Title: A bill to provide for reconciliation pursuant to section 2002 of the concurrent resolution on the budget for fiscal year 2017.
Policy area: Health

Summary:
This bill amends the Patient Protection and Affordable Care Act (PPACA) to terminate the Prevention and Public Health Fund.
The bill increases funding for community health centers.
The Department of Health and Human Services may not make payments under the transitional reinsurance program.
The bill makes appropriations for grants to states to address substance abuse or urgent mental health needs.
This bill amends the Internal Revenue Code, including to require individuals to pay back all excess advance payments of the premium assistance tax credit.
The premium assistance tax credit and reduced cost sharing are terminated at the end of 2019.
The small employer health insurance tax credit does not apply after 2019.
Individuals are no longer required to maintain minimum essential health care coverage.
Large employers are no longer required to provide health coverage to employees.
For one year, the bill restricts the availability of federal funding for payments to certain family planning providers (e.g., Planned Parenthood Federation of America).
This bill amends the Social Security Act, including to end the expansion of Medicaid under PPACA on December 31, 2019.
The tax on high-cost, employer-sponsored health coverage (popularly known as the "Cadillac tax") does not apply after 2019.
The bill revises provisions regarding health savings accounts, Archer medical savings accounts, health flexible spending arrangements, and health reimbursement arrangements, including to allow payments for over-the-counter medications.
The bill eliminates various taxes and fees imposed by PPACA, including the tax on medical devices, the annual fee on health insurers, the indoor tanning services tax, and the net investment income tax.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 554 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                 S. 554

     To provide for reconciliation pursuant to section 2002 of the 
       concurrent resolution on the budget for fiscal year 2017.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 7, 2017

Mr. Paul (for himself and Mr. Lee) introduced the following bill; which 
        was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
     To provide for reconciliation pursuant to section 2002 of the 
       concurrent resolution on the budget for fiscal year 2017.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

            TITLE I--HEALTH, EDUCATION, LABOR, AND PENSIONS

SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND.

    (a) In General.--Subsection (b) of section 4002 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 300u-11) is amended by 
striking paragraphs (3) through (8).
    (b) Rescission of Unobligated Funds.--Of the funds made available 
by such section 4002, the unobligated balance is rescinded.

SEC. 102. COMMUNITY HEALTH CENTER PROGRAM.

    Effective as if included in the enactment of the Medicare Access 
and CHIP Reauthorization Act of 2015 (Public Law 114-10, 129; Stat. 
87), paragraph (1) of section 221(a) of such Act is amended by 
inserting ``, an additional $235,000,000 for fiscal year 2017, and 
$235,000,000 for fiscal year 2018'' after ``through 2017''.

SEC. 103. REINSURANCE, RISK CORRIDOR, AND RISK ADJUSTMENT PROGRAMS.

    (a) Transitional Reinsurance Program for Individual Market.--
Section 1341 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18061) is amended by adding at the end the following:
    ``(e) No Force and Effect.--Effective January 1, 2018, the 
Secretary shall not make payments under this section.''.

SEC. 104. SUPPORT FOR STATE RESPONSE TO SUBSTANCE ABUSE PUBLIC HEALTH 
              CRISIS AND URGENT MENTAL HEALTH NEEDS.

    (a) In General.--There are authorized to be appropriated, and are 
appropriated, out of monies in the Treasury not otherwise obligated, 
$750,000,000 for each of fiscal years 2018 and 2019, to the Secretary 
of Health and Human Services (referred to in this section as the 
``Secretary'') to award grants to States to address the substance abuse 
public health crisis or to respond to urgent mental health needs within 
the State. In awarding grants under this section, the Secretary may 
give preference to States with an incidence or prevalence of substance 
use disorders that is substantial relative to other States or to States 
that identify mental health needs within their communities that are 
urgent relative to such needs of other States. Funds appropriated under 
this subsection shall remain available until expended.
    (b) Use of Funds.--Grants awarded to a State under subsection (a) 
shall be used for one or more of the following public health-related 
activities:
            (1) Improving State prescription drug monitoring programs.
            (2) Implementing prevention activities, and evaluating such 
        activities to identify effective strategies to prevent 
        substance abuse.
            (3) Training for health care practitioners, such as best 
        practices for prescribing opioids, pain management, recognizing 
        potential cases of substance abuse, referral of patients to 
        treatment programs, and overdose prevention.
            (4) Supporting access to health care services provided by 
        federally certified opioid treatment programs or other 
        appropriate health care providers to treat substance use 
        disorders or mental health needs.
            (5) Other public health-related activities, as the State 
        determines appropriate, related to addressing the substance 
        abuse public health crisis or responding to urgent mental 
        health needs within the State.

                           TITLE II--FINANCE

SEC. 201. RECAPTURE EXCESS ADVANCE PAYMENTS OF PREMIUM TAX CREDITS.

    Subparagraph (B) of section 36B(f)(2) of the Internal Revenue Code 
of 1986 is amended by adding at the end the following new clause:
                            ``(iii) Nonapplicability of limitation.--
                        This subparagraph shall not apply to taxable 
                        years ending after December 31, 2017, and 
                        before January 1, 2020.''.

SEC. 202. PREMIUM TAX CREDIT AND COST-SHARING SUBSIDIES.

    (a) Repeal of Premium Tax Credit.--Subpart C of part IV of 
subchapter A of chapter 1 of the Internal Revenue Code of 1986 is 
amended by striking section 36B.
    (b) Repeal of Cost-Sharing Subsidy.--Section 1402 of the Patient 
Protection and Affordable Care Act is repealed.
    (c) Repeal of Eligibility Determinations.--The following sections 
of the Patient Protection and Affordable Care Act are repealed:
            (1) Section 1411 (other than subsection (i), the last 
        sentence of subsection (e)(4)(A)(ii), and such provisions of 
        such section solely to the extent related to the application of 
        the last sentence of subsection (e)(4)(A)(ii)).
            (2) Section 1412.
    (d) Protecting Americans by Repeal of Disclosure Authority To Carry 
Out Eligibility Requirements for Certain Programs.--
            (1) In general.--Paragraph (21) of section 6103(l) of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new subparagraph:
                    ``(D) Termination.--No disclosure may be made under 
                this paragraph after December 31, 2019.''.
    (e) Effective Dates.--
            (1) Premium tax credit.--The amendment made by subsection 
        (a) shall apply to taxable years beginning after December 31, 
        2019.
            (2) Cost sharing-subsidies and eligibility 
        determinations.--The repeals in subsection (b) and (c) shall 
        take effect on December 31, 2019.
            (3) Protecting americans by rescinding disclosure 
        authority.--The amendments made by subsection (d) shall take 
        effect on December 31, 2019.

SEC. 203. SMALL BUSINESS TAX CREDIT.

    (a) In General.--Section 45R of the Internal Revenue Code of 1986 
is amended by adding at the end the following new subsection:
    ``(j) Shall Not Apply.--This section shall not apply with respect 
to amounts paid or incurred in taxable years beginning after December 
31, 2019.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to amounts paid or incurred in taxable years beginning after December 
31, 2019.

SEC. 204. INDIVIDUAL MANDATE.

    (a) In General.--Section 5000A(c) of the Internal Revenue Code of 
1986 is amended--
            (1) in paragraph (2)(B)--
                    (A) by striking ``after 2015'' in clause (iii) and 
                inserting ``in 2016'', and
                    (B) by adding at the end the following new clause:
                            ``(iv) Zero percent for taxable years 
                        beginning after 2016.'', and
            (2) in paragraph (3)--
                    (A) by striking ``$695'' in subparagraph (A) and 
                inserting ``$0'',
                    (B) by striking ``and $325 for 2014'' in 
                subparagraph (B) and inserting ``, $325, for 2014, and 
                $695 for 2016'', and
                    (C) by striking subparagraph (D).
    (b) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2016.

SEC. 205. EMPLOYER MANDATE.

    (a) In General.--
            (1) Paragraph (1) of section 4980H(c) of the Internal 
        Revenue Code of 1986 is amended by inserting ``($0 in the case 
        of months beginning after December 31, 2016)'' after 
        ``$2,000''.
            (2) Paragraph (1) of section 4980H(b) of the Internal 
        Revenue Code of 1986 is amended by inserting ``($0 in the case 
        of months beginning after December 31, 2016)'' after 
        ``$3,000''.
    (b) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2016.

SEC. 206. FEDERAL PAYMENTS TO STATES.

    (a) In General.--Notwithstanding section 504(a), 1902(a)(23), 
1903(a), 2002, 2005(a)(4), 2102(a)(7), or 2105(a)(1) of the Social 
Security Act (42 U.S.C. 704(a), 1396a(a)(23), 1396b(a), 1397a, 
1397d(a)(4), 1397bb(a)(7), 1397ee(a)(1)), or the terms of any Medicaid 
waiver in effect on the date of enactment of this Act that is approved 
under section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 
1396n), for the 1-year period beginning on the date of enactment of 
this Act, no Federal funds provided from a program referred to in this 
subsection that is considered direct spending for any year may be made 
available to a State for payments to a prohibited entity, whether made 
directly to the prohibited entity or through a managed care 
organization under contract with the State.
    (b) Definitions.--In this section:
            (1) Prohibited entity.--The term ``prohibited entity'' 
        means an entity, including its affiliates, subsidiaries, 
        successors, and clinics--
                    (A) that, as of the date of enactment of this Act--
                            (i) is an organization described in section 
                        501(c)(3) of the Internal Revenue Code of 1986 
                        and exempt from tax under section 501(a) of 
                        such Code;
                            (ii) is an essential community provider 
                        described in section 156.235 of title 45, Code 
                        of Federal Regulations (as in effect on the 
                        date of enactment of this Act), that is 
                        primarily engaged in family planning services, 
                        reproductive health, and related medical care; 
                        and
                            (iii) provides for abortions, other than an 
                        abortion--
                                    (I) if the pregnancy is the result 
                                of an act of rape or incest; or
                                    (II) in the case where a woman 
                                suffers from a physical disorder, 
                                physical injury, or physical illness 
                                that would, as certified by a 
                                physician, place the woman in danger of 
                                death unless an abortion is performed, 
                                including a life-endangering physical 
                                condition caused by or arising from the 
                                pregnancy itself; and
                    (B) for which the total amount of Federal and State 
                expenditures under the Medicaid program under title XIX 
                of the Social Security Act in fiscal year 2014 made 
                directly to the entity and to any affiliates, 
                subsidiaries, successors, or clinics of the entity, or 
                made to the entity and to any affiliates, subsidiaries, 
                successors, or clinics of the entity as part of a 
                nationwide health care provider network, exceeded 
                $350,000,000.
            (2) Direct spending.--The term ``direct spending'' has the 
        meaning given that term under section 250(c) of the Balanced 
        Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 
        900(c)).

SEC. 207. MEDICAID.

    The Social Security Act (42 U.S.C. 301 et seq.) is amended--
            (1) in section 1902--
                    (A) in subsection (a)(10)(A), in each of clauses 
                (i)(VIII) and (ii)(XX), by inserting ``and ending 
                December 31, 2019,'' after ``January 1, 2014,'';
                    (B) in subsection (a)(47)(B), by inserting ``and 
                provided that any such election shall cease to be 
                effective on January 1, 2018, and no such election 
                shall be made after that date'' before the semicolon at 
                the end; and
                    (C) in subsection (l)(2)(C), by inserting ``and 
                ending December 31, 2019,'' after ``January 1, 2014,'';
            (2) in section 1905--
                    (A) in the first sentence of subsection (b), by 
                inserting ``(50 percent on or after January 1, 2020)'' 
                after ``55 percent'';
                    (B) in subsection (y)(1), by striking the semicolon 
                at the end of subparagraph (D) and all that follows 
                through ``thereafter''; and
                    (C) in subsection (z)(2)--
                            (i) in subparagraph (A), by striking ``each 
                        year thereafter'' and inserting ``through 
                        2019''; and
                            (ii) in subparagraph (B)(ii)(VI), by 
                        striking ``and each subsequent year'';
            (3) in section 1915(k)(2), by striking ``during the period 
        described in paragraph (1)'' and inserting ``on or after the 
        date referred to in paragraph (1) and before January 1, 2020'';
            (4) in section 1920(e), by adding at the end the following: 
        ``This subsection shall not apply after December 31, 2019.'';
            (5) in section 1937(b)(5), by adding at the end the 
        following: ``This paragraph shall not apply after December 31, 
        2019.''; and
            (6) in section 1943(a), by inserting ``and before January 
        1, 2020,'' after ``January 1, 2014,''.

SEC. 208. REPEAL OF DSH ALLOTMENT REDUCTIONS.

    Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) 
is amended by striking paragraphs (7) and (8).

SEC. 209. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE PREMIUMS AND 
              HEALTH PLAN BENEFITS.

    (a) In General.--Chapter 43 of the Internal Revenue Code of 1986 is 
amended by striking section 4980I.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to taxable years beginning after December 31, 2019.

SEC. 210. REPEAL OF TAX ON OVER-THE-COUNTER MEDICATIONS.

    (a) HSAs.--Subparagraph (A) of section 223(d)(2) of the Internal 
Revenue Code of 1986 is amended by striking ``Such term'' and all that 
follows through the period.
    (b) Archer MSAs.--Subparagraph (A) of section 220(d)(2) of the 
Internal Revenue Code of 1986 is amended by striking ``Such term'' and 
all that follows through the period.
    (c) Health Flexible Spending Arrangements and Health Reimbursement 
Arrangements.--Section 106 of the Internal Revenue Code of 1986 is 
amended by striking subsection (f).
    (d) Effective Dates.--
            (1) Distributions from savings accounts.--The amendments 
        made by subsections (a) and (b) shall apply to amounts paid 
        with respect to taxable years beginning after December 31, 
        2017.
            (2) Reimbursements.--The amendment made by subsection (c) 
        shall apply to expenses incurred with respect to taxable years 
        beginning after December 31, 2017.

SEC. 211. REPEAL OF TAX ON HEALTH SAVINGS ACCOUNTS.

    (a) HSAs.--Section 223(f)(4)(A) of the Internal Revenue Code of 
1986 is amended by striking ``20 percent'' and inserting ``10 
percent''.
    (b) Archer MSAs.--Section 220(f)(4)(A) of the Internal Revenue Code 
of 1986 is amended by striking ``20 percent'' and inserting ``15 
percent''.
    (c) Effective Date.--The amendments made by this section shall 
apply to distributions made after December 31, 2017.

SEC. 212. REPEAL OF LIMITATIONS ON CONTRIBUTIONS TO FLEXIBLE SPENDING 
              ACCOUNTS.

    (a) In General.--Section 125 of the Internal Revenue Code of 1986 
is amended by striking subsection (i).
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2017.

SEC. 213. REPEAL OF TAX ON PRESCRIPTION MEDICATIONS.

    Subsection (j) of section 9008 of the Patient Protection and 
Affordable Care Act is amended to read as follows:
    ``(j) Repeal.--This section shall apply to calendar years beginning 
after December 31, 2010, and ending before January 1, 2018.''.

SEC. 214. REPEAL OF MEDICAL DEVICE EXCISE TAX.

    (a) In General.--Chapter 32 of the Internal Revenue Code of 1986 is 
amended by striking subchapter E.
    (b) Effective Date.--The amendment made by this section shall apply 
to sales in calendar quarters beginning after December 31, 2017.

SEC. 215. REPEAL OF HEALTH INSURANCE TAX.

    Subsection (j) of section 9010 of the Patient Protection and 
Affordable Care Act is amended to read as follows:
    ``(j) Repeal.--This section shall apply to calendar years beginning 
after December 31, 2013, and ending before January 1, 2017.''.

SEC. 216. REPEAL OF ELIMINATION OF DEDUCTION FOR EXPENSES ALLOCABLE TO 
              MEDICARE PART D SUBSIDY.

    (a) In General.--Section 139A of the Internal Revenue Code of 1986 
is amended by adding at the end the following new sentence: ``This 
section shall not be taken into account for purposes of determining 
whether any deduction is allowable with respect to any cost taken into 
account in determining such payment.''.
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2017.

SEC. 217. REPEAL OF CHRONIC CARE TAX.

    (a) In General.--Subsection (a) of section 213 of the Internal 
Revenue Code of 1986 is amended by striking ``10 percent'' and 
inserting ``7.5 percent''.
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2017.

SEC. 218. REPEAL OF MEDICARE TAX INCREASE.

    (a) In General.--Subsection (b) of section 3101 of the Internal 
Revenue Code of 1986 is amended to read as follows:
    ``(b) Hospital Insurance.--In addition to the tax imposed by the 
preceding subsection, there is hereby imposed on the income of every 
individual a tax equal to 1.45 percent of the wages (as defined in 
section 3121(a)) received by such individual with respect to employment 
(as defined in section 3121(b).''.
    (b) SECA.--Subsection (b) of section 1401 of the Internal Revenue 
Code of 1986 is amended to read as follows:
    ``(b) Hospital Insurance.--In addition to the tax imposed by the 
preceding subsection, there shall be imposed for each taxable year, on 
the self-employment income of every individual, a tax equal to 2.9 
percent of the amount of the self-employment income for such taxable 
year.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to remuneration received after, and taxable years 
beginning after, December 31, 2017.

SEC. 219. REPEAL OF TANNING TAX.

    (a) In General.--The Internal Revenue Code of 1986 is amended by 
striking chapter 49.
    (b) Effective Date.--The amendment made by this section shall apply 
to services performed on or after December 31, 2017.

SEC. 220. REPEAL OF NET INVESTMENT TAX.

    (a) In General.--Subtitle A of the Internal Revenue Code of 1986 is 
amended by striking chapter 2A.
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2017.

SEC. 221. REMUNERATION.

    Paragraph (6) of section 162(m) of the Internal Revenue Code of 
1986 is amended by adding at the end the following new subparagraph:
                    ``(I) Termination.--This paragraph shall not apply 
                to taxable years beginning after December 31, 2017.''.

SEC. 222. ECONOMIC SUBSTANCE DOCTRINE.

    (a) In General.--Subsection (o) of section 7701 of the Internal 
Revenue Code of 1986 is repealed.
    (b) Penalty for Underpayments.--Paragraph (6) of section 6662(b) of 
the Internal Revenue Code of 1986 is repealed.
    (c) Increased Penalty for Nondisclosed Transactions.--Subsection 
(i) of section 6662 of the Internal Revenue Code of 1986 is repealed.
    (d) Reasonable Cause Exception for Underpayments.--Paragraph (2) of 
section 6664(c) of the Internal Revenue Code of 1986 is repealed.
    (e) Reasonable Cause Exception for Nondisclosed Transactions.--
Paragraph (2) of section 6664(d) of the Internal Revenue Code of 1986 
is repealed.
    (f) Erroneous Claim for Refund or Credit.--Subsection (c) of 
section 6676 of the Internal Revenue Code of 1986 is repealed.
    (g) Effective Date.--The repeals made by this section shall apply 
to transactions entered into, and to underpayments, understatements, or 
refunds and credits attributable to transactions entered into, after 
December 31, 2017.

SEC. 223. BUDGETARY SAVINGS FOR EXTENDING MEDICARE SOLVENCY.

    As a result of policies contained in this Act, the Secretary of the 
Treasury shall transfer to the Federal Hospital Insurance Trust Fund 
under section 1817 of the Social Security Act (42 U.S.C. 1395i) 
$379,300,000,000 (which represents the full amount of on-budget savings 
during the period of fiscal years 2018 through 2027) for extending 
Medicare solvency, to remain available until expended.
                                 <all>