I 
111TH CONGRESS 
1ST SESSION H. R. 1118 
To amend the Social Security Act to improve choices available to Medicare 
eligible seniors by permitting them to elect (instead of regular Medicare 
benefits) to receive a voucher for a health savings account, for premiums 
for a high deductible health insurance plan, or both and by suspending 
Medicare late enrollment penalties between ages 65 and 70. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 23, 2009 
Mrs. BLACKBURN (for herself, Mr. SESSIONS, Mr. FRANKS of Arizona, Mr. 
PAUL, Mr. WILSON of South Carolina, Mr. WESTMORELAND, Ms. FOXX, 
Mr. SAM JOHNSON of Texas, Mr. ROE of Tennessee, Mrs. BACHMANN, 
and Mr. LAMBORN) introduced the following bill; which was referred to 
the Committee on Ways and Means, and in addition to the Committee 
on Energy and Commerce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To amend the Social Security Act to improve choices avail-
able to Medicare eligible seniors by permitting them to 
elect (instead of regular Medicare benefits) to receive 
a voucher for a health savings account, for premiums 
for a high deductible health insurance plan, or both 
and by suspending Medicare late enrollment penalties 
between ages 65 and 70. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Care Choices 
for Seniors Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) The Social Security Administration’s Pro-
gram 
Operations 
Manual 
System 
section 
HI 
00801.002, titled ‘‘Waiver of Hospital Insurance 
Entitlement by Monthly Beneficiary’’, provides that 
an individual who does not sign up for part A of the 
Medicare program when the individual signs up for 
social security benefits will lose such benefits, re-
gardless of the desire of the individual to not partici-
pate in the Medicare program because of religious or 
philosophical reasons or a preference to have private 
health insurance. 
(2) As part of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173), Congress increased health insur-
ance options by authorizing health savings accounts 
into which individuals may make annual contribu-
tions of not more than $2,650 and families may 
make such contributions of not more than $5,250 
that are allowable as deductions for income tax pur-
poses. Seniors are not allowed to deduct contribu-
tions to their health savings account after the date 
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of the entitlement of such seniors to Medicare bene-
fits. 
(3) Section 1802(b) of the Social Security Act 
(42 U.S.C. 1395a(b)), added by section 4507 of the 
Balanced Budget Act of 1997, states that a Medi-
care beneficiary may only enter into a private con-
tract with a physician for an item or service if no 
claim for payment under title XVIII of such Act will 
be submitted. In the case of such contract, the phy-
sician must sign an affidavit that acknowledges such 
contract and that provides that the physician will 
not submit a claim, and will forgo reimbursement, 
under such title for an item or service provided to 
any Medicare beneficiary for a period of two years. 
SEC. 3. AUTHORITY TO ELECT VOUCHER PROGRAM IN-
STEAD OF MEDICARE PART A ENTITLEMENT. 
(a) IN GENERAL.—Section 226 of the Social Security 
Act (42 U.S.C. 426) is amended by adding at the end the 
following new subsections: 
‘‘(k) WAIVER OF ENTITLEMENT AND ELECTION OF 
VOUCHER PROGRAM.— 
‘‘(1) IN GENERAL.—Notwithstanding the pre-
vious provisions of this section, the Secretary shall 
establish a procedure under which an individual oth-
erwise entitled under subsection (a) to benefits 
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under part A of title XVIII may waive such entitle-
ment and be automatically enrolled in the Medicare 
Alternative Voucher Program established under sub-
section (l) if— 
‘‘(A) at the time such waiver is made the 
individual— 
‘‘(i) has a health savings account de-
scribed in subsection (d) of section 223 of 
the Internal Revenue Code of 1986 (26 
U.S.C. 223); and 
‘‘(ii) is enrolled under a high deduct-
ible health plan, as defined in subsection 
(c)(1) of such section; and 
‘‘(B) the individual makes such waiver dur-
ing the initial enrollment period described in 
section 1837(d). 
‘‘(2) TREATMENT UNDER THE INTERNAL REV-
ENUE CODE OF 1986.—An individual who waives en-
titlement under paragraph (1) shall not be treated 
as entitled to benefits under title XVIII for purposes 
of section 223(b)(7) of the Internal Revenue Code of 
1986. 
‘‘(3) INELIGIBILITY FOR PART B OR D BENE-
FITS.—An individual shall not be eligible for benefits 
under part B or D of title XVIII during the period 
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