[Congressional Record Volume 155, Number 91 (Wednesday, June 17, 2009)]
[Senate]
[Pages S6722-S6727]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself and Mr. Brown):
  S. 1278. A bill to establish the Consumers Choice Health Plan, a 
public health insurance plan that provides an affordable and 
accountable health insurance option for consumers; to the Committee on 
Finance.
  Mr. ROCKEFELLER. Mr. President, there is a stark choice looming 
before Congress. It is the choice between enacting a comprehensive 
reform bill that truly improves our health care system for the American 
people or enacting a mediocre reform bill that largely maintains the 
status quo--which is an ineffective and costly health care system run 
by the insurance industry. I know that most of my colleagues want the 
former--a 21st Century health care system that provides meaningful and 
affordable coverage for all, improves health outcomes, and brings 
accountability and responsibility back into health care.
  I am absolutely convinced that the inclusion of a strong public 
health insurance plan option is the only way to guarantee that all 
consumers have affordable, adequate, and accountable options available 
in the insurance marketplace. It is for this reason that I rise today 
with my good friend, Senator Sherrod Brown of Ohio, to introduce the 
Consumers Health Care Act of 2009--legislation to provide a strong 
public plan option in the National Health Insurance Exchange.
  One of the most contentious, yet critical, pieces of the national 
health care reform effort is whether or not Americans should have the 
option to buy their health insurance from a publicly run organization. 
In other words, in addition to choosing among numerous health plans run 
by private insurers, should consumers also have the option of choosing 
an affordable, stable, and transparent public plan when they are 
deciding what is best for them and their families? I believe consumers 
should have the option of choosing a public plan.
  Opponents of giving Americans a public option regularly use alarmist 
rhetoric such as ``big government'' and ``socialized medicine.'' And, 
somehow, protecting the rights of private health insurers to make 
profits has become more important to some than offering Americans the 
choice of a plan that seeks to insure everyone, no matter how sick, 
that is less expensive, and that is responsible to the American 
people--not to private profit-seeking stockholders.
  I'm not sure when the word ``public'' became such a bad word in the 
eyes of some of my colleagues. Public means acting in the interest of 
the general public--which is exactly what we should aspire to in 
comprehensive health reform.
  The private health insurance market has significantly contributed to 
the broken nature of our health care system, with a long history of 
cutting coverage off or charging too much for too little. A public plan 
option--repeat, option--is an effective way to bring competition to the 
insurance market, hold down costs, and encourage innovation and quality 
improvements. To deny this option is not only shortsighted, but 
downright harmful.
  Everyone knows the sobering statistics that have highlighted the need 
for comprehensive health reform. More than 45 million Americans are 
uninsured and another 25 million are underinsured. Since 1909, the 
average health insurance premium for a family has increased by 119 
percent, from $5,791 in 1999 to $12,680 in 2008. Yet, Americans have 
seen their benefits decrease and have faced substantially larger out-
of-pocket expenses. An estimated 62 percent of all personal 
bankruptcies involve medical expenses and 78 percent of the individuals 
who cited medical expenses in their bankruptcy claims had health 
insurance. Health care costs already consume 17 percent of the United 
State's gross domestic product, which everyone can agree is 
unsustainable.

  However, representing the great state of West Virginia has shown me 
that the need for health reform is far more essential and personal than 
frightening statistics could ever show. I have listened at roundtable 
discussions where West Virginians described how the current health care 
system has failed them. One woman was really struggling to care for 
both herself and her son. She was uninsured because her son, who had a 
serious brain disorder, needed 24 hour a day, seven day a week, 
assistance. Another family wrote to me because their son, who was born 
with serious congenital heart defects, had reached the $1 million limit 
on his mother's insurance policy within the first nine months of his 
life. They were unsure of how to obtain lifesaving treatment for their 
son, now that the insurance company would no longer pay for his care. I 
have heard from countless other West Virginians who have been unable to 
find affordable health care, or have figured out too late that the 
health insurance they had was inadequate for what they needed.
  As Congress works to achieve the transformative reform necessary to 
create a sustainable health care system, a vital component of this 
reform is the inclusion of a strong public plan option like the 
Consumer Choice Health Plan included in the Consumers Health Care Act. 
A public plan will help establish a new insurance framework, one that 
compels insurers to provide Americans with the best value for their 
health care at the best price, rather than the current insurance 
framework, which is focused on avoiding risk and increasing profits. 
The Consumer Choice Health Plan will be available for all individuals 
and small businesses, regardless of health status, and will not be 
concerned with paying a CEO salary or broker commissions.
  The Consumers Health Care Act will increase transparency and 
accountability throughout the health insurance market, as well as give 
individuals guaranteed access to health care coverage should they be 
denied or priced out of affordable private insurance coverage. 
Currently, insurers are allowed to operate in a black box, with little 
oversight of their coverage and payment decisions. Individuals with 
pre-existing conditions are routinely denied access to affordable care. 
For years, United Health was able to underpay providers and overcharge 
patients for out-of-network services. The Consumers Health Care Act 
will address this and other issues by bringing greater transparency to 
the private health insurance market.

[[Page S6723]]

  Consumer Choice Health Plans will serve as a vital safety-net of 
coverage for individuals and families that have been unable to obtain 
affordable and comprehensive health care coverage through the private 
market. A private insurance company's desire to earn greater profits 
will always trump over the need to make health care coverage affordable 
and accessible to all Americans, and greater insurance regulation is 
not enough. The Consumers Health Care Act is necessary in order to 
achieve the sustainable change that the health care system in this 
country needs.
  I trust the good sense of the American public to choose the health 
coverage they want, and they deserve the choice of a public plan with 
lower costs and the guarantee of always being there when they need it. 
The American people trust us to get this right and deliver the best 
coverage options that will keep their families healthy and safe. The 
days of packaging half-baked legislation into a bill and calling it 
transformative reform when it is not have to end now, or the shame is 
on all of us:
  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. 1278

       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 ``Consumers Health Care Act of 
     2009''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Americans need health care coverage that is always 
     affordable.
       (2) Americans need health care coverage that is always 
     adequate.
       (3) Americans need health care coverage that is always 
     accountable.
       (4) A public health insurance plan option that can compete 
     with private insurance plans is the only way to guarantee 
     that all consumers have affordable, adequate, and accountable 
     options available in the insurance marketplace.

     SEC. 3. OFFICE OF HEALTH PLAN MANAGEMENT.

       (a) Establishment.--Not later than July 1, 2010, there 
     shall be established within the Department of Health and 
     Human Services an Office of Health Plan Management (referred 
     to in this Act as the ``Office''). The Office shall be headed 
     by a Director (referred to in this Act as the ``Director'') 
     who shall be appointed by the President, by and with the 
     advice and consent of the Senate.
       (b) Compensation.--The Director shall be paid at the annual 
     rate of pay for a position at level II of the Executive 
     Schedule under section 5313 of title 5, United States Code.
       (c) Limitation.--Neither the Director nor the Office shall 
     participate in the administration of the National Health 
     Insurance Exchange (as defined in section 7) or the 
     promulgation or administration of any regulation regarding 
     the health insurance industry.
       (d) Personnel and Operations Authority.--The Director shall 
     have the same general authorities with respect to personnel 
     and operations of the Office as the heads of other agencies 
     and departments of the Federal Government have with respect 
     to such agencies and departments.

     SEC. 4. CONSUMER CHOICE HEALTH PLAN.

       (a) In General.--The Office shall establish and administer 
     the Consumer Choice Health Plan (referred to in this Act as 
     the ``Plan'') to provide for health insurance coverage that 
     is made available to all eligible individuals (as described 
     in subsection (d)(1)) in the United States and its 
     territories.
       (b) Regulatory Compliance.--The Plan shall comply with--
       (1) all regulations and requirements that are applicable 
     with respect to other health insurance plans that are offered 
     through the National Health Insurance Exchange; and
       (2) any additional regulations and requirements, as 
     determined by the Director.
       (c) Benefits.--
       (1) In general.--The Plan shall offer health insurance 
     coverage at different benefit levels, provided that such 
     benefits are commensurate with the required benefit levels to 
     be provided by a health insurance plan under the National 
     Health Insurance Exchange.
       (2) Minimum benefits for children.--
       (A) In general.--The minimum benefit level available under 
     the Plan for children shall include at least the services 
     described in the most recently published version of the 
     ``Maternal and Child Health Plan Benefit Model'' developed by 
     the National Business Group on Health.
       (B) Amendment of benefit level.--The Secretary of Health 
     and Human Services, acting through the Director of the Agency 
     for Healthcare Research and Quality, may amend the benefits 
     described in subparagraph (A) based on the most recent peer-
     reviewed and evidence-based data.
       (d) Eligibility and Enrollment.--
       (1) Eligibility.--An individual who is eligible to purchase 
     coverage from a health insurance plan through the National 
     Health Insurance Exchange shall be eligible to enroll in the 
     Plan.
       (2) Enrollment process.--An individual may enroll in the 
     Plan only in such manner and form as may be prescribed by 
     applicable regulations, and only during an enrollment period 
     as prescribed by the Director.
       (3) Employer enrollment.--An employer shall be eligible to 
     purchase health insurance coverage for their employees and 
     the employees' dependents to the extent provided for all 
     health benefits plans under the National Health Insurance 
     Exchange.
       (4) Satisfaction of individual mandate requirement.--An 
     individual's enrollment with the Plan shall be treated as 
     satisfying any requirement under Federal law for such 
     individual to demonstrate enrollment in health insurance or 
     benefits coverage.
       (e) Providers.--
       (1) Network requirement.--
       (A) Medicare.--A participating provider who is voluntarily 
     providing health care services under the Medicare program 
     established under title XVIII of the Social Security Act (42 
     U.S.C. 1395 et seq.) shall be required to provide services to 
     any individual enrolled in the Plan.
       (B) Medicaid and chip.--A provider of health care services 
     under the Medicaid program established under title XIX of the 
     Social Security Act (42 U.S.C. 1396 et seq.), or the CHIP 
     program established under title XXI of such Act (42 U.S.C. 
     1397aa et seq.), shall be required to provide services to any 
     individual enrolled in the Plan.
       (2) Exception.--Paragraph (1) shall not be construed as 
     requiring a provider to accept new patients due to bona fide 
     capacity limitations of the provider.
       (3) Opt-out provision.--
       (A) Medicare.--A participating provider as described under 
     paragraph (1)(A) shall be required to provide services to any 
     individual enrolled in the Plan for the 3-year period 
     following the establishment of the Plan. Upon the expiration 
     of the 3-year period, a participating provider in the Plan 
     may elect to become a non-participating provider without 
     affecting their status as a participating provider under the 
     Medicare program.
       (B) Medicaid and chip.--A provider as described under 
     paragraph (1)(B) shall be required to provide services to any 
     individual enrolled in the Plan for the 3-year period 
     following the establishment of the Plan. Upon the expiration 
     of the 3-year period, a provider in the Plan may elect to 
     cease provision of services under the Plan without affecting 
     their status as a provider under the Medicaid program or the 
     CHIP program.
       (4) Payment rates.--
       (A) Initial payment rates.--
       (i) In general.--During the 2-year period following the 
     establishment of the Plan, providers shall be reimbursed at 
     such payment rates as are applicable under the Medicare 
     program.
       (ii) Adjustment.--The Director may reimburse providers at 
     rates lower or higher than applicable under the Medicare 
     program if the Director determines that the adjusted rates 
     are appropriate and ensure that enrollees in the Plan are 
     provided with adequate access to health care services.
       (B) Subsequent payment rates.--Subject to subparagraph (C), 
     upon the expiration of the 2-year period following the 
     establishment of the Plan, the Director shall develop payment 
     rates for reimbursement of providers in order to maintain an 
     adequate provider network necessary to assure that enrollees 
     in the Plan have adequate access to health care. In 
     determining such payment rates, the Director shall consider--
       (i) competitive provider payment rates in both the public 
     and private sectors;
       (ii) best practices among providers;
       (iii) integrated models of care delivery (including medical 
     home and chronic care coordination models);
       (iv) geographic variation in health care costs;
       (v) evidence-based practices;
       (vi) quality improvement;
       (vii) use of health information technology; and
       (viii) any additional measures, as determined by the 
     Director.
       (C) Payment rate consultation.--The Director shall 
     determine payment rates under subparagraph (B) in 
     consultation with providers participating under the Plan, the 
     Director of the Office of Personnel Management, the Medicare 
     Payment Advisory Commission, and the Medicaid and CHIP 
     Payment and Access Commission.
       (5) Adoption of medicare reforms.--The Plan may adopt 
     Medicare system delivery reforms that provide patients with a 
     coordinated system of care and make changes to the provider 
     payment structure.
       (f) Subsidies.--The Plan shall be eligible to accept 
     subsidies, including subsidies for the enrollment of 
     individuals under the Plan, in the same manner and to the 
     same extent as other health insurance plans offered through 
     the National Health Insurance Exchange.
       (g) Financing.--
       (1) Transitional funding.--
       (A) In general.--In order to provide for adequate funding 
     of the Plan in advance of receipt of payments as described in 
     paragraph (2), beginning July 1, 2010, there are transferred 
     to the Plan from the general fund of the Treasury such 
     amounts as may be necessary for operation of the Plan until 
     the end of the 3-year period following the establishment of 
     the Plan.

[[Page S6724]]

       (B) Return of funds.--Upon the expiration of the 3-year 
     period following the establishment of the Plan, the Director 
     shall enter into a repayment schedule with the Secretary of 
     the Treasury to provide for repayment of funds provided under 
     subparagraph (A). Any expenditures made by the Plan pursuant 
     to a repayment schedule established under this subparagraph 
     shall not constitute administrative expenses as described in 
     paragraph (2)(B).
       (2) Self-financing.--
       (A) In general.--The Plan shall be financially self-
     sustaining insofar as funds used for operation of the Plan 
     (including benefits, administration, and marketing) shall be 
     derived from--
       (i) insurance premium payments and subsidies for 
     individuals enrolled in the Plan; and
       (ii) payments made to the Plan by employers that do not 
     offer health insurance coverage to their employees.
       (B) Limitation on administrative expenses.--Not more than 5 
     percent of the amounts provided under subparagraph (A) may be 
     used for the annual administrative costs of the Plan.
       (3) Contingency reserve.--
       (A) In general.--The Director shall establish and fund a 
     contingency reserve for the Plan in a form similar to the 
     contingency reserve provided for health benefits plans under 
     the Federal Employees Health Benefits Program under chapter 
     89 of title 5, United States Code.
       (B) Revenue.--Any revenue generated through the contingency 
     reserve established in subparagraph (A) shall be transferred 
     to the Plan for the purpose of reducing enrollee premiums, 
     reducing enrollee cost-sharing, increasing enrollee benefits, 
     or any combination thereof.
       (4) GAO financial audit and report.--Beginning not later 
     than October 1, 2011, the Comptroller General shall conduct 
     an annual audit of the financial statements and records of 
     the Plan, in accordance with generally accepted government 
     auditing standards, and submit an annual report on such audit 
     to the Congress.
       (5) Supermajority requirement for supplemental funding.--
     Upon certification by the Comptroller General that the 
     financial audit described in paragraph (4) indicates that the 
     Plan is insolvent, supplemental funding may be appropriated 
     for the Plan if such measure receives not less than a three-
     fifths vote of approval of the total number of Members of the 
     House of Representatives and the Senate.
       (h) Transparency.--
       (1) In general.--Beginning with the first year of operation 
     of the Plan through the National Health Insurance Exchange, 
     the Director shall provide standards and undertake activities 
     for promoting transparency in costs, benefits, and other 
     factors for health insurance coverage provided under the 
     Plan.
       (2) Standard definitions of insurance and medical terms.--
       (A) In general.--The Director shall provide for the 
     development of standards for the definitions of terms used in 
     health insurance coverage under the Plan, including 
     insurance-related terms (including the insurance-related 
     terms described in subparagraph (B)) and medical terms 
     (including the medical terms described in subparagraph (C)).
       (B) Insurance-related terms.--The insurance-related terms 
     described in this subparagraph are premium, deductible, co-
     insurance, co-payment, out-of-pocket limit, preferred 
     provider, non-preferred provider, out-of-network co-payments, 
     UCR (usual, customary and reasonable) fees, excluded 
     services, grievance and appeals, and such other terms as the 
     Director determines are important to define so that consumers 
     may compare health insurance coverage and understand the 
     terms of their coverage.
       (C) Medical terms.--The medical terms described in this 
     subparagraph are hospitalization, hospital outpatient care, 
     emergency room care, physician services, prescription drug 
     coverage, durable medical equipment, home health care, 
     skilled nursing care, rehabilitation services, hospice 
     services, emergency medical transportation, and such other 
     terms as the Director determines are important to define so 
     that consumers may compare the medical benefits offered by 
     health insurance plans and understand the extent of those 
     medical benefits (or exceptions to those benefits).
       (3) Disclosure.--
       (A) In general.--In carrying out this subsection, the 
     Director shall disclose to Plan enrollees, potential 
     enrollees, in-network health care providers, and others 
     (through a publically available Internet website and other 
     appropriate means) relevant information regarding each policy 
     of health insurance coverage marketed or in force (in such 
     standardized manner as determined by the Director), 
     including--
       (i) full policy contract language; and
       (ii) a summary of the information described in paragraph 
     (4).
       (B) Personalized statement.--The Director shall disclose to 
     enrollees (in such standardized manner as determined by the 
     Director) an annual personalized statement that summarizes 
     use of health care services and payment of claims with 
     respect to an enrollee (and covered dependents) under health 
     insurance coverage provided through the Plan in the preceding 
     year.
       (4) Required information.--The information described in 
     this paragraph includes, but is not limited to, the 
     following:
       (A) Data on the price of each new policy of health 
     insurance coverage and renewal rating practices.
       (B) Claims payment policies and practices, including how 
     many and how quickly claims were paid.
       (C) Provider fee schedules and usual, customary, and 
     reasonable fees (for both in-network and out-of-network 
     providers).
       (D) Provider participation and provider directories.
       (E) Loss ratios, including detailed information about 
     amount and type of non-claims expenses.
       (F) Covered benefits, cost-sharing, and amount of payment 
     provided toward each type of service identified as a covered 
     benefit, including preventive care services recommended by 
     the United States Preventive Services Task Force.
       (G) Civil or criminal actions successfully concluded 
     against the Plan by any governmental entity.
       (H) Benefit exclusions and limits.
       (5) Development of patient claims scenarios.--
       (A) In general.--In order to improve the ability of 
     individuals and employers to compare the coverage and 
     relative value provided under the Plan, the Director shall 
     develop and make publically available a series of patient 
     claims scenarios under which benefits (including out-of-
     pocket costs) under the Plan are simulated for certain common 
     or expensive conditions or courses of treatment (including 
     maternity care, breast cancer, heart disease, diabetes 
     management, and well-child visits).
       (B) Consultation.--The Director shall develop the patient 
     claims scenarios described in subparagraph (A)--
       (i) in consultation with the Secretary of Health and Human 
     Services, the National Institutes of Health, the Centers for 
     Disease Control and Prevention, the Agency for Healthcare 
     Research and Quality, health professional societies, patient 
     advocates, and other entities as deemed necessary by the 
     Director; and
       (ii) based upon recognized clinical practice guidelines.
       (6) Manner of disclosure.--The Director shall disclose the 
     information under this subsection--
       (A) with all marketing materials;
       (B) on the website for the Plan; and
       (C) at other times upon request.

     SEC. 5. ESTABLISHMENT OF AMERICA'S HEALTH INSURANCE TRUST.

       (a) Establishment.--As of the date of enactment of this 
     Act, there is authorized to be established a non-profit 
     corporation that shall be known as the ``America's Health 
     Insurance Trust'' (referred to in this Act as the ``Trust''), 
     which is neither an agency nor establishment of the United 
     States Government.
       (b) Location; Service of Process.--The Trust shall maintain 
     its principal office within the District of Columbia and have 
     a designated agent in the District of Columbia to receive 
     service of process for the Trust. Notice to or service on the 
     agent shall be deemed as notice to or service on the 
     corporation.
       (c) Application of Provisions.--The Trust shall be subject 
     to the provisions of this section and, to the extent 
     consistent with this section, to the District of Columbia 
     Nonprofit Corporation Act.
       (d) Tax Exempt Status.--The Trust shall be treated as a 
     nonprofit organization described under section 170(c)(2)(B) 
     and section 501(c)(3) of the Internal Revenue Code of 1986 
     that is exempt from taxation under section 501(a) of the 
     Internal Revenue Code of 1986.
       (e) Board of Directors.--
       (1) In general.--The Board of Directors of the Trust 
     (referred to in this Act as the ``Board'') shall consist of 
     19 voting members appointed by the Comptroller General.
       (2) Terms.--
       (A) In general.--Subject to subparagraph (C), each member 
     of the Board shall serve for a term of 6 years.
       (B) Limitation.--No individual shall be appointed to the 
     Board for more than 2 consecutive terms.
       (C) Initial members.--The initial members of the Board 
     shall be appointed by the Comptroller General not later than 
     October 1, 2010, and shall serve terms as follows:
       (i) 8 members shall be appointed for a term of 5 years.
       (ii) 8 members shall be appointed for a term of 3 years.
       (iii) 3 members shall be appointed for a term of 1 year.
       (D) Expiration of term.--Any member of the Board whose term 
     has expired may serve until such member's successor has taken 
     office, or until the end of the calendar year in which such 
     member's term has expired, whichever is earlier.
       (E) Vacancies.--
       (i) In general.--Any member appointed to fill a vacancy 
     prior to the expiration of the term for which such member's 
     predecessor was appointed shall be appointed for the 
     remainder of such term.
       (ii) Vacancies not to affect power of board.--A vacancy on 
     the Board shall not affect its powers, but shall be filled in 
     the same manner as the original appointment was made.
       (3) Chairperson and vice-chairperson.--
       (A) In general.--The Comptroller General shall designate a 
     Chairperson and Vice-Chairperson of the Board from among the 
     members of the Board.
       (B) Term.--The members designated as Chairperson and Vice-
     Chairperson shall serve for a period of 3 years.

[[Page S6725]]

       (4) Conflicts of interest.--An individual may not serve on 
     the Board if such individual (or an immediate family member 
     of such individual) is employed by or has a financial 
     interest in--
       (A) an organization that provides a health insurance plan;
       (B) a pharmaceutical manufacturer; or
       (C) any subsidiary entities of an organization described in 
     subparagraphs (A) or (B).
       (5) Composition of the board.--
       (A) Political parties.--Not more than 10 members of the 
     Board may be affiliated with the same political party.
       (B) Diversity.--In appointing members under this paragraph, 
     the Comptroller General shall ensure that such members 
     provide appropriately diverse representation with respect to 
     race, ethnicity, age, gender, and geography.
       (C) Consumer representation.--10 members of the Board shall 
     be independent and non-conflicted individuals representing 
     the interests of health care consumers. Each member selected 
     under this subparagraph shall represent 1 of the 10 
     Department of Health and Human Services regions in the United 
     States.
       (D) Remaining representation.--
       (i) In general.--9 members of the Board shall be selected 
     based on relevant experience, including expertise in--

       (I) community affairs;
       (II) Federal, State, and local government;
       (III) health professions and administration;
       (IV) business, finance, and accounting;
       (V) legal affairs;
       (VI) insurance;
       (VII) trade unions;
       (VIII) social services; and
       (IX) any additional areas as determined by the Comptroller 
     General.

       (ii) Income from health care industry.--Not more than 4 of 
     the members selected under this subparagraph shall earn more 
     than 10 percent of their income from the health care 
     industry.
       (6) Meetings and hearings.--The Board shall meet and hold 
     hearings at the call of the Chairperson or a majority of its 
     members. Meetings of the Board on matters not related to 
     personnel shall be open to the public and advertised through 
     public notice at least 7 days prior to the meeting.
       (7) Quorum.--A majority of the members of the Board shall 
     constitute a quorum for purposes of conducting the duties of 
     the Trust, but a lesser number of members may meet and hold 
     hearings.
       (8) Executive director and staff; performance of duties.--
     The Board may--
       (A) employ and fix the compensation of an Executive 
     Director and such other personnel as may be necessary to 
     carry out the duties of the Trust;
       (B) seek such assistance and support as may be required in 
     the performance of the duties of the Trust from appropriate 
     departments and agencies of the Federal Government;
       (C) enter into contracts or other arrangements and make 
     such payments as may be necessary for performance of the 
     duties of the Trust;
       (D) provide travel, subsistence, and per diem compensation 
     for individuals performing the duties of the Trust, including 
     members of the Advisory Council (as described in subsection 
     (f)); and
       (E) prescribe such rules, regulations, and bylaws as the 
     Board determines necessary with respect to the internal 
     organization and operation of the Trust.
       (9) Lobbying cooling-off period for members of the board.--
     Section 207(c) of title 18, United States Code, is amended by 
     inserting at the end the following:
       ``(3) Members of the board of directors of the america's 
     health insurance trust.--Paragraph (1) shall apply to a 
     member of the Board of Directors of the America's Health 
     Insurance Trust who was appointed to the Board as of the day 
     before the date of enactment of the Consumers Health Care Act 
     of 2009.''.
       (f) Advisory Council.--
       (1) Establishment.--The Board shall establish an advisory 
     council that shall be comprised of the insurance 
     commissioners of each State (including the District of 
     Columbia) to advise the Board on the development and impact 
     of measures to improve the transparency and accountability of 
     health insurance plans provided through the National Health 
     Insurance Exchange.
       (2) Meetings.--The advisory council shall meet not less 
     than twice a year and at the request of the Board.
       (g) Financial Oversight.--
       (1) Contract for audits.--The Trust shall provide for 
     financial audits of the Trust on an annual basis by a private 
     entity with expertise in conducting financial audits.
       (2) Review and report on audits.--The Comptroller General 
     shall--
       (A) review and evaluate the results of the audits conducted 
     pursuant to paragraph (1); and
       (B) submit a report to Congress containing the results and 
     review of such audits, including an analysis of the adequacy 
     and use of the funding for the Trust and its activities.
       (h) Rules on Gifts and Outside Contributions.--
       (1) Gifts.--The Trust (including the Board and any staff 
     acting on behalf of the Trust) shall not accept gifts, 
     bequeaths, or donations of services or property.
       (2) Prohibition on outside funding or contributions.--The 
     Trust shall not--
       (A) establish a corporation other than as provided under 
     this section; or
       (B) accept any funds or contributions other than as 
     provided under this section.
       (i) America's Health Insurance Trust Fund.--
       (1) In general.--There is established in the Treasury a 
     trust fund to be known as the ``America's Health Insurance 
     Trust Fund'' (referred to in this section as the ``Trust 
     Fund''), consisting of such amounts as may be credited to the 
     Trust Fund as provided under this subsection.
       (2) Transfer.--The Secretary of the Treasury shall transfer 
     to the Trust Fund out of the general fund of the Treasury 
     amounts determined by the Secretary to be equivalent to the 
     amounts received into such general fund that are attributable 
     to the fees collected under sections 4375 and 4376 of the 
     Internal Revenue Code of 1986 (relating to fees on health 
     insurance policies and self-insured health plans).
       (3) Financing for fund from fees on insured and self-
     insured health plans.--
       (A) General rule.--Chapter 34 of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subchapter:

         ``Subchapter B--Insured and Self-Insured Health Plans

``Sec. 4375. Health insurance.
``Sec. 4376. Self-insured health plans.
``Sec. 4377. Definitions and special rules.

     ``SEC. 4375. HEALTH INSURANCE.

       ``(a) Imposition of Fee.--In the case of any specified 
     health insurance policy issued after October 1, 2009, there 
     is hereby imposed a fee equal to--
       ``(1) for policies issued during fiscal years 2010 through 
     2013, 50 cents multiplied by the average number of lives 
     covered under the policy; and
       ``(2) for policies issued after September 30, 2013, $1 
     multiplied by the average number of lives covered under the 
     policy.
       ``(b) Liability for Fee.--The fee imposed by subsection (a) 
     shall be paid by the issuer of the policy.
       ``(c) Specified Health Insurance Policy.--For purposes of 
     this section:
       ``(1) In general.--Except as otherwise provided in this 
     section, the term `specified health insurance policy' means 
     any accident or health insurance policy (including a policy 
     under a group health plan) issued with respect to individuals 
     residing in the United States.
       ``(2) Exemption for certain policies.--The term `specified 
     health insurance policy' does not include any insurance if 
     substantially all of its coverage is of excepted benefits 
     described in section 9832(c).
       ``(3) Treatment of prepaid health coverage arrangements.--
       ``(A) In general.--In the case of any arrangement described 
     in subparagraph (B)--
       ``(i) such arrangement shall be treated as a specified 
     health insurance policy, and
       ``(ii) the person referred to in such subparagraph shall be 
     treated as the issuer.
       ``(B) Description of arrangements.--An arrangement is 
     described in this subparagraph if under such arrangement 
     fixed payments or premiums are received as consideration for 
     any person's agreement to provide or arrange for the 
     provision of accident or health coverage to residents of the 
     United States, regardless of how such coverage is provided or 
     arranged to be provided.
       ``(d) Adjustments for Increases in Health Care Spending.--
     In the case of any policy issued in any fiscal year beginning 
     after September 30, 2014, the dollar amount in effect under 
     subsection (a) for such policy shall be equal to the sum of 
     such dollar amount for policies issued in the previous fiscal 
     year (determined after the application of this subsection), 
     plus an amount equal to the product of--
       ``(1) such dollar amount for policies issued in the 
     previous fiscal year, multiplied by
       ``(2) the percentage increase in the projected per capita 
     amount of National Health Expenditures from the calendar year 
     in which the previous fiscal year ends to the calendar year 
     in which the fiscal year involved ends, as most recently 
     published by the Secretary of Health and Human Services 
     before the beginning of the fiscal year.
       ``(e) Termination.--This section shall not apply to policy 
     years ending after September 30, 2019.

     ``SEC. 4376. SELF-INSURED HEALTH PLANS.

       ``(a) Imposition of Fee.--In the case of any applicable 
     self-insured health plan issued after October 1, 2009, there 
     is hereby imposed a fee equal to--
       ``(1) for plans issued during fiscal years 2010 through 
     2013, 50 cents multiplied by the average number of lives 
     covered under the plan; and
       ``(2) for plans issued after September 30, 2013, $1 
     multiplied by the average number of lives covered under the 
     plans.
       ``(b) Liability for Fee.--
       ``(1) In general.--The fee imposed by subsection (a) shall 
     be paid by the plan sponsor.
       ``(2) Plan sponsor.--For purposes of paragraph (1) the term 
     `plan sponsor' means--
       ``(A) the employer in the case of a plan established or 
     maintained by a single employer,
       ``(B) the employee organization in the case of a plan 
     established or maintained by an employee organization,
       ``(C) in the case of--
       ``(i) a plan established or maintained by 2 or more 
     employers or jointly by 1 or more employers and 1 or more 
     employee organizations,

[[Page S6726]]

       ``(ii) a multiple employer welfare arrangement, or
       ``(iii) a voluntary employees' beneficiary association 
     described in section 501(c)(9),

     the association, committee, joint board of trustees, or other 
     similar group of representatives of the parties who establish 
     or maintain the plan, or
       ``(D) the cooperative or association described in 
     subsection (c)(2)(F) in the case of a plan established or 
     maintained by such a cooperative or association.
       ``(c) Applicable Self-Insured Health Plan.--For purposes of 
     this section, the term `applicable self-insured health plan' 
     means any plan for providing accident or health coverage if--
       ``(1) any portion of such coverage is provided other than 
     through an insurance policy, and
       ``(2) such plan is established or maintained--
       ``(A) by one or more employers for the benefit of their 
     employees or former employees,
       ``(B) by one or more employee organizations for the benefit 
     of their members or former members,
       ``(C) jointly by 1 or more employers and 1 or more employee 
     organizations for the benefit of employees or former 
     employees,
       ``(D) by a voluntary employees' beneficiary association 
     described in section 501(c)(9),
       ``(E) by any organization described in section 501(c)(6), 
     or
       ``(F) in the case of a plan not described in the preceding 
     subparagraphs, by a multiple employer welfare arrangement (as 
     defined in section 3(40) of Employee Retirement Income 
     Security Act of 1974), a rural electric cooperative (as 
     defined in section 3(40)(B)(iv) of such Act), or a rural 
     telephone cooperative association (as defined in section 
     3(40)(B)(v) of such Act).
       ``(d) Adjustments for Increases in Health Care Spending.--
     In the case of any plan issued in any fiscal year beginning 
     after September 30, 2014, the dollar amount in effect under 
     subsection (a) for such plan shall be equal to the sum of 
     such dollar amount for plans issued in the previous fiscal 
     year (determined after the application of this subsection), 
     plus an amount equal to the product of--
       ``(1) such dollar amount for plans issued in the previous 
     fiscal year, multiplied by
       ``(2) the percentage increase in the projected per capita 
     amount of National Health Expenditures from the calendar year 
     in which the previous fiscal year ends to the calendar year 
     in which the fiscal year involved ends, as most recently 
     published by the Secretary of Health and Human Services 
     before the beginning of the fiscal year.
       ``(e) Termination.--This section shall not apply to plans 
     issued after September 30, 2019.

     ``SEC. 4377. DEFINITIONS AND SPECIAL RULES.

       ``(a) Definitions.--For purposes of this subchapter--
       ``(1) Accident and health coverage.--The term `accident and 
     health coverage' means any coverage which, if provided by an 
     insurance policy, would cause such policy to be a specified 
     health insurance policy (as defined in section 4375(c)).
       ``(2) Insurance policy.--The term `insurance policy' means 
     any policy or other instrument whereby a contract of 
     insurance is issued, renewed, or extended.
       ``(3) United states.--The term `United States' includes any 
     possession of the United States.
       ``(b) Treatment of Governmental Entities.--
       ``(1) In general.--For purposes of this subchapter--
       ``(A) the term `person' includes any governmental entity, 
     and
       ``(B) notwithstanding any other law or rule of law, 
     governmental entities shall not be exempt from the fees 
     imposed by this subchapter except as provided in paragraph 
     (2).
       ``(2) Treatment of exempt governmental programs.--In the 
     case of an exempt governmental program, no fee shall be 
     imposed under section 4375 or section 4376 on any covered 
     policy or plan under such program.
       ``(3) Exempt governmental program defined.--For purposes of 
     this subchapter, the term `exempt governmental program' 
     means--
       ``(A) any insurance program established under title XVIII 
     of the Social Security Act,
       ``(B) the medical assistance program established by title 
     XIX or XXI of the Social Security Act,
       ``(C) the Federal Employees Health Benefits Program under 
     chapter 89 of title 5, United States Code,
       ``(D) the Consumer Choice Health Plan established under the 
     Consumers Health Care Act of 2009,
       ``(E) any program established by Federal law for providing 
     medical care (other than through insurance policies) to 
     individuals (or the spouses and dependents thereof) by reason 
     of such individuals being--
       ``(i) members of the Armed Forces of the United States, or
       ``(ii) veterans, and
       ``(F) any program established by Federal law for providing 
     medical care (other than through insurance policies) to 
     members of Indian tribes (as defined in section 4(d) of the 
     Indian Health Care Improvement Act).
       ``(c) Treatment as Tax.--For purposes of subtitle F, the 
     fees imposed by this subchapter shall be treated as if they 
     were taxes.
       ``(d) No Cover Over to Possessions.--Notwithstanding any 
     other provision of law, no amount collected under this 
     subchapter shall be covered over to any possession of the 
     United States.''.
       (B) Clerical amendments.--
       (i) Chapter 34 of such Code is amended by striking the 
     chapter heading and inserting the following:

           ``CHAPTER 34--TAXES ON CERTAIN INSURANCE POLICIES

          ``subchapter a. policies issued by foreign insurers

         ``subchapter b. insured and self-insured health plans

         ``Subchapter A--Policies Issued By Foreign Insurers''.

       (ii) The table of chapters for subtitle D of such Code is 
     amended by striking the item relating to chapter 34 and 
     inserting the following new item:

          ``Chapter 34--Taxes on Certain Insurance Policies''.

     SEC. 6. DUTIES OF AMERICA'S HEALTH INSURANCE TRUST.

       (a) Insurance Plan Rankings and Website.--
       (1) Web-based materials.--The Trust shall establish and 
     maintain a website that provides informational materials 
     regarding the health insurance plans provided through the 
     National Health Insurance Exchange, including appropriate 
     links for all available State insurance commissioner 
     websites.
       (2) Plan rankings.--The Trust shall develop and publish 
     annual rankings of the health insurance plans provided 
     through the National Health Insurance Exchange, based on the 
     assignment of a letter grade between ``grade A'' (highest) 
     and ``grade F'' (lowest). The Trust shall provide for a 
     comparative evaluation of each plan based upon--
       (A) administrative expenditures;
       (B) affordability of coverage;
       (C) adequacy of coverage;
       (D) timeliness and adequacy of consumer claims processing;
       (E) available consumer complaint systems;
       (F) grievance and appeals processes;
       (G) transparency;
       (H) consumer satisfaction; and
       (I) any additional measures as determined by the Board.
       (3) Information available on website by zip code.--The 
     annual rankings of the health insurance plans (as described 
     in paragraph (2)) shall be available on the website for the 
     Trust (as described in paragraph (1)), and the website for 
     the National Health Insurance Exchange, in a manner that is 
     searchable and sortable by zip code.
       (4) Consumer feedback.--
       (A) Consumer complaints.--The Trust shall develop written 
     and web-based methods for individuals to provide 
     recommendations and complaints regarding the health insurance 
     plans provided through the National Health Insurance 
     Exchange.
       (B) Consumer surveys.--The Trust shall obtain meaningful 
     consumer input, including consumer surveys, that measure the 
     extent to which an individual receives the services and 
     supports described in the individual's health insurance plan 
     and the individual's satisfaction with such services and 
     supports.
       (b) Data Sharing.--
       (1) In general.--An organization that provides a health 
     insurance plan through the National Health Insurance Exchange 
     shall provide the Trust with all information and data that is 
     necessary for improving transparency, monitoring, and 
     oversight of such plans.
       (2) Annual disclosure.--Beginning with the first full year 
     of operation of the National Health Insurance Exchange, an 
     organization that provides a health insurance plan through 
     the National Health Insurance Exchange shall annually provide 
     the Trust with appropriate information regarding the 
     following:
       (A) Name of the plan.
       (B) Levels of available plan benefits.
       (C) Description of plan benefits.
       (D) Number of enrollees under the plan.
       (E) Demographic profile of enrollees under the plan.
       (F) Number of claims paid to enrollees.
       (G) Number of enrollees that terminated their coverage 
     under the plan.
       (H) Total operating cost for the plan (including 
     administrative costs).
       (I) Patterns of utilization of the plan's services.
       (J) Availability, accessibility, and acceptability of the 
     plan's services.
       (K) Such information as the Trust may require demonstrating 
     that the organization has a fiscally sound operation.
       (L) Any additional information as determined by the Trust.
       (3) Form and manner of information.--Information to be 
     provided to the Trust under paragraphs (1) and (2) shall be 
     provided--
       (A) in such form and manner as specified by the Trust; and
       (B) within 30 days of the date of receipt of the request 
     for such information, or within such extended period as the 
     Trust deems appropriate.
       (4) Information from the department of health and human 
     services.--
       (A) In general.--Any information regarding the health 
     insurance plans that are offered through the National Health 
     Insurance Exchange that has been provided to the Secretary of 
     Health and Human Services shall also be made available (as 
     deemed appropriate by the Secretary) to the Trust for the 
     purpose of improving transparency, monitoring, and oversight 
     of such plans. Such information may include, but is not 
     limited to, the following:

[[Page S6727]]

       (i) Underwriting guidelines to ensure compliance with 
     applicable Federal health insurance requirements.
       (ii) Rating practices to ensure compliance with applicable 
     Federal health insurance requirements.
       (iii) Enrollment and disenrollment data, including 
     information the Secretary may need to detect patterns of 
     discrimination against individuals based on health status or 
     other characteristics, to ensure compliance with applicable 
     Federal health insurance requirements (including non-
     discrimination in group coverage, guaranteed issue, and 
     guaranteed renewability requirements applicable in all 
     markets).
       (iv) Post-claims underwriting and rescission practices to 
     ensure compliance with applicable Federal health insurance 
     requirements relating to guaranteed renewability.
       (v) Marketing materials and agent guidelines to ensure 
     compliance with applicable Federal health insurance 
     requirements.
       (vi) Data on the imposition of pre-existing condition 
     exclusion periods and claims subjected to such exclusion 
     periods.
       (vii) Information on issuance of certificates of creditable 
     coverage.
       (viii) Information on cost-sharing and payments with 
     respect to any out-of-network coverage.
       (ix) The application to issuers of penalties for violation 
     of applicable Federal health insurance requirements 
     (including failure to produce requested information).
       (x) Such other information as the Trust may determine to be 
     necessary to verify compliance with the requirements of this 
     Act.
       (B) Required disclosure.--The Secretary of Health and Human 
     Services shall provide the Trust with all consumer claims 
     data or information that has been provided to the Secretary 
     by any health insurance plan that is offered through the 
     National Health Insurance Exchange.
       (C) Period for providing information.--Information to be 
     provided to the Trust under this paragraph shall be provided 
     by the Secretary within 30 days of the date of receipt of the 
     request for such information, or within such extended period 
     as the Secretary and the Trust mutually deem appropriate.
       (5) Non-disclosure of health insurance data.--The Trust 
     shall prevent disclosure of any data or information provided 
     under this paragraph that the Trust determines is proprietary 
     or qualifies as a trade secret subject to withholding from 
     public dissemination. Any data or information provided under 
     this paragraph shall not be subject to disclosure under 
     section 552 of title 5, United States Code (commonly referred 
     to as the Freedom of Information Act).

     SEC. 7. DEFINITION OF NATIONAL HEALTH INSURANCE EXCHANGE.

       In this Act, the term ``National Health Insurance 
     Exchange'' means a mechanism established or recognized under 
     Federal law for coordinating the offering of health insurance 
     coverage to individuals in the United States through the 
     establishment of standards for benefits, cost-sharing, and 
     premiums for such health insurance coverage.
                                 ______