I 111th CONGRESS 2d Session H. R. 4529 IN THE HOUSE OF REPRESENTATIVES January 27, 2010 Mr. Ryan of Wisconsin (for himself, Mr. Bartlett, Mrs. Blackburn, Mr. Burgess, Mr. Campbell, Mr. Hensarling, Mr. Nunes, and Mr. Price of Georgia) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, Education and Labor, Rules, the Budget, and the Judiciary, 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 provide for the reform of health care, the Social Security system, the tax code for individuals and business, job training, and the budget process.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Roadmap for America’s Future Act of 2010. (b)

Table of contents

The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings and purpose. Title I—Health Care Reform Subtitle A—Expanding Patient’s Health Care Choices Part 1—State-Based Health Care Exchanges Sec. 101. State-based health care exchanges. Sec. 102. Requirements. Sec. 103. State Exchange incentives. Part 2—Fair Tax Treatment for all Americans to Afford Health Care Sec. 111. Reference. Subpart A—Refundable and Advanceable Credit for Certain Health Insurance Coverage Sec. 112. Refundable and advanceable credit for certain health insurance coverage. Sec. 113. Requiring employer transparency about employee benefits. Sec. 114. Changes to existing tax preferences for medical coverage, etc., for individuals eligible for qualified health insurance credit. Subpart B—Health Savings Accounts Sec. 121. Improvements to health savings accounts. Sec. 122. Exception to requirement for employers to make comparable health savings account contributions. Subtitle B—Health Plan Choice; Small Business Health Fairness; Tax Amendments Sec. 131. Cooperative governing of individual health insurance coverage. Sec. 132. Small business health fairness. Sec. 133. Repeal of certain tax exemptions for health insurance payments. Subtitle C—Health Care Services Commission Part I—Establishment and General Duties Sec. 141. Establishment. Sec. 142. General authorities and duties. Sec. 143. Dissemination. Part II—Forum for Quality and Effectiveness in Health Care Sec. 151. Establishment of office. Sec. 152. Membership. Sec. 153. Duties. Sec. 154. Adoption and enforcement of guidelines and standards. Sec. 155. Additional requirements. Part III—General Provisions Sec. 161. Certain administrative authorities. Sec. 162. Funding. Sec. 163. Definitions. Part IV—Terminations and Transition Sec. 171. Termination of Agency for Healthcare Research and Quality. Sec. 172. Transition. Part V—Independent Health Record Trust Sec. 181. Short title of part. Sec. 182. Purpose. Sec. 183. Definitions. Sec. 184. Establishment, certification, and membership of independent health record trusts. Sec. 185. Duties of IHRT to IHRT participants. Sec. 186. Availability and use of information from records in IHRT consistent with privacy protections and agreements. Sec. 187. Voluntary nature of trust participation and information sharing. Sec. 188. Financing of activities. Sec. 189. Regulatory oversight. Title II—Fairness for Every American Patient Subtitle A—Medicaid Modernization Sec. 201. Medicaid modernization. Sec. 202. Outreach. Sec. 203. Transition rules; miscellaneous provisions. Subtitle B—Supplemental Health Care Assistance for Low-Income Families Sec. 211. Supplemental health care assistance for low-income families. Title III—Medicare Reform Subtitle A—New Medicare Program Sec. 301. Benefit changes. Sec. 302. Increase in Medicare eligibility age. Sec. 303. Unified Medicare Trust Fund. Subtitle B—Changes in Current Medicare Program Sec. 311. Income-related reduction in part D premium subsidy. Sec. 312. Reduction in hospital marketbasket increases. Sec. 313. Elimination of indexing of income thresholds for part B income-related premiums. Sec. 314. Reinstatement of the Medicare trigger. Sec. 315. Eliminating inefficiencies and increasing choice in Medicare Advantage. Subtitle C—Medical Liability Reform Part 1—Enacting Real Medical Liability Reform Sec. 321. Encouraging speedy resolution of claims. Sec. 322. Compensating patient injury. Sec. 323. Maximizing patient recovery. Sec. 324. Additional health benefits. Sec. 325. Punitive damages. Sec. 326. Authorization of payment of future damages to claimants in health care lawsuits. Sec. 327. Definitions. Sec. 328. Effect on other laws. Sec. 329. State flexibility and protection of States’ rights. Sec. 330. Applicability; effective date. Part 2—Ending Lawsuit Abuse Sec. 331. State grants to create health court solutions. Title IV—Social Security reform Sec. 401. Short title. Sec. 402. Establishment of Personal Social Security Savings Program. Sec. 403. Monthly insurance benefits for participating individuals. Sec. 404. Tax treatment of accounts. Sec. 405. Self-Liquidating Social Security Transition Fund. Sec. 406. Budgetary treatment of Social Security. Sec. 407. Accounting for the Old-Age, Survivors, and Disability Insurance Program and the Personal Social Security Savings Program. Sec. 408. Progressive indexing of benefits for old-age, wife’s, and husband’s insurance benefits. Sec. 409. Adjustments to schedule for increases in normal retirement age. Title V—Simplified Income Tax Sec. 501. Short title. Sec. 502. Repeal of alternative minimum tax for noncorporate taxpayers. Sec. 503. Simplified income tax system. Sec. 504. Exclusion for capital gains, dividends, and interest. Sec. 505. Repeal of estate and gift taxes. Title VI—BUSINESS CONSUMPTION TAX Sec. 601. Short title. Sec. 602. Repeal of corporate income tax; new tax paid by corporations and other businesses. Sec. 603. Repeal of chapter 6. Title VII—Job Training Results Act of 2010 Sec. 701. Short title. Sec. 702. Purpose. Sec. 703. Improvement of job training programs; performance metrics for WIA job training programs. Sec. 704. Other job training programs. Sec. 705. Transparency. Sec. 706. Evaluations. Sec. 707. Encouraging innovation. Sec. 708. Making WIA Training Vouchers more accessible and flexible. Sec. 709. Life long learning awareness campaigns. Sec. 710. GAO reports. Title VIII—SPENDING LIMITS AND DEFICIT CONTROL Sec. 800. Short title. Subtitle A—Spending Limits and Deficit Control Sec. 801. Discretionary spending limits. Sec. 802. Total spending limits. Subtitle B—Reports and Orders Sec. 811. Reports and orders. Sec. 812. Spending limits enforcement. Sec. 813. Spending reduction orders. Sec. 814. Alternate spending reduction legislation in the House of Representatives. Sec. 815. Alternate spending reduction legislation in the Senate. Subtitle C—Long-Term Budgeting Sec. 821. CBO and OMB projections. Sec. 822. GAO and OMB statements of the Federal Government’s financial condition. Sec. 823. Five-year fiscal sustainability review. Sec. 824. Long-term reconciliation. Sec. 825. Long-term spending increase point of order.

2.

Findings and purpose

(a)

Findings

The Congress finds as follows: (1)The Congressional Budget Office, the Government Accountability Office, and the Federal Reserve have all found that Social Security, Medicare, and Medicaid, as currently structured, will result in unsustainable levels of spending, deficits, and debt. (2)Although Americans remain committed to the missions of these initiatives, the goals can no longer be met on models created nearly 80 years ago—with large, centralized institutions, especially government, serving as sole providers for an increasingly dependent population. (3)The continuing failure to enact solutions makes these problems more intractable with each succeeding year. (4)Among the inescapable signs are the following: an unsustainable path of Government spending; levels of projected debt that threaten to bankrupt the country; trillions of dollars of unfunded liabilities in the Government’s major benefit programs; and the erosion of Americans’ security and confidence in health care and retirement. (5)These conditions pose significant potential burdens not only for the Government, but for the United States economy as well, threatening its ability to continue raising standards of living, and its leadership in an increasingly international marketplace. (6)A comprehensive plan is needed, and this legislation aims to gain control of Federal spending, deficits, and debt while energizing the productive capacities of Americans to generate sustained economic growth. (b)

Purpose

The purpose of this Act is as follows: (1)

Health care reform

To provide access to health care coverage for uninsured Americans by establishing a new tax credit; to reform health insurance markets, high-risk pools, and electronic health records; and to create a new agency to promote the dissemination of industry-defined health care price and quality data. (2)

Medicaid and SCHIP reform

To ensure health care coverage for those who need it most and can be sustained, reforms the Medicaid and SCHIP to expand coverage options for beneficiaries, gives greater flexibility, and slows the growth in spending. (3)

Medicare reform

To ensure the Medicare benefit continues to provide health care coverage for seniors by establishing modernizing the program to slowly phase in reforms for those younger than 55 years of age, and to make the program permanently solvent and fiscally sustainable. (4)

Social Security reform

To reform Social Security to ensure retirement security for future generations and to make it solvent for the foreseeable future; to address inequities in the system and provide millions of Americans with the opportunity to build a retirement nest egg that they can pass on to their heirs. (5)

Individual income tax reform

To offer taxpayers a choice in paying their Federal income taxes; to allow individuals to choose between the current tax code or a highly simplified tax system with virtually no deductions or credits (apart from an individual health care credit), two low tax rates and a generous standard deduction and personal exemption; to fully repeal the alternative minimum tax (AMT), eliminate the tax on interest, capital gains and dividends in order to promote saving; and to repeal the estate tax. (6)

Business tax reform

To eliminate the United States corporate income tax and establishes a border-adjustable business consumption tax in its place; to provide a new method of business taxation that will level the playing field for United States businesses to compete with foreign businesses and will promote sustained economic growth, investment and job creation in America. (7)

Job Training

To assist working Americans in an increasingly global economy, reforms 49 job training programs across eight agencies to enhance transparency, accountability, and performance. (8)

Budget process

To keep total spending of the Government under control, nondefense discretionary spending limits are set forth, a limit on total outlays as a percentage of the gross domestic produce is established, and the process is reformed to put a greater focus on long-term budgetary trends.

. (b)

Repeal of Title XXI

Effective January 1, 2011, title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) is repealed.

202.

Outreach

(a)

Authorization of appropriations

The following amounts are authorized to be appropriated to the Secretary of Health and Human Services: (1)For fiscal year 2010, $100,000,000 for the design and implementation of a public outreach campaign to inform the public about the changes to the programs under such titles that take effect on January 1, 2011, as a result of the amendment made by section 201. (2)For each of fiscal years 2011and 2012, $200,000,000 to carry out such public outreach campaign. (3)For fiscal year 2013, $50,000,000 to carry out such public outreach campaign. (b)

Availability

Funds appropriated under subsection (a) shall remain available for expenditure through September 30, 2012. (c)

Authority for use of funds

The Secretary may use funds made available under paragraphs (2) and (3) of subsection (a) to award grants to, or enter into contracts with, public or private entities, including States, local governments, schools, churches, and community groups.

203.

Transition rules; miscellaneous provisions

(a)

In general

(1)Not later than June 30, 2011, a State that is one of the 50 States or the District of Columbia shall inform all individuals enrolled in a State plan under title XIX or XXI of the Social Security Act on such date (and any new enrollees after such date) of the changes to the programs under such titles that take effect on January 1, 2012, as a result of the amendment made by section 201. (2)No State that is one of the 50 States or the District of Columbia shall approve any applications for medical assistance or child health assistance under a State plan under title XIX or XXI (as in effect for fiscal year 2011) after December 31, 2011. (b)

Submission of legislative proposal for technical and conforming amendments

Not later than 6 months after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a legislative proposal for such technical and conforming amendments as are necessary to carry out the amendments made by this Act.

B

Supplemental Health Care Assistance for Low-Income Families

211.

Supplemental health care assistance for low-income families

Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by adding at the end the following: XI

Health care assistance to low-income families

340A–1.

Financial assistance to low-income families

(a)

In general

The Secretary shall supplement the costs of private health insurance for eligible low-income families through the distribution of supplemental debit cards to eligible families, which may be used to pay for costs associated with health care for the members of such eligible families and provide direct support to such families in accessing health care. (b)

Eligibility

(1)

Eligible families

To be eligible for financial assistance under this section— (A)a family shall— (i)consist of 2 or more individuals living together who are related by marriage, birth, adoption, or guardianship; (ii)have a gross income that does not exceed 200 percent of the poverty line, as applicable to a family of the size involved; and (iii)include at least 1 individual who is a dependent under the age of 19; and (B)no member of the family shall be covered by private health insurance. (2)

Determination of gross income

The gross income of a family shall be determined by taking the sum of the income of each family member who is at least age 21 but not older than age 65, except that the income of any member of the family who qualifies for coverage under Medicaid Part A or B shall not be counted. (3)

Limitation on individual eligibility; assistance

(A)

In general

No individual who is a member of an eligible family under paragraph (1) is eligible to qualify separately for financial assistance under this section. (B)

Aliens

The Secretary shall ensure that financial assistance under this section is not provided for costs associated with health care for any member of an eligible family who is an alien individual who is not a lawful permanent resident of the United States. (c)

Supplemental debit card for health care expenditures

(1)

In general

The Secretary shall issue to each eligible family that enrolls in the program in accordance with subsection (f) a supplemental debit card with a dollar-amount value, in accordance with subsection (d), that may be used to pay for qualifying health care expenses. (2)

Use of the debit card

(A)

Qualifying health care expenses

A supplemental debit card issued under this section may be used by members of the eligible family to pay for— (i)the purchase of health care insurance for any member of the family; (ii)cost sharing expenses related to health care, including deductibles, copayments, and coinsurance, for any member of the family; and (iii)the direct purchase of health care services and supplies for any member of the family. (B)

Geographic range

Each supplemental debit card may be used to pay for qualifying health care expenses incurred anywhere in the 50 States or the District of Columbia. (C)

Limitations

No supplemental debit card shall be used to make a payment for any cost— (i)incurred prior to the determination of the family's eligibility for assistance under this section; or (ii)that is not a health-related expense. (3)

Rollover of unused amounts

Not more than one-quarter of the annual dollar amount of a supplemental debit card that is unexpended at the end of each 12-month period may rollover— (A)to the family's supplemental debit card for expenditure during the subsequent 12-month period, provided that the family to which the supplemental debit card was issued in the previous 12-month period is eligible to receive a supplemental debit card in the subsequent 12-month period; or (B)to the family's health savings account (as defined in section 223(g)(2) of the Internal Revenue Code of 1986). (4)

Monthly statements

The Secretary shall issue a monthly statement to each family to which a supplemental debit card has been issued under this section, which shall state each payment made with the family's supplemental debit card during the month covered by the statement, the dollar amount of each such payment, and the provider to which each such payment was made. (d)

Amount of financial assistance

(1)

Amounts for calendar year 2011

Subject to paragraph (5), the amount of financial assistance available to each eligible family during the calendar year 2011 shall be determined as follows: (A)Each family whose annual income does not exceed 100 percent of the poverty level, as applicable to a family of the size involved, shall receive $5,000. (B)Each family whose annual income exceeds 100 percent, but does not exceed 200 percent, of the poverty level, as applicable to a family of the size involved, shall receive an amount as follows: (i)For families whose annual income exceeds 100 percent but does not exceed 120 percent, of the poverty level, $4,000. (ii)For families whose annual income exceeds 120 percent but does not exceed 140 percent, of the poverty level, $3,500. (iii)For families whose annual income exceeds 140 percent but does not exceed 160 percent, of the poverty level, $3,000. (iv)For families whose annual income exceeds 160 percent but does not exceed 180 percent, of the poverty level, $2,500. (v)For families whose annual income exceeds 180 percent but does not exceed 200 percent, of the poverty level, $2,000. (2)

Additional amounts

In addition to the amounts under paragraph (1), subject to paragraph (5), the following amounts shall be added to the supplemental debit cards of qualifying families: (A)For each pregnancy during which a pregnant woman's family is eligible for assistance under this section, an additional amount of $1,000 shall be added to the family's supplemental debit card, except that no family shall receive such additional $1,000 for any pregnancy for which the family received such amount in the previous 12-month period. (B)For each member of an eligible family who is less than 1 year old on any day within the calendar year in which the family is eligible for assistance, an additional amount of $500 shall be added to the family's supplemental debit card. (3)

Cost of living adjustments

In the case of any taxable year beginning in a calendar year after 2011, each dollar amount contained in paragraphs (1) and (2) shall be increased in the same manner as the dollar amounts specified in section 25E(b)(3) of the Internal Revenue Code of 1986 are increased by the blended cost-of-living adjustment determined under subsection (k)(2) of section 25E of the Internal Revenue Code for the taxable year involved. (4)

State option to increase amounts

At the option of each State, amounts in excess of the annual dollar amounts under paragraphs (1) and (2) may be provided through the supplemental debit card to eligible families in that State, but no Federal funds shall be paid to any State for any amount provided in excess of such annual dollar amount. (5)

Risk adjustment

The Secretary may adjust the amount of financial assistance available to an eligible family for a calendar year under this section based on age, health indicators, and other factors that represent distinct patterns of health care services utilization and costs. (e)

Contributions of States

(1)

In general

As a condition for receiving Federal funds under Part A or Part B of Medicaid, each State shall contribute 50 percent of the total amount expended under the supplemental debit card program by the participating families that reside within the State during the time that the family resides in that State. For purposes of this section, the residency of a family is determined by the residency the legally responsible head of the household. (2)

Payments from States

(A)

Billing notification

(i)

Timing

On June 30th and December 31st of each year, the Secretary shall send written notification to each State of that State's 50 percent share of expenses, as described in paragraph (1), for the 6-month period ending on the last day of the month previous to such notification. (ii)

Contents

Each such notification to a State shall clearly state— (I)the payment amount due from the State; (II)the name of each individual for whom payment was made through the supplemental debit card program; (III)the health care provider to whom each payment was made; (IV)the amount of each payment; and (V)any other information, as the Secretary requires. (B)

Payments

Each State shall make a payment to the Secretary, in the amount billed, not later than 30 days after the billing notification date, in accordance with subparagraph (A)(i). (C)

Penalties

If a State fails to pay to the Secretary an amount required under subparagraph (B), interest shall accrue on such amount at the rate provided under old section 1903(d)(5) of the Social Security Act. The amount so owed and applicable interest shall be immediately offset against amounts otherwise payable to the State under this section, in accordance with the Federal Claims Collection Act of 1996 and applicable regulations. (f)

Enrollment

(1)

In general

The Secretary shall establish procedures and times for enrollment in the supplemental debit card program. Open enrollment shall be available not less than 4 times per calendar year. (2)

Transition of individuals enrolled in Medicaid or the State Children's Health Insurance Program

(A)

Information from the States

Each State shall— (i)not later than June 30, 2011, inform all individuals then enrolled in Medicaid or the State Children's Health Insurance Program (SCHIP), of the changes in effect beginning on January 1, 2012; and (ii)not later than October 31, 2011, redetermine the eligibility of each individual enrolled in Medicaid or SCHIP, other than those individuals who qualify for Medicaid or SCHIP as disabled, elderly, or a special population, for the supplemental debit card program, according to the eligibility criteria under subsection (b). (B)

Automatic enrollment

The Secretary shall provide for the automatic enrollment in the supplemental debit card program of all individuals who are enrolled in Medicaid or SCHIP and who have been redetermined by a State under subparagraph (A) to be eligible for Medicaid or SCHIP. Any individual who is determined by a State not to qualify for the supplemental debit card program may retain coverage under Medicaid or SCHIP until June 30, 2012. (3)

Assistance with qualified health insurance credit

Each State shall, to the extent practicable, provide individuals residing within the State with information regarding the qualified health insurance credit described in section 25E of the Internal Revenue Code of 1986, including information regarding eligibility for, and how to claim, such credit. (g)

Administration

(1)

National system

The Secretary may enter into contracts or agreements with a State, a consortium of States, or a private entity, including a bank, enrollment broker, or similar entity, to establish and maintain a unified national system to support the processes and transactions necessary to administer this section. (2)

Automated system

The Secretary shall establish an automated means, such as an electronic benefit transfer system, by which the benefits under this section shall be transferred to eligible families. (3)

Verification of applicant information

The Secretary may verify information provided by applicants with the appropriate Federal, State, and local agencies, including the Internal Revenue Service, the Social Security Administration, the Department of Labor, and child support enforcement agencies. (4)

Choice counseling

The Secretary may enter into contracts or agreements with a State, a consortium of a State, or a private entity, including an enrollment broker or community organization or other organization, to educate eligible families about their options and to assist in their enrollment in the supplemental debit card plan. (5)

Appeals

The Secretary shall establish an independent appeals process, to be administered by an entity separate from the entity that makes initial eligibility determinations, which shall be available to individuals who are denied benefits under the supplemental debit card program. (6)

Resolution of errors

The Secretary shall provide for a reconciliation process with the States to resolve any errors and adjudicate disputes due to incomplete or false information in a family's application or in the billing process described in subsection (e). (7)

Penalties for false information

Any person who provides false information to qualify for the supplemental debit card program shall pay a penalty in the amount of 110 percent of the amount of assistance paid on behalf of such person and all members of such person's family. (h)

Implementation plan

Not later than 6 months after the date of enactment of this section, the Secretary shall submit to Congress a plan for implementing this program. (i)

Authorization of appropriations

(1)

Administration of the supplemental debit card program

To administer the program under this section, there are authorized to be appropriated— (A)for fiscal year 2009, $300,000,000, for the design of a unified, national system of conducting the supplemental debit card program; (B)for fiscal year 2010, $1,000,000,000 for start-up costs, including, contracting, hiring and training employees, and testing the program; and (C)for fiscal year 2011 and each subsequent fiscal year, $3,000,000,000. (2)

Authorization of benefits under the supplemental debit card program

To provide the supplemental debit card benefits described in this section, there are authorized to be appropriated— (A)for fiscal year 2011, $24,020,000,000; (B)for fiscal year 2012, $25,220,000,000; (C)for fiscal year 2013, $26,480,000,000; (D)for fiscal year 2014, $27,810,000,000; and (E)for fiscal year 2015, $29,200,000,000.

.