I 
109TH CONGRESS 
1ST SESSION H. R. 4256 
To amend the Social Security Act and the Internal Revenue Code of 1986 
to assure comprehensive, affordable health insurance coverage for all 
Americans through an American Health Benefits Program. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 8, 2005 
Mr. LANGEVIN introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend the Social Security Act and the Internal Revenue 
Code of 1986 to assure comprehensive, affordable health 
insurance coverage for all Americans through an Amer-
ican Health Benefits Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘American Health Benefits Program Act of 2005’’. 
(b) FINDINGS.—Congress finds the following:
(1) UNINSURED AMERICANS AND LACK OF AC-
CESS TO CHOICES.—(A) In 2002, 43.6 million Amer-
icans were uninsured, 80 percent of whom were em-
ployed (or dependents of individuals who were em-
ployed). 
(B) Health care providers provided to unin-
sured Americans $35 billion in care for which they 
were not compensated by the individuals or through 
insurance. 
(C) Only 8 percent of employers providing 
health benefits are able to offer their employees a 
choice between two or more health plans. 
(2) DOUBLE-DIGIT
GROWTH
IN
EMPLOYER 
COSTS.—In 2003 the average per capita cost for em-
ployers to provide health benefits coverage increased 
by almost 14 percent. This was the third consecutive 
year of double-digit increases in such cost. 
(3) ADMINISTRATIVE
EFFICIENCY
OF
USING 
FEHBP MODEL FOR PROVIDING HEALTH INSURANCE 
COVERAGE.—(A) The private insurance market pre-
sents increasing administrative challenges for em-
ployers in seeking out, contracting with, and admin-
istering health benefits. 
(B) The Federal Employee Health Benefits 
Program (FEHBP) currently manages negotiations
with health insurers over premiums and benefits on 
behalf of 8.6 million Federal employees and retirees 
and their dependents. 
(C) Overhead costs for employers providing 
health benefits coverage can be over 30 percent for 
employers with fewer than 10 employees and about 
12 percent for employers with more than 500 em-
ployees. 
(D) In comparison, the overhead cost of cov-
erage provided under FEHBP is about 3 percent. 
(4) EXPANSION OF FEHBP MODEL TO COVER 
UNINSURED
AND
OTHER
AMERICANS.—Requiring 
participation in an FEHBP-style program would ex-
pand consumer choice, ensure portability and con-
tinuity of coverage, improve incentives for cost con-
tainment, and stabilize the burden on businesses 
(5) PERSONAL RESPONSIBILITY.—A recent sur-
vey indicates that a clear majority of Americans sees 
securing health insurance coverage as a personal re-
sponsibility for themselves and others. 
(c) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; findings; table of contents. 
Sec. 2. Establishment of American Health Benefits Program. 
‘‘TITLE XXII—AMERICAN HEALTH BENEFITS PROGRAM 
‘‘Sec. 2201. Establishment of program. 
‘‘Sec. 2202. Eligibility; requirement of coverage. 
‘‘Sec. 2203. Qualified health plans; benefits; premiums.
‘‘Sec. 2204. Government contribution; American Health Benefits Program 
Trust Fund. 
‘‘Sec. 2205. Premium and cost-sharing subsidies for lower income individ-
uals. 
‘‘Sec. 2206. Administration. 
‘‘Sec. 2207. Definitions. 
Sec. 3. Collection of premiums, subsidies, and employer funding. 
‘‘PART VIII—AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS 
‘‘Sec. 59B. American Health Benefits Program premiums. 
‘‘Sec. 36. Subsidy and prepayment of American Health Benefits premiums. 
‘‘CHAPTER 25—AMERICAN HEALTH BENEFITS PROGRAM 
‘‘Sec. 3451. Tax on employers. 
‘‘Sec. 3452. Refund of tax in case of qualified employer-provided coverage. 
‘‘Sec. 3453. Instrumentalities of the United States. 
Sec. 4. Amendments to the medicaid program and SCHIP. 
Sec. 5. Studies. 
SEC. 2. ESTABLISHMENT OF AMERICAN HEALTH BENEFITS 
PROGRAM. 
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following new title: 
‘‘TITLE XXII—AMERICAN 
HEALTH BENEFITS PROGRAM 
‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM. 
‘‘There is established under this title a program (to 
be known as the ‘American Health Benefits Program’) to 
provide comprehensive health insurance coverage to all 
Americans who are not covered under certain Federal 
health insurance programs and who are not eligible for 
employer-provided insurance coverage. The coverage shall 
be provided in a manner similar to the manner in which 
coverage has been provided to Members of Congress and 
Federal government employees and retirees and their de-
pendents under the Federal Employees Health Benefits 
Program (FEHBP). 
‘‘SEC. 2202. ELIGIBILITY; REQUIREMENT OF COVERAGE. 
‘‘(a) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—Each AHBP-eligible indi-
vidual is eligible to enroll in a qualified health plan 
offered under this title. 
‘‘(2) AHBP-ELIGIBLE INDIVIDUAL DEFINED.— 
‘‘(A) IN GENERAL.—For purposes of this 
title, the term ‘AHBP-eligible individual’ means 
an individual residing in the United States who 
is— 
‘‘(i) a citizen or national of the United 
States; 
‘‘(ii) an alien lawfully admitted to the 
United States for permanent residence; 
‘‘(iii) an alien admitted into the 
United States under section 207 of the Im-
migration and Nationality Act (relating to 
refugees); 
‘‘(iv) an alien otherwise permanently 
residing in the United States under color 
of law (as specified by the Commissioner); 
or
‘‘(v) an alien with the status of a non-
immigrant who is within a class of long- 
term 
nonimmigrants 
under 
section 
101(a)(15) of the Immigration and Nation-
ality Act that the Commissioner deter-
mines, in consultation with the Secretary 
of Homeland Security, to be appropriate. 
‘‘(B) EXCEPTIONS.—Such term does not 
include the following individuals: 
‘‘(i) 
INDIVIDUALS
ELIGIBLE
FOR 
QUALIFIED
EMPLOYER-PROVIDED
COV-
ERAGE.—An individual who is eligible for 
employer-provided coverage, as defined in 
section 2207(6), whether an employee, de-
pendent, or otherwise. 
‘‘(ii) INCARCERATED INDIVIDUALS.— 
An individual who is incarcerated (as spec-
ified by the Commissioner). 
‘‘(b) REQUIREMENT OF COVERAGE.— 
‘‘(1) IN GENERAL.—Except as provided in this 
subsection, each AHBP-eligible individual shall be 
enrolled in a qualified health plan under this title. 
‘‘(2) 
EXCEPTION
FOR
INDIVIDUALS
DEM-
ONSTRATING
PUBLIC
HEALTH
INSURANCE
COV-
ERAGE.—The requirement of paragraph (1) shall
not apply to an individual who demonstrates cov-
erage under any of the following: 
‘‘(A) MEDICARE.—Coverage under parts A 
and B (or under part C) of title XVIII. 
‘‘(B) MEDICAID.—Coverage under a State 
plan under title XIX. 
‘‘(C) 
TRICARE/CHAMPUS.—Coverage 
under the TRICARE program under chapter 
55, of title 10, United States Code. 
‘‘(D) INDIAN
HEALTH
SERVICES.—Cov-
erage under a medical care program of the In-
dian Health Service or of a tribal organization. 
‘‘(E) 
VETERANS
HEALTH.—Coverage 
under the veterans health care program under 
chapter 17 of title 38, United States Code, if 
the coverage for the individual involved is deter-
mined to be not less than the coverage provided 
under a qualified health plan, based on the indi-
vidual’s priority for services as provided under 
section 1705(a) of such title. 
‘‘(3) EXCEPTION
FOR
NONIMMIGRANTS.—The 
requirement of paragraph (1) shall not apply to an 
individual described in subsection (a)(2)(A)(v). 
‘‘(c) ENROLLMENT; DEFAULT ENROLLMENT.—
‘‘(1) IN GENERAL.—The Commissioner shall es-
tablish a process for AHBP-eligible individuals to 
enroll in qualified health plans. Such process shall 
be based on the enrollment process used under 
FEHBP and shall provide for the dissemination of 
information to AHBP-eligible individuals on quali-
fied health plans being offered. 
‘‘(2) DEFAULT ENROLLMENT.— 
‘‘(A) IN
GENERAL.—The Commissioner 
shall establish a procedure under which an 
AHBP-eligible individual who is required under 
subsection (b) to enroll, but is not enrolled, in 
a qualified health plan will be assigned to, and 
enrolled in, such a plan. 
‘‘(B) RULES.—In carrying out subpara-
graph (A), the Commissioner shall assign 
AHBP-eligible individuals and families to plans 
the premium of which is below the average pre-
mium for the AHBP region or other area in 
which the individuals or families reside. 
‘‘(3) CHANGES
IN
ENROLLMENT.—The Com-
missioner shall establish enrollment procedures that 
include an annual open season and permit changes 
in enrollment with qualified health plans at other 
times (such as by reason of changes in marital or
dependent status). Such procedures shall be based 
on the enrollment procedures established under 
FEHBP. 
‘‘(d) TREATMENT OF FAMILY MEMBERS.—Enroll-
ment under this title shall include both individual and 
family enrollment, in a manner similar to that provided 
under FEHBP. To the extent consistent with eligibility 
under subsection (a), the Commissioner shall provide rules 
similar to the rules under FEHBP for the enrollment of 
family members who are AHBP-eligible individuals in the 
same plan, except that such rules shall permit a family 
consisting only of a married couple to elect to enroll each 
spouse in a different qualified health plan. 
‘‘(e) CHANGES IN PLAN ENROLLMENT.—The Com-
missioner shall provide for and permit changes in the 
qualified health plan in which an individual or family is 
enrolled under this section in a manner similar to the 
manner in which such changes are provided or permitted 
under FEHBP. The Commissioner shall provide for termi-
nation of such enrollment for an individual at the time 
the individual is no longer an AHBP-eligible individual. 
‘‘(f) ENROLLMENT
GUIDES.—The Commissioner 
shall provide for the broad dissemination of information 
on qualified health plans offered under this title. Such in-
formation shall be provided in a comparative manner,
similar to that used under FEHBP, and shall include in-
formation, collected through surveys of enrollees, on meas-
ures of enrollee satisfaction with the different plans. 
‘‘SEC. 2203. QUALIFIED HEALTH PLANS; BENEFITS; PRE-
MIUMS. 
‘‘(a) OFFERING OF PLANS.— 
‘‘(1) CONTRACTS.—The Commissioner shall 
enter into contracts with entities for the offering of 
qualified health plans in accordance with this title. 
Such contracts shall be entered into in a manner 
similar to the process by which the Director of the 
Office of Personnel Management is authorized to 
enter into contracts with health benefits plans under 
FEHBP. 
‘‘(2) REQUIREMENTS FOR ENTITIES OFFERING 
PLANS.—No such contract shall be entered into with 
an entity for the offering of a qualified health plan 
in a region unless the entity— 
‘‘(A) is licensed as a health maintenance 
organization in that State or is licensed to sell 
group health insurance coverage in that State; 
‘‘(B) meets such requirements, similar to 
requirements under FEHBP, as the Commis-
sioner may establish relating to solvency, orga-
nization, structure, governance, access, and 
quality; and 
‘‘(C) agrees to participate in the high-risk 
reinsurance pool described in subsection (d). 
‘‘(3) CONTRACTING WITH LIMITED NUMBER OF 
PLANS IN A REGION WITHIN TYPES OF PLANS.— 
‘‘(A) IN
GENERAL.—The Commissioner 
shall contract with only a limited number of 
qualified health plans of each type (as specified 
under subparagraph (B)) in each AHBP region. 
‘‘(B) TYPES OF PLANS.—For purposes of 
subparagraph (A), the Commissioner shall clas-
sify the different types of qualified health plans, 
such as fee-for-service plans, health mainte-
nance plans, preferred provider plans, and other 
types of plans. 
‘‘(b) FEHBP SCOPE OF BENEFITS.— 
‘‘(1) COMPREHENSIVE
BENEFITS.—Qualified 
health plans shall provide for the same scope and 
type of comprehensive benefits that have been pro-
vided under FEHBP, including the types of benefits 
described in section 8904 of title 5, United States 
Code and including benefits previously required by 
regulation or direction (such as preventive benefits,
including childhood immunization and cancer screen-
ing, and mental health parity) under FEHBP. 
‘‘(2) NO EXCLUSION FOR PRE-EXISTING CONDI-
TIONS.—Qualified health plans shall not impose pre- 
existing condition exclusions or otherwise discrimi-
nate against any enrollee based on the health status 
of such enrollee (including genetic information relat-
ing to such enrollee) . 
‘‘(3) OTHER CONSUMER PROTECTIONS.—Quali-
fied health plans also shall meet consumer and pa-
tient protection requirements that the Commissioner 
establishes, based on similar requirements previously 
imposed under FEHBP, including protections of pa-
tients’ rights previously effected pursuant to Execu-
tive Memorandum. 
‘‘(c) COMMUNITY-RATED PREMIUMS.— 
‘‘(1) IN GENERAL.—The premiums established 
for a qualified health plan under this title for indi-
vidual or family coverage shall be community-rated 
and shall not vary based on age, gender, health sta-
tus (including genetic information), or other factors. 
‘‘(2) COLLECTION
PROCESS.—The Commis-
sioner shall establish a process for the timely and 
accurate collection of premiums owed by enrollees, 
taking into account any Government contribution
under section 2204(a) and any premium subsidy re-
ferred to in section 2205(a). Such process shall in-
clude methods for payment through payroll with-
holding, as well as payment through automatic deb-
iting of accounts with financial institutions, and 
shall be coordinated with the application of section 
59B of the Internal Revenue Code of 1986. Such 
premiums shall be deposited into the American 
Health Benefits Program Trust Fund established 
under section 2204(c). 
‘‘(d) HIGH-RISK REINSURANCE POOL.—The Com-
missioner shall establish an arrangement among the enti-
ties offering qualified health plans under which such enti-
ties contribute in an equitable manner (as determined by 
the Commissioner) into a fund that provides payment to 
plans for a percentage (specified by the Commissioner and 
not to exceed 90 percent) of the costs that they incur for 
enrollees beyond a predetermined threshold specified from 
time to time by the Commissioner. 
‘‘(e) MARKETING
PRACTICES
AND
COSTS.—The 
Commissioner shall monitor marketing practices with re-
spect to qualified health plans in order to assure— 
‘‘(1) the accuracy of the information dissemi-
nated regarding such plans; and