To allow tribal members to make their own health care choices.

SA 4033. Mr. COBURN (for himself and Mr. DeMint) submitted an
amendment intended to be proposed to amendment SA 3899 proposed by Mr.
Dorgan (for himself, Ms. Murkowski, Mr. Baucus, Mr. Kennedy, Mr. Smith,
Mr. Nelson of Nebraska, and Mr. Salazar) 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 336, between lines 13 and 14, insert the following:

``SEC. 817. TRIBAL MEMBER CHOICE DEMONSTRATION PROJECT.

``(a) In General.--The Secretary shall establish a
demonstration project in not less than 3 Service Areas
(chosen by the Secretary for optimal participation) under
which eligible participants shall be provided with a risk-
adjusted subsidy for the purchase of qualified health
insurance (as defined in subsection (f)) in order to--
``(1) improve Indian access to high quality health care
services;
``(2) provide incentives to Indian patients to seek
preventive health care services;
``(3) create opportunities for Indians to participate in
the health care decision process;
``(4) encourage effective use of health care services by
Indians; and
``(5) allow Indians to make health care coverage and
delivery decisions and choices.
``(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 a member of a federally-recognized Indian Tribe;
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) Subsidies Requirement.--The average amount of all
subsidies provided to eligible participants enrolled in the
demonstration project established under this section for each
12-month period during which the project is conducted shall
not exceed the amount equal to the average of the per capita
expenditures for providing Indians items or services from all
Indian Health Programs for the most recent fiscal year for
which data is available.
``(d) Special Rules.--
``(1) 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.
``(2) 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.--
``(1) Demonstration period.--
``(A) Initial period.--The demonstration project
established under this section shall begin not later than the
date that is 1 year after the date of enactment of this
section 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
progress of demonstration project conducted under this
section. Each report shall include information concerning the
populations participating in the project, participant
satisfaction (determined by indicators of satisfaction with
security, affordability, access, choice, and quality) as
compared with items and services that the participant would
have received from Indian Health Programs, and the impact of
the project on access to, and the availability of, high
quality health care services for Indians.
``(f) Qualified Health Insurance.--
``(1) In general.--In this section, the term `qualified
health insurance' means insurance which constitutes medical
care as defined in section 213(d) of the Internal Revenue
Code of 1986 without regard to--
``(A) paragraph (1)(C) thereof, and
``(B) so much of paragraph (1)(D) thereof as relates to
qualified long-term care insurance contracts.
``(2) Exclusion of certain other contracts.--Such term
shall not include insurance if a substantial portion of its
benefits are excepted benefits (as defined in section 9832(c)
of such Code).''.
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