I 
111TH CONGRESS 
1ST SESSION H. R. 2668 
To provide for the offering of an American Trust Health Plan to provide 
choice in health insurance options so as to ensure quality, affordable 
health coverage for all Americans. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 2, 2009 
Mr. MURPHY of Connecticut (for himself, Mr. BRALEY of Iowa, and Mr. 
WELCH) 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 provide for the offering of an American Trust Health 
Plan to provide choice in health insurance options so 
as to ensure quality, affordable health coverage for all 
Americans. 
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 
‘‘Choice in Health Options Insures Care for Everyone 
(CHOICE) Act of 2009’’. 
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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. Establishment of American Trust Health Plan; administrative structure. 
Sec. 3. Finances. 
Sec. 4. Eligibility and enrollment. 
Sec. 5. Providers. 
Sec. 6. Benefits. 
Sec. 7. Premiums. 
SEC. 2. ESTABLISHMENT OF AMERICAN TRUST HEALTH 
PLAN; ADMINISTRATIVE STRUCTURE. 
(a) IN GENERAL.—There is established an American 
Trust Health Plan (in this Act referred to as the ‘‘Amer-
ican Trust Health Plan’’ or the ‘‘Plan’’) or to provide for 
the offering to eligible individuals of health benefits cov-
erage throughout the United States, including its terri-
tories. 
(b) COMPLIANCE WITH REQUIREMENTS.— 
(1) IN GENERAL.—The American Trust Health 
Plan shall comply with all requirements that are ap-
plicable with respect to other health benefits plans to 
be offered through a National Health Insurance Ex-
change (as defined in subsection (e)), including (as 
specified in this Act) minimum benefit and cost- 
sharing requirements and premium rating require-
ments. 
(2) EXEMPTION FROM STATE INSURANCE REG-
ULATIONS.—As a Federal health program, the 
American Trust Health Plan is not required to com-
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ply with the insurance regulations of the States to 
the extent health benefits plans offered through the 
National Health Insurance Exchange are exempt 
from such regulations. 
(3) SATISFACTION
OF
INDIVIDUAL
MANDATE 
REQUIREMENT.—An individual’s enrollment with the 
Plan shall be treated as satisfying any requirement 
under Federal law for the individual to demonstrate 
enrollment in health insurance or benefits coverage. 
(c) PLAN ADMINISTRATION.— 
(1) ADMINISTRATOR.—The American Trust 
Health Plan shall be administered by an Office of 
American Trust Health Administration (in this Act 
referred to as the ‘‘Office’’) within the Department 
of Health and Human Services. The Office shall be 
headed by an Administrator (in this Act referred to 
as the ‘‘Administrator’’) who shall be appointed by 
the President, by and with the advice and consent 
of the Senate. 
(2) COMPENSATION.—The Administrator shall 
be entitled to compensation at the level II of the Ex-
ecutive Schedule (under section 5313 of title 5, 
United States Code). 
(3) LIMITATION.—The Administrator and the 
Office shall not participate in the administration of 
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any regulation regarding the health insurance mar-
ket or in the administration of the National Health 
Insurance Exchange. 
(4) GENERAL AUTHORITY.—The Administrator 
shall have the same general authorities with respect 
to personnel and operations of the Office as the 
heads of other agencies and departments of the Fed-
eral Government have with respect to such agencies 
and departments. 
(d) ADVISORY BOARD.— 
(1) IN GENERAL.—The Administrator shall be 
advised by an Advisory Board (in this Act referred 
to as the ‘‘Advisory Board’’) composed of 7 individ-
uals appointed by the President. The President shall 
nominate individuals to serve on the Advisory Board 
in a manner that provides for inclusion on the Board 
of individuals who— 
(A) represent the interests of patients or 
consumers; 
(B) represent the interests health care pro-
viders, at least one of whom is a physician; and 
(C) are experts in health care quality 
measurements and reporting. 
(2) DUTIES.—The Advisory Board shall advise 
the Administrator regarding the operation of the 
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American Trust Health Plan and the Administrator 
shall consult with the Advisory Board not less often 
than quarterly and before making any annual 
changes in benefits under Plan. 
(3) TERMS, COMPENSATION, CHAIR, MEETINGS, 
ETC.—The provisions of paragraphs (2)(D), (3), (4), 
(5), and (6) of section 1805(c) of the Social Security 
Act (42 U.S.C. 1395b–6(c)) shall apply with respect 
to the Advisory Board and the President under this 
section in the same manner as such provisions apply 
to the Medicare Payment Advisory Commission and 
the Comptroller General, respectively, under section 
1805 of such Act. 
(4) FINANCING.—Within the budget established 
for the operation of the Plan, the Administrator 
shall provide for payment for the costs of operation 
of the Advisory Board. 
(e) NATIONAL HEALTH INSURANCE EXCHANGE DE-
FINED.—In this Act, the term ‘‘National Health Insur-
ance Exchange’’ means a mechanism established or recog-
nized under Federal law for coordinating the offering of 
health benefits coverage to individuals in the United 
States (and includes such a mechanism that may be oper-
ated at a State or regional level) through the establish-
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ment of standards for benefits and cost-sharing and for 
premiums for such health benefits coverage. 
SEC. 3. FINANCES. 
(a) SELF-FINANCING.—The American Trust Health 
Plan shall be financially self-sustaining insofar as funds 
to operate the Plan, including costs of benefits, adminis-
tration, and marketing, shall be derived from premiums 
for individuals enrolled under the Plan. The Plan is eligi-
ble to accept subsidies, including subsidies for the enroll-
ment of such individuals, in the same manner and to the 
same extent as other health benefits plans offered through 
a National Health Insurance Exchange are eligible to ac-
cept subsidies. 
(b) CONTINGENCY RESERVE.—The Administrator 
shall establish and fund a contingency reserve for the Plan 
in a form similar to that of a contingency reserve for 
health benefits plans under the Federal Employees Health 
Benefits Program under chapter 89 of title 5, United 
States Code. 
SEC. 4. ELIGIBILITY AND ENROLLMENT. 
(a) ELIGIBILITY.— 
(1) IN GENERAL.—Any individual who is made 
eligible to purchase coverage with a health benefits 
plan through the National Health Insurance Ex-
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change is eligible to enroll with the American Health 
Trust Plan. 
(2) EMPLOYER ENROLLMENT.—To the extent 
provided by the National Health Insurance Ex-
change with respect to health benefits coverage of-
fered through the Exchange, employers are eligible 
to purchase coverage for, and enroll their employees 
and dependents with, the Plan. 
(b) ANNUAL OPEN ENROLLMENT PERIOD.—The Ad-
ministrator shall determine a yearly period of open enroll-
ment for eligible individuals of not less than four consecu-
tive weeks. Such a period shall be consistent with any 
similar annual open enrollment period established by the 
National Health Insurance Exchange for health benefits 
plans offered through the Exchange. 
(c) NOTICES OF SIGNIFICANT CHANGES.— 
(1) IN GENERAL.—No significant change shall 
be made under the Plan except with public notice 
and on an annual basis and consistent with rules es-
tablished by the National Health Insurance Ex-
change for health benefits coverage offered through 
the Exchange. 
(2) SIGNIFICANT
CHANGE
DEFINED.—In this 
subsection, the term ‘‘significant change’’ includes 
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any change in benefits, copayments, deductibles, or 
premiums. 
SEC. 5. PROVIDERS. 
(a) ACCESS TO MEDICARE PROVIDER NETWORK.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), any health care provider that is eligible 
for and accepts reimbursement for services under 
the Medicare program under title XVIII of the So-
cial Security Act (in this section referred to as the 
‘‘Medicare’’) shall, as a condition of continuing to 
participate under such program, also participate 
under the American Health Trust Plan. 
(2) EXCEPTION.—Paragraph (1) shall not be 
construed as requiring a provider to accept new pa-
tients due to bona fide capacity limitations of the 
provider. 
(b) REIMBURSEMENT LEVELS.— 
(1) IN GENERAL.—The Administrator shall pro-
vide for payment to health care providers for covered 
services at rates not less, on average and in the ag-
gregate nationally, than 105 percent of the payment 
rates recognized for such services (or substantially 
similar services) under Medicare. In the case of 
those services which are covered under the Plan but 
are not covered under Medicare, the Administrator 
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shall seek to apply payment rates and methodologies 
similar to those described in the previous sentence. 
(2) ADJUSTMENT.—The Administrator, in de-
termining the competitiveness of the Plan within dif-
ferent markets and compared to other health bene-
fits plans offered through the National Health In-
surance Exchange, may increase the payment rates 
for health care providers above the rate otherwise 
provided under paragraph (1). 
(3) GPCI FLOORS.—In applying paragraph (1), 
the work and practice expense geographic indices ap-
plied under section 1848(e)(1) of the Social Security 
Act for any locality shall not be less than 1.00. 
(c) ADOPTION OF MEDICARE REFORMS.—The Plan 
may adopt Medicare system delivery reforms that provide 
patients with a coordinated system of care and make 
changes to the provider payment structure. 
SEC. 6. BENEFITS. 
(a) IN GENERAL.—The Administrator shall specify 
the benefits to be provided under the Plan consistent with 
this section and in consultation with the Advisory Board. 
(b) MINIMUM BENEFIT LEVEL.—The Plan may offer 
coverage with differing benefit levels so long as such bene-
fits and levels are consistent with the benefits and levels 
of benefits required to be offered by health benefits plans 
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under the National Health Insurance Exchange, and shall 
include the offering of at least one benefit level which 
closely reflects the lowest benefit level that may be offered 
by a health benefits plan through such Exchange. 
SEC. 7. PREMIUMS. 
(a) IN GENERAL.—The Administrator shall specify 
the levels of premiums for coverage under the Plan so long 
as they— 
(1) are based upon a system of rating that is 
consistent with rating rules that is established for 
health benefits plans offered through the National 
Health Insurance Exchange; 
(2) do not take into account health status re-
lated factors for any individual enrollee; and 
(3) are designed to provide sufficient funds to 
meet the requirement of section 3(a). 
(b) RATING RULES.—To the extent permitted for 
health benefits plans offered through the National Health 
Insurance Exchange, the premiums for the Plan shall vary 
based on geographic area and family size and may vary 
based on tobacco usage of an enrollee or other factors per-
mitted for health benefits plans offered through the Ex-
change. 
Æ 
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