II 

110TH CONGRESS 

1ST SESSION S. 1169 

To ensure the provision of high-quality health care coverage for uninsured 

individuals through State health care coverage pilot projects that expand 

coverage and access and improve quality and efficiency in the health 

care system. 

IN THE SENATE OF THE UNITED STATES 

APRIL 19, 2007 

Mr. FEINGOLD (for himself and Mr. GRAHAM) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To ensure the provision of high-quality health care coverage 

for uninsured individuals through State health care coverage pilot projects that expand coverage and access 

and improve quality and efficiency in the health care 

system. 

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. 

4 This Act may be cited as the ‘‘State-Based Health 

5 Care Reform Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) Health care remains one of the most impor2 tant domestic issues for Americans. 

3 (2) According to the Census Bureau, 

4 46,600,000 Americans were uninsured in 2005. Over 

5 8,300,000 of these individuals were children. 

6 (3) Health outcomes for the uninsured are 

7 worse than health outcomes for those who have 

8 health insurance. According to the Institute of Medi9 cine, the number of deaths due to uninsurance 

10 among adults ages 25 to 64 is estimated at around 

11 18,000 a year. Fifty-nine percent of uninsured 

12 adults who had a chronic illness, such as diabetes or 

13 asthma, did not fill a prescription or skipped their 

14 medications because they could not afford them. 

15 (4) The cost of providing care to the uninsured 

16 weighs heavily on the United States economy. Ac17 cording to the Kaiser Family Foundation, 

18 $124,600,000,000 was spent on care provided to in19 dividuals who were uninsured for all or part of 2004. 

20 Despite this spending, the United States ranks sec21 ond to last among industrialized countries in infant 

22 mortality rates. 


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1 SEC. 3. PURPOSE. 

2 It is the purpose of this Act to establish a program 

3 to award grants to States for the establishment of State4 based projects to— 

5 (1) establish pilot projects to increase health 

6 care coverage for uninsured individuals in selected 

7 States within the 5-year period beginning on the 

8 date of enactment of this Act; 

9 (2) ensure high-quality health care coverage 

10 with the goal of providing adequate access to pro11 viders, services, and benefits; 

12 (3) improve the efficiency of health care spend13 ing and lower the cost of health care for the partici14 pating State; and 

15 (4) provide health care coverage with the ulti16 mate goal of covering all individuals residing within 

17 States awarded a grant under this Act. 

18 TITLE I—HEALTH CARE 

19 COVERAGE 

20 SEC. 101. STATE-BASED HEALTH CARE COVERAGE PRO21 GRAM. 

22 (a) APPLICATIONS BY STATES, MULTI-STATE RE23 GIONS, LOCAL GOVERNMENTS, AND TRIBES.— 

24 (1) STATE APPLICATION.—A State, in consulta25 tion with local governments, Indian tribes, and In26 dian organizations involved in the provision of health 


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1 care (referred to in this Act as a ‘‘State’’), may 

2 apply for a State health care coverage grant for the 

3 entire State (or for regions of two or more States) 

4 under paragraph (2). 

5 (2) SUBMISSION OF APPLICATION.—In accord6 ance with this section, each State desiring to imple7 ment a State health care reform program shall sub8 mit an application to the Health Care Coverage 

9 Task Force established under subsection (b) (re10 ferred to in this section as the ‘‘Task Force’’) for 

11 approval and referral to Congress. 

12 (3) LOCAL GOVERNMENT AND OTHER APPLICA13 TIONS.— 

14 (A) IN GENERAL.—Where a State fails to 

15 submit an application under this section, a unit 

16 of local government of such State, or a consor17 tium of such units of local governments, may 

18 submit, with the collaboration of the State gov19 ernment, an application directly to the Task 

20 Force for programs or projects under this sec21 tion. Such an application shall be subject to the 

22 requirements of this section. 

23 (B) OTHER APPLICATIONS.—Subject to 

24 such additional regulations as the Secretary of 

25 Health and Human Services (referred to in this 


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1 Act as the ‘‘Secretary’’) may prescribe, a unit 

2 of local government, Indian tribe, or Indian 

3 health organization may submit an application 

4 under this section, whether or not the State 

5 submits such an application, if such unit, tribe, 

6 or organization can demonstrate unique demo7 graphic needs or a significant population size 

8 that warrants a substate program under this 

9 subsection. 

10 (b) HEALTH CARE COVERAGE TASK FORCE.— 

11 (1) ESTABLISHMENT.—Not later than 180 days 

12 after the date of the enactment of this Act, the Sec13 retary shall establish a Health Care Coverage Task 

14 Force in accordance with this subsection. 

15 (2) MEMBERSHIP.— 

16 (A) IN GENERAL.—The Task Force shall 

17 be comprised of the Secretary and not fewer 

18 than 16 members to be appointed in accordance 

19 with subparagraph (B). 

20 (B) APPOINTED MEMBERS.—With respect 

21 to the members appointed under subparagraph 

22 (A)— 

23 (i) two individuals shall be appointed 

24 by the Speaker of the House of Represent25 atives; 


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1 (ii) two individuals shall be appointed 

2 by the Minority Leader of the House of 

3 Representatives; 

4 (iii) two individuals shall be appointed 

5 by the Majority Leader of the Senate; 

6 (iv) two individuals shall be appointed 

7 by the Minority Leader of the Senate; and 

8 (v) not to exceed 8 members shall be 

9 appointed by the Comptroller General. 

10 (C) REQUIREMENTS.—In appointing mem11 bers to the Task Force under subparagraph 

12 (B)(v), the Comptroller General shall ensure 

13 that— 

14 (i) such members include at least 2 

15 representatives of consumers who are unin16 sured and who have had a chronic illness, 

17 1 of which shall represent individuals with 

18 disabilities; 

19 (ii) such members include individ20 uals— 

21 (I) representing business and 

22 labor; and 

23 (II) who are health care pro24 viders; 


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1 (iii) such members have a broad geo2 graphic representation and be balanced be3 tween urban and rural areas; and 

4 (iv) such members include representa5 tives of Indian tribes or tribal organiza6 tions. 

7 (3) GENERAL DUTIES.— 

8 (A) APPROVAL OF APPLICATIONS AND

9 OTHER MATTERS.—The Task Force shall— 

10 (i) formally approve the applications 

11 of States for grants under this section, and 

12 submit a legislative proposal concerning 

13 such approvals (which shall be politically 

14 balanced and include a variety of different 

15 approaches to covering the uninsured pop16 ulations of States) to Congress together 

17 with recommendations on the level of fund18 ing required; 

19 (ii) establish minimum performance 

20 measures with respect to coverage, quality, 

21 and cost of State programs, as described 

22 under subsection (c)(1); 

23 (iii) conduct a thorough review of the 

24 grant application from a State and conduct 

25 detailed discussions and negotiations with 


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1 such State applicants concerning possible 

2 modifications and adjustments; 

3 (iv) be responsible for monitoring the 

4 status and progress achieved under pro5 grams and projects granted under this sec6 tion; and 

7 (v) report to the public concerning 

8 progress made by States with respect to 

9 the performance measures and goals estab10 lished under this Act, the periodic progress 

11 of the State relative to its State perform12 ance measures and goals, and the State 

13 program application procedures, by region 

14 and State jurisdiction. 

15 (B) LIMITATION.—The Task Force shall 

16 not approve a State application that— 

17 (i) proposes to adopt criteria for in18 come or resource standards or methodolo19 gies for purposes of determining an indi20 vidual’s eligibility for medical assistance 

21 under the State plan for services provided 

22 through the State Medicaid program under 

23 title XIX of the Social Security Act, the 

24 State Children’s Health Insurance Pro25 gram under title XXI of the Act, the MediVerDate Aug 31 2005 17:42 Apr 22, 2007 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1169.IS S1169

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1 care program under title XVIII of such 

2 Act, or any other State and local program 

3 that provides health care to low-income or 

4 targeted populations, as defined by such 

5 program policies, that are more restrictive 

6 than those applied as of the date of enact7 ment of this Act; 

8 (ii) would revise Federal requirements 

9 for participation in the State Medicaid pro10 gram, the State Children’s Health Insur11 ance Program, or the Medicare program in 

12 a manner that applies criteria for eligibility 

13 that is more restrictive than the criteria 

14 applied on the date of enactment of this 

15 Act for those categories of individuals cur16 rently enrolled in such program or future 

17 categories of individuals under applicable 

18 law; or 

19 (iii) would result in making those in20 dividuals who are enrolled, or who may be 

21 enrolled, in a program described in clause 

22 (ii) ineligible for such enrollment in such 

23 program. 

24 (4) PERIOD OF APPOINTMENT; REPRESENTA25 TION REQUIREMENTS; VACANCIES.—Members shall 


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1 be appointed for a term of 5 years. Any vacancy on 

2 the Task Force shall not affect its powers, but shall 

3 be filled within 60 days and in the same manner as 

4 the original appointment. 

5 (5) CHAIRPERSON, MEETINGS, APPROVAL OF

6 STATE PLANS.— 

7 (A) CHAIRPERSON.—The Task Force shall 

8 select a Chairperson from among its members. 

9 (B) QUORUM.—A majority of the members 

10 of the Task Force shall constitute a quorum, 

11 but a lesser number of members may hold hear12 ings subject to approval by the Task Force or 

13 the Chairperson. 

14 (C) MEETINGS.—Not later than 30 days 

15 after the date on which all members of the 

16 Task Force have been appointed, the Task 

17 Force shall hold its first meeting. The Task 

18 Force shall meet at the call of the Chairperson. 

19 (6) POWERS OF THE TASK FORCE.— 

20 (A) NEGOTIATIONS WITH STATES.—The 

21 Task Force may conduct detailed discussions 

22 and negotiations with States submitting appli23 cations under this section, either individually or 

24 in groups, to facilitate a final set of rec25 ommendations for purposes of subsection 


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1 (c)(1)(C). Such final set of recommendations 

2 shall be made available to the general public. 

3 Such negotiations shall, to the extent prac4 ticable, be conducted in a public forum. The 

5 minutes of any meetings at which such negotia6 tions are conducted shall be maintained and 

7 made available to the general public. 

8 (B) SUBCOMMITTEES.—The Task Force 

9 may establish such subcommittees as the Task 

10 Force determines are necessary to increase the 

11 efficiency of the Task Force. 

12 (C) HEARINGS.—The Task Force may 

13 hold hearings, so long as the Task Force deter14 mines such meetings to be necessary in order to 

15 carry out the purposes of this Act, sit and act 

16 at such times and places, take such testimony, 

17 and receive such evidence as the Task Force 

18 considers advisable to carry out the purposes of 

19 this subsection. 

20 (D) ANNUAL MEETING.—In addition to 

21 other meetings the Task Force may hold, the 

22 Task Force shall hold an annual meeting with 

23 the participating States under this section for 

24 the purpose of having States report progress toVerDate Aug 31 2005 17:42 Apr 22, 2007 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1169.IS S1169

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1 ward the purposes described in section 3 and 

2 for an exchange of public information. 

3 (E) INFORMATION.—The Task Force may 

4 obtain information directly from any Federal 

5 department or agency as the Task Force con6 siders necessary to carry out the provisions of 

7 this subsection. Upon request of the Chair8 person of the Task Force, the head of such de9 partment or agency shall furnish such informa10 tion to the Task Force. 

11 (F) CONTRACTING.—The Task Force may 

12 enter into contracts with qualified independent 

13 organizations to obtain necessary information 

14 for the development of the performance stand15 ards, reporting requirements, financing mecha16 nisms, or any other matters determined by the 

17 Task Force to be appropriate and reasonable. 

18 (G) POSTAL SERVICES.—The Task Force 

19 may use the United States mails in the same 

20 manner and under the same conditions as other 

21 departments and agencies of the Federal Gov22 ernment. 

23 (7) PERSONNEL MATTERS.— 

24 (A) COMPENSATION.—Each member of the 

25 Task Force who is not an officer or employee 


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1 of the Federal Government shall be com2 pensated at a rate equal to the daily equivalent 

3 of the annual rate of basic pay prescribed for 

4 level IV of the Executive Schedule under section 

5 5315 of title 5, United States Code, for each 

6 day (including travel time) during which such 

7 member is engaged in the performance of the 

8 duties of the Task Force. All members of the 

9 Task Force who are officers or employees of the 

10 United States shall serve without compensation 

11 in addition to that received for their services as 

12 officers or employees of the United States. 

13 (B) TRAVEL EXPENSES.—The members of 

14 the Task Force shall be allowed travel expenses, 

15 including per diem in lieu of subsistence, at 

16 rates authorized for employees of agencies 

17 under subchapter I of chapter 57 of title 5, 

18 United States Code, while away from their 

19 homes or regular places of business in the per20 formance of services for the Task Force. 

21 (C) STAFF.—The Chairperson of the Task 

22 Force may, without regard to the civil service 

23 laws and regulations, appoint and terminate 

24 personnel as may be necessary to enable the 

25 Task Force to perform its duties. 


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1 (D) DETAIL OF GOVERNMENT EMPLOY2 EES.—Any Federal Government employee may 

3 be detailed to the Task Force without reim4 bursement, and such detail shall be without 

5 interruption or loss of civil service status or 

6 privilege. 

7 (E) TEMPORARY AND INTERMITTENT

8 SERVICES.—The Chairperson of the Task Force 

9 may procure temporary and intermittent serv10 ices under section 3109(b) of title 5, United 

11 States Code, at rates for individuals which do 

12 not exceed the daily equivalent of the annual 

13 rate of basic pay prescribed for level V of the 

14 Executive Schedule under section 5316 of such 

15 title. 

16 (8) FUNDING.—For the purpose of carrying out 

17 this subsection, there are authorized to be appro18 priated $4,000,000 for fiscal year 2008 and each fis19 cal year thereafter. 

20 (c) STATE PLAN.— 

21 (1) IN GENERAL.—A State that seeks to receive 

22 a grant to operate a program under this section 

23 shall prepare and submit to the Task Force, as part 

24 of the application under subsection (a), a State 

25 health care plan that— 


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1 (A) designates the lead State entity that 

2 will be responsible for administering the State 

3 program; 

4 (B) describes the benefits that will be pro5 vided to all individuals covered under the State 

6 program, which shall, at a minimum, provide 

7 for the same scope of coverage required under 

8 section 2103 (a)(1), (a)(2), and (a)(4), (b), and 

9 (c) of title XXI of the Social Security Act; 

10 (C) provides a methodology, in consulta11 tion with organizations including the Institute 

12 of Medicine, for demonstrating that the choice 

13 of benefits under the State program is based 

14 upon available medical evidence; 

15 (D) contains a description of any other 

16 health care reform programs that the State will 

17 implement under the State program, which may 

18 include the expansion of the State’s Medicaid, 

19 SCHIP or other public health care programs, 

20 single-payer systems, the implementation of 

21 State-based health savings accounts, the estab22 lishment of health care purchasing or pooling 

23 arrangements, new individual insurance pur24 chasing options, State tax credits, or any com25 bination of such reforms and any approaches 


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1 submitted by the state and approved by the 

2 Task Force in the State application; 

3 (E) describes the number and percentage 

4 of currently uninsured individuals who will 

5 achieve coverage under the State health pro6 gram; 

7 (F) provides and describes the manner in 

8 which the State will ensure that an increased 

9 number of individuals residing within the State 

10 will have expanded access to health care cov11 erage with a specific 5-year target for reduction 

12 in the number of uninsured individuals through 

13 either private or public program expansion, or 

14 both, in accordance with the options established 

15 under this Act; 

16 (G) identifies Federal, State, or local and 

17 private programs that currently provide health 

18 care services in the State and describes— 

19 (i) how such programs could be co20 ordinated with the State health program, 

21 to the extent practicable; and 

22 (ii) current Federal, State, and local 

23 expenditures for the identified programs 

24 that utilize public financing; 


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1 (H) provides for improvements in the 

2 availability of appropriate health care services 

3 that will increase access to care in urban, rural, 

4 and frontier areas of the State with medically 

5 underserved populations or where there is an 

6 inadequate supply of health care providers and 

7 the area meets the requirements for designation 

8 as a Health Professional Shortage Area under 

9 section 332 of the Public Health Service Act 

10 (42 U.S.C. 254e); and 

11 (I) otherwise complies with this subsection. 

12 (2) EFFECTIVENESS AND EFFICIENCY.—The 

13 State plan shall include provisions to improve the ef14 fectiveness and efficiency of health care in the State, 

15 including provisions to attempt to reduce adminis16 trative health care costs within the State. 

17 (3) COSTS.— 

18 (A) IN GENERAL.—With respect to the 

19 costs of health care provided under the pro20 gram, the State plan shall— 

21 (i) describe the public and private sec22 tor financing to be provided for the State 

23 health program; 

24 (ii) estimate the amount of Federal, 

25 State, and local expenditures, as well as 


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1 the costs to business and individuals under 

2 the State health program; 

3 (iii) describe how the State plan will 

4 ensure the financial solvency of the State 

5 health program; and 

6 (iv) contain assurances that the State 

7 will comply with the premium and cost 

8 sharing limitations described in subpara9 graph (B). 

10 (B) PREMIUM AND COST SHARING LIMITA11 TIONS.— 

12 (i) PREMIUMS.—In providing health 

13 care coverage under a State program 

14 under this Act, the State shall ensure 

15 that— 

16 (I) with respect to an individual 

17 whose family income is at or below 

18 100 percent of the poverty line, the 

19 State program shall not require— 

20 (aa) the payment of pre21 miums for such coverage; or 

22 (bb) the payment of cost 

23 sharing for such coverage in an 

24 amount that exceeds .5 percent 


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1 of the family’s income for the 

2 year involved; 

3 (II) with respect to an individual 

4 whose family income is greater than 

5 100 percent, but at or below 200 per6 cent, of the poverty line, the State 

7 program shall not require— 

8 (aa) the payment of pre9 miums for such coverage in ex10 cess of 20 percent of the average 

11 cost of providing benefits to an 

12 individual or family or 3 percent 

13 of the amount of the family’s in14 come for the year involved; or 

15 (bb) the payment of cost 

16 sharing for such coverage in an 

17 amount that, together with the 

18 premium amount, does not ex19 ceed 5 percent of the family’s in20 come for the year involved; and 

21 (III) with respect to an individual 

22 whose family income is greater than 

23 200 percent, but at or below 300 per24 cent, of the poverty line, the State 

25 program shall not require— 


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1 (aa) the payment of pre2 miums for such coverage in ex3 cess of 20 percent of the average 

4 cost of providing benefits to an 

5 individual or family or 5 percent 

6 of the amount of the family’s in7 come for the year involved; or 

8 (bb) the payment of cost 

9 sharing for such coverage in an 

10 amount that, together with the 

11 premium amount, does not ex12 ceed 7 percent of the family’s in13 come for the year involved. 

14 (ii) DEFINITION.—For purposes of 

15 this subparagraph, the term ‘‘poverty line’’ 

16 has the meaning given such term in section 

17 2110(c)(5) of the Social Security Act (42 

18 U.S.C. 1397jj(c)(5)). 

19 (4) PROTECTION FOR LOWER INCOME INDIVID20 UALS.—The State plan may only vary premiums, 

21 deductibles, coinsurance, and other cost sharing 

22 under the plan based on the family income of the 

23 family involved in a manner that does not favor indi24 viduals from families with higher income over indi25 viduals from families with lower income. 


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1 (5) AUTHORITY TO CONTRACT.—The State plan 

2 may provide for the awarding of contracts by the 

3 State to independent entities (such as the Institute 

4 of Medicine) for the conduct of activities to enable 

5 the State to fully comply with the requirements of 

6 this Act and of the State plan. 

7 (d) REVIEW; DETERMINATION; AND PROJECT PE8 RIOD.— 

9 (1) INITIAL REVIEW.—With respect to a State 

10 application for a grant under subsection (a), the 

11 Secretary and the Task Force shall, not later than 

12 90 days after receipt of such application, complete 

13 an initial review of such State application, an anal14 ysis of the scope of the proposal, and a determina15 tion of whether additional information is needed 

16 from the State. The Task Force shall advise the 

17 State within such 90-day period of the need to sub18 mit additional information. 

19 (2) FINAL DETERMINATION.—Not later than 90 

20 days after completion of the initial review under 

21 paragraph (1), the Task Force shall determine 

22 whether to approve such application and submit a 

23 legislative proposal concerning such application to 

24 Congress for final approval. Such application may be 


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approved only if 2 1 ⁄3 of the members of the Task 

2 Force vote to approve such application. 

3 (3) PROGRAM OR PROJECT PERIOD.—If ap4 proved by the Task Force and Congress, a State 

5 program or project may extend for a period not to 

6 exceed 5 years and may be extended for subsequent 

7 5-year periods upon approval by the Task Force and 

8 the Secretary, based upon achievement of targets as 

9 specified by the Task Force, except that a shorter 

10 period may be requested by a State and granted by 

11 the Secretary. 

12 (e) EXPEDITED CONGRESSIONAL CONSIDERATION.— 

13 (1) INTRODUCTION AND COMMITTEE CONSIDER14 ATION.— 

15 (A) INTRODUCTION.—The legislative pro16 posal submitted pursuant to subsection 

17 (b)(3)(A) shall be in the form of a joint resolu18 tion (in this subsection referred to as the ‘‘reso19 lution’’). Such resolution shall be introduced in 

20 the House of Representatives by the Speaker, 

21 and in the Senate, by the Majority Leader, im22 mediately upon receipt of the language and 

23 shall be referred to the appropriate committee 

24 of Congress. If the resolution is not introduced 

25 in accordance with the preceding sentence, the 


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1 resolution may be introduced in either House of 

2 Congress by any member thereof. 

3 (B) COMMITTEE CONSIDERATION.—A reso4 lution introduced in the House of Representa5 tives shall be referred to the appropriate com6 mittees of jurisdiction within the House of Rep7 resentatives. A resolution introduced in the 

8 Senate shall be referred to the appropriate com9 mittees of jurisdiction within the Senate. Not 

10 later than 15 calendar days after the introduc11 tion of the resolution, the committee of Con12 gress to which the resolution was referred shall 

13 report the resolution. If the committee has not 

14 reported such resolution (or an identical resolu15 tion) at the end of 15 calendar days after its 

16 introduction or at the end of the first day after 

17 there has been reported to the House involved 

18 a resolution, whichever is earlier, such com19 mittee shall be deemed to be discharged from 

20 further consideration of such resolution and 

21 such resolution shall be placed on the appro22 priate calendar of the House involved. No 

23 amendments shall be in order to such resolution 

24 during committee consideration. 

25 (2) EXPEDITED PROCEDURE.— 


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1 (A) CONSIDERATION.—Not later than 5 

2 days after the date on which a committee has 

3 been discharged from consideration of a resolu4 tion, the Speaker of the House of Representa5 tives, or the Speaker’s designee, or the Majority 

6 Leader of the Senate, or the Leader’s designee, 

7 shall move to proceed to the consideration of 

8 the resolution. It shall also be in order for any 

9 member of the House of Representatives or the 

10 Senate, respectively, to move to proceed to the 

11 consideration of the resolution at any time after 

12 the conclusion of such 5-day period. All points 

13 of order against the resolution (and against 

14 consideration of the resolution) are waived. A 

15 motion to proceed to the consideration of the 

16 resolution is highly privileged in the House of 

17 Representatives and is privileged in the Senate 

18 and is not debatable. The motion is not subject 

19 to amendment, to a motion to postpone consid20 eration of the resolution, or to a motion to pro21 ceed to the consideration of other business. A 

22 motion to reconsider the vote by which the mo23 tion to proceed is agreed to or not agreed to 

24 shall not be in order. If the motion to proceed 

25 is agreed to, the House of Representatives or 


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1 the Senate, as the case may be, shall imme2 diately proceed to consideration of the resolu3 tion without intervening motion, order, or other 

4 business, and the resolution shall remain the 

5 unfinished business of the House of Represent6 atives or the Senate, as the case may be, until 

7 disposed of. No amendments shall be in order 

8 to such resolution during such consideration. 

9 (B) CONSIDERATION BY OTHER HOUSE.— 

10 If, before the passage by one House of the reso11 lution that was introduced in such House, such 

12 House receives from the other House a resolu13 tion as passed by such other House— 

14 (i) the resolution of the other House 

15 shall not be referred to a committee and 

16 may only be considered for final passage, 

17 without amendment, in the House that re18 ceives it under clause (iii); 

19 (ii) the procedure in the House in re20 ceipt of the resolution of the other House, 

21 with respect to the resolution that was in22 troduced in the House in receipt of the res23 olution of the other House, shall be the 

24 same as if no resolution had been received 

25 from the other House; and 


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1 (iii) notwithstanding clause (ii), the 

2 vote on final passage shall be on the re3 form bill of the other House. 

4 Upon disposition of a resolution that is received 

5 by one House from the other House, it shall no 

6 longer be in order to consider the resolution bill 

7 that was introduced in the receiving House. 

8 (3) RULES OF THE SENATE AND HOUSE OF

9 REPRESENTATIVES.—This subsection is enacted by 

10 Congress— 

11 (A) as an exercise of the rulemaking power 

12 of the Senate and House of Representatives, re13 spectively, and is deemed to be part of the rules 

14 of each House, respectively, but applicable only 

15 with respect to the procedure to be followed in 

16 that House in the case of a resolution, and it 

17 supersedes other rules only to the extent that it 

18 is inconsistent with such rules; and 

19 (B) with full recognition of the constitu20 tional right of either House to change the rules 

21 (so far as they relate to the procedure of that 

22 House) at any time, in the same manner, and 

23 to the same extent as in the case of any other 

24 rule of that House. 

25 (f) FUNDING.— 


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1 (1) IN GENERAL.—The Secretary shall provide 

2 a grant to a State that has an application approved 

3 under subsection (d)(2) and agreed to by Congress 

4 under subsection (e) to enable such State to carry 

5 out the State health program under the grant. 

6 (2) AMOUNT OF GRANT.—The amount of a 

7 grant provided to a State under paragraph (1) shall 

8 be determined based upon the recommendations of 

9 the Task Force, subject to the amount appropriated 

10 under subsection (i). 

11 (3) MATCHING REQUIREMENT.—To be eligible 

12 to receive a grant under paragraph (1), a State shall 

13 provide assurances to the Secretary that the State 

14 shall, in addition to meeting the requirement of 

15 paragraph (4), contribute to the costs of carrying 

16 out activities under the grant an amount equal to 

17 not less than the product of— 

18 (A) the amount of the grant; and 

19 (B) one minus the sum of the enhanced 

20 FMAP for the State (as defined in section 

21 2105(b) of the Social Security Act (42 U.S.C. 

22 1397ee(b))) and 5 percent. 

23 (4) MAINTENANCE OF EFFORT.—A State, in 

24 utilizing the proceeds of a grant received under 

25 paragraph (1), shall maintain the non-Federal exVerDate Aug 31 2005 21:39 Apr 22, 2007 Jkt 059200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S1169.IS S1169

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1 penditures of the State and local units of govern2 ment for health care coverage purposes (including 

3 expenditures under the State programs under titles 

4 XIX and XXI of the Social Security Act) for the 

5 support of direct health care delivery at a level equal 

6 to not less than the level of such expenditures main7 tained by the State for the fiscal year preceding the 

8 fiscal year for which the grant is received. Funds re9 ceived under this Act shall be used to supplement, 

10 not supplant existing State spending for the activi11 ties described in this Act. Such expenditures shall be 

12 increased annually by the same percentage as the 

13 percentage increase in the Consumer Price Index for 

14 All Urban Consumers. 

15 (5) COMPLIANCE.—The Secretary may withhold 

16 payments under this Act from a State that fails to 

17 comply with its State plan under subsection (c) and 

18 the reporting requirements under subsection (g)(1). 

19 (g) REPORTS.— 

20 (1) BY STATES.—Each State that has received 

21 a grant under subsection (f)(1) shall submit to the 

22 Task Force an annual report for the period rep23 resenting the respective State’s fiscal year, that shall 

24 contain a description of the results, with respect to 


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1 health care coverage, quality, and costs, of the State 

2 program. 

3 (2) BY TASK FORCE.—At the end of the 5-year 

4 period beginning on the date on which the Secretary 

5 awards the first grant under paragraph (1), the 

6 Task Force established under subsection (b) shall 

7 prepare and submit to the appropriate committees of 

8 Congress, a report on the progress made by States 

9 receiving grants under paragraph (1) in meeting the 

10 goals of expanded coverage, improved quality, and 

11 cost containment through performance measures es12 tablished during the 5-year period of the grant. Such 

13 report shall contain— 

14 (A) the recommendation of the Task Force 

15 concerning any future action that Congress 

16 should take concerning health care reform, in17 cluding whether or not to extend the program 

18 established under this subsection; 

19 (B) an evaluation of the effectiveness of 

20 State health care coverage reforms— 

21 (i) in expanding health care coverage 

22 for State residents; 

23 (ii) in improving the quality of health 

24 care provided in the States; 


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1 (iii) in reducing or containing health 

2 care costs in the States; and 

3 (iv) on employer sponsored coverage; 

4 (C) recommendations regarding the advis5 ability of increasing Federal financial assistance 

6 for State ongoing or future health program ini7 tiatives, including the amount and source of 

8 such assistance; and 

9 (D) recommendations concerning whether 

10 any particular State program should serve as a 

11 model for implementation as a national health 

12 care reform program. 

13 (h) MISCELLANEOUS PROVISIONS.— 

14 (1) APPLICATION OF CERTAIN REQUIRE15 MENTS.— 

16 (A) RESTRICTION ON APPLICATION OF

17 PREEXISTING CONDITION EXCLUSIONS.— 

18 (i) IN GENERAL.—Subject to subpara19 graph (B), a State shall not permit the im20 position of any preexisting condition exclu21 sion for covered benefits under a program 

22 or project under this section. 

23 (ii) GROUP HEALTH PLANS AND

24 GROUP HEALTH INSURANCE COVERAGE.— 

25 If the State program or project provides 


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1 for benefits through payment for, or a con2 tract with, a group health plan or group 

3 health insurance coverage, the program or 

4 project may permit the imposition of a pre5 existing condition exclusion but only inso6 far and to the extent that such exclusion is 

7 permitted under the applicable provisions 

8 of part 7 of subtitle B of title I of the Em9 ployee Retirement Income Security Act of 

10 1974 and title XXVII of the Public Health 

11 Service Act. 

12 (B) COMPLIANCE WITH OTHER REQUIRE13 MENTS.—Coverage offered under the program 

14 or project shall comply with the requirements of 

15 subpart 2 of part A of title XXVII of the Public 

16 Health Service Act insofar as such require17 ments apply with respect to a health insurance 

18 issuer that offers group health insurance cov19 erage. 

20 (2) PREVENTION OF DUPLICATIVE PAY21 MENTS.— 

22 (A) OTHER HEALTH PLANS.—No payment 

23 shall be made to a State under this section for 

24 expenditures for health assistance provided for 

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1 surer (as defined by the Secretary by regulation 

2 and including a group health plan (as defined 

3 in section 607(1) of the Employee Retirement 

4 Income Security Act of 1974), a service benefit 

5 plan, and a health maintenance organization) 

6 would have been obligated to provide such as7 sistance but for a provision of its insurance con8 tract which has the effect of limiting or exclud9 ing such obligation because the individual is eli10 gible for or is provided health assistance under 

11 the plan. 

12 (B) OTHER FEDERAL GOVERNMENTAL

13 PROGRAMS.—Except as provided in any other 

14 provision of law, no payment shall be made to 

15 a State under this section for expenditures for 

16 health assistance provided for an individual to 

17 the extent that payment has been made or can 

18 reasonably be expected to be made promptly (as 

19 determined in accordance with regulations) 

20 under any other federally operated or financed 

21 health care insurance program, other than an 

22 insurance program operated or financed by the 

23 Indian Health Service, as identified by the Sec24 retary. For purposes of this paragraph, rules 

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1 tion 1903(d)(2) of the Social Security Act shall 

2 apply. 

3 (3) APPLICATION OF CERTAIN GENERAL PROVI4 SIONS.—The following sections of the Social Security 

5 Act shall apply to States under this section in the 

6 same manner as they apply to a State under such 

7 title XIX: 

8 (A) TITLE XIX PROVISIONS.— 

9 (i) Section 1902(a)(4)(C) (relating to 

10 conflict of interest standards). 

11 (ii) Paragraphs (2), (16), and (17) of 

12 section 1903(i) (relating to limitations on 

13 payment). 

14 (iii) Section 1903(w) (relating to limi15 tations on provider taxes and donations). 

16 (iv) Section 1920A (relating to pre17 sumptive eligibility for children). 

18 (B) TITLE XI PROVISIONS.— 

19 (i) Section 1116 (relating to adminis20 trative and judicial review), but only inso21 far as consistent with this title. 

22 (ii) Section 1124 (relating to disclo23 sure of ownership and related informa24 tion). 


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1 (iii) Section 1126 (relating to disclo2 sure of information about certain convicted 

3 individuals). 

4 (iv) Section 1128A (relating to civil 

5 monetary penalties). 

6 (v) Section 1128B(d) (relating to 

7 criminal penalties for certain additional 

8 charges). 

9 (vi) Section 1132 (relating to periods 

10 within which claims must be filed). 

11 (4) RELATION TO OTHER LAWS.—Health bene12 fits coverage provided under a State program or 

13 project under this section shall be treated as cred14 itable coverage for purposes of part 7 of subtitle B 

15 of title I of the Employee Retirement Income Secu16 rity Act of 1974, title XXVII of the Public Health 

17 Service Act, and subtitle K of the Internal Revenue 

18 Code of 1986. 

19 (i) AUTHORIZATIONS.— 

20 (1) IN GENERAL.—There are appropriated in 

21 each of fiscal years 2007 through 2016 to carry out 

22 this Act, an amount equal to the amount of savings 

23 to the Federal Government in each such fiscal year 

24 as a result of the enactment of the provisions of title 

25 II. 


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1 (2) USE OF FUNDS.—Amounts appropriated for 

2 a fiscal year under paragraph (1) and not expended 

3 may be used in subsequent fiscal years to carry out 

4 this section. 

5 (3) LIMITATION.—Notwithstanding any other 

6 provision of this Act, the total amount of funds ap7 propriated to carry out this Act through fiscal year 

8 2016 shall not exceed $40,000,000,000. 

9 (j) TERMINATION.—The authority provided under 

10 this title shall terminate on the date that is 10 years after 

11 the date of enactment of this Act. 

12 TITLE II—OFFSETS 

13 SEC. 201. INCREASE IN REBATES FOR COVERED OUT14 PATIENT DRUGS. 

15 Section 1927(c)(1)(B)(i) of the Social Security Act 

16 (42 U.S.C. 1396r–8(c)(1)(B)(i)) is amended— 

17 (1) in subclause (IV), by striking ‘‘and’’ after 

18 the semicolon; 

19 (2) in subclause (V)— 

20 (A) by inserting ‘‘and before January 1, 

21 2008,’’ after ‘‘1995,’’; and 

22 (B) by striking the period and inserting ‘‘; 

23 and’’; and 

24 (3) by adding at the end the following: 


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1 ‘‘(VI) after December 31, 2007, 

2 is 20 percent.’’. 

3 SEC. 202. AVIATION SECURITY SERVICE PASSENGER FEES. 

4 Section 44940 of title 49, United States Code, is 

5 amended— 

6 (1) in subsection (a)(1), by inserting ‘‘in an 

7 amount equal to $5.00 per one-way trip’’ after ‘‘uni8 form fee’’; 

9 (2) by striking subsection (c); and 

10 (3) in subsection (d)— 

11 (A) in paragraph (2), by striking ‘‘sub12 section (d)’’ each place it appears and inserting 

13 ‘‘this subsection’’; and 

14 (B) in paragraph (3), by striking ‘‘in ac15 cordance with paragraph (1)’’ and inserting 

16 ‘‘under subsection (a)(2)’’. 

17 SEC. 203. EXTENSION OF FCC SPECTRUM AUCTION AU18 THORITY. 

19 Section 309(j)(11) of the Communications Act of 

20 1934 (47 U.S.C. 309(j)(11)) is amended by striking 

21 ‘‘2011’’ and inserting ‘‘2016’’. 

22 SEC. 204. EXTENSION OF FEES FOR CERTAIN CUSTOMS 

23 SERVICES. 

24 Section 13031(j)(3)(A) and (B) of the Consolidated 

25 Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 


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1 58c(j)(3)(A) and (B)) is amended by striking ‘‘2014’’ each 

2 place it appears and inserting ‘‘2016’’. 

3 SEC. 205. INCOME-RELATED REDUCTION IN PART D PRE4 MIUM SUBSIDY. 

5 (a) IN GENERAL.—Section 1860D–13(a) of the So6 cial Security Act (42 U.S.C. 1395w–113(a)) is amended 

7 by adding at the end the following new paragraph: 

8 ‘‘(7) REDUCTION IN PREMIUM SUBSIDY BASED

9 ON INCOME.—The provisions of subsection (i) of sec10 tion 1839 shall apply to the monthly beneficiary pre11 mium under this subsection in the same manner as 

12 they apply to the monthly premium under such sec13 tion except that in so applying— 

14 ‘‘(A) paragraph (1) of such subsection (i) 

15 to this subsection— 

16 ‘‘(i) the reference to December 2006 

17 is deemed a reference to December 2007; 

18 and 

19 ‘‘(ii) the reference to the monthly pre20 mium is deemed a reference to the base 

21 beneficiary premium (computed under 

22 paragraph (2) of this subsection); 

23 ‘‘(B) clause (i) of paragraph (3)(A) of such 

24 subsection (i) to this subsection, the reference 

25 to 25 percentage points is deemed a reference 


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1 to the beneficiary premium percentage (as spec2 ified in paragraph (3) of this subsection); 

3 ‘‘(C) clause (ii) of paragraph (3)(A) of 

4 such subsection (i) to this subsection, the na5 tional average monthly bid amount (computed 

6 under paragraph (4) of this subsection) shall be 

7 substituted for the amount specified in such 

8 clause (ii) (relating to the unsubsidized part B 

9 premium amount); and 

10 ‘‘(D) subparagraph (B) of paragraph (3) 

11 of such subsection (i) to this subsection, the 

12 reference to 2009 shall be a reference to 2010, 

13 the reference to 2007 shall be a reference to 

14 2008, and the reference to 2008 shall be a ref15 erence to 2009.’’. 

16 (b) CONFORMING AMENDMENTS.— 

17 (1) MEDICARE.—Section 1860D–13(a)(1) of 

18 the Social Security Act (42 U.S.C. 1395w– 

19 113(a)(1)) is amended— 

20 (A) by redesignating subparagraph (F) as 

21 subparagraph (G); 

22 (B) in subparagraph (G), as redesignated 

23 by subparagraph (A), by striking ‘‘(D) and 

24 (E)’’ and inserting ‘‘(D), (E), and (F)’’; and 


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1 (C) by inserting after subparagraph (E) 

2 the following new subparagraph: 

3 ‘‘(F) INCREASE BASED ON INCOME.—The 

4 base beneficiary premium shall be increased 

5 pursuant to paragraph (7).’’. 

6 (2) INTERNAL REVENUE CODE.—Section 

7 6103(l)(20) of the Internal Revenue Code of 1986 

8 (relating to disclosure of return information to carry 

9 out Medicare part B premium subsidy adjustment) 

10 is amended— 

11 (A) in the heading, by striking ‘‘PART B

12 PREMIUM SUBSIDY ADJUSTMENT’’ and inserting 

13 ‘‘PARTS B AND D PREMIUM SUBSIDY ADJUST14 MENTS’’; 

15 (B) in subparagraph (A)— 

16 (i) in the matter preceding clause (i), 

17 by inserting ‘‘or 1860D–13(a)(7)’’ after 

18 ‘‘1839(i)’’; and 

19 (ii) in clause (vii), by inserting after 

20 ‘‘the amount of such adjustment’’ the fol21 lowing: ‘‘or that the amount of the pre22 mium of the taxpayer under such sub23 section (as applied under section 1860D– 

24 13(a)(7)) may be subject to adjustment 


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1 under such section 1860D–13(a)(7) and 

2 the amount of such adjustment’’; and 

3 (C) in subparagraph (B), by inserting ‘‘or 

4 such section 1860D–13(a)(7)’’ before the period 

5 at the end. 

Æ 


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