[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6400 Introduced in House (IH)]







109th CONGRESS
  2d Session
                                H. R. 6400

 To amend title XVIII of the Social Security Act to provide for access 
 to health benefits under the Medicare Program for certain individuals 
             21 to 65 years of age, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 6, 2006

Mr. Jefferson introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committees on 
Energy and Commerce and Education and the Workforce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL



 To amend title XVIII of the Social Security Act to provide for access 
 to health benefits under the Medicare Program for certain individuals 
             21 to 65 years of age, and for other purposes.

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

SECTION 1. SHORT TITLE, TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Extended Access to 
Medicare Benefits Act of 2006''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title, table of contents.
Sec. 2. Findings.
Sec. 3. Access to Medicare benefits for certain individuals 21 to 65 
                            years of age.
``Part E--Purchase of Medicare Benefits by Certain Individuals 21 to 65 
                              Years of Age

        ``Sec. 1860E-1. Program Benefits; eligibility.
        ``Sec. 1860E-2. Enrollment process; coverage.
        ``Sec. 1860E-3. Premiums.
        ``Sec. 1860E-4. Payment of premiums.
        ``Sec. 1860E-5. Medicare for the uninsured trust fund.
        ``Sec. 1860E-6. Oversight and accountability.
        ``Sec. 1860E-7. Administration and miscellaneous.
Sec. 4. Refundable and advanceable income tax credit for certain 
                            Medicare premiums for the uninsured.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to a 2006 Kaiser Family Foundation report, 
        over 46 million individuals in the United States who are under 
        the age of 65 did not have health insurance coverage in 2005, 
        an increase of 1.3 million individuals from the year before and 
        an increase of over 7 million individuals since 2000.
            (2) According to a Kaiser Family Foundation Health 
        Insurance Survey, in 2004, more than eight out of ten 
        individual who were uninsured came from working families, 
        almost 70 percent of whom were from families with one or more 
        full-time workers and 11 percent of whom were from families 
        with part-time workers. Fifty-three percent of individuals 
        without health insurance who are poor (defined as having an 
        income of less than 100 percent of the Federal poverty level) 
        have at least one worker in the family.
            (3) According to a 2005 Kaiser Family Foundation report, 
        because of the high cost of health insurance, the poor and 
        near-poor have the greatest risk of not have health insurance. 
        The uninsured rate among the non-elderly poor, which is 36 
        percent, is twice as high as the national average of uninsured 
        individuals, which is 18 percent. Were it not for the Medicaid 
        program, many more of the poor would be uninsured. The near-
        poor (those with incomes between 100 percent and 199 percent of 
        the Federal poverty level) also run a high risk of being 
        uninsured, in part, because they are less likely to be eligible 
        for Medicaid. Two-thirds of the uninsured are either poor or 
        near-poor.
            (4) According to a 2004 Kaiser Family Foundation Health 
        Insurance Survey, adults are more likely to be uninsured than 
        children. Adults make up about 70 percent of the nonelderly 
        population, but make up 80 percent of the uninsured population. 
        Most low-income children qualify for Medicaid or SCHIP, but 
        low-income adults under the age of 65 qualify for Medicaid only 
        if they are disabled, pregnant, or have dependent children.
            (5) According to a 2005 Kaiser Family Foundation Health 
        Insurance Survey, more than 60 percent of non-elderly uninsured 
        adults did not attend college, making them less able to get 
        higher-skilled jobs that more typically provide health 
        coverage. Those with less education are also more likely to be 
        uninsured for longer periods of time.
            (6) According to a 2005 Kaiser Family Foundation report, 
        minorities are much more likely to be uninsured than 
        Caucasians. About one-third of Hispanics and Native Americans 
        are uninsured compared to 13 percent of Caucasians are 
        uninsured. The uninsured rates among African Americans, which 
        is 21 percent, and among Asian Americans, which is 19 percent, 
        are also much higher than that of Caucasians. These differences 
        in rates are only partly explained by income disparities. 
        Health insurance disparities exist at both lower and higher 
        income levels.
            (7) According to a 2002 Institute of Medicine report, 80 
        percent of the uninsured in the United States are native or 
        naturalized United States citizens.
            (8) According to a 2006 Kaiser Family Foundation Health 
        Insurance Survey, 59 percent of uninsured adults have gone 
        without coverage for a period of at least two years. Because 
        health insurance is primarily obtained as an employment 
        benefit, health coverage can be disrupted when people change 
        jobs. This, as well as other changes in income and family 
        composition, can cause temporary gaps in health insurance.
            (9) According to a 2004 Kaiser Family Foundation report, 
        health insurance makes a difference in whether and when 
        individuals get necessary medical care, where they get their 
        care, and ultimately, the health level of individuals. 
        Uninsured adults are far more likely than insured adults to 
        postpone or forgo health care altogether and less able to 
        afford prescription drugs or follow through with recommended 
        treatments. The consequences of reduced access to health care 
        can be severe, particularly when preventable conditions go 
        undetected.
            (10) According to a 2004 Kaiser Family Foundation report, 
        anticipating high medical bills, many of the uninsured are not 
        able to follow recommended treatment. Over one-third of 
        uninsured adults say they did not fill a drug prescription in 
        the past year and over one-third of uninsured adults went 
        without a recommended medical test or treatment because of the 
        cost of the test or treatment. Insured non-elderly adults are 
        at least 50 percent more likely than uninsured adults to have 
        preventive care such as pap smears, mammograms, and prostate 
        exams.
            (11) According to a 2003 Kaiser Family Foundation report, 
        uninsured children also have problems getting needed health 
        care. Uninsured children are much more likely than insured 
        children to lack a usual source of health care, to delay health 
        care, or to have unmet medical needs. Uninsured children with 
        common childhood illnesses and injuries often do not receive 
        the same level of care as insured children. As a result, 
        uninsured children are at a higher risk for preventable 
        hospitalizations and for missed diagnoses of serious health 
        conditions.
            (12) According to a 2005 Kaiser Family Foundation report, 
        because uninsured individuals are less likely than insured 
        individuals to have regular outpatient care, they are more 
        likely to be hospitalized for avoidable health problems. When 
        uninsured individuals are hospitalized, they are more likely 
        than insured individuals to receive fewer services and to die 
        in the hospital.
            (13) According to a 2006 Kaiser Family Foundation report, 
        having health insurance improves health overall and access to 
        health insurance by those who are currently uninsured could 
        reduce the mortality rates for such uninsured individuals by 10 
        to 15 percent. It has been estimated that the number of excess 
        deaths among uninsured adults who are between the ages of 25 
        and 64 years of age is in the range of 18,000 per year.

SEC. 3. ACCESS TO MEDICARE BENEFITS FOR CERTAIN INDIVIDUALS 21 TO 65 
              YEARS OF AGE.

    (a) In General.--Title XVIII of the Social Security Act is 
amended--
            (1) by redesignating part E as part F; and
            (2) by inserting after part D the following new part:

``Part E--Purchase of Medicare Benefits by Certain Individuals 21 to 65 
                              Years of Age

                    ``program benefits; eligibility

    ``Sec. 1860E-1.  (a) Entitlement to Medicare Benefits for Enrolled 
Individuals.--
            ``(1) In general.--An individual enrolled under this part 
        is entitled to the same benefits under this title (including 
        the ability to enroll in plans under parts C and D) as an 
        individual entitled to benefits under part A and enrolled under 
        part B, except that the Secretary shall provide for the 
        addition of benefits under this part for prenatal care and 
        family planning services.
            ``(2) Definitions.--For purposes of this part:
                    ``(A) Federal or state cobra continuation 
                provision.--The term `Federal or State COBRA 
                continuation provision' has the meaning given the term 
                `COBRA continuation provision' in section 2791(d)(4) of 
                the Public Health Service Act and includes a comparable 
                State program, as determined by the Secretary.
                    ``(B) Federal health insurance program defined.--
                The term `Federal health insurance program' means any 
                of the following:
                            ``(i) Medicare.--A program under any part 
                        of this title (other than by reason of this 
                        part).
                            ``(ii) Medicaid.--A State plan under title 
                        XIX.
                            ``(iii) FEHBP.--The Federal employees 
                        health benefit program under chapter 89 of 
                        title 5, United States Code.
                            ``(iv) TRICARE.--The TRICARE program (as 
                        defined in section 1072(7) of title 10, United 
                        States Code).
                            ``(v) Active duty military.--Health 
                        benefits under title 10, United States Code, to 
                        an individual as a member of the uniformed 
                        services of the United States.
                    ``(C) Group health plan.--The term `group health 
                plan' has the meaning given such term in section 
                2791(a)(1) of the Public Health Service Act.
                    ``(D) Qualified coverage.--The term `qualified 
                coverage' means coverage that has been certified by an 
                actuary (who is a member of the American Academy of 
                Actuaries or a comparable group) as having coverage 
                that is actuarially equivalent to or better than the 
                actuarial value of the coverage provided under parts A 
                and B.
    ``(b) Eligibility of Certain Individuals Age 21 to 65 Years of 
Age.--
            ``(1) In general.--Subject to paragraph (2), an individual 
        who meets the following requirements with respect to a month is 
        eligible to enroll under this part with respect to such month:
                    ``(A) Age.--As of the last day of the month, the 
                individual has attained 21 years of age (or, in the 
                case of an individual residing in a State which applies 
                (as of the date of the enactment of this section and 
                under clause (i) of section 1905(a)) an age lower than 
                21, such lower age), but has not attained 65 years of 
                age.
                    ``(B) Not eligible for qualified coverage under 
                group health plans or federal health insurance 
                programs.--The individual is not eligible for benefits 
                or coverage that constitutes qualified coverage under a 
                Federal health insurance program (as defined in 
                subsection (a)(2)(B)) or under a group health plan 
                (other than such eligibility merely through a Federal 
                or State COBRA continuation provision) as of the last 
                day of the month involved.
                    ``(C) Family income between 200 and 500 percent of 
                federal poverty level.--The income of the individual's 
                family is at least 200 percent, but does not exceed 500 
                percent, of the poverty line for a family of the size 
                involved.
                    ``(D) Not covered for previous 6 months.--During 
                the 6 preceding months the individual was not receiving 
                benefits or coverage that constitutes qualified 
                coverage under a Federal health insurance program, 
                under a group health plan, or under individual health 
                insurance coverage.
            ``(2) Limitation on eligibility if terminated enrollment.--
        If an individual described in paragraph (1) enrolls under this 
        part and coverage of the individual is terminated under section 
        1860E-2(d) (other than because of age), the individual is not 
        again eligible to enroll under this subsection unless each of 
        the following requirements are met:
                    ``(A) New qualified coverage under group health 
                plan or federal health insurance program.--After the 
                date of termination of coverage under such section, the 
                individual obtains qualified coverage under a group 
                health plan or under a Federal health insurance 
                program.
                    ``(B) Subsequent loss of new coverage.--The 
                individual subsequently loses eligibility for the 
                qualified coverage described in subparagraph (A) 
                without regard to whether the individual has exhausted 
                any eligibility the individual may subsequently have 
                for coverage under a Federal or State COBRA 
                continuation provision and the individual meets the 
                requirement of paragraph (1)(D).

                     ``enrollment process; coverage

    ``Sec. 1860E-2.  (a) In General.--An individual may enroll in the 
program established under this part only in such manner and form as may 
be prescribed by regulations, and only during an enrollment period 
prescribed by the Secretary consistent with the provisions of this 
section. Such regulations shall provide a process under which 
individuals eligible to enroll as of a month are permitted to pre-
enroll during a prior month within an enrollment period described in 
subsection (b).
    ``(b) Enrollment Periods.--
            ``(1) Individuals 21 to 65 years of age.--In the case of 
        individuals eligible to enroll under this part under section 
        1860E-1(b), the following enrollment periods shall apply:
                    ``(A) Initial enrollment period.--If the individual 
                is eligible to enroll under such section as of January 
                2008, the enrollment period shall begin on November 1, 
                2007, and shall end on February 28, 2008. Any such 
                enrollment before January 1, 2008, is conditioned upon 
                compliance with the conditions of eligibility for 
                January 2008.
                    ``(B) Subsequent periods.--If the individual is 
                eligible to enroll under such section as of a month 
                after January 2008, the enrollment period shall begin 
                on the first day of the second month before the month 
                in which the individual first is eligible to so enroll 
                and shall end four months later. Any such enrollment 
                before the first day of the third month of such 
                enrollment period is conditioned upon compliance with 
                the conditions of eligibility for such third month.
            ``(2) Authority to correct for government errors.--The 
        provisions of section 1837(h) apply with respect to enrollment 
        under this part in the same manner as they apply to enrollment 
        under part B.
    ``(c) Date Coverage Begins.--
            ``(1) In general.--The period during which an individual is 
        entitled to benefits under this part shall begin as follows, 
        but in no case earlier than January 1, 2008:
                    ``(A) For enrollments before month of 
                eligibility.--In the case of an individual who enrolls 
                (including pre-enrolls) before the month in which the 
                individual first satisfies eligibility for enrollment 
                under section 1860E-1, the first day of such month in 
                which the individual first satisfies eligibility.
                    ``(B) For enrollments during or after month of 
                eligibility.--In the case of an individual who enrolls 
                during or after the month in which the individual first 
                satisfies eligibility for enrollment under such 
                section, the first day of the following month.
            ``(2) Authority to provide for partial months of 
        coverage.--Under regulations, the Secretary may, in the 
        Secretary's discretion, provide for coverage periods that 
        include portions of a month in order to avoid lapses of 
        coverage.
            ``(3) Limitation on payments.--No payments may be made 
        under this title with respect to the expenses of an individual 
        enrolled under this part unless such expenses were incurred by 
        such individual during a period which, with respect to the 
        individual, is a coverage period under this section.
    ``(d) Termination of Coverage.--
            ``(1) In general.--An individual's coverage period under 
        this part shall continue until the individual's enrollment has 
        been terminated at the earliest of the following:
                    ``(A) General provisions.--
                            ``(i) Notice.--The individual files notice 
                        (in a form and manner prescribed by the 
                        Secretary) that the individual no longer wishes 
                        to participate in the insurance program under 
                        this part.
                            ``(ii) Nonpayment of premiums.--The 
                        individual fails to make payment of premiums 
                        required for enrollment under this part.
                            ``(iii) Eligibility for medicare, group 
                        health plan, or other federal health 
                        insurance.--The individual becomes entitled to 
                        benefits or enrolled under any other part of 
                        this title (other than by reason of this part) 
                        or for qualified coverage under a group health 
                        plan or under another Federal health insurance 
                        program.
                    ``(B) Termination based on age.--The individual 
                attains 65 years of age.
            ``(2) Effective date of termination.--
                    ``(A) Notice.--The termination of a coverage period 
                under paragraph (1)(A)(i) shall take effect at the 
                close of the month following the month for which the 
                notice is filed.
                    ``(B) Nonpayment of premium.--The termination of a 
                coverage period under paragraph (1)(A)(ii) shall take 
                effect on a date determined under regulations, which 
                may be determined so as to provide a grace period in 
                which overdue premiums may be paid and coverage 
                continued. The grace period determined under the 
                preceding sentence shall not exceed 60 days; except 
                that it may be extended for an additional 30 days in 
                any case where the Secretary determines that there was 
                good cause for failure to pay the overdue premiums 
                within such 60-day period.
                    ``(C) Age or health insurance eligibility.--The 
                termination of a coverage period under paragraph 
                (1)(A)(iii) or (1)(B) shall take effect as of the first 
                day of the month in which the individual attains 65 
                years of age or becomes entitled to benefits or 
                enrolled under a plan or program described in 
                subparagraph (A)(iii).
            ``(3) No effect of termination on continued medicare 
        benefits when turns 65.--Nothing in this subsection shall be 
        construed as affecting the continuation of benefits under this 
        title (other than under this part) in the case of an individual 
        who attains 65 years of age or who otherwise subsequently 
        qualifies for benefits under this title other than under this 
        part.

                               ``premiums

    ``Sec. 1860E-3.  (a) Amount of Monthly Premiums.--The Secretary 
shall, during September of each year (beginning with 2007), determine a 
monthly premium for individuals 21 years of age or older, equal to \1/
12\ of the annual premium computed under subsection (b)(2), which shall 
apply with respect to coverage provided under this title for any month 
in the succeeding year.
    ``(b) Annual Premium.--
            ``(1) National, per capita average.--The Secretary shall 
        estimate the average, annual per capita amount that would be 
        payable under this title with respect to individuals residing 
        in the United States who meet the requirement of section 1860E-
        1(b)(1)(A) as if all such individuals were eligible for (and 
        enrolled) under this title during the entire year (and assuming 
        that section 1862(b)(2)(A)(i) did not apply).
            ``(2) Annual premium.--The annual premium under this 
        subsection for months in a year is equal to the average, annual 
        per capita amount estimated under paragraph (1) for the year.

                         ``payment of premiums

    ``Sec. 1860E-4.  (a) Payment of Monthly Premium.--
            ``(1) In general.--The Secretary shall provide for payment 
        and collection of the monthly premium, determined under section 
        1860E-3(a) for the age of the individual involved, in the same 
        manner as for payment of monthly premiums under section 1840, 
        except that, for purposes of applying this section, any 
        reference in such section to the Federal Supplementary Medical 
        Insurance Trust Fund is deemed a reference to the Trust Fund 
        established under section 1860E-5.
            ``(2) Period of payment.--In the case of an individual who 
        participates in the program established by this part, the 
        monthly premium shall be payable for the period commencing with 
        the first month of the individual's coverage period and ending 
        with the month in which the individual's coverage under this 
        part terminates.
    ``(b) Application of Certain Provisions.--The provisions of section 
1840 (other than subsection (h)) shall apply to premiums collected 
under this section in the same manner as they apply to premiums 
collected under part B, except that any reference in such section to 
the Federal Supplementary Medical Insurance Trust Fund is deemed a 
reference to the Trust Fund established under section 1860E-5.

                ``medicare for the uninsured trust fund

    ``Sec. 1860E-5.  (a) Establishment of Trust Fund.--
            ``(1) In general.--There is hereby created on the books of 
        the Treasury of the United States a trust fund to be known as 
        the `Medicare for the Uninsured Trust Fund' (in this section 
        referred to as the `Trust Fund'). The Trust Fund shall consist 
        of such gifts and bequests as may be made as provided in 
        section 201(i)(1) and such amounts as may be deposited in, or 
        appropriated to, such fund as provided in this title.
            ``(2) Premiums.--Premiums collected under section 1860E-3 
        and payable under section 1860E- 4(a)(2) shall be transferred 
        to the Trust Fund.
    ``(b) Incorporation of Provisions.--
            ``(1) In general.--Subject to paragraph (2), subsections 
        (b) through (i) of section 1841 shall apply with respect to the 
        Trust Fund and this part in the same manner as they apply with 
        respect to the Federal Supplementary Medical Insurance Trust 
        Fund and part B, respectively.
            ``(2) Miscellaneous references.--In applying provisions of 
        section 1841 under paragraph (1)--
                    ``(A) any reference in such section to `this part' 
                is construed to refer to this part E;
                    ``(B) any reference in section 1841(h) to section 
                1840(d) and in section 1841(i) to sections 1840(b)(1) 
                and 1842(g) are deemed references to comparable 
                authority exercised under this part; and
                    ``(C) payments may be made under section 1841(g) to 
                the Trust Funds under sections 1817 and 1841 as 
                reimbursement to such funds for payments they made for 
                benefits provided under this part.

                     ``oversight and accountability

    ``Sec. 1860E-6.  (a) Through Annual Reports of Trustees.--The Board 
of Trustees of the Medicare for the Uninsured Trust Fund under section 
1860E-5(b)(1) shall report on an annual basis to Congress concerning 
the status of the Trust Fund and the need for adjustments in the 
program under this part to maintain financial solvency of the program 
under this part.
    ``(b) Periodic GAO Reports.--The Comptroller General of the United 
States shall periodically submit to Congress reports on the adequacy of 
the financing of coverage provided under this part. The Comptroller 
General shall include in such report such recommendations for 
adjustments in such financing and coverage as the Comptroller General 
deems appropriate in order to maintain financial solvency of the 
program under this part.

                   ``administration and miscellaneous

    ``Sec. 1860E-7.  (a) Treatment for Purposes of Title.--Except as 
otherwise provided in this part--
            ``(1) individuals enrolled under this part shall be treated 
        for purposes of this title as though the individual were 
        entitled to benefits under part A and enrolled under part B; 
        and
            ``(2) benefits described in section 1860E-1 shall be 
        payable under this title to such individuals in the same manner 
        as if such individuals were so entitled and enrolled.
    ``(b) Not Treated as Medicare Program for Purposes of Medicaid 
Program.--For purposes of applying title XIX (including the provision 
of Medicare cost-sharing assistance under such title), an individual 
who is enrolled under this part shall not be treated as being entitled 
to benefits under this title.
    ``(c) Not Treated as Medicare Program for Purposes of COBRA 
Continuation Provisions.--In applying a COBRA continuation provision 
(as defined in section 2791(d)(4) of the Public Health Service Act), 
any reference to an entitlement to benefits under this title shall not 
be construed to include entitlement to benefits under this title 
pursuant to the operation of this part.
    ``(d) Payment Schedule.--The Secretary, with the assistance of the 
Medicare Payment Advisory Commission, shall develop and implement a 
payment schedule for benefits provided under parts A and B pursuant to 
this part. To the extent feasible, such payment schedule shall be 
consistent with comparable payment schedules and reimbursement 
methodologies applied under parts A and B.''.
    (b) Conforming Amendments to Social Security Act Provisions.--
            (1) Section 201(i)(1) of the Social Security Act (42 U.S.C. 
        401(i)(1)) is amended by striking ``or the Federal 
        Supplementary Medical Insurance Trust Fund'' and inserting 
        ``the Federal Supplementary Medical Insurance Trust Fund, and 
        the Medicare for the Uninsured Trust Fund''.
            (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 
        401(g)(1)(A)) is amended by striking ``and the Federal 
        Supplementary Medical Insurance Trust Fund established by title 
        XVIII'' and inserting ``, the Federal Supplementary Medical 
        Insurance Trust Fund, and the Medicare for the Uninsured Trust 
        Fund established by title XVIII''.
            (3) Section 1820(i) of such Act (42 U.S.C. 1395i-4(i)) is 
        amended by striking ``part D'' and inserting ``part F''.
            (4) Section 1853 of such Act (42 U.S.C. 1395w-23) is 
        amended by adding at the end the following new subsection:
    ``(k) Adjustment for Part E Beneficiaries.--In applying this 
section with respect to individuals entitled to benefits under part E, 
the Secretary shall provide for an appropriate adjustment in, for 2007, 
the annual MA capitation rate, and for years beginning with 2008, the 
payment amount determined under this section or section 1858, as may be 
appropriate to reflect differences between the population served under 
such part and the population under parts A and B.''.
            (5) Section 1860D-15(c)(1) of such Act (42 U.S.C. 1395w-
        115(c)(1)) is amended by adding at the end the following new 
        subparagraph:
                    ``(E) Adjustment for part e beneficiaries.--In 
                applying this section with respect to individuals 
                entitled to benefits under part E, the Secretary shall 
                provide for an appropriate adjustment in the payment 
                amount determined under this section as may be 
                appropriate to reflect differences between the 
                population served under such part and the population 
                under parts A and B.''.
    (c) Other Conforming Amendments.--
            (1) Section 602(2)(D)(ii) of the Employee Retirement Income 
        Security Act of 1974 (29 U.S.C. 1162(2)) is amended by 
        inserting ``(not including an individual who is so entitled 
        pursuant to enrollment under section 1860E-1 of such Act)'' 
        after ``Social Security Act''.
            (2) Section 2202(2)(D)(ii) of the Public Health Service Act 
        (42 U.S.C. 300bb-2(2)(D)(ii)) is amended by inserting ``(not 
        including an individual who is so entitled pursuant to 
        enrollment under section 1860E-1 of such Act)'' after ``Social 
        Security Act''.
            (3) Section 4980B(f)(2)(B)(i)(V) of the Internal Revenue 
        Code of 1986 is amended by inserting ``(not including an 
        individual who is so entitled pursuant to enrollment under 
        section 1860E-1 of such Act)'' after ``Social Security Act''.

SEC. 4. REFUNDABLE AND ADVANCEABLE INCOME TAX CREDIT FOR CERTAIN 
              MEDICARE PREMIUMS FOR THE UNINSURED.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to refundable personal 
credits) is amended by redesignating section 36 as section 37 and by 
inserting after section 35 the following new section:

``SEC. 36. CERTAIN MEDICARE PREMIUMS FOR THE UNINSURED.

    ``(a) In General.--In the case of an individual, there shall be 
allowed as a credit against the tax imposed by this chapter for the 
taxable year an amount equal to 85 percent of the amount paid during 
such year as premiums under part E of title XVIII of the Social 
Security Act for coverage of the taxpayer and the taxpayer's spouse and 
dependents under such part.
    ``(b) Coordination With Advance Payment.--With respect to any 
taxable year, the amount which would (but for this subsection) be 
allowed as a credit under subsection (a) shall be reduced (but not 
below zero) by the aggregate amount paid on behalf of such taxpayer 
under section 7529 for such taxable year.
    ``(c) Special Rules.--Rules similar to the rules of paragraphs (2), 
(3), and (4) of section 35(g) and paragraphs (2), (3), and (4) of 
section 21(e) shall apply for purposes of this section.''.
    (b) Advance Payment of Credit.--Chapter 77 of such Code (relating 
to miscellaneous provisions) is amended by adding at the end the 
following new section:

``SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR CERTAIN MEDICARE PREMIUMS 
              FOR THE UNINSURED.

    ``(a) General Rule.--The Secretary shall establish a program for 
making payments on behalf of individuals enrolled under part E of title 
XVIII of the Social Security Act to the Secretary of Health and Human 
Services for premiums payable by such individuals under such part.
    ``(b) Limitation on Advance Payments During Any Taxable Year.--The 
Secretary may make payments under subsection (a) only to the extent 
that the total amount of such payments made on behalf of any individual 
during the taxable year does not exceed the amount allowable as a 
credit to such individual for such year under section 36 (determined 
without regard to subsection (b) thereof).''.
    (c) Conforming Amendments.--
            (1) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting ``or 36'' after ``section 
        35''.
            (2) The table of sections for subpart C of part IV of 
        subchapter A of chapter 1 of the Internal Revenue Code of 1986 
        is amended by redesignating the item relating to section 36 as 
        an item relating to section 37 and by inserting after the item 
        relating to section 35 the following new item:

``Sec. 36.  Certain Medicare premiums for the uninsured.''.
            (3) The table of sections for chapter 77 of such Code is 
        amended by adding at the end the following new item:

``Sec. 7529. Advance payment of credit for certain Medicare premiums 
                            for the uninsured.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years ending after the date of the enactment of this 
Act.
                                 <all>