I 
111TH CONGRESS 
2D SESSION 
H. R. 5853 
To amend title XXXII of the Public Health Service Act to require review 
and approval by law prior to collection of premiums under the CLASS 
program, to require notice to individuals prior to enrollment, and to 
require termination of the program in the event of actuarial unsoundness, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 26, 2010 
Mr. BOUSTANY 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 amend title XXXII of the Public Health Service Act 
to require review and approval by law prior to collection 
of premiums under the CLASS program, to require no-
tice to individuals prior to enrollment, and to require 
termination of the program in the event of actuarial 
unsoundness, 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. 
This Act may be cited as the ‘‘Fiscal Responsibility 
and Retirement Security Act’’. 
SEC. 2. REVIEW AND APPROVAL BY LAW OF DESIGNATION 
OF CLASS INDEPENDENCE BENEFIT PLAN. 
Title XXXII of the Public Health Service Act, as 
added by section 8002(a) of the Patient Protection and 
Affordable Care Act (Public Law 111–148), is amended— 
(1) in section 3203(a)— 
(A) in paragraph (3), in the second sen-
tence, by inserting ‘‘and shall submit to Con-
gress a report containing such designation, de-
tails, and reasons’’ after ‘‘public comment’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) APPROVAL BY LAW OF DESIGNATION.—No 
premiums may be deducted from an individual’s 
wages or otherwise collected under section 3204(e) 
unless there is enacted into law, in accordance with 
section 3211(a), a joint resolution approving the 
designation of the CLASS Independence Benefit 
Plan by the Secretary under paragraph (3).’’; and 
(2) by adding at the end the following new sec-
tion: 
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‘‘SEC. 3211. PROCEDURAL REQUIREMENTS FOR APPROVAL 
BY LAW OF DESIGNATION OF CLASS INDE-
PENDENCE BENEFIT PLAN. 
‘‘(a) IN GENERAL.—For purposes of paragraph (4) 
of section 3203(a), the following shall apply: 
‘‘(1) RECEIPT OF REPORTS.—It shall not be in 
order in the Senate or in the House of Representa-
tives to consider a joint resolution described in such 
paragraph unless the Senate or the House of Rep-
resentatives, respectively, has received, not fewer 
than 60 days prior to such consideration— 
‘‘(A) the report of the Secretary described 
in section 3203(a)(3); and 
‘‘(B) the report of the Chief Actuary of the 
Centers for Medicare & Medicaid Services de-
scribed in paragraph (2). 
‘‘(2) REPORT OF CMS CHIEF ACTUARY.—Not 
later than 60 days after the Secretary designates the 
CLASS Independence Benefit Plan under section 
3203(a)(3), the Chief Actuary of the Centers for 
Medicare & Medicaid Services shall submit to Con-
gress a report on the long-term actuarial soundness 
of the CLASS Independence Benefit Plan. Such re-
port shall include— 
‘‘(A) an estimate of the average premium 
per enrollee per year that will be required to en-
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sure that the CLASS Independence Fund will 
be actuarially sound over the 75-year period be-
ginning with the fiscal year in which such re-
port is submitted; and 
‘‘(B) an estimate of the average amount of 
benefits that will be paid per enrollee per year 
over such period. 
‘‘(3) JOINT RESOLUTION DEFINED.—The term 
‘joint resolution’ means only a joint resolution, the 
matter after the resolving clause of which is as fol-
lows: ‘That Congress approves of the CLASS Inde-
pendence Benefit Plan designated by the Secretary 
of Health and Human Services under section 
3203(a)(3) of the Public Health Service Act.’. Such 
term does not include a resolution that specifies 
more than one action. 
‘‘(b) EXERCISE OF THE RULEMAKING POWER OF 
EACH HOUSE.—Subsection (a) is enacted by Congress— 
‘‘(1) as an exercise of the rulemaking power of 
the Senate and the House of Representatives, re-
spectively, and is deemed to be part of the rules of 
each House, respectively, but applicable only with re-
spect to the procedure to be followed in that House 
in the case of a joint resolution under such sub-
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section, and it supersedes other rules only to the ex-
tent that it is inconsistent with such rules; and 
‘‘(2) with full recognition of the constitutional 
right of either House to change the rules (so far as 
they relate 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.’’. 
SEC. 3. REQUIRED NOTICE PRIOR TO ENROLLMENT. 
Section 3204(a) of the Public Health Service Act, as 
added by section 8002(a) of the Patient Protection and 
Affordable Care Act (Public Law 111–148), is amended 
by adding at the end the following new paragraph: 
‘‘(4) REQUIRED
NOTICE
PRIOR
TO
ENROLL-
MENT.— 
‘‘(A) IN GENERAL.—An employer may not 
enroll an employee in the CLASS program 
under paragraph (1) unless, prior to enrolling 
the employee, the employer— 
‘‘(i) has provided to the employee the 
exact statements described in subpara-
graph (C) in a single written notice that 
displays such statements in the order in 
which they are set forth in such subpara-
graph; and 
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‘‘(ii) certifies to the Secretary that the 
individual has received such notice. 
‘‘(B) ENROLLMENT OTHER THAN BY EM-
PLOYER.—In the case of an individual seeking 
to enroll in the CLASS program other than 
through enrollment by the individual’s employer 
under paragraph (1), the Secretary shall not 
permit the individual to enroll unless, prior to 
the individual’s enrollment, the Secretary has 
provided to the individual the exact statements 
described in subparagraph (C) in a single writ-
ten notice that displays such statements in the 
order in which they are set forth in such sub-
paragraph and the individual has acknowledged 
in writing the receipt of such notice. 
‘‘(C) 
STATEMENTS
DESCRIBED.—The 
statements described in this subparagraph are 
the following: 
‘‘(i) The Chief Actuary of the Centers 
for Medicare & Medicaid Services made the 
following assessment in April 2010 regard-
ing the CLASS program: ‘In general, vol-
untary, 
unsubsidized, 
and 
non-under-
written 
insurance 
programs 
such 
as 
CLASS face a significant risk of failure as 
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a result of adverse selection by partici-
pants. Individuals with health problems or 
who anticipate a greater risk of functional 
limitation would be more likely to partici-
pate than those in better-than-average 
health. . . . [T]here is a very serious risk 
that the problem of adverse selection will 
make the CLASS program unsustainable.’. 
‘‘(ii) The Chief Actuary estimated in 
April 2010 that the CLASS program will 
likely begin to run deficits in 2025 and 
continue to run deficits thereafter. 
‘‘(iii) The Chief Actuary further esti-
mated in April 2010 that an initial average 
premium level of about $240 per month 
would be required to adequately fund 
CLASS program costs. 
‘‘(iv) The Federal Government will 
collect more than $70 billion in CLASS 
program premiums from 2012 through 
2019, according to an estimate of the Con-
gressional Budget Office in March 2010. 
Although these premiums are credited as 
IOUs or United States Government securi-
ties in a ‘CLASS Independence Fund,’ the 
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money, itself, is used to pay for other Gov-
ernment expenses, including other pro-
grams under the health care law enacted in 
March 2010 that are unrelated to the 
CLASS program. There is no separate pool 
of money set aside to pay CLASS program 
benefits, and workers and retirees could be 
required to repay these IOUs in the form 
of higher taxes. 
‘‘(v) Under section 3212 of the Public 
Health Service Act, the CLASS program 
will terminate immediately if an annual re-
port of the Board of Trustees of the Class 
Independence Fund indicates that the 
CLASS program will not be actuarially 
sound over the 75-year period beginning 
with the fiscal year in which the report is 
submitted.’’. 
SEC. 4. NO COLLECTION OF PREMIUMS PENDING PROMUL-
GATION OF FINAL REGULATIONS. 
Section 3208(c) of the Public Health Service Act, as 
added by section 8002(a) of the Patient Protection and 
Affordable Care Act (Public Law 111–148), is amended— 
(1) by striking ‘‘The Secretary’’ and inserting 
the following: 
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‘‘(1) IN GENERAL.—The Secretary’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2) NO COLLECTION OF PREMIUMS PENDING 
PROMULGATION OF FINAL REGULATIONS.—No pre-
miums may be deducted from an individual’s wages 
or otherwise collected under section 3204(e) before 
the Secretary has promulgated, in final form— 
‘‘(A) the regulations described in section 
3202(6)(C); 
‘‘(B) 
the 
rule 
described 
in 
section 
3203(a)(3); and 
‘‘(C) the regulations described in para-
graph (1).’’. 
SEC. 5. TERMINATION OF PROGRAM IF CLASS INDEPEND-
ENCE FUND ACTUARIALLY UNSOUND. 
Title XXXII of the Public Health Service Act, as 
amended by section 2, is further amended by adding at 
the end the following new section: 
‘‘SEC. 3212. TERMINATION OF PROGRAM IF CLASS INDE-
PENDENCE FUND ACTUARIALLY UNSOUND. 
‘‘(a) IN GENERAL.—If the Board of Trustees of the 
CLASS Independence Fund submits to Congress the re-
port described in subsection (b) (relating to the actuarial 
unsoundness of the CLASS Independence Fund)— 
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‘‘(1) no individual shall be enrolled under sec-
tion 3204(a) in the CLASS program after the date 
of the submission of the report; 
‘‘(2) no premiums shall be deducted from an in-
dividual’s wages or otherwise collected under section 
3204(e) after such date; 
‘‘(3) no benefits shall be provided under section 
3205(c) after such date; 
‘‘(4) the Secretary shall refund any amount re-
maining in the CLASS Independence Fund (estab-
lished under section 3206(a)) on such date, accord-
ing to the process described in subsection (c), and 
send notification to the Secretary of the Treasury 
when the refund is complete; 
‘‘(5) in the case of notification under paragraph 
(4), the CLASS Independence Fund and the Board 
of Trustees of the CLASS Independence Fund (es-
tablished under section 3206(c)(1)) shall be abol-
ished as of the date of such notification; 
‘‘(6) the CLASS Independence Advisory Council 
(established under section 3207(a)) is abolished as 
of the date of the submission of the report; 
‘‘(7) the Secretary shall take such other steps 
as the Secretary considers necessary to terminate 
the CLASS program; 
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‘‘(8) in lieu of the annual report required by 
section 3208(d), the Secretary shall submit to Con-
gress a quarterly report on the status of the termi-
nation of the CLASS program in accordance with 
this section, until such time as the Secretary indi-
cates in such a report that the program has been 
completely terminated; and 
‘‘(9) in lieu of the annual report required by 
section 3209, the Inspector General of the Depart-
ment of Health and Human Services shall submit to 
Congress a quarterly report on the Secretary’s 
progress in terminating the CLASS program in ac-
cordance with this section, including the existence of 
any waste, fraud, or abuse in connection with the 
termination activities, until such time as the Inspec-
tor General indicates in such a report that the pro-
gram has been completely terminated. 
‘‘(b) REPORT OF UNSOUNDNESS.—The report de-
scribed in this subsection is a report under subparagraph 
(A)(ii) of section 3206(c)(2) that contains a statement de-
scribed in subparagraph (B)(i)(III) of such section that 
indicates that the CLASS Independence Fund is projected 
to be actuarially unsound over the 75-year period begin-
ning with the fiscal year in which such report is submitted. 
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