1.This Act may be cited as
the Congressional Health Care for
Seniors Act of 2012
.
2.Enrolling
seniors in the same health care plans as Members of Congress
(a)Chapter 89 of title 5, United States Code, is
amended—
(1)in section
8901—
(A)in paragraph
(10), by striking and
at the end;
(B)in paragraph
(11), by striking the period at the end and inserting ; and
;
and
(C)by adding at the
end the following:
(12)the term
covered individual means an individual who, taking into account
section 226(k) of the Social Security Act, would have been entitled to, or
could have enrolled for, benefits under part A of title XVIII of such Act or
could have enrolled under part B of such title if section 1899B had not been
enacted.
;
(2)by inserting
after section 8901 the following:
I
;
(3)in section
8902—
(A)in subsection
(a)—
(i)by
inserting (1)
after (a)
; and
(ii)by
adding at the end the following:
(2)(A)In this paragraph, the
term equivalent health benefits plan means a health benefits plan
proposed to be provided that offers benefits that the Director of the Office of
Personnel Management determines are substantially equivalent or superior to
benefits offered under, and does not impose requirements that are substantially
different than requirements under, a health benefits plan in which an employee
could enroll on the date of enactment of the Congressional Health Care for Seniors Act of
2012 if the employee resided—
(i)anywhere in the United States;
or
(ii)in the same region of the United
States as the health benefits plan proposed to be provided.
(B)For contract years beginning on or
after January 1, 2014, if a carrier offers to provide an equivalent health
benefits plan, the Director shall enter into a contract with the carrier to
provide the equivalent health benefits
plan.
;
(B)in subsection
(e), by striking The Office may prescribe
and inserting
Subject to subsection (a)(2), the Office may prescribe
;
and
(C)by adding at the
end the following:
(p)A contract under
this chapter for a contract year beginning on or after January 1, 2014, shall
offer benefits for employees, annuitants, members of their families, former
spouses, persons having continued coverage under section 8905a of this title,
and covered individuals. In administering this subchapter and subchapter II,
employees, annuitants, members of their families, former spouses, persons
having continued coverage under section 8905a of this title, and covered
individuals shall be in the same risk
pool.
;
(4)in section
8904—
(A)by striking
(a) The benefits
and inserting The
benefits
;
(B)by striking
this subsection
each place it appears and inserting this
section
; and
(C)by striking
subsection (b);
(5)in section
8909(a)(1), by inserting and for all payments under section
8921(d)
before the semicolon;
(6)in section 8910,
by striking subsection (d); and
(7)by adding at the
end the following:
II
8921.Health
insurance for covered individuals
(a)For contract
years beginning on or after January 1, 2014, and except as otherwise provided
in this subchapter, the Director of the Office of Personnel Management shall
ensure that to the greatest extent possible health benefits plans provide
benefits for covered individuals to the same extent and in the same manner as
provided under subchapter I for employees, annuitants, members of their
families, former spouses, and persons having continued coverage under section
8905a of this title.
(b)(1)The Director shall
establish the deadline by which a covered individual shall elect to—
(A)enroll in a health benefits plan under
this chapter based on the status of the individual as a covered
individual;
(B)with the concurrence of the employer
or former employer of the covered individual, receive payments under subsection
(d) to assist in paying for health insurance provided through the employer or
former employer of the covered individual; or
(C)not enroll in a health benefits plan
or receive payments under this chapter.
(2)Failure to make a timely election
under this subsection shall be deemed as an election to not enroll in a health
benefits plan or receive payment under this chapter.
(3)A covered individual—
(A)may elect to enroll in a health
benefits plan as an individual; and
(B)may not enroll in a health benefits
plan for self and family.
(4)(A)A covered individual
who elects not to enroll, or who elects not to continue enrollment, in a health
benefits plan under this chapter (including a covered individual who elects to
receive payments under subsection (d)) may subsequently enroll in a health
benefits plan under this chapter based on the status of the covered individual
as a covered individual in accordance with such procedures, and after paying
such fees, as the Director of the Office of Personnel Management may
establish.
(B)The fact that a covered individual
elects not to enroll, or elects not to continue enrollment, in a health
benefits plan under this chapter shall not affect the eligibility of the
covered individual for benefits under title II of the Social Security Act (42
U.S.C. 401 et seq.).
(c)(1)(A)A covered individual
who elects to enroll in a health benefits plan under this chapter based on the
status of the covered individual as a covered individual shall pay a monthly
individual premium payment determined in accordance with subparagraph
(B).
(B)The individual premium payment under
subparagraph (A) shall be determined based on income, as follows:
(i)For an individual with an adjusted
gross income (as defined under section 62 of the Internal Revenue Code of 1986)
of not more than $85,000, the individual premium payment shall be in an amount
equal to the employee contribution for the health benefits plan, as determined
under section 8906.
(ii)For an individual with an adjusted
gross income of more than $85,000 and not more than $107,000, the individual
premium payment shall be in an amount equal to the sum of—
(I)the employee contribution for the
health benefits plan, as determined under section 8906; and
(II)the product obtained by
multiplying—
- (aa)the Government contribution (as
determined under section 8906(b)); by
- (bb)0.05.
(iii)For an individual with an adjusted
gross income of more than $107,000 and not more than $160,000, the individual
premium payment shall be in an amount equal to the sum of—
(I)the employee contribution for the
health benefits plan, as determined under section 8906; and
(II)the product obtained by
multiplying—
- (aa)the Government contribution (as
determined under section 8906(b)); by
- (bb)0.1.
(iv)For an individual with an adjusted
gross income of more than $160,000 and not more than $250,000, the individual
premium payment shall be in an amount equal to the sum of—
(I)the employee contribution for the
health benefits plan, as determined under section 8906; and
(II)the product obtained by
multiplying—
- (aa)the Government contribution (as
determined under section 8906(b)); by
- (bb)0.15.
(v)For an individual with an adjusted
gross income of more than $250,000 and not more than $1,000,000, the individual
premium payment shall be in an amount equal to the sum of—
(I)the employee contribution for the
health benefits plan, as determined under section 8906; and
(II)the product obtained by
multiplying—
- (aa)the Government contribution (as
determined under section 8906(b)); by
- (bb)0.5.
(vi)For an individual with an adjusted
gross income of more than $1,000,000, the individual premium payment shall be
in an amount equal to the sum of—
(I)the employee contribution for the
health benefits plan, as determined under section 8906; and
(II)the Government contribution (as
determined under section 8906(b)).
(C)The Director of the Office of
Personnel Management shall adjust the income amounts under subparagraph (B)
annually to reflect changes in the Consumer Price Index for all Urban Consumers
published by the Department of Labor.
(2)(A)For a covered
individual who is entitled to monthly benefits under section 202 or 223 of the
Social Security Act (42 U.S.C. 402 and 423), the monthly premiums of the
covered individual under this subchapter shall (except as provided in
subparagraph (B) or (C)) be collected by deducting the amount of the premium
from the amount of such monthly benefits.
(B)For a covered individual who is
entitled to receive for a month an annuity under the Railroad Retirement Act of
1974 (whether or not the covered individual is also entitled for such month to
a monthly insurance benefit under section 202 of the Social Security Act (42
U.S.C. 402)), the monthly premiums of the covered individual under this
subchapter shall (except as provided in subparagraph (C)) be collected by
deducting the amount thereof from such annuity or pension.
(C)If a covered individual to whom
subparagraph (A) or (B) applies estimates that the amount which will be
available for deduction under such subparagraph for any premium payment period
will be less than the amount of the monthly premiums for such period, the
covered individual may pay to the Director of the Office of Personnel
Management such portion of the monthly premiums for such period as the covered
individual desires.
(D)For a covered individual who is not
described in subparagraph (A) or (B) and who elects to enroll in a health
benefits plan under this chapter, or with respect to whom subparagraph (C)
applies, the covered individual shall pay monthly premiums to the Director of
the Office of Personnel Management at such times, and in such manner, as the
Director shall by regulations prescribe.
(E)Amounts deducted or paid under this
paragraph shall be deposited in the Treasury to the credit of the Employees
Health Benefits Fund established under section 8909.
(F)After consultation with the Director
of the Office of Personnel Management, the Secretary of Health and Human
Services shall establish procedures for making and depositing deductions under
this paragraph.
(3)The Director of the Office of
Personnel Management shall establish procedures for terminating the enrollment
of a covered individual in a health benefits plan if the covered individual
fails to make timely payment of premiums, which shall allow such a covered
individual to reenroll in a health benefits plan under such terms and
conditions as the Director may prescribe.
(d)The Director of
the Office of Personnel Management shall make periodic payments to the employer
or former employer providing health insurance to a covered individual who makes
an election under subsection (b)(1)(B) in a total amount not to exceed the
lesser of—
(1)the cost to the
employer or former employer of providing health insurance to the covered
individual; and
(2)the average
Government contribution for an individual enrolled in a health benefits plan
under this chapter that is available to individuals residing anywhere in the
United States.
(e)For fiscal year
2014 and each fiscal year thereafter, there are appropriated to the Employees
Health Benefits Fund established under section 8909, out of any funds in the
Treasury not otherwise appropriated—
(1)an amount equal
to—
(A)the taxes imposed
by sections 3101(b) and 3111(b) of the Internal Revenue Code of 1986 with
respect to wages reported to the Secretary of the Treasury pursuant to subtitle
F of such Code after December 31, 2013, as determined by the Secretary of the
Treasury by applying the applicable rates of tax under such sections to such
wages, which wages shall be certified by the Commissioner of Social Security on
the basis of records of wages established and maintained by the Commissioner of
Social Security in accordance with such reports;
(B)the taxes imposed
by section 1401(b) of the Internal Revenue Code of 1986 with respect to
self-employment income reported to the Secretary of the Treasury on tax returns
under subtitle F of such Code, as determined by the Secretary of the Treasury
by applying the applicable rate of tax under such section to such
self-employment income, which self-employment income shall be certified by the
Commissioner of Social Security on the basis of records of self-employment
established and maintained by the Commissioner of Social Security in accordance
with such returns; and
(C)any amounts that,
on or after January 1, 2014, are to be deposited in the Federal Hospital
Insurance Trust Fund established under section 1817 of the Social Security Act
(42 U.S.C. 1395i) under any other provision of law; and
(2)a Government
contribution equal to the difference obtained by subtracting—
(A)the sum
of—
(i)the total amount
of premiums paid by covered individuals under subsection (c)(2) for the fiscal
year; and
(ii)the amount
appropriated under paragraph (1); from
(B)the sum
of—
(i)the total cost
for the fiscal year of subscription charges for health benefits plans for
covered individuals enrolled in a health benefits plan based on the status of
the covered individuals as covered individuals; and
(ii)the total amount
of payments for the fiscal year under subsection (d).
(f)The Director of
the Office of Personnel Management shall establish, in consultation with the
Secretary of Health and Human Services acting through the Administrator of the
Centers for Medicare & Medicaid Services, procedures to ensure that health
benefits plans coordinate with State Medicaid programs with respect to the
provision of cost-sharing and other medical assistance for covered individuals
enrolled in health benefit plans who are also eligible for medical assistance
and enrolled in a State Medicaid program.
III
8941.Reimbursement
of costs for high risk individuals
(a)In this section,
the term high risk individual means an individual—
(1)enrolled in a
health benefits plan under this chapter for a contract year; and
(2)who, of all
individuals enrolled in a health benefits plan under this chapter for the
contract year, is in the highest 5 percent in terms of benefits paid by a
carrier under a health benefits plan relating to the contract year.
(b)After the end of
each contract year beginning on or after January 1, 2014, the Director of the
Office of Personnel Management shall—
(1)identify the high
risk individuals for the contract year; and
(2)pay to a carrier
contracting to provide a health benefits plan to a high risk individual for the
contract year 90 percent of the benefits paid by the carrier relating to the
high risk individual.
(c)(1)For fiscal year 2014
and each fiscal year thereafter, there are appropriated to the Director of the
Office of Personnel Management from the Federal Hospital Insurance Trust Fund
established under section 1817 of the Social Security Act (42 U.S.C. 1395i)
such sums as are necessary to carry out this section.
(2)If the amounts appropriated under
paragraph (1) are insufficient to carry out this section, for fiscal year 2014
and each fiscal year thereafter, there are appropriated to the Director of the
Office of Personnel Management, out of any funds in the Treasury not otherwise
appropriated, such sums as are necessary to carry out this
section.
.
(b)Exemption from
insurance requirements
(1)Chapter 89 of title 5, United States Code, is amended by
inserting after section 8901 the following:
8901A.Exemption
from insurance requirementsTitle I of the Patient Protection and
Affordable Care Act, subtitle A of title X of such Act, and the amendments made
by such title I and subtitle A shall not apply to health benefits
plans.
.
(2)Section 2709 of the Public Health Service Act (42
U.S.C. 300gg–8) (as added by section 10103 of the Patient Protection and
Affordable Care Act) is amended—
(A)by striking
subsection (g); and
(B)by redesignating
subsection (h) as subsection (g).
(c)Technical and
conforming amendmentsChapter 89 of title 5, United States Code,
is amended—
(1)in the table of
sections—
(A)by inserting
after the item relating to section 8901 the following:
8901A. Exemption from insurance requirements.
SUBCHAPTER I—Federal
employees
;
and(B)by adding at the
end the following:
SUBCHAPTER II—Covered individuals
8921. Health insurance for covered individuals.
SUBCHAPTER III—High risk pool
8941. Reimbursement of costs for high risk
individuals.
;
(2)in section
8902a(d)(1)—
(A)in subparagraph
(A), by adding or
at the end;
(B)by striking
subparagraph (B); and
(C)by redesignating
subparagraph (C) as subparagraph (B); and
(3)by striking
section 8910(d).
(d)Effective date;
applicabilityThe amendments made by this section shall take
effect on the date of enactment of this Act and apply on and after January 1,
2014.
3.Transitioning
Medicare patients to coverage under the Federal Employees Health Benefits
Program
(a)Increase in
Medicare eligibility ageSection 226 of the Social Security Act (42
U.S.C. 426) is amended by adding at the end the following new
subsection:
(k)Increasing
Medicare qualifying age
(1)Notwithstanding any
other provision of law, any reference in this section and title XVIII, title
XIX to age 65 shall be deemed a reference to the Medicare qualifying age
specified in paragraph (2).
(2)Medicare
qualifying age specifiedThe Medicare qualifying age specified in
this paragraph is determined as follows:
(A)In the case of an
individual who attains 65 years of age before January 1, 2014, the Medicare
qualifying age is 65 years of age.
(B)In the case of an
individual who attains 65 years of age in a year after 2013, and before 2034,
the Medicare qualifying age is the Medicare qualifying age specified in this
paragraph for the previous year increased by 3 months.
(C)In the case of an individual who attains 65
years of age in a year after 2033, the Medicare qualifying age is 70 years of
age plus the number of months in the age increase factor (as determined under
paragraph (3)).
(3)The Commissioner of
Social Security shall determine (using reasonable actuarial assumptions) and
publish on or before November 1 of each calendar year after 2032 the number of
months (rounded, if not a multiple of one month, to the next lower multiple of
one month) by which life expectancy as of October 1 of such calendar year of an
individual attaining age 65 on such October 1 exceeds the life expectancy as of
October 1, 2033, of an individual attaining age 65 on October 1, 2033. With
respect to an individual who attains age 65 in the calendar year following any
calendar year in which a determination is made under this paragraph, the age
increase factor shall be the number of months determined under this paragraph
as of October 1 of such calendar year in which such determination is
made.
.
(b)Title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) is amended by adding at the end the following new
section:
1899B.Sunset of Medicare program with transition to coverage under
the Federal Employees Health Benefits ProgramNotwithstanding
any other provision of law, on and after January 1, 2014, the following rules
shall apply:
(1)The preceding provisions of this title
shall not apply.
(2)No payments for items and services
furnished under this title after such date shall be made. No additional, bonus,
or incentive payments under this title, such as graduate medical education
payments, may be made.
(3)Payments for items and services furnished
under this title prior to such date shall be made in the same manner as if this
section had not been enacted.
(4)All Medicare supplemental policies under
section 1882 are terminated.
(5)All demonstration projects conducted under
this title are terminated.
(6)Entitlement to health benefits for
individuals who, but for this section (and taking into account section 226(k)),
would have been entitled to, or could have enrolled for, benefits under part A
or could have enrolled under part B shall be through enrollment in a health
benefits plan under chapter 89 of title 5, United States Code.
(7)At a date determined appropriate by the
Secretary (after payments described in paragraph (3) have been made), amounts
in the Federal Hospital Insurance Trust Fund and the Federal Supplementary
Medical Insurance Trust Fund (including the Medicare Prescription Drug Account
within such Trust Fund) shall be transferred to the Employees Health Benefits
Fund established under section 8909 of chapter 5, United States Code.
(8)Any determination under Federal law (other
than this title and title II) relating to Medicare eligibility shall be made
based on whether an individual is a covered individual, as defined in section
8901 of title 5, United States
Code.
.
(c)(1)Section 226 of the
Social Security Act (42 U.S.C. 426) is amended by adding at the end the
following new subsection:
(k)Notwithstanding
the preceding provisions of this section, on and after January 1, 2014,
entitlement to health benefits to individuals who, but for this subsection and
section 1899B, would have been entitled to benefits under part A and eligible
to enroll under part B of title XVIII pursuant to this section shall be through
enrollment in a health benefits plan under chapter 89 of title 5, United States
Code, rather than under title XVIII of this
Act.
.
(2)Section 226A of the Social Security
Act (42 U.S.C. 426) is amended by adding at the end the following new
subsection:
(d)Notwithstanding
the preceding provisions of this section, on and after January 1, 2014,
entitlement to health benefits to individuals who, but for this subsection and
section 1899B, would have been entitled to benefits under part A and eligible
to enroll under part B of title XVIII pursuant to this section shall be through
enrollment in a health benefits plan under chapter 89 of title 5, United States
Code, rather than under title XVIII of this
Act.
.
(d)Recommendations
to StatesNot later than 1 year after the date of the enactment
of this Act, the Secretary of Health and Human Services shall make available to
States recommendations with respect to requirements for health care entities
and individuals under the Medicare program that, by reason of section 1899B of
the Social Security Act, as added by subsection (b), will no longer apply but
that should be considered on the State level.