S.Amdt. 2949

SA 2949. Mr. ROCKEFELLER (for himself and Mr. Brown) submitted an
amendment intended to be proposed to amendment SA 2786 proposed by Mr.
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the
first-time homebuyers credit in the case of members of the Armed Forces
and certain other Federal employees, and for other purposes; which was
ordered to lie on the table; as follows:

Beginning on page 182, strike line 8 and all that follows
through page 200, line 5, and insert the following:

SEC. 1323. CONSUMERS CHOICE HEALTH PLAN.

(a) Findings.--Congress makes the following findings:
(1) Americans need health care coverage that is always
affordable.
(2) Americans need health care coverage that is always
adequate.
(3) Americans need health care coverage that is always
accountable.
(4) A public health insurance plan option that can compete
with private insurance plans is the only way to guarantee
that all consumers have affordable, adequate, and accountable
options available in the insurance marketplace.
(b) Office of Health Plan Management.--
(1) Establishment.--Not later than July 1, 2010, there
shall be established within the Department of Health and
Human Services an Office of Health Plan Management (referred
to in this section as the ``Office''). The Office shall be
headed by a Director (referred to in this section as the
``Director'') who shall be appointed by the President, by and
with the advice and consent of the Senate.
(2) Compensation.--The Director shall be paid at the annual
rate of pay for a position at level II of the Executive
Schedule under section 5313 of title 5, United States Code.
(3) Limitation.--Neither the Director nor the Office shall
participate in the administration of the Exchanges
established under

[[Page S12557]]

this title or the promulgation or administration of any
regulation regarding the health insurance industry.
(4) Personnel and operations authority.--The Director shall
have the same general authorities with respect to personnel
and operations of the Office as the heads of other agencies
and departments of the Federal Government have with respect
to such agencies and departments.
(c) Consumer Choice Health Plan.--
(1) In general.--The Office shall establish and administer
the Consumer Choice Health Plan (referred to in this section
as the ``Plan'') to provide for health insurance coverage
that is made available to all eligible individuals (as
described in paragraph (4)(A)) in the United States and its
territories.
(2) Regulatory compliance.--The Plan shall comply with--
(A) all regulations and requirements that are applicable
with respect to other qualified health plans that are offered
through the Exchanges; and
(B) any additional regulations and requirements, as
determined by the Director.
(3) Benefits.--
(A) In general.--The Plan shall offer health insurance
coverage at different benefit levels, provided that such
benefits are commensurate with the required benefit levels to
be provided by a qualified health plan through the Exchanges.
(B) Minimum benefits for children.--
(i) In general.--The minimum benefit level available under
the Plan for children shall include at least the services
described in the most recently published version of the
``Maternal and Child Health Plan Benefit Model'' developed by
the National Business Group on Health.
(ii) Amendment of benefit level.--The Secretary of Health
and Human Services, acting through the Director of the Agency
for Healthcare Research and Quality, may amend the benefits
described in clause (i) based on the most recent peer-
reviewed and evidence-based data.
(4) Eligibility and enrollment.--
(A) Eligibility.--An individual who is eligible to purchase
coverage from a qualified health plan through an Exchange
shall be eligible to enroll in the Plan.
(B) Enrollment process.--An individual may enroll in the
Plan only in such manner and form as may be prescribed by
applicable regulations, and only during an enrollment period
as prescribed by the Director.
(C) Employer enrollment.--An employer shall be eligible to
purchase health insurance coverage for their employees and
the employees' dependents to the extent provided for all
qualified health plans under the Exchanges.
(D) Satisfaction of individual mandate requirement.--An
individual's enrollment with the Plan shall be treated as
satisfying any requirement under Federal law for such
individual to demonstrate enrollment in health insurance or
benefits coverage, including the requirement under section
5000A of the Internal Revenue Code of 1986.
(5) Providers.--
(A) Network requirement.--
(i) Medicare.--A participating provider who is voluntarily
providing health care services under the Medicare program
established under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) shall be required to provide services to
any individual enrolled in the Plan.
(ii) Medicaid and chip.--A provider of health care services
under the Medicaid program established under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.), or the CHIP
program established under title XXI of such Act (42 U.S.C.
1397aa et seq.), shall be required to provide services to any
individual enrolled in the Plan.
(B) Exception.--Subparagraph (A) shall not be construed as
requiring a provider to accept new patients due to bona fide
capacity limitations of the provider.
(C) Opt-out provision.--
(i) Medicare.--A participating provider as described under
subparagraph (A)(i) shall be required to provide services to
any individual enrolled in the Plan for the 3-year period
following the establishment of the Plan. Upon the expiration
of the 3-year period, a participating provider in the Plan
may elect to become a non-participating provider without
affecting their status as a participating provider under the
Medicare program.
(ii) Medicaid and chip.--A provider as described under
subparagraph (A)(ii) shall be required to provide services to
any individual enrolled in the Plan for the 3-year period
following the establishment of the Plan. Upon the expiration
of the 3-year period, a provider in the Plan may elect to
cease provision of services under the Plan without affecting
their status as a provider under the Medicaid program or the
CHIP program.
(D) Payment rates.--
(i) Initial payment rates.--

(I) In general.--During the 2-year period following the
establishment of the Plan, providers shall be reimbursed at
such payment rates as are applicable under the Medicare
program.
(II) Adjustment.--The Director may reimburse providers at
rates lower or higher than applicable under the Medicare
program if the Director determines that the adjusted rates
are appropriate and ensure that enrollees in the Plan are
provided with adequate access to health care services.

(ii) Subsequent payment rates.--Subject to clause (iii),
upon the expiration of the 2-year period following the
establishment of the Plan, the Director shall develop payment
rates for reimbursement of providers in order to maintain an
adequate provider network necessary to assure that enrollees
in the Plan have adequate access to health care. In
determining such payment rates, the Director shall consider--

(I) competitive provider payment rates in both the public
and private sectors;
(II) best practices among providers;
(III) integrated models of care delivery (including medical
home and chronic care coordination models);
(IV) geographic variation in health care costs;
(V) evidence-based practices;
(VI) quality improvement;
(VII) use of health information technology; and
(VIII) any additional measures, as determined by the
Director.

(iii) Payment rate consultation.--The Director shall
determine payment rates under clause (ii) in consultation
with providers participating under the Plan, the Director of
the Office of Personnel Management, the Medicare Payment
Advisory Commission, and the Medicaid and CHIP Payment and
Access Commission.
(E) Adoption of medicare reforms.--The Plan may adopt
Medicare system delivery reforms that provide patients with a
coordinated system of care and make changes to the provider
payment structure.
(6) Subsidies.--The Plan shall be eligible to accept
subsidies, including subsidies for the enrollment of
individuals under the Plan, in the same manner and to the
same extent as other qualified health plans offered through
an Exchange (including credits under section 36B of the
Internal Revenue Code of 1986).
(7) Financing.--
(A) Transitional funding.--
(i) In general.--In order to provide for adequate funding
of the Plan in advance of receipt of payments as described in
subparagraph (B), beginning July 1, 2010, there are
transferred to the Plan from the general fund of the Treasury
such amounts as may be necessary for operation of the Plan
until the end of the 3-year period following the
establishment of the Plan.
(ii) Return of funds.--Upon the expiration of the 3-year
period following the establishment of the Plan, the Director
shall enter into a repayment schedule with the Secretary of
the Treasury to provide for repayment of funds provided under
clause (i). Any expenditures made by the Plan pursuant to a
repayment schedule established under this subparagraph shall
not constitute administrative expenses as described in
subparagraph (B)(ii).
(B) Self-financing.--
(i) In general.--The Plan shall be financially self-
sustaining insofar as funds used for operation of the Plan
(including benefits, administration, and marketing) shall be
derived from--

(I) insurance premium payments and subsidies for
individuals enrolled in the Plan; and
(II) assessable payments made pursuant to section 4980H of
the Internal Revenue Code of 1986 (as added by section 1513)
by employers that fail to offer their full-time employees
(and their dependents) the opportunity to enroll in minimum
essential coverage under an eligible employer-sponsored plan.

(ii) Limitation on administrative expenses.--Not more than
5 percent of the amounts provided under clause (i) may be
used for the annual administrative costs of the Plan.
(C) Contingency reserve.--
(i) In general.--The Director shall establish and fund a
contingency reserve for the Plan in a form similar to the
contingency reserve provided for health benefits plans under
the Federal Employees Health Benefits Program under chapter
89 of title 5, United States Code.
(ii) Revenue.--Any revenue generated through the
contingency reserve established in clause (i) shall be
transferred to the Plan for the purpose of reducing enrollee
premiums, reducing enrollee cost-sharing, increasing enrollee
benefits, or any combination thereof.
(D) GAO financial audit and report.--Beginning not later
than October 1, 2011, the Comptroller General shall conduct
an annual audit of the financial statements and records of
the Plan, in accordance with generally accepted government
auditing standards, and submit an annual report on such audit
to the Congress.
(E) Supermajority requirement for supplemental funding.--
Upon certification by the Comptroller General that the
financial audit described in subparagraph (D) indicates that
the Plan is insolvent, supplemental funding may be
appropriated for the Plan if such measure receives not less
than a three-fifths vote of approval of the total number of
Members of the House of Representatives and the Senate.
(8) Transparency.--
(A) In general.--Beginning with the first year of operation
of the Plan through the Exchanges, the Director shall provide
standards and undertake activities for promoting transparency
in costs, benefits, and other factors for health insurance
coverage provided under the Plan.
(B) Standard definitions of insurance and medical terms.--
(i) In general.--The Director shall provide for the
development of standards for the definitions of terms used in
health insurance

[[Page S12558]]

coverage under the Plan, including insurance-related terms
(including the insurance-related terms described in clause
(ii)) and medical terms (including the medical terms
described in clause (iii)).
(ii) Insurance-related terms.--The insurance-related terms
described in this clause are premium, deductible, co-
insurance, co-payment, out-of-pocket limit, preferred
provider, non-preferred provider, out-of-network co-payments,
UCR (usual, customary and reasonable) fees, excluded
services, grievance and appeals, and such other terms as the
Director determines are important to define so that consumers
may compare health insurance coverage and understand the
terms of their coverage.
(iii) Medical terms.--The medical terms described in this
clause are hospitalization, hospital outpatient care,
emergency room care, physician services, prescription drug
coverage, durable medical equipment, home health care,
skilled nursing care, rehabilitation services, hospice
services, emergency medical transportation, and such other
terms as the Director determines are important to define so
that consumers may compare the medical benefits offered by
health insurance plans and understand the extent of those
medical benefits (or exceptions to those benefits).
(C) Disclosure.--
(i) In general.--In carrying out this paragraph, the
Director shall disclose to Plan enrollees, potential
enrollees, in-network health care providers, and others
(through a publically available Internet website and other
appropriate means) relevant information regarding each policy
of health insurance coverage marketed or in force (in such
standardized manner as determined by the Director),
including--

(I) full policy contract language; and
(II) a summary of the information described in subparagraph
(D).

(ii) Personalized statement.--The Director shall disclose
to enrollees (in such standardized manner as determined by
the Director) an annual personalized statement that
summarizes use of health care services and payment of claims
with respect to an enrollee (and covered dependents) under
health insurance coverage provided through the Plan in the
preceding year.
(D) Required information.--The information described in
this subparagraph includes, but is not limited to, the
following:
(i) Data on the price of each new policy of health
insurance coverage and renewal rating practices.
(ii) Claims payment policies and practices, including how
many and how quickly claims were paid.
(iii) Provider fee schedules and usual, customary, and
reasonable fees (for both in-network and out-of-network
providers).
(iv) Provider participation and provider directories.
(v) Loss ratios, including detailed information about
amount and type of non-claims expenses.
(vi) Covered benefits, cost-sharing, and amount of payment
provided toward each type of service identified as a covered
benefit, including preventive care services recommended by
the United States Preventive Services Task Force.
(vii) Civil or criminal actions successfully concluded
against the Plan by any governmental entity.
(viii) Benefit exclusions and limits.
(E) Development of patient claims scenarios.--
(i) In general.--In order to improve the ability of
individuals and employers to compare the coverage and
relative value provided under the Plan, the Director shall
develop and make publically available a series of patient
claims scenarios under which benefits (including out-of-
pocket costs) under the Plan are simulated for certain common
or expensive conditions or courses of treatment (including
maternity care, breast cancer, heart disease, diabetes
management, and well-child visits).
(ii) Consultation.--The Director shall develop the patient
claims scenarios described in clause (i)--

(I) in consultation with the Secretary of Health and Human
Services, the National Institutes of Health, the Centers for
Disease Control and Prevention, the Agency for Healthcare
Research and Quality, health professional societies, patient
advocates, and other entities as deemed necessary by the
Director; and
(II) based upon recognized clinical practice guidelines.

(F) Manner of disclosure.--The Director shall disclose the
information under this paragraph--
(i) with all marketing materials;
(ii) on the website for the Plan; and
(iii) at other times upon request.
(d) Conforming Amendments.--
(1) Community health insurance option.--
(A) In general.--Title I of this Act is amended by striking
``community health insurance option'' each place it appears
and inserting ``Consumer Choice Health Plan''.
(B) Annual fee on health insurance providers.--Section
9010(c)(2)(B) is amended by striking ``community health
insurance option'' and inserting ``Consumer Choice Health
Plan''.
(2) Special rules.--Section 1303(a)(1)(C) is amended by--
(A) in clause (i)(III), striking ``section 1323(e)(1)(C)
or''; and
(B) in clause (ii), striking ``section 1323(b)(3)(A)'' and
inserting ``section 1323(c)(3)(A)''.

SEC. 1323A. ESTABLISHMENT OF AMERICA'S HEALTH INSURANCE
TRUST.

(a) Establishment.--As of the date of enactment of this
Act, there is authorized to be established a non-profit
corporation that shall be known as the ``America's Health
Insurance Trust'' (referred to in this section and section
1323B as the ``Trust''), which is neither an agency nor
establishment of the United States Government.
(b) Location; Service of Process.--The Trust shall maintain
its principal office within the District of Columbia and have
a designated agent in the District of Columbia to receive
service of process for the Trust. Notice to or service on the
agent shall be deemed as notice to or service on the
corporation.
(c) Application of Provisions.--The Trust shall be subject
to the provisions of this section and, to the extent
consistent with this section, to the District of Columbia
Nonprofit Corporation Act.
(d) Tax Exempt Status.--The Trust shall be treated as a
nonprofit organization described under section 170(c)(2)(B)
and section 501(c)(3) of the Internal Revenue Code of 1986
that is exempt from taxation under section 501(a) of the
Internal Revenue Code of 1986.
(e) Board of Directors.--
(1) In general.--The Board of Directors of the Trust
(referred to in this section as the ``Board'') shall consist
of 19 voting members appointed by the Comptroller General.
(2) Terms.--
(A) In general.--Subject to subparagraph (C), each member
of the Board shall serve for a term of 6 years.
(B) Limitation.--No individual shall be appointed to the
Board for more than 2 consecutive terms.
(C) Initial members.--The initial members of the Board
shall be appointed by the Comptroller General not later than
October 1, 2010, and shall serve terms as follows:
(i) 8 members shall be appointed for a term of 5 years.
(ii) 8 members shall be appointed for a term of 3 years.
(iii) 3 members shall be appointed for a term of 1 year.
(D) Expiration of term.--Any member of the Board whose term
has expired may serve until such member's successor has taken
office, or until the end of the calendar year in which such
member's term has expired, whichever is earlier.
(E) Vacancies.--
(i) In general.--Any member appointed to fill a vacancy
prior to the expiration of the term for which such member's
predecessor was appointed shall be appointed for the
remainder of such term.
(ii) Vacancies not to affect power of board.--A vacancy on
the Board shall not affect its powers, but shall be filled in
the same manner as the original appointment was made.
(3) Chairperson and vice-chairperson.--
(A) In general.--The Comptroller General shall designate a
Chairperson and Vice-Chairperson of the Board from among the
members of the Board.
(B) Term.--The members designated as Chairperson and Vice-
Chairperson shall serve for a period of 3 years.
(4) Conflicts of interest.--An individual may not serve on
the Board if such individual (or an immediate family member
of such individual) is employed by or has a financial
interest in--
(A) an organization that provides a health insurance plan;
(B) a pharmaceutical manufacturer; or
(C) any subsidiary entities of an organization described in
subparagraphs (A) or (B).
(5) Composition of the board.--
(A) Political parties.--Not more than 10 members of the
Board may be affiliated with the same political party.
(B) Diversity.--In appointing members under this paragraph,
the Comptroller General shall ensure that such members
provide appropriately diverse representation with respect to
race, ethnicity, age, gender, and geography.
(C) Consumer representation.--10 members of the Board shall
be independent and non-conflicted individuals representing
the interests of health care consumers. Each member selected
under this subparagraph shall represent 1 of the 10
Department of Health and Human Services regions in the United
States.
(D) Remaining representation.--
(i) In general.--9 members of the Board shall be selected
based on relevant experience, including expertise in--

(I) community affairs;
(II) Federal, State, and local government;
(III) health professions and administration;
(IV) business, finance, and accounting;
(V) legal affairs;
(VI) insurance;
(VII) trade unions;
(VIII) social services; and
(IX) any additional areas as determined by the Comptroller
General.

(ii) Income from health care industry.--Not more than 4 of
the members selected under this subparagraph shall earn more
than 10 percent of their income from the health care
industry.
(6) Meetings and hearings.--The Board shall meet and hold
hearings at the call of the Chairperson or a majority of its
members. Meetings of the Board on matters not related to
personnel shall be open to the public and advertised through
public notice at least 7 days prior to the meeting.
(7) Quorum.--A majority of the members of the Board shall
constitute a quorum for purposes of conducting the duties of
the Trust,

[[Page S12559]]

but a lesser number of members may meet and hold hearings.
(8) Executive director and staff; performance of duties.--
The Board may--
(A) employ and fix the compensation of an Executive
Director and such other personnel as may be necessary to
carry out the duties of the Trust;
(B) seek such assistance and support as may be required in
the performance of the duties of the Trust from appropriate
departments and agencies of the Federal Government;
(C) enter into contracts or other arrangements and make
such payments as may be necessary for performance of the
duties of the Trust;
(D) provide travel, subsistence, and per diem compensation
for individuals performing the duties of the Trust, including
members of the Advisory Council (as described in subsection
(f)); and
(E) prescribe such rules, regulations, and bylaws as the
Board determines necessary with respect to the internal
organization and operation of the Trust.
(9) Lobbying cooling-off period for members of the board.--
Section 207(c) of title 18, United States Code, as amended by
section 3403(a)(2), is amended by inserting at the end the
following:
``(4) Members of the board of directors of the america's
health insurance trust.--Paragraph (1) shall apply to a
member of the Board of Directors of the America's Health
Insurance Trust who was appointed to the Board as of the day
before the date of enactment of the Patient Protection and
Affordable Care Act.''.
(f) Advisory Council.--
(1) Establishment.--The Board shall establish an advisory
council that shall be comprised of the insurance
commissioners of each State (including the District of
Columbia) to advise the Board on the development and impact
of measures to improve the transparency and accountability of
qualified health plans provided through the Exchanges
established under this title.
(2) Meetings.--The advisory council shall meet not less
than twice a year and at the request of the Board.
(g) Financial Oversight.--
(1) Contract for audits.--The Trust shall provide for
financial audits of the Trust on an annual basis by a private
entity with expertise in conducting financial audits.
(2) Review and report on audits.--The Comptroller General
shall--
(A) review and evaluate the results of the audits conducted
pursuant to paragraph (1); and
(B) submit a report to Congress containing the results and
review of such audits, including an analysis of the adequacy
and use of the funding for the Trust and its activities.
(h) Rules on Gifts and Outside Contributions.--
(1) Gifts.--The Trust (including the Board and any staff
acting on behalf of the Trust) shall not accept gifts,
bequeaths, or donations of services or property.
(2) Prohibition on outside funding or contributions.--The
Trust shall not--
(A) establish a corporation other than as provided under
this section; or
(B) accept any funds or contributions other than as
provided under this section.
(i) America's Health Insurance Trust Fund.--
(1) In general.--There is established in the Treasury a
trust fund to be known as the ``America's Health Insurance
Trust Fund'' (referred to in this section as the ``Trust
Fund''), consisting of such amounts as may be credited to the
Trust Fund as provided under this subsection.
(2) Transfer.--The Secretary of the Treasury shall transfer
to the Trust Fund out of the general fund of the Treasury
amounts determined by the Secretary to be equivalent to the
amounts received into such general fund that are attributable
to the fees collected under sections 4385 and 4386 of the
Internal Revenue Code of 1986 (relating to fees on health
insurance policies and self-insured health plans).
(3) Financing for fund from fees on insured and self-
insured health plans.--
(A) General rule.--Chapter 34 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subchapter:

``Subchapter C--Additional Fees on Insured and Self-Insured Health
Plans

``Sec. 4385. Health insurance.
``Sec. 4386. Self-insured health plans.
``Sec. 4387. Definitions and special rules.

``SEC. 4385. HEALTH INSURANCE.

``(a) Imposition of Fee.--In the case of any specified
health insurance policy issued after October 1, 2009, there
is hereby imposed a fee equal to--
``(1) for policies issued during fiscal years 2010 through
2013, 50 cents multiplied by the average number of lives
covered under the policy; and
``(2) for policies issued after September 30, 2013, $1
multiplied by the average number of lives covered under the
policy.
``(b) Liability for Fee.--The fee imposed by subsection (a)
shall be paid by the issuer of the policy.
``(c) Specified Health Insurance Policy.--For purposes of
this section:
``(1) In general.--Except as otherwise provided in this
section, the term `specified health insurance policy' means
any accident or health insurance policy (including a policy
under a group health plan) issued with respect to individuals
residing in the United States.
``(2) Exemption for certain policies.--The term `specified
health insurance policy' does not include any insurance if
substantially all of its coverage is of excepted benefits
described in section 9832(c).
``(3) Treatment of prepaid health coverage arrangements.--
``(A) In general.--In the case of any arrangement described
in subparagraph (B)--
``(i) such arrangement shall be treated as a specified
health insurance policy, and
``(ii) the person referred to in such subparagraph shall be
treated as the issuer.
``(B) Description of arrangements.--An arrangement is
described in this subparagraph if under such arrangement
fixed payments or premiums are received as consideration for
any person's agreement to provide or arrange for the
provision of accident or health coverage to residents of the
United States, regardless of how such coverage is provided or
arranged to be provided.
``(d) Adjustments for Increases in Health Care Spending.--
In the case of any policy issued in any fiscal year beginning
after September 30, 2014, the dollar amount in effect under
subsection (a) for such policy shall be equal to the sum of
such dollar amount for policies issued in the previous fiscal
year (determined after the application of this subsection),
plus an amount equal to the product of--
``(1) such dollar amount for policies issued in the
previous fiscal year, multiplied by
``(2) the percentage increase in the projected per capita
amount of National Health Expenditures from the calendar year
in which the previous fiscal year ends to the calendar year
in which the fiscal year involved ends, as most recently
published by the Secretary of Health and Human Services
before the beginning of the fiscal year.
``(e) Termination.--This section shall not apply to policy
years ending after September 30, 2019.

``SEC. 4386. SELF-INSURED HEALTH PLANS.

``(a) Imposition of Fee.--In the case of any applicable
self-insured health plan issued after October 1, 2009, there
is hereby imposed a fee equal to--
``(1) for plans issued during fiscal years 2010 through
2013, 50 cents multiplied by the average number of lives
covered under the plan; and
``(2) for plans issued after September 30, 2013, $1
multiplied by the average number of lives covered under the
plans.
``(b) Liability for Fee.--
``(1) In general.--The fee imposed by subsection (a) shall
be paid by the plan sponsor.
``(2) Plan sponsor.--For purposes of paragraph (1) the term
`plan sponsor' means--
``(A) the employer in the case of a plan established or
maintained by a single employer,
``(B) the employee organization in the case of a plan
established or maintained by an employee organization,
``(C) in the case of--
``(i) a plan established or maintained by 2 or more
employers or jointly by 1 or more employers and 1 or more
employee organizations,
``(ii) a multiple employer welfare arrangement, or
``(iii) a voluntary employees' beneficiary association
described in section 501(c)(9),
the association, committee, joint board of trustees, or other
similar group of representatives of the parties who establish
or maintain the plan, or
``(D) the cooperative or association described in
subsection (c)(2)(F) in the case of a plan established or
maintained by such a cooperative or association.
``(c) Applicable Self-Insured Health Plan.--For purposes of
this section, the term `applicable self-insured health plan'
means any plan for providing accident or health coverage if--
``(1) any portion of such coverage is provided other than
through an insurance policy, and
``(2) such plan is established or maintained--
``(A) by one or more employers for the benefit of their
employees or former employees,
``(B) by one or more employee organizations for the benefit
of their members or former members,
``(C) jointly by 1 or more employers and 1 or more employee
organizations for the benefit of employees or former
employees,
``(D) by a voluntary employees' beneficiary association
described in section 501(c)(9),
``(E) by any organization described in section 501(c)(6),
or
``(F) in the case of a plan not described in the preceding
subparagraphs, by a multiple employer welfare arrangement (as
defined in section 3(40) of Employee Retirement Income
Security Act of 1974), a rural electric cooperative (as
defined in section 3(40)(B)(iv) of such Act), or a rural
telephone cooperative association (as defined in section
3(40)(B)(v) of such Act).
``(d) Adjustments for Increases in Health Care Spending.--
In the case of any plan issued in any fiscal year beginning
after September 30, 2014, the dollar amount in effect under
subsection (a) for such plan shall be equal to the sum of
such dollar amount for plans issued in the previous fiscal
year (determined after the application of this subsection),
plus an amount equal to the product of--
``(1) such dollar amount for plans issued in the previous
fiscal year, multiplied by
``(2) the percentage increase in the projected per capita
amount of National Health

[[Page S12560]]

Expenditures from the calendar year in which the previous
fiscal year ends to the calendar year in which the fiscal
year involved ends, as most recently published by the
Secretary of Health and Human Services before the beginning
of the fiscal year.
``(e) Termination.--This section shall not apply to plans
issued after September 30, 2019.

``SEC. 4387. DEFINITIONS AND SPECIAL RULES.

``(a) Definitions.--For purposes of this subchapter--
``(1) Accident and health coverage.--The term `accident and
health coverage' means any coverage which, if provided by an
insurance policy, would cause such policy to be a specified
health insurance policy (as defined in section 4385(c)).
``(2) Insurance policy.--The term `insurance policy' means
any policy or other instrument whereby a contract of
insurance is issued, renewed, or extended.
``(3) United states.--The term `United States' includes any
possession of the United States.
``(b) Treatment of Governmental Entities.--
``(1) In general.--For purposes of this subchapter--
``(A) the term `person' includes any governmental entity,
and
``(B) notwithstanding any other law or rule of law,
governmental entities shall not be exempt from the fees
imposed by this subchapter except as provided in paragraph
(2).
``(2) Treatment of exempt governmental programs.--In the
case of an exempt governmental program, no fee shall be
imposed under section 4385 or section 4386 on any covered
policy or plan under such program.
``(3) Exempt governmental program defined.--For purposes of
this subchapter, the term `exempt governmental program'
means--
``(A) any insurance program established under title XVIII
of the Social Security Act,
``(B) the medical assistance program established by title
XIX or XXI of the Social Security Act,
``(C) the Federal Employees Health Benefits Program under
chapter 89 of title 5, United States Code,
``(D) the Consumer Choice Health Plan established under
section 1323 of the Patient Protection and Affordable Care
Act,
``(E) any program established by Federal law for providing
medical care (other than through insurance policies) to
individuals (or the spouses and dependents thereof) by reason
of such individuals being--
``(i) members of the Armed Forces of the United States, or
``(ii) veterans, and
``(F) any program established by Federal law for providing
medical care (other than through insurance policies) to
members of Indian tribes (as defined in section 4(d) of the
Indian Health Care Improvement Act).
``(c) Treatment as Tax.--For purposes of subtitle F, the
fees imposed by this subchapter shall be treated as if they
were taxes.
``(d) No Cover Over to Possessions.--Notwithstanding any
other provision of law, no amount collected under this
subchapter shall be covered over to any possession of the
United States.''.
(B) Clerical amendments.--
(i) Chapter 34 of such Code is amended by striking the
chapter heading and inserting the following:

``CHAPTER 34--TAXES ON CERTAIN INSURANCE POLICIES

``subchapter a. policies issued by foreign insurers

``subchapter b. insured and self-insured health plans

``subchapter c. additional fees on insured and self-insured health
plans

``Subchapter A--Policies Issued By Foreign Insurers''.

(ii) The table of chapters for subtitle D of such Code is
amended by striking the item relating to chapter 34 and
inserting the following new item:

``Chapter 34--Taxes on Certain Insurance Policies''.

SEC. 1323B. DUTIES OF AMERICA'S HEALTH INSURANCE TRUST.

(a) Insurance Plan Rankings and Website.--
(1) Web-based materials.--The Trust shall establish and
maintain a website that provides informational materials
regarding the qualified health plans provided through the
Exchanges established under this title, including appropriate
links for all available State insurance commissioner
websites.
(2) Plan rankings.--The Trust shall develop and publish
annual rankings of the qualified health plans provided
through the Exchanges, based on the assignment of a letter
grade between ``grade A'' (highest) and ``grade F'' (lowest).
The Trust shall provide for a comparative evaluation of each
plan based upon--
(A) administrative expenditures;
(B) affordability of coverage;
(C) adequacy of coverage;
(D) timeliness and adequacy of consumer claims processing;
(E) available consumer complaint systems;
(F) grievance and appeals processes;
(G) transparency;
(H) consumer satisfaction; and
(I) any additional measures as determined by the Board.
(3) Information available on website by zip code.--The
annual rankings of the qualified health plans (as described
in paragraph (2)) shall be available on the website for the
Trust (as described in paragraph (1)), and websites for the
Exchanges, in a manner that is searchable and sortable by zip
code.
(4) Consumer feedback.--
(A) Consumer complaints.--The Trust shall develop written
and web-based methods for individuals to provide
recommendations and complaints regarding the qualified health
plans provided through the Exchanges.
(B) Consumer surveys.--The Trust shall obtain meaningful
consumer input, including consumer surveys, that measure the
extent to which an individual receives the services and
supports described in the individual's health insurance plan
and the individual's satisfaction with such services and
supports.
(b) Data Sharing.--
(1) In general.--An organization that provides a qualified
health plan through an Exchange shall provide the Trust with
all information and data that is necessary for improving
transparency, monitoring, and oversight of such plans.
(2) Annual disclosure.--Beginning with the first full year
for which Exchanges are required to be operational under this
title, an organization that provides a qualified health plan
through an Exchange shall annually provide the Trust with
appropriate information regarding the following:
(A) Name of the plan.
(B) Levels of available plan benefits.
(C) Description of plan benefits.
(D) Number of enrollees under the plan.
(E) Demographic profile of enrollees under the plan.
(F) Number of claims paid to enrollees.
(G) Number of enrollees that terminated their coverage
under the plan.
(H) Total operating cost for the plan (including
administrative costs).
(I) Patterns of utilization of the plan's services.
(J) Availability, accessibility, and acceptability of the
plan's services.
(K) Such information as the Trust may require demonstrating
that the organization has a fiscally sound operation.
(L) Any additional information as determined by the Trust.
(3) Form and manner of information.--Information to be
provided to the Trust under paragraphs (1) and (2) shall be
provided--
(A) in such form and manner as specified by the Trust; and
(B) within 30 days of the date of receipt of the request
for such information, or within such extended period as the
Trust deems appropriate.
(4) Information from the department of health and human
services.--
(A) In general.--Any information regarding the qualified
health plans that are offered through the Exchanges that has
been provided to the Secretary of Health and Human Services
shall also be made available (as deemed appropriate by the
Secretary) to the Trust for the purpose of improving
transparency, monitoring, and oversight of such plans. Such
information may include, but is not limited to, the
following:
(i) Underwriting guidelines to ensure compliance with
applicable Federal health insurance requirements.
(ii) Rating practices to ensure compliance with applicable
Federal health insurance requirements.
(iii) Enrollment and disenrollment data, including
information the Secretary may need to detect patterns of
discrimination against individuals based on health status or
other characteristics, to ensure compliance with applicable
Federal health insurance requirements (including non-
discrimination in group coverage, guaranteed issue, and
guaranteed renewability requirements applicable in all
markets).
(iv) Post-claims underwriting and rescission practices to
ensure compliance with applicable Federal health insurance
requirements relating to guaranteed renewability.
(v) Marketing materials and agent guidelines to ensure
compliance with applicable Federal health insurance
requirements.
(vi) Data on the imposition of pre-existing condition
exclusion periods and claims subjected to such exclusion
periods.
(vii) Information on issuance of certificates of creditable
coverage.
(viii) Information on cost-sharing and payments with
respect to any out-of-network coverage.
(ix) The application to issuers of penalties for violation
of applicable Federal health insurance requirements
(including failure to produce requested information).
(x) Such other information as the Trust may determine to be
necessary to verify compliance with the requirements of this
section.
(B) Required disclosure.--The Secretary of Health and Human
Services shall provide the Trust with all consumer claims
data or information that has been provided to the Secretary
by any qualified health plan that is offered through an
Exchange.
(C) Period for providing information.--Information to be
provided to the Trust under this paragraph shall be provided
by the Secretary within 30 days of the date of receipt of the
request for such information, or within such extended period
as the Secretary and the Trust mutually deem appropriate.

[[Page S12561]]

(5) Non-disclosure of health insurance data.--The Trust
shall prevent disclosure of any data or information provided
under this paragraph that the Trust determines is proprietary
or qualifies as a trade secret subject to withholding from
public dissemination. Any data or information provided under
this paragraph shall not be subject to disclosure under
section 552 of title 5, United States Code (commonly referred
to as the Freedom of Information Act).
______