H.Res. 508 (103rd): Making in order, in the consideration by the House of Representatives of H.R. 3600 (the “Health Security ...

...Act”), an amendment-in-the-nature-of-a-substitute consisting of the text of H.R. 3080 and including a title providing for assistan

103rd Congress, 1993–1994. Text as of Aug 04, 1994 (Introduced).

Status & Summary | PDF | Source: GPO

HRES 508 IH

103d CONGRESS

2d Session

H. RES. 508

Making in order, in the consideration by the House of Representatives of H.R. 3600 (the ‘Health Security Act’), an amendment-in-the-nature-of-a-substitute consisting of the text of H.R. 3080 and including a title providing for assistance for the purpose of health insurance.

IN THE HOUSE OF REPRESENTATIVES

August 4, 1994

Mr. MCMILLAN submitted the following resolution; which was referred to the Committee on Rules


RESOLUTION

Making in order, in the consideration by the House of Representatives of H.R. 3600 (the ‘Health Security Act’), an amendment-in-the-nature-of-a-substitute consisting of the text of H.R. 3080 and including a title providing for assistance for the purpose of health insurance.

    Resolved,

SECTION 1. CONSIDERATION OF CERTAIN AMENDMENTS TO H.R. 3600.

    (a) IN GENERAL- In the consideration of the bill (H.R. 3600), to ensure individual and family security through health care coverage for all Americans in a manner that contains the rate of growth in health care costs and promotes responsible insurance practices, to promote choice in health care, and to ensure and protect the health care of all Americans, in the Committee of the Whole--

      (1) an amendment-in-the-nature-of-a-substitute consisting of the text of H.R. 3080, as introduced in the 103d Congress and the amendments described in subsection (b), if offered by Mr. Michel of Illinois, (or his designee), shall be made in order,

      (2) any points of order against such amendment are hereby waived, and

      (3) the amendment shall not be subject to amendment or to a demand for a division of the question in the House or in the Committee of the Whole.

    (b) AMENDMENTS DESCRIBED- The amendments described in this subsection are specified in the following paragraphs:

      (1) LIMITATIONS ON UNDERWRITING- Strike part 2 of subtitle A of title I and insert the following:

‘PART 2--RESTRICTIONS ON UNDERWRITING

‘SEC. 1011. LIMITATIONS ON UNDERWRITING.

    ‘(a) GUARANTEED ISSUE- Subject to permissible plan restrictions based on capacity, as specified under rules established by the Secretary, each group health plan or health insurance plan that provides standard coverage described in section 1102(c) must accept for enrollment every individual who resides in the area covered by the plan and who seeks such enrollment, without regard to health status or the need for health services.

    ‘(b) GUARANTEED RENEWABILITY- Each group health plan and health insurance plan that provides such coverage may not deny renewal of a policy other than on the basis of--

      ‘(1) fraud or material misrepresentation, or

      ‘(2) nonpayment of premiums.

    ‘(c) ELIMINATION OF PRE-EXISTING CONDITION EXCLUSIONS- A group health plan or health insurance plan that provides such coverage may not restrict, limit, or exclude coverage of items or services included in the standard coverage because of health status, the need for health services, or existing (or pre-existing) medical conditions.’

      (2) STANDARD BENEFIT PACKAGE- Insert after section 1102 the following new sections:

‘SEC. 1102A. STANDARD BENEFIT PACKAGE.

    ‘(a) IN GENERAL- Subject to the cost-sharing described in section 1102B or section 1102C applicable to the items and services involved, notwithstanding section 1102(c), the standard coverage described in such section shall include benefits for--

      ‘(1) the acute care items and services described in subsection (b), and

      ‘(2) the long-term care services described in subsection (c)(1) for an individual determined to be eligible for such services under subsection (c)(2) provided pursuant to a plan of care.

    ‘(b) ACUTE CARE-

      ‘(1) IN GENERAL- Subject to paragraph (2), the acute care items and services described in this subsection include the following (as specified in regulations of the Secretary):

        ‘(A) INPATIENT CARE-

          ‘(i) Inpatient hospital care (other than mental health and substance abuse treatment services).

          ‘(ii) Inpatient surgical and medical care (other than mental health and substance abuse treatment services), including dental services required due to injury requiring surgery.

        ‘(B) OUTPATIENT CARE-

          ‘(i) Outpatient hospital care (other than mental health and substance abuse treatment services).

          ‘(ii) Outpatient surgical and medical care (other than mental health and substance abuse treatment services), including dental services required due to injury requiring surgery.

        ‘(C) OUTPATIENT PRESCRIPTION DRUG BENEFITS- Outpatient prescription drugs, including biologicals and insulin.

        ‘(D) DENTAL CARE- Periodic teeth cleaning and preventive dental care.

      ‘(2) LIMITATIONS ON MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT BENEFITS-

        ‘(A) ANNUAL LIMIT FOR SUBSTANCE ABUSE TREATMENT SERVICES- Subject to subparagraph (B), a health plan providing standard coverage is not required to provide for payment for more than $3,000 in any year for any individual for substance abuse treatment services.

        ‘(B) LIFETIME LIMIT- Such a health plan is not required to provide for payment for either mental health or substance abuse treatment services for an individual once the plan (or another such plan) has provided for payment of $50,000 for such services for the individual in the individual’s lifetime.

        ‘(C) INDEXING- The dollar amounts specified in subparagraphs (A) and (B) of this paragraph shall be increased for each year after 1994 by the same percentage as the percentage increase in the consumer price index for all urban consumers (U.S. city average) between September of the previous year and September 1993. Any such increase that is not a multiple of $10 or $100, respectively, shall be rounded to the nearest multiple of $10 or $100.

    ‘(c) LONG-TERM CARE SERVICES-

      ‘(1) SERVICES-

        ‘(A) IN GENERAL- Subject to subparagraph (B), the long-term care services described in this paragraph include the following (as specified in regulations of the Secretary):

          ‘(i) NURSING FACILITY SERVICES-

            ‘(I) IN GENERAL- Nursing facility services.

            ‘(II) BED RESERVATION- Payment for reservation of a bed in a nursing facility during a period of temporary hospitalization (not to exceed 21 days of continuous hospitalization).

          ‘(ii) HOME CARE SERVICES- Home care services, including--

            ‘(I) home health services provided by a registered nursing or licensed practical nurse,

            ‘(II) professional services of a licensed physical, occupational, respiratory, or speech therapist,

            ‘(III) adult day care,

            ‘(IV) home health aide and personal care attendant services,

            ‘(V) homemaker services, and

            ‘(VI) chore services.

        ‘(B) BENEFIT PERIOD AND LIMITATION- Benefits for long-term care services are limited to--

          ‘(i) a consecutive period of 2 years (beginning on the first date benefits are first covered),

          ‘(ii) $150 per day, and

          ‘(iii) $60,000 for an individual in a lifetime.

        Subsection (b)(2)(C) shall apply to the dollar amounts under clauses (ii) and (iii) of this subparagraph in the same manner as it applies to the dollar amounts under subparagraphs (A) and (B) of subsection (b)(2), except that for this purpose any reference to $10 is deemed a reference to $1.

      ‘(2) ELIGIBILITY- An individual is eligible for long-term care services described in paragraph (1) only if a physician certifies that the individual--

        ‘(A) cannot perform at least 2 of 5 of the following activities of daily living without on-hand help from some else when performing the activity: dressing, eating, continence, toileting, and transferring from a chair or bed; or

        ‘(B) is dependent upon another person because of cognitive impairment.

‘SEC. 1102B. COST-SHARING FOR LONG-TERM CARE SERVICES.

    ‘(a) REQUIRED DEDUCTIBLE- No benefits are payable under standard coverage with respect to long-term care services for an individual until the individual has satisfied a deductible under subsection (b). Once such deductible has been satisfied, benefits are covered for long-term care services until there has elapsed 180 consecutive days on which no covered long-term care benefits are provided. Not more than $150 per day may be counted toward the deductible and only expenses incurred in a consecutive period of 90 days may be counted toward the deductible. The dollar amount under the previous sentence is subject to annual increases in the same manner as the dollar amount under section 1102A(c)(1)(B)(ii) is subject to annual increases under section 1102A(c)(1)(B).

    ‘(b) DEDUCTIBLE- The amount of the long-term care deductible shall be based on the income of the family of which the individual is a member (expressed as a percentage of the applicable poverty line) as follows:

      ‘(1) $450, if family income is less than 100 percent of the applicable poverty line.

      ‘(2) $1,250, if family income is at least 100 percent, but less than 200 percent, of the applicable poverty line.

      ‘(3) $4,500, if family income is at least 200 percent, but less than 300 percent, of the applicable poverty line.

      ‘(4) $6,750, if family income is at least 300 percent of the applicable poverty line.

    ‘(c) INDEXING- The dollar amounts specified in subsection (b) shall be increased for each year after 1994 by the same percentage as the percentage increase in the consumer price index for all urban consumers (U.S. city average) between September of the previous year and September 1993. Any such increase that is not a multiple of $10 shall be rounded to the nearest multiple of $10.

‘SEC. 1102C. INCOME RELATED COST SHARING FOR ACUTE CARE SERVICES.

    ‘(a) DEDUCTIBLE- Subject to subsections (d) and (e)--

      ‘(1) INDIVIDUAL DEDUCTIBLE- The individual deductible under a health plan that provides standard coverage for an individual shall be based on the income of the family of which the individual is a member (expressed as a percentage of the applicable poverty line) in accordance with the following table (subject to subsection (e)):

‘INDIVIDUAL DEDUCTIBLE
‘[Based on Family Income (Expressed as a Percent of Poverty Line)]
------------------------------------------------------------------------------------
 ‘Income (Expressed as a Percent of Applicable Poverty Line): Individual Deductible 
------------------------------------------------------------------------------------
                    Less than 100% of Applicable Poverty Line                  $100 
At least 100%, but less than 120%, of Applicable Poverty Line                  $140 
At least 120%, but less than 140%, of Applicable Poverty Line                  $180 
At least 140%, but less than 160%, of Applicable Poverty Line                  $220 
At least 160%, but less than 180%, of Applicable Poverty Line                  $260 
At least 180%, but less than 200%, of Applicable Poverty Line                  $300 
At least 200%, but less than 220%, of Applicable Poverty Line                  $340 
At least 220%, but less than 240%, of Applicable Poverty Line                  $380 
At least 240%, but less than 260%, of Applicable Poverty Line                  $420 
At least 260%, but less than 280%, of Applicable Poverty Line                  $460 
At least 280%, but less than 300%, of Applicable Poverty Line                  $500 
At least 300%, but less than 320%, of Applicable Poverty Line                  $540 
At least 320%, but less than 340%, of Applicable Poverty Line                  $580 
At least 340%, but less than 360%, of Applicable Poverty Line                  $620 
At least 360%, but less than 380%, of Applicable Poverty Line                  $660 
At least 380%, but less than 400%, of Applicable Poverty Line                  $700 
                     At least 400% of Applicable Poverty Line                  $740 
------------------------------------------------------------------------------------
      ‘(2) MAXIMUM OF 2 DEDUCTIBLES FOR A FAMILY- The deductible shall be considered to have been met with respect to a family when the family has incurred expenses, that are countable with respect to covered items and services, equal to twice the individual deductible described in paragraph (1).

    ‘(b) COPAYMENTS AND COINSURANCE- Subject to subsections (d) and (e)--

      ‘(1) SMALL COPAYMENTS FOR FAMILIES WITH INCOME BELOW THE POVERTY LINE- In the case of an individual with family income that is less than the applicable poverty line, a health plan that provides standard coverage shall only impose cost-sharing for acute care benefits in the form of a copayment of $5 for each item or service provided (as identified in accordance with rules established by the Secretary).

      ‘(2) COINSURANCE FOR OTHER FAMILIES- In the case of any other individual, such a plan shall impose cost-sharing for acute care benefits in the form of coinsurance, based on the income of the family of which the individual is a member (expressed as a percentage of the applicable poverty line) in accordance with the percentage specified in the following table:

‘COINSURANCE PERCENTAGE
‘[Based on Family Income (Expressed as a Percent of Applicable Poverty Line)]
--------------------------------------------------------------------------
 ‘Income (Expressed as a Percent of Applicable Poverty Line): Coinsurance 
--------------------------------------------------------------------------
At least 100%, but less than 200%, of Applicable Poverty Line  10 percent 
At least 200%, but less than 300%, of Applicable Poverty Line  15 percent 
At least 300%, but less than 400%, of Applicable Poverty Line  20 percent 
                     At least 400% of Applicable Poverty Line  25 percent 
--------------------------------------------------------------------------
    ‘(c) CATASTROPHIC LIMIT ON OUT-OF-POCKET EXPENSES- The catastrophic limit on out-of-pocket expenses under a health plan that provides standard coverage for an individual shall be based on the income of the family of which the individual is a member (expressed as a percentage of the applicable poverty line) in accordance with the following table (subject to subsection (e)):

‘CATASTROPHIC LIMIT ON OUT-OF-POCKET EXPENSES
‘[Based on Family Income (Expressed as a Percent of Applicable Poverty Line)]
-----------------------------------------------------------------------------------------------------------
 ‘Income (Expressed as a Percent of Applicable Poverty Line): Catastrophic Limit on Out-of-Pocket Expenses 
-----------------------------------------------------------------------------------------------------------
                    Less than 100% of Applicable Poverty Line                                       $2,000 
At least 100%, but less than 120%, of Applicable Poverty Line                                       $2,400 
At least 120%, but less than 140%, of Applicable Poverty Line                                       $2,800 
At least 140%, but less than 160%, of Applicable Poverty Line                                       $3,200 
At least 160%, but less than 180%, of Applicable Poverty Line                                       $3,600 
At least 180%, but less than 200%, of Applicable Poverty Line                                       $4,000 
At least 200%, but less than 220%, of Applicable Poverty Line                                       $4,400 
At least 220%, but less than 240%, of Applicable Poverty Line                                       $4,800 
At least 240%, but less than 260%, of Applicable Poverty Line                                       $5,200 
At least 260%, but less than 280%, of Applicable Poverty Line                                       $5,600 
At least 280%, but less than 300%, of Applicable Poverty Line                                       $6,000 
At least 300%, but less than 320%, of Applicable Poverty Line                                       $6,400 
At least 320%, but less than 340%, of Applicable Poverty Line                                       $6,800 
At least 340%, but less than 360%, of Applicable Poverty Line                                       $7,200 
At least 360%, but less than 380%, of Applicable Poverty Line                                       $7,600 
At least 380%, but less than 400%, of Applicable Poverty Line                                       $8,000 
                     At least 400% of Applicable Poverty Line                                       $8,400 
-----------------------------------------------------------------------------------------------------------
    ‘(d) SPECIAL RULES- Under a plan providing standard coverage:

      ‘(1) NO COPAYMENTS OR COINSURANCE FOR INPATIENT HOSPITAL SERVICES- There shall be no copayments or coinsurance imposed for inpatient hospital services.

      ‘(2) NO COST-SHARING FOR MATERNITY SERVICES- There shall be no cost-sharing imposed for maternity services.

      ‘(3) NO COST-SHARING FOR HOSPITAL AND PHYSICIAN EMERGENCY CARE FOR TREATMENT OF INJURIES WITHIN 72 HOURS OF ONSET OF INJURY- There shall be no cost-sharing imposed for hospital and physician emergency care for treatment of injuries within 72 hours of onset of injury.

      ‘(4) NO DEDUCTIBLE FOR DENTAL CARE- The deductible under subsection (a) shall not apply to coverage of dental services described in section 1102A(b)(1)(D) (relating to periodic dental cleaning and dental preventive care).

      ‘(5) MENTAL HEALTH SERVICES- In the case of mental health and substance abuse treatment services (whether inpatient or outpatient):

        ‘(A) SEPARATE PER PERSON ANNUAL DEDUCTIBLE- There shall be a separate calendar year deductible of $250 per individual, without regard to the income of the family of which the individual is a member.

        ‘(B) HIGHER COINSURANCE- A plan providing standard coverage may impose coinsurance of 40 percent, without regard to the income of the family of which the individual is a member.

    ‘(e) INDEXING VALUES- The dollar amounts specified in subsections (a), (c), and (d)(5)(A) shall be increased for each year after 1994 by the same percentage as the percentage increase in the consumer price index for all urban consumers (U.S. city average) between September of the previous year and September 1993. Any such increase that is not a multiple of $10, $100, or $10, respectively, shall be rounded to the nearest multiple of $10, $100, or $10.’

      (3) PREMIUMS- Strike sections 1104 and 1005 and insert the following:

‘SEC. 1104. ESTABLISHMENT OF PREMIUMS.

    ‘(a) IN GENERAL- Each group health plan or health insurance plan that provides coverage of standard benefits described in section 1102(c) shall establish premiums on a per capita basis that vary within a premium rating area (as defined by the Secretary) only based on age of the individual and income classification (within the same classes of age and income used for the reference per person annual premium amount under section 1703(a)) and may vary among such classes only in the same ratios as the reference amounts under such section vary among such classes.

    ‘(b) FAMILY RATE AS SUM OF INDIVIDUAL RATES- The premium imposed by such a plan with respect to members of a family shall be the sum of the per capita rates established under subsection (a) with respect to all the members of the family.’

      (4) INCOME-RELATED TAX DEDUCTIONS- Amend subtitle D of title I to read as follows:

‘Subtitle B--Tax Provisions

‘SEC. 1301. ELIMINATION OF EXCLUSION FROM INCOME FOR EMPLOYER-PROVIDED HEALTH CARE.

    ‘(a) IN GENERAL- The text of section 106 of the Internal Revenue Code of 1986 (relating to contributions by employer to accident and health plans) is amended to read as follows:

    ‘(a) IN GENERAL- Gross income of an employee does not include employer-provided coverage under an accident or health plan.

    ‘(b) TERMINATION- Gross income of an employee shall include employer-provided coverage under an accident or health plan if such coverage is provided after December 31, 1995.’

    ‘(b) EMPLOYMENT TAX TREATMENT-

      ‘(1) SOCIAL SECURITY TAX-

        ‘(A) Subsection (a) of section 3121 of such Code is amended by inserting after paragraph (21) the following new sentence:

    ‘Nothing in paragraph (2) shall exclude from the term ‘wages’ any amount which is required to be included in gross income under section 106(b).’

        ‘(B) Subsection (a) of section 209 of the Social Security Act is amended by inserting after paragraph (21) the following new sentence:

    ‘Nothing in paragraph (2) shall exclude from the term ‘wages’ any amount which is required to be included in gross income under section 106(b) of the Internal Revenue Code of 1986.’

      ‘(2) RAILROAD RETIREMENT TAX- Paragraph (1) of section 3231(e) of such Code is amended by adding at the end thereof the following new sentence: ‘Nothing in clause (i) of the second sentence of this paragraph shall exclude from the term ‘compensation’ any amount which is required to be included in gross income under section 106(b).’

      ‘(3) UNEMPLOYMENT TAX- Subsection (b) of section 3306 of such Code is amended by inserting after paragraph (16) the following new sentence:

    ‘Nothing in paragraph (2) shall exclude from the term ‘wages’ any amount which is required to be included in gross income under section 106(b).’

      ‘(4) WAGE WITHHOLDING- Subsection (a) of section 3401 of such Code is amended by adding at the end thereof the following new sentence:

    ‘Nothing in the preceding provisions of this subsection shall exclude from the term ‘wages’ any amount which is required to be included in gross income under section 106(b).’

    ‘(c) EFFECTIVE DATE-

      ‘(1) INCOME TAX- The amendment made by subsection (a) shall apply to taxable years ending after December 31, 1995.

      ‘(2) EMPLOYMENT TAX- The amendments made by subsection (b) shall apply to remuneration paid after December 31, 1995.

‘SEC. 1302. LIMITATION ON EMPLOYER DEDUCTION FOR HEALTH CARE PROVIDED TO EMPLOYEES.

    ‘(a) IN GENERAL- Section 162 of the Internal Revenue Code of 1986 (relating to trade or business expenses) is amended by redesignating subsection (o) as subsection (p) and by inserting after subsection (n) the following new subsection:

    ‘(o) DENIAL OF DEDUCTION FOR CERTAIN HEALTH CARE COVERAGE PROVIDED TO EMPLOYEE- No deduction shall be allowed under this chapter to an employer for coverage provided to an employee (or the spouse or any dependent of an employee) under an accident or health plan unless such plan provides standard coverage in accordance with the applicable provisions of the Affordable Health Care Now Act of 1993.’

    ‘(b) EFFECTIVE DATE- The amendment made by this section shall apply to coverage for periods after December 31, 1995, in taxable years ending after such date.

‘SEC. 1303. NON-ITEMIZED DEDUCTION FOR PREMIUMS FOR QUALIFIED HEALTH PLANS AND FOR CONTRIBUTIONS TO MEDICAL SAVINGS ACCOUNTS BY TAXPAYERS COVERED UNDER CATASTROPHIC COVERAGE HEALTH PLANS.

    ‘(a) IN GENERAL- Part VII of subchapter B of chapter 1 of the Internal Revenue Code of 1986 (relating to additional itemized deductions for individuals), as amended by section 2202, is amended by redesignating section 221 as section 222 and by inserting after section 220 the following new section:

‘SEC. 221. CERTAIN PAYMENTS FOR HEALTH COVERAGE.

    ‘(a) IN GENERAL- In the case of an individual, there shall be allowed as a deduction for the taxable year an amount equal to the qualified health expenses paid by the taxpayer during the taxable year.

    ‘(b) QUALIFIED HEALTH EXPENSES- For purposes of this section:

      ‘(1) IN GENERAL- The term ‘qualified health expenses’ means expenses for coverage of the taxpayer and the spouse and dependents (as defined in section 152) of the taxpayer under a qualified health plan.

      ‘(2) TAXPAYERS COVERED UNDER CATASTROPHIC COVERAGE HEALTH PLAN- In the case of a taxpayer who is covered (and whose spouse and dependents are covered) under a qualified health plan which is a catastrophic coverage health plan, the term ‘qualified health expenses’ includes amounts contributed by or on behalf of such taxpayer to a medical savings account (as defined in section 220(d)(1)(A)) for the benefit of such taxpayer.

    ‘(c) LIMITATION- The amount allowed as a deduction under subsection (a) for the taxable year shall not exceed the excess (if any) of--

      ‘(1) the maximum voucher amount that would have been provided to the taxpayer under subtitle A of title I of the Affordable Health Care Now Act of 1993 for the calendar year ending with or within such taxable year if the taxpayer’s family income were zero for such calendar year, over

      ‘(2) the voucher amount provided to the taxpayer under such subtitle A for such calendar year.

    ‘(d) DEFINITIONS- For purposes of this section--

      ‘(1) the term ‘qualified health plan’ means a MedAccess plan or other health plan that provides standard coverage consistent with the applicable requirements of the Affordable Health Care Now Act of 1993; and

      ‘(2) the term ‘catastrophic coverage health plan’ has the meaning given such term in section 220(c)(2).’

    ‘(b) CLERICAL AMENDMENT- The table of sections for part VII is amended by striking the last item and inserting the following new items:

‘Sec. 221. Certain payments for health coverage.

‘Sec. 222. Cross reference.’

    ‘(c) EFFECTIVE DATE- The amendments made by this section shall apply to coverage for periods after December 31, 1995, in taxable years ending after such date.’

      (5) INDIVIDUAL MANDATE AND INCOME-RELATED VOUCHERS- Strike subtitles G and H of title I and insert the following:

‘Subtitle G--Individual Mandate

‘SEC. 1601. REQUIREMENT.

    ‘(a) IN GENERAL- Each individual who is lawfully in the United States shall obtain health insurance coverage under a health plan that is a MedAccess plan or a plan that benefits equivalent to the benefits provided in a MedAccess plan.

    ‘(b) EXCEPTIONS- An individual who is a member of the Uniformed Services of the United States on active duty or is entitled to benefits under the CHAMPUS program or title 38, United States Code, is deemed to have satisfied the requirement of subsection (a).

    ‘(c) ENFORCEMENT- Each individual who fails to meet the requirement of subsection (a) shall be enrolled, in a manner specified by the Secretary, in a plan described in such subsection and is liable for the premiums otherwise payable during the period in which the individual failed to be enrolled, plus a penalty or interest as specified by the Secretary. Amounts so owed may be collected by the Secretary through garnishment, withholding of tax refunds owed, or other appropriate means.

‘Subtitle H--Income-Related Vouchers

‘SEC. 1701. ELIGIBILITY.

    ‘(a) ELIGIBILITY-

      ‘(1) IN GENERAL- Each qualified family (as defined in subsection (b)) is entitled to be provided financial assistance toward the cost of the premium for a health plan that provides standard coverage either--

        ‘(A) in the form of a voucher under paragraph (2) in the amount specified in section 1702(a), or

        ‘(B) in the form of a non-itemized deduction against taxes otherwise payable, in accordance with section 221 of the Internal Revenue Code of 1986.

      ‘(2) USE OF VOUCHER-

        ‘(A) IN GENERAL- Subject to subparagraph (B), a voucher provided to a family under this subtitle shall be remitted by any individual in such family to the health plan, the exempted multiple employer health plan (as defined in section 701 of the Employee Retirement Income Security Act of 1974), or, in the case of an employment-related health plan, to the employee’s employer, as the case may be, for payment by the Secretary. The health plan, multiple employer health plan, or employer shall make proper adjustments in billing statements to reflect such family’s remaining premium obligations (if any).

        ‘(B) ELECTION OF TAX CREDIT- A family may elect, in a manner specified by the Secretary in consultation with the Secretary of the Treasury, to be provided the voucher in the form of a credit against income taxes payable by members of the family.

    ‘(b) QUALIFIED FAMILY- For purposes of this subtitle, except as provided in subsection (c), the term ‘qualified family’ means an individual and dependents (as defined in section 1023).

    ‘(c) SPECIAL TREATMENT OF MEDICARE BENEFICIARIES-

      ‘(1) INDIVIDUALS CURRENTLY 60 YEARS OF AGE OR OLDER- In the case of individuals who are 60 years of age or older on the date of the enactment of this Act, the individual shall only be considered to be a member of a qualified family if the individual elects to be eligible for benefits under this subtitle instead of any entitlement to benefits under the medicare program under title XVIII of the Social Security Act. Such election shall be made at such time and in such manner as the Secretary specifies. Once such an election is made with respect to an individual it is irrevocable.

      ‘(2) OTHER INDIVIDUALS- In the case of eligible individuals not described in paragraph (1), the individuals are entitled to benefits under this title instead of entitlement to benefits under the medicare program under title XVIII of the Social Security Act.

      ‘(3) MEDICARE PAYMENTS- In the case of an individual who, under paragraph (1) or (2), is entitled to benefits under this title instead of entitlement to benefits under the medicare program, the Secretary shall provide for payment on behalf of the individual for premiums under health plans that provide benefits for the individual in an amount equal to the amount that would be payable under section 1876 of the Social Security Act if the individual had been enrolled under a risk-sharing contract with an eligible organization under such section (but substituting 100 percent for 95 percent in subsection (a)(2)(C) of such section).

    ‘(d) SPECIAL TREATMENT OF MEDICAID BENEFICIARIES-

      ‘(1) STATE OPTIONS FOR ACUTE CARE- Each State that has a medicaid plan approved under title XIX of the Social Security Act shall elect one of the following options in relation to such plan with respect to medical assistance with respect to acute care services:

        ‘(A) CONTRIBUTION OPTION- The State may pay an amount equivalent to the product of--

          ‘(i) 1 minus the Federal medical assistance percentage for the State (as defined in section 1905(b) of the Social Security Act), and

          ‘(ii) the Federal subsidies provided under this subtitle for individuals residing in the State who have family incomes below the applicable poverty line for a family of the size involved.

        ‘(B) CAPITATION OPTION- The State may assume responsibility for providing (through capitated plans or otherwise) benefits under standard coverage (described in section 1102A) for all individuals described in subparagraph (A) and the State is entitled to receive from the Federal Government an amount equal to the Federal subsidies that otherwise would have been provided under this subtitle for such individuals reduced by the amount the State would have been required to pay under subparagraph (A) if the option under such subparagraph had been elected.

      ‘(2) TRANSITIONAL LONG-TERM CARE SERVICES-

        ‘(A) ELIMINATION OF CURRENT MEDICAID COVERAGE FOR TRANSITIONAL SERVICES- An individual who first becomes entitled to and receives transitional long-term care services under a State medicaid plan on or after the effective date of this subtitle shall not be entitled to medical assistance with respect to such services under the plan, but shall receive benefits with respect to such services under the standard benefit package or under the State option described in paragraph (1)(B).

        ‘(B) GRANDFATHERING OF LONG-TERM CARE MEDICAID RECIPIENTS- An individual who is entitled to and is receiving, as of the effective date of this subtitle, transitional long-term care services under a State medicaid plan shall continue to be entitled to medical assistance with respect to such services and States may not change the benefits made available under such plans with respect to such individuals.

        ‘(C) TRANSITIONAL LONG-TERM CARE SERVICES- In this subsection, the term ‘transitional long-term care services’ means, with respect to an individual, long-term care services furnished to the individual during the 2-year period beginning on the date such services are first furnished to the individual.

      ‘(3) EXTENDED LONG-TERM CARE SERVICES- With respect to coverage of long-term care services other than transitional long-term care services under a State medicaid plan, on and after the effective date of this subtitle the Federal medical assistance percentage shall be equal to 100 percent.

    ‘(e) ADDITIONAL SPECIAL RULES-

      ‘(1) ACTIVE DUTY MILITARY NOT ELIGIBLE- An individual who is a member of the Uniformed Services of the United States on active duty is not eligible for benefits under this section.

      ‘(2) ELECTION BY INDIVIDUALS ELIGIBLE FOR CHAMPUS AND VETERANS BENEFITS- An individual who is receiving benefits under the CHAMPUS program or under title 38, United States Code, as of the effective date of this subtitle shall only be eligible for benefits under this section if the individual elects, on a 1-time basis, to waive the rights to benefits under such program or title and instead receive benefits described in subsection (a).

‘SEC. 1702. AMOUNT OF VOUCHER.

    ‘(a) IN GENERAL- The amount of a voucher specified in this subsection for a qualified family for a year is the sum of the voucher amounts for each member of the family in the year. The voucher amount for each member of a family in the year is the lesser of--

      ‘(1) the annual premium paid by or on behalf of the family member for such year for coverage under a health plan that provides standard coverage in which the member is enrolled, or

      ‘(2) the voucher percentage (specified in subsection (b)) of the sum, for all months in the year, of 1/12 of the reference per person annual premium amount (specified under section 1703) for that member for that year.

    Paragraph (2) shall be applied to a member based on the age, income class, family status, and geographic location of the member as of the first day of the month.

    ‘(b) VOUCHER PERCENTAGE-

      ‘(1) IN GENERAL- Subject to paragraph (2), for a qualified family, the voucher percentage is the percentage specified in the following table, based on the income (expressed as a percent of the applicable poverty line for a family of the size involved) of the family of which the individual is a member:

‘VOUCHER PERCENTAGE
‘[Based on Family Income (Expressed as a Percent of Applicable Poverty Line)]
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 ‘Income (Expressed as a Percent of Applicable Poverty Line): Voucher Percentage 
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                    Less than 100% of Applicable Poverty Line               100% 
At least 100%, but less than 110%, of Applicable Poverty Line                90% 
At least 110%, but less than 120%, of Applicable Poverty Line                80% 
At least 120%, but less than 130%, of Applicable Poverty Line                70% 
At least 130%, but less than 140%, of Applicable Poverty Line                60% 
At least 140%, but less than 160%, of Applicable Poverty Line                60% 
At least 160%, but less than 160%, of Applicable Poverty Line                60% 
At least 160%, but less than 170%, of Applicable Poverty Line                55% 
At least 170%, but less than 220%, of Applicable Poverty Line                50% 
At least 220%, but less than 240%, of Applicable Poverty Line                40% 
                     At least 240% of Applicable Poverty Line                 0% 
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      ‘(2) TREATMENT OF ELDERLY INDIVIDUALS- In the case of an individual who is 65 years of age or older as of the first day of a month and whose family income (expressed as a percent of applicable poverty line) is at least 240 percent of the applicable poverty line, the voucher percentage is 20 percent.

    ‘(c) DEFINITIONS AND DETERMINATION OF INCOME- For purposes of this subtitle:

      ‘(1) APPLICABLE POVERTY LINE- The term ‘applicable poverty line’ means the income official poverty line (as defined by the Office of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved. Such poverty line shall be revised as of October 1 of each year for the next succeeding year.

      ‘(2) DETERMINATIONS OF INCOME-

        ‘(A) IN GENERAL- Subject to paragraph (3), the term ‘income’ means adjusted gross income (as defined in section 62(a) of the Internal Revenue Code of 1986)--

          ‘(i) determined without regard to sections 135, 162(l), 911, 931, and 933 of such Code; and

          ‘(ii) increased by--

            ‘(I) the amount of interest received or accrued which is exempt from tax, plus

            ‘(II) the amount of social security benefits (described in section 86(d) of such Code) which is not includible in gross income under section 86 of such Code.

        ‘(B) FAMILY INCOME- The term ‘family income’ means, with respect to a family, the sum of the income for all members of the family, not including the income of a dependent child with respect to which no return is required under the Internal Revenue Code of 1986.

        ‘(C) FAMILY SIZE- The family size to be applied under this section, with respect to family income, is the number of individuals included in the family for purposes of coverage under a health plan that provides standard coverage.

      ‘(3) SPECIAL RULE WHERE LOSS OF EARNED INCOME DURING A YEAR-

        ‘(A) IN GENERAL- In the case of a family described in subparagraph (B), the family may elect to have the voucher amount under this subtitle computed based only on other, nonearned income (and attributable amounts described in subparagraph (C)).

        ‘(B) FAMILY DESCRIBED- A family described in this subparagraph is a family--

          ‘(i) that has a significant loss of wages or earned income (as defined by the Secretary) during a year, and

          ‘(ii) has net assets (as determined in accordance with rules specified by the Secretary) of less than $500,000.

        ‘(C) ATTRIBUTABLE AMOUNTS- In applying subparagraph (A), any nonexempt assets of a family shall be deemed to provide income at a rate of not less than the interest rate applicable to long-term obligations of the United States (as determined by the Secretary of the Treasury).

‘SEC. 1703. REFERENCE PER PERSON ANNUAL PREMIUM AMOUNT.

    ‘(a) IN GENERAL- Subject to the succeeding provisions of this section, for purposes of this subtitle, the reference per person annual premium amount for an individual is the following amount for standard coverage, based on the age of the individual and the income (expressed as a percent of the applicable poverty line for a family of the size involved) of the family of which the individual is a member in accordance with the following table:

‘REFERENCE PER PERSON ANNUAL PREMIUM AMOUNT FOR STANDARD COVERAGE
‘[Based on Family Income (Expressed as a Percent of Applicable Poverty Line) and Based on Age of Individual]
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  ‘Income Expressed as a Percent of Applicable Poverty Line): Under 18   18-34   35-49   50-64  Over 64 
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                    Less than 100% of Applicable Poverty Line  $1,568   $2,613  $3,714  $5,057  $13,233 
At least 100%, but less than 200%, of Applicable Poverty Line  $776     $1,293  $1,839  $2,503   $8,537 
                     At least 200% of Applicable Poverty Line  $644     $1,074  $1,526  $2,078   $7,086 
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    ‘(b) UPDATE- The reference per person annual premium amounts specified in subsection (a) shall be updated annually by the Secretary, based on estimates of changes in the actuarial value for the different classes based on income and age of the standard benefit package between 1993 and the year involved.

    ‘(c) GEOGRAPHIC ADAPTATION-

      ‘(1) IN GENERAL- The reference per person annual premium amounts specified in subsection (a) and updated under subsection (b) shall be adjusted by the Secretary for each geographic area so they reflect variations in costs of the standard benefit package in different areas.

      ‘(2) METHODOLOGY- The Secretary shall make such adjustment using methodology (and areas) similar to the methodology and areas used for establishing the average annual per capita cost for payments to eligible organizations under section 1876 of the Social Security Act.

    ‘(d) APPLICATION ON MONTHLY BASIS- The reference per person annual premium amounts under this section shall be computed for a family on a monthly basis, to take into account the age, income class, and family status as of the first day of the month involved.

‘SEC. 1704. APPLICATION FOR VOUCHER.

    ‘(a) TIME OF FILING-

      ‘(1) NOVEMBER 1 OF PREVIOUS YEAR- Not later than November 1 of each year (beginning with 1995), each family desiring to obtain a voucher under this subtitle shall submit to the Secretary (in such form and manner as the Secretary may require, in consultation with the Secretary of the Treasury) an estimate of the individual’s family income anticipated for the taxable year ending with or within the following calendar year, to be used to determine initially whether the individual is eligible for a voucher under this subtitle, and the amount of such a voucher, for such following calendar year.

      ‘(2) SPECIAL RULE FOR FIRST YEAR OF COVERAGE- For the first year in which an individual is eligible for such a voucher, the individual shall submit to the Secretary (at such time and in such form and manner as the Secretary may require, in consultation with the Secretary of the Treasury) an estimate of the individual’s family income anticipated for the taxable year ending with December 31 of such year, to be used to determine initially whether the individual is eligible for a voucher under this subtitle, and the amount of such a voucher, for such following calendar year.

      ‘(3) SUBSEQUENT APPLICATIONS- Under rules established by the Secretary, applications for a voucher may also be filed at other times during a year.

    ‘(b) FORM-

      ‘(1) USE OF SIMPLE FORM- The Secretary shall use an application which shall be as simple in form as possible and understandable to the average individual. The application may require attachment of such documentation as deemed necessary by the Secretary in order to ensure eligibility for assistance. The Secretary shall use, as deemed practicable by the Secretary, any existing forms employed for Federal income tax filings as an application for assistance.

      ‘(2) AVAILABILITY OF FORMS- The Secretary shall make application forms available through health care providers and plans, public assistance offices, public libraries, and at other locations (including post offices) accessible to a broad cross-section of families.

      ‘(3) SUBMISSION OF APPLICATION FORM- An application form under this section may be submitted in such manner as the Secretary shall provide.

    ‘(c) PERMITTING SUBMISSION OF REVISED APPLICATION- During a year, a family may submit a revised application to reflect changes in the estimated income of the family, including changes in employment status of family members, during the year. The voucher amount shall be revised to reflect such a revised application.

    ‘(d) ENROLLMENT AT POINT OF APPLICATION- To the extent practicable, the Secretary shall provide for the option of enrollment in a health plan that provides standard coverage as part of the application and approval process for assistance under this subtitle. In providing for such an option, the Secretary may require the State of residence to provide such information and assistance regarding such plans as may be necessary.

‘SEC. 1705. DETERMINATION OF ELIGIBILITY AND AMOUNT OF VOUCHER.

    ‘(a) IN GENERAL- Upon receiving an application for a voucher under section 1804, the Secretary shall provide in a prompt manner for notice of the determination of eligibility for, and amount of, a voucher under this subtitle.

    ‘(b) ELECTION WITH RESPECT TO INCOME DETERMINATION- As elected by a family at the time of submission of an application for a voucher under section 1804, the family income shall be determined either--

      ‘(1) by multiplying by a factor of 4 the income for the 3-month period immediately preceding the month in which the application is made, or

      ‘(2) based upon estimated income for the entire year in which the application is submitted.

    ‘(c) DISCLOSURE OF CERTAIN TAX INFORMATION BY SECRETARY OF TREASURY-

      ‘(1) IN GENERAL- Subsection (l) of section 6103 of the Internal Revenue Code of 1986 (relating to confidentiality and disclosure of returns and return information) is amended by adding at the end thereof the following new paragraph:

      ‘(14) DISCLOSURE OF RETURN INFORMATION-

        ‘(A) IN GENERAL- The Secretary shall, upon written request from the Secretary of Health and Human Services, disclose to the officers and employees of the Department of Health and Human Services return information necessary to determine the family income (as defined in section 1702(c)(2)(B) of the Affordable Health Care Now Act of 1993) of any individual to be used to determine whether the individual is eligible for a voucher under subtitle I of title I of such Act, and the amount of such a voucher.

        ‘(B) RESTRICTION ON USE OF DISCLOSED INFORMATION- Any officer or employee of the Department of Health and Human Services receiving return information under subparagraph (A) shall use such information only for purposes of, and to the extent necessary in, establishing the family income (as so defined) for such purpose.’

      ‘(2) CONFORMING AMENDMENTS- Paragraphs (3)(A) and (4) of section 6103(p) of such Code are each amended by striking ‘or (13)’ each place it appears and inserting ‘(13), or (14)’.

      ‘(3) EFFECTIVE DATE- The amendments made by paragraphs (1) and (2) shall apply with respect to information for taxable years beginning after the date of the enactment of this Act.

‘SEC. 1706. RECONCILIATION.

    ‘(a) NOTICE OF VOUCHER AMOUNTS PROVIDED- In the case of a qualified family that has received a voucher under this subtitle for any month in a year, the Secretary shall, not later than January 31 of the following year, notify such family of the total amount of the vouchers that such family received during the year.

    ‘(b) FILING OF NOTICE-

      ‘(1) IN GENERAL- A family that receives a notice under subsection (a) shall attach such notice to the tax return filed by such family for the year involved. The Secretary of the Treasury shall establish a procedure to enable a family that is not required to file a tax return for the year involved to file the notice received under subsection (a).

      ‘(2) INSTRUCTIONS FOR FILING NOTICE- The Secretary shall provide instructions for filing the notice described in paragraph (1) (in such form as the Secretary prescribes) no later than January 31 of the year following the year involved.

    ‘(c) Reconciliation of Assistance Based on Actual Income-

      ‘(1) IN GENERAL- Based on and using the information contained in the notice filed under subsection (b) with respect to a family, the Secretary of the Treasury shall compute the amount of the voucher that should have been provided under this subtitle with respect to the family in the year involved.

      ‘(2) OVERPAYMENT OF VOUCHER- If the amount of the voucher provided was greater than the amount computed under paragraph (1), the excess amount shall be treated as an underpayment of a tax imposed by chapter 1 of the Internal Revenue Code of 1986 and paid by the Secretary of the Treasury to the family involved.

      ‘(3) UNDERPAYMENT OF VOUCHER- If the amount computed under paragraph (1) is greater than the amount of the voucher provided, the amount of the difference shall be treated as an overpayment of tax imposed by such chapter, or in the event such family is entitled to a refund of such a tax, subject to the provisions of section 6402(d) of such Code.

    ‘(d) FAILURE TO FILE- In the case of any family that is required to file a notice under subsection (b) for a year and that fails to file such a notice by the deadline specified by the Secretary, the entire amount of the voucher provided in such year shall be considered the excess amount under subsection (c)(2). The Secretary shall waive the application of this subsection if the family establishes, to the satisfaction of the Secretary, good cause for the failure to file the notice on a timely basis.

‘SEC. 1707. PENALTIES FOR FALSE INFORMATION.

    ‘Any individual who knowingly makes a material misrepresentation of information in an application for a voucher under this subtitle, shall be liable to the Federal Government for excess payments made based on such misrepresentation and interest on such excess payments at a rate specified by the Secretary, and, in addition, shall be liable to the Federal Government for $1,000 or, if greater, 3 times the excess payments made based on such misrepresentation.

‘SEC. 1708. ADMINISTRATION.

    ‘(a) IN GENERAL- Except as provided in this section, this subtitle shall be administered by the Secretary of Health and Human Services.

    ‘(b) ADMINISTRATION BY A STATE- Upon application of a State, the Secretary may provide for the administration of this subtitle in a State through an appropriate State agency.’