[Congressional Record Volume 155, Number 66 (Friday, May 1, 2009)]
[Senate]
[Pages S5014-S5027]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. SNOWE (for herself, Mr. Nelson of Florida, Ms. Cantwell, 
        Mr. Levin, Mr. Vitter, Mr. Cardin, Ms. Landrieu, and Mrs. 
        Boxer):
  S. 952. A bill to develop and promote a compressive plan for a 
national strategy to address harmful algal blooms and hypoxia through 
baseline research, forecasting and monitoring, and mitigation and 
control while helping communities detect, control, and mitigate coastal 
and Great Lakes harmful algal blooms and hypoxia events; to the 
Committee on Commerce, Science, and Transportation.
  Ms. SNOWE. Mr. President, I rise today to introduce the Harmful Algal 
Blooms and Hypoxia Research and Control Amendments Act of 2009. This 
bill would enhance the research programs established in the Harmful 
Algal Blooms and Hypoxia Research and Control Act of 1998 and 
reauthorized in 2004, which have greatly enhanced our ability to 
predict outbreaks of harmful algal blooms and the extent of hypoxic 
zones. But knowing when outbreaks will occur is only half the battle. 
By funding additional research into mitigation and prevention of HABs 
and hypoxia, and by enabling communities to develop response strategies 
to more effectively reduce their effects on our coastal communities, 
this legislation would take the next critical steps to reducing the 
social and economic impacts of these potentially disastrous outbreaks.
  I am proud to continue my leadership on this important issue and I 
particularly want to thank my counterpart on this key piece of 
legislation, Senator Bill Nelson. My partnership with Senator Breaux on 
the first two harmful algal bloom bills proved extremely fruitful, and 
I am pleased that Gulf of Mexico--whose coastal residents are severely 
impacted by both harmful algal blooms, also known as HABs, and 
hypoxia--will continue to be so well represented as this program moves 
into the future. I also want to thank the bill's additional co-
sponsors, Senators Cantwell, Cardin, Vitter, Landrieu, Boxer and Levin 
for their vital contributions. We all represent coastal States directly 
affected by harmful algal blooms and hypoxia, and we see first hand the 
ecological and economic damage caused by these events.
  In New England blooms of Alexandrium algae, more commonly known as 
``red tide'' can cause shellfish to accumulate toxins that when 
consumed by humans lead to paralytic shellfish poisoning, PSP, a 
potentially fatal neurological disorder. Therefore, when levels of 
Alexandrium reach dangerous levels, our fishery managers are

[[Page S5015]]

forced to close shellfish beds that provide hundreds of jobs and add 
millions of dollars to our regional economy. Red tide outbreaks--which 
occur in various forms not just in the northeast, but along thousands 
of miles of U.S. coastline--have increased dramatically in the Gulf of 
Maine in the last 20 years, with major blooms occurring almost every 
year.
  In 2005, the most severe red tide since 1972 blanketed the New 
England coast from Martha's Vineyard to Downeast Maine, resulting in 
extensive commercial and recreational shellfish harvesting closures 
lasting several months at the peak of the seafood harvesting season. In 
a peer-reviewed study, economists found that the 2005 event caused over 
$4.9 million in lost landings of shellfish in the State of Maine alone, 
and more than $20 million throughout New England.
  Last year's outbreak of red tide tracked very closely the patter of 
the 2005 event in both location and severity, but unlike in 2005 when 
nearly the entire coasts of Maine and Massachusetts were closed, 
resource managers had improved testing capabilities in place that 
allowed many localized areas to remain open. Such procedures were a 
direct result of programs established by the Harmful Algal Blooms and 
Hypoxia Research and Control Acts of 1998 and 2004.

  Most recently, on April 22, 2009 researchers at Woods Hole 
Oceanographic Institution and North Carolina State University announced 
the potential for ``red tide'' in the Gulf of Maine this season is 
expected to be ``moderately large'', based on a regional seafloor 
survey of Alexandrium abundance. This survey revealed that levels of 
Alexandrium are currently higher than those observed just prior to the 
2005 red tide. Just a few days ago, officials from the Maine Department 
of Resources Marine Biotoxin Monitoring Program closed a large parcel 
of the Maine coast to the harvest of mussels, oysters, and carnivorous 
snails due to the presence of PSP. The current trend of increasing 
frequency and intensity of red tide events in new England waters is 
just one example of the need to further enhance our ability to provide 
detailed forecasting and testing measures. The quick response time 
these capabilities enable will greatly reduce the economic impact such 
outbreaks impose on our coastal communities.
  While we have made great strides in bloom prediction and monitoring, 
it is clear that these problems have not gone away, but rather 
increased in magnitude. Harmful algal blooms remain prevalent 
nationwide, and areas of hypoxia, also known as ``dead zones'' are now 
occurring with increasing frequency. Within a dead zone, oxygen levels 
plummet to the point at which they can no longer sustain life, driving 
out animals that can move, and killing those that cannot. The most 
infamous dead zone occurs annually in the Gulf of Mexico, off the 
shores of Louisiana. In 2008, researchers determined that this dead 
zone extended over 12,875 square miles, making it the second largest 
since measurements began in 1985. Dead zones are also occurring with 
increasing frequency in more areas than ever before, including off the 
coasts of Oregon, the Chesapeake Bay and Texas.
  The amendments contained in this legislation would enhance the 
Nation's ability to predict, monitor, and ultimately control harmful 
algal blooms and hypoxia. Understanding when these blooms will occur is 
vital, but the time has come to take this program to the next level--to 
determine not just when an outbreak will occur, but how to reduce its 
intensity or prevent its occurrence all together. This bill would build 
on NOAA's successes in research and forecasting by creating a program 
to mitigate and control HAB outbreaks.
  This bill also recognizes the need to enhance coordination among 
state and local resource managers--those on the front lines who must 
make the decisions to close beaches or shellfish beds. Their decisions 
are critical to protecting human health, but can also impose 
significant economic impacts. The bill would mandate creation of 
Regional Research and Action Plans that would identify baseline 
research, possible State and local government actions to prepare for 
and mitigate the impacts of HABs, and establish outreach strategies to 
ensure the public is informed of the dangers these events can present. 
A regional focus on these issues will ensure a more effective and 
efficient response to future events. And finally, this bill would, for 
the first time, create a pilot program to examine harmful algal blooms 
and hypoxia in fresh water systems.
  If enacted, this critical reauthorization would greatly enhance our 
Nation's ability to predict, monitor, mitigate, and control outbreaks 
of HABs and hypoxia. Over half the U.S. population resides in coastal 
regions, and we must do all in our power to safeguard their health and 
the health of the marine environment. The existing Harmful Algal Bloom 
and Hypoxia Program has done a laudable job to date, and this 
authorization will allow them to expand their scope and provide greater 
benefits to the Nation as a whole. I thank Senator Bill Nelson, and all 
of my cosponsors again for their efforts in developing this vital 
legislation.
  Mr. President, I ask unamimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                 S. 952

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Harmful 
     Algal Blooms and Hypoxia Research and Control Amendments Act 
     of 2009''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Amendment of Harmful Algal Bloom and Hypoxia Research and 
              Control Act of 1998.
Sec. 3. Findings.
Sec. 4. Purpose.
Sec. 5. Interagency task force on harmful algal blooms and hypoxia.
Sec. 6. National harmful algal bloom and hypoxia program.
Sec. 7. Regional research and action plans.
Sec. 8. Reporting.
Sec. 9. Northern Gulf of Mexico Hypoxia.
Sec. 10 Pilot program for freshwater harmful algal blooms and hypoxia.
Sec. 11. Interagency financing.
Sec. 12. Application with other laws.
Sec. 13. Definitions.
Sec. 14. Authorization of appropriations.

     SEC. 2. AMENDMENT OF HARMFUL ALGAL BLOOM AND HYPOXIA RESEARCH 
                   AND CONTROL ACT OF 1998.

       Except as otherwise expressly provided, whenever in this 
     title an amendment or repeal is expressed in terms of an 
     amendment to, or repeal of, a section or other provision, the 
     reference shall be considered to be made to a section or 
     other provision of the Harmful Algal Bloom and Hypoxia 
     Research and Control Act of 1998 (16 U.S.C. 1451 note).

     SEC. 3. FINDINGS.

       Section 602 is amended to read as follows:

     ``SEC. 602. FINDINGS.

       The Congress finds the following:
       ``(1) Harmful algal blooms and hypoxia are increasing in 
     frequency and intensity in the Nation's coastal waters and 
     Great Lakes and pose a threat to the health of coastal and 
     Great Lakes ecosystems, are costly to coastal economies, and 
     threaten the safety of seafood and human health.
       ``(2) Excessive nutrients in coastal waters have been 
     linked to the increased intensity and frequency of hypoxia 
     and some harmful algal blooms and there is a need to identify 
     more workable and effective actions to reduce the negative 
     impacts of harmful algal blooms and hypoxia on coastal 
     waters.
       ``(3) The National Oceanic and Atmospheric Administration, 
     through its ongoing research, monitoring, observing, 
     education, grant, and coastal resource management programs 
     and in collaboration with the other Federal agencies, on the 
     Interagency Task Force, along with States, Indian tribes, and 
     local governments, possesses a full range of capabilities 
     necessary to support a near and long-term comprehensive 
     effort to prevent, reduce, and control the human and 
     environmental costs of harmful algal blooms and hypoxia.
       ``(4) Harmful algal blooms and hypoxia can be triggered and 
     exacerbated by increases in nutrient loading from point and 
     non-point sources, much of which originates in upland areas 
     and is delivered to marine and freshwater bodies via river 
     discharge, thereby requiring integrated and landscape-level 
     research and control strategies.
       ``(5) Harmful algal blooms and hypoxia affect many sectors 
     of the coastal economy, including tourism, public health, and 
     recreational and commercial fisheries; and according to a 
     recent report produced by NOAA, the United States seafood and 
     tourism industries suffer annual losses of $82 million due to 
     economic impacts of harmful algal blooms.
       ``(6) Global climate change and its effect on oceans and 
     the Great Lakes may ultimately play a role in the increase or 
     decrease of harmful algal bloom and hypoxic events.

[[Page S5016]]

       ``(7) Proliferations of harmful and nuisance algae can 
     occur in all United States waters, including coastal areas 
     and estuaries, the Great Lakes, and inland waterways, 
     crossing political boundaries and necessitating regional 
     coordination for research, monitoring, mitigation, response, 
     and prevention efforts.
       ``(8) Following passage of the Harmful Algal Bloom and 
     Hypoxia Research and Control Act of 1998, Federally-funded 
     and other research has led to several technological advances, 
     including remote sensing, molecular and optical tools, 
     satellite imagery, and coastal and ocean observing systems, 
     that provide data for forecast models, improve the monitoring 
     and prediction of these events, and provide essential 
     decision making tools for managers and stakeholders.''.

     SEC. 4. PURPOSE.

       The Act is amended by inserting after section 602 the 
     following:

     ``SEC. 602A. PURPOSES.

       ``The purposes of this Act are--
       ``(1) to provide for the development and coordination of a 
     comprehensive and integrated national program to address 
     harmful algal blooms and hypoxia through baseline research, 
     monitoring, prevention, mitigation, and control;
       ``(2) to provide for the assessment of environmental, 
     socio-economic, and human health impacts of harmful algal 
     blooms and hypoxia on a regional and national scale, and to 
     integrate that assessment into marine and freshwater resource 
     decisions; and
       ``(3) to facilitate regional, State, and local efforts to 
     develop and implement appropriate harmful algal bloom and 
     hypoxia response plans, strategies, and tools including 
     outreach programs and information dissemination 
     mechanisms.''.

     SEC. 5. INTERAGENCY TASK FORCE ON HARMFUL ALGAL BLOOMS AND 
                   HYPOXIA.

       (a) Federal Representatives.--Section 603(a) is amended--
       (1) by striking ``The Task Force shall consist of the 
     following representatives from--'' and inserting ``The Task 
     Force shall consist of representatives of the Office of the 
     Secretary from each of the following departments and of the 
     office of the head of each of the following Federal 
     agencies:'';
       (2) by striking ``the'' in paragraphs (1) through (11) and 
     inserting ``The'';
       (3) by striking the semicolon in paragraphs (1) through 
     (10) and inserting a period.
       (4) by striking ``Quality; and'' in paragraph (11) and 
     inserting ``Quality.''; and
       (5) by striking ``such other'' in paragraph (12) and 
     inserting ``Other''.
       (b) State Representatives.--Section 603 is amended--
       (1) by striking subsections (b) through (i); and
       (2) by inserting after subsection (a) the following:
       ``(b) State Representatives.--The Secretary shall establish 
     criteria for determining appropriate States to serve on the 
     Task Force and establish and implement a nominations process 
     to select representatives from 2 appropriate States in 
     different regions, on a rotating basis, to serve 2-year terms 
     on the Task Force.''.

     SEC. 6. NATIONAL HARMFUL ALGAL BLOOM AND HYPOXIA PROGRAM.

       The Act is amended by inserting after section 603 the 
     following:

     ``SEC. 603A. NATIONAL HARMFUL ALGAL BLOOM AND HYPOXIA 
                   PROGRAM.

       ``(a) Establishment.--The President, acting through NOAA, 
     shall establish and maintain a national program for 
     integrating efforts to address harmful algal bloom and 
     hypoxia research, monitoring, prediction, control, 
     mitigation, prevention, and outreach.
       ``(b) Task Force Functions.--The Task Force shall be the 
     oversight body for the development and implementation of the 
     national harmful algal bloom and hypoxia program and shall--
       ``(1) coordinate interagency review of plans and policies 
     of the Program;
       ``(2) assess interagency work and spending plans for 
     implementing the activities of the Program;
       ``(3) review the Program's distribution of Federal grants 
     and funding to address research priorities;
       ``(4) support implementation of the actions and strategies 
     identified in the regional research and action plans under 
     subsection (d);
       ``(5) support the development of institutional mechanisms 
     and financial instruments to further the goals of the 
     program;
       ``(6) expedite the interagency review process and ensure 
     timely review and dispersal of required reports and 
     assessments under this Act; and
       ``(7) promote the development of new technologies for 
     predicting, monitoring, and mitigating harmful algal blooms 
     and hypoxia conditions.
       ``(c) Lead Federal Agency.--NOAA shall be the lead Federal 
     agency for implementing and administering the National 
     Harmful Algal Bloom and Hypoxia Program.
       ``(d) Responsibilities.--The Program shall--
       ``(1) promote a national strategy to help communities 
     understand, detect, predict, control, and mitigate freshwater 
     and marine harmful algal bloom and hypoxia events;
       ``(2) plan, coordinate, and implement the National Harmful 
     Algal Bloom and Hypoxia Program; and
       ``(3) report to the Task Force via the Administrator.
       ``(e) Duties.--
       ``(1) Administrative duties.--The Program shall--
       ``(A) prepare work and spending plans for implementing the 
     activities of the Program and developing and implementing the 
     Regional Research and Action Plans;
       ``(B) administer merit-based, competitive grant funding to 
     support the projects maintained and established by the 
     Program, and to address the research and management needs and 
     priorities identified in the Regional Research and Action 
     Plans;
       ``(C) coordinate NOAA programs that address harmful algal 
     blooms and hypoxia and other ocean and Great Lakes science 
     and management programs and centers that address the 
     chemical, biological, and physical components of harmful 
     algal blooms and hypoxia;
       ``(D) coordinate and work cooperatively with other Federal, 
     State, and local government agencies and programs that 
     address harmful algal blooms and hypoxia;
       ``(E) coordinate with the State Department to support 
     international efforts on harmful algal bloom and hypoxia 
     information sharing, research, mitigation, and control.''.
       ``(F) coordinate an outreach, education, and training 
     program that integrates and augments existing programs to 
     improve public education about and awareness of the causes, 
     impacts, and mitigation efforts for harmful algal blooms and 
     hypoxia;
       ``(G) facilitate and provide resources for training of 
     State and local coastal and water resource managers in the 
     methods and technologies for monitoring, controlling, and 
     mitigating harmful algal blooms and hypoxia;
       ``(H) support regional efforts to control and mitigate 
     outbreaks through--
       ``(i) communication of the contents of the Regional 
     Research and Action Plans and maintenance of online data 
     portals for other information about harmful algal blooms and 
     hypoxia to State and local stakeholders within the region for 
     which each plan is developed; and
       ``(ii) overseeing the development, review, and periodic 
     updating of Regional Research and Action Plans established 
     under section 602C(b);
       ``(I) convene an annual meeting of the Task Force; and
       ``(J) perform such other tasks as may be delegated by the 
     Task Force.
       ``(2) NOAA Duties.--NOAA shall maintain and enhance--
       ``(A) the Ecology and Oceanography of Harmful Algal Blooms 
     Program;
       ``(B) the Monitoring and Event Response for Harmful Algal 
     Blooms Program;
       ``(C) the Northern Gulf of Mexico Ecosystems and Hypoxia 
     Assessment Program; and
       ``(D) the Coastal Hypoxia Research Program.
       ``(3) Program duties.--The Program shall--
       ``(A) establish--
       ``(i) a Mitigation and Control of Harmful Algal Blooms 
     Program--

       ``(I) to develop and promote strategies for the prevention, 
     mitigation, and control of harmful algal blooms; and
       ``(II) to fund research that may facilitate the prevention, 
     mitigation, and control of harmful algal blooms; and
       ``(III) to develop and demonstrate technology that may 
     mitigate and control harmful algal blooms; and

       ``(ii) other programs as necessary; and
       ``(B) work cooperatively with other offices, centers, and 
     programs within NOAA and other agencies represented on the 
     Task Force, States, and nongovernmental organizations 
     concerned with marine and aquatic issues to manage data, 
     products, and infrastructure, including--
       ``(i) compiling, managing, and archiving data from relevant 
     programs in Task Force member agencies;
       ``(ii) creating data portals for general education and data 
     dissemination on centralized, publicly available databases; 
     and
       ``(iii) establishing communication routes for data, 
     predictions, and management tools both to and from the 
     regions, states, and local communities.''.

     SEC. 7. REGIONAL RESEARCH AND ACTION PLANS.

       The Act, as amended by section 6, is amended by inserting 
     after section 602A the following:

     ``SEC. 602B. REGIONAL RESEARCH AND ACTION PLANS.

       ``(a) In General.--The Program shall--
       ``(1) oversee the development and implementation of 
     Regional Research and Action Plans; and
       ``(2) identify appropriate regions and sub-regions to be 
     addressed by each Regional Research and Action Plan.
       ``(b) Regional Panels of Experts.--
       ``(1) In general.--In accordance with the schedule set 
     forth in paragraph (2), the Program shall convene a panel of 
     experts for each region identified under subsection (a)(2) 
     from among--
       ``(A) State coastal management and planning officials;
       ``(B) water management and watershed officials from both 
     coastal states and noncoastal states with water sources that 
     drain into water bodies affected by harmful algal blooms and 
     hypoxia;
       ``(C) public health officials;
       ``(D) emergency management officials;
       ``(E) nongovernmental organizations concerned with marine 
     and aquatic issues;
       ``(F) science and technology development institutions;

[[Page S5017]]

       ``(G) economists;
       ``(H) industries and businesses affected by coastal and 
     freshwater harmful algal blooms and hypoxia;
       ``(I) scientists, with expertise concerning harmful algal 
     blooms or hypoxia, from academic or research institutions; 
     and
       ``(J) other stakeholders as appropriate.
       ``(2) Schedule.--The Program shall--
       ``(A) convene panels in at least \1/3\ of the regions 
     within 9 months after the date of enactment of the Harmful 
     Algal Blooms and Hypoxia Research and Control Amendments Act 
     of 2009;
       ``(B) convene panels in at least \2/3\ of the regions 
     within 21 months after such date; and
       ``(C) convene panels in the remaining regions within 33 
     months after such date; and
       ``(D) reconvene each panel at least every 5 years after the 
     date on which it was initially convened.
       ``(c) Plan Development.--Each regional panel of experts 
     shall develop a Regional Research and Action Plan for its 
     respective region and submit it to the Program for approval 
     and to the Task Force. The Plan shall identify appropriate 
     elements for the region, including--
       ``(1) baseline ecological, social, and economic research 
     needed to understand the biological, physical, and chemical 
     conditions that cause, exacerbate, and result from harmful 
     algal blooms and hypoxia;
       ``(2) regional priorities for ecological and socio-economic 
     research on issues related to, and impacts of, harmful algal 
     blooms and hypoxia;
       ``(3) research needed to develop and advance technologies 
     for improving capabilities to predict, monitor, prevent, 
     control, and mitigate harmful algal blooms and hypoxia;
       ``(4) State and local government actions that may be 
     implemented--
       ``(A) to support long-term monitoring efforts and emergency 
     monitoring as needed;
       ``(B) to minimize the occurrence of harmful algal blooms 
     and hypoxia;
       ``(C) to reduce the duration and intensity of harmful algal 
     blooms and hypoxia in times of emergency;
       ``(D) to address human health dimensions of harmful algal 
     blooms and hypoxia; and
       ``(E) to identify and protect vulnerable ecosystems that 
     could be, or have been, affected by harmful algal blooms and 
     hypoxia;
       ``(5) mechanisms by which data and products are transferred 
     between the Program and State and local governments and 
     research entities;
       ``(6) communication, outreach and information dissemination 
     efforts that State and local governments and nongovernmental 
     organizations can undertake to educate and inform the public 
     concerning harmful algal blooms and hypoxia and alternative 
     coastal resource-utilization opportunities that are 
     available; and
       ``(7) pilot projects, if appropriate, that may be 
     implemented on local, State, and regional scales to address 
     the research priorities and response actions identified in 
     the Plan.
       ``(d) Plan Timelines; Updates.--The Program shall ensure 
     that Regional Research and Action Plans developed under this 
     section are--
       ``(1) completed and approved by the Program within 12 
     months after the date on which a regional panel is convened 
     or reconvened under subsection (b)(2); and
       ``(2) updated no less frequently than once every 5 years.
       ``(e) Funding.--
       ``(1) In general.--Subject to available appropriations, the 
     Program shall make funding available to eligible 
     organizations to implement the research, monitoring, 
     forecasting, modeling, and response actions included under 
     each approved Regional Research and Action Plan. The Program 
     shall select recipients through a merit-based, competitive 
     process and seek to fund research proposals that most 
     effectively align with the research priorities identified in 
     the relevant Regional Research and Action Plan.
       ``(2) Application; assurances.--Any organization seeking 
     funding under this subsection shall submit an application to 
     the Program at such time, in such form and manner, and 
     containing such information and assurances as the Program may 
     require. The Program shall require any organization receiving 
     funds under this subsection to utilize the mechanisms 
     described in subsection (c)(5) to ensure the transfer of data 
     and products developed under the Plan.
       ``(3) Eligible organization.--In this subsection, the term 
     `eligible organization' means--
       ``(A) a nongovernmental researcher or organization; or
       ``(B) any other entity that applies for funding to 
     implement the State, local, and non-governmental control, 
     mitigation, and prevention strategies identified in the 
     relevant Regional Research and Action Plan.
       ``(f) Intermediate Reviews.--If the Program determines that 
     an intermediate review is necessary to address emergent needs 
     in harmful algal blooms and hypoxia under a Regional Research 
     and Action Plan, it shall notify the Task Force and reconvene 
     the relevant regional panel of experts for the purpose of 
     revising the Regional Research and Action Plan so as to 
     address the emergent threat or need.''.

     SEC. 8. REPORTING.

       Section 603, as amended by section 5, is amended by adding 
     at the end thereof the following:
       ``(c) Biennial Reports.--Every 2 years the Program shall 
     prepare a report for the Senate Committee on Commerce, 
     Science, and Transportation and the House of Representatives 
     Committees on Science and Technology and on Natural Resources 
     that describe--
       ``(1) activities, budgets, and progress on implementing the 
     national harmful algal bloom and hypoxia program;
       ``(2) the proceedings of the annual Task Force meetings; 
     and
       ``(3) the status, activities, and funding for 
     implementation of the Regional Research and Action Plans, 
     including a description of research funded under the program 
     and actions and outcomes of Plan response strategies carried 
     out by States.
       ``(d) Quinquennial Reports.--Not less than once every 5 
     years after the date of enactment of the Harmful Algal Blooms 
     and Hypoxia Research and Control Amendments Act of 2009, the 
     Task Force shall complete and submit a report on harmful 
     algal blooms and hypoxia in marine and freshwater systems to 
     the Senate Committee on Commerce, Science, and Transportation 
     and the House of Representatives Committees on Science and 
     Technology and on Natural Resources. The report shall--
       ``(1) evaluate the state of scientific knowledge of harmful 
     algal blooms and hypoxia in marine and freshwater systems, 
     including their causes and ecological consequences;
       ``(2) evaluate the social and economic impacts of harmful 
     algal blooms and hypoxia, including their impacts on coastal 
     communities, and review those communities' efforts and 
     associated economic costs related to event forecasting, 
     planning, mitigation, response, and public outreach and 
     education;
       ``(3) examine and evaluate the human health impacts of 
     harmful algal blooms and hypoxia, including any gaps in 
     existing research;
       ``(4) describe advances in capabilities for monitoring, 
     forecasting, modeling, control, mitigation, and prevention of 
     harmful algal blooms and hypoxia, including techniques for, 
     integrating landscape- and watershed-level water quality 
     information into marine and freshwater harmful algal bloom 
     and hypoxia prevention and mitigation strategies at Federal 
     and regional levels;
       ``(5) evaluate progress made by, and the needs of, Federal, 
     regional, State, and local policies and strategies for 
     forecasting, planning, mitigating, preventing, and responding 
     to harmful algal blooms and hypoxia, including the economic 
     costs and benefits of such policies and strategies;
       ``(6) make recommendations for integrating, improving, and 
     funding future Federal, regional, State, and local policies 
     and strategies for preventing and mitigating the occurrence 
     and impacts of harmful algal blooms and hypoxia; and
       ``(7) describe communication, outreach, and education 
     efforts to raise public awareness of harmful algal blooms and 
     hypoxia, their impacts, and the methods for mitigation and 
     prevention.''.

     SEC. 9. NORTHERN GULF OF MEXICO HYPOXIA.

       Section 604 is amended to read as follows:

     ``SEC. 604. NORTHERN GULF OF MEXICO HYPOXIA.

       (a) Task force annual progress reports.--For each of the 
     years from 2009 through 2013, the Mississippi River/Gulf of 
     Mexico Watershed Nutrient Task Force shall complete and 
     submit to the Congress and the President an annual report on 
     the progress made by Task Force-directed activities toward 
     attainment of the Coastal Goal of the Gulf Hypoxia Action 
     Plan 2008.
       (b) Task force 5-year progress report.--In 2013, that Task 
     Force shall complete and submit to Congress and the President 
     a 5-Year report on the progress made by Task Force-directed 
     activities toward attainment of the Coastal Goal of the Gulf 
     Hypoxia Action Plan 2008. The report shall assess progress 
     made toward nutrient load reductions, the response of the 
     hypoxic zone and water quality throughout the Mississippi/
     Atchafalaya River Basin, and the economic and social effects. 
     The report shall include an evaluation of how current 
     policies and programs affect management decisions, including 
     those made by municipalities and industrial and agricultural 
     producers, evaluate lessons learned, and recommend 
     appropriate actions to continue to implement or, if 
     necessary, revise this strategy.

     SEC. 10. PILOT PROGRAM FOR FRESHWATER HARMFUL ALGAL BLOOMS 
                   AND HYPOXIA.

       The Act, as amended by section 7, is amended by inserting 
     after section 603B the following:

     ``SEC. 603C. PILOT PROGRAM FOR FRESHWATER HARMFUL ALGAL 
                   BLOOMS AND HYPOXIA.

       ``(a) Pilot Program.--The Secretary shall establish a 
     collaborative pilot program with the Environmental Protection 
     Agency and other appropriate Federal agencies to examine 
     harmful algal blooms and hypoxia occurring in freshwater 
     systems, including the Great Lakes. The pilot program shall--
       ``(1) assess the issues associated with, and impacts of, 
     harmful algal blooms and hypoxia in freshwater ecosystems;
       ``(2) research the efficacy of mitigation measures, 
     including measures to reduce nutrient loading; and
       ``(3) recommend potential management solutions.
       ``(b) Report.--The Secretary of Commerce, in consultation 
     with other participating Federal agencies, shall conduct an 
     assessment of the effectiveness of the pilot program in 
     improving freshwater habitat quality and publish a report, 
     available to the public, of the results of the assessment.''.

[[Page S5018]]

     SEC. 11. INTERAGENCY FINANCING.

       The Act is amended by inserting after section 604 the 
     following:

     ``SEC. 604A. INTERAGENCY FINANCING.

       ``The departments and agencies represented on the Task 
     Force are authorized to participate in interagency financing 
     and share, transfer, receive, obligate, and expend funds 
     appropriated to any member of the Task Force for the purposes 
     of carrying out any administrative or programmatic project or 
     activity under this Act, including support for the Program, a 
     common infrastructure, information sharing, and system 
     integration for harmful algal bloom and hypoxia research, 
     monitoring, forecasting, prevention, and control. Funds may 
     be transferred among such departments and agencies through an 
     appropriate instrument that specifies the goods, services, or 
     space being acquired from another Task Force member and the 
     costs of the same.''.

     SEC. 12. APPLICATION WITH OTHER LAWS.

       The Act is amended by inserting after section 606 the 
     following:

     ``SEC. 607. EFFECT ON OTHER FEDERAL AUTHORITY.

       ``Nothing in this title supersedes or limits the authority 
     of any agency to carry out its responsibilities and missions 
     under other laws.''.

     SEC. 13. DEFINITIONS.

       (a) In General.--The Act is amended by inserting after 
     section 605 the following:

     ``SEC. 605A. DEFINITIONS.

       ``In this Act:
       ``(1) Administrator.--The term `Administrator' means the 
     Administrator of the NOAA.
       ``(2) Harmful algal bloom.--The term `harmful algal bloom' 
     means marine and freshwater phytoplankton that proliferate to 
     high concentrations, resulting in nuisance conditions or 
     harmful impacts on marine and aquatic ecosystems, coastal 
     communities, and human health through the production of toxic 
     compounds or other biological, chemical, and physical impacts 
     of the algae outbreak.
       ``(3) Hypoxia.--The term `hypoxia' means a condition where 
     low dissolved oxygen in aquatic systems causes stress or 
     death to resident organisms.
       ``(4) NOAA.--The term `NOAA' means the National Oceanic and 
     Atmospheric Administration.
       ``(5) Program.--The term `Program' means the Integrated 
     Harmful Algal Bloom and Hypoxia Program established under 
     section 603A.
       ``(6) Regional Research and Action Plan.--The term 
     `Regional Research and Action Plan' means a plan established 
     under section 602B.
       ``(7) Secretary.--The term `Secretary' means the Secretary 
     of Commerce, acting through NOAA.''.
       ``(8) Task force.--The term `Task Force' means the 
     Interagency Task Force established by section 603(a).
       ``(9) United states coastal waters.--The term `United 
     States coastal waters' includes the Great Lakes.''.
       (b) Conforming Amendment.--Section 603(a) is amended by 
     striking ``Hypoxia (hereinafter referred to as the `Task 
     force').'' and inserting ``Hypoxia.''.

     SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

       Section 605 is amended to read as follows:--

     ``SEC. 605. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--There are authorized to be appropriated 
     to NOAA to implement the Program under this title $40,000,000 
     for each of fiscal years 2010 through 2014, of which up to 
     $10,000,000 shall be allocated each fiscal year to the 
     creation of Regional Research and Action Plans required by 
     section 602B.
       ``(b) Extramural Research Activities.--The Secretary shall 
     ensure that a substantial portion of funds appropriated 
     pursuant to subsection (a) that are used for research 
     purposes are allocated to extramural research activities.
       ``(c) Pilot Program.--In addition to any amounts 
     appropriated pursuant to subsection (a), there are authorized 
     to be appropriated to NOAA such sums as may be necessary to 
     carry out the pilot program established under section 
     603C.''.

  Mr. NELSON of Florida. Mr. President, I rise today to introduce 
legislation that will address an ongoing problem that adversely affects 
local communities and coastal areas around my home State of Florida and 
across coastal and Great Lakes States.
  Today, Senator Snowe and I, along with Senators Boxer, Cantwell, 
Cardin, Landrieu, Levin and Vitter. introduced a bill that would 
reauthorize and enhance the Harmful Algal Bloom and Hypoxia Research 
and Control Act, HABHRCA, which was enacted in 1998 and reauthorized 5 
years ago. This act enabled critical monitoring, forecasting, and 
research activities that have greatly improved our understanding and 
prediction of harmful algal blooms, nuisance blooms like red drift, and 
low-oxygen or hypoxia events that plague our estuaries and coastal 
waters.
  We have made great strides through HABHRCA to address this problem, 
but there is more yet to do. Reports of harmful algal blooms in U.S. 
waters and around the world have drastically increased over the past 3 
decades.
  Harmful algae can produce potent toxins causing illness and death in 
humans, fish, seabirds, marine mammals like manatees and dolphins, and 
other oceanic life. Other harmful algae are non-toxic to humans, but 
can still cause damage to ecosystems, corals, fisheries resources, and 
recreational facilities. Harmful algae also have a significant economic 
impact. A 2006 study conservatively estimated that coastal harmful 
algal blooms cost more than $82 million per year on average in the 
U.S., with the majority of impacts in the public health and commercial 
fisheries sectors.
  Virtually every coastal state in the country is affected by harmful 
algal blooms. For instance, toxins from harmful algae found in razor 
clams along the Pacific Coast eventually shut down Washington's clam 
fishery in 2002. This event resulted in $10-12 million in lost revenue. 
In 2005, a red tide event in New England caused closures of shellfish 
harvesting to prevent paralytic shellfish poisoning in humans. These 
closures resulted in approximately $18 million in lost shellfish sales 
in Massachusetts and $4.9 million in Maine. In Hawaii, macroalgal 
blooms, which impact coral reefs and local aesthetics, result in more 
than $20 million in lost revenue every year due to reductions in real 
estate value, lost hotel business, and increased clean-up costs.
  A particularly devastating and intense red tide struck the Gulf Coast 
of my home State of Florida in the summer of 2005, causing widespread 
animal deaths as well as public health and economic problems. The St. 
Petersburg/Clearwater Area Convention and Visitors Bureau estimated 
upwards of $240 million in losses for the Tampa region as a result of 
this bloom.
  Scientists have told us that red tides are a lot like hurricanes--
complex but natural phenomena that can have profound impacts on our 
environment and society. Although we may not be able to stop this 
natural process, we can do more to predict it and take actions to 
minimize its impacts on our citizens and natural resources.
  In April 2008, researchers predicted a severe outbreak of New England 
Red Tide, Alexandrium fundyense, which produces potent neurotoxins that 
are filtered by shellfish. When humans consume contaminated shellfish 
they become extremely ill and can die without immediate medical 
treatment. This was the first time that researchers could issue a 
prediction of this kind several weeks in advance. The 2008 prediction 
was derived from a model based on 10 years of ecosystem research in the 
Gulf of Maine. The prediction was remarkably accurate, and it allowed 
State managers and the shellfish aquaculture industry to plan for a 
difficult season. By showing the news media and the public that the 
event was expected and that state managers were prepared, the 
prediction may have also reduced the ``halo'' effect in which shellfish 
harvesting closures in one area reduce shellfish and fish sales from 
areas unaffected by toxicity. This prediction was made possible from 
research funded under programs authorized by HABARCA.
  It is clear that harmful algal blooms and hypoxia events can have 
devastating impacts on water and air quality, aquatic species, 
wildlife, and beach conditions, which in turn affect public health, 
commercial and recreational fishing, tourism, and related businesses in 
our coastal communities. The question becomes, what can we do to stop 
this? If we can't stop these events, how can we better plan for them 
and take steps to minimize the impacts?
  We have learned from scientists and researchers that some harmful 
algal blooms and red drift events can be triggered by excess nutrients 
from upland areas that wash into rivers and are delivered to the coast. 
Because this problem often crosses political and geographic boundaries, 
we must pursue solutions that are regional in nature and bring together 
expertise from all levels of government, from academia, and from other 
outside groups who have a stake in keeping our coastal waters healthy, 
clean, and productive.
  Senator Snowe and I have worked together to craft a bill that will 
not only continue critical research on harmful algal blooms and 
hypoxia, but will help address some of these pressing needs that exist 
on every coast--from the Atlantic and Gulf of Mexico, to the Pacific 
and the Great Lakes. Our bill will

[[Page S5019]]

help to integrate and improve coordination among the government's 
programs that study and monitor these events. The bill also would 
improve how regional, state, and local needs are considered when 
prioritizing research grants and developing related products. Most 
importantly, this bill would focus new resources on translating 
research results into tools and products that state and local 
governments can use to help prevent, respond to, and mitigate the 
impacts of these events.
  Although we have made significant progress in identifying some of the 
causes and consequences of harmful algal blooms and hypoxia since 1998, 
much work remains to find solutions that minimize the occurrence of 
these events and enable our coastal communities to become resilient to 
the impacts. This legislation to amend and reauthorize the Harmful 
Algal Blooms and Hypoxia Act represents an important step toward 
realizing those goals.
  In closing, I would like to recognize Senator Snowe for her 
leadership on this issue. As the sponsor of both the original 
legislation in 1998 and the 2004 amendments, her expertise on harmful 
algal blooms and the impacts of these events on her constituents has 
proved invaluable as we developed the measure before us today. I look 
forward to working with Senator Snowe, in her role as ranking member of 
the Oceans, Atmosphere, Fisheries, and Coast Guard Subcommittee of the 
Commerce, Science, and Transportation Committee, as well as with 
Chairman Cantwell and the other members of the subcommittee, to debate 
this important legislation.
                                 ______
                                 
      By Mr. HARKIN:
  S. 953. A bill to provide for the establishment of programs and 
activities to increase influenza vaccination rates through the 
provision of free vaccines; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. HARKIN. Mr. President, I am introducing the Seasonal Influenza 
and Pandemic Preparation Act of 2009. The bill was given the number S. 
953. This bill would establish a nationwide free, voluntary influenza 
vaccination program, under which any individual in this country may 
receive an annual influenza vaccine shot free of charge.
  I offered this bill 3 years ago because at that time we started the 
process of building up our vaccine capacity. I will have more to say 
about that. What is happening currently with H1N1 being almost at a 
pandemic stage now, it brings home again what we need to do in this 
country to be prepared, and that is what this bill is about. Offering 
free flu shots to everyone in the United States is a good idea in and 
of itself.
  The Centers for Disease Control and Prevention says an average of 
more than 40,000 Americans die each year from flu-related diseases and 
causes. Think about that: 40,000 Americans die every year due to flu-
related causes. Seasonal flu is responsible for more than 31 million 
outpatient visits and more than 3 million days annually in the 
hospital. Seasonal flu costs the U.S. economy nearly $90 billion 
annually, including $10 billion in direct medical costs--$10 billion a 
year just in direct medical costs. Think about that: 40,000 people 
dying every year, $10 billion in direct medical costs, $90 billion 
annually in lost productivity to our economy, over 3 million days in 
the hospital every year, and this is seasonal flu.
  We can significantly reduce all those numbers. In addition, there is 
some evidence that people who are vaccinated each year against seasonal 
flu viruses actually build up a limited degree of resistance to 
pandemic viruses. So strictly as a matter of prudent prevention, it is 
desirable to maximize the number of Americans who are vaccinated 
against flu each year. By offering the vaccinations for free and making 
them conveniently available, we would remove major barriers to more 
widespread participation.
  There is precedence for this. Medicare, right now, will pay for one 
seasonal flu shot for everybody on Medicare every year. So we already 
have that out there. We just need to get it to the rest of the 
population.
  There are other compelling reasons for establishing a nationwide 
voluntary free flu vaccination program. Let me explain.
  As chairman of the appropriations subcommittee that funds health 
programs, I have taken the lead in the past in providing funding to 
prepare for a future flu pandemic. Since 2006, my subcommittee has 
provided more than $6 billion to these activities.
  As a consequence, while public health authorities in the United 
States may have been surprised by the H1N1 virus outbreak, they have 
not been caught unprepared. To the contrary, since 2006 we have 
undertaken very robust measures to prepare for exactly this kind of 
outbreak and potential pandemic.
  First, we have made major investments in antivirals that can be given 
to a person once exposed and shows signs of the illness. We have made 
major investments in medical equipment, which are right now, as we 
speak, being distributed nationally to our local public health 
authorities across the country. Many of them are now in place. Many 
started going out earlier this week. I daresay that probably most, if 
not all, of them are probably out there right now--from the stockpiles 
that we built up. There are over 50 million doses of Tamiflu and 
Relenza that we built up in our stockpile. Well, not all of that, but 
most of it, has gone out around the country to be prepared.
  Second, we have stepped up our public health and surveillance 
activities, which helped us to detect the H1N1 virus earlier than we 
otherwise might have.
  Third, we have increased the capacity of the Centers for Disease 
Control and Prevention to identify viruses and respond aggressively and 
very immediately, including producing what is called a ``seed'' virus, 
necessary for the development of a vaccine. That is being done right 
now.
  Fourth, we have also made major investments in building up our 
vaccine production capacity in the United States. Mr. President, when 
we started on this in 2005, there was at that time only one plant in 
the entire United States of America that could produce flu vaccines--
one. I believe it is located in Pennsylvania, and that was making 
vaccines based upon an old methodology of using eggs. We had to use 
millions of eggs every year to produce that vaccine, and that takes a 
long time.
  There have been, in the research and development, processes by which 
we can make cell-based vaccines. We can shorten the timeframe. That is 
nice, but we don't have any cell-based plants in the United States. In 
the fiscal 2006 bill, we put over $3 billion out there to build these 
plants. They are being built now. So we are building up our vaccine 
production capacity and doing it in a way in which we can get the 
vaccines produced more rapidly.
  Fifth, we have funded research into adjuvants. These are agents that 
increase the vaccine's effectiveness. Let me put it this way. If we 
have one dose of a vaccine, we might actually be able to cut that dose 
down and give that one dose to four or five people by adding the 
adjuvant to it.
  Lastly, we have worked with State and local public health agencies to 
boost their capacity to respond to a flu pandemic. We have done that, 
but because of the economic downturn many of our State budgets have 
been slashed. In our States around the country, we were told at our 
hearing the other day, over 60,000 people have been laid off from our 
public health agencies. That makes it more difficult to get the 
antivirals out to people who may come down with H1N1 or any other kind 
of flu virus.
  Because of all these things we did, I think I can safely say there is 
no reason for anyone anywhere in the United States to panic because of 
the H1N1 flu virus. As I said, one of the most important things we have 
done is to build up our vaccine manufacturing capacity.
  Here is the problem. This really is the crux of this bill I have 
introduced today. Say we build up the vaccine manufacturing capacity 
and we build these plants that can respond aggressively and immediately 
to a pandemic outbreak. What happens the rest of the time? What 
happens? Do they sit there idle, not being utilized? We cannot have 
that.
  What we need to do is to use these plants, then, to make more of the 
seasonal flu vaccines every year. Well, if we have the plants out 
there, and they make more of the seasonal flu viruses but not everybody 
is using them, what do we do, just throw it away? We want the plant 
capacity to prepare for any

[[Page S5020]]

pandemic in the future, but they need to be active and they need to 
produce annually. If they are going to produce annually, then we have 
to find something to do with these vaccines.
  By offering annual free vaccines to every single person in America, 
we will keep our vaccine production capacity up and running. It will be 
ready to shift at a moment's notice, when necessary, from producing 
seasonal flu vaccines to a mass production of vaccines to fight any 
future outbreak or pandemic.

  There is another reason for this bill. If we are faced with a flu 
virus pandemic, we are going to have to mobilize people. We are going 
to have to get the vaccines out in a hurry and get the vaccines right 
down to the individual people all over this country--people in small 
towns and communities, in rural areas, and in cities. Well, by having 
an annual free flu vaccination, we will give public health agencies 
across America valuable experience in administering vaccines to masses 
of people, local agencies that will have a reason to develop trained 
cadres of people who are capable of administering vaccines.
  We will also develop an established network of sites that might 
include grocery stores, shopping malls, schools, places of worship, and 
senior centers where people can conveniently go to get vaccinated in 
case of an outbreak. These annual activities will significantly 
increase State and local public health readiness to fight a pandemic. 
Not all these people are going to be employed by the Government. These 
will be volunteers, but they will be trained. They will know where to 
go and how to administer a vaccine because they will be doing it on an 
annual basis, free of charge, to people. We will build up a network of 
sites and a cadre of people who can be relied upon in case we face a 
pandemic.
  On Tuesday, in response to the H1N1 outbreak, I chaired an emergency 
hearing on the Health Appropriations Subcommittee. We heard assessments 
of the outbreak from top medical experts, including Dr. Anthony Fauci, 
the renowned and remarkable Director of the National Institute of 
Allergy and Infectious Diseases at NIH.
  Years ago, when we first started this, back in 2005, Dr. Fauci warned 
us that it is not a matter of ``whether'' there will be a flu pandemic 
but rather ``when'' it will happen. It is not a matter of whether but 
when.
  When the Senate drafted its version of the American Recovery and 
Reinvestment Act this year--the stimulus bill--I included an additional 
$870 million for pandemic preparedness. Most of that funding was to be 
used to complete the work of building up our vaccine production 
capacity; in other words, to get these plants built more rapidly. 
Unfortunately, it was taken out in the final bill. Again, what we are 
trying to do is shift from egg-based production to cell-based 
production, so we can get these vaccines developed more rapidly. Taking 
it out of the stimulus bill was the typical shortsighted resistance 
that I have often encountered when I talk about this.
  Some accused me a couple years ago of crying wolf. The wolf is here. 
One day in the future we can encounter an even worse wolf, such as the 
flu pandemic of 1918, which was the Spanish flu. It infected one out of 
three people worldwide and killed more than 50 million people. It would 
be the height of folly not to do what we can to prepare for such a 
possibility. The harsh reality is that we have repeatedly experienced 
flu pandemics. I mentioned the one of 1918 and 1919.
  There was the Asian flu pandemic of 1957 and 1958 that killed over 
1.5 million people.
  The Hong Kong flu pandemic of 1968 and 1969 killed over 1 million 
people. Not only did it kill over 1 million people, it caused hundreds 
of millions of illnesses and hospital stays all across the globe.
  We cannot predict the future course or severity of the current H1N1 
outbreak, but clearly it is one more wake-up call.
  Again, I am reintroducing the Seasonal Influenza and Pandemic 
Preparation Act today as a stand-alone bill. I first introduced it in 
2005, as I said. It is now a stand-alone bill. We either pass it that 
way or, if not, I plan to incorporate it into the prevention and public 
health title of comprehensive health reform legislation that we will 
hopefully pass this year. A program offering annual free flu shots to 
every American is exactly the kind of smart, cost-effective, 
prevention-focused public health that must be at the center of our 
reformed health care system in America. It will save lives and money. 
When--when not whether--a pandemic flu strikes the U.S. in the future, 
we will be ready.
  I encourage Senators to cosponsor the legislation. I think this is 
one more wake-up call and we have to move ahead aggressively in 
preparing for these pandemics. As Dr. Fauci said, it is not a question 
of whether, it is only a question of when and how severe it will be. We 
don't know.
  I remind people that a few years ago when we started this, back in 
2005, we were confronting the possible pandemic of an avian flu or H5N1 
flu, which started in Southeast Asia. Thanks to surveillance, to the 
CDC, and to a lot of people working on it, we were able to contain it. 
That H5N1 avian flu is one of the most deadly we have confronted, with 
over a 50-percent mortality. One out of every two persons who 
contracted it died. Now we have contained it and tamped it down. That 
H5N1 virus is still out there and, periodically, we pick it up in 
places such as Southeast Asia.
  There was a thought that because of migratory birds, it may be spread 
to other places, but we don't know that.
  But because it has reared its ugly head, because we know that virus 
is out here someplace, it behooves us to do everything we can to 
protect the people of this country and in doing so to prepare. I hope 
it doesn't happen. I hope when there is a pandemic flu, it will be just 
a mild one and will not kill people. But we don't know. The best way to 
prepare for it is to build up our vaccine-manufacturing capacity as 
rapidly as possible; secondly, make sure our public health agencies on 
the State and local levels are ready to go, that they are trained, that 
they are equipped; and thirdly, that we have some experience, that we 
know how to do this.
  One of the best ways is to give everyone a free flu shot every year--
everyone, a voluntary free flu shot every year. To me, that will set us 
up well to prepare for and to protect the American people against any 
flu pandemic that may come our way in the future.
                                 ______
                                 
      By Mr. DURBIN (for himself, Mr. Bingaman, Mr. Casey, and Mr. 
        Feingold):
  S. 957. A bill to amend the Public Health Service Act to ensure that 
victims of public health emergencies have meaningful and immediate 
access to medically necessary health care services; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. DURBIN: Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                 S. 957

       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 ``Public Health Emergency 
     Response Act of 2009''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds the following:
       (1) Since 2000, the Secretary of Health and Human Services 
     has declared that a public health emergency existed 
     nationwide in response to the attacks of September 11th and 
     in response to Hurricanes Katrina and Rita.
       (2) In the event of a public health emergency, compliance 
     with recommendations to seek immediate care may be critical 
     to containing the spread of an infectious disease outbreak or 
     responding to a bioterror attack.
       (3) Nearly 16 percent of Americans lack health insurance 
     coverage.
       (4) Fears of out-of-pocket expenses may cause individuals 
     to delay seeking medical attention during a public health 
     emergency.
       (5) A public health emergency may disrupt health care 
     assistance programs for individuals with chronic conditions, 
     exacerbating the costs and risks to their health.
       (6) The uninsured could place great financial strain on 
     health care providers during a public health emergency.
       (7) The Department of Health and Human Services Pandemic 
     Influenza Plan projects that a pandemic influenza outbreak 
     could result in 45,000,000 additional outpatient visits, with 
     865,000 to 9,900,000 individuals requiring hospitalization, 
     depending upon the severity of the pandemic.

[[Page S5021]]

       (8) Hospitals in the United States could lose as much as 
     $3,900,000,000 in uncompensated care and cash flow losses in 
     the event of a severe pandemic.
       (9) Under current statute, no dedicated mechanism exists to 
     reimburse providers for uncompensated care during a public 
     health emergency.
       (b) Purposes.--The purposes of this Act are--
       (1) to provide temporary emergency health care coverage for 
     uninsured and certain otherwise qualified individuals in the 
     event of a public health emergency declared by the Secretary 
     of Health and Human Services;
       (2) to ensure that health care providers remain fiscally 
     solvent and are not overburdened by the cost of uncompensated 
     care during a public health emergency;
       (3) to eliminate a primary disincentive for uninsured and 
     certain otherwise qualified individuals to promptly seek 
     medical care during a public health emergency; and
       (4) to minimize delays in the provision of emergency health 
     care coverage by clarifying eligibility requirements and the 
     scope of such coverage and identifying the funding mechanisms 
     for emergency health care services.

     SEC. 3. EMERGENCY HEALTH CARE COVERAGE.

       (a) In General.--Title III of the Public Health Service Act 
     (42 U.S.C. 241 et seq.) is amended by inserting after section 
     319K the following new section:

     ``SEC. 319K-1. EMERGENCY HEALTH CARE COVERAGE.

       ``(a) Activation and Termination of Emergency Health Care 
     Coverage.--
       ``(1) Based on public health emergency.--
       ``(A) In general.--The Secretary may activate the coverage 
     of emergency health care services under this section only if 
     the Secretary determines that there is a public health 
     emergency.
       ``(B) Determination of public health emergency.--For 
     purposes of this section, there is a `public health 
     emergency' only if a public health emergency exists under 
     section 319.
       ``(2) Considerations.--In making a determination under 
     paragraph (1), the Secretary shall consider a range of 
     factors including the following:
       ``(A) The degree to which the emergency is likely to 
     overwhelm health care providers in the region.
       ``(B) The opportunity to minimize morbidity and mortality 
     through intervention under this section.
       ``(C) The estimated number of direct casualties of the 
     emergency.
       ``(D) The potential number of casualties in the absence of 
     intervention under this section (such as in the case of 
     infectious disease).
       ``(E) The potential adverse financial impacts on local 
     health care providers in the absence of activation of this 
     section.
       ``(F) Whether the need for health care services is of 
     sufficient severity and magnitude to warrant major assistance 
     under this section above and beyond the emergency services 
     otherwise available from the Federal Government.
       ``(G) Such other factors as the Secretary may deem 
     appropriate.
       ``(3) Termination and extension.--
       ``(A) In general.--Coverage of emergency health care 
     services under this section shall terminate, subject to 
     subsection (c)(2), upon the earlier of the following:
       ``(i) The Secretary's determination that a public health 
     emergency no longer exists.
       ``(ii) Subject to subparagraph (B), 90 days after the 
     initiation of coverage of emergency health care services.
       ``(B) Extension authority.--The Secretary may extend a 
     public health emergency for a second 90-day period, but only 
     if a report to Congress is made under paragraph (4) in 
     conjunction with making such extension.
       ``(4) Report.--
       ``(A) In general.--Prior to making an extension under 
     paragraph (3)(B), the Secretary shall transmit a report to 
     Congress that includes information on the nature of the 
     public health emergency and the expected duration of the 
     emergency. The Secretary shall include in such report 
     recommendations, if deemed appropriate, that Congress provide 
     a further extension of the public health emergency period 
     beyond the second 90-day period.
       ``(B) Report contents.--A report under subparagraph (A) 
     shall include a discussion of the health care needs of 
     emergency victims and affected individuals including the 
     likely need for follow-up care over a 2-year period.
       ``(5) Coordination.--The Secretary shall ensure that the 
     activation, implementation, and termination of emergency 
     health care services under this section in response to a 
     public health emergency is coordinated with all functions, 
     personnel, and assets of the Federal, State, local, and 
     tribal responses to the emergency.
       ``(6) Medical monitoring program.--The Secretary shall 
     establish a medical monitoring program for monitoring and 
     reporting on health care needs of the affected population 
     over time. At least annually during the 5-year period 
     following the date of a public health emergency, the 
     Secretary shall report to Congress on any continuing health 
     care needs of the affected population related to the public 
     health emergency. Such reports shall include recommendations 
     on how to ensure that emergency victims and affected 
     individuals have access to needed health care services.
       ``(b) Eligibility for Coverage of Emergency Health Care 
     Services.--
       ``(1) Limited eligibility.--
       ``(A) In general.--Eligibility for coverage of emergency 
     health care services under this section for a public health 
     emergency is limited to individuals who--
       ``(i) are emergency victims who are uninsured or otherwise 
     qualified; or
       ``(ii) are affected individuals who are uninsured.
       ``(B) Definitions.--For purposes of this section with 
     respect to a public health emergency:
       ``(i) Insured.--An individual is `insured' if the 
     individual has group or individual health insurance coverage 
     or publicly financed health insurance (as defined by the 
     Secretary).
       ``(ii) Otherwise qualified.--An individual is ``otherwise 
     qualified'' if the individual is insured but the Secretary 
     determines that the individual's health care insurance 
     coverage is not at least actuarially-equivalent to benchmark 
     coverage. In establishing such benchmark coverage, the 
     Secretary shall consider the standard Blue Cross/Blue Shield 
     preferred provider option service benefit plan described in 
     and offered under section 8903(1) of title 5, United States 
     Code.
       ``(iii) Uninsured.--An individual is `uninsured' if the 
     individual is not insured.
       ``(iv) Emergency victim.--An individual is an `emergency 
     victim' with respect to a public health emergency if the 
     individual needs health care services due to injuries or 
     disease resulting from the public health emergency.
       ``(v) Affected individual.--An individual is an `affected 
     individual' with respect to a public health emergency if--

       ``(I) the individual--

       ``(aa) resides in an assistance area designated for the 
     emergency (or whose residence was displaced by the 
     emergency); or
       ``(bb) in the case of such an emergency constituting a 
     pandemic flu or other infectious disease outbreak, resides in 
     the area affected by the outbreak (or whose residence was 
     displaced by the emergency); and

       ``(II) the individual's ability to access care or medicine 
     is disrupted as a result of the emergency.

       ``(2) Process.--The Secretary shall establish a streamlined 
     process for determining eligibility for emergency health care 
     services under this section. In establishing such process--
       ``(A) the Secretary shall recognize that in the context of 
     a public health emergency, individuals may be unable to 
     provide identification cards, health care insurance 
     information, or other documentation; and
       ``(B) the primary method for determining eligibility for 
     such services shall be an attestation provided to the health 
     care provider by the recipient of the services that the 
     recipient meets the eligibility criteria established under 
     paragraph (1)(A), with a standard alternative for unattended 
     minors and adults without the capacity to sign such an 
     attestation form.
       ``(3) Service delivery.--Providers may commence provision 
     of emergency health care services for an individual in the 
     absence of any centralized enrollment process, if the 
     provider has collected basic information, specified by the 
     Secretary, including the individual's name, address, social 
     security number, and existing health insurance coverage (if 
     any), that establishes a prima facie basis for eligibility, 
     except that such information shall not be required in cases 
     where the individual is unable to provide the information due 
     to disability or incapacitation.
       ``(c) Emergency Health Care Services.--
       ``(1) In general.--For purposes of this section, the term 
     `emergency health care services'--
       ``(A) means items and services for which payment may be 
     made under parts A and B of the Medicare program;
       ``(B) includes prescription drugs (not covered under such 
     part B) specified by the Secretary under subsection (g), 
     based on the formularies of the two or more prescription drug 
     plans under part D of the Medicare program with the largest 
     enrollment;
       ``(C) may include drugs, devices, biological products, and 
     other health care products, if such products are authorized 
     for use by the Food and Drug Administration pursuant to an 
     alternate authority, including the emergency use authority 
     under section 564 of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 360bbb-3); and
       ``(D) for an affected individual, is limited to those items 
     and services described under subparagraphs (A), (B) or (C) 
     that a third-party payor, such as a government program or 
     charitable organization, reimbursed or otherwise provided to 
     an affected individual during the 90 days prior to the 
     declaration of the public health emergency.
       ``(2) Not medicare, medicaid, or schip benefits.--The 
     emergency health care services provided under this section 
     are not benefits under Medicare, Medicaid or SCHIP. Nothing 
     in this section shall be interpreted as altering or otherwise 
     conflicting with titles XVIII, XIX, or XXI of the Social 
     Security Act.
       ``(3) Completion of treatment for emergency victims.--
     Notwithstanding termination of the coverage of emergency 
     health care services pursuant to subsection (a)(3), the 
     Secretary may identify a subgroup of emergency victims on a 
     case-by-case basis or otherwise to continue receiving 
     coverage of emergency health care services for up to an 
     additional 60 days. Such emergency health care services 
     provided after the termination date shall be limited to 
     services and items

[[Page S5022]]

     that are medically necessary to treat an injury or disease 
     resulting directly from the public health emergency involved.
       ``(d) Covered Providers.--
       ``(1) In general.--Subject to paragraph (2), health care 
     services are not covered under this section unless they are 
     furnished by a health care provider that--
       ``(A) has a valid provider number under the Medicare 
     program, the Medicaid program, or SCHIP;
       ``(B) is in good standing with such program; and
       ``(C) is not excluded from participation in a Federal 
     health care program (as defined in section 1128B(f) of the 
     Social Security Act (42 U.S.C. 1320a-7b(f))).
       ``(2) Waiver authority.--
       ``(A) In general.--The Secretary may by regulation waive 
     certain requirements for provider enrollment that otherwise 
     apply under the Medicare or Medicaid program or under SCHIP 
     to ensure an adequate supply of health care providers (such 
     as nurses and other health care providers who do not 
     typically participate in the Medicare or Medicaid program or 
     SCHIP) and services in the case of a public health emergency. 
     Such requirements may include the requirement that a licensed 
     physician or other health care professional holds a license 
     in the State in which the professional provides services or 
     is otherwise authorized under State law to provide the 
     services involved.
       ``(B) Report on emergency system for advance registration 
     of volunteer health professionals (esar-vhp).--Not later than 
     180 days after the date of the enactment of this section, the 
     Secretary shall submit to Congress a report on the number of 
     volunteers, by profession and credential level, enrolled in 
     the Emergency System for Advance Registration of Volunteer 
     Health Professionals (ESAR-VHP) that will be available to 
     each State in the event of a public health emergency. The 
     Secretary shall determine if the number of such volunteers is 
     adequate for interstate deployment in response to regional 
     requests for volunteers and, if not, shall include in the 
     report recommendations for actions to ensure an adequate 
     surge capacity for public health emergencies in defined 
     geographic areas.
       ``(3) Medicare and medicaid programs and schip defined.--
     For purposes of this section:
       ``(A) The term `Medicare program' means the program under 
     parts A, B, and D of title XVIII of the Social Security Act.
       ``(B) The term `Medicaid program' means the program of 
     medical assistance under title XIX of such Act.
       ``(C) The term `SCHIP' means the State children's health 
     insurance program under title XXI of such Act.
       ``(e) Payments and Claims Administration.--
       ``(1) Payment amount.--The amount of payment under this 
     section to a provider for emergency health care services 
     shall be equal to 100 percent of the payment rate for the 
     corresponding service under part A or B of the Medicare 
     program, or, in the case of prescription drugs and other 
     items and services not covered under either such part, such 
     amount as the Secretary may specify by rule. Such a provider 
     shall not be permitted to impose any cost-sharing or to 
     balance bill for services furnished under this section.
       ``(2) Use of medicare contractors.--The Secretary shall 
     enter into arrangements with Medicare administrative 
     contractors under which such contractors process claims for 
     emergency health care services under this section using the 
     claim forms, codes, and nomenclature in effect under the 
     Medicare program.
       ``(3) Application of secondary payer rules.--In the case of 
     payment under this section for emergency health care services 
     for otherwise qualified individuals who have some health 
     insurance coverage with respect to such services, the 
     administrative contractors under paragraph (2) shall submit a 
     claim to the entity offering such coverage to recoup all or 
     some of such payment, reflecting whatever amount the entity 
     would normally reimburse for each covered service. The 
     provisions of section 1862(b) of the Social Security Act (42 
     U.S.C. 1395y(b)) shall apply to benefits provided under this 
     section in the same manner as they apply to benefits provided 
     under the Medicare program.
       ``(4) Payments for emergency health care services and 
     related costs.--Payments to provide, and costs to administer, 
     emergency health care services under this section shall be 
     made from the Public Health Emergency Fund, as provided under 
     subsection (f)(1).
       ``(5) Attestation requirement.--No payment shall be made 
     under this section to a provider for emergency health care 
     services unless the provider has executed an attestation 
     that--
       ``(A) the provider has notified the administrative 
     contractor of any third-party payment received or claims 
     pending for such services;
       ``(B) the recipient of the services has executed an 
     attestation or otherwise satisfies the eligibility criteria 
     established under subsection (b); and
       ``(C) the services were medically necessary.
       ``(f) Public Health Emergency Fund; Fraud and Abuse 
     Provisions.--
       ``(1) The public health emergency fund.--There is 
     authorized to be appropriated to the Public Health Emergency 
     Fund (established under section 319(b)) such sums as may be 
     necessary under this section for payments to provide 
     emergency health care services and costs to administer the 
     services during a public health emergency.
       ``(2) No use of medicare funds.--No funds under the 
     Medicare program shall be made available or used to make 
     payments under this section.
       ``(3) Fraud and abuse provisions.--Providers and recipients 
     of emergency health care services under this section shall be 
     subject to the Federal fraud and abuse protections that apply 
     to Federal health care programs as defined in section 
     1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)).
       ``(g) Rulemaking.--The Secretary may issue regulations to 
     carry out this section and shall use a negotiated rulemaking 
     process to advise the Secretary on key issues regarding the 
     implementation of this section.
       ``(h) Public Health Emergency Planning and the Education of 
     Health Care Providers and the General Population.--
       ``(1) Planning for coverage of emergency health care 
     services in public health emergencies.--The Secretary shall, 
     not later than 90 days after the date of the enactment of 
     this section, initiate planning to carry out this section, 
     including planning relating to implementation of the payments 
     and claims administration under subsection (e), in the event 
     of activation of emergency health care coverage.
       ``(2) Outreach and public education campaign.--The 
     Secretary shall conduct an outreach and public education 
     campaign to inform health care providers and the general 
     public about the availability of emergency health care 
     coverage under this section during the period of the 
     emergency. Such campaign shall include--
       ``(A) an explanation of the emergency health care coverage 
     program under this section;
       ``(B) claim forms and instructions for health care 
     providers to use when providing covered services during the 
     emergency period; and
       ``(C) special outreach initiatives to vulnerable and hard-
     to-reach populations.
       ``(3) Authorization of appropriations.--There are 
     authorized to be appropriated for each fiscal year (beginning 
     with fiscal year 2009) $7,000,000 to carry out paragraphs (1) 
     and (2) during the fiscal year.
       ``(i) Application of Policies Under Other Federal Health 
     Care Programs.--As specified in subsections (c) through (e), 
     the Secretary may adopt in whole or in part the coverage, 
     reimbursement, provider enrollment, and other policies used 
     under the Medicare program and other Federal health care 
     programs in administering emergency health care services 
     under this section to the extent consistent with this 
     section.''.
       (b) Application of Public Health Emergency Fund.--Section 
     319(b)(1) of such Act (42 U.S.C. 247d(b)(1)) is amended--
       (1) by inserting ``and section 319K-1'' after ``subsection 
     (a)''; and
       (2) by striking ``such subsection'' and inserting 
     ``subsection (a)''.
                                 ______
                                 
      By Mr. ROCKEFELLER (for himself, Mr. Casey, and Mrs. Gillibrand):
  S. 958. A bill to amend the Social Security Act to guarantee 
comprehensive health care coverage for all children born after 2009; to 
the Committee on Finance.
  Mr. ROCKEFELLER, Mr. President, I rise today, with my colleagues, 
Senator Gillibrand and Senator Casey, to reintroduce an important piece 
of legislation--the MediKids Health Insurance Act of 2009. This 
legislation will finish the job we started with CHIP reauthorization by 
providing health care coverage for every child in the U.S. by 2015, 
regardless of family income.
  Congressman Stark and I have introduced our MediKids legislation in 
each of the last five Congresses because we know how vital health 
insurance is to a child. Year after year, study after study has shown 
that uninsured children are more likely to have unmet health care 
needs. Without adequate health care, childhood illnesses are more 
likely to turn into chronic conditions in adulthood with debilitating 
effects. Even something as simple as an ear infection, if left 
untreated, can cause hearing loss, which can hinder a child's speech 
and language development. Furthermore, children with unmet health care 
needs often underperform in the classroom and miss more days of school. 
Less time in school means students can struggle to develop the skills 
necessary to become productive members of society.
  Despite the well-documented benefits of providing health insurance 
coverage for children, according to the Kaiser Family Foundation, there 
were over 9 million uninsured children in America in 2007. A 
significant step forward in providing health insurance for our 
uninsured children was the reauthorization of the Children's Health 
Insurance Program, a bill I coauthored. Expansions in Medicaid and the 
Children's Health Insurance Program have helped reduce the percentage 
of low-income children that are uninsured from 28

[[Page S5023]]

percent to 15 percent since 1997, with another significant reduction 
probable after the 2009 CHIP reauthorization legislation is fully 
implemented. As pleased as I was with the reauthorization of this vital 
program, it is estimated that millions of children will still remain 
uninsured. This is unacceptable. We must provide universal coverage for 
children.
  Children are entirely reliant on others to care for them. They cannot 
go out and purchase their own health insurance. Just as Congress 
provides for the care of the other segment of our population that is 
heavily reliant on others, the elderly through Medicare, the time has 
come to make certain that all children also have access to 
comprehensive health care. Healthy, well educated children are the key 
to the future success of our country and we cannot allow them to 
continue to fall through the cracks. Now, more than ever, it is time to 
finally pass the MediKids Health Insurance Act.
  This legislation is a clear investment in our future--our children. 
Every child would be automatically enrolled at birth into a new, 
comprehensive, Federal safety net health insurance program beginning in 
2010 and would be eligible up to age 23. The benefits would be tailored 
to meet the needs of children and would be similar to those currently 
available to children through the Medicaid Early and Periodic 
Screening, Diagnosis, and Treatment, EPSDT, program.
  Families below 150 percent of poverty would pay no premiums or co-
payments, while those between 150 and 300 percent of poverty would pay 
graduated premiums up to 5 percent of income and a graduated refundable 
tax credit for cost-sharing. Families above 300 percent of poverty 
would pay a small premium equivalent to one fourth of the average 
annual cost per child. There would be no cost sharing for preventive or 
well-child visits for any child.
  MediKids children would remain enrolled in the program throughout 
childhood. When families move to another state, MediKids would be 
available until parents enroll their children in a new insurance 
program. Between jobs or during family crises, MediKids would offer 
extra security and ensure continuous health coverage to our nation's 
children. During the critical period when a family climbs out of 
poverty and out of the eligibility range for means-tested assistance 
programs, MediKids would fill in the gaps as parents move into jobs 
that provide reliable health insurance coverage. Our program rests on 
the premise that whenever other sources of health insurance fail, 
MediKids would stand ready to cover the health needs of our next 
generation. Ultimately, every child in America would grow up with 
consistent, continuous health insurance coverage.
  Congress cannot rest on the success we achieved by reauthorizing the 
Children's Health Insurance Program. Although CHIP was a remarkable 
step toward reducing the ranks of uninsured children, there is still 
much more work to be done. The MediKids Health Insurance Act is a 
comprehensive approach toward eliminating the damaging lack of health 
insurance for so many children in our country, and I urge my colleagues 
to support this legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed. in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 958

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``MediKids 
     Health Insurance Act of 2009''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents; findings.
Sec. 2. Benefits for all children born after 2009.

                     ``TITLE XXII--MEDIKIDS PROGRAM

``Sec. 2201. Eligibility.
``Sec. 2202. Benefits.
``Sec. 2203. Premiums.
``Sec. 2204. MediKids Trust Fund.
``Sec. 2205. Oversight and accountability.
``Sec. 2206. Inclusion of care coordination services.
``Sec. 2207. Administration and miscellaneous.
Sec. 3. MediKids premium.
Sec. 4. Refundable credit for certain cost-sharing expenses under 
              MediKids program.
Sec. 5. Report on long-term revenues.
       (c) Findings.--Congress finds the following:
       (1) More than 9 million American children are uninsured.
       (2) Children who are uninsured receive less medical care 
     and less preventive care and have a poorer level of health, 
     which result in lifetime costs to themselves and to the 
     entire American economy.
       (3) Although CHIP and Medicaid are successfully extending a 
     health coverage safety net to a growing portion of the 
     vulnerable low-income population of uninsured children, they 
     alone cannot achieve 100 percent health insurance coverage 
     for our nation's children due to inevitable gaps during 
     outreach and enrollment, fluctuations in eligibility, 
     variations in access to private insurance at all income 
     levels, and variations in States' ability to provide required 
     matching funds.
       (4) As all segments of society continue to become more 
     transient, with many changes in employment over the working 
     lifetime of parents, the need for a reliable safety net of 
     health insurance which follows children across State lines, 
     already a major problem for the children of migrant and 
     seasonal farmworkers, will become a major concern for all 
     families in the United States.
       (5) The medicare program has successfully evolved over the 
     years to provide a stable, universal source of health 
     insurance for the nation's disabled and those over age 65, 
     and provides a tested model for designing a program to reach 
     out to America's children.
       (6) The problem of insuring 100 percent of all American 
     children could be gradually solved by automatically enrolling 
     all children born after December 31, 2009, in a program 
     modeled after Medicare (and to be known as ``MediKids''), and 
     allowing those children to be transferred into other 
     equivalent or better insurance programs, including either 
     private insurance, CHIP, or Medicaid, if they are eligible to 
     do so, but maintaining the child's default enrollment in 
     MediKids for any times when the child's access to other 
     sources of insurance is lost.
       (7) A family's freedom of choice to use other insurers to 
     cover children would not be interfered with in any way, and 
     children eligible for CHIP and Medicaid would continue to be 
     enrolled in those programs, but the underlying safety net of 
     MediKids would always be available to cover any gaps in 
     insurance due to changes in medical condition, employment, 
     income, or marital status, or other changes affecting a 
     child's access to alternate forms of insurance.
       (8) The MediKids program can be administered without 
     impacting the finances or status of the existing Medicare 
     program.
       (9) The MediKids benefit package can be tailored to the 
     special needs of children and updated over time.
       (10) The financing of the program can be administered 
     without difficulty by a yearly payment of affordable premiums 
     through a family's tax filing (or adjustment of a family's 
     earned income tax credit).
       (11) The cost of the program will gradually rise as the 
     number of children using MediKids as the insurer of last 
     resort increases, and a future Congress always can accelerate 
     or slow down the enrollment process as desired, while the 
     societal costs for emergency room usage, lost productivity 
     and work days, and poor health status for the next generation 
     of Americans will decline.
       (12) Over time 100 percent of American children will always 
     have basic health insurance, and we can therefore expect a 
     healthier, more equitable, and more productive society.

     SEC. 2. BENEFITS FOR ALL CHILDREN BORN AFTER 2009.

       (a) In General.--The Social Security Act is amended by 
     adding at the end the following new title:

                     ``TITLE XXII--MEDIKIDS PROGRAM

     ``SEC. 2201. ELIGIBILITY.

       ``(a) Eligibility of Individuals Born After December 31, 
     2009; All Children Under 23 Years of Age in Fifth Year.--An 
     individual who meets the following requirements with respect 
     to a month is eligible to enroll under this title with 
     respect to such month:
       ``(1) Age.--
       ``(A) First year.--As of the first day of the first year in 
     which this title is effective, the individual has not 
     attained 6 years of age.
       ``(B) Second year.--As of the first day of the second year 
     in which this title is effective, the individual has not 
     attained 11 years of age.
       ``(C) Third year.--As of the first day of the third year in 
     which this title is effective, the individual has not 
     attained 16 years of age.
       ``(D) Fourth year.--As of the first day of the fourth year 
     in which this title is effective, the individual has not 
     attained 21 years of age.
       ``(E) Fifth and subsequent years.--As of the first day of 
     the fifth year in which this title is effective and each 
     subsequent year, the individual has not attained 23 years of 
     age.
       ``(2) Citizenship.--The individual is a citizen or national 
     of the United States or is permanently residing in the United 
     States under color of law.
       ``(b) Enrollment Process.--An individual may enroll in the 
     program established under this title only in such manner and 
     form as may be prescribed by regulations, and only

[[Page S5024]]

     during an enrollment period prescribed by the Secretary 
     consistent with the provisions of this section. Such 
     regulations shall provide a process under which--
       ``(1) individuals who are born in the United States after 
     December 31, 2009, are deemed to be enrolled at the time of 
     birth and a parent or guardian of such an individual is 
     permitted to pre-enroll in the month prior to the expected 
     month of birth;
       ``(2) individuals who are born outside the United States 
     after such date and who become eligible to enroll by virtue 
     of immigration into (or an adjustment of immigration status 
     in) the United States are deemed enrolled at the time of 
     entry or adjustment of status;
       ``(3) eligible individuals may otherwise be enrolled at 
     such other times and manner as the Secretary shall specify, 
     including the use of outstationed eligibility sites as 
     described in section 1902(a)(55)(A) and the use of 
     presumptive eligibility provisions like those described in 
     section 1920A; and
       ``(4) at the time of automatic enrollment of a child, the 
     Secretary provides for issuance to a parent or custodian of 
     the individual a card evidencing coverage under this title 
     and for a description of such coverage.

     The provisions of section 1837(h) apply with respect to 
     enrollment under this title in the same manner as they apply 
     to enrollment under part B of title XVIII. An individual who 
     is enrolled under this title is not eligible to be enrolled 
     under an MA or MA-PD plan under part C of title XVIII.
       ``(c) Date Coverage Begins.--
       ``(1) In general.--The period during which an individual is 
     entitled to benefits under this title shall begin as follows, 
     but in no case earlier than January 1, 2010:
       ``(A) In the case of an individual who is enrolled under 
     paragraph (1) or (2) of subsection (b), the date of birth or 
     date of obtaining appropriate citizenship or immigration 
     status, as the case may be.
       ``(B) In the case of another individual who enrolls 
     (including pre-enrolls) before the month in which the 
     individual satisfies eligibility for enrollment under 
     subsection (a), the first day of such month of eligibility.
       ``(C) In the case of another individual who enrolls during 
     or after the month in which the individual first satisfies 
     eligibility for enrollment under such subsection, the first 
     day of the following month.
       ``(2) Authority to provide for partial months of 
     coverage.--Under regulations, the Secretary may, in the 
     Secretary's discretion, provide for coverage periods that 
     include portions of a month in order to avoid lapses of 
     coverage.
       ``(3) Limitation on payments.--No payments may be made 
     under this title with respect to the expenses of an 
     individual enrolled under this title unless such expenses 
     were incurred by such individual during a period which, with 
     respect to the individual, is a coverage period under this 
     section.
       ``(d) Expiration of Eligibility.--An individual's coverage 
     period under this section shall continue until the 
     individual's enrollment has been terminated because the 
     individual no longer meets the requirements of subsection (a) 
     (whether because of age or change in immigration status).
       ``(e) Entitlement to MediKids Benefits for Enrolled 
     Individuals.--An individual enrolled under this title is 
     entitled to the benefits described in section 2202.
       ``(f) Low-Income Information.--
       ``(1) Inquiry of income.--At the time of enrollment of a 
     child under this title, the Secretary shall make an inquiry 
     as to whether the family income (as determined for purposes 
     of section 1905(p)) of the family that includes the child is 
     within any of the following income ranges:
       ``(A) Up to 150 percent of poverty.--The income of the 
     family does not exceed 150 percent of the poverty line for a 
     family of the size involved.
       ``(B) Between 150 and 200 percent of poverty.--The income 
     of the family exceeds 150 percent, but does not exceed 200 
     percent, of such poverty line.
       ``(C) Between 200 and 300 percent of poverty.--The income 
     of the family exceeds 200 percent, but does not exceed 300 
     percent, of such poverty line.
       ``(2) Coding.--If the family income is within a range 
     described in paragraph (1), the Secretary shall encode in the 
     identification card issued in connection with eligibility 
     under this title a code indicating the range applicable to 
     the family of the child involved.
       ``(3) Provider verification through electronic system.--The 
     Secretary also shall provide for an electronic system through 
     which providers may verify which income range described in 
     paragraph (1), if any, is applicable to the family of the 
     child involved.
       ``(g) Construction.--Nothing in this title shall be 
     construed as requiring (or preventing) an individual who is 
     enrolled under this title from seeking medical assistance 
     under a State medicaid plan under title XIX or child health 
     assistance under a State child health plan under title XXI.

     ``SEC. 2202. BENEFITS.

       ``(a) Secretarial Specification of Benefit Package.--
       ``(1) In general.--The Secretary shall specify the benefits 
     to be made available under this title consistent with the 
     provisions of this section and in a manner designed to meet 
     the health needs of enrollees.
       ``(2) Updating.--The Secretary shall update the 
     specification of benefits over time to ensure the inclusion 
     of age-appropriate benefits to reflect the enrollee 
     population.
       ``(3) Annual updating.--The Secretary shall establish 
     procedures for the annual review and updating of such 
     benefits to account for changes in medical practice, new 
     information from medical research, and other relevant 
     developments in health science.
       ``(4) Input.--The Secretary shall seek the input of the 
     pediatric community in specifying and updating such benefits.
       ``(5) Limitation on updating.--In no case shall updating of 
     benefits under this subsection result in a failure to provide 
     benefits required under subsection (b).
       ``(b) Inclusion of Certain Benefits.--
       ``(1) Medicare core benefits.--Such benefits shall include 
     (to the extent consistent with other provisions of this 
     section) at least the same benefits (including coverage, 
     access, availability, duration, and beneficiary rights) that 
     are available under parts A and B of title XVIII.
       ``(2) All required medicaid benefits.--Such benefits shall 
     also include all items and services for which medical 
     assistance is required to be provided under section 
     1902(a)(10)(A) to individuals described in such section, 
     including early and periodic screening, diagnostic services, 
     and treatment services.
       ``(3) Inclusion of prescription drugs.--Such benefits also 
     shall include (as specified by the Secretary) benefits for 
     prescription drugs and biologicals which are not less than 
     the benefits for such drugs and biologicals under the 
     standard option for the service benefit plan described in 
     section 8903(1) of title 5, United States Code, offered 
     during 2008.
       ``(4) Cost-sharing.--
       ``(A) In general.--Subject to subparagraph (B), such 
     benefits also shall include the cost-sharing (in the form of 
     deductibles, coinsurance, and copayments) which is 
     substantially similar to such cost-sharing under the health 
     benefits coverage in any of the four largest health benefits 
     plans (determined by enrollment) offered under chapter 89 of 
     title 5, United States Code, and including an out-of-pocket 
     limit for catastrophic expenditures for covered benefits, 
     except that no cost-sharing shall be imposed with respect to 
     early and periodic screening and diagnostic services included 
     under paragraph (2).
       ``(B) Reduced cost-sharing for low income children.--Such 
     benefits shall provide that--
       ``(i) there shall be no cost-sharing for children in 
     families the income of which is within the range described in 
     section 2201(f)(1)(A);
       ``(ii) the cost-sharing otherwise applicable shall be 
     reduced by 75 percent for children in families the income of 
     which is within the range described in section 2201(f)(1)(B); 
     or
       ``(iii) the cost-sharing otherwise applicable shall be 
     reduced by 50 percent for children in families the income of 
     which is within the range described in section 2201(f)(1)(C).
       ``(C) Catastrophic limit on cost-sharing.--For a refundable 
     credit for cost-sharing in the case of cost-sharing in excess 
     of a percentage of the individual's adjusted gross income, 
     see section 36 of the Internal Revenue Code of 1986.
       ``(c) Payment Schedule.--The Secretary, with the assistance 
     of the Medicare Payment Advisory Commission, shall develop 
     and implement a payment schedule for benefits covered under 
     this title. To the extent feasible, such payment schedule 
     shall be consistent with comparable payment schedules and 
     reimbursement methodologies applied under parts A and B of 
     title XVIII.
       ``(d) Input.--The Secretary shall specify such benefits and 
     payment schedules only after obtaining input from appropriate 
     child health providers and experts.
       ``(e) Enrollment in Health Plans.--The Secretary shall 
     provide for the offering of benefits under this title through 
     enrollment in a health benefit plan that meets the same (or 
     similar) requirements as the requirements that apply to 
     Medicare Advantage plans under part C of title XVIII (other 
     than any such requirements that relate to part D of such 
     title). In the case of individuals enrolled under this title 
     in such a plan, the payment rate shall be based on payment 
     rates provided for under section 1853(c) in effect before the 
     date of the enactment of the Medicare Prescription Drug, 
     Modernization, and Improvement Act of 2003 (Public Law 108-
     173), except that such payment rates shall be adjusted in an 
     appropriate manner to reflect differences between the 
     population served under this title and the population under 
     title XVIII.

     ``SEC. 2203. PREMIUMS.

       ``(a) Amount of Monthly Premiums.--
       ``(1) In general.--The Secretary shall, during September of 
     each year (beginning with 2009), establish a monthly MediKids 
     premium for the following year. Subject to paragraph (2), the 
     monthly MediKids premium for a year is equal to \1/12\ of the 
     annual premium rate computed under subsection (b).
       ``(2) Elimination of monthly premium for demonstration of 
     equivalent coverage (including coverage under low-income 
     programs).--The amount of the monthly premium imposed under 
     this section for an individual for a month shall be zero in 
     the case of an individual who demonstrates to the 
     satisfaction of the Secretary that the individual has basic 
     health insurance coverage for that month. For purposes of the 
     previous sentence enrollment in a medicaid plan under title 
     XIX, a State child health insurance plan under title XXI, or 
     under the medicare program under title XVIII is deemed to

[[Page S5025]]

     constitute basic health insurance coverage described in such 
     sentence.
       ``(b) Annual Premium.--
       ``(1) National per capita average.--The Secretary shall 
     estimate the average, annual per capita amount that would be 
     payable under this title with respect to individuals residing 
     in the United States who meet the requirement of section 
     2201(a)(1) as if all such individuals were eligible for (and 
     enrolled) under this title during the entire year (and 
     assuming that section 1862(b)(2)(A)(i) did not apply).
       ``(2) Annual premium.--Subject to subsection (d), the 
     annual premium under this subsection for months in a year is 
     equal to 25 percent of the average, annual per capita amount 
     estimated under paragraph (1) for the year.
       ``(c) Payment of Monthly Premium.--
       ``(1) Period of payment.--In the case of an individual who 
     participates in the program established by this title, 
     subject to subsection (d), the monthly premium shall be 
     payable for the period commencing with the first month of the 
     individual's coverage period and ending with the month in 
     which the individual's coverage under this title terminates.
       ``(2) Collection through tax return.--For provisions 
     providing for the payment of monthly premiums under this 
     subsection, see section 59B of the Internal Revenue Code of 
     1986.
       ``(3) Protections against fraud and abuse.--The Secretary 
     shall develop, in coordination with States and other health 
     insurance issuers, administrative systems to ensure that 
     claims which are submitted to more than one payor are 
     coordinated and duplicate payments are not made.
       ``(d) Reduction in Premium for Certain Low-Income 
     Families.--For provisions reducing the premium under this 
     section for certain low-income families, see section 59B(d) 
     of the Internal Revenue Code of 1986.

     ``SEC. 2204. MEDIKIDS TRUST FUND.

       ``(a) Establishment of Trust Fund.--
       ``(1) In general.--There is hereby created on the books of 
     the Treasury of the United States a trust fund to be known as 
     the `MediKids Trust Fund' (in this section referred to as the 
     `Trust Fund'). The Trust Fund shall consist of such gifts and 
     bequests as may be made as provided in section 201(i)(1) and 
     such amounts as may be deposited in, or appropriated to, such 
     fund as provided in this title.
       ``(2) Premiums.--Premiums collected under section 59B of 
     the Internal Revenue Code of 1986 shall be periodically 
     transferred to the Trust Fund.
       ``(3) Transitional funding before receipt of premiums.--In 
     order to provide for funds in the Trust Fund to cover 
     expenditures from the fund in advance of receipt of premiums 
     under section 2203, there are transferred to the Trust Fund 
     from the general fund of the United States Treasury such 
     amounts as may be necessary.
       ``(b) Incorporation of Provisions.--
       ``(1) In general.--Subject to paragraph (2), subsection (b) 
     (other than the last sentence) and subsections (c) through 
     (i) of section 1841 shall apply with respect to the Trust 
     Fund and this title in the same manner as they apply with 
     respect to the Federal Supplementary Medical Insurance Trust 
     Fund and part B, respectively.
       ``(2) Miscellaneous references.--In applying provisions of 
     section 1841 under paragraph (1)--
       ``(A) any reference in such section to `this part' is 
     construed to refer to title XXII;
       ``(B) any reference in section 1841(h) to section 1840(d) 
     and in section 1841(i) to sections 1840(b)(1) and 1842(g) are 
     deemed references to comparable authority exercised under 
     this title;
       ``(C) payments may be made under section 1841(g) to the 
     Trust Funds under sections 1817 and 1841 as reimbursement to 
     such funds for payments they made for benefits provided under 
     this title; and
       ``(D) the Board of Trustees of the MediKids Trust Fund 
     shall be the same as the Board of Trustees of the Federal 
     Supplementary Medical Insurance Trust Fund.

     ``SEC. 2205. OVERSIGHT AND ACCOUNTABILITY.

       ``(a) Periodic GAO Reports.--The Comptroller General of the 
     United States shall periodically submit to Congress reports 
     on the operation of the program under this title, including 
     on the financing of coverage provided under this title.
       ``(b) Periodic MACPAC Reports.--The Medicaid and CHIP 
     Payment and Access Commission shall periodically report to 
     Congress concerning the program under this title.

     ``SEC. 2206. INCLUSION OF CARE COORDINATION SERVICES.

       ``(a) In General.--
       ``(1) Program authority.--The Secretary, beginning in 2010, 
     may implement a care coordination services program in 
     accordance with the provisions of this section under which, 
     in appropriate circumstances, eligible individuals under 
     section 2201 may elect to have health care services covered 
     under this title managed and coordinated by a designated care 
     coordinator.
       ``(2) Administration by contract.--The Secretary may 
     administer the program under this section through a contract 
     with an appropriate program administrator.
       ``(3) Coverage.--Care coordination services furnished in 
     accordance with this section shall be treated under this 
     title as if they were included in the definition of medical 
     and other health services under section 1861(s) and benefits 
     shall be available under this title with respect to such 
     services without the application of any deductible or 
     coinsurance.
       ``(b) Eligibility Criteria; Identification and Notification 
     of Eligible Individuals.--
       ``(1) Individual eligibility criteria.--The Secretary shall 
     specify criteria to be used in making a determination as to 
     whether an individual may appropriately be enrolled in the 
     care coordination services program under this section, which 
     shall include at least a finding by the Secretary that for 
     cohorts of individuals with characteristics identified by the 
     Secretary, professional management and coordination of care 
     can reasonably be expected to improve processes or outcomes 
     of health care and to reduce aggregate costs to the programs 
     under this title.
       ``(2) Procedures to facilitate enrollment.--The Secretary 
     shall develop and implement procedures designed to facilitate 
     enrollment of eligible individuals in the program under this 
     section.
       ``(c) Enrollment of Individuals.--
       ``(1) Secretary's determination of eligibility.--The 
     Secretary shall determine the eligibility for services under 
     this section of individuals who are enrolled in the program 
     under this section and who make application for such services 
     in such form and manner as the Secretary may prescribe.
       ``(2) Enrollment period.--
       ``(A) Effective date and duration.--Enrollment of an 
     individual in the program under this section shall be 
     effective as of the first day of the month following the 
     month in which the Secretary approves the individual's 
     application under paragraph (1), shall remain in effect for 
     one month (or such longer period as the Secretary may 
     specify), and shall be automatically renewed for additional 
     periods, unless terminated in accordance with such procedures 
     as the Secretary shall establish by regulation. Such 
     procedures shall permit an individual to disenroll for cause 
     at any time and without cause at re-enrollment intervals.
       ``(B) Limitation on reenrollment.--The Secretary may 
     establish limits on an individual's eligibility to reenroll 
     in the program under this section if the individual has 
     disenrolled from the program more than once during a 
     specified time period.
       ``(d) Program.--The care coordination services program 
     under this section shall include the following elements:
       ``(1) Basic care coordination services.--
       ``(A) In general.--Subject to the cost-effectiveness 
     criteria specified in subsection (b)(1), except as otherwise 
     provided in this section, enrolled individuals shall receive 
     services described in section 1905(t)(1) and may receive 
     additional items and services as described in subparagraph 
     (B).
       ``(B) Additional benefits.--The Secretary may specify 
     additional benefits for which payment would not otherwise be 
     made under this title that may be available to individuals 
     enrolled in the program under this section (subject to an 
     assessment by the care coordinator of an individual's 
     circumstance and need for such benefits) in order to 
     encourage enrollment in, or to improve the effectiveness of, 
     such program.
       ``(2) Care coordination requirement.--Notwithstanding any 
     other provision of this title, the Secretary may provide that 
     an individual enrolled in the program under this section may 
     be entitled to payment under this title for any specified 
     health care items or services only if the items or services 
     have been furnished by the care coordinator, or coordinated 
     through the care coordination services program. Under such 
     provision, the Secretary shall prescribe exceptions for 
     emergency medical services as described in section 
     1852(d)(3), and other exceptions determined by the Secretary 
     for the delivery of timely and needed care.
       ``(e) Care Coordinators.--
       ``(1) Conditions of participation.--In order to be 
     qualified to furnish care coordination services under this 
     section, an individual or entity shall--
       ``(A) be a health care professional or entity (which may 
     include physicians, physician group practices, or other 
     health care professionals or entities the Secretary may find 
     appropriate) meeting such conditions as the Secretary may 
     specify;
       ``(B) have entered into a care coordination agreement; and
       ``(C) meet such criteria as the Secretary may establish 
     (which may include experience in the provision of care 
     coordination or primary care physician's services).
       ``(2) Agreement term; payment.--
       ``(A) Duration and renewal.--A care coordination agreement 
     under this subsection shall be for one year and may be 
     renewed if the Secretary is satisfied that the care 
     coordinator continues to meet the conditions of participation 
     specified in paragraph (1).
       ``(B) Payment for services.--The Secretary may negotiate or 
     otherwise establish payment terms and rates for services 
     described in subsection (d)(1).
       ``(C) Liability.--Care coordinators shall be subject to 
     liability for actual health damages which may be suffered by 
     recipients as a result of the care coordinator's decisions, 
     failure or delay in making decisions, or other actions as a 
     care coordinator.
       ``(D) Terms.--In addition to such other terms as the 
     Secretary may require, an agreement under this section shall 
     include the terms specified in subparagraphs (A) through (C) 
     of section 1905(t)(3).

[[Page S5026]]

     ``SEC. 2207. ADMINISTRATION AND MISCELLANEOUS.

       ``(a) In General.--Except as otherwise provided in this 
     title--
       ``(1) the Secretary shall enter into appropriate contracts 
     with providers of services, other health care providers, 
     carriers, and fiscal intermediaries, taking into account the 
     types of contracts used under title XVIII with respect to 
     such entities, to administer the program under this title;
       ``(2) beneficiary protections for individuals enrolled 
     under this title shall not be less than the beneficiary 
     protections (including limits on balance billing) provided 
     medicare beneficiaries under title XVIII;
       ``(3) benefits described in section 2202 that are payable 
     under this title to such individuals shall be paid in a 
     manner specified by the Secretary (taking into account, and 
     based to the greatest extent practicable upon, the manner in 
     which they are provided under title XVIII); and
       ``(4) provider participation agreements under title XVIII 
     shall apply to enrollees and benefits under this title in the 
     same manner as they apply to enrollees and benefits under 
     title XVIII.
       ``(b) Coordination With Medicaid and CHIP.--Notwithstanding 
     any other provision of law, individuals entitled to benefits 
     for items and services under this title who also qualify for 
     benefits under title XIX or XXI or any other Federally funded 
     health care program that provides basic health insurance 
     coverage described in section 2203(a)(2) may continue to 
     qualify and obtain benefits under such other title or 
     program, and in such case such an individual shall elect 
     either--
       ``(1) such other title or program to be primary payor to 
     benefits under this title, in which case no benefits shall be 
     payable under this title and the monthly premium under 
     section 2203 shall be zero; or
       ``(2) benefits under this title shall be primary payor to 
     benefits provided under such title or program, in which case 
     the Secretary shall enter into agreements with States as may 
     be appropriate to provide that, in the case of such 
     individuals, the benefits under titles XIX and XXI or such 
     other program (including reduction of cost-sharing) are 
     provided on a `wrap-around' basis to the benefits under this 
     title.''.
       (b) Conforming Amendments to Social Security Act 
     Provisions.--
       (1) Section 201(i)(1) of the Social Security Act (42 U.S.C. 
     401(i)(1)) is amended by striking ``or the Federal 
     Supplementary Medical Insurance Trust Fund'' and inserting 
     ``the Federal Supplementary Medical Insurance Trust Fund, and 
     the MediKids Trust Fund''.
       (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 
     401(g)(1)(A)) is amended by striking ``and the Federal 
     Supplementary Medical Insurance Trust Fund established by 
     title XVIII'' and inserting ``, the Federal Supplementary 
     Medical Insurance Trust Fund, and the MediKids Trust Fund 
     established by title XVIII''.
       (c) Maintenance of Medicaid Eligibility and Benefits for 
     Children.--
       (1) In general.--In order for a State to continue to be 
     eligible for payments under section 1903(a) of the Social 
     Security Act (42 U.S.C. 1396b(a))--
       (A) the State may not reduce standards of eligibility, or 
     benefits, provided under its State medicaid plan under title 
     XIX of the Social Security Act or under its State child 
     health plan under title XXI of such Act for individuals under 
     23 years of age below such standards of eligibility, and 
     benefits, in effect on the date of the enactment of this Act; 
     and
       (B) the State shall demonstrate to the satisfaction of the 
     Secretary of Health and Human Services that any savings in 
     State expenditures under title XIX or XXI of the Social 
     Security Act that results from children enrolling under title 
     XXII of such Act shall be used in a manner that improves 
     services to beneficiaries under title XIX of such Act, such 
     as through expansion of eligibility, improved nurse and nurse 
     aide staffing and improved inspections of nursing facilities, 
     and coverage of additional services.
       (2) Medikids as primary payor.--In applying title XIX of 
     the Social Security Act, the MediKids program under title 
     XXII of such Act shall be treated as a primary payor in cases 
     in which the election described in section 2207(b)(2) of such 
     Act, as added by subsection (a), has been made.
       (d) Expansion of MACPAC Duties.--Section 1900 of the Social 
     Security Act (42 U.S.C. 1396) is amended--
       (1) in subsection (b)(1)(A)--
       (A) by striking ``and the State'' and inserting ``, the 
     State''; and
       (B) by inserting ``and the MediKids program established 
     under title XXII (in this section referred to as 
     `MediKids')'' before ``affecting''; and
       (2) by striking ``and CHIP'' each place it appears (other 
     than in subsection (a)) and inserting ``, CHIP, and 
     MediKids''.

     SEC. 3. MEDIKIDS PREMIUM.

       (a) General Rule.--Subchapter A of chapter 1 of the 
     Internal Revenue Code of 1986 (relating to determination of 
     tax liability) is amended by adding at the end the following 
     new part:

                     ``PART VIII--MEDIKIDS PREMIUM

``Sec. 59B. MediKids premium.

     ``SEC. 59B. MEDIKIDS PREMIUM.

       ``(a) Imposition of Tax.--In the case of a taxpayer to whom 
     this section applies, there is hereby imposed (in addition to 
     any other tax imposed by this subtitle) a MediKids premium 
     for the taxable year.
       ``(b) Individuals Subject to Premium.--
       ``(1) In general.--This section shall apply to a taxpayer 
     if a MediKid is a dependent of the taxpayer for the taxable 
     year.
       ``(2) Medikid.--For purposes of this section, the term 
     `MediKid' means any individual enrolled in the MediKids 
     program under title XXII of the Social Security Act.
       ``(c) Amount of Premium.--For purposes of this section, the 
     MediKids premium for a taxable year is the sum of the monthly 
     premiums (for months in the taxable year) determined under 
     section 2203 of the Social Security Act with respect to each 
     MediKid who is a dependent of the taxpayer for the taxable 
     year.
       ``(d) Exceptions Based on Adjusted Gross Income.--
       ``(1) Exemption for very low-income taxpayers.--
       ``(A) In general.--No premium shall be imposed by this 
     section on any taxpayer having an adjusted gross income not 
     in excess of the exemption amount.
       ``(B) Exemption amount.--For purposes of this paragraph, 
     the exemption amount is--
       ``(i) $20,535 in the case of a taxpayer having 1 MediKid,
       ``(ii) $25,755 in the case of a taxpayer having 2 MediKids,
       ``(iii) $30,975 in the case of a taxpayer having 3 
     MediKids, and
       ``(iv) $35,195 in the case of a taxpayer having 4 or more 
     MediKids.
       ``(C) Phaseout of exemption.--In the case of a taxpayer 
     having an adjusted gross income which exceeds the exemption 
     amount but does not exceed twice the exemption amount, the 
     premium shall be the amount which bears the same ratio to the 
     premium which would (but for this subparagraph) apply to the 
     taxpayer as such excess bears to the exemption amount.
       ``(D) Inflation adjustment of exemption amounts.--In the 
     case of any taxable year beginning in a calendar year after 
     2010, each dollar amount contained in subparagraph (C) shall 
     be increased by an amount equal to the product of--
       ``(i) such dollar amount, and
       ``(ii) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which the taxable 
     year begins, determined by substituting `calendar year 2009' 
     for `calendar year 1992' in subparagraph (B) thereof.

     If any increase determined under the preceding sentence is 
     not a multiple of $50, such increase shall be rounded to the 
     nearest multiple of $50.
       ``(2) Premium limited to 5 percent of adjusted gross 
     income.--In no event shall any taxpayer be required to pay a 
     premium under this section in excess of an amount equal to 5 
     percent of the taxpayer's adjusted gross income.
       ``(e) Coordination With Other Provisions.--
       ``(1) Not treated as medical expense.--For purposes of this 
     chapter, any premium paid under this section shall not be 
     treated as expense for medical care.
       ``(2) Not treated as tax for certain purposes.--The premium 
     paid under this section shall not be treated as a tax imposed 
     by this chapter for purposes of determining--
       ``(A) the amount of any credit allowable under this 
     chapter, or
       ``(B) the amount of the minimum tax imposed by section 55.
       ``(3) Treatment under subtitle f.--For purposes of subtitle 
     F, the premium paid under this section shall be treated as if 
     it were a tax imposed by section 1.''.
       (b) Technical Amendments.--
       (1) Subsection (a) of section 6012 of the Internal Revenue 
     Code of 1986 is amended by inserting after paragraph (9) the 
     following new paragraph:
       ``(10) Every individual liable for a premium under section 
     59B.''.
       (2) The table of parts for subchapter A of chapter 1 of 
     such Code is amended by adding at the end the following new 
     item:

                    ``Part VIII. MediKids Premium''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 2009, in 
     taxable years ending after such date.

     SEC. 4. REFUNDABLE CREDIT FOR CERTAIN COST-SHARING EXPENSES 
                   UNDER MEDIKIDS PROGRAM.

       (a) In General.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 (relating to 
     refundable credits) is amended by inserting after section 36A 
     the following new section:

     ``SEC. 36B. CATASTROPHIC LIMIT ON COST-SHARING EXPENSES UNDER 
                   MEDIKIDS PROGRAM.

       ``(a) In General.--In the case of a taxpayer who has a 
     MediKid (as defined in section 59B) at any time during the 
     taxable year, there shall be allowed as a credit against the 
     tax imposed by this subtitle an amount equal to the excess 
     of--
       ``(1) the amount paid by the taxpayer during the taxable 
     year as cost-sharing under section 2202(b)(4) of the Social 
     Security Act, over
       ``(2) 5 percent of the taxpayer's adjusted gross income for 
     the taxable year.
       ``(b) Coordination With Other Provisions.--The excess 
     described in subsection (a) shall not be taken into account 
     in computing the amount allowable to the taxpayer as a 
     deduction under section 162(l) or 213(a).''.
       (b) Technical Amendments.--
       (1) The table of sections for subpart C of part IV of 
     subchapter A of chapter 1 of the Internal Revenue Code of 
     1986 is amended by

[[Page S5027]]

     inserting after the item relating to section 36A the 
     following new item:

``Sec. 36B. Catastrophic limit on cost-sharing expenses under MediKids 
              program.''.

       (2) Paragraph (2) of section 1324(b) of title 31, United 
     States Code, is amended by inserting ``36B,'' after ``36A,''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2009.

     SEC. 5. REPORT ON LONG-TERM REVENUES.

       Within one year after the date of the enactment of this 
     Act, the Secretary of the Treasury shall propose a gradual 
     schedule of progressive tax changes to fund the program under 
     title XXII of the Social Security Act, as the number of 
     enrollees grows in the out-years.

                          ____________________