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

SA 4034. Mr. COBURN 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 PROGRAM.

``(a) In General.--The Secretary shall establish a program
in geographically feasible Service Areas (as determined by
the Secretary, taking into account those Service Areas that
are likely to have 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 program
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 program.
``(B) Voluntary extensions of enrollment.--An eligible
participant may voluntarily extend the participant's
enrollment in the program for additional 12-month periods.
``(2) Hardship exception.--The Secretary shall specify
criteria for permitting an eligible participant to disenroll
from the program

[[Page S989]]

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
program established under this section for each 12-month
period during which the program 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 program 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 program under
this section, the Secretary shall ensure that the aggregate
payments made to carry out the program 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 program had not been implemented.
``(e) Implementation; Reports to Congress.--
``(1) Implementation.--
``(A) Initial period.--The program 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 at least 5 years.
``(B) Extensions.--The Secretary may extend the program for
such additional periods as the Secretary determines
appropriate, unless the Secretary determines that the program
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) Reports to congress.--During the initial 5-year
period in which the program is conducted, and during any
period thereafter in which the program is extended, the
Secretary shall periodically submit reports to Congress
regarding the progress of program. Each report shall include
information concerning the populations participating in the
program, 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 program 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).''.
______