I 

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. 

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; FINDINGS; TABLE OF CONTENTS. 

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

5 ‘‘American Health Benefits Program Act of 2008’’. 

6 (b) FINDINGS.—Congress finds the following: 


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1 (1) UNINSURED AMERICANS AND LACK OF AC2 CESS TO CHOICES.—(A) In 2006, 46.5 million Amer3 icans were uninsured, over 80 percent of whom were 

4 employed (or dependents of individuals who were 

5 employed). 

6 (B) Health care providers provided to unin7 sured Americans $41 billion in care for which they 

8 were not compensated by the individuals or through 

9 insurance. 

10 (C) Only 8 percent of employers providing 

11 health benefits are able to offer their employees a 

12 choice between two or more health plans. 

13 (2) DOUBLE-DIGIT GROWTH IN EMPLOYER

14 COSTS.—In 2003 the average per capita cost for em15 ployers to provide health benefits coverage increased 

16 by almost 14 percent. This was the third consecutive 

17 year of double-digit increases in such cost. 

18 (3) ADMINISTRATIVE EFFICIENCY OF USING

19 FEHBP MODEL FOR PROVIDING HEALTH INSURANCE

20 COVERAGE.—(A) The private insurance market pre21 sents increasing administrative challenges for em22 ployers in seeking out, contracting with, and admin23 istering health benefits. 

24 (B) The Federal Employee Health Benefits 

25 Program (FEHBP) currently manages negotiations 


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1 with health insurers over premiums and benefits on 

2 behalf of 8.6 million Federal employees and retirees 

3 and their dependents. 

4 (C) Overhead costs for employers providing 

5 health benefits coverage can be over 30 percent for 

6 employers with fewer than 10 employees and about 

7 12 percent for employers with more than 500 em8 ployees. 

9 (D) In comparison, the overhead cost of cov10 erage provided under FEHBP is about 3 percent. 

11 (4) EXPANSION OF FEHBP MODEL TO COVER

12 UNINSURED AND OTHER AMERICANS.—Requiring 

13 participation in an FEHBP-style program would ex14 pand consumer choice, ensure portability and con15 tinuity of coverage, improve incentives for cost con16 tainment, and stabilize the burden on businesses 

17 (5) PERSONAL RESPONSIBILITY.—A recent sur18 vey indicates that a clear majority of Americans sees 

19 securing health insurance coverage as a personal re20 sponsibility for themselves and others. 

21 (6) SAVINGS FROM IMPLEMENTATION OF

22 HEALTH INFORMATION TECHNOLOGY.—Properly im23 plemented and widely adopted health information 

24 technology could significantly improve the quality, 


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1 safety and efficiency of healthcare delivery while sav2 ing an estimated $77 billion per year 

3 (c) TABLE OF CONTENTS.—The table of contents of 

4 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. 

5 SEC. 2. ESTABLISHMENT OF AMERICAN HEALTH BENEFITS 

6 PROGRAM. 

7 (a) IN GENERAL.—The Social Security Act is amend8 ed by adding at the end the following new title: 

9 ‘‘TITLE XXII—AMERICAN 

10 HEALTH BENEFITS PROGRAM 

11 ‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM. 

12 ‘‘There is established under this title a program (to 

13 be known as the ‘American Health Benefits Program’) to 

14 provide comprehensive health insurance coverage to all 

15 Americans who are not covered under certain Federal 

16 health insurance programs and who are not eligible for 

17 employer-provided insurance coverage. The coverage shall 


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1 be provided in a manner similar to the manner in which 

2 coverage has been provided to Members of Congress and 

3 Federal Government employees and retirees and their de4 pendents under the Federal Employees Health Benefits 

5 Program (FEHBP). 

6 ‘‘SEC. 2202. ELIGIBILITY; REQUIREMENT OF COVERAGE. 

7 ‘‘(a) ELIGIBILITY.— 

8 ‘‘(1) IN GENERAL.—Each AHBP-eligible indi9 vidual is eligible to enroll in a qualified health plan 

10 offered under this title. 

11 ‘‘(2) AHBP-ELIGIBLE INDIVIDUAL DEFINED.— 

12 ‘‘(A) IN GENERAL.—For purposes of this 

13 title, the term ‘AHBP-eligible individual’ means 

14 an individual residing in the United States who 

15 is— 

16 ‘‘(i) a citizen or national of the United 

17 States; 

18 ‘‘(ii) an alien lawfully admitted to the 

19 United States for permanent residence; 

20 ‘‘(iii) an alien admitted into the 

21 United States under section 207 of the Im22 migration and Nationality Act (relating to 

23 refugees); 

24 ‘‘(iv) an alien otherwise permanently 

25 residing in the United States under color 


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1 of law (as specified by the Commissioner); 

2 or 

3 ‘‘(v) an alien with the status of a non4 immigrant who is within a class of long5 term nonimmigrants under section 

6 101(a)(15) of the Immigration and Nation7 ality Act that the Commissioner deter8 mines, in consultation with the Secretary 

9 of Homeland Security, to be appropriate. 

10 ‘‘(B) EXCEPTIONS.—Such term does not 

11 include the following individuals: 

12 ‘‘(i) INDIVIDUALS ELIGIBLE FOR

13 QUALIFIED EMPLOYER-PROVIDED COV14 ERAGE.—An individual who is eligible for 

15 employer-provided coverage, as defined in 

16 section 2207(6), whether an employee, de17 pendent, or otherwise. 

18 ‘‘(ii) INCARCERATED INDIVIDUALS.— 

19 An individual who is incarcerated (as spec20 ified by the Commissioner). 

21 ‘‘(b) REQUIREMENT OF COVERAGE.— 

22 ‘‘(1) IN GENERAL.—Except as provided in this 

23 subsection, each AHBP-eligible individual shall be 

24 enrolled in a qualified health plan under this title. 


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1 ‘‘(2) EXCEPTION FOR INDIVIDUALS DEM2 ONSTRATING PUBLIC HEALTH INSURANCE COV3 ERAGE.—The requirement of paragraph (1) shall 

4 not apply to an individual who demonstrates cov5 erage under any of the following: 

6 ‘‘(A) MEDICARE.—Coverage under parts A 

7 and B (or under part C) of title XVIII. 

8 ‘‘(B) MEDICAID.—Coverage under a State 

9 plan under title XIX. 

10 ‘‘(C) TRICARE/CHAMPUS.—Coverage 

11 under the TRICARE program under chapter 

12 55, of title 10, United States Code. 

13 ‘‘(D) INDIAN HEALTH SERVICES.—Cov14 erage under a medical care program of the In15 dian Health Service or of a tribal organization. 

16 ‘‘(E) VETERANS HEALTH.—Coverage 

17 under the veterans health care program under 

18 chapter 17 of title 38, United States Code, if 

19 the coverage for the individual involved is deter20 mined to be not less than the coverage provided 

21 under a qualified health plan, based on the indi22 vidual’s priority for services as provided under 

23 section 1705(a) of such title. 


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1 ‘‘(3) EXCEPTION FOR NONIMMIGRANTS.—The 

2 requirement of paragraph (1) shall not apply to an 

3 individual described in subsection (a)(2)(A)(v). 

4 ‘‘(4) EXCEPTION BASED ON RELIGIOUS OBJEC5 TION.—The requirement of paragraph (1) shall not 

6 apply to an individual who executes a written state7 ment (in a form and manner specified by the Sec8 retary) that— 

9 ‘‘(A) the individual is conscientiously op10 posed to acceptance of medical treatment of the 

11 type covered by qualified health plans; and 

12 ‘‘(B) the individual’s acceptance of medical 

13 treatment covered by such a plan would be in14 consistent with the individual’s sincere religious 

15 beliefs. 

16 ‘‘(c) ENROLLMENT; DEFAULT ENROLLMENT.— 

17 ‘‘(1) IN GENERAL.—The Commissioner shall es18 tablish a process for AHBP-eligible individuals to 

19 enroll in qualified health plans. Such process shall 

20 be based on the enrollment process used under 

21 FEHBP and shall provide for the dissemination of 

22 information to AHBP-eligible individuals on quali23 fied health plans being offered. 

24 ‘‘(2) DEFAULT ENROLLMENT.— 


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1 ‘‘(A) IN GENERAL.—The Commissioner 

2 shall establish a procedure under which an 

3 AHBP-eligible individual who is required under 

4 subsection (b) to enroll, but is not enrolled, in 

5 a qualified health plan will be assigned to, and 

6 enrolled in, such a plan. 

7 ‘‘(B) RULES.—In carrying out subpara8 graph (A), the Commissioner shall assign 

9 AHBP-eligible individuals and families to the 

10 basic plan the premium of which is the lowest 

11 premium for the AHBP region or other area in 

12 which the individuals or families reside. 

13 ‘‘(3) CHANGES IN ENROLLMENT.—The Com14 missioner shall establish enrollment procedures that 

15 include an annual open season and permit changes 

16 in enrollment with qualified health plans at other 

17 times (such as by reason of changes in marital or 

18 dependent status). Such procedures shall be based 

19 on the enrollment procedures established under 

20 FEHBP. 

21 ‘‘(d) TREATMENT OF FAMILY MEMBERS.—Enroll22 ment under this title shall include both individual and 

23 family enrollment, in a manner similar to that provided 

24 under FEHBP. To the extent consistent with eligibility 

25 under subsection (a), the Commissioner shall provide rules 


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1 similar to the rules under FEHBP for the enrollment of 

2 family members who are AHBP-eligible individuals in the 

3 same plan, except that such rules shall permit a family 

4 consisting only of a married couple to elect to enroll each 

5 spouse in a different qualified health plan. 

6 ‘‘(e) CHANGES IN PLAN ENROLLMENT.—The Com7 missioner shall provide for and permit changes in the 

8 qualified health plan in which an individual or family is 

9 enrolled under this section in a manner similar to the 

10 manner in which such changes are provided or permitted 

11 under FEHBP. The Commissioner shall provide for termi12 nation of such enrollment for an individual at the time 

13 the individual is no longer an AHBP-eligible individual. 

14 ‘‘(f) ENROLLMENT GUIDES.—The Commissioner 

15 shall provide for the broad dissemination of information 

16 on qualified health plans offered under this title. Such in17 formation shall be provided in a comparative manner, 

18 similar to that used under FEHBP, and shall include in19 formation, collected through surveys of enrollees, on meas20 ures of enrollee satisfaction with the different plans. 

21 ‘‘SEC. 2203. QUALIFIED HEALTH PLANS; BENEFITS; PRE22 MIUMS. 

23 ‘‘(a) OFFERING OF PLANS.— 

24 ‘‘(1) CONTRACTS.—The Commissioner shall 

25 enter into contracts with entities for the offering of 


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1 qualified health plans in accordance with this title. 

2 Such contracts shall be entered into in a manner 

3 similar to the process by which the Director of the 

4 Office of Personnel Management is authorized to 

5 enter into contracts with health benefits plans under 

6 FEHBP. 

7 ‘‘(2) REQUIREMENTS FOR ENTITIES OFFERING

8 PLANS.—No such contract shall be entered into with 

9 an entity for the offering of a qualified health plan 

10 in a region unless the entity— 

11 ‘‘(A) is licensed as a health maintenance 

12 organization in that State or is licensed to sell 

13 group health insurance coverage in that State; 

14 ‘‘(B) meets such requirements, similar to 

15 requirements under FEHBP, as the Commis16 sioner may establish relating to solvency, orga17 nization, structure, governance, access, and 

18 quality; 

19 ‘‘(C) agrees to participate in the high-risk 

20 reinsurance pool described in subsection (d); 

21 and 

22 ‘‘(D) provides assurances satisfactory to 

23 the Commissioner that at least 90 percent of 

24 the premium payments for the plan will be re25 turned in the form of aggregate health care 


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1 benefits or improvements, including health in2 formation technology. 

3 ‘‘(3) CONTRACTING WITH LIMITED NUMBER OF

4 PLANS IN A REGION WITHIN TYPES OF PLANS.— 

5 ‘‘(A) IN GENERAL.—The Commissioner 

6 shall contract with only a limited number of 

7 qualified health plans of each type (as specified 

8 under subparagraph (B)) in each AHBP region. 

9 ‘‘(B) TYPES OF PLANS.—For purposes of 

10 subparagraph (A), the Commissioner shall clas11 sify the different types of qualified health plans, 

12 such as fee-for-service plans, health mainte13 nance plans, preferred provider plans, and other 

14 types of plans. 

15 ‘‘(b) FEHBP SCOPE OF BENEFITS.— 

16 ‘‘(1) COMPREHENSIVE BENEFITS.—Qualified 

17 health plans shall provide for the same scope and 

18 type of comprehensive benefits that have been pro19 vided under FEHBP, including the types of benefits 

20 described in section 8904 of title 5, United States 

21 Code and including benefits previously required by 

22 regulation or direction (such as preventive benefits, 

23 including childhood immunization and cancer screen24 ing, and mental health parity) under FEHBP. 


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1 ‘‘(2) NO EXCLUSION FOR PRE-EXISTING CONDI2 TIONS.—Qualified health plans shall not impose pre3 existing condition exclusions or otherwise discrimi4 nate against any enrollee based on the health status 

5 of such enrollee (including genetic information relat6 ing to such enrollee). 

7 ‘‘(3) OTHER CONSUMER PROTECTIONS.—Quali8 fied health plans also shall meet consumer and pa9 tient protection requirements that the Commissioner 

10 establishes, based on similar requirements previously 

11 imposed under FEHBP, including protections of pa12 tients’ rights previously effected pursuant to Execu13 tive Memorandum. 

14 ‘‘(c) COMMUNITY-RATED PREMIUMS.— 

15 ‘‘(1) IN GENERAL.—The premiums established 

16 for a qualified health plan under this title for indi17 vidual or family coverage shall be community-rated 

18 and shall not vary based on age, gender, health sta19 tus (including genetic information), or other factors. 

20 ‘‘(2) COLLECTION PROCESS.—The Commis21 sioner shall establish a process for the timely and 

22 accurate collection of premiums owed by enrollees, 

23 taking into account any Government contribution 

24 under section 2204(a) and any premium subsidy re25 ferred to in section 2205(a). Such process shall inVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 clude methods for payment through payroll with2 holding, as well as payment through automatic deb3 iting of accounts with financial institutions, and 

4 shall be coordinated with the application of section 

5 59B of the Internal Revenue Code of 1986. Such 

6 premiums shall be deposited into the American 

7 Health Benefits Program Trust Fund established 

8 under section 2204(c). 

9 ‘‘(d) HIGH-RISK REINSURANCE POOL.—The Com10 missioner shall establish an arrangement among the enti11 ties offering qualified health plans under which such enti12 ties contribute in an equitable manner (as determined by 

13 the Commissioner) into a fund that provides payment to 

14 plans for a percentage (specified by the Commissioner and 

15 not to exceed 90 percent) of the costs that they incur for 

16 enrollees beyond a predetermined threshold specified from 

17 time to time by the Commissioner. 

18 ‘‘(e) MARKETING PRACTICES AND COSTS.—The 

19 Commissioner shall monitor marketing practices with re20 spect to qualified health plans in order to assure— 

21 ‘‘(1) the accuracy of the information dissemi22 nated regarding such plans; and 

23 ‘‘(2) that costs of marketing are reasonable and 

24 do not exceed a percentage of total costs that is 

25 specified by the Commissioner and that takes into 


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1 account costs of market entry for new qualified 

2 health plans. 

3 ‘‘SEC. 2204. GOVERNMENT CONTRIBUTION; AMERICAN 

4 HEALTH BENEFITS PROGRAM TRUST FUND. 

5 ‘‘(a) GOVERNMENT CONTRIBUTION.— 

6 ‘‘(1) IN GENERAL.—The Commissioner shall 

7 provide each year for a contribution under this sub8 section towards the coverage provided under this 

9 title for those AHBP-eligible individuals who are re10 quired to be enrolled in a qualified health plan under 

11 section 2202(b). Except as provided in this sub12 section, the amount of such contribution shall be de13 termined using the same methodology that is applied 

14 for purposes of determining the Government con15 tribution under section 8906 of title 5, United 

16 States Code and shall not exceed 75 percent of the 

17 premium for the plan selected. 

18 ‘‘(2) USE OF REGIONAL WEIGHTED AVERAGE.— 

19 Instead of computing the Government contribution 

20 using methodology under section 8906(b)(1) of title 

21 5, United States Code, based on 72 percent of the 

22 weighted average premium for qualified health plans 

23 nationally, the Commissioner shall compute such 

24 contribution based on 72 percent of the weighted avVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 erage premium for qualified health plans in each re2 gion involved (as identified by the Commissioner). 

3 ‘‘(b) PLAN PAYMENT.— 

4 ‘‘(1) IN GENERAL.—The Commissioner shall 

5 provide for payment of qualified health plans of the 

6 premiums for such plans, as adjusted under this 

7 subsection. 

8 ‘‘(2) RISK ADJUSTED PAYMENT.—The payment 

9 to a qualified health plan under this subsection shall 

10 be adjusted in a budget-neutral manner specified by 

11 the Commissioner to reflect the actuarial risk of the 

12 enrollees in the plan compared to an average actu13 arial risk. 

14 ‘‘(3) REDUCTION FOR ADMINISTRATIVE EX15 PENSES AND CONTINGENCY RESERVE.—The Com16 missioner shall provide for a uniform percentage re17 duction in payment otherwise made to a qualified 

18 health plan under this subsection. Such percentage 

19 shall consist of the following: 

20 ‘‘(A) CONTINGENCY RESERVE.—A percent21 age (not to exceed 3 percent) to provide for a 

22 contingency reserve described in section 

23 2206(h)(1). 

24 ‘‘(B) FEDERAL ADMINISTRATIVE COSTS.— 

25 A percentage (not to exceed 5 percent) to cover 


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1 Federal administrative costs in implementing 

2 this title. 

3 ‘‘(c) TRUST FUND.— 

4 ‘‘(1) ESTABLISHMENT.—There is hereby estab5 lished a trust fund, to be known as the ‘American 

6 Health Benefits Program Trust Fund’ (in this sub7 section referred to as the ‘Trust Fund’). 

8 ‘‘(2) DEPOSITS.—The Trust Fund shall consist 

9 of such gifts and bequests as may be provided in 

10 section 201(i)(1) and such amounts as may be de11 posited in, or appropriated to, such fund as provided 

12 in this title. There are hereby appropriated to the 

13 Trust Fund, out of any moneys in the Treasury not 

14 otherwise appropriated, amounts equivalent to 100 

15 percent of— 

16 ‘‘(A) the taxes imposed by section 3451 of 

17 the Internal Revenue Code of 1986 with respect 

18 to wages reported to the Secretary of the 

19 Treasury or the Secretary ’s delegate pursuant 

20 to subtitle F of such Code, as determined by 

21 the Secretary of the Treasury by applying the 

22 applicable rates of tax under such section to 

23 such wages, which wages shall be certified by 

24 the Commissioner of Social Security on the 

25 basis of records of wages established and mainVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 tained by such Commissioner in accordance 

2 with such reports; 

3 ‘‘(B) the taxes imposed by section 1401(c) 

4 of the Internal Revenue Code of 1986 with re5 spect to self-employment income reported to the 

6 Secretary of the Treasury or the Secretary’s 

7 delegate pursuant to subtitle F of such Code, as 

8 determined by the Secretary of the Treasury by 

9 applying the applicable rates of tax under such 

10 section to such self-employment income, which 

11 self-employment income shall be certified by the 

12 Commissioner of Social Security on the basis of 

13 records of self-employment established and 

14 maintained by such Commissioner in accord15 ance with such returns; and 

16 ‘‘(C) the excess of the amounts imposed 

17 under section 59B of the Internal Revenue 

18 Code of 1986 over the amounts of credits al19 lowed under section 36. 

20 The amounts appropriated by the preceding sentence 

21 shall be transferred from time to time from the gen22 eral fund in the Treasury to the Trust Fund, such 

23 amounts to be determined on the basis of estimates 

24 by the Secretary of the Treasury of the taxes, speci25 fied in the preceding sentence, paid to or deposited 


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1 into the Treasury; and proper adjustments shall be 

2 made in amounts subsequently transferred to the ex3 tent prior estimates were in excess of or were less 

4 than the taxes specified in such sentence. 

5 ‘‘(3) APPLICATION OF TRUST FUND PROVI6 SIONS.—The provisions of subsections (b) through 

7 (f) of section 1817 shall apply to the Trust Fund in 

8 the same manner as they apply to the Federal Hos9 pital Insurance Trust Fund, except that, for pur10 poses of this paragraph, any reference in such sub11 sections to a provision of the Internal Revenue Code 

12 of 1986 is deemed a reference to the corresponding 

13 provision of such Code referred to in paragraph (2) 

14 of this subsection. 

15 ‘‘SEC. 2205. PREMIUM AND COST-SHARING SUBSIDIES FOR 

16 LOWER INCOME INDIVIDUALS. 

17 ‘‘(a) PREMIUM SUBSIDIES.—The Commissioner, in 

18 consultation with the Secretary of the Treasury, shall as19 sist individuals in estimating the amount of the premium 

20 subsidy which will be allowed to such individuals under 

21 section 36 of the Internal Revenue Code of 1986 with re22 spect to any month, and shall take the estimated amount 

23 of such premium subsidy into account for purposes of col24 lecting any premium under section 2203(c)(2). 

25 ‘‘(b) COST-SHARING SUBSIDIES.— 


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1 ‘‘(1) NO COST-SHARING FOR INDIVIDUALS WITH

2 FAMILY INCOME BELOW LOWEST INCOME THRESH3 OLD.—In the case of a cost-sharing subsidy-eligible 

4 individual whose family income is less than the low5 est income threshold, there shall be a cost-sharing 

6 subsidy so the cost-sharing is reduced to zero. 

7 ‘‘(2) NO COST-SHARING FOR PREGNANT WOMEN

8 AND CHILDREN.—In the case of a cost-sharing sub9 sidy-eligible individual who is under 18 years of age 

10 or who is a pregnant woman, there shall be a cost11 sharing subsidy so the cost-sharing is reduced to 

12 zero. 

13 ‘‘(3) SLIDING SCALE FOR OTHER INDIVID14 UALS.—In the case of cost-sharing subsidy-eligible 

15 individuals not described in paragraph (1) or (2), 

16 the Commissioner, in consultation with the Secretary 

17 of the Treasury, shall establish a schedule of cost18 sharing subsidies consistent with this paragraph. 

19 Under such schedule the amount of a cost-sharing 

20 subsidy for such individuals shall be such that— 

21 ‘‘(A) the cost-sharing is nominal (as de22 fined for purposes of section 1916(a)(3)) for in23 dividuals whose family income is at the lowest 

24 income threshold; and 


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1 ‘‘(B) as the family income increases from 

2 such lowest income threshold to twice such 

3 threshold, the cost-sharing subsidy is reduced in 

4 a ratable matter to zero. 

5 ‘‘(4) APPLICATION OF A PREVIOUS YEAR’S FA M6 ILY INCOME.—In applying this subsection for cost7 sharing subsidies for expenses incurred for services 

8 furnished in a year, family income shall be deter9 mined based on the modified AGI, as defined in 

10 paragraph (7)(D), for taxable years ending in or 

11 with the previous year (or, if information on such 

12 modified AGI for such taxable years is not available 

13 on a timely basis, for the most recent taxable years 

14 for which such information is so available). 

15 ‘‘(5) APPLICATION FOR SUBSIDIES.—A cost16 sharing subsidy shall not be available to a cost-shar17 ing subsidy-eligible individual under this subsection 

18 unless an application, in a form and manner and 

19 containing such information and in such frequency 

20 as the Commissioner shall specify, has been made 

21 for such subsidy. 

22 ‘‘(6) PAYMENT OF SUBSIDIES TO PLANS.—The 

23 Commissioner shall establish the form of additional 

24 payments to qualified health plans to compensate 

25 such plans for cost-sharing subsidies provided to enVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 rollees under this subsection. Such payments may be 

2 in such form as the Commissioner specifies and may 

3 include— 

4 ‘‘(A) a capitation payment, in an amount 

5 that reflects the per capita actuarial value of 

6 such subsidies; 

7 ‘‘(B) reimbursement for the reductions in 

8 cost-sharing made to carry out this subsection; 

9 or 

10 ‘‘(C) a combination of the methodologies 

11 under subparagraphs (A) and (B). 

12 ‘‘(7) DEFINITIONS.—For purposes of this sub13 section: 

14 ‘‘(A) COST-SHARING SUBSIDY-ELIGIBLE IN15 DIVIDUAL DEFINED.—The term ‘cost-sharing 

16 subsidy-eligible individual’ means an AHBP-eli17 gible individual— 

18 ‘‘(i) who is enrolled, and required 

19 under section 2202(b) to be enrolled, in a 

20 qualified health plan under this title; 

21 ‘‘(ii) whose family income does not ex22 ceed twice the lowest income threshold (as 

23 defined in subparagraph (B)); and 

24 ‘‘(iii) who does not have in effect (and 

25 any of whose family members does not 


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1 have in effect), in a form and manner 

2 specified by the Commissioner, in consulta3 tion with the Secretary of the Treasury, 

4 for any portion of the year involved an ob5 jection to the release of information under 

6 section 6103(l)(21) of the Internal Rev7 enue Code of 1986. 

8 ‘‘(B) LOWEST INCOME THRESHOLD.—The 

9 term ‘lowest income threshold’ means— 

10 ‘‘(i) in the case of coverage consisting 

11 of only an individual, 125 percent of the 

12 poverty line (as defined in section 673(2) 

13 of the Community Services Block Grant 

14 Act (42 U.S.C. 9902(2)), including any re15 vision required by such section) for a sin16 gle individual; or 

17 ‘‘(ii) in the case of coverage consisting 

18 of a family of two or more individuals, 150 

19 percent of the poverty line (as so defined) 

20 for a family of the size involved. 

21 ‘‘(C) FAMILY INCOME.—The term ‘family 

22 income’ means, with respect to an AHBP-eligi23 ble individual who is enrolled in a qualified 

24 health plan— 


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1 ‘‘(i) for individual-only coverage, the 

2 modified AGI of the individual; or 

3 ‘‘(ii) for coverage that includes other 

4 family members, the sum of the modified 

5 AGI of the individual and of each other in6 dividual covered under the plan as a family 

7 member of the individual. 

8 The Commissioner, in consultation with the 

9 Secretary of the Treasury, may provide for ex10 clusion from family income under clause (ii) of 

11 family members (such as children) who have de 

12 minimis income (as specified by the Commis13 sioner). 

14 ‘‘(D) MODIFIED AGI DEFINED.—The term 

15 ‘modified AGI’ means adjusted gross income 

16 (as defined in section 62 of the Internal Rev17 enue Code of 1986)— 

18 ‘‘(i) determined without regard to sec19 tions 135, 911, 931, and 933 of such 

20 Code; and 

21 ‘‘(ii) increased by the amount of inter22 est received or accrued during the taxable 

23 year which is exempt from tax under such 

24 Code. 


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1 In the case of an individual filing a joint return, 

2 any reference in this subsection to the modified 

3 adjusted gross income of such individual shall 

be 1 4 ⁄2 such return’s modified adjusted gross in5 come. 

6 ‘‘SEC. 2206. ADMINISTRATION. 

7 ‘‘(a) APPLICATION OF FEHBP RULES.— 

8 ‘‘(1) IN GENERAL.—Except as otherwise pro9 vided in this title, the program under this title shall 

10 be administered in the same manner as FEHBP. 

11 ‘‘(2) SPECIFIC PROVISIONS.—In carrying out 

12 this title, the Commissioner pursuant to paragraph 

13 (1) shall provide for the following: 

14 ‘‘(A) Approval and disapproval of plans as 

15 qualified health plans. 

16 ‘‘(B) Negotiation of plan benefits (includ17 ing cost-sharing) and plan premiums. 

18 ‘‘(b) ESTABLISHMENT OF HEALTH BENEFITS AD19 MINISTRATION.—There is hereby established, as an inde20 pendent agency in the executive branch of Government, 

21 a Health Benefits Administration (in this title referred to 

22 as the ‘Administration’). 

23 ‘‘(c) DUTIES.— 

24 ‘‘(1) IN GENERAL.—The Administration shall 

25 administer the program under this title and, with reVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 spect to application of any provision of FEHBP 

2 under this title, any reference in FEHBP to the Di3 rector of the Office of Management and Budget is 

4 deemed a reference to the Commissioner of Health 

5 Benefits. 

6 ‘‘(2) ESTABLISHMENT OF AHBP REGIONS.—For 

7 purposes of carrying out this title, the Commissioner 

8 shall divide the United States into, and establish, 

9 AHBP regions. 

10 ‘‘(d) OFFICERS.— 

11 ‘‘(1) COMMISSIONER OF HEALTH BENEFITS.— 

12 ‘‘(A) IN GENERAL.—There shall be in the 

13 Administration a Commissioner of Health Ben14 efits who shall be appointed by the President, 

15 by and with the advice and consent of the Sen16 ate. 

17 ‘‘(B) COMPENSATION.—The Commissioner 

18 shall be compensated at the rate provided for 

19 level I of the Executive Schedule. 

20 ‘‘(C) TERM.—The provisions of section 

21 702(a)(3) shall apply to the Commissioner of 

22 Health Benefits in the same manner as they 

23 apply to the Commissioner of Social Security, 

24 except that any reference to January 19, 2001, 

25 shall be treated as a reference to the date that 


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1 is January 19 of the seventh year that begins 

2 after the date of the enactment of this title. 

3 ‘‘(2) DEPUTY COMMISSIONER.— 

4 ‘‘(A) IN GENERAL.—There shall be in the 

5 Administration a Deputy Commissioner for 

6 Health Benefits, who shall be appointed by the 

7 President, by and with the advice and consent 

8 of the Senate. 

9 ‘‘(B) APPLICATION OF SSA PROVISIONS.— 

10 The provisions of paragraphs (2) through (4) of 

11 section 702(b) shall apply to the Deputy Com12 missioner in the same manner as they apply to 

13 the Deputy Commissioner of Social Security, 

14 except that any reference to January 19, 2001, 

15 shall be treated as a reference to the date speci16 fied under paragraph (1)(C). 

17 ‘‘(3) OTHER OFFICERS.—There shall be in the 

18 Administration a Chief Actuary, Chief Financial Of19 ficer, and Inspector General. The provisions of sub20 sections (c) through (e) of section 702 shall apply 

21 with respect to such officers in the same manner as 

22 they apply with respect to comparable officers in the 

23 Social Security Administration. 

24 ‘‘(4) PERSONNEL; BUDGETARY MATTERS; SEAL

25 OF OFFICE.—The provisions of subsections (a)(1), 


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1 (a)(2), (b), and (d) of section 704 shall apply to the 

2 Commissioner and the Administration in the same 

3 manner as they apply to the Commissioner of Social 

4 Security and the Social Security Administration, re5 spectively. 

6 ‘‘(e) AUTHORITY AND RULEMAKING.—The provisions 

7 of paragraphs (4) through (7) of section 702(a) shall 

8 apply to the Administration and Commissioner in the 

9 same manner as they apply to the Social Security Admin10 istration and the Commissioner of Social Security. 

11 ‘‘(f) USE OF REGIONAL AND FIELD OFFICES.—The 

12 Commissioner shall establish such regional and field of13 fices as may be appropriate for the convenient and effi14 cient administration of this title. 

15 ‘‘(g) COVERAGE OF ADMINISTRATION COSTS.—The 

16 Commissioner shall provide for the collection of adminis17 trative costs of offering coverage under this title from enti18 ties offering qualified health plans in the same manner 

19 as FEHBP provides for coverage of its administrative 

20 costs. 

21 ‘‘(h) CONTINGENCY RESERVES.— 

22 ‘‘(1) AHBP CONTINGENCY RESERVE.—The 

23 Commissioner is authorized to establish and main24 tain a contingency reserve for purposes of carrying 

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1 tion 2204(b)(3)(A) a premium surcharge of up to 

2 three percent in order to provide financing for such 

3 reserve. 

4 ‘‘(2) PLAN RESERVES.—A qualified health plan 

5 may establish contingency reserves, that are in addi6 tion to the reserve described in paragraph (1), in a 

7 manner similar to that permitted under FEHBP. 

8 ‘‘SEC. 2207. DEFINITIONS. 

9 ‘‘For purposes of this title, except as otherwise pro10 vided: 

11 ‘‘(1) The term ‘Administration’ means the 

12 Health Benefits Administration established under 

13 section 2206(b). 

14 ‘‘(2) The term ‘AHBP-eligible individual’ 

15 means an individual described in section 2202(a)(2). 

16 ‘‘(3) The term ‘AHBP region’ means a region 

17 as specified by the Commissioner under section 

18 2206(c)(2). 

19 ‘‘(4) The term ‘Commissioner’ means the Com20 missioner of Health Benefits appointed under sec21 tion 2206(d)(1). 

22 ‘‘(5) The term ‘FEHBP’ means the program 

23 under chapter 89 of title 5, United States Code, as 

24 in effect before the date of the enactment of this 

25 title. 


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1 ‘‘(6) The term ‘qualified employer-provided cov2 erage’ means health coverage that is provided on the 

3 basis of employment and that the Commissioner has 

4 certified as being equivalent to the coverage under 

5 qualified health plans. For purposes of the previous 

6 sentence, coverage provided on the basis of employ7 ment is not equivalent to coverage under a qualified 

8 health plan unless the employer’s share of the cost 

9 of such coverage is not less than the Government’s 

10 share of the cost of coverage under qualified health 

11 plans. 

12 ‘‘(7) The term ‘qualified health plan’ means 

13 such a plan offered under this title.’’. 

14 (b) EFFECTIVE DATE; COLLECTIVE BARGAINING

15 AGREEMENTS.— 

16 (1) BENEFITS.—Title XXII of the Social Secu17 rity Act shall first apply to benefits for items and 

18 services furnished on or after January 1, 2011. 

19 (2) EFFECT ON COLLECTIVE BARGAINING

20 AGREEMENTS.—Nothing in this Act shall be con21 strued as preventing a collectively bargained agree22 ment from providing coverage that is additional to, 

23 or supplementary of, benefits provided under the 

24 American Health Benefits Program. 


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1 SEC. 3. COLLECTION OF PREMIUMS, SUBSIDIES, AND EM2 PLOYER FUNDING. 

3 (a) PREMIUM COLLECTION.— 

4 (1) IN GENERAL.—Subchapter A of chapter 1 

5 of the Internal Revenue Code of 1986 (relating to 

6 determination of tax liability) is amended by adding 

7 at the end the following new part: 

8 ‘‘PART VIII—AMERICAN HEALTH BENEFITS 

9 PROGRAM PREMIUMS 

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

10 ‘‘SEC. 59B. AMERICAN HEALTH BENEFITS PROGRAM PRE11 MIUMS. 

12 ‘‘(a) IN GENERAL.—In the case of a specified indi13 vidual who is enrolled in a qualified health plan under title 

14 XXII of the Social Security Act (including by reason of 

15 a default enrollment under section 2202(c)(2)), there is 

16 hereby imposed (in addition to any other amount imposed 

17 by this subtitle) for the taxable year an amount equal to 

18 the aggregate premiums established under such title with 

19 respect to the coverage under such title which covers such 

20 individual for months beginning in such taxable year. The 

21 amount imposed under this subsection shall be reduced by 

22 the amount of any government contribution under section 

23 2204(a) of such Act which relates to such coverage. 

24 ‘‘(b) SPECIFIED INDIVIDUAL.—For purposes of this 

25 section, the term ‘specified individual’ means, with respect 


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1 to coverage under title XXII of the Social Security Act 

2 for any month beginning in a taxable year— 

3 ‘‘(1) in the case of self-only coverage, the indi4 vidual covered under such coverage, and 

5 ‘‘(2) in the case of family coverage, each indi6 vidual covered under such coverage unless such indi7 vidual is covered under such coverage by reason of 

8 being a member of the family (other than a spouse). 

9 ‘‘(c) JOINT AND SEVERAL LIABILITY.—In the case 

10 of an individual and such individual’s spouse covered 

11 under family coverage— 

12 ‘‘(1) each such individual shall be jointly and 

13 severally liable for the amount imposed under sub14 section (a), and 

15 ‘‘(2) the aggregate amount imposed under sub16 section (a) with respect to such coverage may not 

17 exceed the amount imposed with respect to either 

18 such individual. 

19 ‘‘(d) COORDINATION WITH OTHER PROVISIONS.— 

20 ‘‘(1) NOT TREATED AS MEDICAL EXPENSE.— 

21 For purposes of section 213, the amount imposed by 

22 this section for any taxable year shall not be treated 

23 as an expense paid for medical care. 

24 ‘‘(2) NOT TREATED AS TAX FOR CERTAIN PUR25 POSES.—The amount imposed by this section shall 


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1 not be treated as a tax imposed by this chapter for 

2 purposes of determining— 

3 ‘‘(A) the amount of any credit allowable 

4 under this chapter, or 

5 ‘‘(B) the amount of the minimum tax im6 posed by section 55. 

7 ‘‘(3) TREATMENT UNDER SUBTITLE F.—For 

8 purposes of subtitle F, the amount imposed by this 

9 section shall be treated as if it were a tax imposed 

10 by section 1. 

11 ‘‘(4) SECTION 15 NOT TO APPLY.—Section 15 

12 shall not apply to the amount imposed by this sec13 tion. 

14 ‘‘(5) SECTION NOT TO AFFECT LIABILITY OF

15 POSSESSIONS, ETC.—This section shall not apply for 

16 purposes of determining liability to any possession of 

17 the United States. For purposes of section 932 and 

18 7654, the amount imposed under this section shall 

19 not be treated as a tax imposed by this chapter. 

20 ‘‘(e) REGULATIONS.—The Secretary may prescribe 

21 such regulations as may be appropriate to carry out the 

22 purposes of this section.’’. 

23 (2) ADJUSTMENTS TO WITHHOLDING.—Sub24 section (a) of section 3402 of such Code (relating to 


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1 income tax collected at source) is amended by add2 ing at the end the following new paragraph: 

3 ‘‘(3) SPECIAL RULE FOR AMOUNTS IMPOSED BY

4 SECTION 59B.— 

5 ‘‘(A) IN GENERAL.—In determining the 

6 amount required to be deducted and withheld 

7 from wages paid to an individual during any 

8 month by such individual’s employer, the 

9 amount imposed by section 59B shall be taken 

10 into account. 

11 ‘‘(B) WAGES NOT REDUCED BY EXEMP12 TIONS.—In determining the amount to be de13 ducted and withheld by reason of subparagraph 

14 (A), the amount of wages shall not be reduced 

15 as provided in paragraph (2).’’. 

16 (3) CLERICAL AMENDMENT.—The table of 

17 parts for subchapter A of chapter 1 of such Code is 

18 amended by adding at the end the following new 

19 item: 

‘‘PART VIII—AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS’’. 

20 (b) CREDIT FOR SUBSIDY AND PREPAYMENTS OF

21 AMERICAN HEALTH BENEFITS PREMIUMS.— 

22 (1) IN GENERAL.—Subpart C of part IV of sub23 chapter A of chapter 1 of the Internal Revenue Code 

24 of 1986 is amended by redesignating section 36 as 


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1 section 37 and by inserting after section 35 the fol2 lowing new section: 

3 ‘‘SEC. 36. SUBSIDY AND PREPAYMENT OF AMERICAN 

4 HEALTH BENEFITS PREMIUMS. 

5 ‘‘(a) IN GENERAL.—In the case of a specified indi6 vidual (as defined in section 59B(b)), there shall be al7 lowed as a credit against the tax imposed by this subtitle 

8 for the taxable year an amount equal to the sum of— 

9 ‘‘(1) the aggregate amount of premiums paid 

10 (other than any government contribution under sec11 tion 2204(a) of the Social Security Act) with respect 

12 to the coverage of such individual under title XXII 

13 of the Social Security Act, and 

14 ‘‘(2) in the case of any premium subsidy-eligible 

15 individual, the applicable premium subsidy. 

16 ‘‘(b) APPLICABLE PREMIUM SUBSIDY.— 

17 ‘‘(1) IN GENERAL.—For purposes of this sec18 tion, the term ‘applicable premium subsidy’ means, 

19 with respect to any premium subsidy-eligible indi20 vidual, the lowest premium in effect for the calendar 

21 year in which the taxable year begins (for the type 

22 of coverage involved) for any basic plan in the 

23 AHBP region involved, as determined by the Com24 missioner of Health Benefits. 


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1 ‘‘(2) REDUCTION BASED ON FAMILY INCOME.— 

2 The amount otherwise determined under paragraph 

3 (1) shall be reduced (but not below zero) by an 

4 amount which bears the same ratio to the amount 

5 so determined as— 

6 ‘‘(A) the amount (if any) by which the tax7 payer’s family income for the taxable year ex8 ceeds the lowest income threshold, bears to 

9 ‘‘(B) the lowest income threshold. 

10 ‘‘(c) PREMIUM SUBSIDY-ELIGIBLE INDIVIDUAL.— 

11 For purposes of this section, the term ‘premium subsidy12 eligible individual’ means an individual— 

13 ‘‘(1) who is enrolled, and required to be en14 rolled, in a qualified health plan under title XXII of 

15 the Social Security Act, 

16 ‘‘(2) whose family income does not exceed twice 

17 the lowest income threshold, and 

18 ‘‘(3) who does not have in effect (and, in the 

19 case of family coverage, each other individual cov20 ered under such coverage does not have in effect), 

21 in a form and manner specified by the Secretary of 

22 the Treasury in consultation with the Commissioner 

23 of Health Benefits, for any portion of the taxable 

24 year of such individual an objection to the release of 

25 information under section 6103(k)(10)). 


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1 ‘‘(d) LOWEST INCOME THRESHOLD.—For purposes 

2 of this section, the term ‘lowest income threshold’ means, 

3 with respect to coverage consisting of— 

4 ‘‘(1) only an individual, 125 percent of the pov5 erty line (as defined in section 673(2) of the Com6 munity Services Block Grant Act (42 U.S.C. 

7 9902(2)), including any revision required by such 

8 section) for a single individual for the calendar year 

9 which includes the close of the taxable year, or 

10 ‘‘(2) a family of two or more individuals, 150 

11 percent of the poverty line (as so defined) for a fam12 ily of the size involved for the calendar year which 

13 includes the close of the taxable year. 

14 ‘‘(e) FAMILY INCOME.—For purposes of this sec15 tion— 

16 ‘‘(1) IN GENERAL.—The term ‘family income’ 

17 means, with respect to a specified individual (as de18 fined in section 59B(b)) covered under coverage con19 sisting of— 

20 ‘‘(A) only such individual, the modified ad21 justed gross income of such individual, or 

22 ‘‘(B) two or more individuals, the sum of 

23 the modified adjusted gross income of the speci24 fied individual and the modified adjusted gross 

25 income of each other individual covered under 


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1 the plan for the taxable year that ends in or 

2 with the taxable year of the specified individual. 

3 ‘‘(2) MODIFIED ADJUSTED GROSS INCOME.— 

4 The term ‘modified adjusted gross income’ means 

5 adjusted gross income— 

6 ‘‘(A) determined without regard to sections 

7 135, 911, 931, and 933, and 

8 ‘‘(B) increased by the amount of interest 

9 received or accrued during the taxable year 

10 which is exempt from tax under this title. 

11 ‘‘(f) DENIAL OF CREDIT TO DEPENDENTS.—No 

12 credit shall be allowed under this section to any individual 

13 with respect to whom a deduction under section 151 is 

14 allowable to another taxpayer for a taxable year beginning 

15 in the calendar year in which such individual’s taxable 

16 year begins. 

17 ‘‘(g) REGULATIONS.—The Secretary may prescribe 

18 such regulations as are necessary or appropriate to carry 

19 out this section, including regulations which provide for 

20 not taking into account individuals with de minimis in21 come for purposes of determining family income for pur22 poses of this section.’’. 

23 (2) CONFORMING AMENDMENTS.— 


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1 (A) Paragraph (2) of section 1324(b) of 

2 title 31, United States Code, is amended by in3 serting ‘‘or 36’’ after ‘‘section 35’’. 

4 (B) The table of section for subpart C of 

5 part IV of subchapter A of chapter 1 of the In6 ternal Revenue Code of 1986 is amended by 

7 striking the item relating to section 36 and in8 serting the following new items: 

‘‘Sec. 36. Subsidy and prepayment of American Health Benefits premiums. 

‘‘Sec. 37. Overpayments of tax.’’. 

9 (c) EMPLOYER FUNDING.— 

10 (1) IN GENERAL.—Subtitle C of the Internal 

11 Revenue Code of 1986 (relating to employment 

12 taxes) is amended by redesignating chapter 25 as 

13 chapter 26 and by inserting after chapter 24 the fol14 lowing new chapter: 

15 ‘‘CHAPTER 25—AMERICAN HEALTH 

16 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. 

17 ‘‘SEC. 3451. TAX ON EMPLOYERS. 

18 ‘‘(a) IMPOSITION OF TAX.—In addition to other 

19 taxes, there is hereby imposed on every employer an excise 

20 tax, with respect to having individuals in his employ, equal 

21 to the applicable percentage of the wages paid by him with 

22 respect to employment. 


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1 ‘‘(b) APPLICABLE PERCENTAGE.—For purposes of 

2 this section— 

3 ‘‘(1) IN GENERAL.—The term ‘applicable per4 centage’ means, with respect to wages paid during 

5 any taxable year of an employer of a specified firm 

6 size and average earnings per employee, the percent7 age determined in accordance with the following 

8 table: 

‘‘Applicable percentage (in percent) 

A firm size of: 

Average 

earnings per 

employee of 

$21,000 or 

less: 

Average 

earnings per 

employee of 

more than 

$21,000 and 

not in 

excess of 

$42,000: 

Average 

earnings per 

employee of 

more than 

$42,000 and 

not in 

excess of 

$83,000: 

Average 

earnings per 

employee of 

more than 

$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 

9 ‘‘(2) FIRM SIZE.—The term ‘firm size’ means, 

10 with respect to any employer for any taxable year, 

11 the average number of employees employed by such 

12 person during the 3 taxable years preceding such 

13 taxable year. 

14 ‘‘(3) AVERAGE EARNINGS PER EMPLOYEE.— 

15 With respect to any employer for any taxable year— 

16 ‘‘(A) IN GENERAL.—The term ‘average 

17 earnings per employee’ means the average earn18 ings of such employer for such taxable year diVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 vided by the firm size of such employer for such 

2 taxable year. 

3 ‘‘(B) AVERAGE EARNINGS.—The term ‘av4 erage earnings’ means the average taxable in5 come of the employer for the 3 taxable years 

6 preceding such taxable year. 

7 ‘‘(4) AGGREGATION RULE.—All persons treated 

8 as a single employer under subsection (a) or (b) of 

9 section 52, or subsection (m) or (o) of section 414, 

10 shall be treated as one person. 

11 ‘‘(5) INFLATION ADJUSTMENT.—In the case of 

12 a taxable year beginning after December 31, 2011, 

13 each of the dollar amounts in the table contained in 

14 paragraphs (1) shall be increased by an amount 

15 equal to— 

16 ‘‘(A) such dollar amount, multiplied by 

17 ‘‘(B) the cost-of-living adjustment deter18 mined under section 1(f)(3) for the calendar 

19 year in which the taxable year begins, deter20 mined by substituting ‘calendar year 2010’ for 

21 ‘calendar year 1992’ in subparagraph (B) 

22 thereof. 

23 If any amount as increased under the preceding sen24 tence is not a multiple of $100, such amount shall 

25 be rounded to the nearest multiple of $100. 


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1 ‘‘(c) NO COVER OVER TO POSSESSIONS.—Notwith2 standing any other provision of law, no amount collected 

3 under this chapter shall be covered over to any possession 

4 of the United States. 

5 ‘‘(d) OTHER DEFINITIONS.—For purposes of this 

6 chapter, the terms ‘wages’, ‘employer’, and ‘employment’ 

7 have the same respective meanings as when used in chap8 ter 21 and section 3121(a)(1) shall apply for purposes of 

9 this chapter in the same manner as such section applies 

10 for purposes of section 3101(a) and 3111(a). 

11 ‘‘SEC. 3452. REFUND OF TAX IN CASE OF QUALIFIED EM12 PLOYER-PROVIDED COVERAGE. 

13 ‘‘(a) IN GENERAL.—In the case of a person subject 

14 to tax under section 3451 or section 1401(c), there shall 

15 be allowed as a credit against the tax imposed by such 

16 section an amount equal to the tax imposed under such 

17 section with respect to the wages or self-employment in18 come of individuals for periods during which the individual 

19 is covered by qualified employer-provided coverage (which 

20 is provided by such person). 

21 ‘‘(b) QUALIFIED EMPLOYER-PROVIDED COV22 ERAGE.—For purposes of subsection (a), the term ‘quali23 fied employer-provided coverage’ has the meaning given 

24 that term in section 2207(6) of the Social Security Act. 


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1 ‘‘SEC. 3453. INSTRUMENTALITIES OF THE UNITED STATES. 

2 ‘‘Notwithstanding any other provision of law (wheth3 er enacted before or after the enactment of this section) 

4 which grants to any instrumentality of the United States 

5 an exemption from taxation, such instrumentality shall 

6 not be exempt from the tax imposed by section 3451 un7 less such other provision of law grants a specific exemp8 tion, by reference to section 3451, from the tax imposed 

9 by such section.’’. 

10 (2) SELF-EMPLOYMENT.—Section 1401 of such 

11 Code is amended by redesignating subsection (c) as 

12 subsection (d) and by inserting after subsection (b) 

13 the following new subsection: 

14 ‘‘(c) AMERICAN HEALTH BENEFITS PROGRAM.—In 

15 addition to other taxes, there shall be imposed for each 

16 taxable year, on the self-employment income of every indi17 vidual, a tax equal to the applicable percentage (as defined 

18 in section 3451(b)) of the amount of the self-employment 

19 income for such taxable year.’’. 

20 (3) CLERICAL AMENDMENT.—The table of 

21 chapters for subtitle C of such Code is amended by 

22 striking the item relating to chapter 25 and insert23 ing the following: 

‘‘CHAPTER 25—AMERICAN HEALTH BENEFITS PROGRAM

‘‘CHAPTER 26—GENERAL PROVISIONS RELATING TO EMPLOYMENT TAXES’’. 

24 (d) ADDITIONAL TA X ON HOSPITAL REVENUES.— 


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1 (1) IN GENERAL.—Subchapter A of chapter 1 

2 of the Internal Revenue Code of 1986 is amended by 

3 adding at the end the following new part: 

4 ‘‘PART VIII—TAX ON HOSPITAL REVENUES 

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

5 ‘‘SEC. 59B. TAX ON HOSPITAL REVENUES. 

6 ‘‘(a) IN GENERAL.—In the case of a corporation, 

7 there is hereby imposed (in addition to any other tax im8 posed by this subtitle) a tax equal to 2 percent of the hos9 pital revenues of such corporation. 

10 ‘‘(b) HOSPITAL REVENUES.—For purposes of this 

11 section, the term ‘hospital revenues’means, with respect 

12 to any corporation for any taxable year, the excess (if any) 

13 of— 

14 ‘‘(1) so much of such corporation’s gross in15 come for such taxable year as is derived from the 

16 operation of one or more hospitals (as defined in 

17 section 1861(e) of the Social Security Act), over 

18 ‘‘(2) so much of the deductions allowed under 

19 this chapter for such taxable year as are properly al20 locable to such income. 

21 ‘‘(c) SECTION 15 NOT TO APPLY.—Section 15 shall 

22 not apply to the tax imposed by this section.’’. 

23 (2) CONFORMING AMENDMENTS.— 


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1 (A) Section 26(b)(2) of the Internal Rev2 enue Code of 1986 is amended by striking 

3 ‘‘and’’ at the end of subparagraph (U), by 

4 striking the period at the end of subparagraph 

5 (V) and inserting ‘‘, and’’, and by adding at the 

6 end the following new subparagraph: 

7 ‘‘(W) section 59B (relating to tax on hos8 pital revenues).’’. 

9 (B) Section 30A(c) of such Code is amend10 ed by striking ‘‘or’’ at the end of paragraph (3), 

11 by striking the period at the end of paragraph 

12 (4) and inserting ‘‘, or’’, and by adding at the 

13 end the following new paragraph: 

14 ‘‘(5) section 59B (relating to tax on hospital 

15 revenues).’’. 

16 (C) Section 882(a)(1) of such Code is 

17 amended by inserting ‘‘59B,’’ after ‘‘59A,’’. 

18 (D) Section 936(a)(3) of such Code is 

19 amended by striking ‘‘or’’ at the end of sub20 paragraph (C), by striking the period at the end 

21 of subparagraph (D) and inserting ‘‘, or’’, and 

22 by adding at the end the following new sub23 paragraph: 

24 ‘‘(E) section 59B (relating to tax on hos25 pital revenues).’’. 


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1 (E) Section 6425(c)(1)(A) of such Code is 

2 amended by striking ‘‘plus’’ at the end of clause 

3 (ii), by striking ‘‘over’’ at the end of clause (iii) 

4 and inserting ‘‘plus’’, and by adding at the end 

5 the following new clause: 

6 ‘‘(iv) the tax imposed by section 59B, 

7 over’’. 

8 (F) Section 6655(g)(1)(A) of such Code is 

9 amended by striking ‘‘plus’’ at the end of clause 

10 (iii), by redesignating clause (iv) as clause (v), 

11 and by inserting after clause (iii) the following 

12 new clause: 

13 ‘‘(iv) the tax imposed by section 59B, 

14 plus’’. 

15 (G) The table of parts for subchapter A of 

16 chapter 1 of such Code is amended by adding 

17 at the end the following new item: 

‘‘PART VIII—TA X ON HOSPITAL REVENUES’’. 

18 (e) DISCLOSURE OF TAXPAYER RETURN INFORMA19 TION TO CARRY OUT COST-SHARING SUBSIDIES.— 

20 (1) IN GENERAL.—Section 6103(l) of the Inter21 nal Revenue Code of 1986 is amended by adding at 

22 the end the following new paragraph: 

23 ‘‘(21) DISCLOSURE OF RETURN INFORMATION

24 TO CARRY OUT AMERICAN HEALTH BENEFITS PRO25 GRAM.— 


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1 ‘‘(A) IN GENERAL.—The Secretary shall, 

2 upon written request from the Commissioner of 

3 Health Benefits, disclose to officers, employees, 

4 and contractors of the Health Benefits Admin5 istration return information of a taxpayer who 

6 is, according to the records of the Secretary, a 

7 cost-sharing subsidy-eligible individual (as de8 fined in section 2205(b)(7)(A) of the Social Se9 curity Act) or a family member of such an indi10 vidual. Such return information shall be limited 

11 to— 

12 ‘‘(i) taxpayer identity information 

13 with respect to such taxpayer, 

14 ‘‘(ii) the filing status of such tax15 payer, 

16 ‘‘(iii) the adjusted gross income of 

17 such taxpayer, 

18 ‘‘(iv) the amounts excluded from such 

19 taxpayer’s gross income under sections 135 

20 and 911 to the extent such information is 

21 available, 

22 ‘‘(v) the interest received or accrued 

23 during the taxable year which is exempt 

24 from the tax imposed by chapter 1 to the 

25 extent such information is available, 


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1 ‘‘(vi) the amounts excluded from such 

2 taxpayer’s gross income by sections 931 

3 and 933 to the extent such information is 

4 available, and 

5 ‘‘(vii) the taxable year with respect to 

6 which the preceding information relates. 

7 ‘‘(B) RESTRICTION ON USE OF DISCLOSED

8 INFORMATION.—Return information disclosed 

9 under subparagraph (A) may be used by offi10 cers, employees, and contractors of the Health 

11 Benefits Administration only for the purposes 

12 of, and to the extent necessary in, establishing 

13 the appropriate amount of any cost-sharing 

14 subsidies under section 2205 of the Social Secu15 rity Act.’’. 

16 (2) CONFORMING AMENDMENTS.— 

17 (A) Paragraph (3) of section 6103(a) of 

18 such Code is amended by striking ‘‘or (20)’’ 

19 and inserting ‘‘(20), or (21)’’. 

20 (B) Paragraph (4) of section 6103(p) of 

21 such Code is amended by striking ‘‘(l)(16), 

22 (17), (19), or (20)’’ each place it appears and 

23 inserting ‘‘(l)(16), (17), (19), (20), or (21)’’. 


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1 (C) Paragraph (2) of section 7213(a) of 

2 such Code is amended by striking ‘‘or (20)’’ 

3 and inserting ‘‘(20), or (21)’’. 

4 (f) DISCLOSURE OF TAXPAYER RETURN INFORMA5 TION TO CARRY OUT PREMIUM SUBSIDIES.—Section 

6 6103(k) of the Internal Revenue Code of 1986 is amended 

7 by adding at the end the following new paragraph: 

8 ‘‘(10) DISCLOSURE OF INFORMATION TO AD9 MINISTER PREMIUM SUBSIDY UNDER SECTION 36.— 

10 To the extent that Secretary determines that disclo11 sure is necessary to permit the effective administra12 tion of section 36, the Secretary may disclose the 

13 modified adjusted gross income (as defined in sec14 tion 36) of any individual whose modified adjusted 

15 gross income is taken into account in determining 

16 the amount of any credit under such section.’’. 

17 (g) EFFECTIVE DATE.— 

18 (1) IN GENERAL.—Except as provided in para19 graph (2), the amendments made by this section 

20 shall take effect on January 1, 2011. 

21 (2) SUBSECTIONS (a) AND (b).—The amend22 ments made by subsections (a) and (b) shall apply 

23 to months beginning after December 31, 2010, in 

24 taxable years ending after such date. 


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1 (3) SUBSECTION (d).—The amendments made 

2 by subsection (d) shall apply to taxable years begin3 ning after December 31, 2010. 

4 SEC. 4. AMENDMENTS TO THE MEDICAID PROGRAM AND 

5 SCHIP. 

6 (a) MAINTENANCE OF EFFORT IN MEDICAID PAY7 MENTS.—Section 1902 of the Social Security Act (42 

8 U.S.C. 1396b) is amended by adding at the end the fol9 lowing new subsection: 

10 ‘‘(dd)(1) For each State fiscal year that begins on 

11 or after January 1 of the first calendar year in which cov12 erage is provided under title XXII, each State shall submit 

13 a report to the Secretary on the amount of State expendi14 tures for health services, as defined by the Secretary. 

15 ‘‘(2) Subject to paragraph (4), if the amount so re16 ported for a State fiscal year is less than the amount spec17 ified in paragraph (3) for that State fiscal year, the State 

18 shall provide for payment to the Secretary of the amount 

19 of such difference. The provisions of subparagraphs (B) 

20 and (C) of section 1935(c)(1) shall apply to payment 

21 under the previous sentence in the same manner as they 

22 apply to payment under subparagraph (A) of such section, 

23 except that such payments shall be deposited into the 

24 American Health Benefits Program Trust Fund estab25 lished under section 2204(c). 


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1 ‘‘(3) The amount specified in this paragraph for a 

2 State for— 

3 ‘‘(A) the first State fiscal year described in 

4 paragraph (1), is the total amount of the State 

5 share of expenditures for health services (as defined 

6 in paragraph (1)) under all public health programs 

7 operated in the State that are funded in whole or in 

8 part with State expenditures, including expenditures 

9 under this title and title XXI, for the previous State 

10 fiscal year; and 

11 ‘‘(B) a subsequent State fiscal year, is the 

12 amount specified in this paragraph for the previous 

13 State fiscal year increased by the percentage change, 

14 if any, in the consumer price index for all urban con15 sumers for the most recent completed Federal fiscal 

16 year. 

17 ‘‘(4) The Secretary may waive payment of all or a 

18 portion of the amount otherwise payable under paragraph 

19 (2) based on criteria specified by the Secretary’’. 

20 (b) SUNSET OF SCHIP FUNDING.—Section 2105 of 

21 such Act (42 U.S.C. 1397ee) is amended by adding at the 

22 end the following new subsection: 

23 ‘‘(h) SUNSET OF PROGRAM UPON INITIATION OF

24 AMERICAN HEALTH BENEFITS PROGRAM.—No payment 

25 shall be made under this title to a State for items and 


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1 services furnished after the effective date of the American 

2 Health Benefits Program under title XXII.’’. 

3 (c) REDUCTION IN MEDICAID DSH PAYMENTS.— 

4 Section 1923(f) of such Act (42 U.S.C. 1396r–4(f)) is 

5 amended— 

6 (1) by redesignating paragraph (7) as para7 graph (8); and 

8 (2) by inserting after paragraph (6) the fol9 lowing new paragraph: 

10 ‘‘(7) REDUCTION IN CONNECTION WITH

11 AHBP.—Notwithstanding the previous provisions in 

12 this paragraph, the Secretary shall provide for a 

13 phased-down reduction over a 5-fiscal-year-period 

14 beginning with fiscal year 2011 of the amount of the 

15 DSH allotment for each State so that, by the end 

16 of such period, such amount is equal to 10 percent 

17 of the amount of such allotment for such State for 

18 fiscal year 2010.’’. 

19 SEC. 5. PROMOTION OF USE OF HEALTH INFORMATION 

20 TECHNOLOGIES. 

21 The Commissioner of Health Benefits (appointed 

22 under section 2206(d)(1) of the Social Security Act, as 

23 added by section 2(a)), in consultation with the Secretary 

24 of Health and Human Services, shall establish new guideVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 lines that promote the proper use and understanding of 

2 health information technologies. 

3 SEC. 6. NON-PREEMPTION OF EXISTING COLLECTIVE BAR4 GAINING AGREEMENTS. 

5 Nothing in this Act shall be construed as preempting 

6 any collective bargaining agreement that is in effect as of 

7 the date of the enactment of this Act, during the period 

8 in which such agreement is in effect (without regard to 

9 any extension of such agreement effected as such date of 

10 enactment). 

11 SEC. 7. HEALTH BENEFITS COMMISSION. 

12 (a) ESTABLISHMENT.—There is established an inde13 pendent commission to be known as the Health Benefits 

14 Commission (in this section referred to as the ‘‘Commis15 sion’’). 

16 (b) DUTIES OF THE COMMISSION.— 

17 (1) GENERAL DUTIES.—The Commission shall 

18 examine and make recommendations regarding the 

19 major issues and cost drivers affecting the delivery 

20 of healthcare services as it pertains to the American 

21 Health Benefits Program under title XXII of the 

22 Social Security Act (in this section referred to as 

23 ‘‘AHBP’’). 


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1 (2) SPECIFIC ISSUES.—The Commission shall 

2 specifically examine and make recommendations re3 garding each of the following: 

4 (A) A comparison of AHBP to other public 

5 health insurance programs (described in section 

6 2202(b)(2) of the Social Security Act) and the 

7 feasibility and desirability of their integration 

8 into AHBP. 

9 (B) The proper implementation and utili10 zation of electronic medical records and other 

11 health information technologies, including pri12 vacy and interoperability issues. 

13 (C) The effects of medical malpractice in14 surance and ‘‘defensive medicine’’ on the deliv15 ery and cost of health care. 

16 (D) The patterns and effects of overutiliza17 tion on AHBP. 

18 (E) Cost and implementation factors of re19 tiree health coverage under AHBP. 

20 (F) A comparison of prescription drug 

21 prices under AHBP with such prices under 

22 other public health programs. 

23 (G) The effects of insurance monopolies on 

24 healthcare costs and delivery. 

25 (c) MEMBERSHIP.— 


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1 (1) NUMBER AND APPOINTMENT.—The Com2 mission shall be composed of 9 members, of whom— 

3 (A) one shall be appointed by the Presi4 dent; 

5 (B) one shall be appointed by the majority 

6 leader of the Senate; 

7 (C) one shall be appointed by the minority 

8 leader of the Senate; 

9 (D) one shall be appointed by the Speaker 

10 of the House of Representatives; 

11 (E) one shall be appointed by the minority 

12 leader of the House of Representatives; and 

13 (F) four shall be appointed by the Comp14 troller General of the United States, of whom 

15 one shall be designated by the Comptroller Gen16 eral as the Chair and another as the Vice Chair 

17 of the Commission. 

18 (2) TERMS OF APPOINTMENT.—The term of 

19 any appointment under paragraph (1) to the Com20 mission shall be for 3 years. 

21 (3) TERMS.— 

22 (A) IN GENERAL.—The terms of members 

23 of the Commission shall be for 3 years, except 

24 that the Comptroller General shall designate 


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1 staggered terms for the members first ap2 pointed. 

3 (B) VACANCIES.—Any member appointed 

4 to fill a vacancy occurring before the expiration 

5 of the term for which the member’s predecessor 

6 was appointed shall be appointed only for the 

7 remainder of that term. A member may serve 

8 after the expiration of that member’s term until 

9 a successor has taken office. A vacancy in the 

10 Commission shall be filled in the manner in 

11 which the original appointment was made. 

12 (4) MEETINGS.—The Commission shall meet at 

13 the call of its Chair or a majority of its members. 

14 (5) QUORUM.—A quorum shall consist of 5 

15 members of the Commission, except that 3 members 

16 may conduct a hearing under subsection (e). 

17 (6) VACANCIES.—A vacancy on the Commission 

18 shall be filled in the same manner in which the origi19 nal appointment was made not later than 30 days 

20 after the Commission is given notice of the vacancy 

21 and shall not affect the power of the remaining 

22 members to execute the duties of the Commission. 

23 (7) COMPENSATION.—While serving on the 

24 business of the Commission (including traveltime), a 

25 member of the Commission shall be entitled to comVerDate Aug 31 2005 02:14 Feb 16, 2008 Jkt 069200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H5348.IH H5348

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1 pensation at the per diem equivalent of the rate pro2 vided for level IV of the Executive Schedule under 

3 section 5315 of title 5, United States Code; and 

4 while so serving away from home and the member’s 

5 regular place of business, a member may be allowed 

6 travel expenses, as authorized by the Chairman of 

7 the Commission. 

8 (8) CHAIR; VICE CHAIR.—The Comptroller Gen9 eral shall designate a member of the Commission ap10 pointed under paragraph (1)(F), at the time of ap11 pointment of the member as Chair and a member as 

12 Vice Chair for that term of appointment, except that 

13 in the case of vacancy of the Chair or Vice Chair, 

14 the Comptroller General may designate another 

15 member for the remainder of that member’s term. 

16 (9) EXPENSES.—Each member of the Commis17 sion shall receive travel expenses and per diem in 

18 lieu of subsistence in accordance with sections 5702 

19 and 5703 of title 5, United States Code. 

20 (10) CONTINUATION OF OPERATION.—Section 

21 14 of the Federal Advisory Committee Act (5 U.S.C. 

22 App.) shall not apply to the Commission. 

23 (d) DIRECTOR AND STAFF; EXPERTS AND CONSULT24 ANTS.—Subject to such review as the Comptroller General 


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1 deems necessary to assure the efficient administration of 

2 the Commission, the Commission may— 

3 (1) employ and fix the compensation of an Ex4 ecutive Director (subject to the approval of the 

5 Comptroller General) and such other personnel (not 

6 to exceed 11) as may be necessary to carry out its 

7 duties (without regard to the provisions of title 5, 

8 United States Code, governing appointments in the 

9 competitive service); 

10 (2) seek such assistance and support as may be 

11 required in the performance of its duties from ap12 propriate Federal departments and agencies; 

13 (3) enter into contracts or make other arrange14 ments, as may be necessary for the conduct of the 

15 work of the Commission (without regard to section 

16 3709 of the Revised Statutes (41 U.S.C. 5)); 

17 (4) make advance, progress, and other pay18 ments which relate to the work of the Commission; 

19 (5) provide transportation and subsistence for 

20 persons serving without compensation; and 

21 (6) prescribe such rules and regulations as it 

22 deems necessary with respect to the internal organi23 zation and operation of the Commission. 

24 Physicians serving as personnel of the Commission may 

25 be provided a physician comparability allowance by the 


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1 Commission in the same manner as Government physi2 cians may be provided such an allowance by an agency 

3 under section 5948 of title 5, United States Code, and 

4 for such purpose subsection (i) of such section shall apply 

5 to the Commission in the same manner as it applies to 

6 the Tennessee Valley Authority. For purposes of pay 

7 (other than pay of members of the Commission) and em8 ployment benefits, rights, and privileges, all personnel of 

9 the Commission shall be treated as if they were employees 

10 of the United States Senate. 

11 (e) POWERS OF COMMISSION.— 

12 (1) HEARINGS AND OTHER ACTIVITIES.—For 

13 the purpose of carrying out its duties, the Commis14 sion may hold such hearings and undertake such 

15 other activities as the Commission determines to be 

16 necessary to carry out its duties. 

17 (2) STUDIES BY GAO.—Upon the request of the 

18 Commission, the Comptroller General of the United 

19 States shall conduct such studies or investigations as 

20 the Commission determines to be necessary to carry 

21 out its duties. 

22 (3) COST ESTIMATES BY CONGRESSIONAL

23 BUDGET OFFICE.— 

24 (A) The Director of the Congressional 

25 Budget Office shall provide to the Commission, 


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1 upon the request of the Commission, such cost 

2 estimates as the Commission determines to be 

3 necessary to carry out its duties. 

4 (B) The Commission shall reimburse the 

5 Director of the Congressional Budget Office for 

6 expenses relating to the employment in the of7 fice of the Director of such additional staff as 

8 may be necessary for the Director to comply 

9 with requests by the Commission under sub10 paragraph (A). 

11 (4) DETAIL OF FEDERAL EMPLOYEES.—Upon 

12 the request of the Commission, the head of any Fed13 eral agency is authorized to detail, without reim14 bursement, any of the personnel of such agency to 

15 the Commission to assist the Commission in car16 rying out its duties. Any such detail shall not inter17 rupt or otherwise affect the civil service status or 

18 privileges of the Federal employee. 

19 (5) TECHNICAL ASSISTANCE.—Upon the re20 quest of the Commission, the head of a Federal 

21 agency shall provide such technical assistance to the 

22 Commission as the Commission determines to be 

23 necessary to carry out its duties. 

24 (6) USE OF MAILS.—The Commission may use 

25 the United States mails in the same manner and 


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1 under the same conditions as Federal agencies and 

2 shall, for purposes of the frank, be considered a 

3 commission of Congress as described in section 3215 

4 of title 39, United States Code. 

5 (7) OBTAINING INFORMATION.—The Commis6 sion may secure directly from any Federal agency 

7 information necessary to enable it to carry out its 

8 duties, if the information may be disclosed under 

9 section 552 of title 5, United States Code. Upon re10 quest of the Chairman of the Commission, the head 

11 of such agency shall furnish such information to the 

12 Commission. 

13 (8) ADMINISTRATIVE SUPPORT SERVICES.— 

14 Upon the request of the Commission, the Adminis15 trator of General Services shall provide to the Com16 mission on a reimbursable basis such administrative 

17 support services as the Commission may request. 

18 (9) PRINTING.—For purposes of costs relating 

19 to printing and binding, including the cost of per20 sonnel detailed from the Government Printing Of21 fice, the Commission shall be deemed to be a com22 mittee of the Congress. 

23 (f) REPORTS.— 

24 (1) INITIAL FINDINGS.—Not later than 6 

25 months after the date of the enactment of this Act, 


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1 the Commission shall submit to the Commissioner of 

2 Health Benefits and to appropriate committees of 

3 Congress a report which contains a statement of the 

4 initial findings of the Commission. 

5 (2) INITIAL REPORT.—Not later than 18 

6 months after the date of the enactment of this Act, 

7 the Commission shall submit to such Commissioner 

8 and committees an initial report which contains a 

9 detailed statement of its recommendations, findings, 

10 and conclusions of the Commission. 

11 (3) ANNUAL REPORT.—Subsequently, the Com12 mission shall annually submit to such Commissioner 

13 and such committees a report containing such a 

14 statement. 

15 (4) OTHER REPORTS.—The Commission may 

16 issue such other reports at such times as the Com17 mission determines appropriate. 

18 (5) SUPERMAJORITY REQUIREMENT.—The 

19 Commission shall not include in any report sub20 mitted under this subsection a recommendation, 

21 finding, or conclusion unless it has received the ap22 proval of at least 6 members of the Commission. 

23 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

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1 ginning with fiscal year 2009 such sums as are necessary 

2 to carry out this section. 

Æ 


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