163 
‘‘(iv) INCLUSION
OF
INPUT
FROM 
STAKEHOLDERS.—Patients, 
providers, 
health 
care 
consumer 
representatives, 
health industry representatives, and law-
makers shall be consulted regarding prior-
ities and dissemination of the research.’’; 
(3) in paragraph (3)(C), by adding at the end 
the following: 
‘‘(iii) UPDATES.—The Secretary shall 
make available and disseminate updated 
evaluations, syntheses, and findings under 
this subparagraph not less than every 6 
months.’’; and 
(4) in paragraph (4)(A), by striking ‘‘the pro-
grams established under titles XVIII, XIX, and XXI 
of the Social Security Act’’ and inserting ‘‘the Fed-
eral health care programs’’. 
(b) REPORTS TO CONGRESS.—Such section is further 
amended— 
(1) by redesignating subsection (e) as sub-
section (f); and 
(2) by inserting after subsection (d) the fol-
lowing: 
‘‘(e) REPORTS.—Not later than 1 year after the date 
of the enactment of this subsection, and annually there-
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164 
after, the Secretary, in consultation with the Comparative 
Effectiveness Advisory Board, shall submit to Congress a 
report on the activities conducted under this section. The 
report submitted under this subsection in 2013 shall in-
clude a description of the total activities conducted under 
this section since the date of the enactment of this sub-
section, including— 
‘‘(1) an evaluation of the return on the invest-
ment in the program conducted under this section, 
including the overall cost of the program, the sci-
entific knowledge created through the program, and 
the ways in which such knowledge has been used; 
‘‘(2) an evaluation of any backlog of unfunded 
research projects; and 
‘‘(3) an assessment of— 
‘‘(A) how the program is working; 
‘‘(B) the governance structure of the pro-
gram; 
‘‘(C) the ability of the program to include 
public comment and patient perspectives in pri-
ority setting; and 
‘‘(D) the ability of the program to dissemi-
nate findings and conclusions.’’. 
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165 
SEC. 802. HEALTH CARE COMPARATIVE EFFECTIVENESS 
RESEARCH TRUST FUND; FINANCING FOR 
TRUST FUND. 
(a) ESTABLISHMENT OF TRUST FUND.— 
(1) IN GENERAL.—Subchapter A of chapter 98 
of the Internal Revenue Code of 1986 (relating to 
Trust Fund code), as amended by this Act, is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 9512. HEALTH CARE COMPARATIVE EFFECTIVENESS 
RESEARCH TRUST FUND. 
‘‘(a) CREATION OF TRUST FUND.—There is estab-
lished in the Treasury of the United States a Trust Fund 
to be known as the ‘Health Care Comparative Effective-
ness Research Trust Fund’ (hereinafter in this section re-
ferred to as the ‘Trust Fund’), consisting of such amounts 
as may be appropriated or credited to such Trust Fund 
as provided in this section and section 9602(b). 
‘‘(b) TRANSFERS TO FUND.—There are hereby ap-
propriated to the Trust Fund the following: 
‘‘(1) Amounts equivalent to the net revenues re-
ceived in the Treasury from the fees imposed under 
subchapter B of chapter 34 (relating to fees on 
health insurance and self-insured plans). 
‘‘(2) Subject to subsection (c)(2), for each fiscal 
year beginning with fiscal year 2010, amounts deter-
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166 
mined by the Secretary of Health and Human Serv-
ices to be equivalent to fair share amount deter-
mined under subsection (c) multiplied by the average 
number of individuals entitled to benefits under part 
A, or enrolled under part B, of title XVIII of the So-
cial Security Act during such fiscal year. 
The amounts appropriated under paragraph (2) shall be 
transferred from the Federal Hospital Insurance Trust 
Fund (established under section 1817 of the Social Secu-
rity Act) and from the Federal Supplementary Medical In-
surance Trust Fund (established under section 1841 of 
such Act), and from the Medicare Prescription Drug Ac-
count within such Trust Fund, in proportion (as estimated 
by the Secretary) to the total expenditures during such 
fiscal year that are made under title XVIIII of such Act 
from the respective Trust Fund or account. 
‘‘(c) FAIR SHARE AMOUNT.— 
‘‘(1) IN GENERAL.—The Secretary of Health 
and Human Services shall compute for each fiscal 
year (beginning with fiscal year 2010) a fair share 
amount under this subsection that is an amount 
that, when applied under this section and subchapter 
B of chapter 34 of the Internal Revenue Code of 
1986, will result in revenues to the Trust Fund (tak-
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167 
ing into account any outstanding balance in the 
Trust Fund) for the fiscal year as follows: 
‘‘(A) for fiscal year 2010, $100,000,000; 
‘‘(B) for fiscal year 2011, $200,000,000; 
and 
‘‘(C) for each of fiscal years 2012 through 
2014, $900,000,000. 
‘‘(2) LIMITATION ON MEDICARE FUNDING.—In 
no case shall the amount transferred under sub-
section 
(b)(2) 
for 
any 
fiscal 
year 
exceed 
$200,000,000. 
‘‘(d) EXPENDITURES FROM FUND.—Amounts in the 
Trust Fund are available to the Secretary of Health and 
Human Services for carrying out section 1013 of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003. 
‘‘(e) NET REVENUES.—For purposes of this section, 
the term ‘net revenues’ means the amount estimated by 
the Secretary based on the excess of— 
‘‘(1) the fees received in the Treasury under 
subchapter B of chapter 34, over 
‘‘(2) the decrease in the tax imposed by chapter 
1 resulting from the fees imposed by such sub-
chapter.’’. 
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168 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter A is amended by adding 
at the end thereof the following new item: 
‘‘Sec. 9512. Health Care Comparative Effectiveness Research Trust Fund.’’. 
(b) FINANCING FOR FUND FROM FEES ON INSURED 
AND SELF-INSURED HEALTH PLANS.— 
(1) GENERAL RULE.—Chapter 34 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new subchapter: 
‘‘Subchapter B—Insured Health Plans 
‘‘Sec. 4375. Health insurance. 
‘‘Sec. 4376. Definitions and special rules. 
‘‘SEC. 4375. HEALTH INSURANCE. 
‘‘(a) IMPOSITION OF FEE.—There is hereby imposed 
on each specified health insurance policy for each policy 
year a fee equal to the fair share amount determined 
under section 9512(c)(1) multiplied by the average num-
ber of lives covered under the policy. 
‘‘(b) LIABILITY FOR FEE.—The fee imposed by sub-
section (a) shall be paid by the issuer of the policy. 
‘‘(c) SPECIFIED HEALTH INSURANCE POLICY.—For 
purposes of this section— 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this section, the term ‘specified health in-
surance policy’ means any accident or health insur-
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169 
ance policy issued with respect to individuals resid-
ing in the United States. 
‘‘(2) EXEMPTION OF CERTAIN POLICIES.—The 
term ‘specified health insurance policy’ does not in-
clude any insurance policy if substantially all of the 
coverage provided under such policy relates to— 
‘‘(A) liabilities incurred under workers’ 
compensation laws, 
‘‘(B) tort liabilities, 
‘‘(C) liabilities relating to ownership or use 
of property, 
‘‘(D) credit insurance, 
‘‘(E) Medicare supplemental coverage, or 
‘‘(F) such other similar liabilities as the 
Secretary may specify by regulations. 
‘‘(3) TREATMENT OF PREPAID HEALTH COV-
ERAGE ARRANGEMENTS.— 
‘‘(A) IN GENERAL.—In the case of any ar-
rangement described in subparagraph (B)— 
‘‘(i) such arrangement shall be treated 
as a specified health insurance policy, and 
‘‘(ii) the person referred to in such 
subparagraph shall be treated as the 
issuer. 
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170 
‘‘(B) DESCRIPTION OF ARRANGEMENTS.— 
An arrangement is described in this subpara-
graph if under such arrangement fixed pay-
ments or premiums are received as consider-
ation for any person’s agreement to provide or 
arrange for the provision of accident or health 
coverage to residents of the United States, re-
gardless of how such coverage is provided or ar-
ranged to be provided. 
‘‘SEC. 4376. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this sub-
chapter— 
‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The 
term ‘accident and health coverage’ means any cov-
erage which, if provided by an insurance policy, 
would cause such policy to be a specified health in-
surance policy (as defined in section 4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘insurance 
policy’ means any policy or other instrument where-
by a contract of insurance is issued, renewed, or ex-
tended. 
‘‘(3) UNITED
STATES.—The term ‘United 
States’ includes any possession of the United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTITIES.— 
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‘‘(1) IN GENERAL.—For purposes of this sub-
chapter— 
‘‘(A) the term ‘person’ includes any gov-
ernmental entity, and 
‘‘(B) notwithstanding any other law or rule 
of law, governmental entities shall not be ex-
empt from the fees imposed by this subchapter 
except as provided in paragraph (2). 
‘‘(2) TREATMENT OF EXEMPT GOVERNMENTAL 
PROGRAMS.—In the case of an exempt governmental 
program, no fee shall be imposed under section 4375 
or section 4376 on any covered life under such pro-
gram. 
‘‘(3) EXEMPT
GOVERNMENTAL
PROGRAM
DE-
FINED.—For purposes of this subchapter, the term 
‘exempt governmental program’ means— 
‘‘(A) any insurance program established 
under title XVIII of the Social Security Act, 
‘‘(B) the medical assistance program es-
tablished by title XIX or XXI of the Social Se-
curity Act, 
‘‘(C) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to individuals (or 
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172 
the spouses and dependents thereof) by reason 
of such individuals being— 
‘‘(i) members of the Armed Forces of 
the United States, or 
‘‘(ii) veterans, and 
‘‘(D) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to members of In-
dian tribes (as defined in section 4(d) of the In-
dian Health Care Improvement Act). 
‘‘(c) TREATMENT AS TAX.—For purposes of subtitle 
F, the fees imposed by this subchapter shall be treated 
as if they were taxes. 
‘‘(d) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this subchapter shall be covered over to any posses-
sion of the United States.’’ 
(2) CLERICAL
AMENDMENT.—Chapter 34 of 
such Code is amended by striking the chapter head-
ing and inserting the following: 
‘‘CHAPTER 34—TAXES ON CERTAIN 
INSURANCE POLICIES 
‘‘SUBCHAPTER A—POLICIES ISSUED BY FOREIGN INSURERS 
‘‘SUBCHAPTER B— INSURED HEALTH PLANS 
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‘‘Subchapter A—Policies Issued By Foreign 
Insurers’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this section shall apply with respect to policies 
and plans for portions or policy or plan years begin-
ning on or after October 1, 2008. 
SEC. 803. IMPROVED COORDINATION OF HEALTH SERVICES 
RESEARCH. 
(a) ADDITIONAL DUTIES FOR FCCCER.— 
(1) PUBLIC
MEETINGS.—Not later than 120 
days after the date of the enactment of this Act, the 
Federal Coordinating Council for Comparative Ef-
fectiveness Research established under section 804 
of division A of the American Recovery and Rein-
vestment Act of 2009 (Public Law 111–5), in this 
section referred to as the ‘‘Council’’, shall hold pub-
lic meetings with producers and users of health serv-
ices research to examine— 
(A) the major infrastructure challenges 
facing the field of health services research; 
(B) the field’s research priorities over the 
next 5 years; 
(C) the current portfolio of health services 
research being funded; 
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174 
(D) ways to stimulate innovation in the 
field of health services research; and 
(E) ways in which the field of health serv-
ices research might help to transform the health 
care system by 2021. 
(2) ADDITIONAL MEETINGS.—The Council may 
hold additional public meetings on subjects other 
than those listed in the paragraph (1) so long as the 
meetings are determined to be necessary by the 
Council in carrying out its duties. Additional meet-
ings are not required to be completed within the 
time period specified in paragraph (1). 
(3) DEVELOP A STRATEGIC PLAN.—Not later 
than 2 years after the meetings described in para-
graph (1) and (2) are completed, the Council shall 
prepare and make public through the Internet and 
other channels a strategic plan for the field of health 
services research, which plan shall include the fol-
lowing: 
(A) A health services research agenda to 
address the Nation’s evolving health care prior-
ities. 
(B) A plan for addressing the infrastruc-
ture needs of the field of health services re-
search, including professional development for 
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175 
the next generation of researchers and improved 
methods and data. 
(C) A plan for fostering innovation in the 
field of health services research. 
(D) A uniform definition of health services 
research and standard research categories to be 
used across the funders of health services re-
search in developing research budgets and re-
porting research expenditures. 
(b) ANNUAL REPORT.—Not later than 1 year after 
the publication of the Council’s strategic plan under sub-
section (a)(3), and annually thereafter, the Council shall 
report to the Congress on, and make public a detailed de-
scription of, the following: 
(1) The Council’s progress in implementing the 
strategic plan. 
(2) Organizational expenditures in health serv-
ices research by the Federal agencies participating 
in the Counco; according to the uniform definition 
and standard research categories developed by the 
Council. 
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176 
TITLE 
IX—CONTAINING 
MED-
ICAL COSTS AND GETTING 
MORE 
VALUE 
FOR 
THE 
HEALTH CARE DOLLAR 
SEC. 901. COST-CONTAINMENT RESULTS OF THE HEALTHY 
AMERICANS ACT. 
Congress finds that the Healthy Americans Act will 
result in the following: 
(1) Private insurance companies will be forced 
to hold down costs and will slow the rate of growth 
because they are required to offer standardized 
Healthy American Private Insurance plans. 
(2) Administrative savings will be derived from 
decoupling employers from the health care infra-
structure and reducing employers’ and insurers’ ad-
ministrative costs. 
(3) Private insurance companies will implement 
uniform billing and common claims forms. 
(4) Congress will reclaim Medicare and Med-
icaid disproportionate share hospital (DSH) pay-
ments because previously uninsured persons will go 
to providers on an outpatient basis instead of an 
emergency department. 
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(5) State and local governments will save 
money on programs they operated for the uninsured 
before enactment of this Act. 
(6) The Federal Government will save money 
on Federal tax subsidies that reward inefficient care 
and are regressive. 
(7) The Federal Government and the private 
sector will save money if the Food and Drug Admin-
istration determines whether products provide new 
value. 
(8) Reducing medical errors will save the gov-
ernment and the private sector money. 
(9) Requiring hospitals to send large bills to pa-
tients for their review will reduce errors in medical 
billing and force major providers to be more cost 
conscious. 
(10) Requiring insurers to reimburse for quality 
and cost effective services will hold down private sec-
tor costs. 
(11) Reduction of Medicare’s restriction on bar-
gaining power for prescription drugs will reduce 
costs for sole source drugs and other medications. 
(12) 
Establishment 
of 
electronic 
medical 
records by insurers will create savings. 
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(13) Publication of cost and quality data will 
enable people to look up by zip code affordable high- 
quality providers. 
Æ 
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