II 111th CONGRESS 1st Session S. 391 IN THE SENATE OF THE UNITED STATES February 5, 2009 Mr. Wyden (for himself, Mr. Bennett, Mr. Inouye, Mr. Specter, Mr. Lieberman, Ms. Landrieu, Mr. Crapo, Mr. Nelson of Florida, Ms. Stabenow, Ms. Cantwell, Mr. Graham, Mr. Alexander, and Mr. Merkley) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Healthy Americans Act. (b)

Table of contents

Sec. 1. Short title; table of contents. Sec. 2. Findings. Sec. 3. Definitions. TITLE I—Healthy Americans Private Insurance Plans Subtitle A—Guaranteed private coverage Sec. 101. Guarantee of Healthy Americans Private Insurance coverage. Sec. 102. Individual responsibility to enroll in a Healthy Americans Private Insurance plan. Sec. 103. Guaranteeing you can keep the coverage you have. Sec. 104. Coordination of supplemental coverage under the Medicaid program to HAPI plan coverage for nondisabled, nonelderly adult individuals. Subtitle B—Standards for Healthy Americans Private Insurance Coverage Sec. 111. Healthy Americans Private Insurance Plans. Sec. 112. Specific coverage requirements. Sec. 113. Updating Healthy Americans Private Insurance plan requirements. Subtitle C—Eligibility for premium and personal responsibility contribution subsidies Sec. 121. Eligibility for premium subsidies. Sec. 122. Eligibility for personal responsibility contribution subsidies. Sec. 123. Definitions and special rules. Subtitle D—Wellness programs Sec. 131. Requirements for wellness programs. TITLE II—Healthy start for children Subtitle A—Benefits and eligibility Sec. 201. General goal and authorization of appropriations for HAPI plan coverage for children. Sec. 202. Coordination of supplemental coverage under the Medicaid program with HAPI plan coverage for children. Subtitle B—Service providers Sec. 211. Inclusion of providers under HAPI plans. Sec. 212. Use of, and grants for, school-based health centers. TITLE III—Better health for older and disabled Americans Subtitle A—Assurance of supplemental Medicaid coverage Sec. 301. Coordination of supplemental coverage under the Medicaid program for elderly and disabled individuals. Subtitle B—Empowering individuals and states To improve long-term care choices Sec. 311. New, automatic Medicaid option for State Choices for Long-Term Care Program. Sec. 312. Simpler and more affordable long-term care insurance coverage. TITLE IV—Healthier Medicare Subtitle A—Authority To adjust amount of part B premium To reward positive health behavior Sec. 401. Authority to adjust amount of Medicare part B premium to reward positive health behavior. Subtitle B—Promoting primary care for Medicare beneficiaries Sec. 411. Primary care services management payment. Subtitle C—Chronic care disease management Sec. 421. Chronic care disease management. Sec. 422. Chronic Care Education Centers. Subtitle D—Part D improvements Sec. 431. Process for individuals entering the Medicare coverage gap to switch to a plan that provides coverage in the gap. Subtitle E—Improving quality in hospitals for all patients Sec. 441. Improving quality in hospitals for all patients. Subtitle F—End-of-life care improvements Sec. 451. Patient empowerment and following a patient’s health care wishes. Sec. 452. Permitting hospice beneficiaries to receive curative care. Sec. 453. Providing beneficiaries with information regarding end-of-life care clearinghouse. Sec. 454. Clearinghouse. Subtitle G—Additional Provisions Sec. 461. Additional cost information. Sec. 462. Reducing Medicare paperwork and regulatory burdens. TITLE V—State Health Help Agencies Sec. 501. Establishment. Sec. 502. Responsibilities and authorities. Sec. 503. Appropriations for Transition to State Health Help Agencies. TITLE VI—Shared responsibilities Subtitle A—Individual responsibilities Sec. 601. Individual responsibility to ensure HAPI plan coverage. Subtitle B—Employer responsibilities Sec. 611. Health care responsibility payments. Sec. 612. Distribution of individual responsibility payments to HHAs. Subtitle C—Insurer responsibilities Sec. 621. Insurer responsibilities. Subtitle D—State responsibilities Sec. 631. State responsibilities. Sec. 632. Empowering states to innovate through waivers. Subtitle E—Federal Fallback Guarantee Responsibility Sec. 641. Federal guarantee of access to coverage. Subtitle F—Federal Financing Responsibilities Sec. 651. Appropriation for subsidy payments. Sec. 652. Recapture of Medicare and 90 percent of Medicaid Federal DSH funds to strengthen Medicare and ensure continued support for public health programs. Subtitle G—Tax treatment of health care coverage under Healthy Americans program; termination of coverage under other governmental programs and transition rules for Medicaid and CHIP Part I—Tax treatment of health care coverage under Healthy Americans program Sec. 661. Limited employee income and payroll tax exclusion for employer shared responsibility payments, historic retiree health contributions, and transitional coverage contributions. Sec. 662. Exclusion for limited employer-provided health care fringe benefits. Sec. 663. Limited employer deduction for employer shared responsibility payments, historic retiree health contributions, and other health care expenses. Sec. 664. Health care standard deduction. Sec. 665. Modification of other tax incentives to complement Healthy Americans program. Part II—Clarification of ERISA treatment; termination of coverage under other governmental programs and transition rules for Medicaid and CHIP Sec. 671. Clarification of ERISA applicability to employer-sponsored HAPI plans. Sec. 672. Federal Employees Health Benefits Plan. Sec. 673. Medicaid and CHIP. TITLE VII—Purchasing Health Services and Products That Are Most Effective Subtitle A—Effective health services and products Sec. 701. One time disallowance of deduction for advertising and promotional expenses for certain prescription pharmaceuticals. Sec. 702. Enhanced new drug and device approval. Sec. 703. Medical schools and finding what works in health care. Sec. 704. Finding affordable health care providers nearby. Subtitle B—Other provisions to improve health care services and quality Sec. 711. Individual medical records. Sec. 712. Bonus payment for medical malpractice reform. Sec. 713. Prioritizing health care employment and training activities. TITLE VIII—Containing medical costs and getting more value for the health care dollar Sec. 801. Cost-containment results of the Healthy Americans Act.

2.

Findings

Congress makes the following findings: (1)Americans want affordable, guaranteed private health coverage that makes them healthier and can never be taken away. (2)American health care provides primarily sick care and does not do enough to prevent chronic illnesses like heart disease, stroke, and diabetes. This results in significantly higher health costs for all Americans. (3)Staying as healthy as possible often requires an individual to change behavior and assume more personal responsibility for his or her health. (4)Personal responsibility for one’s health should include purchasing one’s own private health care coverage. (5)To accompany this new focus on staying healthy and personal responsibility, our government must guarantee that all Americans receive private affordable health coverage that can never be taken away. (6)Financing this guarantee should be a shared responsibility between individuals, the Government, and employers. (7)The $2,200,000,000,000 spent annually on American health care must be spent more effectively in order to meet this guarantee. (8)This guarantee must include easier access to understandable information about the quality, cost, and effectiveness of health care providers, products, and services. (9)The fact that businesses in the United States compete globally against businesses whose governments pay for health care, coupled with the aging of the American population and the explosive growth of preventable health problems, makes the status quo in American health care unacceptable.

3.

Definitions

In this Act: (1)

Adult individual

The term adult individual means an individual who— (A)is— (i)age 19 or older; (ii)a resident of a State; (iii)(I)a United States citizen; or (II)an alien with permanent residence; (iv)not a dependent child; and (v)not an alien unlawfully present in the United States; and (B)in the case of an incarcerated individual, such an individual who is incarcerated for less than 1 month. (2)

Alien with permanent residence

The term alien with permanent residence has the meaning given the term qualified alien in section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641). (3)

Covered individual

The term covered individual means an individual who is enrolled in a HAPI plan. (4)

Dependent child

The term dependent child has the meaning given the term qualifying child in section 152(c) of the Internal Revenue Code of 1986. (5)

HAPI plan

The term HAPI plan means— (A)a Healthy Americans Private Insurance plan described under subtitle B of title I; or (B)an employer-sponsored health coverage plan described under section 103 offered by an employer. (6)

HHA

The term HHA means the Health Help Agency of a State as described under title V. (7)

Health insurance issuer

The term health insurance issuer means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (7)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974). Such term does not include a group health plan. (8)

Health maintenance organization

The term health maintenance organization means— (A)a federally qualified health maintenance organization (as defined in section 1301(a)), (B)an organization recognized under State law as a health maintenance organization, or (C)a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization. (9)

Personal responsibility contribution

The term personal responsibility contribution means a payment made by a covered individual to a health care provider or a health insurance issuer with respect to the provision of health care services under a HAPI plan, not including any health insurance premium payment. (10)

Qualified collective bargaining agreement

(A)

In general

The term qualified collective bargaining agreement means an agreement between a qualified collective bargaining employer and an employee organization that represents the employees of such employer that is in effect until the date that is the earlier of— (i)January 1 of the first year which is more than 7 years after the date of enactment of this Act, or (ii)the date the collective bargaining agreement expires. (B)

Qualified collective bargaining employer

The term qualified collective bargaining employer means an employer who provides health insurance to employees under the terms of a collective bargaining agreement which is entered into before the date of the enactment of this Act. (11)

Secretary

The term Secretary means the Secretary of Health and Human Services. (12)

State

The term State means each of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and other territories of the United States. (13)

State of residence

The term State of residence, with respect to an individual, means the State in which the individual has primary residence.