(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE 
I—ESTABLISHMENT 
OF 
A 
STATE-BASED 
AMERICAN 
HEALTH SECURITY PROGRAM; UNIVERSAL ENTITLEMENT; EN-
ROLLMENT 
Sec. 101. Establishment of a State-based American Health Security Program. 
Sec. 102. Universal entitlement. 
Sec. 103. Enrollment. 
Sec. 104. Portability of benefits. 
Sec. 105. Effective date of benefits. 
Sec. 106. Relationship to existing Federal health programs. 
TITLE II—COMPREHENSIVE BENEFITS, INCLUDING PREVENTIVE 
BENEFITS AND BENEFITS FOR LONG-TERM CARE 
Sec. 201. Comprehensive benefits. 
Sec. 202. Definitions relating to services. 
Sec. 203. Special rules for home and community-based long-term care services. 
Sec. 204. Exclusions and limitations. 
Sec. 205. Certification; quality review; plans of care. 
TITLE III—PROVIDER PARTICIPATION 
Sec. 301. Provider participation and standards. 
Sec. 302. Qualifications for providers. 
Sec. 303. Qualifications for comprehensive health service organizations. 
Sec. 304. Limitation on certain physician referrals. 
TITLE IV—ADMINISTRATION 
Subtitle A—General administrative provisions 
Sec. 401. American Health Security Standards Board. 
Sec. 402. American Health Security Advisory Council. 
Sec. 403. Consultation with private entities. 
Sec. 404. State health security programs. 
Sec. 405. Complementary conduct of related health programs. 
Subtitle B—Control over fraud and abuse 
Sec. 411. Application of Federal sanctions to all fraud and abuse under Amer-
ican Health Security Program. 
Sec. 412. Requirements for operation of State health care fraud and abuse con-
trol units. 
TITLE V—QUALITY ASSESSMENT 
Sec. 501. American Health Security Quality Council. 
Sec. 502. Development of certain methodologies, guidelines, and standards. 
Sec. 503. State quality review programs. 
Sec. 504. Elimination of utilization review programs; transition.
TITLE VI—HEALTH SECURITY BUDGET; PAYMENTS; COST 
CONTAINMENT MEASURES 
Subtitle A—Budgeting and payments to States 
Sec. 601. National health security budget. 
Sec. 602. Computation of individual and State capitation amounts. 
Sec. 603. State health security budgets. 
Sec. 604. Federal payments to States. 
Sec. 605. Account for health professional education expenditures. 
Subtitle B—Payments by States to providers 
Sec. 611. Payments to hospitals and other facility-based services for operating 
expenses on the basis of approved global budgets. 
Sec. 612. Payments to health care practitioners based on prospective fee sched-
ule. 
Sec. 613. Payments to comprehensive health service organizations. 
Sec. 614. Payments for community-based primary health services. 
Sec. 615. Payments for prescription drugs. 
Sec. 616. Payments for approved devices and equipment. 
Sec. 617. Payments for other items and services. 
Sec. 618. Payment incentives for medically underserved areas. 
Sec. 619. Authority for alternative payment methodologies. 
Subtitle C—Mandatory assignment and administrative provisions 
Sec. 631. Mandatory assignment. 
Sec. 632. Procedures for reimbursement; appeals. 
TITLE VII—PROMOTION OF PRIMARY HEALTH CARE; DEVELOP-
MENT OF HEALTH SERVICE CAPACITY; PROGRAMS TO ASSIST 
THE MEDICALLY UNDERSERVED 
Subtitle A—Promotion and expansion of primary care professional training 
Sec. 701. Role of Board; establishment of primary care professional output 
goals. 
Sec. 702. Establishment of Advisory Committee on Health Professional Edu-
cation. 
Sec. 703. Grants for health professions education, nurse education, and the Na-
tional Health Service Corps. 
Subtitle B—Direct health care delivery 
Sec. 711. Setaside for public health. 
Sec. 712. Setaside for primary health care delivery. 
Sec. 713. Primary care service expansion grants. 
Subtitle C—Primary care and outcomes research 
Sec. 721. Set-aside for outcomes research. 
Sec. 722. Office of Primary Care and Prevention Research. 
Subtitle D—School-related health services 
Sec. 731. Authorizations of appropriations. 
Sec. 732. Eligibility for development and operation grants. 
Sec. 733. Preferences.
Sec. 734. Grants for development of projects. 
Sec. 735. Grants for operation of projects. 
Sec. 736. Federal administrative costs. 
Sec. 737. Definitions. 
TITLE VIII—FINANCING PROVISIONS; AMERICAN HEALTH 
SECURITY TRUST FUND 
Sec. 800. Amendment of 1986 code; section 15 not to apply. 
Subtitle A—American Health Security Trust Fund 
Sec. 801. American Health Security Trust Fund. 
Subtitle B—Taxes based on income and wages 
Sec. 811. Payroll tax on employers. 
Sec. 812. Health care income tax. 
Subtitle C—Increase in excise taxes on tobacco products 
Sec. 821. Increase in excise taxes on tobacco products. 
TITLE IX—CONFORMING AMENDMENTS TO THE EMPLOYEE 
RETIREMENT INCOME SECURITY ACT OF 1974 
Sec. 901. ERISA inapplicable to health coverage arrangements under State 
health security programs. 
Sec. 902. Exemption of State health security programs from ERISA preemp-
tion. 
Sec. 903. Prohibition of employee benefits duplicative of benefits under State 
health security programs; coordination in case of workers’ com-
pensation. 
Sec. 904. Repeal of continuation coverage requirements under ERISA and cer-
tain other requirements relating to group health plans. 
Sec. 905. Effective date of title. 
TITLE X—ADDITIONAL CONFORMING AMENDMENTS 
Sec. 1001. Repeal of certain provisions in Internal Revenue Code of 1986. 
Sec. 1002. Repeal of certain provisions in the Employee Retirement Income Se-
curity Act of 1974. 
Sec. 1003. Repeal of certain provisions in the Public Health Service Act and 
related provisions. 
Sec. 1004. Effective date of title.
TITLE I—ESTABLISHMENT OF A 
STATE-BASED 
AMERICAN 
HEALTH 
SECURITY 
PRO-
GRAM; UNIVERSAL ENTITLE-
MENT; ENROLLMENT 
SEC. 101. ESTABLISHMENT OF A STATE-BASED AMERICAN 
HEALTH SECURITY PROGRAM. 
(a) IN GENERAL.—There is hereby established in the 
United States a State-Based American Health Security 
Program to be administered by the individual States in 
accordance with Federal standards specified in, or estab-
lished under, this Act. 
(b) STATE HEALTH SECURITY PROGRAMS.—In order 
for a State to be eligible to receive payment under section 
604, a State must establish a State health security pro-
gram in accordance with this Act. 
(c) STATE DEFINED.— 
(1) IN GENERAL.—In this Act, subject to para-
graph (2), the term ‘‘State’’ means each of the 50 
States and the District of Columbia. 
(2) ELECTION.—If the Governor of Puerto 
Rico, the Virgin Islands, Guam, American Samoa, or 
the Northern Mariana Islands certifies to the Presi-
dent that the legislature of the Commonwealth or 
territory has enacted legislation desiring that the
Commonwealth or territory be included as a State 
under the provisions of this Act, such Common-
wealth or territory shall be included as a ‘‘State’’ 
under this Act beginning January 1 of the first year 
beginning 90 days after the President receives the 
notification. 
SEC. 102. UNIVERSAL ENTITLEMENT. 
(a) IN GENERAL.—Every individual who is a resident 
of the United States and is a citizen or national of the 
United States or lawful resident alien (as defined in sub-
section (d)) is entitled to benefits for health care services 
under this Act under the appropriate State health security 
program. In this section, the term ‘‘appropriate State 
health security program’’ means, with respect to an indi-
vidual, the State health security program for the State in 
which the individual maintains a primary residence. 
(b) TREATMENT OF CERTAIN NONIMMIGRANTS.— 
(1) IN GENERAL.—The American Health Secu-
rity Standards Board (in this Act referred to as the 
‘‘Board’’) may make eligible for benefits for health 
care services under the appropriate State health se-
curity program under this Act such classes of aliens 
admitted to the United States as nonimmigrants as 
the Board may provide.
(2) CONSIDERATION.—In providing for eligi-
bility under paragraph (1), the Board shall consider 
reciprocity in health care services offered to United 
States citizens who are nonimmigrants in other for-
eign states, and such other factors as the Board de-
termines to be appropriate. 
(c) TREATMENT OF OTHER INDIVIDUALS.— 
(1) BY BOARD.—The Board also may make eli-
gible for benefits for health care services under the 
appropriate State health security program under this 
Act other individuals not described in subsection (a) 
or (b), and regulate the nature of the eligibility of 
such individuals, in order— 
(A) to preserve the public health of com-
munities; 
(B) to compensate States for the addi-
tional health care financing burdens created by 
such individuals; and 
(C) to prevent adverse financial and med-
ical consequences of uncompensated care, 
while inhibiting travel and immigration to the 
United States for the sole purpose of obtaining 
health care services.
(2) BY STATES.—Any State health security pro-
gram may make individuals described in paragraph 
(1) eligible for benefits at the expense of the State. 
(d) LAWFUL RESIDENT ALIEN DEFINED.—For pur-
poses of this section, the term ‘‘lawful resident alien’’ 
means an alien lawfully admitted for permanent residence 
and any other alien lawfully residing permanently in the 
United States under color of law, including an alien with 
lawful temporary resident status under section 210, 210A, 
or 234A of the Immigration and Nationality Act (8 U.S.C. 
1160, 1161, or 1255a). 
SEC. 103. ENROLLMENT. 
(a) IN GENERAL.—Each State health security pro-
gram shall provide a mechanism for the enrollment of indi-
viduals entitled or eligible for benefits under this Act. The 
mechanism shall— 
(1) include a process for the automatic enroll-
ment of individuals at the time of birth in the 
United States and at the time of immigration into 
the United States or other acquisition of lawful resi-
dent status in the United States; 
(2) provide for the enrollment, as of January 1, 
2007, of all individuals who are eligible to be en-
rolled as of such date; and
(3) include a process for the enrollment of indi-
viduals made eligible for health care services under 
subsections (b) and (c) of section 102. 
(b) AVAILABILITY OF APPLICATIONS.—Each State 
health security program shall make applications for enroll-
ment under the program available— 
(1) at employment and payroll offices of em-
ployers located in the State; 
(2) at local offices of the Social Security Ad-
ministration; 
(3) at social services locations; 
(4) at out-reach sites (such as provider and 
practitioner locations); and 
(5) at other locations (including post offices 
and schools) accessible to a broad cross-section of in-
dividuals eligible to enroll. 
(c) ISSUANCE OF HEALTH SECURITY CARDS.—In 
conjunction with an individual’s enrollment for benefits 
under this Act, the State health security program shall 
provide for the issuance of a health security card that shall 
be used for purposes of identification and processing of 
claims for benefits under the program. The State health 
security program may provide for issuance of such cards 
by employers for purposes of carrying out enrollment pur-
suant to subsection (a)(2).