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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3478 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3478

To amend the Internal Revenue Code of 1986 to modify rules relating to 
   health savings accounts, to provide payments for a health savings 
account and for a high deductible health plan instead of entitlement to 
benefits under Medicare, Medicaid, and SCHIP, to give more control and 
  coverage to patients, to lower health care costs through increased 
price transparency, and to require immigrants to have a health savings 
   account and high deductible health coverage at time of admission.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             July 31, 2009

 Mr. Gohmert introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committees on 
Energy and Commerce and the Judiciary, 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 Internal Revenue Code of 1986 to modify rules relating to 
   health savings accounts, to provide payments for a health savings 
account and for a high deductible health plan instead of entitlement to 
benefits under Medicare, Medicaid, and SCHIP, to give more control and 
  coverage to patients, to lower health care costs through increased 
price transparency, and to require immigrants to have a health savings 
   account and high deductible health coverage at time of admission.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Patient-Controlled 
Healthcare Protection Act of 2009''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
                 TITLE I--HEALTH SAVINGS ACCOUNT REFORM

Sec. 101. Advantage HSA.
Sec. 102. Health Savings Account reform.
Sec. 103. Advantage HSA grant program.
Sec. 104. Health Savings Account debit card.
Sec. 105. HSA Healthcare Panel.
     TITLE II--TRANSPARENCY RELATED TO HEALTH CARE PROVIDER CHARGES

Sec. 201. Transparency requirements related to health care provider 
                            charges.
               TITLE III--IMMIGRATION-RELATED PROVISIONS

Sec. 301. Requirement for immigrant to be covered under high deductible 
                            health plan and HSA.
Sec. 302. Reentry of removed alien who received emergency medical 
                            assistance.

                 TITLE I--HEALTH SAVINGS ACCOUNT REFORM

SEC. 101. ADVANTAGE HSA.

    (a) In General.--Part III of subchapter B of chapter 1 of the 
Internal Revenue Code of 1986 is amended by inserting after section 138 
the following new section:

``SEC. 138A. ADVANTAGE HSA.

    ``(a) In General.--Gross income shall not include any payment to 
the Advantage HSA of an individual by the Secretary of the Treasury 
under section 103 of Patient-Controlled Healthcare Protection Act of 
2009 or any premium payment under such section for the high deductible 
health plan with respect to which such Advantage HSA relates.
    ``(b) Advantage HSA.--For purposes of this section, the term 
`Advantage HSA' means a health savings account (as defined in section 
223(d))--
            ``(1) which is designated as an Advantage HSA,
            ``(2) with respect to which no contribution may be made 
        other than--
                    ``(A) a contribution described in subsection (a),
                    ``(B) a contribution in cash without limitation as 
                to amount, or
                    ``(C) a trustee-to-trustee transfer described in 
                subsection (d), and
            ``(3) the governing instrument of which provides that 
        trustee-to-trustee transfers described in subsection (d) may be 
        made to and from such account.
    ``(c) Ten Percent Bonus Distribution.--
            ``(1) In general.--Section 223(f)(2) shall not apply to any 
        bonus distribution from a health savings account.
            ``(2) Distributions.--An eligible Advantage HSA participant 
        may receive 10 percent of excess funds that have been 
        contributed to the individual or household HSA over the 
        deductible in a calendar year. The funds will be directly 
        deposited into the desired account of the participant.
            ``(3) Bonus distribution.--For purposes of this subsection, 
        the term `bonus distribution' means any distribution which is 
        made during the 30-day period beginning on the first day of the 
        calendar year to the extent such distribution does not exceed 
        an amount equal to the excess (if any) of--
                    ``(A) the fair market value of the assets in such 
                health savings account as of the close of the preceding 
                calendar year, over
                    ``(B) the sum of the annual deductible required to 
                be paid under the plan for covered benefits for the 
                calendar year.
    ``(d) State Certification for High Deductible Health Plans.--For 
purposes of this section--
            ``(1) In general.--For purposes of determining whether or 
        not an individual is an eligible individual, a health plan 
        shall not be treated as a high deductible health plan (as 
        defined under section 223(c)(2)) unless such plan is certified 
        by the State within which the individual's principal place of 
        abode is located.
            ``(2) Insurance bidding.--If an insurance company is based 
        in the United States, they may offer and sell policies in all 
        States and they may bid on other policies across State lines.
    ``(e) Trustee-to-Trustee Transfer.--Section 223(f)(2) shall not 
apply to any trustee-to-trustee transfer from an Advantage HSA of an 
account holder to another Advantage HSA or health savings account of 
such account holder.
    ``(f) Associations.--Employers who choose to participate in the 
Advantage HSA Program may join together in associations in an effort to 
purchase less expensive insurance for their employees.''.
    (b) Conforming Amendment.--The table of sections for part III of 
subchapter B of chapter 1 of such Code is amended by inserting after 
the item relating to section 138 the following new item:

``138A. Advantage HSA.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2009.

SEC. 102. HEALTH SAVINGS ACCOUNT REFORM.

    (a) Account-to-Account Transfers.--
            (1) In general.--Subparagraph (A) of section 223(f)(5) of 
        the Internal Revenue Code of 1986 is amended by striking ``a 
        health savings account for the benefit of such beneficiary'' 
        and inserting ``any health savings account''.
            (2) Limitation.--Subparagraph (B) of section 223(f)(5) of 
        such Code is amended--
                    (A) by striking ``Limitation.--This paragraph'' and 
                inserting the following:
                    ``(B) Limitations.--
                            ``(i) In general.--This paragraph'', and
                    (B) by adding at the end of subparagraph (B), as so 
                amended, the following new clause:
                            ``(ii) Transfers to other account 
                        beneficiaries.--This paragraph shall not apply 
                        to any amount described in subparagraph (A) to 
                        the extent that immediately after such 
                        distribution the fair market value of the 
                        account is less than the annual deductible 
                        required to be paid under the plan for the 
                        calendar year within which the distribution is 
                        made.''.
    (b) Migrant Worker HSA.--Section 223 of such Code is amended by 
adding at the end the following new subsection:
    ``(i) Migrant Worker HSA.--
            ``(1) In general.--An employer may establish for the 
        benefit of any eligible employee a health savings account.
            ``(2) Eligible employee.--For purposes of this subsection, 
        the term `eligible employee' means any individual (other than a 
        citizen or resident of the United States)--
                    ``(A) with respect to whom the employee provides 
                remuneration for employment, and
                    ``(B) who is lawfully present in the United States 
                and has been granted authorization to engage in 
                employment in the United States.''.
    (c) Other Reforms.--Section 223 of such Code is amended as follows:
            (1) By striking paragraphs (1) through (4) and (6) through 
        (8) of subsection (b) and by redesignating paragraph (5) as 
        paragraph (1).
            (2) By inserting after paragraph (1), as so redesignated, 
        the following new paragraph:
            ``(2) Household hsa.--In the case of health savings 
        accounts with respect to which individuals who are members of 
        the same household are the account beneficiaries, upon filing 
        the return of tax for any taxable year, each such individual 
        shall include on the return each social security number of all 
        participating members of such individual's household.''.
            (3) By amending paragraph (1) of subsection (c) to read as 
        follows:
            ``(1) Eligible individual.--The term `eligible individual' 
        means any individual.''.
            (4) By amending subsection (c)(2)(A) to read as follows:
                    ``(A) In general.--The term `high deductible health 
                plan' means a health plan which has an annual 
                deductible which is not less than--
                            ``(i) $2,500 for self-only coverage, and
                            ``(ii) $3,500 for family or household 
                        coverage.''.
            (5) By striking subparagraph (B) of subsection (c)(2) and 
        redesignating subparagraphs (C) and (D) thereof as 
        subparagraphs (B) and (C), respectively.
            (6) By adding at the end of subsection (c)(2), as so 
        amended, the following new subparagraph:
                    ``(D) Other requirements.--An Advantage HSA plan 
                will offer the following to the individual or household 
                participants--
                            ``(i) the plan shall not require that an 
                        individual see a general physician prior to a 
                        seeing specialist, and
                            ``(ii) coverage may not be denied based on 
                        a pre-existing condition of an individual.''.
            (7) By adding at the end of subparagraph (A) of subsection 
        (d)(2) the following: ``Such term shall include any expense 
        which is on the list of eligible healthcare expenses most 
        recently submitted by the HSA Healthcare Panel under section 
        105(b)(2) of the Patient-Controlled Healthcare Protection Act 
        of 2009.''.
            (8) By striking ``the individual'' in subsection (d)(3) and 
        inserting ``an individual''.
            (9) By adding at the end of subsection (e) the following 
        new paragraph:
            ``(3) Exception.--In the case of a termination occurring 
        after the date of the enactment of the Patient-Controlled 
        Healthcare Protection Act of 2009, in lieu of being treated as 
        a distribution not used to pay qualified medical expenses, such 
        amounts shall be transferred by the account beneficiaries to 
        another health savings account.''.
            (10) In subsection (f), by striking paragraphs (2), (3), 
        (5), and (8) of and redesignating paragraphs (4), (6), and (7) 
        as paragraphs (2), (3), and (4), respectively.
            (11) By amending paragraph (2) of subsection (f), as so 
        redesignated, to read as follows:
            ``(2) Amounts not used for qualified medical expenses.--Any 
        amount paid or distributed out of a health savings account 
        which is not used exclusively to pay the qualified medical 
        expenses of an account beneficiary shall be recontributed by 
        the beneficiary to such health savings account.''.
            (12) By adding at the end (as amended by this Act) the 
        following new subsection:
    ``(j) Other Special Rules.--For purposes of this section--
            ``(1) Investment of hsa funds.--Account beneficiaries may 
        invest any amount in their health savings account in excess of 
        their deductible in inflation-proof United States bonds.
            ``(2) Termination of household.--Any account beneficiaries 
        of a household HSA shall sign an agreement as to distribution 
        of amounts from such HSA prior to termination of the HSA, which 
        will be kept on file with the entity in which the HSA funds are 
        being held.
            ``(3) Portability.--An individual or household participant 
        owns their HSA and insurance policy (if they choose to have 
        one) and therefore the policies are portable.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2009.

SEC. 103. ADVANTAGE HSA PAYMENT PROGRAM.

    (a) In General.--The Advantage HSA payment program provided under 
this section shall be in lieu of entitlement to, and eligibility for, 
benefits and assistance described in subsection (d)(2). Effective on 
the date the Advantage HSA payment program is established, titles 
XVIII, XIX, and XXI of the Social Security Act are repealed, except for 
purposes of determining whether an individual is an Advantage eligible 
individual under this section.
    (b) HSA Contributions.--In the case of an individual or household 
who is eligible for an Advantage HSA, the Secretary of Treasury, in 
consultation with the Secretary of Health and Human Services, shall pay 
an annual amount to the Advantage HSA of the individual or household.
    (c) HSA Premium Assistance.--The Secretary of the Treasury, in 
consultation with the Secretary of Health and Human Services, shall 
establish a program under which the Secretary of the Treasury shall pay 
the premiums for the high deductible health plan with respect to the 
Advantage HSA of such individual. Such program shall provide for 
prorated payment of such premiums in the case that such individual is 
not an Advantage eligible individual for a full calendar year.
    (d) Advantage Eligible Individual.--For purposes of this section--
            (1) In general.--The term ``Advantage eligible individual'' 
        means, with respect to any month, any individual--
                    (A) who is an eligible individual (as defined in 
                section 223(c) of the Internal Revenue Code of 1986); 
                and
                    (B)(i) who is Advantage eligible; or
                    (ii) whose dependent (within the meaning of section 
                152 of the Internal Revenue Code of 1986) or spouse is 
                Advantage eligible (but only if an election under this 
                section is in effect with respect to such spouse or 
                dependent).
            (2) Advantage eligible.--The term ``Advantage eligible'' 
        means, with respect to any month--
                    (A) entitled, as of the 1st day of such month, to 
                benefits under part A of title XVIII of the Social 
                Security Act or to enroll under part B of such title, 
                or
                    (B) eligible, as of the 1st day of such month, for 
                medical or child health assistance under title XIX or 
                XXI of such Act (other than under section 1928 of such 
                Act).
    (e) Applicable Annual Amount.--For purposes of this section--
            (1) In general.--The term ``applicable annual amount'' 
        means $2,500.
            (2) Additional amount.--In the case of an Advantage HSA 
        eligible household, $3,500.
    (f) Definitions.--Except as otherwise provided, terms used in this 
section shall have the same respective meanings as when used in 
sections 138A and 223 of the Internal Revenue Code of 1986.
    (g) Regulations.--The Secretary of the Treasury shall prescribe 
such regulations as may be necessary or appropriate to carry out the 
purposes of this section, including regulations providing for the 
following:
            (1) Recapture of amounts paid under subsection (a) (and any 
        earnings attributable thereto) which are distributed out of an 
        Advantage HSA and not used exclusively to pay qualified medical 
        expenses of the account beneficiary.
            (2) Ensuring that not more than the applicable annual 
        amount under paragraph (1) of subsection (d) (and any 
        additional amount under paragraph (2) of such subsection) shall 
        be paid with respect to any individual, the spouse of such 
        individual, and all dependents with respect to such individual.
            (3) Ensuring that all individuals with respect to whom an 
        election has been made under this section are covered under the 
        high deductible plan to which the applicable Advantage HSA 
        relates.

SEC. 104. HEALTH SAVINGS ACCOUNT DEBIT CARD.

    (a) In General.--The Secretary of the Treasury, in consultation 
with the Secretary of Health and Human Services, shall establish a 
program under which trustees of health savings accounts can issue debit 
cards with which account beneficiaries may pay for qualified medical 
expenses (as defined in section 223 of the Internal Revenue Code of 
1986). Such program shall provide for the following:
            (1) Participation from health care providers and vendors of 
        products the purchase of which qualifies as a qualified medical 
        expense (as so defined).
            (2) A uniform coding system implemented by such providers 
        and vendors such that such debit cards may not be used to 
        purchase services or products which are not qualified medical 
        expenses (as so defined).
            (3) That prior to payment with such card such providers and 
        vendors require presentation an identification card that 
        matches the individual identified on the debit card and 
        provides a photograph and is issued by a State or the Federal 
        Government, or a document that, with respect to identification 
        of the individual identified on the debit card, is considered 
        acceptable for purposes of sections 274a.2(b)(1)(v)(A) and 
        274a.2(b)(1)(v)(B) of title 8, Code of Federal Regulations (as 
        in effect on or after the date of the enactment of this Act).
            (4) That the individual presenting such debit card for 
        payment sign a statement that affirms payment is for a 
        qualified medical expense with respect to such individual and 
        which acknowledges that use of such debit card for any other 
        expense constitutes a false statements or misrepresentations 
        which may subject the purchaser to criminal penalties under 
        section 1001 of title 18, United States Code, which notice 
        specifies the maximum fine and term of imprisonment under such 
        section.
    (b) Submission of Information.--Each trustee of a health savings 
account shall submit to the HSA Healthcare Panel (established under 
section 105) a report detailing all purchases made with debit cards 
from health savings accounts of the trustee. Such report shall not 
contain any personal information of the account beneficiaries of such 
health savings accounts.
    (c) Health Savings Account; Qualified Medical Expenses.--For 
purposes of this section, the terms ``health savings account'' and 
``qualified medical expenses'' shall have the respective meanings given 
such terms by section 223 of the Internal Revenue Code of 1986.

SEC. 105. HSA HEALTHCARE PANEL.

    (a) Establishment.--There is established a Panel to be known as the 
``HSA Healthcare Panel'' (in this section referred to as the 
``Panel'').
    (b) Duties.--
            (1) Review of qualified medical expenses.--The Panel shall 
        review the reports and other information submitted to the Panel 
        under section 104 or requested by the Panel and review 
        appropriate information regarding the healthcare treatments, 
        services, and products that are potentially treatable as 
        qualified medical expenses for purposes of section 223 of the 
        Internal Revenue Code of 1986.
            (2) Report.--The Panel shall, not later than 1 year after 
        the date of enactment of this Act and annually thereafter 
        submit a report to Congress providing a new list of eligible 
        healthcare expenses.
    (c) Membership.--
            (1) In general.--The Panel shall be comprised of 101 
        members.
            (2) Appointments.--
                    (A) Voting member and chair.--The Surgeon General 
                of the United States shall be a voting member of the 
                Panel, and shall be the chairperson.
                    (B) Other voting members.--The Governor of each 
                State shall appoint 2 voting members to the Panel, one 
                of whom shall be a health care specialist and one of 
                whom shall not be a health care specialist.
            (3) Date of appointments.--The appointment of a members of 
        the Panel shall be made not later than 60 days after the date 
        of the enactment of this Act.
            (4) Term.--Members shall be appointed for 1-year terms.
            (5) Vacancies.--A vacancy in the Panel shall be filled not 
        later than 60 days after such vacancy occurs and in the manner 
        in which the original appointment was made.
    (d) Powers of Panel.--
            (1) Meetings and hearings.--
                    (A) In general.--The Panel shall meet upon the call 
                of the chairperson or a majority of its voting members. 
                Such meetings, to the extent practicable, may be 
                conducted over the internet or in person.
                    (B) Hearings.--The Panel may, for the purpose of 
                carrying out this section, hold hearings, sit and act 
                at times and places, take testimony, and receive 
                evidence to carry out its duties under this section. 
                The Panel may administer oaths or affirmations to 
                witnesses appearing before it.
            (2) Obtaining official information.--
                    (A) Requirement to furnish.--Except as provided in 
                subparagraph (B), if the Panel submits a request to a 
                Federal department or agency for information necessary 
                to enable the Panel to carry out this section, the head 
                of that department or agency shall furnish that 
                information to the Panel.
                    (B) Exception for national security.--If the head 
                of a Federal department or agency determines that it is 
                necessary to withhold requested information from 
                disclosure to protect the national security interests 
                of the United States, the department or agency head 
                shall not furnish that information to the Panel.
            (3) Mails.--The Panel may use the United States mails in 
        the same manner and under the same conditions as other 
        departments and agencies of the United States.
            (4) Contracts.--The Panel may contract with and compensate 
        persons and government agencies for supplies and services, 
        without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5).
    (e) Pay and Reimbursement.--
            (1) No compensation for members of panel.--Except as 
        provided in paragraph (2), a member of the Panel may not 
        receive pay, allowances, or benefits by reason of the member's 
        service on the Panel.
            (2) Travel expenses.--Each member shall receive travel 
        expenses, including per diem in lieu of subsistence under 
        subchapter I of chapter 57 of title 5, United States Code.
    (f) Quorum.--Thirty members of the Panel shall constitute a quorum, 
but a lesser number may hold hearings.

     TITLE II--TRANSPARENCY RELATED TO HEALTH CARE PROVIDER CHARGES

SEC. 201. TRANSPARENCY REQUIREMENTS RELATED TO HEALTH CARE PROVIDER 
              CHARGES.

    (a) In General.--Notwithstanding any other provision of law, a 
health care provider shall provide to an individual who is scheduled to 
receive a service or treatment the following:
            (1) Actual prices to be charged.--The actual price that the 
        health care provider will charge for the service or treatment.
            (2) Payment rates applicable to other entities.--In the 
        case such charge amount for the service or treatment is 
        different from--
                    (A) the rate of payment for the service or 
                treatment to the health care provider that has been 
                negotiated by or on behalf of the provider with a 
                network plan or managed care plan;
                    (B) the rate of payment for the service or 
                treatment applicable to the provider under the Medicare 
                program under title XVIII; or
                    (C) such charge amount or payment rate that is 
                applicable with respect to any other entity;
        the amount of such different rate of payment or charge amount 
        and a description of the type of entity to which such rate or 
        charge applies (without naming such entity).
    (b) Application of Requirement on Request.--A health care provider 
is required to provide the applicable information under subsection (a) 
for a service or treatment when requested by anyone in person, or by 
phone, fax, or email.
    (c) Clarification.--Nothing in this section shall be construed as 
preventing a health care provider from providing a service or treatment 
free of charge as a charitable gesture without publicly disclosing the 
individual to whom such charitable service or treatment has been 
provided.
    (d) Effective Date.--The requirement under subsection (a) shall 
apply with respect to services and treatments provided on or after the 
date that is 60 days after the date of the enactment of this Act.

               TITLE III--IMMIGRATION-RELATED PROVISIONS

SEC. 301. REQUIREMENT FOR IMMIGRANT TO BE COVERED UNDER HIGH DEDUCTIBLE 
              HEALTH PLAN AND HSA.

    Notwithstanding any other provision of law, a consular officer (as 
defined in section 101(a) of the Immigration and Nationality Act (8 
U.S.C. 1101(a)) may not issue or renew an immigrant visa to an alien 
unless the alien presents evidence (which may be in the form of an 
attestation by a sponsoring employer or individual United States 
citizen in whose household the alien intends to reside who will be 
responsible for providing the requisite coverage) that the alien (and 
the alien's spouse and children who are accompanying or following to 
join the alien) will be covered under a high deductible health plan (as 
defined in section 223 of the Internal Revenue Code of 1986) and will 
be an account beneficiary of a health savings account under such 
section after the alien's admission to the United States as an 
immigrant and for the duration of the alien's residence in the United 
States, or be subject to removal.

SEC. 302. REENTRY OF REMOVED ALIEN WHO RECEIVED EMERGENCY MEDICAL 
              ASSISTANCE.

    Section 276(b) of the Immigration and Nationality Act (8 U.S.C. 
1326(b)) is amended--
            (1) in paragraph (3), by striking ``. or'' at the end;
            (2) in paragraph (4), by striking the period at the end and 
        inserting ``; or''; and
            (3) by adding at the end the following:
            ``(5) whose removal was subsequent to the provision of 
        medical assistance pursuant to section 401(b)(1)(A) of the 
        Personal Responsibility and Work Opportunity Act of 1996 (8 
        U.S.C. 1611(b)(1)(A)), such alien shall be fined under title 
        18, United States Code, imprisoned not more than 10 years, or 
        both.''.
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