I 
109TH CONGRESS 
2D SESSION 
H. R. 5864 
To provide for innovation in health care through State initiatives that expand 
coverage and access. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 24, 2006 
Ms. BALDWIN (for herself, Mr. PRICE of Georgia, Mr. TIERNEY, and Mr. 
BEAUPREZ) introduced the following bill; which was referred to the Com-
mittee 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 jurisdiction 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’’. 
SEC. 2. STATE HEALTH REFORM PROJECTS. 
(a) PURPOSES; ESTABLISHMENT OF STATE HEALTH 
CARE EXPANSION AND IMPROVEMENT PROGRAM.— 
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(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.— 
(1) ENTITIES THAT MAY APPLY.— 
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(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 
this section, a unit of local government of such 
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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; 
(iv) two county officials to be ap-
pointed by the National Association of 
Counties on a bipartisan basis; 
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(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 
purchasing options, single risk pool or single 
payer systems, health savings accounts, a com-
bination of the options described in this sub-
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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-
ures and goals, and the State program applica-
tion procedures, by region and State jurisdic-
tion; 
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(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-
ers, but shall be filled in the same manner as the 
original appointment. 
(3) CHAIRPERSON, MEETINGS.— 
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(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 
such evidence as the Commission considers ad-
visable to carry out the purposes of this sub-
section. 
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(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. 
(5) PERSONNEL MATTERS.— 
(A) COMPENSATION.—Each member of the 
Commission who is not an officer or employee 
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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. 
(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 
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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-
priated $3,000,000 for fiscal year 2007 and each fis-
cal year thereafter. 
(d) REQUIREMENTS FOR PROGRAMS.— 
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