I 

111TH CONGRESS 

1ST SESSION H. R. 2668 

To provide for the offering of an American Trust Health Plan to provide 

choice in health insurance options so as to ensure quality, affordable 

health coverage for all Americans. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 2, 2009 

Mr. MURPHY of Connecticut (for himself, Mr. BRALEY of Iowa, and Mr. 

WELCH) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, 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 provide for the offering of an American Trust Health 

Plan to provide choice in health insurance options so 

as to ensure quality, affordable health coverage for all 

Americans. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Choice in Health Options Insures Care for Everyone 

6 (CHOICE) Act of 2009’’. 


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

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Establishment of American Trust Health Plan; administrative structure. 

Sec. 3. Finances. 

Sec. 4. Eligibility and enrollment. 

Sec. 5. Providers. 

Sec. 6. Benefits. 

Sec. 7. Premiums. 

3 SEC. 2. ESTABLISHMENT OF AMERICAN TRUST HEALTH 

4 PLAN; ADMINISTRATIVE STRUCTURE. 

5 (a) IN GENERAL.—There is established an American 

6 Trust Health Plan (in this Act referred to as the ‘‘Amer7 ican Trust Health Plan’’ or the ‘‘Plan’’) or to provide for 

8 the offering to eligible individuals of health benefits cov9 erage throughout the United States, including its terri10 tories. 

11 (b) COMPLIANCE WITH REQUIREMENTS.— 

12 (1) IN GENERAL.—The American Trust Health 

13 Plan shall comply with all requirements that are ap14 plicable with respect to other health benefits plans to 

15 be offered through a National Health Insurance Ex16 change (as defined in subsection (e)), including (as 

17 specified in this Act) minimum benefit and cost18 sharing requirements and premium rating require19 ments. 

20 (2) EXEMPTION FROM STATE INSURANCE REG21 ULATIONS.—As a Federal health program, the 

22 American Trust Health Plan is not required to comVerDate Nov 24 2008 23:00 Jun 03, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2668.IH H2668

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1 ply with the insurance regulations of the States to 

2 the extent health benefits plans offered through the 

3 National Health Insurance Exchange are exempt 

4 from such regulations. 

5 (3) SATISFACTION OF INDIVIDUAL MANDATE

6 REQUIREMENT.—An individual’s enrollment with the 

7 Plan shall be treated as satisfying any requirement 

8 under Federal law for the individual to demonstrate 

9 enrollment in health insurance or benefits coverage. 

10 (c) PLAN ADMINISTRATION.— 

11 (1) ADMINISTRATOR.—The American Trust 

12 Health Plan shall be administered by an Office of 

13 American Trust Health Administration (in this Act 

14 referred to as the ‘‘Office’’) within the Department 

15 of Health and Human Services. The Office shall be 

16 headed by an Administrator (in this Act referred to 

17 as the ‘‘Administrator’’) who shall be appointed by 

18 the President, by and with the advice and consent 

19 of the Senate. 

20 (2) COMPENSATION.—The Administrator shall 

21 be entitled to compensation at the level II of the Ex22 ecutive Schedule (under section 5313 of title 5, 

23 United States Code). 

24 (3) LIMITATION.—The Administrator and the 

25 Office shall not participate in the administration of 


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1 any regulation regarding the health insurance mar2 ket or in the administration of the National Health 

3 Insurance Exchange. 

4 (4) GENERAL AUTHORITY.—The Administrator 

5 shall have the same general authorities with respect 

6 to personnel and operations of the Office as the 

7 heads of other agencies and departments of the Fed8 eral Government have with respect to such agencies 

9 and departments. 

10 (d) ADVISORY BOARD.— 

11 (1) IN GENERAL.—The Administrator shall be 

12 advised by an Advisory Board (in this Act referred 

13 to as the ‘‘Advisory Board’’) composed of 7 individ14 uals appointed by the President. The President shall 

15 nominate individuals to serve on the Advisory Board 

16 in a manner that provides for inclusion on the Board 

17 of individuals who— 

18 (A) represent the interests of patients or 

19 consumers; 

20 (B) represent the interests health care pro21 viders, at least one of whom is a physician; and 

22 (C) are experts in health care quality 

23 measurements and reporting. 

24 (2) DUTIES.—The Advisory Board shall advise 

25 the Administrator regarding the operation of the 


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1 American Trust Health Plan and the Administrator 

2 shall consult with the Advisory Board not less often 

3 than quarterly and before making any annual 

4 changes in benefits under Plan. 

5 (3) TERMS, COMPENSATION, CHAIR, MEETINGS, 

6 ETC.—The provisions of paragraphs (2)(D), (3), (4), 

7 (5), and (6) of section 1805(c) of the Social Security 

8 Act (42 U.S.C. 1395b–6(c)) shall apply with respect 

9 to the Advisory Board and the President under this 

10 section in the same manner as such provisions apply 

11 to the Medicare Payment Advisory Commission and 

12 the Comptroller General, respectively, under section 

13 1805 of such Act. 

14 (4) FINANCING.—Within the budget established 

15 for the operation of the Plan, the Administrator 

16 shall provide for payment for the costs of operation 

17 of the Advisory Board. 

18 (e) NATIONAL HEALTH INSURANCE EXCHANGE DE19 FINED.—In this Act, the term ‘‘National Health Insur20 ance Exchange’’ means a mechanism established or recog21 nized under Federal law for coordinating the offering of 

22 health benefits coverage to individuals in the United 

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1 ment of standards for benefits and cost-sharing and for 

2 premiums for such health benefits coverage. 

3 SEC. 3. FINANCES. 

4 (a) SELF-FINANCING.—The American Trust Health 

5 Plan shall be financially self-sustaining insofar as funds 

6 to operate the Plan, including costs of benefits, adminis7 tration, and marketing, shall be derived from premiums 

8 for individuals enrolled under the Plan. The Plan is eligi9 ble to accept subsidies, including subsidies for the enroll10 ment of such individuals, in the same manner and to the 

11 same extent as other health benefits plans offered through 

12 a National Health Insurance Exchange are eligible to ac13 cept subsidies. 

14 (b) CONTINGENCY RESERVE.—The Administrator 

15 shall establish and fund a contingency reserve for the Plan 

16 in a form similar to that of a contingency reserve for 

17 health benefits plans under the Federal Employees Health 

18 Benefits Program under chapter 89 of title 5, United 

19 States Code. 

20 SEC. 4. ELIGIBILITY AND ENROLLMENT. 

21 (a) ELIGIBILITY.— 

22 (1) IN GENERAL.—Any individual who is made 

23 eligible to purchase coverage with a health benefits 

24 plan through the National Health Insurance ExVerDate Nov 24 2008 22:10 Jun 03, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2668.IH H2668

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1 change is eligible to enroll with the American Health 

2 Trust Plan. 

3 (2) EMPLOYER ENROLLMENT.—To the extent 

4 provided by the National Health Insurance Ex5 change with respect to health benefits coverage of6 fered through the Exchange, employers are eligible 

7 to purchase coverage for, and enroll their employees 

8 and dependents with, the Plan. 

9 (b) ANNUAL OPEN ENROLLMENT PERIOD.—The Ad10 ministrator shall determine a yearly period of open enroll11 ment for eligible individuals of not less than four consecu12 tive weeks. Such a period shall be consistent with any 

13 similar annual open enrollment period established by the 

14 National Health Insurance Exchange for health benefits 

15 plans offered through the Exchange. 

16 (c) NOTICES OF SIGNIFICANT CHANGES.— 

17 (1) IN GENERAL.—No significant change shall 

18 be made under the Plan except with public notice 

19 and on an annual basis and consistent with rules es20 tablished by the National Health Insurance Ex21 change for health benefits coverage offered through 

22 the Exchange. 

23 (2) SIGNIFICANT CHANGE DEFINED.—In this 

24 subsection, the term ‘‘significant change’’ includes 


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1 any change in benefits, copayments, deductibles, or 

2 premiums. 

3 SEC. 5. PROVIDERS. 

4 (a) ACCESS TO MEDICARE PROVIDER NETWORK.— 

5 (1) IN GENERAL.—Except as provided in para6 graph (2), any health care provider that is eligible 

7 for and accepts reimbursement for services under 

8 the Medicare program under title XVIII of the So9 cial Security Act (in this section referred to as the 

10 ‘‘Medicare’’) shall, as a condition of continuing to 

11 participate under such program, also participate 

12 under the American Health Trust Plan. 

13 (2) EXCEPTION.—Paragraph (1) shall not be 

14 construed as requiring a provider to accept new pa15 tients due to bona fide capacity limitations of the 

16 provider. 

17 (b) REIMBURSEMENT LEVELS.— 

18 (1) IN GENERAL.—The Administrator shall pro19 vide for payment to health care providers for covered 

20 services at rates not less, on average and in the ag21 gregate nationally, than 105 percent of the payment 

22 rates recognized for such services (or substantially 

23 similar services) under Medicare. In the case of 

24 those services which are covered under the Plan but 

25 are not covered under Medicare, the Administrator 


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1 shall seek to apply payment rates and methodologies 

2 similar to those described in the previous sentence. 

3 (2) ADJUSTMENT.—The Administrator, in de4 termining the competitiveness of the Plan within dif5 ferent markets and compared to other health bene6 fits plans offered through the National Health In7 surance Exchange, may increase the payment rates 

8 for health care providers above the rate otherwise 

9 provided under paragraph (1). 

10 (3) GPCI FLOORS.—In applying paragraph (1), 

11 the work and practice expense geographic indices ap12 plied under section 1848(e)(1) of the Social Security 

13 Act for any locality shall not be less than 1.00. 

14 (c) ADOPTION OF MEDICARE REFORMS.—The Plan 

15 may adopt Medicare system delivery reforms that provide 

16 patients with a coordinated system of care and make 

17 changes to the provider payment structure. 

18 SEC. 6. BENEFITS. 

19 (a) IN GENERAL.—The Administrator shall specify 

20 the benefits to be provided under the Plan consistent with 

21 this section and in consultation with the Advisory Board. 

22 (b) MINIMUM BENEFIT LEVEL.—The Plan may offer 

23 coverage with differing benefit levels so long as such bene24 fits and levels are consistent with the benefits and levels 

25 of benefits required to be offered by health benefits plans 


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1 under the National Health Insurance Exchange, and shall 

2 include the offering of at least one benefit level which 

3 closely reflects the lowest benefit level that may be offered 

4 by a health benefits plan through such Exchange. 

5 SEC. 7. PREMIUMS. 

6 (a) IN GENERAL.—The Administrator shall specify 

7 the levels of premiums for coverage under the Plan so long 

8 as they— 

9 (1) are based upon a system of rating that is 

10 consistent with rating rules that is established for 

11 health benefits plans offered through the National 

12 Health Insurance Exchange; 

13 (2) do not take into account health status re14 lated factors for any individual enrollee; and 

15 (3) are designed to provide sufficient funds to 

16 meet the requirement of section 3(a). 

17 (b) RATING RULES.—To the extent permitted for 

18 health benefits plans offered through the National Health 

19 Insurance Exchange, the premiums for the Plan shall vary 

20 based on geographic area and family size and may vary 

21 based on tobacco usage of an enrollee or other factors per22 mitted for health benefits plans offered through the Ex23 change. 

Æ 


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