I 
112TH CONGRESS 
1ST SESSION 
H. R. 105 
To repeal the Patient Protection and Affordable Care Act and related health- 
care provisions and to enact in its place incentives to encourage health 
insurance coverage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 5, 2011 
Mr. BURTON of Indiana introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Commit-
tees on the Budget, Education and the Workforce, Natural Resources, 
House Administration, Ways and Means, the Judiciary, Rules, Appropria-
tions, and Oversight and Government Reform, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To repeal the Patient Protection and Affordable Care Act 
and related health-care provisions and to enact in its 
place incentives to encourage health insurance coverage, 
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 
‘‘Empowering Patients First Act’’. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Repeal of the Patient Protection and Affordable Care Act (PPACA) and 
health care-related provisions in the Health Care and Edu-
cation Reconciliation Act of 2010. 
TITLE I—TAX INCENTIVES FOR MAINTAINING HEALTH 
INSURANCE COVERAGE 
Sec. 101. Refundable tax credit for health insurance costs of low-income indi-
viduals. 
Sec. 102. Advance payment of credit as premium payment for qualified health 
insurance. 
Sec. 103. Election of tax credit instead of alternative government or group plan 
benefits. 
Sec. 104. Deduction for qualified health insurance costs of individuals. 
Sec. 105. Limitation on abortion funding. 
Sec. 106. Non-discrimination on abortion and respect for rights of conscience. 
Sec. 107. Equal employer contribution rule to promote choice. 
Sec. 108. Limitations on State restrictions on employer auto-enrollment. 
Sec. 109. Credit for small employers adopting auto-enrollment and defined con-
tribution options. 
Sec. 110. Require employers to disclose amounts paid for employer-provided 
health plan coverage. 
Sec. 111. HSA modifications and clarifications. 
TITLE II—HEALTH INSURANCE POOLING MECHANISMS FOR 
INDIVIDUALS 
Subtitle A—Safety Net for Individuals With Pre-Existing Conditions 
Sec. 201. Requiring operation of high-risk pool or other mechanism as condi-
tion for availability of tax credit. 
Subtitle B—Federal Block Grants for State Insurance Expenditures 
Sec. 211. Federal block grants for State insurance expenditures. 
Subtitle C—Health Care Access and Availability 
Sec. 221. Expansion of access and choice through individual membership asso-
ciations (IMAs). 
Subtitle D—Small Business Health Fairness 
Sec. 231. Short title. 
Sec. 232. Rules governing association health plans. 
Sec. 233. Clarification of treatment of single employer arrangements. 
Sec. 234. Enforcement provisions relating to association health plans. 
Sec. 235. Cooperation between Federal and State authorities. 
Sec. 236. Effective date and transitional and other rules. 
TITLE III—INTERSTATE MARKET FOR HEALTH INSURANCE 
Sec. 301. Cooperative governing of individual health insurance coverage. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6211
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
TITLE IV—SAFETY NET REFORMS 
Sec. 401. Requiring outreach and coverage before expansion of eligibility. 
Sec. 402. Easing administrative barriers to State cooperation with employer- 
sponsored insurance coverage. 
Sec. 403. Improving beneficiary choice in SCHIP. 
Sec. 404. Liability protections for health center volunteer practitioners. 
Sec. 405. Liability protections for health center practitioners providing services 
in emergency areas. 
TITLE V—MEDICAL LIABILITY AND UNCOMPENSATED CARE 
REFORMS 
Sec. 501. Short title. 
Sec. 502. Findings and purpose. 
Sec. 503. Encouraging speedy resolution of claims. 
Sec. 504. Compensating patient injury. 
Sec. 505. Maximizing patient recovery. 
Sec. 506. Additional health benefits. 
Sec. 507. Punitive damages. 
Sec. 508. Authorization of payment of future damages to claimants in health 
care lawsuits. 
Sec. 509. Definitions. 
Sec. 510. Effect on other laws. 
Sec. 511. State flexibility and protection of states’ rights. 
Sec. 512. Applicability; effective date. 
Sec. 513. Sense of Congress. 
Sec. 514. State grants to create administrative health care tribunals. 
Sec. 515. Affirmative defense based on compliance with best practice guidelines. 
Sec. 516. Bad debt deduction for doctors to partially offset the cost of pro-
viding uncompensated care required to be provided under 
amendments made by the Emergency Medical Treatment and 
Labor Act. 
TITLE VI—WELLNESS AND PREVENTION 
Sec. 601. Providing financial incentives for treatment compliance. 
TITLE VII—TRANSPARENCY AND INSURANCE REFORM MEASURES 
Sec. 701. Receipt and response to requests for claim information. 
TITLE VIII—QUALITY 
Sec. 801. Prohibition on certain uses of data obtained from comparative effec-
tiveness research; accounting for personalized medicine and dif-
ferences in patient treatment response. 
Sec. 802. Establishment of performance-based quality measures. 
TITLE IX—STATE TRANSPARENCY PLAN PORTAL 
Sec. 901. Providing information on health coverage options and health care 
providers. 
TITLE X—PHYSICIAN PAYMENT REFORM 
Sec. 1001. Sustainable growth rate reform. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6211
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
TITLE XI—INCENTIVES TO REDUCE PHYSICIAN SHORTAGES 
Subtitle A—Federally Supported Student Loan Funds for Medical Students 
Sec. 1101. Federally Supported Student Loan Funds for Medical Students. 
Subtitle B—Loan Forgiveness for Primary Care Providers 
Sec. 1111. Loan forgiveness for primary care providers. 
TITLE XII—OFFSETS 
Subtitle A—Enforcing Discretionary Spending Limits 
Sec. 1201. Enforcing discretionary spending limits. 
Subtitle B—Repeal of Unused Stimulus Funds 
Sec. 1211. Rescission and repeal in ARRA. 
Subtitle C—Savings From Health Care Efficiencies 
Sec. 1221. Medicare DSH report and payment adjustments in response to cov-
erage expansion. 
Sec. 1222. Reduction in Medicaid DSH. 
Subtitle D—Fraud, Waste, and Abuse 
Sec. 1231. Provide adequate funding to HHS OIG and HCFAC. 
Sec. 1232. Improved enforcement of the Medicare secondary payor provisions. 
Sec. 1233. Strengthen Medicare provider enrollment standards and safeguards. 
Sec. 1234. Tracking banned providers across State lines. 
Sec. 1235. Reinstate the Medicare trigger. 
SEC. 2. REPEAL OF THE PATIENT PROTECTION AND AF-
FORDABLE CARE ACT (PPACA) AND HEALTH 
CARE-RELATED PROVISIONS IN THE HEALTH 
CARE AND EDUCATION RECONCILIATION ACT 
OF 2010. 
(a) PATIENT PROTECTION AND AFFORDABLE CARE 
ACT.—Effective as of the enactment of the Patient Pro-
tection and Affordable Care Act (Public Law 111–148), 
such Act is repealed, and the provisions of law amended 
or repealed by such Act are restored or revived as if such 
Act had not been enacted. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
(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. 
(c) APPLICATION OF SUBSEQUENT PROVISIONS.— 
The remainder of this Act shall be applied after the appli-
cation of subsections (a) and (b). 
TITLE I—TAX INCENTIVES FOR 
MAINTAINING 
HEALTH 
IN-
SURANCE COVERAGE 
SEC. 101. REFUNDABLE TAX CREDIT FOR HEALTH INSUR-
ANCE COSTS OF LOW-INCOME INDIVIDUALS. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to refundable credits) is amended by insert-
ing after section 36C the following new section: 
‘‘SEC. 36D. HEALTH INSURANCE COSTS OF LOW-INCOME IN-
DIVIDUALS. 
‘‘(a) IN GENERAL.—In the case of an individual, 
there shall be allowed as a credit against the tax imposed 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
by subtitle A the aggregate amount paid by the taxpayer 
for coverage of the taxpayer and the taxpayer’s qualifying 
family members under qualified health insurance for eligi-
ble coverage months beginning in the taxable year. 
‘‘(b) LIMITATIONS.— 
‘‘(1) IN GENERAL.—The amount allowable as a 
credit under subsection (a) for the taxable year shall 
not exceed the lesser of— 
‘‘(A) the sum of the monthly limitations 
for months during such taxable year that the 
taxpayer or the taxpayer’s qualifying family 
members is an eligible individual, and 
‘‘(B) the aggregate premiums paid by the 
taxpayer for the taxable year for coverage de-
scribed in subsection (a). 
‘‘(2) MONTHLY LIMITATION.—The monthly lim-
itation for any month is the credit percentage of 1⁄12 
of the sum of— 
‘‘(A) $2,000 for coverage of the taxpayer 
($4,000 in the case of a joint return for cov-
erage of the taxpayer and the taxpayer’s 
spouse), and 
‘‘(B) $500 for coverage of each dependent 
of the taxpayer. 
‘‘(3) CREDIT PERCENTAGE.— 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
‘‘(A) IN GENERAL.—For purposes of this 
section, the term ‘credit percentage’ means 100 
percent reduced by 1 percentage point for each 
$1,000 (or fraction thereof) by which the tax-
payer’s adjusted gross income for the taxable 
year exceeds the threshold amount. 
‘‘(B) THRESHOLD AMOUNT.—For purposes 
of this paragraph, the term ‘threshold amount’ 
means, with respect to any taxpayer for any 
taxable year, 200 percent of the Federal pov-
erty guideline (as determined by the Secretary 
of Health and Human Service for the taxable 
year) applicable to the taxpayer. 
‘‘(4) ONLY
DEPENDENTS
TAKEN
INTO
AC-
COUNT.—Not more than 2 dependents of the tax-
payer may be taken into account under paragraphs 
(2)(C) and (3)(B). 
‘‘(5) INFLATION ADJUSTMENT.—In the case of 
any taxable year beginning in a calendar year after 
2011, each dollar amount contained in paragraph 
(2) 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 the calendar 
year in which the taxable year begins, deter-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
mined by substituting ‘calendar year 2010’ for 
‘calendar year 1992’ in subparagraph (B) 
thereof. 
Any increase determined under the preceding sen-
tence shall be rounded to the nearest multiple of 
$50. 
‘‘(c) ELIGIBLE COVERAGE MONTH.—For purposes of 
this section, the term ‘eligible coverage month’ means, 
with respect to any individual, any month if, as of the first 
day of such month, the individual— 
‘‘(1) is covered by qualified health insurance, 
‘‘(2) does not have other specified coverage, and 
‘‘(3) is not imprisoned under Federal, State, or 
local authority. 
‘‘(d) QUALIFYING FAMILY MEMBER.—For purposes 
of this section, the term ‘qualifying family member’ 
means— 
‘‘(1) in the case of a joint return, the taxpayer’s 
spouse, and 
‘‘(2) any dependent of the taxpayer. 
‘‘(e) QUALIFIED HEALTH INSURANCE.—For pur-
poses of this section, the term ‘qualified health insurance’ 
means health insurance coverage (other than excepted 
benefits as defined in section 9832(c)) which constitutes 
medical care. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
‘‘(f) OTHER SPECIFIED COVERAGE.—For purposes of 
this section, an individual has other specified coverage for 
any month if, as of the first day of such month— 
‘‘(1) COVERAGE UNDER MEDICARE, MEDICAID, 
OR SCHIP.—Such individual— 
‘‘(A) is entitled to benefits under part A of 
title XVIII of the Social Security Act or is en-
rolled under part B of such title, or 
‘‘(B) is enrolled in the program under title 
XIX or XXI of such Act (other than under sec-
tion 1928 of such Act). 
‘‘(2) CERTAIN OTHER COVERAGE.—Such indi-
vidual— 
‘‘(A) is enrolled in a health benefits plan 
under chapter 89 of title 5, United States Code, 
‘‘(B) is entitled to receive benefits under 
chapter 55 of title 10, United States Code, 
‘‘(C) in entitled to receive benefits under 
chapter 17 of title 38, United States Code, or 
‘‘(D) is enrolled in a group health plan 
(within the meaning of section 5000(b)(1)) 
which is subsidized by the employer. 
‘‘(g) SPECIAL RULES.— 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
‘‘(1) COORDINATION WITH ADVANCE PAYMENTS 
OF CREDIT; RECAPTURE OF EXCESS ADVANCE PAY-
MENTS.—With respect to any taxable year— 
‘‘(A) the amount which would (but for this 
subsection) be allowed as a credit to the tax-
payer under subsection (a) shall be reduced 
(but not below zero) by the aggregate amount 
paid on behalf of such taxpayer under section 
7529 for months beginning in such taxable 
year, and 
‘‘(B) the tax imposed by section 1 for such 
taxable year shall be increased by the excess (if 
any) of— 
‘‘(i) the aggregate amount paid on be-
half of such taxpayer under section 7529 
for months beginning in such taxable year, 
over 
‘‘(ii) the amount which would (but for 
this subsection) be allowed as a credit to 
the taxpayer under subsection (a). 
‘‘(2) COORDINATION
WITH
OTHER
DEDUC-
TIONS.—Amounts taken into account under sub-
section (a) shall not be taken into account in deter-
mining— 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
‘‘(A) any deduction allowed under section 
162(l), 213, or 224, or 
‘‘(B) any credit allowed under section 35. 
‘‘(3) MEDICAL
AND
HEALTH
SAVINGS
AC-
COUNTS.—Amounts distributed from an Archer 
MSA (as defined in section 220(d)) or from a health 
savings account (as defined in section 223(d)) shall 
not be taken into account under subsection (a). 
‘‘(4) DENIAL OF CREDIT TO DEPENDENTS AND 
NONPERMANENT RESIDENT ALIEN INDIVIDUALS.— 
No credit shall be allowed under this section to any 
individual who is— 
‘‘(A) not a citizen or lawful permanent 
resident of the United States for the calendar 
year in which the taxable year begins, or 
‘‘(B) a dependent with respect to another 
taxpayer for a taxable year beginning in the 
calendar year in which such individual’s taxable 
year begins. 
‘‘(5) INSURANCE WHICH COVERS OTHER INDI-
VIDUALS.—For purposes of this section, rules simi-
lar to the rules of section 213(d)(6) shall apply with 
respect to any contract for qualified health insurance 
under which amounts are payable for coverage of an 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
individual other than the taxpayer and qualifying 
family members. 
‘‘(6) TREATMENT
OF
PAYMENTS.—For pur-
poses of this section— 
‘‘(A) PAYMENTS
BY
SECRETARY.—Pay-
ments made by the Secretary on behalf of any 
individual under section 7529 (relating to ad-
vance payment of credit for health insurance 
costs of low-income individuals) shall be treated 
as having been made by the taxpayer on the 
first day of the month for which such payment 
was made. 
‘‘(B) PAYMENTS
BY
TAXPAYER.—Pay-
ments made by the taxpayer for eligible cov-
erage months shall be treated as having been 
made by the taxpayer on the first day of the 
month for which such payment was made. 
‘‘(7) REGULATIONS.—The Secretary may pre-
scribe such regulations and other guidance as may 
be necessary or appropriate to carry out this section, 
section 6050W, and section 7529.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Paragraph (2) of section 1324(b) of title 
31, United States Code, is amended by inserting 
‘‘36D,’’ after ‘‘36C,’’. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
(2) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 of the Internal Rev-
enue Code of 1986 is amended by inserting after the 
item relating to section 36C the following new item: 
‘‘Sec. 36D. Health insurance costs of low-income individuals.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2011. 
(d) SENSE OF CONGRESS.—It is the sense of Con-
gress that the cost of the advanceable refundable credit 
under sections 36D and 7529 of the Internal Revenue 
Code of 1986, as added by this title, will be offset by sav-
ings derived from the provisions of title XII. 
SEC. 102. ADVANCE PAYMENT OF CREDIT AS PREMIUM 
PAYMENT FOR QUALIFIED HEALTH INSUR-
ANCE. 
(a) IN GENERAL.—Chapter 77 of the Internal Rev-
enue Code of 1986 (relating to miscellaneous provisions) 
is amended by adding at the end the following: 
‘‘SEC. 7529. ADVANCE PAYMENT OF CREDIT AS PREMIUM 
PAYMENT FOR QUALIFIED HEALTH INSUR-
ANCE. 
‘‘(a) GENERAL RULE.—Not later than January 1, 
2012, the Secretary shall establish a program for making 
payments to providers of qualified health insurance (as de-
fined in section 36D(e)) on behalf of taxpayers eligible for 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
the credit under section 36D. Except as otherwise pro-
vided by the Secretary, such payments shall be made on 
the basis of the adjusted gross income of the taxpayer for 
the preceding taxable year. 
‘‘(b) CERTIFICATION PROCESS AND PROOF OF COV-
ERAGE.—For purposes of this section, payments may be 
made pursuant to subsection (a) only with respect to indi-
viduals for whom a qualified health insurance costs credit 
eligibility certificate is in effect.’’. 
(b) DISCLOSURE
OF RETURN INFORMATION
FOR 
PURPOSES OF ADVANCE PAYMENT OF CREDIT AS PRE-
MIUMS FOR QUALIFIED HEALTH INSURANCE.— 
(1) IN
GENERAL.—Subsection (l) of section 
6103 of such Code is amended by adding at the end 
the following new paragraph: 
‘‘(23) DISCLOSURE OF RETURN INFORMATION 
FOR PURPOSES OF ADVANCE PAYMENT OF CREDIT 
AS
PREMIUMS
FOR
QUALIFIED
HEALTH
INSUR-
ANCE.—The Secretary may, on behalf of taxpayers 
eligible for the credit under section 36D, disclose to 
a provider of qualified health insurance (as defined 
in section 36(e)), and persons acting on behalf of 
such provider, return information with respect to 
any such taxpayer only to the extent necessary (as 
prescribed by regulations issued by the Secretary) to 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
carry out the program established by section 7529 
(relating to advance payment of credit as premium 
payment for qualified health insurance).’’. 
(2) CONFIDENTIALITY
OF
INFORMATION.— 
Paragraph (3) of section 6103(a) of such Code is 
amended by striking ‘‘or (21)’’ and inserting ‘‘(21), 
or (23)’’. 
(3) UNAUTHORIZED
DISCLOSURE.—Paragraph 
(2) of section 7213(a) of such Code is amended by 
striking ‘‘or (21)’’ and inserting ‘‘(21), or (23)’’. 
(c) INFORMATION REPORTING.— 
(1) IN GENERAL.—Subpart B of part III of 
subchapter A of chapter 61 of such Code (relating 
to information concerning transactions with other 
persons) is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 6050X. RETURNS RELATING TO CREDIT FOR HEALTH 
INSURANCE COSTS OF LOW-INCOME INDIVID-
UALS. 
‘‘(a) REQUIREMENT OF REPORTING.—Every person 
who is entitled to receive payments for any month of any 
calendar year under section 7529 (relating to advance pay-
ment of credit as premium payment for qualified health 
insurance) with respect to any individual shall, at such 
time as the Secretary may prescribe, make the return de-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
scribed in subsection (b) with respect to each such indi-
vidual. 
‘‘(b) FORM AND MANNER OF RETURNS.—A return 
is described in this subsection if such return— 
‘‘(1) is in such form as the Secretary may pre-
scribe, and 
‘‘(2) contains— 
‘‘(A) the name, address, and TIN of each 
individual referred to in subsection (a), 
‘‘(B) the number of months for which 
amounts were entitled to be received with re-
spect to such individual under section 7529 (re-
lating to advance payment of credit as premium 
payment for qualified health insurance), 
‘‘(C) the amount entitled to be received for 
each such month, and 
‘‘(D) such other information as the Sec-
retary may prescribe. 
‘‘(c) STATEMENTS TO BE FURNISHED TO INDIVID-
UALS WITH RESPECT TO WHOM INFORMATION IS RE-
QUIRED.—Every person required to make a return under 
subsection (a) shall furnish to each individual whose name 
is required to be set forth in such return a written state-
ment showing— 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
‘‘(1) the name and address of the person re-
quired to make such return and the phone number 
of the information contact for such person, and 
‘‘(2) the information required to be shown on 
the return with respect to such individual. 
The written statement required under the preceding sen-
tence shall be furnished on or before January 31 of the 
year following the calendar year for which the return 
under subsection (a) is required to be made.’’. 
(2) ASSESSABLE PENALTIES.— 
(A) 
Subparagraph 
(B) 
of 
section 
6724(d)(1) of such Code (relating to defini-
tions) is amended by striking ‘‘or’’ at the end 
of clause (xxii), by striking ‘‘and’’ at the end of 
clause (xxiii) and inserting ‘‘or’’, and by insert-
ing after clause (xxiii) the following new clause: 
‘‘(xxiv) section 6050X (relating to re-
turns relating to credit for health insur-
ance costs of low-income individuals), 
and’’. 
(B) Paragraph (2) of section 6724(d) of 
such Code is amended by striking ‘‘or’’ at the 
end of subparagraph (EE), by striking the pe-
riod at the end of subparagraph (FF) and in-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
serting ‘‘, or’’, and by adding after subpara-
graph (FF) the following new subparagraph: 
‘‘(GG) section 6050X (relating to returns 
relating to credit for health insurance costs of 
low-income individuals).’’. 
(d) CLERICAL AMENDMENTS.— 
(1) The table of sections for chapter 77 of such 
Code is amended by adding at the end the following 
new item: 
‘‘Sec. 7529. Advance payment of credit as premium payment for qualified 
health insurance.’’. 
(2) The table of sections for subpart B of part 
III of subchapter A of chapter 61 of such Code is 
amended by adding at the end the following new 
item: 
‘‘Sec. 6050X. Returns relating to credit for health insurance costs of low-in-
come individuals.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of the enactment 
of this Act. 
SEC. 103. ELECTION OF TAX CREDIT INSTEAD OF ALTER-
NATIVE GOVERNMENT OR GROUP PLAN BEN-
EFITS. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, an individual who is otherwise eligible for ben-
efits under a health program (as defined in subsection (c)) 
may elect, in a form and manner specified by the Sec-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
retary of Health and Human Services in consultation with 
the Secretary of the Treasury, to receive a tax credit de-
scribed in section 36D of the Internal Revenue Code of 
1986 (which may be used for the purpose of health insur-
ance coverage) in lieu of receiving any benefits under such 
program. 
(b) EFFECTIVE DATE.—An election under subsection 
(a) may first be made for calendar year 2012 and any 
such election shall be effective for such period (not less 
than one calendar year) as the Secretary of Health and 
Human Services shall specify, in consultation with the 
Secretary of the Treasury. 
(c) HEALTH PROGRAM DEFINED.—For purposes of 
this section, the term ‘‘health program’’ means any of the 
following: 
(1) MEDICARE.—The Medicare Program under 
part A of title XVIII of the Social Security Act. 
(2) MEDICAID.—The Medicaid program under 
title XIX of such Act (including such a program op-
erating under a Statewide waiver under section 1115 
of such Act). 
(3) SCHIP.—The State children’s health insur-
ance program under title XXI of such Act. 
(4) 
TRICARE.—The 
TRICARE 
program 
under chapter 55 of title 10, United States Code. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
(5) VETERANS BENEFITS.—Coverage for bene-
fits under chapter 17 of title 38, United States 
Code. 
(6) FEHBP.—Coverage under chapter 89 of 
title 5, United States Code. 
(7) SUBSIDIZED GROUP HEALTH PLANS.—Cov-
erage under a group health plan (within the meaning 
of section 5000(b)(1)) which is subsidized by the 
employer. 
(d) OTHER
SOCIAL
SECURITY
BENEFITS
NOT 
WAIVED.—An election to waive the benefits described in 
subsection (c)(1) shall not result in the waiver of any other 
benefits under the Social Security Act. 
SEC. 104. DEDUCTION FOR QUALIFIED HEALTH INSURANCE 
COSTS OF INDIVIDUALS. 
(a) IN GENERAL.—Part VII of subchapter B of chap-
ter 1 of the Internal Revenue Code of 1986 (relating to 
additional itemized deductions) is amended by redesig-
nating section 224 as section 225 and by inserting after 
section 223 the following new section: 
‘‘SEC. 224. COSTS OF QUALIFIED HEALTH INSURANCE. 
‘‘(a) IN GENERAL.—In the case of an individual, 
there shall be allowed as a deduction an amount equal to 
the amount paid during the taxable year for coverage for 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
the taxpayer, his spouse, and dependents under qualified 
health insurance. 
‘‘(b) LIMITATION.—In the case of any taxpayer for 
any taxable year, the deduction under subsection (a) shall 
not exceed an amount that would cause the taxpayer’s 
Federal income tax liability to be reduced by more than 
the average value of the national health exclusion for em-
ployer sponsored insurance as determined by calculating 
the value of the exclusion for each household followed by 
calculating the average of those values. 
‘‘(c) QUALIFIED HEALTH INSURANCE.—For pur-
poses of this section, the term ‘qualified health insurance’ 
has the meaning given such term by section 36D(e). 
‘‘(d) SPECIAL RULES.— 
‘‘(1) COORDINATION
WITH
MEDICAL
DEDUC-
TION, ETC.—Any amount paid by a taxpayer for in-
surance to which subsection (a) applies shall not be 
taken into account in computing the amount allow-
able to the taxpayer as a deduction under section 
162(l) or 213(a). Any amount taken into account in 
determining the credit allowed under section 35 or 
36D shall not be taken into account for purposes of 
this section. 
‘‘(2) DEDUCTION NOT ALLOWED FOR SELF-EM-
PLOYMENT
TAX
PURPOSES.—The deduction allow-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
able by reason of this section shall not be taken into 
account in determining an individual’s net earnings 
from self-employment (within the meaning of section 
1402(a)) for purposes of chapter 2.’’. 
(b) DEDUCTION
ALLOWED
IN
COMPUTING
AD-
JUSTED GROSS INCOME.—Subsection (a) of section 62 of 
such Code is amended by inserting before the last sentence 
the following new paragraph: 
‘‘(22) COSTS
OF
QUALIFIED
HEALTH
INSUR-
ANCE.—The deduction allowed by section 224.’’. 
(c) CLERICAL AMENDMENT.—The table of sections 
for part VII of subchapter B of chapter 1 of such Code 
is amended by redesignating the item relating to section 
224 as an item relating to section 225 and inserting before 
such item the following new item: 
‘‘Sec. 224. Costs of qualified health insurance.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2011. 
SEC. 105. LIMITATION ON ABORTION FUNDING. 
No funds authorized under this Act (or any amend-
ment made by this Act) may be used to pay for any abor-
tion or to cover any part of the costs of any health plan 
that includes coverage of abortion, except in the case 
where a woman suffers from a physical disorder, physical 
injury, or physical illness that would, as certified by a phy-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
sician, place the woman in danger of death unless an abor-
tion is performed, including a life-endangering physical 
condition caused by or arising from the pregnancy itself, 
or unless the pregnancy is the result of an act of forcible 
rape or incest. 
SEC. 106. NON-DISCRIMINATION ON ABORTION AND RE-
SPECT FOR RIGHTS OF CONSCIENCE. 
(a) NON-DISCRIMINATION.—A Federal agency or 
program, and any State or local government that receives 
Federal financial assistance, may not subject any indi-
vidual or institutional health care entity to discrimination 
on the basis that the health care entity does not provide, 
pay for, provide coverage of, or refer for abortions. 
(b) DEFINITION.—In this section, the term ‘‘health 
care entity’’ includes an individual physician or other 
health care professional, a hospital, a provider-sponsored 
organization, a health maintenance organization, a health 
insurance plan, or any other kind of health care facility, 
organization, or plan. 
(c) ADMINISTRATION.—The Office for Civil Rights of 
the Department of Health and Human Services is des-
ignated to receive complaints of discrimination based on 
this section, and coordinate the investigation of such com-
plaints. 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
(d) CONSCIENTIOUS OBJECTION.—Nothing in this 
Act shall be construed as forbidding a health plan or 
health insurance issuer to accommodate the conscientious 
objection of a purchaser or an individual or institutional 
health care provider when a procedure is contrary to the 
religious beliefs or moral convictions of such purchaser or 
provider. 
SEC. 107. EQUAL EMPLOYER CONTRIBUTION RULE TO PRO-
MOTE CHOICE. 
(a) EXCISE TAX FOR FAILURE TO PROVIDE CON-
TRIBUTION ELECTION.—Section 5000 of the Internal 
Revenue Code of 1986 is amended by adding at the end 
the following new subsection: 
‘‘(e) HEALTH CARE CONTRIBUTION ELECTION.— 
‘‘(1) IN
GENERAL.—Subsection (a) shall not 
apply in the case of a group health plan with respect 
to which the requirements of paragraphs (2) and (3) 
are met. 
‘‘(2) CONTRIBUTION ELECTION.—The require-
ment of this paragraph is met with respect to a 
group health plan if any employee of an employer 
(who but for this paragraph would be covered by 
such plan) may elect to have the employer or em-
ployee organization pay an amount which is not less 
than the contribution amount to any provider of in-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
surance (other than excepted benefits as defined in 
section 9832(c)(1)) which constitutes medical care of 
the individual or individual’s spouse or dependents 
in lieu of such group health plan coverage otherwise 
provided or contributed to by the employer with re-
spect to such employee. 
‘‘(3) PRE-EXISTING CONDITIONS.— 
‘‘(A) IN
GENERAL.—The requirement of 
this paragraph is met with respect to health in-
surance coverage provided to a participant or 
beneficiary by any health insurance issuer if, 
under such plan the requirements of section 
9801 are met with respect to the participant or 
beneficiary. 
‘‘(B) ENFORCEMENT
WITH
RESPECT
TO 
INDIVIDUAL ELECTION.—For purposes of sub-
paragraph (A), any health insurance coverage 
with respect to the participant or beneficiary 
shall be treated as health insurance coverage 
under a group health plan to which section 
9801 applies. 
‘‘(4) CONTRIBUTION
AMOUNT.—For purposes 
of this section, the term ‘contribution amount’ 
means, with respect to an individual under a group 
health plan, the portion of the applicable premium of 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
‘‘(A) IN
GENERAL.—The requirement of 
this paragraph is met with respect to health in-
surance coverage provided to a participant or 
beneficiary by any health insurance issuer if, 
under such plan the requirements of section 
9801 are met with respect to the participant or 
beneficiary. 
‘‘(B) ENFORCEMENT
WITH
RESPECT
TO 
INDIVIDUAL ELECTION.—For purposes of sub-
paragraph (A), any health insurance coverage 
with respect to the participant or beneficiary 
shall be treated as health insurance coverage 
under a group health plan to which section 
9801 applies. 
‘‘(4) CONTRIBUTION AMOUNT.— 
‘‘(A) IN GENERAL.—For purposes of this 
subsection, the term ‘contribution amount’ 
means, with respect to any period of health in-
surance coverage offered to a participant or 
beneficiary, the portion of the applicable pre-
mium of such participant or beneficiary under 
such plan which is not paid by such participant 
or beneficiary. In the case that the employer of-
fers more than one group health plan, the con-
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
SEC. 109. CREDIT FOR SMALL EMPLOYERS ADOPTING 
AUTO-ENROLLMENT 
AND 
DEFINED 
CON-
TRIBUTION OPTIONS. 
(a) IN GENERAL.—Subpart D of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to business-related credits) is amended by 
adding at the end the following new section: 
‘‘SEC. 45S. AUTO-ENROLLMENT AND DEFINED CONTRIBU-
TION OPTION FOR HEALTH BENEFITS PLANS 
OF SMALL EMPLOYERS. 
‘‘(a) IN GENERAL.—For purposes of section 38, in 
the case of a small employer, the health benefits plan im-
plementation credit determined under this section for the 
taxable year is an amount equal to 100 percent of the 
amount paid or incurred by the taxpayer during the tax-
able year for qualified health benefits expenses. 
‘‘(b) LIMITATION.—The credit determined under sub-
section (a) with respect to any taxpayer for any taxable 
year shall not exceed the excess of— 
‘‘(1) $1,500, over 
‘‘(2) sum of the credits determined under sub-
section (a) with respect to such taxpayer for all pre-
ceding taxable years. 
‘‘(c) QUALIFIED HEALTH BENEFITS EXPENSES.— 
For purposes of this section, the term ‘qualified health 
benefits auto-enrollment expenses’ means, with respect to 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00039
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS
143 
‘‘(i) prohibit an individual, solely on 
the basis of affiliation with the issuer, 
from serving as an independent medical re-
viewer if— 
‘‘(I) a non-affiliated individual is 
not reasonably available; 
‘‘(II) the affiliated individual is 
not involved in the provision of items 
or services in the case under review; 
‘‘(III) the fact of such an affili-
ation is disclosed to the issuer and the 
enrollee (or authorized representative) 
and neither party objects; and 
‘‘(IV) the affiliated individual is 
not an employee of the issuer and 
does not provide services exclusively or 
primarily to or on behalf of the issuer; 
‘‘(ii) prohibit an individual who has 
staff privileges at the institution where the 
treatment involved takes place from serv-
ing as an independent medical reviewer 
merely on the basis of such affiliation if 
the affiliation is disclosed to the issuer and 
the enrollee (or authorized representative), 
and neither party objects; or 
VerDate Mar 15 2010 
21:55 Jan 11, 2011
Jkt 099200
PO 00000
Frm 00143
Fmt 6652
Sfmt 6201
E:\BILLS\H105.IH
H105
srobinson on DSKHWCL6B1PROD with BILLS