I 
114TH CONGRESS 
1ST SESSION H. R. 3777 
To provide for relief from sequester under the Balanced Budget and Emer-
gency Deficit Control Act of 1985 and offsets to such relief through 
reforms in certain revenue and direct spending programs, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 21, 2015 
Mr. RIGELL introduced the following bill; which was referred to the Committee 
on Ways and Means, and in addition to the Committees on the Budget, 
Energy and Commerce, the Judiciary, Education and the Workforce, 
Oversight and Government Reform, Homeland Security, Financial Serv-
ices, and Agriculture, 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 relief from sequester under the Balanced 
Budget and Emergency Deficit Control Act of 1985 and 
offsets to such relief through reforms in certain revenue 
and direct spending programs, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘America First Act’’. 
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SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—SEQUESTER RELIEF 
Sec. 101. Amendments to the Balanced Budget and Emergency Deficit Control 
Act of 1985. 
TITLE II—REVENUE 
Sec. 201. Permanent extension of modifications to earned income tax credit. 
Sec. 202. 35-percent limitation on certain deductions and exclusions. 
Sec. 203. Repeal of medical device tax. 
TITLE III—HEALTHCARE SAVINGS 
Subtitle A—Medicare and Medicaid Provisions 
Sec. 301. Freeze income-related thresholds in calculation of Medicare part B 
and part D premiums. 
Sec. 302. Adjustment to applicable percentage increase for Medicare part B 
and D premiums for high-income beneficiaries. 
Sec. 303. Improved benefit structure. 
Sec. 304. Prohibition on first-dollar coverage under medigap policies and devel-
opment of new standards for medigap policies. 
Sec. 305. Adjust Post-Acute Payment Updates. 
Sec. 306. Payment bundling for post-acute care (PAC) under Medicare. 
Sec. 307. Reduction of bad debt treated as an allowable cost. 
Sec. 308. Reduce Excess Subsidies to Teaching Hospitals. 
Sec. 309. Equalizing payment for certain covered OPD services and physicians’ 
services. 
Sec. 310. Medicare Advantage coding intensity adjustment. 
Sec. 311. Modifications to cost-sharing reductions under Medicare part D for 
low-income individuals. 
Sec. 312. Rebase Medicare payments at post-sequester levels. 
Sec. 313. Phased-in reduction of allowable provider taxes under Medicaid. 
Subtitle B—Medical Malpractice Reform 
Sec. 321. Definitions. 
Sec. 322. Encouraging speedy resolution of claims. 
Sec. 323. Compensating patient injury. 
Sec. 324. Maximizing patient recovery. 
Sec. 325. Additional HEALTH benefits. 
Sec. 326. Effect on other laws. 
Sec. 327. State flexibility and protection of States’ rights. 
Sec. 328. State demonstration programs to evaluate alternatives to current 
medical tort litigation. 
Sec. 329. Affirmative defense based on compliance with best practice guidelines. 
Sec. 330. Medical malpractice reform State incentive fund. 
Sec. 331. Sense of Congress concerning additional reforms. 
Sec. 332. Applicability; effective date. 
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TITLE IV—SOCIAL SECURITY SAVINGS 
Sec. 401. Adjustments in supplemental security income benefits for certain 
long-time beneficiaries. 
TITLE V—OTHER MANDATORY SAVINGS AND RECEIPTS 
Sec. 501. Conversion to chained CPI. 
Sec. 502. Adjustment for inflation of fees for certain customs services. 
Sec. 503. Adjustment for inflation of TSA service security fees and fee levels. 
Sec. 504. Dividends and surplus funds of reserve banks. 
Sec. 505. Cost-saving reforms for Federal Crop Insurance Program. 
Sec. 506. Federal employee annuities. 
Sec. 507. Repayment plans. 
Sec. 508. REPAYE. 
Sec. 509. Public service loan forgiveness. 
TITLE I—SEQUESTER RELIEF 
SEC. 101. AMENDMENTS TO THE BALANCED BUDGET AND 
EMERGENCY DEFICIT CONTROL ACT OF 1985. 
(a) DISCRETIONARY
SPENDING
LIMITS.—Section 
251(c) of the Balanced Budget and Emergency Deficit 
Control Act of 1985 (2 U.S.C. 901(c)) is amended by 
striking paragraphs (3) through (8) and inserting the fol-
lowing: 
‘‘(3) for fiscal year 2016— 
‘‘(A) for the revised security category, 
$564,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$521,000,000,000 in new budget authority; 
‘‘(4) for fiscal year 2017— 
‘‘(A) for the revised security category, 
$577,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$532,000,000,000 in new budget authority; 
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‘‘(5) for fiscal year 2018— 
‘‘(A) for the revised security category, 
$590,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$544,000,000,000 in new budget authority; 
‘‘(6) for fiscal year 2019— 
‘‘(A) for the revised security category, 
$603,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$557,000,000,000 in new budget authority; 
‘‘(7) for fiscal year 2020— 
‘‘(A) for the revised security category, 
$617,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$569,000,000,000 in new budget authority; 
‘‘(8) for fiscal year 2021— 
‘‘(A) for the revised security category, 
$631,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$581,000,000,000 in new budget authority; 
‘‘(9) for fiscal year 2022— 
‘‘(A) for the revised security category, 
$646,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$596,000,000,000 in new budget authority; 
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‘‘(10) for fiscal year 2023— 
‘‘(A) for the revised security category, 
$662,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$610,000,000,000 in new budget authority; 
‘‘(11) for fiscal year 2024— 
‘‘(A) for the revised security category, 
$679,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$626,000,000,000 in new budget authority; and 
‘‘(12) for fiscal year 2025— 
‘‘(A) for the revised security category, 
$695,000,000,000 in new budget authority; and 
‘‘(B) for the revised nonsecurity category, 
$641,000,000,000 in new budget authority;’’. 
(b) ELIMINATION OF DIRECT SPENDING SEQUESTER 
AND OTHER ADJUSTMENTS.— 
(1) IN GENERAL.—Section 251A of the Bal-
anced Budget and Emergency Deficit Control Act of 
1985 (2 U.S.C. 901a) is repealed. 
(2) CLARIFICATION.—Any order issued by the 
Director of the Office of Management and Budget to 
reduce the discretionary spending limit for fiscal 
year 2016 under such section (as in effect on the 
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date before the date of enactment of this Act) shall 
have no force or effect. 
(c) ADJUSTMENTS
TO DISCRETIONARY SPENDING 
LIMITS.—Section 251(b)(2) of the Balanced Budget and 
Emergency Deficit Control Act of 1985 (2 U.S.C. 
901(b)(2)) is amended as follows: 
(1) In subparagraph (B)— 
(A) in subclause (IX), by striking ‘‘and’’ at 
the end; 
(B) in subclause (X), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(XI) 
for 
fiscal 
year 
2022, 
$1,309,000,000 in additional new 
budget authority; 
‘‘(XII) for fiscal year 2023, 
$1,309,000,000 in additional new 
budget authority; 
‘‘(XIII) for fiscal year 2024, 
$1,309,000,000 in additional new 
budget authority; and 
‘‘(XIV) for fiscal year 2025, 
$1,309,000,000 in additional new 
budget authority.’’. 
(2) In subparagraph (C)— 
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(A) in subclause (IX), by striking ‘‘and’’ at 
the end; 
(B) in subclause (X), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(XI) 
for 
fiscal 
year 
2022, 
$496,000,000 in additional new budg-
et authority; 
‘‘(XII) for fiscal year 2023, 
$496,000,000in additional new budget 
authority; 
‘‘(XIII) for fiscal year 2024, 
$496,000,000 in additional new budg-
et authority; and 
‘‘(XIV) for fiscal year 2025, 
$496,000,000 in additional new budg-
et authority.’’. 
(3) In subparagraph (D), by striking ‘‘fiscal 
years 2012 through 2021’’ and inserting ‘‘fiscal 
years 2012 through 2025’’. 
(d) CLERICAL AMENDMENT.—Section 250(a) of the 
Balanced Budget and Emergency Deficit Control Act of 
1985 (2 U.S.C. 900(a)) is amended by striking the item 
relating to section 251A. 
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