To authorize the Secretary of Health and Human Services to establish an Indian health savings account demonstration project.

SA 4015.  Mr. DeMINT submitted an amendment intended to be proposed
by him to the bill S. 1200, to amend the Indian Health Care Improvement
Act to revise and extend the Act; which was ordered to lie on the
table; as follows:

On page __, between lines __ and __, insert the following
(at the end of title VIII of the Indian Health Care
Improvement Act, as amended by section 101(a) add the
following):

``SEC. 818. INDIAN HEALTH SAVINGS ACCOUNT DEMONSTRATION
PROJECT.

``(a) In General.--The Secretary shall establish a
demonstration project under which eligible participants shall
be provided with a subsidy for the purchase of a high
deductible health plan (as defined under section 223(c)(2) of
the Internal Revenue Code of 1986) and a contribution to a
health savings account (as defined in section 223(d) of such
Code) in order to--
``(1) improve Indian access to high quality health care
services;
``(2) provide incentives to Indian patients to seek
preventive medical care services;
``(3) create Indian patient awareness regarding the high
cost of medical care; and
``(4) encourage appropriate use of health care services by
Indians.
``(b) Eligible Participant.--
``(1) Voluntary enrollment for 12-month periods.--
``(A) In general.--In this section, the term `eligible
participant' means an Indian who--
``(i) is an eligible individual (as defined in section
223(c)(1) of the Internal Revenue Code of 1986); and
``(ii) voluntarily agrees to enroll in the project
conducted under this section (or in the case of a minor, is
voluntarily enrolled on their behalf by a parent or
caretaker) for a period of not less than 12 months in lieu of
obtaining items or services through any Indian Health Program
or any other federally-funded program during any period in
which the Indian is enrolled in the project.
``(B) Voluntary extensions of enrollment.--An eligible
participant may voluntarily extend the participant's
enrollment in the project for additional 12-month periods.
``(2) Hardship exception.--The Secretary shall specify
criteria for permitting an eligible participant to disenroll
from the project before the end of any 12-month period of
enrollment to prevent undue hardship.
``(c) Subsidy Amount.--The amount of a subsidy provided to
an eligible participant for a 12-month period shall not
exceed the amount equal to the average per capita expenditure
for an Indian obtaining items or services from any Indian
Health Program for the most recent fiscal year for which data
is available with respect to the same population category as
the eligible participant.
``(d) Special Rules.--
``(1) No deduction allowed for subsidy.--For purposes of
determining the amount allowable as a deduction with respect
to amounts contributed to a health savings account by an
eligible participant under section 223 of the Internal
Revenue Code of 1986, the limitation which would (but for
this paragraph) apply under section 223(b) of such Code to
such participant for any taxable year shall be reduced (but
not below zero) by the amount of any subsidy provided to the
participant under this section for such taxable year.
``(2) Treatment.--The amount of a subsidy provided to an
eligible participant in the project shall not be counted as
income or assets for purposes of determining eligibility for
benefits under any Federal public assistance program.
``(3) Budget neutrality.--In conducting the demonstration
project under this section, the Secretary shall ensure that
the aggregate payments made to carry out the project do not
exceed the amount of Federal expenditures which would have
been made for the provision of health care items and services
to eligible participants if the project had not been
implemented.
``(e) Demonstration Period; Reports to Congress; Gao
Evaluation and Report.--
``(1) Demonstration period.--
``(A) Initial period.--The demonstration project
established under this section shall begin on January 1,
2007, and shall be conducted for a period of 5 years.
``(B) Extensions.--The Secretary may extend the project for
such additional periods as the Secretary determines
appropriate, unless the Secretary determines that the project
is unsuccessful in achieving the purposes described in
subsection (a), taking into account cost-effectiveness,
quality of care, and such other criteria as the Secretary may
specify.
``(2) Periodic reports to congress.--During the 5-year
period described in paragraph (1), the Secretary shall
periodically submit reports to Congress regarding the success
of demonstration project conducted under this section. Each
report shall include information concerning the populations
participating in the project and the impact of the project on
access to, and the availability of, high quality health care
services for Indians.
``(3) GAO evaluation and report.--
``(A) Evaluation.--The Comptroller General of the United
States shall enter into a contract with an organization with
expertise in health economics, health insurance markets, and
actuarial science for the purpose of conducting a
comprehensive study regarding the effects of high deductible
health plans and health savings accounts in the Indian
community. The evaluation shall include an analysis of the
following issues:
``(i) Selection of, access to, and availability of, high
quality health care services.
``(ii) The use of preventive health services.
``(iii) Consumer choice.
``(iv) The scope of coverage provided by high deductible
health plans purchased in conjunction with health savings
accounts under the project.
``(v) Such other issues as the Comptroller General
determines appropriate.
``(B) Report.--Not later than January 1, 2013, the
Comptroller General shall submit a report to Congress on the
evaluation of demonstration project conducted under this
section.''.
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