I 

111TH CONGRESS 

1ST SESSION H. R. 2816 

To amend the Social Security Act to provide grants and flexibility through 

demonstration projects for States to provide universal, comprehensive, 

cost-effective systems of health care coverage, with simplified administration. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 10, 2009 

Mr. TIERNEY (for himself, Mr. KUCINICH, and Ms. BALDWIN) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education 

and Labor, and Oversight and Government Reform, 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 to provide grants and 

flexibility through demonstration projects for States to 

provide universal, comprehensive, cost-effective systems 

of health care coverage, with simplified administration. 

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 ‘‘States’ Right To Innovate in Health Care 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. Findings and purposes. 

Sec. 3. Amendment to Social Security Act. 

‘‘TITLE XXII—STATE COMPREHENSIVE HEALTH CARE AND COST 

CONTAINMENT DEMONSTRATION PROJECTS 

‘‘Sec. 2201. State-based Universal Health Care Coverage Commission. 

‘‘Sec. 2202. Planning grants. 

‘‘Sec. 2203. Demonstration grants. 

‘‘Sec. 2204. State plan requirements. 

‘‘Sec. 2205. Interstate arrangements. 

‘‘Sec. 2206. Definitions. 

3 SEC. 2. FINDINGS AND PURPOSES. 

4 (a) FINDINGS.—Congress finds the following: 

5 (1) In 2006, annual health care expenditures in 

6 the United States totaled $2.1 trillion, or $6,800 per 

7 person. 

8 (2) In 2006, health care expenditures rep9 resented 16 percent of the gross domestic product 

10 (‘‘GDP’’) in the United States and grew at the rate 

11 of 6.7 percent. 

12 (3) Health care spending in the United States 

13 is expected to increase at similar levels for the next 

14 decade, reaching $4 trillion in 2015, or 20 percent 

15 of GDP. 

16 (4) Yet, access to health care is a problem for 

17 many citizens of the United States. According to the 

18 Census Bureau, there are now over 46,000,000 citi19 zens who lack health insurance and each year this 


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1 figure grows. This figure does not include the mil2 lions of citizens who are under-insured and millions 

3 of others who may not have insurance coverage at 

4 some point during a year. 

5 (5) There is enough money in the health care 

6 system to ensure that the rationing of health care 

7 services does not need to occur, either explicitly by 

8 design or, as happens currently, implicitly due to an 

9 individual’s or family’s economic status. Health care 

10 reform is needed to assure that there is universal 

11 health coverage for all citizens of the United States. 

12 (6) States are the natural vehicles to test meth13 ods and forms of achieving universal health cov14 erage. There is a well-established tradition for this. 

15 In the past, States have led the way in testing ideas 

16 for national application, involving such areas as 

17 child labor, social security, welfare reform, and envi18 ronmental protection. Several States are embarking 

19 on major health care initiatives to cover residents of 

20 the State who are uninsured. Given past successes in 

21 individual State action that have resulted in national 

22 changes, the Federal Government should invest in a 

23 broad range of efforts in a variety of geographically 

24 dispersed States prior to attempting a national sys25 tem of health care reform. 


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1 (7) In 2002, in response to a request from the 

2 Secretary of Health and Human Services, the Insti3 tute of Medicine of the National Academy of 

4 Sciences established a committee, officially known as 

5 the ‘‘Committee on Rapid Advance Demonstration 

6 Projects: Health Care Finance and Delivery Sys7 tems’’, with the goal of formulating models for 

8 broader health care reform. The committee rec9 ommended a 10-year commitment to State dem10 onstration projects as a means to encourage States 

11 to develop their own systems of universal health care 

12 and to facilitate innovation. 

13 (b) PURPOSE.—The purpose of this Act is to encour14 age States— 

15 (1) to develop plans for universal, comprehen16 sive, cost-effective systems of health care with sim17 plified administration to individuals residing in such 

18 States; and 

19 (2) to implement such plans by offering transi20 tional grants and by removing Federal statutory and 

21 administrative barriers that may inhibit or discour22 age efforts by States to provide such health care 

23 while maintaining Federal payments for health care 

24 under Federal health care programs. 


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1 SEC. 3. AMENDMENT TO SOCIAL SECURITY ACT. 

2 The Social Security Act (42 U.S.C. 301 et seq.) is 

3 amended by adding at the end the following new title: 

4 ‘‘TITLE XXII—STATE COM5 PREHENSIVE HEALTH CARE 

6 AND COST CONTAINMENT 

7 DEMONSTRATION PROJECTS 

8 ‘‘SEC. 2201. STATE-BASED UNIVERSAL HEALTH CARE COV9 ERAGE COMMISSION. 

10 ‘‘(a) ESTABLISHMENT.— 

11 ‘‘(1) IN GENERAL.—Not later than 90 days 

12 after the date of the enactment of this title, the Sec13 retary shall establish a State-based Universal Health 

14 Care Coverage Commission (in this section referred 

15 to as the ‘Commission’). 

16 ‘‘(2) MEMBERSHIP.—The Commission shall be 

17 composed of 17 members— 

18 ‘‘(A) 1 of whom shall be the Secretary; 

19 ‘‘(B) 4 of whom shall be governors of a 

20 State who are appointed by the National Gov21 ernors Association on a bipartisan basis; 

22 ‘‘(C) 4 of whom shall be State legislators 

23 who are appointed, on a joint and bipartisan 

24 basis, by the National Conference of State Leg25 islators and the American Legislative Exchange 

26 Council; 


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1 ‘‘(D) 2 of whom shall be appointed by the 

2 majority leader of the Senate; 

3 ‘‘(E) 2 of whom shall be appointed by the 

4 minority leader of the Senate; 

5 ‘‘(F) 2 of whom shall be appointed by the 

6 Speaker of the House of Representatives; and 

7 ‘‘(G) 2 of whom shall be appointed by the 

8 minority leader of the House of Representa9 tives. 

10 ‘‘(b) DUTIES OF THE COMMISSION.— 

11 ‘‘(1) GUIDANCE AND INFORMATION.—The Com12 mission shall— 

13 ‘‘(A) provide guidance to State health care 

14 officials regarding applications for grants under 

15 this title and exchange information with, and 

16 otherwise assist, such officials upon the request 

17 of the officials; 

18 ‘‘(B) submit proposed procedures with re19 spect to applications for grants under this title; 

20 ‘‘(C) review and recommend the approval 

21 of applications for demonstration grants under 

22 section 2203, including providing guidance on 

23 the issuance of appropriate waivers described in 

24 section 2203(f); 


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1 ‘‘(D) suggest appropriate levels of funding 

2 for applications for planning grants approved 

3 under section 2202 consistent with such sec4 tion; 

5 ‘‘(E) provide guidance with respect to such 

6 evaluation, monitoring, compliance, and other 

7 review functions with respect to grants under 

8 this title as may be appropriate; 

9 ‘‘(F) develop proposed guidelines, stand10 ards, and formats for the evaluation, reporting, 

11 and collection of data by States in order to en12 able the Secretary to monitor State plan admin13 istration and compliance, and to evaluate and 

14 compare the effectiveness of State plans; and 

15 ‘‘(G) provide guidance on the implementa16 tion of any other requirements or activities nec17 essary and appropriate under this title. 

18 ‘‘(2) ANNUAL REPORT.—The Commission shall 

19 prepare and submit to the President and to Con20 gress an annual report. Such report shall be sub21 mitted not later than March 30 of each year and 

22 shall include information concerning States that re23 ceive grants under this title and the effectiveness of 

24 any health care programs assisted by such grants 

25 during the previous year. 


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1 ‘‘(3) APPROVAL PROCESS.—The provisions of 

2 section 2106(c) shall apply to State plans and the 

3 Secretary under this title in the same manner as 

4 they apply to State plans and the Secretary under 

5 such section. 

6 ‘‘(4) CONSULTATION.—To the extent feasible, 

7 the Secretary shall carry out the State Comprehen8 sive Health Care and Cost Containment demonstra9 tion projects under this title based on, and in ac10 cordance with, the advice and recommendations of 

11 the Commission. 

12 ‘‘(c) PERIOD OF APPOINTMENT; REPRESENTATION

13 REQUIREMENTS; VACANCIES.—Members shall be ap14 pointed for a term of such time as is needed to complete 

15 the requirements of this section and to carry out the re16 quirements of this section. In appointing members under 

17 subsection (a)(2), the designated appointing individuals 

18 shall ensure the representation of urban and rural areas 

19 and an appropriate geographic distribution of such mem20 bers. Any vacancy in the Commission shall not affect its 

21 powers, but shall be filled in the same manner as the origi22 nal appointment. 

23 ‘‘(d) CHAIRPERSON, MEETINGS.— 

24 ‘‘(1) CHAIRPERSON.—The Commission shall se25 lect a Chairperson from among its members. 


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1 ‘‘(2) QUORUM.—Two-thirds of the members of 

2 the Commission shall constitute a quorum, but a 

3 lesser number of members may hold hearings. 

4 ‘‘(3) MEETINGS.—Not later than 30 days after 

5 the date on which all members of the Commission 

6 have been appointed, the Commission shall hold its 

7 first meeting. The Commission shall meet at the call 

8 of the Chairperson. 

9 ‘‘(e) PERSONNEL MATTERS.— 

10 ‘‘(1) COMPENSATION.—Each member of the 

11 Commission who is not an officer or employee of the 

12 Federal Government or of a State or local govern13 ment shall be compensated at a rate equal to the 

14 daily equivalent of the annual rate of basic pay pre15 scribed for level IV of the Executive Schedule under 

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

17 day (including travel time) during which such mem18 ber is engaged in the performance of the duties of 

19 the Commission. All members of the Commission 

20 who are officers or employees of the United States 

21 shall serve without compensation in addition to that 

22 received for their services as officers or employees of 

23 the United States. 

24 ‘‘(2) TRAVEL EXPENSES.—The members of the 

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1 ing per diem in lieu of subsistence, at rates author2 ized for employees of agencies under subchapter I of 

3 chapter 57 of title 5, United States Code, while 

4 away from their homes or regular places of business 

5 in the performance of services for the Commission. 

6 ‘‘(3) STAFF.—The Chairperson of the Commis7 sion may, without regard to the civil service laws 

8 and regulations, appoint and terminate an executive 

9 director and such other additional personnel as may 

10 be necessary to enable the Commission to perform 

11 its duties. The employment of an executive director 

12 shall be subject to confirmation by the Commission. 

13 ‘‘(4) DETAIL OF GOVERNMENT EMPLOYEES.— 

14 Any Federal Government employee may be detailed 

15 to the Commission without reimbursement, and such 

16 detail shall be without interruption or loss of civil 

17 service status or privilege. 

18 ‘‘(5) TEMPORARY AND INTERMITTENT SERV19 ICES.—The Chairperson of the Commission may 

20 procure temporary and intermittent services under 

21 section 3109(b) of title 5, United States Code, at 

22 rates for individuals which do not exceed the daily 

23 equivalent of the annual rate of basic pay prescribed 

24 for level V of the Executive Schedule under section 

25 5316 of such title. 


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1 ‘‘(f) FUNDING.—There are authorized to be appro2 priated such funds as necessary for the purposes of car3 rying out this section. 

4 ‘‘SEC. 2202. PLANNING GRANTS. 

5 ‘‘(a) APPLICATION.—A State may apply to the Sec6 retary for a State planning grant under this section to 

7 develop a State plan to offer universal comprehensive 

8 health care, with simplified administration, and to improve 

9 the cost-effectiveness of the health care delivery system. 

10 ‘‘(b) CONTENTS.—The Secretary may not approve 

11 such a State planning grant for a State unless the applica12 tion for the grant includes or provides for the following: 

13 ‘‘(1) BUDGET.—A budget and a budget jus14 tification. 

15 ‘‘(2) PLANNING PROCESS.—A description of 

16 how under the grant the State shall— 

17 ‘‘(A) identify options to provide a uni18 versal, comprehensive, and cost-effective system 

19 of health care, with simplified administration, 

20 that is affordable and accessible to all eligible 

21 beneficiaries in the State; and 

22 ‘‘(B) conduct an analysis that compares 

23 projected overall health expenditures over a 5- 

24 year period under the proposed system with the 


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1 projected overall health expenditures that would 

2 otherwise occur during such period. 

3 ‘‘(3) OPPORTUNITY FOR PUBLIC PARTICIPA4 TION.—Assurances that the State will include a 

5 process for public contribution and participation in 

6 the planning process. 

7 ‘‘(c) NUMBER OF STATES; PERIOD OF GRANT.—The 

8 Secretary may not award State planning grants under this 

9 section to more than 10 States. A State planning grant 

10 under this section shall be effective for a period of up to 

11 30 months. In awarding State planning grants under this 

12 section the Secretary shall give preference to States from 

13 a variety of geographic areas in the United States. 

14 ‘‘(d) AMOUNT.—The amount of a State planning 

15 grant under this section to a State may not exceed 

16 $4,500,000. 

17 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 

18 provide States with technical assistance in applying for 

19 and implementing State planning grants under this sec20 tion. At the request of the Secretary, other Departments 

21 and Offices of the Federal Government shall provide 

22 States with such technical assistance. 

23 ‘‘SEC. 2203. DEMONSTRATION GRANTS. 

24 ‘‘(a) APPLICATION.—A State that has developed a 

25 State plan may apply to the Secretary for approval of a 


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1 demonstration grant under this section to achieve a cost2 effective delivery system of universal, comprehensive 

3 health care with simplified administration. The Secretary 

4 shall reach out to States in order to ensure that at least 

5 1 application is for approval of a demonstration grant to 

6 provide a single payer system of health care coverage. The 

7 Secretary shall notify the chief executive officer of all 

8 States of the availability of demonstration grants under 

9 this section. 

10 ‘‘(b) APPROVAL.—The Secretary shall approve the 

11 applications of not more than 5 States under this section. 

12 In approving grants under this section the Secretary shall 

13 give preference to States from a variety of geographic 

14 areas in the United States and for a variety of policy op15 tions, at least 1 of which shall be a single-payer system 

16 of health care coverage. If the Secretary determines that 

17 a State no longer meets the conditions for approval of the 

18 grant, the Secretary shall notify the State of such deter19 mination and provide the State with an opportunity to cor20 rect deficiencies in a timely manner. If the Secretary fur21 ther determines that a State has not corrected such defi22 ciencies in a timely manner, the Secretary shall terminate 

23 the grant (including waivers authorized under the grant). 

24 ‘‘(c) PERIOD.—A demonstration grant approved 

25 under this section shall be effective for up to 5 years from 


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1 the date of final approval of the demonstration grant ap2 plication under subsection (b). 

3 ‘‘(d) STATE PLAN REQUIRED.—The Secretary may 

4 not approve a demonstration grant under this section un5 less the State has a State plan to carry out the grant con6 sistent with the requirements of section 2204. 

7 ‘‘(e) FUNDING.— 

8 ‘‘(1) TRANSITIONAL GRANT AMOUNT.—The 

9 amount awarded under this section to a State with 

10 a demonstration grant approved under this section 

11 may not exceed an aggregate amount of 

12 $13,000,000 plus $4 multiplied by the number of el13 igible State residents of the State to assist the State 

14 in the transition of the health care delivery and fi15 nancing infrastructure. Such amount shall be made 

16 available to a State during the period of transition, 

17 as provided in the State plan. The number of eligible 

18 State residents of a State shall be determined based 

19 on the best available Census Bureau data as of the 

20 July 1 before the date the grant under this section 

21 is approved. 

22 ‘‘(2) MAINTENANCE OF FEDERAL FUNDS

23 UNDER WAIVERS.—Pursuant to the waivers under 

24 subsection (f), the Federal Government shall pay to 

25 a State amounts for health care under Federal 


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1 health care programs that would otherwise have 

2 been payable by the Federal Government but for the 

3 State’s universal, comprehensive health care system 

4 under this section. 

5 ‘‘(3) GENERAL 3 PERCENTAGE POINTS IN6 CREASE IN FMAP FOR CALENDAR QUARTERS OCCUR7 RING DURING THE PERIOD OF THE DEMONSTRATION

8 GRANT.— 

9 ‘‘(A) IN GENERAL.—Notwithstanding any 

10 other provision of law, for each State for which 

11 a demonstration grant is approved under this 

12 section, the FMAP of the State shall be in13 creased by 3 percentage points for each cal14 endar quarter occurring during the period re15 ferred to in subsection (c). 

16 ‘‘(B) FMAP.—In this paragraph, the term 

17 ‘FMAP’ means the Federal medical assistance 

18 percentage, as defined in section 1905(b). 

19 ‘‘(f) WAIVER OF ERISA PREEMPTION AND WAIVERS

20 TO POOL FUNDS.—As part of a demonstration grant 

21 under this section and subject to the benefit maintenance 

22 requirements applicable under section 2204(b), a State 

23 may request (and the Secretary may grant) the following 

24 waivers of requirements and provisions to the extent nec25 essary to carry out the State plan under section 2204: 


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1 ‘‘(1) ERISA.—Waiving application of section 

2 514 of the Employee Retirement Income Security 

3 Act of 1974. 

4 ‘‘(2) MEDICARE.—Waiving provisions necessary 

5 to permit the State— 

6 ‘‘(A) to use funds otherwise paid under 

7 title XVIII for beneficiaries residing in the 

8 State; and 

9 ‘‘(B) to permit the State to enter into an 

10 arrangement with the Secretary under which el11 igible State residents who are not otherwise en12 rolled for benefits under parts A and B of such 

13 title are enrolled for such benefits under such 

14 title and the State provides for such actuarially 

15 appropriate reimbursement to the Secretary 

16 with respect to coverage of such benefits for 

17 such residents as is necessary to assure that the 

18 Federal Hospital Insurance Trust Fund and 

19 the Federal Supplementary Medical Insurance 

20 Trust Fund under such title are not adversely 

21 affected by virtue of such waiver, such reim22 bursement subject to— 

23 ‘‘(i) an independent audit, to be re24 viewed by the Comptroller General of the 

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1 bursement does not adversely affect in any 

2 way such Trust Funds, and 

3 ‘‘(ii) in the case that the audit deter4 mines that additional reimbursement to the 

5 Secretary is required, such additional reim6 bursement, with appropriate adjustments 

7 for interest attributable to the late reim8 bursement. 

9 ‘‘(3) MEDICAID.—Waiving provisions necessary 

10 to permit the State to use funds otherwise paid to 

11 the State under title XIX. 

12 ‘‘(4) SCHIP.—Waiving provisions necessary to 

13 permit the State to use funds otherwise paid to the 

14 State under title XXI. 

15 ‘‘(5) FEHBP.—Waiving provisions necessary to 

16 permit the State to use funds otherwise paid under 

17 chapter 89 of title 5, United States Code, or allow18 ing the Office of Personnel Management to purchase 

19 health care coverage for Federal employees and re20 tirees in the State under the State plan. 

21 ‘‘(6) USE OF OTHER FUNDS.—Waiving provi22 sions necessary to permit the State to use funds oth23 erwise provided under other Federal programs for 

24 the provision of health care coverage or services, as 

25 identified by the State. 


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1 ‘‘(7) OTHER LAWS.—Waiving of other provi2 sions of Federal law identified by the State under 

3 section 2204(f)(3) only if the Secretary determines 

4 such a waiver to be appropriate after consultation 

5 with the head of the Federal agency or department 

6 concerned. 

7 The Secretary may grant a waiver under this subsection 

8 only if the State provides the Secretary with satisfactory 

9 assurances that necessary safeguards have been taken to 

10 protect the health and welfare of individuals provided serv11 ices under the waiver and that financial accountability is 

12 maintained for any funds expended under the waiver. The 

13 Secretary may grant a waiver under paragraph (1) only 

14 with the concurrence of the Secretary of Labor. 

15 ‘‘(g) REENROLLMENT OF ELIGIBLE STATE RESI16 DENTS WHO MOVE FROM A PARTICIPATING STATE.—In 

17 the case of an eligible State resident who is covered under 

18 a State plan under section 2204, who (but for such cov19 erage) is eligible to be enrolled in a program described in 

20 subsection (f) (including the Medicare and Medicaid pro21 grams), and who is not enrolled in such a program because 

22 of such coverage, if the resident leaves the State to reside 

23 in a State that does not have such a State plan in effect, 

24 the resident shall be permitted, notwithstanding any other 

25 provision of law, to enroll immediately in such a program 


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1 if the resident is still otherwise eligible to be so enrolled. 

2 In the case of such enrollment in the Medicare program, 

3 the resident shall be treated for purposes of section 

4 1882(s)(2) (relating to availability of Medicare supple5 mental policies without underwriting) as if the resident 

6 had turned 65 years of age on the date the resident enrolls 

7 in the Medicare program. 

8 ‘‘SEC. 2204. STATE PLAN REQUIREMENTS. 

9 ‘‘(a) COVERAGE.— 

10 ‘‘(1) IN GENERAL.—A State plan shall provide 

11 a process and a timeline for achieving coverage of all 

12 eligible State residents statewide, without regard to 

13 employment status, income, health status or pre14 existing condition, or location of residency within the 

15 State. 

16 ‘‘(2) OUTREACH MECHANISMS.—A State plan 

17 shall describe the outreach mechanisms to be used to 

18 assure coverage of all eligible individuals, including 

19 measures to assure coverage of individuals in hard20 to-reach populations and to assure benefits are pro21 vided to eligible individuals located in underserved 

22 areas. 

23 ‘‘(b) BENEFITS.— 

24 ‘‘(1) IN GENERAL.— 


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1 ‘‘(A) BASIC BENEFITS.—A State plan shall 

2 provide for health benefits that are at least ac3 tuarially equivalent to the standard Blue Cross/ 

4 Blue Shield preferred provider option service 

5 benefit plan, described in and offered under sec6 tion 8903(1) of title 5, United States Code. 

7 ‘‘(B) ITEMS AND SERVICES.—A State plan 

8 shall include benefits for at least the following 

9 items and services: 

10 ‘‘(i) Inpatient and outpatient hospital 

11 services, including emergency services 

12 available 24 hours a day. 

13 ‘‘(ii) Long-term, acute, and chronic 

14 care services, including skilled nursing fa15 cility services, intermediate care facility 

16 services, home health services, home and 

17 community-based long-term care services, 

18 hospice care, and services in intermediate 

19 care facilities for individuals diagnosed 

20 with mental retardation. 

21 ‘‘(iii) Professional services of health 

22 care practitioners authorized to provide 

23 health care services under State law. 

24 ‘‘(iv) Community-based primary 

25 health care services, including rural health 


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1 clinic services and federally qualified health 

2 center services. 

3 ‘‘(v) Laboratory, x-ray services, and 

4 diagnostic tests. 

5 ‘‘(vi) Preventive care, including pre6 natal, well-baby, and well-child care, appro7 priate immunizations, pap smears, screen8 ing mammography, colorectal cancer 

9 screening, physical examinations, and fam10 ily planning. 

11 ‘‘(vii) Prescription drugs and 

12 biologicals, including insulin and medical 

13 foods. 

14 ‘‘(viii) Mental health services. 

15 ‘‘(ix) Substance use disorder services. 

16 ‘‘(x) Vision services, including routine 

17 eye examinations, eyeglasses, and contact 

18 lenses. 

19 ‘‘(xi) Hearing services, including hear20 ing aids. 

21 ‘‘(xii) Dental services, including rou22 tine check ups. 

23 ‘‘(xiii) Durable medical equipment, in24 cluding home dialysis supplies and equip25 ment. 


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1 ‘‘(xiv) Emergency ambulance services. 

2 ‘‘(xv) Prosthetics. 

3 ‘‘(xvi) Outpatient therapy, including 

4 physical therapy, occupational therapy, and 

5 speech language pathology services and re6 lated services. 

7 ‘‘(2) ASSURANCE THAT BENEFITS ARE NOT RE8 DUCED FOR INDIVIDUALS COVERED UNDER FED9 ERAL PROGRAMS.—Insofar as the State under the 

10 plan incorporates funding provided by Federal pro11 grams described in section 2203(f), the State plan 

12 may not provide for a reduction in benefits (includ13 ing coverage, access, availability, duration, and bene14 ficiary rights, and, if applicable, vaccine benefits 

15 under section 1928) otherwise provided for under 

16 such programs or an increase in cost-sharing and 

17 premiums otherwise provided for under such pro18 grams. 

19 ‘‘(c) QUALITY ASSURANCE.— 

20 ‘‘(1) IN GENERAL.—A State plan shall provide, 

21 and describe, mechanisms to be used to assure, mon22 itor, and maintain the quality of items and services 

23 furnished under the plan. 

24 ‘‘(2) HEALTH OUTCOMES.—A State plan shall 

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1 comes in the State, including estimates of health 

2 benefits, decreased morbidity and mortality, and im3 proved productivity resulting from reduction in the 

4 number of individuals without health benefits. 

5 ‘‘(d) PROGRAMS FOR MEDICAL EDUCATION.—A 

6 State plan shall describe health professions training and 

7 graduate medical education activities applicable under the 

8 plan, and shall provide, under the State plan, for payment 

9 from Federal, State, and local governments for such train10 ing and education activities in the amounts that would 

11 otherwise be payable by such governments but for the 

12 State’s universal, comprehensive health care system under 

13 the State plan. 

14 ‘‘(e) FINANCING.— 

15 ‘‘(1) BUDGET.—A State plan shall incorporate 

16 a budget which contains— 

17 ‘‘(A) detailed projections of health care ex18 penditures prior to and under the proposed sys19 tem, including an identification and calculation 

20 of the amount of funding to be provided by 

21 Federal, State, and local governments under the 

22 plan and an assurance that the amount of ex23 penditures made by the State and local govern24 ments will not be reduced as a result of the im25 plementation of the plan; and 


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1 ‘‘(B) a description (and an estimate of the 

2 costs) of transitional activities to be undertaken 

3 in implementing the proposed system. 

4 ‘‘(2) COST CONTAINMENT.—A State plan shall 

5 describe the means to be used to contain costs under 

6 the plan, including when and how the plan will in7 crease efficiencies. 

8 ‘‘(3) FEDERAL EXPENDITURE LIMIT.—A State 

9 plan shall contain assurances that aggregate Federal 

10 expenditures on health care (including Federal ex11 penditures under titles 5, 10, and 38 of the United 

12 States Code, and under this Act) under the plan will 

13 not exceed aggregate Federal expenditures that 

14 would have been incurred in the absence of such 

15 plan. 

16 ‘‘(f) IMPLEMENTATION.— 

17 ‘‘(1) IN GENERAL.—A State plan shall describe 

18 the method (including a timetable and period of 

19 transition) for implementing the plan. 

20 ‘‘(2) COORDINATION.—A State plan shall iden21 tify all Federal, State, and local programs that pro22 vide health care services in the State and describe 

23 how such programs would be incorporated in, or co24 ordinated with, the health coverage system under the 

25 plan. 


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1 ‘‘(3) FEDERAL WAIVERS REQUIRED.—A State 

2 plan shall identify any waivers of Federal law re3 quired to implement the plan, including the use of 

4 any pooled Federal funds and other waivers de5 scribed in section 2203(f). 

6 ‘‘(4) APPROVAL OF STATE LEGISLATURE.—A 

7 State plan shall provide that State approvals and 

8 commitments (including approval of the State legis9 lature) necessary for the implementation of the plan 

10 will be obtained by not later than 1 year after the 

11 date of the Secretary’s approval of the plan. Any ap12 proval of a grant is conditioned upon the timely 

13 completion of such approvals and commitments. 

14 ‘‘(g) EVALUATION.—A State plan shall provide for a 

15 process for its evaluation, and shall comply with any eval16 uation, reporting, or data collection requirements imposed 

17 by the Secretary. 

18 ‘‘(h) CONSTRUCTION.—Nothing in this title shall be 

19 construed as preempting State laws that provide greater 

20 protections or benefits than the protections or benefits re21 quired under this title. 

22 ‘‘SEC. 2205. INTERSTATE ARRANGEMENTS. 

23 ‘‘(a) IN GENERAL.—One or more contiguous States 

24 in a geographic region may file a joint application for 

25 planning and demonstration grants under this title. 


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1 ‘‘(b) CONGRESSIONAL APPROVAL.—Congress hereby 

2 authorizes and approves States entering into Interstate 

3 Compacts in order to conduct joint health care programs 

4 under such a grant. 

5 ‘‘(c) REFERENCES TO STATE.—In the case of a joint 

6 application described in subsection (a), any reference in 

7 this title to a State is deemed to refer to all of the States 

8 that have filed the application, and the approval of a grant 

9 with respect to such a joint application shall be counted 

10 as 1 State for purposes of applying sections 2202(c) and 

11 2203(b). 

12 ‘‘SEC. 2206. DEFINITIONS. 

13 ‘‘In this title: 

14 ‘‘(1) ELIGIBLE STATE RESIDENT.—The term 

15 ‘eligible State resident’ means any resident of the 

16 United States who is a citizen or national of the 

17 United States, or lawful resident alien, and who re18 sides in any particular State. Such term may in19 clude, at the option of a State, the following: 

20 ‘‘(A) State employees and dependents of 

21 such employees. 

22 ‘‘(B) Employees, and dependents of such 

23 employees, working in a work site of a business 

24 located in the State. 


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1 ‘‘(C) One or more classes of non2 immigrants (as defined in section 101(a)(15) of 

3 the Immigration and Nationality Act) specified 

4 in the State plan. 

5 ‘‘(2) LAWFUL RESIDENT ALIEN.—The term 

6 ‘lawful resident alien’ means an alien lawfully admit7 ted for permanent residence and any other alien law8 fully residing permanently in the United States 

9 under color of law, including an alien granted asy10 lum or with lawful temporary resident status under 

11 section 210, 210A, or 245A of the Immigration and 

12 Nationality Act. 

13 ‘‘(3) SECRETARY.—The term ‘Secretary’ means 

14 the Secretary of Health and Human Services. 

15 ‘‘(4) SINGLE PAYER SYSTEM.—The term ‘single 

16 payer system’ means an approach to health care fi17 nancing with only 1 source of money for paying 

18 health care providers. The payer may be either a 

19 governmental unit or other entity (such as an insur20 ance company). The elements of a single payer sys21 tem offer administrative simplicity for patients and 

22 providers, and savings in overhead costs. 

23 ‘‘(5) STATE.—Subject to section 2205(c), the 

24 term ‘State’ means a State, the District of Colum25 bia, the Commonwealth of Puerto Rico, the United 


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1 States Virgin Islands, Guam, American Samoa, and 

2 the Commonwealth of the Northern Mariana Is3 lands. 

4 ‘‘(6) STATE PLAN.—The term ‘State plan’ 

5 means a comprehensive health care plan of a State 

6 participating in a State Comprehensive Health Care 

7 and Cost Containment demonstration project under 

8 this title that meets the requirements of section 

9 2204.’’. 

Æ 


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