I
103D CONGRESS
1ST SESSION
H. R. 3115
To improve access, affordability, and competition in health care, through
the implementation of flexible savings accounts and malpractice reform,
and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 22, 1993
Mr. DREIER introduced the following bill; which was referred jointly to the
Committees on Ways and Means, Energy and Commerce, and the Judiciary
A BILL
To improve access, affordability, and competition in health
care, through the implementation of flexible savings ac-
counts and malpractice reform, and for other purposes.
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
‘‘Competitive Affordable Health Care Act of 1993’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—TAX PROVISIONS ENCOURAGING LOW-COST HEALTH
PLANS AND HEALTH CARE SAVINGS ACCOUNTS
Sec. 101. Refundable tax credit for individuals not covered under employer-pro-
vided health plan.
Sec. 102. Limitation on exclusion for employer-provided health coverage.
Sec. 103. Health care savings accounts.
TITLE II—HEALTH CARE COST CONTAINMENT
Subtitle A—Health Care Liability Reform
Sec. 201. Federal reform of health care liability actions.
Sec. 202. Statute of limitations.
Sec. 203. Requirement for initial resolution of actions in Federal court through
alternative dispute resolution.
Sec. 204. Calculation and payment of damages.
Sec. 205. Treatment of attorney’s fees.
Sec. 206. Joint and several liability.
Sec. 207. Mandatory offsets for damages paid by a collateral source.
Sec. 208. Preemption.
Sec. 209. Definitions.
Sec. 210. Effective date.
Subtitle B—Limit on Self-Referrals by Health Care Provider
Sec. 221. Limitation on self-referrals by health care providers.
Subtitle C—Administrative Cost Savings
Sec. 230. Definitions.
PART 1—STANDARDIZATION OF CLAIMS PROCESSING
Sec. 231. Adoption of data elements, uniform claims, and uniform electronic
transmission standards.
Sec. 232. Application of standards.
Sec. 233. Periodic review and revision of standards.
PART 2—ELECTRONIC MEDICAL DATA STANDARDS
Sec. 241. Medical data standards for hospitals and other providers.
Sec. 242. Application of electronic data standards to certain hospitals.
Sec. 243. Electronic transmission to Federal agencies.
Sec. 244. Advisory commission.
PART 3—DEVELOPMENT AND DISTRIBUTION OF COMPARATIVE VALUE
INFORMATION
Sec. 251. State comparative value information programs for health care pur-
chasing.
Sec. 252. Comparative value information concerning Federal programs.
Sec. 253. Development of model systems.
PART 4—ADDITIONAL STANDARDS AND REQUIREMENTS
Sec. 261. Standards relating to use of medicare and medicaid magnetized
health benefit cards; secondary payer data bank.
Sec. 262. Preemption of State quill pen laws.
Sec. 263. Use of standard identification numbers.
Subtitle D—Limitation of Antitrust Recovery for Certain Hospital Joint
Ventures
Sec. 271. Purpose.
Sec. 272. Definitions.
Sec. 273. Limitation on damages for antitrust violations.
Sec. 274. Disclosure of hospital joint venture.
Subtitle E—Medicaid Program Flexibility
Sec. 281. Modification of Federal requirements to allow States more flexibility
in contracting for coordinated care services under medicaid.
Sec. 282. Period of certain waivers.
TITLE III—REFUNDABLE CREDIT FOR COSTS OF PROVIDING
EMERGENCY INDIGENT CARE
Sec. 301. Refundable credit for costs of providing emergency indigent care.
TITLE I—TAX PROVISIONS EN-
COURAGING 
LOW-COST
HEALTH PLANS AND HEALTH
CARE SAVINGS ACCOUNTS
SEC. 101. REFUNDABLE TAX CREDIT FOR INDIVIDUALS NOT
COVERED 
UNDER 
EMPLOYER-PROVIDED
HEALTH PLAN.
(a) REFUNDABLE CREDIT.—Subpart C of part IV of
subchapter A of chapter 1 of the Internal Revenue Code
of 1986 (relating to refundable credits) is amended by re-
designating section 35 as section 37 and by inserting after
section 34 the following new section:
‘‘SEC. 35. QUALIFIED HEALTH CARE COSTS.
‘‘(a) ALLOWANCE OF CREDIT.—In the case of an eli-
gible individual, there shall be allowed as a credit against
the tax imposed by this subtitle an amount equal to 15
percent of the lesser of—
‘‘(1) the health care expenses of the taxpayer,
or
‘‘(2) the maximum health care expense amount.
‘‘(b) MAXIMUM HEALTH CARE EXPENSE AMOUNT.—
The maximum health care expense amount for any taxable
year is—
‘‘(1) $1,250 in the case of a taxpayer who is al-
lowed only 1 exemption amount under section 151,
‘‘(2) $2,500 in the case of a taxpayer who is al-
lowed only 2 exemption amounts under section 151,
and
‘‘(3) $4,750 in the case of a taxpayer who is al-
lowed 3 or more exemption amounts under section
151.
‘‘(c) DEFINITIONS.—For purposes of this section—
‘‘(1) ELIGIBLE INDIVIDUAL.—The term ‘eligible
individual’ means any individual who is not covered
under any employer-provided health plan. Such term
shall not include an individual for whom an election
under section 220 is in effect for the taxable year.
‘‘(2) HEALTH
CARE
EXPENSES.—The term
‘health care expenses’ means the amount paid dur-
ing the taxable year which would be allowable as a
deduction for the taxable year under section 213 but
for the threshold based on adjusted gross income
and subsection (e) of this section.
‘‘(d) DOLLAR AMOUNTS ADJUSTED
FOR INFLA-
TION.—
‘‘(1) IN GENERAL.—In the case of any taxable
year beginning in a calendar year beginning after
the date of the enactment of this section, each dollar
amount in subsection (b) shall be increased by an
amount equal to—
‘‘(A) such dollar amount, multiplied by
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar
year in the taxable year begins, by substituting
the calendar year which includes the date of the
enactment of this section for the calendar year
referred to in subparagraph (B) thereof.
‘‘(2) ROUNDING.—If any dollar amount as in-
creased under paragraph (1) is not a multiple of
$10, such dollar amount shall be rounded to the
nearest multiple of $10 (or, if such dollar amount is
a multiple of $5 and not of $10, such dollar amount
shall be increased to the nearest multiple of $10).
‘‘(e) DENIAL
OF MEDICAL EXPENSE DEDUCTION
FOR CREDITED AMOUNTS.—Any amount for which a cred-
it is allowed under this section shall not be taken into ac-
count in computing the amount allowable as a deduction
under section 213(a).’’
(b) ALTERNATIVE DEDUCTION.—
(1) IN GENERAL.—Part VII of subchapter B of
chapter 1 of such Code is amended by redesignating
section 220 as section 221 and by inserting after
section 219 the following new section:
‘‘SEC. 220. QUALIFIED HEALTH CARE COSTS.
‘‘(a) ALLOWANCE OF DEDUCTION.—At the election
of an eligible individual for the taxable year, there shall
be allowed as a deduction for the taxable year an amount
equal to the lesser of—
‘‘(1) the health care expenses of the taxpayer,
or
‘‘(2) the maximum health care expense amount.
‘‘(b) DEFINITIONS.—For purposes of this section,
terms used in this section which are also used in section
35 shall have the respective meanings given such terms
in section 35.
‘‘(c) DENIAL
OF MEDICAL EXPENSE DEDUCTION
FOR DEDUCTED AMOUNTS.—Any amount for which a de-
duction is allowed under this section shall not be taken
into account in computing the amount allowable as a de-
duction under section 213(a).’’