for each State a factor to adjust the national aver-
age per capita costs for each risk group to reflect—
(A) average labor and nonlabor costs that
are necessary to produce the services described
in subsection (a),
(B) any special social, environmental, epi-
demiological, or other condition affecting health
status or the need for health care services and
long-term care services,
(C) the geographic distribution of the
State’s population, particularly the proportion
of the population residing in rural or medically
underserved areas,
(D) the quality and availability of the
State’s existing health care resources needed for
delivering health care services and long-term
care services, and
(E) any other economic, geographic, and
sociologic factors.
(c) STATE TOTAL EXPENDITURES.—The Board shall
compute for each State total projected expenditures in the
next fiscal year for each of the services described in sub-
section (a), by multiplying—
(1) the national average per capita costs of each
risk group designated in subsection (b)(2)(B), by
(2) the product of the State adjustment factors
described in subsection (b)(3) and the number of
persons in the State estimated by the Bureau of the
Census to be resident members of each risk group
at the beginning of the next fiscal year.
(d) FEDERAL CONTRIBUTIONS.—
(1) IN GENERAL.—The Board shall determine
the appropriate Federal contribution for each State,
constituting the Federal percentage share of each
State’s total projected expenditures for the services
described in section (a). The Federal share shall be
determined by subtracting the State share from 100
percent of the total projected expenditures for such
State (as described under subsection (c)), but in no
event shall such Federal contribution be less than 75
percent nor more than 85 percent of such expendi-
tures. The Federal share for all States shall equal
80 percent of the aggregate of such expenditures for
all States.
(2) ADJUSTMENTS IN STATE SHARE.—In deter-
mining each State share, the Board shall develop a
formula that considers a State’s—
(A) per capita income,
(B) total taxable resources,
(C) economic performance relative to the
national economy as it affects the availability of
taxable resources, and
(D) other relevant economic and demo-
graphic indicators.
(e) SUBSEQUENT CALCULATIONS.—For each subse-
quent fiscal year, the Board shall recompute under sub-
sections (a), (b), (c), and (d) at least 6 months before the
beginning of such fiscal year. In making such a recom-
putation, the Board shall take into account—
(1) changes in medical technology, outcomes re-
search evidence concerning the efficacy and safety of
health care services and long-term care services,
needs for health personnel, professional practice
guidelines, and changing health care priorities, after
reviewing recommendations of the Advisory Council
and the Priorities Council, and
(2) changes in the services described in sub-
section (a) under regulations promulgated by the
Board and accepted by the Congress under section
204.
(f) EFFECT OF BOARD ACTIONS.—Any determina-
tion made by the Board under this section with respect
to any fiscal year shall be submitted to the Congress at
least 6 months before the beginning of such fiscal year,
and shall have the force of law, unless within 60 days of
the submission of such determination, the Congress enacts
a disapproval resolution under the procedures described
in section 501.
SEC. 402. PAYMENTS TO STATES.
(a) IN GENERAL.—For each fiscal year, each State
with a State program approved under section 311, is enti-
tled to receive (subject to section 311(d)), from amounts
in the Trust Fund, a Federal contribution in an amount
equal to the product of—
(1) the Federal share for such State (computed
under section 401(d), and
(2) such State’s total projected expenditures
(computed under section 401(c)).
(b) USE OF DEDICATED FUNDS.—
(1) IN GENERAL.—All revenues, including the
Federal contribution and State revenues provided to
finance a State program under this Act shall be allo-
cated to a dedicated fund specified by the State.
Payments for health care services and long-term
care services covered under this Act shall be made
from such fund.
(2) SPECIAL ACCOUNTS.—Each State shall es-
tablish within its designated fund special accounts,
the amount of revenues deposited in each to be de-
termined by the State. The various special accounts
shall include the following:
(A) An Institutional Global Operating
Budget Account shall be used to fund total ex-
penditures for the operating costs of hospitals
and other health care and long-term care insti-
tutions, allocated according to the method spec-
ified in section 411(b).
(B) An Institutional Capital Account shall
be used to fund total expenditures for capital-
related items in hospitals and other health care
and long-term care institutions, allocated ac-
cording to the method specified in section
411(c).
(C) A Health Training Account shall be
used to fund direct and indirect graduate medi-
cal education in hospitals and other health care
and long-term care institutions to cover excess
operating and capital costs associated with
teaching and related research activities, allo-
cated according to the method specified in sec-
tion 411(d).
(D) A Practitioner Reimbursement Ac-
count shall be used to fund the reimbursement
of services provided by health care practitioners,
allocated according to the method specified in
section 412.
SEC. 403. STATE PROGRAM BUDGETS.
(a) IN GENERAL.—Each State program shall estab-
lish an annual fiscal year State program budget which pro-
vides for—
(1) the total expenditures to be made under the
State program in such fiscal year for health care
services and long-term care services covered under
this Act (including administrative and associated
costs), and
(2) the revenues to meet such expenditures.
(b) COORDINATION.—Each State program budget
shall be coordinated, in a manner specified by the Board,
with the national health budget established under section
401(a).
(c) STATE SHARE.—
(1) IN GENERAL.—Each State program shall
cover the State share of program costs through the
use of tax revenues and other financing methods al-
lowed under section 424.
(2) ADDITIONS TO STATE SHARE.—Each State
shall raise the revenues necessary to cover at least
the State share specified in the national health
budget established by the Board (computed under
section 401(d)). Each State is permitted to raise ad-
ditional revenues and to increase such State’s health
program expenditures beyond the amount specified
in the State share specified for the national health
budget—
(A) to cover the costs of benefits for health
care services or long-term care services the
State program authorizes in addition to the
services covered in this Act or as amended by
the Board and the Congress,
(B) to provide for increased global operat-
ing, capital, or health training budgets for hos-
pitals and other health care and long-term care
institutions,
(C) to provide for any unexpected increase
in health care costs identified by the State pro-
gram, and
(D) for other purposes that may be identi-
fied by the Board.
(d) BARRIERS TO ACCESS PROHIBITED.—No State,
either by intention or as an unstated consequence of budg-
et allocations, may restrict or cause to be restricted timely
access to the medically necessary and appropriate health
care services and long-term care services covered under
this Act, or permit queues for services to form that have
the potential of being life threatening.
(e) ANNUAL PUBLICATION.—The State program
shall provide for the publication annually of the most re-
cent State program budget established under this section.
Subtitle B—Payments to Providers
SEC. 411. PAYMENTS TO HOSPITALS AND OTHER HEALTH
CARE AND LONG-TERM CARE INSTITUTIONS.
(a) IN GENERAL.—Each State program shall be re-
sponsible for—
(1) allocating from the State program budget
the aggregate amount of money to be directed to
hospitals and other health care and long-term care
institutions for the global operating, capital, and
health training budgets of such institutions, and
(2) devising mechanisms for the allocation from
such budget of capital expenditures in non-institu-
tional settings.
(b) GLOBAL BUDGETS FOR OPERATING EXPENSES
FOR HOSPITALS AND OTHER HEALTH CARE AND LONG-
TERM CARE INSTITUTIONS.—The following principles
shall guide a State institution reimbursement negotiation
board in negotiating institutional global operating budg-
ets:
(1) Each State program budget shall include a
separate account for global operating expenses to
provide for total State expenditures for the operat-
ing expenses of hospitals and other health care and
long-term care institutions.
(2) Payment shall be based on an annual pro-
spective global budget for operating expenses sub-
mitted by an institution, in a manner specified by
the State program, to the agency designated by the
State program.
(3) The budgets shall take into account
amounts that are reasonable and necessary in the ef-
ficient provision of necessary hospital and other in-
stitutional services covered under this Act.
(4) The operating budgets shall not include
capital-related and health training expenses.
(5) Adjustments may later be made in the
budget to reflect significant changes in the volume
or types of services assumed in the approval of the
budget.
(6) A State should encourage innovation by per-
mitting any institution to include in its budget for
the immediate year any programs designed to in-
crease efficiency in later years, if those improve-
ments can be demonstrated to the satisfaction of the
designated State agency.
(c) CAPITAL BUDGETS FOR HOSPITALS AND OTHER
HEALTH CARE AND LONG-TERM CARE INSTITUTIONS.—
The following principles shall guide a State institution re-
imbursement negotiation board in negotiating institutional
capital budgets:
(1) Each State program budget shall include a
separate account for capital expenses to provide for
total State expenditures for the capital-related items
in hospitals and other health care and long-term
care institutions.
(2) Each State program budget shall specify
the general manner in which such expenditures for
capital-related items are to be distributed among dif-
ferent types of institutions and the different areas of
the State to take into account the need for capital
expenditures throughout the State.
(3) Capital expenditures are those authorized
by the State for the provision of insured health serv-
ices, regardless of whether the source of funds for
the capital expenditure is derived from accumulated
depreciation charges, operating surpluses or retained
earnings, expenditure of accumulated fund balances,
issuance of bonds, notes, debentures or other evi-
dence of indebtedness, borrowed funds, or any other
source including equity capitalization.
(4) Unless otherwise provided in this Act re-
garding underserved areas, or waived by the des-
ignated State agency if necessary to provide equi-
table resource allocation and access to quality care,
hospitals and other health care and long-term care
institutions shall furnish a 15 percent match for
funds allocated from the Institutional Capital Ac-
count of the budget.
(d) HEALTH TRAINING FOR HOSPITALS AND OTHER
HEALTH CARE AND LONG-TERM CARE INSTITUTIONS.—
The following principles shall guide a State institution re-
imbursement negotiation board in negotiating institutional
health training budgets:
(1) Each State program budget shall include a
separate account for direct and indirect graduate
medical education-related expenses in hospitals and
other health care and long-term care institutions.
(2) Each state program budget shall specify the
general manner in which such expenditures for di-
rect and indirect graduate medical education are to
be distributed among different types of institutions
and the different areas of the State.
(3) The distribution of funds to hospitals and
other health care and long-term care institutions
from the Health Training Account must conform to
the following principles:
(A) At least 50 percent of the funding
from the Health Training Account is to be di-
rected to primary care training programs.
(B) For each 5-year period beginning after
the date which is 5 years after the date of the
enactment of this Act, the Advisory Board will
evaluate the required minimum percentage of
funds that States must direct to primary care
and recommend whether the percentage should
be changed to ensure consistency with the goal
of encouraging primary care residency training
programs.
(C) The State is to develop a methodology
for funding nonhospital-based residency pro-
grams and to establish opportunities for
residencies in community-based health care fa-
cilities.
(D) The distribution of funds from the
Health Training Account must take into ac-
count the potentially higher costs of placing
medical students in rural residency programs.
(E) The distribution of funds from the
Health Training Account must accommodate
the 
education 
and 
training 
needs 
of
nonphysician practitioners.
SEC. 412. PAYMENTS FOR PRACTITIONERS SERVICES.
The State practitioner reimbursement negotiation
board shall negotiate with the State organizations rep-
resenting each of the practitioner disciplines in order to
derive a relative value scale fee schedule that fulfills each
of the following principles:
(1) Appropriate levels of payment are provided
primary care services, including general, family, and
preventive procedures.
(2) The same compensation is given for the
same procedures even when performed by different
types of practitioners licensed to offer those proce-
dures.
(3) Reimbursement rates for different proce-
dures performed by practitioners in different dis-
ciplines reflect the relative value of those procedures.
(4) Urban and rural practitioners receive the
same reimbursement rates for the same services, un-
less the State determines that a differential rate is
required to increase the access to health care practi-
tioners in underserved areas.
(b) ENFORCEMENT.—The State program shall apply
appropriate sanctions against the entity if such entity
knowingly and willfully charges for an item or service or
accepts payment in violation of subsection (a).
Subtitle C—Revenues
SEC. 421. FEDERAL SOURCES OF REVENUES.
(a) AMERICAN
HEALTH
SECURITY
PLAN
PRE-
MIUMS.—The Board, in consultation with the Secretary
of the Treasury, shall develop a mechanism for determin-
ing and collecting a premium from individuals and employ-
ers for health care services and long-term care services
covered under this Act, to be known as the American
Health Security Plan premium.
(b) DETERMINATION OF PREMIUM AMOUNT.—The
Board shall determine the American Health Security Plan
premium for each taxable year beginning after December
31, 1996, by estimating the total amount necessary to
equal the excess of—
(1) expenditures described in section 423(c) for
the fiscal year beginning in such taxable year, over
(2) receipts described in section 423(b) (other
than paragraph (1)) for such fiscal year.
(c) COLLECTION OF PREMIUM.—
(1) INDIVIDUALS.—The Board shall collect the
American Health Security Plan premium from indi-
viduals using a mechanism with the following char-
acteristics:
(A) Income-based (including earned and
unearned income).
(B) Progressive.
(C) Payable in increments during the
course of the year.
(D) Payable by individuals or by employers
on behalf of employees (at the option of the em-
ployer), as described in paragraph (2)(C).
(E) Subject to the provisions of subtitle F
of the Internal Revenue Code of 1986.
(2) EMPLOYERS.—The Board shall collect the
American Health Security Plan premium from em-
ployers using a mechanism with the following char-
acteristics:
(A) 
Aggregate 
employer 
contributions
would equal an amount necessary to prevent an
increase in the percentage of 1993 aggregate
household health care expenditures.
(B) Contribution rate based on each em-
ployer’s ability to pay as indicated by factors
such as the size of the employer’s workforce
and profitability.
(C) Any employer would have the option of
paying all or part of the American Health Secu-
rity Plan premium otherwise payable by such
employer’s employees.
(D) Subject to the provisions of subtitle F
of the Internal Revenue Code of 1986.
(d) EFFECT OF BOARD ACTIONS.—Any premium de-
termination made by the Board under this subsection with
respect to any taxable year shall be submitted to the Con-
gress at least 6 months before the beginning of such tax-
able year, and shall have the force of law, unless within
60 days of the submission of such determination, the Con-
gress enacts a disapproval resolution under the procedures
described in section 501.
(e) EFFECTIVE DATE.—The provisions of this section
shall apply with respect to remuneration paid after De-
cember 31, 1996, and with respect to earnings from self-
employment attributable to taxable years beginning after
such date.
SEC. 422. TAX TREATMENT OF AMERICAN HEALTH SECU-
RITY PLAN AND PRIVATE HEALTH AND LONG-
TERM CARE INSURANCE.
(a) TAX EXCLUSIONS
FOR AMOUNTS RECEIVED
FROM, 
AND
EMPLOYER
CONTRIBUTIONS
TO, 
THE
PLAN.—
(1) AMOUNTS
RECEIVED.—Subsection (e) of
section 105 of the Internal Revenue Code of 1986
(relating to amounts received under accident and
health plans) is amended to read as follows:
‘‘(e) ACCIDENT OR HEALTH INSURANCE.—For pur-
poses of this section, section 104, and section 106, the
term ‘accident or health insurance’ means an approved
State program under section 311 of the American Health
Security Plan Act of 1993.’’.
(2) EMPLOYER CONTRIBUTIONS.—Section 106
of such Code (relating to contributions by employer
to accident and health plans) is amended by striking
‘‘an accident or health plan’’ and inserting ‘‘accident
or health insurance’’.
(3) CONFORMING
AMENDMENT.—Section 105
of such Code is amended by striking subsection (h).
(b) BUSINESS EXPENSE DEDUCTION FOR HEALTH
INSURANCE.—Section 162 of the Internal Revenue Code
of 1986 (relating to trade or business expenses) is amend-
ed by redesignating subsection (m) as subsection (n) and
by inserting after subsection (l) the following new sub-
section:
‘‘(m) GROUP HEALTH PLANS.—The expenses paid or
incurred by an employer for a group health plan shall not
be allowed as a deduction under this section unless the
plan is an approved State program under section 311 of
the American Health Security Plan Act of 1993.’’.
(c) RULES RELATING TO DEDUCTIONS FOR INDIVID-
UALS.—
(1) SAME
TREATMENT
FOR
SELF-EMPLOYED
INDIVIDUALS AND BUSINESSES.—Section 162(l) of
the Internal Revenue Code of 1986 (relating to spe-
cial rules for health insurance costs of self-employed
individuals) is amended—
(A) by striking ‘‘25 percent of’’ in para-
graph (1), and
(B) by striking paragraph (6).
(2) SIMILAR TREATMENT FOR OTHER INDIVID-
UALS.—Subsection (d) of section 213 of such Code
(relating to medical, dental, etc., expenses) is
amended—
(A) by striking paragraph (1) and insert-
ing the following new paragraph:
‘‘(1) MEDICAL CARE.—The term ‘medical care’
means American Health Security Plan premiums
and cost-sharing amounts paid for coverage under
an approved State program under section 311 of the
American Health Security Plan Act of 1993.’’,
(B) by striking paragraphs (2), (6), (7),
and (9), and by redesignating paragraphs (3),
(4), (5), and (8) as paragraphs (2), (3), (4),
and (5), respectively.
(d) TERMINATION OF CHILD HEALTH INSURANCE
CREDIT.—Clause (i) of section 32(b)(2)(A) of such Code
is amended by inserting ‘‘(0 percent for taxable years be-
ginning after December 31, 1999)’’ after ‘‘6 percent’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to any taxable year
beginning after December 31, 1999.
SEC. 423. FEDERAL HEALTH TRUST FUND.
(a) TRUST FUND ESTABLISHED.—There is hereby
created on the books of the Treasury of the United States
a trust fund to be known as the ‘‘Federal Health Care
Trust Fund’’. The Trust Fund shall consist of such gifts
and bequests as may be made and such amounts as may
be deposited in, or appropriated to, such Trust Fund as
provided in this Act.
(b) RECEIPTS.—
(1) TRANSFER OF AMOUNTS EQUIVALENT TO
CERTAIN TAXES.—
(A) IN GENERAL.—There are hereby ap-
propriated to the Trust Fund amounts equiva-
lent to 100 percent of the American Health Se-
curity Plan premiums received in the Treasury
as the result of the mechanism described in sec-
tion 421 of this Act.
(B) ADDITIONAL
REVENUES.—There are
appropriated to the Trust Fund amounts equiv-
alent to the additional revenues received in the
Treasury as the result of the amendments made
by section 422 of this Act.
(C) TRANSFERS BASED ON ESTIMATES.—
The amounts appropriated by subparagraphs
(A) and (B) shall be transferred from time to
time (not less frequently than monthly) from
the general fund in the Treasury to the Trust
Fund, such amounts to be determined on the
basis of estimates by the Secretary of the
Treasury of the taxes and premiums, specified
in such subparagraphs, paid to or deposited
into the Treasury; and proper adjustments shall
be made in amounts subsequently transferred to
the extent prior estimates were in excess of or
were less than the taxes and premiums specified
in such subparagraphs.
(2) TRANSFER OF FUNDS.—All amounts, not
otherwise obligated, that remain in the Federal Hos-
pital Insurance Trust Fund and the Federal Supple-
mental Medical Insurance Trust Fund on the first
(1) TO STATES.—Payments in each fiscal year
to each State from the Trust Fund as determined
under section 402 are hereby authorized and appro-
priated.
(2) 
ADMINISTRATIVE
EXPENSES
AND
GRANTS.—There are hereby authorized and appro-
priated such sums as are necessary for the adminis-
trative expenses and grants described in sections
212(g), 304, 315, 316(c) and 803 of this Act for
each fiscal year.
(3) CONTINGENCY ACCOUNT.—There are here-
by authorized and appropriated such sums as deter-
mined necessary by the Board to cover unanticipated
events that affect the health care needs of individ-
uals described in section 101(a), to be available
without fiscal year limitation.
(d) INCORPORATION OF TRUST FUND PROVISIONS.—
The provisions of subsections (b) through (e) of section
1841 of the Social Security Act (42 U.S.C. 1395t), as in
effect on the day before the date of the enactment of this
Act, shall apply to the Trust Fund in the same manner
as such provisions apply to the Federal Supplemental
Medical Insurance Trust Fund, except that any reference
to the Secretary of Health and Human Services or the
Administrator of the Health Care Financing Administra-
tion shall be deemed a reference to the Board.
(e) TRUST FUND OFF-BUDGET.—The receipts and
disbursements of the Trust Fund and the taxes described
in subsection (b)(1) shall not be included in the totals of
the budget of the United States Government as submitted
by the President or of the congressional budget and shall
be exempt from any general budget limitation imposed by
statute on expenditures and net lending (budget outlays)
of the United States Government.
SEC. 424. STATE SOURCES OF REVENUES.
(a) IN GENERAL.—Each State shall be responsible
for establishing a financing program for the implementa-
tion of the State program in the State. Such financing
program may include—
(1) funds used to finance the State share of
medicaid under title XIX of the Social Security Act
as in effect on the day before the date described in
section 902(f) of this Act,
(2) State and local funding for public hospitals
and other indigent care programs, and
(3) State funding from general revenues, ear-
marked taxes, payroll taxes, sales taxes, and such
other measures consistent with this Act as the State
may provide.
(b) ON-GOING ENTITLEMENT.—Each State with a
State program approved by the Commission is entitled to
funding from the Commission in the amounts provided
under section 402.
TITLE V—CONGRESSIONAL
CONSIDERATION
SEC. 501. RULES GOVERNING CONGRESSIONAL CONSIDER-
ATION.
(a) RULES OF HOUSE OF REPRESENTATIVES AND
SENATE.—This section is enacted by the Congress—
(1) as an exercise of the rulemaking power of
the House of Representatives and the Senate, re-
spectively, and as such is deemed a part of the rules
of each House, respectively, but applicable only with
respect to the procedure to be followed in that
House in the case of disapproval resolutions de-
scribed in subsection (b), and supersedes other rules
only to the extent that such rules are inconsistent
therewith; and
(2) with full recognition of the constitutional
right of either House to change the rules (so far as
relating to the procedure of that House) at any time,
in the same manner and to the same extent as in
the case of any other rule of that House.
(b) TERMS OF THE RESOLUTION.—For purposes of
this Act, the term ‘‘disapproval resolution’’ means only a
joint resolution of the two Houses of the Congress, provid-
ing in—
(1) the matter after the resolving clause of
which is as follows: ‘‘That the Congress disapproves
the action of the Federal Health Board as submitted
by the Board on llllllllllllll’’,
the blank space being filled in with the appropriate
date; and
(2) the title of which is as follows: ‘‘Joint Reso-
lution disapproving the action of the Federal Health
Board’’.
(c) INTRODUCTION AND REFERRAL.—On the day on
which the action of the Board is transmitted to the House
of Representatives and the Senate, a disapproval resolu-
tion with respect to such action shall be introduced (by
request) in the House of Representatives by the Majority
Leader of the House, for himself and the Minority Leader
of the House, or by Members of the House designated by
the Majority Leader of the House, for himself and the Mi-
nority Leader of the House, or by Members of the House
designated by the Majority Leader and Minority Leader
of the House; and shall be introduced (by request) in the
Senate by the Majority Leader of the Senate, for himself
and the Minority Leader of the Senate, or by Members
of the Senate designated by the Majority Leader and Mi-
nority Leader of the Senate. If either House is not in ses-
sion on the day on which such an action is transmitted,
the disapproval resolution with respect to such action shall
be introduced in the House, as provided in the preceding
sentence, on the first day thereafter on which the House
is in session. The disapproval resolution introduced in the
House of Representatives and the Senate shall be referred
to the appropriate committees of each House.
(d) AMENDMENTS PROHIBITED.—No amendment to
a disapproval resolution shall be in order in either the
House of Representatives or the Senate; and no motion
to suspend the application of this subsection shall be in
order in either House, nor shall it be in order in either
House for the Presiding Officer to entertain a request to
suspend the application of this subsection by unanimous
consent.
(e) PERIOD FOR COMMITTEE AND FLOOR CONSIDER-
ATION.—
(1) IN GENERAL.—Except as provided in para-
graph (2), if the committee or committees of either
House to which a disapproval resolution has been re-
ferred have not reported it at the close of the 45th
day after its introduction, such committee or com-
mittees shall be automatically discharged from fur-
ther consideration of the disapproval resolution and
it shall be placed on the appropriation calendar. A
vote on final passage of the disapproval resolution
shall be taken in each House on or before the close
of the 45th day after the disapproval resolution is
reported by the committees or committee of that
House to which it was referred, or after such com-
mittee or committees have been discharged from fur-
ther consideration of the disapproval resolution. If
prior to the passage by one House of a disapproval
resolution of that House, that House receives the
same disapproval resolution from the other House
then—
(A) the procedure in that House shall be
the same as if no disapproval resolution had
been received from the other House; but
(B) the vote on final passage shall be on
the disapproval resolution of the other House.
(2) COMPUTATION OF DAYS.—For purposes of
paragraph (1), in computing a number of days in ei-
ther House, there shall be excluded any day on
which the House is not in session.
(f) FLOOR CONSIDERATION IN THE HOUSE OF REP-
RESENTATIVES.—
(1) MOTION TO PROCEED.—A motion in the
House of Representatives to proceed to the consider-
ation of a disapproval resolution shall be highly priv-
ileged and not debatable. An amendment to the mo-
tion shall not be in order, nor shall it be in order
to move to reconsider the vote by which the motion
is agreed to or disagreed to.
(2) DEBATE.—Debate in the House of Rep-
resentatives on a disapproval resolution shall be lim-
ited to not more than 20 hours, which shall be di-
vided equally between those favoring and those op-
posing the disapproval resolution. A motion further
to limit debate shall not be debatable. It shall not
be in order to move to recommit a disapproval reso-
lution or to move to reconsider the vote by which a
disapproval resolution is agreed to or disagreed to.
(3) MOTION TO POSTPONE.—Motions to post-
pone, made in the House of Representatives with re-
spect to the consideration of a disapproval resolu-
tion, and motions to proceed to the consideration of
other business, shall be decided without debate.
(4) APPEALS.—All appeals from the decisions
of the Chair relating to the application of the Rules
of the House of Representatives to the procedure re-
lating to a disapproval resolution shall be decided
without debate.
(5) GENERAL RULES APPLY.—Except to the ex-
tent specifically provided in the preceding provisions
of this subsection, consideration of a disapproval res-
olution shall be governed by the Rules of the House
of Representatives applicable to other bills and reso-
lutions in similar circumstances.
(g) FLOOR CONSIDERATION IN THE SENATE.—
(1) MOTION TO PROCEED.—A motion in the
Senate to proceed to the consideration of a dis-
approval resolution shall be privileged and not debat-
able. An amendment to the motion shall not be in
order, nor shall it be in order to move to reconsider
the vote by which the motion is agreed to or dis-
agreed to.
(2) GENERAL DEBATE.—Debate in the Senate
on a disapproval resolution, and all debatable mo-
tions and appeals in connection therewith, shall be
limited to not more than 20 hours. The time shall
be equally divided between, and controlled by, the
Majority Leader and the Minority Leader or their
designees.
(3) DEBATE OF MOTIONS AND APPEALS.—De-
bate in the Senate on any debatable motion or ap-
peal in connection with a disapproval resolution shall
be limited to not more than 1 hour, to be equally di-
vided between, and controlled by, the mover and the
manager of the disapproval resolution, except that in
the event the manager of the disapproval resolution
is in favor of any such motion or appeal, the time
in opposition thereto, shall be controlled by the Mi-
nority Leader or his designee. Such leaders, or ei-
ther of them, may, from time under their control on
the passage of a disapproval resolution, allot addi-
tional time to any Senator during the consideration
of any debatable motion or appeal.
(4) OTHER MOTIONS.—A motion in the Senate
to further limit debate is not debatable. A motion to
recommit a disapproval resolution is not in order.
(h) POINT OF ORDER REQUIRING SUPERMAJORITY
FOR MODIFICATIONS TO ACTIONS ONCE APPROVED.—
(1) IN GENERAL.—It shall not be in order in
the House of Representatives or the Senate to con-
sider any amendment to the actions of the Federal
Health Board except as provided in paragraph (2).
(2) WAIVER.—The point of order described in
paragraph (1) may be waived or suspended in the
House of Representatives or the Senate only, by the
affirmative vote of three-fifths of the Members duly
chosen and sworn.
TITLE VI—PRIVATE OPTIONS
SEC. 601. PRIVATE SUPPLEMENTAL INSURANCE.
Except as provided in section 603, nothing in this Act
shall be construed to prohibit the purchase of private in-
surance that provides coverage of health care and long-
term care services supplementing the services covered
under this Act.
SEC. 602. OPTION TO PURCHASE DUPLICATIVE PRIVATE IN-
SURANCE.
Except as provided in section 603, nothing in this Act
shall be construed to prohibit the purchase of private in-
surance that provides coverage of health care and long-
term care services covered under this Act.
SEC. 603. LIMITS ON PRIVATE INSURANCE.
(a) IN GENERAL.—No insurer may issue a private
insurance policy if such policy provides coverage for the
cost-sharing requirements for health care services and
other non-long-term care services covered under this Act.
(b) CERTIFICATION OF NOTIFICATION.—At the time
of sale, the issuer of any private insurance policy shall se-
cure in writing a certification by the purchaser that the
purchaser has been informed of any duplication in cov-
erage of the services covered under this Act.
(c) REVIEW OF PRACTICES.—No later than 2 years
after the full implementation of the provisions of this Act,
the Comptroller General of the United States shall review
the practices of the private insurance industry and make
such recommendations as necessary to the Congress in
order to prevent fraud and abuse in the sale of duplicative
or supplemental private health insurance and to protect
the integrity of the American Health Security Plan.
(d) OBLIGATION TO PAY PREMIUM REMAINS.—The
purchase of any type of private health insurance policy
shall not relieve the purchaser of the payment of the
American Health Security Plan premium imposed under
section 421.
TITLE VII—EXPANSION OF OUT-
COMES RESEARCH AND DE-
LIVERY OF SERVICES IN UN-
DERSERVED AREAS
SEC. 701. EXPANSION OF OUTCOMES RESEARCH.
Paragraph (1) of section 1142(i) of the Social Secu-
rity Act (42 U.S.C. 1320b–12(i)) is amended by striking
‘‘and’’ at the end of subparagraph (D) and by striking
(E) and inserting the following:
‘‘(E) $225,000,000 for fiscal year 1994;
‘‘(F) $275,000,000 for fiscal year 1995;
and
‘‘(G) $325,000,000 for fiscal year 1996.’’.
SEC. 702. NATIONAL HEALTH SERVICE CORPS.
(a) INCREASE IN AUTHORIZATION OF APPROPRIA-
TIONS.—There are authorized to be appropriated to carry
out subpart II of part D of title III of the Public Health
Services Act (42 U.S.C. 254d et seq.) for fiscal year 1994,
an amount equal to—
(1) the amount appropriated under such sub-
part for fiscal year 1993; and
(2) an additional amount equal to 40 percent of
the amount described in paragraph (1).
When making loans under such subpart, priority should
be given to students from schools that have primary care
programs and that stress underserved practices.
(b) COMMUNITY FINANCING PROGRAM.—Subpart II
of part D of title III of the Public Health Service Act
(42 U.S.C. 254d et seq.) is amended by inserting after
section 336A, the following new section:
‘‘SEC. 336B. COMMUNITY FINANCING PROGRAMS.
‘‘(a) ESTABLISHMENT.—The Secretary may award
grants under this section to local communities to enable
such communities to establish programs to finance the
health-related education of residents of such communities.
‘‘(b) APPLICATION.—To be eligible to receive a grant
under subsection (a), a community shall prepare and sub-
mit to the Secretary an application, at such time, in such
manner and containing such information as the Secretary
may require.
‘‘(c) USE.—A community that receives a grant under
subsection (a), shall use amounts received under such
grant to provide assistance to local residents with respect
to the health-related educational expenses of such resi-
dents. Such community shall not provide assistance under
a grant under this section to a local resident unless such
resident agrees to practice in a health-related field in such
community for not less than 4 years after graduation. In
providing assistance to such residents, the community
should give priority to residents attending schools that
have primary care programs and that stress underserved
practices.
‘‘(d) AMOUNTS.—The amount of a grant awarded to
a community under this section shall not exceed 75 per-
cent of the cost to such community in administering and
implementing a community financing program under this
section.
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to carry out this section, $10,000,000 for
each of the fiscal year 1994 through 1996.’’.
SEC. 703. COMMUNITY AND MIGRANT HEALTH CENTERS.
Subpart I of part D of title III of the Public Health
Service Act (42 U.S.C. 254d et seq.) is amended by insert-
ing after section 330, the following new section:
‘‘SEC. 330A. NEW COMMUNITY AND MIGRANT HEALTH CEN-
TERS.
‘‘(a) NEW COMMUNITY AND MIGRANT HEALTH CEN-
TERS.—
‘‘(1) IN GENERAL.—The Secretary shall award
grants to eligible entities to expand the availability
of comprehensive primary health services (as defined
in section 330(b)(1)) in medically underserved areas.
‘‘(2) ELIGIBILITY.—To be eligible to receive a
grant under this section an entity shall—
‘‘(A) be an entity that—
‘‘(i) meets the requirements of section
329(a) or 330(a) for being a migrant or
community health center, though not a re-
cipient of a grant under either section;
‘‘(ii) does not meet the requirements
of section 329(a) or 330(a) for being a mi-
grant or community health center, but that
provides assurances satisfactory to the Sec-
retary, including subsequent demonstrable
evidence, that such entity will meet the re-
quirements of either section not later than
2 years after receiving a grant under this
section;
‘‘(iii) is eligible for a planning grant
under sections 329(c) or 330(c); or
‘‘(iv) is able to provide a subset of the
required services, be able to prove that it
cannot meet the requirements of section
329(a) or 330(a), and demonstrate that it
is the most qualified entity in the service
area; and
‘‘(B) prepare and submit to the Secretary
an application at such time, in such manner
and containing such information as the Sec-
retary may require.
‘‘(b) EXPANSION OF CURRENT COMMUNITY AND MI-
GRANT HEALTH CENTERS.—
‘‘(1) IN GENERAL.— Community and migrant
health centers in existence on the date of enactment
of this section may utilize any increase in revenue
experienced as a result of the increase in the number
of insured patients treated for the expansion of the
amounts and types of services furnished, to serve ad-
ditional patients or areas, or to promote the recruit-
ment, training or retention of personnel.
‘‘(2) RECOMMENDATIONS.—Not later than 3
years after the date of enactment of this section, the
Secretary shall prepare and submit to the appro-
priate committees of Congress recommendations con-
cerning the provision of paragraph (1).
‘‘(c) REPORT.—Not later than 3 years after the date
of enactment of this section, the Secretary shall prepare
and submit to the appropriate committees of Congress a
report concerning the need for further migrant and com-
munity health center primary care service capacity devel-
opment and recommendations concerning the appropriate
level of support needed for activities to address such ca-
pacity development.
‘‘(d) AUTHORIZATIONS OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—There are authorized to be
appropriated to carry out this section, $300,000,000
for fiscal years 1994 through 1996.
‘‘(2) ADDITIONAL
AMOUNTS.—Amounts pro-
vided under this section shall be in addition to any
amounts appropriated under sections 329 and 330.’’.
TITLE VIII—MALPRACTICE
REFORM
SEC. 801. GRANTS TO STATES.
(a) IN GENERAL.—The Board shall make grants to
States for the development and implementation of medical
malpractice reforms, as described in section 802. A State
shall use a grant made under this section to develop, im-
plement, and evaluate the effectiveness of such reforms.
(b) COMPLIANCE WITH FEDERAL STANDARDS.—Be-
ginning 2 years after the implementation of the reforms,
each State shall annually submit a report to the Board
containing such information as the Board may require to
determine whether the State is in compliance with the
terms of the grant made under this section.
SEC. 802. CRITERIA FOR STATE MALPRACTICE REFORMS.
(a) IN GENERAL.—Each State must demonstrate to
the Board that the reforms to the State medical mal-
practice system that the State develops or has already
adopted or intends to adopt meet the criteria described
in subsection (b).
(b) CRITERIA.—The criteria for medical malpractice
reforms are as follows:
(1) COSTS.—Decrease administrative costs and
reduce incentives for filing non-meritorious claims.
(2) EFFICIENCY.—Reduce the time between the
filing of medical malpractice claims and case resolu-
tions using procedures which may include the estab-
lishment of voluntary alternative dispute resolution
mechanisms, 
such 
as 
mediation, 
arbitration,
minitrials, and summary judgments, to facilitate ear-
lier case resolutions.
(3) ACCESS.—Develop mechanisms to ensure
that victims of malpractice or medically injured pa-
tients have the meaningful ability to seek compensa-
tion, including voluntary alternative dispute resolu-
tion mechanisms designed for small claims.
(4) QUALITY.—Improve the quality of health
care by strengthening mechanisms that reduce the
occurrence of medical injury, and detect and sanc-
tion health care professionals who commit health
care malpractice.
(5) EQUITY.—Enhance the fairness of com-
pensation provided to injured individuals for both
medically and non-medically-related damages, and
increase incentives for experience rating of insurance
premiums.
(c) BOARD STUDY OF CRITERIA.—
(1) STUDY.—The Board shall collect data from
the States awarded grants under section 801 on the
effects of the reforms established to meet the criteria
described in subsection (b) on the medical mal-
practice systems of such States. The data shall be
used to evaluate the effectiveness and appropriate-
ness of the criteria described in subsection (b) in ad-
dressing the problems of the medical malpractice
systems of such States. The Board may modify such
criteria based on such study.
(2) REPORT.—The Board shall report the re-
sults of the study described in paragraph (1) to the
Congress on a periodic basis.
SEC. 803. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated for grants
under this title such sums as may be necessary for fiscal
years 1994 through 1997.
TITLE 
IX—EFFECTIVE 
DATES;
TERMINATIONS; TRANSITION;
RELATION TO ERISA.
SEC. 901. EFFECTIVE DATES.
(a) FEDERAL ADMINISTRATION.—Not later than Oc-
tober 1, 1995, the Board shall promulgate regulations re-
garding the health care and long-term care services cov-
ered under this Act and the related patient cost-sharing
schedules under title II, develop the means for computing
the National Health Budget and Federal contributions to
the States under subtitle A of title IV, and establish the
procedures for reviewing and approving State plans under
section 311.
(b) PROVISION OF SERVICES.—
to change an effective date under this Act shall be
submitted to the Congress at least 6 months before
the new effective date, and shall have the force of
law, unless within 60 days of the submission of such
determination, the Congress enacts a disapproval
resolution under the procedures described in section
501.
SEC. 902. TERMINATION OF OTHER PROGRAMS.
(a) MEDICARE AND MEDICAID.—
(1) IN GENERAL.—Titles XVIII and XIX of the
Social Security Act are repealed.
(2) REPEAL OF HOSPITAL INSURANCE TAXES
UPON FULL IMPLEMENTATION OF PLAN.—Sections
1401(b), 1402(k)(2), 3101(b), 3111(b), 3121(x)(2),
3231(e)(2)(B)(i)(II), and 6413(c)(3) of the Internal
Revenue Code of 1986 are repealed.
(b) REPEAL OF CHAMPUS PROVISIONS.—
(1) AMENDMENTS TO CHAPTER 55 OF TITLE
10.—Sections 1079 through 1083, 1086, and 1097
through 1100 of title 10, United States Code, are
repealed.
(2) TABLE OF SECTIONS.—The table of sections
at the beginning of chapter 55 of title 10, United
States Code, is amended by striking out the items
relating to the sections referred to in paragraph (1).
(3) CONFORMING AMENDMENTS.—Chapter 55
of title 10, United States Code, is amended as fol-
lows:
(A) DEFINITION.—Section 1072 is amend-
ed by striking out paragraph (4).
(B) REIMBURSEMENT
OF
THE
DEPART-
MENT
OF
VETERANS
AFFAIRS.—Section
1104(b) is amended—
(i) in the subsection heading, by strik-
ing out ‘‘FROM CHAMPUS FUNDS’’; and
(ii) by striking out ‘‘from funds’’ and
all that follows and inserting in lieu thereof
‘‘for medical care provided by the Depart-
ment of Veterans Affairs pursuant to such
agreement.’’.
(c) REPEAL
OF FEDERAL EMPLOYEES HEALTH
BENEFITS PROGRAM.—Chapter 89 of title 5, United
States Code, is repealed.
(d) EFFECTIVE DATE.—The repeals and amend-
ments made by this section shall take effect on October
1, 1999.
SEC. 903. TRANSITION.
(a) IN GENERAL.—The Board shall issue such regu-
lations as are necessary to provide for a transition to the
American Health Security Plan established under this Act
from the programs repealed under section 902.
(b) RELATION TO OTHER PROGRAMS.—The Board
shall recommend to the Congress appropriate legislative
proposals for the amendment or repeal of any other Fed-
eral program inconsistent with, or duplicative of, the prin-
ciples of the American Health Security Plan established
under this Act.
SEC. 904. RELATION TO ERISA.
The provisions of the Employee Retirement Income
Security Act are superseded to the extent inconsistent
with the requirements of this Act.
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