I 
109TH CONGRESS 
1ST SESSION H. R. 3891 
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 administra-
tion. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 22, 2005 
Mr. TIERNEY (for himself, Mr. BRADY of Pennsylvania, Mr. CAPUANO, Mr. 
CONYERS, Mr. DAVIS of Illinois, Mr. DEFAZIO, Mr. EVANS, Mr. FATTAH, 
Mr. FILNER, Mr. GUTIERREZ, Mr. HINCHEY, Ms. JACKSON-LEE of 
Texas, Mr. KENNEDY of Rhode Island, Mr. KILDEE, Mr. LANTOS, Ms. 
LEE, Mr. LEWIS
of Georgia, Mr. LYNCH, Mrs. MALONEY, Mr. 
MCDERMOTT, Mr. MCGOVERN, Mr. MEEHAN, Mr. NADLER, Mr. OLVER, 
Mr. OWENS, Mr. SANDERS, Ms. SOLIS, Mr. STARK, Mr. THOMPSON of 
Mississippi, Mr. UDALL of New Mexico, Mr. WEINER, Mr. DELAHUNT, 
Ms. BALDWIN, Mr. PAYNE, Ms. NORTON, Mr. GEORGE MILLER of Cali-
fornia, Mr. HASTINGS of Florida, Mr. KUCINICH, Mrs. CHRISTENSEN, 
Mrs. JONES of Ohio, Ms. MILLENDER-MCDONALD, and Ms. CARSON) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
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. 
Be it enacted by the Senate and House of Representa-
tives 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 
‘‘States’ Right To Innovate in Health Care Act of 2005’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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. Planning grants. 
‘‘Sec. 2202. Demonstration grants. 
‘‘Sec. 2203. State plan requirements. 
‘‘Sec. 2204. Interstate arrangements. 
‘‘Sec. 2205. Definitions. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
(1) In 2002, in response to a request from the 
Secretary of Health and Human Services (SHHS), 
the Institute of Medicine (IOM) established a Com-
mittee, officially known as the Committee on Rapid 
Advance Demonstration Projects: Health Care Fi-
nance and Delivery Systems, with the goal of formu-
lating models for broader health care reform. The 
committee recommended a 10-year commitment to 
State demonstration projects as a means to encour-
age States to develop their own systems of universal 
care and facilitate innovation.
(2) In 2003, annual health care expenditures in 
the United States totaled $1.7 trillion, or $5,670 per 
person. 
(3) In 2003, health care expenditures rep-
resented 15.3 percent of the gross domestic product 
(GDP) in the United States and grew at the rate of 
7.7 percent while the gross domestic product grew 
only at the rate of 4.9 percent. 
(4) Center for Medicare and Medicaid Studies 
(CMS) actuaries report that the United States as a 
whole spent an estimated $1.5 trillion on health care 
in 2003, or 14.9 percent of GDP of $10.9 trillion. 
They project by 2013 the United States will spend 
about $3.36 trillion on health care, or 18.4 percent 
of a GDP of $18.24 trillion. 
(5) Because many individuals do not have 
health insurance coverage, they may incur health 
care costs which they do not fully reimburse, result-
ing in cost-shifting to others. 
(6) According to the Kaiser Family Foundation 
and Health Research Educational Trust, the total 
premium for a typical employment-based health in-
surance policy for a family in 2003 was $8,800, split 
between employer and employee. Health Administra-
tion costs in the United States total over $1,000 per
capita, adding to the high cost of insurance. In 2003 
health insurance enrollment declined by nearly a 
percentage point for a third year in a row. 
(b) PURPOSE.—It is the purpose of this Act to en-
courage States— 
(1) to develop plans for universal, comprehen-
sive, cost-effective systems of health care with sim-
plified administration to individuals residing in such 
States; and 
(2) to implement such plans by offering transi-
tional grants and by removing Federal statutory and 
administrative barriers that may inhibit or discour-
age efforts by States to provide such health care 
while maintaining Federal payments for health care 
under Federal health care programs. 
SEC. 3. AMENDMENT TO SOCIAL SECURITY ACT. 
The Social Security Act (42 U.S.C. 301 et seq.) is 
amended by adding at the end the following new title: 
‘‘TITLE 
XXII—STATE 
COM-
PREHENSIVE HEALTH CARE 
AND 
COST 
CONTAINMENT 
DEMONSTRATION PROJECTS 
‘‘SEC. 2201. PLANNING GRANTS. 
‘‘(a) APPLICATION.—A State may apply to the Sec-
retary for a State planning grant under this section to