point 4 members of the Commission and the Sec-
retary shall appoint 1 member. 
(2) CRITERIA.—Members of the Commission 
shall include representatives of the following: 
(A) Consumers of health insurance. 
(B) Health care professionals. 
(C) State officials. 
(D) Economists. 
(E) Health care providers. 
(F) Experts on health insurance. 
(G) Experts on expanding health care to 
individuals who are uninsured. 
(3) CHAIRPERSON.—At the first meeting of the 
Commission, the Commission shall select a Chair-
person from among its members. 
(c) MEETINGS.— 
(1) IN GENERAL.—After the initial meeting of 
the Commission which shall be called by the Sec-
retary, the Commission shall meet at the call of the 
Chairperson. 
(2) QUORUM.—A majority of the members of 
the Commission shall constitute a quorum, but a 
lesser number of members may hold hearings. 
(3) SUPERMAJORITY VOTING REQUIREMENT.— 
To approve a report required under paragraph (2)
or (3) of subsection (e), at least 60 percent of the 
membership of the Commission must vote in favor of 
such a report. 
(d) DUTIES.—The Commission shall— 
(1) assess the effectiveness of programs de-
signed to expand health care coverage or make 
health care coverage affordable to the otherwise un-
insured individuals through identifying the accom-
plishments and needed improvements of each pro-
gram; 
(2) make recommendations about benefits and 
cost-sharing to be included in health care coverage 
for various groups, taking into account— 
(A) the special health care needs of chil-
dren and individuals with disabilities; 
(B) the different ability of various popu-
lations to pay out-of-pocket costs for services; 
(C) incentives for efficiency and cost-con-
trol; and 
(D) preventative care, disease management 
services, and other factors; 
(3) recommend mechanisms to discourage indi-
viduals and employers from voluntarily opting out of 
health insurance coverage;
(4) recommend mechanisms to expand health 
care coverage to uninsured individuals with incomes 
above 200 percent of the official income poverty line 
(as defined by the Office of Management and Budg-
et, and revised annually in accordance with section 
673(2) of the Omnibus Budget Reconciliation Act of 
1981) applicable to a family of the size involved; 
(5) recommend automatic enrollment and reten-
tion procedures and other measures to increase 
health care coverage among those eligible for assist-
ance; 
(6) review the roles, responsibilities, and rela-
tionship between Federal and State agencies with re-
spect to health care coverage and recommend im-
provements; and 
(7) analyze the size, effectiveness, and efficiency 
of current tax and other subsidies for health care 
coverage and recommend improvements. 
(e) REPORTS.— 
(1) ANNUAL REPORT.—The Commission shall 
submit annual reports to the President and Con-
gress addressing the matters identified in subsection 
(d). 
(2) BIENNIAL REPORT.—
(A) IN GENERAL.—The Commission shall 
submit biennial reports to the President and 
Congress, which shall contain— 
(i) recommendations concerning essen-
tial benefits and maximum out-of-pocket 
cost-sharing (for the general population 
and for individuals with limited ability to 
pay, which shall not exceed the out-of- 
pocket cost-sharing permitted under sec-
tion 2103(e) of the Social Security Act (42 
U.S.C. 1397cc(e))) for the coverage op-
tions described in title II; and 
(ii) proposed legislative language to 
implement such recommendations. 
(B) CONGRESSIONAL ACTION.—The legis-
lative language proposed under subparagraph 
(A)(ii) shall proceed to immediate consideration 
on the floor of the House of Representatives 
and the Senate and shall be approved or re-
jected, without amendment, using procedures 
employed for recommendations of military base 
closing commissions. 
(3) COMMISSION REPORT.—No later than Janu-
ary 15, 2009, the Commission shall submit a report 
to the President and Congress, which shall include—
(A) recommendations on policies to provide 
health care coverage to uninsured individuals 
with incomes above 200 percent of the official 
income poverty line (as defined by the Office of 
Management and Budget, and revised annually 
in accordance with section 673(2) of the Omni-
bus Budget Reconciliation Act of 1981) applica-
ble to a family of the size involved; 
(B) recommendations on changes to poli-
cies enacted under this Act; and 
(C) proposed legislative language to imple-
ment such recommendations. 
(f) ADMINISTRATION.— 
(1) POWERS.— 
(A) HEARINGS.—The Commission may 
hold such hearings, sit and act at such times 
and places, take such testimony, and receive 
such evidence as the Commission considers ad-
visable to carry out this section. 
(B) INFORMATION FROM FEDERAL AGEN-
CIES.—The Commission may secure directly 
from any Federal department or agency such 
information as the Commission considers nec-
essary to carry out this section. Upon request 
of the Chairperson of the Commission, the head
of such department or agency shall furnish such 
information to the Commission. 
(C) POSTAL SERVICES.—The Commission 
may use the United States mails in the same 
manner and under the same conditions as other 
departments and agencies of the Federal Gov-
ernment. 
(D) GIFTS.—The Commission may accept, 
use, and dispose of gifts or donations of serv-
ices or property. 
(2) COMPENSATION.—While serving on the 
business of the Commission (including travel time), 
a member of the Commission shall be entitled to 
compensation at the per diem equivalent of the rate 
provided for level IV of the Executive Schedule 
under section 5315 of title 5, United States Code, 
and while so serving away from home and the mem-
ber’s regular place of business, a member may be al-
lowed travel expenses, as authorized by the chair-
person of the Commission. All members of the Com-
mission who are officers or employees of the United 
States shall serve without compensation in addition 
to that received for their services as officers or em-
ployees of the United States. 
(3) STAFF.—
(A) IN GENERAL.—The Chairperson of the 
Commission may, without regard to the civil 
service laws and regulations, appoint and termi-
nate an executive director and such other addi-
tional personnel as may be necessary to enable 
the Commission to perform its duties. The em-
ployment of an executive director shall be sub-
ject to confirmation by the Commission. 
(B) STAFF
COMPENSATION.—The Chair-
person of the Commission may fix the com-
pensation of the executive director and other 
personnel without regard to chapter 51 and 
subchapter III of chapter 53 of title 5, United 
States Code, relating to classification of posi-
tions and General Schedule pay rates, except 
that the rate of pay for the executive director 
and other personnel may not exceed the rate 
payable for level V of the Executive Schedule 
under section 5316 of such title. 
(C) DETAIL
OF
GOVERNMENT
EMPLOY-
EES.—Any Federal Government employee may 
be detailed to the Commission without reim-
bursement, and such detail shall be without 
interruption or loss of civil service status or 
privilege.
(D) PROCUREMENT OF TEMPORARY AND 
INTERMITTENT SERVICES.—The Chairperson of 
the Commission may procure temporary and 
intermittent services under section 3109(b) of 
title 5, United States Code, at rates for individ-
uals which do not exceed the daily equivalent of 
the annual rate of basic pay prescribed for level 
V of the Executive Schedule under section 5316 
of such title. 
(g) TERMINATION.—Except with respect to activities 
in connection with the ongoing biennial report required 
under subsection (e)(2), the Commission shall terminate 
90 days after the date on which the Commission submits 
the report required under subsection (e)(3). 
(h) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated, such sums as may be 
necessary to carry out this section for fiscal year 2006 
and each fiscal year thereafter. 
SEC. 302. CONGRESSIONAL ACTION. 
(a) BILL INTRODUCTION.— 
(1) IN GENERAL.—Any legislative language in-
cluded in the report required under section 
301(e)(3) may be introduced as a bill by request in 
the following manner:
(A) HOUSE OF REPRESENTATIVES.—In the 
House of Representatives, by the Majority 
Leader and the Minority Leader not later than 
10 days after receipt of the legislative language. 
(B) SENATE.—In the Senate, by the Ma-
jority Leader and the Minority Leader not later 
than 10 days after receipt of the legislative lan-
guage. 
(2) ALTERNATIVE
BY
ADMINISTRATION.—The 
President may submit legislative language based on 
the recommendations of the Commission and such 
legislative language may be introduced in the man-
ner described in paragraph (1). 
(b) COMMITTEE CONSIDERATION.— 
(1) IN
GENERAL.—Any legislative language 
submitted pursuant to paragraph (1) or (2) of sub-
section (a) (in this section referred to as ‘‘imple-
menting legislation’’) shall be referred to the appro-
priate committees of the House of Representatives 
and the Senate. 
(2) REPORTING.— 
(A) COMMITTEE
ACTION.—If, not later 
than 150 days after the date on which the im-
plementing legislation is referred to a com-
mittee under paragraph (1), the committee has
reported the implementing legislation or has re-
ported an original bill whose subject is related 
to reforming the health care system, or to pro-
viding access to affordable health care coverage 
for Americans, the regular rules of the applica-
ble House of Congress shall apply to such legis-
lation. 
(B) DISCHARGE FROM COMMITTEES.— 
(i) SENATE.— 
(I) IN GENERAL.—If the imple-
menting legislation or an original bill 
described in subparagraph (A) has not 
been reported by a committee of the 
Senate within 180 days after the date 
on which such legislation was referred 
to committee under paragraph (1), it 
shall be in order for any Senator to 
move to discharge the committee from 
further consideration of such imple-
menting legislation. 
(II) SEQUENTIAL REFERRALS.— 
Should a sequential referral of the im-
plementing legislation be made, the 
additional committee has 30 days for 
consideration of implementing legisla-
tion before the discharge motion de-
scribed in subclause (I) would be in 
order. 
(III) PROCEDURE.—The motion 
described in subclause (I) shall not be 
in order after the implementing legis-
lation has been placed on the cal-
endar. While the motion described in 
subclause (I) is pending, no other mo-
tions related to the motion described 
in subclause (I) shall be in order. De-
bate on a motion to discharge shall be 
limited to not more than 10 hours, 
equally divided and controlled by the 
Majority Leader and the Minority 
Leader, or their designees. An amend-
ment to the motion shall not be in 
order, nor shall it be in order to move 
to reconsider the vote by which the 
motion is agreed or disagreed to. 
(IV) 
EXCEPTION.—If 
imple-
menting language is submitted on a 
date later than May 1 of the second 
session of a Congress, the committee 
shall have 90 days to consider the im-
plementing legislation before a motion 
to discharge under this clause would 
be in order. 
(ii) HOUSE OF REPRESENTATIVES.— 
If the implementing legislation or an origi-
nal bill described in subparagraph (A) has 
not been reported out of a committee of 
the House of Representatives within 180 
days after the date on which such legisla-
tion was referred to committee under para-
graph (1), then on any day on which the 
call of the calendar for motions to dis-
charge committees is in order, any member 
of the House of Representatives may move 
that the committee be discharged from 
consideration of the implementing legisla-
tion, and this motion shall be considered 
under the same terms and conditions, and 
if adopted the House of Representatives 
shall follow the procedure described in sub-
section (c)(1). 
(c) FLOOR CONSIDERATION.— 
(1) MOTION TO PROCEED.—If a motion to dis-
charge made pursuant to subsection (b)(2)(B)(i) or 
(b)(2)(B)(ii) is adopted, then, not earlier than 5 leg-
islative days after the date on which the motion to 
discharge is adopted, a motion may be made to pro-
ceed to the bill. 
(2) FAILURE OF MOTION.—If the motion to dis-
charge made pursuant to subsection (b)(2)(B)(i) or 
(b)(2)(B)(ii) fails, such motion may be made not 
more than 2 additional times, but in no case more 
frequently than within 30 days of the previous mo-
tion. Debate on each of such motions shall be limited 
to 5 hours, equally divided. 
(3) APPLICABLE RULES.—Once the Senate is 
debating the implementing legislation the regular 
rules of the Senate shall apply. 
TITLE IV—STATE WAIVERS 
SEC. 401. STATE WAIVERS. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, a State may apply to the Secretary of Health 
and Human Services for waivers of such provisions of law 
as may be necessary for the State to implement policies 
that make comprehensive, affordable health coverage 
available for all State residents, including access to essen-
tial benefits with limits on cost-sharing, as provided in the 
most recent report under section 301(e)(2). 
(b) REQUIREMENTS.—In order to ensure that waivers 
under this section benefit rather than harm health care
consumers, a State shall not be eligible for a waiver under 
this section unless— 
(1) the State reasonably expects to achieve a 
level of enrollment in coverage described in sub-
section (a) that is at least equal to the level of cov-
erage (taking into account the number of insured in-
dividuals, covered benefits, and premium and out-of- 
pocket costs to the consumer for such coverage) that 
the State would have achieved if the State had fully 
implemented the coverage options available under ti-
tles I and II of this Act; 
(2) no individual who would have qualified for 
assistance under the State medicaid program under 
title XIX of the Social Security Act or the State 
children’s health insurance program under title XXI 
of such Act, as of either the date of the waiver re-
quest or the date of enactment of this Act, will be 
denied eligibility for such program, have a reduction 
in benefits under such program, have reduced access 
to geographically and linguistically appropriate care 
or essential community providers, or be subject to 
increased premiums or cost-sharing under the waiver 
program under this section; and 
(3) the State agrees to comply with such stand-
ards or guidelines as the Secretary of Health and
Human Services may require to ensure that the re-
quirements of paragraphs (1) and (2) are satisfied. 
(c) FEDERAL PAYMENTS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall pay a State with a waiver ap-
proved under this section an amount each quarter 
equal to the sum of— 
(A) the Federal payments the State and 
residents of the State (including, but not lim-
ited to, through the credit allowed under section 
36 of the Internal Revenue Code of 1986 for 
health insurance costs) would have received if 
the State had exercised the coverage options 
under titles I and II of this Act with respect to 
residents of the State who have not attained 
age 65; and 
(B) the amount of any grants authorized 
by this Act that the State would have received 
if the State had applied for such grants. 
(2) ADDITIONAL
PAYMENT
FOR
MEDICARE 
BENEFICIARIES UNDER AGE 65.— 
(A) IN GENERAL.—In the case of a State 
that elects to enroll an individual described in 
subparagraph (B) in coverage described in sub-
section (a), the amount described in paragraph
(1) with respect to a quarter shall be increased 
by the amount described in subparagraph (C). 
(B) INDIVIDUAL
DESCRIBED.—An indi-
vidual is described in this subparagraph if the 
individual— 
(i) has not attained age 65; 
(ii) is eligible for coverage under title 
XVIII of the Social Security Act; and 
(iii) voluntarily elects to enroll in cov-
erage described in subsection (a). 
(C) AMOUNT
DESCRIBED.—The amount 
described in this subparagraph is the amount 
equal to the amount that the Federal Govern-
ment would have incurred with respect to a 
quarter for providing coverage to an individual 
described in subparagraph (B) under title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(d) IMPLEMENTATION DATE.—No State may submit 
a request for a waiver under this section before October 
1, 2009. 
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