I 
112TH CONGRESS 
2D SESSION 
H. R. 6389 
To replace automatic spending cuts with targeted reforms, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 13, 2012 
Mr. LAMBORN introduced the following bill; which was referred to the Com-
mittee on the Budget, and in addition to the Committees on Ways and 
Means, Energy and Commerce, Education and the Workforce, the Judici-
ary, House Administration, Natural Resources, Rules, Appropriations, 
Agriculture, 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 replace automatic spending cuts with targeted reforms, 
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 
‘‘Sequestration Prevention Act of 2012’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
TITLE I—FULLY REPEAL THE SEQUESTRATION PROVISION OF 
ROUND 2 OF THE BUDGET CONTROL ACT 
Sec. 101. Repeal. 
TITLE II—REPEAL OF HEALTH CARE LAW 
Sec. 201. Short title. 
Sec. 202. Repeal of the job-killing health care law and health care-related provi-
sions in the Health Care and Education Reconciliation Act of 
2010. 
Sec. 203. Budgetary effects of this Act. 
TITLE III—NUTRITION ASSISTANCE BLOCK GRANT PROGRAM 
Sec. 301. Nutrition assistance block grant program. 
Sec. 302. Funding. 
Sec. 303. Repeals. 
Sec. 304. Baseline. 
TITLE IV—BLOCK GRANT THE MEDICAID PROGRAM 
Sec. 401. Medical assistance block grant program. 
Sec. 402. Funding. 
Sec. 403. Termination of mandatory funding. 
Sec. 404. Miscellaneous. 
Sec. 405. Baseline. 
Sec. 406. Definitions. 
TITLE V—REDUCTION OF FEDERAL WORKFORCE 
Sec. 501. Reduction in the number of Federal employees. 
TITLE VI—PROHIBITION ON CLIMATE CHANGE AND GLOBAL 
WARMING FUNDING 
Sec. 601. No funding for climate change or global warming. 
TITLE VII—PROTECTING ACCESS TO HEALTH CARE 
Sec. 700. Short title. 
Subtitle A—HEALTH Act 
Sec. 701. Short title. 
Sec. 702. Purpose. 
Sec. 703. Encouraging speedy resolution of claims. 
Sec. 704. Compensating patient injury. 
Sec. 705. Maximizing patient recovery. 
Sec. 706. Punitive damages. 
Sec. 707. Authorization of payment of future damages to claimants in health 
care lawsuits. 
Sec. 708. Definitions. 
Sec. 709. Effect on other laws. 
Sec. 710. State flexibility and protection of States’ rights. 
Sec. 711. Applicability; effective date. 
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Subtitle B—Health Care Safety Net Enhancement 
Sec. 721. Short title. 
Sec. 722. Protection for emergency and related services furnished pursuant to 
EMTALA. 
Sec. 723. Constitutional authority. 
Subtitle C—Restoring the Application of Antitrust Laws to Health Sector 
Insurers 
Sec. 731. Short title. 
Sec. 732. Application of the antitrust laws to the business of health insurance. 
Subtitle D—Protections for Good Samaritan Health Professionals 
Sec. 741. Short title. 
Sec. 742. Limitation on liability for volunteer health care professionals. 
TITLE VIII—BUDGET CONTROL ACT SPENDING CAP 
ADJUSTMENTS 
Sec. 801. Budget Control Act spending cap adjustments. 
TITLE I—FULLY REPEAL THE SE-
QUESTRATION PROVISION OF 
ROUND 2 OF THE BUDGET 
CONTROL ACT 
SEC. 101. REPEAL. 
Section 251A of the Balanced Budget and Emer-
gency Deficit Control Act of 1985 is repealed. 
TITLE II—REPEAL OF HEALTH 
CARE LAW 
SEC. 201. SHORT TITLE. 
This title may be cited as the ‘‘Repealing the Job- 
Killing Health Care Law Act’’. 
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SEC. 202. REPEAL OF THE JOB-KILLING HEALTH CARE LAW 
AND HEALTH CARE-RELATED PROVISIONS IN 
THE HEALTH CARE AND EDUCATION REC-
ONCILIATION ACT OF 2010. 
(a) JOB-KILLING HEALTH CARE LAW.—Effective as 
of the enactment of Public Law 111–148, such Act is re-
pealed, and the provisions of law amended or repealed by 
such Act are restored or revived as if such Act had not 
been enacted. 
(b) HEALTH CARE-RELATED PROVISIONS IN THE 
HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 
2010.—Effective as of the enactment of the Health Care 
and Education Reconciliation Act of 2010 (Public Law 
111–152), title I and subtitle B of title II of such Act 
are repealed, and the provisions of law amended or re-
pealed by such title or subtitle, respectively, are restored 
or revived as if such title and subtitle had not been en-
acted. 
SEC. 203. BUDGETARY EFFECTS OF THIS ACT. 
The budgetary effects of this title, for the purpose 
of complying with the Statutory Pay-As-You-Go Act of 
2010, shall be determined by reference to the latest state-
ment titled ‘‘Budgetary Effects of PAYGO Legislation’’ 
for this title, submitted for printing in the Congressional 
Record by the Chairman of the Committee on the Budget 
of the House of Representatives, as long as such statement 
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has been submitted prior to the vote on passage of this 
Act. 
TITLE 
III—NUTRITION 
ASSIST-
ANCE 
BLOCK 
GRANT 
PRO-
GRAM 
SEC. 301. NUTRITION ASSISTANCE BLOCK GRANT PRO-
GRAM. 
(a) IN GENERAL.—For each of fiscal years 2014 
through 2022, the Secretary shall establish a nutrition as-
sistance block grant program under which the Secretary 
shall make annual grants to each participating State that 
establishes a nutrition assistance program in the State 
and submits to the Secretary annual reports under sub-
section (d). 
(b) REQUIREMENTS.—As a requirement of receiving 
grants under this section, the Governor of each partici-
pating State shall certify that the State nutrition assist-
ance program includes— 
(1) work requirements; 
(2) mandatory drug testing; and 
(3) limitations on the eligible uses of benefits 
that are at least as restrictive as the limitations in 
place for the supplemental nutrition assistance pro-
gram established under the Food and Nutrition Act 
of 2008 (7 U.S.C. 2011 et seq.) as of May 31, 2012. 
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(c) AMOUNT OF GRANT.—For each fiscal year, the 
Secretary shall make a grant to each participating State 
in an amount equal to the product of— 
(1) the amount made available under section 
302 for the applicable fiscal year; and 
(2) the proportion that— 
(A) the number of legal residents in the 
State whose income does not exceed 100 per-
cent of the poverty line (as defined in section 
673(2) of the Community Services Block Grant 
Act (42 U.S.C. 9902(2), including any revision 
required by such section)) applicable to a family 
of the size involved; bears to 
(B) the number of such individuals in all 
participating States for the applicable fiscal 
year, based on data for the most recent fiscal 
year for which data is available. 
(d) ANNUAL REPORT REQUIREMENTS.— 
(1) IN GENERAL.—Not later than January 1 of 
each year, each State that receives a grant under 
this section shall submit to the Secretary a report 
that shall include, for the year covered by the re-
port— 
(A) a description of the structure and de-
sign of the nutrition assistance program of the 
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State, including the manner in which residents 
of the State qualify for the program; 
(B) the cost the State incurs to administer 
the program; 
(C) whether the State has established a 
rainy day fund for the nutrition assistance pro-
gram of the State; and 
(D) general statistics about participation 
in the nutrition assistance program. 
(2) AUDIT.—Each year, the Comptroller Gen-
eral of the United States shall— 
(A) conduct an audit on the effectiveness 
of the nutritional assistance block grant pro-
gram and the manner in which each partici-
pating State is implementing the program; and 
(B) not later than June 30, submit to the 
appropriate committees of Congress a report 
describing— 
(i) the results of the audit; and 
(ii) the manner in which the State will 
carry out the supplemental nutrition as-
sistance program in the State, including 
eligibility and fraud prevention require-
ments. 
(e) USE OF FUNDS.— 
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(1) IN
GENERAL.—A State that receives a 
grant under this section may use the grant in any 
manner determined to be appropriate by the State to 
provide nutrition assistance to the legal residents of 
the State. 
(2) AVAILABILITY
OF
FUNDS.—Grant funds 
made available to a State under this section shall— 
(A) remain available to the State for a pe-
riod of 5 years; and 
(B) after that period, shall— 
(i) revert to the Federal Government 
to be deposited in the Treasury and used 
for Federal budget deficit reduction; or 
(ii) if there is no Federal budget def-
icit, be used to reduce the Federal debt in 
such manner as the Secretary of the 
Treasury considers appropriate. 
SEC. 302. FUNDING. 
There is authorized to be appropriated to carry out 
this title— 
(1) for fiscal year 2014, $44,400,000,000; 
(2) for fiscal year 2015, $45,500,000,000; 
(3) for fiscal year 2016, $46,600,000,000; 
(4) for fiscal year 2017, $47,800,000,000; 
(5) for fiscal year 2018, $49,000,000,000; 
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(6) for fiscal year 2019, $50,200,000,000; 
(7) for fiscal year 2020, $51,500,000,000; 
(8) for fiscal year 2021, $52,800,000,000; and 
(9) for fiscal year 2022, $54,100,000,000. 
SEC. 303. REPEALS. 
(a) IN GENERAL.—Effective September 30, 2013, the 
Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) 
is repealed. 
(b) REPEAL OF MANDATORY FUNDING.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, effective September 30, 2013, the 
supplemental nutrition assistance program estab-
lished under the Food and Nutrition Act of 2008 (7 
U.S.C. 2011 et seq.) (as in effect prior to that date) 
shall cease to be a program funded through direct 
spending (as defined in section 250(c) of the Bal-
anced Budget and Emergency Deficit Control Act of 
1985 (2 U.S.C. 900(c)) prior to the amendment 
made by paragraph (2)). 
(2) DIRECT
SPENDING.—Effective September 
30, 2013, section 250(c)(8) of the Balanced Budget 
and Emergency Deficit Control Act of 1985 (2 
U.S.C. 900(c)(8)) is amended— 
(A) in subparagraph (A), by adding ‘‘and’’ 
at the end; 
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(B) in subparagraph (B), by striking ‘‘; 
and’’ at the end and inserting a period; and 
(C) by striking subparagraph (C). 
(3) ENTITLEMENT AUTHORITY.—Effective Sep-
tember 30, 2013, section 3(9) of the Congressional 
Budget and Impoundment Control Act of 1974 (2 
U.S.C. 622(9)) is amended— 
(A) by striking ‘‘means—’’ and all that fol-
lows through ‘‘the authority to make’’ and in-
serting ‘‘means the authority to make’’; 
(B) by striking ‘‘; and’’ and inserting a pe-
riod; and 
(C) by striking subparagraph (B). 
(4) OTHER DIRECT SPENDING.—Effective Sep-
tember 30, 2013, section 1026(5) of the Congres-
sional Budget and Impoundment Control Act of 
1974 (2 U.S.C. 691e(5)) is amended— 
(A) in subparagraph (A), by adding ‘‘and’’ 
at the end; 
(B) in subparagraph (B), by striking ‘‘; 
and’’ at the end and inserting a period; and 
(C) by striking subparagraph (C). 
(c) RELATIONSHIP TO OTHER LAW.—Any reference 
in this title, an amendment made by this title, or any other 
law to the supplemental nutrition assistance program shall 
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be considered to be a reference to the nutrition assistance 
block grant program under this title. 
SEC. 304. BASELINE. 
Notwithstanding section 257 of the Balanced Budget 
and Emergency Deficit Control Act of 1985 (2 U.S.C. 
907), the baseline shall assume that, on and after Sep-
tember 30, 2013, no benefits shall be provided under the 
supplemental nutrition assistance program established 
under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 
et seq.) (as in effect prior to that date). 
TITLE IV—BLOCK GRANT THE 
MEDICAID PROGRAM 
SEC. 401. MEDICAL ASSISTANCE BLOCK GRANT PROGRAM. 
(a) IN GENERAL.—For each of fiscal years 2014 
through 2022, the Secretary shall establish a Medicaid 
block grant program under which the Secretary shall make 
annual grants to each participating State that establishes 
a medical assistance program for individuals in the State 
and submits to the Secretary annual reports under sub-
section (d). 
(b) AMOUNT OF GRANT.—For each fiscal year, the 
Secretary shall make a grant to each participating State 
in an amount equal to the product of— 
(1) the amount made available under section 
402 for the applicable fiscal year; and 
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(2) the proportion that— 
(A) the number of legal residents in the 
State whose income does not exceed 185 per-
cent of the poverty line (as defined in section 
673(2) of the Community Services Block Grant 
Act (42 U.S.C. 9902(2), including any revision 
required by such section)) applicable to a family 
of the size involved; bears to 
(B) the number of such individuals in all 
participating States for the applicable fiscal 
year, based on data for the most recent fiscal 
year for which data is available. 
(c) USE OF FUNDS.— 
(1) IN
GENERAL.—A State that receives a 
grant under this section may use the grant in any 
manner determined to be appropriate by the State to 
provide medical assistance to legal residents of the 
State. 
(2) AVAILABILITY
OF
FUNDS.—Grant funds 
made available to a State under this section shall— 
(A) remain available to the State for a pe-
riod of 5 years; and 
(B) after that period, shall— 
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(i) revert to the Federal Government 
to be deposited in the Treasury and used 
for Federal budget deficit reduction; or 
(ii) if there is no Federal budget def-
icit, be used to reduce the Federal debt in 
such manner as the Secretary of the 
Treasury considers appropriate. 
(d) ANNUAL REPORT REQUIREMENTS.— 
(1) IN GENERAL.—Not later than January 1 of 
each year, each State that receives a grant under 
this section shall submit to the Secretary a report 
that shall include, for the year covered by the re-
port— 
(A) a description of the structure and de-
sign of the Medicaid program of the State, in-
cluding the manner in which residents of the 
State qualify for the program; 
(B) the cost the State incurs to administer 
the program; 
(C) whether the State has established a 
rainy day fund for the Medicaid program of the 
State; and 
(D) general statistics about participation 
in Medicaid program. 
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(2) AUDIT.—Each year, the Comptroller Gen-
eral of the United States shall— 
(A) conduct an audit on the effectiveness 
of the Medicaid block grant program and the 
manner in which each participating State is im-
plementing the program; and 
(B) not later than June 30, submit to the 
appropriate committees of Congress a report 
describing— 
(i) the results of the audit; and 
(ii) the manner in which the State will 
carry out the Medicaid program in the 
State, including eligibility and fraud pre-
vention requirements. 
SEC. 402. FUNDING. 
There is authorized to be appropriated to carry out 
this title— 
(1) for fiscal year 2014, $304,000,000,000; 
(2) for fiscal year 2015, $311,000,000,000; 
(3) for fiscal year 2016, $317,000,000,000; 
(4) for fiscal year 2017, $334,000,000,000; 
(5) for fiscal year 2018, $345,000,000,000; 
(6) for fiscal year 2019, $355,000,000,000; 
(7) for fiscal year 2020, $370,000,000,000; 
(8) for fiscal year 2021, $382,000,000,000; and 
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(9) for fiscal year 2022, $402,000,000,000. 
SEC. 403. TERMINATION OF MANDATORY FUNDING. 
(a) IN GENERAL.—Effective October 1, 2013, title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
and subsections (f) and (g) of section 1108 of the Social 
Security Act (42 U.S.C. 1308) are repealed. 
(b) ELIMINATION OF MANDATORY FUNDING.—Not-
withstanding any other provision of law, effective October 
1, 2013, the Medicaid program established under title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
shall cease to be a program funded through direct spend-
ing (as defined in section 250(c) of the Balanced Budget 
and Emergency Deficit Control Act of 1985 (2 U.S.C. 
900(c)). 
SEC. 404. MISCELLANEOUS. 
(a) RELATIONSHIP TO OTHER LAW.—Any reference 
in this Act, an amendment made by this Act, or any other 
Act to the Medicaid program or to title XIX of the Social 
Security Act shall be considered to be a reference to the 
Medicaid block grant program established under this title. 
(b) NONENTITLEMENT.—Nothing in this title shall 
be construed as providing— 
(1) an individual with an entitlement to medical 
assistance provided under a grant made under this 
title; or 
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(2) as an obligation of the Federal Government 
to provide payments to States to carry out this title 
other than to the extent funds are made available 
for that purpose through an appropriations Act. 
(c) WAIVERS.— 
(1) IN GENERAL.—In the case of a State con-
ducting an experimental, pilot, or demonstration 
project under section 1115 of the Social Security 
Act (42 U.S.C. 1315) or other authority relating to 
the Medicaid program under title XIX of the Social 
Security Act that is in effect on the date of enact-
ment of this Act, the waiver shall terminate on Sep-
tember 30, 2013, unless the State submits a request, 
not later than July 1, 2013, to the Secretary to con-
tinue the project. The Secretary may approve the re-
quest of a State to continue with such a project only 
if the total amount of Federal funds paid to the 
State to conduct the project will not exceed the 
amount of Federal funds that would be paid to the 
State under this title if the project were not contin-
ued. 
(2) NO
WAIVER
AUTHORITY.—The Secretary 
may not waive any provision of this title under sec-
tion 1115 of the Social Security Act (42 U.S.C. 
1315). 
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(d) HOLD HARMLESS PROVISIONS.— 
(1) CHIP.—The State children’s health insur-
ance program established under title XXI of the So-
cial Security Act (42 U.S.C. 1397aa et seq.) shall 
continue to be operated in accordance with the pro-
visions of that title. 
(2) CHILD SUPPORT AND FOSTER CARE PAY-
MENTS.—The Federal medical assistance percent-
age, as defined in section 1905(b) of the Social Se-
curity Act (42 U.S.C. 1396d(b)), (as in effect on 
September 30, 2013) shall continue to apply to pay-
ments to States under parts D and E of title IV of 
the Social Security Act (42 U.S.C. 651 et seq.; 670 
et seq.). Notwithstanding the repeal of title XIX of 
the Social Security Act under section 403(a), the 
Secretary shall annually determine and promulgate 
the Federal medical assistance percentage for each 
State in accordance with the provisions of section 
1101(a)(8)(B) of the Social Security Act (42 U.S.C. 
1301(a)(8)(B)). 
(3) VACCINES FOR CHILDREN PROGRAM.—The 
program for the distribution of pediatric vaccines es-
tablished under section 1928 of the Social Security 
Act (42 U.S.C. 1396s) shall continue to be operated 
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in accordance with the provisions of that section (as 
in effect on September 30, 2013). 
(e) TECHNICAL ASSISTANCE.—The Secretary shall 
provide technical assistance and guidance to States to co-
ordinate the transition to the Medicaid block grant pro-
gram established under this title. 
SEC. 405. BASELINE. 
Notwithstanding section 257 of the Balanced Budget 
and Emergency Deficit Control Act of 1985 (2 U.S.C. 
907), the baseline shall assume that after September 30, 
2013, no payments shall be provided under section 1903 
of title XIX of the Social Security Act (42 U.S.C. 1396b). 
SEC. 406. DEFINITIONS. 
In this title: 
(1) MEDICAL ASSISTANCE.—The term ‘‘medical 
assistance’’ means payment for part or all of the 
cost of providing, or arranging for the provision of 
(including through the purchase of health insurance 
coverage), health benefits. 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(3) STATE.—The term ‘‘State’’ means each of 
the 50 States, the District of Columbia, Puerto Rico, 
the United States Virgin Islands, Guam, the North-
ern Mariana Islands, and American Samoa. 
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‘‘(E)(i) Nothing in this paragraph (or in any 
other provision of this section as such provision ap-
plies to entities described in subparagraph (B) by 
operation of subparagraph (A)) shall be construed as 
authorizing or requiring the Secretary to make pay-
ments to such entities, the budget authority for 
which is not provided in advance by appropriation 
Acts. 
‘‘(ii) The Secretary shall limit the total amount 
of payments under this paragraph for a fiscal year 
to the total amount appropriated in advance by ap-
propriation Acts for such purpose for such fiscal 
year. If the total amount of payments that would 
otherwise be made under this paragraph for a fiscal 
year exceeds such total amount appropriated, the 
Secretary shall take such steps as may be necessary 
to ensure that the total amount of payments under 
this paragraph for such fiscal year does not exceed 
such total amount appropriated.’’. 
SEC. 723. CONSTITUTIONAL AUTHORITY. 
The constitutional authority upon which this subtitle 
rests is the power of the Congress to provide for the gen-
eral welfare, to regulate commerce, and to make all laws 
which shall be necessary and proper for carrying into exe-
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