[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1469 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                S. 1469

     To provide higher-quality, lower-cost health care to seniors.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 1, 2013

   Mr. Paul introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
     To provide higher-quality, lower-cost health care to seniors.

    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 ``Congressional Health Care for 
Seniors Act of 2013''.

SEC. 2. ENROLLING SENIORS IN THE SAME HEALTH CARE PLANS AS MEMBERS OF 
              CONGRESS.

    (a) In General.--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:

                  ``SUBCHAPTER I--FEDERAL EMPLOYEES'';

            (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 2013 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, 2015, 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, 2015, 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:

                  ``SUBCHAPTER II--COVERED INDIVIDUALS

``Sec. 8921. Health insurance for covered individuals
    ``(a) For contract years beginning on or after January 1, 2015, 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 2015 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, 2014, 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, 
                2015, 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.

          ``SUBCHAPTER III--COVERAGE OF HIGH RISK INDIVIDUALS

``Sec. 8941. Reimbursement of costs for high risk individuals
    ``(a) In this section, the term `high risk individual' means an 
individual identified under subsection (b)(1).
    ``(b) After the end of each contract year beginning on or after 
January 1, 2015, the Director of the Office of Personnel Management 
shall--
            ``(1) identify, for the contract year, individuals who--
                    ``(A) enrolled in a health benefits plan under this 
                chapter for a contract year; and
                    ``(B) who, of all individuals enrolled in a health 
                benefits plan under this chapter for the contract year, 
                are in the highest 5 percent in terms of benefits paid 
                by a carrier under a health benefits plan relating to 
                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 2015 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 2015 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) Amendment to title 5.--Chapter 89 of title 5, United 
        States Code, is amended by inserting after section 8901 the 
        following:
``Sec. 8901A. Exemption from insurance requirements
    ``Title 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) Conforming amendment.--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 Amendments.--Chapter 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--coverage of high risk individuals

``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; Applicability.--The amendments made by this 
section shall take effect on the date of enactment of this Act and 
apply on and after January 1, 2015.

SEC. 3. TRANSITIONING MEDICARE PATIENTS TO COVERAGE UNDER THE FEDERAL 
              EMPLOYEES HEALTH BENEFITS PROGRAM.

    (a) Increase in Medicare Eligibility Age.--Section 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) In general.--Notwithstanding any other provision of 
        law, any reference in this section, title XVIII, or title XIX 
        (insofar as it relates to the eligibility age for Medicare 
        benefits under title XVIII) to `age 65' shall be deemed a 
        reference to the Medicare qualifying age specified in paragraph 
        (2).
            ``(2) Medicare qualifying age specified.--The 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, 2015, 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 2014, and before 2035, 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 2034, 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) Age increase factor.--The Commissioner of Social 
        Security shall determine (using reasonable actuarial 
        assumptions) and publish on or before November 1 of each 
        calendar year after 2033 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, 2034, of an 
        individual attaining age 65 on October 1, 2034. 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) Sunset.--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:

  ``sunset of medicare program with transition to coverage under the 
               federal employees health benefits program

    ``Sec. 1899B. Notwithstanding any other provision of law, on and 
after January 1, 2015, 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) Conforming Amendment.--(1) Section 226 of the Social Security 
Act (42 U.S.C. 426), as amended by subsection (a), is amended by adding 
at the end the following new subsection:
    ``(l) Notwithstanding the preceding provisions of this section, on 
and after January 1, 2015, 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, 2015, 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 States.--Not 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.
                                 <all>