detection and chronic care management programs 
categorized by health insurance issuer, and other 
data as the HHA determines appropriate. 
(c) DETERMINATION
AND
ADMINISTRATION
OF 
HAPI PLAN SUBSIDIES.—Each HHA shall oversee the 
determination and administration of HAPI plan subsidies 
by— 
(1) informing State residents about how subsidy 
eligibility determinations are made; 
(2) obtaining necessary information about in-
come from individuals and Federal and State agen-
cies; 
(3) making eligibility determinations on an indi-
vidual basis and informing individuals of such deter-
minations; 
(4) establishing a process by which an indi-
vidual may appeal an eligibility determination; 
(5) collecting from health insurance issuers an 
administrative fee for joining the HHA system and 
offering a HAPI plan in a State; 
(6) collecting premium payments made by, or 
on behalf of, covered individuals, and remitting such 
payments to the HAPI plans; and 
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(7) collecting Federal premium subsidies for 
covered individuals and remitting such subsidies to 
HAPI plans. 
(d) PREMIUM RATING RULES.—Each HHA shall en-
sure that the premium payments for each HAPI plan are 
determined in accordance with the rating rules described 
in section 111(e). 
(e) DETERMINATION OF PLAN COVERAGE AREAS.— 
Each HHA shall establish, and may revise, HAPI plan 
coverage areas for the State in which the HHA is located. 
The service area of a HAPI plan shall consist of an entire 
coverage area established under the preceding sentence. 
(f) COOPERATION
AMONG
STATES.—States that 
share 1 or more metropolitan statistical area may enter 
into agreements to share administrative responsibilities 
described under this section. 
(g) TRANSITION FROM MEDICAID AND SCHIP; CO-
ORDINATION OF SUPPLEMENTAL MEDICAL ASSISTANCE 
FOR ELDERLY AND DISABLED MEDICAID ELIGIBLES.— 
Each HHA shall work with the Secretary to ensure that 
the requirements of section 301 of this Act, section 1941 
of the Social Security Act (as added by section 673(a) of 
this Act), and subsections (a) and (b) of section 1940 of 
the Social Security Act (as added by section 311 of this 
Act) are met. 
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SEC. 503. APPROPRIATIONS FOR TRANSITION TO STATE 
HEALTH HELP AGENCIES. 
(a) APPROPRIATION.—There is authorized to be ap-
propriated and there is appropriated, for each of the 4 
full fiscal years immediately following the date of enact-
ment of this Act, such sums as may be necessary for the 
purpose of enabling each State to carry out the purposes 
of this title. The sums made available under this section 
shall be used for making payments to States that have 
submitted, and had approved by the Secretary, an HHA 
plan under this section. 
(b) SUBMISSION OF STATE HHA PLAN.—Each HHA 
plan submitted by a State shall provide for— 
(1) the establishment of an HHA within such 
State by the date that is 4 years after the date of 
enactment of this Act; 
(2) the administration by State of such HHA in 
accordance with the requirements described under 
this Act; and 
(3) the compliance by the State of the require-
ments described under section 631. 
(c) PAYMENT TO STATES.—From the sums appro-
priated under subsection (a), the Secretary shall pay to 
each State that has an HHA plan approved under this 
section, an amount necessary for the State to implement 
such plan for the applicable fiscal year. 
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TITLE VI—SHARED 
RESPONSIBILITIES 
Subtitle A—Individual 
Responsibilities 
SEC. 601. INDIVIDUAL RESPONSIBILITY TO ENSURE HAPI 
PLAN COVERAGE. 
(a) OPEN SEASON.—An adult individual, on behalf 
of such individual and the dependent children of such indi-
vidual, shall— 
(1) enroll in a HAPI plan through the HHA of 
the individual’s State of residence during an open 
enrollment period; and 
(2) submit necessary documentation to the ap-
plicable HHA so that such HHA may determine in-
dividual eligibility for premium and personal respon-
sibility contribution subsidies. 
An adult individual may carry out the activities described 
under paragraphs (1) and (2) on behalf of the spouse of 
such adult individual. 
(b) DURING PLAN YEAR.—A covered individual 
shall— 
(1) submit any required monthly premium pay-
ments; 
(2) submit any personal responsibility contribu-
tions as required; and 
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(3) inform such HHA of any changes in the 
family status or residence of such individual. 
Subtitle B—Employer 
Responsibilities 
SEC. 611. HEALTH CARE RESPONSIBILITY PAYMENTS. 
(a) PAYMENT REQUIREMENTS.— 
(1) IN GENERAL.—Subtitle C of the Internal 
Revenue Code of 1986 is amended by inserting after 
chapter 24 the following new chapter: 
‘‘CHAPTER 24A—HEALTH CARE 
RESPONSIBILITY PAYMENTS 
‘‘SUBCHAPTER A—EMPLOYER SHARED RESPONSIBILITY PAYMENTS 
‘‘SUBCHAPTER B—INDIVIDUAL SHARED RESPONSIBILITY PAYMENTS 
‘‘SUBCHAPTER C—GENERAL PROVISIONS 
‘‘Subchapter A—Employer Shared 
Responsibility Payments 
‘‘Sec. 3411. Payment requirement. 
‘‘Sec. 3412. Instrumentalities of the United States. 
‘‘SEC. 3411. PAYMENT REQUIREMENT. 
‘‘(a) EMPLOYER
SHARED
RESPONSIBILITY
PAY-
MENTS.—Every employer shall pay an employer shared re-
sponsibility payment for each calendar year in an amount 
equal to the product of— 
‘‘(1) the number of full-time equivalent employ-
ees employed by the employer during the preceding 
calendar year, multiplied by 
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‘‘(2) the applicable percentage of the average 
HAPI plan premium amount for such calendar year. 
‘‘(b) APPLICABLE PERCENTAGE.—For purposes of 
subsection (a)(2)— 
‘‘(1) IN GENERAL.—The applicable percentage 
shall be determined as follows: 
‘‘Revenue per employee national percentile of the 
taxpayer for the preceding calendar year: 
Large 
employer: 
Small 
employer: 
0–20th percentile ........................................................
18% 
3%
21st–40th percentile ...................................................
20% 
5%
41st–60th percentile ...................................................
22% 
7%
61st–80th percentile ...................................................
24% 
9%
81st–99th percentile ...................................................
26% 
11%. 
‘‘(2) APPLICABLE PERCENTAGE FOR CERTAIN 
NON-REVENUE PRODUCING ENTITIES.—In the case 
of an employer which is a nonprofit entity, a State 
or local government, or any other type of entity for 
which the Secretary determines that calculating rev-
enue per employee is not appropriate, the applicable 
percentage shall be— 
‘‘(A) in the case of a large employer, 18 
percent, and 
‘‘(B) in the case of a small employer, 3 
percent. 
‘‘(3) APPLICABLE PERCENTAGE FOR CERTAIN 
LARGE EMPLOYERS.—In the case of any large em-
ployer which did not provide health insurance cov-
erage for employees on the day before the date of 
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‘‘(1) TRANSITION RATE FOR EMPLOYERS NOT 
PREVIOUSLY PROVIDING HEALTH INSURANCE.— 
‘‘(A) IN GENERAL.—In the case of the first 
four calendar years to which this section ap-
plies, in the case of any employer who provided 
health insurance coverage for employees on the 
day before the date of enactment of the Healthy 
Americans Act, the employer shared responsi-
bility payment shall be, in lieu of the amount 
determined under subsection (a), an amount 
equal to— 
‘‘(i) 100 percent of the designated em-
ployee health insurance premium amount 
of such employer, minus 
‘‘(ii) the employee salary investment 
amount. 
‘‘(B) EMPLOYEE
SALARY
INVESTMENT 
AMOUNT.—For purposes of this paragraph— 
‘‘(i) IN
GENERAL.—The term ‘em-
ployee salary investment amount’ means 
the lesser of— 
‘‘(I) the excess of the amount of 
average yearly wages paid to all em-
ployees for such year over the amount 
of average yearly wages paid to such 
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employee for the year before the first 
year this section applies, or 
‘‘(II) the designated employee 
health insurance premium amount of 
such employer. 
‘‘(ii) NONDISCRIMINATION
RULES.— 
No amount paid by an employer shall be 
treated as an employee salary investment 
amount unless such amount is distributed 
to all employees on a basis that is propor-
tional to the amount of wages paid to such 
employee before such distribution. 
‘‘(iii) 
NOTICE
REQUIREMENT.—No 
amount paid by an employer shall be treat-
ed as an employee salary investment 
amount unless the employer gives each em-
ployee notice of the amount of the des-
ignated employee health insurance pre-
mium amount paid by the employer with 
respect to the employee. 
‘‘(iv) TREATMENT
OF
AMOUNT.—An 
employee salary investment amount shall 
not be treated as income or otherwise 
taken into account for purposes of deter-
mining any individual’s eligibility for bene-
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fits or assistance under any governmental 
assistance program. 
‘‘(C) EMPLOYER SHARED RESPONSIBILITY 
CREDIT.—The Secretary may provide a credit 
to private employers who provided health insur-
ance benefits greater than the 80th percentile 
of the national average in the 2 years prior to 
enactment of the Healthy Americans Act, if 
such employer can demonstrate the benefits 
provided encouraged prevention and wellness 
activities as defined in such Act, and that the 
employer continues to provide wellness pro-
grams. 
‘‘(D) SPECIAL
RULE
FOR
SELF-INSURED 
EMPLOYERS.—In the case of any employer who 
provided health care coverage for employees 
through self-insurance, ‘average HAPI plan 
premium amount for the first year this section 
applies’ shall be substituted for ‘designated em-
ployee health insurance premium amount of 
such employer’ in subparagraphs (A)(i) and 
(B)(i)(II). 
‘‘(E) REGULATIONS.—The Secretary may 
establish such rules and regulations as nec-
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essary to carry out the purposes of this para-
graph. 
‘‘(2) TRANSITION RATE FOR OTHER EMPLOY-
ERS.— 
‘‘(A) IN GENERAL.—In the case of an em-
ployer who did not provide health insurance to 
employees on the day before the date of enact-
ment of the Healthy Americans Act— 
‘‘(i) the employer shared responsibility 
payment for the first year this section ap-
plies shall be an amount equal to 1⁄3 of the 
amount otherwise required under this sec-
tion (determined without regard to this 
subsection), and 
‘‘(ii) the employer shared responsi-
bility payment for the second year this sec-
tion applies shall be an amount equal to 2⁄3 
of the amount otherwise required under 
this section (determined without regard to 
this subsection). 
‘‘(B) TRANSITION RATE DOES NOT APPLY 
TO
CERTAIN
LARGE
EMPLOYERS.—Subpara-
graph (A) shall not apply to any large employer 
covered by subsection (b)(3). 
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‘‘SEC. 3412. 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 
not be exempt from the payment required by section 3411 
unless such provision of law grants a specific exemption, 
by reference to section 3111 from the payment required 
by such section. 
‘‘Subchapter B—Individual Shared 
Responsibility Payments 
‘‘Sec. 3421. Amount of payment. 
‘‘Sec. 3422. Deduction of tax from wages. 
‘‘SEC. 3421. AMOUNT OF PAYMENT. 
‘‘(a) IN GENERAL.—Every individual shall pay an in-
dividual shared responsibility payment in an amount equal 
to the HAPI plan premium amount of such individual. 
‘‘(b) EXCEPTION.—This section shall not apply to 
any individual— 
‘‘(1) who is covered under a HAPI plan of an-
other individual, or 
‘‘(2) who provides such documentation as re-
quired by the Secretary demonstrating that such in-
dividual has paid such HAPI plan premium amount, 
but only for the period with respect to which such 
amount is shown to be paid. 
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‘‘SEC. 3422. DEDUCTION OF INDIVIDUAL SHARED RESPON-
SIBILITY PAYMENT FROM WAGES. 
‘‘(a) IN GENERAL.—The individual shared responsi-
bility payment imposed by section 3421 shall be collected 
by the employer by deducting the amount of the payment 
from the wages as and when paid. The preceding sentence 
shall not apply to any employer who has fewer than 10 
employees. 
‘‘(b) NONDEDUCTIBILITY BY EMPLOYER.—The indi-
vidual shared responsibility payment deducted and with-
held by the employer under subsection (a) shall not be al-
lowed as a deduction to the employer in computing taxable 
income under subtitle A. 
‘‘(c) INDEMNIFICATION
OF
EMPLOYER; SPECIAL 
RULE FOR TIPS.—Rules similar to the rules of subsections 
(b) and (c) of section 3102 shall apply for purposes of 
this section. 
‘‘Subchapter C—General Provisions 
‘‘Sec. 3431. Definitions and special rules. 
‘‘Sec. 3432. Labor contracts. 
‘‘SEC. 3431. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this chapter— 
‘‘(1) 
AVERAGE
HAPI
PLAN
PREMIUM 
AMOUNT.—The term ‘average HAPI plan premium 
amount’ means the national average yearly premium 
for HAPI plans with standard coverage (as deter-
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mined under section 111(b) of the Healthy Ameri-
cans Act), determined without regard to differing 
classes of coverage. 
‘‘(2) DESIGNATED EMPLOYEE HEALTH INSUR-
ANCE
PREMIUM
AMOUNT.—The term ‘designated 
employee health insurance premium amount’ means 
the greater of— 
‘‘(A) the yearly premium paid by an em-
ployer for health insurance coverage for employ-
ees for the most recent calendar year ending be-
fore the date of enactment of the Healthy 
Americans Act, or 
‘‘(B) the yearly premium paid by an em-
ployer for health insurance coverage for employ-
ees for the year before the first year this section 
applies. 
‘‘(3) EMPLOYER.— 
‘‘(A) IN GENERAL.—The term ‘employer’ 
has the meaning given such term under section 
3401(d). 
‘‘(B) AGGREGATION RULES.—For purposes 
of this chapter, all persons treated as a single 
employer under subsection (a) or (b) of section 
52 shall be treated as 1 person. 
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‘‘(4) EMPLOYMENT.—The term ‘employment’ 
has the meaning given such term under section 
3121(b). 
‘‘(5) FULL-TIME
EQUIVALENT
EMPLOYEE.— 
The term ‘full-time equivalent employee’ means the 
equivalent number of full-time employees of an em-
ployer determined for any year under the following 
formula: 
‘‘(A) The sum of the number of full-time 
employees employed by the employer for more 
than 3 months during such year, plus 
‘‘(B) The quotient of— 
‘‘(i) the sum of the average weekly 
hours worked during such year for each 
employee of the employer (including com-
mon law employees) who— 
‘‘(I) was employed by such em-
ployer during such year for more than 
3 months, and 
‘‘(II) is not a full-time employee, 
divided by 
‘‘(ii) 40. 
‘‘(6) FULL-TIME EMPLOYEE.—The term ‘full- 
time employee’ means an employee (including a com-
mon law employee) who during an average workweek 
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performs, or can reasonably be expected to perform, 
at least 40 hours of work. The Secretary may pre-
scribe alternative rules for determining full-time 
equivalent employees in occupations or industries not 
using a standard workweek. 
‘‘(7) HAPI PLAN.—The term ‘HAPI plan’ has 
the meaning given such term under section 3 of the 
Healthy Americans Act. 
‘‘(8) HAPI PLAN
PREMIUM
AMOUNT.—The 
term ‘HAPI plan premium amount’ means, with re-
spect to any individual, the monthly premium for the 
HAPI plan under which such individual is enrolled, 
determined after taking into account any subsidy 
provided to such individual under section 131 of the 
Healthy Americans Act. 
‘‘(9) LARGE EMPLOYER.—The term ‘large em-
ployer’ means, with respect to any year, an employer 
who employs an average of over 200 full-time equiv-
alent employees during such year. 
‘‘(10) REVENUE
PER
EMPLOYEE.—The term 
‘revenue per employee’ means, with respect to any 
employer for any year, the gross receipts of the em-
ployer for such year divided by the number of full- 
time equivalent employees employed by such em-
ployer for such year. 
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‘‘(11) SMALL EMPLOYER.—The term ‘small em-
ployer’ means, with respect to any year, an employer 
who employs an average of 200 or fewer full-time 
equivalent employees during such year. 
‘‘(12) WAGES.—The term ‘wages’ has the 
meaning given such term under section 3401(a). 
‘‘(b) SPECIAL RULES.— 
‘‘(1) SPECIAL RULE FOR SELF-EMPLOYED INDI-
VIDUALS.—For purposes of this chapter, a self-em-
ployed 
individual 
(as 
defined 
by 
section 
401(c)(1)(B)) shall be treated as both a full-time 
equivalent employee and as an employer. 
‘‘(2) TREATMENT
OF
PAYMENTS.—For pur-
poses of this title, the payments required by sections 
3411 and 3421 shall be treated as a tax imposed by 
such sections, respectively. 
‘‘(3) OTHER SPECIAL RULES.—For purposes of 
this chapter, rules similar to rules under the fol-
lowing provisions shall apply: 
‘‘(A) Section 3122 (relating to Federal 
service). 
‘‘(B) Section 3123 (relating to deductions 
as constructive payments). 
‘‘(C) Section 3125 (relating to returns in 
the case of governmental employees in States, 
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Guam, American Samoa, and the District of 
Columbia). 
‘‘(D) Section 3126 (relating to return and 
payment by government employer). 
‘‘(E) Section 3127 (relating to exemption 
for employers and their employees where both 
are members of religious faiths opposed to par-
ticipation in Social Security Act programs). 
‘‘SEC. 3432. LABOR CONTRACTS. 
‘‘(a) IN GENERAL.—This chapter shall not apply with 
respect to any qualified collective bargaining employee of 
any qualified collective bargaining employer before the 
earlier of— 
‘‘(1) January 1 of the first year which is more 
than 9 years after the date of the enactment of this 
chapter, or 
‘‘(2) the date the collective bargaining agree-
ment expires. 
‘‘(b) DEFINITIONS.—For purposes of this section— 
‘‘(1) QUALIFIED COLLECTIVE BARGAINING EM-
PLOYER.—The term ‘qualified collective bargaining 
employer’ means an employer who provides health 
insurance to employees under the terms of a collec-
tive bargaining agreement which is entered into be-
fore the date of the enactment of this chapter. 
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‘‘(2) QUALIFIED COLLECTIVE BARGAINING EM-
PLOYEE.—The term ‘qualified collective bargaining 
employee’ means an employee of a qualified collec-
tive bargaining employer who is covered by a collec-
tive bargaining agreement governing the employee’s 
health insurance.’’. 
(2) CONFORMING AMENDMENT.—The table of 
chapters of the Internal Revenue Code of 1986 is 
amended by inserting after the item relating to 
chapter 24 the following new item: 
‘‘CHAPTER 24A—HEALTH CARE RESPONSIBILITY PAYMENTS’’. 
(b) COLLECTION OF INDIVIDUAL SHARED RESPONSI-
BILITY PAYMENTS THROUGH ESTIMATED TAXES.—Sec-
tion 6654 of the Internal Revenue Code of 1986 (relating 
to failure by individual to pay estimated tax) is amended— 
(1) in subsection (a), by striking ‘‘and the tax 
under chapter 2’’ and inserting ‘‘, the tax under 
chapter 2, and the individual shared responsibility 
payment required under subchapter B of chapter 
24A’’, and 
(2) in subsection (f)— 
(A) by striking ‘‘minus’’ at the end of 
paragraph (2) and inserting ‘‘plus’’, 
(B) by redesignating paragraph (3) as 
paragraph (5), and 
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