110 HR 5348 IH: American Health Benefits Program Act of U.S. House of Representatives 2008-02-12 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 110th CONGRESS 2d Session H. R. 5348 IN THE HOUSE OF REPRESENTATIVES February 12, 2008 Mr. Langevin (for himself and Mr. Shays) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 the Social Security Act and the Internal Revenue Code of 1986 to assure comprehensive, affordable health insurance coverage for all Americans through an American Health Benefits Program.

1.

Short title; findings; table of contents

(a)

Short title

This Act may be cited as the American Health Benefits Program Act of 2008. (b)

Findings

Congress finds the following: (1)

Uninsured Americans and lack of access to choices

(A)In 2006, 46.5 million Americans were uninsured, over 80 percent of whom were employed (or dependents of individuals who were employed). (B)Health care providers provided to uninsured Americans $41 billion in care for which they were not compensated by the individuals or through insurance. (C)Only 8 percent of employers providing health benefits are able to offer their employees a choice between two or more health plans. (2)

Double-digit growth in employer costs

In 2003 the average per capita cost for employers to provide health benefits coverage increased by almost 14 percent. This was the third consecutive year of double-digit increases in such cost. (3)

Administrative efficiency of using FEHBP model for providing health insurance coverage

(A)The private insurance market presents increasing administrative challenges for employers in seeking out, contracting with, and administering health benefits. (B)The Federal Employee Health Benefits Program (FEHBP) currently manages negotiations with health insurers over premiums and benefits on behalf of 8.6 million Federal employees and retirees and their dependents. (C)Overhead costs for employers providing health benefits coverage can be over 30 percent for employers with fewer than 10 employees and about 12 percent for employers with more than 500 employees. (D)In comparison, the overhead cost of coverage provided under FEHBP is about 3 percent. (4)

Expansion of FEHBP model to cover uninsured and other Americans

Requiring participation in an FEHBP-style program would expand consumer choice, ensure portability and continuity of coverage, improve incentives for cost containment, and stabilize the burden on businesses (5)

Personal responsibility

A recent survey indicates that a clear majority of Americans sees securing health insurance coverage as a personal responsibility for themselves and others. (6)

Savings from implementation of health information technology

Properly implemented and widely adopted health information technology could significantly improve the quality, safety and efficiency of healthcare delivery while saving an estimated $77 billion per year (c)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; findings; table of contents. Sec. 2. Establishment of American Health Benefits Program. Title XXII—American Health Benefits Program Sec. 2201. Establishment of program. Sec. 2202. Eligibility; requirement of coverage. Sec. 2203. Qualified health plans; benefits; premiums. Sec. 2204. Government contribution; American Health Benefits Program Trust Fund. Sec. 2205. Premium and cost-sharing subsidies for lower income individuals. Sec. 2206. Administration. Sec. 2207. Definitions. Sec. 3. Collection of premiums, subsidies, and employer funding. Sec. 4. Amendments to the Medicaid program and SCHIP. Sec. 5. Promotion of use of health information technologies. Sec. 6. Non-preemption of existing collective bargaining agreements. Sec. 7. Health Benefits Commission.

2.

Establishment of American Health Benefits Program

(a)

In general

The Social Security Act is amended by adding at the end the following new title: . (b)

Effective date; collective bargaining agreements

(1)

Benefits

Title XXII of the Social Security Act shall first apply to benefits for items and services furnished on or after January 1, 2011. (2)

Effect on collective bargaining agreements

Nothing in this Act shall be construed as preventing a collectively bargained agreement from providing coverage that is additional to, or supplementary of, benefits provided under the American Health Benefits Program.

3.

Collection of premiums, subsidies, and employer funding

(a)

Premium collection

(1)

In general

Subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to determination of tax liability) is amended by adding at the end the following new part: VIII

American Health Benefits Program premiums

Sec. 59B. American Health Benefits Program premiums.

59B.

American Health Benefits Program premiums

(a)

In general

In the case of a specified individual who is enrolled in a qualified health plan under title XXII of the Social Security Act (including by reason of a default enrollment under section 2202(c)(2)), there is hereby imposed (in addition to any other amount imposed by this subtitle) for the taxable year an amount equal to the aggregate premiums established under such title with respect to the coverage under such title which covers such individual for months beginning in such taxable year. The amount imposed under this subsection shall be reduced by the amount of any government contribution under section 2204(a) of such Act which relates to such coverage. (b)

Specified individual

For purposes of this section, the term specified individual means, with respect to coverage under title XXII of the Social Security Act for any month beginning in a taxable year— (1)in the case of self-only coverage, the individual covered under such coverage, and (2)in the case of family coverage, each individual covered under such coverage unless such individual is covered under such coverage by reason of being a member of the family (other than a spouse). (c)

Joint and several liability

In the case of an individual and such individual’s spouse covered under family coverage— (1)each such individual shall be jointly and severally liable for the amount imposed under subsection (a), and (2)the aggregate amount imposed under subsection (a) with respect to such coverage may not exceed the amount imposed with respect to either such individual. (d)

Coordination with other provisions

(1)

Not treated as medical expense

For purposes of section 213, the amount imposed by this section for any taxable year shall not be treated as an expense paid for medical care. (2)

Not treated as tax for certain purposes

The amount imposed by this section shall not be treated as a tax imposed by this chapter for purposes of determining— (A)the amount of any credit allowable under this chapter, or (B)the amount of the minimum tax imposed by section 55. (3)

Treatment under subtitle F

For purposes of subtitle F, the amount imposed by this section shall be treated as if it were a tax imposed by section 1. (4)

Section 15 not to apply

Section 15 shall not apply to the amount imposed by this section. (5)

Section not to affect liability of possessions, etc

This section shall not apply for purposes of determining liability to any possession of the United States. For purposes of section 932 and 7654, the amount imposed under this section shall not be treated as a tax imposed by this chapter. (e)

Regulations

The Secretary may prescribe such regulations as may be appropriate to carry out the purposes of this section.

. (2)

Adjustments to withholding

Subsection (a) of section 3402 of such Code (relating to income tax collected at source) is amended by adding at the end the following new paragraph: (3)

Special rule for amounts imposed by section 59b

(A)

In general

In determining the amount required to be deducted and withheld from wages paid to an individual during any month by such individual’s employer, the amount imposed by section 59B shall be taken into account. (B)

Wages not reduced by exemptions

In determining the amount to be deducted and withheld by reason of subparagraph (A), the amount of wages shall not be reduced as provided in paragraph (2). . (3)

Clerical amendment

The table of parts for subchapter A of chapter 1 of such Code is amended by adding at the end the following new item: Part VIII—American Health Benefits Program Premiums . (b)

Credit for subsidy and prepayments of American Health Benefits premiums

(1)

In general

Subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by redesignating section 36 as section 37 and by inserting after section 35 the following new section:

36.

Subsidy and prepayment of American Health Benefits premiums

(a)

In General

In the case of a specified individual (as defined in section 59B(b)), there shall be allowed as a credit against the tax imposed by this subtitle for the taxable year an amount equal to the sum of— (1)the aggregate amount of premiums paid (other than any government contribution under section 2204(a) of the Social Security Act) with respect to the coverage of such individual under title XXII of the Social Security Act, and (2)in the case of any premium subsidy-eligible individual, the applicable premium subsidy. (b)

Applicable premium subsidy

(1)

In general

For purposes of this section, the term applicable premium subsidy means, with respect to any premium subsidy-eligible individual, the lowest premium in effect for the calendar year in which the taxable year begins (for the type of coverage involved) for any basic plan in the AHBP region involved, as determined by the Commissioner of Health Benefits. (2)

Reduction based on family income

The amount otherwise determined under paragraph (1) shall be reduced (but not below zero) by an amount which bears the same ratio to the amount so determined as— (A)the amount (if any) by which the taxpayer's family income for the taxable year exceeds the lowest income threshold, bears to (B)the lowest income threshold. (c)

Premium subsidy-eligible individual

For purposes of this section, the term premium subsidy-eligible individual means an individual— (1)who is enrolled, and required to be enrolled, in a qualified health plan under title XXII of the Social Security Act, (2)whose family income does not exceed twice the lowest income threshold, and (3)who does not have in effect (and, in the case of family coverage, each other individual covered under such coverage does not have in effect), in a form and manner specified by the Secretary of the Treasury in consultation with the Commissioner of Health Benefits, for any portion of the taxable year of such individual an objection to the release of information under section 6103(k)(10)). (d)

Lowest income threshold

For purposes of this section, the term lowest income threshold means, with respect to coverage consisting of— (1)only an individual, 125 percent of the poverty line (as defined in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section) for a single individual for the calendar year which includes the close of the taxable year, or (2)a family of two or more individuals, 150 percent of the poverty line (as so defined) for a family of the size involved for the calendar year which includes the close of the taxable year. (e)

Family income

For purposes of this section— (1)

In general

The term family income means, with respect to a specified individual (as defined in section 59B(b)) covered under coverage consisting of— (A)only such individual, the modified adjusted gross income of such individual, or (B)two or more individuals, the sum of the modified adjusted gross income of the specified individual and the modified adjusted gross income of each other individual covered under the plan for the taxable year that ends in or with the taxable year of the specified individual. (2)

Modified adjusted gross income

The term modified adjusted gross income means adjusted gross income— (A)determined without regard to sections 135, 911, 931, and 933, and (B)increased by the amount of interest received or accrued during the taxable year which is exempt from tax under this title. (f)

Denial of credit to dependents

No credit shall be allowed under this section to any individual with respect to whom a deduction under section 151 is allowable to another taxpayer for a taxable year beginning in the calendar year in which such individual's taxable year begins. (g)

Regulations

The Secretary may prescribe such regulations as are necessary or appropriate to carry out this section, including regulations which provide for not taking into account individuals with de minimis income for purposes of determining family income for purposes of this section.

. (2)

Conforming amendments

(A)Paragraph (2) of section 1324(b) of title 31, United States Code, is amended by inserting or 36 after section 35. (B)The table of section for subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by striking the item relating to section 36 and inserting the following new items: Sec. 36. Subsidy and prepayment of American Health Benefits premiums. Sec. 37. Overpayments of tax. . (c)

Employer funding

(1)

In general

Subtitle C of the Internal Revenue Code of 1986 (relating to employment taxes) is amended by redesignating chapter 25 as chapter 26 and by inserting after chapter 24 the following new chapter: 25

American Health Benefits Program

Sec. 3451. Tax on employers. Sec. 3452. Refund of tax in case of qualified employer-provided coverage. Sec. 3453. Instrumentalities of the United States.

3451.

Tax on employers

(a)

Imposition of tax

In addition to other taxes, there is hereby imposed on every employer an excise tax, with respect to having individuals in his employ, equal to the applicable percentage of the wages paid by him with respect to employment. (b)

Applicable percentage

For purposes of this section— (1)

In general

The term applicable percentage means, with respect to wages paid during any taxable year of an employer of a specified firm size and average earnings per employee, the percentage determined in accordance with the following table: Applicable percentage (in percent) A firm size of:Average earnings per employee of $21,000 or less:Average earnings per employee of more than $21,000 and not in excess of $42,000:Average earnings per employee of more than $42,000 and not in excess of $83,000:Average earnings per employee of more than $83,000: Less than 104.005.006.008.75 10 through 254.255.256.759.50 26 through 494.505.507.2510.00 50 through 1994.755.758.0010.00 200 through 4995.006.008.7510.00 500 or more5.256.259.5010.00 (2)

Firm size

The term firm size means, with respect to any employer for any taxable year, the average number of employees employed by such person during the 3 taxable years preceding such taxable year. (3)

Average earnings per employee

With respect to any employer for any taxable year— (A)

In general

The term average earnings per employee means the average earnings of such employer for such taxable year divided by the firm size of such employer for such taxable year. (B)

Average earnings

The term average earnings means the average taxable income of the employer for the 3 taxable years preceding such taxable year. (4)

Aggregation rule

All persons treated as a single employer under subsection (a) or (b) of section 52, or subsection (m) or (o) of section 414, shall be treated as one person. (5)

Inflation adjustment

In the case of a taxable year beginning after December 31, 2011, each of the dollar amounts in the table contained in paragraphs (1) shall be increased by an amount equal to— (A)such dollar amount, multiplied by (B)the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins, determined by substituting calendar year 2010 for calendar year 1992 in subparagraph (B) thereof. If any amount as increased under the preceding sentence is not a multiple of $100, such amount shall be rounded to the nearest multiple of $100.(c)

No Cover Over to Possessions

Notwithstanding any other provision of law, no amount collected under this chapter shall be covered over to any possession of the United States. (d)

Other definitions

For purposes of this chapter, the terms wages, employer, and employment have the same respective meanings as when used in chapter 21 and section 3121(a)(1) shall apply for purposes of this chapter in the same manner as such section applies for purposes of section 3101(a) and 3111(a).

3452.

Refund of tax in case of qualified employer-provided coverage

(a)

In general

In the case of a person subject to tax under section 3451 or section 1401(c), there shall be allowed as a credit against the tax imposed by such section an amount equal to the tax imposed under such section with respect to the wages or self-employment income of individuals for periods during which the individual is covered by qualified employer-provided coverage (which is provided by such person). (b)

Qualified employer-provided coverage

For purposes of subsection (a), the term qualified employer-provided coverage has the meaning given that term in section 2207(6) of the Social Security Act.

3453.

Instrumentalities of the United States

Notwithstanding any other provision of law (whether enacted before or after the enactment of this section) which grants to any instrumentality of the United States an exemption from taxation, such instrumentality shall not be exempt from the tax imposed by section 3451 unless such other provision of law grants a specific exemption, by reference to section 3451, from the tax imposed by such section.

. (2)

Self-employment

Section 1401 of such Code is amended by redesignating subsection (c) as subsection (d) and by inserting after subsection (b) the following new subsection: (c)

American Health Benefits Program

In addition to other taxes, there shall be imposed for each taxable year, on the self-employment income of every individual, a tax equal to the applicable percentage (as defined in section 3451(b)) of the amount of the self-employment income for such taxable year. . (3)

Clerical amendment

The table of chapters for subtitle C of such Code is amended by striking the item relating to chapter 25 and inserting the following: Chapter 25—American Health Benefits Program Chapter 26—General provisions relating to employment taxes . (d)

Additional tax on hospital revenues

(1)

In general

Subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new part: VIII

Tax on hospital revenues

Sec. 59B. Tax on hospital revenues.

59B.

Tax on hospital revenues

(a)

In general

In the case of a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to 2 percent of the hospital revenues of such corporation. (b)

Hospital revenues

For purposes of this section, the term hospital revenuesmeans, with respect to any corporation for any taxable year, the excess (if any) of— (1)so much of such corporation’s gross income for such taxable year as is derived from the operation of one or more hospitals (as defined in section 1861(e) of the Social Security Act), over (2)so much of the deductions allowed under this chapter for such taxable year as are properly allocable to such income. (c)

Section 15 not To apply

Section 15 shall not apply to the tax imposed by this section.

. (2)

Conforming amendments

(A)Section 26(b)(2) of the Internal Revenue Code of 1986 is amended by striking and at the end of subparagraph (U), by striking the period at the end of subparagraph (V) and inserting , and, and by adding at the end the following new subparagraph: (W)section 59B (relating to tax on hospital revenues). . (B)Section 30A(c) of such Code is amended by striking or at the end of paragraph (3), by striking the period at the end of paragraph (4) and inserting , or, and by adding at the end the following new paragraph: (5)section 59B (relating to tax on hospital revenues). . (C)Section 882(a)(1) of such Code is amended by inserting 59B, after 59A,. (D)Section 936(a)(3) of such Code is amended by striking or at the end of subparagraph (C), by striking the period at the end of subparagraph (D) and inserting , or, and by adding at the end the following new subparagraph: (E)section 59B (relating to tax on hospital revenues). . (E)Section 6425(c)(1)(A) of such Code is amended by striking plus at the end of clause (ii), by striking over at the end of clause (iii) and inserting plus, and by adding at the end the following new clause: (iv)the tax imposed by section 59B, over . (F)Section 6655(g)(1)(A) of such Code is amended by striking plus at the end of clause (iii), by redesignating clause (iv) as clause (v), and by inserting after clause (iii) the following new clause: (iv)the tax imposed by section 59B, plus . (G)The table of parts for subchapter A of chapter 1 of such Code is amended by adding at the end the following new item: Part VIII—Tax on Hospital Revenues . (e)

Disclosure of taxpayer return information To carry out cost-sharing subsidies

(1)

In general

Section 6103(l) of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph: (21)

Disclosure of return information to carry out American Health Benefits Program

(A)

In general

The Secretary shall, upon written request from the Commissioner of Health Benefits, disclose to officers, employees, and contractors of the Health Benefits Administration return information of a taxpayer who is, according to the records of the Secretary, a cost-sharing subsidy-eligible individual (as defined in section 2205(b)(7)(A) of the Social Security Act) or a family member of such an individual. Such return information shall be limited to— (i)taxpayer identity information with respect to such taxpayer, (ii)the filing status of such taxpayer, (iii)the adjusted gross income of such taxpayer, (iv)the amounts excluded from such taxpayer’s gross income under sections 135 and 911 to the extent such information is available, (v)the interest received or accrued during the taxable year which is exempt from the tax imposed by chapter 1 to the extent such information is available, (vi)the amounts excluded from such taxpayer’s gross income by sections 931 and 933 to the extent such information is available, and (vii)the taxable year with respect to which the preceding information relates. (B)

Restriction on use of disclosed information

Return information disclosed under subparagraph (A) may be used by officers, employees, and contractors of the Health Benefits Administration only for the purposes of, and to the extent necessary in, establishing the appropriate amount of any cost-sharing subsidies under section 2205 of the Social Security Act. . (2)

Conforming amendments

(A)Paragraph (3) of section 6103(a) of such Code is amended by striking or (20) and inserting (20), or (21). (B)Paragraph (4) of section 6103(p) of such Code is amended by striking (l)(16), (17), (19), or (20) each place it appears and inserting (l)(16), (17), (19), (20), or (21). (C)Paragraph (2) of section 7213(a) of such Code is amended by striking or (20) and inserting (20), or (21). (f)

Disclosure of taxpayer return information To carry out premium subsidies

Section 6103(k) of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph: (10)

Disclosure of information to administer premium subsidy under section 36

To the extent that Secretary determines that disclosure is necessary to permit the effective administration of section 36, the Secretary may disclose the modified adjusted gross income (as defined in section 36) of any individual whose modified adjusted gross income is taken into account in determining the amount of any credit under such section. . (g)

Effective Date

(1)

In general

Except as provided in paragraph (2), the amendments made by this section shall take effect on January 1, 2011. (2)

Subsections (a) and (b)

The amendments made by subsections (a) and (b) shall apply to months beginning after December 31, 2010, in taxable years ending after such date. (3)

Subsection (d)

The amendments made by subsection (d) shall apply to taxable years beginning after December 31, 2010.

4.

Amendments to the Medicaid program and SCHIP

(a)

Maintenance of effort in medicaid payments

Section 1902 of the Social Security Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection: (dd)(1)For each State fiscal year that begins on or after January 1 of the first calendar year in which coverage is provided under title XXII, each State shall submit a report to the Secretary on the amount of State expenditures for health services, as defined by the Secretary. (2)Subject to paragraph (4), if the amount so reported for a State fiscal year is less than the amount specified in paragraph (3) for that State fiscal year, the State shall provide for payment to the Secretary of the amount of such difference. The provisions of subparagraphs (B) and (C) of section 1935(c)(1) shall apply to payment under the previous sentence in the same manner as they apply to payment under subparagraph (A) of such section, except that such payments shall be deposited into the American Health Benefits Program Trust Fund established under section 2204(c). (3)The amount specified in this paragraph for a State for— (A)the first State fiscal year described in paragraph (1), is the total amount of the State share of expenditures for health services (as defined in paragraph (1)) under all public health programs operated in the State that are funded in whole or in part with State expenditures, including expenditures under this title and title XXI, for the previous State fiscal year; and (B)a subsequent State fiscal year, is the amount specified in this paragraph for the previous State fiscal year increased by the percentage change, if any, in the consumer price index for all urban consumers for the most recent completed Federal fiscal year. (4)The Secretary may waive payment of all or a portion of the amount otherwise payable under paragraph (2) based on criteria specified by the Secretary . (b)

Sunset of SCHIP funding

Section 2105 of such Act (42 U.S.C. 1397ee) is amended by adding at the end the following new subsection: (h)

Sunset of program upon initiation of American Health Benefits Program

No payment shall be made under this title to a State for items and services furnished after the effective date of the American Health Benefits Program under title XXII. . (c)

Reduction in Medicaid DSH payments

Section 1923(f) of such Act (42 U.S.C. 1396r–4(f)) is amended— (1)by redesignating paragraph (7) as paragraph (8); and (2)by inserting after paragraph (6) the following new paragraph: (7)

Reduction in connection with AHBP

Notwithstanding the previous provisions in this paragraph, the Secretary shall provide for a phased-down reduction over a 5-fiscal-year-period beginning with fiscal year 2011 of the amount of the DSH allotment for each State so that, by the end of such period, such amount is equal to 10 percent of the amount of such allotment for such State for fiscal year 2010. .

5.

Promotion of use of health information technologies

The Commissioner of Health Benefits (appointed under section 2206(d)(1) of the Social Security Act, as added by section 2(a)), in consultation with the Secretary of Health and Human Services, shall establish new guidelines that promote the proper use and understanding of health information technologies.

6.

Non-preemption of existing collective bargaining agreements

Nothing in this Act shall be construed as preempting any collective bargaining agreement that is in effect as of the date of the enactment of this Act, during the period in which such agreement is in effect (without regard to any extension of such agreement effected as such date of enactment).

7.

Health Benefits Commission

(a)

Establishment

There is established an independent commission to be known as the Health Benefits Commission (in this section referred to as the Commission). (b)

Duties of the commission

(1)

General duties

The Commission shall examine and make recommendations regarding the major issues and cost drivers affecting the delivery of healthcare services as it pertains to the American Health Benefits Program under title XXII of the Social Security Act (in this section referred to as AHBP). (2)

Specific issues

The Commission shall specifically examine and make recommendations regarding each of the following: (A)A comparison of AHBP to other public health insurance programs (described in section 2202(b)(2) of the Social Security Act) and the feasibility and desirability of their integration into AHBP. (B)The proper implementation and utilization of electronic medical records and other health information technologies, including privacy and interoperability issues. (C)The effects of medical malpractice insurance and “defensive medicine” on the delivery and cost of health care. (D)The patterns and effects of overutilization on AHBP. (E)Cost and implementation factors of retiree health coverage under AHBP. (F)A comparison of prescription drug prices under AHBP with such prices under other public health programs. (G)The effects of insurance monopolies on healthcare costs and delivery. (c)

Membership

(1)

Number and appointment

The Commission shall be composed of 9 members, of whom— (A)one shall be appointed by the President; (B)one shall be appointed by the majority leader of the Senate; (C)one shall be appointed by the minority leader of the Senate; (D)one shall be appointed by the Speaker of the House of Representatives; (E)one shall be appointed by the minority leader of the House of Representatives; and (F)four shall be appointed by the Comptroller General of the United States, of whom one shall be designated by the Comptroller General as the Chair and another as the Vice Chair of the Commission. (2)

Terms of appointment

The term of any appointment under paragraph (1) to the Commission shall be for 3 years. (3)

Terms

(A)

In general

The terms of members of the Commission shall be for 3 years, except that the Comptroller General shall designate staggered terms for the members first appointed. (B)

Vacancies

Any member appointed to fill a vacancy occurring before the expiration of the term for which the member's predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member's term until a successor has taken office. A vacancy in the Commission shall be filled in the manner in which the original appointment was made. (4)

Meetings

The Commission shall meet at the call of its Chair or a majority of its members. (5)

Quorum

A quorum shall consist of 5 members of the Commission, except that 3 members may conduct a hearing under subsection (e). (6)

Vacancies

A vacancy on the Commission shall be filled in the same manner in which the original appointment was made not later than 30 days after the Commission is given notice of the vacancy and shall not affect the power of the remaining members to execute the duties of the Commission. (7)

Compensation

While serving on the business of the Commission (including traveltime), a member of the Commission shall be entitled to compensation at the per diem equivalent of the rate provided for level IV of the Executive Schedule under section 5315 of title 5, United States Code; and while so serving away from home and the member's regular place of business, a member may be allowed travel expenses, as authorized by the Chairman of the Commission. (8)

Chair; vice chair

The Comptroller General shall designate a member of the Commission appointed under paragraph (1)(F), at the time of appointment of the member as Chair and a member as Vice Chair for that term of appointment, except that in the case of vacancy of the Chair or Vice Chair, the Comptroller General may designate another member for the remainder of that member's term. (9)

Expenses

Each member of the Commission shall receive travel expenses and per diem in lieu of subsistence in accordance with sections 5702 and 5703 of title 5, United States Code. (10)

Continuation of operation

Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Commission. (d)

Director and Staff; Experts and Consultants

Subject to such review as the Comptroller General deems necessary to assure the efficient administration of the Commission, the Commission may— (1)employ and fix the compensation of an Executive Director (subject to the approval of the Comptroller General) and such other personnel (not to exceed 11) as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service); (2)seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies; (3)enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Commission (without regard to section 3709 of the Revised Statutes (41 U.S.C. 5)); (4)make advance, progress, and other payments which relate to the work of the Commission; (5)provide transportation and subsistence for persons serving without compensation; and (6)prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the Commission. Physicians serving as personnel of the Commission may be provided a physician comparability allowance by the Commission in the same manner as Government physicians may be provided such an allowance by an agency under section 5948 of title 5, United States Code, and for such purpose subsection (i) of such section shall apply to the Commission in the same manner as it applies to the Tennessee Valley Authority. For purposes of pay (other than pay of members of the Commission) and employment benefits, rights, and privileges, all personnel of the Commission shall be treated as if they were employees of the United States Senate.(e)

Powers of commission

(1)

Hearings and other activities

For the purpose of carrying out its duties, the Commission may hold such hearings and undertake such other activities as the Commission determines to be necessary to carry out its duties. (2)

Studies by GAO

Upon the request of the Commission, the Comptroller General of the United States shall conduct such studies or investigations as the Commission determines to be necessary to carry out its duties. (3)

Cost estimates by Congressional Budget Office

(A)The Director of the Congressional Budget Office shall provide to the Commission, upon the request of the Commission, such cost estimates as the Commission determines to be necessary to carry out its duties. (B)The Commission shall reimburse the Director of the Congressional Budget Office for expenses relating to the employment in the office of the Director of such additional staff as may be necessary for the Director to comply with requests by the Commission under subparagraph (A). (4)

Detail of federal employees

Upon the request of the Commission, the head of any Federal agency is authorized to detail, without reimbursement, any of the personnel of such agency to the Commission to assist the Commission in carrying out its duties. Any such detail shall not interrupt or otherwise affect the civil service status or privileges of the Federal employee. (5)

Technical assistance

Upon the request of the Commission, the head of a Federal agency shall provide such technical assistance to the Commission as the Commission determines to be necessary to carry out its duties. (6)

Use of mails

The Commission may use the United States mails in the same manner and under the same conditions as Federal agencies and shall, for purposes of the frank, be considered a commission of Congress as described in section 3215 of title 39, United States Code. (7)

Obtaining information

The Commission may secure directly from any Federal agency information necessary to enable it to carry out its duties, if the information may be disclosed under section 552 of title 5, United States Code. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the Commission. (8)

Administrative support services

Upon the request of the Commission, the Administrator of General Services shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request. (9)

Printing

For purposes of costs relating to printing and binding, including the cost of personnel detailed from the Government Printing Office, the Commission shall be deemed to be a committee of the Congress. (f)

Reports

(1)

Initial findings

Not later than 6 months after the date of the enactment of this Act, the Commission shall submit to the Commissioner of Health Benefits and to appropriate committees of Congress a report which contains a statement of the initial findings of the Commission. (2)

Initial report

Not later than 18 months after the date of the enactment of this Act, the Commission shall submit to such Commissioner and committees an initial report which contains a detailed statement of its recommendations, findings, and conclusions of the Commission. (3)

Annual report

Subsequently, the Commission shall annually submit to such Commissioner and such committees a report containing such a statement. (4)

Other reports

The Commission may issue such other reports at such times as the Commission determines appropriate. (5)

Supermajority requirement

The Commission shall not include in any report submitted under this subsection a recommendation, finding, or conclusion unless it has received the approval of at least 6 members of the Commission. (g)

Authorization of appropriations

There are authorized to be appropriated for each fiscal year beginning with fiscal year 2009 such sums as are necessary to carry out this section.