I 
114TH CONGRESS 
1ST SESSION H. R. 2756 
To reform the provision of health insurance coverage by promoting health 
savings accounts, State-based alternatives to coverage under the Afford-
able Care Act, and price transparency, in order to promote a more 
market-based health care system, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 12, 2015 
Mr. ABRAHAM introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means and Education and the Workforce, 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 reform the provision of health insurance coverage by 
promoting health savings accounts, State-based alter-
natives to coverage under the Affordable Care Act, and 
price transparency, in order to promote a more market- 
based health care system, and for other purposes. 
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 
‘‘Patient Freedom Act of 2015’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Sense of Congress. 
TITLE I—HEALTH REFORM 
Sec. 100. Definitions. 
Subtitle A—Insurance Reforms 
Sec. 101. State options in response to Burwell decision. 
Sec. 102. State alternative option. 
Sec. 103. Computation of monthly HSA deposit amount for deposit qualifying 
residents. 
Sec. 104. State options for improved access to health insurance coverage in 
each State. 
Sec. 105. Expanded access and patient protections. 
Sec. 106. Sunsetting certain ACA provisions; continuation of policies of cov-
ering adult children and not applying lifetime or annual limits. 
Subtitle B—Medicaid 
Sec. 111. Application of health savings accounts in relation to Medicaid. 
Subtitle C—Provider Price Transparency 
Sec. 121. Ensuring access to emergency services without excessive charges for 
out-of-network services. 
TITLE II—REFORM OF TAX PROVISIONS RELATING TO HEALTH 
CARE 
Subtitle A—Promotion of Health Savings Accounts 
Sec. 201. Repeal of high deductible health plan requirement. 
Sec. 202. Treatment of HSA after death of account beneficiary. 
Sec. 203. Purchase of health insurance from HSA account. 
Sec. 204. Publishing of cash price for care paid through health savings ac-
counts. 
Subtitle B—Health Care Tax Credits 
Sec. 211. Limited application of PPACA health premium credit. 
Sec. 212. New HSA credit. 
SEC. 2. SENSE OF CONGRESS. 
It is the sense of Congress that there is a need for 
legislation providing temporary transition funding for 
those who lose health insurance subsidies in the aftermath 
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of a Supreme Court decision in favor of the plaintiffs-ap-
pellants in the case of King v. Burwell. 
TITLE I—HEALTH REFORM 
SEC. 100. DEFINITIONS. 
In this title: 
(1) PATIENT-GRANT
ELECTING
STATE.—The 
term ‘‘patient-grant electing State’’ means an elect-
ing State that specifies under section 102(a)(4)(B) 
that it will carry out section 102(b) itself (and not 
to have section 102(b) carried out by means of the 
credit under section 36C of the Internal Revenue 
Code of 1986). 
(2) CHIP.—The term ‘‘CHIP’’ means the chil-
dren’s health insurance program established under 
title XXI of the Social Security Act (42 U.S.C. 1396 
et seq.). 
(3) CREDITABLE COVERAGE.—The term ‘‘cred-
itable coverage’’ has the meaning given such term in 
section 2704(c)(1) of the Public Health Service Act 
(42 U.S.C. 300gg–3(c)(1)), as in effect as of the day 
before the date of the enactment of this Act. 
(4) 
DEFAULT
HEALTH
INSURANCE
COV-
ERAGE.—The term ‘‘default health insurance cov-
erage’’ has the meaning given such term in section 
104(c)(2). 
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(5) DEPOSIT
QUALIFYING
RESIDENT.—The 
term ‘‘deposit qualifying resident’’ has the meaning 
given such term in section 102(b)(2). 
(6) ELECTING
STATE.—The term ‘‘electing 
State’’ means a State that elects under section 
101(a)(3) the alternative option described in section 
102. 
(7) HEALTH INSURANCE COVERAGE.—The term 
‘‘health insurance coverage’’ has the meaning given 
such term in section 2791(b)(1) of the Public Health 
Service Act (42 U.S.C. 300gg–91(b)(1)). 
(8) HEALTH
SAVINGS
ACCOUNT; HSA.—The 
terms ‘‘health savings account’’ and ‘‘HSA’’ mean a 
health savings account established under section 223 
of the Internal Revenue Code of 1986. 
(9) HEALTH
SAVINGS
DEPOSIT.—The term 
‘‘health savings deposit’’ means a deposit made into 
a health savings account pursuant to section 102. 
(10) MEDICAID.—The term ‘‘Medicaid’’ means 
the program under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.). 
(11) MEDICARE.—The term ‘‘Medicare’’ means 
the program under part A or B of title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.). 
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(12) PPACA.—The term ‘‘PPACA’’ means the 
Patient Protection and Affordable Care Act (Public 
Law 111–148), as in effect before the date of the 
enactment of this Act, unless otherwise specified. 
(13) QUALIFIED HEALTH PLAN COVERAGE.— 
The term ‘‘qualified health plan coverage’’ means, 
with respect to residents of a State, health insurance 
coverage that meets applicable standards under 
State law, which standards need not be the same as 
that previously required of qualified health plans 
under title I of PPACA, and includes a high deduct-
ible health plan (as defined in section 223(c)(2) of 
the Internal Revenue Code of 1986) and includes 
coverage under a group health plan. 
(14) QUALIFIED RESIDENT.—The term ‘‘quali-
fied resident’’ means, with respect to a State for a 
month, an individual who is a resident of the State 
as of the first day of the month and is a citizen or 
national of the United States or otherwise lawfully 
residing in the State under color of law. 
(15) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Health and Human Services. 
(16) STATE.—The term ‘‘State’’ means the 50 
States and the District of Columbia. 
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(17) 
UNINSURED.—The 
term 
‘‘uninsured’’ 
means, with respect to an individual, that the indi-
vidual does not have creditable coverage. 
Subtitle A—Insurance Reforms 
SEC. 101. STATE OPTIONS IN RESPONSE TO BURWELL DECI-
SION. 
(a) IN GENERAL.—Each State may elect, through 
written notice to the Secretary after the date of the enact-
ment of this Act and in accordance with this subtitle, one 
of the following three options in relation to the implemen-
tation of title I of the Patient Protection and Affordable 
Care Act after the decision of the Supreme Court in King 
v. Burwell: 
(1) CONTINUING IMPLEMENTATION OF PPACA, 
INCLUDING FEDERAL SUBSIDIES THROUGH A STATE- 
ESTABLISHED EXCHANGE.—Under current law, the 
State establishing a health insurance Exchange 
under title I of PPACA, which thereby permits the 
continuation of Federal premium and cost-sharing 
subsidies for coverage offered through the Exchange 
as well as continuation of insurance and other re-
quirements under such title. 
(2) REJECTION OF PPACA, INCLUDING ELIMI-
NATION
OF
FEDERAL
SUBSIDIES
NOW
PROVIDED 
THROUGH FEDERALLY ESTABLISHED EXCHANGE.— 
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Under current law, the State not establishing such 
an Exchange, potentially resulting, post-Burwell, in 
the loss of such Federal premium and cost-sharing 
subsidies and the continued application of other re-
quirements under such title. 
(3) ESTABLISHING NEW STATE AND MARKET- 
BASED ALTERNATIVE, WITH ALTERNATIVE PER CAP-
ITA FEDERAL DEPOSIT SYSTEM.—The State imple-
menting the alternative option described in section 
102, which includes— 
(A) the waiver of most requirements im-
posed under such title; and 
(B) the provision of a new, HSA- and mar-
ket-based deposit system for individuals who do 
not otherwise qualify for Federal or State sub-
sidies for health benefits coverage. 
If a State fails to make an election described in this sub-
section, the State shall be deemed to have made the elec-
tion described in paragraph (2). A State may, through 
written notice to the Secretary, change an election pre-
viously made under this subsection. 
(b) RELATION TO CURRENT MEDICAID ACA COV-
ERAGE OPTION.—Nothing in this section shall be con-
strued to change the option of a State with respect to the 
implementation of Medicaid ACA coverage under section 
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1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 
U.S.C. 1395a(a)(10)(A)(i)(VIII)), except that a State that 
elects not to provide medical assistance to individuals 
under such section may make such individuals deposit 
qualifying residents under this title. 
SEC. 102. STATE ALTERNATIVE OPTION. 
(a) IN GENERAL.—In the case of a State that elects 
under section 101(a)(3) the alternative option under this 
section, subject to subsection (d) and section 105, the fol-
lowing shall apply: 
(1) NO
FEDERAL
EXCHANGE.—The Federal 
Government shall not establish or maintain an Ex-
change in the State under title I of PPACA. 
(2) ELIMINATION
OF
INDIVIDUAL
AND
EM-
PLOYER
SHARED
RESPONSIBILITY
FOR
HEALTH 
CARE TAX REQUIREMENTS FOR RESIDENTS AND EM-
PLOYEES IN STATE.—The individual and employer 
health care responsibilities under the amendments 
made by title I of PPACA (including under sections 
5000A and 4980H of the Internal Revenue Code of 
1986) shall no longer apply pursuant to section 106 
with respect to individuals who are residents of such 
State and with respect to individuals who are em-
ployed in such State, respectively. 
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(3) MODIFICATION
OF
INSURANCE
REQUIRE-
MENTS.—Except as specifically provided in this title, 
the requirements under title I of PPACA (including 
amendments made by such title) relating to health 
insurance coverage offered in the State shall not 
apply except to the extent specified by the State. 
(4) NEW DEPOSIT SYSTEM THROUGH FUNDING 
HSAS.— 
(A) IN GENERAL.—Deposit qualifying resi-
dents (as defined in subsection (b)(2)) who are 
residing in the State are eligible for a deposit 
to a health savings account that may be used 
for premiums and cost-sharing for health insur-
ance coverage in accordance with subsection 
(b). 
(B) STATE SPECIFICATION OF MANNER OF 
CARRYING OUT HSA DEPOSIT SYSTEM (PATIENT- 
GRANT ELECTING STATE).—In making the elec-
tion under this subsection, a State shall specify 
whether the State will carry out subsection (b) 
or if such subsection shall be carried out by 
means of the credit under section 36C of the 
Internal Revenue Code of 1986. 
(5) ADDITIONAL
AMOUNTS
FOR
POPULATION 
HEALTH
INITIATIVES
FOR
STATE
ADMINISTERED 
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HSA
DEPOSIT
SYSTEM.—A patient-grant electing 
State (as defined in section 100(1)) is entitled to re-
ceive additional funding under subsection (c) for 
population health initiatives. 
(b) DEPOSIT THROUGH PAYMENT INTO HSA FOR 
DEPOSIT QUALIFYING RESIDENTS.— 
(1) IN GENERAL.—The subsidies described in 
subsection (a)(4) for an electing State shall be fur-
nished for each deposit qualifying resident through 
the deposit of a contribution into an HSA of the in-
dividual in the amount determined under section 
103. 
(2) 
DEPOSIT
QUALIFYING
RESIDENT
DE-
FINED.—In this title, the term ‘‘deposit qualifying 
resident’’ means, with respect to a State and a 
month, an individual— 
(A) who is a qualified resident (as defined 
in section 100(14)) of the State as of the first 
day of the month (or such other day in the 
month as the Secretary may specify); 
(B) with respect to whom an HSA has 
been established, which HSA may have been es-
tablished by the State in carrying out this sec-
tion; 
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(C) who is enrolled in qualified health plan 
coverage (as defined in section 100(13)), which 
enrollment may have been effected by the State 
in carrying out this section; and 
(D) who is not eligible for coverage under 
Medicare, is not enrolled for benefits under 
Medicaid or CHIP, and is not enrolled for bene-
fits under chapter 55 of title 10, United States 
Code (relating to TRICARE), or title 39 of 
such Code (relating to veterans’ benefits) or 
chapter 89 of title 5 of such Code (relating to 
the Federal Employees Health Benefits Pro-
gram). 
(3) PAYMENT ADMINISTRATION.— 
(A) STATE.—In the case of an electing 
State that elects to carry out this subsection 
through the State, the Secretary shall provide 
for payment to the State in amounts and in a 
time and manner sufficient to permit the State 
to make timely monthly contributions to HSAs 
under this subsection. The Secretary may pro-
vide for payment to the State using the pay-
ment methodology described in subsection (d) of 
section 1903 of the Social Security Act for pay-
ments under subsection (a) of such section (ap-
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plied without regard to any State matching re-
quirement) and may condition such payments 
upon the provision of such information as the 
Secretary may require to ensure the proper pay-
ments under this subsection. As a condition of 
receiving payment under this section, a State 
shall submit such information, in such form, 
and manner, as the Secretary shall specify, in-
cluding information necessary to make the com-
putations of amounts under this section. 
(B) FEDERAL.—In the case of a State 
electing to carry out this subsection other than 
through the State, subsidies described in sub-
section (a)(4) shall be provided through a re-
fundable tax credit under section 36C of the In-
ternal Revenue Code of 1986. 
(4) CONSTRUCTION.—Nothing in this sub-
section shall be construed— 
(A) to prevent an individual from affirma-
tively electing not to have an HSA established 
on the individual’s behalf and not to be enrolled 
under health insurance coverage; 
(B) subject to subparagraph (A), to pre-
vent a State from establishing an HSA for each 
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deposit qualifying resident who does not other-
wise have an HSA; 
(C) subject to subparagraph (A), to pre-
vent a State from establishing a mechanism 
whereby individuals who would be deposit quali-
fying residents but for paragraph (2)(C) are en-
rolled under health insurance coverage; and 
(D) to prevent a State from changing its 
State Medicaid plan to eliminate coverage under 
section 1902(a)(10)(A)(i)(VIII) of the Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(i)(VIII)), in order that indi-
viduals otherwise covered under such section 
may qualify for subsidies under this section. 
(c) POPULATION HEALTH INITIATIVE FUNDING.— 
(1) IN GENERAL.—In the case of an electing 
State for a year, the State is entitled to receive pay-
ment from the Secretary of Health and Human 
Services after the end of such year in an amount 
equal to 2 percent of the actual aggregate amount 
deposited under subsection (b) into HSAs for resi-
dents of the State for the year. 
(2) USE OF FUNDS.—Amounts paid to a State 
under paragraph (1) may only be used for popu-
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lation health initiatives (as defined by the Sec-
retary). 
(3) ENTITLEMENT.—Paragraph (1) constitutes 
budget authority in advance of appropriations Acts 
and represents the obligation of the Federal Govern-
ment to provide for the payment to States of 
amounts provided under such paragraph. 
(d) REQUIRING RULES
FOR COMPUTING USUAL, 
CUSTOMARY, AND REASONABLE (UCR) PRICES.—As a 
condition for a State’s election of the alternative option 
under this section, the State must provide, through its de-
partment of insurance or equivalent agency, for establish-
ment of rules to carry out section 1867(j)(1)(A)(ii) of the 
Social Security Act, as added by section 121(a)(2). 
SEC. 103. COMPUTATION OF MONTHLY HSA DEPOSIT 
AMOUNT FOR DEPOSIT QUALIFYING RESI-
DENTS. 
(a) COMPUTATION.— 
(1) IN GENERAL.—The Secretary shall develop 
a standardized methodology to determine consistent 
with this section a monthly HSA deposit amount for 
deposit qualifying residents in each State for months 
in each year. Subject to paragraphs (3) and (4), 
such amount shall be equal to 1⁄12 of the average per 
capita annual amount computed under subsection 
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(b) for the State for the year, as adjusted for the 
deposit qualifying resident involved— 
(A) for age and geographic area under 
subsection (c); and 
(B) for income under subsection (d). 
(2) NO
VARIATION
BASED
ON
HOW
DEPOSIT 
AMOUNT DISTRIBUTED.—Such amount shall be the 
same for a deposit qualifying individual without re-
gard to whether the contribution to the individual’s 
HSA is made by a State under this section or by the 
Federal Government through the operation of sec-
tion 36C of the Internal Revenue Code of 1986. 
(3) PATIENT-GRANT
ELECTING
STATE
HAS 
FLEXIBILITY TO MAINTAIN LEVEL OF BENEFITS FOR 
CURRENT
ACA
BENEFICIARIES.—A patient-grant 
electing State may elect to increase the amount of 
the deposit for all deposit qualifying individuals 
under this section to the amounts that the Secretary 
estimates would have been paid with respect to such 
individuals under section 36B of the Internal Rev-
enue Code of 1986 and section 1402 of PPACA if 
those sections had remained in effect in the State 
with respect to such individuals. Such election shall 
be made for a year and shall continue from year to 
year until the State elects to terminate such election. 
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(4) SPECIAL RULE FOR PARTIAL DEPOSIT FOR 
LOW-INCOME
INDIVIDUALS
WITH
EMPLOYER-SPON-
SORED INSURANCE (ESI).—In the case of an indi-
vidual who is covered under a group health plan and 
with respect to such coverage there is a contribution 
by an employer which is excluded from the individ-
ual’s gross income under the Internal Revenue Code 
of 1986, insofar as the individual is a deposit quali-
fying resident, the amount of the deposit with re-
spect to the individual shall be reduced, in a manner 
specified by the Secretary in consultation with the 
Secretary of the Treasury and taking into account 
the income of the individual’s household, by an 
amount that is approximately equivalent to the esti-
mated amount of the reduction in the amount of in-
come tax resulting from such exclusion (and any re-
duction in taxes imposed by chapter 21 or chapter 
2 of such Code by reason of any exclusion of such 
contributions from wages and self employment in-
come). 
(b) COMPUTATION OF UNADJUSTED PER CAPITA.— 
(1) FOR STATES THAT CONTINUE PPACA MED-
ICAID COVERAGE.— 
(A) IN GENERAL.—In the case of a State 
that provides medical assistance under section 
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1902(a)(10)(A)(i)(VIII) of the Social Security 
Act (42 U.S.C. 1396b(a)(10)(A)(i)(VIII)) dur-
ing a year, subject to paragraphs (3) and (4), 
the Secretary shall compute an average per cap-
ita annual amount for the State for the year 
equal to— 
(i) the amount specified in subpara-
graph (B), divided by 
(ii) the average monthly number of 
deposit qualifying residents of the State in 
the year. 
(B) AMOUNT BASED ON PPACA PROJECTED 
FEDERAL EXPENDITURES.—The amount speci-
fied in this subparagraph for a State for a year 
is 95 percent of the Secretary’s estimate of the 
total payments that would have been made (as-
suming the existence of a State established Ex-
change in the State) under section 36B of the 
Internal Revenue Code of 1986 and under sec-
tion 1402 of PPACA with respect to all quali-
fied residents in the State in the year (or tax-
able year ending with such year, if applicable). 
(2) FOR STATES THAT DO NOT PROVIDE PPACA 
MEDICAID COVERAGE.— 
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‘‘(d) SPECIAL RULES.—For purposes of this sec-
tion— 
‘‘(1) RECONCILIATION
OF
CREDIT
AND
AD-
VANCE CREDIT.— 
‘‘(A) EXCESS ADVANCE PAYMENTS.—If the 
advance payments to an individual for a taxable 
year under subsection (e) exceed the credit al-
lowed by this section with respect to such indi-
vidual for such taxable year, the tax imposed by 
this chapter for the taxable year shall be in-
creased by the amount of such excess. 
‘‘(B) ADVANCE PAYMENT SHORTFALL.—If 
the credit allowed by this section (determined 
without regard to this subparagraph) with re-
spect to an individual for a taxable year exceeds 
the advance payments to such individual for 
such taxable year under subsection (e), the Sec-
retary shall, in lieu of a credit allowed against 
the tax imposed by this subtitle, make a pay-
ment on behalf of such individual to such indi-
vidual’s health savings account in an amount 
equal to such excess. 
‘‘(2) MARRIED COUPLES MUST FILE JOINT RE-
TURN.—If the taxpayer is married (within the mean-
ing of section 7703) at the close of the taxable year, 
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the credit shall be allowed under this section only if 
the taxpayer and the taxpayer’s spouse file a joint 
return for the taxable year. 
‘‘(e) ADVANCE PAYMENT PROGRAM.— 
‘‘(1) IN
GENERAL.—The Secretary of the 
Treasury, in consultation with the Secretary of 
Health and Human Services, shall establish a pro-
gram— 
‘‘(A) to make advance determinations with 
respect to the eligibility of individuals for the 
credit allowed under this section, and 
‘‘(B) to make advance payments of the 
credit allowed under this section directly to the 
health savings account of any such individual so 
eligible. 
‘‘(2) PROGRAM
REQUIREMENTS.—Such pro-
gram shall be established under rules similar to the 
rules of section 1412 of the Patient Protection and 
Affordable Care Act, except that advance determina-
tions and advance payments shall be made on re-
quest of the individual with respect to whom the de-
termination is to be made and taking into account 
the enrollment process (including any opt-out elec-
tion under such process) established under section 
104(c)(1) of the Patient Freedom Act of 2015.’’. 
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