I 
109TH CONGRESS 
2D SESSION 
H. R. 5886 
To amend the Social Security Act and the Internal Revenue Code of 1986 
to provide for an AmeriCare that assures the provision of health insur-
ance coverage to all residents, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 25, 2006 
Mr. STARK (for himself, Ms. SCHAKOWSKY, Mr. MCDERMOTT, Mr. RANGEL, 
Mr. LEWIS of Georgia, Mr. BROWN of Ohio, Mr. GEORGE MILLER of 
California, Mr. WAXMAN, Mr. BECERRA, Ms. CORRINE BROWN of Flor-
ida, Ms. CARSON, Mrs. CHRISTENSEN, Mr. CONYERS, Mr. DAVIS of Illi-
nois, Mr. FILNER, Mr. GRIJALVA, Mr. HINCHEY, Ms. NORTON, Ms. 
JACKSON-LEE of Texas, Ms. KILPATRICK of Michigan, Mr. LANTOS, Ms. 
LEE, Mr. MCGOVERN, Mr. NADLER, Mr. OWENS, Mr. PALLONE, Mr. 
THOMPSON of Mississippi, Mr. TOWNS, Ms. WOOLSEY, and Ms. SOLIS) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Ways and 
Means and Education and the Workforce, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Social Security Act and the Internal Revenue 
Code of 1986 to provide for an AmeriCare that assures 
the provision of health insurance coverage to all resi-
dents, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as 
‘‘AmeriCare Health Care Act of 2006’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—HEALTH CARE ELIGIBILITY AND BENEFITS 
Sec. 101. Eligibility and benefits. 
‘‘TITLE XXII—AMERICARE HEALTH BENEFITS 
‘‘PART A—ELIGIBILITY 
‘‘Sec. 2201. Eligibility. 
‘‘Sec. 2202. Enrollment and AmeriCare cards. 
‘‘PART B—BENEFITS 
‘‘Sec. 2221. Scope of benefits. 
‘‘Sec. 2222. Exclusions. 
‘‘PART C—PAYMENT FOR BENEFITS AND FINANCING 
‘‘Sec. 2241. Payments for benefits. 
‘‘Sec. 2242. AmeriCare Trust Fund. 
‘‘PART D—ADMINISTRATIVE SIMPLIFICATION 
‘‘Sec. 2251. Requirement for entitlement verification system. 
‘‘Sec. 2252. Requirements for uniform claims and electronic claims data 
set. 
‘‘Sec. 2253. Electronic medical records and reporting. 
‘‘Sec. 2254. Uniform hospital cost reporting. 
‘‘Sec. 2255. Health service provider defined. 
‘‘PART E—GENERAL PROVISIONS 
‘‘Sec. 2261. Definitions relating to beneficiaries and income. 
‘‘Sec. 2262. Incorporation of certain medicare provisions and other provi-
sions. 
‘‘Sec. 2263. State maintenance of effort payments. 
‘‘Sec. 2264. Modification of medicaid and other programs to avoid duplica-
tion of benefits. 
‘‘Sec. 2265. Construction regarding continuation of obligations under cur-
rent group health plan contracts and provision of addi-
tional benefits. 
‘‘Sec. 2266. Standards and requirements for AmeriCare supplemental poli-
cies. 
TITLE II—FINANCING PROVISIONS 
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Subtitle A—Individual Contributions 
Sec. 201. General obligation for individuals. 
Sec. 202. Additional premium subsidies. 
Sec. 203. Effective date. 
Subtitle B—Employer Contributions 
Sec. 211. General obligation for employers. 
Sec. 212. Effective date. 
TITLE I—HEALTH CARE 
ELIGIBILITY AND BENEFITS 
SEC. 101. ELIGIBILITY AND BENEFITS. 
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following new title: 
‘‘TITLE XXII—AMERICARE HEALTH BENEFITS 
‘‘PART A—ELIGIBILITY 
‘‘SEC. 2201. ELIGIBILITY. 
‘‘(a) UNIVERSAL ELIGIBILITY FOR RESIDENTS.— 
(1) IN GENERAL.—Except as provided in sec-
tion 2263(a), each individual who is a resident of 
the United States is entitled to health insurance 
benefits under this title. 
‘‘(2) EFFECTIVE DATE FOR BENEFITS.—This 
title shall apply to items and services furnished on 
or after January 1, 2010. 
‘‘(b) SPECIAL ELIGIBILITY GROUPS.—For purposes 
of this title, an individual described in subsection (a) may 
obtain special benefits under this title on the basis of one 
or more of the following special eligibility groups: 
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‘‘(1) 
Children 
(as 
defined 
in 
section 
2261(a)(1)). 
‘‘(2) Low-income individuals (as defined in sec-
tion 2261(a)(2)). 
‘‘(3) Pregnant women (as defined in section 
2261(a)(3)). 
‘‘(c) RECIPROCAL COVERAGE OF NONRESIDENTS.— 
An individual who— 
‘‘(1) is not a resident of the United States, 
‘‘(2) is in the United States, and 
‘‘(3) is a national of a foreign state which pro-
vides health benefits to nationals of the United 
States who are nonresidents in that state, 
is entitled to such health insurance benefits under this 
title, but only to the extent the Secretary determines that 
such benefits would be available to nationals of the United 
States similarly situated as a nonresident in the foreign 
state. 
‘‘SEC. 2202. ENROLLMENT AND AMERICARE CARDS. 
‘‘(a) ENROLLMENT.—The Secretary shall provide a 
mechanism for the enrollment of individuals entitled to 
benefits under this title and, in conjunction with such en-
rollment, the issuance of an AmeriCare card which may 
be used for purposes of identification and processing of 
claims for benefits under this title. AmeriCare cards shall 
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identify (as appropriate) the date of birth (for purposes 
of identifying children) and provide a coded means for 
identifying whether the individual is a low-income indi-
vidual for the year involved. 
‘‘(b) CLASSES OF ENROLLMENT.—The mechanism 
under subsection (a) shall provide for individuals to be en-
rolled on the basis of the following classes of enrollment: 
(1) Coverage only of an individual. 
(2) Coverage of a married couple without chil-
dren. 
(3) Coverage of an unmarried individual and 
one or more children. 
(4) Coverage of a married couple and one or 
more children. 
‘‘(c) ENROLLMENT
AT
BIRTH.—The mechanism 
under subsection (a) shall include a process for the auto-
matic enrollment of individuals at the time of birth in the 
United States. 
‘‘(d) OPT OUT FOR THOSE COVERED UNDER GROUP 
HEALTH PLAN.—Notwithstanding any other provision of 
this title, an individual may elect not to be enrolled for 
benefits under this title if the individual demonstrates to 
the satisfaction of the Secretary that the individual has 
health benefits coverage under a group health plan (as de-
fined in section 5000(b)(1) of the Internal Revenue Code 
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of 1986) that is at least equivalent to the coverage other-
wise provided under this title, as certified by the Sec-
retary. 
‘‘PART B—BENEFITS 
‘‘SEC. 2221. SCOPE OF BENEFITS. 
‘‘(a) IN GENERAL.—Except as provided in the suc-
ceeding provisions of this part, the benefits provided to 
an individual described in section 2201(a) by the program 
established by this title shall consist of entitlement to the 
same benefits as are provided under parts A and B of title 
XVIII to individuals entitled to benefits under part A, and 
enrolled under part B, of title XVIII. 
‘‘(b) CHANGE IN THE COST-SHARING.— 
‘‘(1) DEDUCTIBLE.—Except as provided in the 
succeeding provisions of this part, the amount of ex-
penses (other than expenses for benefits described in 
subsection (c)) with respect to which an individual is 
entitled to have payment made under this title for 
any year shall first be reduced by a deductible of 
$350, except that in no case shall the amount of the 
deductible for all the members of a family exceed 
$500. Such deductible shall be instead of the deduct-
ible for inpatient hospital services under the first 
sentence of section 1813(a)(1) and the deductible 
under section 1833(b). 
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‘‘(2) COINSURANCE.—After the application of 
the deductible under paragraph (1), the expenses re-
ferred to in such paragraph shall be subject to a co-
insurance of 20 percent until the limit on out-of- 
pocket expenses under paragraph (3) is met. 
‘‘(3) LIMIT ON OUT-OF-POCKET EXPENSES AND 
TOTAL EXPENSES.— 
‘‘(A) LIMITATION
ON
COST-SHARING.— 
Subject to subparagraph (B), whenever in a cal-
endar year an individual’s expenses for the de-
ductible and coinsurance with respect to serv-
ices covered under this title (including expenses 
for benefits described in subsection (c)) and 
furnished during the year equals $2,500, or 
$4,000 for all the members of a family, pay-
ment of benefits under this title for the indi-
vidual (or for the members of such family, re-
spectively) for services furnished during the re-
mainder of the year shall be paid without the 
application of any coinsurance. 
‘‘(B) LIMITATION
ON
PREMIUMS
AND 
COST-SHARING
FOR
CERTAIN
INDIVIDUALS 
BASED ON INCOME.— 
‘‘(i) INCOME BETWEEN 200 AND 300 
PERCENT OF POVERTY LINE.—In the case 
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of a family whose applicable modified gross 
income (expressed as a percentage of the 
poverty 
level, 
as 
defined 
in 
section 
2261(b)(2)) is equal to or exceeds 200 per-
cent, but does not exceed 300 percent, of 
the poverty level applicable to a family of 
the size involved, whenever in a calendar 
year an individual’s expenses in the family 
for premiums under this title and for the 
deductible and coinsurance with respect to 
services covered under this title (including 
expenses for benefits described in sub-
section (c)) and furnished during the year 
equals 5 percent of the amount of such ap-
plicable modified gross income for the fam-
ily— 
‘‘(I) no additional premiums shall 
be imposed for remaining months in 
the year; and 
‘‘(II) payment of benefits under 
this title for members of such family 
for services furnished during the re-
mainder of the year shall be paid 
without the application of any deduct-
ible or coinsurance. 
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‘‘(ii) INCOME BETWEEN 300 AND 500 
PERCENT OF POVERTY LINE.—In the case 
of a family whose applicable modified gross 
income (expressed as a percentage of the 
poverty 
level, 
as 
defined 
in 
section 
2261(b)(2)) exceeds 300 percent, but does 
not exceed 500 percent, of such poverty 
level applicable to a family of the size in-
volved, whenever in a calendar year an in-
dividual’s expenses in the family for pre-
miums under this title and for the deduct-
ible and coinsurance with respect to serv-
ices covered under this title (including ex-
penses for benefits described in subsection 
(c)) and furnished during the year equals 
7.5 percent of the amount of such applica-
ble modified gross income for the family— 
‘‘(I) no additional premiums shall 
be imposed for remaining months in 
the year; and 
‘‘(II) payment of benefits under 
this title for members of such family 
for services furnished during the re-
mainder of the year shall be paid 
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without the application of any deduct-
ible or coinsurance. 
‘‘(C) COUNTING ALL EXPENSES FOR PRE-
MIUMS, 
DEDUCTIBLES
AND
COINSURANCE 
WITHOUT
REGARD
TO
TRUE
OUT-OF-POCKET 
COSTS.—.In applying subparagraphs (A) and 
(B), expenses for an individual’s premiums, de-
ductible, and coinsurance shall be counted with-
out regard to whether such expenses are paid, 
payable, reimbursed, or reimbursable by an-
other person, including through a group health 
plan, insurance or otherwise, or other third 
party payment arrangement. 
‘‘(4) INDEXING
DOLLAR
AMOUNTS
BY
CPI.— 
Each dollar amount specified in paragraphs (1) and 
(3)(A) shall be increased to the year involved by the 
compounded sum of the increase in the consumer 
price index for all urban consumers (U.S. City aver-
age, as published by the Bureau of Labor Statistics 
of the Department of Labor) for each year after 
2006 and up to the year involved. Any increase 
under this paragraph for a year shall be rounded, 
with respect to paragraph (1), to the nearest mul-
tiple of $5 and, with respect to paragraph (2), to the 
nearest multiple of $100. 
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‘‘(c) PRESCRIPTION DRUGS.—Benefits shall also be 
made available under this title (as specified by the Sec-
retary) for prescription drugs and biologicals which are 
not less than the benefits for such drugs and biologicals 
under the standard option for the service benefit plan de-
scribed in section 8903(1) of title 5, United States Code, 
offered during 2005. 
‘‘(d) CHILDREN.— 
‘‘(1) NO DEDUCTIBLES OR COINSURANCE.—In 
the case of children (as defined in section 
2261(a)(1)), there shall be no deductible or coinsur-
ance applicable to covered benefits (including bene-
fits described in paragraphs (2) and (3)). 
‘‘(2) ADDITIONAL PREVENTIVE BENEFITS.— 
‘‘(A) IN GENERAL.—Subject to the perio-
dicity schedule established with respect to the 
services under subparagraph (B), for children 
benefits shall be available under this title for 
the following items and services: 
‘‘(i) Newborn and well-baby care, in-
cluding normal newborn care and pediatri-
cian services for high-risk deliveries. 
‘‘(ii) Well-child care, including routine 
office visits, routine immunizations (includ-
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