I 
109TH CONGRESS 
2D SESSION 
H. R. 4719 
To amend titles XVIII and XIX of the Social Security Act to make improve-
ments to payments to Medicare Advantage plans and to reinstate protec-
tions in the Medicaid program for working families, their children, and 
the disabled against excessive out-of-pocket costs, inadequate benefits, 
and health care coverage loss. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2006 
Mr. DINGELL (for himself, Mr. WAXMAN, Mr. RANGEL, Mr. STARK, and Mr. 
BROWN of Ohio) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to make improvements to payments to Medicare Advan-
tage plans and to reinstate protections in the Medicaid 
program for working families, their children, and the 
disabled against excessive out-of-pocket costs, inadequate 
benefits, and health care coverage loss. 
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 ‘‘Patients Before Profits 
Act of 2006’’. 
SEC. 2. ELIMINATION OF CERTAIN MEDICARE ADVANTAGE 
OVERPAYMENTS. 
(a) IN GENERAL.—Section 1853(a)(1)(C)(ii) of the 
Social Security Act (42 U.S.C. 1395w–23(a)(1)(C)(ii)), as 
added by section 5301 of the Deficit Reduction Act of 
2005, is amended— 
(1) in the heading, by striking ‘‘DURING PHASE- 
OUT OF BUDGET NEUTRALITY FACTOR’’; 
(2) in the matter preceding subclause (I), by 
striking ‘‘through 2010’’ and inserting ‘‘and subse-
quent years’’; and 
(3) in subclause (II), by striking ‘‘only for 
2008, 2009, and 2010’’ and inserting ‘‘for 2008 and 
subsequent years’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 5301 of the Deficit Reduction Act of 2005. 
SEC. 3. ELIMINATION OF PRIVATE INSURANCE SLUSH 
FUND. 
(a) ELIMINATION.—Subsection (e) of section 1858 of 
the Social Security Act (42 U.S.C. 1395w–27a) is re-
pealed.
(b) CONFORMING AMENDMENT.—Section 1858(f)(1) 
of the Social Security Act (42 U.S.C. 1395w–27a(f)(1)) 
is amended by striking ‘‘subject to subsection (e),’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 221(c) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2181). 
SEC. 4. REINSTATING PROTECTIONS FOR ADEQUATE BENE-
FITS AND AFFORDABLE COST SHARING. 
(a) REPEAL OF STATE OPTION FOR ALTERNATIVE 
PREMIUMS AND COST SHARING.— 
(1) REPEAL.—Section 1916A of the Social Se-
curity Act, as added by sections 6041(a), 6042(a), 
and 6043(a) of the Deficit Reduction Act of 2005, 
is repealed. 
(2) CONFORMING AMENDMENTS.— 
(A) Subsection (y) of section 1903 of the 
Social Security Act (42 U.S.C. 1396b), as 
added by section 6043(b) of the Deficit Reduc-
tion Act of 2005, is repealed. 
(B) Section 1916 of the Social Security 
Act (42 U.S.C. 1396o) is amended— 
(i) in subsection (f), by striking ‘‘and 
section 1916A’’ after ‘‘(b)(3)’’; and
(ii) by striking subsection (h). 
(b) REPEAL
OF STATE OPTION
OF PROVIDING 
BENCHMARK BENEFIT PACKAGES.—Section 1937 of the 
Social Security Act, as added by section 6044(a) of the 
Deficit Reduction Act of 2005, is repealed. 
(c) REPEAL OF HEALTH OPPORTUNITY ACCOUNTS 
DEMONSTRATION.—Section 1938 of the Social Security 
Act, as added by section 6082 of the Deficit Reduction 
Act of 2005, is repealed. 
(d) ADDITIONAL CONFORMING AMENDMENT.—Sec-
tion 1939 of the Social Security Act, as redesignated by 
section 6082 of the Deficit Reduction Act of 2005, is re-
designated as section 1937 of the Social Security Act. 
(e) EFFECTIVE DATE.—The repeals and amend-
ments made by subsections (a) through (d) shall take ef-
fect as if included in the enactment of the Deficit Reduc-
tion Act of 2005. 
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