3) ensure that persons with meritorious health 

19 care injury claims receive fair and adequate com20 pensation, including reasonable noneconomic dam21 ages; 

22 (4) improve the fairness and cost-effectiveness 

23 of our current health care liability system to resolve 

24 disputes over, and provide compensation for, health 


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1 care liability by reducing uncertainty in the amount 

2 of compensation provided to injured individuals; and 

3 (5) provide an increased sharing of information 

4 in the health care system which will reduce unin5 tended injury and improve patient care. 

6 SEC. 703. ENCOURAGING SPEEDY RESOLUTION OF CLAIMS. 

7 The time for the commencement of a health care law8 suit shall be 3 years after the date of manifestation of 

9 injury or 1 year after the claimant discovers, or through 

10 the use of reasonable diligence should have discovered, the 

11 injury, whichever occurs first. In no event shall the time 

12 for commencement of a health care lawsuit exceed 3 years 

13 after the date of manifestation of injury unless tolled for 

14 any of the following— 

15 (1) upon proof of fraud; 

16 (2) intentional concealment; or 

17 (3) the presence of a foreign body, which has no 

18 therapeutic or diagnostic purpose or effect, in the 

19 person of the injured person. 

20 Actions by a minor shall be commenced within 3 years 

21 from the date of the alleged manifestation of injury except 

22 that actions by a minor under the full age of 6 years shall 

23 be commenced within 3 years of manifestation of injury 

24 or prior to the minor’s 8th birthday, whichever provides 

25 a longer period. Such time limitation shall be tolled for 


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1 minors for any period during which a parent or guardian 

2 and a health care provider or health care organization 

3 have committed fraud or collusion in the failure to bring 

4 an action on behalf of the injured minor. 

5 SEC. 704. COMPENSATING PATIENT INJURY. 

6 (a) UNLIMITED AMOUNT OF DAMAGES FOR ACTUAL

7 ECONOMIC LOSSES IN HEALTH CARE LAWSUITS.—In any 

8 health care lawsuit, nothing in this subtitle shall limit a 

9 claimant’s recovery of the full amount of the available eco10 nomic damages, notwithstanding the limitation in sub11 section (b). 

12 (b) ADDITIONAL NONECONOMIC DAMAGES.—In any 

13 health care lawsuit, the amount of noneconomic damages, 

14 if available, may be as much as $250,000, regardless of 

15 the number of parties against whom the action is brought 

16 or the number of separate claims or actions brought with 

17 respect to the same injury. 

18 (c) NO DISCOUNT OF AWARD FOR NONECONOMIC

19 DAMAGES.—For purposes of applying the limitation in 

20 subsection (b), future noneconomic damages shall not be 

21 discounted to present value. The jury shall not be in22 formed about the maximum award for noneconomic dam23 ages. An award for noneconomic damages in excess of 

24 $250,000 shall be reduced either before the entry of judg25 ment, or by amendment of the judgment after entry of 


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1 judgment, and such reduction shall be made before ac2 counting for any other reduction in damages required by 

3 law. If separate awards are rendered for past and future 

4 noneconomic damages and the combined awards exceed 

5 $250,000, the future noneconomic damages shall be re6 duced first. 

7 (d) FAIR SHARE RULE.—In any health care lawsuit, 

8 each party shall be liable for that party’s several share 

9 of any damages only and not for the share of any other 

10 person. Each party shall be liable only for the amount of 

11 damages allocated to such party in direct proportion to 

12 such party’s percentage of responsibility. Whenever a 

13 judgment of liability is rendered as to any party, a sepa14 rate judgment shall be rendered against each such party 

15 for the amount allocated to such party. For purposes of 

16 this section, the trier of fact shall determine the propor17 tion of responsibility of each party for the claimant’s 

18 harm. 

19 SEC. 705. MAXIMIZING PATIENT RECOVERY. 

20 (a) COURT SUPERVISION OF SHARE OF DAMAGES

21 ACTUALLY PAID TO CLAIMANTS.—In any health care law22 suit, the court shall supervise the arrangements for pay23 ment of damages to protect against conflicts of interest 

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1 ticular, in any health care lawsuit in which the attorney 

2 for a party claims a financial stake in the outcome by vir3 tue of a contingent fee, the court shall have the power 

4 to restrict the payment of a claimant’s damage recovery 

5 to such attorney, and to redirect such damages to the 

6 claimant based upon the interests of justice and principles 

7 of equity. In no event shall the total of all contingent fees 

8 for representing all claimants in a health care lawsuit ex9 ceed the following limits: 

10 (1) Forty percent of the first $50,000 recovered 

11 by the claimant(s). 

12 (2) Thirty-three and one-third percent of the 

13 next $50,000 recovered by the claimant(s). 

14 (3) Twenty-five percent of the next $500,000 

15 recovered by the claimant(s). 

16 (4) Fifteen percent of any amount by which the 

17 recovery by the claimant(s) is in excess of $600,000. 

18 (b) APPLICABILITY.—The limitations in this section 

19 shall apply whether the recovery is by judgment, settle20 ment, mediation, arbitration, or any other form of alter21 native dispute resolution. In a health care lawsuit involv22 ing a minor or incompetent person, a court retains the 

23 authority to authorize or approve a fee that is less than 

24 the maximum permitted under this section. The requireVerDate Mar 15 2010 05:57 Aug 03, 2012 Jkt 019200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S3473.IS S3473

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1 ment for court supervision in the first two sentences of 

2 subsection (a) applies only in civil actions. 

3 SEC. 706. PUNITIVE DAMAGES. 

4 (a) IN GENERAL.—Punitive damages may, if other5 wise permitted by applicable State or Federal law, be 

6 awarded against any person in a health care lawsuit only 

7 if it is proven by clear and convincing evidence that such 

8 person acted with malicious intent to injure the claimant, 

9 or that such person deliberately failed to avoid unneces10 sary injury that such person knew the claimant was sub11 stantially certain to suffer. In any health care lawsuit 

12 where no judgment for compensatory damages is rendered 

13 against such person, no punitive damages may be awarded 

14 with respect to the claim in such lawsuit. No demand for 

15 punitive damages shall be included in a health care lawsuit 

16 as initially filed. A court may allow a claimant to file an 

17 amended pleading for punitive damages only upon a mo18 tion by the claimant and after a finding by the court, upon 

19 review of supporting and opposing affidavits or after a 

20 hearing, after weighing the evidence, that the claimant has 

21 established by a substantial probability that the claimant 

22 will prevail on the claim for punitive damages. At the re23 quest of any party in a health care lawsuit, the trier of 

24 fact shall consider in a separate proceeding— 


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1 (1) whether punitive damages are to be award2 ed and the amount of such award; and 

3 (2) the amount of punitive damages following a 

4 determination of punitive liability. 

5 If a separate proceeding is requested, evidence relevant 

6 only to the claim for punitive damages, as determined by 

7 applicable State law, shall be inadmissible in any pro8 ceeding to determine whether compensatory damages are 

9 to be awarded. 

10 (b) DETERMINING AMOUNT OF PUNITIVE DAM11 AGES.— 

12 (1) FACTORS CONSIDERED.—In determining 

13 the amount of punitive damages, if awarded, in a 

14 health care lawsuit, the trier of fact shall consider 

15 only the following— 

16 (A) the severity of the harm caused by the 

17 conduct of such party; 

18 (B) the duration of the conduct or any 

19 concealment of it by such party; 

20 (C) the profitability of the conduct to such 

21 party; 

22 (D) the number of products sold or med23 ical procedures rendered for compensation, as 

24 the case may be, by such party, of the kind 


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1 causing the harm complained of by the claim2 ant; 

3 (E) any criminal penalties imposed on such 

4 party, as a result of the conduct complained of 

5 by the claimant; and 

6 (F) the amount of any civil fines assessed 

7 against such party as a result of the conduct 

8 complained of by the claimant. 

9 (2) MAXIMUM AWARD.—The amount of punitive 

10 damages, if awarded, in a health care lawsuit may 

11 be as much as $250,000 or as much as two times 

12 the amount of economic damages awarded, which13 ever is greater. The jury shall not be informed of 

14 this limitation. 

15 (c) NO PUNITIVE DAMAGES FOR PRODUCTS THAT

16 COMPLY WITH FDA STANDARDS.— 

17 (1) IN GENERAL.— 

18 (A) No punitive damages may be awarded 

19 against the manufacturer or distributor of a 

20 medical product, or a supplier of any compo21 nent or raw material of such medical product, 

22 based on a claim that such product caused the 

23 claimant’s harm where— 

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1 censure by the Food and Drug Administra2 tion with respect to the safety of the for3 mulation or performance of the aspect of 

4 such medical product which caused the 

5 claimant’s harm or the adequacy of the 

6 packaging or labeling of such medical 

7 product; and 

8 (II) such medical product was so ap9 proved, cleared, or licensed; or 

10 (ii) such medical product is generally 

11 recognized among qualified experts as safe 

12 and effective pursuant to conditions estab13 lished by the Food and Drug Administra14 tion and applicable Food and Drug Admin15 istration regulations, including without 

16 limitation those related to packaging and 

17 labeling, unless the Food and Drug Admin18 istration has determined that such medical 

19 product was not manufactured or distrib20 uted in substantial compliance with appli21 cable Food and Drug Administration stat22 utes and regulations. 

23 (B) RULE OF CONSTRUCTION.—Subpara24 graph (A) may not be construed as establishing 

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1 tration to demonstrate affirmatively that a 

2 manufacturer, distributor, or supplier referred 

3 to in such subparagraph meets any of the con4 ditions described in such subparagraph. 

5 (2) LIABILITY OF HEALTH CARE PROVIDERS.— 

6 A health care provider who prescribes, or who dis7 penses pursuant to a prescription, a medical product 

8 approved, licensed, or cleared by the Food and Drug 

9 Administration shall not be named as a party to a 

10 product liability lawsuit involving such product and 

11 shall not be liable to a claimant in a class action 

12 lawsuit against the manufacturer, distributor, or 

13 seller of such product. Nothing in this paragraph 

14 prevents a court from consolidating cases involving 

15 health care providers and cases involving products li16 ability claims against the manufacturer, distributor, 

17 or product seller of such medical product. 

18 (3) PACKAGING.—In a health care lawsuit for 

19 harm which is alleged to relate to the adequacy of 

20 the packaging or labeling of a drug which is required 

21 to have tamper-resistant packaging under regula22 tions of the Secretary of Health and Human Serv23 ices (including labeling regulations related to such 

24 packaging), the manufacturer or product seller of 

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1 ages unless such packaging or labeling is found by 

2 the trier of fact by clear and convincing evidence to 

3 be substantially out of compliance with such regula4 tions. 

5 (4) EXCEPTION.—Paragraph (1) shall not 

6 apply in any health care lawsuit in which— 

7 (A) a person, before or after premarket ap8 proval, clearance, or licensure of such medical 

9 product, knowingly misrepresented to or with10 held from the Food and Drug Administration 

11 information that is required to be submitted 

12 under the Federal Food, Drug, and Cosmetic 

13 Act (21 U.S.C. 301 et seq.) or section 351 of 

14 the Public Health Service Act (42 U.S.C. 262) 

15 that is material and is causally related to the 

16 harm which the claimant allegedly suffered; 

17 (B) a person made an illegal payment to 

18 an official of the Food and Drug Administra19 tion for the purpose of either securing or main20 taining approval, clearance, or licensure of such 

21 medical product; or 

22 (C) the defendant caused the medical prod23 uct which caused the claimant’s harm to be 

24 misbranded or adulterated (as such terms are 


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1 used in chapter V of the Federal Food, Drug, 

2 and Cosmetic Act (21 U.S.C. 351 et seq.)). 

3 SEC. 707. AUTHORIZATION OF PAYMENT OF FUTURE DAM4 AGES TO CLAIMANTS IN HEALTH CARE LAW5 SUITS. 

6 (a) IN GENERAL.—In any health care lawsuit, if an 

7 award of future damages, without reduction to present 

8 value, equaling or exceeding $50,000 is made against a 

9 party with sufficient insurance or other assets to fund a 

10 periodic payment of such a judgment, the court shall, at 

11 the request of any party, enter a judgment ordering that 

12 the future damages be paid by periodic payments, in ac13 cordance with the Uniform Periodic Payment of Judg14 ments Act promulgated by the National Conference of 

15 Commissioners on Uniform State Laws. 

16 (b) APPLICABILITY.—This section applies to all ac17 tions which have not been first set for trial or retrial be18 fore the effective date of this subtitle. 

19 SEC. 708. DEFINITIONS. 

20 In this subtitle: 

21 (1) ALTERNATIVE DISPUTE RESOLUTION SYS22 TEM; ADR.—The term ‘‘alternative dispute resolution 

23 system’’ or ‘‘ADR’’ means a system that provides 

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1 ner other than through a civil action brought in a 

2 State or Federal court. 

3 (2) CLAIMANT.—The term ‘‘claimant’’ means 

4 any person who brings a health care lawsuit, includ5 ing a person who asserts or claims a right to legal 

6 or equitable contribution, indemnity, or subrogation, 

7 arising out of a health care liability claim or action, 

8 and any person on whose behalf such a claim is as9 serted or such an action is brought, whether de10 ceased, incompetent, or a minor. 

11 (3) COMPENSATORY DAMAGES.—The term 

12 ‘‘compensatory damages’’ means objectively 

13 verifiable monetary losses incurred as a result of the 

14 provision of, use of, or payment for (or failure to 

15 provide, use, or pay for) health care services or med16 ical products, such as past and future medical ex17 penses, loss of past and future earnings, cost of ob18 taining domestic services, loss of employment, and 

19 loss of business or employment opportunities, dam20 ages for physical and emotional pain, suffering, in21 convenience, physical impairment, mental anguish, 

22 disfigurement, loss of enjoyment of life, loss of soci23 ety and companionship, loss of consortium (other 

24 than loss of domestic service), hedonic damages, in25 jury to reputation, and all other nonpecuniary losses 


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1 of any kind or nature. The term ‘‘compensatory 

2 damages’’ includes economic damages and non3 economic damages, as such terms are defined in this 

4 section. 

5 (4) CONTINGENT FEE.—The term ‘‘contingent 

6 fee’’ includes all compensation to any person or per7 sons which is payable only if a recovery is effected 

8 on behalf of one or more claimants. 

9 (5) ECONOMIC DAMAGES.—The term ‘‘economic 

10 damages’’ means objectively verifiable monetary 

11 losses incurred as a result of the provision of, use 

12 of, or payment for (or failure to provide, use, or pay 

13 for) health care services or medical products, such as 

14 past and future medical expenses, loss of past and 

15 future earnings, cost of obtaining domestic services, 

16 loss of employment, and loss of business or employ17 ment opportunities. 

18 (6) HEALTH CARE LAWSUIT.—The term 

19 ‘‘health care lawsuit’’ means any health care liability 

20 claim concerning the provision of health care goods 

21 or services or any medical product affecting inter22 state commerce, or any health care liability action 

23 concerning the provision of health care goods or 

24 services or any medical product affecting interstate 

25 commerce, brought in a State or Federal court or 


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1 pursuant to an alternative dispute resolution system, 

2 against a health care provider, a health care organi3 zation, or the manufacturer, distributor, supplier, 

4 marketer, promoter, or seller of a medical product, 

5 regardless of the theory of liability on which the 

6 claim is based, or the number of claimants, plain7 tiffs, defendants, or other parties, or the number of 

8 claims or causes of action, in which the claimant al9 leges a health care liability claim. Such term does 

10 not include a claim or action which is based on 

11 criminal liability; which seeks civil fines or penalties 

12 paid to Federal, State, or local government; or which 

13 is grounded in antitrust. 

14 (7) HEALTH CARE LIABILITY ACTION.—The 

15 term ‘‘health care liability action’’ means a civil ac16 tion brought in a State or Federal court or pursuant 

17 to an alternative dispute resolution system, against 

18 a health care provider, a health care organization, or 

19 the manufacturer, distributor, supplier, marketer, 

20 promoter, or seller of a medical product, regardless 

21 of the theory of liability on which the claim is based, 

22 or the number of plaintiffs, defendants, or other par23 ties, or the number of causes of action, in which the 

24 claimant alleges a health care liability claim. 


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1 (8) HEALTH CARE LIABILITY CLAIM.—The 

2 term ‘‘health care liability claim’’ means a demand 

3 by any person, whether or not pursuant to ADR, 

4 against a health care provider, health care organiza5 tion, or the manufacturer, distributor, supplier, mar6 keter, promoter, or seller of a medical product, in7 cluding, but not limited to, third-party claims, cross8 claims, counter-claims, or contribution claims, which 

9 are based upon the provision of, use of, or payment 

10 for (or the failure to provide, use, or pay for) health 

11 care services or medical products, regardless of the 

12 theory of liability on which the claim is based, or the 

13 number of plaintiffs, defendants, or other parties, or 

14 the number of causes of action. 

15 (9) HEALTH CARE ORGANIZATION.—The term 

16 ‘‘health care organization’’ means any person or en17 tity which is obligated to provide or pay for health 

18 benefits under any health plan, including any person 

19 or entity acting under a contract or arrangement 

20 with a health care organization to provide or admin21 ister any health benefit. 

22 (10) HEALTH CARE PROVIDER.—The term 

23 ‘‘health care provider’’ means any person or entity 

24 required by State or Federal laws or regulations to 

25 be licensed, registered, or certified to provide health 


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1 care services, and being either so licensed, reg2 istered, or certified, or exempted from such require3 ment by other statute or regulation. 

4 (11) HEALTH CARE GOODS OR SERVICES.—The 

5 term ‘‘health care goods or services’’ means any 

6 goods or services provided by a health care organiza7 tion, provider, or by any individual working under 

8 the supervision of a health care provider, that relates 

9 to the diagnosis, prevention, or treatment of any 

10 human disease or impairment, or the assessment or 

11 care of the health of human beings. 

12 (12) MALICIOUS INTENT TO INJURE.—The 

13 term ‘‘malicious intent to injure’’ means inten14 tionally causing or attempting to cause physical in15 jury other than providing health care goods or serv16 ices. 

17 (13) MEDICAL PRODUCT.—The term ‘‘medical 

18 product’’ means a drug, device, or biological product 

19 intended for humans, and the terms ‘‘drug’’, ‘‘de20 vice’’, and ‘‘biological product’’ have the meanings 

21 given such terms in sections 201(g)(1) and 201(h) 

22 of the Federal Food, Drug and Cosmetic Act (21 

23 U.S.C. 321(g)(1) and (h)) and section 351(a) of the 

24 Public Health Service Act (42 U.S.C. 262(a)), reVerDate Mar 15 2010 05:57 Aug 03, 2012 Jkt 019200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S3473.IS S3473

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1 spectively, including any component or raw material 

2 used therein, but excluding health care services. 

3 (14) NONECONOMIC DAMAGES.—The term 

4 ‘‘noneconomic damages’’ means damages for phys5 ical and emotional pain, suffering, inconvenience, 

6 physical impairment, mental anguish, disfigurement, 

7 loss of enjoyment of life, loss of society and compan8 ionship, loss of consortium (other than loss of do9 mestic service), hedonic damages, injury to reputa10 tion, and all other nonpecuniary losses of any kind 

11 or nature. 

12 (15) PUNITIVE DAMAGES.—The term ‘‘punitive 

13 damages’’ means damages awarded, for the purpose 

14 of punishment or deterrence, and not solely for com15 pensatory purposes, against a health care provider, 

16 health care organization, or a manufacturer, dis17 tributor, or supplier of a medical product. Punitive 

18 damages are neither economic nor noneconomic 

19 damages. 

20 (16) RECOVERY.—The term ‘‘recovery’’ means 

21 the net sum recovered after deducting any disburse22 ments or costs incurred in connection with prosecu23 tion or settlement of the claim, including all costs 

24 paid or advanced by any person. Costs of health care 

25 incurred by the plaintiff and the attorneys’ office 


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1 overhead costs or charges for legal services are not 

2 deductible disbursements or costs for such purpose. 

3 (17) STATE.—The term ‘‘State’’ means each of 

4 the several States, the District of Columbia, the 

5 Commonwealth of Puerto Rico, the Virgin Islands, 

6 Guam, American Samoa, the Northern Mariana Is7 lands, the Trust Territory of the Pacific Islands, and 

8 any other territory or possession of the United 

9 States, or any political subdivision thereof. 

10 SEC. 709. EFFECT ON OTHER LAWS. 

11 (a) VACCINE INJURY.— 

12 (1) To the extent that title XXI of the Public 

13 Health Service Act establishes a Federal rule of law 

14 applicable to a civil action brought for a vaccine-re15 lated injury or death— 

16 (A) this subtitle does not affect the appli17 cation of the rule of law to such an action; and 

18 (B) any rule of law prescribed by this sub19 title in conflict with a rule of law of such title 

20 XXI shall not apply to such action. 

21 (2) If there is an aspect of a civil action 

22 brought for a vaccine-related injury or death to 

23 which a Federal rule of law under title XXI of the 

24 Public Health Service Act does not apply, then this 

25 subtitle or otherwise applicable law (as determined 


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1 under this subtitle) will apply to such aspect of such 

2 action. 

3 (b) OTHER FEDERAL LAW.—Except as provided in 

4 this section, nothing in this subtitle shall be deemed to 

5 affect any defense available to a defendant in a health care 

6 lawsuit or action under any other provision of Federal law. 

7 SEC. 710. STATE FLEXIBILITY AND PROTECTION OF 

8 STATES’ RIGHTS. 

9 (a) HEALTH CARE LAWSUITS.—The provisions gov10 erning health care lawsuits set forth in this subtitle pre11 empt, subject to subsections (b) and (c), State law to the 

12 extent that State law prevents the application of any pro13 visions of law established by or under this subtitle. The 

14 provisions governing health care lawsuits set forth in this 

15 subtitle supersede chapter 171 of title 28, United States 

16 Code, to the extent that such chapter— 

17 (1) provides for a greater amount of damages 

18 or contingent fees, a longer period in which a health 

19 care lawsuit may be commenced, or a reduced appli20 cability or scope of periodic payment of future dam21 ages, than provided in this subtitle; or 

22 (2) prohibits the introduction of evidence re23 garding collateral source benefits, or mandates or 

24 permits subrogation or a lien on collateral source 

25 benefits. 


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1 (b) PROTECTION OF STATES’ RIGHTS AND OTHER

2 LAWS.—(1) Any issue that is not governed by any provi3 sion of law established by or under this subtitle (including 

4 State standards of negligence) shall be governed by other5 wise applicable State or Federal law. 

6 (2) This subtitle shall not preempt or supersede any 

7 State or Federal law that imposes greater procedural or 

8 substantive protections for health care providers and 

9 health care organizations from liability, loss, or damages 

10 than those provided by this subtitle or create a cause of 

11 action. 

12 (c) STATE FLEXIBILITY.—No provision of this sub13 title shall be construed to preempt— 

14 (1) any State law (whether effective before, on, 

15 or after the date of the enactment of this title) that 

16 specifies a particular monetary amount of compen17 satory or punitive damages (or the total amount of 

18 damages) that may be awarded in a health care law19 suit, regardless of whether such monetary amount is 

20 greater or lesser than is provided for under this sub21 title, notwithstanding section 704(a); or 

22 (2) any defense available to a party in a health 

23 care lawsuit under any other provision of State or 

24 Federal law. 


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1 SEC. 711. APPLICABILITY; EFFECTIVE DATE. 

2 This subtitle shall apply to any health care lawsuit 

3 brought in a Federal or State court, or subject to an alter4 native dispute resolution system, that is initiated on or 

5 after the date of the enactment of this title, except that 

6 any health care lawsuit arising from an injury occurring 

7 prior to the date of the enactment of this title shall be 

8 governed by the applicable statute of limitations provisions 

9 in effect at the time the injury occurred. 

10 Subtitle B—Health Care Safety Net 

11 Enhancement 

12 SEC. 721. SHORT TITLE. 

13 This subtitle may be cited as the ‘‘Health Care Safety 

14 Net Enhancement Act of 2012’’. 

15 SEC. 722. PROTECTION FOR EMERGENCY AND RELATED 

16 SERVICES FURNISHED PURSUANT TO 

17 EMTALA. 

18 Section 224(g) of the Public Health Service Act (42 

19 U.S.C. 233(g)) is amended— 

20 (1) in paragraph (4), by striking ‘‘An entity’’ 

21 and inserting ‘‘Subject to paragraph (6), an entity’’; 

22 and 

23 (2) by adding at the end the following: 

24 ‘‘(6)(A) For purposes of this section— 


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1 ‘‘(i) an entity described in subparagraph 

2 (B) shall be considered to be an entity de3 scribed in paragraph (4); and 

4 ‘‘(ii) the provisions of this section shall 

5 apply to an entity described in subparagraph 

6 (B) in the same manner as such provisions 

7 apply to an entity described in paragraph (4), 

8 except that— 

9 ‘‘(I) notwithstanding paragraph 

10 (1)(B), the deeming of any entity described 

11 in subparagraph (B), or of an officer, gov12 erning board member, employee, con13 tractor, or on-call provider of such an enti14 ty, to be an employee of the Public Health 

15 Service for purposes of this section shall 

16 apply only with respect to items and serv17 ices that are furnished to an individual 

18 pursuant to section 1867 of the Social Se19 curity Act and to post stabilization services 

20 (as defined in subparagraph (D)) furnished 

21 to such an individual; 

22 ‘‘(II) nothing in paragraph (1)(D) 

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1 cation referred to in such paragraph or as 

2 conditioning the deeming of a physician or 

3 physician group that makes such an appli4 cation upon receipt by the Secretary of an 

5 application from the hospital or emergency 

6 department that employs or contracts with 

7 the physician or group, or enlists the phy8 sician or physician group as an on-call pro9 vider; 

10 ‘‘(III) notwithstanding paragraph (3), 

11 this paragraph shall apply only with re12 spect to causes of action arising from acts 

13 or omissions that occur on or after Janu14 ary 1, 2012; 

15 ‘‘(IV) paragraph (5) shall not apply to 

16 a physician or physician group described in 

17 subparagraph (B)(ii); 

18 ‘‘(V) the Attorney General, in con19 sultation with the Secretary, shall make 

20 separate estimates under subsection (k)(1) 

21 with respect to entities described in sub22 paragraph (B) and entities described in 

23 paragraph (4) (other than those described 

24 in subparagraph (B)), and the Secretary 

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1 section (k)(2) with respect to such groups 

2 of entities, and any appropriations under 

3 this subsection for entities described in 

4 subparagraph (B) shall be separate from 

5 the amounts authorized by subsection 

6 (k)(2); 

7 ‘‘(VI) notwithstanding subsection 

8 (k)(2), the amount of the fund established 

9 by the Secretary under such subsection 

10 with respect to entities described in sub11 paragraph (B) may exceed a total of 

12 $10,000,000 for a fiscal year; and 

13 ‘‘(VII) subsection (m) shall not apply 

14 to entities described in subparagraph (B). 

15 ‘‘(B) An entity described in this subparagraph 

16 is— 

17 ‘‘(i) a hospital or an emergency depart18 ment to which section 1867 of the Social Secu19 rity Act applies; and 

20 ‘‘(ii) a physician or physician group that is 

21 employed by, is under contract with, or is an 

22 on-call provider of such hospital or emergency 

23 department, to furnish items and services to in24 dividuals under such section. 


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1 ‘‘(C) For purposes of this paragraph, the term 

2 ‘on-call provider’ means a physician or physician 

3 group that— 

4 ‘‘(i) has full, temporary, or locum tenens 

5 staff privileges at a hospital or emergency de6 partment to which section 1867 of the Social 

7 Security Act applies; and 

8 ‘‘(ii) is not employed by or under contract 

9 with such hospital or emergency department, 

10 but agrees to be ready and available to provide 

11 services pursuant to section 1867 of the Social 

12 Security Act or post-stabilization services to in13 dividuals being treated in the hospital or emer14 gency department with or without compensation 

15 from the hospital or emergency department. 

16 ‘‘(D) For purposes of this paragraph, the term 

17 ‘post stabilization services’ means, with respect to an 

18 individual who has been treated by an entity de19 scribed in subparagraph (B) for purposes of com20 plying with section 1867 of the Social Security Act, 

21 services that are— 

22 ‘‘(i) related to the condition that was so 

23 treated; and 

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1 tion or to improve or resolve the condition of 

2 the individual. 

3 ‘‘(E)(i) Nothing in this paragraph (or in any 

4 other provision of this section as such provision ap5 plies to entities described in subparagraph (B) by 

6 operation of subparagraph (A)) shall be construed as 

7 authorizing or requiring the Secretary to make pay8 ments to such entities, the budget authority for 

9 which is not provided in advance by appropriation 

10 Acts. 

11 ‘‘(ii) The Secretary shall limit the total amount 

12 of payments under this paragraph for a fiscal year 

13 to the total amount appropriated in advance by ap14 propriation Acts for such purpose for such fiscal 

15 year. If the total amount of payments that would 

16 otherwise be made under this paragraph for a fiscal 

17 year exceeds such total amount appropriated, the 

18 Secretary shall take such steps as may be necessary 

19 to ensure that the total amount of payments under 

20 this paragraph for such fiscal year does not exceed 

21 such total amount appropriated.’’. 

22 SEC. 723. CONSTITUTIONAL AUTHORITY. 

23 The constitutional authority upon which this subtitle 

24 rests is the power of the Congress to provide for the gen25 eral welfare, to regulate commerce, and to make all laws 


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1 which shall be necessary and proper for carrying into exe2 cution Federal powers, as enumerated in Section 8 of Arti3 cle I of the Constitution of the United States. 

4 Subtitle C—Restoring the Applica5 tion of Antitrust Laws to Health 

6 Sector Insurers 

7 SEC. 731. SHORT TITLE. 

8 This subtitle may be cited as the ‘‘Health Insurance 

9 Industry Fair Competition Act of 2012’’. 

10 SEC. 732. APPLICATION OF THE ANTITRUST LAWS TO THE 

11 BUSINESS OF HEALTH INSURANCE. 

12 (a) AMENDMENT TO MCCARRAN-FERGUSON ACT.— 

13 Section 3 of the Act of March 9, 1945 (15 U.S.C. 1013), 

14 commonly known as the McCarran-Ferguson Act, is 

15 amended by adding at the end the following: 

16 ‘‘(c) Nothing contained in this Act shall modify, im17 pair, or supersede the operation of any of the antitrust 

18 laws with respect to the business of health insurance. For 

19 purposes of the preceding sentence, the term ‘antitrust 

20 laws’ has the meaning given it in subsection (a) of the 

21 first section of the Clayton Act, except that such term in22 cludes section 5 of the Federal Trade Commission Act to 

23 the extent that such section 5 applies to unfair methods 

24 of competition. For the purposes of this subsection, the 

25 term ‘business of health insurance’ shall— 


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1 ‘‘(1) mean ‘health insurance coverage’ offered 

2 by a ‘health insurance issuer’ as those terms are de3 fined in section 9001 of the Patient Protection and 

4 Affordable Care Act, which incorporates by reference 

5 and utilizes the definitions included in section 9832 

6 of the Internal Revenue Code (26 U.S.C. 9832); and 

7 ‘‘(2) not include— 

8 ‘‘(A) life insurance and annuities; 

9 ‘‘(B) property or casualty insurance, in10 cluding but not limited to, automobile, medical 

11 malpractice or workers’ compensation insur12 ance; or 

13 ‘‘(C) any insurance or benefits defined as 

14 ‘excepted benefits’ under section 9832(c) of the 

15 Internal Revenue Code (26 U.S.C. 9832(c)), 

16 whether offered separately or in combination 

17 with products described in subparagraph (A).’’. 

18 (b) RELATED PROVISION.—For purposes of section 

19 5 of the Federal Trade Commission Act (15 U.S.C. 45) 

20 to the extent such section applies to unfair methods of 

21 competition, section 3(c) of the McCarran-Ferguson Act 

22 shall apply with respect to the business of health insurance 

23 without regard to whether such business is carried on for 

24 profit, notwithstanding the definition of ‘‘Corporation’’ 


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1 contained in section 4 of the Federal Trade Commission 

2 Act. 

3 (c) LIMITATION ON CLASS ACTIONS.— 

4 (1) LIMITATION.—No class action may be 

5 heard in a Federal or State court on a claim against 

6 a person engaged in the business of health insurance 

7 for a violation of any of the antitrust laws (as de8 fined in section 3(c) of the Act of March 9, 1945 

9 (15 U.S.C. 1013), commonly known as the 

10 McCarran-Ferguson Act). 

11 (2) EXEMPTION.—Paragraph (1) shall not 

12 apply with respect to any action commenced— 

13 (A) by the United States or any State; or 

14 (B) by a named claimant for an injury 

15 only to itself. 

16 Subtitle D—Protections for Good 

17 Samaritan Health Professionals 

18 SEC. 741. SHORT TITLE. 

19 This subtitle may be cited as the ‘‘Good Samaritan 

20 Health Professionals Act of 2012’’. 

21 SEC. 742. LIMITATION ON LIABILITY FOR VOLUNTEER 

22 HEALTH CARE PROFESSIONALS. 

23 (a) IN GENERAL.—Title II of the Public Health Serv24 ice Act (42 U.S.C. 202 et seq.) is amended by inserting 

25 after section 224 the following: 


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1 ‘‘SEC. 224A. LIMITATION ON LIABILITY FOR VOLUNTEER 

2 HEALTH CARE PROFESSIONALS. 

3 ‘‘(a) LIMITATION ON LIABILITY.—Except as provided 

4 in subsection (b), a health care professional shall not be 

5 liable under Federal or State law for any harm caused 

6 by an act or omission of the professional if— 

7 ‘‘(1) the professional is serving as a volunteer 

8 for purposes of responding to a disaster; and 

9 ‘‘(2) the act or omission occurs— 

10 ‘‘(A) during the period of the disaster, as 

11 determined under the laws listed in subsection 

12 (e)(1); 

13 ‘‘(B) in the health care professional’s ca14 pacity as such a volunteer; and 

15 ‘‘(C) in a good faith belief that the indi16 vidual being treated is in need of health care 

17 services. 

18 ‘‘(b) EXCEPTIONS.—Subsection (a) does not apply 

19 if— 

20 ‘‘(1) the harm was caused by an act or omission 

21 constituting willful or criminal misconduct, gross 

22 negligence, reckless misconduct, or a conscious fla23 grant indifference to the rights or safety of the indi24 vidual harmed by the health care professional; or 

25 ‘‘(2) the health care professional rendered the 

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1 mined pursuant to applicable State law) of intoxi2 cating alcohol or an intoxicating drug. 

3 ‘‘(c) STANDARD OF PROOF.—In any civil action or 

4 proceeding against a health care professional claiming that 

5 the limitation in subsection (a) applies, the plaintiff shall 

6 have the burden of proving by clear and convincing evi7 dence the extent to which limitation does not apply. 

8 ‘‘(d) PREEMPTION.— 

9 ‘‘(1) IN GENERAL.—This section preempts the 

10 laws of a State or any political subdivision of a State 

11 to the extent that such laws are inconsistent with 

12 this section, unless such laws provide greater protec13 tion from liability. 

14 ‘‘(2) VOLUNTEER PROTECTION ACT.—Protec15 tions afforded by this section are in addition to those 

16 provided by the Volunteer Protection Act of 1997. 

17 ‘‘(e) DEFINITIONS.—In this section: 

18 ‘‘(1) The term ‘disaster’ means— 

19 ‘‘(A) a national emergency declared by the 

20 President under the National Emergencies Act; 

21 ‘‘(B) an emergency or major disaster de22 clared by the President under the Robert T. 

23 Stafford Disaster Relief and Emergency Assist24 ance Act; or 


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1 ‘‘(C) a public health emergency determined 

2 by the Secretary under section 319 of this Act. 

3 ‘‘(2) The term ‘harm’ includes physical, non4 physical, economic, and noneconomic losses. 

5 ‘‘(3) The term ‘health care professional’ means 

6 an individual who is licensed, certified, or authorized 

7 in one or more States to practice a health care pro8 fession. 

9 ‘‘(4) The term ‘State’ includes each of the sev10 eral States, the District of Columbia, the Common11 wealth of Puerto Rico, the Virgin Islands, Guam, 

12 American Samoa, the Northern Mariana Islands, 

13 and any other territory or possession of the United 

14 States. 

15 ‘‘(5)(A) The term ‘volunteer’ means a health 

16 care professional who, with respect to the health 

17 care services rendered, does not receive— 

18 ‘‘(i) compensation; or 

19 ‘‘(ii) any other thing of value in lieu of 

20 compensation, in excess of $500 per year. 

21 ‘‘(B) For purposes of subparagraph (A), the 

22 term ‘compensation’— 

23 ‘‘(i) includes payment under any insurance 

24 policy or health plan, or under any Federal or 

25 State health benefits program; and 


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1 ‘‘(ii) excludes— 

2 ‘‘(I) reasonable reimbursement or al3 lowance for expenses actually incurred; 

4 ‘‘(II) receipt of paid leave; and 

5 ‘‘(III) receipt of items to be used ex6 clusively for rendering the health services 

7 in the health care professional’s capacity 

8 as a volunteer described in subsection 

9 (a)(1).’’. 

10 (b) EFFECTIVE DATE.— 

11 (1) IN GENERAL.—This subtitle and the 

12 amendment made by subsection (a) shall take effect 

13 90 days after the date of the enactment of this title. 

14 (2) APPLICATION.—This subtitle applies to any 

15 claim for harm caused by an act or omission of a 

16 health care professional where the claim is filed on 

17 or after the effective date of this subtitle, but only 

18 if the harm that is the subject of the claim or the 

19 conduct that caused such harm occurred on or after 

20 such effective date. 


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1 TITLE VIII—BUDGET CONTROL 

2 ACT SPENDING CAP ADJUST3 MENTS 

4 SEC. 801. BUDGET CONTROL ACT SPENDING CAP ADJUST5 MENTS. 

6 (a) REENACTMENT.—Section 251 of the Balanced 

7 Budget and Emergency Deficit Control Act of 1985 is re8 enacted as in effect on January 15, 2012. 

9 (b) NEW CAPS.—The Balanced Budget and Emer10 gency Deficit Control Act of 1985 is amended— 

11 (1) in section 250(c)(4), by striking subpara12 graph (B) and inserting the following: 

13 ‘‘(B) The term ‘security category’ means discre14 tionary appropriations in budget function 050.’’; and 

15 (2) in section 251(c), by striking paragraphs 

16 (2) through (10) and inserting the following: 

17 ‘‘(2) with respect to fiscal year 2013— 

18 ‘‘(A) for the security category, 

19 $546,000,000,000; and 

20 ‘‘(B) for the nonsecurity category, 

21 $430,700,000,000; 

22 ‘‘(3) with respect to fiscal year 2014— 

23 ‘‘(A) for the security category, 

24 $566,800,000,000; and 


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1 ‘‘(B) for the nonsecurity category, 

2 $769,100,000,000; 

3 ‘‘(4) with respect to fiscal year 2015— 

4 ‘‘(A) for the security category, 

5 $620,400,000,000; and 

6 ‘‘(B) for the nonsecurity category, 

7 $777,200,000,000; 

8 ‘‘(5) with respect to fiscal year 2016— 

9 ‘‘(A) for the security category, 

10 $657,700,000,000; and 

11 ‘‘(B) for the nonsecurity category, 

12 $784,300,000,000; 

13 ‘‘(6) with respect to fiscal year 2017— 

14 ‘‘(A) for the security category, 

15 $702,000,000,000; and 

16 ‘‘(B) for the nonsecurity category, 

17 $802,000,000,000; 

18 ‘‘(7) with respect to fiscal year 2018— 

19 ‘‘(A) for the security category, 

20 $736,800,000,000; and 

21 ‘‘(B) for the nonsecurity category, 

22 $824,400,000,000; 

23 ‘‘(8) with respect to fiscal year 2019— 

24 ‘‘(A) for the security category, 

25 $780,900,000,000; and 


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1 ‘‘(B) for the nonsecurity category, 

2 $845,700,000,000; 

3 ‘‘(9) with respect to fiscal year 2020— 

4 ‘‘(A) for the security category, 

5 $828,100,000,000; and 

6 ‘‘(B) for the nonsecurity category, 

7 $872,100,000,000; 

8 ‘‘(10) with respect to fiscal year 2021— 

9 ‘‘(A) for the security category, 

10 $865,300,000,000; and 

11 ‘‘(B) for the nonsecurity category, 

12 $894,400,000,000; and 

13 ‘‘(11) with respect to fiscal year 2022— 

14 ‘‘(A) for the security category, 

15 $990,800,000,000; and 

16 ‘‘(B) for the nonsecurity category: 

17 $925,300,000,000.’’. 

Æ 


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