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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5348 Introduced in House (IH)]

110th CONGRESS
  2d Session
                                H. R. 5348

To amend the Social Security Act and the Internal Revenue Code of 1986 
 to assure comprehensive, affordable health insurance coverage for all 
         Americans through an American Health Benefits Program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           February 12, 2008

Mr. Langevin (for himself and Mr. Shays) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addition 
      to the Committee on Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL

 
To amend the Social Security Act and the Internal Revenue Code of 1986 
 to assure comprehensive, affordable health insurance coverage for all 
         Americans through an American Health Benefits Program.

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

SECTION 1. SHORT TITLE; FINDINGS; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``American Health 
Benefits Program Act of 2008''.
    (b) Findings.--Congress finds the following:
            (1) Uninsured americans and lack of access to choices.--(A) 
        In 2006, 46.5 million Americans were uninsured, over 80 percent 
        of whom were employed (or dependents of individuals who were 
        employed).
            (B) Health care providers provided to uninsured Americans 
        $41 billion in care for which they were not compensated by the 
        individuals or through insurance.
            (C) Only 8 percent of employers providing health benefits 
        are able to offer their employees a choice between two or more 
        health plans.
            (2) Double-digit growth in employer costs.--In 2003 the 
        average per capita cost for employers to provide health 
        benefits coverage increased by almost 14 percent. This was the 
        third consecutive year of double-digit increases in such cost.
            (3) Administrative efficiency of using fehbp model for 
        providing health insurance coverage.--(A) The private insurance 
        market presents increasing administrative challenges for 
        employers in seeking out, contracting with, and administering 
        health benefits.
            (B) The Federal Employee Health Benefits Program (FEHBP) 
        currently manages negotiations with health insurers over 
        premiums and benefits on behalf of 8.6 million Federal 
        employees and retirees and their dependents.
            (C) Overhead costs for employers providing health benefits 
        coverage can be over 30 percent for employers with fewer than 
        10 employees and about 12 percent for employers with more than 
        500 employees.
            (D) In comparison, the overhead cost of coverage provided 
        under FEHBP is about 3 percent.
            (4) Expansion of fehbp model to cover uninsured and other 
        americans.--Requiring participation in an FEHBP-style program 
        would expand consumer choice, ensure portability and continuity 
        of coverage, improve incentives for cost containment, and 
        stabilize the burden on businesses
            (5) Personal responsibility.--A recent survey indicates 
        that a clear majority of Americans sees securing health 
        insurance coverage as a personal responsibility for themselves 
        and others.
            (6) Savings from implementation of health information 
        technology.--Properly implemented and widely adopted health 
        information technology could significantly improve the quality, 
        safety and efficiency of healthcare delivery while saving an 
        estimated $77 billion per year
    (c) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; findings; table of contents.
Sec. 2. Establishment of American Health Benefits Program.
             ``TITLE XXII--AMERICAN HEALTH BENEFITS PROGRAM

        ``Sec. 2201. Establishment of program.
        ``Sec. 2202. Eligibility; requirement of coverage.
        ``Sec. 2203. Qualified health plans; benefits; premiums.
        ``Sec. 2204. Government contribution; American Health Benefits 
                            Program Trust Fund.
        ``Sec. 2205. Premium and cost-sharing subsidies for lower 
                            income individuals.
        ``Sec. 2206. Administration.
        ``Sec. 2207. Definitions.
Sec. 3. Collection of premiums, subsidies, and employer funding.
Sec. 4. Amendments to the Medicaid program and SCHIP.
Sec. 5. Promotion of use of health information technologies.
Sec. 6. Non-preemption of existing collective bargaining agreements.
Sec. 7. Health Benefits Commission.

SEC. 2. ESTABLISHMENT OF AMERICAN HEALTH BENEFITS PROGRAM.

    (a) In General.--The Social Security Act is amended by adding at 
the end the following new title:

             ``TITLE XXII--AMERICAN HEALTH BENEFITS PROGRAM

``SEC. 2201. ESTABLISHMENT OF PROGRAM.

    ``There is established under this title a program (to be known as 
the `American Health Benefits Program') to provide comprehensive health 
insurance coverage to all Americans who are not covered under certain 
Federal health insurance programs and who are not eligible for 
employer-provided insurance coverage. The coverage shall be provided in 
a manner similar to the manner in which coverage has been provided to 
Members of Congress and Federal Government employees and retirees and 
their dependents under the Federal Employees Health Benefits Program 
(FEHBP).

``SEC. 2202. ELIGIBILITY; REQUIREMENT OF COVERAGE.

    ``(a) Eligibility.--
            ``(1) In general.--Each AHBP-eligible individual is 
        eligible to enroll in a qualified health plan offered under 
        this title.
            ``(2) AHBP-eligible individual defined.--
                    ``(A) In general.--For purposes of this title, the 
                term `AHBP-eligible individual' means an individual 
                residing in the United States who is--
                            ``(i) a citizen or national of the United 
                        States;
                            ``(ii) an alien lawfully admitted to the 
                        United States for permanent residence;
                            ``(iii) an alien admitted into the United 
                        States under section 207 of the Immigration and 
                        Nationality Act (relating to refugees);
                            ``(iv) an alien otherwise permanently 
                        residing in the United States under color of 
                        law (as specified by the Commissioner); or
                            ``(v) an alien with the status of a 
                        nonimmigrant who is within a class of long-term 
                        nonimmigrants under section 101(a)(15) of the 
                        Immigration and Nationality Act that the 
                        Commissioner determines, in consultation with 
                        the Secretary of Homeland Security, to be 
                        appropriate.
                    ``(B) Exceptions.--Such term does not include the 
                following individuals:
                            ``(i) Individuals eligible for qualified 
                        employer-provided coverage.--An individual who 
                        is eligible for employer-provided coverage, as 
                        defined in section 2207(6), whether an 
                        employee, dependent, or otherwise.
                            ``(ii) Incarcerated individuals.--An 
                        individual who is incarcerated (as specified by 
                        the Commissioner).
    ``(b) Requirement of Coverage.--
            ``(1) In general.--Except as provided in this subsection, 
        each AHBP-eligible individual shall be enrolled in a qualified 
        health plan under this title.
            ``(2) Exception for individuals demonstrating public health 
        insurance coverage.--The requirement of paragraph (1) shall not 
        apply to an individual who demonstrates coverage under any of 
        the following:
                    ``(A) Medicare.--Coverage under parts A and B (or 
                under part C) of title XVIII.
                    ``(B) Medicaid.--Coverage under a State plan under 
                title XIX.
                    ``(C) TRICARE/CHAMPUS.--Coverage under the TRICARE 
                program under chapter 55, of title 10, United States 
                Code.
                    ``(D) Indian health services.--Coverage under a 
                medical care program of the Indian Health Service or of 
                a tribal organization.
                    ``(E) Veterans health.--Coverage under the veterans 
                health care program under chapter 17 of title 38, 
                United States Code, if the coverage for the individual 
                involved is determined to be not less than the coverage 
                provided under a qualified health plan, based on the 
                individual's priority for services as provided under 
                section 1705(a) of such title.
            ``(3) Exception for nonimmigrants.--The requirement of 
        paragraph (1) shall not apply to an individual described in 
        subsection (a)(2)(A)(v).
            ``(4) Exception based on religious objection.--The 
        requirement of paragraph (1) shall not apply to an individual 
        who executes a written statement (in a form and manner 
        specified by the Secretary) that--
                    ``(A) the individual is conscientiously opposed to 
                acceptance of medical treatment of the type covered by 
                qualified health plans; and
                    ``(B) the individual's acceptance of medical 
                treatment covered by such a plan would be inconsistent 
                with the individual's sincere religious beliefs.
    ``(c) Enrollment; Default Enrollment.--
            ``(1) In general.--The Commissioner shall establish a 
        process for AHBP-eligible individuals to enroll in qualified 
        health plans. Such process shall be based on the enrollment 
        process used under FEHBP and shall provide for the 
        dissemination of information to AHBP-eligible individuals on 
        qualified health plans being offered.
            ``(2) Default enrollment.--
                    ``(A) In general.--The Commissioner shall establish 
                a procedure under which an AHBP-eligible individual who 
                is required under subsection (b) to enroll, but is not 
                enrolled, in a qualified health plan will be assigned 
                to, and enrolled in, such a plan.
                    ``(B) Rules.--In carrying out subparagraph (A), the 
                Commissioner shall assign AHBP-eligible individuals and 
                families to the basic plan the premium of which is the 
                lowest premium for the AHBP region or other area in 
                which the individuals or families reside.
            ``(3) Changes in enrollment.--The Commissioner shall 
        establish enrollment procedures that include an annual open 
        season and permit changes in enrollment with qualified health 
        plans at other times (such as by reason of changes in marital 
        or dependent status). Such procedures shall be based on the 
        enrollment procedures established under FEHBP.
    ``(d) Treatment of Family Members.--Enrollment under this title 
shall include both individual and family enrollment, in a manner 
similar to that provided under FEHBP. To the extent consistent with 
eligibility under subsection (a), the Commissioner shall provide rules 
similar to the rules under FEHBP for the enrollment of family members 
who are AHBP-eligible individuals in the same plan, except that such 
rules shall permit a family consisting only of a married couple to 
elect to enroll each spouse in a different qualified health plan.
    ``(e) Changes in Plan Enrollment.--The Commissioner shall provide 
for and permit changes in the qualified health plan in which an 
individual or family is enrolled under this section in a manner similar 
to the manner in which such changes are provided or permitted under 
FEHBP. The Commissioner shall provide for termination of such 
enrollment for an individual at the time the individual is no longer an 
AHBP-eligible individual.
    ``(f) Enrollment Guides.--The Commissioner shall provide for the 
broad dissemination of information on qualified health plans offered 
under this title. Such information shall be provided in a comparative 
manner, similar to that used under FEHBP, and shall include 
information, collected through surveys of enrollees, on measures of 
enrollee satisfaction with the different plans.

``SEC. 2203. QUALIFIED HEALTH PLANS; BENEFITS; PREMIUMS.

    ``(a) Offering of Plans.--
            ``(1) Contracts.--The Commissioner shall enter into 
        contracts with entities for the offering of qualified health 
        plans in accordance with this title. Such contracts shall be 
        entered into in a manner similar to the process by which the 
        Director of the Office of Personnel Management is authorized to 
        enter into contracts with health benefits plans under FEHBP.
            ``(2) Requirements for entities offering plans.--No such 
        contract shall be entered into with an entity for the offering 
        of a qualified health plan in a region unless the entity--
                    ``(A) is licensed as a health maintenance 
                organization in that State or is licensed to sell group 
                health insurance coverage in that State;
                    ``(B) meets such requirements, similar to 
                requirements under FEHBP, as the Commissioner may 
                establish relating to solvency, organization, 
                structure, governance, access, and quality;
                    ``(C) agrees to participate in the high-risk 
                reinsurance pool described in subsection (d); and
                    ``(D) provides assurances satisfactory to the 
                Commissioner that at least 90 percent of the premium 
                payments for the plan will be returned in the form of 
                aggregate health care benefits or improvements, 
                including health information technology.
            ``(3) Contracting with limited number of plans in a region 
        within types of plans.--
                    ``(A) In general.--The Commissioner shall contract 
                with only a limited number of qualified health plans of 
                each type (as specified under subparagraph (B)) in each 
                AHBP region.
                    ``(B) Types of plans.--For purposes of subparagraph 
                (A), the Commissioner shall classify the different 
                types of qualified health plans, such as fee-for-
                service plans, health maintenance plans, preferred 
                provider plans, and other types of plans.
    ``(b) FEHBP Scope of Benefits.--
            ``(1) Comprehensive benefits.--Qualified health plans shall 
        provide for the same scope and type of comprehensive benefits 
        that have been provided under FEHBP, including the types of 
        benefits described in section 8904 of title 5, United States 
        Code and including benefits previously required by regulation 
        or direction (such as preventive benefits, including childhood 
        immunization and cancer screening, and mental health parity) 
        under FEHBP.
            ``(2) No exclusion for pre-existing conditions.--Qualified 
        health plans shall not impose pre-existing condition exclusions 
        or otherwise discriminate against any enrollee based on the 
        health status of such enrollee (including genetic information 
        relating to such enrollee).
            ``(3) Other consumer protections.--Qualified health plans 
        also shall meet consumer and patient protection requirements 
        that the Commissioner establishes, based on similar 
        requirements previously imposed under FEHBP, including 
        protections of patients' rights previously effected pursuant to 
        Executive Memorandum.
    ``(c) Community-Rated Premiums.--
            ``(1) In general.--The premiums established for a qualified 
        health plan under this title for individual or family coverage 
        shall be community-rated and shall not vary based on age, 
        gender, health status (including genetic information), or other 
        factors.
            ``(2) Collection process.--The Commissioner shall establish 
        a process for the timely and accurate collection of premiums 
        owed by enrollees, taking into account any Government 
        contribution under section 2204(a) and any premium subsidy 
        referred to in section 2205(a). Such process shall include 
        methods for payment through payroll withholding, as well as 
        payment through automatic debiting of accounts with financial 
        institutions, and shall be coordinated with the application of 
        section 59B of the Internal Revenue Code of 1986. Such premiums 
        shall be deposited into the American Health Benefits Program 
        Trust Fund established under section 2204(c).
    ``(d) High-Risk Reinsurance Pool.--The Commissioner shall establish 
an arrangement among the entities offering qualified health plans under 
which such entities contribute in an equitable manner (as determined by 
the Commissioner) into a fund that provides payment to plans for a 
percentage (specified by the Commissioner and not to exceed 90 percent) 
of the costs that they incur for enrollees beyond a predetermined 
threshold specified from time to time by the Commissioner.
    ``(e) Marketing Practices and Costs.--The Commissioner shall 
monitor marketing practices with respect to qualified health plans in 
order to assure--
            ``(1) the accuracy of the information disseminated 
        regarding such plans; and
            ``(2) that costs of marketing are reasonable and do not 
        exceed a percentage of total costs that is specified by the 
        Commissioner and that takes into account costs of market entry 
        for new qualified health plans.

``SEC. 2204. GOVERNMENT CONTRIBUTION; AMERICAN HEALTH BENEFITS PROGRAM 
              TRUST FUND.

    ``(a) Government Contribution.--
            ``(1) In general.--The Commissioner shall provide each year 
        for a contribution under this subsection towards the coverage 
        provided under this title for those AHBP-eligible individuals 
        who are required to be enrolled in a qualified health plan 
        under section 2202(b). Except as provided in this subsection, 
        the amount of such contribution shall be determined using the 
        same methodology that is applied for purposes of determining 
        the Government contribution under section 8906 of title 5, 
        United States Code and shall not exceed 75 percent of the 
        premium for the plan selected.
            ``(2) Use of regional weighted average.--Instead of 
        computing the Government contribution using methodology under 
        section 8906(b)(1) of title 5, United States Code, based on 72 
        percent of the weighted average premium for qualified health 
        plans nationally, the Commissioner shall compute such 
        contribution based on 72 percent of the weighted average 
        premium for qualified health plans in each region involved (as 
        identified by the Commissioner).
    ``(b) Plan Payment.--
            ``(1) In general.--The Commissioner shall provide for 
        payment of qualified health plans of the premiums for such 
        plans, as adjusted under this subsection.
            ``(2) Risk adjusted payment.--The payment to a qualified 
        health plan under this subsection shall be adjusted in a 
        budget-neutral manner specified by the Commissioner to reflect 
        the actuarial risk of the enrollees in the plan compared to an 
        average actuarial risk.
            ``(3) Reduction for administrative expenses and contingency 
        reserve.--The Commissioner shall provide for a uniform 
        percentage reduction in payment otherwise made to a qualified 
        health plan under this subsection. Such percentage shall 
        consist of the following:
                    ``(A) Contingency reserve.--A percentage (not to 
                exceed 3 percent) to provide for a contingency reserve 
                described in section 2206(h)(1).
                    ``(B) Federal administrative costs.--A percentage 
                (not to exceed 5 percent) to cover Federal 
                administrative costs in implementing this title.
    ``(c) Trust Fund.--
            ``(1) Establishment.--There is hereby established a trust 
        fund, to be known as the `American Health Benefits Program 
        Trust Fund' (in this subsection referred to as the `Trust 
        Fund').
            ``(2) Deposits.--The Trust Fund shall consist of such gifts 
        and bequests as may be provided in section 201(i)(1) and such 
        amounts as may be deposited in, or appropriated to, such fund 
        as provided in this title. There are hereby appropriated to the 
        Trust Fund, out of any moneys in the Treasury not otherwise 
        appropriated, amounts equivalent to 100 percent of--
                    ``(A) the taxes imposed by section 3451 of the 
                Internal Revenue Code of 1986 with respect to wages 
                reported to the Secretary of the Treasury or the 
                Secretary 's delegate pursuant to subtitle F of such 
                Code, as determined by the Secretary of the Treasury by 
                applying the applicable rates of tax under such section 
                to such wages, which wages shall be certified by the 
                Commissioner of Social Security on the basis of records 
                of wages established and maintained by such 
                Commissioner in accordance with such reports;
                    ``(B) the taxes imposed by section 1401(c) of the 
                Internal Revenue Code of 1986 with respect to self-
                employment income reported to the Secretary of the 
                Treasury or the Secretary's delegate pursuant to 
                subtitle F of such Code, as determined by the Secretary 
                of the Treasury by applying the applicable rates of tax 
                under such section to such self-employment income, 
                which self-employment income shall be certified by the 
                Commissioner of Social Security on the basis of records 
                of self-employment established and maintained by such 
                Commissioner in accordance with such returns; and
                    ``(C) the excess of the amounts imposed under 
                section 59B of the Internal Revenue Code of 1986 over 
                the amounts of credits allowed under section 36.
        The amounts appropriated by the preceding sentence shall be 
        transferred from time to time from the general fund in the 
        Treasury to the Trust Fund, such amounts to be determined on 
        the basis of estimates by the Secretary of the Treasury of the 
        taxes, specified in the preceding sentence, paid to or 
        deposited into the Treasury; and proper adjustments shall be 
        made in amounts subsequently transferred to the extent prior 
        estimates were in excess of or were less than the taxes 
        specified in such sentence.
            ``(3) Application of trust fund provisions.--The provisions 
        of subsections (b) through (f) of section 1817 shall apply to 
        the Trust Fund in the same manner as they apply to the Federal 
        Hospital Insurance Trust Fund, except that, for purposes of 
        this paragraph, any reference in such subsections to a 
        provision of the Internal Revenue Code of 1986 is deemed a 
        reference to the corresponding provision of such Code referred 
        to in paragraph (2) of this subsection.

``SEC. 2205. PREMIUM AND COST-SHARING SUBSIDIES FOR LOWER INCOME 
              INDIVIDUALS.

    ``(a) Premium Subsidies.--The Commissioner, in consultation with 
the Secretary of the Treasury, shall assist individuals in estimating 
the amount of the premium subsidy which will be allowed to such 
individuals under section 36 of the Internal Revenue Code of 1986 with 
respect to any month, and shall take the estimated amount of such 
premium subsidy into account for purposes of collecting any premium 
under section 2203(c)(2).
    ``(b) Cost-Sharing Subsidies.--
            ``(1) No cost-sharing for individuals with family income 
        below lowest income threshold.--In the case of a cost-sharing 
        subsidy-eligible individual whose family income is less than 
        the lowest income threshold, there shall be a cost-sharing 
        subsidy so the cost-sharing is reduced to zero.
            ``(2) No cost-sharing for pregnant women and children.--In 
        the case of a cost-sharing subsidy-eligible individual who is 
        under 18 years of age or who is a pregnant woman, there shall 
        be a cost-sharing subsidy so the cost-sharing is reduced to 
        zero.
            ``(3) Sliding scale for other individuals.--In the case of 
        cost-sharing subsidy-eligible individuals not described in 
        paragraph (1) or (2), the Commissioner, in consultation with 
        the Secretary of the Treasury, shall establish a schedule of 
        cost-sharing subsidies consistent with this paragraph. Under 
        such schedule the amount of a cost-sharing subsidy for such 
        individuals shall be such that--
                    ``(A) the cost-sharing is nominal (as defined for 
                purposes of section 1916(a)(3)) for individuals whose 
                family income is at the lowest income threshold; and
                    ``(B) as the family income increases from such 
                lowest income threshold to twice such threshold, the 
                cost-sharing subsidy is reduced in a ratable matter to 
                zero.
            ``(4) Application of a previous year's family income.--In 
        applying this subsection for cost-sharing subsidies for 
        expenses incurred for services furnished in a year, family 
        income shall be determined based on the modified AGI, as 
        defined in paragraph (7)(D), for taxable years ending in or 
        with the previous year (or, if information on such modified AGI 
        for such taxable years is not available on a timely basis, for 
        the most recent taxable years for which such information is so 
        available).
            ``(5) Application for subsidies.--A cost-sharing subsidy 
        shall not be available to a cost-sharing subsidy-eligible 
        individual under this subsection unless an application, in a 
        form and manner and containing such information and in such 
        frequency as the Commissioner shall specify, has been made for 
        such subsidy.
            ``(6) Payment of subsidies to plans.--The Commissioner 
        shall establish the form of additional payments to qualified 
        health plans to compensate such plans for cost-sharing 
        subsidies provided to enrollees under this subsection. Such 
        payments may be in such form as the Commissioner specifies and 
        may include--
                    ``(A) a capitation payment, in an amount that 
                reflects the per capita actuarial value of such 
                subsidies;
                    ``(B) reimbursement for the reductions in cost-
                sharing made to carry out this subsection; or
                    ``(C) a combination of the methodologies under 
                subparagraphs (A) and (B).
            ``(7) Definitions.--For purposes of this subsection:
                    ``(A) Cost-sharing subsidy-eligible individual 
                defined.--The term `cost-sharing subsidy-eligible 
                individual' means an AHBP-eligible individual--
                            ``(i) who is enrolled, and required under 
                        section 2202(b) to be enrolled, in a qualified 
                        health plan under this title;
                            ``(ii) whose family income does not exceed 
                        twice the lowest income threshold (as defined 
                        in subparagraph (B)); and
                            ``(iii) who does not have in effect (and 
                        any of whose family members does not have in 
                        effect), in a form and manner specified by the 
                        Commissioner, in consultation with the 
                        Secretary of the Treasury, for any portion of 
                        the year involved an objection to the release 
                        of information under section 6103(l)(21) of the 
                        Internal Revenue Code of 1986.
                    ``(B) Lowest income threshold.--The term `lowest 
                income threshold' means--
                            ``(i) in the case of coverage consisting of 
                        only an individual, 125 percent of the poverty 
                        line (as defined in section 673(2) of the 
                        Community Services Block Grant Act (42 U.S.C. 
                        9902(2)), including any revision required by 
                        such section) for a single individual; or
                            ``(ii) in the case of coverage consisting 
                        of a family of two or more individuals, 150 
                        percent of the poverty line (as so defined) for 
                        a family of the size involved.
                    ``(C) Family income.--The term `family income' 
                means, with respect to an AHBP-eligible individual who 
                is enrolled in a qualified health plan--
                            ``(i) for individual-only coverage, the 
                        modified AGI of the individual; or
                            ``(ii) for coverage that includes other 
                        family members, the sum of the modified AGI of 
                        the individual and of each other individual 
                        covered under the plan as a family member of 
                        the individual.
                The Commissioner, in consultation with the Secretary of 
                the Treasury, may provide for exclusion from family 
                income under clause (ii) of family members (such as 
                children) who have de minimis income (as specified by 
                the Commissioner).
                    ``(D) Modified agi defined.--The term `modified 
                AGI' means adjusted gross income (as defined in section 
                62 of the Internal Revenue Code of 1986)--
                            ``(i) determined without regard to sections 
                        135, 911, 931, and 933 of such Code; and
                            ``(ii) increased by the amount of interest 
                        received or accrued during the taxable year 
                        which is exempt from tax under such Code.
                In the case of an individual filing a joint return, any 
                reference in this subsection to the modified adjusted 
                gross income of such individual shall be \1/2\ such 
                return's modified adjusted gross income.

``SEC. 2206. ADMINISTRATION.

    ``(a) Application of FEHBP Rules.--
            ``(1) In general.--Except as otherwise provided in this 
        title, the program under this title shall be administered in 
        the same manner as FEHBP.
            ``(2) Specific provisions.--In carrying out this title, the 
        Commissioner pursuant to paragraph (1) shall provide for the 
        following:
                    ``(A) Approval and disapproval of plans as 
                qualified health plans.
                    ``(B) Negotiation of plan benefits (including cost-
                sharing) and plan premiums.
    ``(b) Establishment of Health Benefits Administration.--There is 
hereby established, as an independent agency in the executive branch of 
Government, a Health Benefits Administration (in this title referred to 
as the `Administration').
    ``(c) Duties.--
            ``(1) In general.--The Administration shall administer the 
        program under this title and, with respect to application of 
        any provision of FEHBP under this title, any reference in FEHBP 
        to the Director of the Office of Management and Budget is 
        deemed a reference to the Commissioner of Health Benefits.
            ``(2) Establishment of ahbp regions.--For purposes of 
        carrying out this title, the Commissioner shall divide the 
        United States into, and establish, AHBP regions.
    ``(d) Officers.--
            ``(1) Commissioner of health benefits.--
                    ``(A) In general.--There shall be in the 
                Administration a Commissioner of Health Benefits who 
                shall be appointed by the President, by and with the 
                advice and consent of the Senate.
                    ``(B) Compensation.--The Commissioner shall be 
                compensated at the rate provided for level I of the 
                Executive Schedule.
                    ``(C) Term.--The provisions of section 702(a)(3) 
                shall apply to the Commissioner of Health Benefits in 
                the same manner as they apply to the Commissioner of 
                Social Security, except that any reference to January 
                19, 2001, shall be treated as a reference to the date 
                that is January 19 of the seventh year that begins 
                after the date of the enactment of this title.
            ``(2) Deputy commissioner.--
                    ``(A) In general.--There shall be in the 
                Administration a Deputy Commissioner for Health 
                Benefits, who shall be appointed by the President, by 
                and with the advice and consent of the Senate.
                    ``(B) Application of ssa provisions.--The 
                provisions of paragraphs (2) through (4) of section 
                702(b) shall apply to the Deputy Commissioner in the 
                same manner as they apply to the Deputy Commissioner of 
                Social Security, except that any reference to January 
                19, 2001, shall be treated as a reference to the date 
                specified under paragraph (1)(C).
            ``(3) Other officers.--There shall be in the Administration 
        a Chief Actuary, Chief Financial Officer, and Inspector 
        General. The provisions of subsections (c) through (e) of 
        section 702 shall apply with respect to such officers in the 
        same manner as they apply with respect to comparable officers 
        in the Social Security Administration.
            ``(4) Personnel; budgetary matters; seal of office.--The 
        provisions of subsections (a)(1), (a)(2), (b), and (d) of 
        section 704 shall apply to the Commissioner and the 
        Administration in the same manner as they apply to the 
        Commissioner of Social Security and the Social Security 
        Administration, respectively.
    ``(e) Authority and Rulemaking.--The provisions of paragraphs (4) 
through (7) of section 702(a) shall apply to the Administration and 
Commissioner in the same manner as they apply to the Social Security 
Administration and the Commissioner of Social Security.
    ``(f) Use of Regional and Field Offices.--The Commissioner shall 
establish such regional and field offices as may be appropriate for the 
convenient and efficient administration of this title.
    ``(g) Coverage of Administration Costs.--The Commissioner shall 
provide for the collection of administrative costs of offering coverage 
under this title from entities offering qualified health plans in the 
same manner as FEHBP provides for coverage of its administrative costs.
    ``(h) Contingency Reserves.--
            ``(1) AHBP contingency reserve.--The Commissioner is 
        authorized to establish and maintain a contingency reserve for 
        purposes of carrying out this title and is authorized to impose 
        under section 2204(b)(3)(A) a premium surcharge of up to three 
        percent in order to provide financing for such reserve.
            ``(2) Plan reserves.--A qualified health plan may establish 
        contingency reserves, that are in addition to the reserve 
        described in paragraph (1), in a manner similar to that 
        permitted under FEHBP.

``SEC. 2207. DEFINITIONS.

    ``For purposes of this title, except as otherwise provided:
            ``(1) The term `Administration' means the Health Benefits 
        Administration established under section 2206(b).
            ``(2) The term `AHBP-eligible individual' means an 
        individual described in section 2202(a)(2).
            ``(3) The term `AHBP region' means a region as specified by 
        the Commissioner under section 2206(c)(2).
            ``(4) The term `Commissioner' means the Commissioner of 
        Health Benefits appointed under section 2206(d)(1).
            ``(5) The term `FEHBP' means the program under chapter 89 
        of title 5, United States Code, as in effect before the date of 
        the enactment of this title.
            ``(6) The term `qualified employer-provided coverage' means 
        health coverage that is provided on the basis of employment and 
        that the Commissioner has certified as being equivalent to the 
        coverage under qualified health plans. For purposes of the 
        previous sentence, coverage provided on the basis of employment 
        is not equivalent to coverage under a qualified health plan 
        unless the employer's share of the cost of such coverage is not 
        less than the Government's share of the cost of coverage under 
        qualified health plans.
            ``(7) The term `qualified health plan' means such a plan 
        offered under this title.''.
    (b) Effective Date; Collective Bargaining Agreements.--
            (1) Benefits.--Title XXII of the Social Security Act shall 
        first apply to benefits for items and services furnished on or 
        after January 1, 2011.
            (2) Effect on collective bargaining agreements.--Nothing in 
        this Act shall be construed as preventing a collectively 
        bargained agreement from providing coverage that is additional 
        to, or supplementary of, benefits provided under the American 
        Health Benefits Program.

SEC. 3. COLLECTION OF PREMIUMS, SUBSIDIES, AND EMPLOYER FUNDING.

    (a) Premium Collection.--
            (1) In general.--Subchapter A of chapter 1 of the Internal 
        Revenue Code of 1986 (relating to determination of tax 
        liability) is amended by adding at the end the following new 
        part:

         ``PART VIII--AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS

``Sec. 59B. American Health Benefits Program premiums.

``SEC. 59B. AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS.

    ``(a) In General.--In the case of a specified individual who is 
enrolled in a qualified health plan under title XXII of the Social 
Security Act (including by reason of a default enrollment under section 
2202(c)(2)), there is hereby imposed (in addition to any other amount 
imposed by this subtitle) for the taxable year an amount equal to the 
aggregate premiums established under such title with respect to the 
coverage under such title which covers such individual for months 
beginning in such taxable year. The amount imposed under this 
subsection shall be reduced by the amount of any government 
contribution under section 2204(a) of such Act which relates to such 
coverage.
    ``(b) Specified Individual.--For purposes of this section, the term 
`specified individual' means, with respect to coverage under title XXII 
of the Social Security Act for any month beginning in a taxable year--
            ``(1) in the case of self-only coverage, the individual 
        covered under such coverage, and
            ``(2) in the case of family coverage, each individual 
        covered under such coverage unless such individual is covered 
        under such coverage by reason of being a member of the family 
        (other than a spouse).
    ``(c) Joint and Several Liability.--In the case of an individual 
and such individual's spouse covered under family coverage--
            ``(1) each such individual shall be jointly and severally 
        liable for the amount imposed under subsection (a), and
            ``(2) the aggregate amount imposed under subsection (a) 
        with respect to such coverage may not exceed the amount imposed 
        with respect to either such individual.
    ``(d) Coordination With Other Provisions.--
            ``(1) Not treated as medical expense.--For purposes of 
        section 213, the amount imposed by this section for any taxable 
        year shall not be treated as an expense paid for medical care.
            ``(2) Not treated as tax for certain purposes.--The amount 
        imposed by this section shall not be treated as a tax imposed 
        by this chapter for purposes of determining--
                    ``(A) the amount of any credit allowable under this 
                chapter, or
                    ``(B) the amount of the minimum tax imposed by 
                section 55.
            ``(3) Treatment under subtitle f.--For purposes of subtitle 
        F, the amount imposed by this section shall be treated as if it 
        were a tax imposed by section 1.
            ``(4) Section 15 not to apply.--Section 15 shall not apply 
        to the amount imposed by this section.
            ``(5) Section not to affect liability of possessions, 
        etc.--This section shall not apply for purposes of determining 
        liability to any possession of the United States. For purposes 
        of section 932 and 7654, the amount imposed under this section 
        shall not be treated as a tax imposed by this chapter.
    ``(e) Regulations.--The Secretary may prescribe such regulations as 
may be appropriate to carry out the purposes of this section.''.
            (2) Adjustments to withholding.--Subsection (a) of section 
        3402 of such Code (relating to income tax collected at source) 
        is amended by adding at the end the following new paragraph:
            ``(3) Special rule for amounts imposed by section 59b.--
                    ``(A) In general.--In determining the amount 
                required to be deducted and withheld from wages paid to 
                an individual during any month by such individual's 
                employer, the amount imposed by section 59B shall be 
                taken into account.
                    ``(B) Wages not reduced by exemptions.--In 
                determining the amount to be deducted and withheld by 
                reason of subparagraph (A), the amount of wages shall 
                not be reduced as provided in paragraph (2).''.
            (3) Clerical amendment.--The table of parts for subchapter 
        A of chapter 1 of such Code is amended by adding at the end the 
        following new item:

       ``Part VIII--American Health Benefits Program Premiums''.

    (b) Credit for Subsidy and Prepayments of American Health Benefits 
Premiums.--
            (1) In general.--Subpart C of part IV of subchapter A of 
        chapter 1 of the Internal Revenue Code of 1986 is amended by 
        redesignating section 36 as section 37 and by inserting after 
        section 35 the following new section:

``SEC. 36. SUBSIDY AND PREPAYMENT OF AMERICAN HEALTH BENEFITS PREMIUMS.

    ``(a) In General.--In the case of a specified individual (as 
defined in section 59B(b)), there shall be allowed as a credit against 
the tax imposed by this subtitle for the taxable year an amount equal 
to the sum of--
            ``(1) the aggregate amount of premiums paid (other than any 
        government contribution under section 2204(a) of the Social 
        Security Act) with respect to the coverage of such individual 
        under title XXII of the Social Security Act, and
            ``(2) in the case of any premium subsidy-eligible 
        individual, the applicable premium subsidy.
    ``(b) Applicable Premium Subsidy.--
            ``(1) In general.--For purposes of this section, the term 
        `applicable premium subsidy' means, with respect to any premium 
        subsidy-eligible individual, the lowest premium in effect for 
        the calendar year in which the taxable year begins (for the 
        type of coverage involved) for any basic plan in the AHBP 
        region involved, as determined by the Commissioner of Health 
        Benefits.
            ``(2) Reduction based on family income.--The amount 
        otherwise determined under paragraph (1) shall be reduced (but 
        not below zero) by an amount which bears the same ratio to the 
        amount so determined as--
                    ``(A) the amount (if any) by which the taxpayer's 
                family income for the taxable year exceeds the lowest 
                income threshold, bears to
                    ``(B) the lowest income threshold.
    ``(c) Premium Subsidy-Eligible Individual.--For purposes of this 
section, the term `premium subsidy-eligible individual' means an 
individual--
            ``(1) who is enrolled, and required to be enrolled, in a 
        qualified health plan under title XXII of the Social Security 
        Act,
            ``(2) whose family income does not exceed twice the lowest 
        income threshold, and
            ``(3) who does not have in effect (and, in the case of 
        family coverage, each other individual covered under such 
        coverage does not have in effect), in a form and manner 
        specified by the Secretary of the Treasury in consultation with 
        the Commissioner of Health Benefits, for any portion of the 
        taxable year of such individual an objection to the release of 
        information under section 6103(k)(10)).
    ``(d) Lowest Income Threshold.--For purposes of this section, the 
term `lowest income threshold' means, with respect to coverage 
consisting of--
            ``(1) only an individual, 125 percent of the poverty line 
        (as defined in section 673(2) of the Community Services Block 
        Grant Act (42 U.S.C. 9902(2)), including any revision required 
        by such section) for a single individual for the calendar year 
        which includes the close of the taxable year, or
            ``(2) a family of two or more individuals, 150 percent of 
        the poverty line (as so defined) for a family of the size 
        involved for the calendar year which includes the close of the 
        taxable year.
    ``(e) Family Income.--For purposes of this section--
            ``(1) In general.--The term `family income' means, with 
        respect to a specified individual (as defined in section 
        59B(b)) covered under coverage consisting of--
                    ``(A) only such individual, the modified adjusted 
                gross income of such individual, or
                    ``(B) two or more individuals, the sum of the 
                modified adjusted gross income of the specified 
                individual and the modified adjusted gross income of 
                each other individual covered under the plan for the 
                taxable year that ends in or with the taxable year of 
                the specified individual.
            ``(2) Modified adjusted gross income.--The term `modified 
        adjusted gross income' means adjusted gross income--
                    ``(A) determined without regard to sections 135, 
                911, 931, and 933, and
                    ``(B) increased by the amount of interest received 
                or accrued during the taxable year which is exempt from 
                tax under this title.
    ``(f) Denial of Credit to Dependents.--No credit shall be allowed 
under this section to any individual with respect to whom a deduction 
under section 151 is allowable to another taxpayer for a taxable year 
beginning in the calendar year in which such individual's taxable year 
begins.
    ``(g) Regulations.--The Secretary may prescribe such regulations as 
are necessary or appropriate to carry out this section, including 
regulations which provide for not taking into account individuals with 
de minimis income for purposes of determining family income for 
purposes of this section.''.
            (2) Conforming amendments.--
                    (A) Paragraph (2) of section 1324(b) of title 31, 
                United States Code, is amended by inserting ``or 36'' 
                after ``section 35''.
                    (B) The table of section for subpart C of part IV 
                of subchapter A of chapter 1 of the Internal Revenue 
                Code of 1986 is amended by striking the item relating 
                to section 36 and inserting the following new items:

``Sec. 36. Subsidy and prepayment of American Health Benefits premiums.
``Sec. 37. Overpayments of tax.''.
    (c) Employer Funding.--
            (1) In general.--Subtitle C of the Internal Revenue Code of 
        1986 (relating to employment taxes) is amended by redesignating 
        chapter 25 as chapter 26 and by inserting after chapter 24 the 
        following new chapter:

             ``CHAPTER 25--AMERICAN HEALTH BENEFITS PROGRAM

``Sec. 3451. Tax on employers.
``Sec. 3452. Refund of tax in case of qualified employer-provided 
                            coverage.
``Sec. 3453. Instrumentalities of the United States.

``SEC. 3451. TAX ON EMPLOYERS.

    ``(a) Imposition of Tax.--In addition to other taxes, there is 
hereby imposed on every employer an excise tax, with respect to having 
individuals in his employ, equal to the applicable percentage of the 
wages paid by him with respect to employment.
    ``(b) Applicable Percentage.--For purposes of this section--
            ``(1) In general.--The term `applicable percentage' means, 
        with respect to wages paid during any taxable year of an 
        employer of a specified firm size and average earnings per 
        employee, the percentage determined in accordance with the 
        following table:

                                      ``Applicable percentage (in percent)
----------------------------------------------------------------------------------------------------------------
                                                                             Average      Average
                                                                             earnings     earnings
                                                                Average        per          per        Average
                                                                earnings   employee of  employee of    earnings
                       A firm size of:                            per       more than    more than       per
                                                              employee of  $21,000 and  $42,000 and  employee of
                                                               $21,000 or     not in       not in     more than
                                                                 less:      excess of    excess of     $83,000:
                                                                             $42,000:     $83,000:
----------------------------------------------------------------------------------------------------------------
Less than 10................................................         4.00         5.00         6.00         8.75
10 through 25...............................................         4.25         5.25         6.75         9.50
26 through 49...............................................         4.50         5.50         7.25        10.00
50 through 199..............................................         4.75         5.75         8.00        10.00
200 through 499.............................................         5.00         6.00         8.75        10.00
500 or more.................................................         5.25         6.25         9.50        10.00
----------------------------------------------------------------------------------------------------------------

            ``(2) Firm size.--The term `firm size' means, with respect 
        to any employer for any taxable year, the average number of 
        employees employed by such person during the 3 taxable years 
        preceding such taxable year.
            ``(3) Average earnings per employee.--With respect to any 
        employer for any taxable year--
                    ``(A) In general.--The term `average earnings per 
                employee' means the average earnings of such employer 
                for such taxable year divided by the firm size of such 
                employer for such taxable year.
                    ``(B) Average earnings.--The term `average 
                earnings' means the average taxable income of the 
                employer for the 3 taxable years preceding such taxable 
                year.
            ``(4) Aggregation rule.--All persons treated as a single 
        employer under subsection (a) or (b) of section 52, or 
        subsection (m) or (o) of section 414, shall be treated as one 
        person.
            ``(5) Inflation adjustment.--In the case of a taxable year 
        beginning after December 31, 2011, each of the dollar amounts 
        in the table contained in paragraphs (1) shall be increased by 
        an amount equal to--
                    ``(A) such dollar amount, multiplied by
                    ``(B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year in which 
                the taxable year begins, determined by substituting 
                `calendar year 2010' for `calendar year 1992' in 
                subparagraph (B) thereof.
        If any amount as increased under the preceding sentence is not 
        a multiple of $100, such amount shall be rounded to the nearest 
        multiple of $100.
    ``(c) No Cover Over to Possessions.--Notwithstanding any other 
provision of law, no amount collected under this chapter shall be 
covered over to any possession of the United States.
    ``(d) Other Definitions.--For purposes of this chapter, the terms 
`wages', `employer', and `employment' have the same respective meanings 
as when used in chapter 21 and section 3121(a)(1) shall apply for 
purposes of this chapter in the same manner as such section applies for 
purposes of section 3101(a) and 3111(a).

``SEC. 3452. REFUND OF TAX IN CASE OF QUALIFIED EMPLOYER-PROVIDED 
              COVERAGE.

    ``(a) In General.--In the case of a person subject to tax under 
section 3451 or section 1401(c), there shall be allowed as a credit 
against the tax imposed by such section an amount equal to the tax 
imposed under such section with respect to the wages or self-employment 
income of individuals for periods during which the individual is 
covered by qualified employer-provided coverage (which is provided by 
such person).
    ``(b) Qualified Employer-Provided Coverage.--For purposes of 
subsection (a), the term `qualified employer-provided coverage' has the 
meaning given that term in section 2207(6) of the Social Security Act.

``SEC. 3453. INSTRUMENTALITIES OF THE UNITED STATES.

    ``Notwithstanding any other provision of law (whether enacted 
before or after the enactment of this section) which grants to any 
instrumentality of the United States an exemption from taxation, such 
instrumentality shall not be exempt from the tax imposed by section 
3451 unless such other provision of law grants a specific exemption, by 
reference to section 3451, from the tax imposed by such section.''.
            (2) Self-employment.--Section 1401 of such Code is amended 
        by redesignating subsection (c) as subsection (d) and by 
        inserting after subsection (b) the following new subsection:
    ``(c) American Health Benefits Program.--In addition to other 
taxes, there shall be imposed for each taxable year, on the self-
employment income of every individual, a tax equal to the applicable 
percentage (as defined in section 3451(b)) of the amount of the self-
employment income for such taxable year.''.
            (3) Clerical amendment.--The table of chapters for subtitle 
        C of such Code is amended by striking the item relating to 
        chapter 25 and inserting the following:

             ``Chapter 25--American Health Benefits Program

    ``Chapter 26--General Provisions Relating to Employment Taxes''.

    (d) Additional Tax on Hospital Revenues.--
            (1) In general.--Subchapter A of chapter 1 of the Internal 
        Revenue Code of 1986 is amended by adding at the end the 
        following new part:

                 ``PART VIII--TAX ON HOSPITAL REVENUES

``Sec. 59B. Tax on hospital revenues.

``SEC. 59B. TAX ON HOSPITAL REVENUES.

    ``(a) In General.--In the case of a corporation, there is hereby 
imposed (in addition to any other tax imposed by this subtitle) a tax 
equal to 2 percent of the hospital revenues of such corporation.
    ``(b) Hospital Revenues.--For purposes of this section, the term 
`hospital revenues'means, with respect to any corporation for any 
taxable year, the excess (if any) of--
            ``(1) so much of such corporation's gross income for such 
        taxable year as is derived from the operation of one or more 
        hospitals (as defined in section 1861(e) of the Social Security 
        Act), over
            ``(2) so much of the deductions allowed under this chapter 
        for such taxable year as are properly allocable to such income.
    ``(c) Section 15 Not To Apply.--Section 15 shall not apply to the 
tax imposed by this section.''.
            (2) Conforming amendments.--
                    (A) Section 26(b)(2) of the Internal Revenue Code 
                of 1986 is amended by striking ``and'' at the end of 
                subparagraph (U), by striking the period at the end of 
                subparagraph (V) and inserting ``, and'', and by adding 
                at the end the following new subparagraph:
                    ``(W) section 59B (relating to tax on hospital 
                revenues).''.
                    (B) Section 30A(c) of such Code is amended by 
                striking ``or'' at the end of paragraph (3), by 
                striking the period at the end of paragraph (4) and 
                inserting ``, or'', and by adding at the end the 
                following new paragraph:
            ``(5) section 59B (relating to tax on hospital 
        revenues).''.
                    (C) Section 882(a)(1) of such Code is amended by 
                inserting ``59B,'' after ``59A,''.
                    (D) Section 936(a)(3) of such Code is amended by 
                striking ``or'' at the end of subparagraph (C), by 
                striking the period at the end of subparagraph (D) and 
                inserting ``, or'', and by adding at the end the 
                following new subparagraph:
                    ``(E) section 59B (relating to tax on hospital 
                revenues).''.
                    (E) Section 6425(c)(1)(A) of such Code is amended 
                by striking ``plus'' at the end of clause (ii), by 
                striking ``over'' at the end of clause (iii) and 
                inserting ``plus'', and by adding at the end the 
                following new clause:
                            ``(iv) the tax imposed by section 59B, 
                        over''.
                    (F) Section 6655(g)(1)(A) of such Code is amended 
                by striking ``plus'' at the end of clause (iii), by 
                redesignating clause (iv) as clause (v), and by 
                inserting after clause (iii) the following new clause:
                            ``(iv) the tax imposed by section 59B, 
                        plus''.
                    (G) The table of parts for subchapter A of chapter 
                1 of such Code is amended by adding at the end the 
                following new item:

                ``Part VIII--Tax on Hospital Revenues''.

    (e) Disclosure of Taxpayer Return Information To Carry Out Cost-
Sharing Subsidies.--
            (1) In general.--Section 6103(l) of the Internal Revenue 
        Code of 1986 is amended by adding at the end the following new 
        paragraph:
            ``(21) Disclosure of return information to carry out 
        american health benefits program.--
                    ``(A) In general.--The Secretary shall, upon 
                written request from the Commissioner of Health 
                Benefits, disclose to officers, employees, and 
                contractors of the Health Benefits Administration 
                return information of a taxpayer who is, according to 
                the records of the Secretary, a cost-sharing subsidy-
                eligible individual (as defined in section 
                2205(b)(7)(A) of the Social Security Act) or a family 
                member of such an individual. Such return information 
                shall be limited to--
                            ``(i) taxpayer identity information with 
                        respect to such taxpayer,
                            ``(ii) the filing status of such taxpayer,
                            ``(iii) the adjusted gross income of such 
                        taxpayer,
                            ``(iv) the amounts excluded from such 
                        taxpayer's gross income under sections 135 and 
                        911 to the extent such information is 
                        available,
                            ``(v) the interest received or accrued 
                        during the taxable year which is exempt from 
                        the tax imposed by chapter 1 to the extent such 
                        information is available,
                            ``(vi) the amounts excluded from such 
                        taxpayer's gross income by sections 931 and 933 
                        to the extent such information is available, 
                        and
                            ``(vii) the taxable year with respect to 
                        which the preceding information relates.
                    ``(B) Restriction on use of disclosed 
                information.--Return information disclosed under 
                subparagraph (A) may be used by officers, employees, 
                and contractors of the Health Benefits Administration 
                only for the purposes of, and to the extent necessary 
                in, establishing the appropriate amount of any cost-
                sharing subsidies under section 2205 of the Social 
                Security Act.''.
            (2) Conforming amendments.--
                    (A) Paragraph (3) of section 6103(a) of such Code 
                is amended by striking ``or (20)'' and inserting 
                ``(20), or (21)''.
                    (B) Paragraph (4) of section 6103(p) of such Code 
                is amended by striking ``(l)(16), (17), (19), or (20)'' 
                each place it appears and inserting ``(l)(16), (17), 
                (19), (20), or (21)''.
                    (C) Paragraph (2) of section 7213(a) of such Code 
                is amended by striking ``or (20)'' and inserting 
                ``(20), or (21)''.
    (f) Disclosure of Taxpayer Return Information To Carry Out Premium 
Subsidies.--Section 6103(k) of the Internal Revenue Code of 1986 is 
amended by adding at the end the following new paragraph:
            ``(10) Disclosure of information to administer premium 
        subsidy under section 36.--To the extent that Secretary 
        determines that disclosure is necessary to permit the effective 
        administration of section 36, the Secretary may disclose the 
        modified adjusted gross income (as defined in section 36) of 
        any individual whose modified adjusted gross income is taken 
        into account in determining the amount of any credit under such 
        section.''.
    (g) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall take effect on January 1, 
        2011.
            (2) Subsections (a) and (b).--The amendments made by 
        subsections (a) and (b) shall apply to months beginning after 
        December 31, 2010, in taxable years ending after such date.
            (3) Subsection (d).--The amendments made by subsection (d) 
        shall apply to taxable years beginning after December 31, 2010.

SEC. 4. AMENDMENTS TO THE MEDICAID PROGRAM AND SCHIP.

    (a) Maintenance of Effort in Medicaid Payments.--Section 1902 of 
the Social Security Act (42 U.S.C. 1396b) is amended by adding at the 
end the following new subsection:
    ``(dd)(1) For each State fiscal year that begins on or after 
January 1 of the first calendar year in which coverage is provided 
under title XXII, each State shall submit a report to the Secretary on 
the amount of State expenditures for health services, as defined by the 
Secretary.
    ``(2) Subject to paragraph (4), if the amount so reported for a 
State fiscal year is less than the amount specified in paragraph (3) 
for that State fiscal year, the State shall provide for payment to the 
Secretary of the amount of such difference. The provisions of 
subparagraphs (B) and (C) of section 1935(c)(1) shall apply to payment 
under the previous sentence in the same manner as they apply to payment 
under subparagraph (A) of such section, except that such payments shall 
be deposited into the American Health Benefits Program Trust Fund 
established under section 2204(c).
    ``(3) The amount specified in this paragraph for a State for--
            ``(A) the first State fiscal year described in paragraph 
        (1), is the total amount of the State share of expenditures for 
        health services (as defined in paragraph (1)) under all public 
        health programs operated in the State that are funded in whole 
        or in part with State expenditures, including expenditures 
        under this title and title XXI, for the previous State fiscal 
        year; and
            ``(B) a subsequent State fiscal year, is the amount 
        specified in this paragraph for the previous State fiscal year 
        increased by the percentage change, if any, in the consumer 
        price index for all urban consumers for the most recent 
        completed Federal fiscal year.
    ``(4) The Secretary may waive payment of all or a portion of the 
amount otherwise payable under paragraph (2) based on criteria 
specified by the Secretary''.
    (b) Sunset of SCHIP Funding.--Section 2105 of such Act (42 U.S.C. 
1397ee) is amended by adding at the end the following new subsection:
    ``(h) Sunset of Program Upon Initiation of American Health Benefits 
Program.--No payment shall be made under this title to a State for 
items and services furnished after the effective date of the American 
Health Benefits Program under title XXII.''.
    (c) Reduction in Medicaid DSH Payments.--Section 1923(f) of such 
Act (42 U.S.C. 1396r-4(f)) is amended--
            (1) by redesignating paragraph (7) as paragraph (8); and
            (2) by inserting after paragraph (6) the following new 
        paragraph:
            ``(7) Reduction in connection with ahbp.--Notwithstanding 
        the previous provisions in this paragraph, the Secretary shall 
        provide for a phased-down reduction over a 5-fiscal-year-period 
        beginning with fiscal year 2011 of the amount of the DSH 
        allotment for each State so that, by the end of such period, 
        such amount is equal to 10 percent of the amount of such 
        allotment for such State for fiscal year 2010.''.

SEC. 5. PROMOTION OF USE OF HEALTH INFORMATION TECHNOLOGIES.

    The Commissioner of Health Benefits (appointed under section 
2206(d)(1) of the Social Security Act, as added by section 2(a)), in 
consultation with the Secretary of Health and Human Services, shall 
establish new guidelines that promote the proper use and understanding 
of health information technologies.

SEC. 6. NON-PREEMPTION OF EXISTING COLLECTIVE BARGAINING AGREEMENTS.

    Nothing in this Act shall be construed as preempting any collective 
bargaining agreement that is in effect as of the date of the enactment 
of this Act, during the period in which such agreement is in effect 
(without regard to any extension of such agreement effected as such 
date of enactment).

SEC. 7. HEALTH BENEFITS COMMISSION.

    (a) Establishment.--There is established an independent commission 
to be known as the Health Benefits Commission (in this section referred 
to as the ``Commission'').
    (b) Duties of the Commission.--
            (1) General duties.--The Commission shall examine and make 
        recommendations regarding the major issues and cost drivers 
        affecting the delivery of healthcare services as it pertains to 
        the American Health Benefits Program under title XXII of the 
        Social Security Act (in this section referred to as ``AHBP'').
            (2) Specific issues.--The Commission shall specifically 
        examine and make recommendations regarding each of the 
        following:
                    (A) A comparison of AHBP to other public health 
                insurance programs (described in section 2202(b)(2) of 
                the Social Security Act) and the feasibility and 
                desirability of their integration into AHBP.
                    (B) The proper implementation and utilization of 
                electronic medical records and other health information 
                technologies, including privacy and interoperability 
                issues.
                    (C) The effects of medical malpractice insurance 
                and ``defensive medicine'' on the delivery and cost of 
                health care.
                    (D) The patterns and effects of overutilization on 
                AHBP.
                    (E) Cost and implementation factors of retiree 
                health coverage under AHBP.
                    (F) A comparison of prescription drug prices under 
                AHBP with such prices under other public health 
                programs.
                    (G) The effects of insurance monopolies on 
                healthcare costs and delivery.
    (c) Membership.--
            (1) Number and appointment.--The Commission shall be 
        composed of 9 members, of whom--
                    (A) one shall be appointed by the President;
                    (B) one shall be appointed by the majority leader 
                of the Senate;
                    (C) one shall be appointed by the minority leader 
                of the Senate;
                    (D) one shall be appointed by the Speaker of the 
                House of Representatives;
                    (E) one shall be appointed by the minority leader 
                of the House of Representatives; and
                    (F) four shall be appointed by the Comptroller 
                General of the United States, of whom one shall be 
                designated by the Comptroller General as the Chair and 
                another as the Vice Chair of the Commission.
            (2) Terms of appointment.--The term of any appointment 
        under paragraph (1) to the Commission shall be for 3 years.
            (3) Terms.--
                    (A) In general.--The terms of members of the 
                Commission shall be for 3 years, except that the 
                Comptroller General shall designate staggered terms for 
                the members first appointed.
                    (B) Vacancies.--Any member appointed to fill a 
                vacancy occurring before the expiration of the term for 
                which the member's predecessor was appointed shall be 
                appointed only for the remainder of that term. A member 
                may serve after the expiration of that member's term 
                until a successor has taken office. A vacancy in the 
                Commission shall be filled in the manner in which the 
                original appointment was made.
            (4) Meetings.--The Commission shall meet at the call of its 
        Chair or a majority of its members.
            (5) Quorum.--A quorum shall consist of 5 members of the 
        Commission, except that 3 members may conduct a hearing under 
        subsection (e).
            (6) Vacancies.--A vacancy on the Commission shall be filled 
        in the same manner in which the original appointment was made 
        not later than 30 days after the Commission is given notice of 
        the vacancy and shall not affect the power of the remaining 
        members to execute the duties of the Commission.
            (7) Compensation.--While serving on the business of the 
        Commission (including traveltime), a member of the Commission 
        shall be entitled to compensation at the per diem equivalent of 
        the rate provided for level IV of the Executive Schedule under 
        section 5315 of title 5, United States Code; and while so 
        serving away from home and the member's regular place of 
        business, a member may be allowed travel expenses, as 
        authorized by the Chairman of the Commission.
            (8) Chair; vice chair.--The Comptroller General shall 
        designate a member of the Commission appointed under paragraph 
        (1)(F), at the time of appointment of the member as Chair and a 
        member as Vice Chair for that term of appointment, except that 
        in the case of vacancy of the Chair or Vice Chair, the 
        Comptroller General may designate another member for the 
        remainder of that member's term.
            (9) Expenses.--Each member of the Commission shall receive 
        travel expenses and per diem in lieu of subsistence in 
        accordance with sections 5702 and 5703 of title 5, United 
        States Code.
            (10) Continuation of operation.--Section 14 of the Federal 
        Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
        Commission.
    (d) Director and Staff; Experts and Consultants.--Subject to such 
review as the Comptroller General deems necessary to assure the 
efficient administration of the Commission, the Commission may--
            (1) employ and fix the compensation of an Executive 
        Director (subject to the approval of the Comptroller General) 
        and such other personnel (not to exceed 11) as may be necessary 
        to carry out its duties (without regard to the provisions of 
        title 5, United States Code, governing appointments in the 
        competitive service);
            (2) seek such assistance and support as may be required in 
        the performance of its duties from appropriate Federal 
        departments and agencies;
            (3) enter into contracts or make other arrangements, as may 
        be necessary for the conduct of the work of the Commission 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            (4) make advance, progress, and other payments which relate 
        to the work of the Commission;
            (5) provide transportation and subsistence for persons 
        serving without compensation; and
            (6) prescribe such rules and regulations as it deems 
        necessary with respect to the internal organization and 
        operation of the Commission.
Physicians serving as personnel of the Commission may be provided a 
physician comparability allowance by the Commission in the same manner 
as Government physicians may be provided such an allowance by an agency 
under section 5948 of title 5, United States Code, and for such purpose 
subsection (i) of such section shall apply to the Commission in the 
same manner as it applies to the Tennessee Valley Authority. For 
purposes of pay (other than pay of members of the Commission) and 
employment benefits, rights, and privileges, all personnel of the 
Commission shall be treated as if they were employees of the United 
States Senate.
    (e) Powers of Commission.--
            (1) Hearings and other activities.--For the purpose of 
        carrying out its duties, the Commission may hold such hearings 
        and undertake such other activities as the Commission 
        determines to be necessary to carry out its duties.
            (2) Studies by gao.--Upon the request of the Commission, 
        the Comptroller General of the United States shall conduct such 
        studies or investigations as the Commission determines to be 
        necessary to carry out its duties.
            (3) Cost estimates by congressional budget office.--
                    (A) The Director of the Congressional Budget Office 
                shall provide to the Commission, upon the request of 
                the Commission, such cost estimates as the Commission 
                determines to be necessary to carry out its duties.
                    (B) The Commission shall reimburse the Director of 
                the Congressional Budget Office for expenses relating 
                to the employment in the office of the Director of such 
                additional staff as may be necessary for the Director 
                to comply with requests by the Commission under 
                subparagraph (A).
            (4) Detail of federal employees.--Upon the request of the 
        Commission, the head of any Federal agency is authorized to 
        detail, without reimbursement, any of the personnel of such 
        agency to the Commission to assist the Commission in carrying 
        out its duties. Any such detail shall not interrupt or 
        otherwise affect the civil service status or privileges of the 
        Federal employee.
            (5) Technical assistance.--Upon the request of the 
        Commission, the head of a Federal agency shall provide such 
        technical assistance to the Commission as the Commission 
        determines to be necessary to carry out its duties.
            (6) Use of mails.--The Commission may use the United States 
        mails in the same manner and under the same conditions as 
        Federal agencies and shall, for purposes of the frank, be 
        considered a commission of Congress as described in section 
        3215 of title 39, United States Code.
            (7) Obtaining information.--The Commission may secure 
        directly from any Federal agency information necessary to 
        enable it to carry out its duties, if the information may be 
        disclosed under section 552 of title 5, United States Code. 
        Upon request of the Chairman of the Commission, the head of 
        such agency shall furnish such information to the Commission.
            (8) Administrative support services.--Upon the request of 
        the Commission, the Administrator of General Services shall 
        provide to the Commission on a reimbursable basis such 
        administrative support services as the Commission may request.
            (9) Printing.--For purposes of costs relating to printing 
        and binding, including the cost of personnel detailed from the 
        Government Printing Office, the Commission shall be deemed to 
        be a committee of the Congress.
    (f) Reports.--
            (1) Initial findings.--Not later than 6 months after the 
        date of the enactment of this Act, the Commission shall submit 
        to the Commissioner of Health Benefits and to appropriate 
        committees of Congress a report which contains a statement of 
        the initial findings of the Commission.
            (2) Initial report.--Not later than 18 months after the 
        date of the enactment of this Act, the Commission shall submit 
        to such Commissioner and committees an initial report which 
        contains a detailed statement of its recommendations, findings, 
        and conclusions of the Commission.
            (3) Annual report.--Subsequently, the Commission shall 
        annually submit to such Commissioner and such committees a 
        report containing such a statement.
            (4) Other reports.--The Commission may issue such other 
        reports at such times as the Commission determines appropriate.
            (5) Supermajority requirement.--The Commission shall not 
        include in any report submitted under this subsection a 
        recommendation, finding, or conclusion unless it has received 
        the approval of at least 6 members of the Commission.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated for each fiscal year beginning with fiscal year 2009 such 
sums as are necessary to carry out this section.
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