I 
111TH CONGRESS 
1ST SESSION H. R. 2816 
To amend the Social Security Act to provide grants and flexibility through 
demonstration projects for States to provide universal, comprehensive, 
cost-effective systems of health care coverage, with simplified administra-
tion. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 10, 2009 
Mr. TIERNEY (for himself, Mr. KUCINICH, and Ms. BALDWIN) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, Education 
and Labor, and Oversight and Government Reform, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee con-
cerned 
A BILL 
To amend the Social Security Act to provide grants and 
flexibility through demonstration projects for States to 
provide universal, comprehensive, cost-effective systems 
of health care coverage, with simplified administration. 
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 
‘‘States’ Right To Innovate in Health Care Act of 2009’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings and purposes. 
Sec. 3. Amendment to Social Security Act. 
‘‘TITLE XXII—STATE COMPREHENSIVE HEALTH CARE AND COST 
CONTAINMENT DEMONSTRATION PROJECTS 
‘‘Sec. 2201. State-based Universal Health Care Coverage Commission. 
‘‘Sec. 2202. Planning grants. 
‘‘Sec. 2203. Demonstration grants. 
‘‘Sec. 2204. State plan requirements. 
‘‘Sec. 2205. Interstate arrangements. 
‘‘Sec. 2206. Definitions. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
(1) In 2006, annual health care expenditures in 
the United States totaled $2.1 trillion, or $6,800 per 
person. 
(2) In 2006, health care expenditures rep-
resented 16 percent of the gross domestic product 
(‘‘GDP’’) in the United States and grew at the rate 
of 6.7 percent. 
(3) Health care spending in the United States 
is expected to increase at similar levels for the next 
decade, reaching $4 trillion in 2015, or 20 percent 
of GDP. 
(4) Yet, access to health care is a problem for 
many citizens of the United States. According to the 
Census Bureau, there are now over 46,000,000 citi-
zens who lack health insurance and each year this 
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figure grows. This figure does not include the mil-
lions of citizens who are under-insured and millions 
of others who may not have insurance coverage at 
some point during a year. 
(5) There is enough money in the health care 
system to ensure that the rationing of health care 
services does not need to occur, either explicitly by 
design or, as happens currently, implicitly due to an 
individual’s or family’s economic status. Health care 
reform is needed to assure that there is universal 
health coverage for all citizens of the United States. 
(6) States are the natural vehicles to test meth-
ods and forms of achieving universal health cov-
erage. There is a well-established tradition for this. 
In the past, States have led the way in testing ideas 
for national application, involving such areas as 
child labor, social security, welfare reform, and envi-
ronmental protection. Several States are embarking 
on major health care initiatives to cover residents of 
the State who are uninsured. Given past successes in 
individual State action that have resulted in national 
changes, the Federal Government should invest in a 
broad range of efforts in a variety of geographically 
dispersed States prior to attempting a national sys-
tem of health care reform. 
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(7) In 2002, in response to a request from the 
Secretary of Health and Human Services, the Insti-
tute of Medicine of the National Academy of 
Sciences established a committee, officially known as 
the ‘‘Committee on Rapid Advance Demonstration 
Projects: Health Care Finance and Delivery Sys-
tems’’, with the goal of formulating models for 
broader health care reform. The committee rec-
ommended a 10-year commitment to State dem-
onstration projects as a means to encourage States 
to develop their own systems of universal health care 
and to facilitate innovation. 
(b) PURPOSE.—The purpose of this Act is to encour-
age States— 
(1) to develop plans for universal, comprehen-
sive, cost-effective systems of health care with sim-
plified administration to individuals residing in such 
States; and 
(2) to implement such plans by offering transi-
tional grants and by removing Federal statutory and 
administrative barriers that may inhibit or discour-
age efforts by States to provide such health care 
while maintaining Federal payments for health care 
under Federal health care programs. 
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SEC. 3. AMENDMENT TO SOCIAL SECURITY ACT. 
The Social Security Act (42 U.S.C. 301 et seq.) is 
amended by adding at the end the following new title: 
‘‘TITLE 
XXII—STATE 
COM-
PREHENSIVE HEALTH CARE 
AND 
COST 
CONTAINMENT 
DEMONSTRATION PROJECTS 
‘‘SEC. 2201. STATE-BASED UNIVERSAL HEALTH CARE COV-
ERAGE COMMISSION. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN
GENERAL.—Not later than 90 days 
after the date of the enactment of this title, the Sec-
retary shall establish a State-based Universal Health 
Care Coverage Commission (in this section referred 
to as the ‘Commission’). 
‘‘(2) MEMBERSHIP.—The Commission shall be 
composed of 17 members— 
‘‘(A) 1 of whom shall be the Secretary; 
‘‘(B) 4 of whom shall be governors of a 
State who are appointed by the National Gov-
ernors Association on a bipartisan basis; 
‘‘(C) 4 of whom shall be State legislators 
who are appointed, on a joint and bipartisan 
basis, by the National Conference of State Leg-
islators and the American Legislative Exchange 
Council; 
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‘‘(D) 2 of whom shall be appointed by the 
majority leader of the Senate; 
‘‘(E) 2 of whom shall be appointed by the 
minority leader of the Senate; 
‘‘(F) 2 of whom shall be appointed by the 
Speaker of the House of Representatives; and 
‘‘(G) 2 of whom shall be appointed by the 
minority leader of the House of Representa-
tives. 
‘‘(b) DUTIES OF THE COMMISSION.— 
‘‘(1) GUIDANCE AND INFORMATION.—The Com-
mission shall— 
‘‘(A) provide guidance to State health care 
officials regarding applications for grants under 
this title and exchange information with, and 
otherwise assist, such officials upon the request 
of the officials; 
‘‘(B) submit proposed procedures with re-
spect to applications for grants under this title; 
‘‘(C) review and recommend the approval 
of applications for demonstration grants under 
section 2203, including providing guidance on 
the issuance of appropriate waivers described in 
section 2203(f); 
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‘‘(D) suggest appropriate levels of funding 
for applications for planning grants approved 
under section 2202 consistent with such sec-
tion; 
‘‘(E) provide guidance with respect to such 
evaluation, monitoring, compliance, and other 
review functions with respect to grants under 
this title as may be appropriate; 
‘‘(F) develop proposed guidelines, stand-
ards, and formats for the evaluation, reporting, 
and collection of data by States in order to en-
able the Secretary to monitor State plan admin-
istration and compliance, and to evaluate and 
compare the effectiveness of State plans; and 
‘‘(G) provide guidance on the implementa-
tion of any other requirements or activities nec-
essary and appropriate under this title. 
‘‘(2) ANNUAL REPORT.—The Commission shall 
prepare and submit to the President and to Con-
gress an annual report. Such report shall be sub-
mitted not later than March 30 of each year and 
shall include information concerning States that re-
ceive grants under this title and the effectiveness of 
any health care programs assisted by such grants 
during the previous year. 
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‘‘(3) APPROVAL
PROCESS.—The provisions of 
section 2106(c) shall apply to State plans and the 
Secretary under this title in the same manner as 
they apply to State plans and the Secretary under 
such section. 
‘‘(4) CONSULTATION.—To the extent feasible, 
the Secretary shall carry out the State Comprehen-
sive Health Care and Cost Containment demonstra-
tion projects under this title based on, and in ac-
cordance with, the advice and recommendations of 
the Commission. 
‘‘(c) PERIOD OF APPOINTMENT; REPRESENTATION 
REQUIREMENTS; VACANCIES.—Members shall be ap-
pointed for a term of such time as is needed to complete 
the requirements of this section and to carry out the re-
quirements of this section. In appointing members under 
subsection (a)(2), the designated appointing individuals 
shall ensure the representation of urban and rural areas 
and an appropriate geographic distribution of such mem-
bers. Any vacancy in the Commission shall not affect its 
powers, but shall be filled in the same manner as the origi-
nal appointment. 
‘‘(d) CHAIRPERSON, MEETINGS.— 
‘‘(1) CHAIRPERSON.—The Commission shall se-
lect a Chairperson from among its members. 
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‘‘(2) QUORUM.—Two-thirds of the members of 
the Commission shall constitute a quorum, but a 
lesser number of members may hold hearings. 
‘‘(3) MEETINGS.—Not later than 30 days after 
the date on which all members of the Commission 
have been appointed, the Commission shall hold its 
first meeting. The Commission shall meet at the call 
of the Chairperson. 
‘‘(e) PERSONNEL MATTERS.— 
‘‘(1) COMPENSATION.—Each member of the 
Commission who is not an officer or employee of the 
Federal Government or of a State or local govern-
ment shall be compensated at a rate equal to the 
daily equivalent of the annual rate of basic pay pre-
scribed for level IV of the Executive Schedule under 
section 5315 of title 5, United States Code, for each 
day (including travel time) during which such mem-
ber is engaged in the performance of the duties of 
the Commission. All members of the Commission 
who are officers or employees of the United States 
shall serve without compensation in addition to that 
received for their services as officers or employees of 
the United States. 
‘‘(2) TRAVEL EXPENSES.—The members of the 
Commission shall be allowed travel expenses, includ-
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ing per diem in lieu of subsistence, at rates author-
ized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while 
away from their homes or regular places of business 
in the performance of services for the Commission. 
‘‘(3) STAFF.—The Chairperson of the Commis-
sion may, without regard to the civil service laws 
and regulations, appoint and terminate an executive 
director and such other additional personnel as may 
be necessary to enable the Commission to perform 
its duties. The employment of an executive director 
shall be subject to confirmation by the Commission. 
‘‘(4) DETAIL OF GOVERNMENT EMPLOYEES.— 
Any Federal Government employee may be detailed 
to the Commission without reimbursement, and such 
detail shall be without interruption or loss of civil 
service status or privilege. 
‘‘(5) TEMPORARY
AND
INTERMITTENT
SERV-
ICES.—The Chairperson of the Commission may 
procure temporary and intermittent services under 
section 3109(b) of title 5, United States Code, at 
rates for individuals 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. 
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‘‘(f) FUNDING.—There are authorized to be appro-
priated such funds as necessary for the purposes of car-
rying out this section. 
‘‘SEC. 2202. PLANNING GRANTS. 
‘‘(a) APPLICATION.—A State may apply to the Sec-
retary for a State planning grant under this section to 
develop a State plan to offer universal comprehensive 
health care, with simplified administration, and to improve 
the cost-effectiveness of the health care delivery system. 
‘‘(b) CONTENTS.—The Secretary may not approve 
such a State planning grant for a State unless the applica-
tion for the grant includes or provides for the following: 
‘‘(1) BUDGET.—A budget and a budget jus-
tification. 
‘‘(2) PLANNING
PROCESS.—A description of 
how under the grant the State shall— 
‘‘(A) identify options to provide a uni-
versal, comprehensive, and cost-effective system 
of health care, with simplified administration, 
that is affordable and accessible to all eligible 
beneficiaries in the State; and 
‘‘(B) conduct an analysis that compares 
projected overall health expenditures over a 5- 
year period under the proposed system with the 
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projected overall health expenditures that would 
otherwise occur during such period. 
‘‘(3) OPPORTUNITY
FOR
PUBLIC
PARTICIPA-
TION.—Assurances that the State will include a 
process for public contribution and participation in 
the planning process. 
‘‘(c) NUMBER OF STATES; PERIOD OF GRANT.—The 
Secretary may not award State planning grants under this 
section to more than 10 States. A State planning grant 
under this section shall be effective for a period of up to 
30 months. In awarding State planning grants under this 
section the Secretary shall give preference to States from 
a variety of geographic areas in the United States. 
‘‘(d) AMOUNT.—The amount of a State planning 
grant under this section to a State may not exceed 
$4,500,000. 
‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 
provide States with technical assistance in applying for 
and implementing State planning grants under this sec-
tion. At the request of the Secretary, other Departments 
and Offices of the Federal Government shall provide 
States with such technical assistance. 
‘‘SEC. 2203. DEMONSTRATION GRANTS. 
‘‘(a) APPLICATION.—A State that has developed a 
State plan may apply to the Secretary for approval of a 
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the date of final approval of the demonstration grant ap-
plication under subsection (b). 
‘‘(d) STATE PLAN REQUIRED.—The Secretary may 
not approve a demonstration grant under this section un-
less the State has a State plan to carry out the grant con-
sistent with the requirements of section 2204. 
‘‘(e) FUNDING.— 
‘‘(1) TRANSITIONAL
GRANT
AMOUNT.—The 
amount awarded under this section to a State with 
a demonstration grant approved under this section 
may 
not 
exceed 
an 
aggregate 
amount 
of 
$13,000,000 plus $4 multiplied by the number of el-
igible State residents of the State to assist the State 
in the transition of the health care delivery and fi-
nancing infrastructure. Such amount shall be made 
available to a State during the period of transition, 
as provided in the State plan. The number of eligible 
State residents of a State shall be determined based 
on the best available Census Bureau data as of the 
July 1 before the date the grant under this section 
is approved. 
‘‘(2) 
MAINTENANCE
OF
FEDERAL
FUNDS 
UNDER WAIVERS.—Pursuant to the waivers under 
subsection (f), the Federal Government shall pay to 
a State amounts for health care under Federal 
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