I 
112TH CONGRESS 
1ST SESSION H. R. 3243 
To amend titles XIX and XXI of the Social Security Act, titles I and 
II of the Patient Protection and Affordable Care Act, and other Acts 
for the purpose of eliminating certain health entitlement programs and 
reducing the deficit. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 24, 2011 
Mr. REHBERG introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend titles XIX and XXI of the Social Security Act, 
titles I and II of the Patient Protection and Affordable 
Care Act, and other Acts for the purpose of eliminating 
certain health entitlement programs and reducing the 
deficit. 
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 
‘‘The Common Sense Deficit Reduction Act of 2011’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Medicaid expansion for certain adults. 
Sec. 3. Elimination of Medicaid coverage of former foster care children. 
Sec. 4. Removal of requirement of minimal essential coverage for Medicaid 
benchmark benefits. 
Sec. 5. Elimination of Medicaid premium assistance requirement. 
Sec. 6. Elimination of Medicaid and CHIP MAGI requirements. 
Sec. 7. Elimination of increased FMAP for CHIP. 
Sec. 8. Restoration of CHIP appropriation amounts under CHIPRA. 
Sec. 9. Treatment of children who are unable to be enrolled in CHIP due to 
a funding shortfall. 
Sec. 10. Grants to improve CHIP outreach and enrollment. 
Sec. 11. Additional one-time appropriations for CHIP. 
Sec. 12. Repeal of PPACA Premium tax credits and cost-sharing subsidies. 
Sec. 13. Treatment of individual mandate. 
Sec. 14. Repeal of CLASS Act. 
SEC. 2. MEDICAID EXPANSION FOR CERTAIN ADULTS. 
(a) MANDATORY POPULATIONS.—Section 1902 of 
the Social Security Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(10)— 
(A) in subparagraph (A)(i)— 
(i) by inserting ‘‘or’’ at the end of 
subclause (VI); and 
(ii) by striking subclause (VIII); and 
(B) in the matter following subparagraph 
(G) by striking ‘‘(XV) the medical assistance 
made available to an individual described in 
subparagraph (A)(i)(VIII) shall be limited to 
medical assistance described in subsection 
(k)(1)’’; 
(2) by striking subsection (k); and 
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(3) in subsection (l)(2)(C) by striking ‘‘(or, be-
ginning January 1, 2014, 133 percent)’’. 
(b) OPTIONAL POPULATION.—Section 1902 of the 
Social Security Act (42 U.S.C. 1396a) is further amend-
ed— 
(1) in subsection (a)(10)(A)(ii) by striking sub-
clause (XX); and 
(2) by striking subsection (hh). 
(c) ELIMINATION OF FUNDING.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d), is amended— 
(1) in subsection (a), in the matter preceding 
paragraph (1), by striking clauses (xiv) and (xv); 
(2) in subsection (b), in the first sentence, by 
striking ‘‘(y),’’ before ‘‘(z),’’; and 
(3) by striking subsection (y). 
(d) CONFORMING AMENDMENTS.— 
(1) Section 1903 of the Social Security Act (42 
U.S.C. 1396b) is amended— 
(A) in subsection (f)(4), by striking 
‘‘1902(a)(10)(A)(i)(VIII),’’ 
and 
‘‘1902(a)(10)(A)(ii)(XX),’’; and 
(B) in subsection (i)— 
(i) by inserting ‘‘or’’ at the end of 
paragraph (24); 
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(ii) by striking ‘‘; or’’ at the end of 
paragraph (25) and inserting a period; and 
(iii) by striking paragraph (26). 
(2) Section 1920 of the Social Security Act (42 
U.S.C. 1396r–1) is amended by striking subsection 
(e). 
(3) Section 1937(a)(1)(B) of such Act (42 
U.S.C. 1396u–7(a)(1)(B)) is amended by striking 
‘‘subclause (VIII) of section 1902(a)(10)(A)(i) or 
under’’. 
SEC. 3. ELIMINATION OF MEDICAID COVERAGE OF FORMER 
FOSTER CARE CHILDREN. 
(a) IN GENERAL.—Section 1902(a)(10)(A)(i) of the 
Social Security Act (42 U.S.C. 1396a) is amended by 
striking subclause (IX). 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902(a)(10) of such Act (42 U.S.C. 
1396a(a)(10)) is amended in the matter following 
subparagraph (G)— 
(A) by inserting ‘‘and’’ before ‘‘XVI if an 
individual’’; and 
(B) by striking ‘‘and (XVII) if an indi-
vidual is described in subclause (IX) of sub-
paragraph (A)(i) and is also described in sub-
clause (VIII) of that subparagraph, the medical 
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assistance shall be made available to the indi-
vidual through subclause (IX) instead of 
through subclause (VIII)’’. 
(2) Section 1903(f)(4) of such Act (42 U.S.C. 
1396b(f)(4)) 
is 
amended 
by 
striking 
‘‘1902(a)(10)(A)(i)(IX),’’. 
(3) Section 1937(a)(2)(B)(viii) of such Act (42 
U.S.C. 1396u–7(a)(2)(B)(viii)) is amended by strik-
ing ‘‘, or the individual qualifies for medical assist-
ance on the basis of section 1902(a)(10)(A)(i)(IX)’’. 
SEC. 4. REMOVAL OF REQUIREMENT OF MINIMAL ESSEN-
TIAL COVERAGE FOR MEDICAID BENCHMARK 
BENEFITS. 
Section 1937(b) of the Social Security Act (42 U.S.C. 
1396–7(b)) is amended— 
(1) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘subject to para-
graphs (5) and (6)’’; 
(2) in paragraph (2)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘subject to paragraphs (5) and 
(6)’’; 
(B) in subparagraph (A)— 
(i) by striking clauses (iv) and (v); 
and 
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(ii) by redesignating clauses (vi) and 
(vii) as clauses (iv) and (v), respectively; 
and 
(C) in subparagraph (C)— 
(i) by redesignating clauses (i) and 
(ii) as clauses (iii) and (iv), respectively; 
and 
(ii) by inserting before clause (iii), as 
so redesignated, the following: 
‘‘(i) Coverage of prescription drugs. 
‘‘(ii) Mental health services.’’; and 
(3) by striking paragraphs (5) and (6). 
SEC. 5. ELIMINATION OF MEDICAID PREMIUM ASSISTANCE 
REQUIREMENT. 
Section 2003 of the Patient Protection and Afford-
able Care Act is repealed and the provisions of law amend-
ed by such section are restored as if such section had never 
been enacted. 
SEC. 6. ELIMINATION OF MEDICAID AND CHIP MAGI RE-
QUIREMENTS. 
(a) MEDICAID.—Section 1902(e) of the Social Secu-
rity Act (42 U.S.C. 1396a(e)) is amended by striking 
paragraph (14). 
(b) CHIP.— 
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(1) IN
GENERAL.—Section 2102(b)(1)(B) of 
such Act (42 U.S.C. 1397bb) is amended— 
(A) by inserting ‘‘and’’ at the end of clause 
(iii); 
(B) by striking ‘‘and’’ at the end of clause 
(iv); and 
(C) by striking clause (v). 
(2) ELIMINATION
OF
RELATED
ELIGIBILITY 
RULE.—Section 2101(f) of the Patient Protection 
and Affordable Care Act is repealed. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1902(a)(17) of such Act (42 U.S.C. 
1396a(a)(17)) is amended by striking ‘‘(e)(14)’’. 
(2) Section 2105(d)(1) of such Act (42 U.S.C. 
1397ee(d)(1)) is amended by striking ‘‘, except as 
required under section 1902(e)(14)’’. 
(3) Section 2107(e)(1) of such Act (42 U.S.C. 
1397gg(e)(1)) is amended by striking subparagraph 
(F) (relating to income determined using modified 
adjusted gross income and household income). 
SEC. 7. ELIMINATION OF INCREASED FMAP FOR CHIP. 
Section 2105(b) of the Social Security Act (42 U.S.C. 
1397ee(b)) is amended by striking ‘‘Notwithstanding the 
preceding sentence, during the period that begins on Octo-
ber 1, 2015, and ends on September 30, 2019, the en-
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hanced FMAP determined for a State for a fiscal year 
(or for any portion of a fiscal year occurring during such 
period) shall be increased by 23 percentage points, but in 
no case shall exceed 100 percent. The increase in the en-
hanced FMAP under the preceding sentence shall not 
apply with respect to determining the payment to a State 
under subsection (a)(1) for expenditures described in sub-
paragraph (D)(iv), paragraphs (8), (9), (11) of subsection 
(c), or clause (4) of the first sentence of section 1905(b).’’. 
SEC. 8. RESTORATION OF CHIP APPROPRIATION AMOUNTS 
UNDER CHIPRA. 
(a) RESTORATION
OF
CHIPRA APPROPRIATION 
AMOUNTS.—Section 2104(a) of the Social Security Act 
(42 U.S.C. 1397dd(a)) is amended— 
(1) in paragraph (15), by inserting ‘‘and’’ after 
the semicolon at the end; and 
(2) by striking paragraphs (16) through (18) 
and inserting the following: 
‘‘(16) for fiscal year 2013, for purposes of mak-
ing 2 semiannual allotments— 
‘‘(A) $2,850,000,000 for the period begin-
ning on October 1, 2012, and ending on March 
31, 2013, and 
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‘‘(B) $2,850,000,000 for the period begin-
ning on April 1, 2013, and ending on Sep-
tember 30, 2013.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 2104(m) of such Act (42 U.S.C. 
1397dd(m)) is amended— 
(A) in the heading, by striking ‘‘2015’’ and 
inserting ‘‘2013’’; 
(B) in paragraph (2)— 
(i) in paragraph heading, by striking 
‘‘2014’’ and inserting ‘‘2012’’; and 
(ii) by striking subparagraph (B); 
(C) in paragraph (3)— 
(i) in the paragraph heading, by strik-
ing ‘‘2015’’ and inserting ‘‘2013’’; 
(ii) in subparagraphs (A) and (B), by 
striking ‘‘paragraph (18)’’ each place it ap-
pears and inserting ‘‘paragraph (16)’’; 
(iii) in subparagraph (C)— 
(I) by striking ‘‘2014’’ each place 
it appears and inserting ‘‘2012’’; and 
(II) by striking ‘‘2015’’ and in-
serting ‘‘2013’’; and 
(iv) in subparagraph (D)— 
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(I) in clause (i)(I), by striking 
‘‘subsection (a)(18)(A)’’ and inserting 
‘‘subsection (a)(16)(A)’’; and 
(II) in clause (ii)(II), by striking 
‘‘subsection (a)(18)(B)’’ and inserting 
‘‘subsection (a)(16)(B)’’; 
(D) in paragraph (4), by striking ‘‘2015’’ 
and inserting ‘‘2013’’; 
(E) in paragraph (6)— 
(i) in subparagraph (A), by striking 
‘‘2015’’ and inserting ‘‘2013’’; and 
(ii) in the flush text after and below 
subparagraph (B)(ii), by striking ‘‘, fiscal 
year 2012, or fiscal year 2014’’ and insert-
ing ‘‘or fiscal year 2012’’; and 
(F) in paragraph (8)— 
(i) in the paragraph heading, by strik-
ing ‘‘2015’’ and inserting ‘‘2013’’; and 
(ii) by striking ‘‘2015’’ and inserting 
‘‘2013’’. 
(2) Section 2104(n) of such Act (42 U.S.C. 
1397dd(n)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A)(ii)— 
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(I) by striking ‘‘2014’’ and in-
serting ‘‘2012’’; and 
(II) by striking ‘‘2015’’ and in-
serting ‘‘2013’’; and 
(ii) in subparagraph (B)— 
(I) by striking ‘‘2014’’ and in-
serting ‘‘2012’’; and 
(II) by striking ‘‘2015’’ and in-
serting ‘‘2013’’; and 
(B) in paragraph (3)(A), by striking ‘‘fis-
cal year 2013, fiscal year 2014, or a semi-an-
nual allotment period for fiscal year 2015’’ and 
inserting ‘‘or a semiannual allotment period for 
fiscal year 2013’’. 
(3) Section 2105(g)(4) of such Act (42 U.S.C. 
1397ee(g)(4)) is amended— 
(A) in the paragraph heading, by striking 
‘‘2015’’ and inserting ‘‘2013’’; and 
(B) in subparagraph (A), striking ‘‘2015’’ 
and inserting ‘‘2013’’. 
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SEC. 9. TREATMENT OF CHILDREN WHO ARE UNABLE TO 
BE ENROLLED IN CHIP DUE TO A FUNDING 
SHORTFALL. 
Section 2105(d)(3) of the Social Security Act (42 
U.S.C. 1397ee(d)(3)) is amended by striking subpara-
graph (B). 
SEC. 10. GRANTS TO IMPROVE CHIP OUTREACH AND EN-
ROLLMENT. 
Section 2113 of the Social Security Act (42 U.S.C. 
1397mm) is amended— 
(1) in subsection (a)(1), striking ‘‘2015’’ and 
inserting ‘‘2013’’; and 
(2) 
in 
subsection 
(g), 
by 
striking 
‘‘$140,000,000 for the period of fiscal years 2009 
through 2015’’ and inserting ‘‘$100,000,000 for the 
period of fiscal years 2009 through 2013’’. 
SEC. 11. ADDITIONAL ONE-TIME APPROPRIATIONS FOR 
CHIP. 
Section 108 of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2009 (42 U.S.C. 1397ee 
note) is amended by striking ‘‘$15,361,000,000 to accom-
pany the allotment’’ and all that follows through ‘‘allot-
ments provided from such subsection (a)(18)(A)’’ and in-
serting ‘‘$11,706,000,000 to accompany the allotment 
made for the period beginning on October 1, 2012, and 
ending on March 31, 2013, under section 2104(a)(16)(A) 
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of the Social Security Act (42 U.S.C. 1397dd(a)(16)(A)) 
(as added by section 101), to remain available until ex-
pended. Such amount shall be used to provide allotments 
to States under paragraph (3) of section 2104(m) of the 
Social Security Act (42 U.S.C. 1397dd(i)), as added by 
section 102, for the first 6 months of fiscal year 2013 
in the same manner as allotments are provided under sub-
section (a)(16)(A) of such section 2104 and subject to the 
same terms and conditions as apply to the allotments pro-
vided from such subsection (a)(16)(A).’’. 
SEC. 12. REPEAL OF PPACA PREMIUM TAX CREDITS AND 
COST-SHARING SUBSIDIES. 
(a) PREMIUM TAX CREDITS.—Section 36B of the In-
ternal Revenue Code of 1986 is amended by striking sub-
section (a). 
(b) COST-SHARING.—Section 1402 of the Patient 
Protection and Affordable Care Act is repealed. 
(c) CONFORMING AMENDMENTS TO ELIMINATE REF-
ERENCES TO PREMIUM ASSISTANCE AND REDUCTIONS IN 
COST-SHARING.— 
(1) INTERNAL REVENUE CODE OF 1986.—The 
Internal Revenue Code of 1986 is amended— 
(A) in section 36B, as amended by sub-
section (a)— 
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(E) in section 6055(b)(1), by amending 
clause (iii) to read as follows: 
‘‘(iii) in the case of minimum essential 
coverage which consists of health insurance 
coverage, information concerning whether 
or not the coverage is a qualified health 
plan offered through an Exchange estab-
lished under section 1311 of the Patient 
Protection and Affordable Care Act, and’’; 
and 
(F) in section 6103(l)(21)(A), in the mat-
ter before clause (i), by striking ‘‘any premium 
tax credit under section 36B or any cost-shar-
ing reduction under section 1402 of the Patient 
Protection and Affordable Care Act or’’. 
(2) FAIR LABOR STANDARDS ACT OF 1938.— 
The Fair Labor Standards Act of 1938 (29 U.S.C. 
201 et seq.) is amended— 
(A) in section 18B(a)— 
(i) in paragraph (1), by inserting 
‘‘and’’ after the semicolon at the end; and 
(ii) by striking paragraph (2); and 
(B) in section 18C(a), by striking para-
graph (1). 
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(3) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—Title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.) is amended— 
(A) in section 2705(l)(3)(A)— 
(i) by striking the em dash before 
clause (i) and inserting ‘‘will not result in 
any decrease in coverage.’’; and 
(ii) by striking clauses (i) and (ii); 
and 
(B) in section 2793(c)— 
(i) by inserting ‘‘and’’ at the end of 
paragraph (3); 
(ii) by striking ‘‘; and’’ at the end of 
paragraph (4); and 
(iii) by striking paragraph (5). 
(4) PATIENT
PROTECTION
AND
AFFORDABLE 
CARE ACT AMENDMENTS.—The Patient Protection 
and Affordable Care Act (Public Law 111–148, as 
amended) is amended— 
(A) in section 1311(d)(4)— 
(i) in subparagraph (G), by striking 
‘‘after the application of any premium tax 
credit’’ and all that follows through ‘‘sec-
tion 1402’’; and 
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(ii) in subparagraph (I), by striking 
clause (ii); 
(B) in section 1311(i)(3)(B), by striking ‘‘, 
and the availability of premium tax credits’’ 
and all that follows through ‘‘section 1402’’; 
(C) in section 1331(d)(3)(A)(i) is amended 
by inserting ‘‘and section 8 of the Common 
Sense Deficit Reduction Act of 2011 had not 
been enacted’’ before the period at the end; 
(D) in section 1332(a)— 
(i) in paragraph (2), by striking sub-
paragraph (C); and 
(ii) in paragraph (3), by striking 
‘‘premium tax credits, cost-sharing reduc-
tions’’; 
(E) in section 1334(c) by striking para-
graph (3); 
(F) in section 1401(c)(1)(A), by striking 
clause (i); 
(G) in section 1411— 
(i) in subsection (a)(1)— 
(I) by striking ‘‘or who is claim-
ing a premium tax credit or reduced 
cost-sharing,’’; and 
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(II) 
by 
striking 
‘‘sections 
1312(f)(3), 1402(e), and 1412(d)’’ 
and inserting ‘‘section 1312(f)(3)’’; 
(ii) in subsection (a), by striking para-
graph (2); 
(iii) in subsection (b), by striking 
paragraphs (3) and (4); and 
(iv) in subsection (e)— 
(I) in paragraph (2), by amend-
ing subparagraph (A) to read as fol-
lows: 
‘‘(A) ELIGIBILITY FOR ENROLLMENT.—If 
information provided by an applicant under 
paragraphs (1) and (2) of subsection (b) is 
verified under subsections (c) and (d) the indi-
vidual’s eligibility to enroll through the Ex-
change shall be satisfied.’’; and 
(II) in paragraph (4)(B), by 
striking clause (iii); 
(H) by striking section 1412; 
(I) in section 1413(e)(1), by striking ‘‘, in-
cluding the premium tax credits under section 
36B of the Internal Revenue Code of 1986 and 
cost-sharing reductions under section 1402’’; 
(J) by striking section 1415; and 
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(K) in section 2901, by striking subsection 
(a). 
(5) SOCIAL SECURITY ACT.—Section 1943(b) of 
the Social Security Act (42 U.S.C. 1396w–3(b)) is 
amended— 
(A) in paragraph (1)(C)— 
(i) by striking ‘‘and, if applicable, pre-
mium assistance’’ and all that follows 
through ‘‘section 1412 of the Patient Pro-
tection and Affordable Care Act),’’; and 
(ii) by striking ‘‘reduced cost-sharing 
for eligible individuals under section 1402 
of the Patient Protection and Affordable 
Care Act, and any other’’ and inserting 
‘‘any’’; 
(B) in paragraph (1)(D), by striking ‘‘, 
child health assistance, or premium assistance,’’ 
and inserting ‘‘or child health assistance,’’; 
(C) by striking paragraph (2); and 
(D) in paragraph (4), by striking ‘‘and 
who is eligible to receive premium credit assist-
ance for the purchase of a qualified health plan 
under section 36B of the Internal Revenue 
Code of 1986’’. 
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SEC. 13. TREATMENT OF INDIVIDUAL MANDATE. 
Section 1311(d)(4)(H) of the Patient Protection and 
Affordable Care Act is amended— 
(1) in clause (i), by striking ‘‘or’’ after the 
semicolon at the end; 
(2) in clause (ii), by inserting ‘‘or’’ after the 
semicolon at the end; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) the individual would have quali-
fied for premium assistance under section 
36B of the Internal Revenue Code of 
1986, medical assistance under title XIX 
of the Social Security Act, child health as-
sistance under title XXI of such Act, or re-
duced cost-sharing under section 1402, but 
for the enactment of the Common Sense 
Deficit Reduction Act of 2011;’’. 
SEC. 14. REPEAL OF CLASS ACT. 
(a) IN GENERAL.—Title XXXII of the Public Health 
Service Act (42 U.S.C. 30011 et seq.) is repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902(a) of the Social Security Act 
(42 U.S.C. 1396a(a)) is amended— 
(A) in paragraph (80), by inserting ‘‘and’’ 
after the semicolon at the end; and 
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(B) by striking paragraphs (81) and (82). 
(2) Section 8002 of the Patient Protection and 
Affordable Care Act is amended by striking sub-
sections (c) and (f). 
(3) Section 6021(d) of the Deficit Reduction 
Act of 2005 (42 U.S.C. 1396p note) is amended— 
(A) in paragraph (2)(A)— 
(i) in clause (ii), by inserting ‘‘and’’ at 
the end; 
(ii) in clause (iii), by striking ‘‘; and’’ 
at the end and inserting a period; and 
(iii) by striking clause (iv); and 
(B) in paragraph (3), by striking ‘‘2015’’ 
and inserting ‘‘2012’’. 
Æ 
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smartinez on DSK6TPTVN1PROD with BILLS