143 
(6) Training and education for the public 
health professions. 
(7) Research on effective and cost-effective pub-
lic health practices. This function includes the devel-
opment, testing, evaluation, and publication of re-
sults of new prevention and public health control 
interventions. 
(8) Integration and coordination of the preven-
tion programs and services of community-based pro-
viders, local and State health departments, and 
other sectors of State and local government that af-
fect health. 
SEC. 712. SET-ASIDE FOR PRIMARY HEALTH CARE DELIV-
ERY. 
(a) TRANSFERS TO SECTION 330 PROGRAM OF THE 
PUBLIC HEALTH SERVICE ACT.— 
(1) IN GENERAL.—The Board shall make trans-
fers from the American Health Security Trust Fund 
to the Public Health Service for the program author-
ized under section 330 of the Public Health Service 
Act (42 U.S.C. 254b). 
(2) FISCAL
YEAR
2020
AND
SUBSEQUENT 
YEARS.—The amount transferred for fiscal year 
2020 and each subsequent fiscal year shall be equal 
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to the amount transferred for the preceding fiscal 
year adjusted by the product of— 
(A) one plus the average percentage in-
crease in costs incurred per patient served by 
entities receiving funding under such section; 
and 
(B) one plus the average percentage in-
crease in the total number of patients served by 
entities receiving funding under such section. 
(b) TRANSFERS
TO PUBLIC HEALTH SERVICE.— 
From the amounts provided under subsection (d), the 
Board shall make transfers from the American Health Se-
curity Trust Fund to the Public Health Service for the 
program of primary care service expansion grants under 
subpart V of part D of title III of the Public Health Serv-
ice Act (as added by section 713 of this Act). 
(c) RANGE OF FUNDS.—The amount of transfers 
under subsection (b) for any fiscal year shall be an amount 
(specified by the Board each year) not less than 6⁄100 per-
cent and not to exceed 1⁄10 percent of the amounts the 
Board estimates will be expended from the Trust Fund 
in the fiscal year. 
(d) FUNDS SUPPLEMENTAL TO OTHER FUNDS.— 
The funds provided under this section with respect to pro-
vision of services are in addition to, and not in replace-
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145 
ment of, funds made available under the sections 340A, 
1001, and 2655 of the Public Health Service Act. The 
Board shall make no transfer of funds under this section 
for any fiscal year for which the total appropriations for 
such sections are less than the total amount appropriated 
under such sections in fiscal year 2014. 
SEC. 713. PRIMARY CARE SERVICE EXPANSION GRANTS. 
(a) IN GENERAL.—Part D of title III of the Public 
Health Service Act (42 U.S.C. 254b et seq.) is amended 
by adding at the end the following new subpart: 
‘‘Subpart XIII—Primary Care Expansion 
‘‘SEC. 340J. EXPANDING PRIMARY CARE DELIVERY CAPAC-
ITY IN URBAN AND RURAL AREAS. 
‘‘(a) GRANTS FOR PRIMARY CARE CENTERS.—From 
the amounts described in subsection (c), the American 
Health Security Standards Board shall make grants to 
public and nonprofit private entities for projects to plan 
and develop primary care centers which will serve medi-
cally underserved populations (as defined in section 
330(b)(3)) in urban and rural areas and to deliver primary 
care services to such populations in such areas. The funds 
provided under such a grant may be used for the same 
purposes for which a grant may be made under subsection 
(c), (e), (f), (g), (h), or (i) of section 330. 
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‘‘(b) PROCESS OF AWARDING GRANTS.—The provi-
sions of subsection (k)(1) of section 330 shall apply to 
a grant under this section in the same manner as they 
apply to a grant under the corresponding subsection of 
such section. The provisions of subsection (r)(2)(A) of 
such section shall apply to grants for projects to plan and 
develop primary care centers under this section in the 
same manner as they apply to grants under such section. 
‘‘(c) FUNDING AS SET-ASIDE FROM TRUST FUND.— 
Funds in the American Health Security Trust Fund (es-
tablished under section 801 of the Act) shall be available 
to carry out this section. 
‘‘(d) PRIMARY CARE CENTER DEFINED.—In this sec-
tion, the term ‘primary care center’ means— 
‘‘(1) a health center (as defined in section 
330(a)(1)); 
‘‘(2) an entity qualified to receive a grant under 
section 330, 1001, or 2651; or 
‘‘(3) a Federally-qualified health center (as de-
fined in section 1905(l)(2)(B) of the Social Security 
Act).’’. 
(b) TECHNICAL AMENDMENTS.—Part D of title III 
of the Public Health Service Act (42 U.S.C. 254b et seq.) 
is amended— 
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(1) by redesignating subpart XI, as added by 
section 10333 of the Patient Protection and Afford-
able Care Act (Public Law 111–148), as subpart 
XII; and 
(2) by redesignating section 340H of the Public 
Health Service Act (42 U.S.C. 256i), as added by 
section 10333 of the Patient Protection and Afford-
able Care Act (Public Law 111–148), as section 
340I. 
Subtitle C—Primary Care and 
Outcomes Research 
SEC. 721. SET-ASIDE FOR OUTCOMES RESEARCH. 
(a) GRANTS
FOR
OUTCOMES
RESEARCH.—The 
Board shall make transfers from the American Health Se-
curity Trust Fund to the Agency for Healthcare Research 
and Quality under title IX of the Public Health Service 
Act (42 U.S.C. 299 et seq.) for the purpose of carrying 
out activities under such title. The Secretary shall assure 
that there is a special emphasis placed on pediatric out-
comes research. 
(b) RANGE OF FUNDS.—The amount of transfers 
under subsection (a) for any fiscal year shall be an amount 
(specified by the Board each year) not less than 1⁄100 per-
cent and not to exceed 2⁄100 percent of the amounts the 
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Board estimates will be expended from the Trust Fund 
in the fiscal year. 
(c) FUNDS SUPPLEMENTAL TO OTHER FUNDS.—The 
funds provided under this section with respect to provision 
of services are in addition to, and not in replacement of, 
funds made available to the Agency for Healthcare Re-
search and Quality under section 947 of the Public Health 
Service Act (42 U.S.C. 299c–6). The Board shall make 
no transfer of funds under this section for any fiscal year 
for which the total appropriations under such section are 
less than the total amount appropriated under such sec-
tion and title in fiscal year 2014. 
(d) CONFORMING AMENDMENT.—Section 947(b) of 
the Public Health Service Act (42 U.S.C. 299c–6(b)) is 
amended by inserting after ‘‘of the fiscal years 2001 
through 2005’’ the following: ‘‘and of fiscal year 2016 and 
each subsequent year’’. 
SEC. 722. OFFICE OF PRIMARY CARE AND PREVENTION RE-
SEARCH. 
(a) IN GENERAL.—Title IV of the Public Health 
Service Act is amended— 
(1) by redesignating parts G through I as parts 
H through J, respectively; and 
(2) by inserting after part F (42 U.S.C. 287d 
et seq.) the following new part: 
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149 
‘‘PART G—RESEARCH ON PRIMARY CARE AND 
PREVENTION 
‘‘SEC. 486E. OFFICE OF PRIMARY CARE AND PREVENTION 
RESEARCH. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Office of the Director of NIH an office to be known 
as the Office of Primary Care and Prevention Research 
(in this part referred to as the ‘Office’). The Office shall 
be headed by a director, who shall be appointed by the 
Director of NIH. 
‘‘(b) PURPOSE.—The Director of the Office shall— 
‘‘(1) identify projects of research on primary 
care and prevention, for children as well as adults, 
that should be conducted or supported by the na-
tional research institutes, with particular emphasis 
on— 
‘‘(A) clinical patient care, with special em-
phasis on pediatric clinical care and diagnosis; 
‘‘(B) diagnostic effectiveness; 
‘‘(C) primary care education; 
‘‘(D) health and family planning services; 
‘‘(E) medical effectiveness outcomes of pri-
mary care procedures and interventions; and 
‘‘(F) the use of multidisciplinary teams of 
health care practitioners; 
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‘‘(2) identify multidisciplinary research related 
to primary care and prevention that should be so 
conducted; 
‘‘(3) promote coordination and collaboration 
among entities conducting research identified under 
any of paragraphs (1) and (2); 
‘‘(4) encourage the conduct of such research by 
entities receiving funds from the national research 
institutes; 
‘‘(5) recommend an agenda for conducting and 
supporting such research; 
‘‘(6) promote the sufficient allocation of the re-
sources of the national research institutes for con-
ducting and supporting such research; and 
‘‘(7) prepare the report required under section 
486G. 
‘‘(c) PRIMARY CARE AND PREVENTION RESEARCH 
DEFINED.—For purposes of this part, the term ‘primary 
care and prevention research’ means research on improve-
ment of the practice of family medicine, general geriatrics, 
general internal medicine, and general pediatrics, and in-
cludes research relating to— 
‘‘(1) obstetrics and gynecology, dentistry, or 
mental health or substance abuse treatment when 
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151 
provided by a primary care physician or other pri-
mary care practitioner; and 
‘‘(2) primary care provided by multidisciplinary 
teams. 
‘‘SEC. 486F. NATIONAL DATA SYSTEM AND CLEARINGHOUSE 
ON PRIMARY CARE AND PREVENTION RE-
SEARCH. 
‘‘(a) DATA SYSTEM.—The Director of NIH, in con-
sultation with the Director of the Office, shall establish 
a data system for the collection, storage, analysis, re-
trieval, and dissemination of information regarding pri-
mary care and prevention research that is conducted or 
supported by the national research institutes. Information 
from the data system shall be available through informa-
tion systems available to health care professionals and pro-
viders, researchers, and members of the public. 
‘‘(b) CLEARINGHOUSE.—The Director of NIH, in 
consultation with the Director of the Office and with the 
National Library of Medicine, shall establish, maintain, 
and operate a program to provide, and encourage the use 
of, information on research and prevention activities of the 
national research institutes that relate to primary care 
and prevention research. 
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152 
‘‘SEC. 486G. BIENNIAL REPORT. 
‘‘(a) IN GENERAL.—With respect to primary care 
and prevention research, the Director of the Office shall, 
not later than 1 year after the date of the enactment of 
this part, and biennially thereafter, prepare a report— 
‘‘(1) describing and evaluating the progress 
made during the preceding 2 fiscal years in research 
and treatment conducted or supported by the Na-
tional Institutes of Health; 
‘‘(2) summarizing and analyzing expenditures 
made by the agencies of such Institutes (and by 
such Office) during the preceding 2 fiscal years; and 
‘‘(3) making such recommendations for legisla-
tive and administrative initiatives as the Director of 
the Office determines to be appropriate. 
‘‘(b) INCLUSION IN BIENNIAL REPORT OF DIRECTOR 
OF NIH.—The Director of the Office shall submit each 
report prepared under subsection (a) to the Director of 
NIH for inclusion in the report submitted to the President 
and the Congress under section 403. 
‘‘SEC. 486H. AUTHORIZATION OF APPROPRIATIONS. 
‘‘For the Office of Primary Care and Prevention Re-
search, 
there 
are 
authorized 
to 
be 
appropriated 
$150,000,000 for fiscal year 2016, $180,000,000 for fis-
cal year 2017, and $216,000,000 for fiscal year 2018.’’. 
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(b) REQUIREMENT OF SUFFICIENT ALLOCATION OF 
RESOURCES OF INSTITUTES.—Section 402(b) of the Pub-
lic Health Service Act (42 U.S.C. 282(b)) is amended— 
(1) in paragraph (23), by striking ‘‘and’’ after 
the semicolon at the end; 
(2) in paragraph (24), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (24) the fol-
lowing new paragraph: 
‘‘(25) after consultation with the Director of 
the Office of Primary Care and Prevention Re-
search, shall ensure that resources of the National 
Institutes of Health are sufficiently allocated for 
projects on primary care and prevention research 
that are identified under section 486E(b).’’. 
Subtitle D—School-Related Health 
Services 
SEC. 731. AUTHORIZATIONS OF APPROPRIATIONS. 
(a) FUNDING FOR SCHOOL-RELATED HEALTH SERV-
ICES.—For the purpose of carrying out this subtitle, there 
are authorized to be appropriated $100,000,000 for fiscal 
year 
2018, 
$275,000,000 
for 
fiscal 
year 
2019, 
$350,000,000 for fiscal year 2020, and $400,000,000 for 
each of the fiscal years 2021 and 2022. 
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(b) RELATION TO OTHER FUNDS.—The authoriza-
tions of appropriations established in subsection (a) are 
in addition to any other authorizations of appropriations 
that are available for the purpose described in such sub-
section. 
SEC. 732. ELIGIBILITY FOR DEVELOPMENT AND OPER-
ATION GRANTS. 
(a) IN GENERAL.—Entities eligible to apply for and 
receive grants under section 734 or 735 are the following: 
(1) State health agencies that apply on behalf 
of local community partnerships and other commu-
nities in need of health services for school-aged chil-
dren within the State. 
(2) Local community partnerships in States in 
which health agencies have not applied. 
(b) LOCAL COMMUNITY PARTNERSHIPS.— 
(1) IN GENERAL.—A local community partner-
ship under subsection (a)(2) is an entity that, at a 
minimum, includes— 
(A) a local health care provider with expe-
rience in delivering services to school-aged chil-
dren; 
(B) one or more local public schools; and 
(C) at least one community-based organi-
zation located in the community to be served 
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that has a history of providing services to 
school-aged children in the community who are 
at risk. 
(2) PARTICIPATION.—A partnership described 
in paragraph (1) shall, to the maximum extent fea-
sible, involve broad based community participation 
from parents and adolescent children to be served, 
health and social service providers, teachers and 
other public school and school board personnel, de-
velopment and service organizations for adolescent 
children, and interested business leaders. Such par-
ticipation may be evidenced through an expanded 
partnership, or an advisory board to such partner-
ship. 
(c) DEFINITIONS REGARDING CHILDREN.—For pur-
poses of this subtitle: 
(1) The term ‘‘adolescent children’’ means 
school-aged children who are adolescents. 
(2) The term ‘‘school-aged children’’ means in-
dividuals who are between the ages of 4 and 19 (in-
clusive). 
SEC. 733. PREFERENCES. 
(a) IN GENERAL.—In making grants under sections 
734 and 735, the Secretary shall give preference to appli-
cants whose communities to be served show the most sub-
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stantial level of need for such services among school-aged 
children, as measured by indicators of community health 
including the following: 
(1) High levels of poverty. 
(2) The presence of a medically underserved 
population. 
(3) The presence of a health professional short-
age area. 
(4) High rates of indicators of health risk 
among school-aged children, including a high propor-
tion of such children receiving services through the 
Individuals with Disabilities Education Act, adoles-
cent pregnancy, sexually transmitted disease (includ-
ing infection with the human immunodeficiency 
virus), preventable disease, communicable disease, 
intentional and unintentional injuries, community 
and gang violence, unemployment among adolescent 
children, juvenile justice involvement, and high rates 
of drug and alcohol exposure. 
(b) LINKAGE TO COMMUNITY HEALTH CENTERS.— 
In making grants under sections 734 and 735, the Sec-
retary shall give preference to applicants that demonstrate 
a linkage to community health centers. 
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157 
SEC. 734. GRANTS FOR DEVELOPMENT OF PROJECTS. 
(a) IN GENERAL.—The Secretary may make grants 
to State health agencies or to local community partner-
ships to develop school health service sites. 
(b) USE OF FUNDS.—A project for which a grant 
may be made under subsection (a) may include the cost 
of the following: 
(1) Planning for the provision of school health 
services. 
(2) Recruitment, compensation, and training of 
health and administrative staff. 
(3) The development of agreements, and the ac-
quisition and development of equipment and infor-
mation services, necessary to support information 
exchange between school health service sites and 
health plans, health providers, and other entities au-
thorized to collect information under this Act. 
(4) Other activities necessary to assume oper-
ational status. 
(c) APPLICATION FOR GRANT.— 
(1) IN GENERAL.—Applicants shall submit ap-
plications in a form and manner prescribed by the 
Secretary. 
(2) APPLICATIONS BY STATE HEALTH AGEN-
CIES.— 
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(A) In the case of applicants that are State 
health agencies, the application shall contain 
assurances that the State health agency is ap-
plying for funds— 
(i) on behalf of at least one local com-
munity partnership; and 
(ii) on behalf of at least one other 
community identified by the State as in 
need of the services funded under this sub-
title but without a local community part-
nership. 
(B) In the case of the communities identi-
fied in applications submitted by State health 
agencies that do not yet have local community 
partnerships (including the community identi-
fied under subparagraph (A)(ii)), the State 
shall describe the steps that will be taken to aid 
the communities in developing a local commu-
nity partnership. 
(C) A State applying on behalf of local 
community partnerships and other communities 
may retain not more than 10 percent of grants 
awarded under this subtitle for administrative 
costs. 
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(d) CONTENTS OF APPLICATION.—In order to receive 
a grant under this section, an applicant shall include in 
the application the following information: 
(1) An assessment of the need for school health 
services in the communities to be served, using the 
latest available health data and health goals and ob-
jectives established by the Secretary. 
(2) A description of how the applicant will de-
sign the proposed school health services to reach the 
maximum number of school-aged children who are at 
risk. 
(3) An explanation of how the applicant will in-
tegrate its services with those of other health and 
social service programs within the community. 
(4) A description of a quality assurance pro-
gram which complies with standards that the Sec-
retary may prescribe. 
(e) NUMBER OF GRANTS.—Not more than one plan-
ning grant may be made to a single applicant. A planning 
grant may not exceed 2 years in duration. 
SEC. 735. GRANTS FOR OPERATION OF PROJECTS. 
(a) IN GENERAL.—The Secretary may make grants 
to State health agencies or to local community partner-
ships for the cost of operating school health service sites. 
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(b) USE OF GRANT.—The costs for which a grant 
may be made under this section include the following: 
(1) The cost of furnishing health services that 
are not otherwise covered under this Act or by any 
other public or private insurer. 
(2) The cost of furnishing services whose pur-
pose is to increase the capacity of individuals to uti-
lize available health services, including transpor-
tation, community and patient outreach, patient 
education, translation services, and such other serv-
ices as the Secretary determines to be appropriate in 
carrying out such purpose. 
(3) Training, recruitment and compensation of 
health professionals and other staff. 
(4) Outreach services to school-aged children 
who are at risk and to the parents of such children. 
(5) Linkage of individuals to health plans, com-
munity health services and social services. 
(6) Other activities deemed necessary by the 
Secretary. 
(c) APPLICATION FOR GRANT.—Applicants shall sub-
mit applications in a form and manner prescribed by the 
Secretary. In order to receive a grant under this section, 
an applicant shall include in the application the following 
information: 
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(1) A description of the services to be furnished 
by the applicant. 
(2) The amounts and sources of funding that 
the applicant will expend, including estimates of the 
amount of payments the applicant will receive from 
sources other than the grant. 
(3) Such other information as the Secretary de-
termines to be appropriate. 
(d) ADDITIONAL CONTENTS OF APPLICATION.—In 
order to receive a grant under this section, an applicant 
shall meet the following conditions: 
(1) The applicant furnishes the following serv-
ices: 
(A) Diagnosis and treatment of simple ill-
nesses and minor injuries. 
(B) Preventive health services, including 
health screenings. 
(C) Services provided for the purpose de-
scribed in subsection (b)(2). 
(D) Referrals and followups in situations 
involving illness or injury. 
(E) Health and social services, counseling 
services, and necessary referrals, including re-
ferrals regarding mental health and substance 
abuse. 
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(F) Such other services as the Secretary 
determines to be appropriate. 
(2) The applicant is a participating provider in 
the State’s program for medical assistance under 
title XIX of the Social Security Act. 
(3) The applicant does not impose charges on 
students or their families for services (including col-
lection of any cost-sharing for services under the 
comprehensive benefit package that otherwise would 
be required). 
(4) The applicant has reviewed and will periodi-
cally review the needs of the population served by 
the applicant in order to ensure that its services are 
accessible to the maximum number of school-aged 
children in the area, and that, to the maximum ex-
tent possible, barriers to access to services of the ap-
plicant are removed (including barriers resulting 
from the area’s physical characteristics, its eco-
nomic, social and cultural grouping, the health care 
utilization patterns of such children, and available 
transportation). 
(5) In the case of an applicant which serves a 
population that includes a substantial proportion of 
individuals of limited English speaking ability, the 
applicant has developed a plan to meet the needs of 
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163 
such population to the extent practicable in the lan-
guage and cultural context most appropriate to such 
individuals. 
(6) The applicant will provide non-Federal con-
tributions toward the cost of the project in an 
amount determined by the Secretary. 
(7) The applicant will operate a quality assur-
ance program consistent with section 734(d). 
(e) DURATION OF GRANT.—A grant under this sec-
tion shall be for a period determined by the Secretary. 
(f) REPORTS.—A recipient of funding under this sec-
tion shall provide such reports and information as are re-
quired in regulations of the Secretary. 
SEC. 736. FEDERAL ADMINISTRATIVE COSTS. 
Of the amounts made available under section 731, the 
Secretary may reserve not more than 5 percent for admin-
istrative expenses regarding this subtitle. 
SEC. 737. DEFINITIONS. 
For purposes of this subtitle: 
(1) The term ‘‘adolescent children’’ has the 
meaning given such term in section 732(c). 
(2) The term ‘‘at risk’’ means at-risk with re-
spect to health. 
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(3) The term ‘‘community health center’’ has 
the meaning given such term in section 330 of the 
Public Health Service Act. 
(4) The term ‘‘health professional shortage 
area’’ means a health professional shortage area des-
ignated under section 332 of the Public Health Serv-
ice Act. 
(5) The term ‘‘medically underserved popu-
lation’’ has the meaning given such term in section 
330 of the Public Health Service Act. 
(6) The term ‘‘school-aged children’’ has the 
meaning given such term in section 732(c). 
TITLE VIII—FINANCING PROVI-
SIONS; 
AMERICAN 
HEALTH 
SECURITY TRUST FUND 
SEC. 800. AMENDMENT OF 1986 CODE; SECTION 15 NOT TO 
APPLY. 
(a) AMENDMENT OF 1986 CODE.—Except as other-
wise expressly provided, whenever in this title an amend-
ment or repeal is expressed in terms of an amendment 
to, or repeal of, a section or other provision, the reference 
shall be considered to be made to a section or other provi-
sion of the Internal Revenue Code of 1986. 
(b) SECTION 15 NOT TO APPLY.—The amendments 
made by subtitle B shall not be treated as a change in 
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165 
a rate of tax for purposes of section 15 of the Internal 
Revenue Code of 1986. 
Subtitle A—American Health 
Security Trust Fund 
SEC. 801. AMERICAN HEALTH SECURITY TRUST FUND. 
(a) IN GENERAL.—There is hereby created on the 
books of the Treasury of the United States a trust fund 
to be known as the American Health Security Trust Fund 
(in this section referred to as the ‘‘Trust Fund’’). The 
Trust Fund shall consist of such gifts and bequests as 
may be made and such amounts as may be deposited in, 
or appropriated to, such Trust Fund as provided in this 
Act. 
(b) APPROPRIATIONS INTO TRUST FUND.— 
(1) TAXES.—There are hereby appropriated to 
the Trust Fund for each fiscal year (beginning with 
fiscal year 2017), out of any moneys in the Treasury 
not otherwise appropriated, amounts equivalent to 
100 percent of the aggregate increase in tax liabil-
ities under the Internal Revenue Code of 1986 which 
is attributable to the application of the amendments 
made by this title. The amounts appropriated by the 
preceding sentence shall be transferred from time to 
time (but not less frequently than monthly) from the 
general fund in the Treasury to the Trust Fund, 
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166 
such amounts to be determined on the basis of esti-
mates by the Secretary of the Treasury of the taxes 
paid to or deposited into the Treasury; and proper 
adjustments shall be made in amounts subsequently 
transferred to the extent prior estimates were in ex-
cess of or were less than the amounts that should 
have been so transferred. 
(2) CURRENT
PROGRAM
RECEIPTS.—Notwith-
standing any other provision of law, there are hereby 
appropriated to the Trust Fund for each fiscal year 
(beginning with fiscal year 2017) the amounts that 
would otherwise have been available to carry out the 
following programs: 
(A) The Medicare program, under parts A, 
B, and D of title XVIII of the Social Security 
Act (other than amounts attributable to any 
premiums under such parts). 
(B) The Medicaid program, under State 
plans approved under title XIX of such Act. 
(C) The Federal Employees Health Bene-
fits program, under chapter 89 of title 5, 
United States Code. 
(D) The TRICARE program (formerly 
known as the CHAMPUS program), under 
chapter 55 of title 10, United States Code. 
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167 
(E) The maternal and child health pro-
gram (under title V of the Social Security Act), 
vocational rehabilitation programs, programs 
for drug abuse and mental health services 
under the Public Health Service Act, programs 
providing general hospital or medical assistance, 
and any other Federal program identified by 
the Board, in consultation with the Secretary of 
the Treasury, to the extent the programs pro-
vide for payment for health services the pay-
ment of which may be made under this Act. 
(c) INCORPORATION OF PROVISIONS.—The provisions 
of subsections (b) through (i) of section 1817 of the Social 
Security Act shall apply to the Trust Fund under this Act 
in the same manner as they applied to the Federal Hos-
pital Insurance Trust Fund under part A of title XVIII 
of such Act, except that the American Health Security 
Standards Board shall constitute the Board of Trustees 
of the Trust Fund. 
(d) TRANSFER OF FUNDS.—Any amounts remaining 
in the Federal Hospital Insurance Trust Fund or the Fed-
eral Supplementary Medical Insurance Trust Fund after 
the settlement of claims for payments under title XVIII 
have been completed, shall be transferred into the Amer-
ican Health Security Trust Fund. 
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168 
Subtitle B—Taxes Based on Income 
and Wages 
SEC. 811. PAYROLL TAX ON EMPLOYERS. 
(a) IN GENERAL.—Section 3111 (relating to tax on 
employers) is amended by redesignating subsections (c) 
and (d) as subsections (d) and (e), respectively, and by 
inserting after subsection (b) the following new subsection: 
‘‘(c) HEALTH CARE.—In addition to other taxes, 
there is hereby imposed on every employer an excise tax, 
with respect to having individuals in his employ, equal to 
6.7 percent of the wages (as defined in section 3121(a)) 
paid by him with respect to employment (as defined in 
section 3121(b)).’’. 
(b) SELF-EMPLOYMENT INCOME.—Section 1401 (re-
lating to rate of tax on self-employment income) is amend-
ed by redesignating subsection (c) as subsection (d) and 
inserting after subsection (b) the following new subsection: 
‘‘(c) HEALTH CARE.—In addition to other taxes, 
there shall be imposed for each taxable year, on the self- 
employment income of every individual, a tax equal to 6.7 
percent of the amount of the self-employment income for 
such taxable year.’’. 
(c) COMPARABLE
TAXES
FOR
RAILROAD
SERV-
ICES.— 
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169 
(1) TAX
ON
EMPLOYERS.—Section 3221 is 
amended by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively, and by insert-
ing after subsection (b) the following new subsection: 
‘‘(c) HEALTH CARE.—In addition to other taxes, 
there is hereby imposed on every employer an excise tax, 
with respect to having individuals in his employ, equal to 
6.7 percent of the compensation paid by such employer 
for services rendered to such employer.’’. 
(2) TAX ON EMPLOYEE REPRESENTATIVES.— 
Section 3211 (relating to tax on employee represent-
atives) is amended by redesignating subsection (c) as 
subsection (d) and inserting after subsection (b) the 
following new paragraph: 
‘‘(c) HEALTH CARE.—In addition to other taxes, 
there is hereby imposed on the income of each employee 
representative a tax equal to 6.7 percent of the compensa-
tion received during the calendar year by such employee 
representative for services rendered by such employee rep-
resentative.’’. 
(3) NO APPLICABLE BASE.—Subparagraph (A) 
of section 3231(e)(2) is amended by adding at the 
end thereof the following new clause: 
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170 
‘‘(iv) HEALTH CARE TAXES.—Clause 
(i) shall not apply to the taxes imposed by 
sections 3221(c) and 3211(c).’’. 
(4) TECHNICAL AMENDMENT.— 
(A) Subsection (d) of section 3211, as re-
designated by paragraph (2), is amended by 
striking ‘‘and (b)’’ and inserting ‘‘, (b), and 
(c)’’. 
(B) Subsection (d) of section 3221, as re-
designated by paragraph (1), is amended by 
striking ‘‘and (b)’’ and inserting ‘‘, (b), and 
(c)’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to remuneration paid after Decem-
ber 31, 2016. 
SEC. 812. HEALTH CARE INCOME TAX. 
(a) GENERAL RULE.—Subchapter A of chapter 1 (re-
lating to determination of tax liability) is amended by add-
ing at the end thereof the following new part: 
‘‘PART VIII—HEALTH CARE RELATED TAXES 
‘‘SUBPART A. HEALTH CARE INCOME TAX ON INDIVIDUALS 
‘‘Subpart A—Health Care Income Tax on Individuals 
‘‘Sec. 59B. Health care income tax. 
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171 
‘‘SEC. 59B. HEALTH CARE INCOME TAX. 
‘‘(a) IMPOSITION OF TAX.—In the case of an indi-
vidual, there is hereby imposed on the taxable income of 
the taxpayer for the taxable year a tax (in addition to any 
other tax imposed by this subtitle) determined in accord-
ance with the following tables: 
‘‘(1) MARRIED INDIVIDUALS FILING JOINT RE-
TURNS AND SURVIVING SPOUSES.—In the case of 
any taxpayer making a joint return under section 
6013 or a surviving spouse (as defined in section 
2(a)), the following table shall apply: 
‘‘If taxable income is: 
The tax is: 
Not over $250,000 ........................
2.2% of taxable income. 
Over 
$250,000 
but 
not 
over 
$400,000.
$5,500, plus 3.2% of the excess over 
$250,000. 
Over 
$400,000 
but 
not 
over 
$600,000.
$10,300, plus 4.2% of the excess over 
$400,000. 
Over $600,000 ...............................
$18,700, plus 5.2% of the excess over 
$600,000. 
‘‘(2) OTHER TAXPAYERS.—In the case of any 
taxpayer not described in paragraph (1), the fol-
lowing table shall apply: 
‘‘If taxable income is: 
The tax is: 
Not over $200,000 ........................
2.2% of taxable income. 
Over 
$200,000 
but 
not 
over 
$400,000.
$4,400, plus 3.2% of the excess over 
$200,000. 
Over 
$400,000 
but 
not 
over 
$600,000.
$10,800, plus 4.2% of the excess over 
$400,000. 
Over $600,000 ...............................
$19,200, plus 5.2% of the excess over 
$600,000. 
‘‘(b) INFLATION ADJUSTMENT.— 
‘‘(1) IN GENERAL.—In the case of any taxable 
year beginning after 2017, each of the dollar 
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172 
amounts set forth in the tables in subsection (a) 
shall be increased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for such calendar 
year by substituting ‘calendar year 2016’ for 
‘calendar year 1992’ in subparagraph (B) 
thereof. 
‘‘(2) ROUNDING.—If the amount as adjusted 
under paragraph (1) is not a multiple of $1,000, 
such amount shall be rounded to the next lowest 
multiple of $1,000. 
‘‘(c) NO CREDITS AGAINST TAX; NO EFFECT ON 
MINIMUM TAX.—The tax imposed by this section shall not 
be treated as a tax imposed by this chapter for purposes 
of determining— 
‘‘(1) the amount of any credit allowable under 
this chapter, or 
‘‘(2) the amount of the minimum tax imposed 
by section 55. 
‘‘(d) SPECIAL RULES.— 
‘‘(1) TAX TO BE WITHHELD, ETC.—For pur-
poses of this title, the tax imposed by this section 
shall be treated as imposed by section 1. 
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173 
‘‘(2) REIMBURSEMENT OF TAX BY EMPLOYER 
NOT INCLUDIBLE IN GROSS INCOME.—The gross in-
come of an employee shall not include any payment 
by his employer to reimburse the employee for the 
tax paid by the employee under this section. 
‘‘(3) OTHER
RULES.—The rules of section 
59A(d) shall apply to the tax imposed by this sec-
tion.’’. 
(b) CLERICAL AMENDMENT.—The table of parts for 
subchapter A of chapter 1 is amended by adding at the 
end the following new item: 
‘‘PART VIII. HEALTH CARE RELATED TAXES’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2016. 
SEC. 813. SURCHARGE ON HIGH INCOME INDIVIDUALS. 
(a) IN GENERAL.—Part VIII of subchapter A of 
chapter 1, as added by this title, is amended by adding 
at the end the following new subpart: 
‘‘Subpart B—Surcharge on High Income Individuals 
‘‘Sec. 59C. Surcharge on high income individuals. 
‘‘SEC. 59C. SURCHARGE ON HIGH INCOME INDIVIDUALS. 
‘‘(a) GENERAL RULE.—In the case of a taxpayer 
other than a corporation, there is hereby imposed (in addi-
tion to any other tax imposed by this subtitle) a tax equal 
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174 
to 5.4 percent of so much of the modified adjusted gross 
income of the taxpayer as exceeds $1,000,000. 
‘‘(b) TAXPAYERS NOT MAKING A JOINT RETURN.— 
In the case of any taxpayer other than a taxpayer making 
a joint return under section 6013 or a surviving spouse 
(as defined in section 2(a)), subsection (a) shall be applied 
by substituting ‘$500,000’ for ‘$1,000,000’. 
‘‘(c) MODIFIED ADJUSTED GROSS INCOME.—For 
purposes of this section, the term ‘modified adjusted gross 
income’ means adjusted gross income reduced by any de-
duction (not taken into account in determining adjusted 
gross income) allowed for investment interest (as defined 
in section 163(d)). In the case of an estate or trust, ad-
justed gross income shall be determined as provided in sec-
tion 67(e). 
‘‘(d) SPECIAL RULES.— 
‘‘(1) NONRESIDENT ALIEN.—In the case of a 
nonresident alien individual, only amounts taken 
into account in connection with the tax imposed 
under section 871(b) shall be taken into account 
under this section. 
‘‘(2) 
CITIZENS
AND
RESIDENTS
LIVING 
ABROAD.—The dollar amount in effect under sub-
section (a) (after the application of subsection (b)) 
shall be decreased by the excess of— 
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175 
‘‘(A) the amounts excluded from the tax-
payer’s gross income under section 911, over 
‘‘(B) the amounts of any deductions or ex-
clusions disallowed under section 911(d)(6) 
with respect to the amounts described in sub-
paragraph (A). 
‘‘(3) CHARITABLE
TRUSTS.—Subsection (a) 
shall not apply to a trust all the unexpired interests 
in which are devoted to one or more of the purposes 
described in section 170(c)(2)(B). 
‘‘(4) NOT TREATED AS TAX IMPOSED BY THIS 
CHAPTER
FOR
CERTAIN
PURPOSES.—The tax im-
posed under this section shall not be treated as tax 
imposed by this chapter for purposes of determining 
the amount of any credit under this chapter or for 
purposes of section 55.’’. 
(b) CLERICAL AMENDMENT.—The table of subparts 
for part VIII of subchapter A of chapter 1, as added by 
this title, is amended by inserting after the item relating 
to subpart A the following new item: 
‘‘SUBPART B. SURCHARGE ON HIGH INCOME INDIVIDUALS’’. 
(c) SECTION 15 NOT TO APPLY.—The amendment 
made by subsection (a) shall not be treated as a change 
in a rate of tax for purposes of section 15 of the Internal 
Revenue Code of 1986. 
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176 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2016. 
Subtitle C—Other Financing 
Provisions 
SEC. 821. TAX ON SECURITIES TRANSACTIONS. 
(a) IN GENERAL.—Chapter 36 is amended by insert-
ing after subchapter B the following new subchapter: 
‘‘Subchapter C—Tax on Securities 
Transactions 
‘‘Sec. 4475. Tax on securities transactions. 
‘‘SEC. 4475. TAX ON SECURITIES TRANSACTIONS. 
‘‘(a) IMPOSITION OF TAX.— 
‘‘(1) STOCKS.—There is hereby imposed a tax 
on each covered transaction in a stock contract of 
0.25 percent of the value of the instruments involved 
in such transaction. 
‘‘(2) FUTURES.—There is hereby imposed a tax 
on each covered transaction in a futures contract of 
0.02 percent of the value of the instruments involved 
in such transaction. 
‘‘(3) SWAPS.—There is hereby imposed a tax on 
each covered transaction in a swaps contract of 0.02 
percent of the value of the instruments involved in 
such transaction. 
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177 
‘‘(4) CREDIT DEFAULT SWAPS.—There is here-
by imposed a tax on each covered transaction in a 
credit default swaps contract of 0.02 percent of the 
value of the instruments involved in such trans-
action. 
‘‘(5) OPTIONS.—There is hereby imposed a tax 
on each covered transaction in an options contract 
with respect to a transaction described in paragraph 
(1), (2), (3), or (4) of— 
‘‘(A) the rate imposed with respect to such 
underlying transaction under paragraph (1), 
(2), (3), or (4) (as the case may be), multiplied 
by 
‘‘(B) the premium paid on such option. 
‘‘(b) EXCEPTION
FOR
RETIREMENT
ACCOUNTS, 
ETC.—No tax shall be imposed under subsection (a) with 
respect to any stock contract, futures contract, swaps con-
tract, credit default swap, or options contract which is 
held in any plan, account, or arrangement described in 
section 220, 223, 401(a), 403(a), 403(b), 408, 408A, 
457(b), 529, or 530. 
‘‘(c) EXCEPTION
FOR
INTERESTS
IN
MUTUAL 
FUNDS.—No tax shall be imposed under subsection (a) 
with respect to the purchase or sale of any interest in a 
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178 
regulated investment company (as defined in section 851) 
or of any derivative of such an interest. 
‘‘(d) BY WHOM PAID.— 
‘‘(1) IN GENERAL.—The tax imposed by this 
section shall be paid by— 
‘‘(A) in the case of a transaction which oc-
curs on a trading facility located in the United 
States, such trading facility, or 
‘‘(B) in any other case, the purchaser with 
respect to the transaction. 
‘‘(2) WITHHOLDING
IF
BUYER
IS
NOT
A 
UNITED
STATES
PERSON.—See section 1447 for 
withholding by seller if buyer is a foreign person. 
‘‘(e) COVERED TRANSACTION.—The term ‘covered 
transaction’ means any purchase or sale if— 
‘‘(1) such purchase or sale occurs on a trading 
facility located in the United States, or 
‘‘(2) the purchaser or seller is a United States 
person. 
‘‘(f) ADMINISTRATION.—The Secretary shall carry 
out this section in consultation with the Securities and Ex-
change Commission and the Commodity Futures Trading 
Commission.’’. 
(b) CREDIT FOR FIRST $100,000 OF STOCK TRANS-
ACTIONS PER YEAR.—Subpart C of part IV of subchapter 
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179 
A of chapter 1 is amended by inserting after section 36B 
the following new section: 
‘‘SEC. 36C. CREDIT FOR SECURITIES TRANSACTION TAXES. 
‘‘(a) ALLOWANCE OF CREDIT.—In the case of any 
purchaser with respect to a covered transaction, there 
shall be allowed as a credit against the tax imposed by 
this subtitle for the taxable year an amount equal to the 
lesser of— 
‘‘(1) the aggregate amount of tax imposed 
under section 4475 on covered transactions during 
the taxable year with respect to which the taxpayer 
is the purchaser, or 
‘‘(2) $250 ($500 in the case of a joint return). 
‘‘(b) AGGREGATION RULE.—For purposes of this sec-
tion, all persons treated as a single employer under sub-
section (a) or (b) of section 52, or subsection (m) or (o) 
of section 414, shall be treated as one taxpayer. 
‘‘(c) DEFINITIONS.—For purposes of this section, 
any term used in this section which is also used in section 
4475 shall have the same meaning as when used in section 
4475.’’. 
(c) WITHHOLDING.—Subchapter A of chapter 3 is 
amended by adding at the end the following new section: 
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180 
‘‘SEC. 1447. WITHHOLDING ON SECURITIES TRANSACTIONS. 
‘‘(a) IN GENERAL.—In the case of any outbound se-
curities transaction, the transferor shall deduct and with-
hold a tax equal to the tax imposed under section 4475 
with respect to such transaction. 
‘‘(b) OUTBOUND SECURITIES TRANSACTION.—For 
purposes of this section, the term ‘outbound securities 
transaction’ means any covered transaction to which sec-
tion 4475(a) applies if— 
‘‘(1) such transaction does not occur on a trad-
ing facility located in the United States, and 
‘‘(2) the purchaser with respect to such trans-
action is not a United States person.’’. 
(d) CONFORMING AMENDMENTS.— 
(1) Section 6211(b)(4)(A) is amended by insert-
ing ‘‘36C,’’ after ‘‘36B,’’. 
(2) Section 1324(b)(2) of title 31, United 
States Code, is amended by inserting ‘‘36C,’’ after 
‘‘36B,’’. 
(3) The table of subchapters for chapter 36 is 
amended by inserting after the item relating to sub-
chapter B the following new item: 
‘‘SUBCHAPTER C. TAX ON SECURITIES TRANSACTIONS’’. 
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181 
(4) The table of sections for subchapter A of 
chapter 3 is amended by adding at the end the fol-
lowing new item: 
‘‘Sec. 1447. Withholding on securities transactions.’’. 
(5) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 is amended by in-
serting after the item relating to section 36B the fol-
lowing new item: 
‘‘Sec. 36C. Credit for securities transaction taxes.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to transactions occurring more 
than 180 days after the date of the enactment of this Act. 
TITLE IX—CONFORMING AMEND-
MENTS TO THE EMPLOYEE 
RETIREMENT INCOME SECU-
RITY ACT OF 1974 
SEC. 901. ERISA INAPPLICABLE TO HEALTH COVERAGE AR-
RANGEMENTS UNDER STATE HEALTH SECU-
RITY PROGRAMS. 
Section 4 of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1003) is amended— 
(1) in subsection (a), by striking ‘‘(b) or (c)’’ 
and inserting ‘‘(b), (c), or (d)’’; and 
(2) by adding at the end the following new sub-
section: 
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182 
‘‘(d) The provisions of this title shall not apply to 
any arrangement forming a part of a State health security 
program established pursuant to section 101(b) of the 
American Health Security Act of 2015.’’. 
SEC. 902. EXEMPTION OF STATE HEALTH SECURITY PRO-
GRAMS FROM ERISA PREEMPTION. 
Section 514(b) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1144(b)) is amended by 
adding at the end the following new paragraph: 
‘‘(10) Subsection (a) of this section shall not apply 
to State health security programs established pursuant to 
section 101(b) of the American Health Security Act of 
2015.’’. 
SEC. 903. PROHIBITION OF EMPLOYEE BENEFITS DUPLICA-
TIVE OF BENEFITS UNDER STATE HEALTH 
SECURITY 
PROGRAMS; 
COORDINATION 
IN 
CASE OF WORKERS’ COMPENSATION. 
(a) IN GENERAL.—Part 5 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1131 et seq.) is amended by adding at the end 
the following new section: 
‘‘PROHIBITION OF EMPLOYEE BENEFITS DUPLICATIVE OF 
STATE HEALTH SECURITY PROGRAM BENEFITS; CO-
ORDINATION IN CASE OF WORKERS’ COMPENSATION 
‘‘SEC. 522. (a) Subject to subsection (b), no employee 
benefit plan may provide benefits which duplicate payment 
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183 
for any items or services for which payment may be made 
under a State health security program established pursu-
ant to section 101(b) of the American Health Security Act 
of 2015. 
‘‘(b)(1) Each workers compensation carrier that is 
liable for payment for workers compensation services fur-
nished in a State shall reimburse the State health security 
plan for the State in which the services are furnished for 
the cost of such services. 
‘‘(2) In this subsection: 
‘‘(A) The term ‘workers compensation carrier’ 
means an insurance company that underwrites work-
ers compensation medical benefits with respect to 
one or more employers and includes an employer or 
fund that is financially at risk for the provision of 
workers compensation medical benefits. 
‘‘(B) The term ‘workers compensation medical 
benefits’ means, with respect to an enrollee who is 
an employee subject to the workers compensation 
laws of a State, the comprehensive medical benefits 
for work-related injuries and illnesses provided for 
under such laws with respect to such an employee. 
‘‘(C) The term ‘workers compensation services’ 
means items and services included in workers com-
pensation medical benefits and includes items and 
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184 
services (including rehabilitation services and long- 
term-care services) commonly used for treatment of 
work-related injuries and illnesses.’’. 
(b) CONFORMING AMENDMENT.—Section 4(b) of 
such Act (29 U.S.C. 1003(b)) is amended by adding at 
the end the following: ‘‘Paragraph (3) shall apply subject 
to section 522(b) (relating to reimbursement of State 
health security plans by workers compensation carriers).’’. 
(c) CLERICAL AMENDMENT.—The table of contents 
in section 1 of such Act is amended by inserting after the 
item relating to section 521 the following new item: 
‘‘Sec. 522. Prohibition of employee benefits duplicative of State health security 
program benefits; coordination in case of workers’ compensa-
tion.’’. 
SEC. 904. REPEAL OF CONTINUATION COVERAGE REQUIRE-
MENTS UNDER ERISA AND CERTAIN OTHER 
REQUIREMENTS 
RELATING 
TO 
GROUP 
HEALTH PLANS. 
(a) IN GENERAL.—Part 6 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1161 et seq.) is repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 502(a) of such Act (29 U.S.C. 
1132(a)) is amended— 
(A) by striking paragraph (7); and 
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