income tax collected at source) is amended by add-
ing at the end the following new paragraph: 
‘‘(3) SPECIAL RULE FOR AMOUNTS IMPOSED BY 
SECTION 59B.— 
‘‘(A) IN
GENERAL.—In determining the 
amount required to be deducted and withheld 
from wages paid to an individual during any 
month by such individual’s employer, the 
amount imposed by section 59B shall be taken 
into account. 
‘‘(B) WAGES
NOT
REDUCED
BY
EXEMP-
TIONS.—In determining the amount to be de-
ducted and withheld by reason of subparagraph 
(A), the amount of wages shall not be reduced 
as provided in paragraph (2).’’. 
(3) CLERICAL
AMENDMENT.—The table of 
parts for subchapter A of chapter 1 of such Code is 
amended by adding at the end the following new 
item: 
‘‘PART VIII—AMERICAN HEALTH BENEFITS PROGRAM PREMIUMS’’. 
(b) CREDIT FOR SUBSIDY AND PREPAYMENTS OF 
AMERICAN HEALTH BENEFITS PREMIUMS.— 
(1) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code 
of 1986 is amended by inserting after section 36A 
the following new section: 
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‘‘SEC. 36B. SUBSIDY AND PREPAYMENT OF AMERICAN 
HEALTH BENEFITS PREMIUMS. 
‘‘(a) IN GENERAL.—In the case of a specified indi-
vidual (as defined in section 59B(b)), there shall be al-
lowed as a credit against the tax imposed by this subtitle 
for the taxable year an amount equal to the sum of— 
‘‘(1) the aggregate amount of premiums paid 
(other than any government contribution under sec-
tion 2204(a) of the Social Security Act) with respect 
to the coverage of such individual under title XXII 
of the Social Security Act, and 
‘‘(2) in the case of any premium subsidy-eligible 
individual, the applicable premium subsidy. 
‘‘(b) APPLICABLE PREMIUM SUBSIDY.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘applicable premium subsidy’ means, 
with respect to any premium subsidy-eligible indi-
vidual, the lowest premium in effect for the calendar 
year in which the taxable year begins (for the type 
of coverage involved) for any basic plan in the 
AHBP region involved, as determined by the Admin-
istrator of Health Benefits. 
‘‘(2) REDUCTION BASED ON FAMILY INCOME.— 
The amount otherwise determined under paragraph 
(1) shall be reduced (but not below zero) by an 
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amount which bears the same ratio to the amount 
so determined as— 
‘‘(A) the amount (if any) by which the tax-
payer’s family income for the taxable year ex-
ceeds the lowest income threshold, bears to 
‘‘(B) the lowest income threshold. 
‘‘(c) PREMIUM SUBSIDY-ELIGIBLE INDIVIDUAL.— 
For purposes of this section, the term ‘premium subsidy- 
eligible individual’ means an individual— 
‘‘(1) who is enrolled, and required to be en-
rolled, in a qualified health plan under title XXII of 
the Social Security Act, 
‘‘(2) whose family income does not exceed twice 
the lowest income threshold, and 
‘‘(3) who does not have in effect (and, in the 
case of family coverage, each other individual cov-
ered under such coverage does not have in effect), 
in a form and manner specified by the Secretary of 
the Treasury in consultation with the Administrator 
of Health Benefits, for any portion of the taxable 
year of such individual an objection to the release of 
information under section 6103(k)(10). 
‘‘(d) LOWEST INCOME THRESHOLD.—For purposes 
of this section, the term ‘lowest income threshold’ means, 
with respect to coverage consisting of— 
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‘‘(1) only an individual, 125 percent of the pov-
erty line (as defined in section 673(2) of the Com-
munity Services Block Grant Act (42 U.S.C. 
9902(2)), including any revision required by such 
section) for a single individual for the calendar year 
which includes the close of the taxable year, or 
‘‘(2) a family of two or more individuals, 150 
percent of the poverty line (as so defined) for a fam-
ily of the size involved for the calendar year which 
includes the close of the taxable year. 
‘‘(e) FAMILY INCOME.—For purposes of this sec-
tion— 
‘‘(1) IN GENERAL.—The term ‘family income’ 
means, with respect to a specified individual (as de-
fined in section 59B(b)) covered under coverage con-
sisting of— 
‘‘(A) only such individual, the modified ad-
justed gross income of such individual, or 
‘‘(B) two or more individuals, the sum of 
the modified adjusted gross income of the speci-
fied individual and the modified adjusted gross 
income of each other individual covered under 
the plan for the taxable year that ends in or 
with the taxable year of the specified individual. 
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‘‘(2) MODIFIED
ADJUSTED
GROSS
INCOME.— 
The term ‘modified adjusted gross income’ means 
adjusted gross income— 
‘‘(A) determined without regard to sections 
135, 911, 931, and 933, and 
‘‘(B) increased by the amount of interest 
received or accrued during the taxable year 
which is exempt from tax under this title. 
‘‘(f) DENIAL
OF CREDIT
TO DEPENDENTS.—No 
credit shall be allowed under this section to any individual 
with respect to whom a deduction under section 151 is 
allowable to another taxpayer for a taxable year beginning 
in the calendar year in which such individual’s taxable 
year begins. 
‘‘(g) REGULATIONS.—The Secretary may prescribe 
such regulations as are necessary or appropriate to carry 
out this section, including regulations which provide for 
not taking into account individuals with de minimis in-
come for purposes of determining family income for pur-
poses of this section.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Paragraph (2) of section 1324(b) of 
title 31, United States Code, is amended by in-
serting ‘‘36B,’’ after ‘‘36A,’’. 
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(B) The table of section for subpart C of 
part IV of subchapter A of chapter 1 of the In-
ternal Revenue Code of 1986 is amended by in-
serting after the item relating to section 36A 
the following new item: 
‘‘Sec. 36B. Subsidy and prepayment of American Health Benefits premiums.’’. 
(c) EMPLOYER FUNDING.— 
(1) IN GENERAL.—Subtitle C of the Internal 
Revenue Code of 1986 (relating to employment 
taxes) is amended by redesignating chapter 25 as 
chapter 26 and by inserting after chapter 24 the fol-
lowing new chapter: 
‘‘CHAPTER 25—AMERICAN HEALTH 
BENEFITS PROGRAM 
‘‘Sec. 3451. Tax on employers. 
‘‘Sec. 3452. Refund of tax in case of qualified employer-provided coverage. 
‘‘Sec. 3453. Instrumentalities of the United States. 
‘‘SEC. 3451. TAX ON EMPLOYERS. 
‘‘(a) IMPOSITION
OF TAX.—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 the applicable percentage of the wages paid by him with 
respect to employment. 
‘‘(b) APPLICABLE PERCENTAGE.—For purposes of 
this section— 
‘‘(1) IN GENERAL.—The term ‘applicable per-
centage’ means, with respect to wages paid during 
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any taxable year of an employer of a specified firm 
size and average earnings per employee, the percent-
age determined in accordance with the following 
table: 
‘‘Applicable percentage (in percent) 
A firm size of: 
Average 
earnings per 
employee of 
$21,000 or 
less: 
Average 
earnings per 
employee of 
more than 
$21,000 and 
not in 
excess of 
$42,000: 
Average 
earnings per 
employee of 
more than 
$42,000 and 
not in 
excess of 
$83,000: 
Average 
earnings per 
employee of 
more than 
$83,000: 
Less than 10 ...........
4.00 
5.00 
6.00 
8.75
10 through 25 ........
4.25 
5.25 
6.75 
9.50
26 through 49 ........
4.50 
5.50 
7.25 
10.00
50 through 199 ......
4.75 
5.75 
8.00 
10.00
200 through 499 ....
5.00 
6.00 
8.75 
10.00
500 or more ............
5.25 
6.25 
9.50 
10.00. 
‘‘(2) FIRM SIZE.—The term ‘firm size’ means, 
with respect to any employer for any taxable year, 
the average number of employees employed by such 
person during the 3 taxable years preceding such 
taxable year. 
‘‘(3) AVERAGE
EARNINGS
PER
EMPLOYEE.— 
With respect to any employer for any taxable year— 
‘‘(A) IN
GENERAL.—The term ‘average 
earnings per employee’ means the average earn-
ings of such employer for such taxable year di-
vided by the firm size of such employer for such 
taxable year. 
‘‘(B) AVERAGE EARNINGS.—The term ‘av-
erage earnings’ means the average taxable in-
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come of the employer for the 3 taxable years 
preceding such taxable year. 
‘‘(4) AGGREGATION RULE.—All persons treated 
as a single employer under subsection (a) or (b) of 
section 52, or subsection (m) or (o) of section 414, 
shall be treated as one person. 
‘‘(5) INFLATION ADJUSTMENT.—In the case of 
a taxable year beginning after December 31, 2012, 
each of the dollar amounts in the table contained in 
paragraphs (1) 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-
mined by substituting ‘calendar year 2011’ for 
‘calendar year 1992’ in subparagraph (B) 
thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $100, such amount shall 
be rounded to the nearest multiple of $100. 
‘‘(c) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this chapter shall be covered over to any possession 
of the United States. 
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‘‘(d) OTHER DEFINITIONS.—For purposes of this 
chapter, the terms ‘wages’, ‘employer’, and ‘employment’ 
have the same respective meanings as when used in chap-
ter 21 and section 3121(a)(1) shall apply for purposes of 
this chapter in the same manner as such section applies 
for purposes of section 3101(a) and 3111(a). 
‘‘SEC. 3452. REFUND OF TAX IN CASE OF QUALIFIED EM-
PLOYER-PROVIDED COVERAGE. 
‘‘(a) IN GENERAL.—In the case of a person subject 
to tax under section 3451 or section 1401(c), there shall 
be allowed as a credit against the tax imposed by such 
section an amount equal to the tax imposed under such 
section with respect to the wages or self-employment in-
come of individuals for periods during which the individual 
is covered by qualified employer-provided coverage (which 
is provided by such person). 
‘‘(b) 
QUALIFIED
EMPLOYER-PROVIDED
COV-
ERAGE.—For purposes of subsection (a), the term ‘quali-
fied employer-provided coverage’ has the meaning given 
that term in section 2207(6) of the Social Security Act. 
‘‘SEC. 3453. INSTRUMENTALITIES OF THE UNITED STATES. 
‘‘Notwithstanding any other provision of law (wheth-
er enacted before or after the enactment of this section) 
which grants to any instrumentality of the United States 
an exemption from taxation, such instrumentality shall 
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not be exempt from the tax imposed by section 3451 un-
less such other provision of law grants a specific exemp-
tion, by reference to section 3451, from the tax imposed 
by such section.’’. 
(2) SELF-EMPLOYMENT.—Section 1401 of such 
Code is amended by redesignating subsection (c) as 
subsection (d) and by inserting after subsection (b) 
the following new subsection: 
‘‘(c) AMERICAN HEALTH BENEFITS PROGRAM.—In 
addition to other taxes, there shall be imposed for each 
taxable year, on the self-employment income of every indi-
vidual, a tax equal to the applicable percentage (as defined 
in section 3451(b)) of the amount of the self-employment 
income for such taxable year.’’. 
(3) CLERICAL
AMENDMENT.—The table of 
chapters for subtitle C of such Code is amended by 
striking the item relating to chapter 25 and insert-
ing the following: 
‘‘CHAPTER 25—AMERICAN HEALTH BENEFITS PROGRAM 
‘‘CHAPTER 26—GENERAL PROVISIONS RELATING TO EMPLOYMENT TAXES’’. 
(d) ADDITIONAL TAX ON HOSPITAL REVENUES.— 
(1) IN GENERAL.—Subchapter A of chapter 1 
of the Internal Revenue Code of 1986, as amended 
by this Act, is amended by adding at the end the fol-
lowing new part: 
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‘‘PART IX—TAX ON HOSPITAL REVENUES 
‘‘Sec. 59D. Tax on hospital revenues. 
‘‘SEC. 59D. TAX ON HOSPITAL REVENUES. 
‘‘(a) IN GENERAL.—In the case of a corporation, 
there is hereby imposed (in addition to any other tax im-
posed by this subtitle) a tax equal to 2 percent of the hos-
pital revenues of such corporation. 
‘‘(b) HOSPITAL REVENUES.—For purposes of this 
section, the term ‘hospital revenues’ means, with respect 
to any corporation for any taxable year, the excess (if any) 
of— 
‘‘(1) so much of such corporation’s gross in-
come for such taxable year as is derived from the 
operation of one or more hospitals (as defined in 
section 1861(e) of the Social Security Act), over 
‘‘(2) so much of the deductions allowed under 
this chapter for such taxable year as are properly al-
locable to such income. 
‘‘(c) SECTION 15 NOT TO APPLY.—Section 15 shall 
not apply to the tax imposed by this section.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 26(b)(2) of the Internal Rev-
enue Code of 1986 is amended by striking 
‘‘and’’ at the end of subparagraph (W), by 
striking the period at the end of subparagraph 
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(X) and inserting ‘‘, and’’, and by adding at the 
end the following new subparagraph: 
‘‘(Y) section 59D (relating to tax on hos-
pital revenues).’’. 
(B) Section 30A(c) of such Code is amend-
ed by striking ‘‘or’’ at the end of paragraph (3), 
by striking the period at the end of paragraph 
(4) and inserting ‘‘, or’’, and by adding at the 
end the following new paragraph: 
‘‘(5) section 59D (relating to tax on hospital 
revenues).’’. 
(C) Section 882(a)(1) of such Code is 
amended by inserting ‘‘59D,’’ after ‘‘59A,’’. 
(D) Section 936(a)(3) of such Code is 
amended by striking ‘‘or’’ at the end of sub-
paragraph (C), by striking the period at the end 
of subparagraph (D) and inserting ‘‘, or’’, and 
by adding at the end the following new sub-
paragraph: 
‘‘(E) section 59D (relating to tax on hos-
pital revenues).’’. 
(E) Section 6425(c)(1)(A) of such Code is 
amended by striking ‘‘plus’’ at the end of clause 
(ii), by striking ‘‘over’’ at the end of clause (iii) 
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and inserting ‘‘plus’’, and by adding at the end 
the following new clause: 
‘‘(iv) the tax imposed by section 59D, 
over’’. 
(F) Section 6655(g)(1)(A) of such Code is 
amended by striking ‘‘plus’’ at the end of clause 
(iii), by redesignating clause (iv) as clause (v), 
and by inserting after clause (iii) the following 
new clause: 
‘‘(iv) the tax imposed by section 59D, 
plus’’. 
(G) The table of parts for subchapter A of 
chapter 1 of such Code is amended by adding 
at the end the following new item: 
‘‘PART VIII—TAX ON HOSPITAL REVENUES’’. 
(e) DISCLOSURE OF TAXPAYER RETURN INFORMA-
TION TO CARRY OUT COST-SHARING SUBSIDIES.— 
(1) IN GENERAL.—Section 6103(l) of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new paragraph: 
‘‘(21) DISCLOSURE OF RETURN INFORMATION 
TO CARRY OUT AMERICAN HEALTH BENEFITS PRO-
GRAM.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
upon written request from the Administrator of 
Health Benefits, disclose to officers, employees, 
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and contractors of the Health Benefits Admin-
istration return information of a taxpayer who 
is, according to the records of the Secretary, a 
cost-sharing subsidy-eligible individual (as de-
fined in section 2205(b)(7)(A) of the Social Se-
curity Act) or a family member of such an indi-
vidual. Such return information shall be limited 
to— 
‘‘(i) taxpayer identity information 
with respect to such taxpayer, 
‘‘(ii) the filing status of such tax-
payer, 
‘‘(iii) the adjusted gross income of 
such taxpayer, 
‘‘(iv) the amounts excluded from such 
taxpayer’s gross income under sections 135 
and 911 to the extent such information is 
available, 
‘‘(v) the interest received or accrued 
during the taxable year which is exempt 
from the tax imposed by chapter 1 to the 
extent such information is available, 
‘‘(vi) the amounts excluded from such 
taxpayer’s gross income by sections 931 
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and 933 to the extent such information is 
available, and 
‘‘(vii) the taxable year with respect to 
which the preceding information relates. 
‘‘(B) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return information disclosed 
under subparagraph (A) may be used by offi-
cers, employees, and contractors of the Health 
Benefits Administration only for the purposes 
of, and to the extent necessary in, establishing 
the appropriate amount of any cost-sharing 
subsidies under section 2205 of the Social Secu-
rity Act.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Paragraph (3) of section 6103(a) of 
such Code is amended by striking ‘‘or (20)’’ 
and inserting ‘‘(20), or (21)’’. 
(B) Paragraph (4) of section 6103(p) of 
such Code is amended by striking ‘‘(l)(16), 
(17), (19), or (20)’’ each place it appears and 
inserting ‘‘(l)(16), (17), (19), (20), or (21)’’. 
(C) Paragraph (2) of section 7213(a) of 
such Code is amended by striking ‘‘or (20)’’ 
and inserting ‘‘(20), or (21)’’. 
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(f) DISCLOSURE OF TAXPAYER RETURN INFORMA-
TION TO CARRY OUT PREMIUM SUBSIDIES.—Section 
6103(k) of the Internal Revenue Code of 1986 is amended 
by adding at the end the following new paragraph: 
‘‘(10) DISCLOSURE OF INFORMATION TO AD-
MINISTER
PREMIUM
SUBSIDY
UNDER
SECTION 
36B.—To the extent that Secretary determines that 
disclosure is necessary to permit the effective admin-
istration of section 36B, the Secretary may disclose 
the modified adjusted gross income (as defined in 
section 36B) of any individual whose modified ad-
justed gross income is taken into account in deter-
mining the amount of any credit under such sec-
tion.’’. 
(g) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall take effect on January 1, 2012. 
(2) SUBSECTIONS (a) AND (b).—The amend-
ments made by subsections (a) and (b) shall apply 
to months beginning after December 31, 2011, in 
taxable years ending after such date. 
(3) SUBSECTION (d).—The amendments made 
by subsection (d) shall apply to taxable years begin-
ning after December 31, 2011. 
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SEC. 4. AMENDMENTS TO THE MEDICAID PROGRAM AND 
SCHIP. 
(a) MAINTENANCE OF EFFORT IN MEDICAID PAY-
MENTS.—Section 1902 of the Social Security Act (42 
U.S.C. 1396b) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(gg)(1) For each State fiscal year that begins on 
or after January 1 of the first calendar year in which cov-
erage is provided under title XXII, each State shall submit 
a report to the Secretary on the amount of State expendi-
tures for health services, as defined by the Secretary. 
‘‘(2) Subject to paragraph (4), if the amount so re-
ported for a State fiscal year is less than the amount spec-
ified in paragraph (3) for that State fiscal year, the State 
shall provide for payment to the Secretary of the amount 
of such difference. The provisions of subparagraphs (B) 
and (C) of section 1935(c)(1) shall apply to payment 
under the previous sentence in the same manner as they 
apply to payment under subparagraph (A) of such section, 
except that such payments shall be deposited into the 
American Health Benefits Program Trust Fund estab-
lished under section 2204(c). 
‘‘(3) The amount specified in this paragraph for a 
State for— 
‘‘(A) the first State fiscal year described in 
paragraph (1), is the total amount of the State 
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share of expenditures for health services (as defined 
in paragraph (1)) under all public health programs 
operated in the State that are funded in whole or in 
part with State expenditures, including expenditures 
under this title and title XXI, for the previous State 
fiscal year; and 
‘‘(B) a subsequent State fiscal year, is the 
amount specified in this paragraph for the previous 
State fiscal year increased by the percentage change, 
if any, in the consumer price index for all urban con-
sumers for the most recent completed Federal fiscal 
year. 
‘‘(4) The Secretary may waive payment of all or a 
portion of the amount otherwise payable under paragraph 
(2) based on criteria specified by the Secretary’’. 
(b) SUNSET OF SCHIP FUNDING.—Section 2105 of 
such Act (42 U.S.C. 1397ee) is amended by adding at the 
end the following new subsection: 
‘‘(h) SUNSET OF PROGRAM UPON INITIATION OF 
AMERICAN HEALTH BENEFITS PROGRAM.—No payment 
shall be made under this title to a State for items and 
services furnished after the effective date of the American 
Health Benefits Program under title XXII.’’. 
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(c) REDUCTION IN MEDICAID DSH PAYMENTS.— 
Section 1923(f) of such Act (42 U.S.C. 1396r–4(f)) is 
amended— 
(1) by redesignating paragraph (7) as para-
graph (8); and 
(2) by inserting after paragraph (6) the fol-
lowing new paragraph: 
‘‘(7) 
REDUCTION
IN
CONNECTION
WITH 
AHBP.—Notwithstanding the previous provisions in 
this paragraph, the Secretary shall provide for a 
phased-down reduction over a 5-fiscal-year-period 
beginning with fiscal year 2012 of the amount of the 
DSH allotment for each State so that, by the end 
of such period, such amount is equal to 10 percent 
of the amount of such allotment for such State for 
fiscal year 2011.’’. 
SEC. 5. CONSULTATION IN IMPLEMENTATION OF HEALTH 
INFORMATION TECHNOLOGIES. 
The Administrator of Health Benefits (appointed 
under section 2206(d)(1) of the Social Security Act, as 
added by section 2(a)) shall consult with the Office of the 
National Coordinator for Health Information Technology 
and the Secretary of Health and Human Services in car-
rying out the implementation of health information tech-
nology in compliance with the amendments made by divi-
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sion B of the American Recovery and Reinvestment Act 
of 2009 (Public Law 111–5) and regulations promulgated 
under section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996). 
SEC. 6. NON-PREEMPTION OF EXISTING COLLECTIVE BAR-
GAINING AGREEMENTS. 
Nothing in this Act shall be construed as preempting 
any collective bargaining agreement that is in effect as of 
the date of the enactment of this Act, during the period 
in which such agreement is in effect (without regard to 
any extension of such agreement effected as such date of 
enactment). 
SEC. 7. HEALTH BENEFITS COMMISSION. 
(a) ESTABLISHMENT.—There is established in the 
legislative branch an independent commission to be known 
as the Health Benefits Commission (in this section re-
ferred to as the ‘‘Commission’’). 
(b) DUTIES OF THE COMMISSION.— 
(1) GENERAL DUTIES.—The Commission shall 
examine and make recommendations regarding the 
major issues and cost drivers affecting the delivery 
of health care services as it pertains to the American 
Health Benefits Program under title XXII of the 
Social Security Act (in this section referred to as 
‘‘AHBP’’). 
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(2) SPECIFIC ISSUES.—The Commission shall 
specifically examine and make recommendations re-
garding each of the following: 
(A) A comparison of AHBP to other public 
health insurance programs (described in section 
2202(b)(2) of the Social Security Act) and the 
feasibility and desirability of their integration 
into AHBP. 
(B) The proper implementation and utili-
zation of electronic medical records and other 
health information technologies, including pri-
vacy and interoperability issues. 
(C) The effects of medical malpractice in-
surance and ‘‘defensive medicine’’ on the deliv-
ery and cost of health care. 
(D) The patterns and effects of overutiliza-
tion on AHBP. 
(E) Cost and implementation factors of re-
tiree health coverage under AHBP. 
(F) A comparison of prescription drug 
prices under AHBP with such prices under 
other public health programs. 
(G) The effects of insurance monopolies on 
health care costs and delivery. 
(c) MEMBERSHIP.— 
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(1) NUMBER AND APPOINTMENT.—The Com-
mission shall be composed of 9 members, of whom— 
(A) one shall be appointed by the Presi-
dent; 
(B) two shall be appointed by the majority 
leader of the Senate; 
(C) two shall be appointed by the minority 
leader of the Senate; 
(D) two shall be appointed by the Speaker 
of the House of Representatives; and 
(E) two shall be appointed by the minority 
leader of the House of Representatives. 
Members shall first be appointed not later than 60 
days after the date of the enactment of this Act. 
(2) TERMS.— 
(A) IN GENERAL.—The terms of members 
of the Commission shall be for 3 years, except 
that of the members first appointed— 
(i) the initial term shall be for 2 years 
in the case of one of the members ap-
pointed under paragraph (1)(C), as speci-
fied by the minority leader of the Senate, 
one of the members appointed under para-
graph (1)(D), as specified by the Speaker 
of the House of Representatives, and one 
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(4) QUORUM.—A quorum shall consist of 5 
members of the Commission, except that 3 members 
may conduct a hearing under subsection (e). 
(5) VACANCIES.—A vacancy on the Commission 
shall be filled in the same manner in which the origi-
nal appointment was made not later than 30 days 
after the Commission is given notice of the vacancy 
and shall not affect the power of the remaining 
members to execute the duties of the Commission. 
(6) COMPENSATION.—While serving on the 
business of the Commission (including traveltime), a 
member of the Commission shall be entitled to com-
pensation at the per diem equivalent of the rate pro-
vided for level IV of the Executive Schedule under 
section 5315 of title 5, United States Code; and 
while so serving away from home and the member’s 
regular place of business, a member may be allowed 
travel expenses, as authorized by the Chairman of 
the Commission. 
(7) CHAIR; VICE CHAIR.—The Speaker of the 
House of Representatives shall designate a member 
of the Commission at the time of appointment of the 
member as Chair and a member as Vice Chair for 
that term of appointment, except that in the case of 
vacancy of the Chair or Vice Chair, the Speaker may 
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designate another member for the remainder of that 
member’s term. 
(8) EXPENSES.—Each member of the Commis-
sion shall receive travel expenses and per diem in 
lieu of subsistence in accordance with sections 5702 
and 5703 of title 5, United States Code. 
(d) DIRECTOR AND STAFF; EXPERTS AND CONSULT-
ANTS.—The Commission may— 
(1) employ and fix the compensation of an Ex-
ecutive Director and such other personnel (not to ex-
ceed 11) as may be necessary to carry out its duties 
(without regard to the provisions of title 5, United 
States Code, governing appointments in the competi-
tive service), except that the rate of pay for the Ex-
ecutive Director and other personnel may not exceed 
the rate payable for level V of the Executive Sched-
ule under section 5316 of such title; 
(2) seek such assistance and support as may be 
required in the performance of its duties from ap-
propriate Federal departments and agencies; 
(3) enter into contracts or make other arrange-
ments, as may be necessary for the conduct of the 
work of the Commission (without regard to section 
3709 of the Revised Statutes (41 U.S.C. 5)); 
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(4) make advance, progress, and other pay-
ments which relate to the work of the Commission; 
(5) provide transportation and subsistence for 
persons serving without compensation; 
(6) procure supplies, services, and property by 
contract in accordance with applicable laws and reg-
ulations and to the extent or in such amounts as are 
provided in appropriations Acts; 
(7) enter into contracts with departments, 
agencies, and instrumentalities of the Federal Gov-
ernment, State agencies, and private firms, institu-
tions, and agencies, for the conduct of research or 
surveys, the preparation of reports, and other activi-
ties necessary for the discharge of the duties of the 
Commission, to the extent or in such amounts as are 
provided in appropriations Acts; 
(8) notwithstanding section 1342 of title 31, 
United States Code, accept and utilize the services 
of volunteers serving without compensation and re-
imburse such volunteers for local travel and office 
supplies, and for other travel expenses, including per 
diem in lieu of substance, as authorized by section 
5703 of title 5, of such Code; and 
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(9) prescribe such rules and regulations as it 
deems necessary with respect to the internal organi-
zation and operation of the Commission. 
Physicians serving as personnel of the Commission may 
be provided a physician comparability allowance by the 
Commission in the same manner as Government physi-
cians may be provided such an allowance by an agency 
under section 5948 of title 5, United States Code, and 
for such purpose subsection (i) of such section shall apply 
to the Commission in the same manner as it applies to 
the Tennessee Valley Authority. A person providing volun-
teer services to the Commission under paragraph (8) shall 
be considered an employee of the Federal Government in 
the performance of those services for the purposes of chap-
ter 81 of title 5, United States Code (relating to com-
pensation for work-related injuries), chapter 11 of title 18, 
of such Code (relating to conflicts of interests), and chap-
ter 171 of title 28, of such Code (relating to tort claims). 
(e) POWERS OF COMMISSION.— 
(1) HEARINGS
AND
OTHER
ACTIVITIES.—For 
the purpose of carrying out its duties, the Commis-
sion may hold such hearings and undertake such 
other activities as the Commission determines to be 
necessary to carry out its duties. 
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(2) COST
ESTIMATES
BY
CONGRESSIONAL 
BUDGET OFFICE.— 
(A) The Director of the Congressional 
Budget Office shall provide to the Commission, 
upon the request of the Commission, such cost 
estimates as the Commission determines to be 
necessary to carry out its duties. 
(B) The Commission shall reimburse the 
Director of the Congressional Budget Office for 
expenses relating to the employment in the of-
fice of the Director of such additional staff as 
may be necessary for the Director to comply 
with requests by the Commission under sub-
paragraph (A). 
(3) DETAIL OF FEDERAL EMPLOYEES.—Upon 
the request of the Commission, the head of any Fed-
eral agency is authorized to detail, without reim-
bursement, any of the personnel of such agency to 
the Commission to assist the Commission in car-
rying out its duties. Any such detail shall not inter-
rupt or otherwise affect the civil service status or 
privileges of the Federal employee. 
(4) TECHNICAL
ASSISTANCE.—Upon the re-
quest of the Commission, the head of a Federal 
agency shall provide on a reimbursable basis such 
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technical assistance to the Commission as the Com-
mission determines to be necessary to carry out its 
duties. 
(5) USE OF MAILS.—The Commission may use 
the United States mails in the same manner and 
under the same conditions as Federal agencies and 
shall, for purposes of the frank, be considered a 
commission of Congress as described in section 3215 
of title 39, United States Code. 
(6) OBTAINING
INFORMATION.—The Commis-
sion may secure directly from any Federal agency 
information necessary to enable it to carry out its 
duties, if the information may be disclosed under 
section 552 of title 5, United States Code. Upon re-
quest of the Chairman of the Commission, the head 
of such agency shall furnish such information to the 
Commission. 
(7) ADMINISTRATIVE
SUPPORT
SERVICES.— 
Upon the request of the Commission, the Adminis-
trator of General Services shall provide to the Com-
mission on a reimbursable basis such administrative 
support services as the Commission may request. 
(8) PRINTING.—For purposes of costs relating 
to printing and binding, including the cost of per-
sonnel detailed from the Government Printing Of-
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fice, the Commission shall be deemed to be a com-
mittee of the Congress. 
(f) REPORTS.— 
(1) INITIAL
FINDINGS.—Not later than 6 
months after the date of the enactment of this Act, 
the Commission shall submit to the Administrator of 
Health Benefits and to appropriate committees of 
Congress a report which contains a statement of the 
initial findings of the Commission. 
(2) INITIAL
REPORT.—Not later than 18 
months after the date of the enactment of this Act, 
the Commission shall submit to such Administrator 
and committees an initial report which contains a 
detailed statement of its recommendations, findings, 
and conclusions of the Commission. 
(3) ANNUAL REPORT.—Subsequently, the Com-
mission shall annually submit to such Administrator 
and such committees a report containing such a 
statement. 
(4) OTHER
REPORTS.—The Commission may 
issue such other reports at such times as the Com-
mission determines appropriate. 
(5) 
SUPERMAJORITY
REQUIREMENT.—The 
Commission shall not include in any report sub-
mitted under this subsection a recommendation, 
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finding, or conclusion unless it has received the ap-
proval of at least 6 members of the Commission. 
(6) INCLUSION OF MINORITY VIEWS.—Reports 
under this subsection shall include as separate view-
points, the views of a minority of members of the 
Commission. 
(g) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated for each fiscal year be-
ginning with fiscal year 2010 such sums as are necessary 
to carry out this section. 
Æ 
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