[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 698 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 698

   To ensure the provision of high-quality health care coverage for 
uninsured individuals through State health care coverage pilot projects 
 that expand coverage and access and improve quality and efficiency in 
                        the health care system.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 25, 2009

Mr. Feingold (for himself, Mr. Graham, and Ms. Collins) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To ensure the provision of high-quality health care coverage for 
uninsured individuals through State health care coverage pilot projects 
 that expand coverage and access and improve quality and efficiency in 
                        the health care system.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``State-Based Health Care Reform 
Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The need for health care reform has reached crisis 
        proportions in America, with over 46,000,000 Americans 
        uninsured. Children accounted for 8,600,000 of these 
        individuals.
            (2) Health outcomes for the uninsured are worse than health 
        outcomes for those who have health insurance. According to the 
        Institute of Medicine, the number of deaths due to uninsurance 
        among adults ages 25 to 64 is estimated at around 22,000 a 
        year.
            (3) The cost of providing care to the uninsured weighs 
        heavily on the United States economy. According to research 
        done by the journal Health Affairs, the uninsured received 
        approximately $56,000,000,000 in uncompensated care in 2008. 
        Government programs finance about 75 percent of uncompensated 
        care.
            (4) An overwhelming majority of Americans believe that our 
        health care system is broken, and is in need of immediate 
        reform.
            (5) In recent years, States have led the charge for health 
        reform, implementing a wide array of health reforms. These 
        reforms offer Congress valuable lessons on what has proven to 
        work, and what challenges to expect.
            (6) The Federal Government is uniquely positioned to 
        significantly improve the way health care is financed, 
        delivered, and consumed in America. State-based reforms are one 
        of many options available to Congress in undertaking health 
        care reform.

SEC. 3. PURPOSE.

    It is the purpose of this Act to establish a program to award 
grants to States for the establishment of State-based projects to--
            (1) establish pilot projects to increase health care 
        coverage for uninsured individuals in selected States within 
        the 5-year period beginning on the date of enactment of this 
        Act;
            (2) ensure high-quality health care coverage with the goal 
        of providing adequate access to providers, services, and 
        benefits;
            (3) improve the efficiency of health care spending and 
        lower the cost of health care for the participating State; and
            (4) provide health care coverage with the ultimate goal of 
        covering all individuals residing within States awarded a grant 
        under this Act.

                     TITLE I--HEALTH CARE COVERAGE

SEC. 101. STATE-BASED HEALTH CARE COVERAGE PROGRAM.

    (a) Applications by States, Multi-State Regions, Local Governments, 
and Tribes.--
            (1) State application.--A State, in consultation with local 
        governments, Indian tribes, and Indian organizations involved 
        in the provision of health care (referred to in this Act as a 
        ``State''), may apply for a State health care coverage grant 
        for the entire State (or for regions of two or more States) 
        under paragraph (2).
            (2) Submission of application.--In accordance with this 
        section, each State desiring to implement a State health care 
        reform program shall submit an application to the Health Care 
        Coverage Task Force established under subsection (b) (referred 
        to in this section as the ``Task Force'') for approval and 
        referral to Congress.
            (3) Local government and other applications.--
                    (A) In general.--Where a State fails to submit an 
                application under this section, a unit of local 
                government of such State, or a consortium of such units 
                of local governments, may submit, with the 
                collaboration of the State government, an application 
                directly to the Task Force for programs or projects 
                under this section. Such an application shall be 
                subject to the requirements of this section.
                    (B) Other applications.--Subject to such additional 
                regulations as the Secretary of Health and Human 
                Services (referred to in this Act as the ``Secretary'') 
                may prescribe, a unit of local government, Indian 
                tribe, or Indian health organization may submit an 
                application under this section, whether or not the 
                State submits such an application, if such unit, tribe, 
                or organization can demonstrate unique demographic 
                needs or a significant population size that warrants a 
                substate program under this subsection.
    (b) Health Care Coverage Task Force.--
            (1) Establishment.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary shall establish a 
        Health Care Coverage Task Force in accordance with this 
        subsection.
            (2) Membership.--
                    (A) In general.--The Task Force shall be comprised 
                of the Secretary and not fewer than 16 members to be 
                appointed in accordance with subparagraph (B).
                    (B) Appointed members.--With respect to the members 
                appointed under subparagraph (A)--
                            (i) two individuals shall be appointed by 
                        the Speaker of the House of Representatives;
                            (ii) two individuals shall be appointed by 
                        the minority leader of the House of 
                        Representatives;
                            (iii) two individuals shall be appointed by 
                        the majority leader of the Senate;
                            (iv) two individuals shall be appointed by 
                        the minority leader of the Senate; and
                            (v) not to exceed 8 members shall be 
                        appointed by the Comptroller General.
                    (C) Requirements.--In appointing members to the 
                Task Force under subparagraph (B)(v), the Comptroller 
                General shall ensure that--
                            (i) such members include at least 2 
                        representatives of consumers who are uninsured 
                        and who have had a chronic illness, 1 of which 
                        shall represent individuals with disabilities;
                            (ii) such members include individuals--
                                    (I) representing business and 
                                labor; and
                                    (II) who are health care providers;
                            (iii) such members have a broad geographic 
                        representation and be balanced between urban 
                        and rural areas; and
                            (iv) such members include representatives 
                        of Indian tribes or tribal organizations.
            (3) General duties.--
                    (A) Approval of applications and other matters.--
                The Task Force shall--
                            (i) formally approve the applications of 
                        States for grants under this section, and 
                        submit a legislative proposal concerning such 
                        approvals (which shall be politically balanced 
                        and include a variety of different approaches 
                        to covering the uninsured populations of 
                        States) to Congress together with 
                        recommendations on the level of funding 
                        required;
                            (ii) establish minimum performance measures 
                        with respect to coverage, quality, and cost of 
                        State programs, as described under subsection 
                        (c)(1);
                            (iii) conduct a thorough review of the 
                        grant application from a State and conduct 
                        detailed discussions and negotiations with such 
                        State applicants concerning possible 
                        modifications and adjustments;
                            (iv) be responsible for monitoring the 
                        status and progress achieved under programs and 
                        projects granted under this section; and
                            (v) report to the public concerning 
                        progress made by States with respect to the 
                        performance measures and goals established 
                        under this Act, the periodic progress of the 
                        State relative to its State performance 
                        measures and goals, and the State program 
                        application procedures, by region and State 
                        jurisdiction.
                    (B) Limitation.--The Task Force shall not approve a 
                State application that--
                            (i) proposes to adopt criteria for income 
                        or resource standards or methodologies for 
                        purposes of determining an individual's 
                        eligibility for medical assistance under the 
                        State plan for services provided through the 
                        State Medicaid program under title XIX of the 
                        Social Security Act, the State Children's 
                        Health Insurance Program under title XXI of the 
                        Act, the Medicare program under title XVIII of 
                        such Act, or any other State and local program 
                        that provides health care to low-income or 
                        targeted populations, as defined by such 
                        program policies, that are more restrictive 
                        than those applied as of the date of enactment 
                        of this Act;
                            (ii) would revise Federal requirements for 
                        participation in the State Medicaid program, 
                        the State Children's Health Insurance Program, 
                        or the Medicare program in a manner that 
                        applies criteria for eligibility that is more 
                        restrictive than the criteria applied on the 
                        date of enactment of this Act for those 
                        categories of individuals currently enrolled in 
                        such program or future categories of 
                        individuals under applicable law; or
                            (iii) would result in making those 
                        individuals who are enrolled, or who may be 
                        enrolled, in a program described in clause (ii) 
                        ineligible for such enrollment in such program.
            (4) Period of appointment; representation requirements; 
        vacancies.--Members shall be appointed for a term of 5 years. 
        Any vacancy on the Task Force shall not affect its powers, but 
        shall be filled within 60 days and in the same manner as the 
        original appointment.
            (5) Chairperson, meetings, approval of state plans.--
                    (A) Chairperson.--The Task Force shall select a 
                Chairperson from among its members.
                    (B) Quorum.--A majority of the members of the Task 
                Force shall constitute a quorum, but a lesser number of 
                members may hold hearings subject to approval by the 
                Task Force or the Chairperson.
                    (C) Meetings.--Not later than 30 days after the 
                date on which all members of the Task Force have been 
                appointed, the Task Force shall hold its first meeting. 
                The Task Force shall meet at the call of the 
                Chairperson.
            (6) Powers of the task force.--
                    (A) Negotiations with states.--The Task Force may 
                conduct detailed discussions and negotiations with 
                States submitting applications under this section, 
                either individually or in groups, to facilitate a final 
                set of recommendations for purposes of subsection 
                (c)(1)(C). Such final set of recommendations shall be 
                made available to the general public. Such negotiations 
                shall, to the extent practicable, be conducted in a 
                public forum. The minutes of any meetings at which such 
                negotiations are conducted shall be maintained and made 
                available to the general public.
                    (B) Subcommittees.--The Task Force may establish 
                such subcommittees as the Task Force determines are 
                necessary to increase the efficiency of the Task Force.
                    (C) Hearings.--The Task Force may hold hearings, so 
                long as the Task Force determines such meetings to be 
                necessary in order to carry out the purposes of this 
                Act, sit and act at such times and places, take such 
                testimony, and receive such evidence as the Task Force 
                considers advisable to carry out the purposes of this 
                subsection.
                    (D) Annual meeting.--In addition to other meetings 
                the Task Force may hold, the Task Force shall hold an 
                annual meeting with the participating States under this 
                section for the purpose of having States report 
                progress toward the purposes described in section 3 and 
                for an exchange of public information.
                    (E) Information.--The Task Force may obtain 
                information directly from any Federal department or 
                agency as the Task Force considers necessary to carry 
                out the provisions of this subsection. Upon request of 
                the Chairperson of the Task Force, the head of such 
                department or agency shall furnish such information to 
                the Task Force.
                    (F) Contracting.--The Task Force may enter into 
                contracts with qualified independent organizations to 
                obtain necessary information for the development of the 
                performance standards, reporting requirements, 
                financing mechanisms, or any other matters determined 
                by the Task Force to be appropriate and reasonable.
                    (G) Postal services.--The Task Force may use the 
                United States mails in the same manner and under the 
                same conditions as other departments and agencies of 
                the Federal Government.
            (7) Personnel matters.--
                    (A) Compensation.--Each member of the Task Force 
                who is not an officer or employee of the Federal 
                Government shall be compensated at a rate equal to the 
                daily equivalent of the annual rate of basic pay 
                prescribed for level IV of the Executive Schedule under 
                section 5315 of title 5, United States Code, for each 
                day (including travel time) during which such member is 
                engaged in the performance of the duties of the Task 
                Force. All members of the Task Force who are officers 
                or employees of the United States shall serve without 
                compensation in addition to that received for their 
                services as officers or employees of the United States.
                    (B) Travel expenses.--The members of the Task Force 
                shall be allowed travel expenses, including per diem in 
                lieu of subsistence, at rates authorized for employees 
                of agencies under subchapter I of chapter 57 of title 
                5, United States Code, while away from their homes or 
                regular places of business in the performance of 
                services for the Task Force.
                    (C) Staff.--The Chairperson of the Task Force may, 
                without regard to the civil service laws and 
                regulations, appoint and terminate personnel as may be 
                necessary to enable the Task Force to perform its 
                duties.
                    (D) Detail of government employees.--Any Federal 
                Government employee may be detailed to the Task Force 
                without reimbursement, and such detail shall be without 
                interruption or loss of civil service status or 
                privilege.
                    (E) Temporary and intermittent services.--The 
                Chairperson of the Task Force may procure temporary and 
                intermittent services under section 3109(b) of title 5, 
                United States Code, at rates for individuals which do 
                not exceed the daily equivalent of the annual rate of 
                basic pay prescribed for level V of the Executive 
                Schedule under section 5316 of such title.
            (8) Funding.--For the purpose of carrying out this 
        subsection, there are authorized to be appropriated $4,000,000 
        for fiscal year 2010 and each fiscal year thereafter.
    (c) State Plan.--
            (1) In general.--A State that seeks to receive a grant to 
        operate a program under this section shall prepare and submit 
        to the Task Force, as part of the application under subsection 
        (a), a State health care plan that--
                    (A) designates the lead State entity that will be 
                responsible for administering the State program;
                    (B) describes the benefits that will be provided to 
                all individuals covered under the State program, which 
                shall, at a minimum, provide for the same scope of 
                coverage required under section 2103 (a)(1), (a)(2), 
                and (a)(4), (b), and (c) of title XXI of the Social 
                Security Act;
                    (C) provides a methodology, in consultation with 
                organizations including the Institute of Medicine, for 
                demonstrating that the choice of benefits under the 
                State program is based upon available medical evidence;
                    (D) contains a description of any other health care 
                reform programs that the State will implement under the 
                State program, which may include the expansion of the 
                State's Medicaid, SCHIP or other public health care 
                programs, single-payer systems, the implementation of 
                State-based health savings accounts, the establishment 
                of health care purchasing or pooling arrangements, new 
                individual insurance purchasing options, State tax 
                credits, or any combination of such reforms and any 
                approaches submitted by the State and approved by the 
                Task Force in the State application;
                    (E) describes the number and percentage of 
                currently uninsured individuals who will achieve 
                coverage under the State health program;
                    (F) provides and describes the manner in which the 
                State will ensure that an increased number of 
                individuals residing within the State will have 
                expanded access to health care coverage with a specific 
                5-year target for reduction in the number of uninsured 
                individuals through either private or public program 
                expansion, or both, in accordance with the options 
                established under this Act;
                    (G) identifies Federal, State, or local and private 
                programs that currently provide health care services in 
                the State and describes--
                            (i) how such programs could be coordinated 
                        with the State health program, to the extent 
                        practicable; and
                            (ii) current Federal, State, and local 
                        expenditures for the identified programs that 
                        utilize public financing;
                    (H) provides for improvements in the availability 
                of appropriate health care services that will increase 
                access to care in urban, rural, and frontier areas of 
                the State with medically underserved populations or 
                where there is an inadequate supply of health care 
                providers and the area meets the requirements for 
                designation as a Health Professional Shortage Area 
                under section 332 of the Public Health Service Act (42 
                U.S.C. 254e); and
                    (I) otherwise complies with this subsection.
            (2) Effectiveness and efficiency.--The State plan shall 
        include provisions to improve the effectiveness and efficiency 
        of health care in the State, including provisions to attempt to 
        reduce administrative health care costs within the State.
            (3) Costs.--
                    (A) In general.--With respect to the costs of 
                health care provided under the program, the State plan 
                shall--
                            (i) describe the public and private sector 
                        financing to be provided for the State health 
                        program;
                            (ii) estimate the amount of Federal, State, 
                        and local expenditures, as well as the costs to 
                        business and individuals under the State health 
                        program;
                            (iii) describe how the State plan will 
                        ensure the financial solvency of the State 
                        health program; and
                            (iv) contain assurances that the State will 
                        comply with the premium and cost-sharing 
                        limitations described in subparagraph (B).
                    (B) Premium and cost-sharing limitations.--
                            (i) Premiums.--In providing health care 
                        coverage under a State program under this Act, 
                        the State shall ensure that--
                                    (I) with respect to an individual 
                                whose family income is at or below 100 
                                percent of the poverty line, the State 
                                program shall not require--
                                            (aa) the payment of 
                                        premiums for such coverage; or
                                            (bb) the payment of cost-
                                        sharing for such coverage in an 
                                        amount that exceeds .5 percent 
                                        of the family's income for the 
                                        year involved;
                                    (II) with respect to an individual 
                                whose family income is greater than 100 
                                percent, but at or below 200 percent, 
                                of the poverty line, the State program 
                                shall not require--
                                            (aa) the payment of 
                                        premiums for such coverage in 
                                        excess of 20 percent of the 
                                        average cost of providing 
                                        benefits to an individual or 
                                        family or 3 percent of the 
                                        amount of the family's income 
                                        for the year involved; or
                                            (bb) the payment of cost-
                                        sharing for such coverage in an 
                                        amount that, together with the 
                                        premium amount, does not exceed 
                                        5 percent of the family's 
                                        income for the year involved; 
                                        and
                                    (III) with respect to an individual 
                                whose family income is greater than 200 
                                percent, but at or below 300 percent, 
                                of the poverty line, the State program 
                                shall not require--
                                            (aa) the payment of 
                                        premiums for such coverage in 
                                        excess of 20 percent of the 
                                        average cost of providing 
                                        benefits to an individual or 
                                        family or 5 percent of the 
                                        amount of the family's income 
                                        for the year involved; or
                                            (bb) the payment of cost-
                                        sharing for such coverage in an 
                                        amount that, together with the 
                                        premium amount, does not exceed 
                                        7 percent of the family's 
                                        income for the year involved.
                            (ii) Definition.--For purposes of this 
                        subparagraph, the term ``poverty line'' has the 
                        meaning given such term in section 2110(c)(5) 
                        of the Social Security Act (42 U.S.C. 
                        1397jj(c)(5)).
            (4) Protection for lower income individuals.--The State 
        plan may only vary premiums, deductibles, coinsurance, and 
        other cost-sharing under the plan based on the family income of 
        the family involved in a manner that does not favor individuals 
        from families with higher income over individuals from families 
        with lower income.
            (5) Authority to contract.--The State plan may provide for 
        the awarding of contracts by the State to independent entities 
        (such as the Institute of Medicine) for the conduct of 
        activities to enable the State to fully comply with the 
        requirements of this Act and of the State plan.
    (d) Review; Determination; and Project Period.--
            (1) Initial review.--With respect to a State application 
        for a grant under subsection (a), the Secretary and the Task 
        Force shall, not later than 90 days after receipt of such 
        application, complete an initial review of such State 
        application, an analysis of the scope of the proposal, and a 
        determination of whether additional information is needed from 
        the State. The Task Force shall advise the State within such 
        90-day period of the need to submit additional information.
            (2) Final determination.--Not later than 90 days after 
        completion of the initial review under paragraph (1), the Task 
        Force shall determine whether to approve such application and 
        submit a legislative proposal concerning such application to 
        Congress for final approval. Such application may be approved 
        only if \2/3\ of the members of the Task Force vote to approve 
        such application.
            (3) Program or project period.--If approved by the Task 
        Force and Congress, a State program or project may extend for a 
        period not to exceed 5 years and may be extended for subsequent 
        5-year periods upon approval by the Task Force and the 
        Secretary, based upon achievement of targets as specified by 
        the Task Force, except that a shorter period may be requested 
        by a State and granted by the Secretary.
    (e) Expedited Congressional Consideration.--
            (1) Introduction and committee consideration.--
                    (A) Introduction.--The legislative proposal 
                submitted pursuant to subsection (b)(3)(A) shall be in 
                the form of a joint resolution (in this subsection 
                referred to as the ``resolution''). Such resolution 
                shall be introduced in the House of Representatives by 
                the Speaker, and in the Senate, by the majority leader, 
                immediately upon receipt of the language and shall be 
                referred to the appropriate committee of Congress. If 
                the resolution is not introduced in accordance with the 
                preceding sentence, the resolution may be introduced in 
                either House of Congress by any member thereof.
                    (B) Committee consideration.--A resolution 
                introduced in the House of Representatives shall be 
                referred to the appropriate committees of jurisdiction 
                within the House of Representatives. A resolution 
                introduced in the Senate shall be referred to the 
                appropriate committees of jurisdiction within the 
                Senate. Not later than 15 calendar days after the 
                introduction of the resolution, the committee of 
                Congress to which the resolution was referred shall 
                report the resolution. If the committee has not 
                reported such resolution (or an identical resolution) 
                at the end of 15 calendar days after its introduction 
                or at the end of the first day after there has been 
                reported to the House involved a resolution, whichever 
                is earlier, such committee shall be deemed to be 
                discharged from further consideration of such 
                resolution and such resolution shall be placed on the 
                appropriate calendar of the House involved. No 
                amendments shall be in order to such resolution during 
                committee consideration.
            (2) Expedited procedure.--
                    (A) Consideration.--Not later than 5 days after the 
                date on which a committee has been discharged from 
                consideration of a resolution, the Speaker of the House 
                of Representatives, or the Speaker's designee, or the 
                majority leader of the Senate, or the leader's 
                designee, shall move to proceed to the consideration of 
                the resolution. It shall also be in order for any 
                member of the House of Representatives or the Senate, 
                respectively, to move to proceed to the consideration 
                of the resolution at any time after the conclusion of 
                such 5-day period. All points of order against the 
                resolution (and against consideration of the 
                resolution) are waived. A motion to proceed to the 
                consideration of the resolution is highly privileged in 
                the House of Representatives and is privileged in the 
                Senate and is not debatable. The motion is not subject 
                to amendment, to a motion to postpone consideration of 
                the resolution, or to a motion to proceed to the 
                consideration of other business. A motion to reconsider 
                the vote by which the motion to proceed is agreed to or 
                not agreed to shall not be in order. If the motion to 
                proceed is agreed to, the House of Representatives or 
                the Senate, as the case may be, shall immediately 
                proceed to consideration of the resolution without 
                intervening motion, order, or other business, and the 
                resolution shall remain the unfinished business of the 
                House of Representatives or the Senate, as the case may 
                be, until disposed of. No amendments shall be in order 
                to such resolution during such consideration.
                    (B) Consideration by other house.--If, before the 
                passage by one House of the resolution that was 
                introduced in such House, such House receives from the 
                other House a resolution as passed by such other 
                House--
                            (i) the resolution of the other House shall 
                        not be referred to a committee and may only be 
                        considered for final passage, without 
                        amendment, in the House that receives it under 
                        clause (iii);
                            (ii) the procedure in the House in receipt 
                        of the resolution of the other House, with 
                        respect to the resolution that was introduced 
                        in the House in receipt of the resolution of 
                        the other House, shall be the same as if no 
                        resolution had been received from the other 
                        House; and
                            (iii) notwithstanding clause (ii), the vote 
                        on final passage shall be on the reform bill of 
                        the other House.
                Upon disposition of a resolution that is received by 
                one House from the other House, it shall no longer be 
                in order to consider the resolution bill that was 
                introduced in the receiving House.
            (3) Rules of the senate and house of representatives.--This 
        subsection is enacted by Congress--
                    (A) as an exercise of the rulemaking power of the 
                Senate and House of Representatives, respectively, and 
                is deemed to be part of the rules of each House, 
                respectively, but applicable only with respect to the 
                procedure to be followed in that House in the case of a 
                resolution, and it supersedes other rules only to the 
                extent that it is inconsistent with such rules; and
                    (B) with full recognition of the constitutional 
                right of either House to change the rules (so far as 
                they relate to the procedure of that House) at any 
                time, in the same manner, and to the same extent as in 
                the case of any other rule of that House.
    (f) Funding.--
            (1) In general.--The Secretary shall provide a grant to a 
        State that has an application approved under subsection (d)(2) 
        and agreed to by Congress under subsection (e) to enable such 
        State to carry out the State health program under the grant.
            (2) Amount of grant.--The amount of a grant provided to a 
        State under paragraph (1) shall be determined based upon the 
        recommendations of the Task Force, subject to the amount 
        appropriated under subsection (i).
            (3) Matching requirement.--To be eligible to receive a 
        grant under paragraph (1), a State shall provide assurances to 
        the Secretary that the State shall, in addition to meeting the 
        requirement of paragraph (4), contribute to the costs of 
        carrying out activities under the grant an amount equal to not 
        less than the product of--
                    (A) the amount of the grant; and
                    (B) one minus the sum of the enhanced FMAP for the 
                State (as defined in section 2105(b) of the Social 
                Security Act (42 U.S.C. 1397ee(b))) and 5 percent.
            (4) Maintenance of effort.--A State, in utilizing the 
        proceeds of a grant received under paragraph (1), shall 
        maintain the non-Federal expenditures of the State and local 
        units of government for health care coverage purposes 
        (including expenditures under the State programs under titles 
        XIX and XXI of the Social Security Act) for the support of 
        direct health care delivery at a level equal to not less than 
        the level of such expenditures maintained by the State for the 
        fiscal year preceding the fiscal year for which the grant is 
        received. Funds received under this Act shall be used to 
        supplement, not supplant existing State spending for the 
        activities described in this Act. Such expenditures shall be 
        increased annually by the same percentage as the percentage 
        increase in the Consumer Price Index for All Urban Consumers.
            (5) Compliance.--The Secretary may withhold payments under 
        this Act from a State that fails to comply with its State plan 
        under subsection (c) and the reporting requirements under 
        subsection (g)(1).
    (g) Reports.--
            (1) By states.--Each State that has received a grant under 
        subsection (f)(1) shall submit to the Task Force an annual 
        report for the period representing the respective State's 
        fiscal year, that shall contain a description of the results, 
        with respect to health care coverage, quality, and costs, of 
        the State program.
            (2) By task force.--At the end of the 5-year period 
        beginning on the date on which the Secretary awards the first 
        grant under paragraph (1), the Task Force established under 
        subsection (b) shall prepare and submit to the appropriate 
        committees of Congress, a report on the progress made by States 
        receiving grants under paragraph (1) in meeting the goals of 
        expanded coverage, improved quality, and cost containment 
        through performance measures established during the 5-year 
        period of the grant. Such report shall contain--
                    (A) the recommendation of the Task Force concerning 
                any future action that Congress should take concerning 
                health care reform, including whether or not to extend 
                the program established under this subsection;
                    (B) an evaluation of the effectiveness of State 
                health care coverage reforms--
                            (i) in expanding health care coverage for 
                        State residents;
                            (ii) in improving the quality of health 
                        care provided in the States;
                            (iii) in reducing or containing health care 
                        costs in the States; and
                            (iv) on employer sponsored coverage;
                    (C) recommendations regarding the advisability of 
                increasing Federal financial assistance for State 
                ongoing or future health program initiatives, including 
                the amount and source of such assistance; and
                    (D) recommendations concerning whether any 
                particular State program should serve as a model for 
                implementation as a national health care reform 
                program.
    (h) Miscellaneous Provisions.--
            (1) Application of certain requirements.--
                    (A) Restriction on application of preexisting 
                condition exclusions.--
                            (i) In general.--Subject to subparagraph 
                        (B), a State shall not permit the imposition of 
                        any preexisting condition exclusion for covered 
                        benefits under a program or project under this 
                        section.
                            (ii) Group health plans and group health 
                        insurance coverage.--If the State program or 
                        project provides for benefits through payment 
                        for, or a contract with, a group health plan or 
                        group health insurance coverage, the program or 
                        project may permit the imposition of a 
                        preexisting condition exclusion but only 
                        insofar and to the extent that such exclusion 
                        is permitted under the applicable provisions of 
                        part 7 of subtitle B of title I of the Employee 
                        Retirement Income Security Act of 1974 and 
                        title XXVII of the Public Health Service Act.
                    (B) Compliance with other requirements.--Coverage 
                offered under the program or project shall comply with 
                the requirements of subpart 2 of part A of title XXVII 
                of the Public Health Service Act insofar as such 
                requirements apply with respect to a health insurance 
                issuer that offers group health insurance coverage.
            (2) Prevention of duplicative payments.--
                    (A) Other health plans.--No payment shall be made 
                to a State under this section for expenditures for 
                health assistance provided for an individual to the 
                extent that a private insurer (as defined by the 
                Secretary by regulation and including a group health 
                plan (as defined in section 607(1) of the Employee 
                Retirement Income Security Act of 1974), a service 
                benefit plan, and a health maintenance organization) 
                would have been obligated to provide such assistance 
                but for a provision of its insurance contract which has 
                the effect of limiting or excluding such obligation 
                because the individual is eligible for or is provided 
                health assistance under the plan.
                    (B) Other federal governmental programs.--Except as 
                provided in any other provision of law, no payment 
                shall be made to a State under this section for 
                expenditures for health assistance provided for an 
                individual to the extent that payment has been made or 
                can reasonably be expected to be made promptly (as 
                determined in accordance with regulations) under any 
                other federally operated or financed health care 
                insurance program, other than an insurance program 
                operated or financed by the Indian Health Service, as 
                identified by the Secretary. For purposes of this 
                paragraph, rules similar to the rules for overpayments 
                under section 1903(d)(2) of the Social Security Act 
                shall apply.
            (3) Application of certain general provisions.--The 
        following sections of the Social Security Act shall apply to 
        States under this section in the same manner as they apply to a 
        State under such title XIX:
                    (A) Title xix provisions.--
                            (i) Section 1902(a)(4)(C) (relating to 
                        conflict of interest standards).
                            (ii) Paragraphs (2), (16), and (17) of 
                        section 1903(i) (relating to limitations on 
                        payment).
                            (iii) Section 1903(w) (relating to 
                        limitations on provider taxes and donations).
                            (iv) Section 1920A (relating to presumptive 
                        eligibility for children).
                    (B) Title xi provisions.--
                            (i) Section 1116 (relating to 
                        administrative and judicial review), but only 
                        insofar as consistent with this title.
                            (ii) Section 1124 (relating to disclosure 
                        of ownership and related information).
                            (iii) Section 1126 (relating to disclosure 
                        of information about certain convicted 
                        individuals).
                            (iv) Section 1128A (relating to civil 
                        monetary penalties).
                            (v) Section 1128B(d) (relating to criminal 
                        penalties for certain additional charges).
                            (vi) Section 1132 (relating to periods 
                        within which claims must be filed).
            (4) Relation to other laws.--Health benefits coverage 
        provided under a State program or project under this section 
        shall be treated as creditable coverage for purposes of part 7 
        of subtitle B of title I of the Employee Retirement Income 
        Security Act of 1974, title XXVII of the Public Health Service 
        Act, and subtitle K of the Internal Revenue Code of 1986.
    (i) Authorizations.--
            (1) In general.--There are appropriated in each of fiscal 
        years 2010 through 2019 to carry out this Act, an amount equal 
        to the amount of savings to the Federal Government in each such 
        fiscal year as a result of the enactment of the provisions of 
        title II.
            (2) Use of funds.--Amounts appropriated for a fiscal year 
        under paragraph (1) and not expended may be used in subsequent 
        fiscal years to carry out this section.
            (3) Limitation.--Notwithstanding any other provision of 
        this Act, the total amount of funds appropriated to carry out 
        this Act through fiscal year 2019 shall not exceed 
        $40,000,000,000.
    (j) Termination.--The authority provided under this title shall 
terminate on the date that is 10 years after the date of enactment of 
this Act.

                           TITLE II--OFFSETS

SEC. 201. INCREASE IN REBATES FOR COVERED OUTPATIENT DRUGS.

    Section 1927(c)(1)(B)(i) of the Social Security Act (42 U.S.C. 
1396r-8(c)(1)(B)(i)) is amended--
            (1) in subclause (IV), by striking ``and'' after the 
        semicolon;
            (2) in subclause (V)--
                    (A) by inserting ``and before January 1, 2010,'' 
                after ``1995,''; and
                    (B) by striking the period and inserting ``; and''; 
                and
            (3) by adding at the end the following:
                                    ``(VI) after December 31, 2009, is 
                                20 percent.''.

SEC. 202. AVIATION SECURITY SERVICE PASSENGER FEES.

    Section 44940 of title 49, United States Code, is amended--
            (1) in subsection (a)(1), by inserting ``in an amount equal 
        to $5.00 per one-way trip'' after ``uniform fee'';
            (2) by striking subsection (c); and
            (3) in subsection (d)--
                    (A) in paragraph (2), by striking ``subsection 
                (d)'' each place it appears and inserting ``this 
                subsection''; and
                    (B) in paragraph (3), by striking ``in accordance 
                with paragraph (1)'' and inserting ``under subsection 
                (a)(2)''.

SEC. 203. EXTENSION OF FCC SPECTRUM AUCTION AUTHORITY.

    Section 309(j)(11) of the Communications Act of 1934 (47 U.S.C. 
309(j)(11)) is amended by striking ``2011'' and inserting ``2019''.

SEC. 204. EXTENSION OF FEES FOR CERTAIN CUSTOMS SERVICES.

    Section 13031(j)(3)(A) and (B) of the Consolidated Omnibus Budget 
Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)(A) and (B)) is amended 
by striking ``2014'' each place it appears and inserting ``2019''.

SEC. 205. INCOME-RELATED REDUCTION IN PART D PREMIUM SUBSIDY.

    (a) In General.--Section 1860D-13(a) of the Social Security Act (42 
U.S.C. 1395w-113(a)) is amended by adding at the end the following new 
paragraph:
            ``(7) Reduction in premium subsidy based on income.--The 
        provisions of subsection (i) of section 1839 shall apply to the 
        monthly beneficiary premium under this subsection in the same 
        manner as they apply to the monthly premium under such section 
        except that in so applying--
                    ``(A) paragraph (1) of such subsection (i) to this 
                subsection--
                            ``(i) the reference to December 2006 is 
                        deemed a reference to December 2009; and
                            ``(ii) the reference to the monthly premium 
                        is deemed a reference to the base beneficiary 
                        premium (computed under paragraph (2) of this 
                        subsection);
                    ``(B) clause (i) of paragraph (3)(A) of such 
                subsection (i) to this subsection, the reference to 25 
                percentage points is deemed a reference to the 
                beneficiary premium percentage (as specified in 
                paragraph (3) of this subsection);
                    ``(C) clause (ii) of paragraph (3)(A) of such 
                subsection (i) to this subsection, the national average 
                monthly bid amount (computed under paragraph (4) of 
                this subsection) shall be substituted for the amount 
                specified in such clause (ii) (relating to the 
                unsubsidized part B premium amount); and
                    ``(D) subparagraph (B) of paragraph (3) of such 
                subsection (i) to this subsection, the reference to 
                2009 shall be a reference to 2010, the reference to 
                2007 shall be a reference to 2009, and the reference to 
                2008 shall be a reference to 2010.''.
    (b) Conforming Amendments.--
            (1) Medicare.--Section 1860D-13(a)(1) of the Social 
        Security Act (42 U.S.C. 1395w-113(a)(1)) is amended--
                    (A) by redesignating subparagraph (F) as 
                subparagraph (G);
                    (B) in subparagraph (G), as redesignated by 
                subparagraph (A), by striking ``(D) and (E)'' and 
                inserting ``(D), (E), and (F)''; and
                    (C) by inserting after subparagraph (E) the 
                following new subparagraph:
                    ``(F) Increase based on income.--The base 
                beneficiary premium shall be increased pursuant to 
                paragraph (7).''.
            (2) Internal revenue code.--Section 6103(l)(20) of the 
        Internal Revenue Code of 1986 (relating to disclosure of return 
        information to carry out Medicare part B premium subsidy 
        adjustment) is amended--
                    (A) in the heading, by striking ``part b premium 
                subsidy adjustment'' and inserting ``parts b and d 
                premium subsidy adjustments'';
                    (B) in subparagraph (A)--
                            (i) in the matter preceding clause (i), by 
                        inserting ``or 1860D-13(a)(7)'' after 
                        ``1839(i)''; and
                            (ii) in clause (vii), by inserting after 
                        ``the amount of such adjustment'' the 
                        following: ``or that the amount of the premium 
                        of the taxpayer under such subsection (as 
                        applied under section 1860D-13(a)(7)) may be 
                        subject to adjustment under such section 1860D-
                        13(a)(7) and the amount of such adjustment''; 
                        and
                    (C) in subparagraph (B), by inserting ``or such 
                section 1860D-13(a)(7)'' before the period at the end.
                                 <all>