[House Report 114-293]
[From the U.S. Government Publishing Office]


114th Congress }                                             {  Report
 1st Session   }         HOUSE OF REPRESENTATIVES            {  114-293
                                                             
_______________________________________________________________________

                                     

 
   RESTORING AMERICANS' HEALTHCARE FREEDOM RECONCILIATION ACT OF 2015

                               __________

                              R E P O R T

                                 of the

                        COMMITTEE ON THE BUDGET

                        HOUSE OF REPRESENTATIVES

                              to accompany

                               H.R. 3762

 A BILL TO PROVIDE FOR RECONCILIATION PURSUANT TO SECTION 2002 OF THE 
        CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2016

                             together with

                     ADDITIONAL AND MINORITY VIEWS
                     
                     






October 16, 2015.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed
              
                            _______________    
              
   
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                        COMMITTEE ON THE BUDGET

                   TOM PRICE, M.D., Georgia,Chairman
TODD ROKITA, Indiana,Vice Chairman   CHRIS VAN HOLLEN, Maryland,
SCOTT GARRETT, New Jersey              Ranking Minority Member
MARIO DIAZ-BALART, Florida           JOHN A. YARMUTH, Kentucky
TOM COLE, Oklahoma                   BILL PASCRELL, Jr., New Jersey
TOM McCLINTOCK, California           TIM RYAN, Ohio
DIANE BLACK, Tennessee               GWEN MOORE, Wisconsin
ROB WOODALL, Georgia                 KATHY CASTOR, Florida
MARSHA BLACKBURN, Tennessee          JIM McDERMOTT, Washington
VICKY HARTZLER, Missouri             BARBARA LEE, California
TOM RICE, South Carolina             MARK POCAN, Wisconsin
MARLIN A. STUTZMAN, Indiana          MICHELLE LUJAN GRISHAM, New Mexico
MARK SANFORD, South Carolina         DEBBIE DINGELL, Michigan
VERN BUCHANAN, Florida               TED LIEU, California
STEVE WOMACK, Arkansas               DONALD NORCROSS, New Jersey
DAVE BRAT, Virginia                  SETH MOULTON, Massachusetts
ROD BLUM, Iowa
ALEXANDER X. MOONEY, West Virginia
GLENN GROTHMAN, Wisconsin
GARY J. PALMER, Alabama
JOHN R. MOOLENAAR, Michigan
BRUCE WESTERMAN, Arkansas

                           Professional Staff

                     Richard E. May,Staff Director
                 Thomas S. Kahn,Minority Staff Director
                 
                 
                            C O N T E N T S

                              ----------                              
                                                                   Page
Introduction by the Committee on the Budget......................     3
Reconciliation and the Budget Resolution.........................     9
Title I--Committee on Education and the Workforce................    14
Title II--Committee on Energy and Commerce.......................    67
Title III--Committee on Ways and Means...........................    69
    Subtitle A--Revenue Provisions...............................    73
    Subtitle B--Repeal of the Independent Payment Advisory Board.   141
Committee on the Budget:
    Votes of the Committee on the Budget.........................   189
    Other House Report Requirements..............................   193
    Views of Committee Members...................................   199
H.R. 3762, Restoring Americans' Healthcare Freedom Reconciliation 
  Act of 2015....................................................   205
  
  
  
                                                                       
114th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    114-293

======================================================================




   RESTORING AMERICANS' HEALTHCARE FREEDOM RECONCILIATION ACT OF 2015

                                _______
                                

PROVIDING FOR RECONCILIATION PURSUANT TO SECTION 2002 OF THE CONCURRENT 
             RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2016

                                _______
                                

October 16, 2015.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Tom Price of Georgia, from the Committee on the Budget, submitted 
                             the following

                              R E P O R T

                             together with

                     ADDITIONAL AND MINORITY VIEWS

                        [To accompany H.R. 3762]

    The Committee on the Budget, to whom reconciliation 
recommendations were submitted pursuant to section 2002 of S. 
Con. Res. 11, the concurrent resolution on the budget for 
fiscal year 2016, having considered the same, reports favorably 
thereon without amendment and recommends that the bill do pass.

                          INTRODUCTION BY THE
                        COMMITTEE ON THE BUDGET

                              ----------                              


              Clearing the Way for Real Health Care Reform

    The essential failing of Obamacare runs deeper than its 
distortions of health care delivery and financing, its clumsy 
rollout, or the President's numerous unilateral changes in the 
lawafter its enactment. Beneath all these, the fundamental flaw 
of Obamacare is the conceit that Washington could somehow 
centrally manage a vast and complex medical sector serving 
nearly 320 million diverse individuals. That notion has proved 
a failure. It requires suffocating mandates and regulations. It 
stifles health care delivery, making it less responsive and 
more costly. Above all, it necessarily imposes government 
dictates on highly personal medical decisions, effectively 
placing a government agent in every examining room and 
alongside every hospital bed.
    That is why Obamacare must be dismantled. The aim is not 
only to reject this illegitimately conceived government 
expansion, which still--more than 5 years after its enactment--
lacks the support of even a simple majority of the American 
public. It is not just to replace one national health program 
with another. The point is to discard the entire pretense of 
nationalized medicine, and recognize that health care works 
best when it promotes the most important and basic relationship 
in medicine--the one between the patient and the doctor. 
Everything else in the $3 trillion health care network--
hospitals, nurses, technicians, medical device makers, 
pharmaceutical companies, researchers, health insurers, and 
many more--revolves around that fundamental partnership.
    Obamacare must be repealed to clear the way for genuine, 
compassionate, patient-centered health care reform. That is the 
broader aim of this legislation: the Restoring Americans' 
Healthcare Freedom Reconciliation Act of 2015.
    Like so much of Washington's health care policy, this 
massive program--formally called the Affordable Care Act\1\--
was designed to satisfy the ivory tower aspirations of 
academics and protect the fortresses of government 
bureaucracies. Instead of responding to the medical needs of 
real people in the real world, it adds layers of rules and 
directives to further systematize health care as a government-
run service. It seeks to control costs from the top down--which 
can only lead to rationing health services--rather than 
trusting prices to emerge naturally from the free choices of 
millions of individuals.
---------------------------------------------------------------------------
    \1\Because the House and Senate could not agree on a single plan, 
they had to pass two bills, one modifying the other, to create the 
Affordable Care Act. The two measures were the Patient Protection and 
Affordable Care Act (H.R. 3590, Public Law 111-148) and the Health Care 
and Education Reconciliation Act of 2010 (H.R. 4872, Public Law 111-
152).
---------------------------------------------------------------------------
    True health care reform can only arise from a different way 
of thinking about it. There is no one strategy for making 
health care more effective and efficient; there is no unified 
approach, especially not by government. True reform can only 
emerge from the flexibility and innovation of all the 
participants, always seeking creative ways to advance better 
and less costly health care. As spelled out in the fiscal year 
2016 budget resolution, which led to this legislation, 
policymakers should apply the guiding principles below to 
develop real health care reform.\2\
---------------------------------------------------------------------------
    \2\See section 6205 of the Conference Report accompanying the 
Concurrent Resolution on the Budget for Fiscal Year 2016 (S. Con. Res. 
11).

    Affordability. Real reform should ensure that all 
Americans, no matter their age, income, or health status, can 
afford health coverage. The health care delivery structure 
should be improved, and individuals should not be priced out of 
the insurance market due to pre-existing conditions. 
Nationalized health care not only fails to accomplish these 
aims, but in fact undermines them. Individuals should be 
allowed to join together voluntarily to pool risk through 
mechanisms such as Individual Membership Associations and Small 
---------------------------------------------------------------------------
Employer Membership Associations.

    Accessibility. Instead of Washington dictating to Americans 
how they may or may not use their health insurance, reforms 
should make health coverage more portable. Individuals should 
be able to own their insurance and have it follow them in and 
out of jobs throughout their careers. Small business owners 
should be permitted to band together across State lines through 
their membership in bona fide trade or professional 
associations to purchase health coverage for their families and 
employees at a low cost. This will increase small businesses' 
bargaining power, volume discounts, and administrative 
efficiencies while giving them freedom from State-mandated 
benefit packages. Also, insurers licensed to sell policies in 
one State should be permitted to offer them to residents in any 
other State; consumers should be permitted to shop for health 
insurance across State lines, as they are with other insurance 
products online, by mail, by telephone, or in consultation with 
an insurance agent.

    Quality. Incentives for providers to deliver high-quality, 
responsive, and coordinated care will promote better patient 
outcomes and drive down health care costs. Likewise, reforms 
should work to restore the patient-physician relationship by 
reducing administrative burdens and allowing physicians to do 
what they do best: care for patients.

    Choices. Genuine reform should free individuals and 
families to secure the health coverage that best meets their 
needs, rather than instituting one-size-fits-all directives 
from Federal bureaucracies such as the Internal Revenue 
Service, the Department of Health and Human Services, and the 
Independent Payment Advisory Board.

    Innovation. Instead of stifling innovation in health care 
technologies, treatments, medications, and therapies with 
Federal mandates, taxes, and price controls, a reformed health 
care system should encourage research, development, and 
innovation.

    Responsiveness. Reform should vigorously apply the spirit 
of federalism, returning authority to States wherever possible, 
to make health care more responsive to patients and their 
needs. Instead of tying States' hands with Federal requirements 
for their Medicaid programs, the Federal Government should 
return control of this program to the States. The current 
Medicaid Program only drives up Federal debt and threatens to 
bankrupt State budgets. States are better positioned to provide 
quality, affordable care to those eligible for the program and 
to track down and weed out waste, fraud, and abuse. Beneficiary 
choices in the State Children's Health Insurance Program 
[SCHIP] and Medicaid should be improved. States should make 
available the purchase of private insurance as an option to 
their Medicaid and SCHIP populations (though they should not 
require enrollment).

    Legal Reforms. Policymakers should develop reforms that 
prevent lawsuit abuse and curb the practice of defensive 
medicine, which are significant drivers increasing health care 
costs. The burden of proof in medical malpractice cases should 
be based on compliance with best practice guidelines and States 
should be free to implement those policies to best suit their 
needs.

                The Role of the Committee on the Budget

    As required by the conference agreement accompanying the 
Concurrent Resolution on the Budget for Fiscal Year 2016 (S. 
Con. Res. 11), this reconciliation legislation comprises 
provisions from three committees of the House of 
Representatives with jurisdiction related to the Affordable 
Care Act: the Committee on Education and the Workforce, the 
Committee on Energy and Commerce, and the Committee on Ways and 
Means. Each committee met its instruction to achieve at least 
$1 billion in deficit reduction over 10 years, submitting 
targeted provisions aimed at deconstructing the foundation of 
the Affordable Care Act.
    At this stage of the process, the role of the Committee on 
the Budget is to determine whether the bill complies with the 
deficit reduction targets in the budget resolution. It then 
binds together the submissions of the three committees into a 
single bill. The Committee on the Budget subsequently reports 
the combined bill to the House with the recommendation that it 
be passed by the entire House. The Congressional Budget Act of 
1974 precludes the Committee on the Budget from making any 
substantive change in the bill during the course of its markup. 
If a change in the reported bill is necessary, section 
310(d)(5) of the Act prescribes the following procedure: ``The 
Committee on Rules of the House of Representatives may make in 
order amendments to achieve changes specified by reconciliation 
directives contained in a concurrent resolution on the budget 
if a committee or committees of the House fail to submit 
recommended changes to its Committee on the Budget pursuant to 
its instruction.''
    During markup, the Committee on the Budget adopted a motion 
granting the Chairman, at his discretion, the authority to 
request the Committee on Rules to report a rule for 
consideration of this measure that would make in order an 
amendment to the bill.
    It is not unusual for amendments to budget reconciliation 
legislation to be made in order at the Rules Committee for 
reasons other than one or more committees failing to meet 
reconciliation instructions. Amendments often are needed to 
make technical and conforming changes in complex legislation. 
At other times, changes are needed to address any of the many 
House and Senate budget rules. On occasion, amendments are 
needed to resolve the inevitable interactions among multiple 
committees' submissions or to address unresolved policy issues.

                      The Committees' Submissions

    The submissions from the three reporting committees detail 
and explain their specific provisions and outline how they 
fulfill their instructions and provide the required amount of 
deficit reduction over the next 10 years. A summary of the 
provisions is as follows:

           TITLE I: COMMITTEE ON EDUCATION AND THE WORKFORCE

    Section 101: Repeal of Automatic Enrollment Requirement. 
Repeals Section 18A of the Fair Labor Standards Act (29 U.S.C. 
218a), as added by section 1511 of the Affordable Care Act. 
Section 1511 requires employers with more than 200 employees to 
automatically enroll new full-time equivalents into a 
qualifying health plan if offered by that employer, and to 
automatically continue enrollment of current employees.
    Net Change in Deficit, 2016-2025: -$7.9 billion.

               TITLE II: COMMITTEE ON ENERGY AND COMMERCE

    Section 201: Repeal Prevention and Public Health Fund. 
Repeals the Prevention and Public Health Fund [PPHF] and 
rescinds unobligated balances. The PPHF allows the Secretary of 
Health and Human Services to transfer amounts from the fund to 
Department of Health and Human Services accounts to increase 
funding for Public Health Service Act-authorized prevention, 
wellness, and public health activities, including prevention 
research and health screenings.

    Section 202: Federal Payment to States. Prohibits Medicaid 
reimbursement for 1 year for a defined entity, which includes 
its affiliates, subsidiaries, successors, and clinics.

    Section 203: Funding for Community Health Center Program. 
Increases funding to the Community Health Center Fund by $235 
million in each of fiscal years 2016 and 2017, as extended by 
the Medicare Access and CHIP Reauthorization Act (H.R. 2).
    Net Change in Deficit, 2016-2025: -$12.4 billion.

                 TITLE III: COMMITTEE ON WAYS AND MEANS

Subtitle A--Revenue Provisions

    Section 301: Repeal Individual Mandate Tax. Repeals the 
penalty on individuals who do not obtain qualified health 
insurance, effective after 1 December 2014.

    Section 302. Repeal of Employer Mandate. Repeals the 
penalty on employers who do not offer their employees qualified 
health insurance, effective after 1 December 2014.

    Section 303: Repeal Medical Device Tax. Repeals the 2.3-
percent excise tax, effective 31 December 2012, on the sale of 
any taxable medical device by a manufacturer, producer, or 
importer of such device.

    Section 304: Repeal of the Excise Tax on Employee Health 
Insurance Premiums and Health Benefits and Related Reporting 
Requirements (i.e. the Cadillac Tax). Repeals the 40-percent 
excise tax on high-value health plans.

Subtitle B--Repeal of the Independent Payment Advisory Board

    Section 311: Repeal Medicare Independent Payment Advisory 
Board [IPAB]. Repeals IPAB, which would have been required 
under certain circumstances to modify the Medicare Program to 
achieve specified savings in the Medicare Program. See also 
H.R. 1190, which passed the House on 23 June 2015.
    Net Change in Deficit, 2016-2025: -$37.1 billion.

    Due to interactions between the provisions submitted by the 
House committees, an additional net change in the deficit of 
-$19.4 billion for fiscal years 2016-2025 was determined by the 
Congressional Budget Office. The reconciliation bill's total 
net change in the deficit for all reported provisions is -$78.9 
billion for fiscal years 2016-2025.

                         RECONCILIATION AND THE
                           BUDGET RESOLUTION

                              ----------                              

    Budget resolutions and reconciliation bills have a special 
relationship in the congressional budget process. The adoption 
of a budget resolution--formally designated a concurrent 
resolution on the budget--establishes the reconciliation 
process for a fiscal year in addition to providing rules that 
assist in guiding a reconciliation bill through the 
congressional legislative procedure. Conversely, a 
reconciliation bill may be essential to fulfilling the aims of 
a given budget resolution.

                       The Reconciliation Process

    The term ``reconciliation'' refers to both a form of 
legislation and a specific legislative procedure. Only by 
adopting a concurrent resolution on the budget that includes 
reconciliation instructions can Congress initiate the 
reconciliation process,\3\ ideally culminating in the enactment 
of reconciliation legislation. Such a measure is termed a 
``reconciliation bill'' because it is designed to amend 
existing law to reflect the assumptions underlying the budget 
resolution from which it has commenced; that is, it reconciles 
current law to the budget resolution framework.
---------------------------------------------------------------------------
    \3\Section 310 of the Congressional Budget Act of 1974 (2 U.S.C. 
Sec. 641).
---------------------------------------------------------------------------
    S. Con. Res. 11, the conference report accompanying the 
Concurrent Resolution on the Budget for Fiscal Year 2016,\4\ 
agreed to on May 5, 2015, included reconciliation instructions 
requiring three House committees and two Senate committees to 
amend laws in their jurisdictions such that each committee 
reduces the deficit by $1 billion over 10 years.\5\ Under the 
procedure, these legislative amendments were then to be 
submitted to the Committees on the Budget of the House and 
Senate by July 24, 2015.
---------------------------------------------------------------------------
    \4\H. Rept. 114-096.
    \5\Sections 2001(a) and 2002(a) of S. Con. Res. 11 (114th 
Congress).
---------------------------------------------------------------------------
    In the House, the Committee on the Budget accepted 
submissions from the three reconciled committees--the 
Committees on Education and the Workforce, Energy and Commerce, 
and Ways and Means--on October 2, 2015. The submissions 
included legislative text, short summaries, Congressional 
Budget Office estimates, and other material to assist the 
Committee on the Budget in preparing this explanatory report.
    The basic elements of a reconciliation bill are set forth 
in the Congressional Budget Act of 1974 [Budget Act]. 
Additional guidelines over content and procedures governing 
consideration may be included in budget resolutions.

             Reconciliation in the House of Representatives

    Reconciliation is defined as a privileged measure in the 
House and hence takes precedence over certain other matters 
that may be considered on the floor. When a bill is reported by 
the Committee on the Budget, comprising the submissions 
transmitted to it, under House Rules such a bill is 
``originated'' rather than ``introduced''. Only certain 
measures become legislation in this fashion: resolutions 
providing for consideration of bills on the floor, 
appropriation bills, and budget resolutions are examples. 
Therefore, a reconciliation bill neither receives an ``H.R.'' 
number nor is considered a legislative matter until the 
Committee on the Budget votes to report the bill and formally 
files it with the Clerk of the House.

    Budget Resolution Adjustment and House Rules. Under normal 
circumstances, all points of order and other procedural budget-
related requirements apply to House reconciliation bills. For 
the measure reported by the Committee on the Budget on October 
9, 2015, this is not the case. S. Con. Res. 11 specifically 
provided for the consideration of this bill and took into 
account its budgetary effects. Therefore, Budget Act points of 
order, the Cut-As-You-Go point of order,\6\ and the long-term 
direct spending point of order contained in the fiscal year 
2016 budget resolution\7\ do not apply to this House 
reconciliation bill.
---------------------------------------------------------------------------
    \6\Clause 10 of rule XXI of the Rules of the House of 
Representatives.
    \7\Section 3101(b)(2) of S. Con. Res. 11 (114th Congress).
---------------------------------------------------------------------------
    The budget resolution also affirmed and clarified the 
authority of the Chairman of the Committee on the Budget to 
determine the cost estimates of legislative measures.\8\ In 
particular, if the Congressional Budget Office makes 
adjustments to its baseline subsequent to its official 
publication, the Chairman is authorized to make decisions as to 
how to treat those updates. The intent of the provision is to 
affirm the Chairman's ability to take into account 
unforeseeable events that may occur and diverge from the 
assumptions underlying the budget resolution. This has 
important implications in how the budgetary effects of 
reconciliation bills are determined.
---------------------------------------------------------------------------
    \8\Section 2002(b)(1)(A) of S. Con. Res. 11 (114th Congress).

    Reconciliation and Health Care Legislation. An additional 
House component of the budget resolution entails providing 
guidance to the committees receiving reconciliation 
instructions. They are asked to ``note the policies discussed 
in the fiscal year 2016 budget resolution that repeal the 
Affordable Care Act and the health care related provisions of 
the Health Care and Education Reconciliation Act of 2010''.

                      Reconciliation in the Senate

    The two committees in the Senate that received 
reconciliation instructions are the Committee on Finance and 
the Committee on Health, Education, Labor, and Pensions. These 
Senate committees generally have commensurate jurisdiction as 
those in the House, and each was required to reduce the deficit 
by $1 billion over the same 10-year period.

    Reconciliation and the Deficit Point of Order. The budget 
resolution amended Senate legislative procedures by repealing 
the point of order against a reconciliation bill increasing the 
deficit over 5 or 10 fiscal years.\9\ This prohibition was 
originally adopted in the 110th Congress and was intended to 
prevent such bills from reducing taxes. The reconciliation bill 
considered and reported by the Committee on the Budget of the 
House does not increase the deficit in either of the periods 
set forth in the Senate point of order repealed by the budget 
resolution.
---------------------------------------------------------------------------
    \9\Section 3204 of S. Con. Res. 11 (114th Congress).

    Debt Limit Prohibition. Under the Congressional Budget Act 
of 1974, reconciliation bills are specifically allowed to 
include changes in the public debt limit.\10\ Section 
2001(b)(1) of S. Con. Res. 11, though, overturns that authority 
and instead establishes a point of order against including a 
debt limit increase. The Senate may not consider a 
reconciliation bill, joint resolution, conference report, or an 
amendment, if it would increase the public debt limit in any 
year during the period of fiscal years 2016 through 2025.\11\
---------------------------------------------------------------------------
    \10\Section 310(a)(3) of the Congressional Budget Act of 1974 
authorizes a reconciliation measure to ``specify the amounts by which 
the statutory limit on the public debt is to be changed and direct the 
committee having jurisdiction to recommend such change.''
    \11\The statutory debt limit is set in 31 U.S.C. Sec. 3101.
---------------------------------------------------------------------------
    This point of order may be waived, but only if two-thirds 
of the Senate (67 Senators) votes to do so. This supermajority 
is atypical in that most budget-related points of order may be 
waived by a three-fifths vote (60 Senators).

                               Conclusion

    The relationship between the concurrent resolution on the 
budget for a fiscal year, and a reconciliation bill that may 
result from the adoption of such a measure, is a significant 
element of the congressional budget process. Budget resolutions 
not only initiate the reconciliation procedure, but can set key 
parameters and guidelines by which a reconciliation bill 
ultimately navigates the sometimes complex legislative process 
of the U.S. Congress. Conversely, the provisions of a 
reconciliation bill may be necessary for achieving the budget 
resolution's goals. Thus, this reconciliation measure 
represents an important step toward fulfilling the aims of S. 
Con. Res. 11, the Concurrent Resolution on the Budget for 
Fiscal Year 2016.



                           [COMMITTEE PRINT]

[Budget Reconciliation Legislative Recommendations Relating to Repeal of 
                    Automatic Enrollment Requirement]

           TITLE I--COMMITTEE ON EDUCATION AND THE WORKFORCE

SEC._01. REPEAL OF AUTOMATIC ENROLLMENT REQUIREMENT.

  The Fair Labor Standards Act of 1938 (29 U.S.C. 201 et seq.) 
is amended by repealing section 18A (as added by section 1511 
of the Patient Protection and Affordable Care Act (P.L. 111-
148)).


         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets and 
existing law in which no change is proposed is shown in roman):

          SECTION 18A OF THE FAIR LABOR STANDARDS ACT OF 1938


[SEC. 18A. AUTOMATIC ENROLLMENT FOR EMPLOYEES OF LARGE EMPLOYERS.

  [In accordance with regulations promulgated by the Secretary, 
an employer to which this Act applies that has more than 200 
full-time employees and that offers employees enrollment in 1 
or more health benefits plans shall automatically enroll new 
full-time employees in one of the plans offered (subject to any 
waiting period authorized by law) and to continue the 
enrollment of current employees in a health benefits plan 
offered through the employer. Any automatic enrollment program 
shall include adequate notice and the opportunity for an 
employee to opt out of any coverage the individual or employee 
were automatically enrolled in. Nothing in this section shall 
be construed to supersede any State law which establishes, 
implements, or continues in effect any standard or requirement 
relating to employers in connection with payroll except to the 
extent that such standard or requirement prevents an employer 
from instituting the automatic enrollment program under this 
section.]




       Amendment in the nature of a substitute to the committee 
            recommendations for the Committee on the Budget


                  Offered by Ms. Stefanik of New York


  Strike all after the instruction and insert the following:

           TITLE I--COMMITTEE ON EDUCATION AND THE WORKFORCE

SEC._01. REPEAL OF AUTOMATIC ENROLLMENT REQUIREMENT.

  The Fair Labor Standards Act (29 U.S.C. 201 et seq.) is 
amended by repealing section 18A (as added by section 1511 of 
the Patient Protection and Affordable Care Act (P.L. 111-148)).



         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets and 
existing law in which no change is proposed is shown in roman):

               PATIENT PROTECTION AND AFFORDABLE CARE ACT



           *       *       *       *       *       *       *
  TITLE IV--PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH

Subtitle A--Modernizing Disease Prevention and Public Health Systems

           *       *       *       *       *       *       *


[SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND.

  [(a)Purpose.--It is the purpose of this section to establish 
a Prevention and Public Health Fund (referred to in this 
section as the ``Fund''), to be administered through the 
Department of Health and Human Services, Office of the 
Secretary, to provide for expanded and sustained national 
investment in prevention and public health programs to improve 
health and help restrain the rate of growth in private and 
public sector health care costs.
  [(b)Funding.--There are hereby authorized to be appropriated, 
and appropriated, to the Fund, out of any monies in the 
Treasury not otherwise appropriated--
          [(1) for fiscal year 2010, $500,000,000;
          [(2) for each of fiscal years 2012 through 2017, 
        $1,000,000,000;
          [(3) for each of fiscal years 2018 and 2019, 
        $1,250,000,000;
          [(4) for each of fiscal years 2020 and 2021, 
        $1,500,000,000; and
          [(5) for fiscal year 2022, and each fiscal year 
        thereafter, $2,000,000,000.
  [(c)Use of Fund.--The Secretary shall transfer amounts in the 
Fund to accounts within the Department of Health and Human 
Services to increase funding, over the fiscal year 2008 level, 
for programs authorized by the Public Health Service Act, for 
prevention, wellness, and public health activities including 
prevention research, health screenings, and initiatives, such 
as the Community Transformation grant program, the Education 
and Outreach Campaign Regarding Preventive Benefits, and 
immunization programs.
  [(d)Transfer Authority.--The Committee on Appropriations of 
the Senate and the Committee on Appropriations of the House of 
Representatives may provide for the transfer of funds in the 
Fund to eligible activities under this section, subject to 
subsection (c).]

           *       *       *       *       *       *       *

                              ----------                              


          MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015



           *       *       *       *       *       *       *
TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS

           *       *       *       *       *       *       *


Subtitle B--Other Health Extenders

           *       *       *       *       *       *       *


SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY HEALTH CENTERS, THE 
                    NATIONAL HEALTH SERVICE CORPS, AND TEACHING HEALTH 
                    CENTERS.

  (a)Funding for Community Health Centers and the National 
Health Service Corps.--
          (1)Community health centers.--Section 10503(b)(1)(E) 
        of the Patient Protection and Affordable Care Act (42 
        U.S.C. 254b-2(b)(1)(E)) is amendedby striking 
        ``$3,600,000,000'' and inserting ``$3,835,000,000'' and 
        by striking ``for fiscal year 2015'' and inserting 
        ``for each of fiscal years 2015 through 2017''.
          (2)National health service corps.--Section 
        10503(b)(2)(E) of the Patient Protection and Affordable 
        Care Act (42 U.S.C. 254b-2(b)(2)(E)) is amended by 
        striking ``for fiscal year 2015'' and inserting ``for 
        each of fiscal years 2015 through 2017''.
  (b)Extension of Teaching Health Centers Program.--Section 
340H(g) of the Public Health Service Act (42 U.S.C. 256h(g)) is 
amended by inserting ``and $60,000,000 for each of fiscal years 
2016 and 2017'' before the period at the end.
  (c)Application.--Amounts appropriated pursuant to this 
section for fiscal year 2016 and fiscal year 2017 are subject 
to the requirements contained in Public Law 113-235 for funds 
for programs authorized under sections 330 through 340 of the 
Public Health Service Act (42 U.S.C. 254b-256).

           *       *       *       *       *       *       *



 Recommendations Approved By the Committee on Energy and Commerce for 
 Transmittal to the Committee on Budget Pursuant to Section 2002(a)(2) 
  of the Concurrent Resolution on the Budget for Fiscal Year 2016 (S. 
                             Con. Res. 11)


               TITLE II--COMMITTEE ON ENERGY AND COMMERCE

SEC. 201. REPEAL OF THE PREVENTION AND PUBLIC HEALTH FUND.

  (a) In General.--Section 4002 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 300u-11) is repealed.
  (b) Rescission of Unobligated Funds.--Of the funds made 
available by such section 4002, the unobligated balance is 
rescinded.

SEC. 202. FEDERAL PAYMENT TO STATES.

  (a) In General.--Notwithstanding sections 504(a), 
1902(a)(23), 2002, 2005(a)(4), 2102(a)(7), or 2105(a)(1) of the 
Social Security Act (42 U.S.C. 704(a), 1396b(a)(23), 1397a, 
1397d(a)(4), 1397bb(a)(2), 1397ee(a)(1)), or the terms of any 
Medicaid waiver in effect on the date of enactment of this Act 
that is approved under section 1115 or 1915 of the Social 
Security Act (42 U.S.C. 1315, 1396n), for the one-year period 
beginning on the date of the enactment of this Act no Federal 
funds may be made available to a State for payments to a 
prohibited entity.
  (b) Definition of Prohibited Entity.--In this section, the 
term ``prohibited entity'' means an entity, including its 
affiliates, subsidiaries, successors, and clinics--
          (1) that, as of the date of enactment of this Act--
                  (A) is an organization described in section 
                501(c)(3) of the Internal Revenue Code of 1986 
                and exempt from tax under section 501(a) of 
                such Code;
                  (B) is an essential community provider 
                described in section 156.235 of title 45, Code 
                of Federal Regulations, that is primarily 
                engaged in family planning services, 
                reproductive health, and related medical care; 
                and
                  (C) provides for elective abortions; and
          (2) for which the total amount of Federal and State 
        expenditures under the Medicaid program under title XIX 
        of the Social Security Act in fiscal year 2014 made 
        directly to the entity and to any affiliates, 
        subsidiaries, successors, or clinics of the entity, or 
        made to the entity and to any affiliates, subsidiaries, 
        successors, or clinics of the entity as part of a 
        nationwide health care provider network, exceeded 
        $350,000,000.

SEC. 203. FUNDING FOR COMMUNITY HEALTH CENTER PROGRAM.

  Effective as if included in the enactment of the Medicare 
Access and CHIP Reauthorization Act of 2015 (Public Law 114-10, 
129 Stat. 87), paragraph (1) of section 221(a) of such Act is 
amended by inserting after ``Section 10503(b)(1)(E) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-
2(b)(1)(E)) is amended'' the following: ``by striking 
`$3,600,000,000' and inserting `$3,835,000,000' and''.




         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italics and existing law in which no change is 
proposed is shown in roman):

                     INTERNAL REVENUE CODE OF 1986



           *       *       *       *       *       *       *
Subtitle D--Miscellaneous Excise Taxes

           *       *       *       *       *       *       *


CHAPTER 32--MANUFACTURERS EXCISE TAXES

           *       *       *       *       *       *       *


[SUBCHAPTER E--Medical Devices]

           *       *       *       *       *       *       *


                     [Subchapter E--Medical Devices

[SEC. 4191. MEDICAL DEVICES.

  [(a) In General.--There is hereby imposed on the sale of any 
taxable medical device by the manufacturer, producer, or 
importer a tax equal to 2.3 percent of the price for which so 
sold.
  [(b) Taxable Medical Device.--For purposes of this section--
          [(1) In general.--The term ``taxable medical device'' 
        means any device (as defined in section 201(h) of the 
        Federal Food, Drug, and Cosmetic Act) intended for 
        humans.
          [(2) Exemptions.--Such term shall not include--
                  [(A) eyeglasses,
                  [(B) contact lenses,
                  [(C) hearing aids, and
                  [(D) any other medical device determined by 
                the Secretary to be of a type which is 
                generally purchased by the general public at 
                retail for individual use.]

           *       *       *       *       *       *       *


              Subchapter G--Exemptions, Registration, Etc

SEC. 4221. CERTAIN TAX-FREE SALES.

  (a) General Rule.--Under regulations prescribed by the 
Secretary, no tax shall be imposed under this chapter (other 
than under section 4121 or 4081) on the sale by the 
manufacturer (or under subchapter C of chapter 31 on the first 
retail sale) of an article--
          (1) for use by the purchaser for further manufacture, 
        or for resale by the purchaser to a second purchaser 
        for use by such second purchaser in further 
        manufacture,
          (2) for export, or for resale by the purchaser to a 
        second purchaser for export,
          (3) for use by the purchaser as supplies for vessels 
        or aircraft,
          (4) to a State or local government for the exclusive 
        use of a State or local government,
          (5) to a nonprofit educational organization for its 
        exclusive use, or
          (6) to a qualified blood collector organization (as 
        defined in section 7701(a)(49)) for such organization's 
        exclusive use in the collection, storage, or 
        transportation of blood,
but only if such exportation or use is to occur before any 
other use. Paragraphs (4), (5), and (6) shall not apply to the 
tax imposed by section 4064. In the case of taxes imposed by 
section 4051, or 4071, paragraphs (4) and (5) shall not apply 
on and after October 1, 2016. In the case of the tax imposed by 
section 4131, paragraphs (3), (4), and (5) shall not apply and 
paragraph (2) shall apply only if the use of the exported 
vaccine meets such requirements as the Secretary may by 
regulations prescribe. In the case of taxes imposed by 
subchapter C or D, paragraph (6) shall not apply. [In the case 
of the tax imposed by section 4191, paragraphs (3), (4), (5), 
and (6) shall not apply.]
  (b) Proof of Resale for Further Manufacture; Proof of 
Export.--Where an article has been sold free of tax under 
subsection (a)--
          (1) for resale by the purchaser to a second purchaser 
        for use by such second purchaser in further 
        manufacture, or
          (2) for export, or for resale by the purchaser to a 
        second purchaser for export,
subsection (a) shall cease to apply in respect of such sale of 
such article unless, within the 6-month period which begins on 
the date of the sale by the manufacturer (or, if earlier, on 
the date of shipment by the manufacturer), the manufacturer 
receives proof that the article has been exported or resold for 
use in further manufacture.
  (c) Manufacturer Relieved from Liability in Certain Cases.--
In the case of any article sold free of tax under this section 
(other than a sale to which subsection (b) applies), and in the 
case of any article sold free of tax under section 4053(6), if 
the manufacturer in good faith accepts a certification by the 
purchaser that the article will be used in accordance with the 
applicable provisions of law, no tax shall thereafter be 
imposed under this chapter in respect of such sale by such 
manufacturer.
  (d) Definitions.--For purposes of this section--
          (1) Manufacturer.--The term ``manufacturer'' includes 
        a producer or importer of an article, and, in the case 
        of taxes imposed by subchapter C of chapter 31, 
        includes the retailer with respect to the first retail 
        sale.
          (2) Export.--The term ``export'' includes shipment to 
        a possession of the United States; and the term 
        ``exported'' includes shipped to a possession of the 
        United States.
          (3) Supplies for vessels or aircraft.--The term 
        ``supplies for vessels or aircraft'' means fuel 
        supplies, ships' stores, sea stores, or legitimate 
        equipment on vessels of war of the United States or of 
        any foreign nation, vessels employed in the fisheries 
        or in the whaling business, or vessels actually engaged 
        in foreign trade or trade between the Atlantic and 
        Pacific ports of the United States or between the 
        United States and any of its possessions. For purposes 
        of the preceding sentence, the term ``vessels'' 
        includes civil aircraft employed in foreign trade or 
        trade between the United States and any of its 
        possessions, and the term ``vessels of war of the 
        United States or of any foreign nation'' includes 
        aircraft owned by the United States or by any foreign 
        nation and constituting a part of the armed forces 
        thereof.
          (4) State or local government.--The term ``State or 
        local government'' means any State, any political 
        subdivision thereof, or the District of Columbia.
          (5) Nonprofit educational organization.--The term 
        ``nonprofit educational organization'' means an 
        educational organization described in section 
        170(b)(1)(A)(ii) which is exempt from income tax under 
        section 501(a). The term also includes a school 
        operated as an activity of an organization described in 
        section 501(c)(3) which is exempt from income tax under 
        section 501(a), if such school normally maintains a 
        regular faculty and curriculum and normally has a 
        regularly enrolled body of pupils or students in 
        attendance at the place where its educational 
        activities are regularly carried on.
          (6) Use in further manufacture.--An article shall be 
        treated as sold for use in further manufacture if--
                  (A) such article is sold for use by the 
                purchaser as material in the manufacture or 
                production of, or as a component part of, 
                another article taxable under this chapter to 
                be manufactured or produced by him; or
                  (B) in the case of gasoline taxable under 
                section 4081, such gasoline is sold for use by 
                the purchaser, for nonfuel purposes, as a 
                material in the manufacture or production of 
                another article to be manufactured or produced 
                by him.
          (7) Qualified bus.--
                  (A) In general.--The term ``qualified bus'' 
                means--
                          (i) an intercity or local bus, and
                          (ii) a school bus.
                  (B) Intercity or local bus.--The term 
                ``intercity or local bus'' means any automobile 
                bus which is used predominantly in furnishing 
                (for compensation) passenger land 
                transportation available to the general public 
                if--
                          (i) such transportation is scheduled 
                        and along regular routes, or
                          (ii) the seating capacity of such bus 
                        is at least 20 adults (not including 
                        the driver).
                  (C) School bus.--The term ``school bus'' 
                means any automobile bus substantially all the 
                use of which is in transporting students and 
                employees of schools. For purposes of the 
                preceding sentence, the term ``school'' means 
                an educational organization which normally 
                maintains a regular faculty and curriculum and 
                normally has a regularly enrolled body of 
                pupils or students in attendance at the place 
                where its educational activities are carried 
                on.
  (e) Special Rules.--
          (1) Reciprocity required in case of civil aircraft.--
        In the case of articles sold for use as supplies for 
        aircraft, the privileges granted under subsection 
        (a)(3) in respect of civil aircraft employed in foreign 
        trade or trade between the United States and any of its 
        possessions, in respect of aircraft registered in a 
        foreign country, shall be allowed only if the Secretary 
        of the Treasury has been advised by the Secretary of 
        Commerce that he has found that such foreign country 
        allows, or will allow, substantially reciprocal 
        privileges in respect of aircraft registered in the 
        United States. If the Secretary of the Treasury is 
        advised by the Secretary of Commerce that he has found 
        that a foreign country has discontinued or will 
        discontinue the allowance of such privileges, the 
        privileges granted under subsection (a)(3) shall not 
        apply thereafter in respect of civil aircraft 
        registered in that foreign country and employed in 
        foreign trade or trade between the United States and 
        any of its possessions.
          (2) Tires.--
                  (A) Tax-free sales.--Under regulations 
                prescribed by the Secretary, no tax shall be 
                imposed under section 4071 on the sale by the 
                manufacturer of a tire if--
                          (i) such tire is sold for use by the 
                        purchaser for sale on or in connection 
                        with the sale of another article 
                        manufactured or produced by such 
                        purchaser; and
                          (ii) such other article is to be sold 
                        by such purchaser in a sale which 
                        either will satisfy the requirements of 
                        paragraph (2), (3), (4), or (5) of 
                        subsection (a) for a tax-free sale, or 
                        would satisfy such requirements but for 
                        the fact that such other article is not 
                        subject to tax under this chapter.
                  (B) Proof.--Where a tire has been sold free 
                of tax under this paragraph, this paragraph 
                shall cease to apply unless, within the 6-moth 
                period which begins on the date of the sale by 
                him (or, if earlier on the date of the shipment 
                by him), the manufacturer of such tire receives 
                proof that the other article referred to in 
                clause (ii) of subparagraph (A) has been sold 
                in a manner which satisfies the requirements of 
                such clause (ii) (including in the case of a 
                sale for export, proof of export of such other 
                article).
                  (C) Subsection(a)(1) does not apply.--
                Paragraph (1) of subsection (a) shall not apply 
                with respect to the tax imposed under section 
                4071 on the sale of a tire.
          (3) Tires used on intercity, local, and school 
        buses.--Under regulations prescribed by the Secretary, 
        the tax imposed by section 4071 shall not apply in the 
        case of tires sold for use by the purchaser on or in 
        connection with a qualified bus.

           *       *       *       *       *       *       *


               CHAPTER 43--QUALIFIED PENSION, ETC., PLANS

     * * * * * * *
[Sec. 4980I. Excise tax on high cost employer-sponsored health 
          coverage.]

           *       *       *       *       *       *       *


SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING HEALTH 
                    COVERAGE.

  (a) Large Employers Not Offering Health Coverage.--If--
          (1) any applicable large employer fails to offer to 
        its full-time employees (and their dependents) the 
        opportunity to enroll in minimum essential coverage 
        under an eligible employer-sponsored plan (as defined 
        in section 5000A(f)(2)) for any month, and
          (2) at least one full-time employee of the applicable 
        large employer has been certified to the employer under 
        section 1411 of the Patient Protection and Affordable 
        Care Act as having enrolled for such month in a 
        qualified health plan with respect to which an 
        applicable premium tax credit or cost-sharing reduction 
        is allowed or paid with respect to the employee,
then there is hereby imposed on the employer an assessable 
payment equal to the product of the applicable payment amount 
and the number of individuals employed by the employer as full-
time employees during such month.
  (b) Large Employers Offering Coverage With Employees Who 
Qualify for Premium Tax Credits or Cost-Sharing Reductions.--
          (1) In general.--If--
                  (A) an applicable large employer offers to 
                its full-time employees (and their dependents) 
                the opportunity to enroll in minimum essential 
                coverage under an eligible employer-sponsored 
                plan (as defined in section 5000A(f)(2)) for 
                any month, and
                  (B) 1 or more full-time employees of the 
                applicable large employer has been certified to 
                the employer under section 1411 of the Patient 
                Protection and Affordable Care Act as having 
                enrolled for such month in a qualified health 
                plan with respect to which an applicable 
                premium tax credit or cost-sharing reduction is 
                allowed or paid with respect to the employee,
        then there is hereby imposed on the employer an 
        assessable payment equal to the product of the number 
        of full-time employees of the applicable large employer 
        described in subparagraph (B) for such month and an 
        amount equal to \1/12\ of $3,000.
          (2) Overall limitation.--The aggregate amount of tax 
        determined under paragraph (1) with respect to all 
        employees of an applicable large employer for any month 
        shall not exceed the product of the applicable payment 
        amount and the number of individuals employed by the 
        employer as full-time employees during such month.
  (c) Definitions and Special Rules.--For purposes of this 
section--
          (1) Applicable payment amount.--The term ``applicable 
        payment amount'' means, with respect to any month, \1/
        12\ of $2,000.
          (2) Applicable large employer.--
                  (A) In general.--The term ``applicable large 
                employer'' means, with respect to a calendar 
                year, an employer who employed an average of at 
                least 50 full-time employees on business days 
                during the preceding calendar year.
                  (B) Exemption for certain employers.--
                          (i) In general.--An employer shall 
                        not be considered to employ more than 
                        50 full-time employees if--
                                  (I) the employer's workforce 
                                exceeds 50 full-time employees 
                                for 120 days or fewer during 
                                the calendar year, and
                                  (II) the employees in excess 
                                of 50 employed during such 120-
                                day period were seasonal 
                                workers.
                          (ii) Definition of seasonal 
                        workers.--The term ``seasonal worker'' 
                        means a worker who performs labor or 
                        services on a seasonal basis as defined 
                        by the Secretary of Labor, including 
                        workers covered by section 500.20(s)(1) 
                        of title 29, Code of Federal 
                        Regulations and retail workers employed 
                        exclusively during holiday seasons.
                  (C) Rules for determining employer size.--For 
                purposes of this paragraph--
                          (i) Application of aggregation rule 
                        for employers.--All persons treated as 
                        a single employer under subsection (b), 
                        (c), (m), or (o) of section 414 of the 
                        Internal Revenue Code of 1986 shall be 
                        treated as 1 employer.
                          (ii) Employers not in existence in 
                        preceding year.--In the case of an 
                        employer which was not in existence 
                        throughout the preceding calendar year, 
                        the determination of whether such 
                        employer is an applicable large 
                        employer shall be based on the average 
                        number of employees that it is 
                        reasonably expected such employer will 
                        employ on business days in the current 
                        calendar year.
                          (iii) Predecessors.--Any reference in 
                        this subsection to an employer shall 
                        include a reference to any predecessor 
                        of such employer.
                  (D) Application of employer size to 
                assessable penalties.--
                          (i) In general.--The number of 
                        individuals employed by an applicable 
                        large employer as full-time employees 
                        during any month shall be reduced by 30 
                        solely for purposes of calculating--
                                  (I) the assessable payment 
                                under subsection (a), or
                                  (II) the overall limitation 
                                under subsection (b)(2).
                          (ii) Aggregation.--In the case of 
                        persons treated as 1 employer under 
                        subparagraph (C)(i), only 1 reduction 
                        under subclause (I) or (II) shall be 
                        allowed with respect to such persons 
                        and such reduction shall be allocated 
                        among such persons ratably on the basis 
                        of the number of full-time employees 
                        employed by each such person.
                  (E) Full-time equivalents treated as full-
                time employees.--Solely for purposes of 
                determining whether an employer is an 
                applicable large employer under this paragraph, 
                an employer shall, in addition to the number of 
                full-time employees for any month otherwise 
                determined, include for such month a number of 
                full-time employees determined by dividing the 
                aggregate number of hours of service of 
                employees who are not full-time employees for 
                the month by 120.
                  (F) Exemption for health coverage under 
                TRICARE or the Veterans Administration.--Solely 
                for purposes of determining whether an employer 
                is an applicable large employer under this 
                paragraph for any month, an individual shall 
                not be taken into account as an employee for 
                such month if such individual has medical 
                coverage for such month under--
                          (i) chapter 55 of title 10, United 
                        States Code, including coverage under 
                        the TRICARE program, or
                          (ii) under a health care program 
                        under chapter 17 or 18 of title 38, 
                        United States Code, as determined by 
                        the Secretary of Veterans Affairs, in 
                        coordination with the Secretary of 
                        Health and Human Services and the 
                        Secretary.
          (3) Applicable premium tax credit and cost-sharing 
        reduction.--The term ``applicable premium tax credit 
        and cost-sharing reduction'' means--
                  (A) any premium tax credit allowed under 
                section 36B,
                  (B) any cost-sharing reduction under section 
                1402 of the Patient Protection and Affordable 
                Care Act, and
                  (C) any advance payment of such credit or 
                reduction under section 1412 of such Act.
          (4) Full-time employee.--
                  (A) In general.--The term ``full-time 
                employee'' means, with respect to any month, an 
                employee who is employed on average at least 30 
                hours of service per week.
                  (B) Hours of service.--The Secretary, in 
                consultation with the Secretary of Labor, shall 
                prescribe such regulations, rules, and guidance 
                as may be necessary to determine the hours of 
                service of an employee, including rules for the 
                application of this paragraph to employees who 
                are not compensated on an hourly basis.
          [(5) Inflation adjustment.--
                  [(A) In general.--In the case of any calendar 
                year after 2014, each of the dollar amounts in 
                subsection (b) and paragraph (1) shall be 
                increased by an amount equal to the product 
                of--
                          [(i) such dollar amount, and
                          [(ii) the premium adjustment 
                        percentage (as defined in section 
                        1302(c)(4) of the Patient Protection 
                        and Affordable Care Act) for the 
                        calendar year.
                  [(B) Rounding.--If the amount of any increase 
                under subparagraph (A) is not a multiple of 
                $10, such increase shall be rounded to the next 
                lowest multiple of $10.]
          (6) Other definitions.--Any term used in this section 
        which is also used in the Patient Protection and 
        Affordable Care Act shall have the same meaning as when 
        used in such Act.
          (7) Tax nondeductible.--For denial of deduction for 
        the tax imposed by this section, see section 275(a)(6).
  (d) Administration and Procedure.--
          (1) In general.--Any assessable payment provided by 
        this section shall be paid upon notice and demand by 
        the Secretary, and shall be assessed and collected in 
        the same manner as an assessable penalty under 
        subchapter B of chapter 68.
          (2) Time for payment.--The Secretary may provide for 
        the payment of any assessable payment provided by this 
        section on an annual, monthly, or other periodic basis 
        as the Secretary may prescribe.
          (3) Coordination with credits, etc..--The Secretary 
        shall prescribe rules, regulations, or guidance for the 
        repayment of any assessable payment (including 
        interest) if such payment is based on the allowance or 
        payment of an applicable premium tax credit or cost-
        sharing reduction with respect to an employee, such 
        allowance or payment is subsequently disallowed, and 
        the assessable payment would not have been required to 
        be made but for such allowance or payment.
  (e) Termination.--This section shall not apply with respect 
to any month beginning after December 31, 2014.

[SEC. 4980I. EXCISE TAX ON HIGH COST EMPLOYER-SPONSORED HEALTH 
                    COVERAGE.

  [(a) Imposition of Tax.--If--
          [(1) an employee is covered under any applicable 
        employer-sponsored coverage of an employer at any time 
        during a taxable period, and
          [(2) there is any excess benefit with respect to the 
        coverage, there is hereby imposed a tax equal to 40 
        percent of the excess benefit.
  [(b) Excess Benefit.--For purposes of this section--
          [(1) In general.--The term ``excess benefit'' means, 
        with respect to any applicable employer-sponsored 
        coverage made available by an employer to an employee 
        during any taxable period, the sum of the excess 
        amounts determined under paragraph (2) for months 
        during the taxable period.
          [(2) Monthly excess amount.--The excess amount 
        determined under this paragraph for any month is the 
        excess (if any) of--
                  [(A) the aggregate cost of the applicable 
                employer- sponsored coverage of the employee 
                for the month, over
                  [(B) an amount equal to \1/12\ of the annual 
                limitation under paragraph (3) for the calendar 
                year in which the month occurs.
          [(3) Annual limitation.--For purposes of this 
        subsection--
                  [(A) In general.--The annual limitation under 
                this paragraph for any calendar year is the 
                dollar limit determined under subparagraph (C) 
                for the calendar year.
                  [(B) Applicable annual limitation.--
                          [(i) In general.--Except as provided 
                        in clause (ii), the annual limitation 
                        which applies for any month shall be 
                        determined on the basis of the type of 
                        coverage (as determined under 
                        subsection (f)(1)) provided to the 
                        employee by the employer as of the 
                        beginning of the month.
                          [(ii) Multiemployer plan coverage.--
                        Any coverage provided under a 
                        multiemployer plan (as defined in 
                        section 414(f)) shall be treated as 
                        coverage other than self-only coverage.
                  [(C) Applicable dollar limit.--
                          [(i) 2018.--In the case of 2018, the 
                        dollar limit under this subparagraph 
                        is--
                                  [(I) in the case of an 
                                employee with self-only 
                                coverage, $10,200 multiplied by 
                                the health cost adjustment 
                                percentage (determined by only 
                                taking into account self-only 
                                coverage), and
                                  [(II) in the case of an 
                                employee with coverage other 
                                than self-only coverage, 
                                $27,500 multiplied by the 
                                health cost adjustment 
                                percentage (determined by only 
                                taking into account coverage 
                                other than self-only coverage).
                          [(ii)Health cost adjustment 
                        percentage.--For purposes of clause 
                        (i), the health cost adjustment 
                        percentage is equal to 100 percent plus 
                        the excess (if any) of--
                                  [(I) the percentage by which 
                                the per employee cost for 
                                providing coverage under the 
                                Blue Cross/Blue Shield standard 
                                benefit option under the 
                                Federal Employees Health 
                                Benefits Plan for plan year 
                                2018 (determined by using the 
                                benefit package for such 
                                coverage in 2010) exceeds such 
                                cost for plan year 2010, over
                                  [(II) 55 percent.
                          [(iii) Age and gender adjustment.--
                                  [(I) In general.--The amount 
                                determined under subclause (I) 
                                or (II) of clause (i), 
                                whichever is applicable, for 
                                any taxable period shall be 
                                increased by the amount 
                                determined under subclause 
                                (II).
                                  [(II) Amount determined.--The 
                                amount determined under this 
                                subclause is an amount equal to 
                                the excess (if any) of--
                                          [(aa) the premium 
                                        cost of the Blue Cross/
                                        Blue Shield standard 
                                        benefit option under 
                                        the Federal Employees 
                                        Health Benefits Plan 
                                        for the type of 
                                        coverage provided such 
                                        individual in such 
                                        taxable period if 
                                        priced for the age and 
                                        gender characteristics 
                                        of all employees of the 
                                        individual's employer, 
                                        over
                                          [(bb) that premium 
                                        cost for the provision 
                                        of such coverage under 
                                        such option in such 
                                        taxable period if 
                                        priced for the age and 
                                        gender characteristics 
                                        of the national 
                                        workforce.
                          [(iv) Exception for certain 
                        individuals.--In the case of an 
                        individual who is a qualified retiree 
                        or who participates in a plan sponsored 
                        by an employer the majority of whose 
                        employees covered by the plan are 
                        engaged in a high-risk profession or 
                        employed to repair or install 
                        electrical or telecommunications 
                        lines--
                                  [(I) the dollar amount in 
                                clause (i)(I) shall be 
                                increased by $1,650, and
                                  [(II) the dollar amount in 
                                clause (i)(II) shall be 
                                increased by $3,450,
                          [(v) Subsequent years.--In the case 
                        of any calendar year after 2018, each 
                        of the dollar amounts under clauses (i) 
                        (after the application of clause (ii)) 
                        and (iv) shall be increased to the 
                        amount equal to such amount as in 
                        effect for the calendar year preceding 
                        such year, increased by an amount equal 
                        to the product of--
                                  [(I) such amount as so in 
                                effect, multiplied by
                                  [(II) the cost-of-living 
                                adjustment determined under 
                                section 1(f)(3) for such year 
                                (determined by substituting the 
                                calendar year that is 2 years 
                                before such year for ``1992'' 
                                in subparagraph (B) thereof), 
                                increased by 1 percentage point 
                                in the case of determinations 
                                for calendar years beginning 
                                before 2020.
                        If any amount determined under this 
                        clause is not a multiple of $50, such 
                        amount shall be rounded to the nearest 
                        multiple of $50.
  [(c) Liability to Pay Tax.--
          [(1) In general.--Each coverage provider shall pay 
        the tax imposed by subsection (a) on its applicable 
        share of the excess benefit with respect to an employee 
        for any taxable period.
          [(2) Coverage provider.--For purposes of this 
        subsection, the term ``coverage provider'' means each 
        of the following:
                  [(A) Health insurance coverage.--If the 
                applicable employer-sponsored coverage consists 
                of coverage under a group health plan which 
                provides health insurance coverage, the health 
                insurance issuer.
                  [(B) HSA and MSA contributions.--If the 
                applicable employer-sponsored coverage consists 
                of coverage under an arrangement under which 
                the employer makes contributions described in 
                subsection (b) or (d) of section 106, the 
                employer.
                  [(C) Other coverage.--In the case of any 
                other applicable employer-sponsored coverage, 
                the person that administers the plan benefits.
          [(3) Applicable share.--For purposes of this 
        subsection, a coverage provider's applicable share of 
        an excess benefit for any taxable period is the amount 
        which bears the same ratio to the amount of such excess 
        benefit as--
                  [(A) the cost of the applicable employer-
                sponsored coverage provided by the provider to 
                the employee during such period, bears to
                  [(B) the aggregate cost of all applicable 
                employer-sponsored coverage provided to the 
                employee by all coverage providers during such 
                period.
          [(4) Responsibility to calculate tax and applicable 
        shares.--
                  [(A) In general.--Each employer shall--
                          [(i) calculate for each taxable 
                        period the amount of the excess benefit 
                        subject to the tax imposed by 
                        subsection (a) and the applicable share 
                        of such excess benefit for each 
                        coverage provider, and
                          [(ii) notify, at such time and in 
                        such manner as the Secretary may 
                        prescribe, the Secretary and each 
                        coverage provider of the amount so 
                        determined for the provider.
                  [(B) Special rule for multiemployer plans.--
                In the case of applicable employer-sponsored 
                coverage made available to employees through a 
                multiemployer plan (as defined in section 
                414(f)), the plan sponsor shall make the 
                calculations, and provide the notice, required 
                under subparagraph (A).
  [(d) Applicable Employer-Sponsored Coverage; Cost.--For 
purposes of this section--
          [(1) Applicable employer-sponsored coverage.--
                  [(A) In general.--The term ``applicable 
                employer-sponsored coverage'' means, with 
                respect to any employee, coverage under any 
                group health plan made available to the 
                employee by an employer which is excludable 
                from the employee's gross income under section 
                106, or would be so excludable if it were 
                employer-provided coverage (within the meaning 
                of such section 106).
                  [(B) Exceptions.--The term ``applicable 
                employer-sponsored coverage'' shall not 
                include--
                          [(i) any coverage (whether through 
                        insurance or otherwise) described in 
                        section 9832(c)(1) (other than 
                        subparagraph (G) thereof) or for long-
                        term care, or
                          [(ii) any coverage under a separate 
                        policy, certificate, or contract of 
                        insurance which provides benefits 
                        substantially all of which are for 
                        treatment of the mouth (including any 
                        organ or structure within the mouth) or 
                        for treatment of the eye, or
                          [(iii) any coverage described in 
                        section 9832(c)(3) the payment for 
                        which is not excludable from gross 
                        income and for which a deduction under 
                        section 162(l) is not allowable.
                  [(C) Coverage includes employee paid 
                portion.--Coverage shall be treated as 
                applicable employer-sponsored coverage without 
                regard to whether the employer or employee pays 
                for the coverage.
                  [(D) Self-employed individual.--In the case 
                of an individual who is an employee within the 
                meaning of section 401(c)(1), coverage under 
                any group health plan providing health 
                insurance coverage shall be treated as 
                applicable employer-sponsored coverage if a 
                deduction is allowable under section 162(l) 
                with respect to all or any portion of the cost 
                of the coverage.
                  [(E) Governmental plans included.--Applicable 
                employer-sponsored coverage shall include 
                coverage under any group health plan 
                established and maintained primarily for its 
                civilian employees by the Government of the 
                United States, by the government of any State 
                or political subdivision thereof, or by any 
                agency or instrumentality of any such 
                government.
          [(2) Determination of cost.--
                  [(A) In general.--The cost of applicable 
                employer- sponsored coverage shall be 
                determined under rules similar to the rules of 
                section 4980B(f)(4), except that in determining 
                such cost, any portion of the cost of such 
                coverage which is attributable to the tax 
                imposed under this section shall not be taken 
                into account and the amount of such cost shall 
                be calculated separately for self-only coverage 
                and other coverage. In the case of applicable 
                employer-sponsored coverage which provides 
                coverage to retired employees, the plan may 
                elect to treat a retired employee who has not 
                attained the age of 65 and a retired employee 
                who has attained the age of 65 as similarly 
                situated beneficiaries.
                  [(B) Health FSAS.--In the case of applicable 
                employer- sponsored coverage consisting of 
                coverage under a flexible spending arrangement 
                (as defined in section 106(c)(2)), the cost of 
                the coverage shall be equal to the sum of--
                          [(i) the amount of employer 
                        contributions under any salary 
                        reduction election under the 
                        arrangement, plus
                          [(ii) the amount determined under 
                        subparagraph (A) with respect to any 
                        reimbursement under the arrangement in 
                        excess of the contributions described 
                        in clause (i).
                  [(C) Archer MSAS and HSAS.--In the case of 
                applicable employer-sponsored coverage 
                consisting of coverage under an arrangement 
                under which the employer makes contributions 
                described in subsection (b) or (d) of section 
                106, the cost of the coverage shall be equal to 
                the amount of employer contributions under the 
                arrangement.
                  [(D) Allocation on a monthly basis.--If cost 
                is determined on other than a monthly basis, 
                the cost shall be allocated to months in a 
                taxable period on such basis as the Secretary 
                may prescribe.
          [(3) Employee.--The term ``employee'' includes any 
        former employee, surviving spouse, or other primary 
        insured individual.
  [(e) Penalty for Failure to Properly Calculate Excess 
Benefit.--
          [(1) In general.--If, for any taxable period, the tax 
        imposed by subsection (a) exceeds the tax determined 
        under such subsection with respect to the total excess 
        benefit calculated by the employer or plan sponsor 
        under subsection (c)(4)--
                  [(A) each coverage provider shall pay the tax 
                on its applicable share (determined in the same 
                manner as under subsection (c)(4)) of the 
                excess, but no penalty shall be imposed on the 
                provider with respect to such amount, and
                  [(B) the employer or plan sponsor shall, in 
                addition to any tax imposed by subsection (a), 
                pay a penalty in an amount equal to such 
                excess, plus interest at the underpayment rate 
                determined under section 6621 for the period 
                beginning on the due date for the payment of 
                tax imposed by subsection (a) to which the 
                excess relates and ending on the date of 
                payment of the penalty.
          [(2) Limitations on penalty.--
                  [(A) Penalty not to apply where failure not 
                discovered exercising reasonable diligence.--No 
                penalty shall be imposed by paragraph (1)(B) on 
                any failure to properly calculate the excess 
                benefit during any period for which it is 
                established to the satisfaction of the 
                Secretary that the employer or plan sponsor 
                neither knew, nor exercising reasonable 
                diligence would have known, that such failure 
                existed.
                  [(B) Penalty not to apply to failures 
                corrected within30 days.--No penalty shall be 
                imposed by paragraph (1)(B) on any such failure 
                if--
                          [(i) such failure was due to 
                        reasonable cause and not to willful 
                        neglect, and
                          [(ii) such failure is corrected 
                        during the 30-day period beginning on 
                        the 1st date that the employer knew, or 
                        exercising reasonable diligence would 
                        have known, that such failure existed.
                  [(C) Waiver by Secretary.--In the case of any 
                such failure which is due to reasonable cause 
                and not to willful neglect, the Secretary may 
                waive part or all of the penalty imposed by 
                paragraph (1), to the extent that the payment 
                of such penalty would be excessive or otherwise 
                inequitable relative to the failure involved.
  [(f) Other Definitions and Special Rules.--For purposes of 
this section--
          [(1) Coverage determinations.--
                  [(A) In general.--Except as provided in 
                subparagraph (B), an employee shall be treated 
                as having self-only coverage with respect to 
                any applicable employer-sponsored coverage of 
                an employer.
                  [(B) Minimum essential coverage.--An employee 
                shall be treated as having coverage other than 
                self-only coverage only if the employee is 
                enrolled in coverage other than self-only 
                coverage in a group health plan which provides 
                minimum essential coverage (as defined in 
                section 5000A(f)) to the employee and at least 
                one other beneficiary, and the benefits 
                provided under such minimum essential coverage 
                do not vary based on whether any individual 
                covered under such coverage is the employee or 
                another beneficiary.
          [(2) Qualified retiree.--The term ``qualified 
        retiree'' means any individual who--
                  [(A) is receiving coverage by reason of being 
                a retiree,
                  [(B) has attained age 55, and
                  [(C) is not entitled to benefits or eligible 
                for enrollment under the Medicare program under 
                title XVIII of the Social Security Act.
          [(3) Employees engaged in high-risk profession.--The 
        term ``employees engaged in a high-risk profession'' 
        means law enforcement officers (as such term is defined 
        in section 1204 of the Omnibus Crime Control and Safe 
        Streets Act of 1968), employees in fire protection 
        activities (as such term is defined in section 3(y) of 
        the Fair Labor Standards Act of 1938), individuals who 
        provide out- of-hospital emergency medical care 
        (including emergency medical technicians, paramedics, 
        and first-responders), individuals whose primary work 
        is longshore work (as defined in section 258(b) of the 
        Immigration and Nationality Act (8 U.S.C. 1288(b)), 
        determined without regard to paragraph (2) thereof), 
        and individuals engaged in the construction, mining, 
        agriculture (not including food processing), forestry, 
        and fishing industries. Such term includes an employee 
        who is retired from a high-risk profession described in 
        the preceding sentence, if such employee satisfied the 
        requirements of such sentence for a period of not less 
        than 20 years during the employee's employment.
          [(4) Group health plan.--The term ``group health 
        plan'' has the meaning given such term by section 
        5000(b)(1).
          [(5) Health insurance coverage; health insurance 
        issuer.--
                  [(A) Health insurance coverage.--The term 
                ``health insurance coverage'' has the meaning 
                given such term by section 9832(b)(1) (applied 
                without regard to subparagraph (B) thereof, 
                except as provided by the Secretary in 
                regulations).
                  [(B) Health insurance issuer.--The term 
                ``health insurance issuer'' has the meaning 
                given such term by section 9832(b)(2).
          [(6) Person that administers the plan benefits.--The 
        term ``person that administers the plan benefits'' 
        shall include the plan sponsor if the plan sponsor 
        administers benefits under the plan.
          [(7) Plan sponsor.--The term ``plan sponsor'' has the 
        meaning given such term in section 3(16)(B) of the 
        Employee Retirement Income Security Act of 1974.
          [(8) Taxable period.--The term ``taxable period'' 
        means the calendar year or such shorter period as the 
        Secretary may prescribe. The Secretary may have 
        different taxable periods for employers of varying 
        sizes.
          [(9) Aggregation rules.--All employers treated as a 
        single employer under subsection (b), (c), (m), or (o) 
        of section 414 shall be treated as a single employer.
          [(10) Denial of deduction.--For denial of a deduction 
        for the tax imposed by this section, see section 
        275(a)(6).
  [(g) Regulations.--The Secretary shall prescribe such 
regulations as may be necessary to carry out this section.]

           *       *       *       *       *       *       *


         CHAPTER 48--MAINTENANCE OF MINIMUM ESSENTIAL COVERAGE

SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

  (a) Requirement to Maintain Minimum Essential Coverage.--An 
applicable individual shall for each month beginning after 2013 
ensure that the individual, and any dependent of the individual 
who is an applicable individual, is covered under minimum 
essential coverage for such month.
  (b) Shared Responsibility Payment.--
          (1) In general.--If a taxpayer who is an applicable 
        individual, or an applicable individual for whom the 
        taxpayer is liable under paragraph (3), fails to meet 
        the requirement of subsection (a) for 1 or more months, 
        then, except as provided in subsection (e), there is 
        hereby imposed on the taxpayer a penalty with respect 
        to such failures in the amount determined under 
        subsection (c).
          (2) Inclusion with return.--Any penalty imposed by 
        this section with respect to any month shall be 
        included with a taxpayer's return under chapter 1 for 
        the taxable year which includes such month.
          (3) Payment of penalty.--If an individual with 
        respect to whom a penalty is imposed by this section 
        for any month--
                  (A) is a dependent (as defined in section 
                152) of another taxpayer for the other 
                taxpayer's taxable year including such month, 
                such other taxpayer shall be liable for such 
                penalty, or
                  (B) files a joint return for the taxable year 
                including such month, such individual and the 
                spouse of such individual shall be jointly 
                liable for such penalty.
  (c) Amount of Penalty.--
          (1) In general.--The amount of the penalty imposed by 
        this section on any taxpayer for any taxable year with 
        respect to failures described in subsection (b)(1) 
        shall be equal to the lesser of--
                  (A) the sum of the monthly penalty amounts 
                determined under paragraph (2) for months in 
                the taxable year during which 1 or more such 
                failures occurred, or
                  (B) an amount equal to the national average 
                premium for qualified health plans which have a 
                bronze level of coverage, provide coverage for 
                the applicable family size involved, and are 
                offered through Exchanges for plan years 
                beginning in the calendar year with or within 
                which the taxable year ends.
          (2) Monthly penalty amounts.--For purposes of 
        paragraph (1)(A), the monthly penalty amount with 
        respect to any taxpayer for any month during which any 
        failure described in subsection (b)(1) occurred is an 
        amount equal to \1/12\ of the greater of the following 
        amounts:
                  (A) Flat dollar amount.--An amount equal to 
                the lesser of--
                          (i) the sum of the applicable dollar 
                        amounts for all individuals with 
                        respect to whom such failure occurred 
                        during such month, or
                          (ii) 300 percent of the applicable 
                        dollar amount (determined without 
                        regard to paragraph (3)(C)) for the 
                        calendar year with or within which the 
                        taxable year ends.
                  (B) Percentage of income.--An amount equal to 
                the following percentage of the excess of the 
                taxpayer's household income for the taxable 
                year over the amount of gross income specified 
                in section 6012(a)(1) with respect to the 
                taxpayer for the taxable year:
                          (i) 1.0 percent for taxable years 
                        beginning in 2014.
                          [(ii) 2.0 percent for taxable years 
                        beginning in 2015.
                          [(iii) 2.5 percent for taxable years 
                        beginning after 2015.]
          (3) Applicable dollar amount.--For purposes of 
        paragraph (1)--
                  (A) In general.--Except as provided in 
                subparagraphs (B) and (C), the applicable 
                dollar amount is $695.
                  (B) Phase in.--The applicable dollar amount 
                is $95 for [2014 and $325 for 2015.]2014.
                  (C) Special rule for individuals under 
                age18.--If an applicable individual has not 
                attained the age of 18 as of the beginning of a 
                month, the applicable dollar amount with 
                respect to such individual for the month shall 
                be equal to one-half of the applicable dollar 
                amount for the calendar year in which the month 
                occurs.
                  [(D) Indexing of amount.--In the case of any 
                calendar year beginning after 2016, the 
                applicable dollar amount shall be equal to 
                $695, increased by an amount equal to--
                          [(i) $695, multiplied by
                          [(ii) the cost-of-living adjustment 
                        determined under section 1(f)(3) for 
                        the calendar year, determined by 
                        substituting ``calendar year 2015'' for 
                        ``calendar year 1992'' in subparagraph 
                        (B) thereof.]
                If the amount of any increase under clause (i) 
                is not a multiple of $50, such increase shall 
                be rounded to the next lowest multiple of $50.
          (4) Terms relating to income and families.--For 
        purposes of this section--
                  (A) Family size.--The family size involved 
                with respect to any taxpayer shall be equal to 
                the number of individuals for whom the taxpayer 
                is allowed a deduction under section 151 
                (relating to allowance of deduction for 
                personal exemptions) for the taxable year.
                  (B) Household income.--The term ``household 
                income'' means, with respect to any taxpayer 
                for any taxable year, an amount equal to the 
                sum of--
                          (i) the modified adjusted gross 
                        income of the taxpayer, plus
                          (ii) the aggregate modified adjusted 
                        gross incomes of all other individuals 
                        who--
                                  (I) were taken into account 
                                in determining the taxpayer's 
                                family size under paragraph 
                                (1), and
                                  (II) were required to file a 
                                return of tax imposed by 
                                section 1 for the taxable year.
                  (C) Modified adjusted gross income.--The term 
                ``modified adjusted gross income'' means 
                adjusted gross income increased by--
                          (i) any amount excluded from gross 
                        income under section 911, and
                          (ii) any amount of interest received 
                        or accrued by the taxpayer during the 
                        taxable year which is exempt from tax.
  (d) Applicable Individual.--For purposes of this section--
          (1) In general.--The term ``applicable individual'' 
        means, with respect to any month, an individual other 
        than an individual described in paragraph (2), (3), or 
        (4).
          (2) Religious exemptions.--
                  (A) Religious conscience exemption.--Such 
                term shall not include any individual for any 
                month if such individual has in effect an 
                exemption under section 1311(d)(4)(H) of the 
                Patient Protection and Affordable Care Act 
                which certifies that such individual is--
                          (i) a member of a recognized 
                        religious sect or division thereof 
                        which is described in section 
                        1402(g)(1), and
                          (ii) an adherent of established 
                        tenets or teachings of such sect or 
                        division as described in such section.
                  (B)Health care sharing ministry.--
                          (i) In general.--Such term shall not 
                        include any individual for any month if 
                        such individual is a member of a health 
                        care sharing ministry for the month.
                          (ii) Health care sharing ministry.--
                        The term ``health care sharing 
                        ministry'' means an organization--
                                  (I) which is described in 
                                section 501(c)(3) and is exempt 
                                from taxation under section 
                                501(a),
                                  (II) members of which share a 
                                common set of ethical or 
                                religious beliefs and share 
                                medical expenses among members 
                                in accordance with those 
                                beliefs and without regard to 
                                the State in which a member 
                                resides or is employed,
                                  (III) members of which retain 
                                membership even after they 
                                develop a medical condition,
                                  (IV) which (or a predecessor 
                                of which) has been in existence 
                                at all times since December 31, 
                                1999, and medical expenses of 
                                its members have been shared 
                                continuously and without 
                                interruption since at least 
                                December 31, 1999, and
                                  (V) which conducts an annual 
                                audit which is performed by an 
                                independent certified public 
                                accounting firm in accordance 
                                with generally accepted 
                                accounting principles and which 
                                is made available to the public 
                                upon request.
          (3) Individuals not lawfully present.--Such term 
        shall not include an individual for any month if for 
        the month the individual is not a citizen or national 
        of the United States or an alien lawfully present in 
        the United States.
          (4) Incarcerated individuals.--Such term shall not 
        include an individual for any month if for the month 
        the individual is incarcerated, other than 
        incarceration pending the disposition of charges.
  (e) Exemptions.--No penalty shall be imposed under subsection 
(a) with respect to--
          (1) Individuals who cannot afford coverage.--
                  (A) In general.--Any applicable individual 
                for any month if the applicable individual's 
                required contribution (determined on an annual 
                basis) for coverage for the month exceeds 8 
                percent of such individual's household income 
                for the taxable year described in section 
                1412(b)(1)(B) of the Patient Protection and 
                Affordable Care Act. For purposes of applying 
                this subparagraph, the taxpayer's household 
                income shall be increased by any exclusion from 
                gross income for any portion of the required 
                contribution made through a salary reduction 
                arrangement.
                  (B) Required contribution.--For purposes of 
                this paragraph, the term ``required 
                contribution'' means--
                          (i) in the case of an individual 
                        eligible to purchase minimum essential 
                        coverage consisting of coverage through 
                        an eligible-employer-sponsored plan, 
                        the portion of the annual premium which 
                        would be paid by the individual 
                        (without regard to whether paid through 
                        salary reduction or otherwise) for 
                        self-only coverage, or
                          (ii) in the case of an individual 
                        eligible only to purchase minimum 
                        essential coverage described in 
                        subsection (f)(1)(C), the annual 
                        premium for the lowest cost bronze plan 
                        available in the individual market 
                        through the Exchange in the State in 
                        the rating area in which the individual 
                        resides (without regard to whether the 
                        individual purchased a qualified health 
                        plan through the Exchange), reduced by 
                        the amount of the credit allowable 
                        under section 36B for the taxable year 
                        (determined as if the individual was 
                        covered by a qualified health plan 
                        offered through the Exchange for the 
                        entire taxable year).
                  (C) Special rules for individuals related to 
                employees.--For purposes of subparagraph 
                (B)(i), if an applicable individual is eligible 
                for minimum essential coverage through an 
                employer by reason of a relationship to an 
                employee, the determination under subparagraph 
                (A) shall be made by reference to required 
                contribution of the employee.
                  [(D) Indexing.--In the case of plan years 
                beginning in any calendar year after 2014, 
                subparagraph (A) shall be applied by 
                substituting for ``8 percent'' the percentage 
                the Secretary of Health and Human Services 
                determines reflects the excess of the rate of 
                premium growth between the preceding calendar 
                year and 2013 over the rate of income growth 
                for such period.]
          (2) Taxpayers with income below filing threshold.--
        Any applicable individual for any month during a 
        calendar year if the individual's household income for 
        the taxable year described in section 1412(b)(1)(B) of 
        the Patient Protection and Affordable Care Act is the 
        amount of gross income specified in section 6012(a)(1) 
        with respect to the taxpayer.
          (3) Members of Indian tribes.--Any applicable 
        individual for any month during which the individual is 
        a member of an Indian tribe (as defined in section 
        45A(c)(6)).
          (4) Months during short coverage gaps.--
                  (A) In general.--Any month the last day of 
                which occurred during a period in which the 
                applicable individual was not covered by 
                minimum essential coverage for a continuous 
                period of less than 3 months.
                  (B) Special rules.--For purposes of applying 
                this paragraph--
                          (i) the length of a continuous period 
                        shall be determined without regard to 
                        the calendar years in which months in 
                        such period occur,
                          (ii) if a continuous period is 
                        greater than the period allowed under 
                        subparagraph (A), no exception shall be 
                        provided under this paragraph for any 
                        month in the period, and
                          (iii) if there is more than 1 
                        continuous period described in 
                        subparagraph (A) covering months in a 
                        calendar year, the exception provided 
                        by this paragraph shall only apply to 
                        months in the first of such periods.
                The Secretary shall prescribe rules for the 
                collection of the penalty imposed by this 
                section in cases where continuous periods 
                include months in more than 1 taxable year.
          (5) Hardships.--Any applicable individual who for any 
        month is determined by the Secretary of Health and 
        Human Services under section 1311(d)(4)(H) to have 
        suffered a hardship with respect to the capability to 
        obtain coverage under a qualified health plan.
  (f) Minimum Essential Coverage.--For purposes of this 
section--
          (1) In general.--The term ``minimum essential 
        coverage'' means any of the following:
                  (A) Government sponsored programs.--Coverage 
                under--
                          (i) the Medicare program under part A 
                        of title XVIII of the Social Security 
                        Act,
                          (ii) the Medicaid program under title 
                        XIX of the Social Security Act,
                          (iii) the CHIP program under title 
                        XXI of the Social Security Act,
                          (iv) medical coverage under chapter 
                        55 of title 10, United States Code, 
                        including coverage under the TRICARE 
                        program;
                          (v) a health care program under 
                        chapter 17 or 18 of title 38, United 
                        States Code, as determined by the 
                        Secretary of Veterans Affairs, in 
                        coordination with the Secretary of 
                        Health and Human Services and the 
                        Secretary,
                          (vi) a health plan under section 
                        2504(e) of title 22, United States Code 
                        (relating to Peace Corps volunteers); 
                        or
                          (vii) the Nonappropriated Fund Health 
                        Benefits Program of the Department of 
                        Defense, established under section 349 
                        of the National Defense Authorization 
                        Act for Fiscal Year 1995 (Public Law 
                        103-337; 10 U.S.C. 1587 note).
                  (B) Employer-sponsored plan.--Coverage under 
                an eligible employer-sponsored plan.
                  (C) Plans in the individual market.--Coverage 
                under a health plan offered in the individual 
                market within a State.
                  (D) Grandfathered health plan.--Coverage 
                under a grandfathered health plan.
                  (E) Other coverage.--Such other health 
                benefits coverage, such as a State health 
                benefits risk pool, as the Secretary of Health 
                and Human Services, in coordination with the 
                Secretary, recognizes for purposes of this 
                subsection.
          (2) Eligible employer-sponsored plan.--The term 
        ``eligible employer-sponsored plan'' means, with 
        respect to any employee, a group health plan or group 
        health insurance coverage offered by an employer to the 
        employee which is--
                  (A) a governmental plan (within the meaning 
                of section 2791(d)(8) of the Public Health 
                Service Act), or
                  (B) any other plan or coverage offered in the 
                small or large group market within a State.
        Such term shall include a grandfathered health plan 
        described in paragraph (1)(D) offered in a group 
        market.
          (3) Excepted benefits not treated as minimum 
        essential coverage.--The term ``minimum essential 
        coverage'' shall not include health insurance coverage 
        which consists of coverage of excepted benefits--
                  (A) described in paragraph (1) of subsection 
                (c) of section 2791 of the Public Health 
                Service Act; or
                  (B) described in paragraph (2), (3), or (4) 
                of such subsection if the benefits are provided 
                under a separate policy, certificate, or 
                contract of insurance.
          (4) Individuals residing outside United States or 
        residents of territories.--Any applicable individual 
        shall be treated as having minimum essential coverage 
        for any month--
                  (A) if such month occurs during any period 
                described in subparagraph (A) or (B) of section 
                911(d)(1) which is applicable to the 
                individual, or
                  (B) if such individual is a bona fide 
                resident of any possession of the United States 
                (as determined under section 937(a)) for such 
                month.
          (5) Insurance-related terms.--Any term used in this 
        section which is also used in title I of the Patient 
        Protection and Affordable Care Act shall have the same 
        meaning as when used in such title.
  (g) Administration and Procedure.--
          (1) In general.--The penalty provided by this section 
        shall be paid upon notice and demand by the Secretary, 
        and except as provided in paragraph (2), shall be 
        assessed and collected in the same manner as an 
        assessable penalty under subchapter B of chapter 68.
          (2) Special rules.--Notwithstanding any other 
        provision of law--
                  (A) Waiver of criminal penalties.--In the 
                case of any failure by a taxpayer to timely pay 
                any penalty imposed by this section, such 
                taxpayer shall not be subject to any criminal 
                prosecution or penalty with respect to such 
                failure.
                  (B) Limitations on liens and levies.--The 
                Secretary shall not--
                          (i) file notice of lien with respect 
                        to any property of a taxpayer by reason 
                        of any failure to pay the penalty 
                        imposed by this section, or
                          (ii) levy on any such property with 
                        respect to such failure.
  (h) Termination.--This section shall not apply with respect 
to any month beginning after December 31, 2014.

           *       *       *       *       *       *       *


Subtitle F--Procedure and Administration

           *       *       *       *       *       *       *


CHAPTER 61--INFORMATION AND RETURNS

           *       *       *       *       *       *       *


Subchapter A--Returns and Records

           *       *       *       *       *       *       *


PART III--INFORMATION RETURNS

           *       *       *       *       *       *       *


         Subpart C--Information Regarding Wages Paid Employees

SEC. 6051. RECEIPTS FOR EMPLOYEES.

  (a) Requirement.--Every person required to deduct and 
withhold from an employee a tax under section 3101 or 3402, or 
who would have been required to deduct and withhold a tax under 
section 3402 (determined without regard to subsection (n)) if 
the employee had claimed no more than one withholding 
exemption, or every employer engaged in a trade or business who 
pays remuneration for services performed by an employee, 
including the cash value of such remuneration paid in any 
medium other than cash, shall furnish to each such employee in 
respect of the remuneration paid by such person to such 
employee during the calendar year, on or before January 31 of 
the succeeding year, or, if his employment is terminated before 
the close of such calendar year, within 30 days after the date 
of receipt of a written request from the employee if such 30-
day period ends before January 31, a written statement showing 
the following:
          (1) the name of such person,
          (2) the name of the employee (and his social security 
        account number if wages as defined in section 3121(a) 
        have been paid),
          (3) the total amount of wages as defined in section 
        3401(a),
          (4) the total amount deducted and withheld as tax 
        under section 3402,
          (5) the total amount of wages as defined in section 
        3121(a),
          (6) the total amount deducted and withheld as tax 
        under section 3101,
          (8) the total amount of elective deferrals (within 
        the meaning of section 402(g)(3)) and compensation 
        deferred under section 457, including the amount of 
        designated Roth contributions (as defined in section 
        402A),
          (9) the total amount incurred for dependent care 
        assistance with respect to such employee under a 
        dependent care assistance program described in section 
        129(d),
          (10) in the case of an employee who is a member of 
        the Armed Forces of the United States, such employee's 
        earned income as determined for purposes of section 32 
        (relating to earned income credit),
          (11) the amount contributed to any Archer MSA (as 
        defined in section 220(d)) of such employee or such 
        employee's spouse,
          (12) the amount contributed to any health savings 
        account (as defined in section 223(d)) of such employee 
        or such employee's spouse,and
          (13) the total amount of deferrals for the year under 
        a nonqualified deferred compensation plan (within the 
        meaning of section 409A(d))[, and].
          [(14) the aggregate cost (determined under rules 
        similar to the rules of section 4980B(f)(4)) of 
        applicable employer-sponsored coverage (as defined in 
        section 4980I(d)(1)), except that this paragraph shall 
        not apply to--
                  [(A) coverage to which paragraphs (11) and 
                (12) apply, or
                  [(B) the amount of any salary reduction 
                contributions to a flexible spending 
                arrangement (within the meaning of section 
                125).]
In the case of compensation paid for service as a member of a 
uniformed service, the statement shall show, in lieu of the 
amount required to be shown by paragraph (5), the total amount 
of wages as defined in section 3121(a), computed in accordance 
with such section and section 3121(i)(2). In the case of 
compensation paid for service as a volunteer or volunteer 
leader within the meaning of the Peace Corps Act, the statement 
shall show, in lieu of the amount required to be shown by 
paragraph (5), the total amount of wages as defined in section 
3121(a), computed in accordance with such section and section 
3121(i)(3). In the case of tips received by an employee in the 
course of his employment, the amounts required to be shown by 
paragraphs (3) and (5) shall include only such tips as are 
included in statements furnished to the employer pursuant to 
section 6053(a). The amounts required to be shown by paragraph 
(5) shall not include wages which are exempted pursuant to 
sections 3101(c) and 3111(c) from the taxes imposed by sections 
3101 and 3111. In the case of the amounts required to be shown 
by paragraph (13), the Secretary may (by regulation) establish 
a minimum amount of deferrals below which paragraph (13) does 
not apply.
  (b) Special Rule as to Compensation of Members of Armed 
Forces.--In the case of compensation paid for service as a 
member of the Armed Forces, the statement required by 
subsection (a) shall be furnished if any tax was withheld 
during the calendar year under section 3402, or if any of the 
compensation paid during such year is includible in gross 
income under chapter 1, or if during the calendar year any 
amount was required to be withheld as tax under section 3101. 
In lieu of the amount required to be shown by paragraph (3) of 
subsection (a), such statement shall show as wages paid during 
the calendar year the amount of such compensation paid during 
the calendar year which is not excluded from gross income under 
chapter 1 (whether or not such compensation constituted wages 
as defined in section 3401(a)).
  (c) Additional Requirements.--The statements required to be 
furnished pursuant to this section in respect of any 
remuneration shall be furnished at such other times, shall 
contain such other information, and shall be in such form as 
the Secretary may by regulations prescribe. The statements 
required under this section shall also show the proportion of 
the total amount withheld as tax under section 3101 which is 
for financing the cost of hospital insurance benefits under 
part A of title XVIII of the Social Security Act.
  (d) Statements to Constitute Information Returns.--A 
duplicate of any statement made pursuant to this section and in 
accordance with regulations prescribed by the Secretary shall, 
when required by such regulations, be filed with the Secretary.
  (e) Railroad Employees.--
          (1) Additional requirement.--Every person required to 
        deduct and withhold tax under section 3201 from an 
        employee shall include on or with the statement 
        required to be furnished such employee under subsection 
        (a) a notice concerning the provisions of this title 
        with respect to the allowance of a credit or refund of 
        the tax on wages imposed by section 3101(b) and the tax 
        on compensation imposed by section 3201 or 3211 which 
        is treated as a tax on wages imposed by section 
        3101(b).
          (2) Information to be supplied to employees.--Each 
        person required to deduct and withhold tax under 
        section 3201 during any year from an employee who has 
        also received wages during such year subject to the tax 
        imposed by section 3101(b) shall, upon request of such 
        employee, furnish to him a written statement showing--
                  (A) the total amount of compensation with 
                respect to which the tax imposed by section 
                3201 was deducted,
                  (B) the total amount deducted as tax under 
                section 3201, and
                  (C) the portion of the total amount deducted 
                as tax under section 3201 which is for 
                financing the cost of hospital insurance under 
                part A of title XVIII of the Social Security 
                Act.
  (f) Statements Required in Case of Sick Pay Paid by Third 
Parties.--
          (1) Statements required from payor.--
                  (A) In general.--If, during any calendar 
                year, any person makes a payment of third-party 
                sick pay to an employee, such person shall, on 
                or before January 15 of the succeeding year, 
                furnish a written statement to the employer in 
                respect of whom such payment was made showing--
                          (i) the name and, if there is 
                        withholding under section 3402(o), the 
                        social security number of such 
                        employee,
                          (ii) the total amount of the third-
                        party sick pay paid to such employee 
                        during the calendar year, and
                          (iii) the total amount (if any) 
                        deducted and withheld from such sick 
                        pay under section 3402.
                For purposes of the preceding sentence, the 
                term ``third-party sick pay'' means any sick 
                pay (as defined in section 3402(o)(2)(C)) which 
                does not constitute wages for purposes of 
                chapter 24 (determined without regard to 
                section 3402(o)(1)).
                  (B) Special rules.--
                          (i) Statements are in lieu of other 
                        reporting requirements.--The reporting 
                        requirements of subparagraph (A) with 
                        respect to any payments shall, with 
                        respect to such payments, be in lieu of 
                        the requirements of subsection (a) and 
                        of section 6041.
                          (ii) Penalties made applicable.--For 
                        purposes of sections 6674 and 7204, the 
                        statements required to be furnished by 
                        subparagraph (A) shall be treated as 
                        statements required under this section 
                        to be furnished to employees.
          (2) Information required to be furnished by 
        employer.--Every employer who receives a statement 
        under paragraph (1)(A) with respect to sick pay paid to 
        any employee during any calendar year shall, on or 
        before January 31 of the succeeding year, furnish a 
        written statement to such employee showing--
                  (A) the information shown on the statement 
                furnished under paragraph (1)(A), and
                  (B) if any portion of the sick pay is 
                excludable from gross income under section 
                104(a)(3), the portion which is not so 
                excludable and the portion which is so 
                excludable.
        To the extent practicable, the information required 
        under the preceding sentence shall be furnished on or 
        with the statement (if any) required under subsection 
        (a).

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CHAPTER 65--ABATEMENTS, CREDITS, AND REFUNDS

           *       *       *       *       *       *       *


Subchapter B--Rules of Special Application

           *       *       *       *       *       *       *


SEC. 6416. CERTAIN TAXES ON SALES AND SERVICES.

  (a) Condition to Allowance.--
          (1) General rule.--No credit or refund of any 
        overpayment of tax imposed by chapter 31 (relating to 
        retail excise taxes), or chapter 32 (manufacturers 
        taxes), shall be allowed or made unless the person who 
        paid the tax establishes, under regulations prescribed 
        by the Secretary, that he--
                  (A) has not included the tax in the price of 
                the article with respect to which it was 
                imposed and has not collected the amount of the 
                tax from the person who purchased such article;
                  (B) has repaid the amount of the tax to the 
                ultimate purchaser of the article;
                  (C) in the case of an overpayment under 
                subsection (b)(2) of this section--
                          (i) has repaid or agreed to repay the 
                        amount of the tax to the ultimate 
                        vendor of the article, or
                          (ii) has obtained the written consent 
                        of such ultimate vendor to the 
                        allowance of the credit or the making 
                        of the refund; or
                  (D) has filed with the Secretary the written 
                consent of the person referred to in 
                subparagraph (B) to the allowance of the credit 
                or the making of the refund.
          (2) Exceptions.--This subsection shall not apply to--
                  (A) the tax imposed by section 4041 (relating 
                to tax on special fuels) on the use of any 
                liquid, and
                  (B) an overpayment of tax under paragraph 
                (1), (3)(A), (4), (5), or (6) of subsection (b) 
                of this section.
          (3) Special rule.--For purposes of this subsection, 
        in any case in which the Secretary determines that an 
        article is not taxable, the term ``ultimate purchaser'' 
        (when used in paragraph (1)(B) of this subsection) 
        includes a wholesaler, jobber, distributor, or retailer 
        who, on the 15th day after the date of such 
        determination, holds such article for sale; but only if 
        claim for credit or refund by reason of this paragraph 
        is filed on or before the date for filing the return 
        with respect to the taxes imposed under chapter 32 for 
        the first period which begins more than 60 days after 
        the date on such determination.
          (4) Registered ultimate vendor or credit card issuer 
        to administer credits and refunds of gasoline tax.--
                  (A) In general.--For purposes of this 
                subsection, except as provided in subparagraph 
                (B), if an ultimate vendor purchases any 
                gasoline on which tax imposed by section 4081 
                has been paid and sells such gasoline to an 
                ultimate purchaser described in subparagraph 
                (C) or (D) of subsection (b)(2) (and such 
                gasoline is for a use described in such 
                subparagraph), such ultimate vendor shall be 
                treated as the person (and the only person) who 
                paid such tax, but only if such ultimate vendor 
                is registered under section 4101.
                  (B) Credit card issuer.--For purposes of this 
                subsection, if the purchase of gasoline 
                described in subparagraph (A) (determined 
                without regard to the registration status of 
                the ultimate vendor) is made by means of a 
                credit card issued to the ultimate purchaser, 
                paragraph (1) shall not apply and the person 
                extending the credit to the ultimate purchaser 
                shall be treated as the person (and the only 
                person) who paid the tax, but only if such 
                person--
                          (i) is registered under section 4101,
                          (ii) has established, under 
                        regulations prescribed by the 
                        Secretary, that such person--
                                  (I) has not collected the 
                                amount of the tax from the 
                                person who purchased such 
                                article, or
                                  (II) has obtained the written 
                                consent from the ultimate 
                                purchaser to the allowance of 
                                the credit or refund, and
                          (iii) has so established that such 
                        person--
                                  (I) has repaid or agreed to 
                                repay the amount of the tax to 
                                the ultimate vendor,
                                  (II) has obtained the written 
                                consent of the ultimate vendor 
                                to the allowance of the credit 
                                or refund, or
                                  (III) has otherwise made 
                                arrangements which directly or 
                                indirectly provides the 
                                ultimate vendor with 
                                reimbursement of such tax.
                If clause (i), (ii), or (iii) is not met by 
                such person extending the credit to the 
                ultimate purchaser, then such person shall 
                collect an amount equal to the tax from the 
                ultimate purchaser and only such ultimate 
                purchaser may claim such credit or payment.
                  (C) Timing of claims.--The procedure and 
                timing of any claim under subparagraph (A) or 
                (B) shall be the same as for claims under 
                section 6427(i)(4), except that the rules of 
                section 6427(i)(3)(B) regarding electronic 
                claims shall not apply unless the ultimate 
                vendor or credit card issuer has certified to 
                the Secretary for the most recent quarter of 
                the taxable year that all ultimate purchasers 
                of the vendor or credit card issuer are 
                certified and entitled to a refund under 
                subparagraph (C) or (D) of subsection (b)(2).
  (b) Special Cases in Which Tax Payments Considered 
Overpayments.--Under regulations prescribed by the Secretary, 
credit or refund (without interest) shall be allowed or made in 
respect of the overpayments determined under the following 
paragraphs:
          (1) Price readjustments.--
                  (A) In general.--Except as provided in 
                subparagraph (B) or (C), if the price of any 
                article in respect of which a tax, based on 
                such price, is imposed by chapter 31 or 32, is 
                readjusted by reason of the return or 
                repossession of the article or a covering or 
                container, or by a bona fide discount, rebate, 
                or allowance, including a readjustment for 
                local advertising (but only to the extent 
                provided in section 4216(e)(2) and (3)), the 
                part of the tax proportionate to the part of 
                the price repaid or credited to the purchaser 
                shall be deemed to be an overpayment.
                  (B) Further manufacture.--Subparagraph (A) 
                shall not apply in the case of an article in 
                respect of which tax was computed under section 
                4223(b)(2); but if the price for which such 
                article was sold is readjusted by reason of the 
                return or repossession of the article, the part 
                of the tax proportionate to the part of such 
                price repaid or credited to the purchaser shall 
                be deemed to be an overpayment.
                  (C) Adjustment of tire price.--No credit or 
                refund of any tax imposed by subsection (a) or 
                (b) of section 4071 shall be allowed or made by 
                reason of an adjustment of a tire pursuant to a 
                warranty or guarantee.
          (2) Specified uses and resales.--The tax paid under 
        chapter 32 (or under subsection (a) or (d) of section 
        4041 in respect of sales or under section 4051) in 
        respect of any article shall be deemed to be an 
        overpayment if such article was, by any person--
                  (A) exported;
                  (B) used or sold for use as supplies for 
                vessels or aircraft;
                  (C) sold to a State or local government for 
                the exclusive use of a State or local 
                government;
                  (D) sold to a nonprofit educational 
                organization for its exclusive use;
                  (E) sold to a qualified blood collector 
                organization (as defined in section 
                7701(a)(49)) for such organization's exclusive 
                use in the collection, storage, or 
                transportation of blood;
                  (F) in the case of any tire taxable under 
                section 4071(a), sold to any person for use as 
                described in section 4221(e)(3); or
                  (G) in the case of gasoline, used or sold for 
                use in the production of special fuels referred 
                to in section 4041.
        Subparagraphs (C), (D), and (E) shall not apply in the 
        case of any tax paid under section 4064. In the case of 
        the tax imposed by section 4131, subparagraphs (B), 
        (C), (D), and (E) shall not apply and subparagraph (A) 
        shall apply only if the use of the exported vaccine 
        meets such requirements as the Secretary may by 
        regulations prescribe. This paragraph shall not apply 
        in the case of any tax imposed under section 4041(a)(1) 
        or 4081 on diesel fuel or kerosene and any tax paid 
        under section 4121. Subparagraphs (C) and (D) shall not 
        apply in the case of any tax imposed on gasoline under 
        section 4081 if the requirements of subsection (a)(4) 
        are not met. In the case of taxes imposed by subchapter 
        C or D of chapter 32, subparagraph (E) shall not apply. 
        [In the case of the tax imposed by section 4191, 
        subparagraphs (B), (C), (D), and (E) shall not apply.]
          (3) Tax-paid articles used for further manufacture, 
        etc..--If the tax imposed by chapter 32 has been paid 
        with respect to the sale of any article (other than 
        coal taxable under section 4121) by the manufacturer, 
        producer, or importer thereof and such article is sold 
        to a subsequent manufacturer or producer before being 
        used, such tax shall be deemed to be an overpayment by 
        such subsequent manufacturer or producer if--
                  (A) in the case of any article other than any 
                fuel taxable under section 4081, such article 
                is used by the subsequent manufacturer or 
                producer as material in the manufacture or 
                production of, or as a component part of--
                          (i) another article taxable under 
                        chapter 32, or
                          (ii) an automobile bus chassis or an 
                        automobile bus body, manufactured or 
                        produced by him; or
                  (B) in the case of any fuel taxable under 
                section 4081, such fuel is used by the 
                subsequent manufacturer or producer, for 
                nonfuel purposes, as a material in the 
                manufacture or production of any other article 
                manufactured or produced by him.
          (4) Tires.--If--
                  (A) the tax imposed by section 4071 has been 
                paid with respect to the sale of any tire by 
                the manufacturer, producer, or importer 
                thereof, and
                  (B) such tire is sold by any person on or in 
                connection with, or with the sale of, any other 
                article, such tax shall be deemed to be an 
                overpayment by such person if such other 
                article is--
                          (i) an automobile bus chassis or an 
                        automobile bus body,
                          (ii) by such person exported, sold to 
                        a State or local government for the 
                        exclusive use of a State or local 
                        government, sold to a nonprofit 
                        educational organization for its 
                        exclusive use, or used or sold for use 
                        as supplies for vessels or aircraft, or
                          (iii) sold to a qualified blood 
                        collector organization for its 
                        exclusive use in connection with a 
                        vehicle the organization certifies will 
                        be primarily used in the collection, 
                        storage, or transportation of blood.
          (5) Return of certain installment accounts.--If--
                  (A) tax was paid under section 4216(d)(1) in 
                respect of any installment account,
                  (B) such account is, under the agreement 
                under which the account was sold, returned to 
                the person who sold such account, and
                  (C) the consideration is readjusted as 
                provided in such agreement,
        the part of the tax paid under section 4216(d)(1) 
        allocable to the part of the consideration repaid or 
        credited to the purchaser of such account shall be 
        deemed to be an overpayment.
          (6) Truck chassis, bodies, and semitrailers used for 
        further manufacture.--If--
                  (A) the tax imposed by section 4051 has been 
                paid with respect to the sale of any article, 
                and
                  (B) before any other use, such article is by 
                any person used as a component part of another 
                article taxable under section 4051 manufactured 
                or produced by him,
        such tax shall be deemed to be an overpayment by such 
        person. For purposes of the preceding sentence, an 
        article shall be treated as having been used as a 
        component part of another article if, had it not been 
        broken or rendered useless in the manufacture or 
        production of such other article, it would have been so 
        used.
        This subsection shall apply in respect of an article 
        only if the exportation or use referred to in the 
        applicable provision of this subsection occurs before 
        any other use, or, in the case of a sale or resale, the 
        use referred to in the applicable provision of this 
        subsection is to occur before any other use.
  (c) Refund to Exporter or Shipper.--Under regulations 
prescribed by the Secretary the amount of any tax imposed by 
chapter 31, or chapter 32 erroneously or illegally collected in 
respect of any article exported to a foreign country or shipped 
to a possession of the United States may be refunded to the 
exporter or shipper thereof, if the person who paid such tax 
waives his claim to such amount.
  (d) Credit on Returns.--Any person entitled to a refund of 
tax imposed by chapter 31 or 32, paid to the Secretary may, 
instead of filing a claim for refund, take credit therefor 
against taxes imposed by such chapter due on any subsequent 
return. The preceding sentence shall not apply to the tax 
imposed by section 4081 in the case of refunds described in 
section 4081(e).
  (e) Accounting Procedures for Like Articles.--Under 
regulations prescribed by the Secretary, if any person uses or 
resells like articles, then for purposes of this section the 
manufacturer, producer, or importer of any such article may be 
identified, and the amount of tax paid under chapter 32 in 
respect of such article may be determined--
          (1) on a first-in-first-out basis,
          (2) on a last-in-first-out basis, or
          (3) in accordance with any other consistent method 
        approved by the Secretary.
  (f) Meaning of Terms.--For purposes of this section, any term 
used in this section has the same meaning as when used in 
chapter 31, 32, or 33, as the case may be.

           *       *       *       *       *       *       *




         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets and 
existing law in which no change is proposed is shown in roman):

               PATIENT PROTECTION AND AFFORDABLE CARE ACT



           *       *       *       *       *       *       *
TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE

           *       *       *       *       *       *       *


Subtitle E--Ensuring Medicare Sustainability

           *       *       *       *       *       *       *


[SEC. 3403. INDEPENDENT MEDICARE ADVISORY BOARD.

  [(a) Board.--
          [(1) In general.--Title XVIII of the Social Security 
        Act (42 U.S.C. 1395 et seq.), as amended by section 
        3022, is amended by adding at the end the following new 
        section:

                 [``INDEPENDENT MEDICARE ADVISORY BOARD

  [``Sec.1899A. (a) Establishment.--There is established an 
independent board to be known as the `Independent Medicare 
Advisory Board'.
  [``(b) Purpose.--It is the purpose of this section to, in 
accordance with the following provisions of this section, 
reduce the per capita rate of growth in Medicare spending--
          [``(1) by requiring the Chief Actuary of the Centers 
        for Medicare & Medicaid Services to determine in each 
        year to which this section applies (in this section 
        referred to as `a determination year') the projected 
        per capita growth rate under Medicare for the second 
        year following the determination year (in this section 
        referred to as `an implementation year');
          [``(2) if the projection for the implementation year 
        exceeds the target growth rate for that year, by 
        requiring the Board to develop and submit during the 
        first year following the determination year (in this 
        section referred to as `a proposal year') a proposal 
        containing recommendations to reduce the Medicare per 
        capita growth rate to the extent required by this 
        section; and
          [``(3) by requiring the Secretary to implement such 
        proposals unless Congress enacts legislation pursuant 
        to this section.
  [``(c) Board Proposals.--
          [``(1) Development.--
                  [``(A) In general.--The Board shall develop 
                detailed and specific proposals related to the 
                Medicare program in accordance with the 
                succeeding provisions of this section.
                  [``(B) Advisory reports.--Beginning January 
                15, 2014, the Board may develop and submit to 
                Congress advisory reports on matters related to 
                the Medicare program, regardless of whether or 
                not the Board submitted a proposal for such 
                year. Such a report may, for years prior to 
                2020, include recommendations regarding 
                improvements to payment systems for providers 
                of services and suppliers who are not otherwise 
                subject to the scope of the Board's 
                recommendations in a proposal under this 
                section. Any advisory report submitted under 
                this subparagraph shall not be subject to the 
                rules for congressional consideration under 
                subsection (d). In any year (beginning with 
                2014) that the Board is not required to submit 
                a proposal under this section, the Board shall 
                submit to Congress an advisory report on 
                matters related to the Medicare program.
          [``(2) Proposals.--
                  [``(A) Requirements.--Each proposal submitted 
                under this section in a proposal year shall 
                meet each of the following requirements:
                          [``(i) If the Chief Actuary of the 
                        Centers for Medicare & Medicaid 
                        Services has made a determination under 
                        paragraph (7)(A) in the determination 
                        year, the proposal shall include 
                        recommendations so that the proposal as 
                        a whole (after taking into account 
                        recommendations under clause (v)) will 
                        result in a net reduction in total 
                        Medicare program spending in the 
                        implementation year that is at least 
                        equal to the applicable savings target 
                        established under paragraph (7)(B) for 
                        such implementation year. In 
                        determining whether a proposal meets 
                        the requirement of the preceding 
                        sentence, reductions in Medicare 
                        program spending during the 3-month 
                        period immediately preceding the 
                        implementation year shall be counted to 
                        the extent that such reductions are a 
                        result of the implementation of 
                        recommendations contained in the 
                        proposal for a change in the payment 
                        rate for an item or service that was 
                        effective during such period pursuant 
                        to subsection (e)(2)(A).
                          [``(ii) The proposal shall not 
                        include any recommendation to ration 
                        health care, raise revenues or Medicare 
                        beneficiary premiums under section 
                        1818, 1818A, or 1839, increase Medicare 
                        beneficiary cost-sharing (including 
                        deductibles, coinsurance, and 
                        copayments), or otherwise restrict 
                        benefits or modify eligibility 
                        criteria.
                          [``(iii) In the case of proposals 
                        submitted prior to December 31, 2018, 
                        the proposal shall not include any 
                        recommendation that would reduce 
                        payment rates for items and services 
                        furnished, prior to December 31, 2019, 
                        by providers of services (as defined in 
                        section 1861(u)) and suppliers (as 
                        defined in section 1861(d)) scheduled, 
                        pursuant to the amendments made by 
                        section 3401 of the Patient Protection 
                        and Affordable Care Act, to receive a 
                        reduction to the inflationary payment 
                        updates of such providers of services 
                        and suppliers in excess of a reduction 
                        due to productivity in a year in which 
                        such recommendations would take effect.
                          [``(iv) As appropriate, the proposal 
                        shall include recommendations to reduce 
                        Medicare payments under parts C and D, 
                        such as reductions in direct subsidy 
                        payments to Medicare Advantage and 
                        prescription drug plans specified under 
                        paragraph (1) and (2) of section 1860D-
                        15(a) that are related to 
                        administrative expenses (including 
                        profits) for basic coverage, denying 
                        high bids or removing high bids for 
                        prescription drug coverage from the 
                        calculation of the national average 
                        monthly bid amount under section 1860D-
                        13(a)(4), and reductions in payments to 
                        Medicare Advantage plans under clauses 
                        (i) and (ii) of section 1853(a)(1)(B) 
                        that are related to administrative 
                        expenses (including profits) and 
                        performance bonuses for Medicare 
                        Advantage plans under section 1853(n). 
                        Any such recommendation shall not 
                        affect the base beneficiary premium 
                        percentage specified under 1860D-13(a) 
                        or the full premium subsidy under 
                        section 1860D-14(a).
                          [``(v) The proposal shall include 
                        recommendations with respect to 
                        administrative funding for the 
                        Secretary to carry out the 
                        recommendations contained in the 
                        proposal.
                          [``(vi) The proposal shall only 
                        include recommendations related to the 
                        Medicare program.
                          [``(vii) If the Chief Actuary of the 
                        Centers for Medicare & Medicaid 
                        Services has made a determination 
                        described in subsection 
                        (e)(3)(B)(i)(II) in the determination 
                        year, the proposal shall be designed to 
                        help reduce the growth rate described 
                        in paragraph (8) while maintaining or 
                        enhancing beneficiary access to quality 
                        care under this title.
                  [``(B) Additional considerations.--In 
                developing and submitting each proposal under 
                this section in a proposal year, the Board 
                shall, to the extent feasible--
                          [``(i) give priority to 
                        recommendations that extend Medicare 
                        solvency;
                          [``(ii) include recommendations 
                        that--
                                  [``(I) improve the health 
                                care delivery system and health 
                                outcomes, including by 
                                promoting integrated care, care 
                                coordination, prevention and 
                                wellness, and quality and 
                                efficiency improvement; and
                                  [``(II) protect and improve 
                                Medicare beneficiaries' access 
                                to necessary and evidence-based 
                                items and services, including 
                                in rural and frontier areas;
                          [``(iii) include recommendations that 
                        target reductions in Medicare program 
                        spending to sources of excess cost 
                        growth;
                          [``(iv) consider the effects on 
                        Medicare beneficiaries of changes in 
                        payments to providers of services (as 
                        defined in section 1861(u)) and 
                        suppliers (as defined in section 
                        1861(d));
                          [``(v) consider the effects of the 
                        recommendations on providers of 
                        services and suppliers with actual or 
                        projected negative cost margins or 
                        payment updates;
                          [``(vi) consider the unique needs of 
                        Medicare beneficiaries who are dually 
                        eligible for Medicare and the Medicaid 
                        program under title XIX; and
                          [``(vii) take into account the data 
                        and findings contained in the annual 
                        reports under subsection (n) in order 
                        to develop proposals that can most 
                        effectively promote the delivery of 
                        efficient, high quality care to 
                        Medicare beneficiaries.
                  [``(C) No increase in total Medicare program 
                spending.--Each proposal submitted under this 
                section shall be designed in such a manner that 
                implementation of the recommendations contained 
                in the proposal would not be expected to 
                result, over the 10-year period starting with 
                the implementation year, in any increase in the 
                total amount of net Medicare program spending 
                relative to the total amount of net Medicare 
                program spending that would have occurred 
                absent such implementation.
                  [``(D) Consultation with MedPAC.--The Board 
                shall submit a draft copy of each proposal to 
                be submitted under this section to the Medicare 
                Payment Advisory Commission established under 
                section 1805 for its review. The Board shall 
                submit such draft copy by not later than 
                September 1 of the determination year.
                  [``(E) Review and comment by the Secretary.--
                The Board shall submit a draft copy of each 
                proposal to be submitted to Congress under this 
                section to the Secretary for the Secretary's 
                review and comment. The Board shall submit such 
                draft copy by not later than September 1 of the 
                determination year. Not later than March 1 of 
                the submission year, the Secretary shall submit 
                a report to Congress on the results of such 
                review, unless the Secretary submits a proposal 
                under paragraph (5)(A) in that year.
                  [``(F) Consultations.--In carrying out its 
                duties under this section, the Board shall 
                engage in regular consultations with the 
                Medicaid and CHIP Payment and Access Commission 
                under section 1900.
          [``(3) Submission of Board proposal to Congress and 
        the President.--
                  [``(A) In general.--
                          [``(i) In general.--Except as 
                        provided in clause (ii) and subsection 
                        (f)(3)(B), the Board shall submit a 
                        proposal under this section to Congress 
                        and the President on January 15 of each 
                        year (beginning with 2014).
                          [``(ii) Exception.--The Board shall 
                        not submit a proposal under clause (i) 
                        in a proposal year if the year is--
                                  [``(I) a year for which the 
                                Chief Actuary of the Centers 
                                for Medicare & Medicaid 
                                Services makes a determination 
                                in the determination year under 
                                paragraph (6)(A) that the 
                                growth rate described in clause 
                                (i) of such paragraph does not 
                                exceed the growth rate 
                                described in clause (ii) of 
                                such paragraph; or
                                  [``(II) a year in which the 
                                Chief Actuary of the Centers 
                                for Medicare & Medicaid 
                                Services makes a determination 
                                in the determination year that 
                                the projected percentage 
                                increase (if any) for the 
                                medical care expenditure 
                                category of the Consumer Price 
                                Index for All Urban Consumers 
                                (United States city average) 
                                for the implementation year is 
                                less than the projected 
                                percentage increase (if any) in 
                                the Consumer Price Index for 
                                All Urban Consumers (all items; 
                                United States city average) for 
                                such implementation year.
                          [``(iii) Start-up period.--The Board 
                        may not submit a proposal under clause 
                        (i) prior to January 15, 2014.
                  [``(B) Required information.--Each proposal 
                submitted by the Board under subparagraph 
                (A)(i) shall include--
                          [``(i) the recommendations described 
                        in paragraph (2)(A)(i);
                          [``(ii) an explanation of each 
                        recommendation contained in the 
                        proposal and the reasons for including 
                        such recommendation;
                          [``(iii) an actuarial opinion by the 
                        Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifying 
                        that the proposal meets the 
                        requirements of subparagraphs (A)(i) 
                        and (C) of paragraph (2);
                          [``(iv) a legislative proposal that 
                        implements the recommendations; and
                          [``(v) other information determined 
                        appropriate by the Board.
          [``(4) Presidential submission to Congress.--Upon 
        receiving a proposal from the Secretary under paragraph 
        (5), the President shall within 2 days submit such 
        proposal to Congress.
          [``(5) Contingent secretarial development of 
        proposal.--If, with respect to a proposal year, the 
        Board is required, but fails, to submit a proposal to 
        Congress and the President by the deadline applicable 
        under paragraph (3)(A)(i), the Secretary shall develop 
        a detailed and specific proposal that satisfies the 
        requirements of subparagraphs (A) and (C) (and, to the 
        extent feasible, subparagraph (B)) of paragraph (2) and 
        contains the information required paragraph (3)(B)). By 
        not later than January 25 of the year, the Secretary 
        shall transmit--
                  [``(A) such proposal to the President; and
                  [``(B) a copy of such proposal to the 
                Medicare Payment Advisory Commission for its 
                review.
          [``(6) Per capita growth rate projections by chief 
        actuary.--
                  [``(A) In general.--Subject to subsection 
                (f)(3)(A), not later than April 30, 2013, and 
                annually thereafter, the Chief Actuary of the 
                Centers for Medicare & Medicaid Services shall 
                determine in each such year whether--
                          [``(i) the projected Medicare per 
                        capita growth rate for the 
                        implementation year (as determined 
                        under subparagraph (B)); exceeds
                          [``(ii) the projected Medicare per 
                        capita target growth rate for the 
                        implementation year (as determined 
                        under subparagraph (C)).
                  [``(B) Medicare per capita growth rate.--
                          [``(i) In general.--For purposes of 
                        this section, the Medicare per capita 
                        growth rate for an implementation year 
                        shall be calculated as the projected 5-
                        year average (ending with such year) of 
                        the growth in Medicare program spending 
                        (calculated as the sum of per capita 
                        spending under each of parts A, B, and 
                        D).
                          [``(ii) Requirement.--The projection 
                        under clause (i) shall--
                                  [``(I) to the extent that 
                                there is projected to be a 
                                negative update to the single 
                                conversion factor applicable to 
                                payments for physicians' 
                                services under section 1848(d) 
                                furnished in the proposal year 
                                or the implementation year, 
                                assume that such update for 
                                such services is 0 percent 
                                rather than the negative 
                                percent that would otherwise 
                                apply; and
                                  [``(II) take into account any 
                                delivery system reforms or 
                                other payment changes that have 
                                been enacted or published in 
                                final rules but not yet 
                                implemented as of the making of 
                                such calculation.
                  [``(C) Medicare per capita target growth 
                rate.--For purposes of this section, the 
                Medicare per capita target growth rate for an 
                implementation year shall be calculated as the 
                projected 5-year average (ending with such 
                year) percentage increase in--
                          [``(i) with respect to a 
                        determination year that is prior to 
                        2018, the average of the projected 
                        percentage increase (if any) in--
                                  [``(I) the Consumer Price 
                                Index for All Urban Consumers 
                                (all items; United States city 
                                average); and
                                  [``(II) the medical care 
                                expenditure category of the 
                                Consumer Price Index for All 
                                Urban Consumers (United States 
                                city average); and
                          [``(ii) with respect to a 
                        determination year that is after 2017, 
                        the nominal gross domestic product per 
                        capita plus 1.0 percentage point.
          [``(7) Savings requirement.--
                  [``(A) In general.--If, with respect to a 
                determination year, the Chief Actuary of the 
                Centers for Medicare & Medicaid Services makes 
                a determination under paragraph (6)(A) that the 
                growth rate described in clause (i) of such 
                paragraph exceeds the growth rate described in 
                clause (ii) of such paragraph, the Chief 
                Actuary shall establish an applicable savings 
                target for the implementation year.
                  [``(B) Applicable savings target.--For 
                purposes of this section, the applicable 
                savings target for an implementation year shall 
                be an amount equal to the product of--
                          [``(i) the total amount of projected 
                        Medicare program spending for the 
                        proposal year; and
                          [``(ii) the applicable percent for 
                        the implementation year.
                  [``(C) Applicable percent.--For purposes of 
                subparagraph (B), the applicable percent for an 
                implementation year is the lesser of--
                          [``(i) in the case of--
                                  [``(I) implementation year 
                                2015, 0.5 percent;
                                  [``(II) implementation year 
                                2016, 1.0 percent;
                                  [``(III) implementation year 
                                2017, 1.25 percent; and
                                  [``(IV) implementation year 
                                2018 or any subsequent 
                                implementation year, 1.5 
                                percent; and
                          [``(ii) the projected excess for the 
                        implementation year (expressed as a 
                        percent) determined under subparagraph 
                        (A).
          [``(8) Per capita rate of growth in national health 
        expenditures.--In each determination year (beginning in 
        2018), the Chief Actuary of the Centers for Medicare & 
        Medicaid Services shall project the per capita rate of 
        growth in national health expenditures for the 
        implementation year. Such rate of growth for an 
        implementation year shall be calculated as the 
        projected 5-year average (ending with such year) 
        percentage increase in national health care 
        expenditures.
  [``(d) Congressional Consideration.--
          [``(1) Introduction.--
                  [``(A) In general.--On the day on which a 
                proposal is submitted by the Board or the 
                President to the House of Representatives and 
                the Senate under subsection (c)(3)(A)(i) or 
                subsection (c)(4), the legislative proposal 
                (described in subsection (c)(3)(B)(iv)) 
                contained in the proposal shall be introduced 
                (by request) in the Senate by the majority 
                leader of the Senate or by Members of the 
                Senate designated by the majority leader of the 
                Senate and shall be introduced (by request) in 
                the House by the majority leader of the House 
                or by Members of the House designated by the 
                majority leader of the House.
                  [``(B) Not in session.--If either House is 
                not in session on the day on which such 
                legislative proposal is submitted, the 
                legislative proposal shall be introduced in 
                that House, as provided in subparagraph (A), on 
                the first day thereafter on which that House is 
                in session.
                  [``(C) Any Member.--If the legislative 
                proposal is not introduced in either House 
                within 5 days on which that House is in session 
                after the day on which the legislative proposal 
                is submitted, then any Member of that House may 
                introduce the legislative proposal.
                  [``(D) Referral.--The legislation introduced 
                under this paragraph shall be referred by the 
                Presiding Officers of the respective Houses to 
                the Committee on Finance in the Senate and to 
                the Committee on Energy and Commerce and the 
                Committee on Ways and Means in the House of 
                Representatives.
          [``(2) Committee consideration of proposal.--
                  [``(A) Reporting bill.--Not later than April 
                1 of any proposal year in which a proposal is 
                submitted by the Board or the President to 
                Congress under this section, the Committee on 
                Ways and Means and the Committee on Energy and 
                Commerce of the House of Representatives and 
                the Committee on Finance of the Senate may 
                report the bill referred to the Committee under 
                paragraph (1)(D) with committee amendments 
                related to the Medicare program.
                  [``(B) Calculations.--In determining whether 
                a committee amendment meets the requirement of 
                subparagraph (A), the reductions in Medicare 
                program spending during the 3-month period 
                immediately preceding the implementation year 
                shall be counted to the extent that such 
                reductions are a result of the implementation 
                provisions in the committee amendment for a 
                change in the payment rate for an item or 
                service that was effective during such period 
                pursuant to such amendment.
                  [``(C) Committee jurisdiction.--
                Notwithstanding rule XV of the Standing Rules 
                of the Senate, a committee amendment described 
                in subparagraph (A) may include matter not 
                within the jurisdiction of the Committee on 
                Finance if that matter is relevant to a 
                proposal contained in the bill submitted under 
                subsection (c)(3).
                  [``(D) Discharge.--If, with respect to the 
                House involved, the committee has not reported 
                the bill by the date required by subparagraph 
                (A), the committee shall be discharged from 
                further consideration of the proposal.
          [``(3) Limitation on changes to the Board 
        recommendations.--
                  [``(A) In general.--It shall not be in order 
                in the Senate or the House of Representatives 
                to consider any bill, resolution, or amendment, 
                pursuant to this subsection or conference 
                report thereon, that fails to satisfy the 
                requirements of subparagraphs (A)(i) and (C) of 
                subsection (c)(2).
                  [``(B) Limitation on changes to the Board 
                recommendations in other legislation.--It shall 
                not be in order in the Senate or the House of 
                Representatives to consider any bill, 
                resolution, amendment, or conference report 
                (other than pursuant to this section) that 
                would repeal or otherwise change the 
                recommendations of the Board if that change 
                would fail to satisfy the requirements of 
                subparagraphs (A)(i) and (C) of subsection 
                (c)(2).
                  [``(C) Limitation on changes to this 
                subsection.--It shall not be in order in the 
                Senate or the House of Representatives to 
                consider any bill, resolution, amendment, or 
                conference report that would repeal or 
                otherwise change this subsection.
                  [``(D) Waiver.--This paragraph may be waived 
                or suspended in the Senate only by the 
                affirmative vote of three-fifths of the 
                Members, duly chosen and sworn.
                  [``(E) Appeals.--An affirmative vote of 
                three-fifths of the Members of the Senate, duly 
                chosen and sworn, shall be required in the 
                Senate to sustain an appeal of the ruling of 
                the Chair on a point of order raised under this 
                paragraph.
          [``(4) Expedited procedure.--
                  [``(A) Consideration.--A motion to proceed to 
                the consideration of the bill in the Senate is 
                not debatable.
                  [``(B) Amendment.--
                          [``(i) Time limitation.--Debate in 
                        the Senate on any amendment to a bill 
                        under this section shall be limited to 
                        1 hour, to be equally divided between, 
                        and controlled by, the mover and the 
                        manager of the bill, and debate on any 
                        amendment to an amendment, debatable 
                        motion, or appeal shall be limited to 
                        30 minutes, to be equally divided 
                        between, and controlled by, the mover 
                        and the manager of the bill, except 
                        that in the event the manager of the 
                        bill is in favor of any such amendment, 
                        motion, or appeal, the time in 
                        opposition thereto shall be controlled 
                        by the minority leader or such leader's 
                        designee.
                          [``(ii) Germane.--No amendment that 
                        is not germane to the provisions of 
                        such bill shall be received.
                          [``(iii) Additional time.--The 
                        leaders, or either of them, may, from 
                        the time under their control on the 
                        passage of the bill, allot additional 
                        time to any Senator during the 
                        consideration of any amendment, 
                        debatable motion, or appeal.
                          [``(iv) Amendment not in order.--It 
                        shall not be in order to consider an 
                        amendment that would cause the bill to 
                        result in a net reduction in total 
                        Medicare program spending in the 
                        implementation year that is less than 
                        the applicable savings target 
                        established under subsection (c)(7)(B) 
                        for such implementation year.
                          [``(v) Waiver and appeals.--This 
                        paragraph may be waived or suspended in 
                        the Senate only by the affirmative vote 
                        of three-fifths of the Members, duly 
                        chosen and sworn. An affirmative vote 
                        of three-fifths of the Members of the 
                        Senate, duly chosen and sworn, shall be 
                        required in the Senate to sustain an 
                        appeal of the ruling of the Chair on a 
                        point of order raised under this 
                        section.
                  [``(C) Consideration by the other House.--
                          [``(i) In general.--The expedited 
                        procedures provided in this subsection 
                        for the consideration of a bill 
                        introduced pursuant to paragraph (1) 
                        shall not apply to such a bill that is 
                        received by one House from the other 
                        House if such a bill was not introduced 
                        in the receiving House.
                          [``(ii) Before passage.--If a bill 
                        that is introduced pursuant to 
                        paragraph (1) is received by one House 
                        from the other House, after 
                        introduction but before disposition of 
                        such a bill in the receiving House, 
                        then the following shall apply:
                                  [``(I) The receiving House 
                                shall consider the bill 
                                introduced in that House 
                                through all stages of 
                                consideration up to, but not 
                                including, passage.
                                  [``(II) The question on 
                                passage shall be put on the 
                                bill of the other House as 
                                amended by the language of the 
                                receiving House.
                          [``(iii) After passage.--If a bill 
                        introduced pursuant to paragraph (1) is 
                        received by one House from the other 
                        House, after such a bill is passed by 
                        the receiving House, then the vote on 
                        passage of the bill that originates in 
                        the receiving House shall be considered 
                        to be the vote on passage of the bill 
                        received from the other House as 
                        amended by the language of the 
                        receiving House.
                          [``(iv) Disposition.--Upon 
                        disposition of a bill introduced 
                        pursuant to paragraph (1) that is 
                        received by one House from the other 
                        House, it shall no longer be in order 
                        to consider the bill that originates in 
                        the receiving House.
                          [``(v) Limitation.--Clauses (ii), 
                        (iii), and (iv) shall apply only to a 
                        bill received by one House from the 
                        other House if the bill--
                                  [``(I) is related only to the 
                                program under this title; and
                                  [``(II) satisfies the 
                                requirements of subparagraphs 
                                (A)(i) and (C) of subsection 
                                (c)(2).
                  [``(D) Senate limits on debate.--
                          [``(i) In general.--In the Senate, 
                        consideration of the bill and on all 
                        debatable motions and appeals in 
                        connection therewith shall not exceed a 
                        total of 30 hours, which shall be 
                        divided equally between the majority 
                        and minority leaders or their 
                        designees.
                          [``(ii) Motion to further limit 
                        debate.--A motion to further limit 
                        debate on the bill is in order and is 
                        not debatable.
                          [``(iii) Motion or appeal.--Any 
                        debatable motion or appeal is debatable 
                        for not to exceed 1 hour, to be divided 
                        equally between those favoring and 
                        those opposing the motion or appeal.
                          [``(iv) Final disposition.--After 30 
                        hours of consideration, the Senate 
                        shall proceed, without any further 
                        debate on any question, to vote on the 
                        final disposition thereof to the 
                        exclusion of all amendments not then 
                        pending before the Senate at that time 
                        and to the exclusion of all motions, 
                        except a motion to table, or to 
                        reconsider and one quorum call on 
                        demand to establish the presence of a 
                        quorum (and motions required to 
                        establish a quorum) immediately before 
                        the final vote begins.
                  [``(E) Consideration in conference.--
                          [``(i) In general.--Consideration in 
                        the Senate and the House of 
                        Representatives on the conference 
                        report or any messages between Houses 
                        shall be limited to 10 hours, equally 
                        divided and controlled by the majority 
                        and minority leaders of the Senate or 
                        their designees and the Speaker of the 
                        House of Representatives and the 
                        minority leader of the House of 
                        Representatives or their designees.
                          [``(ii) Time limitation.--Debate in 
                        the Senate on any amendment under this 
                        subparagraph shall be limited to 1 
                        hour, to be equally divided between, 
                        and controlled by, the mover and the 
                        manager of the bill, and debate on any 
                        amendment to an amendment, debatable 
                        motion, or appeal shall be limited to 
                        30 minutes, to be equally divided 
                        between, and controlled by, the mover 
                        and the manager of the bill, except 
                        that in the event the manager of the 
                        bill is in favor of any such amendment, 
                        motion, or appeal, the time in 
                        opposition thereto shall be controlled 
                        by the minority leader or such leader's 
                        designee.
                          [``(iii) Final disposition.--After 10 
                        hours of consideration, the Senate 
                        shall proceed, without any further 
                        debate on any question, to vote on the 
                        final disposition thereof to the 
                        exclusion of all motions not then 
                        pending before the Senate at that time 
                        or necessary to resolve the differences 
                        between the Houses and to the exclusion 
                        of all other motions, except a motion 
                        to table, or to reconsider and one 
                        quorum call on demand to establish the 
                        presence of a quorum (and motions 
                        required to establish a quorum) 
                        immediately before the final vote 
                        begins.
                          [``(iv) Limitation.--Clauses (i) 
                        through (iii) shall only apply to a 
                        conference report, message or the 
                        amendments thereto if the conference 
                        report, message, or an amendment 
                        thereto--
                                  [``(I) is related only to the 
                                program under this title; and
                                  [``(II) satisfies the 
                                requirements of subparagraphs 
                                (A)(i) and (C) of subsection 
                                (c)(2).
                  [``(F) Veto.--If the President vetoes the 
                bill debate on a veto message in the Senate 
                under this subsection shall be 1 hour equally 
                divided between the majority and minority 
                leaders or their designees.
          [``(5) Rules of the Senate and House of 
        Representatives.--This subsection and subsection (f)(2) 
        are enacted by Congress--
                  [``(A) as an exercise of the rulemaking power 
                of the Senate and the House of Representatives, 
                respectively, and is deemed to be part of the 
                rules of each House, respectively, but 
                applicable only with respect to the procedure 
                to be followed in that House in the case of 
                bill under this section, and it supersedes 
                other rules only to the extent that it is 
                inconsistent with such rules; and
                  [``(B) with full recognition of the 
                constitutional right of either House to change 
                the rules (so far as they relate to the 
                procedure of that House) at any time, in the 
                same manner, and to the same extent as in the 
                case of any other rule of that House.
  [``(e) Implementation of Proposal.--
          [``(1) In general.--Notwithstanding any other 
        provision of law, the Secretary shall, except as 
        provided in paragraph (3), implement the 
        recommendations contained in a proposal submitted by 
        the Board or the President to Congress pursuant to this 
        section on August 15 of the year in which the proposal 
        is so submitted.
          [``(2) Application.--
                  [``(A) In general.--A recommendation 
                described in paragraph (1) shall apply as 
                follows:
                          [``(i) In the case of a 
                        recommendation that is a change in the 
                        payment rate for an item or service 
                        under Medicare in which payment rates 
                        change on a fiscal year basis (or a 
                        cost reporting period basis that 
                        relates to a fiscal year), on a 
                        calendar year basis (or a cost 
                        reporting period basis that relates to 
                        a calendar year), or on a rate year 
                        basis (or a cost reporting period basis 
                        that relates to a rate year), such 
                        recommendation shall apply to items and 
                        services furnished on the first day of 
                        the first fiscal year, calendar year, 
                        or rate year (as the case may be) that 
                        begins after such August 15.
                          [``(ii) In the case of a 
                        recommendation relating to payments to 
                        plans under parts C and D, such 
                        recommendation shall apply to plan 
                        years beginning on the first day of the 
                        first calendar year that begins after 
                        such August 15.
                          [``(iii) In the case of any other 
                        recommendation, such recommendation 
                        shall be addressed in the regular 
                        regulatory process timeframe and shall 
                        apply as soon as practicable.
                  [``(B) Interim final rulemaking.--The 
                Secretary may use interim final rulemaking to 
                implement any recommendation described in 
                paragraph (1).
          [``(3) Exceptions.--
                  [``(A) In general.--The Secretary shall not 
                implement the recommendations contained in a 
                proposal submitted in a proposal year by the 
                Board or the President to Congress pursuant to 
                this section if--
                          [``(i) prior to August 15 of the 
                        proposal year, Federal legislation is 
                        enacted that includes the following 
                        provision: `This Act supercedes the 
                        recommendations of the Board contained 
                        in the proposal submitted, in the year 
                        which includes the date of enactment of 
                        this Act, to Congress under section 
                        1899A of the Social Security Act.'; and
                          [``(ii) in the case of implementation 
                        year 2020 and subsequent implementation 
                        years, a joint resolution described in 
                        subsection (f)(1) is enacted not later 
                        than August 15, 2017.
                  [``(B) Limited additional exception.--
                          [``(i) In general.--Subject to clause 
                        (ii), the Secretary shall not implement 
                        the recommendations contained in a 
                        proposal submitted by the Board or the 
                        President to Congress pursuant to this 
                        section in a proposal year (beginning 
                        with proposal year 2019) if--
                                  [``(I) the Board was required 
                                to submit a proposal to 
                                Congress under this section in 
                                the year preceding the proposal 
                                year; and
                                  [``(II) the Chief Actuary of 
                                the Centers for Medicare & 
                                Medicaid Services makes a 
                                determination in the 
                                determination year that the 
                                growth rate described in 
                                subsection (c)(8) exceeds the 
                                growth rate described in 
                                subsection (c)(6)(A)(i).
                          [``(ii) Limited additional exception 
                        may not be applied in two consecutive 
                        years.--This subparagraph shall not 
                        apply if the recommendations contained 
                        in a proposal submitted by the Board or 
                        the President to Congress pursuant to 
                        this section in the year preceding the 
                        proposal year were not required to be 
                        implemented by reason of this 
                        subparagraph.
                          [``(iii) No affect on requirement to 
                        submit proposals or for congressional 
                        consideration of proposals.--Clause (i) 
                        and (ii) shall not affect--
                                  [``(I) the requirement of the 
                                Board or the President to 
                                submit a proposal to Congress 
                                in a proposal year in 
                                accordance with the provisions 
                                of this section; or
                                  [``(II) Congressional 
                                consideration of a legislative 
                                proposal (described in 
                                subsection (c)(3)(B)(iv)) 
                                contained such a proposal in 
                                accordance with subsection (d).
          [``(4) No affect on authority to implement certain 
        provisions.--Nothing in paragraph (3) shall be 
        construed to affect the authority of the Secretary to 
        implement any recommendation contained in a proposal or 
        advisory report under this section to the extent that 
        the Secretary otherwise has the authority to implement 
        such recommendation administratively.
          [``(5) Limitation on review.--There shall be no 
        administrative or judicial review under section 1869, 
        section 1878, or otherwise of the implementation by the 
        Secretary under this subsection of the recommendations 
        contained in a proposal.
  [``(f) Joint resolution Required To Discontinue the Board.--
          [``(1) In general.--For purposes of subsection 
        (e)(3)(B), a joint resolution described in this 
        paragraph means only a joint resolution--
                  [``(A) that is introduced in 2017 by not 
                later than February 1 of such year;
                  [``(B) which does not have a preamble;
                  [``(C) the title of which is as follows: 
                `Joint resolution approving the discontinuation 
                of the process for consideration and automatic 
                implementation of the annual proposal of the 
                Independent Medicare Advisory Board under 
                section 1899A of the Social Security Act'; and
                  [``(D) the matter after the resolving clause 
                of which is as follows: `That Congress approves 
                the discontinuation of the process for 
                consideration and automatic implementation of 
                the annual proposal of the Independent Medicare 
                Advisory Board under section 1899A of the 
                Social Security Act.'.
          [``(2) Procedure.--
                  [``(A) Referral.--A joint resolution 
                described in paragraph (1) shall be referred to 
                the Committee on Ways and Means and the 
                Committee on Energy and Commerce of the House 
                of Representatives and the Committee on Finance 
                of the Senate.
                  [``(B) Discharge.--In the Senate, if the 
                committee to which is referred a joint 
                resolution described in paragraph (1) has not 
                reported such joint resolution (or an identical 
                joint resolution) at the end of 20 days after 
                the joint resolution described in paragraph (1) 
                is introduced, such committee may be discharged 
                from further consideration of such joint 
                resolution upon a petition supported in writing 
                by 30 Members of the Senate, and such joint 
                resolution shall be placed on the calendar.
                  [``(C) Consideration.--
                          [``(i) In general.--In the Senate, 
                        when the committee to which a joint 
                        resolution is referred has reported, or 
                        when a committee is discharged (under 
                        subparagraph (C)) from further 
                        consideration of a joint resolution 
                        described in paragraph (1), it is at 
                        any time thereafter in order (even 
                        though a previous motion to the same 
                        effect has been disagreed to) for a 
                        motion to proceed to the consideration 
                        of the joint resolution to be made, and 
                        all points of order against the joint 
                        resolution (and against consideration 
                        of the joint resolution) are waived, 
                        except for points of order under the 
                        Congressional Budget act of 1974 or 
                        under budget resolutions pursuant to 
                        that Act. The motion is not debatable. 
                        A motion to reconsider the vote by 
                        which the motion is agreed to or 
                        disagreed to shall not be in order. If 
                        a motion to proceed to the 
                        consideration of the joint resolution 
                        is agreed to, the joint resolution 
                        shall remain the unfinished business of 
                        the Senate until disposed of.
                          [``(ii) Debate limitation.--In the 
                        Senate, consideration of the joint 
                        resolution, and on all debatable 
                        motions and appeals in connection 
                        therewith, shall be limited to not more 
                        than 10 hours, which shall be divided 
                        equally between the majority leader and 
                        the minority leader, or their 
                        designees. A motion further to limit 
                        debate is in order and not debatable. 
                        An amendment to, or a motion to 
                        postpone, or a motion to proceed to the 
                        consideration of other business, or a 
                        motion to recommit the joint resolution 
                        is not in order.
                          [``(iii) Passage.--In the Senate, 
                        immediately following the conclusion of 
                        the debate on a joint resolution 
                        described in paragraph (1), and a 
                        single quorum call at the conclusion of 
                        the debate if requested in accordance 
                        with the rules of the Senate, the vote 
                        on passage of the joint resolution 
                        shall occur.
                          [``(iv) Appeals.--Appeals from the 
                        decisions of the Chair relating to the 
                        application of the rules of the Senate 
                        to the procedure relating to a joint 
                        resolution described in paragraph (1) 
                        shall be decided without debate.
                  [``(D) Other House acts first.--If, before 
                the passage by 1 House of a joint resolution of 
                that House described in paragraph (1), that 
                House receives from the other House a joint 
                resolution described in paragraph (1), then the 
                following procedures shall apply:
                          [``(i) The joint resolution of the 
                        other House shall not be referred to a 
                        committee.
                          [``(ii) With respect to a joint 
                        resolution described in paragraph (1) 
                        of the House receiving the joint 
                        resolution--
                                  [``(I) the procedure in that 
                                House shall be the same as if 
                                no joint resolution had been 
                                received from the other House; 
                                but
                                  [``(II) the vote on final 
                                passage shall be on the joint 
                                resolution of the other House.
                  [``(E) Excluded days.--For purposes of 
                determining the period specified in 
                subparagraph (B), there shall be excluded any 
                days either House of Congress is adjourned for 
                more than 3 days during a session of Congress.
                  [``(F) Majority required for adoption.--A 
                joint resolution considered under this 
                subsection shall require an affirmative vote of 
                three-fifths of the Members, duly chosen and 
                sworn, for adoption.
          [``(3) Termination.--If a joint resolution described 
        in paragraph (1) is enacted not later than August 15, 
        2017--
                  [``(A) the Chief Actuary of the Medicare & 
                Medicaid Services shall not--
                          [``(i) make any determinations under 
                        subsection (c)(6) after May 1, 2017; or
                          [``(ii) provide any opinion pursuant 
                        to subsection (c)(3)(B)(iii) after 
                        January 16, 2018;
                  [``(B) the Board shall not submit any 
                proposals, advisory reports, or advisory 
                recommendations under this section or produce 
                the public report under subsection (n) after 
                January 16, 2018; and
                  [``(C) the Board and the consumer advisory 
                council under subsection (k) shall terminate on 
                August 16, 2018.
  [``(g) Board Membership; Terms of Office; Chairperson; 
Removal.--
          [``(1) Membership.--
                  [``(A) In general.--The Board shall be 
                composed of--
                          [``(i) 15 members appointed by the 
                        President, by and with the advice and 
                        consent of the Senate; and
                          [``(ii) the Secretary, the 
                        Administrator of the Center for 
                        Medicare & Medicaid Services, and the 
                        Administrator of the Health Resources 
                        and Services Administration, all of 
                        whom shall serve ex officio as 
                        nonvoting members of the Board.
                  [``(B) Qualifications.--
                          [``(i) In general.--The appointed 
                        membership of the Board shall include 
                        individuals with national recognition 
                        for their expertise in health finance 
                        and economics, actuarial science, 
                        health facility management, health 
                        plans and integrated delivery systems, 
                        reimbursement of health facilities, 
                        allopathic and osteopathic physicians, 
                        and other providers of health services, 
                        and other related fields, who provide a 
                        mix of different professionals, broad 
                        geographic representation, and a 
                        balance between urban and rural 
                        representatives.
                          [``(ii) Inclusion.--The appointed 
                        membership of the Board shall include 
                        (but not be limited to) physicians and 
                        other health professionals, experts in 
                        the area of pharmaco-economics or 
                        prescription drug benefit programs, 
                        employers, third-party payers, 
                        individuals skilled in the conduct and 
                        interpretation of biomedical, health 
                        services, and health economics research 
                        and expertise in outcomes and 
                        effectiveness research and technology 
                        assessment. Such membership shall also 
                        include representatives of consumers 
                        and the elderly.
                          [``(iii) Majority nonproviders.--
                        Individuals who are directly involved 
                        in the provision or management of the 
                        delivery of items and services covered 
                        under this title shall not constitute a 
                        majority of the appointed membership of 
                        the Board.
                  [``(C) Ethical disclosure.--The President 
                shall establish a system for public disclosure 
                by appointed members of the Board of financial 
                and other potential conflicts of interest 
                relating to such members. Appointed members of 
                the Board shall be treated as officers in the 
                executive branch for purposes of applying title 
                I of the Ethics in Government Act of 1978 
                (Public Law 95-521).
                  [``(D) Conflicts of interest.--No individual 
                may serve as an appointed member if that 
                individual engages in any other business, 
                vocation, or employment.
                  [``(E) Consultation with congress.--In 
                selecting individuals for nominations for 
                appointments to the Board, the President shall 
                consult with--
                          [``(i) the majority leader of the 
                        Senate concerning the appointment of 3 
                        members;
                          [``(ii) the Speaker of the House of 
                        Representatives concerning the 
                        appointment of 3 members;
                          [``(iii) the minority leader of the 
                        Senate concerning the appointment of 3 
                        members; and
                          [``(iv) the minority leader of the 
                        House of Representatives concerning the 
                        appointment of 3 members.
          [``(2) Term of office.--Each appointed member shall 
        hold office for a term of 6 years except that--
                  [``(A) a member may not serve more than 2 
                full consecutive terms (but may be reappointed 
                to 2 full consecutive terms after being 
                appointed to fill a vacancy on the Board);
                  [``(B) a member appointed to fill a vacancy 
                occurring prior to the expiration of the term 
                for which that member's predecessor was 
                appointed shall be appointed for the remainder 
                of such term;
                  [``(C) a member may continue to serve after 
                the expiration of the member's term until a 
                successor has taken office; and
                  [``(D) of the members first appointed under 
                this section, 5 shall be appointed for a term 
                of 1 year, 5 shall be appointed for a term of 3 
                years, and 5 shall be appointed for a term of 6 
                years, the term of each to be designated by the 
                President at the time of nomination.
          [``(3) Chairperson.--
                  [``(A) In general.--The Chairperson shall be 
                appointed by the President, by and with the 
                advice and consent of the Senate, from among 
                the members of the Board.
                  [``(B) Duties.--The Chairperson shall be the 
                principal executive officer of the Board, and 
                shall exercise all of the executive and 
                administrative functions of the Board, 
                including functions of the Board with respect 
                to--
                          [``(i) the appointment and 
                        supervision of personnel employed by 
                        the Board;
                          [``(ii) the distribution of business 
                        among personnel appointed and 
                        supervised by the Chairperson and among 
                        administrative units of the Board; and
                          [``(iii) the use and expenditure of 
                        funds.
                  [``(C) Governance.--In carrying out any of 
                the functions under subparagraph (B), the 
                Chairperson shall be governed by the general 
                policies established by the Board and by the 
                decisions, findings, and determinations the 
                Board shall by law be authorized to make.
                  [``(D) Requests for appropriations.--Requests 
                or estimates for regular, supplemental, or 
                deficiency appropriations on behalf of the 
                Board may not be submitted by the Chairperson 
                without the prior approval of a majority vote 
                of the Board.
          [``(4) Removal.--Any appointed member may be removed 
        by the President for neglect of duty or malfeasance in 
        office, but for no other cause.
  [``(h) Vacancies; Quorum; Seal; Vice Chairperson; Voting on 
Reports.--
          [``(1) Vacancies.--No vacancy on the Board shall 
        impair the right of the remaining members to exercise 
        all the powers of the Board.
          [``(2) Quorum.--A majority of the appointed members 
        of the Board shall constitute a quorum for the 
        transaction of business, but a lesser number of members 
        may hold hearings.
          [``(3) Seal.--The Board shall have an official seal, 
        of which judicial notice shall be taken.
          [``(4) Vice Chairperson.--The Board shall annually 
        elect a Vice Chairperson to act in the absence or 
        disability of the Chairperson or in case of a vacancy 
        in the office of the Chairperson.
          [``(5) Voting on proposals.--Any proposal of the 
        Board must be approved by the majority of appointed 
        members present.
  [``(i) Powers of the Board.--
          [``(1) Hearings.--The Board may hold such hearings, 
        sit and act at such times and places, take such 
        testimony, and receive such evidence as the Board 
        considers advisable to carry out this section.
          [``(2) Authority to inform research priorities for 
        data collection.--The Board may advise the Secretary on 
        priorities for health services research, particularly 
        as such priorities pertain to necessary changes and 
        issues regarding payment reforms under Medicare.
          [``(3) Obtaining official data.--The Board may secure 
        directly from any department or agency of the United 
        States information necessary to enable it to carry out 
        this section. Upon request of the Chairperson, the head 
        of that department or agency shall furnish that 
        information to the Board on an agreed upon schedule.
          [``(4) Postal services.--The Board may use the United 
        States mails in the same manner and under the same 
        conditions as other departments and agencies of the 
        Federal Government.
          [``(5) Gifts.--The Board may accept, use, and dispose 
        of gifts or donations of services or property.
          [``(6) Offices.--The Board shall maintain a principal 
        office and such field offices as it determines 
        necessary, and may meet and exercise any of its powers 
        at any other place.
  [``(j) Personnel Matters.--
          [``(1) Compensation of members and chairperson.--Each 
        appointed member, other than the Chairperson, shall be 
        compensated at a rate equal to the annual rate of basic 
        pay prescribed for level III of the Executive Schedule 
        under section 5315 of title 5, United States Code. The 
        Chairperson shall be compensated at a rate equal to the 
        daily equivalent of the annual rate of basic pay 
        prescribed for level II of the Executive Schedule under 
        section 5315 of title 5, United States Code.
          [``(2) Travel expenses.--The appointed members shall 
        be allowed travel expenses, including per diem in lieu 
        of subsistence, at rates authorized for employees of 
        agencies under subchapter I of chapter 57 of title 5, 
        United States Code, while away from their homes or 
        regular places of business in the performance of 
        services for the Board.
          [``(3) Staff.--
                  [``(A) In general.--The Chairperson may, 
                without regard to the civil service laws and 
                regulations, appoint and terminate an executive 
                director and such other additional personnel as 
                may be necessary to enable the Board to perform 
                its duties. The employment of an executive 
                director shall be subject to confirmation by 
                the Board.
                  [``(B) Compensation.--The Chairperson may fix 
                the compensation of the executive director and 
                other personnel without regard to chapter 51 
                and subchapter III of chapter 53 of title 5, 
                United States Code, relating to classification 
                of positions and General Schedule pay rates, 
                except that the rate of pay for the executive 
                director and other personnel may not exceed the 
                rate payable for level V of the Executive 
                Schedule under section 5316 of such title.
          [``(4) Detail of government employees.--Any Federal 
        Government employee may be detailed to the Board 
        without reimbursement, and such detail shall be without 
        interruption or loss of civil service status or 
        privilege.
          [``(5) Procurement of temporary and intermittent 
        services.--The Chairperson may procure temporary and 
        intermittent services under section 3109(b) of title 5, 
        United States Code, at rates for individuals which do 
        not exceed the daily equivalent of the annual rate of 
        basic pay prescribed for level V of the Executive 
        Schedule under section 5316 of such title.
  [``(k) Consumer Advisory Council.--
          [``(1) In general.--There is established a consumer 
        advisory council to advise the Board on the impact of 
        payment policies under this title on consumers.
          [``(2) Membership.--
                  [``(A) Number and appointment.--The consumer 
                advisory council shall be composed of 10 
                consumer representatives appointed by the 
                Comptroller General of the United States, 1 
                from among each of the 10 regions established 
                by the Secretary as of the date of enactment of 
                this section.
                  [``(B) Qualifications.--The membership of the 
                council shall represent the interests of 
                consumers and particular communities.
          [``(3) Duties.--The consumer advisory council shall, 
        subject to the call of the Board, meet not less 
        frequently than 2 times each year in the District of 
        Columbia.
          [``(4) Open meetings.--Meetings of the consumer 
        advisory council shall be open to the public.
          [``(5) Election of officers.--Members of the consumer 
        advisory council shall elect their own officers.
          [``(6) Application of FACA.--The Federal Advisory 
        Committee Act (5 U.S.C. App.) shall apply to the 
        consumer advisory council except that section 14 of 
        such Act shall not apply.
  [``(l) Definitions.--In this section:
          [``(1) Board; Chairperson; Member.--The terms 
        `Board', `Chairperson', and `Member' mean the 
        Independent Medicare Advisory Board established under 
        subsection (a) and the Chairperson and any Member 
        thereof, respectively.
          [``(2) Medicare.--The term `Medicare' means the 
        program established under this title, including parts 
        A, B, C, and D.
          [``(3) Medicare beneficiary.--The term `Medicare 
        beneficiary' means an individual who is entitled to, or 
        enrolled for, benefits under part A or enrolled for 
        benefits under part B.
          [``(4) Medicare program spending.--The term `Medicare 
        program spending' means program spending under parts A, 
        B, and D net of premiums.
  [``(m) Funding.--
          [``(1) In general.--There are appropriated to the 
        Board to carry out its duties and functions--
                  [``(A) for fiscal year 2012, $15,000,000; and
                  [``(B) for each subsequent fiscal year, the 
                amount appropriated under this paragraph for 
                the previous fiscal year increased by the 
                annual percentage increase in the Consumer 
                Price Index for All Urban Consumers (all items; 
                United States city average) as of June of the 
                previous fiscal year.
          [``(2) From trust funds.--Sixty percent of amounts 
        appropriated under paragraph (1) shall be derived by 
        transfer from the Federal Hospital Insurance Trust Fund 
        under section 1817 and 40 percent of amounts 
        appropriated under such paragraph shall be derived by 
        transfer from the Federal Supplementary Medical 
        Insurance Trust Fund under section 1841.
  [``(n) Annual Public Report.--
          [``(1) In general.--Not later than July 1, 2014, and 
        annually thereafter, the Board shall produce a public 
        report containing standardized information on system-
        wide health care costs, patient access to care, 
        utilization, and quality-of-care that allows for 
        comparison by region, types of services, types of 
        providers, and both private payers and the program 
        under this title.
          [``(2) Requirements.--Each report produced pursuant 
        to paragraph (1) shall include information with respect 
        to the following areas:
                  [``(A) The quality and costs of care for the 
                population at the most local level determined 
                practical by the Board (with quality and costs 
                compared to national benchmarks and reflecting 
                rates of change, taking into account quality 
                measures described in section 1890(b)(7)(B)).
                  [``(B) Beneficiary and consumer access to 
                care, patient and caregiver experience of care, 
                and the cost-sharing or out-of-pocket burden on 
                patients.
                  [``(C) Epidemiological shifts and demographic 
                changes.
                  [``(D) The proliferation, effectiveness, and 
                utilization of health care technologies, 
                including variation in provider practice 
                patterns and costs.
                  [``(E) Any other areas that the Board 
                determines affect overall spending and quality 
                of care in the private sector.
  [``(o) Advisory Recommendations for Non-Federal Health Care 
Programs.--
          [``(1) In general.--Not later than January 15, 2015, 
        and at least once every two years thereafter, the Board 
        shall submit to Congress and the President 
        recommendations to slow the growth in national health 
        expenditures (excluding expenditures under this title 
        and in other Federal health care programs) while 
        preserving or enhancing quality of care, such as 
        recommendations--
                  [``(A) that the Secretary or other Federal 
                agencies can implement administratively;
                  [``(B) that may require legislation to be 
                enacted by Congress in order to be implemented;
                  [``(C) that may require legislation to be 
                enacted by State or local governments in order 
                to be implemented;
                  [``(D) that private sector entities can 
                voluntarily implement; and
                  [``(E) with respect to other areas determined 
                appropriate by the Board.
          [``(2) Coordination.--In making recommendations under 
        paragraph (1), the Board shall coordinate such 
        recommendations with recommendations contained in 
        proposals and advisory reports produced by the Board 
        under subsection (c).
          [``(3) Available to public.--The Board shall make 
        recommendations submitted to Congress and the President 
        under this subsection available to the public.''.
          [(2)Lobbying cooling-off period for members of the 
        Independent Medicare Advisory Board.--Section 207(c) of 
        title 18, United States Code, is amended by inserting 
        at the end the following:
          [``(3) Members of the Independent Medicare Advisory 
        Board.--
                  [``(A) In general.--Paragraph (1) shall apply 
                to a member of the Independent Medicare 
                Advisory Board under section 1899A.
                  [``(B) Agencies and Congress.--For purposes 
                of paragraph (1), the agency in which the 
                individual described in subparagraph (A) served 
                shall be considered to be the Independent 
                Medicare Advisory Board, the Department of 
                Health and Human Services, and the relevant 
                committees of jurisdiction of Congress, 
                including the Committee on Ways and Means and 
                the Committee on Energy and Commerce of the 
                House of Representatives and the Committee on 
                Finance of the Senate.''.
  [(b) GAO Study and Report on Determination and Implementation 
of Payment and Coverage Policies Under the Medicare Program.--
          [(1) Initial study and report.--
                  [(A) Study.--The Comptroller General of the 
                United States (in this section referred to as 
                the ``Comptroller General'') shall conduct a 
                study on changes to payment policies, 
                methodologies, and rates and coverage policies 
                and methodologies under the Medicare program 
                under title XVIII of the Social Security Act as 
                a result of the recommendations contained in 
                the proposals made by the Independent Medicare 
                Advisory Board under section 1899A of such Act 
                (as added by subsection (a)), including an 
                analysis of the effect of such recommendations 
                on--
                          [(i) Medicare beneficiary access to 
                        providers and items and services;
                          [(ii) the affordability of Medicare 
                        premiums and cost-sharing (including 
                        deductibles, coinsurance, and 
                        copayments);
                          [(iii) the potential impact of 
                        changes on other government or private-
                        sector purchasers and payers of care; 
                        and
                          [(iv) quality of patient care, 
                        including patient experience, outcomes, 
                        and other measures of care.
                  [(B) Report.--Not later than July 1, 2015, 
                the Comptroller General shall submit to 
                Congress a report containing the results of the 
                study conducted under subparagraph (A), 
                together with recommendations for such 
                legislation and administrative action as the 
                Comptroller General determines appropriate.
          [(2) Subsequent studies and reports.--The Comptroller 
        General shall periodically conduct such additional 
        studies and submit reports to Congress on changes to 
        Medicare payments policies, methodologies, and rates 
        and coverage policies and methodologies as the 
        Comptroller General determines appropriate, in 
        consultation with the Committee on Ways and Means and 
        the Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Finance of the 
        Senate.
  [(c) Conforming Amendments.--Section 1805(b) of the Social 
Security Act (42 U.S.C. 1395b-6(b)) is amended--
          [(1) by redesignating paragraphs (4) through (8) as 
        paragraphs (5) through (9), respectively; and
          [(2) by inserting after paragraph (3) the following:
          [``(4) Review and comment on the Independent Medicare 
        Advisory Board or secretarial proposal.--If the 
        Independent Medicare Advisory Board (as established 
        under subsection (a) of section 1899A) or the Secretary 
        submits a proposal to the Commission under such section 
        in a year, the Commission shall review the proposal 
        and, not later than March 1 of that year, submit to the 
        Committee on Ways and Means and the Committee on Energy 
        and Commerce of the House of Representatives and the 
        Committee on Finance of the Senate written comments on 
        such proposal. Such comments may include such 
        recommendations as the Commission deems 
        appropriate.''.]

           *       *       *       *       *       *       *


    TITLE X--STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR ALL 
AMERICANS

           *       *       *       *       *       *       *


Subtitle C--Provisions Relating to Title III

           *       *       *       *       *       *       *


[SEC. 10320. EXPANSION OF THE SCOPE OF, AND ADDITIONAL IMPROVEMENTS TO, 
                    THE INDEPENDENT MEDICARE ADVISORY BOARD.

  [(a) In general.--Section 1899A of the Social Security Act, 
as added by section 3403, is amended--
          [(1) in subsection (c)--
                  [(A) in paragraph (1)(B), by adding at the 
                end the following new sentence: ``In any year 
                (beginning with 2014) that the Board is not 
                required to submit a proposal under this 
                section, the Board shall submit to Congress an 
                advisory report on matters related to the 
                Medicare program.'';
                  [(B) in paragraph (2)(A)--
                          [(i) in clause (iv), by inserting 
                        ``or the full premium subsidy under 
                        section 1860D-14(a)'' before the period 
                        at the end of the last sentence; and
                          [(ii) by adding at the end the 
                        following new clause:
                          [``(vii) If the Chief Actuary of the 
                        Centers for Medicare & Medicaid 
                        Services has made a determination 
                        described in subsection 
                        (e)(3)(B)(i)(II) in the determination 
                        year, the proposal shall be designed to 
                        help reduce the growth rate described 
                        in paragraph (8) while maintaining or 
                        enhancing beneficiary access to quality 
                        care under this title.'';
                  [(C) in paragraph (2)(B)--
                          [(i) in clause (v), by striking 
                        ``and'' at the end;
                          [(ii) in clause (vi), by striking the 
                        period at the end and inserting ``; 
                        and''; and
                          [(iii) by adding at the end the 
                        following new clause:
                          [``(vii) take into account the data 
                        and findings contained in the annual 
                        reports under subsection (n) in order 
                        to develop proposals that can most 
                        effectively promote the delivery of 
                        efficient, high quality care to 
                        Medicare beneficiaries.'';
                  [(D) in paragraph (3)--
                          [(i) in the heading, by striking 
                        ``Transmission of board proposal to 
                        president'' and inserting ``Submission 
                        of board proposal to congress and the 
                        president'';
                          [(ii) in subparagraph (A)(i), by 
                        striking ``transmit a proposal under 
                        this section to the President'' and 
                        insert ``submit a proposal under this 
                        section to Congress and the 
                        President''; and
                          [(iii) in subparagraph (A)(ii)--
                                  [(I) in subclause (I), by 
                                inserting ``or'' at the end;
                                  [(II) in subclause (II), by 
                                striking ``; or'' and inserting 
                                a period; and
                                  [(III) by striking subclause 
                                (III);
                  [(E) in paragraph (4)--
                          [(i) by striking ``the Board under 
                        paragraph (3)(A)(i) or''; and
                          [(ii) by striking ``immediately'' and 
                        inserting ``within 2 days'';
                  [(F) in paragraph (5)--
                          [(i) by striking ``to but'' and 
                        inserting ``but''; and
                          [(ii) by inserting ``Congress and'' 
                        after ``submit a proposal to''; and
                  [(G) in paragraph (6)(B)(i), by striking 
                ``per unduplicated enrollee'' and inserting 
                ``(calculated as the sum of per capita spending 
                under each of parts A, B, and D)'';
          [(2) in subsection (d)--
                  [(A) in paragraph (1)(A)--
                          [(i) by inserting ``the Board or'' 
                        after ``a proposal is submitted by''; 
                        and
                          [(ii) by inserting ``subsection 
                        (c)(3)(A)(i) or'' after ``the Senate 
                        under''; and
                  [(B) in paragraph (2)(A), by inserting ``the 
                Board or'' after ``a proposal is submitted 
                by'';
          [(3) in subsection (e)--
                  [(A) in paragraph (1), by inserting ``the 
                Board or'' after ``a proposal submitted by''; 
                and
                  [(B) in paragraph (3)--
                          [(i) By striking ``Exception.--The 
                        Secretary shall not be required to 
                        implement the recommendations contained 
                        in a proposal submitted in a proposal 
                        year by'' and inserting
                  [``(A) In general.--The Secretary shall not 
                implement the recommendations contained in a 
                proposal submitted in a proposal year by the 
                Board or'';
                          [(ii) by redesignating subparagraphs 
                        (A) and (B) as clauses (i) and (ii), 
                        respectively, and indenting 
                        appropriately; and
                          [(iii) by adding at the end the 
                        following new subparagraph:
                  [``(B) Limited additional exception.--
                          [``(i) In general.--Subject to clause 
                        (ii), the Secretary shall not implement 
                        the recommendations contained in a 
                        proposal submitted by the Board or the 
                        President to Congress pursuant to this 
                        section in a proposal year (beginning 
                        with proposal year 2019) if--
                                  [``(I) the Board was required 
                                to submit a proposal to 
                                Congress under this section in 
                                the year preceding the proposal 
                                year; and
                                  [``(II) the Chief Actuary of 
                                the Centers for Medicare & 
                                Medicaid Services makes a 
                                determination in the 
                                determination year that the 
                                growth rate described in 
                                subsection (c)(8) exceeds the 
                                growth rate described in 
                                subsection (c)(6)(A)(i).
                          [``(ii)Limited additional exception 
                        may not be applied in two consecutive 
                        years.--This subparagraph shall not 
                        apply if the recommendations contained 
                        in a proposal submitted by the Board or 
                        the President to Congress pursuant to 
                        this section in the year preceding the 
                        proposal year were not required to be 
                        implemented by reason of this 
                        subparagraph.
                          [``(iii)No affect on requirement to 
                        submit proposals or for congressional 
                        consideration of proposals.--Clause (i) 
                        and (ii) shall not affect--
                                  [``(I) the requirement of the 
                                Board or the President to 
                                submit a proposal to Congress 
                                in a proposal year in 
                                accordance with the provisions 
                                of this section; or
                                  [``(II) Congressional 
                                consideration of a legislative 
                                proposal (described in 
                                subsection (c)(3)(B)(iv)) 
                                contained such a proposal in 
                                accordance with subsection 
                                (d).'';
          [(4) in subsection (f)(3)(B)--
                  [(A) by striking ``or advisory reports to 
                Congress'' and inserting ``, advisory reports, 
                or advisory recommendations''; and
                  [(B) by inserting ``or produce the public 
                report under subsection (n)'' after ``this 
                section''; and
          [(5) by adding at the end the following new 
        subsections:
  [``(n) Annual Public Report.--
          [``(1) In general.--Not later than July 1, 2014, and 
        annually thereafter, the Board shall produce a public 
        report containing standardized information on system-
        wide health care costs, patient access to care, 
        utilization, and quality-of-care that allows for 
        comparison by region, types of services, types of 
        providers, and both private payers and the program 
        under this title.
          [``(2) Requirements.--Each report produced pursuant 
        to paragraph (1) shall include information with respect 
        to the following areas:
                  [``(A) The quality and costs of care for the 
                population at the most local level determined 
                practical by the Board (with quality and costs 
                compared to national benchmarks and reflecting 
                rates of change, taking into account quality 
                measures described in section 1890(b)(7)(B)).
                  [``(B) Beneficiary and consumer access to 
                care, patient and caregiver experience of care, 
                and the cost-sharing or out-of-pocket burden on 
                patients.
                  [``(C) Epidemiological shifts and demographic 
                changes.
                  [``(D) The proliferation, effectiveness, and 
                utilization of health care technologies, 
                including variation in provider practice 
                patterns and costs.
                  [``(E) Any other areas that the Board 
                determines affect overall spending and quality 
                of care in the private sector.
  [``(o) Advisory Recommendations for Non-Federal Health Care 
Programs.--
          [``(1) In general.--Not later than January 15, 2015, 
        and at least once every two years thereafter, the Board 
        shall submit to Congress and the President 
        recommendations to slow the growth in national health 
        expenditures (excluding expenditures under this title 
        and in other Federal health care programs) while 
        preserving or enhancing quality of care, such as 
        recommendations--
                  [``(A) that the Secretary or other Federal 
                agencies can implement administratively;
                  [``(B) that may require legislation to be 
                enacted by Congress in order to be implemented;
                  [``(C) that may require legislation to be 
                enacted by State or local governments in order 
                to be implemented;
                  [``(D) that private sector entities can 
                voluntarily implement; and
                  [``(E) with respect to other areas determined 
                appropriate by the Board.
          [``(2)Coordination.--In making recommendations under 
        paragraph (1), the Board shall coordinate such 
        recommendations with recommendations contained in 
        proposals and advisory reports produced by the Board 
        under subsection (c).
          [``(3) Available to public.--The Board shall make 
        recommendations submitted to Congress and the President 
        under this subsection available to the public.''.
  [(b) Name Change.--Any reference in the provisions of, or 
amendments made by, section 3403 to the ``Independent Medicare 
Advisory Board'' shall be deemed to be a reference to the 
``Independent Payment Advisory Board''.
  [(c) Rule of Construction.--Nothing in the amendments made by 
this section shall preclude the Independent Medicare Advisory 
Board, as established under section 1899A of the Social 
Security Act (as added by section 3403), from solely using data 
from public or private sources to carry out the amendments made 
by subsection (a)(4).]

           *       *       *       *       *       *       *


                  VOTES OF THE COMMITTEE ON THE BUDGET

                              ----------                              

    Clause 3(b) of House Rule XIII requires each committee 
report to accompany any bill or resolution of a public 
character to include the total number of votes cast for and 
against each roll call vote, on a motion to report and any 
amendments offered to the measure or matter, together with the 
names of those voting for and against.
    Listed below are the actions taken in the Committee on the 
Budget of the House of Representatives on the Restoring 
Americans' Healthcare Freedom Reconciliation Act of 2015.
    On October 9, 2015, the Committee met in open session, a 
quorum being present.
    Mr. Rokita asked unanimous consent that the Chair be 
authorized, consistent with clause 4 of House Rule XVI, to 
declare a recess at any time during the Committee meeting.
    There was no objection to the unanimous consent request.
    The Committee adopted and ordered reported the Restoring 
Americans' Healthcare Freedom Reconciliation Act of 2015.
    The Committee on the Budget took the following votes:
    Mr. Rokita made a motion that the Committee report the bill 
with the recommendation that the bill do pass.
    The motion was agreed to by a roll call vote of 21 ayes to 
11 noes.

                           ROLLCALL VOTE NO. 1
------------------------------------------------------------------------
  Name &                     Answer     Name &                   Answer
  State      Aye     No     Present     State      Aye     No    Present
------------------------------------------------------------------------
PRICE         X                       VAN                  X
 (GA)                                  HOLLEN
 (Chairma                              (MD)
 n)                                    (Ranking
                                       )
------------------------------------------------------------------------
ROKITA        X                       YARMUTH              X
 (IN)                                  (KY)
------------------------------------------------------------------------
GARRETT       X                       PASCRELL             X
 (NJ)                                  (NJ)
------------------------------------------------------------------------
DIAZ-BALA     X                       RYAN (OH)            X
 RT (FL)
------------------------------------------------------------------------
COLE (OK)     X                       MOORE                X
                                       (WI)
------------------------------------------------------------------------
McCLINTOC     X                       CASTOR               X
 K (CA)                                (FL)
------------------------------------------------------------------------
BLACK         X                       McDERMOTT            X
 (TN)                                  (WA)
------------------------------------------------------------------------
WOODALL       X                       LEE (CA)             X
 (GA)
------------------------------------------------------------------------
BLACKBURN     X                       POCAN                X
 (TN)                                  (WI)
------------------------------------------------------------------------
HARTZLER      X                       LUJAN
 (MO)                                  GRISHAM
                                       (NM)
------------------------------------------------------------------------
RICE (SC)     X                       DINGELL
                                       (MI)
------------------------------------------------------------------------
STUTZMAN      X                       LIEU (CA)
 (IN)
------------------------------------------------------------------------
SANFORD                               NORCROSS             X
 (SC)                                  (NJ)
------------------------------------------------------------------------
BUCHANAN      X                       MOULTON              X
 (FL)                                  (MA)
------------------------------------------------------------------------
WOMACK        X            .........
 (AR)
------------------------------------------------------------------------
BRAT (VA)     X            .........
------------------------------------------------------------------------
BLUM (IA)     X                       .........
------------------------------------------------------------------------
MOONEY        X                       .........
 (WV)
------------------------------------------------------------------------
GROTHMMAN     X                       .........
 (WI)
------------------------------------------------------------------------
PALMER        X            .........
 (AL)
------------------------------------------------------------------------
MOOLENAAR     X            .........
 (MI)
------------------------------------------------------------------------
WESTERMAN     X
 (AR)
------------------------------------------------------------------------

    Mr. Rokita made a motion that, pursuant to clause 1 of rule 
XXII, the Chair be authorized to offer motions to go to 
conference and file any related conference report; the staff be 
authorized to make any necessary technical and conforming 
corrections prior to filing the bill, such as inserting the 
short title of the bill; and the motion to reconsider be laid 
on the table.
    The motion was agreed to without objection.

   MOTIONS ON THE RULE FOR CONSIDERATION OF THE RESTORING AMERICANS' 
             HEALTHCARE FREEDOM RECONCILIATION ACT OF 2015

A Motion Offered by Mr. Van Hollen

    1. Representative Van Hollen moved that the Committee on 
the Budget direct its Chairman to request on behalf of the 
Committee that the rule for consideration of the reconciliation 
bill make in order an amendment that would (1) strike all of 
the underlying text, which is an irresponsible attack on 
women's health care and the Affordable Care Act, and (2) 
replace it with the text of H.R. 3708, which calls for 
bipartisan negotiations to raise the discretionary spending 
caps for fiscal year 2016 or, if those negotiations fail, 
raises the defense and non-defense discretionary caps by equal 
amounts to the President's requested level to allow 
appropriations action to proceed and fund essential services at 
necessary levels.
    The motion was not agreed to by a roll call vote of 13 ayes 
to 19 noes.

                           ROLLCALL VOTE NO. 2
------------------------------------------------------------------------
  Name &                     Answer     Name &                   Answer
  State      Aye     No     Present     State      Aye     No    Present
------------------------------------------------------------------------
PRICE                 X               VAN           X
 (GA)                                  HOLLEN
 (Chairma                              (MD)
 n)                                    (Ranking
                                       )
------------------------------------------------------------------------
ROKITA                X               YARMUTH       X
 (IN)                                  (KY)
------------------------------------------------------------------------
GARRETT               X               PASCRELL      X
 (NJ)                                  (NJ)
------------------------------------------------------------------------
DIAZ-BALA             X               RYAN (OH)     X
 RT (FL)
------------------------------------------------------------------------
COLE (OK)             X               MOORE         X
                                       (WI)
------------------------------------------------------------------------
McCLINTOC             X               CASTOR        X
 K (CA)                                (FL)
------------------------------------------------------------------------
BLACK                 X               McDERMOTT     X
 (TN)                                  (WA)
------------------------------------------------------------------------
WOODALL               X               LEE (CA)      X
 (GA)
------------------------------------------------------------------------
BLACKBURN             X               POCAN         X
 (TN)                                  (WI)
------------------------------------------------------------------------
HARTZLER              X               LUJAN         X
 (MO)                                  GRISHAM
                                       (NM)
------------------------------------------------------------------------
RICE (SC)             X               DINGELL
                                       (MI)
------------------------------------------------------------------------
STUTZMAN              X               LIEU (CA)     X
 (IN)
------------------------------------------------------------------------
SANFORD                               NORCROSS      X
 (SC)                                  (NJ)
------------------------------------------------------------------------
BUCHANAN              X               MOULTON       X
 (FL)                                  (MA)
------------------------------------------------------------------------
WOMACK                X    .........
 (AR)
------------------------------------------------------------------------
BRAT (VA)             X    .........
------------------------------------------------------------------------
BLUM (IA)             X               .........
------------------------------------------------------------------------
MOONEY                X               .........
 (WV)
------------------------------------------------------------------------
GROTHMMAN                             .........
 (WI)
------------------------------------------------------------------------
PALMER                     .........
 (AL)
------------------------------------------------------------------------
MOOLENAAR             X    .........
 (MI)
------------------------------------------------------------------------
WESTERMAN             X
 (AR)
------------------------------------------------------------------------

    Pursuant to a unanimous consent request made by Chairman 
Price, Representative Palmer requested that the record reflect 
he would have voted no on the roll call vote, but was unable to 
be present because he was voting at the Committee on Oversight 
and Government Reform when the vote in the Committee on the 
Budget was called.

A Motion Offered by Mr. Rokita

    2. Representative Rokita moved that the Chairman of the 
Committee on the Budget be provided the discretion to request 
the Committee on Rules report a rule that would make in order 
an amendment to the Restoring Americans' Healthcare Freedom 
Reconciliation Act of 2015, as reported.
    The motion was agreed to by a roll call vote of 21 ayes to 
13 noes.

                           ROLLCALL VOTE NO. 3
------------------------------------------------------------------------
  Name &                     Answer     Name &                   Answer
  State      Aye     No     Present     State      Aye     No    Present
------------------------------------------------------------------------
PRICE         X                       VAN                  X
 (GA)                                  HOLLEN
 (Chairma                              (MD)
 n)                                    (Ranking
                                       )
------------------------------------------------------------------------
ROKITA        X                       YARMUTH              X
 (IN)                                  (KY)
------------------------------------------------------------------------
GARRETT       X                       PASCRELL             X
 (NJ)                                  (NJ)
------------------------------------------------------------------------
DIAZ-BALA     X                       RYAN (OH)            X
 RT (FL)
------------------------------------------------------------------------
COLE (OK)     X                       MOORE                X
                                       (WI)
------------------------------------------------------------------------
McCLINTOC     X                       CASTOR               X
 K (CA)                                (FL)
------------------------------------------------------------------------
BLACK         X                       McDERMOTT            X
 (TN)                                  (WA)
------------------------------------------------------------------------
WOODALL       X                       LEE (CA)             X
 (GA)
------------------------------------------------------------------------
BLACKBURN     X                       POCAN                X
 (TN)                                  (WI)
------------------------------------------------------------------------
HARTZLER      X                       LUJAN                X
 (MO)                                  GRISHAM
                                       (NM)
------------------------------------------------------------------------
RICE (SC)     X                       DINGELL
                                       (MI)
------------------------------------------------------------------------
STUTZMAN      X                       LIEU (CA)            X
 (IN)
------------------------------------------------------------------------
SANFORD                               NORCROSS             X
 (SC)                                  (NJ)
------------------------------------------------------------------------
BUCHANAN      X                       MOULTON              X
 (FL)                                  (MA)
------------------------------------------------------------------------
WOMACK        X            .........
 (AR)
------------------------------------------------------------------------
BRAT (VA)     X            .........
------------------------------------------------------------------------
BLUM (IA)     X                       .........
------------------------------------------------------------------------
MOONEY        X                       .........
 (WV)
------------------------------------------------------------------------
GROTHMMAN     X                       .........
 (WI)
------------------------------------------------------------------------
PALMER        X            .........
 (AL)
------------------------------------------------------------------------
MOOLENAAR     X            .........
 (MI)
------------------------------------------------------------------------
WESTERMAN     X
 (AR)
------------------------------------------------------------------------


                    OTHER HOUSE REPORT REQUIREMENTS

                              ----------                              


                      Committee Oversight Findings

    Clause 3(c)(1) of rule XIII of the Rules of the House of 
Representatives requires the report of a committee on a measure 
to contain oversight findings and recommendations required 
pursuant to clause (2)(b)(1) of rule X. The Committee on the 
Budget has examined its activities over the past session and 
has determined that there are no specific oversight findings on 
the text of the reported bill.

                        Committee Cost Estimate

    For purposes of clauses 3(c)(2) and (3) of rule XIII of the 
Rules of the House of Representatives and section 308(a)(1) of 
the Congressional Budget Act of 1974 (relating to estimates of 
new budget authority, new spending autohrity, new credit 
authority, or increased or decreased revenues or tax 
expenditures), the committee report incorporates the cost 
estimate prepared by the Director of the Congressional Budget 
Office pursuant to sections 402 and 423 of the Congressional 
Budget Act of 1974.

                                  ESTIMATE OF THE BUDGETARY EFFECTS OF DRAFT LEGISLATION TO PROVIDE FOR RECONCILIATION
 [Pursuant to Title II of the Concurrent Resolution on the Budget for Fiscal Year 2016, as posted on the website of the House Committee on the Budget on
                                                    October 8, 2015--without macroeconomic feedback]
--------------------------------------------------------------------------------------------------------------------------------------------------------
   Billions of dollars, by fiscal year      2016     2017     2018     2019     2020     2021     2022     2023     2024     2025   2016-2020  2016-2025
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CHANGES IN DIRECT SPENDING
Title I--Committee on Education and the
 Workforce:
Auto-Enrollment for Certain Large
 Employers:
  Estimated Budget Authority............      0        0.1      0.2      0.4      0.5      0.5      0.5      0.6      0.6      0.7        1.3        4.3
  Estimated Outlays.....................      0        0.1      0.2      0.4      0.5      0.5      0.5      0.6      0.6      0.7        1.3        4.3
Title II--Committee on Energy and
 Commerce:
Prevention and Public Health Fund:
  Estimated Budget Authority............     -1.0     -1.0     -1.3     -1.3     -1.5     -1.5     -2.0     -2.0     -2.0     -2.0       -6.0      -15.5
  Estimated Outlays.....................     -0.2     -0.5     -0.9     -1.1     -1.3     -1.4     -1.6     -1.8     -1.9     -2.0       -4.1      -12.7
Medicaid:
  Estimated Budget Authority............     -0.2      *        *        *        *        *        *        *        *        0         -0.2       -0.2
  Estimated Outlays.....................     -0.2      *        *        *        *        *        *        *        *        0         -0.2       -0.2
Community Health Center Program
  Estimated Budget Authority............      0.2      0.2      0        0        0        0        0        0        0        0          0.5        0.5
  Estimated Outlays.....................      0.1      0.2      0.1      *        0        0        0        0        0        0          0.5        0.5
Title III--Committee on Ways and Means:
Repeal Individual and Employer Mandates:
  Estimated Budget Authority............     -8.7    -17.2    -21.0    -24.3    -26.4    -28.3    -30.3    -31.9    -33.7    -35.1      -97.6     -256.9
  Estimated Outlays.....................     -8.7    -17.2    -21.0    -24.3    -26.4    -28.3    -30.3    -31.9    -33.7    -35.1      -97.6     -256.9
Repeal Excise Tax on High-Premium
 Insurance Plans:
  Estimated Budget Authority............      0        0       -0.7     -0.9     -1.4     -1.6     -2.4     -3.1     -3.9     -4.1       -3.0      -18.2
  Estimated Outlays.....................      0        0       -0.7     -0.9     -1.4     -1.6     -2.4     -3.1     -3.9     -4.1       -3.0      -18.2
Repeal IPAB:
  Estimated Budget Authority............      0        0        0        0        0        0        0.6      1.5      1.9      3.1        0          7.1
  Estimated Outlays.....................      0        0        0        0        0        0        0.6      1.5      1.9      3.1        0          7.1
Interaction Effects Across Titles:\a\
  Estimated Budget Authority............      0        *       -0.1     -0.2     -0.3     -0.3     -0.3     -0.3     -0.2     -0.3       -0.7       -2.0
  Estimated Outlays.....................      0        *       -0.1     -0.2     -0.3     -0.3     -0.3     -0.3     -0.2     -0.3       -0.7       -2.0
Total Changes in Direct Spending:
  Estimated Budget Authority............     -9.7    -17.9    -22.8    -26.2    -29.0    -31.1    -33.8    -35.3    -37.3    -37.7     -105.7     -281.0
  Estimated Outlays.....................     -9.1    -17.5    -22.4    -26.1    -28.8    -31.0    -33.4    -35.0    -37.2    -37.7     -103.8     -278.2
 
                                                                   CHANGES IN REVENUES
 
Title I--Committee on Education and the
 Workforce:
Auto-Enrollment for Certain Large             0        0.2      0.8      1.4      0.8      1.1      1.7      1.9      2.1      2.2        3.3       12.2
 Employers..............................
Title III--Committee on Ways and Means:
  Repeal Individual and Employer            -10.1     -8.0     -8.0     -9.8    -10.5    -10.9    -11.9    -12.9    -13.5    -14.1      -46.4     -109.8
   Mandates.............................
  Repeal Medical Device Tax.............     -1.4     -2.0     -2.1     -2.2     -2.3     -2.5     -2.6     -2.8     -2.9     -3.1      -10.0      -23.9
  Repeal Excise Tax on High-Premium           0        0       -2.9     -8.1     -9.7    -11.5    -14.0    -17.1    -20.8    -25.0      -20.8     -109.3
   Insurance Plans......................
Interaction Effects within Title III....      0        0        *        2.1      2.0      1.7      1.7      1.6      1.6      1.4        4.1       12.1
Interaction Effects Across Titles\a\....      0        0.3      1.0      1.7      2.3      2.5      2.5      2.8      3.1      3.4        5.2       19.4
Total Changes in Revenues...............    -11.5     -9.4    -11.2    -15.0    -17.5    -19.7    -22.6    -26.5    -30.5    -35.2      -64.6     -199.3
  On-Budget.............................    -13.0    -13.7    -15.8    -19.7    -21.8    -24.1    -26.8    -30.2    -33.8    -37.7      -84.1     -236.6
  Off-Budget\b\.........................      1.5      4.3      4.6      4.8      4.4      4.4      4.2      3.7      3.3      2.4       19.7       37.6
 
                               NET INCREASE OR DECREASE (-) IN THE DEFICIT FROM CHANGES IN DIRECT SPENDING AND REVENUES\c\
 
Impact on Deficit.......................      2.4     -8.0    -11.2    -11.1    -11.4    -11.4    -10.8     -8.5     -6.7     -2.4      -39.2      -78.9
  On-Budget.............................      3.9     -3.8     -6.6     -6.4     -7.0     -6.0     -6.5     -4.8     -3.4      *        -19.5      -41.3
  Off-Budget\b\.........................     -1.5     -4.3     -4.6     -4.8     -4.4     -4.4     -4.2     -3.7     -3.3     -2.4      -19.7      -37.6
Memorandum:
Net Effect on Deficit:
  Title I...............................      0       -0.2     -0.6     -0.9     -0.2     -0.5     -1.1     -1.3     -1.4     -1.5       -2.0       -7.9
  Title II..............................     -0.4     -0.3     -0.8     -1.1     -1.3     -1.4     -1.6     -1.8     -1.9     -2.0       -3.8      -12.5
  Title III.............................      2.8     -7.2     -8.7     -7.2     -7.3     -6.7     -5.3     -2.3     -0.1      4.7      -27.5      -37.1
  Interaction Effects Across Titles.....      0       -0.4     -1.1     -1.9     -2.5     -2.7     -2.8     -3.1     -3.3     -3.6       -5.9      -21.4
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sources: Congressional Budget Office and the staff of the Joint Committee on Taxation
 
Notes: Numbers may not add up to totals because of rounding; IPAB = Independent Payment Advisory Board; * = an increase or decrease between zero and
  $500 million; This legislation meets the threshold established in section 3112 of the Concurrent Resolution on the Budget for Fiscal Year 2016, which
  requires that the CBO estimate incorporate macroeconomic effects. CBO has not yet completed an analysis of those effects. An estimate including that
  analysis will be released at a later date
 
a. Includes the additional effects of combining the repeal of the auto-enrollment requirement for large employers with the repeal of the individual and
  employer mandates
 
b. All off-budget effects would come from changes in revenues. (The payroll taxes for Social Security are classified as off-budget.)
 
c. CBO and JCT estimate that enacting the legislation would not increase net direct spending in either of the first two consecutive 10-year periods
  beginning in 2026; at some point the costs of repealing IPAB would exceed the savings from the other provisions, but the agencies cannot determine
  whether that would occur during the third or fourth 10-year period after 2026 or later. On a preliminary basis, the agencies estimate that enacting
  the legislation would increase on-budget deficits by at least $5 billion in one or more of the four consecutive 10-year periods beginning in 2026

                        Macroeconomic Estimates

    Clause 8 of rule XIII of the Rules of the House of 
Representatives requires that the estimates provided under 
section 402 of the Congressional Budget Act of 1974 for major 
legislation to include, to the extent practicable, the 
budgetary effects of changes in economic output, employment, 
capital stock, and other macroeconomic variables resulting from 
such legislation. It was not practicable for the Congressional 
Budget Office to produce the macroeconomic estimates prior to 
the deadline for filing this bill. It is anticipated that such 
estimate will be available prior to the consideration of this 
bill by the House, which will be made available on the 
Congressional Budget Office's website.

                    Performance Goals and Objectives

    Clause 3(c)(4) of rule XIII of the Rules of the House of 
Representatives requires the report of a committee on a measure 
to include a statement of general performance goals and 
objectives, including outcome-related goals and objectives, for 
which the measure authorizes funding. This bill is reported 
pursuant to section 2002 of S. Con. Res. 11, the Concurrent 
Resolution on the Budget for Fiscal Year 2016. The goals and 
objectives of this bill are to reduce the deficit by at least 
$3 billion over the 10-year period and clear the way for real 
health care reform that meets the principles set forth in the 
introduction of this report.

                   Constitutional Authority Statement

    Clause 7(c)(1) of rule XII of the Rules of the House of 
Representatives requires each report of a committee on a public 
bill or public joint resolution contain a statement citing the 
specific powers granted to Congress in the Constitution to 
enact the law proposed by the bill or joint resolution. The 
Committee on the Budget finds the Constitutional authority for 
this legislation in Article I of the Constitution, Sections 5 
and 8.

         Changes in Existing Law Made by the Bill, as Reported

    Clause 3(e) of rule XIII of the Rules of the House of 
Representatives requires each report of a committee on a bill 
or joint resolution contain the text of statutes that are 
proposed to be repealed and a comparative print of that part of 
the bill proposed to be amended whenever the bill repeals or 
amends any statute. The required matter is included in the 
report language for each title, or in the case of the Committee 
on Ways and Means each subtitle, of the legislative 
recommendations submitted by the appropriate authorizing 
committees and reported to the House by the Committee on the 
Budget.

                       Federal Mandates Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act of 1974 requires a statement of whether the 
provisions of the reported bill include unfunded mandates. The 
Congressional Budget Office has determined that the bill 
contains no intergovernmental or private sector mandates within 
the narrow definition of the Unfunded Mandates Reform Act of 
1995. Any statements regarding unfunded mandates for the 
legislative recommendations submitted by each of the 
authorizing committees are included under the appropriate 
titles.

                          Advisory on Earmarks

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, the bill does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(e), 9(f), or 9(g) of rule XXI 
of the Rules of the House of Representatives.

                    Duplication of Federal Programs

    Section 3(g)(2) of H. Res. 5 requires reports for measures 
creating or reauthorizing programs of the Federal Government to 
include a statement indicating whether any such program is 
known to be duplicative of another such program. The 
reconciliation bill reported by the Committee on the Budget 
does not establish or authorize any new Federal programs.

                   Disclosure of Directed Rulemakings

    Section 3(i) of H. Res. 5 requires committee reports on any 
bill or joint resolution to include a statement estimating the 
number directed makings required by the measure. This bill does 
not require any directed rulemakings.

                       VIEWS OF COMMITTEE MEMBERS

                              ----------                              

    Clause 2(c) of rule XIII of the Rules of the House of 
Representatives requires each report by a committee on a public 
matter to include any additional, minority, supplemental, or 
dissenting views submitted pursuant to clause 2(l) of rule XI 
by one or more members of the committee. In addition, this 
report includes views from members of committees submitting 
reconciliation recommendations pursuant to section 2002 of S. 
Con. Res. 11 under the appropriate titles or subtitles, as the 
case may be, of this report. The [minority and additional 
views] of members of the Committee on the Budget are as 
follows:


  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 ``Restoring 
Americans' Healthcare Freedom Reconciliation Act of 2015''.
  (b) Table of Contents.--The table of contents of this Act is 
as follows:

Sec. 1. Short title; table of contents.

            TITLE I--COMMITTEE ON EDUCATION AND THE WORKFORCE

Sec. 101. Repeal of automatic enrollment requirement.

               TITLE II--COMMITTEE ON ENERGY AND COMMERCE

Sec. 201. Repeal of the Prevention and Public Health Fund.
Sec. 202. Federal payment to States.
Sec. 203. Funding for community health center program.

                 TITLE III--COMMITTEE ON WAYS AND MEANS

                     Subtitle A--Revenue Provisions

Sec. 301. Repeal of individual mandate.
Sec. 302. Repeal of employer mandate.
Sec. 303. Repeal of medical device excise tax.
Sec. 304. Repeal of the tax on employee health insurance premiums and 
          health plan benefits and related reporting requirements.

        Subtitle B--Repeal of Independent Payment Advisory Board

Sec. 311. Repeal of Independent Payment Advisory Board.

           TITLE I--COMMITTEE ON EDUCATION AND THE WORKFORCE

SEC. 101. REPEAL OF AUTOMATIC ENROLLMENT REQUIREMENT.

  The Fair Labor Standards Act of 1938 (29 U.S.C. 201 et seq.) 
is amended by repealing section 18A (as added by section 1511 
of the Patient Protection and Affordable Care Act (Public Law 
111-148)).

               TITLE II--COMMITTEE ON ENERGY AND COMMERCE

SEC. 201. REPEAL OF THE PREVENTION AND PUBLIC HEALTH FUND.

  (a) In General.--Section 4002 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 300u-11) is repealed.
  (b) Rescission of Unobligated Funds.--Of the funds made 
available by such section 4002, the unobligated balance is 
rescinded.

SEC. 202. FEDERAL PAYMENT TO STATES.

  (a) In General.--Notwithstanding sections 504(a), 
1902(a)(23), 2002, 2005(a)(4), 2102(a)(7), or 2105(a)(1) of the 
Social Security Act (42 U.S.C. 704(a), 1396b(a)(23), 1397a, 
1397d(a)(4), 1397bb(a)(2), 1397ee(a)(1)), or the terms of any 
Medicaid waiver in effect on the date of enactment of this Act 
that is approved under section 1115 or 1915 of the Social 
Security Act (42 U.S.C. 1315, 1396n), for the one-year period 
beginning on the date of the enactment of this Act no Federal 
funds may be made available to a State for payments to a 
prohibited entity.
  (b) Definition of Prohibited Entity.--In this section, the 
term ``prohibited entity'' means an entity, including its 
affiliates, subsidiaries, successors, and clinics--
          (1) that, as of the date of enactment of this Act--
                  (A) is an organization described in section 
                501(c)(3) of the Internal Revenue Code of 1986 
                and exempt from tax under section 501(a) of 
                such Code;
                  (B) is an essential community provider 
                described in section 156.235 of title 45, Code 
                of Federal Regulations, that is primarily 
                engaged in family planning services, 
                reproductive health, and related medical care; 
                and
                  (C) provides for elective abortions; and
          (2) for which the total amount of Federal and State 
        expenditures under the Medicaid program under title XIX 
        of the Social Security Act in fiscal year 2014 made 
        directly to the entity and to any affiliates, 
        subsidiaries, successors, or clinics of the entity, or 
        made to the entity and to any affiliates, subsidiaries, 
        successors, or clinics of the entity as part of a 
        nationwide health care provider network, exceeded 
        $350,000,000.

SEC. 203. FUNDING FOR COMMUNITY HEALTH CENTER PROGRAM.

  Effective as if included in the enactment of the Medicare 
Access and CHIP Reauthorization Act of 2015 (Public Law 114-10, 
129 Stat. 87), paragraph (1) of section 221(a) of such Act is 
amended by inserting after ``Section 10503(b)(1)(E) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-
2(b)(1)(E)) is amended'' the following: ``by striking 
`$3,600,000,000' and inserting `$3,835,000,000' and''.

                 TITLE III--COMMITTEE ON WAYS AND MEANS

                     Subtitle A--Revenue Provisions

SEC. 301. REPEAL OF INDIVIDUAL MANDATE.

  (a) In General.--Section 5000A of the Internal Revenue Code 
of 1986 is amended by adding at the end the following:
  ``(h) Termination.--This section shall not apply with respect 
to any month beginning after December 31, 2014.''.
  (b) Conforming Amendments.--
          (1) Section 5000A(c) of such Code is amended--
                  (A) in paragraph (2)(B) by striking clauses 
                (ii) and (iii),
                  (B) in paragraph (3)(B) by striking ``2014'' 
                and all that follows and inserting ``2014.'', 
                and
                  (C) in paragraph (3) by striking subparagraph 
                (D).
          (2) Section 5000A(e)(1) of such Code is amended by 
        striking subparagraph (D).
  (c)Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2014.

SEC. 302. REPEAL OF EMPLOYER MANDATE.

  (a) In General.--Section 4980H of the Internal Revenue Code 
of 1986 is amended by adding at the end the following:
  ``(e) Termination.--This section shall not apply with respect 
to any month beginning after December 31, 2014.''.
  (b) Conforming Amendment.--Section 4980H(c) of such Code is 
amended by striking paragraph (5).
  (c)Effective Date.--The amendments made by this section shall 
apply to months beginning after December 31, 2014.

SEC. 303. REPEAL OF MEDICAL DEVICE EXCISE TAX.

  (a) In General.--Chapter 32 of the Internal Revenue Code of 
1986 is amended by striking subchapter E.
  (b) Conforming Amendments.--
          (1) Subsection (a) of section 4221 of such Code is 
        amended by striking the last sentence.
          (2) Paragraph (2) of section 6416(b) of such Code is 
        amended by striking the last sentence.
  (c) Clerical Amendment.--The table of subchapters for chapter 
32 of such Code is amended by striking the item relating to 
subchapter E.
  (d) Effective Date.--The amendments made by this section 
shall apply to sales in calendar quarters beginning after the 
date of the enactment of this Act.

SEC. 304. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE PREMIUMS AND 
                    HEALTH PLAN BENEFITS AND RELATED REPORTING 
                    REQUIREMENTS.

  (a) Excise Tax.--Chapter 43 of the Internal Revenue Code of 
1986 is amended by striking section 4980I.
  (b) Reporting Requirement.--Section 6051(a) of such Code is 
amended by inserting ``and'' at the end of paragraph (12), by 
striking ``, and'' at the end of paragraph (13) and inserting a 
period, and by striking paragraph (14).
  (c) Clerical Amendment.--The table of sections for chapter 43 
of such Code is amended by striking the item relating to 
section 4980I.
  (d) Effective Dates.--
          (1) In general.--Except as provided by paragraph (2), 
        the amendments made by this section shall apply to 
        taxable years beginning after December 31, 2017.
          (2) Reporting requirement.--The amendment made by 
        subsection (b) shall apply to calendar years beginning 
        after December 31, 2014.

        Subtitle B--Repeal of Independent Payment Advisory Board

SEC. 311. REPEAL OF INDEPENDENT PAYMENT ADVISORY BOARD.

  Effective as of the enactment of the Patient Protection and 
Affordable Care Act (Public Law 111-148), sections 3403 and 
10320 of such Act (including the amendments made by such 
sections) are repealed, and any provision of law amended by 
such sections is hereby restored as if such sections had not 
been enacted into law.