I 
110TH CONGRESS 
2D SESSION 
H. R. 7166 
To improve access to health care and health insurance. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 26, 2008 
Mr. SALI introduced the following bill; which was referred to the Committee 
on Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To improve access to health care and health insurance. 
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 
‘‘American Health Care Access Improvement, Portability, 
and Cost Reduction Act of 2008’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Nonrefundable credit for certain primary health services providers serv-
ing health professional shortage areas. 
Sec. 3. Increase in Medicare physician payments through 2010. 
VerDate Aug 31 2005 
05:33 Oct 02, 2008
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6211
E:\BILLS\H7166.IH
H7166
wwoods2 on PRODPC68 with BILLS
Sec. 4. Refundable credit for health insurance coverage. 
Sec. 5. Health reimbursement arrangements and spending arrangements in 
combination with health savings accounts. 
Sec. 6. Increase in annual HSA contribution limitation. 
Sec. 7. Purchase of health insurance from HSA account. 
Sec. 8. Special rule for certain medical expenses incurred before establishment 
of account. 
Sec. 9. Provisions relating to Medicare. 
Sec. 10. Individuals eligible for veterans benefits for a service-connected dis-
ability. 
Sec. 11. Allow both spouses to make catch-up contributions to the same HSA 
account. 
Sec. 12. FSA and HRA Termination to fund HSAs. 
Sec. 13. Including information on advance directives in Medicare & You Hand-
book. 
Sec. 14. Restoring access requirements for certain MA private fee-for-service 
plan provisions as in existence before Public Law 110–275. 
SEC. 2. NONREFUNDABLE CREDIT FOR CERTAIN PRIMARY 
HEALTH 
SERVICES 
PROVIDERS 
SERVING 
HEALTH PROFESSIONAL SHORTAGE AREAS. 
(a) IN GENERAL.—Subpart A of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to nonrefundable personal credits) is 
amended by inserting after section 25D the following new 
section: 
‘‘SEC. 25E. PRIMARY CARE PHYSICIANS PROVIDERS SERV-
ING 
HEALTH 
PROFESSIONAL 
SHORTAGE 
AREAS. 
‘‘(a) ALLOWANCE OF CREDIT.—In the case of an in-
dividual who is a qualified primary care physician or quali-
fied nurse practitioner for any month during the taxable 
year, there shall be allowed as a credit against the tax 
imposed by this chapter for such taxable year an amount 
VerDate Aug 31 2005 
05:33 Oct 02, 2008
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H7166.IH
H7166
wwoods2 on PRODPC68 with BILLS
equal to $1,000 for each month during such taxable 
year— 
‘‘(1) which is part of the eligible service period 
of such individual, and 
‘‘(2) for which such individual is a qualified pri-
mary care physician or qualified nurse practitioner, 
respectively. 
‘‘(b) QUALIFIED PRIMARY CARE PHYSICIAN.—For 
purposes of this section, the term ‘qualified primary care 
physician’ means, with respect to any month, any physi-
cian who is certified for such month by the Bureau to be 
a primary health services provider or a licensed mental 
health provider who— 
‘‘(1) is providing primary health services full 
time and substantially all of whose primary health 
services are provided in a health professional short-
age area, 
‘‘(2) is not receiving during the calendar year 
which includes such month a scholarship under the 
National Health Service Corps Scholarship Program 
or the Indian health professions scholarship program 
or a loan repayment under the National Health 
Service Corps Loan Repayment Program or the In-
dian Health Service Loan Repayment Program, 
VerDate Aug 31 2005 
05:33 Oct 02, 2008
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H7166.IH
H7166
wwoods2 on PRODPC68 with BILLS
‘‘(3) is not fulfilling service obligations under 
such Programs, and 
‘‘(4) has not defaulted on such obligations. 
‘‘(c) ELIGIBLE SERVICE PERIOD.—For purposes of 
this section, the term ‘eligible service period’ means the 
period of 60 consecutive calendar months beginning with 
the first month the taxpayer is a qualified primary care 
physician or qualified nurse practitioner. 
‘‘(d) OTHER DEFINITIONS AND SPECIAL RULE.—For 
purposes of this section— 
‘‘(1) BUREAU.—The term ‘Bureau’ means the 
Bureau of Primary Health Care, Health Resources 
and Services Administration of the United States 
Department of Health and Human Services. 
‘‘(2) PHYSICIAN.—The term ‘physician’ has the 
meaning given to such term by section 1861(r) of 
the Social Security Act. 
‘‘(3) PRIMARY HEALTH SERVICES PROVIDER.— 
The term ‘primary health services provider’ means a 
provider of basic health services (as described in sec-
tion 330(b)(1)(A)(i) of the Public Health Service 
Act). 
‘‘(4) QUALIFIED
NURSE
PRACTITIONER.—The 
term ‘qualified nurse practitioner’ means a nurse 
practitioner (as defined in section 1861(aa)(5) of the 
VerDate Aug 31 2005 
05:33 Oct 02, 2008
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H7166.IH
H7166
wwoods2 on PRODPC68 with BILLS