Text: H.R.3478 — 111th Congress (2009-2010)All Information (Except Text)

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Introduced in House (07/31/2009)


111th CONGRESS
1st Session
H. R. 3478


To amend the Internal Revenue Code of 1986 to modify rules relating to health savings accounts, to provide payments for a health savings account and for a high deductible health plan instead of entitlement to benefits under Medicare, Medicaid, and SCHIP, to give more control and coverage to patients, to lower health care costs through increased price transparency, and to require immigrants to have a health savings account and high deductible health coverage at time of admission.


IN THE HOUSE OF REPRESENTATIVES

July 31, 2009

Mr. Gohmert introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned


A BILL

To amend the Internal Revenue Code of 1986 to modify rules relating to health savings accounts, to provide payments for a health savings account and for a high deductible health plan instead of entitlement to benefits under Medicare, Medicaid, and SCHIP, to give more control and coverage to patients, to lower health care costs through increased price transparency, and to require immigrants to have a health savings account and high deductible health coverage at time of admission.

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 “Patient-Controlled Healthcare Protection Act of 2009”.

(b) Table of contents.—The table of contents for this Act is as follows:


Sec. 1. Short title; table of contents.

Sec. 101. Advantage HSA.

Sec. 102. Health Savings Account reform.

Sec. 103. Advantage HSA grant program.

Sec. 104. Health Savings Account debit card.

Sec. 105. HSA Healthcare Panel.

Sec. 201. Transparency requirements related to health care provider charges.

Sec. 301. Requirement for immigrant to be covered under high deductible health plan and HSA.

Sec. 302. Reentry of removed alien who received emergency medical assistance.

SEC. 101. Advantage HSA.

(a) In general.—Part III of subchapter B of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after section 138 the following new section:

“SEC. 138A. Advantage HSA.

“(a) In general.—Gross income shall not include any payment to the Advantage HSA of an individual by the Secretary of the Treasury under section 103 of Patient-Controlled Healthcare Protection Act of 2009 or any premium payment under such section for the high deductible health plan with respect to which such Advantage HSA relates.

“(b) Advantage HSA.—For purposes of this section, the term ‘Advantage HSA’ means a health savings account (as defined in section 223(d))—

“(1) which is designated as an Advantage HSA,

“(2) with respect to which no contribution may be made other than—

“(A) a contribution described in subsection (a),

“(B) a contribution in cash without limitation as to amount, or

“(C) a trustee-to-trustee transfer described in subsection (d), and

“(3) the governing instrument of which provides that trustee-to-trustee transfers described in subsection (d) may be made to and from such account.

“(c) Ten percent bonus distribution.—

“(1) IN GENERAL.—Section 223(f)(2) shall not apply to any bonus distribution from a health savings account.

“(2) DISTRIBUTIONS.—An eligible Advantage HSA participant may receive 10 percent of excess funds that have been contributed to the individual or household HSA over the deductible in a calendar year. The funds will be directly deposited into the desired account of the participant.

“(3) BONUS DISTRIBUTION.—For purposes of this subsection, the term ‘bonus distribution’ means any distribution which is made during the 30-day period beginning on the first day of the calendar year to the extent such distribution does not exceed an amount equal to the excess (if any) of—

“(A) the fair market value of the assets in such health savings account as of the close of the preceding calendar year, over

“(B) the sum of the annual deductible required to be paid under the plan for covered benefits for the calendar year.

“(d) State certification for high deductible health plans.—For purposes of this section—

“(1) IN GENERAL.—For purposes of determining whether or not an individual is an eligible individual, a health plan shall not be treated as a high deductible health plan (as defined under section 223(c)(2)) unless such plan is certified by the State within which the individual’s principal place of abode is located.

“(2) INSURANCE BIDDING.—If an insurance company is based in the United States, they may offer and sell policies in all States and they may bid on other policies across State lines.

“(e) Trustee-to-Trustee transfer.—Section 223(f)(2) shall not apply to any trustee-to-trustee transfer from an Advantage HSA of an account holder to another Advantage HSA or health savings account of such account holder.

“(f) Associations.—Employers who choose to participate in the Advantage HSA Program may join together in associations in an effort to purchase less expensive insurance for their employees.”.

(b) Conforming amendment.—The table of sections for part III of subchapter B of chapter 1 of such Code is amended by inserting after the item relating to section 138 the following new item:


“138A. Advantage HSA.”.

(c) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2009.

SEC. 102. Health Savings Account reform.

(a) Account-to-Account transfers.—

(1) IN GENERAL.—Subparagraph (A) of section 223(f)(5) of the Internal Revenue Code of 1986 is amended by striking “a health savings account for the benefit of such beneficiary” and inserting “any health savings account”.

(2) LIMITATION.—Subparagraph (B) of section 223(f)(5) of such Code is amended—

(A) by striking “Limitation.—This paragraph” and inserting the following:

“(B) LIMITATIONS.—

“(i) IN GENERAL.—This paragraph”, and

(B) by adding at the end of subparagraph (B), as so amended, the following new clause:

“(ii) TRANSFERS TO OTHER ACCOUNT BENEFICIARIES.—This paragraph shall not apply to any amount described in subparagraph (A) to the extent that immediately after such distribution the fair market value of the account is less than the annual deductible required to be paid under the plan for the calendar year within which the distribution is made.”.

(b) Migrant worker HSA.—Section 223 of such Code is amended by adding at the end the following new subsection:

“(i) Migrant worker HSA.—

“(1) IN GENERAL.—An employer may establish for the benefit of any eligible employee a health savings account.

“(2) ELIGIBLE EMPLOYEE.—For purposes of this subsection, the term ‘eligible employee’ means any individual (other than a citizen or resident of the United States)—

“(A) with respect to whom the employee provides remuneration for employment, and

“(B) who is lawfully present in the United States and has been granted authorization to engage in employment in the United States.”.

(c) Other reforms.—Section 223 of such Code is amended as follows:

(1) By striking paragraphs (1) through (4) and (6) through (8) of subsection (b) and by redesignating paragraph (5) as paragraph (1).

(2) By inserting after paragraph (1), as so redesignated, the following new paragraph:

“(2) HOUSEHOLD HSA.—In the case of health savings accounts with respect to which individuals who are members of the same household are the account beneficiaries, upon filing the return of tax for any taxable year, each such individual shall include on the return each social security number of all participating members of such individual’s household.”.

(3) By amending paragraph (1) of subsection (c) to read as follows:

“(1) ELIGIBLE INDIVIDUAL.—The term ‘eligible individual’ means any individual.”.

(4) By amending subsection (c)(2)(A) to read as follows:

“(A) IN GENERAL.—The term ‘high deductible health plan’ means a health plan which has an annual deductible which is not less than—

“(i) $2,500 for self-only coverage, and

“(ii) $3,500 for family or household coverage.”.

(5) By striking subparagraph (B) of subsection (c)(2) and redesignating subparagraphs (C) and (D) thereof as subparagraphs (B) and (C), respectively.

(6) By adding at the end of subsection (c)(2), as so amended, the following new subparagraph:

“(D) OTHER REQUIREMENTS.—An Advantage HSA plan will offer the following to the individual or household participants—

“(i) the plan shall not require that an individual see a general physician prior to a seeing specialist, and

“(ii) coverage may not be denied based on a pre-existing condition of an individual.”.

(7) By adding at the end of subparagraph (A) of subsection (d)(2) the following: “Such term shall include any expense which is on the list of eligible healthcare expenses most recently submitted by the HSA Healthcare Panel under section 105(b)(2) of the Patient-Controlled Healthcare Protection Act of 2009.”.

(8) By striking “the individual” in subsection (d)(3) and inserting “an individual”.

(9) By adding at the end of subsection (e) the following new paragraph:

“(3) EXCEPTION.—In the case of a termination occurring after the date of the enactment of the Patient-Controlled Healthcare Protection Act of 2009, in lieu of being treated as a distribution not used to pay qualified medical expenses, such amounts shall be transferred by the account beneficiaries to another health savings account.”.

(10) In subsection (f), by striking paragraphs (2), (3), (5), and (8) of and redesignating paragraphs (4), (6), and (7) as paragraphs (2), (3), and (4), respectively.

(11) By amending paragraph (2) of subsection (f), as so redesignated, to read as follows:

“(2) AMOUNTS NOT USED FOR QUALIFIED MEDICAL EXPENSES.—Any amount paid or distributed out of a health savings account which is not used exclusively to pay the qualified medical expenses of an account beneficiary shall be recontributed by the beneficiary to such health savings account.”.

(12) By adding at the end (as amended by this Act) the following new subsection:

“(j) Other special rules.—For purposes of this section—

“(1) INVESTMENT OF HSA FUNDS.—Account beneficiaries may invest any amount in their health savings account in excess of their deductible in inflation-proof United States bonds.

“(2) TERMINATION OF HOUSEHOLD.—Any account beneficiaries of a household HSA shall sign an agreement as to distribution of amounts from such HSA prior to termination of the HSA, which will be kept on file with the entity in which the HSA funds are being held.

“(3) PORTABILITY.—An individual or household participant owns their HSA and insurance policy (if they choose to have one) and therefore the policies are portable.”.

(d) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2009.

SEC. 103. Advantage HSA payment program.

(a) In general.—The Advantage HSA payment program provided under this section shall be in lieu of entitlement to, and eligibility for, benefits and assistance described in subsection (d)(2). Effective on the date the Advantage HSA payment program is established, titles XVIII, XIX, and XXI of the Social Security Act are repealed, except for purposes of determining whether an individual is an Advantage eligible individual under this section.

(b) HSA contributions.—In the case of an individual or household who is eligible for an Advantage HSA, the Secretary of Treasury, in consultation with the Secretary of Health and Human Services, shall pay an annual amount to the Advantage HSA of the individual or household.

(c) HSA premium assistance.—The Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, shall establish a program under which the Secretary of the Treasury shall pay the premiums for the high deductible health plan with respect to the Advantage HSA of such individual. Such program shall provide for prorated payment of such premiums in the case that such individual is not an Advantage eligible individual for a full calendar year.

(d) Advantage eligible individual.—For purposes of this section—

(1) IN GENERAL.—The term “Advantage eligible individual” means, with respect to any month, any individual—

(A) who is an eligible individual (as defined in section 223(c) of the Internal Revenue Code of 1986); and

(B)(i) who is Advantage eligible; or

(ii) whose dependent (within the meaning of section 152 of the Internal Revenue Code of 1986) or spouse is Advantage eligible (but only if an election under this section is in effect with respect to such spouse or dependent).

(2) ADVANTAGE ELIGIBLE.—The term “Advantage eligible” means, with respect to any month—

(A) entitled, as of the 1st day of such month, to benefits under part A of title XVIII of the Social Security Act or to enroll under part B of such title, or

(B) eligible, as of the 1st day of such month, for medical or child health assistance under title XIX or XXI of such Act (other than under section 1928 of such Act).

(e) Applicable annual amount.—For purposes of this section—

(1) IN GENERAL.—The term “applicable annual amount” means $2,500.

(2) ADDITIONAL AMOUNT.—In the case of an Advantage HSA eligible household, $3,500.

(f) Definitions.—Except as otherwise provided, terms used in this section shall have the same respective meanings as when used in sections 138A and 223 of the Internal Revenue Code of 1986.

(g) Regulations.—The Secretary of the Treasury shall prescribe such regulations as may be necessary or appropriate to carry out the purposes of this section, including regulations providing for the following:

(1) Recapture of amounts paid under subsection (a) (and any earnings attributable thereto) which are distributed out of an Advantage HSA and not used exclusively to pay qualified medical expenses of the account beneficiary.

(2) Ensuring that not more than the applicable annual amount under paragraph (1) of subsection (d) (and any additional amount under paragraph (2) of such subsection) shall be paid with respect to any individual, the spouse of such individual, and all dependents with respect to such individual.

(3) Ensuring that all individuals with respect to whom an election has been made under this section are covered under the high deductible plan to which the applicable Advantage HSA relates.

SEC. 104. Health Savings Account debit card.

(a) In general.—The Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, shall establish a program under which trustees of health savings accounts can issue debit cards with which account beneficiaries may pay for qualified medical expenses (as defined in section 223 of the Internal Revenue Code of 1986). Such program shall provide for the following:

(1) Participation from health care providers and vendors of products the purchase of which qualifies as a qualified medical expense (as so defined).

(2) A uniform coding system implemented by such providers and vendors such that such debit cards may not be used to purchase services or products which are not qualified medical expenses (as so defined).

(3) That prior to payment with such card such providers and vendors require presentation an identification card that matches the individual identified on the debit card and provides a photograph and is issued by a State or the Federal Government, or a document that, with respect to identification of the individual identified on the debit card, is considered acceptable for purposes of sections 274a.2(b)(1)(v)(A) and 274a.2(b)(1)(v)(B) of title 8, Code of Federal Regulations (as in effect on or after the date of the enactment of this Act).

(4) That the individual presenting such debit card for payment sign a statement that affirms payment is for a qualified medical expense with respect to such individual and which acknowledges that use of such debit card for any other expense constitutes a false statements or misrepresentations which may subject the purchaser to criminal penalties under section 1001 of title 18, United States Code, which notice specifies the maximum fine and term of imprisonment under such section.

(b) Submission of information.—Each trustee of a health savings account shall submit to the HSA Healthcare Panel (established under section 105) a report detailing all purchases made with debit cards from health savings accounts of the trustee. Such report shall not contain any personal information of the account beneficiaries of such health savings accounts.

(c) Health savings account; Qualified medical expenses.—For purposes of this section, the terms “health savings account” and “qualified medical expenses” shall have the respective meanings given such terms by section 223 of the Internal Revenue Code of 1986.

SEC. 105. HSA Healthcare Panel.

(a) Establishment.—There is established a Panel to be known as the “HSA Healthcare Panel” (in this section referred to as the “Panel”).

(b) Duties.—

(1) REVIEW OF QUALIFIED MEDICAL EXPENSES.—The Panel shall review the reports and other information submitted to the Panel under section 104 or requested by the Panel and review appropriate information regarding the healthcare treatments, services, and products that are potentially treatable as qualified medical expenses for purposes of section 223 of the Internal Revenue Code of 1986.

(2) REPORT.—The Panel shall, not later than 1 year after the date of enactment of this Act and annually thereafter submit a report to Congress providing a new list of eligible healthcare expenses.

(c) Membership.—

(1) IN GENERAL.—The Panel shall be comprised of 101 members.

(2) APPOINTMENTS.—

(A) VOTING MEMBER AND CHAIR.—The Surgeon General of the United States shall be a voting member of the Panel, and shall be the chairperson.

(B) OTHER VOTING MEMBERS.—The Governor of each State shall appoint 2 voting members to the Panel, one of whom shall be a health care specialist and one of whom shall not be a health care specialist.

(3) DATE OF APPOINTMENTS.—The appointment of a members of the Panel shall be made not later than 60 days after the date of the enactment of this Act.

(4) TERM.—Members shall be appointed for 1-year terms.

(5) VACANCIES.—A vacancy in the Panel shall be filled not later than 60 days after such vacancy occurs and in the manner in which the original appointment was made.

(d) Powers of panel.—

(1) MEETINGS AND HEARINGS.—

(A) IN GENERAL.—The Panel shall meet upon the call of the chairperson or a majority of its voting members. Such meetings, to the extent practicable, may be conducted over the internet or in person.

(B) HEARINGS.—The Panel may, for the purpose of carrying out this section, hold hearings, sit and act at times and places, take testimony, and receive evidence to carry out its duties under this section. The Panel may administer oaths or affirmations to witnesses appearing before it.

(2) OBTAINING OFFICIAL INFORMATION.—

(A) REQUIREMENT TO FURNISH.—Except as provided in subparagraph (B), if the Panel submits a request to a Federal department or agency for information necessary to enable the Panel to carry out this section, the head of that department or agency shall furnish that information to the Panel.

(B) EXCEPTION FOR NATIONAL SECURITY.—If the head of a Federal department or agency determines that it is necessary to withhold requested information from disclosure to protect the national security interests of the United States, the department or agency head shall not furnish that information to the Panel.

(3) MAILS.—The Panel may use the United States mails in the same manner and under the same conditions as other departments and agencies of the United States.

(4) CONTRACTS.—The Panel may contract with and compensate persons and government agencies for supplies and services, without regard to section 3709 of the Revised Statutes (41 U.S.C. 5).

(e) Pay and Reimbursement.—

(1) NO COMPENSATION FOR MEMBERS OF PANEL.—Except as provided in paragraph (2), a member of the Panel may not receive pay, allowances, or benefits by reason of the member’s service on the Panel.

(2) TRAVEL EXPENSES.—Each member shall receive travel expenses, including per diem in lieu of subsistence under subchapter I of chapter 57 of title 5, United States Code.

(f) Quorum.—Thirty members of the Panel shall constitute a quorum, but a lesser number may hold hearings.

SEC. 201. Transparency requirements related to health care provider charges.

(a) In general.—Notwithstanding any other provision of law, a health care provider shall provide to an individual who is scheduled to receive a service or treatment the following:

(1) ACTUAL PRICES TO BE CHARGED.—The actual price that the health care provider will charge for the service or treatment.

(2) PAYMENT RATES APPLICABLE TO OTHER ENTITIES.—In the case such charge amount for the service or treatment is different from—

(A) the rate of payment for the service or treatment to the health care provider that has been negotiated by or on behalf of the provider with a network plan or managed care plan;

(B) the rate of payment for the service or treatment applicable to the provider under the Medicare program under title XVIII; or

(C) such charge amount or payment rate that is applicable with respect to any other entity;

the amount of such different rate of payment or charge amount and a description of the type of entity to which such rate or charge applies (without naming such entity).

(b) Application of requirement on request.—A health care provider is required to provide the applicable information under subsection (a) for a service or treatment when requested by anyone in person, or by phone, fax, or email.

(c) Clarification.—Nothing in this section shall be construed as preventing a health care provider from providing a service or treatment free of charge as a charitable gesture without publicly disclosing the individual to whom such charitable service or treatment has been provided.

(d) Effective date.—The requirement under subsection (a) shall apply with respect to services and treatments provided on or after the date that is 60 days after the date of the enactment of this Act.

SEC. 301. Requirement for immigrant to be covered under high deductible health plan and HSA.

Notwithstanding any other provision of law, a consular officer (as defined in section 101(a) of the Immigration and Nationality Act (8 U.S.C. 1101(a)) may not issue or renew an immigrant visa to an alien unless the alien presents evidence (which may be in the form of an attestation by a sponsoring employer or individual United States citizen in whose household the alien intends to reside who will be responsible for providing the requisite coverage) that the alien (and the alien’s spouse and children who are accompanying or following to join the alien) will be covered under a high deductible health plan (as defined in section 223 of the Internal Revenue Code of 1986) and will be an account beneficiary of a health savings account under such section after the alien’s admission to the United States as an immigrant and for the duration of the alien’s residence in the United States, or be subject to removal.

SEC. 302. Reentry of removed alien who received emergency medical assistance.

Section 276(b) of the Immigration and Nationality Act (8 U.S.C. 1326(b)) is amended—

(1) in paragraph (3), by striking “. or” at the end;

(2) in paragraph (4), by striking the period at the end and inserting “; or”; and

(3) by adding at the end the following:

“(5) whose removal was subsequent to the provision of medical assistance pursuant to section 401(b)(1)(A) of the Personal Responsibility and Work Opportunity Act of 1996 (8 U.S.C. 1611(b)(1)(A)), such alien shall be fined under title 18, United States Code, imprisoned not more than 10 years, or both.”.