I 
113TH CONGRESS 
1ST SESSION H. R. 2300 
To provide for incentives to encourage health insurance coverage, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 6, 2013 
Mr. PRICE of Georgia introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Education and the Workforce, Ways and Means, the Judiciary, Nat-
ural Resources, House Administration, Rules, Appropriations, the Budg-
et, and Oversight and Government Reform, for a period to be subse-
quently 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 incentives to encourage health insurance 
coverage, 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Empowering Patients First Act of 2013’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Repeal of PPACA and health care-related HCERA provisions. 
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Sec. 3. No mandate of guaranteed issue or community rating. 
TITLE I—TAX INCENTIVES FOR MAINTAINING HEALTH 
INSURANCE COVERAGE 
Sec. 101. Refundable tax credit for health insurance costs of low-income indi-
viduals. 
Sec. 102. Advance payment of credit as premium payment for qualified health 
insurance. 
Sec. 103. Election of tax credit instead of alternative government or group plan 
benefits. 
Sec. 104. Deduction for qualified health insurance costs of individuals. 
Sec. 105. Limitation on abortion funding. 
Sec. 106. No government discrimination against certain health care entities. 
Sec. 107. Equal employer contribution rule to promote choice. 
Sec. 108. Limitations on State restrictions on employer auto-enrollment. 
Sec. 109. Credit for small employers adopting auto-enrollment and defined con-
tribution options. 
Sec. 110. HSA modifications and clarifications. 
TITLE II—HEALTH INSURANCE POOLING MECHANISMS FOR 
INDIVIDUALS 
Subtitle A—Federal Grants for State Insurance Expenditures 
Sec. 201. Federal grants for State insurance expenditures. 
Subtitle B—Health Care Access and Availability 
Sec. 211. Expansion of access and choice through individual and small em-
ployer membership associations (IMAs). 
Subtitle C—Small Business Health Fairness 
Sec. 221. Short title. 
Sec. 222. Rules governing association health plans. 
Sec. 223. Clarification of treatment of single employer arrangements. 
Sec. 224. Enforcement provisions relating to association health plans. 
Sec. 225. Cooperation between Federal and State authorities. 
Sec. 226. Effective date and transitional and other rules. 
TITLE III—INTERSTATE MARKET FOR HEALTH INSURANCE 
Sec. 301. Cooperative governing of individual health insurance coverage. 
TITLE IV—SAFETY NET REFORMS 
Sec. 401. Requiring outreach and coverage before expansion of eligibility. 
Sec. 402. Easing administrative barriers to State cooperation with employer- 
sponsored insurance coverage. 
Sec. 403. Improving beneficiary choice in SCHIP. 
TITLE V—LAWSUIT ABUSE REFORMS 
Sec. 501. Change in burden of proof based on compliance with best practice 
guidelines. 
Sec. 502. State grants to create administrative health care tribunals. 
Sec. 503. Authorization of payment of future damages to claimants in health 
care lawsuits. 
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Sec. 504. Definitions. 
Sec. 505. Effect on other laws. 
Sec. 506. Applicability; effective date. 
TITLE VI—WELLNESS AND PREVENTION 
Sec. 601. Providing financial incentives for treatment compliance. 
TITLE VII—TRANSPARENCY AND INSURANCE REFORM MEASURES 
Sec. 701. Receipt and response to requests for claim information. 
TITLE VIII—QUALITY 
Sec. 801. Prohibition on certain uses of data obtained from comparative effec-
tiveness research or from patient-centered outcomes research; 
accounting for personalized medicine and differences in patient 
treatment response. 
Sec. 802. Establishment of performance-based quality measures. 
TITLE IX—STATE TRANSPARENCY PLAN PORTAL 
Sec. 901. Providing information on health coverage options and health care 
providers. 
TITLE X—PATIENT FREEDOM OF CHOICE 
Sec. 1001. Guaranteeing freedom of choice and contracting for patients under 
Medicare. 
Sec. 1002. Preemption of State laws limiting charges for eligible professional 
services. 
Sec. 1003. Health care provider licensure cannot be conditioned on participa-
tion in a health plan. 
Sec. 1004. Bad debt deduction for doctors to partially offset the cost of pro-
viding uncompensated care required to be provided under 
amendments made by the Emergency Medical Treatment and 
Labor Act. 
Sec. 1005. Right of contract with health care providers. 
TITLE XI—INCENTIVES TO REDUCE PHYSICIAN SHORTAGES 
Subtitle A—Federally Supported Student Loan Funds for Medical Students 
Sec. 1101. Federally supported student loan funds for medical students. 
Subtitle B—Loan Forgiveness for Primary Care Providers 
Sec. 1111. Loan forgiveness for primary care providers. 
TITLE XII—QUALITY HEALTH CARE COALITION 
Sec. 1201. Quality Health Care Coalition. 
TITLE XIII—OFFSETS 
Subtitle A—Discretionary Spending Limits 
Sec. 1301. Discretionary spending limits. 
Subtitle B—Savings From Health Care Efficiencies 
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Sec. 1311. Medicare DSH report and payment adjustments in response to cov-
erage expansion. 
Sec. 1312. Reduction in Medicaid DSH. 
Subtitle C—Fraud, Waste, and Abuse 
Sec. 1321. Provide adequate funding to HHS OIG and HCFAC. 
Sec. 1322. Improved enforcement of the Medicare secondary payor provisions. 
Sec. 1323. Strengthen Medicare provider enrollment standards and safeguards. 
Sec. 1324. Tracking banned providers across State lines. 
SEC. 2. REPEAL OF PPACA AND HEALTH CARE-RELATED 
HCERA PROVISIONS. 
(a) PPACA.—Effective as of the enactment of the 
Patient Protection and Affordable Care Act (Public Law 
111–148), such Act is repealed, and the provisions of law 
amended or repealed by such Act are restored or revived 
as if such Act had not been enacted. 
(b) HEALTH CARE-RELATED PROVISIONS IN THE 
HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 
2010.—Effective as of the enactment of the Health Care 
and Education Reconciliation Act of 2010 (Public Law 
111–152), title I and subtitle B of title II of such Act 
are repealed, and the provisions of law amended or re-
pealed by such title or subtitle, respectively, are restored 
or revived as if such title and subtitle had not been en-
acted. 
SEC. 3. NO MANDATE OF GUARANTEED ISSUE OR COMMU-
NITY RATING. 
Nothing in this Act shall be construed to provide a 
mandate for guaranteed issue or community rating in the 
private insurance market. 
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TITLE I—TAX INCENTIVES FOR 
MAINTAINING 
HEALTH 
IN-
SURANCE COVERAGE 
SEC. 101. REFUNDABLE TAX CREDIT FOR HEALTH INSUR-
ANCE COSTS OF LOW-INCOME INDIVIDUALS. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986, as amended by section 2, is amended by inserting 
after section 36A the following new section: 
‘‘SEC. 36B. HEALTH INSURANCE COSTS OF LOW-INCOME IN-
DIVIDUALS. 
‘‘(a) IN GENERAL.—In the case of an individual, 
there shall be allowed as a credit against the tax imposed 
by subtitle A the aggregate amount paid by the taxpayer 
for coverage of the taxpayer and the taxpayer’s qualifying 
family members under qualified health insurance for eligi-
ble coverage months beginning in the taxable year. 
‘‘(b) LIMITATIONS.— 
‘‘(1) IN GENERAL.—The amount allowable as a 
credit under subsection (a) for the taxable year shall 
not exceed the lesser of— 
‘‘(A) the sum of the monthly limitations 
for months during such taxable year that the 
taxpayer or the taxpayer’s qualifying family 
members is an eligible individual, and 
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‘‘(B) the aggregate premiums paid by the 
taxpayer for the taxable year for coverage de-
scribed in subsection (a). 
‘‘(2) MONTHLY LIMITATION.—The monthly lim-
itation for any month is the credit percentage of 1⁄12 
of the sum of— 
‘‘(A) $2,000 for coverage of the taxpayer 
($4,000 in the case of a joint return for cov-
erage of the taxpayer and the taxpayer’s 
spouse), and 
‘‘(B) $500 for coverage of each dependent 
of the taxpayer. 
‘‘(3) CREDIT PERCENTAGE.— 
‘‘(A) IN GENERAL.—For purposes of this 
section, the term ‘credit percentage’ means 100 
percent reduced by 1 percentage point for each 
$1,000 (or fraction thereof) by which the tax-
payer’s adjusted gross income for the taxable 
year exceeds the threshold amount. 
‘‘(B) THRESHOLD AMOUNT.—For purposes 
of this paragraph, the term ‘threshold amount’ 
means, with respect to any taxpayer for any 
taxable year, 200 percent of the Federal pov-
erty guideline (as determined by the Secretary 
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of Health and Human Services for the taxable 
year) applicable to the taxpayer. 
‘‘(4) ONLY
DEPENDENTS
TAKEN
INTO
AC-
COUNT.—Not more than 2 dependents of the tax-
payer may be taken into account under paragraphs 
(2)(C) and (3)(B). 
‘‘(5) INFLATION ADJUSTMENT.—In the case of 
any taxable year beginning in a calendar year after 
2013, each dollar amount contained in paragraph 
(2) shall be increased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar 
year in which the taxable year begins, deter-
mined by substituting ‘calendar year 2012’ for 
‘calendar year 1992’ in subparagraph (B) 
thereof. 
Any increase determined under the preceding sen-
tence shall be rounded to the nearest multiple of 
$50. 
‘‘(c) ELIGIBLE COVERAGE MONTH.—For purposes of 
this section, the term ‘eligible coverage month’ means, 
with respect to any individual, any month if, as of the first 
day of such month, the individual— 
‘‘(1) is covered by qualified health insurance, 
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‘‘(2) does not have other specified coverage, and 
‘‘(3) is not imprisoned under Federal, State, or 
local authority. 
‘‘(d) QUALIFYING FAMILY MEMBER.—For purposes 
of this section, the term ‘qualifying family member’ 
means— 
‘‘(1) in the case of a joint return, the taxpayer’s 
spouse, and 
‘‘(2) any dependent of the taxpayer. 
‘‘(e) QUALIFIED HEALTH INSURANCE.—For pur-
poses of this section, the term ‘qualified health insurance’ 
means health insurance coverage (other than excepted 
benefits as defined in section 9832(c)) which constitutes 
medical care. 
‘‘(f) OTHER SPECIFIED COVERAGE.—For purposes of 
this section, an individual has other specified coverage for 
any month if, as of the first day of such month— 
‘‘(1) COVERAGE UNDER MEDICARE, MEDICAID, 
OR SCHIP.—Such individual— 
‘‘(A) is entitled to benefits under part A of 
title XVIII of the Social Security Act or is en-
rolled under part B of such title, or 
‘‘(B) is enrolled in the program under title 
XIX or XXI of such Act (other than under sec-
tion 1928 of such Act). 
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‘‘(2) CERTAIN OTHER COVERAGE.—Such indi-
vidual— 
‘‘(A) is enrolled in a health benefits plan 
under chapter 89 of title 5, United States Code, 
‘‘(B) is entitled to receive benefits under 
chapter 55 of title 10, United States Code, 
‘‘(C) is entitled to receive benefits under 
chapter 17 of title 38, United States Code, 
‘‘(D) is enrolled in a group health plan 
(within the meaning of section 5000(b)(1)) 
which is subsidized by the employer, or 
‘‘(E) is a member of a health care sharing 
ministry. 
‘‘(3) HEALTH CARE SHARING MINISTRY.—For 
purposes of this subsection, the term ‘health care 
sharing ministry’ means an organization— 
‘‘(A) 
which 
is 
described 
in 
section 
501(c)(3) and is exempt from taxation under 
section 501(a), 
‘‘(B) members of which share a common 
set of ethical or religious beliefs and share med-
ical expenses among members in accordance 
with those beliefs and without regard to the 
State in which a member resides or is em-
ployed, 
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‘‘(C) members of which retain membership 
even after they develop a medical condition, 
‘‘(D) which (or a predecessor of which) has 
been in existence at all times since December 
31, 1999, and medical expenses of its members 
have been shared continuously and without 
interruption since at least December 31, 1999, 
and 
‘‘(E) which conducts an annual audit 
which is performed by an independent certified 
public accounting firm in accordance with gen-
erally accepted accounting principles and which 
is made available to the public upon request. 
‘‘(g) SPECIAL RULES.— 
‘‘(1) COORDINATION WITH ADVANCE PAYMENTS 
OF CREDIT; RECAPTURE OF EXCESS ADVANCE PAY-
MENTS.—With respect to any taxable year— 
‘‘(A) the amount which would (but for this 
subsection) be allowed as a credit to the tax-
payer under subsection (a) shall be reduced 
(but not below zero) by the aggregate amount 
paid on behalf of such taxpayer under section 
7529 for months beginning in such taxable 
year, and 
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‘‘(B) the tax imposed by section 1 for such 
taxable year shall be increased by the excess (if 
any) of— 
‘‘(i) the aggregate amount paid on be-
half of such taxpayer under section 7529 
for months beginning in such taxable year, 
over 
‘‘(ii) the amount which would (but for 
this subsection) be allowed as a credit to 
the taxpayer under subsection (a). 
‘‘(2) COORDINATION
WITH
OTHER
DEDUC-
TIONS.—Amounts taken into account under sub-
section (a) shall not be taken into account in deter-
mining— 
‘‘(A) any deduction allowed under section 
162(l), 213, or 224, or 
‘‘(B) any credit allowed under section 35. 
‘‘(3) MEDICAL
AND
HEALTH
SAVINGS
AC-
COUNTS.—Amounts distributed from an Archer 
MSA (as defined in section 220(d)) or from a health 
savings account (as defined in section 223(d)) shall 
not be taken into account under subsection (a). 
‘‘(4) DENIAL OF CREDIT TO DEPENDENTS AND 
NONPERMANENT RESIDENT ALIEN INDIVIDUALS.— 
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No credit shall be allowed under this section to any 
individual who is— 
‘‘(A) not a citizen or lawful permanent 
resident of the United States for the calendar 
year in which the taxable year begins, or 
‘‘(B) a dependent with respect to another 
taxpayer for a taxable year beginning in the 
calendar year in which such individual’s taxable 
year begins. 
‘‘(5) INSURANCE WHICH COVERS OTHER INDI-
VIDUALS.—For purposes of this section, rules simi-
lar to the rules of section 213(d)(6) shall apply with 
respect to any contract for qualified health insurance 
under which amounts are payable for coverage of an 
individual other than the taxpayer and qualifying 
family members. 
‘‘(6) TREATMENT
OF
PAYMENTS.—For pur-
poses of this section— 
‘‘(A) PAYMENTS
BY
SECRETARY.—Pay-
ments made by the Secretary on behalf of any 
individual under section 7529 (relating to ad-
vance payment of credit for health insurance 
costs of low-income individuals) shall be treated 
as having been made by the taxpayer on the 
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first day of the month for which such payment 
was made. 
‘‘(B) PAYMENTS
BY
TAXPAYER.—Pay-
ments made by the taxpayer for eligible cov-
erage months shall be treated as having been 
made by the taxpayer on the first day of the 
month for which such payment was made. 
‘‘(7) REGULATIONS.—The Secretary may pre-
scribe such regulations and other guidance as may 
be necessary or appropriate to carry out this section, 
section 6050W, and section 7529.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Paragraph (2) of section 1324(b) of title 
31, United States Code, as amended by section 2, is 
amended by inserting ‘‘36B,’’ after ‘‘36A,’’. 
(2) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 of the Internal Rev-
enue Code of 1986, as amended by section 2, is 
amended by inserting after the item relating to sec-
tion 36A the following new item: 
‘‘Sec. 36B. Health insurance costs of low-income individuals.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2013. 
(d) SENSE OF CONGRESS.—It is the sense of Con-
gress that the cost of the advanceable refundable credit 
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under sections 36B and 7529 of the Internal Revenue 
Code of 1986, as added by this title, will be offset by sav-
ings derived from the provisions of title XIII. 
SEC. 102. ADVANCE PAYMENT OF CREDIT AS PREMIUM 
PAYMENT FOR QUALIFIED HEALTH INSUR-
ANCE. 
(a) IN GENERAL.—Chapter 77 of the Internal Rev-
enue Code of 1986 (relating to miscellaneous provisions) 
is amended by adding at the end the following: 
‘‘SEC. 7529. ADVANCE PAYMENT OF CREDIT AS PREMIUM 
PAYMENT FOR QUALIFIED HEALTH INSUR-
ANCE. 
‘‘(a) GENERAL RULE.—Not later than January 1, 
2014, the Secretary shall establish a program for making 
payments to providers of qualified health insurance (as de-
fined in section 36B(e)) on behalf of taxpayers eligible for 
the credit under section 36B. Except as otherwise pro-
vided by the Secretary, such payments shall be made on 
the basis of the adjusted gross income of the taxpayer for 
the preceding taxable year. 
‘‘(b) CERTIFICATION PROCESS AND PROOF OF COV-
ERAGE.—For purposes of this section, payments may be 
made pursuant to subsection (a) only with respect to indi-
viduals for whom a qualified health insurance costs credit 
eligibility certificate is in effect.’’. 
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(b) DISCLOSURE
OF RETURN INFORMATION
FOR 
PURPOSES OF ADVANCE PAYMENT OF CREDIT AS PRE-
MIUMS FOR QUALIFIED HEALTH INSURANCE.— 
(1) IN
GENERAL.—Subsection (l) of section 
6103 of such Code, as amended by section 2, is 
amended by adding at the end the following new 
paragraph: 
‘‘(21) DISCLOSURE OF RETURN INFORMATION 
FOR PURPOSES OF ADVANCE PAYMENT OF CREDIT 
AS
PREMIUMS
FOR
QUALIFIED
HEALTH
INSUR-
ANCE.—The Secretary may, on behalf of taxpayers 
eligible for the credit under section 36B, disclose to 
a provider of qualified health insurance (as defined 
in section 36(e)), and persons acting on behalf of 
such provider, return information with respect to 
any such taxpayer only to the extent necessary (as 
prescribed by regulations issued by the Secretary) to 
carry out the program established by section 7529 
(relating to advance payment of credit as premium 
payment for qualified health insurance).’’. 
(2) CONFIDENTIALITY
OF
INFORMATION.— 
Paragraph (3) of section 6103(a) of such Code, as 
amended by section 2, is amended by striking ‘‘or 
(20)’’ and inserting ‘‘(20), or (21)’’. 
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