II 113th CONGRESS 1st Session S. 1469 IN THE SENATE OF THE UNITED STATES August 1, 2013 Mr. Paul introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide higher-quality, lower-cost health care to seniors.

1. Short title This Act may be cited as the Congressional Health Care for Seniors Act of 2013 . 2. Enrolling seniors in the same health care plans as Members of Congress (a) In general Chapter 89 of title 5, United States Code, is amended— (1) in section 8901— (A) in paragraph (10), by striking and at the end; (B) in paragraph (11), by striking the period at the end and inserting ; and ; and (C) by adding at the end the following: (12) the term covered individual means an individual who, taking into account section 226(k) of the Social Security Act, would have been entitled to, or could have enrolled for, benefits under part A of title XVIII of such Act or could have enrolled under part B of such title if section 1899B had not been enacted. ; (2) by inserting after section 8901 the following: I Federal employees ; (3) in section 8902— (A) in subsection (a)— (i) by inserting (1) after (a) ; and (ii) by adding at the end the following: (2) (A) In this paragraph, the term equivalent health benefits plan means a health benefits plan proposed to be provided that offers benefits that the Director of the Office of Personnel Management determines are substantially equivalent or superior to benefits offered under, and does not impose requirements that are substantially different than requirements under, a health benefits plan in which an employee could enroll on the date of enactment of the Congressional Health Care for Seniors Act of 2013 if the employee resided— (i) anywhere in the United States; or (ii) in the same region of the United States as the health benefits plan proposed to be provided. (B) For contract years beginning on or after January 1, 2015, if a carrier offers to provide an equivalent health benefits plan, the Director shall enter into a contract with the carrier to provide the equivalent health benefits plan. ; (B) in subsection (e), by striking The Office may prescribe and inserting Subject to subsection (a)(2), the Office may prescribe ; and (C) by adding at the end the following: (p) A contract under this chapter for a contract year beginning on or after January 1, 2015, shall offer benefits for employees, annuitants, members of their families, former spouses, persons having continued coverage under section 8905a of this title, and covered individuals. In administering this subchapter and subchapter II, employees, annuitants, members of their families, former spouses, persons having continued coverage under section 8905a of this title, and covered individuals shall be in the same risk pool. ; (4) in section 8904— (A) by striking (a) The benefits and inserting The benefits ; (B) by striking this subsection each place it appears and inserting this section ; and (C) by striking subsection (b); (5) in section 8909(a)(1), by inserting and for all payments under section 8921(d) before the semicolon; (6) in section 8910, by striking subsection (d); and (7) by adding at the end the following: II Covered individuals 8921. Health insurance for covered individuals (a) For contract years beginning on or after January 1, 2015, and except as otherwise provided in this subchapter, the Director of the Office of Personnel Management shall ensure that to the greatest extent possible health benefits plans provide benefits for covered individuals to the same extent and in the same manner as provided under subchapter I for employees, annuitants, members of their families, former spouses, and persons having continued coverage under section 8905a of this title. (b) (1) The Director shall establish the deadline by which a covered individual shall elect to— (A) enroll in a health benefits plan under this chapter based on the status of the individual as a covered individual; (B) with the concurrence of the employer or former employer of the covered individual, receive payments under subsection (d) to assist in paying for health insurance provided through the employer or former employer of the covered individual; or (C) not enroll in a health benefits plan or receive payments under this chapter. (2) Failure to make a timely election under this subsection shall be deemed as an election to not enroll in a health benefits plan or receive payment under this chapter. (3) A covered individual— (A) may elect to enroll in a health benefits plan as an individual; and (B) may not enroll in a health benefits plan for self and family. (4) (A) A covered individual who elects not to enroll, or who elects not to continue enrollment, in a health benefits plan under this chapter (including a covered individual who elects to receive payments under subsection (d)) may subsequently enroll in a health benefits plan under this chapter based on the status of the covered individual as a covered individual in accordance with such procedures, and after paying such fees, as the Director of the Office of Personnel Management may establish. (B) The fact that a covered individual elects not to enroll, or elects not to continue enrollment, in a health benefits plan under this chapter shall not affect the eligibility of the covered individual for benefits under title II of the Social Security Act (42 U.S.C. 401 et seq.). (c) (1) (A) A covered individual who elects to enroll in a health benefits plan under this chapter based on the status of the covered individual as a covered individual shall pay a monthly individual premium payment determined in accordance with subparagraph (B). (B) The individual premium payment under subparagraph (A) shall be determined based on income, as follows: (i) For an individual with an adjusted gross income (as defined under section 62 of the Internal Revenue Code of 1986) of not more than $85,000, the individual premium payment shall be in an amount equal to the employee contribution for the health benefits plan, as determined under section 8906. (ii) For an individual with an adjusted gross income of more than $85,000 and not more than $107,000, the individual premium payment shall be in an amount equal to the sum of— (I) the employee contribution for the health benefits plan, as determined under section 8906; and (II) the product obtained by multiplying— (aa) the Government contribution (as determined under section 8906(b)); by (bb) 0.05. (iii) For an individual with an adjusted gross income of more than $107,000 and not more than $160,000, the individual premium payment shall be in an amount equal to the sum of— (I) the employee contribution for the health benefits plan, as determined under section 8906; and (II) the product obtained by multiplying— (aa) the Government contribution (as determined under section 8906(b)); by (bb) 0.1. (iv) For an individual with an adjusted gross income of more than $160,000 and not more than $250,000, the individual premium payment shall be in an amount equal to the sum of— (I) the employee contribution for the health benefits plan, as determined under section 8906; and (II) the product obtained by multiplying— (aa) the Government contribution (as determined under section 8906(b)); by (bb) 0.15. (v) For an individual with an adjusted gross income of more than $250,000 and not more than $1,000,000, the individual premium payment shall be in an amount equal to the sum of— (I) the employee contribution for the health benefits plan, as determined under section 8906; and (II) the product obtained by multiplying— (aa) the Government contribution (as determined under section 8906(b)); by (bb) 0.5. (vi) For an individual with an adjusted gross income of more than $1,000,000, the individual premium payment shall be in an amount equal to the sum of— (I) the employee contribution for the health benefits plan, as determined under section 8906; and (II) the Government contribution (as determined under section 8906(b)). (C) The Director of the Office of Personnel Management shall adjust the income amounts under subparagraph (B) annually to reflect changes in the Consumer Price Index for all Urban Consumers published by the Department of Labor. (2) (A) For a covered individual who is entitled to monthly benefits under section 202 or 223 of the Social Security Act (42 U.S.C. 402 and 423), the monthly premiums of the covered individual under this subchapter shall (except as provided in subparagraph (B) or (C)) be collected by deducting the amount of the premium from the amount of such monthly benefits. (B) For a covered individual who is entitled to receive for a month an annuity under the Railroad Retirement Act of 1974 (whether or not the covered individual is also entitled for such month to a monthly insurance benefit under section 202 of the Social Security Act (42 U.S.C. 402)), the monthly premiums of the covered individual under this subchapter shall (except as provided in subparagraph (C)) be collected by deducting the amount thereof from such annuity or pension. (C) If a covered individual to whom subparagraph (A) or (B) applies estimates that the amount which will be available for deduction under such subparagraph for any premium payment period will be less than the amount of the monthly premiums for such period, the covered individual may pay to the Director of the Office of Personnel Management such portion of the monthly premiums for such period as the covered individual desires. (D) For a covered individual who is not described in subparagraph (A) or (B) and who elects to enroll in a health benefits plan under this chapter, or with respect to whom subparagraph (C) applies, the covered individual shall pay monthly premiums to the Director of the Office of Personnel Management at such times, and in such manner, as the Director shall by regulations prescribe. (E) Amounts deducted or paid under this paragraph shall be deposited in the Treasury to the credit of the Employees Health Benefits Fund established under section 8909. (F) After consultation with the Director of the Office of Personnel Management, the Secretary of Health and Human Services shall establish procedures for making and depositing deductions under this paragraph. (3) The Director of the Office of Personnel Management shall establish procedures for terminating the enrollment of a covered individual in a health benefits plan if the covered individual fails to make timely payment of premiums, which shall allow such a covered individual to reenroll in a health benefits plan under such terms and conditions as the Director may prescribe. (d) The Director of the Office of Personnel Management shall make periodic payments to the employer or former employer providing health insurance to a covered individual who makes an election under subsection (b)(1)(B) in a total amount not to exceed the lesser of— (1) the cost to the employer or former employer of providing health insurance to the covered individual; and (2) the average Government contribution for an individual enrolled in a health benefits plan under this chapter that is available to individuals residing anywhere in the United States. (e) For fiscal year 2015 and each fiscal year thereafter, there are appropriated to the Employees Health Benefits Fund established under section 8909, out of any funds in the Treasury not otherwise appropriated— (1) an amount equal to— (A) the taxes imposed by sections 3101(b) and 3111(b) of the Internal Revenue Code of 1986 with respect to wages reported to the Secretary of the Treasury pursuant to subtitle F of such Code after December 31, 2014, as determined by the Secretary of the Treasury by applying the applicable rates of tax under such sections to such wages, which wages shall be certified by the Commissioner of Social Security on the basis of records of wages established and maintained by the Commissioner of Social Security in accordance with such reports; (B) the taxes imposed by section 1401(b) of the Internal Revenue Code of 1986 with respect to self-employment income reported to the Secretary of the Treasury on tax returns under subtitle F of such Code, as determined by the Secretary of the Treasury by applying the applicable rate of tax under such section to such self-employment income, which self-employment income shall be certified by the Commissioner of Social Security on the basis of records of self-employment established and maintained by the Commissioner of Social Security in accordance with such returns; and (C) any amounts that, on or after January 1, 2015, are to be deposited in the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act ( 42 U.S.C. 1395i ) under any other provision of law; and (2) a Government contribution equal to the difference obtained by subtracting— (A) the sum of— (i) the total amount of premiums paid by covered individuals under subsection (c)(2) for the fiscal year; and (ii) the amount appropriated under paragraph (1); from (B) the sum of— (i) the total cost for the fiscal year of subscription charges for health benefits plans for covered individuals enrolled in a health benefits plan based on the status of the covered individuals as covered individuals; and (ii) the total amount of payments for the fiscal year under subsection (d). (f) The Director of the Office of Personnel Management shall establish, in consultation with the Secretary of Health and Human Services acting through the Administrator of the Centers for Medicare & Medicaid Services, procedures to ensure that health benefits plans coordinate with State Medicaid programs with respect to the provision of cost-sharing and other medical assistance for covered individuals enrolled in health benefit plans who are also eligible for medical assistance and enrolled in a State Medicaid program. III Coverage of high risk individuals 8941. Reimbursement of costs for high risk individuals (a) In this section, the term high risk individual means an individual identified under subsection (b)(1). (b) After the end of each contract year beginning on or after January 1, 2015, the Director of the Office of Personnel Management shall— (1) identify, for the contract year, individuals who— (A) enrolled in a health benefits plan under this chapter for a contract year; and (B) who, of all individuals enrolled in a health benefits plan under this chapter for the contract year, are in the highest 5 percent in terms of benefits paid by a carrier under a health benefits plan relating to the contract year; and (2) pay to a carrier contracting to provide a health benefits plan to a high risk individual for the contract year 90 percent of the benefits paid by the carrier relating to the high risk individual. (c) (1) For fiscal year 2015 and each fiscal year thereafter, there are appropriated to the Director of the Office of Personnel Management from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act ( 42 U.S.C. 1395i ) such sums as are necessary to carry out this section. (2) If the amounts appropriated under paragraph (1) are insufficient to carry out this section, for fiscal year 2015 and each fiscal year thereafter, there are appropriated to the Director of the Office of Personnel Management, out of any funds in the Treasury not otherwise appropriated, such sums as are necessary to carry out this section. . (b) Exemption from insurance requirements (1) Amendment to title 5 Chapter 89 of title 5, United States Code, is amended by inserting after section 8901 the following: 8901A. Exemption from insurance requirements Title I of the Patient Protection and Affordable Care Act, subtitle A of title X of such Act, and the amendments made by such title I and subtitle A shall not apply to health benefits plans. . (2) Conforming amendment Section 2709 of the Public Health Service Act (42 U.S.C. 300gg–8) (as added by section 10103 of the Patient Protection and Affordable Care Act) is amended— (A) by striking subsection (g); and (B) by redesignating subsection (h) as subsection (g). (c) Technical and conforming amendments Chapter 89 of title 5, United States Code, is amended— (1) in the table of sections— (A) by inserting after the item relating to section 8901 the following: 8901A. Exemption from insurance requirements. SUBCHAPTER I—Federal employees ; and (B) by adding at the end the following: SUBCHAPTER II—Covered individuals 8921. Health insurance for covered individuals. SUBCHAPTER III—Coverage of high risk individuals 8941. Reimbursement of costs for high risk individuals. ; (2) in section 8902a(d)(1)— (A) in subparagraph (A), by adding or at the end; (B) by striking subparagraph (B); and (C) by redesignating subparagraph (C) as subparagraph (B); and (3) by striking section 8910(d). (d) Effective date; applicability The amendments made by this section shall take effect on the date of enactment of this Act and apply on and after January 1, 2015. 3. Transitioning Medicare patients to coverage under the Federal Employees Health Benefits Program (a) Increase in Medicare eligibility age Section 226 of the Social Security Act (42 U.S.C. 426) is amended by adding at the end the following new subsection: (k) Increasing Medicare qualifying age (1) In general Notwithstanding any other provision of law, any reference in this section, title XVIII, or title XIX (insofar as it relates to the eligibility age for Medicare benefits under title XVIII) to age 65 shall be deemed a reference to the Medicare qualifying age specified in paragraph (2). (2) Medicare qualifying age specified The Medicare qualifying age specified in this paragraph is determined as follows: (A) In the case of an individual who attains 65 years of age before January 1, 2015, the Medicare qualifying age is 65 years of age. (B) In the case of an individual who attains 65 years of age in a year after 2014, and before 2035, the Medicare qualifying age is the Medicare qualifying age specified in this paragraph for the previous year increased by 3 months. (C) In the case of an individual who attains 65 years of age in a year after 2034, the Medicare qualifying age is 70 years of age plus the number of months in the age increase factor (as determined under paragraph (3)). (3) Age increase factor The Commissioner of Social Security shall determine (using reasonable actuarial assumptions) and publish on or before November 1 of each calendar year after 2033 the number of months (rounded, if not a multiple of one month, to the next lower multiple of one month) by which life expectancy as of October 1 of such calendar year of an individual attaining age 65 on such October 1 exceeds the life expectancy as of October 1, 2034, of an individual attaining age 65 on October 1, 2034. With respect to an individual who attains age 65 in the calendar year following any calendar year in which a determination is made under this paragraph, the age increase factor shall be the number of months determined under this paragraph as of October 1 of such calendar year in which such determination is made. . (b) Sunset Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section: 1899B. Sunset of Medicare program with transition to coverage under the Federal Employees Health Benefits Program Notwithstanding any other provision of law, on and after January 1, 2015, the following rules shall apply: (1) The preceding provisions of this title shall not apply. (2) No payments for items and services furnished under this title after such date shall be made. No additional, bonus, or incentive payments under this title, such as graduate medical education payments, may be made. (3) Payments for items and services furnished under this title prior to such date shall be made in the same manner as if this section had not been enacted. (4) All Medicare supplemental policies under section 1882 are terminated. (5) All demonstration projects conducted under this title are terminated. (6) Entitlement to health benefits for individuals who, but for this section (and taking into account section 226(k)), would have been entitled to, or could have enrolled for, benefits under part A or could have enrolled under part B shall be through enrollment in a health benefits plan under chapter 89 of title 5, United States Code. (7) At a date determined appropriate by the Secretary (after payments described in paragraph (3) have been made), amounts in the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund (including the Medicare Prescription Drug Account within such Trust Fund) shall be transferred to the Employees Health Benefits Fund established under section 8909 of chapter 5, United States Code. (8) Any determination under Federal law (other than this title and title II) relating to Medicare eligibility shall be made based on whether an individual is a covered individual, as defined in section 8901 of title 5, United States Code. . (c) Conforming amendment (1) Section 226 of the Social Security Act ( 42 U.S.C. 426 ), as amended by subsection (a), is amended by adding at the end the following new subsection: (l) Notwithstanding the preceding provisions of this section, on and after January 1, 2015, entitlement to health benefits to individuals who, but for this subsection and section 1899B, would have been entitled to benefits under part A and eligible to enroll under part B of title XVIII pursuant to this section shall be through enrollment in a health benefits plan under chapter 89 of title 5, United States Code, rather than under title XVIII of this Act. . (2) Section 226A of the Social Security Act ( 42 U.S.C. 426 ) is amended by adding at the end the following new subsection: (d) Notwithstanding the preceding provisions of this section, on and after January 1, 2015, entitlement to health benefits to individuals who, but for this subsection and section 1899B, would have been entitled to benefits under part A and eligible to enroll under part B of title XVIII pursuant to this section shall be through enrollment in a health benefits plan under chapter 89 of title 5, United States Code, rather than under title XVIII of this Act. . (d) Recommendations to States Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall make available to States recommendations with respect to requirements for health care entities and individuals under the Medicare program that, by reason of section 1899B of the Social Security Act, as added by subsection (b), will no longer apply but that should be considered on the State level.