I 
118TH CONGRESS 
1ST SESSION H. R. 3129 
To ensure health care fairness and affordability for all Americans through 
universal access to equitable health insurance tax credits, reformed health 
savings accounts, and strengthened consumer protections, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 9, 2023 
Mr. SESSIONS introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, and Education and the Workforce, 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 con-
cerned 
A BILL 
To ensure health care fairness and affordability for all Amer-
icans through universal access to equitable health insur-
ance tax credits, reformed health savings accounts, and 
strengthened consumer protections, and for other pur-
poses. 
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; PURPOSES; TABLE OF CON-
TENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Health Care Fairness for All Act’’. 
(b) PURPOSES.—The purposes of this Act are as fol-
lows: 
(1) ELIMINATION
OF
INDIVIDUAL
AND
EM-
PLOYER MANDATES.—To eliminate mandates on in-
dividuals and employers, and other tax requirements, 
imposed under Public Law 111–148. 
(2) PROVIDING
STATES
WITH
ALTERNATIVE, 
AFFORDABLE
COVERAGE
OPTIONS.—To 
provide 
greater flexibility in providing States with options in 
making affordable health insurance coverage avail-
able by eliminating certain mandates under Public 
Law 111–148, while retaining essential consumer 
protections, by promoting health savings accounts to 
pay for such coverage and long-term care coverage, 
while permitting States to continue coverage as pro-
vided under such public law. 
(c) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; purposes; table of contents. 
Sec. 2. Definitions. 
TITLE I—REVISION OF FEDERAL HEALTH LAW 
Subtitle A—Elimination of Employer and Individual Mandates 
Sec. 101. Repeal of individual health insurance mandate. 
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Sec. 102. Repeal of employer health insurance mandate. 
Sec. 103. Clarifying employer’s ability to reimburse employee premiums for 
purchase of individual health insurance coverage. 
Subtitle B—Limitation on Application of Federal Health Plan Requirements 
Sec. 121. Limiting application of requirements to consumer protections. 
Sec. 122. Offering of basic health insurance; protection of assets from liability 
or attachment or seizure. 
Sec. 123. Ensuring access to short-term limited duration insurance. 
Sec. 124. Making telehealth flexibilities permanent. 
Subtitle C—Health Insurance Tax Benefit 
Sec. 131. Health insurance tax benefit. 
Sec. 132. Application of portion of unused tax credits by States for indigent 
health care. 
Sec. 133. Medicaid option of enrollment under private plan and contribution to 
an HSA. 
Sec. 134. Repeal of reporting requirements relating to employee health insur-
ance premiums and health plan benefits. 
Sec. 135. Report. 
Subtitle D—Medicare Reforms 
Sec. 141. Physician-owned hospitals. 
Sec. 142. Prohibiting the use of an inpatient-only list in designating hospital 
outpatient services under the Medicare program. 
Sec. 143. Promoting Medicare site-neutral payments. 
Sec. 144. Medicare Advantage contributions to Roth HSAs for chronically ill 
enrollees. 
Sec. 145. Extending acute hospital care at home waiver flexibilities. 
TITLE II—IMPROVING HEALTH SAVINGS ACCOUNTS TO PROMOTE 
ACCOUNTABILITY 
Sec. 201. Transition to non-deductible HSAs. 
Sec. 202. Elimination of medical expense deduction. 
Sec. 203. Treatment of HSA after death of account beneficiary. 
Sec. 204. Treatment of direct patient care arrangements. 
TITLE III—STATE FLEXIBILITY IN REGULATION OF HEALTH 
INSURANCE COVERAGE 
Sec. 301. State flexibility in regulation of health insurance coverage. 
TITLE IV—MEDICAID PAYMENT REFORM 
Sec. 401. Medicaid payment reform to ensure equitable access to care. 
TITLE V—PRICE TRANSPARENCY 
Sec. 501. Promoting transparent hospital prices for consumers. 
SEC. 2. DEFINITIONS. 
Except as otherwise provided, in this Act: 
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(1) BASIC
HEALTH
INSURANCE.—The term 
‘‘basic health insurance’’ is defined in section 
122(a). 
(2) 
DEFAULT
HEALTH
INSURANCE
COV-
ERAGE.—The term ‘‘default health insurance cov-
erage’’ is defined in section 121(b)(4)(B). 
(3) EXCHANGE.—The term ‘‘Exchange’’ means 
an Exchange established under title I of Public Law 
111–148. 
(4) HEALTH
INSURANCE
COVERAGE; GROUP 
HEALTH PLAN, ETC.—The terms defined in section 
2791 of the Public Health Service Act, including 
‘‘health insurance coverage’’, ‘‘group health plan’’ 
‘‘individual market’’, shall apply. 
(5) LIMITED BENEFIT INSURANCE.—The term 
‘‘limited benefit insurance’’ is defined in section 
122(b). 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(7) STATE.—The term ‘‘State’’ includes the 
District of Columbia, Puerto Rico, the United States 
Virgin Islands, American Samoa, Guam, and the 
Northern Mariana Islands. 
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TITLE I—REVISION OF FEDERAL 
HEALTH LAW 
Subtitle A—Elimination of 
Employer and Individual Mandates 
SEC. 101. REPEAL OF INDIVIDUAL HEALTH INSURANCE 
MANDATE. 
Section 5000A of the Internal Revenue Code of 1986 
is amended by adding at the end the following new sub-
section: 
‘‘(h) TERMINATION.—This section shall not apply to 
months beginning after December 31, 2022.’’. 
SEC. 102. REPEAL OF EMPLOYER HEALTH INSURANCE MAN-
DATE. 
(a) IN GENERAL.—Chapter 43 of the Internal Rev-
enue Code of 1986 is amended— 
(1) by striking section 4980H, and 
(2) by striking the item relating to section 
4980H from the table of sections for such chapter. 
(b) REPEAL
OF RELATED REPORTING REQUIRE-
MENTS.—Subpart D of part III of subchapter A of chap-
ter 61 of such Code is amended by striking section 6056 
and by striking the item relating to section 6056 in the 
table of sections for such subpart. 
(c) CONFORMING AMENDMENTS.— 
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(1) Section 6724(d)(1)(B) of such Code is 
amended by striking clause (xxv). 
(2) Section 6724(d)(2) of such Code is amend-
ed by striking subparagraph (HH). 
(3) Section 1513 of Public Law 111–148 is 
amended by striking subsection (c). 
(d) EFFECTIVE DATES.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided in this subsection, the amendments made by 
this section shall apply to months and other periods 
beginning more than 30 days after the date of the 
enactment of this Act. 
(2) REPEAL
OF
STUDY
AND
REPORT.—The 
amendment made by subsection (c)(3) shall take ef-
fect on the date of the enactment of this Act. 
SEC. 103. CLARIFYING EMPLOYER’S ABILITY TO REIM-
BURSE 
EMPLOYEE 
PREMIUMS 
FOR 
PUR-
CHASE OF INDIVIDUAL HEALTH INSURANCE 
COVERAGE. 
An employer health care arrangement, such as a 
health or medical reimbursement arrangement (HRA) or 
other employment plans, under which an employer reim-
burses an employee for the premiums for the purchase of 
individual health insurance coverage does not constitute 
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a group health plan for any purposes, including for pur-
poses of applying any of the following: 
(1) The Public Health Service Act (including 
sections 2711 and 2714 of such Act, 42 U.S.C. 
300gg–11, 300gg–14). 
(2) Public Law 111–148. 
(3) The Internal Revenue Code of 1986 (other 
than for purposes of section 36B of such Code). 
(4) The Employee Retirement Income Security 
Act of 1974. 
(5) The HIPAA privacy regulations (as defined 
in section 1180(b)(3) of the Social Security Act, 42 
U.S.C. 1320d–9(b)(3)). 
(6) The Health Insurance Portability and Ac-
countability Act of 1996. 
(7) COBRA continuation coverage under title 
XXII of the Public Health Service Act (42 U.S.C. 
300bb–1 et seq.), section 4980B of the Internal Rev-
enue Code of 1986, or title VI of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1161 et seq.). 
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Subtitle B—Limitation on Applica-
tion of Federal Health Plan Re-
quirements 
SEC. 121. LIMITING APPLICATION OF REQUIREMENTS TO 
CONSUMER PROTECTIONS. 
(a) REMOVAL OF PUBLIC LAW 111–148 PLAN RE-
QUIREMENTS, OTHER THAN CERTAIN CONSUMER PRO-
TECTIONS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, with respect to group health plans 
and health insurance coverage whether or not of-
fered through an Exchange, except as provided in 
paragraphs (2) and (3), the provisions of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.) as in effect on the day before the date 
of the enactment of Public Law 111–148 shall apply 
instead of the provisions of such title as in effect 
after such date. 
(2) PUBLIC LAW 111–148 CONSUMER PROTEC-
TIONS CONTINUING TO BE APPLIED.—The following 
sections of the Public Health Service Act, that were 
added or amended by subtitles A and C of title I of 
Public Law 111–148, shall continue to apply to 
group health plans and to health insurance coverage 
offered in the individual and group market: 
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(A) NO LIFETIME OR ANNUAL LIMITS.— 
Section 2711 (42 U.S.C. 300gg–11; relating to 
no lifetime or annual limits), except in the case 
of limited benefit insurance (as defined in sec-
tion 122(b)). 
(B) DEPENDENT
COVERAGE
THROUGH 
AGE 26.—Section 2714 (42 U.S.C. 300bb–14; 
relating to extension of dependent coverage). 
(C) 
MODIFIED
GUARANTEED
AVAIL-
ABILITY.—Section 2702 (42 U.S.C. 300gg–1; 
relating to guaranteed availability of coverage), 
subject to paragraph (3) and subsection (c). 
(D) GUARANTEED
RENEWABILITY.—Sec-
tion 2703 (42 U.S.C. 300gg–2; relating to 
guaranteed renewability of coverage). 
(E) PROHIBITING
PRE-EXISTING
CONDI-
TION EXCLUSIONS.—Section 2704 (42 U.S.C. 
300gg–3; relating to prohibition on preexisting 
conditions). 
(F) PROHIBITING DISCRIMINATION BASED 
ON HEALTH STATUS.—Section 2705 (42 U.S.C. 
300gg–4; relating to prohibiting discrimination 
against individual participants and beneficiaries 
based on health status), subject to subsection 
(c). 
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(G) 
NON-DISCRIMINATION
IN
HEALTH 
CARE.—Section 2706 (42 U.S.C. 300gg–5; re-
lating to non-discrimination in health care). 
(3) APPLICATION
OF
A
LATE
ENROLLMENT 
PENALTY FOR THOSE WITHOUT CONTINUOUS COV-
ERAGE.— 
(A) IN GENERAL.—In the case of an indi-
vidual who seeks to enroll in health insurance 
coverage and who, as of the effective date of 
such enrollment, does not have a continuous pe-
riod of at least 12 months of creditable cov-
erage, there shall be imposed a late enrollment 
penalty in the form of an increase in the 
monthly premiums for coverage of under the 
plan of 20 percent of the monthly premium oth-
erwise determined for each consecutive full 12- 
month period (ending before such effective 
date) in which the individual was not enrolled 
in creditable coverage. Such increase shall apply 
during a period, to be specified under regula-
tions of the Secretary but in no case longer 
than 3 times the length of the most recent pe-
riod in which the individual did not have contin-
uous coverage. 
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(B) STATE WAIVER.—A State may apply 
to the Secretary for a waiver of the provisions 
of subparagraph (A) and the application of al-
ternative provisions providing incentives for 
State residents to enroll in creditable coverage 
and maintain continuous creditable coverage. 
The Secretary shall approve such waiver if the 
Secretary determines that the alternative provi-
sions provide similar or greater incentives for 
such enrollment than the incentives otherwise 
applicable. 
(4) COORDINATING IMPLEMENTATION OF PRE- 
PUBLIC LAW 111–148 PHSA PROVISIONS WITH PUBLIC 
LAW 111–148 CONSUMER PROTECTIONS.— 
(A) IN GENERAL.—In applying this sub-
section, the provisions described in paragraph 
(2) shall be treated as if they were included in 
title XXVII of the Public Health Service Act, 
as in effect before the date of enactment of 
Public Law 111–148, and, with respect to 
group health plans and health insurance cov-
erage offered in connection with such plans, in 
part 7 of subtitle B of title I of the Employee 
Retirement and Income Security Act of 1974 
(29 U.S.C. 1181 et seq.), and, with respect to 
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group health plans, in chapter 100 of the Inter-
nal Revenue Code of 1986 as follows: 
(i) LIFETIME
LIMITS; 
DEPENDENT 
COVERAGE.—The provisions described in 
paragraphs (2)(A) and (2)(B) shall be 
treated as included— 
(I) with respect to group health 
plans (and health insurance coverage 
offered with respect to such plans), 
under subpart 2 of part A of title 
XXVII of the Public Health Service 
Act (42 U.S.C. 300gg–11 et seq.) and 
subpart B of part 7 of subtitle B of 
title I of the Employee Retirement 
and Income Security Act of 1974 (29 
U.S.C. 1181 et seq.); 
(II) also with respect to group 
health plans, under subchapter B of 
chapter 100 of the Internal Revenue 
Code of 1986; and 
(III) with respect to individual 
health insurance coverage, under sub-
part 2 of part B of title XXVII of the 
Public Health Service Act (42 U.S.C. 
300gg–15 et seq.). 
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(ii) 
REMAINING
PROVISIONS.—The 
provision described in paragraph (2) (other 
than in subparagraph (A) or (B) of such 
paragraph) shall be treated as included— 
(I) with respect to group health 
plans (and health insurance coverage 
offered with respect to such plans), 
under subpart 1 of part A of title 
XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.) and 
subpart A of part 7 of subtitle B of 
title I of the Employee Retirement 
and Income Security Act of 1974 (29 
U.S.C. 1181 et seq.); 
(II) also with respect to group 
health plans, under subchapter A of 
chapter 100 of the Internal Revenue 
Code of 1986; and 
(III) with respect to individual 
health insurance coverage, under sub-
part 1 of part B of title XXVII of the 
Public Health Service Act (42 U.S.C. 
300gg–41 et seq.). 
(B) CONFLICTING
PROVISIONS.—In the 
case described in paragraph (1) where there is 
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a conflict between a provision described in para-
graph (2) and a provision of law described in 
paragraph (1), the provision described in para-
graph (2) shall control and the Secretary, in 
consultation with the Secretary of the Treasury 
and the Secretary of Labor, shall establish such 
rules as may be necessary to carry out this sub-
paragraph. 
(5) CONFORMING AMENDMENTS.— 
(A) ERISA.—Section 715 of the Employee 
Retirement Income Security Act of 1974 (29 
U.S.C. 1185d) is amended— 
(i) in subsection (a), by striking ‘‘sub-
section (b)’’ and inserting ‘‘subsections (b) 
and (c)’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(c) ADDITIONAL EXCEPTION.—Pursuant to section 
121 of the Health Care Fairness for All Act, the provi-
sions of part A of title XXVII of the Public Health Service 
Act referred to in subsection (a), other than those provi-
sions specified in section 121(a)(2) of the Health Care 
Fairness for All Act, shall not apply to plans and coverage 
described in subsection (a), whether or not the plans or 
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coverage are offered through an Exchange established by 
Public Law 111–148.’’. 
(B) IRC.—Section 9815 of the Internal 
Revenue Code of 1986 is amended— 
(i) in subsection (a), by striking ‘‘sub-
section (b)’’ and inserting ‘‘subsections (b) 
and (c)’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(c) ADDITIONAL EXCEPTION.—Pursuant to section 
121 of the Health Care Fairness for All Act, the provi-
sions of part A of title XXVII of the Public Health Service 
Act referred to in subsection (a), other than those provi-
sions specified in section 121(a)(2) of the Health Care 
Fairness for All Act, shall not apply to plans described 
in subsection (a).’’. 
(b) STATE FLEXIBILITY
IN ENSURING ORDERLY 
HEALTH INSURANCE MARKET OUTSIDE
OF
AN EX-
CHANGE.— 
(1) IN GENERAL.—With respect to health insur-
ance coverage offered in a State, the State may, in 
consultation with the Secretary, take such steps, 
such as limiting the availability of general open en-
rollment periods, imposing delays in the effectiveness 
for coverage, permitting differentials in premiums 
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based on age and other factors, as the State deter-
mines necessary in order to ensure an orderly mar-
ket for health insurance coverage in the State that 
is not offered through an Exchange. Such steps may 
include the establishment of such initial open enroll-
ment period during which qualified residents may 
enroll in health insurance coverage without the im-
position of any underwriting as the State determines 
to be appropriate in ensuring initial access to such 
coverage. 
(2) FLEXIBILITY IN IMPOSING ADDITIONAL RE-
QUIREMENTS.—Subject to paragraph (5), nothing in 
this section shall be construed as preventing a State 
from continuing to apply, to health insurance cov-
erage issued in the State, requirements under the 
provisions of title XXVII of the Public Health Serv-
ice Act (as amended by subtitles A and C of title I 
of Public Law 111–148) that are not continued 
under subsection (a). 
(3) STATE FLEXIBILITY WITH RESPECT TO EX-
CHANGES.—A State may waive such provisions of 
part II of subtitle D of title I of Public Law 111– 
148 (42 U.S.C. 18031 et seq.), in relation to the es-
tablishment of an Exchange in such State, as the 
State determines appropriate in order for the State 
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to implement and administer a market-based system 
for the availability of health insurance coverage 
throughout the State. 
(4) STATE DEFAULT ENROLLMENT OPTION.— 
(A) ENROLLMENT, 
SUBJECT
TO
INDI-
VIDUAL
OPT-OUT.—Subject to subparagraph 
(D), a State may elect to provide for the enroll-
ment of residents of the State who are unin-
sured in default health insurance coverage (as 
defined in subparagraph (B)) and establishing a 
Roth HSA for such residents who do not have 
a Roth HSA unless the resident has affirma-
tively elected not to be so enrolled and not to 
have such an account, respectively. If a State 
makes such an election, the State shall permit 
eligible residents to enroll in such coverage on 
a continuous basis. 
(B) DEFAULT
HEALTH
INSURANCE
COV-
ERAGE DEFINED.—In this paragraph, the term 
‘‘default health insurance coverage’’ means, 
with respect to a State, health insurance cov-
erage that— 
(i) is a high deductible health plan 
(within the meaning of section 223(c)(2) of 
the Internal Revenue Code of 1986) with 
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prescription drug coverage limited to ge-
neric drugs for a limited number of chronic 
conditions (commonly referred to as tier I 
pharmacy benefit); 
(ii) meets such requirements as may 
apply to qualify for the payment of plan 
premiums from a health savings account 
under section 223 of such Code (such as 
age-related premiums and limitation on 
imposition of preexisting condition exclu-
sions); 
(iii) has a provider network for cov-
ered benefits that is adequate (as deter-
mined consistent with guidelines issued by 
the Secretary) to ensure access to health 
benefits under such plan; 
(iv) provides for coverage of childhood 
immunizations without cost sharing re-
quirements to the extent such immuniza-
tions have in effect a recommendation 
from the Advisory Committee on Immuni-
zation Practices of the Centers for Disease 
Control and Prevention with respect to the 
individual involved; and 
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(v) meets such other requirements as 
the State may specify. 
(C) ROTH
HSA.—In this paragraph, the 
term ‘‘Roth HSA’’ shall have the meaning given 
such term by section 530A(c) of the Internal 
Revenue Code of 1986, as added by section 
201(a) of this Act. 
(D) SIMPLE PROCESS FOR INDIVIDUALS TO 
OPT OUT.—As a condition of a State providing 
for the enrollment function described in sub-
paragraph (A), the State must establish an 
easy-to-use and transparent means by which in-
dividuals may elect not to be enrolled in default 
health insurance coverage or to have a Roth 
HSA established on the individual’s behalf, or 
both. 
(5) MINIMUM AGE VARIATION PERMITTED FOR 
PREMIUM RATES.—With respect to the premium rate 
charged by a health insurance issuer for health in-
surance coverage offered in the individual or small 
group market, a State may not limit the variation by 
age in such rate with respect to a particular plan or 
coverage involved by less than a factor of 5 to 1 for 
adults. The previous sentence shall be treated as if 
it were included in subpart I of part A of title 
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XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.). 
(c) INAPPLICABILITY
OF
REQUIRED
ESSENTIAL 
HEALTH BENEFITS.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, no health benefits plan shall be re-
quired by reason of Federal law to comply with the 
requirements of sections 1301(a)(1)(B) and 1302 of 
Public Law 111–148 (42 U.S.C. 18021(a)(1)(B), 
18022). 
(2) STATE FLEXIBILITY.—Nothing in this sub-
section shall be construed as preventing a State 
from applying, at its option with respect to health 
insurance coverage offered through an Exchange or 
otherwise in the State, the requirements referred to 
in paragraph (1). 
(d) EFFECTIVE DATE; TRANSITION.— 
(1) IN GENERAL.—Subsection (a), (b), and (c) 
shall apply to plan years beginning after the date of 
the enactment of this Act. 
(2) SUNSETTING REQUIRED CONTRIBUTION FOR 
ACA REINSURANCE PROGRAM.—No contribution shall 
be required under section 1341 of Public Law 111– 
148 (42 U.S.C. 18061) from any group health plan 
or health insurance issuer for portions of plans years 
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occurring in months beginning more than 30 days 
after the date of the enactment of this Act. 
(e) SECRETARIAL
GUIDANCE.—The Secretary of 
Health and Human Services, in coordination with the Sec-
retary of Labor and the Secretary of the Treasury, shall 
provide such guidance as may be necessary for the coordi-
nated implementation of this section on a timely basis. 
(f) TRANSFERRING HEALTH PLAN RECORDS UPON 
CHANGING PLANS.— 
(1) IN GENERAL.—In the case of an individual 
who is covered under health insurance coverage or as 
a beneficiary or participant in a group health plan 
(as such terms are defined in section 2791 of the 
Public Health Service Act, 42 U.S.C. 300gg–91), if 
such coverage is ended and the individual obtains 
other health insurance coverage, group health plan 
coverage, or other creditable coverage (as defined for 
purposes of title XXVII of such Act), the issuer of 
the prior coverage or administrator of the prior plan 
shall forward information respecting such prior cov-
erage to the issuer of the new coverage or adminis-
trator of the new plan or coverage, as the case may 
be, subject to such rules as the Secretary establishes 
regarding the right of the beneficiary or participant 
to object to such forwarding of information. 
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(2) 
TREATMENT
AS
PLAN
REQUIREMENT 
UNDER
PHSA, ERISA, IRC.—The requirement of 
paragraph (1) shall apply as if it were a section 
under part A of title XXVII of the Public Health 
Service Act, including for purposes of applying sec-
tion 715 of the Employee Retirement Income Secu-
rity Act of 1976 (29 U.S.C. 1185d) and section 
9815 of the Internal Revenue Code of 1986. 
(g) APPLICATION OF RISK ADJUSTMENT.— 
(1) IN GENERAL.—Any issuer that offers health 
insurance coverage in the individual market in any 
of the 50 States or the District of Columbia shall 
participate in a risk adjustment mechanism under 
this subsection with respect to any health insurance 
coverage it so offers in such market, whether or not 
such coverage is offered through an Exchange. 
(2) FORM AND DESIGN OF RISK ADJUSTMENT 
MECHANISM.—The Secretary shall, in consultation 
with the National Association of Insurance Commis-
sioners and other interested parties, develop a mech-
anism to permit the adjustment of risk among 
health insurance coverage offered in the individual 
market throughout the 50 States and the District of 
Columbia. Such mechanism shall be designed to ef-
fect the same type of risk adjustment among such 
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coverage that is applicable to risk adjustment of 
payments among Medicare Advantage organizations 
under part C of title XVIII of the Social Security 
Act (42 U.S.C. 1395w–21 et seq.). 
(3) TRANSITION
FOR
NEW
COVERAGE.—The 
mechanism developed under paragraph (2) shall pro-
vide for transitional protection, over a 3-year period, 
in the case of health insurance coverage that has not 
been previously marketed. 
(4) DEVELOPMENT OF FURTHER RISK ADJUST-
MENT MECHANISM.—The Secretary shall request the 
National Association of Insurance Commissioners to 
develop a permanent model for adjustment of risk 
among health insurance issuers with respect to 
health insurance coverage offered in the individual 
market, with the intention that such a model would 
substitute for the mechanism developed under para-
graph (2). 
(5) 
TREATMENT
AS
PLAN
REQUIREMENT 
UNDER
PHSA, ERISA, IRC.—The requirement of 
paragraph (1) shall apply as if it were a section 
under part A of title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.), including for 
purposes of applying section 715 of the Employee 
Retirement Income Security Act of 1976 (29 U.S.C. 
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1185d) and section 9815 of the Internal Revenue 
Code of 1986. 
SEC. 122. OFFERING OF BASIC HEALTH INSURANCE; PRO-
TECTION OF ASSETS FROM LIABILITY OR AT-
TACHMENT OR SEIZURE. 
(a) REQUIREMENT FOR EXCHANGES.— 
(1) IN GENERAL.—No tax credit shall be allow-
able under section 36B or 36C of the Internal Rev-
enue Code of 1986 for residents of a State unless 
any Exchange established in the State provides for 
the offering of basic health insurance in all areas of 
the State. 
(2) BASIC HEALTH INSURANCE DEFINED.—In 
this subsection, the term ‘‘basic health insurance’’ 
means, with respect to a State, such health insur-
ance coverage as the State may specify and includes 
limited benefit insurance (as defined in subsection 
(b)). 
(b) LIMITED BENEFIT INSURANCE DEFINED.— 
(1) IN GENERAL.—In this title, the term ‘‘lim-
ited benefit insurance’’ means individual health in-
surance coverage that, with respect to a plan year, 
imposes (consistent with paragraph (2)) an annual 
limit on the amounts that may be payable under the 
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coverage with respect to expenses incurred for items 
and services furnished in that plan year. 
(2) SPECIFICATION
OF
ANNUAL
LIMIT; VARI-
ATION IN LIMIT FOR INDIVIDUAL AND FAMILY COV-
ERAGE.—The Secretary shall specify, from year to 
year, the annual limit (or range of annual limits) 
that may be applied under paragraph (1). Such a 
limit may distinguish between coverage that is only 
provided for an individual and coverage that is pro-
vided also for family members of the individual. 
(c) PROTECTION OF CERTAIN ASSETS IN CASE OF 
INDIVIDUALS COVERED UNDER LIMITED BENEFIT IN-
SURANCE.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, if an individual is covered under 
limited benefit insurance for a plan year and bene-
fits under such insurance have reached the annual 
limit under such insurance for items and services 
furnished in the plan year, the individual is not lia-
ble for debt incurred and arising from the provision 
of subsequently furnished items and services during 
the plan year, regardless of whether benefits are oth-
erwise covered for such items and services under 
such policy, insofar as the liability attributable to 
such items and services exceeds— 
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(A) the bankruptcy valuation of the indi-
vidual’s property at the time the debt is in-
curred; reduced by 
(B) such annual limit of benefits under the 
limited benefit insurance for the plan year. 
Property in the amount so protected from liability 
shall be exempt and immune from attachment or sei-
zure with respect to any judgment related to such 
debt. 
(2) BANKRUPTCY
VALUATION
DEFINED.—In 
this subsection, the term ‘‘bankruptcy valuation’’ 
means, with respect to property of an individual as 
of a date, the value of the property as of such date 
as determined as if the individual were a debtor in 
a bankruptcy case that could have been filed under 
title 11 of the United States Code and the property 
could not be exempt under section 522 of such title. 
(3) NO REQUIREMENT FOR PROVIDERS TO FUR-
NISH SUBSEQUENT SERVICES WITHOUT ENSURING 
PAYMENT.—Except as may be explicitly provided in 
other law (such as under section 1867 of the Social 
Security Act, 42 U.S.C. 1395dd; popularly known as 
EMTALA), a health care provider is not required to 
furnish any items or services to an individual who 
has exhausted benefits under limited benefit insur-
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ance for a plan year without the individual (or an-
other person on the individual’s behalf) providing for 
such advance or guarantee of payment for such 
items and services as may be arranged between the 
health care provider and the individual. 
SEC. 123. ENSURING ACCESS TO SHORT-TERM LIMITED DU-
RATION INSURANCE. 
Section 2791(b)(5) of the Public Health Service Act 
(42 U.S.C. 300gg–91(b)(5)) is amended by inserting ‘‘(as 
defined in the rule entitled ‘Short-Term, Limited Duration 
Insurance’ (83 Fed. Reg. 38212 (August 3, 2018)))’’ after 
‘‘short-term limited duration insurance’’. 
SEC. 124. MAKING TELEHEALTH FLEXIBILITIES PERMA-
NENT. 
Notwithstanding any other provision of law, in the 
case of any provision of section 1834(m) of the Social Se-
curity Act (42 U.S.C. 1395m(m)) that would, absent this 
section, end on the last day of the emergency period de-
scribed in section 1135(g)(1)(B) of the Social Security Act 
(42 U.S.C. 1320b–5(a)(1)(B)) or December 1, 2024, such 
provision shall be deemed to continue to apply on or after 
such last day or such date (as applicable). 
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Subtitle C—Health Insurance Tax 
Benefit 
SEC. 131. HEALTH INSURANCE TAX BENEFIT. 
(a) 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 36B the fol-
lowing new section: 
‘‘SEC. 36C. HEALTH INSURANCE TAX CREDIT. 
‘‘(a) IN GENERAL.—In the case of an individual who 
is a qualified resident, there shall be allowed as a credit 
against the tax imposed by this subtitle for any taxable 
year an amount equal to the health credit amount of the 
taxpayer for the taxable year. 
‘‘(b) HEALTH CREDIT AMOUNT.—For purposes of 
this section— 
‘‘(1) IN
GENERAL.—The term ‘health credit 
amount’ means the sum of the amounts determined 
under paragraph (2) with respect to all months of 
the taxpayer for the taxable year. 
‘‘(2) MONTHLY CREDIT AMOUNT.— 
‘‘(A) IN GENERAL.—Subject to paragraph 
(4), the amount determined under this para-
graph with respect to any month shall be an 
amount equal to the sum of— 
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‘‘(i) 1⁄12 of $4,000 in the case of any 
month the first day of which the taxpayer 
is a qualified resident and is covered by 
creditable coverage (twice such amount in 
the case of a joint return if both spouses 
are so covered by creditable coverage and 
are qualified residents), plus 
‘‘(ii) 
1⁄12
of an amount equal to 
$2,000 multiplied by the number of quali-
fying children (within the meaning of sec-
tion 152) who are qualified residents 
and— 
‘‘(I) for whom the taxpayer is al-
lowed a deduction under section 151 
for the taxable year in which such 
month ends, and 
‘‘(II) who are covered by cred-
itable coverage on the first day of 
such month. 
‘‘(B) CARRYFORWARD OF MONTHLY CRED-
IT AMOUNT IN CASE CREDIT AMOUNT EXCEEDS 
HSA
CONTRIBUTIONS
AND
PREMIUM
PAY-
MENTS.—In the case of any month for which 
the credit amount determined with respect to 
the taxpayer under subparagraph (A) exceeds 
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the limitation amount determined with respect 
to the taxpayer for such month under para-
graph (3), such excess may be carried forward 
to any subsequent month during the taxable 
year for purposes of determining the credit 
amount for such month under this paragraph. 
‘‘(3) MONTHLY LIMITATION.— 
‘‘(A) IN
GENERAL.—The amount deter-
mined under paragraph (2) for any month of 
the taxpayer shall not exceed the sum of— 
‘‘(i) the amounts contributed to a 
health savings account of the taxpayer for 
such month, plus 
‘‘(ii) the premiums paid by the tax-
payer for creditable coverage. 
‘‘(B) CARRYFORWARD OF MONTHLY LIMI-
TATION IN CASE HSA CONTRIBUTIONS AND PRE-
MIUM
PAYMENTS
EXCEED
MONTHLY
CREDIT 
AMOUNT.—In the case of any month for which 
the amount determined with respect to the tax-
payer under subparagraph (A) exceeds the cred-
it amount determined with respect to the tax-
payer for such month under paragraph (2), 
such excess may be carried forward to any sub-
sequent month during the taxable year for pur-
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poses of determining the limitation under sub-
paragraph (A). 
‘‘(4) ADJUSTMENT FOR LIMITED BENEFIT IN-
SURANCE.—In the case of a taxpayer whose only 
health insurance coverage for a month is limited 
benefit insurance (as defined in section 123(b) of the 
Health Care Fairness for All Act), the amount de-
termined under paragraph (2) shall be decreased by 
such proportion as the Secretary, in consultation 
with the Secretary of Health and Human Services, 
determines appropriate, taking into account the ratio 
of the actuarial value of such limited benefit insur-
ance to the average actuarial value of health insur-
ance coverage that is not limited benefit insurance. 
‘‘(c) COORDINATION
WITH
EMPLOYER-PROVIDED 
HEALTH INSURANCE TAX SUBSIDY.— 
‘‘(1) CREDIT LIMITED BY EMPLOYER-PROVIDED 
HEALTH INSURANCE TAX SUBSIDY.—The credit al-
lowed under this section for any taxable year shall 
not exceed an amount equal to the excess (if any) 
of— 
‘‘(A) the maximum credit which would be 
allowed for all months of the taxpayer during 
the taxable year (determined under subsection 
(b)(2) and without regard to this subsection, 
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the limitation under subsection (b)(3), and any 
reduction under subsection (d)(1)), over 
‘‘(B) the taxpayer’s employer-provided 
health insurance tax subsidy for the taxable 
year. 
‘‘(2) EXCESS EMPLOYER-PROVIDED HEALTH IN-
SURANCE
TAX
SUBSIDY
INCLUDED
IN
GROSS
IN-
COME.—In the case of a taxpayer for whom sub-
paragraph (B) of paragraph (1) exceeds subpara-
graph (A) of such paragraph for the taxable year, 
the tax imposed by this chapter shall be increased 
for such taxable year by the amount of such excess. 
‘‘(3) EMPLOYER-PROVIDED HEALTH INSURANCE 
TAX SUBSIDY.—For purposes of this subsection— 
‘‘(A) IN GENERAL.—The term ‘employer- 
provided health insurance tax subsidy’ means, 
with respect to any taxpayer for a taxable year, 
the sum of— 
‘‘(i) the Federal income tax subsidy of 
the taxpayer for the taxable year, plus 
‘‘(ii) the Federal payroll tax subsidy 
of the taxpayer for the taxable year. 
‘‘(B) FEDERAL INCOME TAX SUBSIDY.— 
The term ‘Federal income tax subsidy’ means, 
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with respect to any taxpayer for the taxable 
year, the excess (if any) of— 
‘‘(i) the amount of tax that would 
have been imposed by this chapter for the 
taxable year had such tax been determined 
without regard to this section and by in-
cluding amounts otherwise excluded from 
gross income which were paid by or on be-
half of the taxpayer for employer-provided 
insurance that constitutes medical care, 
over 
‘‘(ii) the amount of tax imposed by 
this chapter for the taxable year (deter-
mined without regard to this section). 
‘‘(C) FEDERAL PAYROLL TAX SUBSIDY.— 
The term ‘Federal payroll tax subsidy’ means, 
with respect to any taxpayer for the taxable 
year, the excess (if any) of— 
‘‘(i) the sum of— 
‘‘(I) the amount of tax that 
would have been imposed by chapter 
21 with respect to any wages of the 
taxpayer paid during the taxable year 
had such tax been determined by in-
cluding amounts otherwise excluded 
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from wages which were paid by or on 
behalf of the taxpayer during the tax-
able year for employer-provided insur-
ance that constitutes medical care, 
plus 
‘‘(II) the amount of tax that 
would have been imposed by chapter 2 
on any self-employment income of the 
taxpayer for such taxable year had 
self-employment income been deter-
mined without regard to any deduc-
tion from gross income for amounts 
paid for insurance which constitutes 
medical care for the taxpayer, the tax-
payer’s spouse, and any qualifying 
children (within the meaning of sec-
tion 152) for whom the taxpayer is al-
lowed a deduction under section 151 
for the taxable year, over 
‘‘(ii) the amount of tax imposed with 
respect to the taxpayer during such taxable 
year under chapter 21 and for such taxable 
year under chapter 2. 
‘‘(d) RECONCILIATION
OF CREDIT
AND ADVANCE 
CREDIT.— 
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‘‘(1) IN GENERAL.—The amount of the credit 
allowed under this section for any taxable year (after 
the application of subsections (b) and (c)) shall be 
reduced (but not below zero) by the amount of any 
advance payment of such credit under subsection 
(e)(1). 
‘‘(2) EXCESS ADVANCE PAYMENTS.— 
‘‘(A) IN GENERAL.—If the advance pay-
ments to a taxpayer under subsection (e)(1) for 
a taxable year exceed the credit allowed by this 
section (determined without regard to para-
graph (1)), the tax imposed by this chapter for 
the taxable year shall be increased by the 
amount of such excess. 
‘‘(B) LIMITATION ON INCREASE.—In the 
case of a taxpayer whose household income is 
less than 400 percent of the poverty line for the 
size of the family involved for the taxable year, 
the amount of the increase under subparagraph 
(A) shall in no event exceed an amount equal 
to the applicable percentage of the amount of 
the credit allowed under this section for the 
taxable year, determined in accordance with the 
following table (one-half of such amount so de-
termined in the case of a taxpayer whose tax is 
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determined under section 1(c) for the taxable 
year): 
‘‘If the household income
(expressed as a percent
of poverty line) is: 
The applicable 
percentage 
is: 
Less than 200% ..............................................................
30% 
At least 200% but less than 300% ................................
50% 
At least 300% but less than 400% ................................
80% 
‘‘(e) SPECIAL RULES.—For purpose of this section— 
‘‘(1) ADVANCE PAYMENT PROGRAM.— 
‘‘(A) IN GENERAL.—The Secretary of the 
Treasury, in consultation with the Secretary of 
Health and Human Services, shall establish a 
program— 
‘‘(i) to make advance determinations 
with respect to the eligibility of individuals 
for the credit allowed under this section, 
and 
‘‘(ii) to make advance payments of the 
credit allowed under this section, at the 
election of any such individual so eligible, 
directly to the health savings account of 
any such individual, or, as a subsidy to the 
cost of health insurance coverage provided 
to any such individual, to the health insur-
ance issuer providing such coverage or the 
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person that administers the plan benefits 
with respect to such coverage. 
‘‘(B) 
PROGRAM
REQUIREMENTS.—Such 
program shall be established under rules similar 
to the rules of section 1412 of Public Law 111– 
148, as in effect on the day before the date of 
the enactment of this section, except that ad-
vance determinations and advance payments 
shall be made on request of the individual with 
respect to whom the determination is to be 
made. 
‘‘(2) INFORMATION REQUIREMENTS.— 
‘‘(A) IN GENERAL.—Each person providing 
health insurance coverage which constitutes 
medical care, and each trustee of a health sav-
ings account, shall provide the following infor-
mation to the Secretary and to the taxpayer 
with respect to such coverage or such account: 
‘‘(i) The total premium for the cov-
erage without regard to the credit under 
this section. 
‘‘(ii) The aggregate amount of any ad-
vance payment of such credit made with 
respect to such coverage or to such ac-
count. 
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‘‘(iii) The name, address, age, and 
TIN of the primary insured or account 
holder (as the case may be) and the name, 
age, and TIN of each other individual ob-
taining coverage under such policy of in-
surance. 
‘‘(iv) Any information provided to 
such person necessary to determine eligi-
bility for, and the amount of, such credit. 
‘‘(v) Information necessary to deter-
mine whether a taxpayer has received ex-
cess advance payments. 
‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply to any coverage with respect to 
which reporting under section 6051 is required. 
‘‘(3) INDEXING.— 
‘‘(A) IN GENERAL.—In the case of any cal-
endar year beginning after 2024, each of the 
dollar amounts in subsection (b)(2) and in the 
table contained under subsection (d)(2)(B) shall 
be equal to such dollar amount multiplied by 
the ratio of— 
‘‘(i) the current dollar gross domestic 
product (as determined based on the third 
estimate of the Bureau of Economic Anal-
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ysis of the Department of Commerce for 
the second quarter of the previous year), to 
‘‘(ii) the current dollar gross domestic 
product (as so determined) for the second 
quarter of 2023. 
‘‘(B) ROUNDING.—If the amount of any 
change under subparagraph (A) is not a mul-
tiple of $50, such change shall be rounded to 
the next lowest multiple of $50. 
‘‘(f) DEFINITIONS.—For purposes of this section— 
‘‘(1) CREDITABLE COVERAGE.— 
‘‘(A) IN GENERAL.—The term ‘creditable 
coverage’ has the meaning given such term for 
purposes of title XXVII of the Public Health 
Service Act. Such term shall not include cov-
erage under any health plan that includes cov-
erage for abortions (other than any abortion de-
scribed in subparagraph (B)). 
‘‘(B) EXCEPTION.—The second sentence of 
subparagraph (A) shall not apply to an abor-
tion— 
‘‘(i) if the pregnancy is the result of 
an act of rape or incest, or 
‘‘(ii) in the case where a woman suf-
fers from a physical disorder, physical in-
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jury, or physical illness that would, as cer-
tified by a physician, place the woman in 
danger of death unless an abortion is per-
formed, including a life-endangering phys-
ical condition caused by or arising from 
the pregnancy itself. 
‘‘(C) SEPARATE ABORTION COVERAGE OR 
PLAN ALLOWED.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any individual from purchasing separate 
coverage for abortions described in such 
subparagraph, or a health plan that in-
cludes such abortions, so long as no credit 
is allowed under this section with respect 
to the premiums for such coverage or plan. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
issuer offering a health plan from offering 
separate coverage for abortions described 
in such subparagraph, or a plan that in-
cludes such abortions, so long as premiums 
for such separate coverage or plan are not 
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paid for with any amount attributable to 
the credit allowed under this section (or 
the amount of any advance payment of the 
credit). 
‘‘(2) QUALIFIED RESIDENT.—The term ‘quali-
fied resident’ means an individual who is a citizen or 
national of the United States or otherwise lawfully 
residing in the United States under color of law.’’. 
(b) DISQUALIFICATION FROM EXCHANGE PLAN SUB-
SIDIES FOR INDIVIDUAL ONCE THEY ELECT TAX BENE-
FITS.—Section 36B(c)(1) of such Code is amended by 
adding at the end the following new subparagraph: 
‘‘(F) DENIAL
OF
CREDIT
FOR
THOSE 
ELECTING UNIVERSAL CREDIT.—In the case of 
an individual who is allowed a credit under sec-
tion 36C for any taxable year, no credit shall be 
allowed under this section to such individual for 
such taxable year or any subsequent taxable 
year.’’. 
(c) GUIDANCE.—The Secretary of the Treasury shall 
issue such guidance as is necessary— 
(1) to assist employees and employers in adjust-
ing Federal income tax withholding to take into ac-
count the health insurance tax credit under section 
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36C of the Internal Revenue Code of 1986 (and any 
advance payment thereof), and 
(2) to require employers to report to each em-
ployee with respect to periods not longer than quar-
terly the employer-provided health insurance tax 
subsidy (as defined in section 36C(c)(2) of such 
Code) with respect to such employee for such period. 
(d) TRANSFERS TO FEDERAL OLD-AGE AND SUR-
VIVORS INSURANCE TRUST FUND.—With respect to each 
individual for whom tax is increased under section 
36C(c)(2), there are hereby appropriated to the Federal 
Old Age and Survivors Trust Fund and the Disability In-
surance Trust Fund established under section 201 of the 
Social Security Act amounts equal to the amount which 
bears the same ratio to the amount of such increase as— 
(1) the Federal payroll tax subsidy (as defined 
in section 36C(c)(3)) of such individual for the tax-
able year, bears to 
(2) the employer-provided health insurance tax 
subsidy (as defined in such section) of the individual 
for the taxable year. 
(e) CLERICAL AMENDMENT.—The table of sections 
for subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 is amended by in-
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serting after the item relating to section 36B the following 
new item: 
‘‘Sec. 36C. Health insurance tax credit.’’. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2023. 
SEC. 132. APPLICATION OF PORTION OF UNUSED TAX 
CREDITS BY STATES FOR INDIGENT HEALTH 
CARE. 
(a) COMPUTATION OF UNUSED CREDITS.—The Sec-
retary, in consultation with the Secretary of the Treasury, 
shall calculate for each State for each year, beginning with 
2024, using the most recent data available — 
(1) the maximum aggregate amount of credits 
under section 36C of the Internal Revenue Code of 
1986 that would have been allowed for the year for 
qualified residents of the State for taxable years 
ending in the year if all eligible qualified residents 
had qualified for such credits; 
(2) the aggregate amount of credits under such 
section that were allowed for taxable years ending in 
the year by qualified residents of such State; and 
(3) 25 percent of the amount by which— 
(A) the amount determined under para-
graph (1) with respect to qualified residents of 
the State for such year; exceeds 
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(B) the amount determined under para-
graph (2) for such State for that year. 
(b) APPROPRIATION.—For the purpose of making 
grants to States under this section, there is hereby appro-
priated to the Secretary, out of any funds in the Treasury 
not otherwise appropriated, for each year (beginning with 
2023) an amount equivalent to the amount determined 
under subsection (a)(3) for all States under subsection (a) 
for the year in which such fiscal year ends, subject to ad-
justment under subsection (d)(2). 
(c) GRANTS
TO STATES
FOR INDIGENT ASSIST-
ANCE.— 
(1) APPLICATION.—A State may file with the 
Secretary (in a form and manner specified by the 
Secretary) an application to provide assistance in 
furnishing health services to indigent individuals re-
siding in the State. Such application shall dem-
onstrate the manner in which such assistance is fur-
nished in an equitable manner to individuals residing 
in all parts of the State. 
(2) AMOUNT OF FUNDS.—From the funds ap-
propriated under subsection (b) for a year, the 
amount of funds paid to any State in any year 
under this section with an application filed in ac-
cordance with paragraph (1) is equal to an amount 
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specified in the application, but not to exceed the 
amount computed under subsection (a)(3) for the 
State and the year. 
(3) USE OF FUNDS.—Funds paid to a State 
under this subsection may be used only to assist in 
the furnishing of health services to uninsured indi-
viduals residing in the State or for purposes of in-
creasing the payment adjustments made under sec-
tions 1886(d)(5)(F) and 1923 of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(F), 1396r–4) to hos-
pitals that serve a disproportionate share of such in-
dividuals in the State. 
(d) INITIAL ESTIMATE; FINAL CALCULATION AND 
RECONCILIATION.— 
(1) USE
OF
ESTIMATES.—The calculations 
under subsection (a) for a year shall initially be esti-
mated before the beginning of the year. Payments 
under this section to a State for a year shall be 
made, subject to reconciliation under paragraph (2), 
based on the amount so estimated. 
(2) RECONCILIATION
BASED
ON
FINAL
CAL-
CULATION.—The calculations under subsection (a) 
for a year shall also be made after the end of the 
year. Insofar as the amount calculated under this 
paragraph for subsection (a)(3) for a State for a 
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year exceeds (or is less than) by a material amount 
from the amount for subsection (a)(3) estimated and 
applied for the State and year under paragraph (1), 
the amount calculated under subsection (a)(3) for 
the State for the 2nd year beginning after such year, 
shall be reduced or increased, respectively by the 
amount of such excess or deficit. 
SEC. 133. MEDICAID OPTION OF ENROLLMENT UNDER PRI-
VATE PLAN AND CONTRIBUTION TO AN HSA. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, a State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) may make available 
to an individual, who is entitled to medical assistance for 
a full range of acute care items and services under such 
title and at the individual’s option, instead of the medical 
assistance otherwise provided, medical assistance con-
sisting of coverage under a health plan that qualifies for 
a tax credit under section 36C of the Internal Revenue 
Code of 1986, but only if the State provides for the indi-
vidual medical assistance, in the form of a deposit into 
a health savings account for the individual, an amount 
equivalent to the amount by which the amount of tax cred-
it for the individual under such section exceeds the cost 
of coverage of the individual under the plan. 
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(b) FFP TREATMENT.—The payments by a State de-
scribed in subsection (a) for coverage under a health plan 
and for deposit into a health savings account shall be 
treated as medical assistance for purposes of section 1903 
of the Social Security Act (42 U.S.C. 1396b) and subject 
to Federal financial participating, including the applica-
tion of State matching payments, in the same manner as 
other medical assistance furnished under title XIX of such 
Act, except that such amount shall be reduced by the 
amount of any health insurance credits provided under 
section 36C of the Internal Revenue Code of 1986 with 
respect to such coverage or deposit. 
SEC. 134. REPEAL OF REPORTING REQUIREMENTS RELAT-
ING TO EMPLOYEE HEALTH INSURANCE PRE-
MIUMS AND HEALTH PLAN BENEFITS. 
(a) REPORTING REQUIREMENTS.—Section 6051(a) 
of the Internal Revenue Code of 1986 is amended by strik-
ing paragraph (14) and by redesignating paragraphs (15), 
(16), and (17) as paragraphs (14), (15), and (16), respec-
tively. 
(b) EFFECTIVE DATES.—The amendment made by 
this section shall apply to calendar years beginning after 
December 31, 2018. 
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SEC. 135. REPORT. 
For each year beginning on or after the date of the 
enactment of this Act, the Secretary of Health and 
Human Services shall submit to Congress a report on the 
extent to which health insurance tax credits allowed under 
section 36C of the Internal Revenue Code of 1986, as 
added by this Act, are sufficient to cover the cost of health 
insurance coverage for individuals electing to purchase 
such coverage. 
Subtitle D—Medicare Reforms 
SEC. 141. PHYSICIAN-OWNED HOSPITALS. 
The amendments made by section 6001 of Public 
Law 111–148 are repealed and the provisions amended 
by such section are restored as if such amendments had 
never occurred. 
SEC. 142. PROHIBITING THE USE OF AN INPATIENT-ONLY 
LIST 
IN 
DESIGNATING 
HOSPITAL 
OUT-
PATIENT SERVICES UNDER THE MEDICARE 
PROGRAM. 
Section 1833(t)(1) of the Social Security Act (42 
U.S.C. 1395l(t)(1)) is amended by adding at the end the 
following new subparagraph: 
‘‘(C) PROHIBITION ON USE OF AN INPA-
TIENT-ONLY
LIST.—In designating outpatient 
hospital services pursuant to subparagraph 
(B)(i), the Secretary may not refuse to so des-
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