I 
110TH CONGRESS 
1ST SESSION 
H. R. 506 
To provide for innovation in health care through State initiatives that expand 
coverage and access. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 17, 2007 
Ms. BALDWIN (for herself, Mr. PRICE of Georgia, Mr. TIERNEY, Mr. 
FORTUN˜O, Mr. STARK, Mr. LINDER, Mr. CONYERS, Mr. WESTMORE-
LAND, Mrs. CAPPS, Mr. SOUDER, Mr. ALLEN, Mr. MARCHANT, Mr. GENE 
GREEN of Texas, Mr. GOHMERT, Mr. LARSON of Connecticut, Mr. BUR-
TON of Indiana, Mr. WELCH of Vermont, Mr. GINGREY, Mr. HOLT, Mr. 
WAMP, Mr. COOPER, Mr. CANTOR, Mr. PAYNE, Mr. CARTER, Ms. JACK-
SON-LEE of Texas, Mr. AKIN, Ms. MOORE of Wisconsin, Mr. WU, and 
Mr. LANGEVIN) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Rules, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To provide for innovation in health care through State 
initiatives that expand coverage and access. 
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 ‘‘Health Partnership 
Through Creative Federalism Act’’. 
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SEC. 2. STATE HEALTH REFORM PROJECTS. 
(a) PURPOSES; ESTABLISHMENT OF STATE HEALTH 
CARE EXPANSION AND IMPROVEMENT PROGRAM.— 
(1) PURPOSES.—The purposes of the programs 
approved under this section shall include, but not be 
limited to— 
(A) achieving the goals of increased health 
coverage and access; and 
(B) testing alternative reforms, such as 
building on the public or private health systems, 
or creating new systems, to achieve the objec-
tives of this Act. 
(2) INTENT OF CONGRESS.—It is the intent of 
Congress that— 
(A) the programs approved under this Act 
each comprise significant coverage expansions; 
(B) taken as a whole, such programs 
should be diverse and balanced in their ap-
proaches to covering the uninsured; and 
(C) each such program should be rigor-
ously and objectively evaluated, so that the 
State programs developed pursuant to this Act 
may guide the development of future State and 
national policy. 
(b) APPLICATIONS BY STATES AND LOCAL GOVERN-
MENTS.— 
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(1) ENTITIES THAT MAY APPLY.— 
(A) IN GENERAL.—A State may apply for 
a State health care expansion and improvement 
program for the entire State (or for regions of 
the State) under paragraph (2). 
(B) REGIONAL AND SUB-STATE GROUPS.— 
A regional entity consisting of more than one 
State or one or more local governments within 
a State may apply for a multi-State or a sub- 
state health care expansion and improvement 
program for the region or area involved. 
(C) DEFINITION.—In this Act, the term 
‘‘State’’ means the 50 States, the District of 
Columbia, and the Commonwealth of Puerto 
Rico. Such term shall include a regional entity 
described in subparagraph (B). 
(2) SUBMISSION OF APPLICATION.—In accord-
ance with this section, each State or regional entity 
desiring to implement a State health care expansion 
and improvement program may submit an applica-
tion to the State Health Coverage Innovation Com-
mission under subsection (c) (referred to in this sec-
tion as the ‘‘Commission’’) for approval. 
(3) LOCAL
GOVERNMENT
APPLICATIONS.— 
Where a State fails to submit an application under 
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this section, a unit of local government of such 
State, or a consortium of such units of local govern-
ments, may submit an application directly to the 
Commission for programs or projects under this sub-
section. Such an application shall be subject to the 
requirements of this section. 
(c) STATE HEALTH COVERAGE INNOVATION COM-
MISSION.— 
(1) IN
GENERAL.—Within 90 days after the 
date of the enactment of this Act, the Secretary of 
Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) shall establish a State Health 
Coverage Innovation Commission that— 
(A) shall be comprised of— 
(i) the Secretary; 
(ii) four State governors to be ap-
pointed by the National Governors Associa-
tion on a bipartisan basis; 
(iii) two members of a State legisla-
ture to be appointed, on a joint and bipar-
tisan basis, by the National Conference of 
State Legislators and the American Legis-
lative Exchange Council; 
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(iv) two county officials to be ap-
pointed by the National Association of 
Counties on a bipartisan basis; 
(v) two mayors to be appointed, on a 
joint and bipartisan basis, by the National 
League of Cities and by the United States 
Conference of Mayors; 
(vi) two individuals to be appointed by 
the Speaker of the House of Representa-
tives; 
(vii) two individuals to be appointed 
by the Minority Leader of the House of 
Representatives; 
(viii) two individuals to be appointed 
by the Majority Leader of the Senate; and 
(ix) two individuals to be appointed by 
the Minority Leader of the Senate; 
(B) shall request States to submit pro-
posals, which may include a variety of reform 
options such as tax credit approaches, expan-
sions of public programs such as Medicaid and 
the State Children’s Health Insurance Pro-
gram, the creation of purchasing pooling ar-
rangements similar to the Federal Employees 
Health Benefits Program, individual market 
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purchasing options, single risk pool or single 
payer systems, health savings accounts, a com-
bination of the options described in this sub-
paragraph, or other alternatives determined ap-
propriate by the Commission, including options 
suggested by States or the public, and nothing 
in this subparagraph shall be construed to pre-
vent the Commission from approving a reform 
proposal not included in this subparagraph; 
(C) shall conduct a thorough review of the 
grant application from a State and carry on a 
dialogue with all State applicants concerning 
possible modifications and adjustments; 
(D) shall submit the recommendations and 
legislative proposal described in subsection 
(d)(4)(C); 
(E) shall be responsible for receiving infor-
mation to determine the status and progress 
achieved under program or projects granted 
under this section; 
(F) shall report to the public concerning 
progress made by States with respect to the 
performance measures and goals established 
under this Act, the periodic progress of the 
State relative to its State performance meas-
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ures and goals, and the State program applica-
tion procedures, by region and State jurisdic-
tion; 
(G) shall promote information exchange 
between States and the Federal Government; 
(H) shall be responsible for making rec-
ommendations to the Secretary and the Con-
gress, using equivalency or minimum standards, 
for minimizing the negative effect of State pro-
gram on national employer groups, provider or-
ganizations, and insurers because of differing 
State requirements under the programs; and 
(I) may require States to submit additional 
information or reports concerning the status 
and progress achieved under health care expan-
sion and improvement programs granted under 
this section, as needed. 
(2) PERIOD
OF
APPOINTMENT; REPRESENTA-
TION
REQUIREMENTS; VACANCIES.—Members shall 
be appointed for a term of 5 years. In appointing 
such members under paragraph (1)(A), the des-
ignated appointing individuals shall ensure the rep-
resentation of urban and rural areas and an appro-
priate geographic distribution of such members. Any 
vacancy in the Commission shall not affect its pow-
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ers, but shall be filled in the same manner as the 
original appointment. 
(3) CHAIRPERSON, MEETINGS.— 
(A) CHAIRPERSON.—The Commission shall 
select a Chairperson from among its members. 
(B) QUORUM.—Two-thirds of the members 
of the Commission shall constitute a quorum, 
but a lesser number of members may hold hear-
ings. 
(C) MEETINGS.—Not later than 30 days 
after the date on which all members of the 
Commission have been appointed, the Commis-
sion shall hold its first meeting. The Commis-
sion shall meet at the call of the Chairperson. 
(4) POWERS OF THE COMMISSION.— 
(A) NEGOTIATIONS
WITH
STATES.—The 
Commission may conduct detailed discussions 
and negotiations with States submitting appli-
cations under this section, either individually or 
in groups, to facilitate a final set of rec-
ommendations 
for 
purposes 
of 
subsection 
(d)(4)(C). 
(B) HEARINGS.—The Commission may 
hold such hearings, sit and act at such times 
and places, take such testimony, and receive 
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such evidence as the Commission considers ad-
visable to carry out the purposes of this sub-
section. 
(C) MEETINGS.—In addition to other 
meetings the Commission may hold, the Com-
mission shall hold an annual meeting with the 
participating States under this section for the 
purpose of having States report progress to-
ward the purposes in subsection (a) and for an 
exchange of information. 
(D) INFORMATION.—The Commission may 
secure directly from any Federal department or 
agency such information as the Commission 
considers necessary to carry out the provisions 
of this subsection. Upon request of the Chair-
person of the Commission, the head of such de-
partment or agency shall furnish such informa-
tion to the Commission if the head of the de-
partment or agency involved determines it ap-
propriate. 
(E) POSTAL SERVICES.—The Commission 
may use the United States mails in the same 
manner and under the same conditions as other 
departments and agencies of the Federal Gov-
ernment. 
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(5) PERSONNEL MATTERS.— 
(A) COMPENSATION.—Each member of the 
Commission who is not an officer or employee 
of the Federal Government or of a State or 
local government shall be compensated at a rate 
equal to the daily equivalent of the annual rate 
of basic pay prescribed for level IV of the Exec-
utive Schedule under section 5315 of title 5, 
United States Code, for each day (including 
travel time) during which such member is en-
gaged in the performance of the duties of the 
Commission. All members of the Commission 
who are officers or employees of the United 
States shall serve without compensation in addi-
tion to that received for their services as offi-
cers or employees of the United States. 
(B) TRAVEL EXPENSES.—The members of 
the Commission shall be allowed travel ex-
penses, including per diem in lieu of subsist-
ence, at rates authorized for employees of agen-
cies under subchapter I of chapter 57 of title 5, 
United States Code, while away from their 
homes or regular places of business in the per-
formance of services for the Commission. 
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(C) STAFF.—The Chairperson of the Com-
mission may, without regard to the civil service 
laws and regulations, appoint and terminate an 
executive director and such other additional 
personnel as may be necessary to enable the 
Commission to perform its duties. The employ-
ment of an executive director shall be subject to 
confirmation by the Commission. 
(D) DETAIL
OF
GOVERNMENT
EMPLOY-
EES.—Any Federal Government employee may 
be detailed to the Commission without reim-
bursement, and such detail shall be without 
interruption or loss of civil service status or 
privilege. 
(E) 
TEMPORARY
AND
INTERMITTENT 
SERVICES.—The Chairperson of the Commis-
sion may procure temporary and intermittent 
services under section 3109(b) of title 5, United 
States Code, at rates for individuals which do 
not exceed the daily equivalent of the annual 
rate of basic pay prescribed for level V of the 
Executive Schedule under section 5316 of such 
title. 
(6) FUNDING.—For the purpose of carrying out 
this subsection, there are authorized to be appro-
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priated $3,000,000 for fiscal year 2008 and each fis-
cal year thereafter. 
(d) REQUIREMENTS FOR PROGRAMS.— 
(1) STATE PLAN.—A State that seeks to oper-
ate a program under this section shall prepare and 
submit to the Commission, as part of the application 
under subsection (b), a State health care plan that 
shall have as its goal increased coverage, and in 
service of that goal such additional goals as improve-
ments in quality, efficiency, cost-effectiveness, and 
the appropriate use of information technology. To 
achieve such goal, the State plan shall comply with 
the following: 
(A) COVERAGE.— 
(i) IN
GENERAL.—With respect to 
coverage, the State plan shall— 
(I) provide and describe the man-
ner in which the State will ensure that 
an increased number of individuals re-
siding within the State will have ex-
panded access to health care coverage 
with a specific 5-year target for reduc-
tion in the number or proportion of 
uninsured individuals through either 
private or public program expansion, 
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or both, in accordance with or in addi-
tion to the options established by the 
Commission; 
(II) describe the number and per-
centage of current uninsured individ-
uals who will achieve coverage under a 
State health program; 
(III) describe the coverage that 
will be provided to beneficiaries under 
a State health program; 
(IV) identify Federal, State, or 
local and private programs that cur-
rently provide health care services in 
the State and describe how such pro-
grams could be coordinated with a 
State health program, to the extent 
practicable; and 
(V) provide for improvements in 
the availability of appropriate health 
care coverage that will increase access 
to care in urban, suburban, rural, and 
frontier areas of the State with medi-
cally 
underserved 
populations 
or 
where there may be an inadequate 
supply of health care providers. 
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ers under section 1115 of the Social Secu-
rity Act. 
(B) QUALITY.—With respect to quality, 
the State plan may describe efforts to improve 
health care quality in the State, including an 
explanation of how such efforts would change 
(if at all) under the State plan. 
(C) COSTS.—With respect to costs, the 
State plan shall— 
(i) describe such steps as the State 
may undertake to improve the efficiency of 
health care; 
(ii) describe the public and private 
sector financing to be provided for the 
State health program; 
(iii) estimate the amount of Federal, 
State, and local expenditures, as well as, 
the costs to business and individuals under 
the State health program; and 
(iv) describe how the State plan will 
ensure the financial solvency of the State 
health program. 
(D) 
HEALTH
INFORMATION
TECH-
NOLOGY.—With respect to health information 
technology, the State plan may describe efforts 
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to improve the appropriate use of health infor-
mation technology, including an explanation of 
how such efforts would change (if at all) under 
the State plan. 
(E) EXCEPTIONS TO FEDERAL POLICIES.— 
The State plan shall describe the exceptions to 
otherwise applicable Federal statutes, regula-
tions, and policies that would apply within the 
geographic area and time period governed by 
the plan. 
(2) TECHNICAL
ASSISTANCE.—The Secretary 
shall, if requested, provide technical assistance to 
States to assist such States in developing applica-
tions and plans under this section, including tech-
nical assistance by private sector entities if deter-
mined appropriate by the Commission. 
(3) INITIAL REVIEW.—With respect to a State 
application under subsection (b), the Secretary and 
the Commission shall complete an initial review of 
such State application within 60 days of the receipt 
of such application, analyze the scope of the pro-
posal, and determine whether additional information 
is needed from the State. The Commission shall ad-
vise the State within such period of the need to sub-
mit additional information. 
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(4) FINAL DETERMINATION.— 
(A) IN
GENERAL.—In a timely manner 
consistent with subparagraph (C), the Commis-
sion shall determine whether to submit a State 
proposal to Congress for approval. 
(B) VOTING.— 
(i) IN GENERAL.—The determination 
to submit a State proposal to Congress 
under subparagraph (A) shall be approved 
by 2⁄3 of the members of the Commission 
who are present and eligible to vote and a 
majority of the entire Commission. 
(ii) ELIGIBILITY.—A member of the 
Commission shall not participate in a de-
termination under subparagraph (A) if— 
(I) in the case of a member who 
is a Governor, such determination re-
lates to the State of which the mem-
ber is the Governor; or 
(II) in the case of member not 
described in subclause (I), such deter-
mination relates to the geographic 
area of a State of which such member 
serves as a State or local official or as 
a Member of Congress. 
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(C) SUBMISSION.—Not later than 90 days 
prior to October 1 of each fiscal year, the Com-
mission may submit to Congress a list, in the 
form of a legislative proposal, of the State ap-
plications that the Commission recommends for 
approval under this section. 
(5) PROGRAM OR PROJECT PERIOD.—A State 
program or project may be approved for a period of 
5 years and may be extended for a subsequent pe-
riod of time upon approval by the Commission, 
based upon achievement of targets. 
(e) EXPEDITED CONGRESSIONAL CONSIDERATION.— 
(1) INTRODUCTION AND EXPEDITED CONSIDER-
ATION IN THE HOUSE OF REPRESENTATIVES.— 
(A) INTRODUCTION
IN
HOUSE
OF
REP-
RESENTATIVES.—The legislative proposal sub-
mitted pursuant to subsection (d)(4)(C) shall be 
in the form of a joint resolution (in this sub-
section referred to as the ‘‘resolution’’). Such 
resolution shall be introduced in the House of 
Representatives by the Speaker immediately 
upon receipt of the language and shall be re-
ferred non-sequentially to the appropriate com-
mittee (or committees) of House of Representa-
tives. If the resolution is not introduced in ac-
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cordance with the preceding sentence, the reso-
lution may be introduced by any member of the 
House of Representatives. 
(B) COMMITTEE
CONSIDERATION.—Not 
later than 15 calendar days after the introduc-
tion of the resolution described in subparagraph 
(A), each committee of House of Representa-
tives to which the resolution was referred shall 
report the resolution. The report may include, 
at the committee’s discretion, a recommenda-
tion for action by the House. If a committee 
has not reported such resolution (or an iden-
tical resolution) at the end of 15 calendar days 
after its introduction or at the end of the first 
day after there has been reported to the House 
a resolution, whichever is earlier, such com-
mittee shall be deemed to be discharged from 
further consideration of such resolution and 
such resolution shall be placed on the appro-
priate calendar of the House of Representatives. 
(C) EXPEDITED PROCEDURE IN HOUSE.— 
Not later than 5 legislative days after the date 
on which all committees have been discharged 
from consideration of a resolution, the Speaker 
of the House of Representatives, or the Speak-
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er’s designee, shall move to proceed to the con-
sideration of the resolution. It shall also be in 
order for any member of the House of Rep-
resentatives to move to proceed to the consider-
ation of the resolution at any time after the 
conclusion of such 5-day period. All points of 
order against the resolution (and against con-
sideration of the resolution) are waived. A mo-
tion to proceed to the consideration of the reso-
lution is highly privileged in the House of Rep-
resentatives and is not debatable. The motion is 
not subject to amendment, to a motion to post-
pone consideration of the resolution, or to a mo-
tion to proceed to the consideration of other 
business. A motion to reconsider the vote by 
which the motion to proceed is agreed to or not 
agreed to shall not be in order. If the motion 
to proceed is agreed to, the House of Rep-
resentatives shall immediately proceed to con-
sideration of the resolution without intervening 
motion, order, or other business, and the reso-
lution shall remain the unfinished business of 
the House of Representatives until disposed of. 
A motion to recommit the resolution shall not 
be in order. Upon its passage in the House, the 
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