II 
Calendar No. 210 
111TH CONGRESS 
1ST SESSION H. R. 3962 
IN THE SENATE OF THE UNITED STATES 
NOVEMBER 10, 2009 
Received and read the first time 
NOVEMBER 16, 2009 
Read the second time and placed on the calendar 
AN ACT 
To provide affordable, quality health care for all Americans 
and reduce the growth in health care spending, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF DIVISIONS, TITLES, 
AND SUBTITLES. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Affordable Health Care for America Act’’. 
(b) TABLE
OF
DIVISIONS, TITLES, AND
SUB-
TITLES.—This Act is divided into divisions, titles, and 
subtitles as follows: 
DIVISION A—AFFORDABLE HEALTH CARE CHOICES 
TITLE I—IMMEDIATE REFORMS 
TITLE 
II—PROTECTIONS 
AND 
STANDARDS 
FOR 
QUALIFIED 
HEALTH BENEFITS PLANS 
Subtitle A—General Standards 
Subtitle B—Standards Guaranteeing Access to Affordable Coverage 
Subtitle C—Standards Guaranteeing Access to Essential Benefits 
Subtitle D—Additional Consumer Protections 
Subtitle E—Governance 
Subtitle F—Relation to Other Requirements; Miscellaneous 
TITLE III—HEALTH INSURANCE EXCHANGE AND RELATED PROVI-
SIONS 
Subtitle A—Health Insurance Exchange 
Subtitle B—Public Health Insurance Option 
Subtitle C—Individual Affordability Credits 
TITLE IV—SHARED RESPONSIBILITY 
Subtitle A—Individual Responsibility 
Subtitle B—Employer Responsibility 
TITLE V—AMENDMENTS TO INTERNAL REVENUE CODE OF 1986 
Subtitle A—Shared Responsibility 
Subtitle B—Credit for Small Business Employee Health Coverage Expenses 
Subtitle C—Disclosures To Carry Out Health Insurance Exchange Subsidies 
Subtitle D—Other Revenue Provisions 
DIVISION B—MEDICARE AND MEDICAID IMPROVEMENTS 
TITLE I—IMPROVING HEALTH CARE VALUE 
Subtitle A—Provisions related to Medicare part A 
Subtitle B—Provisions Related to Part B 
Subtitle C—Provisions Related to Medicare Parts A and B 
Subtitle D—Medicare Advantage Reforms 
Subtitle E—Improvements to Medicare Part D 
Subtitle F—Medicare Rural Access Protections 
TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS 
Subtitle A—Improving and Simplifying Financial Assistance for Low Income 
Medicare Beneficiaries 
Subtitle B—Reducing Health Disparities 
Subtitle C—Miscellaneous Improvements 
TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH SERV-
ICES, AND COORDINATED CARE 
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TITLE IV—QUALITY 
Subtitle A—Comparative Effectiveness Research 
Subtitle B—Nursing Home Transparency 
Subtitle C—Quality Measurements 
Subtitle D—Physician Payments Sunshine Provision 
Subtitle E—Public Reporting on Health Care-Associated Infections 
TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION 
TITLE VI—PROGRAM INTEGRITY 
Subtitle A—Increased funding to fight waste, fraud, and abuse 
Subtitle B—Enhanced penalties for fraud and abuse 
Subtitle C—Enhanced Program and Provider Protections 
Subtitle D—Access to Information Needed to Prevent Fraud, Waste, and Abuse 
TITLE VII—MEDICAID AND CHIP 
Subtitle A—Medicaid and Health Reform 
Subtitle B—Prevention 
Subtitle C—Access 
Subtitle D—Coverage 
Subtitle E—Financing 
Subtitle F—Waste, Fraud, and Abuse 
Subtitle G—Puerto Rico and the Territories 
Subtitle H—Miscellaneous 
TITLE VIII—REVENUE-RELATED PROVISIONS 
TITLE IX—MISCELLANEOUS PROVISIONS 
DIVISION C—PUBLIC HEALTH AND WORKFORCE DEVELOPMENT 
TITLE I—COMMUNITY HEALTH CENTERS 
TITLE II—WORKFORCE 
Subtitle A—Primary Care Workforce 
Subtitle B—Nursing Workforce 
Subtitle C—Public Health Workforce 
Subtitle D—Adapting Workforce to Evolving Health System Needs 
TITLE III—PREVENTION AND WELLNESS 
TITLE IV—QUALITY AND SURVEILLANCE 
TITLE V—OTHER PROVISIONS 
Subtitle A—Drug Discount for Rural and Other Hospitals; 340B Program In-
tegrity 
Subtitle B—Programs 
Subtitle C—Food and Drug Administration 
Subtitle D—Community Living Assistance Services and Supports 
Subtitle E—Miscellaneous 
DIVISION D—INDIAN HEALTH CARE IMPROVEMENT 
TITLE I—AMENDMENTS TO INDIAN LAWS 
TITLE II—IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED 
UNDER THE SOCIAL SECURITY ACT 
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DIVISION A—AFFORDABLE 
HEALTH CARE CHOICES 
SEC. 100. PURPOSE; TABLE OF CONTENTS OF DIVISION; 
GENERAL DEFINITIONS. 
(a) PURPOSE.— 
(1) IN GENERAL.—The purpose of this division 
is to provide affordable, quality health care for all 
Americans and reduce the growth in health care 
spending. 
(2) BUILDING ON CURRENT SYSTEM.—This di-
vision achieves this purpose by building on what 
works in today’s health care system, while repairing 
the aspects that are broken. 
(3) INSURANCE REFORMS.—This division— 
(A) enacts strong insurance market re-
forms; 
(B) creates a new Health Insurance Ex-
change, with a public health insurance option 
alongside private plans; 
(C) includes sliding scale affordability 
credits; and 
(D) initiates shared responsibility among 
workers, employers, and the Government; 
so that all Americans have coverage of essential 
health benefits. 
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